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1.
Medicine (Baltimore) ; 99(2): e18202, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914013

RESUMO

To observe thoracolumbar segmental mobility using kinetic magnetic resonance imaging (kMRI) in patients with minimal thoracolumbar spondylosis and establish normal values for translational and angular segmental motion as well as the relative contribution of each segment to total thoracolumbar segmental motion in order to obtain a more complete understanding of this segmental motion in healthy and pathological conditions.Mid-sagittal images obtained by weight-bearing, multi-position kMRI in patients with symptomatic low back pain or radiculopathy were reviewed. The translational motion and angular variation of each segment from T10-L2 were calculated using MRAnalyzer Automated software. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, for all thoracolumbar discs from T10-T11 to L1-L2 were included for further analysis.The mean translational motion measurements for each level of the lumbar spine were 1.15 mm at T10-T11, 1.20 mm at T11-T12, 1.23 mm at T12-L1, and 1.34 mm at L1-L2 (P < .05 for L1-L2 vs T10-T11). The mean angular motion measurements at each level were 3.26° at T10-T11, 3.92° at T11-T12, 4.95° at T12-L1, and 6.85° at L1-L2. The L1-L2 segment had significantly more angular motion than all other levels (P < .05). The mean percentage contribution of each level to the total angular mobility of the thoracolumbar spine was highest at L1-L2 (36.1%) and least at T10-T11 (17.1%; P < .01).Segmental motion was greatest in the proximal lumbar levels, and angular motion showed a gradually increasing trend from T10 to L2.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Espondilose/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Degeneração do Disco Intervertebral/classificação , Degeneração do Disco Intervertebral/patologia , Cinética , Dor Lombar/patologia , Vértebras Lombares/patologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Espondilose/fisiopatologia , Vértebras Torácicas/patologia , Vértebras Torácicas/fisiopatologia , Suporte de Carga , Adulto Jovem
2.
J Forensic Sci ; 65(1): 144-153, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31503337

RESUMO

Conducted electrical weapons are designed to cause temporary electro-muscular incapacitation (EMI) without significant injury. The objective of this study was to assess the risk and cause of spinal injury due to exposure to a benchtop EMI device. Porcine subjects were exposed to 19 and 40 Hz electrical stimuli for a prolonged duration of 30 sec. X-ray imaging, necropsy, and accelerometry found that lumbosacral spinal fractures occurred in at least 89% of all subjects, regardless of the stimulus group, and were likely caused by musculoskeletal fatigue-related stress in the lumbosacral spine. Spinal fractures occurred in the porcine model at an unusually high rate compared to human. This may be due to both the prolonged duration of electrical stimulation and significant musculoskeletal differences between humans and pigs, which suggests that the porcine model is not a good model of EMI-induced spinal fracture in humans.


Assuntos
Lesões por Armas de Eletrochoque , Vértebras Lombares , Fraturas da Coluna Vertebral , Animais , Lesões por Armas de Eletrochoque/diagnóstico por imagem , Lesões por Armas de Eletrochoque/patologia , Estimulação Elétrica/instrumentação , Medicina Legal , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/patologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/patologia , Modelos Animais , Radiografia , Sacro/diagnóstico por imagem , Sacro/lesões , Sacro/patologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/patologia , Suínos
3.
Medicine (Baltimore) ; 98(49): e18157, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804327

RESUMO

The objective of this study is to investigate the role of paraspinal muscles in the progression of different types of spondylolisthesis by examining the correlation between cross-sectional area (CSA) of lumbar paraspinal muscle and slip percentage (SP) in degenerative spondylolisthesis and isthmic spondylolisthesis.A multicenter retrospective analysis was carried out including 219 subjects diagnosed with lumbar spondylolisthesis. Using T2-weighted axial magnetic resonance imgaging, CSAs of the psoas major (PM), multifidus (MU), and erector spinae were measured and divided by L5 vertebral body (VB) CSA. SP was measured using sagittal T2-weighted images. Correlations between muscle CSA ratio and SP were calculated in each group. Regression analysis was performed to predict the influence of each muscle CSA/VB CSA ratio on SP.No significant correlation was found in the degenerative spondylolisthesis group between any of the muscle CSA ratios and SP. Both PM/VB ratio (r = -0.24, P = .021) and MU/VB ratio (r = -0.26, P = .012) were negatively correlated with SP in the isthmic spondylolisthesis group. MU had more influence on SP than PM in the isthmic spondylolisthesis group (regression coefficient MU/VB: -8.08, PM/VB: -4.34).Both PM and MU muscle CSA ratios were negatively correlated with SP in the isthmic group. MU had more influence on SP than PM. No muscles had any correlations with SP in the degenerative group. This discrepancy between the two groups suggests that exercise programs or interventions regarding the segmental stability of isthmic spondylolisthesis and degenerative spondylolisthesis should be distinguished in clinical practice.Clinical Research Information Service of Korea Centers for Disease control and Prevention, KCT0002588. Registered on 12 December 2017, https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=10702.


Assuntos
Vértebras Lombares/patologia , Músculos Paraespinais/patologia , Espondilolistese/patologia , Adulto , Idoso , Progressão da Doença , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Músculos Paraespinais/diagnóstico por imagem , República da Coreia , Estudos Retrospectivos , Espondilolistese/diagnóstico por imagem
4.
BMJ ; 367: l5654, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619437

RESUMO

OBJECTIVE: To assess the efficacy of three months of antibiotic treatment compared with placebo in patients with chronic low back pain, previous disc herniation, and vertebral endplate changes (Modic changes). DESIGN: Double blind, parallel group, placebo controlled, multicentre trial. SETTING: Hospital outpatient clinics at six hospitals in Norway. PARTICIPANTS: 180 patients with chronic low back pain, previous disc herniation, and type 1 (n=118) or type 2 (n=62) Modic changes enrolled from June 2015 to September 2017. INTERVENTIONS: Patients were randomised to three months of oral treatment with either 750 mg amoxicillin or placebo three times daily. The allocation sequence was concealed by using a computer generated number on the prescription. MAIN OUTCOME MEASURES: The primary outcome was the Roland-Morris Disability Questionnaire (RMDQ) score (range 0-24) at one year follow-up in the intention to treat population. The minimal clinically important between group difference in mean RMDQ score was predefined as 4. RESULTS: In the primary analysis of the total cohort at one year, the difference in the mean RMDQ score between the amoxicillin group and the placebo group was -1.6 (95% confidence interval -3.1 to 0.0, P=0.04). In the secondary analysis, the difference in the mean RMDQ score between the groups was -2.3 (-4.2 to-0.4, P=0.02) for patients with type 1 Modic changes and -0.1 (-2.7 to 2.6, P=0.95) for patients with type 2 Modic changes. Fifty patients (56%) in the amoxicillin group experienced at least one drug related adverse event compared with 31 (34%) in the placebo group. CONCLUSIONS: In this study on patients with chronic low back pain and Modic changes at the level of a previous disc herniation, three months of treatment with amoxicillin did not provide a clinically important benefit compared with placebo. Secondary analyses and sensitivity analyses supported this finding. Therefore, our results do not support the use of antibiotic treatment for chronic low back pain and Modic changes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02323412.


Assuntos
Amoxicilina , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar , Vértebras Lombares , Adulto , Amoxicilina/administração & dosagem , Amoxicilina/efeitos adversos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Dor Crônica/diagnóstico , Dor Crônica/tratamento farmacológico , Dor Crônica/etiologia , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Noruega , Medição da Dor/métodos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(39): e17316, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574861

RESUMO

The purpose of this study was to investigate the effect of intraoperative positions in single-level (L4-5) transforaminal lumbar interbody fusion (TLIF) on segmental and overall lumbar lordosis (LL) in patients with lumbar degenerative disease. Thirty-eight consecutive patients who had undergone single-segment (L4-5) TLIF with 0° polyetheretherketone (PEEK) cage and pedicle screw fixation were evaluated. Twenty patients underwent surgery on the four-poster type frame with hip flexion at 30° (Group I) and 18 patients were operated on a Jackson spinal table to adjust their hip flexion to 0° (Group II). Preoperative standing, intraoperative prone, and postoperative standing lateral radiographs were obtained in each patient. The overall and segmental LL were analyzed according to the position in which the patients were placed for their operation and results compared between Groups I and II. Intraoperative intervertebral segmental LL at L4-5 and L5-S1 was increased in Group II than in Group I, whereas postoperative intervertebral segmental LL at L4-5 (fused level) was increased LL. In Group I intraoperative intervertebral segmental LL at L4-5 did not achieve sufficient lordosis, whereas postoperative intervertebral segmental LL at L3-4 was increased. The overall spinal alignment was unaffected by the decreased segmental LL in the fused level owing to the compensation of the upper adjacent segments. The more the hip was extended intraoperatively, the more the segmental lordosis increased in the lower lumbar spine. Thus, selecting the appropriate surgical table and hip position are very important. Underachievement of segmental lordosis leads to the acceleration of upper adjacent segment load.


Assuntos
Cuidados Intraoperatórios/métodos , Lordose , Vértebras Lombares , Mesas Cirúrgicas , Posicionamento do Paciente/métodos , Fusão Vertebral , Idoso , Feminino , Humanos , Lordose/diagnóstico , Lordose/fisiopatologia , Lordose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Amplitude de Movimento Articular , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Espondilolistese/cirurgia
6.
Medicine (Baltimore) ; 98(40): e17336, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577728

RESUMO

Lumbar 3-joint complex degeneration is a multifactorial, pathological process. Previous studies included insufficient quantitative analyses to prove the relationship between disc degeneration and facet joint osteoarthritis (OA). We assessed the correlation between intervertebral disc and lumbar facet joint degeneration using computed tomography (CT) and magnetic resonance imaging (MRI) parameters.A total of 152 participants who underwent conventional MRI and CT in the clinostat position were included in this study. The presence of lumbar disc degeneration was identified using the Pfirrmann grading system, and the presence of lumbar facet joint degeneration was identified using the Weishaupt grading system. Facet tropism was defined as a divergence more than 7° between the facet joint angles of both sides at the same segment. The intervertebral disc heights were also measured.Most facet joint OA probably appeared at the segment with intervertebral disc degeneration of more than grade III. Facet joint OA was significantly exacerbated with the progression of disc degeneration grade. The intervertebral height significantly decreased with the progression of facet joint degeneration grades, except for grades 0 and 1.Our current study found that each individual joint degeneration influences the other 2 in the lumbar 3-joint complex. Facet tropism was significantly associated with lumbar disc degeneration. Narrowing of the intervertebral disc height probably aggravates the facet joint degeneration further at the same level.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Articulação Zigapofisária/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/patologia , Vértebras Lombares/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem , Articulação Zigapofisária/patologia
7.
Medicine (Baltimore) ; 98(38): e17177, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567958

RESUMO

Lumbar spinal canal stenosis (LSCS) associated with degenerative scoliosis has being increasingly aware by the public and studied by many researchers. Degenerative changes leading to spinal stenosis can precede a spinal deformity which will develop into the de novo scoliosis. There are few studies focusing on the risk factors contributing to the degenerative lumbar scoliosis (DLS) in lumbar spinal stenosis patients.From September, 2017 to December, 2017, 181 patients who were diagnosed with LSCS in the outpatient department of our hospital were enrolled in this retrospective investigation. The patients were divided into 2 groups: DLS group (Cobb angle >10°) and LSCS group. Sex, age, smoking status (yes or no), occupation (heavy or light labor), body mass index (BMI), bone mineral density (BMD) and radiographic parameters including the lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), coronal vertical axis, and sagittal vertical axis (SVA) are all evaluated as potential risk factors. Multivariate logistic regression analysis and receiver-operating characteristic curves were used to identify potential risk factors.Forty-five of 181 patients were diagnosed with DLS and involved in the DLS group. There were significant differences between the 2 groups in BMI (P < .001), LL (P = .0046), BMD (P < .001), SVA (P < .001), and TK (P = .047). BMD < -1.85 g/cm (adjusted odds ratio [AOR] 0.030, 95% confidence interval [CI] 0.008-0.107, P < .001), BMI >25.57 kg/m (AOR 1.270, 95% CI 1.040-1.551, P = .019), and SVA >3.98 cm (AOR 3.651, 95% CI 2.226-5.990, P < .001) had good accuracy to predict the formation of degenerative lumbar scoliosis based on degenerative lumbar spinal stenosis.Degenerative lumbar scoliosis has a high incidence in degenerative lumbar spinal stenosis. BMD <-1.85 g/cm, BMI >25.57 kg/m, and SVA >3.98 cm were the potential risk factors for the formation of degenerative lumbar scoliosis based on degenerative lumbar spinal stenosis.


Assuntos
Vértebras Lombares , Escoliose/complicações , Estenose Espinal/etiologia , Estudos Transversais , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Radiografia , Fatores de Risco , Escoliose/diagnóstico por imagem , Escoliose/patologia , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/patologia
8.
Medicine (Baltimore) ; 98(42): e17341, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626091

RESUMO

RATIONALE: Schwannomas grow slowly, originating from the Schwann cells of the nerve sheath. Schwannomas of cranial origin have the highest incidence, followed by intraspinal schwannomas. However, paravertebral schwannoma is rare, and to our knowledge, giant paravertebral schwannomas near the lumbar nerve roots with bone destruction are extremely rare. PATIENT CONCERNS: A 47-year-old Chinese woman complained of lower back soreness and a sensation of a bulging lumbar disc with no obvious cause for the past 3 years. DIAGNOSIS: Lumbar magnetic resonance imaging showed a large mass with uneven density, 17 × 12 × 15 cm in size, located to the right of the 4th lumbar with obvious bony destruction. Histopathology and immunohistochemistry confirmed that this mass was a benign schwannoma. INTERVENTIONS: Complete resection of the tumor (measuring about 17 × 12 × 15 cm in size) and vertebral reconstruction using internal fixation were performed. OUTCOMES: The patient was discharged without complications after surgery. The 3-year follow-up revealed that the patient recovered well with no evidence of recurrence. LESSONS: Here, we emphasize the importance of careful radiological examination and reflect on the difficulty of tumor resection. Furthermore, understanding the treatment and diagnosis of lumbar paravertebral schwannoma is critical for plastic surgeons and radiologists when encountering similar cases.


Assuntos
Vértebras Lombares/patologia , Neurilemoma/patologia , Neoplasias da Coluna Vertebral/patologia , Raízes Nervosas Espinhais/patologia , Feminino , Humanos , Dor Lombar/etiologia , Vértebras Lombares/virologia , Região Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/cirurgia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(42): e17422, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626098

RESUMO

Symptoms of intervertebral foraminal stenosis are caused by compression of nerve root exiting the intervertebral foramen. Many attempts to measure the size of the neuromuscular exit have been made; however, only a few studies to compare the area differences between foramens by computed tomography (CT) were done. In this retrospective comparative study, we used the region of interest (ROI) in CT to measure and compare the area of intervertebral foramen between the healthy control group and the patient group.Eighty-one patients who underwent CT of the lumbar spine between May 2014 and December 2017 were enrolled. Using the medical imaging program, the foraminal area between L5 and S1 vertebrae was measured on the sagittal, coronal, and axial planes using ROI. Four groups were established for comparison: those diagnosed with foraminal stenosis by a radiologist and those who were not, those diagnosed with foraminal stenosis by orthopedic surgeons and those who were not. These groups were further divided into subcategories depending on whether the area was operated on for foraminal stenosis. Interobserver and intraobserver agreements were assessed.The mean age of patients was 56.5 years (range 17-84). The foraminal area of the surgical group on sagittal plane was significantly narrower than the control group (P = .005). However, the difference between the 2 groups on axial and coronal planes was not statistically significant (P > .1). Foraminal area <80 mm on sagittal images was a statistically significant risk factor for clinical symptom (P = .028) and that <65 mm was a statistically significant risk factor in predicting operability (P = .01). Interobserver and intraobserver agreements were fair to good on axial and coronal planes (about 0.7), whereas the agreements were excellent on sagittal plane (>0.9).In this study, we proved that measuring the intervertebral foraminal area using the ROI in CT in the lumbar spine is useful for diagnosing L5-S1 foraminal stenosis, especially on sagittal plane. Furthermore, not only does it provide aid in diagnosis, but it also helps predicting the operability of foraminal stenosis.


Assuntos
Vértebras Lombares/patologia , Estenose Espinal/diagnóstico por imagem , Estudos de Casos e Controles , Tratamento Conservador/estatística & dados numéricos , Constrição Patológica , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/patologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Fusão Vertebral/estatística & dados numéricos , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/patologia , Estenose Espinal/terapia , Tomografia Computadorizada por Raios X
10.
Ned Tijdschr Geneeskd ; 1632019 09 24.
Artigo em Holandês | MEDLINE | ID: mdl-31556497

RESUMO

Lumbar spondylolisthesis is usually asymptomatic. However, symptomatic spondylolisthesis results in back and/or leg pain such as radicular syndrome or neurogenic claudication. Variation in symptoms is caused by different types of spondylolisthesis. Lytic spondylolisthesis, most common at L5S1, is caused by spondylolysis of the pars interarticularis. This results in foraminal nerve compression and radicular symptoms. Degenerative spondylolisthesis, most common at L4L5 in patients >50 years old, is caused by slippage of the vertebral body and lamina, resulting in lumbar spinal stenosis and neurogenic claudication. Iatrogenic spondylolisthesis develops in 1.6-32.0% of patients after decompression surgery, causing recurrent neurogenic symptoms. It is important to understand the main symptoms patients experience: back or leg pain. In both cases, the preferred treatment is conservative. Surgery is only an option if patients have persistent/progressive leg pain. Shared decision-making is necessary to select the most accurate surgery for each individual patient while also taking into account age, comorbidities and symptoms. Further research is necessary to determine the advantages of each surgery in order to improve advice to patients.


Assuntos
Dor nas Costas/etiologia , Claudicação Intermitente/etiologia , Vértebras Lombares/patologia , Radiculopatia/etiologia , Estenose Espinal/etiologia , Espondilolistese/complicações , Idoso , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Espondilolistese/patologia , Espondilolistese/cirurgia
11.
J Pediatr Orthop ; 39(9): e680-e686, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503224

RESUMO

BACKGROUND: Cervical spine deformity in rhizomelic chondrodysplasia punctata (RCDP) has been described with different findings reported in the literature. However, available literature provides limited data from a few cases with magnetic resonance imaging (MRI) of the cervical spine. Our report describes the MRI findings in a group of children with RCDP, aiming to reach a better understanding of this pathology. METHODS: An Institutional Review Board-approved RCDP Registry was created at our institution with the goal of identifying pertinent medical issues over the lifespan of individuals with RCDP. Records of children within the registry were evaluated, and magnetic resonance images obtained between 2004 and 2015, were available for review. The levels of spinal canal stenosis were recorded and the severity of the stenosis was decided based on adults' parameters. Cord compression and myelomalacia were confirmed on the axial images. Sagittal lumbar spine magnetic resonance images were also evaluated when available, and the presence of tethered cord and fatty filum was recorded. RESULTS: Twenty-six children (15 boys and 11 girls) were identified in the RCDP Registry. Eleven children (6 boys and 5 girls) had sagittal MRI of the cervical spine available for review. Age at the time of MRI study was variable (1 wk to 32 mo). All patients except 1 had stenosis of the cervical spinal canal. Myelomalacia of the cord was noted only in this patient. CONCLUSIONS: This study suggests that, in children with RCDP, cervical spinal stenosis and cord compression are a real risk, and children with this diagnosis should have monitoring for these issues. Tethered cord is also a possible finding that needs to be evaluated. Full sagittal spine MRI is necessary to detect the possible deformities at the cervical and lumbar levels.


Assuntos
Vértebras Cervicais/patologia , Condrodisplasia Punctata Rizomélica/complicações , Compressão da Medula Espinal/etiologia , Estenose Espinal/etiologia , Vértebras Cervicais/diagnóstico por imagem , Pré-Escolar , Condrodisplasia Punctata Rizomélica/diagnóstico por imagem , Condrodisplasia Punctata Rizomélica/patologia , Constrição Patológica , Feminino , Humanos , Lactente , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Masculino , Canal Vertebral/diagnóstico por imagem , Canal Vertebral/patologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/patologia , Doenças da Medula Espinal , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/patologia
13.
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
14.
BMC Musculoskelet Disord ; 20(1): 371, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31409337

RESUMO

BACKGROUND: A displaced femoral neck fracture (FNF) in patients 55-70 years is a serious injury with a high risk of treatment failure and the optimal surgical treatment remains unclear. We aimed to describe characteristics of fracture patients compared to a sample from the normal population. METHODS: Fifty patients aged 55-70 years with a displaced FNF were gender- and age- matched with a control group of 150 persons without a hip fracture using computergenerated randomization and the Norwegian National Population Register. To reduce the risk of spurious selection bias, the sample size of the control group was trebled compared to the fracture group. Dual-energy x-ray absorptiometry (DXA) was performed. Demographics and hip function (Harris Hip Score, Oxford Hip Score, and Hip Dysfunction and Osteoarthritis Outcome Score) were collected. RESULTS: There were more than 75% women in both groups. The mean age was 64.5 years in the fracture group and 65.1 in the control group. Results for DXA measured for lumbar spine, total hip and the femoral neck showed that patients with displaced FNF were significantly more osteoporotic. Fracture patients had significantly lower body mass index, higher Charlson comorbidity index (CCI), and higher ASA (American Society of Anesthesiologists) score than the control group. No clinically relevant differences in hip function were found. There were 48% smokers in the fracture group compared to 10% in the control group. The odds ratio for obtaining a displaced FNF was high if the patients suffered from osteoporosis, smoked or had several comorbidities. CONCLUSIONS: This study showed that patients aged 55-70 years with a displaced femoral neck fracture had lower bone density and higher comorbidity compared with a gender- and age-matched population without femoral neck fractures. This suggests that this patient group is epidemiologically similar to older patients with femoral neck fractures.


Assuntos
Densidade Óssea/fisiologia , Fraturas do Colo Femoral/etiologia , Luxação do Quadril/etiologia , Osteoporose/complicações , Absorciometria de Fóton , Idoso , Artroplastia de Quadril , Estudos de Casos e Controles , Comorbidade , Feminino , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/patologia , Luxação do Quadril/epidemiologia , Luxação do Quadril/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Osteoporose/epidemiologia , Osteoporose/patologia , Distribuição Aleatória , Sistema de Registros/estatística & dados numéricos
15.
Eur J Radiol ; 118: 223-230, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439246

RESUMO

PURPOSE: To identify the predictors of bone-marrow DWI signals from anthropometric, complete blood count (CBC), and C-reactive protein (CRP), and to evaluate the association with fat-content in patients. METHOD: This retrospective study was approved by the institutional review board. A total of 113 consecutive tumor patients underwent whole-body PET/MRI. Apparent diffusion coefficient (ADC) and proton density fat fraction (PDFF) were measured and averaged in lumbar vertebrae (L3-5) and bilateral ilia. Due to respiratory motion, ribs were evaluated by 3-point visual scoring on DWI with b = 800 (1: invisible, 2: partially visible, 3: fully visible). The relationships between ADC/visual scores and anthropometric, CBC, CRP, and PDFF were examined. In females, the age-dependency was evaluated. RESULTS: Multi-regression analyses identified age as the strongest predictor of lumbar ADC (standardized coefficient: ß = 0.45), followed by red cell distribution width (RDW) (ß = -0.24), while age was the strongest predictor of iliac ADC (ß = 0.43), followed by hemoglobin (Hb) (ß = 0.22). RDW was the strongest predictor (ß = 0.47) for rib visual score and age was the second (ß = -0.39). ADC showed significant positive correlations with PDFF at L3-5 and ilium. Lumbar ADC showed a decreasing trend during middle age in females. CONCLUSIONS: Age, anemia (lower Hb), and increased hematopoietic activity (higher RDW) are the predominant predictors of ADC and the visibility of red marrow on DWI. Fat-suppression methods and bone-marrow physiology in middle-aged females may have affected the measured correlations between ADC and PDFF inconsistent with previous studies.


Assuntos
Anemia/patologia , Doenças da Medula Óssea/patologia , Hematopoese/fisiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Prótons , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Imagem Corporal Total/métodos , Adulto Jovem
16.
Cancer Radiother ; 23(5): 408-415, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331841

RESUMO

PURPOSE: Radiotherapy is a treatment method performed using ionizing radiation on cancer patients either alone or with surgery and/or chemotherapy. Although modern radiotherapy techniques provide a significant advantage in protecting healthy tissues, it is inevitable that normal tissues are also located in the areas targeted by radiations. In this study, we aimed to examine the bone mineral density changes in bone structures commonly included in the irradiated area such as, L5 vertebra, sacrum, and femur heads, in patients who have received pelvic radiotherapy; and the relationship between these changes with radiation dose. MATERIAL AND METHODS: Patients included in the study had been previously diagnosed with rectal cancer, which were operated or not. Preoperative or postoperative pelvic radiotherapy was planned for all patients. In terms of convenience when comparing with future scans, all densitometry and CT scans were performed with the same devices. Fifteen patients were included in the study. In order to determine the dose of radiation each identified area had taken after radiotherapy, the sacrum, L5 vertebra, bilateral femoral heads, and L1 regions were contoured in the CT scans in which treatment planning was done. Sagittal cross-sectional images were taken advantage of while these regions were being contoured. RESULTS: Bone mineral density was evaluated with CT and dual-energy X-ray absorptiometry before and after the treatment. The regions that have theoretically been exposed to irradiation, such as L5, sacrum, left to right femur were found to have significant difference in terms of bone density. According to CT evaluation, there was a significant decrease in bone intensity of L5, sacrum, left and right femurs. Dual-energy X-ray absorptiometry assessment revealed that the whole of the left femoral head, left femur neck and Ward's region were significantly affected by radiotherapy. However, there was no significant difference in the sacrum and L5 vertebra before and after radiotherapy. CONCLUSION: More accurate results could be achieved if the same study was conducted on a larger patient population, with a longer follow-up period. When the reduction in bone density is at maximum or a cure is likely in a long-term period, bone mineral density could be determined by measurements performed at regular intervals.


Assuntos
Densidade Óssea , Cabeça do Fêmur/efeitos da radiação , Vértebras Lombares/efeitos da radiação , Órgãos em Risco/efeitos da radiação , Radioterapia Conformacional/efeitos adversos , Neoplasias Retais/radioterapia , Sacro/efeitos da radiação , Absorciometria de Fóton , Adulto , Idoso , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doenças Ósseas Metabólicas/etiologia , Terapia Combinada , Estudos Transversais , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Órgãos em Risco/diagnóstico por imagem , Órgãos em Risco/patologia , Neoplasias Retais/cirurgia , Sacro/diagnóstico por imagem , Sacro/patologia , Tomografia Computadorizada por Raios X
17.
Medicine (Baltimore) ; 98(29): e16460, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335704

RESUMO

BACKGROUND: Lumbar fusion is considered to the gold standard for treatment of spinal degenerative diseases but results in adjacent segment degeneration and acquired spinal instability. Total disc replacement is a relatively new alternative avoiding the occurrence of the above complications. The systematic review and meta-analysis was designed to evaluate whether total disc replacement exhibited better outcomes and safety. METHODS: PubMed, Web of Science, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure Database(CNKI), Wangfang database, and VIP database were searched for RCTs comparing total disc replacement with lumbar fusion. All statistical analyses were carried out using the RevMan5.3 and STATA12.0 software. RESULTS: Of 1116 citations identified by our search strategy, 14 RCTs met the inclusion criteria. Compared to lumbar fusion, total disc replacement significantly improved ODI, VAS, SF-36, patient satisfaction, overall success, reoperation rate, ODI successful, reduced operation time, shortened duration of hospitalization, decreased postsurgical complications. However, total disc replacement did not show a significant difference regarding blood loss, consumption of analgesics, neurologic success and device success with lumbar fusion. And charges were significantly lower for total disc replacement compared with lumbar fusion in the 1-level patient group, while charges were similar in the 2-level group. CONCLUSION: Total disc replacement is recommended to alleviate the pain of degenerative lumbar diseases, improve the state of lumbar function and the quality of life of patients, provide a high level of security, have better health economics benefits for 1-level patients.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/patologia , Fusão Vertebral , Substituição Total de Disco , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Substituição Total de Disco/efeitos adversos , Substituição Total de Disco/métodos , Resultado do Tratamento
18.
Comput Methods Biomech Biomed Engin ; 22(14): 1126-1134, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31294608

RESUMO

Prediction of the biomechanical effects of fusion surgery on adjacent segments is a challenge in computational biomechanics of the spine. In this study, a two-segment L3-L4-L5 computational model was developed to simulate the effects of spinal fusion on adjacent segment biomechanical responses under a follower load condition. The interaction between the degenerative segment (L4-5) and the adjacent segment (L3-4) was simulated using an equivalent follower spring. The spring stiffness was calibrated using a rigid fusion of a completely degenerated disc model at the L4-5 level, resulting in an upper bound response at the adjacent (L3-4) segment. The obtained upper bound equivalent follower spring was used to simulate the upper bound biomechanical responses of fusion of the disc with different degeneration grades. It was predicted that as the disc degeneration grade at the degenerative segment decreased, the effect on the adjacent segment responses decreased accordingly after fusion. The data indicated that the upper bound computational model can be a useful computational tool for evaluation of the interaction between segments and for investigation of the biomechanical mechanisms of adjacent segment degeneration after fusion.


Assuntos
Simulação por Computador , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Fusão Vertebral , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Vértebras Lombares/patologia , Estresse Mecânico
19.
J Comput Assist Tomogr ; 43(4): 568-571, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31310594

RESUMO

PURPOSE: The purpose of this study was to calculate the positive predictive value (PPV) of lumbar spine magnetic resonance imaging (MRI) findings for a painful disc using provocative discography. MATERIALS AND METHODS: Lumbar spine discography records and prediscography MRIs of 736 patients (2457 discs) who underwent discography for diagnostic purposes from 2003 to 2007 were retrospectively reviewed in an Institutional Review Board-exempt and Health Insurance Portability and Accountability Act-compliant protocol. Each level was identified as having high-intensity zone (HIZ) disc, disc protrusion, disc extrusion, or combination (any herniation type), disc bulge, disc degeneration, and spondylolisthesis. Statistical analysis used a 2 × 2 contingency table of significant discography results for each of the MRI variables to calculate P value and PPV with a confidence interval from a binomial distribution. RESULTS: An HIZ disc has a PPV of 0.71 (0.65-0.76, P = 4.31E - 44) for a provocative discography. A disc protrusion has a PPV of 0.79 (0.73-0.83, P = 2.68E - 53). A disc extrusion has a PPV of 0.93 (0.79-0.98, P = 1.34E - 14), a bulge of 0.43 (0.37-0.48, P = 0.002), and a degenerative disc of 0.32 (0.28-0.35, P = 0.08), and spondylolisthesis has a PPV of 0.67 (0.59-0.73, P = 1.70E - 20). A herniation of either type (extrusion or protrusion) has a PPV of 0.80 (0.75-0.84, P = 5.86E - 69). CONCLUSIONS: Disc herniations and HIZ discs have high predictive value in identifying a pain generator. An extruded disc herniation has the highest PPV for discogenic pain.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Doenças da Coluna Vertebral/patologia , Adulto Jovem
20.
Biomed Res Int ; 2019: 3871819, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281838

RESUMO

The aim of this study was to shed light on the association between lumbosacral transitional vertebra (LSTV) and degenerative lumbar spinal stenosis (DLSS). A cross-sectional retrospective study was performed on 165 individuals that were diagnosed with clinical picture of DLSS (age range: 40-88 years; sex ratio: 80M/85F) and 180 individuals without DLSS related symptoms (age range: 40-99 years; sex ratio: 90M/90F). All participants had undergone high-resolution CT scan for the lumbar region in the same position. We also used the volume rendering method to obtain three-dimensional CT images of the lumbosacral area. Both males and females in the stenosis group manifest greater prevalence of LSTV than their counterparts in the control group (P<0.001). Furthermore, the presence of LSTV increases the likelihood of degenerative spinal stenosis (odds ratio= 3.741, P<0.001). In the control group, LSTV was more common in males, and sacral slope angle of males was significantly greater in LSTV group compared to non-LSTV. This study indicates that LSTV was significantly associated with symptomatic DLSS.


Assuntos
Vértebras Lombares/patologia , Região Lombossacral/patologia , Estenose Espinal/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Humanos , Imagem Tridimensional , Disco Intervertebral/patologia , Modelos Logísticos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prevalência , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/epidemiologia
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