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1.
Bone Joint J ; 103-B(4): 725-733, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33789478

RESUMO

AIMS: The aim of this study was to determine the differences in spinal imaging characteristics between subjects with or without lumbar developmental spinal stenosis (DSS) in a population-based cohort. METHODS: This was a radiological analysis of 2,387 participants who underwent L1-S1 MRI. Means and ranges were calculated for age, sex, BMI, and MRI measurements. Anteroposterior (AP) vertebral canal diameters were used to differentiate those with DSS from controls. Other imaging parameters included vertebral body dimensions, spinal canal dimensions, disc degeneration scores, and facet joint orientation. Mann-Whitney U and chi-squared tests were conducted to search for measurement differences between those with DSS and controls. In order to identify possible associations between DSS and MRI parameters, those who were statistically significant in the univariate binary logistic regression were included in a multivariate stepwise logistic regression after adjusting for demographics. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported where appropriate. RESULTS: Axial AP vertebral canal diameter (p < 0.001), interpedicular distance (p < 0.001), AP dural sac diameter (p < 0.001), lamina angle (p < 0.001), and sagittal mid-vertebral body height (p < 0.001) were significantly different between those identified as having DSS and controls. Narrower interpedicular distance (OR 0.745 (95% CI 0.618 to 0.900); p = 0.002) and AP dural sac diameter (OR 0.506 (95% CI 0.400 to 0.641); p < 0.001) were associated with DSS. Lamina angle (OR 1.127 (95% CI 1.045 to 1.214); p = 0.002) and right facet joint angulation (OR 0.022 (95% CI 0.002 to 0.247); p = 0.002) were also associated with DSS. No association was observed between disc parameters and DSS. CONCLUSION: From this large-scale cohort, the canal size is found to be independent of body stature. Other than spinal canal dimensions, abnormal orientations of lamina angle and facet joint angulation may also be a result of developmental variations, leading to increased likelihood of DSS. Other skeletal parameters are spared. There was no relationship between DSS and soft tissue changes of the spinal column, which suggests that DSS is a unique result of bony maldevelopment. These findings require validation in other ethnicities and populations. Level of Evidence: I (diagnostic study) Cite this article: Bone Joint J 2021;103-B(4):725-733.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Canal Vertebral/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
Artigo em Inglês | MEDLINE | ID: mdl-33806268

RESUMO

The relationship between reduced disc height and disc bulging and/or protrusion has been controversial. The purposes of this study were to examine the relationship between disc morphology and disc bulging and protrusion and to establish a model for predicting disc bulging and protrusion. This is a retrospective study. A total of 452 MRI scans from a spine study were analysed, 210 (46.5%) were men. Logistic regression analysis was applied to identify the association between anthropometric factors, disc morphology factors, and outcome. Model 1 was constructed using anthropometric variables to investigate the capacity for predicting outcomes. Model 2 was constructed using anthropometric and disc morphology variables. Age, body weight, body height, disc height, and disc depth were significantly associated with outcome. The area under the curve (AUC) statistics of Model 2 were significantly better than those of Model 1 at the L3-L4 and L4-L5 levels but not at the L5-S1 level. The results showed an association between disc morphology and disc bulging and/or protrusion at the L3-L4, L4-L5, and L5-S1 levels. The model utilizing both anthropometric factors and disc morphology factors had a better capacity to predict disc bulging and/or protrusion compared with the model using only anthropometric factors.


Assuntos
Degeneração do Disco Intervertebral , Vértebras Lombares , Antropometria , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos
3.
BMC Surg ; 21(1): 161, 2021 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-33757478

RESUMO

BACKGROUND: Pre-existing degeneration of adjacent segment is an important risk factor for adjacent-segment degeneration (ASD), but only limited and controversial studies have addressed its management. METHODS: We retrospectively analyzed patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment. Of these patients, those who underwent interbody fusion of the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion of the adjacent L4/5 segment were included in Group A (n = 103), while those who underwent interbody fusion of both the L5/S1 and L4/5 segments were included in Group B (n = 81). Clinical and radiographic outcomes were evaluated. RESULTS: Mean follow-up time was 58.5 months (range, 48-75 months). We found no significant difference in clinical outcomes or incidence of ASD in the L3/4 segment between Groups A and B. Compared with Group B, Group A experienced less bleeding (315 ± 84 ml vs. 532 ± 105 ml), shorter operation time (107 ± 34 min vs. 158 ± 55 min) and lower costs (US $13,830 ± $2640 vs. US $16,020 ± $3380; P < 0.05). In Group A, the disc height ratio (DHR) of the L4/5 segment was significantly increased from a preoperative value of 0.40 ± 0.13 to a last-follow-up value of 0.53 ± 0.18 (P < 0.05), while the degree of canal stenosis (DCS) was decreased from a preoperative value of 34.3 ± 11.2% to a last-follow-up value of 15.9 ± 9.3 % (P < 0.05). CONCLUSIONS: This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in the lumbar spine.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Fusão Vertebral , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
4.
Br J Radiol ; 94(1121): 20201438, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33684306

RESUMO

OBJECTIVES: To compare the grading of lumbar degenerative disc disease (DDD), Modic end-plate changes (MEPC) and identification of high intensity zones (HIZ) on a combination of sagittal T1weighted turbo spin echo (T1W TSE), T2weighted fast spin echo (T2W FSE) and short tau inversion recovery (STIR) sequences (routine protocol) with a single sagittal T2W FSE Dixon MRI sequence which provides in-phase, opposed-phase, water only and fat only images in a single acquisition (Dixon protocol). METHODS: 50 patients underwent lumbar spine MRI using the routine protocol with the addition of a T2W FSE Dixon sequence. DDD grade, MEPC and HIZ for each disc level were assessed on the routine and Dixon protocols. Each protocol was reviewed independently by three readers (consultant musculoskeletal radiologists with 26-, 8- and 4 years' experience), allowing assessment of inter-reader agreement and inter protocol agreement for each assessed variable. RESULTS: The study included 17 males and 33 females (mean age 51 years; range 8-82 years). Inter-reader agreement for DDD grade on the routine protocol was 0.57 and for the Dixon protocol was 0.63 (p = 0.08). Inter-reader agreement for MEPC on the routine protocol was 0.45 and for the Dixon protocol was 0.53 (p = 0.02), and inter-reader agreement for identification of the HIZ on the routine protocol was 0.52 and for the Dixon protocol was 0.46 (p = 0.27). Intersequence agreement for DDD grade ranged from 0.61 to 0.97, for MEPC 0.46-0.62 and for HIZ 0.39-0.5. CONCLUSION: A single sagittal T2W FSE Dixon MRI sequence could potentially replace the routine three sagittal sequence protocol for assessment of lumbar DDD, MEPC and HIZ resulting in ~60% time saving. ADVANCES IN KNOWLEDGE: Grading of lumbar DDD, presence of Modic changes and high intensity zones were compared on sagittal T1W TSE, T2W FSE and STIR sequences with a T2W FSE Dixon sequence, with fair-to-good correlation suggesting that three conventional sequences could be replaced by a single Dixon sequence.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Dor Lombar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Adulto Jovem
5.
Artigo em Russo | MEDLINE | ID: mdl-33560617

RESUMO

Smoking is an obvious risk factor of adverse events in early and long-term postoperative period after spine surgery including lumbar total disk arthroplasty. Objective. To study the effect of smoking on clinical and radiological outcomes after lumbar total disk arthroplasty. MATERIAL AND METHODS: A single-center retrospective observational cohort study was performed. We have analyzed medical records of patients who underwent single-level lumbar total disk arthroplasty for degenerative disease. RESULTS: The study included 57 medical records of respondents. The examined medical records were divided into two groups - smokers (n=26) and non-smokers (n=31). There were no significant between-group differences in clinical outcomes. Incidence of adverse events was similar too. Kaplan-Meier event-free survival was similar in both groups. There were no significant between-group differences in X-ray data. Development of heterotopic ossification after lumbar total disk arthroplasty was more active in smokers. CONCLUSION: Smoking has no significant effect on clinical and radiological outcomes in patients after single-level after lumbar total disk arthroplasty. On the other hand, smoking significantly increases formation of heterotopic ossification after lumbar total disk arthroplasty.


Assuntos
Degeneração do Disco Intervertebral , Ossificação Heterotópica , Substituição Total de Disco , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/etiologia , Degeneração do Disco Intervertebral/cirurgia , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/epidemiologia , Ossificação Heterotópica/etiologia , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Resultado do Tratamento
6.
Mol Med Rep ; 23(4)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33537810

RESUMO

Lower back pain (LBP) is one of the most common reasons for seeking medical advice in orthopedic clinics. Increasingly, research has shown that symptomatic intervertebral disc degeneration (IDD) is mostly related to LBP. This review first outlines the research and findings of studies into IDD, from the physiological structure of the intervertebral disc (IVD) to various pathological cascades. The vicious cycles of IDD are re­described in relation to the analysis of the relationship among the pathological mechanisms involved in IDD. Interestingly, a 'chief molecule' was found, hypoxia­inducible factor­1α (HIF­1α), that may regulate all other mechanisms involved in IDD. When the vicious cycle is established, the low oxygen tension activates the expression of HIF­1α, which subsequently enters into the hypoxia­induced HIF pathways. The HIF pathways are dichotomized as friend and foe pathways according to the oxygen tension of the IVD microenvironment. Combined with clinical outcomes and previous research, the trend of IDD development has been predicted in this paper. Lastly, an early precautionary diagnosis and treatment method is proposed whereby nucleus pulposus tissue for biopsy can be obtained through IVD puncture guided by B­ultrasound when the patient is showing symptoms but MRI imaging shows negative results. The assessment criteria for biopsy and the feasibility, superiority and challenges of this approach have been discussed. Overall, it is clear that HIF­1α is an indispensable reference indicator for the accurate diagnosis and treatment of IDD.


Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Degeneração do Disco Intervertebral/metabolismo , Dor Lombar/metabolismo , Animais , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/patologia , Dor Lombar/diagnóstico por imagem , Dor Lombar/patologia
8.
BMC Musculoskelet Disord ; 22(1): 92, 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468108

RESUMO

BACKGROUND: The purpose of the study is to investigate the correlation between upper lumbar disc herniation (ULDH) and multifidus muscle degeneration via the comparison of width, the cross-sectional area and degree of fatty infiltration of the lumbar multifidus muscle. METHODS: Using the axial T2-weighted images of magnetic resonance imaging as an assessment tool, we retrospectively investigated 132 patients with ULDH and 132 healthy individuals. The total muscle cross-sectional area (TMCSA) and the pure muscle cross-sectional area (PMCSA) of the multifidus muscle at the L1/2, L2/3, and L3/4 intervertebral disc levels were measured respectively, and in the meantime, the average multifidus muscle width (AMMW) and degree of fatty infiltration of bilateral multifidus muscle were evaluated. The resulting data were analyzed to determine the presence/absence of statistical significance between the study and control groups. Multivariate logistical regression analyses were used to evaluate the correlation between ULDH and multifidus degeneration. RESULTS: The results of the analysis of the two groups showed that there were statistically significant differences (p < 0.05) between TMCSA, PMCSA, AMMW and degree of fatty infiltration. The multivariate logistic regression analysis indicated that the TMCSA, PMCSA, AMMW and the degree of fatty infiltration of multifidus muscle were correlated with ULDH, and the differences were statistically significant (P < 0.05). CONCLUSIONS: A correlation could exist between multifidus muscles degeneration and ULDH, that may be a process of mutual influence and interaction. Lumbar muscle strengthening training could prevent and improve muscle atrophy and degeneration.


Assuntos
Degeneração do Disco Intervertebral , Músculos Paraespinais , Adolescente , Adulto , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/patologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Masculino , Músculos , Atrofia Muscular/diagnóstico por imagem , Atrofia Muscular/etiologia , Atrofia Muscular/patologia , Músculos Paraespinais/diagnóstico por imagem , Músculos Paraespinais/patologia , Estudos Retrospectivos , Adulto Jovem
9.
Neurosurgery ; 88(3): 497-505, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33372218

RESUMO

BACKGROUND: Short- and mid-term studies have shown the effectiveness of cervical disc arthroplasty (CDA) to treat cervical disc degeneration. OBJECTIVE: To report the 10-yr outcomes of a multicenter experience with cervical arthroplasty for 1- and 2-level pathology. METHODS: This was a prospective study of patients treated with CDA at 1 or 2 contiguous levels using the Mobi-C® Cervical Disc (Zimmer Biomet). Following completion of the 7-yr Food and Drug Administration postapproval study, follow-up continued to 10 yr for consenting patients at 9 high-enrolling centers. Clinical and radiographic endpoints were collected out to 10 yr. RESULTS: At 10 yr, patients continued to have significant improvement over baseline Neck Disability Index (NDI), neck and arm pain, neurologic function, and segmental range of motion (ROM). NDI and pain outcomes at 10 yr were significantly improved from 7 yr. Segmental and global ROM and sagittal alignment also were maintained from 7 to 10 yr. Clinically relevant adjacent segment pathology was not significantly different between 7 and 10 yr. The incidence of motion restricting heterotopic ossification at 10 yr was not significantly different from 7 yr for 1-level (30.7% vs 29.6%) or 2-level (41.7% vs 39.2%) patients. Only 2 subsequent surgeries were reported after 7 yr. CONCLUSION: Our results through 10 yr were comparable to 7-yr outcomes, demonstrating that CDA with Mobi-C continues to be a safe and effective surgical treatment for patients with 1- or 2-level cervical degenerative disc disease.


Assuntos
Artroplastia/tendências , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Adulto , Artroplastia/métodos , Feminino , Seguimentos , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico por imagem , Cervicalgia/cirurgia , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Fatores de Tempo , Substituição Total de Disco/métodos , Substituição Total de Disco/tendências , Resultado do Tratamento
10.
Niger J Clin Pract ; 23(12): 1748-1752, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33355830

RESUMO

Aims: The study aimed to define the association between spinal degeneration parameters and the rise in smartphone usage time. This was a cross-sectional study. Subjects and Methods: Young adults aged 20-35 years, who presented to our outpatient clinic due to neck pain between 2016 and 2018, were examined. Cervical disc degeneration, disc placement, Modic changes, and sagittal balance were retrospectively measured using magnetic resonance imaging (MRI) in 107 relatively patients. Data about daily phone usage times of the participants were obtained by a questionnaire filled in at the time of admission. Results: The total number of disc distances analyzed was 535 (Group 1; n = 200, Group 2; 335). In Group 1, the disc displacement was present in 30%, and in Group 2, the disc displacement was present in 35%. In terms of DD severity, the total DD score was >10 in 18 (18/40; 45%) patients in Group 1, and in 39 patients (39/67; 58%) in Group 2. The mean Cobb angle of Group 1 was 10.3° ± 6.57° (range, 2° to 34°), and that of Group 2 was 7.6° ± 5.14° (range, 1° to 26°) (Pcobb = 0.048). Modic changes were detected in 17 of the 107 patients (15.8%). Of the 17 patients, 3 (3/40, %7.5) were Group 1 and 14 (14/67, %20.9) were Group 2. MC was detected in 4 vertebrae in Group 1, and 24 vertebrae in Group 2 (P = 0.001). Conclusions: The analysis of cervical spine MRI data of young adult patients with neck pain shows that the smartphone usage time is effective in cervical sagittal balance disruption, disc degeneration, and development of Modic changes.


Assuntos
Degeneração do Disco Intervertebral , Smartphone , Adulto , Vértebras Cervicais/diagnóstico por imagem , Estudos Transversais , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/epidemiologia , Imagem por Ressonância Magnética , Estudos Retrospectivos , Adulto Jovem
11.
Bone Joint J ; 102-B(11): 1505-1510, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135446

RESUMO

AIMS: The complex relationship between acetabular component position and spinopelvic mobility in patients following total hip arthroplasty (THA) renders it difficult to optimize acetabular component positioning. Mobility of the normal lumbar spine during postural changes results in alterations in pelvic tilt (PT) to maintain the sagittal balance in each posture and, as a consequence, markedly changes the functional component anteversion (FCA). This study aimed to investigate the in vivo association of lumbar degenerative disc disease (DDD) with the PT angle and with FCA during postural changes in THA patients. METHODS: A total of 50 patients with unilateral THA underwent CT imaging for radiological evaluation of presence and severity of lumbar DDD. In all, 18 patients with lumbar DDD were compared to 32 patients without lumbar DDD. In vivo PT and FCA, and the magnitudes of changes (ΔPT; ΔFCA) during supine, standing, swing-phase, and stance-phase positions were measured using a validated dual fluoroscopic imaging system. RESULTS: PT, FCA, ΔPT, and ΔFCA were significantly correlated with the severity of lumbar DDD. Patients with severe lumbar DDD showed marked differences in PT with changes in posture; there was an anterior tilt (-16.6° vs -12.3°, p = 0.047) in the supine position, but a posterior tilt in an upright posture (1.0° vs -3.6°, p = 0.005). A significant decrease in ΔFCA during stand-to-swing (8.6° vs 12.8°, p = 0.038) and stand-to-stance (7.3° vs 10.6°,p = 0.042) was observed in the severe lumbar DDD group. CONCLUSION: There were marked differences in the relationship between PT and posture in patients with severe lumbar DDD compared with healthy controls. Clinical decision-making should consider the relationship between PT and FCA in order to reduce the risk of impingement at large ranges of motion in THA patients with lumbar DDD. Cite this article: Bone Joint J 2020;102-B(11):1505-1510.


Assuntos
Artroplastia de Quadril , Articulação do Quadril/diagnóstico por imagem , Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Postura/fisiologia , Feminino , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Degeneração do Disco Intervertebral/fisiopatologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X
12.
Bone Joint J ; 102-B(8): 981-996, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731832

RESUMO

AIMS: Whether to perform hybrid surgery (HS) in contrast to anterior cervical discectomy and fusion (ACDF) when treating patients with multilevel cervical disc degeneration remains a controversial subject. To resolve this we have undertaken a meta-analysis comparing the outcomes from HS with ACDF in this condition. METHODS: Seven databases were searched for studies of HS and ACDF from inception of the study to 1 September 2019. Both random-effects and fixed-effects models were used to evaluate the overall effect of the C2-C7 range of motion (ROM), ROM of superior/inferior adjacent levels, adjacent segment degeneration (ASD), heterotopic ossification (HO), complications, neck disability index (NDI) score, visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Odom's criteria, blood loss, and operating and hospitalization time. To obtain more credible results contour-enhanced funnel plots, Egger's and Begg's tests, meta-regression, and sensitivity analyses were performed. RESULTS: In total, 17 studies involving 861 patients were included in the analysis. HS was found to be superior to ACDF in maintaining C2-C7 ROM and ROM of superior/inferior adjacent levels, but HS did not reduce the incidence of associated level ASD. Also, HS did not cause a higher rate of HO than ACDF. The frequency of complications was similar between the two techniques. HS failed to achieve more favourable outcomes than ACDF using the NDI, VAS, JOA, and Odom's scores. HS did not show any more advantages in operating or hospitalization time but did show reduction in blood loss. CONCLUSION: Although HS maintained cervical kinetics, it failed to reduce the incidence of ASD. This finding differs from previous reports. Moreover, patients did not show more benefits from HS with respect to symptom improvement, prevention of complications, and clinical outcomes. Cite this article: Bone Joint J 2020;102-B(8):981-996.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Degeneração do Disco Intervertebral/cirurgia , Amplitude de Movimento Articular/fisiologia , Fusão Vertebral/métodos , Substituição Total de Disco/métodos , Adulto , Idoso , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Japão , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Cervicalgia/cirurgia , Medição da Dor , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Resultado do Tratamento
13.
J Vet Sci ; 21(4): e52, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32735091

RESUMO

BACKGROUND: Intradural-intramedullary intervertebral disc extrusion (IIVDE) is a rare condition of intervertebral disc disease. However, the diagnosis of IIVDE is challenging because the prognosis and imaging characteristics are poorly characterized. OBJECTIVES: We aimed to describe the clinical and imaging characteristics of tentatively diagnosed IIVDE in dogs to assess the prognostic utility of neurological grade and magnetic resonance imaging (MRI) findings. METHODS: Twenty dogs were included in this retrospective cohort study. RESULTS: Nonchondrodystrophic breeds (n = 16) were more predisposed than chondrodystrophic breeds. Most dogs showed acute onset of clinical signs. Neurological examination at admission showed predominant non-ambulatory paraparesis (n = 9); paresis (n = 16) was confirmed more frequently than paralysis (n = 4). Follow-up neurological examination results were only available for 11 dogs, ten of whom showed neurological improvement and 8 showed successful outcomes at 1 month. The characteristic MRI findings include thoracic vertebra (T)2 hyperintense, T1 hypointense, intramedullary linear tracts with reduced disc volume, and cleft of the annulus fibrosus. None of the MRI measurements were significantly correlated with neurological grade at admission. Neurological grade did not differ according to the presence of parenchymal hemorrhage, parenchymal contrast enhancement, and meningeal contrast enhancement. Neurological grades at admission showed a statistical correlation with those observed at the 1-month follow-up (r = 0.814, p = 0.02). CONCLUSIONS: IIVDE is a rare form of disc extrusion commonly experienced after physical activity or trauma and most frequently affects the cranial-cervical and thoracolumbar regions of nonchondrodystrophic dog breeds. Neurological score at admission emerged as a more useful prognostic indicator than MRI findings in dogs with suspected IIVDE.


Assuntos
Doenças do Cão/diagnóstico , Degeneração do Disco Intervertebral/veterinária , Deslocamento do Disco Intervertebral/veterinária , Vértebras Torácicas/patologia , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Imagem por Ressonância Magnética/veterinária , Masculino , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem
14.
Spine (Phila Pa 1976) ; 45(15): 1024-1029, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675601

RESUMO

STUDY DESIGN: Retrospective analysis using data from RCTs. OBJECTIVE: This study aimed to report on the incidence of radiological adjacent segment degeneration (ASD) in patients with cervical radiculopathy due to a herniated disc that were randomized to receive cervical arthroplasty or arthrodesis. SUMMARY OF BACKGROUND DATA: Cervical disc prostheses were introduced to prevent ASD in the postsurgical follow-up. However, it is still a controversial issue. METHODS: Two hundred fifty-three patients were included in two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF), or without intervertebral cage (ACD) for one-level disc herniation. Neutral lateral radiographs were obtained preoperatively, at 1- and 2-year follow-up after surgery. Radiological ASD was evaluated on X-ray and defined by a decrease in disc height and the presence of anterior osteophyte formation on both the superior and the inferior level in relation to the target level. RESULTS: Radiological ASD was present in 34% of patients at baseline and increased to 59% at 2-year follow-up in the arthrodesis groups (ACD and ACDF combined), and to 56% in the arthroplasty group. Progression of radiological ASD was present in 29% of patients in the arthrodesis group and in 31% of patients in the arthroplasty group for 2-year follow-up. CONCLUSIONS: Radiological ASD occurs in a similar manner in patients who were subjected to arthrodesis in cervical radiculopathy and in patients who received arthroplasty to maintain motion. Current data tend to indicate that the advantage of cervical prosthesis in preventing radiological ASD is absent. LEVEL OF EVIDENCE: 2.


Assuntos
Artroplastia/tendências , Vértebras Cervicais/cirurgia , Discotomia/tendências , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral/cirurgia , Implantação de Prótese/tendências , Adulto , Artroplastia/efeitos adversos , Vértebras Cervicais/diagnóstico por imagem , Discotomia/efeitos adversos , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/prevenção & controle , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos
15.
Spine (Phila Pa 1976) ; 45(15): E917-E926, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675603

RESUMO

STUDY DESIGN: A retrospective study with prospectively-collected data. OBJECTIVE: To determine how type, location, and size of endplate lesions on magnetic resonance imaging (MRI) may be associated with symptoms and clinical outcomes after anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: Structural endplate abnormalities are important, yet understudied, phenomena in the cervical spine. ACDF is a common surgical treatment for degenerative disc disease; however, adjacent segment degeneration/disease (ASD) may develop. METHODS: Assessed the imaging, symptoms and clinical outcomes of 861 patients who underwent ACDF at a single center. MRI and plain radiographs of the cervical spine were evaluated. Endplate abnormalities on MRI were identified and stratified by type (atypical, typical), location, relation to operative levels, presence at the adjacent level, and size. These strata were assessed for association with presenting symptoms, patient-reported, and postoperative outcomes. RESULTS: Of 861 patients (mean follow-up: 17.4 months), 57.3% had evidence of endplate abnormalities, 39.0% had typical abnormalities, while 18.2% had atypical abnormalities. Patients with any endplate abnormality had greater odds of myelopathy irrespective of location or size, while sensory deficits were associated with atypical lesions (P = 0.016). Typical and atypical abnormalities demonstrated differences in patient-reported outcomes based on location relative to the fused segment. Typical variants were not associated with adverse surgical outcomes, while atypical lesions were associated with ASD (irrespective of size/location; P = 0.004) and reoperations, when a large abnormality was present at the proximal adjacent level (P = 0.025). CONCLUSION: This is the first study to examine endplate abnormalities on MRI of the cervical spine, demonstrating distinct risk profiles for symptoms, patient-reported, and surgical outcomes after ACDF. Patients with typical lesions reported worsening postoperative pain/disability, while those with atypical abnormalities experienced greater rates of ASD and reoperation. This highlights the relevance of a degenerative spine phenotypic assessment, and suggests endplate abnormalities may prognosticate clinical outcomes after surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/anormalidades , Vértebras Cervicais/diagnóstico por imagem , Pessoas com Deficiência , Discotomia/efeitos adversos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Dor Pós-Operatória/diagnóstico por imagem , Fusão Vertebral/efeitos adversos , Adulto , Vértebras Cervicais/cirurgia , Discotomia/tendências , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/etiologia , Degeneração do Disco Intervertebral/cirurgia , Imagem por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/cirurgia , Estudos Prospectivos , Reoperação/tendências , Estudos Retrospectivos , Fusão Vertebral/tendências
16.
Pain Physician ; 23(4): 393-404, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709174

RESUMO

BACKGROUND: Posterolateral endoscopic lumbar discectomy (PLELD) or percutaneous endoscopic lumbar discectomy has been reported to be effective as treatment for herniated lumbar disc in degenerative spondylolisthesis. Few studies have investigated the outcomes of open lumbar microdiscectomy (OLM) and PLELD for antero- and retrospondylolisthesis with mild slippage and instability. OBJECTIVES: We aimed to evaluate the outcomes of OLM and PLELD for antero- and retrospondylolisthesis with mild slippage and instability. STUDY DESIGN: This study used a retrospective design. SETTING: Research was conducted in a hospital and outpatient surgical center. METHODS: This study enrolled 84 patients aged 20 to 60 years with low-grade degenerative spondylolisthesis who underwent OLM or PLELD for antero- or retrospondylolisthesis at our hospital between March 2007 and August 2014 and who were followed up for at least 3 years. Telephone survey and chart review, with a particular focus on pre- and postoperative radiographic parameters, were conducted. Additionally, patients were invited to undergo reexamination to update their clinical and radiological data. RESULTS: Telephone surveys and clinical/imaging evaluation were conducted on the OLM and PLELD groups at a mean of 71.44 and 74.69 months, respectively. Out of 43 patients who underwent OLM, 34 responded to the telephone survey, 17 of whom then underwent reexamination. Among 41 patients who underwent PLELD, 32 responded to the telephone survey, 19 of whom then underwent reexamination. Based on telephone surveys and patient charts, reoperation at the same vertebral level was confirmed in 8 patients (23.5%) who underwent OLM and one patient (4.4%) who underwent PLELD, with a significantly higher rate of reoperation in the OLM group (P = .028). Vertebral disc height decreased more after OLM than after PLELD. Compared to PLELD, OLM was associated with significantly worse rates of iatrogenic endplate damage, endplate defect scores, and alterations in subchondral bone signal intensity. However, the final clinical outcomes did not differ between OLM and PLELD. LIMITATIONS: The limitations of this study include its relatively small sample size and the possibility of bias owing to nonrandomized patient selection. CONCLUSIONS: In patients with spondylolisthesis who have a herniated lumbar disc as mild slippage with instability, PLELD may be a good treatment option to reduce recurrence rates and mitigate disc degeneration. IRB approval number: 2016-12-WSH-011. KEY WORDS: Anterospondylolisthesis, disc degeneration, endplate, herniated lumbar disc, open lumbar discectomy, percutaneous endoscopic lumbar discectomy, posterolateral endoscopic lumbar discectomy, retrospondylolisthesis, slippage.


Assuntos
Discotomia Percutânea/métodos , Discotomia/métodos , Vértebras Lombares/cirurgia , Microcirurgia/métodos , Espondilolistese/cirurgia , Adulto , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espondilolistese/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
17.
Adv Clin Exp Med ; 29(6): 639-647, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32589824

RESUMO

BACKGROUND: Intervertebral disc degeneration (IDD) is characterized by increased proteolytic degradation of the extracellular matrix (ECM), leading to a loss of collagen II and proteoglycan in the nucleus pulposus (NP). Although MMP3 has been reported to play a central role in disc degeneration, it is still unknown whether gene therapy targeting MMP3 can inhibit IDD. OBJECTIVES: To investigate whether lentivirus-mediated MMP3 knockdown is capable of attenuating IDD. More importantly, we also explored whether combined gene therapy that simultaneously antagonizes MMP3 and overexpresses Sox9 can synergistically inhibit IDD and induce augmented matrix reconstitution in the degenerative NP. MATERIAL AND METHODS: We performed direct injection of lentiviral vectors LV-MMP3-shRNA and/or LV-Sox9 into rabbit lumbar discs. The animals were scanned using magnetic resonance imaging (MRI) at 8, 12 and 24 weeks after the operation. We also evaluated the gene expression and synthesis of NP matrix components, including collagen II, aggrecan and proteoglycan. RESULTS: The MRI scans showed remarkable needle-puncture-induced progressive IDD in animals injected with PBS or 10^7 viral particles (VP) of the control virus. In contrast, injection of 10^7 VP of LV-MMP3-shRNA or LV-Sox9 substantially inhibited IDD. MMP3 knockdown or Sox9 overexpression stimulated collagen II and aggrecan expression, as well as proteoglycan synthesis. Notably, the injection of a cocktail of LV-MMP3-shRNA and LV-Sox9 (5 × 10^6 VP each) greatly delayed the development of IDD and induced the highest levels of collagen II and proteoglycan production, indicating a synergistic effect in ECM induction. CONCLUSIONS: Our results suggest that gene therapy targeting MMP3 is an efficient way to delay IDD. Combined gene therapy possesses a stronger capacity to induce matrix components in degenerative NP tissue than single-gene delivery.


Assuntos
Degeneração do Disco Intervertebral , Disco Intervertebral , Metaloproteinase 3 da Matriz , Núcleo Pulposo , RNA Interferente Pequeno , Animais , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/prevenção & controle , Lentivirus/genética , Metaloproteinase 3 da Matriz/genética , Coelhos , Fatores de Transcrição SOX9
18.
Zhongguo Gu Shang ; 33(5): 449-53, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32452184

RESUMO

OBJECTIVE: To compare the degeneration of lumbosacral multifidus muscle in patients with lumbar disc herniation. METHODS: Thirty-five healthy volunteers and 35 patients with unilateral L4,5 lumbar disc herniation from December 2015 to September 2017 were recruited. There were 20 males and 15 females in each group, aged from 25 to 55 years old. In healthy volunteers group, the mean age was (35.66±8.73) years old and the BMI was (21.85±1.94) kg /m2. In patients with lumbar disc herniation, the mean age was (36.09±7.70) years old, the BMI was (21.50±1.78) kg /m2, the VAS score was 4.40±0.88, the course of disease was (11.20±7.14) months. Surface electromyography analysis was performed on the multifidus muscle of the two groups. The average myoelectric amplitude of the multifidus muscle in the two groups were compared. RESULTS: The average myoelectric amplitude of the multifidus muscle of healthy volunteers was (48.84±7.77) µV on the left and (49.13±7.86) µV on the right. There was no significant difference between the two sides (P>0.05). The average myoelectric amplitude of multifidus muscle in patients with lumbar disc herniation was(48.82±8.14) µV on the healthy side and (42.81±7.00) µV on the affected side, and the difference was statistically significant between two sides(P<0.05). There was no significant difference in the average myoelectric amplitude of multifidus muscle between the healthy side of lumbar disc herniation and on the left of healthy volunteers, or between the healthy side of lumbar disc herniation and on the right of healthy volunteers (P>0.05). There was significant difference in the average myoelectric amplitude of multifidus muscle between the affected side of lumbar disc herniation and on the left of healthy volunteers, and also between the affected side of lumbar disc herniation and on the right of healthy volunteers(P<0.05). CONCLUSION: Patients with chronic lumbar disc herniation have an imbalance in myoelectric activity, and the muscle strength of the multifidus muscle on the affected side is significantly reduced.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Músculos Paraespinais , Adulto , Eletromiografia , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares , Masculino , Pessoa de Meia-Idade
20.
Spine Deform ; 8(5): 845-851, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32449035

RESUMO

STUDY DESIGN: Ex vivo porcine imaging study. OBJECTIVES: Quantitatively evaluate change in MRI signal at the discs caudal to spinal fusion instrumentation. Individuals who receive posterior spinal instrumentation are at risk of developing accelerated disc degeneration at adjacent levels. Degeneration is associated with a loss of biochemical composition and mechanical integrity of the disc, which can be noninvasively assessed through quantitative T2* (qT2*) MRI techniques. However, qT2* is sensitive to magnetic susceptibility introduced by metal. METHODS: Nine ex vivo porcine lumbar specimens were imaged with 3 T MRI. Fast spin-echo T2-weighted (T2w) images and gradient-echo qT2* maps were acquired, both without and with posterior spinal fusion instrumentation. Average T2* relaxation times of the nuclei pulposi (NP) were measured at the adjacent and sub-adjacent discs and measurements were compared using t tests before and after instrumentation. The size of the signal void and metal artifact were determined (modified ASTM F2119-07) within the vertebral body and spinal cord for both MRI sequences. The relationship between T2* signal loss and distance from the instrumentation was evaluated using Pearson's correlation. RESULTS: There was no significant difference between adjacent and sub-adjacent NP T2* relaxation time prior to instrumentation (p = 0.86). Following instrumentation, there was a significant decrease in the T2* relaxation time at the adjacent NP (average = 20%, p = 0.02), and no significant difference at the sub-adjacent NP (average = - 3%, p = 0.30). Furthermore, there was a significant negative correlation between signal loss and distance to disc (r = - 0.61, p < 0.01). CONCLUSIONS: Spinal fusion instrumentation interferes with T2* relaxation time measurements at the adjacent disc but not at the sub-adjacent discs. However, there is sufficient signal at the adjacent disc to quantify changes in the T2* relaxation time following spinal fusion. Hence, baseline MRI scan following spinal fusion surgery are required to interpret and track changes in disc health at the caudal discs. LEVEL OF EVIDENCE: N/A.


Assuntos
Imagem de Difusão por Ressonância Magnética , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Animais , Artefatos , Degeneração do Disco Intervertebral/patologia , Complicações Pós-Operatórias/patologia , Fusão Vertebral/métodos , Suínos
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