Degenerative Changes Of Spine Research Articles

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.

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 & 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 & 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.

Association of Hallux Valgus with Degenerative Spinal Diseases: A Population-Based Cohort Study.

Background: Although hallux valgus is known to cause lower-back pain, the association between hallux valgus and spinal degenerative disease remains unclear. Methods: A retrospective cohort study was conducted between 1 January 2000 and 31 December 2015 using data from the Longitudinal Health Insurance Database in Taiwan. After propensity score matching for age, sex, and some potential comorbidities, 1000 individuals newly diagnosed with hallux valgus were enrolled in the study group, while 1000 individuals never diagnosed with hallux valgus served as the control group. Both groups were followed up until 2015 to evaluate the incidence of hallux valgus. Kaplan-Meier analysis was used to determine the cumulative incidence of hallux valgus, while the Cox proportional hazard model was adopted to estimate the hazard ratio (HR) and adjusted hazard ratio (aHR) with 95% confidence intervals (CIs). Results: The incidence densities of spinal degeneration in the hallux valgus and non-hallux valgus groups were 73.10 and 42.63 per 1000 person-years, respectively. An increased risk of spinal degenerative changes was associated with hallux valgus (adjusted HR = 1.75, 95% CI = 1.50−2.05). Age- and sex-stratified analyses showed a significantly higher risk of spinal degeneration in the hallux valgus group. Moreover, sub-outcome evaluations revealed significantly higher risks of spondylosis (aHR = 2.01, 95% CI = 1.55−2.61), intervertebral disorder (aHR = 2.27, 95% CI = 1.62−3.17), and spinal stenosis (aHR = 1.24, 95% CI = 1.47−1.76). There was also an increased risk of spinal degenerative change in those with hallux valgus without surgical intervention (aHR = 1.95, 95% CI = 1.66−2.99, p < 0.001). Conclusions: Hallux valgus was associated with increased risk of degenerative spinal changes and other spinal disorders.

Treating peripheral nerve injury-induced spinal cord degeneration and neuropathic pain with peripherally administrated stem cells.

Treating peripheral nerve injury-induced spinal cord degeneration and neuropathic pain with peripherally administrated stem cells.

The current state of radiodiagnostics of degenerative changes in the lumbar spine (literature review)

Examination of the spine using radiological methods remains the most frequently conducted study in the outpatient practice of almost any radiologist. In most cases, changes in the spine are degenerative and dystrophic in nature. These changes in the spine are the leading cause of loss of activity among adults and the elderly, and cover a wide range of age-related structural changes. It is of great importance to understand the possibilities and limitations of radiological methods of diagnostics. The description of morphological changes observed in degenerative and dystrophic changes requires the use of unified terminology and classifications among clinicians and radiologists.The aim. To present modern concepts in the assessment of degenerative changes of the spine using radiological methods. A description of the standardized international nomenclature of intervertebral disc pathology and current classifications of spinal canal stenosis are presented.Material and methods. For literature search, we used electronic databases MEDLINE (PubMed), eLibrary, EMBASE and Cochrane Library with a selection of sources published from 2000 to 2021. We analyzed the works devoted to the diagnosis of degenerative changes in lumbar spine and to degenerative stenosis.Conclusion. The key to productive communication between physicians is the uniformity or standardization of terminology and definitions used. It is important that the protocol of description, its terms, semantic expressions be uniform and understandable to specialists who are involved in the diagnosis and treatment of the spine. Magnetic resonance imaging is a valuable method in the diagnosis of degenerative changes of the spinal column, but it has its limitations.

스마트 자동차 좌석을 이용한 엉덩이의 동적 균형조절이 코어 등근육 활성도에 미치는 효과

Sitting in a car seat for a long time causes fatigue in muscles such as trapezius and paraspinal muscles, which increases muscle fatigue and tension and eventually causes in degenerative spinal changes and pain. Therefore, the authors attempt to investigate the effect of trapezius and lower back muscle activity changes on whether fatigue may be improved by balancing the buttock contact pressure in the sitting position. The purpose of this study was to assess the electrophysiologic effect of dynamic balance control for the trapezius and lower core back muscles through wireless surface electromyographic evaluation using the smart car seat equipped with an ICT-based air bladder. Surface electromyography (sEMG) was measured for each 32 participant’s trapezius and lumbar back muscles in three phases: 1) initial on standing, 2) seated for 25 minutes without balancing ischial pressure, 3) seated for 25 minutes with balancing ischial pressure, and then sEMG was measured for 1 minute on the standing of three individual phases. In the trapezius and low back muscles, the sEMG value of the three-phase MVIC showed a statistically significant increase in the left side compared to the right side (p0.0001). % MVIC difference increased in unbalanced seating (7.32±0.83) compared to the initial measure (7.24±1.72). However, it decreased with balancing seating(6.73±1.81, p=0.049). There was no statistically significant difference in the overall %MVIC differences between both lower back muscles among three phases (p=0.35), but the balanced seating showed a slightly increased % MVIC difference (p=0.10) in contrast to that of the trapezius. Balanced control of hip pressure using automatic logic control of ICT-based smart car seats has the effect of reducing the left-right difference in muscle activity of upper core muscles compared to that of non-balanced seating. Conclusively, it is believed that the difference in the left and right imbalances in the activity of trapezius can be alleviated through the pressure balance seating at the driver’s seat, and the effect of improving muscle fatigue can be expected. Nevertheless, driving in a sitting position, regardless of balance control, the lower core muscles continue to increase the activity of the lumbar muscles, which inevitably causes pain, discomfort, and fatigue over time. Wireless bio-sensing and balanced seat control using ICT-integrated smart car seats can be used as important application science fields that can improve muscle fatigue and degenerative spinal changes associated with professional workers.

Lumbar Spinal Involvement in Calcium Pyrophosphate Dihydrate Disease: A Systematic Literature Review.

BackgroundCalcium-pyrophosphate-dihydrate-disease (CPPD) is a crystal-induced arthropathy. The lumbar-spinal involvement is rare and often under-diagnosed. This study aimed to report the case of a lumbar spine CPPD involvement and to perform a systematic review of clinical, imaging features of lumbar involvement in CPPD patients, and treatments that have been implemented.MethodsThis systematic review was conducted in accordance with the Preferred-Reporting-Items-for-Systematic-Reviews and Meta-Analyses (PRISMA) guidelines.ResultsOne hundred and sixty-seven articles met the search criteria using electronic databases searches. We retained 28 articles (20 case reports, 2 case series, 1 family survey, 4 retrospective studies, and 1 prospective study) involving a total of 62 patients. The age ranged between 39 and 89 years old. Among patients with lumbar spine CPPD, 32 were women. The duration of symptoms varied between one day and 8 years. The affection has been discovered during back pain in most cases. In 5 studies, the diagnosis was made on histological specimens of patients operated on for another pathology. X-ray showed calcifications in 2 cases. CT-scan detected calcium deposit in 7 cases. MRI showed lesions going from the increased signal of the disk, to calcified or not-cystic lesion of the facet joints, an intramedullary mass mimicking a schwannoma. Histological examination established the diagnosis of CPPD in 21 patients in all studies. Medical treatment included NSAIDs, Colchicine, Interleukin-1-receptor-antagonist, and antibiotics. Surgery was performed on 13 patients and allowed to establish the histological diagnosis.ConclusionIn the case of inflammatory back pain in elderly subjects, without an infectious gateway, diagnosis of CPPD should be considered, especially for patients with a history of spinal surgery or degenerative radiography changes. CT scan is more sensitive than conventional radiographs. The discovertebral biopsy is the Gold-Standard and should be performed whenever the diagnosis was uncertain. Treatment includes the medical and surgical components.

Радиологические результаты поясничного моносегментарного спондилодеза 360° у пациентов с изменениями Modic

Introduction A cascade of degenerative spine changes affects the structures including vertebral endplates and bodies of adjacent vertebrae that can be visualized on MRI imaging as Modic changes. The aim of the study was to assess the role of changes in the endplates and adjacent vertebral bodies in radiological results of monosegmental posterior lumbar interbody fusion (PLIF) in patients with degenerative lesions of the spine. Material and methods The design of the study was a monocenter retrospective comparative cohort study. The radiological results of PLIF performed in combination with transpedicular screw fixation for 122 patients with Modic changes in adjacent endplates and adjacent vertebral bodies were evaluated for interbody fusion, subsidence of interbody implants, segmental angle, interbody space height. The followup period was 1-2 years. Results Complete interbody fusion was seen in 94.4 % of Modic type 0 and in 77.3 % of Modic type II changes. Interbody cage subsidence occurred in 38.9 % Modic type I, 22.7 % in Modic type II, 9.1 % in Modic type III and in 11.3 % Modic type 0 changes. A significant decrease in the segmental angle was found in all types of Modic changes (p &lt; 0.05) at 1-2 years with the greatest decrease noted in Modic type I (p = 0.000438). A significant decrease in the interbody space height was noted in all groups (p &lt; 0.05) with the greatest decrease seen in Modic type I changes (p = 0.000438) and the minimum decrease noted in Modic type III changes (p = 0.000438). Discussion The role of the endplates and adjacent vertebral bodies in the results of surgical treatment was evident, and more research is needed to explore the sort of this relationship. Conclusions Modic changes in the endplates and adjacent red bone marrow showed a significant relationship with the radiological outcomes of monosegmental PLIF. The interbody fusion Tan grade I and Tan grade II was more common for Modic type 0 and less common for Modic type II changes. Subsidence of interbody implants was more common for Modic type I and less common for Modic type III changes (9.1%). Postoperative loss of interbody space height and segmental correction was common for Modic type I.

Fibrocartilaginous embolism: a rare cause leading to spinal cord infarction?

Fibrocartilaginous nucleus pulposus components herniation and embolism rarely causes acute ischaemic events involving the spinal cord. Few reports have suggested this as a mechanism leading to anterior spinal artery syndrome. The purpose of this study was to evaluate the topography and pattern of this rare myelopathy by MRI. A retrospective observational case series of patients, admitted to our Institute between 2008 and 2021, with a diagnosis of fibrocartilaginous embolism based on typical clinical and radiological features. Five patients were identified (2 men and 3 women; range 13-38years). No one had pre-existing vascular risk factors. All referred potential precipitating event in the 24h prior to symptom onset. MRI findings showed increased signal intensity of the spinal cord on T2-weighted images in all cases and degenerative disc changes opposite to it in four of them. The outcome was poor: three showed only partial sensitivity and motor improvement (mRs 4, 3, and 2, respectively); one completely recovered except for isolated hand paresis (mRs 1); and one remained severely neurologically affected (mRs 5). Fibrocartilaginous embolism must be a differential diagnosis in case of otherwise unexplained spinal cord infarction in adult and paediatric low risk population. Neuroradiological findings such as abnormal spinal cord signal intensity and degenerative disc changes can aid in early diagnosis of this rare myelopathy. The prevalent myelopathy location was thoracic. All signal alterations were detected in the anterior region of the spinal cord in the territories of the anterior spinal artery.

The Likelihood of Wound Complications Following the Use of Rivaroxaban as a Thrombo-Prophylactic Agent in Patients Undergoing Spinal Canal Stenosis Surgery: A Case Series

Background: Wound complications are major morbidities after orthopedic surgery, and thrombo-prophylactic drugs may increase the likelihood of such complications. In this regard, our study has evaluated the possible effects of rivaroxaban on wound complication issues following spinal canal stenosis surgery.&#x0D; Methods: This prospective cohort study was conducted on 40 patients suffering from spinal canal stenosis secondary to degenerative lumbar spine changes. The eligible patients included those patients receiving rivaroxaban to prevent thrombo-emboli post-operatively. The patients were followed up for three months and assessed for postoperative wound-related complications.&#x0D; Results: None of the patients suffered vascular and thromboembolic complications. Regarding wound complications, these events are mostly limited to the first week post-operatively, including wound dehiscence in 5.0%, serosanguineous discharge in 25.0%, erythema in 35.0%, superficial infection in 10.0%, requiring surgical debridement in 5.0%, cellulitis in 10.0%, and wound induration in 30.0%. Deep infection or hematoma was not reported in our patients. Erythema and wound induration remained 10.0% and 15.0% within the second week, respectively. The hypertrophic scar was a delayed complication that appeared in 15.0% of patients within 1 to 3 months post-operatively.&#x0D; Conclusion: The main risk profiles related to wound complications, especially infections, were a history of hypertension (HTN), uncontrolled diabetes mellitus (DM), and renal insufficiency. The use of rivaroxaban may be accompanied by temporary and minor wound complications and not with potentially debilitating morbidity in patients undergoing spinal canal stenosis surgery. Therefore, its prescription as a safe thrombo-prophylactic drug in patients undergoing spinal canal stenosis surgery is confidently recommended.

49 DCM-Related Degenerative Spinal Changes in the Healthy: Meta-Analysis &amp; Comparison to a Symptomatic Cohort

Abstract Aim Degenerative cervical myelopathy (DCM) is a progressive cervical spinal cord injury brought about by mechanical stress from degenerative changes in the cervical spine. It is typically diagnosed on clinical symptoms, examination findings together with MRI findings. The objective was to determine the significance of category of degenerative pathology (identified in Nouri et al, 2017) to onset of DCM, by comparing symptomatic and asymptomatic populations. Method A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines, cognizant of their adaptation for epidemiological studies. A search strategy was used to identify original research carrying out MRI screening of cervical spines of asymptomatic patients in MEDLINE and Embase from 1985 to the present day. Results The search yielded a total of 1,098 studies of which 17 were included in this meta-analysis, covering a total of 5,059 patients. Ossification of posterior longitudinal ligament (pooled asymptomatic prevalence of 0.4%), enlargement of ligamentum flavum (pooled asymptomatic prevalence of 11.8%) and degenerative multilevel disc pathology (pooled asymptomatic prevalence of 64.5%, I2 100%) were found to be significantly lower in asymptomatic populations (factor of 25 times, 4 times and 1.5 times respectively), and thus associated with DCM. Conclusions Ossification of posterior longitudinal ligament and enlargement of ligamentum flavum were found to be markedly lower in asymptomatic populations, possibly significantly implicating ligamentous pathology in the onset of DCM. Understanding the natural history of DCM is a recognised research priority, and whilst these perspectives require further evaluation, they may be of significance to the evolving biomechanical understanding of the disease.

Pharmacogenetic profiling and individualised therapy in the treatment of degenerative spinal conditions.

Patients presenting with degenerative spinal changes are often poor surgical candidates due to associated co-morbidities, frailty, or sarcopenia. Additionally, surgeries of a degenerative spine can prove difficult due to the distortion of normal surgical anatomy. Therefore, many patients are managed conservatively with a variety of modalities, including over-the-counter and prescription medications. Nevertheless, several patients do not experience adequate relief from pain with analgesic medications, precipitating multiple hospital visits, and usage of resources. As a result, back pain is regarded as a major economic burden, with total costs of associated treatment exceeding $100 billion annually. Pharmacogenetics is a relatively novel method of evaluating an individual's response to analgesic medications, through analysis of germline polymorphisms. It entails obtaining a genetic sample, often via buccal swab or peripheral blood sample, and genetic analysis achieved through either polymerase chain reaction +/- Sanger sequencing, microassays, restriction length fragment polymorphism analysis, or genetic library preparation and next generation sequencing. The potential efficacy of pharmacogenetic analysis has been highlighted across several specialities to date. However, a paucity of evidence exists regarding spine surgery populations. Nevertheless, regular prospective pharmacogenetic analysis may ultimately prove beneficial when concerning degenerative spinal cohorts due to aforementioned surgical and economic considerations. The purpose of this narrative review is to outline how metaboliser profile variants affect the pharmacokinetics of specific analgesia used to treat back pain, and to discuss the current potential and limitations of employing regular pharmacogenetic analysis for spine surgery populations with degenerative conditions.

Degenerative changes of lumbar spine and their clinical implications in patients with axial spondyloarthritis.

The objective of this study was to assess degenerative changes (DCs) on magnetic resonance imaging (MRI) of lumbar spine in axial spondyloarthritis (axSpA) and non-specific mechanical low back pain (mLBP). Patients were consecutively recruited and all underwent MRI of the lumbar spine in this cross-sectional study. Disk degeneration (DD, Pfirrmann classification), endplate changes (Modic, types 1, 2, and 3), annular fissure, disk bulging, and protrusion or extrusion at each lumbar spinal level were assessed using anonymized images. Patients with axSpA were assessed for disease activity, functioning, and quality of life. Univariate and subsequent multivariate logistic regression analyses with adjustments of various covariates were used to assess association between MRI findings and clinical variables. One hundred twenty-three patients had non-radiographic (nr-axSpA) and 144 had radiographic axSpA/ankylosing spondylitis(AS). Degenerative changes were more prevalent in patients with mLBP (n = 105) than axSpA. Disk degeneration was the most prevalent MRI finding, followed by annular fissure, disk herniation (protrusion or extrusion), and Modic changes (MCs) in axSpA. Disk herniation was more prevalent in patients with nr-axSpA compared to AS. Modic changes (OR = 6.455), lumbar disk herniation (OR = 2.278), annular fissure (OR = 2.842), conventional synthetic or biologic disease-modifying antirheumatic drugs (csDMARDs) non-users (OR = 2.225), and advanced age (OR = 31.556) were factors associated with an increased risk of DD in axSpA. Coexisting DD increased the burden of disease in axSpA. A considerable proportion of patients with axSpA had DD at the lumbar spine. These degenerative changes might explain some of the complaints and should not been overlooked in patients with axSpA. Key Points • Lumbar herniated nucleus pulposus (LHNP) is more frequent in nr-axSpA while MC is more frequent in AS. • DD may cause an increase in BASFI and BASMI scores in axSpA. • Spinal DCs might be an alternative explanation for low back complaintsand should not been overlooked in patients with axSpA.

Current understanding of tandem spinal stenosis: epidemiology, diagnosis, and surgical strategy.

Tandem spinal stenosis (TSS) is defined as the concomitant occurrence of stenosis in at least two or more distinct regions (cervical, thoracic, or lumbar) of the spine and may present with a constellation of signs and symptoms. It has four subtypes, including cervico-lumbar, cervico-thoracic, thoraco-lumbar, and cervico-thoraco-lumbar TSS. The prevalence of TSS varies depending on the different subtypes and cohorts.The main aetiologies of TSS are spinal degenerative changes and heterotopic ossification, and patients with developmental spinal stenosis, ligament ossification, and spinal stenosis at any region are at an increased risk of developing TSS.The diagnosis of TSS is challenging. The clinical presentation of TSS could be complex, concealed, or severe, and these features may be confusing to clinicians, resulting in an incomplete or delayed diagnosis. Additionally, a consolidated diagnostic criterion for TSS is urgently required to improve consistency across studies and form a basis for establishing treatment guidelines.The optimal treatment option for TSS is still under debate; areas of controversies include choice of the decompression range, choice between simultaneous or staged surgical patterns, and the order of the surgeries.The present study reviews publications on TSS, consolidates current awareness on prevalence, aetiologies, potential risk factors, diagnostic dilemmas and criteria, and surgical strategies based on TSS subtypes. This is the first review to include thoracic spinal stenosis as a candidate disorder in TSS and aims at providing the readers with a comprehensive overview of TSS.

Whose team do you ski for? The simultaneous presence of Klippel-Feil syndrome and diffuse idiopathic hyperostosis mimics clinical presentation of advanced ankylosing spondylitis.

Introduction: Klippel-Feil syndrome (KFS) is a congenital fusion of two or more cervical vertebrae. Diffuse idiopathic hyperostosis (DISH) is a disorder in which there is calcification of ligaments and tendons, primarily of the spinal column. The simultaneous occurrence of DISH and ankylosing spondylitis (AS) has seldom been described in the literature. Coexistence of KFS and DISH clinically resembling “skier’s posture” of the advanced AS, to the best of our knowledge has never been described before in literature. Case Report: 59-years old male was examined by rheumatologist due to inflammatory back pain and prolonged morning stiffness in spinal joints. He had “skier’s posture” which could be clinical sign of advanced axial disease in AS. Functional measurements had also spoken in favor of spondyloarthropathy. Spinal joints radiography described 2nd and 3rd cervical vertebral fusion along with prominent osteophytes and dorsal spine hyperostosis. Sacroiliac joints had no inflammatory or degenerative radiographic changes. Hip joints ultrasound excluded synovitis and effusion. Conclusion: Patient has two joint diseases, resulting in severe spinal degenerative changes, together resembling clinical presentation of advanced AS.

Sacralisation-Changing Concept

Low back pain is a common complaint among middle aged and elderly persons. There are many causes but one of it could be sacralisation of lumbar vertebra. Sacralisation means addition of sacral elements by the incorporation of the fifth lumbar vertebra. The incorporation of the fifth lumbar vertebra with the sacrum may be unilateral or bilateral producing partial or complete sacralisation. Sacralisation is commonly regarded as a cause of altered patterns of degenerative spine changes. This review will focus on whether sacralisation of the fifth lumbar vertebra is a radiological entity or a clinical entity.

Frequency of MRI Findings in Patients with Neck Pain

Background and objective: Neck pain is one of the most important factors for degenerative changes in cervical spine. Magnetic Resonance Imaging (MRI) is best imaging modality for evaluation of changes in cervical spine due to neck pain. The aim of this study is to determine the frequency of MRI findings in patients with neck pain. Material and methods: A convenient sample of 78 patients with neck pain was used in this descriptive cross-sectional investigation referred to radiology department of Gondal medical complex Gujranwala for evaluation of MRI findings of cervical spine in patients with neck pain during a time period of 4 months from January 24, 2022 to May 24, 2022. MRI was done using 1.5T scanner. Results: The patients belonged to the age group were between 13 to 80 years old, with a mean age ± SD of 44.83 ± 14.22 years. This study showed that female (53.8%) ratio was higher than male (46.2%). Total of 78 patients was suffering from neck pain only 10 were observed with radiating shoulder pain. There were no degenerative findings found in 16 patients. The most common radiological findings were disc osteophyte which account for 46 (59.0%) more prevalent at C5/C6 level. Conclusion: In this study, neck pain is commonly caused by degenerative changes in cervical spine and it is more common at C5/C6 level. MRI is best modality and it's a non-invasive approach for detecting degenerative diseases early and initiating treatment.

Thoracolumbar stenosis and neurologic symptoms: Quantitative MRI in achondroplasia.

Background and PurposeWhole‐spine magnetic resonance imaging (MRI) studies, to identify structural abnormalities associated with the development of symptomatic spinal stenosis in achondroplasia.MethodsForty‐two subjects with achondroplasia were grouped into four age‐related categories. Congenital spinal deformities (vertebral body and disc height, interpedicular distance), acquired spinal degenerative changes, thoracic kyphotic (TK) angle, thoracolumbar kyphotic (TLK) angle, spinal canal widths were evaluated by MRI.ResultsPatients in the first three groups were asymptomatic and younger (group 1: 4.4 ± 0.78 years; group 2: 8.18 ± 0.60 years; group 3: 10.95 ± 0.93 years) than the symptomatic group (group 4: 23 ± 1.30 years). Patients showed height of vertebral bodies, whole canal width, and average lumbar interpedicular distance reduced. Discs degeneration was more pronounced in the lumbar region and in symptomatic adult patients. TK and TLK angles showed a positive correlation with age (p < .05, r = .42; p < .05, r = .41), whereas thoracic and thoracolumbar canal width had a negative correlation (p < .05, r = −.69; p < .05, r = −.58). A negative correlation between lumbar discs degeneration and canal width was found only at L1‐L3 level (p < .05, r = −.35). At L1‐L3, the canal width cutoff value of .59 allowed the differentiation between asymptomatic and symptomatic patients (area under the curve of .966, p < .0001).ConclusionIn achondroplasia, the spinal canal narrowing, due to accelerated degenerative changes, is a predisposing factor of symptomatic lumbar spinal stenosis. Lumbar canal MRI is a helpful tool to detect the risk of the development of neurological symptoms; in adult patients, a stenosis higher than 60% of upper lumbar canal could be a critical value for the onset of neurological symptoms.

Mechanisms and clinical implications of intervertebral disc calcification.

Low back pain is a leading cause of disability worldwide. Intervertebral disc (IVD) degeneration is often associated with low back pain but is sometimes asymptomatic. IVD calcification is an often overlooked disc phenotype that might have considerable clinical impact. IVD calcification is not a rare finding in ageing or in degenerative and scoliotic spinal conditions, but is often ignored and under-reported. IVD calcification may lead to stiffer IVDs and altered segmental biomechanics, more severe IVD degeneration, inflammation and low back pain. Calcification is not restricted to the IVD but is also observed in the degeneration of other cartilaginous tissues, such as joint cartilage, and is involved in the tissue inflammatory process. Furthermore, IVD calcification may also affect the vertebral endplate, leading to Modic changes (non-neoplastic subchondral vertebral bone marrow lesions) and the generation of pain. Such effects in the spine might develop in similar ways to the development of subchondral marrow lesions of the knee, which are associated with osteoarthritis-related pain. We propose that IVD calcification is a phenotypic biomarker of clinically relevant disc degeneration and endplate changes. As IVD calcification has implications for the management and prognosis of degenerative spinal changes and could affect targeted therapeutics and regenerative approaches for the spine, awareness of IVD calcification should be raised in the spine community.