Degenerative Changes Of Spine Research Articles

A study of comparison between pre procedural ultrasound and real time ultrasound for spinal spaces

Background: Use of thoracic epidurals for intra‑ and post‑operative analgesia for open abdominal surgeries has exponentially increased over the last decade. Spinal anaesthesia is used a landmark – guided midline approach, in these absent, indistinct or distorted in the presence of obesity, previous spinal surgeries, deformities, or degenerative changes associated with ageing. In the present study evaluates the efficacy of real‑time ultrasound (RUS)‑guided paramedian approach, and pre‑procedure ultrasound (PUS) landmark‑guided paramedian approach in obese persons. Methods: This is a Prospective Randomized Double-Blind Study conducted in Akash Institute of Medical Sciences and Research centre. Total 50 subjects (Group A – 25, Group A – 25). All the subjects included after informed consent, Along with Chest X- ray and ECG-for patients over 40 years of age. The primary end point was to attain a successful lumbar puncture. Variables like the number of attempts, the number of passes, the time taken for identifying landmark(s), and time for a successful lumbar puncture(s) were secondary end points and were recorded in both the groups. Results: This study was evaluated In real‑time ultrasound (RUS)‑guided paramedian approach, and pre‑procedure ultrasound (PUS) landmark‑guided paramedian approach in obese patients. There is a statistically high significant difference in PUS group than RUS Group. A P value < 0.002 is the statistically in between 2 groups. Conclusion: the space identification and number of attempts, passes and time consuming in pre procedure ultrasound when compared to real time ultrasound. This study suggest real time ultrasound is good for identification of space.

Asymptomatic Degenerative Changes in the Lumbar Spine Among Professional Soccer Players.

Cross-sectional study. The aim of this study was to evaluate the actual prevalence of degenerative spinal changes and their association with age in a cohort of professional soccer players. Presently, there are data that athletes have more degenerative changes than nonathletes; however, the research examining the prevalence of degenerative spinal conditions among professional elite soccer players is scarce. Professional male soccer players were included in the study (n = 40, average age 26,6 ± 4,5 years, average height 18 ± 0.07 m, weight 76.7 ± 7.1 kg). Lumbosacral spine MRI scanning at the L1-S1 level has been performed. Two radiologists with at least 7 years of experience of working with athletes evaluated all images independently of each other. 92.5% (n = 37) of soccer players had ≥1 spinal degenerative condition. Thirty-five percent (n = 14) of players had three to five, and 50% (n = 20) had six or more conditions. The average age of players who had six or more conditions was significantly higher than those who had zero to five or three to five conditions-28.1 ± 4.8 years versus 25.1 ± 3.6 years (P = 0.029), and 24.8 ± 3.6 years, respectively.Kruskal-Wallis test has shown no association between the number of degenerative conditions and weight (P = 0.98) as well as body mass index (P = 0.99). The age was associated with degenerative changes (P = 0.008).Disc desiccation was the most common pathologic condition, which was found in 82.5% of athletes. Facet joint arthropathy and spondylosis were present in 70, and 50% of the studied lumbar spine MRI scans, respectively. The spondylolysis prevalence of 20% was noted. Elite professional soccer players demonstrate a high prevalence of asymptomatic degenerative lumbar spinal degenerative changes, which are significantly associated with age. These conditions might lead to the development of symptomatic lower back pain, given the high-intensity exercise required in professional soccer. It is presently unclear what measures might be applied for the primary prevention of these degenerative spinal conditions.Level of Evidence: 4.

Spinal changes after craniospinal irradiation in pediatric patients.

To evaluate long-term degenerative changes in bone and soft tissue after craniospinal irradiation (CSI). An analysis was performed for 892 vertebral bodies in 220 pediatric patients treated with CSI. To analyze vertebral growth, vertebral body height was calculated. Signal changes for vertebral bodies on MRI, scoliosis and kyphosis, degenerative changes of vertebral bones and discs, and wedging or vertebral height loss were analyzed on images, and factors that influenced these changes were investigated. Vertebral growth was significantly correlated with radiation dose and growth hormone (GH) deficiency. Growth rate was significantly worse at a dose >39Gy. Fatty marrow change was found in 83% of patients, 31% had disc degenerative changes, 13% had degenerative changes of spinal bones, 17% had wedging or spinal height loss, and 27% had scoliosis. Vertebral bone growth was significantly reduced when high doses were administered, and adequate GH replacement was important for bone growth. Even with symmetrical irradiation, the risk of scoliosis is high after CSI. There was also frequent progression of spinal demineralization and degenerative changes after CSI. Therefore, careful attention should be paid to spinal symptoms as pediatric patients grow into adulthood.

Influence of Global Spine Sagittal Balance and Spinal Degenerative Changes on Locomotive Syndrome Risk in a Middle-Age and Elderly Community-Living Population.

Purpose The aim of this study was to describe the characteristics of each locomotive syndrome (LS) risk stage, including global spine sagittal alignment, spinal degenerative changes evident on plain radiographs, low back pain (LBP), muscle strength, and physical ability in middle-aged and elderly people in a health checkup. Methods This study included 211 healthy Japanese volunteers (89 men and 122 women; mean age, 64.0 years) who underwent assessment with both radiographs and Spinal Mouse. Spinal sagittal parameters included thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sagittal vertical axis, and spinal inclination angle (SIA). Lumbar disc height (LDH) and lumbar osteophyte formation (LOF) at each level were evaluated as the spinal degenerative changes. The LS assessment comprised three tests: stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25). The subjects were divided into three groups (no risk, stage 1 LS, or stage 2 LS) according to LS risk test criteria. The prevalence of LBP was investigated with a visual analogue scale (VAS), and physical performances were also compared among the groups. Results Of the participants, 122 had no risk of LS, 56 had stage 1 LS risk, and 29 had stage 2 LS risk. With increasing LS risk stage, the prevalence of and VAS score for LBP increased significantly, and back muscle strength and physical abilities decreased significantly. The TKA did not differ among the three groups. The LLA decreased gradually with LS risk stage (P = 0.0001). At each level except L1–L2 and L5–S1, LDH decreased gradually with LS risk stage. The prevalence of LOF increased significantly with increasing LS risk stage. The SIA increased significantly with LS risk stage (P = 0.0167). Conclusions Participants with LS had higher prevalence of spinal degeneration, small LLA, and global spinal imbalance by anterior spinal inclination.

Compensatory brainstem functional and structural connectivity in patients with degenerative cervical myelopathy by probabilistic tractography and functional MRI

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment in adults. Previous supraspinal investigations have primarily focused on cortical changes in this patient population. As the nexus between the brain and the spinal cord, the brainstem has been understudied in patients with DCM. The current study examined the structural and functional connectivity between the brainstem and cortex in DCM patients using probabilistic tractography and resting-state functional MRI. A total of 26 study patients and 32 neurologically intact, healthy volunteers (HCs) participated in this prospective analysis. The study cohort included DCM patients (n = 18), as well as neurologically asymptomatic patients with evidence of cervical spine degenerative changes and spinal cord compression (n = 8). Results of the study demonstrated significant differences in fiber density (FD), fiber cross-section (FDC), and the functional connectivity (FC) between the study cohort and HCs. Through seeding the brainstem, the study cohort showed reductions in FD and FDC along the corticospinal tract, including regions extending through the corona radiata and internal capsule. By correlating FD and FDC with the Neck Disability Index (NDI), and the modified Japanese Orthopaedic Association (mJOA), we identified increasing total volume of projections to the thalamus, basal ganglia, and internal capsule, and increased functional connectivity to visual network and the posterior parietal cortices. These results support our hypothesis that DCM patients tend to have long-term FC reorganization not only localized to sensorimotor regions, but also to regulatory and visual processing regions, designed to ultimately preserve neurological function.

Pelvic motion the key to understanding spine-hip interaction.

Pelvic motion acting as a hinge between the spine and hips is essential to maintain proper balance during bipedalism. Pelvic rotation is recruited as a compensation mechanism when spinal malalignment occurs.This pelvic rotation can affect functional acetabular orientation, and consequently functional cup positioning if a total hip arthroplasty (THA) is needed. Pelvic retroversion, frequently associated with degenerative spinal changes, implies an increase of acetabular version.Patients with flexible lumbar spines (spine users) protect the hip joint. Patients with stiff, degenerated or fused lumbar spines (hip users) demand higher hip mobility, placing the THA at risk.Pelvises in retroversion place the THA at risk for anterior dislocation when standing. In contrast, pelvises in anteversion or with low pelvic incidence (PI) can place THA at risk for posterior dislocation when sitting.Try to set the cup in an anatomic position. However, bear in mind that low PI pelvises may need more acetabular ante-inclination, and high PI pelvises more acetabular retroversion.If surgery is needed, start first by addressing the hip, except in patients with compensation (high pelvic retroversion), who may need spine surgery first to place the pelvis, and consequently the acetabulum, in a proper position.Cite this article: EFORT Open Rev 2020;5:522-533. DOI: 10.1302/2058-5241.5.200032

Cubital tunnel syndrome masked by spinal osteochondrosis

Cubital tunnel syndrome (CTS) is the second most common compression mononeuropathy that is effectively treated. The risk factors for CTS include repetitive arm flexion at the elbow joint and prolonged arm flexion with support on the elbow. The diagnosis of CTS is based on its clinical presentations, the data of neurological examinations, and the results of electroneuromyography and ultrasound examination. The symptoms of the disease progress quickly, therefore the early diagnosis of CTS and its timely treatment are of great importance for the patient's recovery. Unfortunately, patients with CTS are often observed to be erroneously diagnosed with degenerative and dystrophic spinal changes. The paper presents an observation of effective treatment in a young patient who has been suffering from CTS for a long time and been erroneously diagnosed with spinal osteochondrosis. Six months after surgical treatment (for decompression and neurolysis of the left ulnar nerve), the patient regained hand sensitivity and movement. It is concluded that further investigation is necessary to assess predictors of effective surgical treatment in patients with this disease.

Alkaptonuria presenting as ochronotic spondylo-arthropathy in siblings with low back pain: a case report

Low back pain is one of the commonest symptoms for an orthopaedic consultation. It is also the common first presentation of a rare disorder alkaptonuria. Accumulation of homogentisic acid in connective tissues causes progressive deposition of bluish black pigment causing degenerative changes in ochronotic spine. In this case report, two brothers of Dravidian origin present with alkaptonuria, with clinically more recognizable axial spondyloarthropathy resembling Ankylosing Spondylitis (AS), and the history, clinical presentation, diagnostic techniques, and distinctive diagnosis are reviewed. We suggest for surveillance in clinical practice for this rare, but important cause of back pain. Keywords: Ochronotic Spondyloarthropathy, Alkaptonuria, Familial Ochronosis.

Clinical significance of cervical vertebrae –A review article

A forward head posture has become identity of computer users. The laptops or computer has become essential for most the people. Computers are used for both communication and entertainment purposes, such as messages, music, media, internet access, photos, and games. Since last decade, there has been a rapid increase in the use of computer and mobile phones for communication. Long bending of Neck, forward bending and sitting for long periods in front of computers more prone to degenerative changes in cervical spine. So there is need to focus on the maintenance of health of cervical spine and for that purpose its very essential to know normal anatomy of cervical vertebra, its degenerative changes& clinical significance. The aim & objectives of this study is to compare the literature study and emphasis on the importance of good health of cervical spine. All the relevant material was compiled from Brihatrayi and available commentaries on it. Research articles are also searched from various websites. All the references were collected & analyzed & finally conclusion was drawn. Conclusion of this study is cervical vertebrae play an important role in the maintain posture and if proper precaution not taken it will lead to degenerative changes & forming an ailment.

Постуральные изменения позвоночно-тазового баланса у пациентов с hip-spine синдромом

Relevance It is known that the state of sagittal balance is strictly correlated with the quality of life of the patient. At the same time, reference values for correction of sagittal parameters of the spine are derived only from vertical radiographs. Current evidence shows that the use of only standardized sagittal parameters in the standing position for planning the volume of surgical reconstruction is erroneous. However, rare publications show the difference between the sagittal profile of the spine in the sitting and standing position related to age. There is no information on the profile in extended degenerative pathology of the Aim of the study Comparative assessment of the variability of the parameters of the sagittal profile of patients with Hip-Spine syndrome in the standing and sitting positions and comparison with healthy subjects from the average population. Design A prospective case-control monocenter observational study with historical control. The study included 74 patients with Hip-spine syndrome at the age of 63 ± 9.9 (43 to 83) years at the time of examination. The recruitment period was 23 months. The main group was formed by 74 patients with Hip-Spine syndrome. The control group (58 subjects) was represented by healthy individuals from open sources on the average population. The criteria of the analysis were sagittal vertebral-pelvic parameters of the trunk - CL, TK, TLK, LL, PI, PT, SS, SVA. The calculation of sagittal parameters was performed with Surgimap Spine software. Results In all patients during the transition from standing to sitting, there was kyphotization of the thoracolumbar transition (mean TLK angle was 10.3° – 145 %), a decrease in lumbar lordosis (mean LL angle – 23° – 44.4 %) with pelvic retroversion (PT: 18.6° – 126.5 %, SS: 18.3° – 51.6 %) and an increase in forward SVA deviation (10.5 mm – 25.5 %). No significant changes in cervical lordosis and thoracic kyphosis were revealed. When comparing the average values of sagittal parameters of patients of the main and control groups, there were no significant differences. However, among all patients of the main group, there were 6 patients (8.1 %) in whom the difference in the parameters LL, SS, PT in the standing and sitting positions was less than 10°, which indicates a pronounced rigidity of the lumbosacral Conclusion Postural sagittal vertebral-pelvic parameters of the trunk in the standing and sitting positions in patients with Hip-Spine syndrome differ significantly from each other. A key role in the changes is played by the position of the pelvis, which retains mobility, despite different severity of degenerative changes in the complex hip joints-lumbosacral spine.

Factors Influencing Cervical Spondylosis

Background: Cervical spondylosis is a degenerative disorder of cervical spine prevalent in our population. The disease advances insidiously resulting in worsening with time. This study aims to highlight the factors influencing cervical spondylosis. Methods: The present case control study was conducted at orthopedic OPD (Out Patient Department) and Radiology department of the Patel hospital from September 2018 to February 2019 after acquiring ethical approval from Ethical Review Committee (ERC) of Bahria University Medical and Dental College and Patel Hospital. The study enrolled 88 cases suffering from cervical spondylosis based on history and clinical examination and 88 controls i.e., healthy attendants. The radiography of cervical spine was used to assess degenerative changes of cervical spine. They were asked basic history entailing age, gender, working hours, nature of job, use of computers, mobiles. The independent t-test was used for comparison between these variables, and Fischer exact test and Chi square test was employed to find association between them. Results: The study revealed a significant preponderance of females (56.8%) with shorter stature (159.14±8.88) in patients. There was a predilection for cases in outdoor workers (44.3%) and homemakers (43.2%) as well as increased working hours (73.9%). The mobile use had a significant impact (59.1%) on disease. Conclusion: Considering factors like Middle Ages, females, short stature, obesity, outdoor workers and house workers with increased working hours and use of mobiles for more than 4 hours can influence development of cervical spondylosis. One can intervene in the progression of disease by adopting healthy lifestyle to prevent it.

Reversal of Degenerative Changes in Cervical Spine Following Bipolar Release in a Neglected Case of Congenital Muscular Torticollis: A Case Report

Background & Importance: Congenital Muscular Torticollis (CMT) is a common cause of torticollis in children. Despite the easy diagnosis, rare cases may be neglected and untreated during the management of the patients, which can not only impose cosmetic problems for them but also affect the cervical spine with accelerated degeneration. Most patients with CMT can be managed non-surgically with medical and physical therapies but surgery is indicated in some cases when non-surgical attempts are unsuccessful. Case Presentation: Herein, we are reporting a 16-year-old female with neglected CMT, and neck pain secondary to severe degenerative changes. We believe that neglected and untreated CMT cases may present with accelerated spine degeneration and surgical intervention should be considered promptly to reverse this process. Conclusion: Surgical intervention not only produces good cosmetic results but also reverses the degeneration process and protects the patient from disabling deformities later in life.

Lumbosacral transitional vertebrae are associated with lumbar degeneration: retrospective evaluation of 3855 consecutive abdominal CT scans

ObjectivesTo assess the prevalence of lumbosacral transitional vertebra (LSTV) and associated spinal degenerative changes on abdominal CT scans in Caucasian population.Material and methodsA total of 3855 abdominal CT scans of the year 2017 from a single hospital were retrospectively assessed for LSTV, disc degeneration (DD), and facet joint degeneration (FD). An age- and sex-matched 150-subject control group without LSTV was picked at random. Multivariable logistic regression was used for the analysis.ResultsLSTV was found in 1101 (29%) scans: Castellvi type I in 68%, type II in 16%, type III in 13%, and type IV in 3% of scans. Age- and sex-adjusted prevalence of DD was significantly higher in Castellvi type II and III groups at multiple lumbar levels, and in IV group at L4/5 than in control group (p < 0.001–0.034). At L5/S1, the prevalence of DD was significantly higher in the control group than in type II, III, or IV groups (p < 0.001–0.017). After combining Castellvi types II, III, and IV into one group, significant differences were found at all lumbar levels except L2/3 (p < 0.001–0.016). Prevalence of FD was significantly higher at L4/5 in Castellvi groups I, II, and III than in the control group (p < 0.001–0.002). When Castellvi types II, III, and IV were combined into one group, significant differences were found at lumbar levels L2/3, L3/4, and L4/5 (p < 0.001–0.021).ConclusionLumbosacral vertebrae of Castellvi types II, III, and IV are associated with greater lumbar degeneration, warranting meticulous evaluation of spinal anatomy, even on CT.Key Points• Lumbosacral transitional vertebra is a common incidental finding on abdominal CT scans with a high prevalence of 29%.• When assessing whole lumbar spine, lumbosacral vertebrae of Castellvi types II, III, and IV were associated with greater lumbar degeneration, warranting careful evaluation of the lumbar spine on abdominal CT scans.

Role of radiologic imaging complex in morpho-pathogenetic approach to sanatorium resort intensity regimen selection in patients with dorsopathies

At the present time for sanatorium treatment of dorsopathies no morpho-pathogenetic principles are based on severity of degenerative spine changes. The choice of treatment modalities is provided according only to clinical signs and the fact of degenerative spine disease presence, in spite of limitations and contradictions to some resort procedures because of their mechanisms and peculiarities of therapeutic effects. Materials and methods. Comparison of complex imaging examination and sanatorium resort intensity regimen medical appointments of 952 patients with dorsopathies was provided depending on morphological pattern and severity of degenerative spine changes. Case histories, sanatorium medical outpatient cards and the results of radiologic imaging (computed tomography, magnetic resonance imaging, spondylography and osteodensitom-etry) were analyzed. Results. Three groups of sanatorium resort therapeutic action intensity (maximal, 376 patients; limited, 493 patients; and minimal, 83 patients) for patients with dorsopathies were established. The most significant morphological criteria of patient distribution into appropriate groups were established, such as bone mineral density state, the presence and severity of spinal osteoarthrosis and spondylolisthesis, vertebral-motor segment stability or instability, vertebral body hemangiomas. The size of intervertebral disc extrusions and grade of disc height decreasing played a secondary role. The value of spondylography, computed tomography, magnetic resonance imaging and dual-energy radioabsorptiometry in determination of these criteria is presented, as far as in imaging algorithm of examination of patients with dorsopathies on the pre-sanatorium stage, with calculation of computed tomography and magnetic resonance imaging sensitivity, specificity and accuracy. Discussion. Forming morpho-pathogenetic approach to sanatorium resort treatment of dorsopathy demands essential application of modern radiologic imaging modalities. The presence, type and severity of degenerative spine morphological changes must be as fundamental as clinical and neurological pattern, affecting sanatorium resort intensity regimen selection and treatment modalities and schemes. In basic cases most advisable radiologic imaging pre-sanatorium examination modality should be computed tomography, but others are also necessary to use when concretely indicated.

MRI-detected spinal disc degenerative changes in athletes participating in the Rio de Janeiro 2016 Summer Olympics games

ObjectiveTo describe the frequency and the distribution of degenerative disc disease (DDD) detected in athletes who underwent spine MRI in the 2016 Summer Olympic Games in Rio de Janeiro.MethodsData on spine MRI examinations from the 2016 Summer Olympics were retrospectively analyzed. We assessed the frequency of DDD of the cervical (Cs), thoracic (Ts), and lumbar (Ls) spine using Pfirrmann’s classification. Grade II and III were considered as mild, grade IV as moderate, and grade V as severe disc degeneration. Data were analyzed according to the location of the degenerative disc, type of sport, age-groups, and gender of the athletes.ResultsOne hundred out of 11,274 athletes underwent 108 spine MRI’s (21 C, 6 T, and 81 L) (53% Females (F), 47% Males (M)). The frequency of DDD was 40% (42% F, 58% M) over the entire spine (28% mild, 9% moderate and 3% severe). There were 58% (12%F, 88%M) of the cervical spine discs that showed some degree of degeneration (44% mild, 13.5% moderate and 1% severe). Athletics, Boxing, and Swimming were the sports most affected by DDD in the Cs. There were 12.5% of the thoracic discs that showed some degree of degeneration, all were mild DDD and were exclusively seen in female athletes. There were 39% (53% F, 47% M) of the lumbar discs with DDD (26% mild, 9% moderate, and 4% severe).ConclusionAthletes who underwent spine MRI during the 2016 Summer Olympic Games show a high frequency of DDD of cervical and lumbar spines. Recognition of these conditions is important to develop training techniques that may minimize the development of degenerative pathology of the spine.

The influence of spinal sagittal balance on acetabular component orientation and its clinical relevance

Total hip arthroplasty (THA) is a well developed technique to which the spatial orientation of acetabular component is crucial. Since the idea of safe zone being proposed, such idea has long been obeyed by hip surgeons but has also been challenged in recent years. This is because post-operative instability could happen even if acetabular components are placed within safe zone . The latest researches have demonstrated that sagittal spinal balance and spino-pelvic mobility can affect the spatial orientation of acetabular components. Factors including spinal degenerative changes, long lumbosacral changes and spinal ankyloses can lead to sagittal spinal imbalance and/or influence spino-pelvic mobility, which subsequently affect pelvic retroversion. Proper pelvic retroversion is a way to compensate for sagittal spinal imbalance and is beneficial to post-operative stability. It is necessary for hip surgeons to rethink safe zone before performing THA and understand spinal balance as well as spinopelvic mobility. The goal is to reduce the rate of dislocation. This review started by introducing the related spinopelvic parameters frequently seen in papers published recently and the definitions of acetabular cup orientations. After the spinal sagittal balance and its compensatory mechanisms session, discussed its clinical relevance, as well as the significance of spinal mobility, in spinopelvic motion under three different postures.

Low back pain – literature review

Low back pain (LBP) is the third most common disorder presenting in the neurology outpatient clinic. It is usually defined as acute (less than 4 weeks), subacute (4–8 weeks) and chronic (more than 12 weeks). It is estimated that lifetime prevalence of up to 84 %. LBP is the most common cause of disability. LBP is divided into musculoskeletal and neurologic low back pain. In 90% of patients under the age of 65 the cause of pain is nerve root compression caused by disk herniation. Although serious spinal pathology is rare (less than 1%), the identification of red flags remains key in the evaluation of patients with LBP. A prior history of cancer, even in the absence of other red flags, has the highest predictive value for detection of malignancy. In conjunction with the history, a careful neurologic examination can help establish the presence and localize the lesion. According to guidelines imaging studies should not be obtained in patients with LBP of less than 6 weeks duration in the absence of red flags. Magnetic resonance imaging is the study of choice in patients with LBP. It allows for optimal visualization of the spinal cord, nerve roots and intervertebral discs. The results of MRI should be interpreted with caution because incidental degenerative spine changes unrelated to the pain are commonly seen in MRI. The main goals of treatment the patients presenting with acute LBP are reduction of pain and preservation of sensory and motor function. In the absence of red flags, for most cases conservative management will be appropriate. Prognosis are favorable, although recurrence rates range from 23% to 80%.

Association of cervical spine signs and symptoms with temporomandibular disorders in adults: a systematic review protocol.

The objective of this systematic review is to assess the evidence of association of cervical spine signs and symptoms with temporomandibular disorders (TMD). This will help to lend credence to mechanisms supporting the association in order to improve care strategies for this condition. The association of cervical spine impairments (in relation to neck posture, cervical spine mobility, muscle tenderness, muscle activity, and neck disability) with TMD has been widely discussed in the literature. Clarification of this relationship is important for health professionals to better assess and treat TMD. Eligible studies will include participants aged 18 years and over, with a diagnosis of TMD from the Research and Diagnostic Criteria for Temporomandibular Disorders or a revised version. Exclusion criteria will be participants with previous temporomandibular joint surgery, history of trauma or fracture in the temporomandibular joint or the craniomandibular system; serious comorbid conditions such as cancer, rheumatic disease, and neurological problems; primary cervical spine disorders such as disc herniation or spinal degenerative changes; or systemic disease such as ankylosing spondylitis. The search for articles will be conducted in the databases PubMed, PEDro, CINAHL, Web of Science, and Embase, without language or time restrictions. Two independent reviewers will review the title, abstract, and full texts of identified studies; select studies against the inclusion criteria; assess the methodological quality of eligible studies using critical appraisal tools; and perform data extraction. Relevant quantitative data will be pooled with statistical meta-analysis, when possible. PROSPERO CRD42019123698.

Difficulties in diagnosing sacroiliitis in young patients

In real clinical practice, back pain in young patients is associated with neurological manifestations of degenerative changes in the lumbosacral spine. However, such complaints may be a manifestation of a lesion of the sacroiliac joint-sacroiliitis, and degenerative changes in the spine may accompany it, but not cause pain. Sacroiliitis is an inflammatory lesion of the sacroiliac joint, which can develop as an independent disease or as a symptom of another nosology. The causes of this pathology are diverse: injuries, long-term overloading of the joint, congenital abnormalities of the joints, infectious or systemic diseases, and tumors. In neurological practice, sacroiliitis is similar to myofascial syndromes and can disguise as degenerative diseases of the spine, so early diagnosis and proper therapy are of particular importance. Awareness of doctors about the features of examination of young patients, the use of neuroimaging techniques (CT, MRI), laboratory diagnostics, will help to improve the results of therapy. Prescription of NSAIDs with a pronounced anti-inflammatory potential will slow down the progression of the inflammatory process.

Magnetic resonance imaging evaluation of degenerative changes of cervical spine

Magnetic resonance imaging evaluation of degenerative changes of cervical spine