Degenerative Changes Of Spine Research Articles

Prevalence of cervical spine degenerative changes in elderly population and its weak association with aging, neck pain, and osteoporosis.

To investigate the prevalence of MRI degenerative findings of cervical spine in elderly Chinese males and females. From a general population sample, cervical spine T2 weighted sagittal MR images were acquired in 272 males (mean age: 82.9±3.83) and 150 females (mean age: 81.5±4.27). Images were interpreted and degenerative changes were classified. Study subjects were divided into younger group (group A, ≤81 years) and older group (group B, >81 years). For neck pain, question was structured as 'during the past 12 months, have you had any neck pain?'. Two hundred and fifty-two males and 134 females also had hip bone mineral density (BMD) measured. 98.1% subjects exhibited at least one degenerative change at one or more vertebral levels. The C5/6 level had the highest overall frequency for degenerative changes. Most of the degenerative changes were more common in females. The older female group had higher prevalence or higher severity of degenerative findings than the younger group. Eleven point four percent of the males and 20.6% of the females reported neck pain, and male subjects with neck pain tended to have slightly higher prevalence of cervical degenerative changes. There was a weak trend that osteoporosis was associated with a higher prevalence of spinal cord high signal and a higher prevalence of spinal canal stenosis. The age-dependence of cervical spine degenerative changes was more notable in females. Subjects with neck pain and subjects with osteoporosis were weakly associated with higher prevalence of cervical degenerative changes.

Upregulation of suppressor of cytokine signaling 3 ameliorates spinal degenerative disease in adolescents by mediating leptin and tumor necrosis factor-α levels.

Spinal degenerative changes may occur following the rapid growth observed in adolescents, causing a reduced quality of life. The suppressor of cytokine signaling (SOCS) is involved in various degenerative diseases. The current study recruited adolescents with spinal degenerative disease (SDD) to identify the effect of SOCS-3 on leptin and tumor necrosis factor-α (TNF-α) levels in this disorder. From January 2010 to January 2016, 120 adolescents (aged 14 to 25) were enrolled in the current study, with 68 diagnosed with SDD and the remaining 52 treated as controls. Nucleus pulposus cells (NPCs) were extracted and cultured in vitro. TNF-α levels in NPCs were determined using flow cytometry. Degenerative NPCs were then transfected with pCR3.1-SOCS-3 and ELISA was performed to determined TNF-α and leptin levels. RT-qPCR was performed to measure the mRNA level of SOCS-3 and leptin in NPCs and western blotting was utilized to detect the protein level of leptin and the extent of leptin receptor phosphorylation. The results revealed that TNF-α levels in degenerative NPCs were higher than those in normal NPCs. The overexpression of SOCS-3 reduced levels of TNF-α and leptin in degenerative NPCs. In addition, the upregulation of leptin increased SOCS-3 levels in a concentration-dependent manner. Furthermore, the expression of the leptin receptor and phosphorylated leptin receptor gradually decreased with increasing leptin concentrations and the level of phosphorylated leptin receptor negatively correlated with SOCS-3 expression. The inductive effect of leptin on the level of SOCS-3 and the inhibitory effect of SOCS-3 on the activity of leptin were identified. The current study demonstrated that SOCS-3 reduces leptin and TNF-α levels in degenerative NPCs from adolescents, indicating its potential role in the development of novel SDD therapies.

The impact of degenerative disc disease on regional volumetric bone mineral density (vBMD) measured by quantitative computed tomography

BACKGROUND CONTEXTIt has been reported that degenerative disc disease (DDD) is associated with higher spinal bone mineral density (BMD) based on previous studies that used dual X-ray absorptiometry (DXA). However, DDD is often associated with proliferative bone changes and can lead to an overestimation of BMD measured with DXA. Trabecular volumetric BMD (vBMD) in the vertebral body measured with quantitative computed tomography (QCT) is less affected by those changes and can be a favorable alternative to DXA for patients with degenerative spinal changes. PURPOSEThe purpose of this study is to investigate the effect of DDD on regional trabecular vBMDs in the vertebral body measured by QCT. STUDY DESIGN/SETTINGCross-sectional observational study at a single academic institution. PATIENTS SAMPLEConsecutive patients undergoing posterior lumbar spinal fusion between 2014 and 2017 who had a routine preoperative CT scan and magnetic resonance imaging (MRI) within a 90-day interval. OUTCOME MEASURESRegional trabecular vBMDs in the vertebral body by QCT. METHODSQCT measurements were conducted in L1–S1 vertebral trabecular bone. Any apparent sclerotic lesions that might affect vBMD values were excluded from the region of interest. The vBMDs of each level were defined as the average vBMD of the upper and lower vertebrae. To evaluate DDD, Pfirrmann grade, Modic grade, total end plate score, and vacuum phenomenon were documented. Univariate regression analysis and multivariate analyses with a linear mixed model adjusted with individual variability of segmental vBMDs were conducted with vBMD as the response variable. RESULTSOf 143 patients and 715 disc levels, 125 patients and 596 discs met our inclusion criteria. Mean vBMD (±standard deviation [SD]) of all levels was 119.0±39.6 mg/cm3. After adjusting for all covariates, Pfirrmann grade was not an independent contributor to vBMD, but the presence of any Modic change (type 1, β=6.8, p≤.001; type 2, β=6.7, p<.001; type 3, β=43.6, p<.001), high TEPS (score 10–12, β=14.2, p<.001), or vacuum phenomenon (β=9.0, p<.001) was shown to be independent contributors to vBMD. CONCLUSIONSOur results showed that the presence of certain end plate lesions (Modic changes and high TEPS) on MRI was significantly associated with increased regional QCT-vBMDs in the vertebral body, but no significant association was observed with disc nucleus pathology, unless it was associated with a vacuum phenomenon. When end plate lesions with Modic changes and high TEPS are present at the measuring level, care must be taken to interpret vBMD values, which might be overestimations even if the trabecular area appears normal.

Multidimensional vertebral endplate defects are associated with disc degeneration, modic changes, facet joint abnormalities, and pain.

The aim of the current study was to investigate the multi-dimensional characteristics of lumbar endplate defects in humans in relation to disc degeneration and other MRI phenotypes as well as their role with pain and disability. A total of 108 subjects were recruited and underwent 3T MRI of the lumbar spine. Structural endplate defects were identified and their dimensions were measured in terms of maximum width and depth, and were then standardized to the actual width of the endplate and depth of the vertebral body, respectively. Both width and depth of all endplate defects in each subject were added separately and scores were assigned on the basis of size from 1 to 3. Combining both scores provided "cumulative endplate defect scores." Disc degeneration scores, Modic changes, disc displacement, HIZ, and facet joint changes were assessed. Subject demographics, pain profile, and Oswestry Disability Index (ODI) were also obtained. Endplate defects were observed in 67.5% of the subjects and in 13.5% of the endplates. All dimensions of endplate defects showed significance with disc degenerative scores, Modic changes, and posterior disc displacement (p < 0.05). Maximum width (p = 0.009) and its standardized value (p = 0.02), and cumulative endplate defect scores (p = 0.004) increased with narrow facet joints. Cumulative endplate defect scores showed a strong positive association with ODI (p < 0.05) compared to disc degenerative scores. Large size endplate defects were strongly associated with degenerative spine changes and more back-related disability. Findings from this study stress the need to assess endplate findings from a multi-dimensional perspective, whose role may have clinical utility. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Efficacy of Physiotherapy in Reducing Back Pain and Improve Joint Mobility in Older Women.

Pain of the spine and large appendicular joints may limit the functional mobility of elderly persons and affect their biological fitness. This paper assesses the effects of comprehensive physical therapy in women with lumbar and cervical pain and compares flexibility in the upper and lower body and the range of motion in selected joints. Thirty-three women aged 60-75 years completed a 6-week intervention involving group gymnastics to prevent back pain, relaxation techniques, classic massage, transcutaneous electrical nerve stimulation, and ultrasound therapy to the lumbosacral and cervicothoracic regions. Patient outcomes were assessed by measuring upper and lower body flexibility, upper and lower extremity joint and spinal ROM, and self-reported back pain using a Visual Analogue Scale. Differences in means between successive measurements were calculated with a Student t test for dependent groups, while differences in the range of motion in the joints of the right and left limbs were calculated with the NIR test. The physical therapy significantly improved flexibility of the upper and lower body by increasing the range of motion in selected joints of the limbs and the spine. On completion of the intervention, the intensity of back pain was reduced by 2.9 points in the VAS scale. 1. The 6-week physical therapy programme desig-ned by us constitutes an effective therapy for pain relief in patients with degenerative changes of the spine. 2. The proposed combination of sonotherapy, elec-tro-therapy and classic massage procedures with general fitness exercises in low positions and au-to-genic training contributed significantly to im-provement in flexibility of the upper and lower part of the body and increasing the range of mo-tion in joints of the lower and upper extremities and the spine in women over 60 years of age. 3. The proposed set of procedures and exercises may be used in women over 60 years of age with the aim of improving selected components of biolo-gical fitness.

A proposal of degenerative anterior epidural cysts of the lumbar spine

Abstract Anterior, benign epidural cysts are a rarely described cause of non discal lumbar radiculopathy. The differentiation between synovial, ganglion, fibrous annulus, posterior longitudinal ligament and disc cysts reflects the fragmentary nature of reports so far and it's probably misleading. A case of ventral L5-S1 synovial cyst is reported and the literature is reviewed. It is proposed that these lesions be all grouped together as anterior epidural degenerative cysts of the lumbar spine on the ground of shared clinical and MRI features and management options along with a common pathogenesis (response to degenerative spinal changes) and histological substrate.

The Percutaneous Endoscopic Lumbar Interbody Fusion (PELIF): An Advanced and Innovation Technique

AbstractThe degenerative spine changes, and its costs, have increased with high rates of work absenteeism and difficult clinical management. The search for minimally invasive treatments, with better results and early patients recover, with rapid hospital discharge are alternatives for these problems. The percutaneous endoscopic lumbar interbody fusion (PELIF) is a new and advanced option.

Magnetic-resonance imaging under degenerative changes in lumbar spine: state of the art

Magnetic resonance imaging (MRI) of lumbar spine is a very frequent examination in any computer tomography unit. However, there are still no scan standards or standards for scan interpretation in the world's medical community. In this article based on our experience we describe common problems encountered by a radiologist during MRI examination of lumbar spine and its subsequent description. The literature survey and analysis are presented with a summary of current recommendations. We examined routine sequences, which could be included in MRI protocol, discussed common terminology, and showed the incidence of different pathologies. The special emphasis is made on assessing lumbar canal stenosis. In this article we focus on qualitative and quantitative criteria of lumbar spinal stenosis.

Morphometric Analysis of the Lumbar Vertebrae Concerning the Optimal Screw Selection for Transpedicular Stabilization.

Transpedicular stabilization is a frequently used spinal surgery for fractures, degenerative changes, or neoplastic processes. Improper screw fixation may cause substantial vascular or neurological complications. This study seeks to define detailed morphometric measurements of the pedicle (height, width, and surface area) in the aspects of screw length and girth selection and the trajectory of its implantation, i.e., sagittal and transverse angle of placement. The study was based on CT examinations of 100 Caucasian patients (51 women and 49 men) aged 27-75 with no anatomical, degenerative, or post-traumatic spine changes. The results were stratified by gender and body side, and they were counter compared with the available literature database. Pedicle height decreased from L1 to L4, ranging from 15.9 to 13.3mm. Pedicle width increased from L1 to L5, extending from 6.1 to 13.2mm. Pedicle surface area increased from L1 to L5, ranging from 63 to 140mm2. Distance from the point of entry into the pedicle to the anterior surface of the vertebral body, defining the maximum length of a transpedicular screw, varied from 54.0 to 50.2mm. Variations concerning body sides were inappreciable. A transverse angle of screw trajectory extended from 20° to 32°, shifting caudally from L1 to L5, with statistical differences in the L3-L5 segments. A sagittal angle varied from 10° to 12°, without such definite relations. We conclude that the L1 and L2 segments display the most distinct morphometric similarities, while the greatest differences, in both genders, are noted for L3, L4, and L5. The findings enable the recommendation of the following screw diameters: 4mm for L1-L2, 5mm for L3, 6mm for L4-L5, and the length of 50mm. We believe the study has extended clinical knowledge on lumbar spine morphometry, essential in the training physicians engaged in transpedicular stabilization.

Death by hanging: a retrospective case-control investigation of the intervertebral disc vacuum phenomenon on PMCT.

During hanging gravitational forces affect the spine. Intervertebral vacuum phenomenon (VP) implies that gas accumulations in the discs are caused by degeneration of the spine and trauma. It was hypothesized that VP detected on postmortem computed tomography (PMCT) has a higher incidence in hanging deaths, which can be correlated to age, degenerative spinal changes and type of hanging (complete-incomplete). Secondly, it was investigated whether the presence of Simon's bleedings is related to hanging type and VP on PMCT. A retrospective hanging case-control study of 72 cases was conducted. PMCT data were evaluated by two observers for the presence of VP and its localization within the thoracic and lumbar discs, and for any degenerative changes of the spine. Autopsy protocols were assessed for the presence of Simon's bleedings during autopsy. VP did not statistically differ among hanging and control cases but it was statistically correlated to complete hanging, increasing age and degenerative spinal changes. Centrally located VP within the discs was correlated to hanging, especially complete hanging, and younger ages, contrary to control cases that showed gas at the disc periphery. Simon's bleedings were correlated with complete hanging and centrally located VP. Centrally located VP within the discs increases the probability for complete hanging, while increasing age and degenerative changes reduce this probability. Intervertebral VP is multifactorial radiological entity. The presence of centrally located VP can indicate that hanging could be considered as an alternative mechanism of death and that great forces and loads may have affected the spine perimortem, especially with decreasing age and when Simon's bleedings are present.

Alkaptonuria—an atypical case: multi-modality imaging review

Alkaptonuria is a rare inborn metabolic disorder due to a mutation in the homogentisic acid oxidase enzyme (HGO) gene on chromosome 3q. As HGO is deficient in alkaptonuria patients, there is an accumulation of homogentisic acid in the blood and urine. Homogentisic acid gets deposited in the soft tissues, tendons, cartilages, large joints and intervertebral discs. Ochronosis usually affects the dorsolumbar spine and typically spares the cervical spine and sacroiliac joints. However, in this case of isolated ochronosis, we report co-existent extensive cervical spine degenerative changes and cervical vertebral fusion, which has not been described in the literature so far.

Effect of Vertebral Body Exclusion on TBS and FRAX Calculations

Spinal degenerative changes are common and elevate DXA-measured BMD. However, existing data suggest trabecular bone score (TBS) is relatively unaffected by degenerative changes. Clinically, we observed patients in whom spinal degenerative changes appeared to substantially elevate not only BMD, but also TBS. The purpose of this study was to explore the hypothesis that vertebral body exclusion impacts TBS results and subsequently TBS-adjusted FRAX scores. The reports of DXA scans interpreted by one clinician (NB) over a 4-month time span were reviewed. Vertebral body exclusion was performed following ISCD recommendations. Data collected from those scans with vertebral body exclusion included the L1-4 BMD/TBS and lumbar spine BMD/TBS following vertebral exclusion. FRAX calculations were performed using L1-4 TBS and post-exclusion TBS values and the effect of vertebral exclusion was assessed by T-test. This study was determined exempt by the local IRB. Of 302 patients with TBS, 62 evaluable scans (57 female, 5 male) had vertebral bodies excluded. Patient mean (SD) age, BMI, and lowest T-score, were 71.9 (10.0) years, 24.7 (4.4) kg/m2 and -2.9 (1.1) respectively. Compared to L1-4, mean lumbar spine BMD and TBS declined by 10% and 3.6% respectively with vertebral exclusion (p<0.0001). TBS adjusted FRAX 10-year risk increased by 1% and 0.2% for mean osteoporotic fracture (MOF) and hip fracture respectively (p<0.0001). After vertebral body exclusion 37% of patients shifted into lower TBS categories. Lumbar spine BMD and TBS decline when excluding vertebral bodies per ISCD recommendations. This leads to higher fracture risk estimates using TBS adjusted FRAX. Additionally, a substantial number of patients move into lower TBS categories after exclusion. This study is limited by small sample size; however, these data suggest that vertebral body exclusion may be appropriate with TBS. Further research to determine if vertebral exclusion improves fracture risk prediction is needed.

The Role of Imaging in the Management of Cystic Formations of the Mobile Spine (CYFMOS).

The purpose of this review is to give a better understanding of the pathogenesis of cystic formations of the mobile spine (CYFMOS) and the correlating imaging findings. This would help with medical decision-making, given the plethora of conservative, interventional, and surgical treatment options. There has been a general understanding that CYFMOS are associated with degenerative spine changes. More recent articles however have suggested that identifying detailed imaging characteristics can assist in determining outcomes when CYFMOS are treated with interventional percutaneous methods or surgical decompression with or without concomitant fusion. CYFMOS although uncommon are not a rare finding seen in the spine when there is a background of degenerative spine changes. These cystic lesions are generally symptomatic by exhibiting mass effect on adjacent structure. Most treatments are aimed at decompression by interventional percutaneous or surgical means. Various imaging characteristics of these CYFMOS described in this article including their signal intensity, presence of spinal instability, particular patterns of adjacent degenerative changes, and imaging changes following interventional treatments can help guide physicians when managing these cases.

Effect of vertebral exclusion on TBS and FRAX calculations.

Spinal degenerative changes elevate DXA-measured BMD, but reports find trabecular bone score (TBS) relatively unaffected. However, we observed patients where degenerative changes elevated both. Consequently, this study explored whether vertebral exclusion impacts TBS and subsequently TBS-adjusted FRAX risk. Clinical DXA interpretations of one physician were reviewed; those with vertebrae excluded per ISCD guidance were included in this study. BMD and TBS at L1-4 and from post-exclusion vertebrae were collected and used to adjust fracture risk (FRAX). Of the patients, 102 had vertebrae excluded; their mean (SD) age, BMI, and lowest T-score were 71.6 (9.5)years, 25.4 (4.5)kg/m2, and - 2.8 (1.0), respectively. Compared to L1-4, vertebral exclusion lowered (p < 0.0001) mean spine BMD and TBS by 9.5 and 3.1%, respectively. Vertebral exclusion decreased TBS by 0.040, being lower in 83%. In those with lower TBS, the mean adjusted 10-year fracture risk increased (p < 0.0001) by 0.94 and 0.32% for major osteoporotic (MOF) and hip fracture, respectively, in some risk increased by up to 4%. In those with higher TBS, adjusted risk was reduced, MOF - 0.49% and hip - 0.1%. Vertebral exclusion following ISCD recommendations generally, but not always, lowers TBS. Consequently, the impact on TBS adjusted FRAX risk is variable. In most patients, vertebral exclusion lowers TBS; in some, this could result in a relevant change in calculated fracture risk. It seems reasonable to use TBS values from evaluable vertebrae to adjust FRAX. Further research to determine if vertebral exclusion improves fracture risk prediction is needed.

The UTE Disc Sign on MRI: A Novel Imaging Biomarker Associated With Degenerative Spine Changes, Low Back Pain, and Disability.

Cross-sectional. To assess the distribution of the ultra-short time-to-echo (UTE) disc sign (UDS) and its association with disc degeneration, other magnetic resonance imaging (MRI) phenotypes, pain, and disability profiles. Disc degeneration has been conventionally assessed by T2-weighted (T2W) signal intensity on MRI; however, its clinical utility has been questionable. UTE MRI assesses short T2 components. The authors have identified a new imaging biomarker on UTE-the UDS. One hundred eight subjects were recruited. T2W MRI assessed disc degeneration and other phenotypes, and T1-rho MRI values represented quantitative proteoglycan disc profiles of L1-S1. UDS was detected on UTE (i.e., hyper-/hypointense disc band). A UDS score (cumulative number of UDS levels) and T2W summated lumbar degenerated scores (cumulative disc degeneration score) were assessed. Subject demographics, chronic low back pain (LBP), and disability profiles (Oswestry Disability Index: ODI) were obtained. UDS was noted in 39.8% subjects, 61.4% occurred at the lower lumbar spine and 39.5% had multilevel UDS. UDS subjects had significantly greater severity and extent of disc degeneration, and Modic changes (P < 0.05). By disc levels, a higher prevalence of disc degeneration/displacement, Modic changes, and spondylolisthesis were noted in UDS discs than non-UDS discs (P < 0.05). T1-rho values were also lower in UDS discs (P = 0.022). The majority of UDS could not be detected on T2W. The UDS score significantly correlated with worse ODI scores (r = 0.311; P = 0.001), whereas T2W cumulative disc degeneration score did not (r = 0.13; P = 0.19). LBP subjects exhibited more multilevel UDS (P < 0.015) but not on T2W MRI (P = 0.53). The UDS score was significantly related to LBP (P = 0.009), whereas T2W cumulative disc degeneration score was not (P = 0.127). This is the first study to report "UDS" in humans. UDS is a novel imaging biomarker that is highly associated with degenerative spine changes, chronic LBP, and disability than conventional T2W MRI. 2.

A CLINICAL EFFECT OF AABHADI CHOORNA ON KATISHOOLA W.S.R. TO ASTHIMAJJAGAT VATA - A CASE STUDY

Katishoola is one of the vatavyadhi and it is the commonest disorder found in clinical practice. According to Ayurveda, Katishoola is the diseases with pain in lumber region. Katishoola can be equated with low back pain .The allopathic system of medicine use non-steroidal anti-inflammatory drugs, analgesics, which is not safe and effective for katishoola.&#x0D; A 60 year old male patient had suffering from progressive pain in lower back and difficulty in bending forward over 25 ˚ and tingling sensation in both leg since last 12 months. X-ray of lumbo-sacral region indicated that patient was suffering from reduced L4-L5 intervertebral disc space and bony ankylosis of L4-L5 and degenerative changes in spine. He was taken modern treatment but doesn’t get satisfactory relief even.&#x0D; For Ayurvedic treatment he came at opd of kaychikitsa department of Seth Sakharam Nemchand Jain Ayurvedic Hospital, Solapur. He was treated for 21 days with 3 times treatment follow up. The response of the treatment was recorded and therapeutic effects were evaluated through symptomatic relief. Clinical symptoms were significantly reduced and degree of anterior flexion increased from 25˚ to 90 ˚.&#x0D; This regimen is effective in successfully treating katishoola by helping to reduce the symptoms and improving the degree of anterior flexion.

Frequent Benign, Nontraumatic, Noninflammatory Causes of Low Back Pain in Adolescents: MRI Findings.

Introduction Low back pain (LBP) is common in children and adolescents. There are many factors that cause LBP, including structural disorders, degenerative changes, Scheuermann's disease, fractures, inflammation, and tumors. Magnetic Resonance Imaging is the gold standard for diagnosing spinal abnormalities and is mandatory when neurological symptoms exist. The study focuses on common MRI findings in adolescents with persistent LBP, without history of acute trauma or evidence of either inflammatory or rheumatic disease. Materials and Methods Eleven adolescents were submitted to thoracic and/or lumbar spine MRI due to persistent LBP. The protocol consisted of T1 WI, T2 WI, and T2 WI with FS, in the axial, sagittal, and coronal plane. Results MRI revealed structural abnormalities (scoliosis and kyphosis) in 4/11 (36.36%); disc abnormalities and endplate changes were found on 11/11 (100%). Typical Scheuermann's disease was found in 3/11 (27.27%). Endplate changes were severe in Scheuermann's patients and mild to moderate in the remaining 8/11 (72.72%). Kyphosis was in all cases secondary to Scheuermann's disease. Disk bulges and hernias were found in 8/11 (72.72%), all located in the lumbar spine. Conclusion In adolescents with LBP, structural spinal disorders, degenerative changes, and Scheuermann's disease are commonly found on MRI; however, degenerative changes prevail.

Are Modic Changes Able to Help Us in Our Clinical Practice? A Study of the Modic Changes in Young Adults During Working Age.

Modic changes [vertebral endplate spinal changes (VESC)] have been related to degenerative disk disease, and in past decades it was thought that their presence justified the surgical treatment, in particular spinal fusion. The aim of the present study is to investigate its prevalence and features in a population of young workers suffering from low back pain, and explore the eventual relationship with the treatment applied in each case. We conducted a retrospectively review of 450 magnetic resonance images from our hospital, in patients with low back pain or sciatica and age below 40. Age, sex, symptoms predominance, concurrence with other spine disease, VESC type, evolution, level/s of involvement and placement, affected disk location and extent of the disease, disk height, and status of the endplate were recorded. The applied treatment was divided in groups according to the degree of invasiveness of the procedure. Prevalence of VESC was 13.05% predominant in patients over 30 years, and 100% associated to disk degenerative changes. Most frequent features were: type I (54%), lower lumbar region (98%), along with a decreased disk height (68%), and distortion of the disk endplates (98%, P<0.01). The patients with VESC presented a favorable outcome with conservative treatment, but were more frequently associated with invasive treatment, compared with non-VESC patients (P<0.024). VESC prevalence increases with age, underlying the degenerative causative etiology. Surgical indication should not be stated on the basis of the VESC findings alone, the main factor for indicating surgery depends more on other associated degenerative spinal changes.

Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-IV developmental dysplasia of the hip: classification and management.

There is no consensus about the best method of achieving equal leg lengths at total hip arthroplasty (THA) in patients with Crowe type-IV developmental dysplasia of the hip (DDH). We reviewed our experience of a consecutive series of patients who underwent THA for this indication. We retrospectively reviewed 78 patients (86 THAs) with Crowe type-IV DDH, including 64 women and 14 men, with a minimum follow-up of two years. The mean age at the time of surgery was 52.2 years (34 to 82). We subdivided Crowe type-IV DDH into two major types according to the number of dislocated hips, and further categorised them into three groups according to the occurrence of pelvic obliquity or spinal curvature. Leg length discrepancy (LLD) and functional scores were analysed. Type-I included 53 patients with unilateral dislocation, in which 25 (category A) had no pelvic obliquity or spinal deformity, 19 (category B) had pelvic obliquity with a compensated spinal curvature and nine (category C) had pelvic obliquity and decompensated spinal degenerative changes. Type-II included 25 patients with one dislocated and one dysplastic hip, in which there were eight of category A, 15 of category B and two of category C. Pre-operatively, there were significant differences between the anatomical and functional LLD in type-IB (p = 0.005) and -IC (p < 0.001), but not in type-IA, -IIA or -IIB. Post-operatively, bony LLD increased significantly in types-IB, -IC and -IIB, whereas functional LLD decreased significantly in each type except for IIA. The mean functional LLD decreased from 30.7 mm (standard deviation (sd) 18.5) pre-operatively to 6.2 mm (sd 4.4) post-operatively and the mean anatomical LLD improved from 35.8 mm (sd 19.7) pre-operatively to 12.4 mm (sd 8.3) post-operatively. Pelvic and spinal changes are common in patients with Crowe type-IV DDH and need to be taken into consideration when planning THA, in order to obtain equal leg lengths post-operatively. The principal subdivisions of Crowe type-IV DDH which we describe proved effective in achieving equal leg lengths and satisfactory outcomes. Cite this article: Bone Joint J 2017;99-B:872-9.

АНАЛИЗ КЛИНИКО-СТРУКТУРНЫХ ИЗМЕНЕНИЙ ПРИ ОСТЕОХОНДРОЗЕ ПОЯСНИЧНОГО ОТДЕЛА ПОЗВОНОЧНИКА У ЛИЦ ТРУДОСПОСОБНОГО ВОЗРАСТА

Aim. To assess clinical and anatomical preconditions for relapsing course of lumbar spine osteochondrosis. Material and methods. 71 patients of working age with lumbar spine osteochondrosis were examined. Clinical manifestations, neurological status and magnetic resonance imaging of lumbar spine were analyzed. The analysis took into account gender characteristics and age subgroup. Results. Damage of L3L4 segment was registered in 17 cases (in 3 women and 14 men predominantly of 2 and 3 age subgroup), however all of them had combined character: 9 protrusions (average size – 2.6 ± 0.6 mm) and 8 hernias (average size – 5.6 ± 4.3 mm). Damage of L4L5 segment either isolated or combined is registered in 47 cases out of 71 (in 8 women and 39 men predominantly of 2 and 3 age subgroup): 15 protrusions (average size – 2.9 ± 1.0 mm) and 32 hernias (average size – 6.2 ± 1.8 mm). Damage of L5S1 segment – in 55 cases out of 71 (in 10 women and 45 men predominantly of 2 and 3 age subgroup): 15 protrusions (average size – 2.4 ± 0.8 mm) and 40 hernias (average size – 7.4 ± 2.8 mm). Conclusion. There was a lack of dependence between degenerative changes in L3L4, L4L5, L5S1 segments and age and gender. Statistically significant correlation between degree of spine degenerative changes and severity of clinical manifestations was found.