Classification of Osteophytes Occurring in the Lumbar Intervertebral Foramen.

BACKGROUND: Surgeons have limited knowledge of the lumbar intervertebral foramina. This study aimed to classify osteophytes in the lumbar intervertebral foramen and to determine their pathoanatomical characteristics, discuss their potential biomechanical effects, and contribute to developing surgical methods. METHODS: We conducted a retrospective, non-randomized, single-center study involving 1224 patients. The gender, age, and anatomical location of the osteophytes in the lumbar intervertebral foramina of the patients were recorded. RESULTS: Two hundred and forty-nine (20.34%) patients had one or more osteophytes in their lumbar 4 and 5 foramina. Of the 4896 foramina, 337 (6.88%) contained different types of osteophytes. Moreover, four anatomical types of osteophytes were found: mixed osteophytes in 181 (3.69%) foramina, osteophytes from the lower endplate of the superior vertebrae in 91 (1.85%) foramina, osteophytes from the junction of the pedicle and lamina of the upper vertebrae in 39 foramina (0.79%), and osteophytes from the upper endplate of the lower vertebrae in 26 (0.53%) foramina. The L4 foramen contained a significantly higher number of osteophytes than the L5 foramen. Osteophyte development increased significantly with age, with no difference between males and females. CONCLUSIONS: The findings show that osteophytic extrusions, which alter the natural anatomical structure of the lumbar intervertebral foramina, are common and can narrow the foramen.

The role of neuronal plasticity in cervical spondylotic myelopathy surgery: functional assessment and prognostic implication.

Cervical spondylotic myelopathy (CSM) is a degenerative disease representing the most common spinal cord disorder in the adult population. It is characterized by chronic compression leading to neurological dysfunction due to static and dynamic injury of the spinal cord in cervical spine. These insidious damage mechanisms can result in the reorganization of cortical and subcortical areas. The cerebral cortex can reorganize due to spinal cord injury and may play a role in preserving neurological function. To date, the gold standard treatment of cervical myelopathy is surgery, comprising anterior, posterior, and combined approaches. However, the complex physiologic recovery processes involving cortical and subcortical neural reorganization following surgery are still inadequately understood. It has been demonstrated that diffusion MRI and functional imaging and techniques, such as transcranial magnetic stimulation (TMS) or functional magnetic resonance imaging (fMRI), can provide new insights into the diagnosis and prognosis of CSM. This review aims to shed light on the state-of-the-art regarding the pattern of cortical and subcortical areas reorganization and recovery before and after surgery in CSM patients, underlighting the critical role of neuroplasticity.

Economic access influences degenerative spine disease outcomes at rural Late Medieval Villamagna (Lazio, IT).

OBJECTIVES: Degenerative joint disease in the spine is heavily influenced by genetic, environmental, and epigenetic factors, as well as exacerbated by physical activity and injury. The objective of this study was to investigate the multivariate relationship between known predictors of degenerative joint disease in the spine, such as age and sex, with mortuary indicators of economic access such as grave inclusions, burial location, and burial type. MATERIALS AND METHODS: The presence and severity of vertebral osteophytosis (VO) and vertebral osteoarthritis (VOA) was recorded for the vertebral columns of N = 106 adult individuals from the Late Medieval period at the rural monastery of San Pietro at Villamagna in Lazio, Italy (1300-1450 AD). Multiple skeletal indicators of degenerative joint disease, morphological sex, and age were compared with differences in mortuary treatment across four regions of the spine. RESULTS: There are marked differences in severe joint disease outcome between groups with more and less economic access. Relative risk ratios suggest that males and females with less economic access have elevated risk for VO and VOA in specific spine regions, although this effect is reduced among females. DISCUSSION: Current research on the consequences of economic and social inequality point to the important role of economic inequality in shaping disease outcomes. Our results suggest that biocultural effects of reduced economic access at the intraclass level may increase vulnerability to the downstream effects of risk exposure (e.g., biomechanical injure, physical activity, biochemical imbalance), and ultimately increase the risk and prevalence for severe degenerative disease outcomes in medieval Italy.

Microstructural Changes in Compressed Cervical Spinal Cord Are Consistent With Clinical Symptoms and Symptom Duration.

STUDY DESIGN: A prospective study. OBJECTIVE: To investigate the association between microstructural changes measured by diffusion tensor imaging (DTI) and clinical symptoms and their duration in patients with cervical spondylotic myelopathy (CSM) affected by single level. SUMMARY OF BACKGROUND DATA: No report was reported regarding the association between the microstructural changes and the symptoms and their duration at single-level spinal cord compression. METHODS: Twenty-nine consecutive patients with CSM and 29 normal subjects were enrolled in this study. DTI with tractography was performed on the cervical spinal cord. Clinical symptoms were evaluated using modified Japanese Orthopaedic Association (mJOA) scores for each patient, and the duration of clinical symptoms was noted based on the earliest instance of limb pain or numbness or weakness or bladder dysfunction. Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated from tractography images. RESULTS: The mean FA value of the cervical compressed spinal cord was significantly lower than the FA of the normal population (P < 0.001). The mean ADC value in the cervical compressed spinal cord was obviously higher than those of normal cervical spinal cord (P < 0.001). In the CSM patients, a significant positive association was observed between FA values and mJOA scores (P < 0.001). However, there were a notable negative association between mJOA scores and ADC values (P < 0.001), and between mJOA scores and symptom duration (P < 0.001). CONCLUSION: These results illustrate DTI can measure the micostructural changes of cervical spinal cord and DTI parameters are potential biomarkers for spinal cord dysfunction in patients with CSM. LEVEL OF EVIDENCE: 3.

Analysis of Correlation Between Age and Cervical Facet Joint Degeneration and Modic Changes in Patients with Cervical Spondylotic Myelopathy.

BACKGROUND Because facet joints move with the disc, changes in vertebral bodies occur simultaneously with progression of degeneration of cervical facet joints. This study investigated age-related differences in cervical facet joint abnormalities and multi-dimensional characteristics of MCs in patients with cervical spondylotic myelopathy. MATERIAL AND METHODS Forty-five patients underwent both magnetic resonance imaging (MRI) and computed tomography (CT) of the cervical spine. Axial and sagittal parameter changes from C3 to C7, including facet orientation (FO) and facet tropism (FT), and Modic changes (MCs), were evaluated and documented preoperatively, and we also measured the heights and diameters of MCs and performed correlation analysis and established linear regression models. RESULTS The axial facet orientation increased slightly from C3 66.5 (11.4) to C7 89.9 (19). The sagittal facet orientation and facet tropism increased between C3-C4 and C6-C7, but it decreased between C4 to C6. The MCs volume decreased from C3 to C4 and increased from C4 to C7. There was a gradual decrease of FO and FT from C3 to C5 and a gradual increase of these 2 angles from C5 to C7 in all age groups. The lowest values of FO and FT were detected at C5, while the highest values of FO and FT were detected at C7. CONCLUSIONS Age was negatively correlated with the axial, sagittal, and coronal cervical facet orientation, especially at C4/5 level. The FT with respect to the axial and sagittal plane from C5 to C6 increased with age.

Cervical Osteophytes Increase the Risk for Foreign Body Impaction: A 171-Patient Case-Control Study.

The aim of this study is to define the relationship between anatomical and pathological cervical structures and the impaction of ingested foreign bodies (FBs). The effects of such structures on deglutition have been previously discussed, however their contribution to FB impaction has not yet been examined. This was a retrospective case-control study of 171 patients who underwent computed tomography (CT) scans over the period 2008-2014: 57 patients with an esophageal or hypopharyngeal FB; the other 114 comprised the control group, selected using the 'neighbor control' method. CT scans were reviewed for measurements of cervical structures. The mean age was 63 ± 13 years and 55 ± 17 years in the case and control groups, respectively (p-value = 0.003). Age was the only demographic or clinical characteristic which demonstrated a significant difference. Overall, 24 patients had cervical osteophytes: 28 %(16) with an impacted FB, compared with 7 %(8) from the control group (p-value < 0.001). Of the patients with osteophytes and impacted FBs, 62.5 % had the FB lodged at a vertebral level corresponding to their osteophytes, while another 18.75 % had the FB within three vertebral levels above the osteophytes. Stepwise logistic regression revealed that osteophytes were a significant factor, independent of older age (p-value = 0.004). Adjusted odds ratio for FB impaction in the presence of osteophytes was 4.04. Ventral cervical osteophytes increase the risk for FB impaction in the upper digestive tract. This risk is independent of older age. These findings can be of value in preventive medicine, and emphasize the importance of looking for spinal changes in patients with recurrent FB impaction.

Degenerative Pathways of Lumbar Motion Segments--A Comparison in Two Samples of Patients with Persistent Low Back Pain.

BACKGROUND: Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persistent low back pain. However, the clinical relevance of spinal degenerative MRI findings remains uncertain. Although multiple MRI findings are almost always present at the same time, research into the association with clinical outcomes (such as pain) has predominantly focused on individual MRI findings. This study aimed to: (i) investigate how multiple MRI lumbar spine findings cluster together within two different samples of patients with low back pain, (ii) classify these clusters into hypothetical pathways of degeneration based on scientific knowledge of disco-vertebral degeneration, and (iii) compare these clusters and degenerative pathways between samples. METHODS: We performed a secondary cross-sectional analysis on two dissimilar MRI samples collected in a hospital department: (1) data from the spinal MRI reports of 4,162 low back pain patients and (2) data from an MRI research protocol of 631 low back pain patients. Latent Class Analysis was used in both samples to cluster MRI findings from lumbar motion segments. Using content analysis, each cluster was then categorised into hypothetical pathways of degeneration. RESULTS: Six clusters of MRI findings were identified in each of the two samples. The content of the clusters in the two samples displayed some differences but had the same overall pattern of MRI findings. Although the hypothetical degenerative pathways identified in the two samples were not identical, the overall pattern of increasing degeneration within the pathways was the same. CONCLUSIONS: It was expected that different clusters could emerge from different samples, however, when organised into hypothetical pathways of degeneration, the overall pattern of increasing degeneration was similar and biologically plausible. This evidence of reproducibility suggests that Latent Class Analysis may provide a new approach to investigating the relationship between MRI findings and clinically important characteristics such as pain and activity limitation.

Comparison of vertebral and intervertebral disc lesions in aging humans and rhesus monkeys.

OBJECTIVE: To compare gross and histologic patterns of age-related degeneration within the intervertebral disc and adjacent vertebra between rhesus monkeys and humans. MATERIALS AND METHODS: We examined age-related patterns of disc degeneration from mid-sagittal sections of the intervertebral disc and adjacent vertebral bodies (VB) among six rhesus monkey thoracolumbar and seven human lumbar spines. Gross morphology and histopathology were assessed via the Thompson grading scheme and other degenerative features of the disc and adjacent bone. RESULTS: Thompson grades ranged from 3 through 5 for rhesus monkey discs (T9-L1) and 2 through 5 for the human discs (T12-S1). In both rhesus monkey and human discs, presence of distinct lesions was positively associated with Thompson grade of the overall segment. Degenerative patterns differed for radial tears, which were more prevalent with advanced disc degeneration in humans only. Additionally, compared to the more uniform anteroposterior disc degeneration patterns of humans, rhesus monkeys showed more severe osteophytosis and degeneration on the anterior border of the vertebral column. CONCLUSIONS: Rhesus monkey spines evaluated in the present study appear to develop age-related patterns of disc degeneration similar to humans. One exception is the absence of an association between radial tears and disc degeneration, which could reflect species-specific differences in posture and spinal curvature. Considering rhesus monkeys demonstrate similar patterns of disc degeneration, and age at a faster rate than humans, these findings suggest longitudinal studies of rhesus monkeys may be a valuable model for better understanding the progression of human age-related spinal osteoarthritis (OA) and disc degeneration.

Anatomy and clinical significance of the uncinate process and uncovertebral joint: A comprehensive review.

INTRODUCTION: The uncinate process and its associated uncovertebral articulation are features unique to the cervical spine. This review examines the morphology of these unique structures with particular emphasis on the regional anatomy, development and clinical significance. MATERIALS AND METHODS: Five electronic databases were utilized in the literature search and additional relevant citations were retrieved from the references. A total of 74 citations were included for review. RESULTS: This literature review found that the uncinate processes and uncovertebral articulations are rudimentary at birth and develop and evolve with age. With degeneration they become clinically apparent with compression of related structures; most importantly affecting the spinal nerve root and vertebral artery. The articulations have also been found to precipitate torticollis when edematous and be acutely damaged in severe head and neck injuries. The uncinate processes are also important in providing stability and guiding the motion of the cervical spine. CONCLUSION: This review is intended to re-examine an often overlooked region of the cervical spine as not only an interesting anatomical feature but also a clinically relevant one.

An increase in height of spinous process is associated with decreased heights of intervertebral disc and vertebral body in the degenerative process of lumbar spine.

PURPOSE: Currently degeneration of the intervertebral disc and joint in the degenerative process of the lumbar spine has mainly attracted the attention, however, there are very few literatures focusing on the height of the spinous process. Our objective was to examine in what generation the change in spinous process height occurs and how the change is involved in the degenerative process of the lumbar spine. METHODS: CT or CT myelography of 1,015 patients, 536 males and 579 females were measured in 6 items, including the heights of the L4 and L5 vertebral bodies, the L4 and L5 spinous processes, the L4/5 intervertebral disc, and the L5/S1 intervertebral disc. All data of the 6 items were analyzed and compared between gender in 5 age groups (40s, 50s, 60s, 70s and 80s). RESULTS: The results indicated a significant increase in the height of the L4 and L5 spinous process (P < 0.01) in the 60- to 70-year-old group for both genders, and also showed that the L4 and L5 vertebral body height was significantly decreased in the 50- to 60-year-old group (P < 0.01 in males, P < 0.001 in females). CONCLUSIONS: Changes in the spinous process morphology followed degenerative changes of the intervertebral disc and vertebral body in the degenerative process of the lumbar spine. This result may suggest that the morphological change of an increase in the height of the spinous process may be a kind of biological defense reaction to stabilize the intervertebral portion.

The use of vertebral osteoarthritis and osteophytosis in age estimation.

Previous research on age and vertebral degenerative change has focused on osteophytosis. The present study expands this research by examining the association between osteoarthritis and osteophytosis and by assessing their relationship to age. Researchers scored the bodies and facets in 104 individuals. Statistical analyses assessed relationships between age and degenerative change for the bodies and facets, both separately and combined, for all vertebrae collectively, and for subcategories of vertebral types. Separate analyses were conducted which included only regions that experience heavier stress loads. Results indicate that osteophytosis and osteoarthritis are not associated with each other for all subcategories of vertebrae. Also, the inclusion of osteoarthritis does not enhance the relationship between age and degenerative change, nor does limiting analyses to areas of heaver stress. Finally, although both conditions are significantly correlated with age, the relationship is not strong enough to yield predictive power for establishing age beyond a general estimate.

New diffusion metrics for spondylotic myelopathy at an early clinical stage.

OBJECTIVES: To investigate the use of root mean square displacement (RMSD) and mean diffusional kurtosis (DK) metrics of q-space imaging data to estimate spinal cord compression in patients with early cervical spondylosis. METHODS: We studied 50 consecutive patients at our institution (22 male, 28 female; mean age 58 years; age range 20-86 years) who had clinical signs and symptoms suggestive of early clinical stage cervical myelopathy. After conventional magnetic resonance (MR) imaging, diffusion tensor and q-space image data were acquired using 3-T MR imaging. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), RMSD and mean DK values were calculated and compared between compressed and uncompressed spinal cords. RESULTS: FA and mean DK values were significantly lower and RMSD was significantly higher (P = 0.0060, 0.0020 and 0.0062, respectively; Mann-Whitney U test with the Bonferroni correction) in compressed spinal cords than in uncompressed cords. ADC was also higher in compressed cords, but this difference was not statistically significant. CONCLUSIONS: In the evaluation of spinal cord damage in early cervical spondylosis, mean DK and RMSD values in the spinal cord may be highly sensitive indicators of microstructural change and damage. KEY POINTS: • Absolute surgical indications for cervical spondylosis with myelopathy remain to be established. • Diffusion tensor MRI shows abnormalities in normal-appearing but compressed spinal cord. • Non-Gaussian diffusion analysis is highly sensitive in revealing spinal cord damage.

The influence of sex, age and BMI on the degeneration of the lumbar spine.

Previous research on lumbar spine osteophyte formation has focused on patterned development and the relation of age and sex to degeneration within the vertebral bodies. The inclusion of osteophytes originating on the laminae and body mass index (BMI) may result in a more complete evaluation. This study investigates lumbar osteophyte development on the laminae and vertebral bodies to determine whether osteophyte development: (i) is related bilaterally, at different lumbar levels, and superior and inferior margins; (ii) on the laminae and vertebral bodies are reciprocally dependent responses; (iii) is correlated with sex, age and/or BMI. Seventy-six individuals (39 females, 37 males) were randomly selected from a modern skeletal collection (Bass Donated Collection). Osteophyte development was scored in eight regions on each vertebra at all five lumbar levels. A factor analysis considered all 40 scoring regions and Pearson's correlation analyses assessed the relatedness of age and BMI with the consequent factors. The factor analysis separated the variables into two similar factors for males and females defined as: (i) superior and inferior vertebral body scores and (ii) superior laminar scores at higher lumbar levels. The factor analysis also determined a third factor for females defined as: (iii) inferior laminar scores at lower lumbar levels. The severity of vertebral body osteophytes increased with age for both sexes. Additionally for females, as BMI increased, osteophyte severity increased for both the superior laminar margins higher in the column and the vertebral bodies. Dissimilarities between the factors in males and females and the correlation of BMI to osteophyte severity exclusively in females provide evidence for different biomechanical processes influencing osteophyte development.

Postmortem findings in a woman with history of laminoplasty for severe cervical spondylotic myelopathy.

CONTEXT: We report the autopsy of a 65-year-old woman who underwent a C3-C7 laminoplasty 4 years after the diagnosis of cervical spondylotic myelopathy (CSM). Her sensory disturbance, spasticity, and vesicorectal disturbance, which corresponded to long tract sign, had improved after surgery. FINDINGS: Cross sections at the C4-C5 level showed a triangular shape because of atrophied ventral gray matter. Moreover, despite the scarce glial scar formation around the cystic cavity, regeneration of gray matter had not occurred. In the white matter, the posterior and lateral funiculi were shrunken including three to four segments. CONCLUSION: Pathological change of white matter did not coincide with relief of clinical symptoms in this case. These findings indicate that it may be better to operate earlier in cases of CSM, because delay may lead to irreversible histological change.

Vertebral pathologies in two early modern period (16th-19th century) populations from Croatia.

In order to test to what degree Schmorl's nodes (SN), osteophytosis of the vertebral bodies (VO), and osteoarthritis of the articular facets (OA) are useful indicators of activity-related stress, an analysis of their frequencies and severity of expression was conducted in two early Modern period skeletal samples from Croatia--Koprivno and Sisak. Historic and contemporary ethnographic sources suggest that living conditions were more demanding in Koprivno, and that a sexual division of labor existed in both populations. A total of 2,552 vertebral bodies (990 from Koprivno and 1,562 from Sisak) and 5,186 articular facets (2,135 from Koprivno and 3,051 from Sisak) were analyzed. Koprivno exhibits significantly higher total frequencies of SN, VO, and OA than Sisak, and the total frequencies of SN and OA in both series are significantly higher in males. When, however, the series were analyzed by age and sex categories, the same trend was noted only in SN. The frequencies and severity of VO and OA could not be interpreted in keeping with the historic and contemporary ethnographic sources and were additionally, unlike SN, found to be strongly correlated with increased age. This study, therefore, suggests that while SN are useful indicators of different lifestyles and/or different activity patterns between various archaeological populations, VO and OA are-possibly because of their more varied etiologies-less useful markers of activity-related stress.

Longitudinal study of radiographic spinal osteoarthritis in a macaque model.

Cross-sectional analyses of naturally occurring spinal osteoarthritis (OA) in primates have shown that age and body mass are significant predictors, but whether or not these relationships hold true in longitudinal evaluations remains unclear. Because spinal OA manifests similarly in humans and monkeys and macaque monkeys age >3 times the rate of humans, macaque models offer opportunities for longitudinal study that are difficult in humans. Our objective was to characterize the longitudinal development over 11 years of spinal OA in 68 Macaca mulatta (41 males, 27 females, aged 11-32 years). Average disc space narrowing (DSN) and osteophytosis (OST) scores were computed for the thoracolumbar spine (T8-L7). Our longitudinal analyses confirmed the cross-sectional results: age and body mass (p < 0.001) significantly predicted 50% and 39% of the variability in OST and DSN, respectively. Rates of change in DSN, but not OST, were associated with age at first radiograph. This study represents the first long-term longitudinal assessment of OA in primates and establishes that the relationship among the covariates in the cross-sectional and longitudinal approaches is similar.

[Establishment and significance of an in vitro model of degeneration of human cervical endplate chondrocytes].

OBJECTIVE: To establish an in vitro model of degeneration of human cervical endplate chondrocytes and observe the morphology and phenotypes of endplate chondrocytes in normal and degenerative cervical vertebral endplates. METHODS: Cartilage endplates of 49 patients were divided into control group (n = 19) with cervical vertebral fracture or dislocation and experiment group (n = 30) with cervical spondylotic myelopathy. Endplate chondrocytes were isolated by enzyme digestion and cultured in vitro. The morphological appearances, growth curve and biological characteristics of endplate chondrocytes from normal and degenerative cartilage endplate were observed by inverted phase contrast microscope, HE staining, MTT, toluidine blue staining and reverse transcription-polymerase chain reaction (RT-PCR) respectively. RT-PCR was used to detect the mRNA expression of aggrecan, type II collagen and type I collagen. RESULTS: The endplate chondrocytes expressed aggrecan, type II collagen and type I collagen. The phenotypes and biological characteristics were similar to those of articular chondrocytes. The morphological appearance of primary endplate chondrocytes in the control group were mostly polygons, nucleus with round or ellipse, sometimes nuclei, vacuoles in intra cytoplasm, expressing a high proliferating rate. The cells of the experiment group were fusiform and their proliferating rates decreased. Compared with the control group, the mRNA expression of aggrecan (0.695 ± 0.052 vs 0.950 ± 0.032, t = 7.263, P = 0.002) and type II collagen (0.726 ± 0.035, 0.907 ± 0.078, t = 3.681, P = 0.021) markedly decreased. And the mRNA expression of type I collagen (0.795 ± 0.028 vs 0.552 ± 0.070, t = -5.560, P = 0.005) increased in the experiment group. CONCLUSION: A degenerative cell model of human cervical endplate chondrocytes has been established successfully in vitro. It may offer the cytological rationales for exploring the mechanism of intervertebral disc degeneration. And the previous restrictions of studying only the model of animal cells shall be resolved.

Topography of the lumbar sympathetic trunk in normal lumbar spines and spines with spondylophytes.

BACKGROUND: Degenerative processes of the lumbar spine may change the position of the sympathetic trunk which might cause failure of sympathetic blocks owing to inadequate distribution of local anaesthetic. METHODS: The retroperitoneal spaces of 56 cadavers [24 males and 32 females; 79 (10) yr] embalmed with Thiel's method were investigated by dissection. The course of the lumbar sympathetic trunk (LST) was documented from the diaphragmatic level to the linea terminalis. Topography of the large vessels and the psoas muscle was documented. In the case of spondylophytes, the location or direction of displacement of the trunk was regarded with special interest. RESULTS: The LST entered the retroperitoneal space at the level of the vertebral body of L2 in 70 of the 112 sides and showed the most consistent relationship with the medial margin of the psoas muscle at intervertebral disc level L2/3. On 11 spines with spondylophytes, the sympathetic trunk was dislocated to the most ventrolateral point of the spondylophyte in 12 cases, in six cases dorsolaterally, and in one case ventromedially. The more the sympathetic chain departed at the vertebral body level, the more the body developed a concavity by loss of height. CONCLUSIONS: Spondylophytes influenced the location of the LST and the distribution of the local anaesthetic. The local anaesthetic should wash around the spondylophyte to reach all possible locations of the chain. The medial margin of the psoas muscle was confirmed to be a consistent reference point at intervertebral disc level L2/3.