Relationship Between Degeneration or Sagittal Balance With Modic Changes in the Cervical Spine.

OBJECTIVE: This study evaluates the relationship between degenerative and Modic changes (MCs) in the cervical spine and compares the results with the cervical sagittal balance parameters. METHODS: We retrospectively reviewed 275 patients with neck pain who applied to our outpatient clinic and underwent cervical magnetic resonance imaging (MRI) and cervical anteroposterior (AP)/lateral (Lat) X-ray radiography between January 2016 and January 2018. The clinics, demographic information, and radiological findings of the patients were examined. Modic changes, disc degeneration, and facet degeneration (FD) were examined by cervical MRI, and T1 slope and Cobb angle were measured by cervical AP/Lat X-ray radiography. These results were compared to evaluate their relations with each other. RESULTS: No relationship between the presence or absence of degenerative changes (Modic changes, facet degeneration, and disc degeneration) and sagittal balance parameters (T1 slope and Cobb angle) was found. However, when each cervical segment was examined separately, facet degeneration at the C4-C5 level and Modic changes at the C3-C4, C4-C5, and C6-C7 levels were statistically significant with the Cobb angles, and the Modic changes at the C3-C4 level and disc degeneration at the C2-C3 level were found to be significant with T1 slope values. CONCLUSIONS: Our findings indicate that MCs increased with decreased cervical curvature, increasing disc and facet degeneration, although the causal mechanisms are not clear.

Association between parity and lumbar spine degenerative disorders in young women.

Introduction: Estrogen helps to maintain the health of collagen-containing tissues including the intervertebral disc. Estrogen deficiency after menopause negatively affects the quality of vertebral end plates and induces development of degenerative disc disease (DDD). However, there is no study examining the relationship between parity and spinal degeneration in young women. The aim of this study was to define the relationship between parity and development of vertebral endplate signal changes and DDD in young premenopausal women.Materials and methods: This case-control case study included 224 patients aged 20-40 years with a history of low back pain for at least 3 months. Pfirrmann's grade, Modic changes (MCs), and Schmorl's nodes (SNs) were graded based on magnetic resonance images. Patients' parity, demographics, body mass index, physical activity level, and disability scores were assessed using a questionnaire.Results: The prevalence of abnormal total Pfirrmann's score (>10) and MCs was higher in primiparous patients than multiparous and grand-multiparous; however, it was not statistically significant. The presence of SN was statistically significantly associated with low parity. According to multivariate logistic regression analysis, it was found that the number of births increases by 1 unit, the abnormality in Pfirrmann's score decreases by 1.36 times.Conclusions: This cross-sectional study shows that parity is associated with DDD and vertebral end plate changes. SNs were significantly associated with parity. Modic changes and DDD were less common in grand multipara and multipara young women than in primipara women. These results indicate that low parity may possibly be associated with the development of spinal degeneration.

Effects of Modic Type 1 Changes in the Vertebrae on Low Back Pain.

OBJECTIVE: The present study examined the physical extent of Modic type 1 (MT1) changes and other phenotypic magnetic resonance imaging (MRI) findings in the vertebrae of patients with low back pain (LBP) and MT1 changes. We also identified any correlations of these findings with the severity of pain and the Oswestry Disability Index (ODI). The relationship between the presence of pain and MT1 changes has been examined in several studies. However, to the best of our knowledge, no study has assessed the relationships between pain severity and ODI and the total vertebral area of MT1 involvement. METHODS: After excluding any patient with MT2 or MT3 changes, 49 patients with a diagnosis of LBP and MT1 changes demonstrated on MRI were included. MT1 involvement area, disc height, number of Schmorl's nodes, disc degeneration (Pfirrmann grade), and cross-sectional area of the lumbar muscles were obtained via MRI. Additionally, patient demographic data, body mass index, physical activity level, and disability (ODI) scores were assessed. RESULTS: The total vertebral area of MT1 involvement correlated significantly and positively with the ODI (P = 0.001). In the multivariate linear regression model, with ODI as the dependent variable and age, mean Pfirrmann grade, total vertebral area of MT1 involvement, and sex as independent variables, only the total vertebral area of MT1 involvement was significantly associated with the ODI. CONCLUSIONS: A significant positive correlation was noted between the vertebral MT1 involvement extent and changes in the ODI. Other MRI features of patients with LBP were not related to pain severity or ODI.

Magnetic resonance imaging features of idiopathic granulomatous mastitis: is there any contribution of diffusion-weighted imaging in the differential diagnosis?

PURPOSE: To identify the magnetic resonance imaging (MRI) appearance of idiopathic granulomatous mastitis, and the usefulness of diffusion-weighted magnetic resonance imaging (DW-MRI) in distinguishing idiopathic granulomatous mastitis (IGM) from malignant breast lesions. MATERIAL AND METHODS: A total of 37 women (mean age 36 + 8; range 20-67 years) with histopathologic diagnoses of idiopathic granulomatous mastitis were enrolled in the study. Five patients had bilateral IGM, which were evaluated as ten cases. Dynamic MRI findings were categorized as enhancing mass lesion, non-mass enhancement, or both together. The frequency of quadrant involvement, retroareolar involvement, accompanying abscess, ductal ectasia, skin thickening, breast edema, extension to pectoral muscle, and presence of fistula were investigated. The mean apparent diffusion coefficient (ADC) values for lesions, contralateral normal breast parenchyma, pectoralis major muscle, and sternum were measured in patients with invasive cancers (n = 42) and those with mastitis (n = 42). The ADC ratio of the lesions to the contralateral normal breast parenchyma, pectoralis major muscle, and sternum were determined. RESULTS: The findings of idiopathic granulomatous mastitis on MRI were total (in all quadrants) or wide (2 or 3 quadrants) in 30 (71.5 %), retroareolar space involvement in 28 (66.7 %), skin thickening in 21 (50 %), breast edema in 21 (50 %), extension to pectoral muscle in 18 (42.9 %), accompanying abscess formation in 33 (78 %), ductal ectasia in 17 (40.5 %), and fistulas in 13 (31 %). On dynamic contrast-enhanced MRI, 69 % of the patients had mass appearance of IGM. The most frequent enhancement patterns were rim enhancement in 20 (78 %) in masses and clustered ring in 11 (48 %) in non-mass lesions. Early enhancement pattern of IGM was obtained as 'slow' in 29 cases (69 %), 'medium' in 11 cases (26.1) and 'rapid' in 2 (5 %) cases. Time-signal intensity curves were detected as Type-1 in 27 cases (64 %) and Type-2 in 15 cases (36 %). IGM showed significantly lower mean ADC values when compared with the normal parenchyma. When IGM was compared with malignancy, mastitis ADC was 0.98 ± 0.188 × 10-3, and invasive cancer ADC was 0.95 ± 0.229 × 10-3. The difference in ADC values of mastitis and invasive cancers proved not to be significant (P = 0.185). Our results had no discriminatory power for IGM versus malignant lesions for either ADC values and ADC ratios of normal breast parenchyma, pectoralis major muscle, and sternum. CONCLUSION: Although not characteristic for idiopathic granulomatous mastitis, masses with rim enhancement or clustered-ring non-mass lesions with segmental distribution on MRI are the most common features of the disease. Ductal ectasia and periductal enhancement were commonly accompanying; this and kinetic analysis are valuable findings for distinguishing IGM from invasive cancer. IGM shows similar ADC values to invasive cancers despite being benign, DW-MRI is not helpful in the differentiation with malignant lesions.

Comparison of the C-MAC Videolaryngoscope and Rigid Fiberscope with Direct Laryngoscopy in Easy and Difficult Airway Scenarios: A Manikin Study.

BACKGROUND: Intubation is a fundamental skill in maintaining adequate oxygenation and ventilation of seriously ill patients. OBJECTIVES: To compare the C-MAC video laryngoscope and Bonfils intubation fiberscope with direct laryngoscopy in simulated easy and difficult airway scenarios. METHODS: This was a prospective, randomized-controlled cross-sectional study. Thirty emergency medicine residents attempted to intubate a manikin using four progressively more difficult airway settings (normal airway [scenario 1], cervical spine immobilization [scenario 2], cervical spine immobilization + tongue swelling scenario [scenario 3], and cervical spine immobilization + tongue swelling + limited jaw opening scenario [scenario 4]) with both the C-MAC video laryngoscope and the Bonfils intubation fiberscope and direct laryngoscope. RESULTS: In the first and the second scenarios, there were no statistically significant differences between the airway devices in terms of the duration of endotracheal intubation, the viewing duration of the glottic opening, and endotracheal tube insertion time. There was no statistically significant difference between the laryngoscopes in terms of the duration of endotracheal intubation and endotracheal tube insertion time in the third scenario. The overall success rates and the viewing duration of the glottic opening were shorter with the C-MAC and Bonfils in scenarios 3 and 4. Furthermore, the duration of intubation was better with Bonfils in scenario 4. The severity of dental trauma was lowest with the Bonfils in all scenarios. The device difficulty score was greatest with the Macintosh blade, except in the normal airway scenario. The most preferred airway device was the C-MAC. CONCLUSION: The Bonfils and C-MAC enabled better visualization of the glottic opening when compared with the Macintosh laryngoscope.

Comparison of ultrasonography and surface landmarks in detecting the localization for cricothyroidotomy.

OBJECTIVE: The aim of the study was to compare ultrasonography (US) and surface landmark techniques for detecting the cricothyroid membrane (CTM) to perform a cricothyroidotomy on healthy volunteers. METHODS: In this prospective observational study, 5 operators and 24 models were included. The borders of the CTM were marked with an invisible pen. The operators were asked to point the CTM either with the palpation method or the US-guided fashion. RESULTS: The CTM was detected accurately in 80 (66.7%) attempts with palpation and 83 (69.2%) attempts with US. There was no statistically significant difference in the accuracy of detection of the CTM with palpation and US. The mean time for detecting the CTM with palpation was 8.25 ± 4.8 seconds (95% confidence interval, 7.3-9.1). The mean time for detecting CTM with US was 17 ± 9.2 seconds (95% confidence interval, 15.3-18.7). The duration for detecting the localization of the CTM was longer with US. CONCLUSION: According to the results of this study, the accuracy of US and palpation was similar in detecting the localization of the CTM. However, the duration for detecting the CTM was longer with US when compared with the palpation technique.