Systematic Review and Meta-Analysis of the Effect of Osteoporosis on Reoperation Rates and Complications after Surgical Management of Lumbar Degenerative Disease

Background@#There is considerable heterogeneity in findings and a lack of consensus regarding the interplay between osteoporosis and outcomes in patients with lumbar degenerative spine disease. Therefore, the purpose of this systematic review and meta-analysis was to gather and analyze existing data on the effect of osteoporosis on radiographic, surgical, and clinical outcomes following surgery for lumbar degenerative spinal disease. @*Methods@#A systematic review was performed to determine the effect of osteoporosis on the incidence of adverse outcomes after surgical intervention for lumbar degenerative spinal diseases. The approach focused on the radiographic outcomes, reoperation rates, and other medical and surgical complications. Subsequently, a meta-analysis was performed on the eligible studies. @*Results@#The results of the meta-analysis suggested that osteoporotic patients experienced increased rates of adjacent segment disease (ASD; p=0.015) and cage subsidence (p=0.001) while demonstrating lower reoperation rates than non-osteoporotic patients (7.4% vs. 13.1%; p=0.038). The systematic review also indicated that the length of stay, overall costs, rates of screw loosening, and rates of wound and other medical complications may increase in patients with a lower bone mineral density. Fusion rates, as well as patient-reported and clinical outcomes, did not differ significantly between osteoporotic and non-osteoporotic patients. @*Conclusions@#Osteoporosis was associated with an increased risk of ASD, cage migration, and possibly postoperative screw loosening, as well as longer hospital stays, incurring higher costs and an increased likelihood of postoperative complications. However, a link was not established between osteoporosis and poor clinical outcomes.

Clinicopathological analysis of benign mammary ductal cystic papillomatosis with loss of myoepithelial cells / 中华病理学杂志

Objective: To investigate the histopathological and immunohistochemical characteristics of benign apocrine cystic papillary hyperplasia of the breast with loss of myoepithelial cell layer. Methods: The clinical data, histopathological features and immunohistochemical profile of patients with benign apocrine cystic papillary hyperplasia of breast with loss of myoepithelial cell layer from January 2016 to December 2021 were examined, in which six patients were identified. Results: All six patients were female, aged 36-61 years (median 46 years), who presented with a breast mass; three cases were from the left breast and three cases were from the right breast. Microscopic examination of all cases showed breast hyperplasia with apocrine cysts, accompanied by different degrees of micropapillary and papillary hyperplasia of apocrine cells. One case was associated with lobular carcinoma in situ, and one case was associated with apocrine ductal carcinoma in situ with intraductal dissemination in adenosis. Immunohistochemical staining of CK5/6, p63, SMA, SMMHC, Calponin and CD10 showed complete absence of myoepithelial cell layer surrounding ducts in apocrine cystic papillary hyperplasia. Conclusions: The myoepithelial cells of apocrine cystic papillary hyperplasia of the breast may undergo abnormal changes and may even be completely lost. The diagnosis should be comprehensively considered along with cytomorphological and histological features to avoid overdiagnosis.

TRPS1 expression in salivary gland-type breast carcinoma and its clinical application / 中华病理学杂志

Objective: To investigate the expression of TRPS1 in salivary gland-type breast carcinoma and its clinical application. Methods: A total of 30 cases of salivary gland-type breast carcinoma diagnosed from May 2015 to November 2022 at the Department of Pathology of the First Affiliated Hospital of Nanjing Medical University were collected. The expression of TRPS1 was detected by immunohistochemistry and compared with that of GATA3. TRPS1 and GATA3 expression in 24 cases of primary salivary gland carcinoma. Results: There were 10 cases of breast secretory carcinoma, aged 21-61 years (median 53.5 years), with the size ranging from 0.9-2.2 cm (median 1.6 cm), 2 of which were accompanied by axillary nodal macrometastasis. All patients were alive after 2-55 months of follow-up (median 29.5 months, mean 29.7 months). There were 20 cases of breast adenoid cystic carcinoma, aged 36-77 years (median 53.5 years), with the size ranging from 1.2-5.5 cm (median 2.5 cm), 3 of which were accompanied by axillary nodal macrometastasis. All patients were alive after 3-92 months of follow-up (median 22.5 months, mean 31.7 months), and 1 patient had lung metastasis 15 months after surgery. The medium/high expression ratio of TRPS1 in breast secretory carcinoma was 10/10, which was higher than that of GATA3 (7/10). TRPS1 was also positive in the 2 cases with lymph node metastases. The medium/high expression rate of TRPS1 in breast adenoid cystic carcinoma was 20/20, which was significantly higher than that of GATA3 (2/20). TRPS1 was highly expressed in both classic and solid subtypes, while GATA3 was only expressed in a few cases of the classic subtype. TRPS1 was also positive in 3 cases with lymph node metastases and 1 case of the pulmonary metastases. The expression level of TRPS1 was the same in 1 case before and after neoadjuvant chemotherapy. In addition, TRPS1 was positive in parotid secretory carcinoma and adenoid cystic carcinoma. The medium/high expression rate of TRPS1 in parotid secretory carcinoma (6/6) was higher than that of GATA3 (2/6), and the medium/high expression rate of TRPS1 in parotid adenoid cystic carcinoma (17/18) was higher than that of GATA3 (2/18). Conclusions: The expression of TRPS1 is highly sensitive to salivary gland-type breast carcinoma, especially in GATA3-negative solid subtype of adenoid cystic carcinoma, which plays an important role in clinical practice.

The Efficacy of Herbal Supplement Danggui Buxue Tang for Relieving Menopausal Symptoms

Objectives@#This study aimed to further explore the efficacy and safety of Danggui Buxue Tang (DBT), a simple herbal formula, for improving the quality of life of women suffering from menopausal symptoms. @*Methods@#A third clinical trial to determine the clinical efficacy of high-dose DBT for a period of 12 weeks was carried out. The standard Menopause-Specific Quality of Life (MENQOL) assessment chart was used for the evaluation. Safety was defined as an absence of direct estrogenic effects, serum inflammatory cytokines. Notably, interleukin IL-6, IL-8 and tumor necrosis factor TNF-α, known to be directly related to estrogenic reactions in menopause studies, were monitored. @*Results@#The third clinical trial indicated an overall improvement in the four domains of MENQOL, offering further proof of the efficacy of DBT demonstrated in the two previous trials. The serial checks of the three cytokines related to estrogen activities did not show either upward or downward trends. The haphazard behavior reactions of the three cytokines offered indirect indications that DBT improved the MENQOL independently from estrogen activities. @*Conclusions@#The three clinical trials using DBT to relieve menopausal syndrome have offered solid evidence for its efficacy. The uncertainty regarding whether the “phytoestrogen” contained in DBT had bioactivities similar to estrogen was alleviated through the confirmation that no strict estrogenic bioactivities were observed. The issue of safety was further clarified via laboratory platform studies on DBT, which not only showed the lack of similarity with estrogen actions but also confirmed the value of combining the two herbs in the classic formula.

Patterns of Lumbar Disc Degeneration: Magnetic Resonance Imaging Analysis in Symptomatic Subjects

Methods@#This study included 1,095 patients (mean age, 44.29 years; range, 16–85 years) who underwent upright lumbar MRI. LDD was graded into five categories (I–V). Positive LDD was defined as grade III or greater. The prevalence and pattern of LDD were analyzed, and the correlations between age and total grade of LDD were evaluated. @*Results@#The average number of LDD levels and the total grade of LDD increased with age. LDD moved cephalad with age. The rate of LDD increased rapidly during the decade before the prevalence of LDD and became >50%. In the single-level LDD group, the levels L5–S1 were the most common levels (60.3%). In the two-level group, L4–L5 and L5–S1 were the most common levels (53.5%). In the three-level group, L3–L4, L4–L5, and L5–S1 were the most common levels (55.7%). In the multilevel LDD group, contiguous multilevel disc degeneration (CMDD) was more common than the skipped level disc degeneration (SLDD). The levels L4–L5 were the most common levels in the CMDD group, and L5–S1 were the most common levels among SLDD. @*Conclusions@#LDD was found to correlate with age, and the specific patterns and rates of LDD depended on lumbar disc level and age. These LDD pattern data can be used before spinal procedures to predict the probability of natural LDD progression with age.

Green tea extract as a cryoprotectant additive to preserve the motility and DNA integrity of human spermatozoa / 亚洲男科学杂志(英文版)

Cryopreservation impairs sperm quality and functions, including motility and DNA integrity. Antioxidant additives in sperm freezing media have previously brought improvements in postthawed sperm quality. Green tea extract (GTE) is widely considered as an excellent antioxidant, and its beneficial role has been proven in other human cells. This study aims to evaluate the GTE as a potential additive in cryopreservation media of human spermatozoa. In part one, the semen of 20 normozoospermic men was used to optimize the concentration of GTE that maintains sperm motility and DNA integrity against oxidative stress, induced by hydrogen peroxide (H

Clinical Relationship of Degenerative Changes between the Cervical and Lumbar Spine

STUDY DESIGN: Retrospective, observational, case series. PURPOSE: To elucidate the prevalence of degenerative changes in the cervical and lumbar spine and estimate the degenerative changes in the cervical spine based on the degeneration of lumbar disc through a retrospective review of magnetic resonance (MR) images. OVERVIEW OF LITERATURE: Over 50% of middle-aged adults show evidence of spinal degeneration. However, the relationship between degenerative changes in the cervical and lumbar spine has yet to be elucidated. METHODS: A retrospective review of positional MR images of 152 patients with symptoms related to cervical and lumbar spondylosis with or without a neurogenic component was conducted. The degree of intervertebral disc degeneration (IDD) was assessed on a grade of 1–5 for each segment of the cervical and lumbar spine using MR T2-weighted sagittal images. The grades across all segments were summed to produce the degenerative disc score (DDS) for the cervical and lumbar spine. The patients were divided into two groups based on the IDD grade for each lumbar segment: normal (grades 1 and 2) and degenerative (grades 3–5). RESULTS: DDSs for the cervical and lumbar spine were positively correlated. Significant differences in cervical DDSs between the groups were observed in all lumbar segments. Although there were no significant differences in cervical DDSs among the degenerative lumbar segment, cervical DDSs at the L1–2 and L2–3 segments tended to be higher than those at the L3–4, L4–5, and L5–S degenerative segments. CONCLUSIONS: Our study shows that participants with degenerative changes in the upper lumbar segments are more likely to have a certain amount of cervical spondylosis. This information could be used to lower the incidence of a missed diagnosis of cervical spine disorders in patients presenting with lumbar spine symptomology.

Factors associated with illicit drug use intention in secondary vocational school students based on theory of triadic influence / 中华流行病学杂志

Objective: To explore the factors associated with illicit drug use (IDU) intention in secondary vocational school students based on theory of triadic influence (TTI), and provide theoretical foundation for IDU prevention education. Methods: A total of 8 870 students were selected from secondary vocational schools in 5 cities in China through multistage cluster sampling. A self-administered questionnaire was used to collect the information about students' sensation seeking (SS), parental monitoring (PM), perceived availability of drug (PAD), social benefit expectancies(SBE), refusal efficacy (RE) and social norms and IDU intention. Based on the TTI, the logistic regression model was used to analyze the factors associated with IDU. Results: Among the intrapersonal stream of influence, the higher levels of SS was the risk factor associated with IDU (OR=1.71, 95%CI: 1.22-2.41, P<0.01), medium RE level (OR=0.18, 95%CI: 0.14-0.23, P<0.001) and high RE level (OR=0.17, 95%CI: 0.13-0.22, P<0.001) were the protective factors for IDU intention. Among the interpersonal stream of influence, medium PM level (OR=0.46, 95%CI: 0.37- 0.56, P<0.001) and high PM level (OR=0.33, 95%CI: 0.24-0.46, P<0.001) were the protective factors for IDU intention, perceived others' drug use as well as perceived others' approval of substance use were risk factors for IDU intentions (P<0.001); Among sociocultural environmental stream of influence, perceived easy availability of drugs (OR=3.47, 95%CI: 2.69-4.48, P<0.001) and perceived SBE of drugs (OR=2.04, 95%CI: 1.69-2.46, P<0.001) were risk factors for IDU intentions (P<0.001). Conclusions: High levels of SS and SBE, perceived easier availability of substance, perceived others' substance use and perceived others' approval of substance use positively predict the students' intention of IDU. IDU prevention education for adolescents should be focused on the above factors, and parental supervision and students' refuse skills should be improved.

Screening on serum biomarkers in idiopathic pulmonary fibrosis patients by proteomics technology / 中华流行病学杂志

Objective: Applying the proteomics technology to identify proteins differentially in serums of idiopathic pulmonary fibrosis patients and normal population. Methods: The study included serum samples from idiopathic pulmonary fibrosis group and normal controlled group with 30 cases of each, from the Second Hospital of Shandong University, between October 2014 and October 2015. Proteins differentially expressed in serums were quantified by the isobaric tags for relative and absolute quantization coupled with two-dimensional liquid chromatography/tandem mass spectrometry technology. The proteins were analyzed in terms of molecular function, cell location and biological processes for showing the key protein molecules which were related to the development of idiopathic pulmonary fibrosis. Results: A total of 490 kinds of proteins (with confidence coefficient above 95%) were identified by mass spectrometry and 25 kinds of differentially expressed proteins were found. Compared with the control group, we found 4 types of up-regulated proteins and 21 down-regulated ones in the serum of idiopathic pulmonary fibrosis patients. Data from the Gene ontology analysis showed that most differentially expressed proteins were in the extracellular region (92%) while pathway enrichment analysis showed that most proteins were involved in the complement and coagulation cascade pathway. Conclusion: Proteins related to the complement system coagulation cascade pathway, and the proteins function need to be further studied.

The Clinical Correlations between Diabetes, Cigarette Smoking and Obesity on Intervertebral Degenerative Disc Disease of the Lumbar Spine

STUDY DESIGN: Retrospective analysis of a nationwide private insurance database. Chi-square analysis and linear regression models were utilized for outcome measures. PURPOSE: The purpose of this study was to investigate any relationship between lumbar degenerative disc disease, diabetes, obesity and smoking tobacco. OVERVIEW OF LITERATURE: Diabetes, obesity, and smoking tobacco are comorbid conditions known to individually have effect on degenerative disc disease. Most studies have only been on a small populous scale. No study has yet to investigate the combination of these conditions within a large patient cohort nor have they reviewed the combination of these conditions on degenerative disc disease. METHODS: A retrospective analysis of insurance billing codes within the nationwide Humana insurance database was performed, using PearlDiver software (PearlDiver, Inc., Fort Wayne, IN, USA), to identify trends among patients diagnosed with lumbar disc degenerative disease with and without the associated comorbidities of obesity, diabetes, and/or smoking tobacco. Patients billed for a comorbidity diagnosis on the same patient record as the lumbar disc degenerative disease diagnosis were compared over time to patients billed for lumbar disc degenerative disease without a comorbidity. There were no sources of funding for this manuscript and no conflicts of interest. RESULTS: The total number and prevalence of patients (per 10,000) within the database diagnosed with lumbar disc degenerative disease increased by 241.4% and 130.3%, respectively. The subsets of patients within this population who were concurrently diagnosed with either obesity, diabetes, tobacco use, or a combination thereof, was significantly higher than patients diagnosed with lumbar disc degenerative disease alone (p <0.05 for all). The number of patients diagnosed with lumbar disc degenerative disease and smoking rose significantly more than patients diagnosed with lumbar disc degenerative disease and either diabetes or obesity (p <0.05). The number of patients diagnosed with lumbar disc degenerative disease, smoking and obesity rose significantly more than the number of patients diagnosed with lumbar disc degenerative disease and any other comorbidity alone or combination of comorbidities (p <0.05). CONCLUSIONS: Diabetes, obesity and cigarette smoking each are significantly associated with an increased diagnosis of lumbar degenerative disc disease. The combination of smoking and obesity had a synergistic effect on increased rates of lumbar degenerative disc disease. Patient education and preventative care is a vital goal in prevention of degenerative disc disease within the general population.

Bisphosphonate's and Intermittent Parathyroid Hormone's Effect on Human Spinal Fusion: A Systematic Review of the Literature

There has been a conscious effort to address osteoporosis in the aging population. As bisphosphonate and intermittent parathyroid hormone (PTH) therapy become more widely prescribed to treat osteoporosis, it is important to understand their effects on other physiologic processes, particularly the impact on spinal fusion. Despite early animal model studies and more recent clinical studies, the impact of these medications on spinal fusion is not fully understood. Previous animal studies suggest that bisphosphonate therapy resulted in inhibition of fusion mass with impeded maturity and an unknown effect on biomechanical strength. Prior animal studies demonstrate an improved fusion rate and fusion mass microstructure with the use of intermittent PTH. The purpose of this study was to determine if bisphosphonates and intermittent PTH treatment have impact on human spinal fusion. A systematic review of the literature published between 1980 and 2015 was conducted using major electronic databases. Studies reporting outcomes of human subjects undergoing 1, 2, or 3-level spinal fusion while receiving bisphosphonates and/or intermittent PTH treatment were included. The results of relevant human studies were analyzed for consensus on the effects of these medications in regards to spinal fusion. There were nine human studies evaluating the impact of these medications on spinal fusion. Improved fusion rates were noted in patients receiving bisphosphonates compared to control groups, and greater fusion rates in patients receiving PTH compared to control groups. Prior studies involving animal models found an improved fusion rate and fusion mass microstructure with the use of intermittent PTH. No significant complications were demonstrated in any study included in the analysis. Bisphosphonate use in humans may not be a deterrent to spinal fusion. Intermittent parathyroid use has shown early promise to increase fusion mass in both animal and human studies but further studies are needed to support routine use.

New discovery rarely runs smooth: an update on progranulin/TNFR interactions

Progranulin (PGRN) is a growth factor implicated in various pathophysiological processes, including wound healing, inflammation, tumorigenesis, and neurodegeneration. It was previously reported that PGRN binds to tumor necrosis factor receptors (TNFR) and has therapeutic effects in inflammatory arthritis (Tang et. al, in Science 332:478-484, 2011); however, Chen et al. reported their inability to demonstrate the PGRN-TNFR interactions under their own conditions (Chen et. al, in J Neurosci 33:9202-9213, 2013). A letter-to-editor was then published by the original group in response to the Chen et al. paper that discussed the reasons for the latter's inability to recapitulate the interactions. In addition, the group published follow-up studies that further reinforced and dissected the interactions of PGRN-TNFR. Recently, the dispute about the legitimacy of PGRN-TNFR interactions appears to be finally settled with independent confirmations of these interactions in various conditions by numerous laboratories. This review presents a chronological update on the story of PGRN-TNFR interactions, highlighting the independent confirmations of these interactions in various diseases and conditions.

Genetic characterization of Toxoplasma gondii from domestic animals in central China

Toxoplasma gondii is an obligate intracellular parasite that has a remarkable ability to infect almost all warm-blooded animals, including humans. This study was aimed to determine the genetic characteristics of T. gondii isolates from domestic animals in Henan Province, central China. A total of 363 DNA samples, including 208 from hilar lymph nodes of pigs, 36 from blood samples of cats, 12 from tissues of aborted bovine fetuses and 107 from blood samples of dams with history of abortion in Henan Province, were examined for the presence of T. gondii by nested PCR based on B1 gene. The positive DNA samples were further genotyped by PCR-RFLP at 11 markers, including SAG1, (3’+ 5’) SAG2, alt.SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and Apico. DNA samples from 9 pigs, 5 cats, and 4 dairy cows were T. gondii B1 gene positive. Nine samples were successfully genotyped at all genetic loci, of which 5 samples from pigs, and 2 from cats were identified as ToxoDB genotype #9, and 2 samples from cows belonged to ToxoDB genotype #225. To our knowledge, the present study is the second report of genetic typing of T. gondii isolates from cattle in China, and the first report of T. gondii ToxoDB#225 from cattle.

Image-guided surgery and craniofacial applications: mastering the unseen / 대한악안면성형재건외과학회지

Image-guided surgery potentially enhances intraoperative safety and outcomes in a variety of craniomaxillofacial procedures. We explore the efficiency of one intraoperative navigation system in a single complex craniofacial case, review the initial and recurring costs, and estimate the added cost (e.g., additional setup time, registration). We discuss the potential challenges and benefits of utilizing image-guided surgery in our specific case and its benefits in terms of educational and teaching purposes and compare this with traditional osteotomies that rely on a surgeon's thorough understanding of anatomy coupled with tactile feedback to blindly guide the osteotome during surgery. A 13-year-old presented with untreated syndromic multi-suture synostosis, brachycephaly, severe exorbitism, and midface hypoplasia. For now, initial costs are high, recurring costs are relatively low, and there are perceived benefits of imaged-guided surgery as an excellent teaching tool for visualizing difficult and often unseen anatomy through computerized software and multi-planar real-time images.

Family history and prior allergies of cancers and the risk of adult leukemia in Shandong province, China

A case-control study was carried out to investigate the roles of prior allergies and family history of cancers and their interaction in the etiology of adult leukemia. Prior allergies status and family history of cancers in first-degree relatives were compared between 131 incident leukemia cases and 206 hospital-based controls. Odds ratios [OR] were estimated using an unconditional regression model taking into account potential confounding factors. Significant association between adult leukemia and prior allergies and family history of cancer [OR=2.09, 95% CI: 1.22-3.58 for prior allergies; and OR=2.35, 95% CI: 1.09-5.03 for family history of cancer, OR=15.88. 95% CI: 1.77-142.55 for both the two factors [+], respectively] was found after adjusting for potential confounding factors. Prior allergies and family history of cancers may be risk factors for adult leukemia; their interaction was likely to be synergistic rather than additive for the risk of leukemia

Relationship between serum aminotransferase levels and metabolic disorders in northern China

Increasing evidence suggests an association between ele-vated serum aminotransferase levels and metabolic disorders [metabolic syndrome, hyperlipemia and diabetes mellitus]. However, the significance of relatively low levels of aminotransferases in relation to metabolic disorders has not been fully investigated in the general population. We inves-tigated the association between serum amiontransferase levels and metabolic disorders using data from a survey in Jilin province, China. In 2007, a survey was conducted throughout Jilin, China, covering both urban and rural areas. A total of 3835 people, 18 to 79 years old including 1761 men and 2074 women, underwent real-time ultrasonography, blood tests including aspartate aminotransferase and alanine aminotransferase, and had interviews with a structured questionnaire. Serum aminotransferase levels within the normal range were asso-ciated with metabolic syndrome independent of age, occupation, cultural and educational level, income, body mass index, waist circumference, smoking, and alcohol intake. Compared with the lowest level [<20 IU/L], the adjusted odds ratios for ALT levels of 20-29, 30-39, 40-49 and>50 IU/L were 1.92, 2.50, 2.97, and 3.52 in men, and 1.38, 1.54, 3.06, and 2.62 in women, respectively. Near-normal serum aminotransferase levels asso-ciated with hyperlipemia, NAFLD, DM were also found in the study. Normal to near-normal serum aminotransferase levels are associated with metabolic disorders. Serum ALT levels of 21-25 IU/L for men and 17-22 IU/L for women are suggested as cutoff levels that detect metabolic disorders affecting the liver

effect of microwave radiation on osteogenesis and osteolysis of rats in the hypergravity condition and the role of Rana sylvatica Le conte oil as a radioprotector

Microwave Thermotherapy has been gradually used in radiotherapy and it is reported that microwave radiation increases bone demineralization rate independently of temperature. Furthermore, it becomes more and more widespread that the damage caused by the synergistic effect of microwave radiation and hypergravity. The experiment was designed to investigate the effect of microwave radiation on osteogenesis and osteolysis of rats in the hypergravity condition and to observe the role of Rana sylvatica Le conte oil as a radioprotector. Wistar rats were exposed to microwave radiation of 200mW/cm[2] power density and +6G hypergravity, and the concentrations of osteocalcin, calcitionin, calcium, phosphorus, and hydroxyproline and the activity of alkaline phosphatase were detected in serum. The serum concentrations of osteocalcin and calcitionin and the activity of alkaline phosphatase decreased, while the calcium, phosphorus and hydroxyproline concentrations increased after the synergistic effect of microwave radiation and hypergravity. Rana sylvatica Le conte oil intervention inhibited significantly the decrease of osteocalcin concentration and restrained significantly the increases of hydroxyproline and calcium concentrations in serum. These results imply that the synergistic effect of microwave radiation and hypergravity inhibits osteogenesis and enhances osteolysis in rats causing bone metabolic disturbance, while the injury resulted from microwave radiation and hypergravity could be protected by intervention with Rana sylvatica Le conte oil and it provides an original direction in the investigation of radioprotectors

Relationship of Facet Tropism with Degeneration and Stability of Functional Spinal Unit

PURPOSE: The authors investigated the effect of lumbar facet tropism (FT) on intervertebral disc degeneration (DD), facet joint degeneration (FJD), and segmental translational motion. MATERIALS AND METHODS: Using kinetic MRI (KMRI), lumbar FT, which was defined as a difference in symmetry of more than 7degrees between the orientations of the facet joints, was investigated in 900 functional spinal units (300 subjects) in flexion, neutral, and extension postures. Each segment at L3-L4, L4-L5, and L5-S1 was assessed based on the extent of DD (grade I-V) and FJD (grade 1-4). According to the presence of FT, they were classified into two groups; one with FT and one with facet symmetry. For each group, demographics, DD, FJD and translational segmental motion were compared. RESULTS: The incidence of FT was 34.5% at L3-L4, 35.1% at L4-L5, and 35.2% at L5-S1. Age and gender did not show any significant relationship with FT. Additionally, no correlation was observed between DD and FT. FT, however, wasfound to be associated with a higher incidence of highly degenerated facet joints at L4-L5 when compared to patients without FT (p < 0.01). Finally, FT was not observed to have any effects upon translational segmental motion. CONCLUSION: No significant correlation was observed between lumbar FT and DD or translational segmental motion. However, FT was shown to be associated significantly with the presence of high grades of FJD at L4-L5. This suggests that at active sites of segmental motion, FT may predispose to the development of facet joint degeneration.

Age-related degeneration of each lumbar intervertebral disc in symptomatic patients:MRI analysis / 中国脊柱脊髓杂志

Objective:To determine the most common patterns in symptomatic lumbar intervertibral disc degeneration at various age period.Method:The lumbar MRI imaging data of 529 patients treated for low back pain with or without skelagia in Santa Monica hospital in USA from 2004 to 2006 were reviewed retrospectively in this study .There were 191 females, 338 males.Degenerative grading was made for all disc levels in the lumbar spine for each patient. The patients were also classified into five age different groups starting from below age 30,with the intervals of a single decade,until over age 60 (≤29 years,30-39 years,40-49 years, 50-59 years and≥60 years).The degenerative grade of all disc levels (L1/2 to L5/S1) in each patient was classified based on Pfirrmann's gading system,and locations and the progressive manner of the degeneration were determined for age groups.SPSS software version 13.0 (SPSS Inc.,Chicago,IL) on a personal computer was used for statistical analyses.Result:The most common pattern in all ages is normal in all the discs and it is described as 1-1-1-1-1 and this normal pattern was found in 71 patients (13.4%).There was rare change to develop severe degeneration (grade 4) for low age groups.The upper levels of the lumbar spine had more commonly lower degenerative grades,and the lower levels had relatively higher grades of advanced disc de-generation.In the age groups of below 29 years and 30-39 years,the most common pattern was normal in all the discs of 5 levels as 1-1-1-1-1.And this pattern was more prominent in the age group below 29 years.In the age group of 40-49 years.it was changed to single level L5-S1 degeneration with 1-1-1-1-3(7.6%) butthe normal discs in all levels had also a similar portion(6.8%).In the age groups of 50-59 years and over 60 years,it was changed to the pattern with all discs abnormal as 3-3-3-3-3.Single level involvement was negatively correlated with age (P<0.01 ).On the contrary,whole symmetrical degenerative involvement of all levels was positively correlated with age (P<0.01).Single L5/S1 involvement was most common in the age group of below 29 years,but in the age group of 30-39 years,the most common pattern was changed to L4/5 and L5/ S1 double involvement(P< 0.05).A relative small portion appeared as the most common pattern with less than two-level involvement in the age groups over 50 years.Conclusion:The rate of unilevel degenerative pattern of lumbar spine in overall population decreases with the progression of age, while that of all-level degenerative pattern increases with the progression of age.

Radiographic Parameters of Segmental Instability in Lumbar Spine Using Kinetic MRI

OBJECTIVE: To investigate the effectiveness of radiographic parameters on segmental instability in the lumbar spine using Kinetic magnetic resonance imaging (MRI). METHODS: Segmental motion, defined as excessive (more than 3 mm) translational motion from flexion to extension, was investigated in 309 subjects (927 segments) using Kinetic MRI. Radiographic parameters which can help indicate segmental instability include disc degeneration (DD), facet joint osteoarthritis (FJO), and ligament flavum hypertrophy (LFH). These three radiographic parameters were simultaneously evaluated, and the combinations corresponding to significant segmental instability at each level were determined. RESULTS: The overall incidence of segmental instability was 10.5% at L3-L4, 16.5% at L4-L5, and 7.3% at L5-S1. DD and LFH at L3-L4 and FJO and LFH at L4-L5 were individually associated with segmental instability (p<0.05). At L4-L5, the following combinations had a higher incidence of segmental instability (p<0.05) when compared to other segments : (1) Grade IV DD with grade 3 FJO, (2) Grade 2 or 3 FJO with the presence of LFH, and (3) Grade IV DD with the presence of LFH. At L5-S1, the group with Grade III disc and Grade 3 FJO had a higher incidence of segmental instability than the group with Grade I or II DD and Grade 1 FJO. CONCLUSION: This study showed that the presences of either Grade IV DD or grade 3 FJO with LFH at L4-L5 were good indicators for segmental instability. Therefore, using these parameters simultaneously in patients with segmental instability would be useful for determining candidacy for surgical treatment.