Spinal Changes Research Articles

BILATERAL EAGLE'S SYNDROME IN LUMBAR SPONDYLOSIS – A CASE REPORT AND REVIEW

There are Published case studies involving diffuse idiopathic skeletal hyperostosis (DISH) along with symptomatic ossification of the stylohyoid ligament, or “Eagle syndrome,” are rare. Coincidence of the Eagle syndrome and diffuse idiopathic skeletal hyperostosis can very rarely result with compression of the hypopharynx. The three-dimensional volume-rendered air-specific Multidetector computed tomography MDCT image is accurately used to show the relationship between the Oro-hypopharyngeal air column and the elongated styloid processes. The authors here described a very rare case of hypopharyngeal airway compression and nagging pharyngeal pain secondary to cervical osteophytes in a patient with coincidence of Eagle syndrome and diffuse idiopathic skeletal hyperostosis. A known case of ankylosing spondylosis under treatment since last three years with degenerative changes in the cervical spine was taken up for removal of styloid process under General anesthesia. Follow up was done for one year and it was uneventful.

K-line tilt as a novel potential risk factor for cervical Modic change: a retrospective study

BackgroundCervical sagittal parameters are important parameters that reflect the mechanical stress in the sagittal plane of the cervical spine and are an important basis for predicting the clinical status and prognosis of patients. Although it has been confirmed that there is a significant correlation between cervical Modic changes and some sagittal parameters. However, as a newly discovered sagittal parameter, there is no report on the relationship between the K-line tilt and the Modic changes of cervical spine.MethodsA retrospective analysis was performed for 240 patients who underwent cervical magnetic resonance imaging scan for neck and shoulder pain. Among them, 120 patients with Modic changes, namely the MC(+) group, were evenly divided into three subgroups of 40 patients in each group according to different subtypes, namely MCI subgroup, MCII subgroup and MCIII subgroup. One hundred twenty patients without Modic changes were included in MC(−) group. We measured and compared the sagittal parameters of cervical spine among different groups, including K-line tilt, C2–C7 sagittal axial vertical distance (C2–C7 SVA), T1 slope and C2–7 lordosis. Logistic regression was used to analyse the risk factors of cervical Modic changes.ResultsThe K-line tilt and C2–7 lordosis were significantly different between MC(+) group and MC(−) group (P < 0.05). The K-line tilt greater than 6.72° is a risk factor for Modic changes in cervical spine (P < 0.05). At the same time, the receiver operating characteristic curve showed that this change had moderate diagnostic value when the area under the curve was 0.77.ConclusionThis study shows that the K-line tilt greater than 6.72° is a potential risk factor for Modic changes in cervical spine. When the K-line tilt is greater than 6.72°, we should be alert to the occurrence of Modic changes.Trial registration number: 2022ER023-1.

Regulation of dendritic spines in the amygdala following sleep deprivation.

The amygdala is a hub of emotional circuits involved in the regulation of cognitive and emotional behaviors and its critically involved in emotional reactivity, stress regulation, and fear memory. Growing evidence suggests that the amygdala plays a key role in the consolidation of emotional memories during sleep. Neuroimaging studies demonstrated that the amygdala is selectively and highly activated during rapid eye movement sleep (REM) and sleep deprivation induces emotional instability and dysregulation of the emotional learning process. Regulation of dendritic spines during sleep represents a morphological correlate of memory consolidation. Several studies indicate that dendritic spines are remodeled during sleep, with evidence for broad synaptic downscaling and selective synaptic upscaling in several cortical areas and the hippocampus. Currently, there is a lack of information regarding the regulation of dendritic spines in the amygdala during sleep. In the present work, we investigated the effect of 5 h of sleep deprivation on dendritic spines in the mouse amygdala. Our data demonstrate that sleep deprivation results in differential dendritic spine changes depending on both the amygdala subregions and the morphological subtypes of dendritic spines. We observed decreased density of mushroom spines in the basolateral amygdala of sleep deprived mice, together with increased neck length and decreased surface area and volume. In contrast, we observed greater densities of stubby spines in sleep deprived mice in the central amygdala, indicating that downscaling selectively occurs in this spine type. Greater neck diameters for thin spines in the lateral and basolateral nuclei of sleep deprived mice, and decreases in surface area and volume for mushroom spines in the basolateral amygdala compared to increases in the cental amygdala provide further support for spine type-selective synaptic downscaling in these areas during sleep. Our findings suggest that sleep promotes synaptic upscaling of mushroom spines in the basolateral amygdala, and downscaling of selective spine types in the lateral and central amygdala. In addition, we observed decreased density of phosphorylated cofilin immunoreactive and growth hormone immunoreactive cells in the amygdala of sleep deprived mice, providing further support for upscaling of dendritic spines during sleep. Overall, our findings point to region-and spine type-specific changes in dendritic spines during sleep in the amygdala, which may contribute to consolidation of emotional memories during sleep.

CLINICAL AND RADIOLOGICAL CORRELATION IN ACUTE AND SUBACUTE LOW BACK PAIN IN ADULT MALES OF 20 TO 30 YEAR AGE GROUP

Low back pain (LBP) is one of the most common health problems affecting 75% to 85% of the general population. Young adults are suffering from LBP more frequently than in the past, where loss of working days is a great personal and national loss. This study aims to determine the correlation of clinical features with plain radiograph and Magnetic resonance imaging (MRI) ndings in adult males of 20 to 30 years age group. 100 male patients with acute or subacute low backache were enrolled in the present study. Personal details and history noted and clinical examination was performed. The Oswestry disability index was used for quantication of pain. Plain radiograph and MRI was done. The plain radiograph and MRI ndings were correlated with the clinical ndings. The mean age of patients was 25.18±3.28 years. Sensory loss was found in 15% and paraesthesia in 18% cases. The mean Oswestry lower back pain score was 16.66±10.44. The most common abnormality found on plain radiograph was abnormal disc intensity followed by reduced disc height. The most common abnormality found on MRI was disc bulge followed by abnormal disc intensity. The most common site for osteophytes was anterior of L4 vertebral body followed by anterior of L3. There was a poor agreement between clinical ndings and radiological ndings. Both plain x-ray and MRI imaging found a signicantly higher rate of spine changes which did not correlate well with clinical &amp; neurological ndings

Evaluation and Comparison of Cervical Spine Posture in Class II Division I Patients Treated with Twin Block Appliances, Forsus Appliances, and Bilateral Sagittal Split Osteotomy: A Cephalometric Study.

It has been speculated that a change in cervical spine posture occurs due to forward repositioning of the mandible. Therefore, this study aimed to evaluate and compare the cervical spine posture in Class II division one patient treated with three different treatment modalities. A retrospective cohort study was conducted using pre and post-treatment lateral cephalograms of Class II Division one patients who have undergone orthodontic therapy using twin block appliance, Forsus, and bilateral sagittal split osteotomy (BSSO). This study included a total of 57 subjects comprising 19 subjects in each group. Seven cervical, three sagittal, and one vertical parameters were compared within and between each group. The data were tested using the Dependent t-test, One-way analysis of variance, and Tukey's post hoc test. A significant difference existed between the pre- and post-treatment angular measurements within the three groups showing a change in the cervical spine posture with forward positioning of the mandible. A comparison of mean changes in angular measurements between the three groups showed a significant difference in SNA, SNB, ANB, and odontoid process tangent-cervical vertebral tangent (OPT-CVT), indicating a change in the cervical posture. OPT-CVT angle predicts a change in cervical spine posture after treatment with a significant difference in the Twin Block group (P = 0.029) compared to Forsus and BSSO groups. Thus, the twin block group results in a more upright craniocervical posture than the other two treatment groups.

Relationships between the quality of life and the intensity of pain and functional efficiency in women and men with degenerative changes in the lumbar spine

Introduction. Back pain is a serious medical and social problem. The aim of this study was relationships between the quality of life and the intensity of pain and functional efficiency in women and men with degenerative changes in the lumbar spine. Material and methods. The study involved 53 women and 52 men, who, due to chronic pain in the lumbar spine due to degenerative changes, were qualified for therapy at the Local Government Health Center in Miedziana Gora. The research tool was NRS scale, Oswestry Distability Index ODI and shortened version of the survey WHOQOL-BREF. The collected research results were analysed with the use of Mann-Whitney U test, Chi-square test and Spearman rank correlation. Results. Statistically significant differences in the values of the ODI questionnaire relating to the category "care" (p = 0.046) were found. In men, statistically significant negative associations between body build and the WHOQOL-BREF survey values concerning the somatic (p = 0.012), psychological (p = 0.007) and social (p = 0.022) domains were found. Statistically significant positive associations between the intensity of pain and functional capacity according to the ODI were found in both sexes (p &lt; 0.001). Statistically significant negative relationships between the NRS value and the psychological domain were noted in women (p = 0.023), and with the somatic (p &lt; 0.001), psychological (p = 0.006), socjal (p = 0.013) and environmental (p &lt; 0.001) domain in men. Wnioski. In terms of functional efficiency, men with back pain caused by degenerative changes are characterized by greater limitations in terms of activities related to care. In men, the increase in BMI is accompanied by a decrease in the quality of life in the somatic, psychological and social domains. In both sexes, the increase in the intensity of back pain affects the deterioration of functional efficiency. In women, the increase in the intensity of pain was associated with a decrease in the quality of life in the psychological domain, and in men in the somatic, psychological, social and environmental domains.

Factors of lumbosacral radiculopathy chronicity

Assessment of chronic factors of acute lumbosacral radiculopathy is an urgent problem due to the disease impact on the quality of life of patients, possible loss of work capacity and disability. The aim of the work is to identify chronicity factors of acute compressive lumbosacral radiculopathy depending on the severity of degenerative-dystrophic changes in the spine and pathomorphological changes in the zone of disc-radicular conflict based on complex clinical-neurological, neuro-orthopedic, neuroimaging, neurophysiological and statistical methods of examination. Materials and methods. 100 patients with acute lumbosacral radiculopathy were examined. The patients were divided into two groups: 45 patients with radiculopathy and both discogenic pathology and stenotic process in the spinal canal and/or lateral openings, and 55 patients with radiculopathy developed secondary to a pathology between the vertebral disc at the level of one vertebromotor segment. All the patients underwent neurological, neuroorthopedic, neurophysiological examinations. The study was conducted in two stages – 3–7 days and one months after the disease onset. Results. On the basis of comprehensive clinical, neuroimaging, neurophysiological examinations and statistical processing of the obtained data, factors affecting the chronicity of acute compressive lumbosacral radiculopathy were identified: age (rs = 0.25, P = 0.012), sex (rs = 0.25, P = 0.012), pain syndrome severity according to the VAS (rs = 0.25, P = 0.011), the presence of a neuropathic component of pain according to the PainDETECT questionnaire (rs = 0.74, P &lt; 0.001), biomechanical disorders of the spine during the Schober test (rs = -0.41, P &lt; 0.001), lateroflexion (rs = -0.30, P = 0.003), extension (rs = 0.28, p = 0.004), damage to Aβ fibers (rs = -0.36, P = 0.009), Aδ-fibers (rs = -0.38, P = 0.006), C-fibers (rs = -0.37, P = 0.008), allodynia (rs = 0.38, P &lt; 0.001), hyperalgesia (rs = -0.24, p = 0.014), muscular-tonic syndrome index (rs = 0.26, p = 0.008), the presence of lumbar canal stenosis (rs = 0.42, P &lt; 0.001), spondyloarthrosis (rs = 0.22, P = 0.028), spondylolisthesis (rs = 0.20, P = 0.047). Conclusions. The conducted study has revealed the main factors contributing to the development of acute lumbosacral radiculopathy chronicity. The presence of a neuropathic component of pain in the mechanism of pain syndrome development in the acute period of the disease and the involvement of C-fibers in the pathological process in the late stages of the disease are among the important markers contributing to the disease prolongation. Assessment of the factors that determine the chronicity of the course in the acute period of the disease allows to prescribe complex differential therapy at the early stage of the disease.

Dynamic evaluation of the cervical spine by kinematic MRI in patients with cervical spinal cord injury without fracture and dislocation

BackgroundThe pattern of changes in the cervical spine and the spinal cord and their dynamic characteristics in patients with cervical spinal cord injury without fracture and dislocation remain unclear. This study aimed to evaluate the dynamic changes in the cervical spine and spinal cord from C2/3 to C7/T1 in different positions by using kinematic magnetic resonance imaging in patients with cervical spinal cord injury without fracture and dislocation. This study was approved by the ethics committee of Yuebei People's Hospital.MethodsUsing median sagittal T2-weighted images for 16 patients with cervical spinal cord injury without fracture and dislocation who underwent cervical kinematic MRI, the anterior space available for the cord, spinal cord diameter, posterior space available for the cord from C2/3 to C7/T1, and Muhle’s grade were determined. The spinal canal diameter was calculated by adding the anterior space available for the cord, spinal cord diameter, and posterior space available for the cord.ResultsThe anterior space available for the cord, posterior space available for the cord, and spinal canal diameters at C2/3 and C7/T1 were significantly higher than those from C3/4 to C6/7. Muhle’s grades at C2/3 and C7/T1 were significantly lower than those at the other levels. Spinal canal diameter was lower in extension than in the neutral and flexion positions. In the operated segments, significantly lesser space was available for the cord (anterior space available for the cord + posterior space available for the cord), and the spinal cord diameter/spinal canal diameter ratio was higher than those in the C2/3, C7/T1, and non-operated segments.ConclusionKinematic MRI demonstrated dynamic pathoanatomical changes, such as canal stenosis in different positions, in patients with cervical spinal cord injury without fracture and dislocation. The injured segment had a small canal diameter, high Muhle’s grade, low space available for the cord, and high spinal cord diameter/spinal canal diameter ratio.

Exploiting volume electron microscopy to investigate structural plasticity and stability of the postsynaptic compartment of central synapses.

Volume reconstruction from electron microscopy datasets is a tool increasingly used to study the ultrastructure of the synapse in the broader context of neuronal network and brain organization. Fine modifications of synapse structure, such as activity-dependent dendritic spine enlargement and changes in the size and shape of the postsynaptic density, occur upon maturation and plasticity. The lack of structural plasticity or the inability to stabilize potentiated synapses are associated with synaptic and neuronal functional impairment. Mapping these rearrangements with the high resolution of electron microscopy proved to be essential in order to establish precise correlations between the geometry of synapses and their functional states. In this review we discuss recent discoveries on the substructure of the postsynaptic compartment of central excitatory synapses and how those are correlated with functional states of the neuronal network. The added value of volume electron microscopy analyses with respect to conventional transmission electron microscopy studies is highlighted considering that some limitations of volume-based methods imposed several adjustments to describe the geometry of this synaptic compartment and new parameters-that are good indicators of synapses strength and activity-have been introduced.

Effectiveness of manual therapy and cervical spine stretching exercises on pain and disability in myofascial temporomandibular disorders accompanied by headaches: a single-center cohort study

BackgroundPrevious studies have demonstrated a relationship between headaches and temporomandibular disorders (TMDs). Moreover, recent studies have shown functional, anatomical, and neurological associations between the temporomandibular joint (TMJ) and upper cervical spine. This study aimed to investigate the effectiveness of manual therapy and cervical spine stretching exercises for pain and disability in patients with myofascial TMDs accompanied by headaches.MethodsThirty-four patients recruited from Gyeryong Hospital with headaches and diagnosed with TMDs were randomly assigned to the experimental (n = 17) and control (n = 17) groups. Headache impact was assessed using the Korean Headache Impact Test-6. Masseter myofascial pain was measured using the visual analog scale, and TMJ pressure pain threshold levels were evaluated using an algometer. Neck pain intensity was assessed using the numerical rating scale. Once per week for 10 weeks, the experimental group received cervical spine-focused manual therapy and stretching exercises alongside conservative physical therapy, and the control group received conservative physical therapy alone. Patients were evaluated at baseline and 5 and 10 weeks post-intervention.ResultsAfter the intervention, the experimental group exhibited significant reductions in the cervical kyphotic angle, Korean Headache Impact Assessment score, neck pain intensity, TMJ pain pressure threshold, Neck Disability Index score, and Jaw Functional Limitation Scale level compared with the control group (p < 0.01).ConclusionManual therapy and stretching exercises could help resolve TMDs accompanied by headaches through biomechanical changes in the cervical spine. These findings may guide protocols and clinical trials involving manual therapy that align morphological structures.

Obesity in children with low back pain: implications with imaging phenotypes and opioid use

BACKGROUND CONTEXTLow back pain (LBP) is common in children and adolescents, carrying substantial risk for recurrence and continuation into adulthood. Studies have linked obesity to the development of pediatric LBP; however, its association with lumbar spine degeneration, alignment parameters, and opioid use remains debated. PURPOSEConsidering the increasing prevalence of pediatric obesity and LBP and the inherent issues with opioid use, this study aimed to assess the association of obesity with lumbar spine degeneration, spinopelvic alignment, and opioid therapy among pediatric patients. STUDY DESIGN/SETTINGA retrospective study of pediatric patients presenting to a single institute with LBP and no history of spine deformity, tumor, or infection was performed. PATIENT SAMPLEA totasl of 194 patients (mean age: 16.7±2.3 years, 45.3% male) were included, of which 30 (15.5%) were obese. OUTCOME MEASURESPrevalence of imaging phenotypes and opioid use among obese to nonobese pediatric LBP patients. Magnetic resonance and plain radiographic imaging were evaluated for degenerative phenotypes (disc bulging, disc herniation, disc degeneration [DD], high-intensity zones [HIZ], disc narrowing, Schmorl's nodes, endplate phenotypes, Modic changes, spondylolisthesis, and osteophytes). Lumbopelvic parameters including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence and pelvic incidence-lumbar lordosis (PI–LL) mismatch were also examined. METHODSDemographic and clinical information was recorded, including use of opioids. The associations between obesity and lumbar phenotypes or opiod use were assessed by multiple regression models. RESULTSBased on multivariate analysis, obesity was significantly associated with the presence of HIZ (adjusted OR: 5.36, 95% CI: 1.30 to 22.09). Further analysis demonstrated obesity (adjusted OR: 3.92, 95% CI: 1.49 to 10.34) and disc herniation (OR: 4.10, 95% CI: 1.50 to 11.26) were associated with opioid use, independent of duration of symptoms, other potential demographic determinants, and spinopelvic alignment. CONCLUSIONSIn pediatric patients, obesity was found to be significantly associated with HIZs of the lumbar spine, while disc herniation and obesity were associated with opioid use. Spinopelvic alignment parameters did not mitigate any outcome. This study underscores that pediatric obesity increases the risk of developing specific degenerative spine changes and pain severity that may necessitate opioid use, emphasizing the importance of maintaining healthy body weight in promoting lumbar spine health in the young.

Low occurrence of MRI spinal changes in elite climbing athletes; a cross-sectional study

ObjectivesTo examine the occurrence of magnetic resonance imaging (MRI) changes in the thoracolumbar spine among elite climbing athletes.MethodsAll climbers of the Swedish national sport climbing team (n = 8), and individuals having trained for selection to the national team (n = 11), were prospectively included. A control group, matched in age and sex, were recruited. All participants underwent a thoracolumbar MRI (1.5 T, T1- and T2-weighted imaging), evaluated according to Pfirrmann classification, modified Endplate defect score, Modic changes, apophyseal injuries and spondylolisthesis. Pfirrmann ≥ 3, Endplate defect score ≥ 2 and Modic ≥ 1 was defined as degenerative findings.ResultsFifteen individuals, 8 women, participated in both the climbing group (mean age 23.1, SD 3.2 years) and the control group respectively (mean age 24.3, SD 1.5 years). In the climbing group, 6.1% of the thoracic and 10.6% of the lumbar intervertebral discs showed signs of degeneration according to Pfirrmann. One disc with a grade above 3 was present. Modic changes in the thoracic/lumbar spine were prevalent in 1.7%/1.3% of the vertebrae. Degenerative endplate changes according to the Endplate defect score were found in 8.9% and 6.6% of the thoracic and lumbar spinal segments of the climbing group, respectively. Two apophyseal injuries were found, while no participants displayed signs of spondylolisthesis. There was no difference in point-prevalence of radiographic spinal changes between climbers and controls (0.07 < p < 1.0).ConclusionIn this small cross-sectional study, only a low proportion of elite climbers displayed changes of the spinal endplates or intervertebral discs, as opposed to other sports with high spinal loads. Most observed abnormalities were low grade degenerative changes and did not differ statistically compared to controls.

Synaptic scaling of corticostriatal circuits underlies hyperactivity in GABA Transporter-1 deficient mice

Homeostatic synaptic scaling entails adjustment of synaptic strength on a cell to prolonged changes of neuronal activity, which is postulated to participate in neuropsychiatric disorders invivo. Here, we find that sustained elevation in ambient GABA levels, by either genetic deletion or pharmacological blockade of GABA transporter-1 (GAT1), leads to synaptic scaling up of corticostriatal pathways, which underlies locomotor hyperactivity. Meanwhile, medium spinyneurons of the dorsal striatum exhibit an aberrant increase in excitatory synaptic transmission and corresponding structural changes in dendritic spines. Mechanistically, GAT1 deficiency dampens the expression and function of metabotropic glutamate receptors (mGluRs) and endocannabinoid (eCB)-dependent long-term depression of excitatory transmission. Conversely, restoring mGluR function in GAT1 deficient mice rescues excitatory transmission. Lastly, pharmacological potentiation of mGluR-eCB signaling or inhibition of homomeric-GluA1 AMPA receptors eliminates locomotor hyperactivity in the GAT1 deficient mice. Together, these results reveal a synaptic scaling mechanism in corticostriatal pathways that regulate locomotor activity.

PREVALENCE OF LUMBOSACRAL TRANSITIONAL VERTEBRA IN PATIENTS PRESENTING WITH LOW BACKACHE AND IT'S ASSOCIATION WITH DEGENERATIVE SPINE CHANGES ON MRI: A STUDY IN RURAL TERTIARY CARE HOSPITAL OF SOUTH INDIA.

Introduction- Lumbosacral transitional vertebra (LSTV) is a congenital spinal anomaly dened as either sacralization of lumbar segment or lumbarization of sacral segment of the spine. Identication of accurate level of pathology is of utmost importance in patients undergoing surgical intervention. Failure to do so, might result in wrong level surgery, leading to signicant morbidity. Aims and objectivesŸ To analyze the prevalence, age and sex distribution of LSTV in low back pain patients. Ÿ To analyze the various methods of identifying and numbering LSTV. Ÿ To explore the relationship between LSTV and degenerative spine changes. Materials and methods- This was a crossectional observational study done in 217 cases presented with low back pain and underwent MRI LS spine using PHILIPS Ingenia 1.5 Tesla machine in department of radio-diagnosis at MAHARAJAHS INSTITUTE OF MEDICAL SCIENCES, NELLIMARLA. LSTV prevalence was 18.8% in this study. Most of the patients Conclusion- with LSTV belonged to 4th and 5th decades. No signicant sex predilection was seen. Castellvi types II &amp; IV are the most frequent types. An association between the transitional vertebra and herniation of the disc above was found in patients with low back pain i.e., Disc herniation was always noted above the transitional vertebra and not below that level (L4/5 disc prolapse in sacralization and L5/S1 disc prolapse in lumbarization), Sacralization was common than lumbarization in LSTV, approximately in the ratio of 2.3:1. The reliability of MRI ( sagittal MRI to count from C2, axial MRI to look for iliolumbar ligaments) to identify and correctly numbering LSTV was 100 %. Severity of degenerative spine changes was slightly higher among LSTV group than 'No LSTV' group

MODIFIED OSWESTRY DISABILITY INDEX (ODI) IN ASSESSING MAGNETIC RESONANCE IMAGING FINDINGS IN LUMBAR DEGENERATIVE DISEASES

INTRODUCTION: Lumbar degenerative disease is one of the common causes for low back pain may cause debilitation. Mild degenerative changes of spine are physiological and should be considered pathological only if these abnormalities are causing symptoms and clinical signs. Many structural components of spine are responsible for low backache of degenerative etiology including the intervertebral disc, vertebral periosteum, facet joints and spinal ligaments. The most frequent and common location of these changes is lumbar spine due to heavy mechanical stress. The aim of AIM: this study is to establish a relationship between the MRI changes in established lumbar degenerative disease and the severity of self-assessed modied Oswestry Disability Index in patients. MATERIALS &amp; METHODS: Study included 120 consenting patients of all age groups irrespective of sex, having low back pain who were referred for MRI lumbar spine. Standard spine protocol sequences like T1- weighted image T2-weighted image Fluid-sensitive sequence, such as STIR or fat suppressed T2-weighted image Gradient-echo image Post gadolinium T1- weighted image were performed and the ndings were correlated with Modied Oswestry Disability Index(ODI). Disc degenerative changes is common RESULTS: among 40 – 60 years age group. Females are more commonly affected than males. Central is the most type of disc bulge. L5-S1 is the most common level to be affected by disc bulge. Annulus ssure/ tear is most common in L4-L5 intervertebral disc level. Type I degenerative end plate changes are most common in L5-S1 intervertebral disc level. Whereas typeII degenerative end plate changes are most common in L4-L5 intervertebral disc level. Facetal Arthropathy changes are common in L4- L5 levels both in grade I and II. Spinal canal stenosis is common in L4-L5 levels both in grade I and II. Oswestry disability score is higher in patients with severe spinal canal stenosis. So, there is signicant correlation between spinal canal narrowing and Oswestry disability index is seen. So ODI score acts as an invaluable tool for assessing patients' functional disability. MRI is better for the CONCLUSION: identication and grading the severity of lumbar degenerative disease. Oswestry disability index is a better tool for assessing patients' functional disability.

Efficacy of spinal manipulations and Schroth exercises on psychological parameters in patients with functional scoliosis: a randomised controlled trial

Functional scoliosis is defined as the reversible and temporary lateral spinal curvature that mainly occurs due to abnormal postural habits that leads to non-structural and compensatory changes in spine. Functional scoliosis can lead to the development of mental health issues, such as stress, anxiety and depression. The purpose of the present study was to evaluate the effects of spinal manipulation techniques and Schroth exercises on psychological parameters in patients with functional scoliosis. The subjects were randomly allocated into experimental (n=31) and control group (n=31). Spinal manipulation techniques and Schroth exercises were given to the patients of experimental group, while only Schroth exercises were given to the patients of control group. Outcome measures were Depression, Anxiety &amp; Stress Score that was examined by using ‘DASS-21 questionnaire’. Treatment was given for four weeks, thrice weekly. After the completion of four weeks, DASS scores were obtained from the participants. Patients were followed up after 2 months and data was collected again. Repeated measures ANOVA were used to compare the mean changes within-group. Independent t-test was used to analyse the mean improvement between-group. Results suggested that there was a statistically significant difference between pre-/post and pre-/follow-up scores of the DASS, but there was statistical non-significant difference between post-/follow-up scores of the DASS. Results also suggested that experimental group showed better improvement compared to the control group. This study concluded that the combine use of spinal manipulation techniques and Schroth exercise protocol can significantly reduce the psychosomatic symptoms in functional scoliosis. Clinical Trial Registry of India: CTRI/2020/02/023221

Evaluation of Neck Pain and Posture of Cervical Spine among Helmet Users Riding Motor Bike

Background: Helmet use is become mandatory by the Indian govt. in the year of 2016. After the helmet law the prevalence of helmet users increased up to 80%. Other 20% populations refused to wear helmet while riding due their own reasons such as some founds wearing of helmet causing suffocating, heaviness over neck muscles or some feels headache too. Among various postural disorders, forward head posture (FHP) has found to be commonest. It occurs when position of the head is forward to a plumb line passing over the centre of gravity. The good posture could be present, as the external auditory meatus allied with the plumb line. FHP can be assessed by using various assessment methods and Cranio-vertebral angle (CVA) method is highly reliable method to measure FHP, which indicates smaller the angle greater the FHP. The aim of the study was to evaluate the postural changes in cervical spine and presence of neck pain among helmet users riding motor bike. Method Total 300 subjects participated in the study and were assessed by self- made questionnaire, out of which 260(Male= 189, Female= 71) subjects were taken in the study as they were fulfilling the inclusion criteria. Then dividing them into two groups based on complaining of pain on neck (with neck pain and without neck pain) using Numeric pain rating scale (NPRS). CVA was measured using MB-Ruler software for both the groups. Result The results shows CVA has a significant correlation with helmet weight (p value=0.000), BMI (p value=0.04), years of riding (p value=0.037) and days of riding per week (p value=0.031). NPRS showed to have significant correlation with helmet weight (p value=0.046) and weight of the bag (p value=0.012). 45% of study populations were having FHP and 66% populations were having neck pain. Conclusion The study concludes that helmet weight has significant impact on both neck pain and forward head posture. The incidence rate of forward head posture was greater among with neck pain populations.

CHRONIC CEREBRAL VENOUS DYSFUNCTION SYNDROME AND DEGENERATIVE-DYSTROPHIC CHANGES OF THE CERVICAL SPINE: ANATOMO-PHYSIOLOGICAL UNDERSTANDING OF COMORBIDITY

Aim: to investigate the features of CS DDC in patients with CCVDS in comparison with patients without clinical signs of chronic venous cerebral dysgemia, to substantiate comorbidity.&#x0D; Material and methods. In compliance with ethical norms, 2 groups of patients were examined: 125 patients have CCVDS and different levels of blood pressure (98 women, 27 men, average age 53.60±10.27ys), 28 similar patients, but without CCVDS (17 women and 11 men, 52.54±10.03 years old). General clinical and clinicalneurological examination, clinical assessment of the hypoglossal veins condition, MRI of the cervical spine, X-ray functional tests, MedStat programs.&#x0D; Results. The main group patients had a mixed headache, stiffness, limitation of movements and pain in the CS, irradiation in the upper limb aggravated by movements and forced positions; paresthesias and arm pain, which were significantly different from the control group except for tension headache. A significant difference in cerebral complaints – dizziness, transient visual and hearing impairments (&lt;0.001). Limitation of mobility in the CS up to 30-45 degrees, tension, compaction and tenderness of the paravertebral muscles during palpation, usually asymmetric, expansion and fullness of the sublingual veins of patients in the main group were significantly different from the indicators of the control group (&lt;0.001). According to the MRI and X-ray spondylography, the patients of the main group had structural changes in the spinal cord significantly worse than the control group (&lt;0.001).&#x0D; Conclusions. Patients with CCVDS had significantly worse clinical, structural and dynamic changes in the cervical spine, which were significantly different from the indicators of patients without chronic brain venous dyshemia (&lt;0.001). DDC of the cervical spine should be considered a significant comorbid factor of chronic cerebral venous blood flow disorders, which can be explained by anatomical and physiological dependences.

Motorized Robotic Closed Cervical Traction: Biomechanical Proof of Concept.

Biomechanical study. To demonstrate that robotic cervical traction can apply closed cervical traction as effectively as manual weight-and-pulley traction in extension spring and cadaveric models. Closed cervical traction is used to reduce subaxial cervical spine dislocation injuries and to distract the intervertebral space during cervical spine surgery. Weight-and-pulley cervical traction relies on cumbersome and imprecise technology without any safeguard to prevent over-traction or weights being pulled/released inadvertently. A prototype robotic traction device was designed and manufactured by the authors with real-time tensile force measurement, ±1-lbs (5 N) force application accuracy, locking/non-backdriveable linear actuators with actuator position sensing, 200-lbs (900 N) maximum force capability, up to 20° of flexion/extension manipulation, <25-lbs (111 N) device weight, and compatibility with Gardner-Wells tongs or Mayfield head clamp. The device was tested using an extension spring model and an intact fresh cadaver specimen to assess applied and desired force over time and radiographic changes in the cervical spine as traction force increased. The cadaver was tested in manual traction initially and then robotic traction in 10-lbs (50 N) increments up to 80-lbs (355 N) to compare methods. The prototype device met or exceeded all requirements. In extension spring testing, the device reached the prescribed forces of both 25-lbs (111 N) and 80-lbs (355 N) accurately and maintained the desired weight. In cadaveric testing, radiographic outcomes were equivalent between the prototype and manual weight-and-pulley traction at 80-lbs (355 N; disk space measurements within ±10% for all levels), and the device reached the desired weight within±1-lbs (5 N) of accuracy at each weight interval. This preliminary work demonstrates that motorized robotic cervical traction can safely and effectively apply controlled traction forces.

Flavonoids from Citrus paradise cv. Changshan-huyou exerts protective effect on ischemia-induced cerebral injury in mice via inhibiting RhoA-ROCK2 signaling pathway.

To investigate the protective effect and mechanism of total flavonoids from Citrus paradise cv. Changshan-huyou extracts (TFC) on oxygen-glucose deprivation (OGD) of primary neurons and chronic ischemia-induced cerebral injury in mice. Primary hippocampal neurons of 18-day fetal rats were isolated and cultured for 1 week, then treated with 0.25, 0.50 and 1.00 mg/mL TFC. After oxygen-glucose deprivation for 1 h, cells were reperfused for 6 and 24 h, respectively. The cytoskeleton was observed by phalloidin staining. In animal study, 6-week ICR male mice were randomly divided into sham operation group, model group, low-dose (10 mg/kg), medium-dose (25 mg/kg) and high-dose (50 mg/kg) TFC treatment groups, with 20 mice in each group. After 3 weeks, chronic cerebral ischemia was induced by unilateral common carotid artery ligation in all groups except sham operation group. Mice were treated with different concentrations of TFC in the three TFC treatment groups for 4 weeks. Open field test, novel object recognition test and Morris water maze test were used to evaluate anxiety, learning and memory of these mice. Nissl, HE and Golgi stainings were used to detect neuronal degeneration and dendritic spine changes in the cortex and the hippocampus. The expression levels of Rho-associated kinase (ROCK) 2, LIM kinase (LIMK) 1, cofilin and its phosphorylation, as well as the expression of globular actin (G-actin) and filamentous actin (F-actin) protein in hippocampus of mice were detected by Western blotting. Neurons subjected to OGD showed that neurites displayed shortening and breakage; while treatment with TFC reversed OGD-induced neurite injury, especially in the 0.50 mg/mL TFC group. Compared with the sham operation group, the mice in the model group showed a significant decline in anxiety and cognitive ability (P<0.01), whereas treatment with TFC significantly reversed anxiety and cognitive deficits (P<0.05). Improvement in the medium-dose TFC group was the most obvious. Histopathological analysis indicated that the number of Nissl bodies and dendritic spines in hippocampus and cortex were decreased in the model group (all P<0.01). However, after treatment with medium dose of TFC, the number of Nissl bodies and dendritic spines (all P<0.05) was significantly recovered. Compared with the sham operation group, the phosphorylation level of ROCK2 in the brain tissue of the model group was significantly increased (P<0.05), while the phosphorylation levels of LIMK1 and cofilin were significantly decreased (P<0.05), and the relative content ratio of G-actin/F-actin was significantly increased (P<0.05). After administration of TFC, the phosphorylation level of ROCK2 in brain tissue of each group was significantly decreased (P<0.05), while the phosphorylation levels of LIMK1 and cofilin were significantly up-regulated (P<0.05) and the relative content ratio of G-actin/F-actin was significantly decreased (P<0.05). TFC protects from ischemia-induced cytoskeletal damage, reduces neuronal dendritic spine injury and protects mice against chronic cerebral ischemia through RhoA-ROCK2 signaling pathway, indicating that TFC might be a potential candidate for treatment of chronic ischemic cerebral injury.