The Spatial Relationship between Spinal Osteoarthritis and CSF Venous Fistulas in Patients with Spontaneous Intracranial Hypotension.

BACKGROUND AND PURPOSE: CSF venous fistula leads to spontaneous intracranial hypotension. The exact mechanisms underlying the development of CSF venous fistula remain unclear: Some researchers have postulated that underlying chronic intracranial hypertension may lead to damage to spinal arachnoid granulations, given that many patients with CSF venous fistulas have an elevated body mass index (BMI). However, individuals with higher BMIs are also more prone to spinal degenerative disease, and individuals with CSF venous fistulas also tend to be older. CSF venous fistula tends to occur in the lower thoracic spine, the most frequent location of thoracic degenerative changes. The current study aimed to examine whether CSF venous fistulas are more likely to occur at spinal levels with degenerative changes. MATERIALS AND METHODS: Forty-four consecutive patients with CSF venous fistulas localized on dynamic CT myelography were included in analyses. Whole-spine CT was scrutinized for the presence of degenerative changes at each spinal level. The proportion of levels positive for CSF venous fistula containing any degenerative findings was compared to levels without CSF venous fistula using the Fisher exact test. The Pearson correlation coefficient was calculated to explore the association between the burden of degenerative disease and BMI and age and between BMI and opening pressure. RESULTS: Forty-four patients with 49 total CSF venous fistulas were analyzed (5 patients had 2 CSF venous fistulas). Mean patient age was 62.3 (SD, 9.5) years. Forty-seven CSF venous fistulas were located in the thoracic spine; 1, in the cervical spine; and 1, in the lumbar spine. Within the thoracic spine, 39/49 (79.6%) fistulas were located between levels T7-8 and T12-L1. Forty-four of 49 (89.8%) CSF venous fistulas had degenerative changes at the same level. The levels without CSF venous fistulas demonstrated degenerative changes at 694/1007 (68.9%) total levels. CSF venous fistulas were significantly more likely to be present at spinal levels with associated degenerative changes (OR = 4.03; 95% CI, 1.58-10.27; P = .001). Age demonstrated a positive correlation with the overall burden of degenerative disease (correlation coefficient: 0.573, P < .001), whereas BMI did not (correlation coefficient: 0.076, P = .625). There was a statistically significant positive correlation between BMI and opening pressure (correlation coefficient: 0.321, P = .03). CONCLUSIONS: Results suggest a potential association between spinal degenerative disease and development of CSF venous fistula.

Unilateral high-riding vertebral artery is associated with asymmetric morphological changes of the atlantoaxial joint: a novel risk factor for atlantoaxial osteoarthritis.

PURPOSE: This study aimed to investigate the association between unilateral high-riding vertebral artery (HRVA) and morphological changes in the atlantoaxial joint (AAJ) and to determine whether unilateral HRVA is a risk factor for atlantoaxial osteoarthritis (AAOA). METHODS: We conducted a retrospective analysis of 2496 patients admitted to our medical center between January 2020 and December 2022 who underwent CT imaging of the cervical spine. Two hundred and seventy-two patients with unilateral HRVA (HRVA group) were identified and a respective 2:1 age- and sex-matched control group without HRVA was built. Morphological parameters, including C2 lateral mass settlement (C2 LMS), C1/2 coronal inclination (C1/2 CI), lateral atlanto-dental interval (LADI), and C1/2 relative rotation angle (C1/2 RRA) were measured. The degree of AAOA was recorded. Risk factors associated with AAOA were identified using univariate and multivariable logistic regression analyses. RESULTS: The study included 61.4% women, and the overall average age of the study population was 48.7 years. The morphological parameters (C2 LMS, C1/2 CI, and LADI) in AAJ were asymmetric between the HRVA and the non-HRVA sides in the HRVA group (p < 0.001). These differences in parameters (d-C2 LMS, d-C1/2 CI, and d-LADI) between the HRVA and the non-HRVA sides, and C1/2 RRA were significantly larger than those in the control group. Eighty-three of 816 patients (10.2%) with AAOA had larger values of d-C2 LMS, d-C1/2 CI, d-LADI, and C1/2 RRA compared with the patients without AAOA (p < 0.05). The multivariable logistic regression analysis indicated that unilateral HRVA [adjusted odds ratio (OR) = 2.6, 95% CI: 1.1-6.3, p = 0.029], age in the sixth decade or older (adjusted OR = 30.2, 95% CI: 16.1-56.9, p < 0.001), women (adjusted OR = 2.1, 95% CI: 1.0-5.6, P = 0.034) were independent risk factors for AAOA. CONCLUSION: Unilateral HRVA was associated with asymmetric morphological changes of nonuniform settlement of C2 lateral mass, lateral slip of atlas, and atlantoaxial rotation displacement. Besides age ≥ 60 years and females, unilateral HRVA is an independent risk factor for AAOA.

Association between clinical findings and the presence of lumbar spine osteoarthritis imaging features: A systematic review.

OBJECTIVE: Spinal osteoarthritis is difficult to study and diagnose, partly due to the lack of agreed diagnostic criteria. This systematic review aims to give an overview of the associations between clinical and imaging findings suggestive of spinal osteoarthritis in patients with low back pain to make a step towards agreed diagnostic criteria. DESIGN: We searched MEDLINE, Embase, Web of Science, and CINAHL from inception to April 29, 2021 to identify observational studies in adults that assessed the association between selected clinical and imaging findings suggestive of spinal osteoarthritis. Risk of bias was assessed using the Newcastle Ottawa Scale and the quality of evidence was graded using an adaptation of the GRADE approach. RESULTS: After screening 7902 studies, 30 met the inclusion criteria. High-quality evidence was found for the longitudinal association between low back pain (LBP) intensity, and both disc space narrowing and osteophytes, as well as for the association between LBP-related physical functioning and lumbar disc degeneration, the presence of spinal morning stiffness and disc space narrowing and for the lack of association between physical functioning and Schmorl's nodes. CONCLUSIONS: There is high- and moderate-quality evidence of associations between clinical and imaging findings suggestive of spinal osteoarthritis. However, the majority of the studied outcomes had low or very low-quality of evidence. Furthermore, clinical and methodological heterogeneity was a serious limitation, adding to the need and importance of agreed criteria for spinal osteoarthritis, which should be the scope of future research.

Association between metabolic syndrome and radiographic spine osteoarthritis: Cross-sectional analysis using data from the Korea National Health and Nutrition Examination Survey.

OBJECTIVE: A relationship between spine osteoarthritis (OA) and metabolic syndrome has not been established. This study evaluated whether metabolic syndrome is associated with radiographic spine OA in the Korean population. METHODS: A total of 2252 subjects older than 50 years who underwent plain radiography of the lumbar spine during the Korea National Health and Nutrition Examination Survey (KNHANES) 2012 were enrolled. Radiographic grading of the lumbar spine was performed using the Kellgren-Lawrence (K-L) grading scale, ranging from grade 0 to grade 2. K-L grade 2 was defined as lumbar spine OA, while those of K-L grade 0 or 1 were defined as controls. RESULTS: The prevalence of spine OA was 28.1% (n = 689). The prevalence of metabolic syndrome in spine OA was not different from that among controls. The cumulative number of metabolic syndrome components was significantly different between spine OA and controls (P = .027). Subjects with K-L grade 1 or grade 2 showed higher proportion of metabolic syndrome and its cumulative components than those of K-L grade 0. Two or 3 or more metabolic syndrome components were significantly associated with spine OA (P = .012 and P = .010, respectively). Abnormal waist circumference was weakly associated with spine OA (odds ratio 1.233, 95% CI 1.000-1.520, P = .050). Multivariate logistic regression analysis showed that older age and female gender were linked with spine OA, but not metabolic syndrome. CONCLUSION: This study found lack of association between metabolic syndrome and radiographic spine OA.

Clinical and radiographic features of spinal osteoarthritis predict long-term persistence and severity of back pain in older adults.

BACKGROUND: Patients with back pain can show one or more features of spinal osteoarthritis (OA), such as morning stiffness, limited or painful range of motion (ROM), and lumbar disc degeneration (LDD). However, it has not been investigated whether these features are prognostic of long-term back pain. OBJECTIVES: This study assessed whether spinal morning stiffness, ROM and LDD are prognostic factors for back pain after 1 year in older adults with back pain. METHODS: This prospective observational study (BACE cohort) included patients aged>55 years visiting a general practitioner for a back-pain episode. Baseline patient-reported morning stiffness, physical examined ROM and radiographic LDD features (i.e., multilevel osteophytes and disc space narrowing) were analysed as potential prognostic factors in unadjusted and adjusted regression models with the outcomes of persistent back pain (yes/no) and back pain severity after 1-year follow-up. RESULTS: This study included 543 patients with mean (SD) age 67 (8) years, 59% female, and 62% reporting back pain at 1-year follow-up. When studied in separate adjusted models, persistent back pain was associated with morning stiffness>30min (OR 3.0, 95%CI 1.3; 5.5), restricted lateroflexion (OR 1.8, 95%CI 1.0; 3.2), pain during rotation (OR=1.7, 95%CI 1.0; 2.9), multilevel osteophytes (OR 2.4, 95%CI 1.4; 4.1), and multilevel disc space narrowing (OR 1.5, 95%CI 0.9; 2.4). When investigated in the same adjusted model, persistent back pain remained associated with only morning stiffness>30min (OR 2.4, 95%CI 1.0; 3.9), pain during rotation (OR 1.6, 95%CI 0.9; 2.8), and multilevel osteophytes (OR 2.1, 95%CI 1.2; 3.7). The same spinal OA-related features were associated with back pain severity. CONCLUSIONS: Spinal morning stiffness, painful rotation, and multilevel osteophytes are prognostic factors for persistent back pain and back pain severity after 1 year. Evaluating these clinical and radiographic features of spinal OA could help clinicians identify older patients who will experience long-term back pain.

Predictors of Lumbar Spine Degeneration and Low Back Pain in the Community: The Johnston County Osteoarthritis Project.

OBJECTIVE: To determine the incidence and worsening of lumbar spine structure and low back pain (LBP) and whether they are predicted by demographic characteristics or clinical characteristics or appendicular joint osteoarthritis (OA). METHODS: Paired baseline (2003-2004) and follow-up (2006-2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for osteophytes (OST), disc space narrowing (DSN), spondylolisthesis, and presence of facet joint OA (FOA). Spine OA was defined as at least mild OST and mild DSN at the same level for any level of the lumbar spine. LBP, comorbidities, and back injury were self-reported. Weibull models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of spine phenotypes accounting for potential predictors including demographic characteristics, clinical characteristics, comorbidities, obesity, and appendicular OA. RESULTS: Obesity was a consistent and strong predictor of incidence of DSN (HR 1.80 [95% CI 1.09-2.98]), spine OA (HR 1.56 [95% CI 1.01-2.41]), FOA (HR 4.99 [95% CI 1.46-17.10]), spondylolisthesis (HR 1.87 [95% CI 1.02-3.43]), and LBP (HR 1.75 [95% CI 1.19-2.56]), and worsening of DSN (HR 1.51 [95% CI 1.09-2.09]) and LBP (HR 1.51 [95% CI 1.12-2.06]). Knee OA was a predictor of incident FOA (HR 4.18 [95% CI 1.44-12.2]). Spine OA (HR 1.80 [95% CI 1.24-2.63]) and OST (HR 1.85 [95% CI 1.02-3.36]) were predictors of incidence of LBP. Hip OA (HR 1.39 [95% CI 1.04-1.85]) and OST (HR 1.58 [95% CI 1.00-2.49]) were predictors of LBP worsening. CONCLUSION: Among the multiple predictors of spine phenotypes, obesity was a common predictor for both incidence and worsening of lumbar spine degeneration and LBP.

Spinal Osteoarthritis Is Associated With Stature Loss Independently of Incident Vertebral Fracture in Postmenopausal Women.

STUDY DESIGN: Retrospective observational study from the Nagano Cohort Study. OBJECTIVE: Clarify the association between spinal osteoarthritis and loss of stature in postmenopausal women. SUMMARY OF BACKGROUND DATA: Loss of stature with aging is known to deteriorate health-related quality of life and has been implicated with increased mortality. Although the association of vertebral fracture with height loss has been well documented, the relationship between stature loss and spinal osteoarthritis remains unclear. METHODS: We retrospectively investigated Japanese postmenopausal women recruited from the Nagano Cohort Study. The participants were outpatients at a primary care institute in Nagano prefecture, Japan. A total of 977 postmenopausal patients (mean age: 65.8 yr) completed a minimum of 1 year of follow-up, with an average observation period of 7.6 years. Quartile analysis on the prevalence of spinal osteoarthritis and occurrence of incident fracture was performed based on the rate of stature change per year (Δ cm/yr). Multiple regression analysis was also conducted to identify the determinants of stature change. RESULTS: The lower quartiles of stature change rate (i.e., more rapid stature loss) displayed a significantly higher prevalence of spinal osteoarthritis (P < 0.001) and incident vertebral fracture (P < 0.001). A statistically significant independent negative association for spinal osteoarthritis prevalence with change in stature was revealed by multiple regression analysis after adjusting for confounders including incident vertebral fracture. The partial regression coefficient for spinal osteoarthritis was -0.18 (95% confidence interval -0.33 to -0.03; P = 0.016). CONCLUSION: This study demonstrated an independent association of spinal osteoarthritis with stature loss in postmenopausal women. Adequate understanding of this relationship and appropriate treatment approaches will help improve health-related quality of life in elderly patients. LEVEL OF EVIDENCE: 3.

Facet Arthrosis and Spinal Lipomatosis-Related Spinal Canal Stenosis.

A 33-year-old man was referred to physical therapy by his primary care physician for low back pain that had been present for 7 months. The neurologic screen with mixed upper and lower motor neuron signs was of concern for spinal cord involvement. The primary care physician was contacted and magnetic resonance imaging ordered. Facet arthrosis and epidural lipomatosis were present, resulting in thoracic and lumbar spinal stenosis. J Orthop Sports Phys Ther 2020;50(6):345. doi:10.2519/jospt.2020.9059.

Prevalence and frequency of subchondral bone marrow edema in the lumbar facet joints of asymptomatic and symptomatic individuals.

OBJECTIVE: To prospectively compare the prevalence and frequency of subchondral bone marrow edema (BME) in the lumbar facet joints of low back pain patients and healthy subjects. MATERIALS AND METHODS: Lumbar magnetic resonance imaging (MRI) examinations were performed on 55 asymptomatic participants (18 men; age range 21-63; mean 36 ± 12 years; body mass index (BMI) range 16-31; mean 22.6 ± 3.2 kg/m2) and 79 low back pain patients (36 men; age range 18-77; mean 47 ± 14 years; BMI range 18-40; mean 27.8 ± 4.4 kg/m2). In both groups, facet joint subchondral BME signal was evaluated using T2-weighted STIR imaging, and facet joint osteoarthritis was characterized as mild, moderate, and severe. RESULTS: The BME signal was found in seven asymptomatic participants (12.7%) and 28 low back pain patients (35.4%) (P = 0.003). A significant portion of the patients (15.2%) presented more than one BME signal (P = 0.011). By pooling the ten facet joints of all subjects in each group, a significant difference in osteoarthritis grade distribution was observed between the two groups (P < 0.001). When adjusted for low back pain status, age, BMI, Modic type 1, disk herniation, and facet joint osteoarthritis maximal grade, only the latter was significantly associated with the facet joint BME signal (P < 0.001). CONCLUSION: Despite the higher prevalence and frequency of the BME signal in facet joints of low back pain patients compared to that in healthy subjects, the signal was found to be associated with the severity of the patients' osteoarthritis and not with their low back pain status.

Síndrome de Ehlers-Danlos hipermóvel: um relato de caso / Hypermobile Ehlers-Danlos syndrome: a case report

A síndrome de Ehlers-Danlos é estabelecida por distúrbios hereditários do tecido conjuntivo que tem como manifestações principais a hipermobilidade articular, a hiperextensibilidade da pele e a fragilidade de tecidos, como articulações, ligamentos, pele, vasos sanguíneos e órgãos internos. São reconhecidos 13 subtipos, de acordo com Classificação Internacional de 2017. Dentre estes, abordamos o hipermóvel, cujo diagnóstico é eminentemente clínico, com manifestações sistêmicas distintas. Esse artigo refere-se ao caso de uma paciente diagnosticada com síndrome de Ehlers-Danlos hipermóvel, tendo como intuito a atualização acerca dos novos critérios diagnósticos, assim como o diagnóstico precoce de tal raropatia.

Ehlers-Danlos syndrome is established through hereditary disorders of connective tissue, and has as its manifestations: joint hypermobility, skin hyperextensibility, and fragility of tissues such as joints, ligaments, skin, blood vessels, and internal organs. Thirteen subtypes have been recognized according to the 2017 International Classification. Among these, the hypermobile type, the diagnosis of which is eminently clinical, with distinct systemic manifestations, will be addressed. This article refers to the case of a patient diagnosed with hypermobile Ehlers-Danlos syndrome, with the objective of updating the new diagnostic criteria, as well as the early diagnosis of such a rare disease.

Low skeletal muscle mass and radiographic osteoarthritis in knee, hip, and lumbar spine: a cross-sectional study.

BACKGROUND: Although several studies have shown that low skeletal muscle mass is correlated with knee osteoarthritis, no studies have investigated the correlation between skeletal muscle mass and hip and lumbar spine osteoarthritis (OA). AIM: This study aimed to delineate the relationship between low skeletal muscle mass and radiographic OA (ROA) of the knee, hip, and lumbar spine. METHODS: This is a cross-sectional study using the public data obtained from the Fifth Korean National Health and Nutrition Examination Survey (2010-2011). We included subjects aged ≥ 50 years who completed the surveys (3813 subjects). ROA was assessed by knee, hip, and lumbar spine radiographs and defined as Kellgren/Lawrence (KL) grade of at least 2 in the knee and lumbar spine, whereas KL grade ≥ 1 in the hip. Multivariate logistic regression analyses were performed to evaluate the effects of low skeletal muscle mass on radiographic joint degeneration. RESULTS: Appendicular skeletal muscle mass (ASM) was higher in subjects with healthy joints than in subjects with knee and lumbar spine ROA (18.9 ± 0.1 kg vs. 17.1 ± 0.2 kg, P < 0.0001 and 18.6 ± 0.1 kg vs. 17.4 ± 0.2 kg, P < 0.0001, respectively), whereas it was higher in those with ROA than in those with healthy hip (17.9 ± 0.1 kg vs. 19.1 ± 0.2 kg P < 0.0001). On multivariate logistic regression analysis, lower skeletal muscle mass independently associated with knee ROA [odds ratio (OR) 1.348; 95% confidence interval (CI) 1.037-1.752]. However, it was inversely associated with lumbar spine ROA (OR 0.786; 95% CI 0.623-0.991). CONCLUSION: Low skeletal muscle mass was independently associated with knee ROA alone, whereas it was inversely associated with lumbar spine ROA. These opposite results might originate from measuring the area of ASM.

Relationship Between Modic Changes and Sagittal Balance Parameters in the Cervical Spine.

BACKGROUND We explored the possible relationship between Modic changes (MCs) and sagittal parameters of the cervical spine. MATERIAL AND METHODS We enrolled 150 patients with cervical MC on the magnetic resonance imaging (MRI) scans in the MC (+) group and divided them into 3 sub-groups with 50 patients each: the MC1 sub-group, the MC2 sub-group, and the MC3 sub-group. Another 150 healthy subjects receiving routine health examinations were also enrolled in the study as the MC (-) group. The sagittal parameters in the cervical spine were measured and compared and multiple logistic regression analysis was performed to analyze the risk factor for the occurrence of MC. RESULTS Four cervical sagittal parameters were measured and compared between all the enrolled groups, including neck tilt (NT), T1 slope (T1s), thoracic inlet angle (TIA), and Cobb C2-C7. The results confirmed that the parameter of Cobb C2-C7 was much smaller in the MC(+) group when compared with that in the MC(-) group (P<0.05), while no significant differences were detected between the MC(+) and MC(-) groups for the parameters of NT, T1 T1s, and TIA (P>0.05). Multiple logistic regression analysis showed that Cobb C2-C7 (less than 8.5°) could be regarded as the risk factor for the occurrence of MC, and the receiver operating characteristic (ROC) curve showed that moderate diagnostic significance was obtained with an area under curve (AUC) of 0.82. CONCLUSIONS The present study demonstrated that Cobb C2-C7 (less than 8.5°) is a potential risk factor for the development of MC.

[Periacetabular osteotomy-what influence does age have on patient-relevant results? : A prospective 5­year investigation]. / Periazetabuläre Osteotomie ­ Welchen Einfluss hat das Alter auf patientenrelevante Ergebnisse? : Eine prospektive 5­Jahres-Untersuchung.

INTRODUCTION: Periacetabular osteotomy (PAO) is an effective procedure in treatment of symptomatic hip dysplasia. To achieve a good outcome a strict patient selection has to be applied. The aim of this study was to evaluate the influence of patient age at surgery on clinical outcome. METHODS: In a prospective study 86 patients (106 hips) underwent clinical and radiographic follow-up at a mean time of 5 years (2.5-8.5 years) after PAO. Patient-related outcome measurements (PROMs: EQ-5D, WOMAC, OHS, GTO) were applied preoperatively as well as postoperatively and the deformity correction as well as development of osteoarthritis were evaluated. In order to analyze the influence of patient age at surgery on clinical outcome, we subdivided the patient cohort into four different age groups (<20 years, 20-29 years, 30-39 years, >40 years). RESULTS: Of the patients 90% were very satisfied or satisfied with the results 5 years after surgery, and in all age groups PROMs significantly increased. Even though preoperative as well as postoperative algofunction declined in cohorts with increasing age, the overall benefit as measured in WOMAC and EQ-5D scores was equal in all age groups. Increasing age is associated with a progression in osteoarthritis as well as a higher conversion rate to total arthroplasty. DISCUSSION: Age is an important influencing factor on the long-term outcome after PAO. A certain age as cut off for indications could not be identified in this study. Even patients in the age groups 30-39 years and > 40 years showed PROM improvement and satisfaction with outcome at medium-term follow-up. The expected success rate has to be discussed preoperatively with the patient; however, as a higher conversion rate to hip arthroplasty as well as progressive osteoarthritis is associated with higher age, not only patient age alone but also morphological characteristics of the hip joint have to be taken into consideration.

Modic Type 1 Changes: Detection Performance of Fat-Suppressed Fluid-Sensitive MRI Sequences.

PURPOSE: To assess the performance of fat-suppressed fluid-sensitive MRI sequences compared to T1-weighted (T1w) / T2w sequences for the detection of Modic 1 end-plate changes on lumbar spine MRI. MATERIALS AND METHODS: Sagittal T1w, T2w, and fat-suppressed fluid-sensitive MRI images of 100 consecutive patients (consequently 500 vertebral segments; 52 female, mean age 74 ±â€Š7.4 years; 48 male, mean age 71 ±â€Š6.3 years) were retrospectively evaluated. We recorded the presence (yes/no) and extension (i. e., Likert-scale of height, volume, and end-plate extension) of Modic I changes in T1w/T2w sequences and compared the results to fat-suppressed fluid-sensitive sequences (McNemar/Wilcoxon-signed-rank test). RESULTS: Fat-suppressed fluid-sensitive sequences revealed significantly more Modic I changes compared to T1w/T2w sequences (156 vs. 93 segments, respectively; p < 0.001). The extension of Modic I changes in fat-suppressed fluid-sensitive sequences was significantly larger compared to T1w/T2w sequences (height: 2.53 ±â€Š0.82 vs. 2.27 ±â€Š0.79, volume: 2.35 ±â€Š0.76 vs. 2.1 ±â€Š0.65, end-plate: 2.46 ±â€Š0.76 vs. 2.19 ±â€Š0.81), (p < 0.05). Modic I changes that were only visible in fat-suppressed fluid-sensitive sequences but not in T1w/T2w sequences were significantly smaller compared to Modic I changes that were also visible in T1w/T2w sequences (p < 0.05). CONCLUSION: In conclusion, fat-suppressed fluid-sensitive MRI sequences revealed significantly more Modic I end-plate changes and demonstrated a greater extent compared to standard T1w/T2w imaging. KEY POINTS: · When the Modic classification was defined in 1988, T2w sequences were heavily T2-weighted and thus virtually fat-suppressed.. · Nowadays, the bright fat signal in T2w images masks edema-like changes.. · The conventional definition of Modic I changes is not fully applicable anymore.. · Fat-suppressed fluid-sensitive MRI sequences revealed more/greater extent of Modic I changes.. CITATION FORMAT: · Finkenstaedt T, Del Grande F, Bolog N et al. Modic Type 1 Changes: Detection Performance of Fat-Suppressed Fluid-Sensitive MRI Sequences. Fortschr Röntgenstr 2018; 190: 152 - 160.

Is L5-S1 motion segment different from the rest? A radiographic kinematic assessment of 72 patients with chronic low back pain.

PURPOSE: The relationship between biomechanical instability and degenerative changes in the lumbar spine in chronic low back pain (CLBP) patients remains controversial. The main objective of this retrospective radiographical study was to evaluate changes in kinematics at different lumbar levels (in particular the L5-S1 level) with progressive grades of disc degeneration and facet joint osteoarthritis in CLBP patients. METHODS: Using standing neutral and dynamic flexion/extension (Fx/Ex) radiographs of the lumbar spine, in vivo segmental kinematics at L1-L2 through L5-S1 were evaluated in 72 consecutive CLBP patients. Disc degeneration was quantified using changes in signal intensity and central disc height on mid-sagittal T2-weighted magnetic resonance (MR) scans. Additionally, the presence or absence of facet joint osteoarthritis was noted on T2-weighted axial MR scans. RESULTS: Disc degeneration and facet joint osteoarthritis occurred independent of each other at the L5-S1 level (p = 0.188), but an association was observed between the two at L4-L5 (p < 0.001) and L3-L4 (p < 0.05) levels. In the absence of facet joint osteoarthritis, the L5-S1 segment showed a greater range of motion (ROM) in Ex (3.3° ± 3.6°) and a smaller ROM in Fx (0.6° ± 4.2°) compared with the upper lumbar levels (p < 0.05), but the differences diminished in the presence of it. In the absence of facet joint osteoarthritis, no change in L5-S1 kinematics was observed with progressive disc degeneration, but in its presence, restabilisation of the L5-S1 segment was observed between mild and severe disc degeneration states. CONCLUSION: The L5-S1 motion segment exhibited unique degenerative and kinematic characteristics compared with the upper lumbar motion segments. Disc degeneration and facet joint osteoarthritis occurred independent of each other at the L5-S1 level, but not at the other lumbar levels. Severe disc degeneration in the presence of facet joint osteoarthritis biomechanically restabilised the L5-S1 motion segment.

Characterisation of the correlation between standing lordosis and degenerative joint disease in the lower lumbar spine in women and men: a radiographic study.

BACKGROUND: Degenerative joint disease (DJD) in the lumbar spine is a common condition that is associated with chronic low back pain. Excessive loading of lumbar joints is a risk factor for DJD. Changes in lumbar lordosis significantly redistribute the forces of weight-bearing on the facet joints and the intervertebral discs. However, the relationship between lumbar lordosis and DJD has not been characterized in men and women. METHODS: We characterised the correlation between standing lumbar lordosis and DJD in standing radiographic images from 301 adult female and male chiropractic patients. DJD was rated using the Kellgren-Lawrence scale, and lordosis was measured using the Cobb angle. Linear and curvilinear correlations were investigated while controlling for age and sex. RESULTS: We found a highly significant curvilinear correlation between lordosis and DJD of the lower lumbar spine in both sexes, but especially in women, irrespective of the effects of age. We found the effect size of lordosis on lower lumbar DJD to be between 17.4 and 18.1% in women and 12.9% in older men. In addition, lordosis of 65 (95% CI 55.3-77.7) and 68 (98% CI 58.7-73.3) degrees were associated with minimal DJD in the lower lumbar spine of women and men respectively, and were therefore considered 'optimal'. This optimal lordotic angle was 73 (95% CI 58.8-87.2) degrees in older men. CONCLUSIONS: Both hypo- and hyper-lordosis correlate with DJD in the lumbar spine, particularly in women and in older men. These findings may well be of relevance to spinal pain management and spinal rehabilitation.

Biomarkers reflect differences in osteoarthritis phenotypes of the lumbar spine: the Johnston County Osteoarthritis Project.

OBJECTIVE: To determine differences in biomarker levels between radiographic phenotypes of facet joint osteoarthritis (FOA) only, spine OA only ((disc space narrowing (DSN) and vertebral osteophytes (OST)) or the combination of FOA and spine OA. DESIGN: A cross-sectional analysis of data from 555 participants in the Johnston County Osteoarthritis Project was performed. Lumbar spine levels were graded by severity (OST and DSN) and presence (FOA) of degeneration. Biomarkers included hyaluronan (HA) and type II collagen (CTX-II). Adjusted risk ratios (aRRR) were estimated using multinomial regression, with adjustment for age, race, sex, body mass index (BMI), and radiographic OA (knee, hip, hand). Interactions were tested between sex, race and low back symptoms. RESULTS: FOA only was present in 22.4%, 14.5% had spine OA only, and 34.6% had the combination of FOA and spine OA. Compared to the reference group of neither FOA or spine OA, a one unit higher ln HA level was associated with 31% higher relative risk ratio (RRR = 1.31 (95% 1.03, 1.67)) of having FOA only, while, a one unit higher lnuCTX-II level was associated with 84% higher relative risk ratio (RRR = 1.84 (95% CI 1.19, 2.84)) of having spine OA only. No significant interactions were identified. CONCLUSION: Interestingly, OA affecting the synovial facet joint was associated with a marker of inflammation (HA). Spine OA, affecting intervertebral discs that contain collagen type II, was associated with a marker reflecting collagen type II degradation (CTX-II). These findings suggest that biomarkers may reflect the different pathophysiologic processes of lumbar spine OA phenotypes.

The associations between parity, other reproductive factors, and osteoarthritis in women aged over 50 years; data from the Korean National Health and Nutrition Examination Survey V (2010-2012).

OBJECTIVE: To evaluate the relationships between sociodemographic factors, reproductive history, and subsequent risk of osteoarthritis (OA) or pain of the hip, knee, and back in Korean women. MATERIALS AND METHODS: This study included data of 5101 women aged over 50 years, taken from the Korean National Health and Nutritional Examination Survey V from 2010 to 2012. Women were stratified according to parity, as well as delivery mode. Multivariate logistic regression analysis was conducted to evaluate relationships between radiographic OA or symptomatically possible OA (back, knee, or hip), and historical factors. RESULTS: Vaginal delivery was associated with an increased risk of symptomatic back OA [odds ratio (OR) 1.75, 95% confidence interval (CI) 1.062, 2.881] but was not associated with symptomatic knee and hip OA in adjusted analysis. Radiographically, vaginal delivery was not associated with risks of back and knee OA, but was negatively associated with hip OA (OR 0.184, 95% CI 0.039, 0.863), compared to cesarean delivery. High parity (over 5) was associated with radiographic knee OA (OR 1.328, 95% CI 1.006, 1.754) in adjusted analysis. High parity (over 3) was associated with symptomatic back OA. CONCLUSION: Parity was associated with higher risk of radiographic knee OA. Vaginal delivery was positively associated with symptomatic back OA, but negatively associated with radiographic knee OA. Further study is required to evaluate the mechanism between delivery mode and subsequent OA.

Prevalence of symptomatic hip, knee, and spine osteoarthritis nationwide health survey analysis of an elderly Korean population.

Osteoarthritis is prominent among the elderly, with symptoms originating from multiple parts of the body. A cross-sectional study of a nationwide survey was performed to describe the prevalence of and identify factors related to symptomatic hip, knee, and spine osteoarthritis.This cross-sectional study collected data from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V-5; 2010-2012). After excluding ineligible subjects, there were 8976 subjects in this study (3830 males and 5146 females). All subjects reported symptoms and disabilities related to osteoarthritis. Plain radiographs of the spine, hip, and knee were taken in all subjects.Overall, 9.3% of male participants and 28.5% of female participants were diagnosed with symptomatic osteoarthritis according to survey criteria. Women showed a significantly higher prevalence in all age groups (P < 0.05). Multiple-joint osteoarthritis was diagnosed in 10.8% of male patients and 22.8% of female patients with osteoarthritis. Several demographic and lifestyle variables were related to osteoarthritis morbidity. Anthropometric and laboratory measurements were also related to osteoarthritis morbidity. In addition, mental distress and quality of life were significantly compromised in osteoarthritis. There were more significant relationships for these factors among women with a higher prevalence of multijoint osteoarthritis.A significant proportion of the elderly with single- or multiple-joint osteoarthritis had a variety of pain origins that were closely related. Osteoarthritis was also significantly related to several factors, including mental distress and quality of life.

Relationship between spinal osteoarthritis and vertebral fractures in men older than 50 years: data from the Camargo Cohort Study.

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.