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1.
PLoS One ; 15(2): e0227894, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32101549

RESUMO

OBJECTIVE: Based on the theoretical basis of Gabor wavelet transformation, the application effects of feature extraction algorithm in Magnetic Resonance Imaging (MRI) and the role of feature extraction algorithm in the diagnosis of lumbar vertebra degenerative diseases were explored. METHOD: The structure of lumbar vertebra and degenerative changes were respectively introduced to clarify the onset mechanism and pathological changes of lumbar vertebra degenerative changes. Most importantly, the theoretical basis of Gabor wavelet transformation and the extraction effect of feature information in lumbar vertebra MRI images were introduced. The differentiation effects of feature information extraction algorithm on annulus fibrosus and nucleus pulposus were analyzed. In this study, the data of lumbar spine MRI was randomly selected from the Wenzhou Lumbar Spine Research Database as research objects. A total of 130 discs were successfully fitted, and 109 images were graded by a doctor after observation, which was compared with the results of the artificial diagnosis. Through the comparison with the results of observation and diagnosis by professional doctors, the accuracy of feature extraction algorithm based on Gabor wavelet transformation in the diagnosis of lumbar vertebra degenerative changes was analyzed. RESULTS: 1. Compared with the results of the manual diagnosis, the accuracy of the classification method was 88.3%. In addition, the specificity (SPE), accuracy (ACC), and sensitivity (SEN) of the classification method were respectively 89.5%, 92.4%, and 87.6%. 2. The mutual information method and the KLT algorithm were utilized for vertebral body tracking. The maximum mutual information method was more effective in the case of fewer image sequences; however, with the increase of image frames, the accumulation of errors would make the tracking effects of images get worse. Based on the KLT algorithm, the enhanced vertebral boundary information was selected; the soft tissues showed in the obtained images were smooth, the boundary information of vertebral body was enhanced, and the results were more accurate. CONCLUSION: The feature extraction algorithm based on Gabor wavelet transformation could easily and quickly realize the localization of the lumbar intervertebral disc, and the accuracy of the results was ensured. In addition, from the aspect of vertebral body tracking, the tracking effects based on the KLT algorithm were better and faster than those based on the maximum mutual information method.


Assuntos
Algoritmos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/diagnóstico , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Análise de Ondaletas , Anel Fibroso/diagnóstico por imagem , Anel Fibroso/patologia , Humanos , Imagem por Ressonância Magnética , Núcleo Pulposo/diagnóstico por imagem , Núcleo Pulposo/patologia
2.
AJR Am J Roentgenol ; 214(4): 853-861, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32069076

RESUMO

OBJECTIVE. The purpose of this article is to review the appearance of various abnormalities that affect the lumbar intervertebral disk and diskovertebral segment through anatomic-pathologic correlation in cadavers. CONCLUSION. Familiarity with the pathologic conditions in and around the intervertebral disk is important in recognizing such conditions as a potential source of symptoms. We revisit the principal role of MRI in evaluating these abnormalities and excluding other sources of significant clinical manifestations.


Assuntos
Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Cadáver , Humanos , Dor Lombar/diagnóstico por imagem , Dor Lombar/patologia
3.
BMC Musculoskelet Disord ; 20(1): 438, 2019 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-31564252

RESUMO

BACKGROUND: The aim of this study was to find out whether the shear wave elastography (SWE) findings of patients with unilateral lumbar disc herniation (LDH) were related to clinical characteristics. METHODS: For this purpose, the study group included patients (N = 20; 13 male, 7 female) with complaints of unilateral sciatica, with foraminal stenosis caused by one level of LDH (L4-L5 or L5-S1). An gender-and age-matched control group (N = 27; 16 male, 11 female) was included. All the patients were examined on both the axial and longitudinal planes bilaterally at the same level using a convex array probe (1- 6 MHz, Supersonic Imagine, Aix en Provence, France). RESULTS: The sciatic nerve stiffness measured on longitudinal planes of the affected side was significantly higher than unaffected side (p < 0.001) and the control group (P < 0.05). Furthermore, the symptom duration of unilateral LDH is positively correlated with the stiffness the sciatic nerve (r = 0.52, p = 0.019). CONCLUSION: According to these findings, ultrasound imaging can be considered as a useful tool to detect changes in the sciatic nerve due to disc herniation. This technique will have a promising prospect for many patients with unilateral LDH in monitoring stiffness during rehabilitation and before or after surgery.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Ciática/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ciática/etiologia , Ciática/terapia , Resultado do Tratamento
4.
Radiologe ; 59(10): 925-938, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31549183

RESUMO

Starting with the smallest functional unit, the spinal segment including the centrally located intervertebral disc, the spine and pelvis including the sacroiliac and hip joints form a functional unit. The discs play an important role in the complex interaction between disc, osseous and ligamentous structures and the adjacent muscles. Disc pathologies are very frequently associated with changes of the adjacent endplates of the vertebral bodies and can be depicted at an early stage using magnetic resonance imaging (MRI). The focus of the diagnostics and assessment of degenerative disc pathologies should be centered on the clinical problem. The basis for this is the use of a uniform terminology between the disciplines involved.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Imagem por Ressonância Magnética , Humanos , Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares
5.
BMC Musculoskelet Disord ; 20(1): 414, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488112

RESUMO

BACKGROUND: Chronic low back pain (LBP) is common and associated with lumbar disc herniation. The purpose of this study was to investigate if the grade of lumbar disc degeneration correlates with the degree of lumbar multifidus muscle (LMM) fatty atrophy. METHODS: A retrospective analysis on 16 males and 19 females with chronic LBP and a mean age of 47.2 years. Using MRI, the grade of lumbar intervertebral discs degeneration was assessed according to the Pfirrmann classification at L4/L5 and L5/S1 levels. Fatty infiltration of the LMM was graded as normal, mild, moderate and severe. Adobe Photoshop CS6 was used for qualitative image analysis by measuring the Cross-sectional area (CSA) of the pure fat component of LMM. RESULTS: There was a low correlation (R = 0.37) and significant association (ANOVA, p = 0.001, 95% CI 2.07-8.14) between the grade of lumbar disc degeneration and the degree of LMM fatty atrophy. Mean value of intervertebral disc degeneration was 2.9 for the L4/L5 level and 3.2 for L5/S1 respectively. The percentage of fat infiltration of the LMM at both studied levels showed a mean value of 22.91+/- 13.19% for L4/L5 and a higher mean value of 26.37+/- 12.89% for L5/S1. There were higher fatty atrophy scores in women and more disc degeneration in men. CONCLUSION: The percentage of LMM atrophy is higher in the lower levels (L5/S1) and shows a low correlation with the grade of disc degeneration.


Assuntos
Dor Crônica/etiologia , Degeneração do Disco Intervertebral/complicações , Dor Lombar/etiologia , Atrofia Muscular/complicações , Músculos Paraespinais/patologia , Adulto , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/diagnóstico , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Atrofia Muscular/diagnóstico , Atrofia Muscular/patologia , Músculos Paraespinais/diagnóstico por imagem , Estudos Retrospectivos , Índice de Gravidade de Doença
6.
J Orthop Surg Res ; 14(1): 298, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488187

RESUMO

BACKGROUND: There are few studies to investigate changes in imaging parameters of Modic changes (MCs). The imaging studies examining the distinctions in the lumbar sagittal parameters between MCs and lumbar disc degeneration (LDD) are still lacking. The purpose of this study was to identify the differences in the lumbar sagittal parameters among patients for LDD with/without Modic type 2 change (MII). METHODS: A total of 208 patients with lumbar degenerative disease from January 2017 to August 2018 volunteered for this study. Sixty-two patients with MII were used as the MC group. The other 146 patients served as the disc degeneration (DD) group. The DD scores and sagittal parameters were measured on magnetic resonance imaging (MRI) and X-ray by using Surgimap software. RESULTS: The prevalence of MII for patients with degenerative lumbar diseases in this study was 29.81%, primarily located at L5/S1. There were significant differences in lumbar lordosis (LL) and sacral slope (SS) between these two groups (P < 0.05). Similarly, the significant decrease in intervertebral height index (IHI) was found at L3-S1 in the MC group, compared with the DD group (P < 0.05). However, a significant difference in intervertebral angle (IVA) was observed only at L5/S1 (P < 0.05). The MC group had the smaller endplate concave angle (ECA) than the DD group from L3 caudal endplate to S1 cranial endplate (P < 0.05). CONCLUSIONS: MII has a severe radiographic representation in the process of lumbar degeneration than patients without MII, and the overconcentration of load caused by the smaller LL, SS, and IVA may be a reasonable explanation to answer why MCs are more common at the L5/S1.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/tendências , Índice de Gravidade de Doença , Adulto , Feminino , Humanos , Degeneração do Disco Intervertebral/epidemiologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
BMC Musculoskelet Disord ; 20(1): 425, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521158

RESUMO

BACKGROUND: Gout in spine is rare and commonly mimics some infectious or tumoral lesions, the differentiation of spinal gout from other diseases is not always easy. We report a case of gout involved cervical disc and adjacent vertebral endplates whose etiology was initially not determined. Compared with the previous published 10 similar cases, this case displayed a complete and continuous image data with higher image quality and resolution than before. So we give a brief literature review for concerning cervical gout, with the emphasis on the discussion of radiological findings. CASE PRESENTATION: A 50-year-old male with a 5-year history of neck and shoulder pain had muscle atrophy and weakness in both arms. Physical examination revealed multiple tophi were seen in left wrist, both feet and knee; bilateral superficial sensory declined below level of mastoid portion and the muscle strengths of limbs decreased. Laboratory findings showed hyperuricemia and the C-reactive protein level was very high. Imaging studies including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) showed abnormality of the C5-6 intervertebral disc and irregular osteolytic destruction of both adjacent C5-6 endplates, narrowing of C5-6 disc space and swelling of prevertebral soft tissue. Under the circumstance of the lesions being not determined and nerve root symptoms, surgical treatment was performed and pathological examination of the specimen revealed deposited uric acid crystals surrounded by granulomatous inflammation. After surgery combined with pharmaceutical and rehabilitation treatment, the muscle strengths of limbs, the pain of neck and shoulder and the level of serum uric acid were all improved. CONCLUSIONS: Cervical spinal gout involving the disc and adjacent vertebral endplates is uncommon and may misunderstand infectious spondylodiscitis. Physician and radiologist should take the gouty spondylitis into account with a combination with previous history and clinical manifestations when encountering with such this condition.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Discite/diagnóstico , Gota/diagnóstico , Disco Intervertebral/diagnóstico por imagem , Cervicalgia/terapia , Proteína C-Reativa/análise , Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Colchicina/uso terapêutico , Erros de Diagnóstico , Gota/complicações , Gota/terapia , Humanos , Disco Intervertebral/patologia , Disco Intervertebral/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Prednisolona/uso terapêutico , Fusão Vertebral , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ácido Úrico/sangue
8.
World Neurosurg ; 132: 273-281, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521758

RESUMO

OBJECTIVE: Although many risk factors for cage retropulsion (CR) after lumbar interbody fusion (LIF) have been described in the literature, they still remain controversial. The purpose of this study is to investigate the risk factors for CR after LIF. METHODS: The literature was searched in PubMed, Cochrane library, and Embase from October 2000 to October 2018. The key words and combinations used in the search included LIF, cage, retropulsion, posterior migration, and risk factors. Only studies with sufficient data to calculate odds ratio for CR were included. Odds ratio and 95% confidence interval were calculated for outcomes via RevMan5.3 and SPSS 22.0. RESULTS: A total of 10 studies were included in this study. Twelve risk factors were assessed by analyzing 4467 patients. The pooled results indicated that a pear-shaped disk and straight cage were significant risk factors for CR. However, factors that had no significant relation with CR were preoperative diagnosis (disk herniation, spinal stenosis, and spondylolisthesis); gender; surgical segments (from L2 to S1); multilevel fusion; and unilateral pedicle screws fixation. CONCLUSIONS: According to current evidence, a pear-shaped disk and straight cage are significant risk factors for CR. However, preoperative diagnosis, gender, multilevel fusion, surgical segments, and unilateral pedicle screws fixation are not the risk factors associated with CR. A revision surgery is needed when neurologic symptoms happen after CR. The conclusion should be consulted cautiously due to the limited number of included studies. Therefore larger-scale studies are still needed to investigate the risk factors for CR.


Assuntos
Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Falha de Prótese , Fusão Vertebral/instrumentação , Humanos , Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Parafusos Pediculares , Reoperação , Fatores de Risco , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia
9.
Biomed Res Int ; 2019: 9369853, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380443

RESUMO

Purpose: The endplate defects (EDs), Modic changes (MCs), disc degeneration (DD), facet orientation (FO), and facet tropism (FT) were demonstrated to be related to the low back pain (LBP). The aim of this study was to investigate possible correlations between them. Methods: 75 patients were reviewed to evaluate the degenerative change in vertebral bodies (EDs and MCs), intervertebral discs (DD), and facet joint degeneration (FO and FT). All patients were categorized into four groups based on the grade of EDs. Clinical outcomes were evaluated with the visual analog scale (VAS) and Oswestry disability index (ODI) before and after surgery. Results: There was no difference between the four groups in baseline characteristics except for gender and weight. FT is positively correlated with FO. The same rule exists between EDs, the size of MCs II, FO (left) and FO (right), and VAS and ODI. The grade of EDs is positively correlated with the grade of DD. L4-L5 can bear more load than other levels; thus, the grade of EDs is higher than that of other lumbar levels. The preoperative LBP was relieved in all groups in varying degrees. The change of pain and dysfunction is inversely proportional to the grade of EDs in the general trend. Conclusion: The relationship between weight, gender, and disc degeneration provided a mechanism by which increasing weight can predispose to DD. Different grades of EDs had different effects on patients with LBP. There was a significant correlation between EDs, MCs II, DD, FT, and FO.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Dor Lombar/cirurgia , Espondilose/cirurgia , Articulação Zigapofisária/cirurgia , Idoso , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/fisiopatologia , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/fisiopatologia , Dor Lombar/diagnóstico por imagem , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/fisiopatologia , Região Lombossacral/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espondilose/complicações , Espondilose/fisiopatologia , Escala Visual Analógica , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/fisiopatologia
10.
BMC Musculoskelet Disord ; 20(1): 379, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421680

RESUMO

BACKGROUND: The aim of this study was to investigate the correlation between radiographic measurement in lumbar spine and clinical information including symptoms or results of functional testing using a baseline data of longitudinal cohort study. METHODS: A total of 314 elderly subjects were recruited from 5 orthopedic clinics or affiliated facilities. Data for the present investigation were collected via an interviewer-administered questionnaire, which included questions on past medical history, drug history, pain area. And also results of functional testing and X-ray imaging of the lumbar spine were collected. Analysis was carried out to determine any correlation between results of X-ray imaging of the lumbar spine and other collected data, and sorted regarding Akaike Information Criterion (AIC). The correlations among these variables and odds ratio were also analyzed. RESULTS: T12/L1% disc height showed a minimum AIC value with buttock pain (- 4.57) and history of vertebral fracture (- 4.05). The L1/L2, L2/L3, and L3/L4% disc height had a minimal AIC value with knee pain (- 4.11, - 13.3, - 3.15, respectively), and odds ratio of knee pain were 3.5, 3.8, and 2.7, respectively. CONCLUSIONS: Correlation was recognized between the T12/L1% disc height and both buttock pain and previous vertebral fractures, and the L1/L2, L2/L3, and L3/L4% disc height showed a correlation with knee pain. Especially the L2/L3% disc height and knee pain had a strong correlation. It was suggested that these findings may provide additional basis to the concept that lumbar spinal lesion associates with knee pain clinically.


Assuntos
Artralgia/epidemiologia , Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Espondilose/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Artralgia/etiologia , Artralgia/fisiopatologia , Feminino , Humanos , Disco Intervertebral/patologia , Articulação do Joelho/fisiopatologia , Estudos Longitudinais , Masculino , Fatores de Risco , Fraturas da Coluna Vertebral/complicações , Espondilose/patologia
11.
Medicina (Kaunas) ; 55(8)2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31409017

RESUMO

Low back pain is an extremely common pathology affecting a great share of the population, in particular, young adults. Many structures can be responsible for pain such as intervertebral discs, facet joints, nerve roots, and sacroiliac joints. This review paper focuses on disc pathology and the percutaneous procedures available to date for its treatment. For each option, we will assess the indications, technical aspects, advantages, and complications, as well as outcomes reported in the literature and new emerging trends in the field.


Assuntos
Disco Intervertebral , Dor Lombar/diagnóstico , Dor Lombar/terapia , Vértebras Lombares , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Dor Lombar/patologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Doenças da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X
12.
J Med Syst ; 43(8): 275, 2019 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-31280416

RESUMO

To solve the problem of location and segmentation of intervertebral discs in spinal MRI images, a method of intervertebral disc segmentation and degeneration classification diagnosis based on wavelet image denoising and independent component analysis-active appearance model (ICA-AAM) was proposed. Firstly, the spinal MRI image is decomposed by wavelet transform, and the noise is filtered by soft threshold method. Then, aiming at the inadequacy of PCA method in AAM in describing data details, ICA is used instead of PCA to model shape and texture models, and an improved AAM segmentation model is formed. Finally, the intervertebral discs in MRI images are segmented by AAM model, and the degeneration classification of intervertebral discs is diagnosed according to the gray level characteristics of the segmented region. The experimental results show that the method can accurately locate and segment the intervertebral disc region and make classification diagnosis.


Assuntos
Disco Intervertebral/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Razão Sinal-Ruído , Análise de Ondaletas , Algoritmos , Humanos , Modelos Estatísticos , Traumatismos da Coluna Vertebral/diagnóstico por imagem
13.
Eur Radiol ; 29(12): 6443-6446, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31278582

RESUMO

KEY POINTS: • Molecular intervertebral disc damage was associated with LBP and radiculopathy.• Patients with radiculopathy and LBP demonstrated a depletion of gagCEST values compared with healthy controls.• GagCEST imaging may be a non-invasive tool for investigation of degeneration processes of lumbar intervertebral discs (IVDs). GagCEST imaging may be an imaging biomarker for biochemical IVD alterations.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/diagnóstico por imagem , Dor Lombar/fisiopatologia , Imagem por Ressonância Magnética/métodos , Radiculopatia/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Feminino , Glicosaminoglicanos/metabolismo , Humanos , Disco Intervertebral/metabolismo , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/metabolismo , Dor Lombar/etiologia , Dor Lombar/metabolismo , Vértebras Lombares/metabolismo , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiculopatia/etiologia , Radiculopatia/metabolismo , Adulto Jovem
14.
Spine (Phila Pa 1976) ; 44(19): E1161-E1168, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31261283

RESUMO

STUDY DESIGN: Retrospective matched cohort study. OBJECTIVE: To determine if low-pressure lumbar provocation discography (PD) results in long-term accelerated disc degeneration, internal disc disruption, or disc herniation in patients with symptomatic low back pain (LBP). SUMMARY OF BACKGROUND DATA: Study of subjects without clinically-significant LBP suggests that high-pressure PD may accelerate disc degeneration. METHODS: Consecutive patients with symptomatic LBP who underwent magnetic resonance imaging (MRI), PD, and repeat MRI more than 7 years later, but did not undergo subsequent spinal fusion surgery, were included. Punctured discs were matched (1:2 to 1:4) to corresponding discs in a control cohort by age, BMI, Pfirrmann score (±2), and presence of disc herniation; control cohort inclusion required MRIs for symptomatic LBP, separated by more than 7 years. The primary outcome of the study was a progression in Pfirrmann score category (I-II, III-IV, V). MRI disc-to-CSF T2 signal-intensity ratio, disc height, disc herniations, high intensity zones (HIZs), and Modic changes were assessed. RESULTS: Baseline and follow-up MRIs were available for 77 discs exposed to PD, and for 260 discs in the matched control cohort. There was no difference in the proportion of punctured discs that advanced in Pfirrmann score category in the PD group (17%, 95% CI 9-27%) compared with corresponding discs in the Control group (21%, 95% CI 17-27%), P = 0.3578, or in non-punctured discs in the PD group (35%, 95% CI 21-51%) compared with corresponding discs in the Control group (34%, 95% CI 27-42%), P = 0.1169. There were no differences in disc-to-CSF T2 signal-intensity ratio, presence of disc herniations, HIZs, or Modic changes following puncture in the PD versus matched cohort discs or in the non-punctured PD cohort discs versus corresponding control cohort discs (P > 0.05). CONCLUSION: Patients with symptomatic LBP who underwent low-pressure PD, but who did not undergo a subsequent spinal fusion surgery, developed disc degeneration and new disc herniations at a similar rate to corresponding discs in matched control patients. LEVEL OF EVIDENCE: 3.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Disco Intervertebral , Mielografia , Progressão da Doença , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/fisiopatologia , Imagem por Ressonância Magnética , Mielografia/efeitos adversos , Mielografia/métodos , Mielografia/estatística & dados numéricos , Estudos Retrospectivos
15.
BMC Musculoskelet Disord ; 20(1): 347, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31351455

RESUMO

BACKGROUND: Impaired lumbar artery flow has been reported in clinical and epidemiological studies to be associated with low back pain and lumbar disc degeneration. However, it has not been experimentally demonstrated that impaired lumbar artery flow directly induces intervertebral disc (IVD) degeneration by affecting IVD matrix metabolism. The purpose of this study was to evaluate whether ligation of the lumbar artery can affect degenerative changes in the rabbit IVD. METHODS: New Zealand White rabbits (n = 20) were used in this study. Under general anesthesia, the third and fourth lumbar arteries were double-ligated using vascular clips. The blood flow to the L3/L4 disc (cranial disc) was reduced by ligation of the third lumbar artery and that of the L5/L6 disc (caudal disc) by ligation of the fourth lumbar artery. The blood flow to the L4/L5 disc (bilateral disc) was decreased by ligation of both the third and fourth lumbar arteries. The L2/L3 disc was used as the control. Disc height was radiographically monitored biweekly until 12 weeks after surgery. The rabbits were sacrificed at 4, 8, and 12 weeks after surgery and magnetic resonance imaging (MRI) T2-mapping, histology and immunohistochemistry were assessed. RESULTS: Lumbar artery ligation did not induce significant changes in disc height between control and ischemic discs (cranial, bilateral and caudal discs) during the 12-week experimental period. T2-values of ischemic discs had no significant trend to be lower than those of the control L2/L3 discs. Histologically, Safranin-O staining changed following ligation of corresponding IVD lumbar arteries. Histological grading scores for disc degeneration, which correlated significantly with MRI T2-values, had significant changes after the surgery. Immunohistochemical analysis showed that the ligation of lumbar arteries significantly affected a change in the percentage of HIF-1α immunoreactive cells of ischemia discs compared to that of control discs four weeks after the surgery (p < 0.05). CONCLUSIONS: The MRI and histology results suggest that diminished flow in lumbar arteries induce mild changes in the extracellular matrix metabolism of rabbit IVDs. These matrix changes, however, were not progressive and differed from the degenerative disc changes seen in the process of human IVD degeneration.


Assuntos
Artérias/diagnóstico por imagem , Degeneração do Disco Intervertebral/etiologia , Disco Intervertebral/irrigação sanguínea , Vértebras Lombares/irrigação sanguínea , Animais , Artérias/cirurgia , Modelos Animais de Doenças , Matriz Extracelular/patologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Ligadura , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Coelhos , Fluxo Sanguíneo Regional
16.
Spine (Phila Pa 1976) ; 44(22): E1317-E1324, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31348175

RESUMO

STUDY DESIGN: Prospective longitudinal study. OBJECTIVE: The aim of this study was to evaluate long-term degenerative changes in intervertebral discs in the thoracic spine in healthy asymptomatic subjects. SUMMARY OF BACKGROUND DATA: Longitudinal magnetic resonance imaging (MRI) studies of intervertebral disc degeneration have been reported for the cervical and lumbar but not the thoracic spine. METHODS: In this longitudinal study (average follow-up 10.0 ±â€Š0.6 years), we assessed degenerative changes in the thoracic spine of 103 volunteers (58 men) of 223 healthy volunteers in the initial MRI study of the thoracic spine (follow-up rate 46.2%). The mean age at the initial study was 45.0 ±â€Š11.5 years (24-77 years). Initial and follow-up thoracic-spine MRIs were graded for the following 4 factors of degenerative changes: decrease in signal intensity of intervertebral disc (DSI), posterior disc protrusion (PDP), anterior compression of dura and spinal cord (AC), and disc-space narrowing (DSN) from T1-2 to T12-L1. We assessed associations between changes in MRI grade and demographical factors such as age, sex, body mass index, smoking habits, sports activities, and disc degeneration in the cervical spine. RESULTS: MRIs revealed that 63.1% of the subjects had degenerative changes in the thoracic intervertebral discs that had progressed at least one grade during the follow-up period. DSI progressed in 44.7% of subjects, PDP in 21.4%, and AC in 18.4% during the 10-year period. No DSN progression was seen. DSI was frequently observed in the upper thoracic spine (T1-2 to T4-5). Disc degeneration was relatively scarce in the lower thoracic spine (T9-10 to T12-L1). PDP was frequently observed in the middle thoracic spine (T5-6 toT8-9). We found significant associations between DSI and cervical-spine degeneration (P = .004) and between AC and smoking (P = .04). CONCLUSION: Progressive thoracic disc degeneration, observed in 63.1% of subjects; was significantly associated with smoking and with cervical-spine degeneration. LEVEL OF EVIDENCE: 2.


Assuntos
Envelhecimento/fisiologia , Degeneração do Disco Intervertebral , Disco Intervertebral , Vértebras Torácicas , Adulto , Idoso , Feminino , Seguimentos , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/patologia , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Adulto Jovem
17.
BMC Musculoskelet Disord ; 20(1): 336, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324243

RESUMO

BACKGROUND: The endplate-intervertebral disc (IVD) complex is closely interrelated with the vertebral body (VB) in the structural integrity of the anterior spinal column, including biomechanical and biological functions. Endplate and IVD injuries are usually found in association with vertebral fractures (VFs); however, little is known about their relevance to the healing of osteoporotic VFs (OVFs). The first purpose of this study was to evaluate the incidence and occurrence pattern of endplate and IVD injuries associated with single- and acute-OVFs, and the second was to evaluate the influence of endplate and IVD injuries on the occurrence of delayed union. METHODS: Endplate and IVD injuries associated with single- and acute-OVFs were retrospectively evaluated using magnetic resonance imaging (MRI). Vertebrae of 168 patients were included in the study. The occurrence rate and type of endplate and IVD injuries were radiologically evaluated, and the association between endplate and IVD injuries was statistically analyzed. Vertebrae of 85 patients, who received conservative treatment for acute OVFs, were included in the study and classified into two groups, union and delayed union, at 6 months after injury. To identify factors predicting delayed union, uni- and multivariate statistical analyses were performed. Vertebral MRI signal alternation patterns and endplate and IVD injuries were included as candidate factors in the logistic model. RESULTS: In association with OVFs, endplate injuries were observed in 103 of the 168 vertebrae (61%), and IVDs lesions were observed in 101 of 168 OVFs (60%); the occurrence of both injuries was significantly associated. Although no significant association with endplate and IVD injuries was identified, multivariate analysis demonstrated that intravertebral signal alternation (focal high signal intensity) and posterior wall injury were independent risk factors that predicted delayed union. CONCLUSIONS: The results of this study showed that endplate and IVD injuries were found in approximately 60% of single and acute OVFs. These results suggest that fracture healing of OVFs would be mainly attributed to vertebral factors, including mechanical stress and metabolic status, among the three components of the anterior spinal column.


Assuntos
Consolidação da Fratura , Disco Intervertebral/lesões , Fraturas por Osteoporose/complicações , Fraturas da Coluna Vertebral/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Fraturas por Osteoporose/patologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/patologia , Vértebras Torácicas
18.
Proc Inst Mech Eng H ; 233(8): 849-857, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31203751

RESUMO

The work investigates the effect of proposed novel semi-rigid stabilization device on lumbar segment L2-L3 so as to preserve motion at vertebral level. Here, the biomechanical behavior of intact spine with three instrumented spinal models (semi-rigid stabilization device, rigid implant and dynamic stabilization system NFlex) have been compared under the motion conditions of flexion, extension, bending and twist. Three-dimensional non-linear finite models of intact spine, semi-rigid stabilization device, rigid implant and dynamic stabilization system NFlex were developed in the present study. All the four models were subjected to a combined load of 400 N in axial compression along with 2, 4, 6, 8 and 10 N m as bending moment individually. Dynamic stabilization system NFlex shows the maximum variation in motion and reflects range of motion as 89.7% during lateral bending, 53.4% in flexion, 34.6% in twist and 28.0% in extension with respect to intact spine. However, semi-rigid stabilization device and rigid implant shows the range of motion of 60%, 48.7%, 32% and 21.8% and 60%, 32.3%, 22.3% and 21.7% of intact, respectively, during bending, flexion, twist and extension. Finite element simulation results reveal that semi-rigid stabilization device shows comparatively lower values than dynamic stabilization system NFlex and higher as compared to rigid implant for measured intradiscal pressure and von Mises strain at intervertebral disc-23.


Assuntos
Vértebras Lombares/fisiologia , Teste de Materiais/instrumentação , Fenômenos Mecânicos , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/fisiologia , Vértebras Lombares/diagnóstico por imagem , Masculino , Amplitude de Movimento Articular , Estresse Mecânico , Tomografia Computadorizada por Raios X , Adulto Jovem
19.
Spine (Phila Pa 1976) ; 44(13): E766-E773, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205169

RESUMO

STUDY DESIGN: Reliability study. OBJECTIVE: To evaluate the applicability and reliability of 9.4T magnetic resonance imaging (MRI) in the assessment of degenerative disc disease compared with 3T MRI. SUMMARY OF BACKGROUND DATA: MRI is a reliable indicator of biochemical changes in the intervertebral disc (IVD) including hydration status, proteoglycan content, and disc degeneration compared with anatomical and histological studies. High-field 9.4T MRI has been shown to provide superior resolution and anatomical detail. However, it has not been tested against current standard MRI techniques. METHODS: Disc degeneration was initiated in 36 skeletally mature ewes 6 months prior to necropsy via validated surgical IVD injury models using either scalpel injury or drill-bit injury techniques at lumbar spine levels L2/3 and L3/4 with L1/2, L4/5, and L5/6 serving as control discs. All ex vivo IVDs were examined with 9.4T MRI and 3T MRI. All scans were analyzed using the Pfirrmann grading system by four independent observers. Intra- and interobserver reliability was assessed using kappa statistics and Spearman correlation. RESULTS: Inter- and intraobserver agreement for 9.4T MRI was excellent, both at κ 0.91 (P < 0.001). Comparatively, 3T interobserver reliability demonstrated substantial agreement at κ 0.61 (P < 0.001). Complete agreement was obtained in 92.7% to 100% of discs at 9.4T compared with 69.7% to 83.1% at 3T. A difference of one grade or more occurred in 6.7% at 9.4T and 39.3% at 3T. 9.4T MRI scored 97.3% of discs as grade 1 to 2 compared with 71.3% at 3T. 3T MRI tended to over-score the extent of disc degeneration with 28.6% of discs scored as grade 3 or higher compared with 2.7% at 9.4T MRI. CONCLUSION: 9.4T MRI study of IVD degeneration using the Pfirrmann grading system demonstrated excellent inter- and intraobserver reliability. Comparatively, 3T MRI demonstrated a tendency to over score the extent of disc degeneration. This improved reliability of 9.4T MRI holds great potential for its clinical applications. LEVEL OF EVIDENCE: 3.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/normas , Animais , Biometria/métodos , Feminino , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/patologia , Vértebras Lombares/patologia , Imagem por Ressonância Magnética/métodos , Reprodutibilidade dos Testes , Ovinos
20.
J Orthop Res ; 37(9): 1956-1962, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31042306

RESUMO

In this prospective study, we sought to establish normative data for T2* analysis of lumbar intervertebral discs (IVDs). Further, potential diurnal effects regarding T2* relaxometry of the lower spine were examined. Lumbar IVDs of young, healthy, adult men (n = 20) and women (n = 20; mean age = 24.5 ± 2.9 years) were assessed. Magnetic resonance imaging including T2* mapping was performed on a 3-T scanner. Mid-sagittal T2* values were obtained in five regions: anterior annulus fibrosus (AF), anterior nucleus pulposus (NP), central NP, posterior NP, and posterior AF. Zonal and segmental differences, as well as diurnal variations between the T2* analysis in the morning and the evening and effects of unloading, were analyzed. Discs with signs of degeneration on morphological images or imaging artifacts were excluded. We noted a zonal and segmental T2* distribution with high values in the NP, low T2* values in the AF and a T2* increase towards the caudal NP. We observed no diurnal differences between the mean T2* values in the morning and in the evening (p = 0.748). The effect of unloading the spine was low (maximum T2* difference between four measurements = 13.6 ms; significant difference noted only between the 0 and 15-min measurement). The T2* values obtained in this study will serve as normative values for future T2* measurements. There are no diurnal influences, and we suggest that unloading of the spine has no demonstrable effect after 30 min on the T2* results. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1956-1962, 2019.


Assuntos
Ritmo Circadiano/fisiologia , Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adulto , Feminino , Humanos , Masculino , Núcleo Pulposo/diagnóstico por imagem , Estudos Prospectivos , Adulto Jovem
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