Disc Degeneration In Patients Research Articles

Reconsideration and Reflection on Spinal Disorders Through the Study of Intervertebral Discs in Patients with Lumbar Spondylolisthesis

This study analyzed and explored the relationship between isthmic spondylolisthesis and disc degeneration by comparing the degree of disc degeneration in patients with isthmic spondylolisthesis, lumbar disc herniation, and asymptomatic healthy individuals. This study included a total of 138 cases, consisting of L5-S1 single segment lesion patients and a normal lumbar spine population. The cases were divided into three groups based on the type of disease: 58 cases in the isthmic spondylolisthesis group (IS), 50 cases in the lumbar disc herniation group (LDH), and 30 cases in the normal lumbar vertebrae group (NLV). The research findings indicate that the proportion of intervertebral disc degeneration in the LDH group is significantly higher than that in the IS group and NLV group (65.3% vs. 33.3% vs. 25.8%, P<0.05). The Pfirrmann grades of lumbar intervertebral discs (L1-L4) in the LDH group are significantly higher than those in the IS group and NLV group (P<0.05), and the intervertebral height index (IHI) (L1-L4) of lumbar vertebrae in the LDH group is significantly lower than that in the IS group and NLV group (P<0.05). The results showed that the degree of intervertebral disc degeneration in patients with isthmic spondylolisthesis was lighter than that in patients with lumbar disc herniation, and even similar to that in healthy individuals. The occurrence of isthmic spondylolisthesis may have slowed down the degeneration of non-affected segment intervertebral discs through certain factors.

Magnetic resonance imaging assessment of the patterns and distributions of spinal disc degeneration in patients residing in Lagos State

Background: Degenerative disc disease is a condition in which intervertebral discs losses its structure thereby resulting in loss of cushioning, fragmentation and herniation most times related to ageing. Structural defects and failure are common causes of degenerative disc disease. In some cases, the spine loses flexibility and bone spurs may pinch a nerve root, causing pain or weakness. The aim of this study was to assess the prevalence and distribution of disc degeneration over the spines in patients residing in Lagos state using magnetic resonance imaging. Materials and methods: This was a cross-sectional prospective study conducted among 163 patients presented for spinal magnetic resonance imaging (MRI) scan due to disc degeneration in some selected radio-diagnostic centres in Lagos State, Nigeria. The spine structural appearance, intervertebral disc structural appearance, signal intensity, pathologies, gender, age, height, weight and BMI of the patients will be recorded. Both descriptive (mean, percentage, charts and frequency) and inferential statistics (Chi-square) statistics were used for statistical analysis with p-value set at 0.05. Results: Out of 163, 96(58.9%) were female while males were 67(41.1%). The age of the study population ranges from 20 years to 90 years with a mean age of 57.17 ± 12.35. Grade V was highest 64 (39.3%) followed by 32 (25.8%) grade IV and least 10 (6.1%) were grade II. The study found the most common affected on L4/L5 disc with 35 (21.5%) adults demonstrating disc degeneration, while 17 (10.4%) adults demonstrated no disc degeneration. There is no statistically significant association between gender and pattern of disc degeneration (χ2 = 5.943, p =0.203). Conclusion: The majority of the patients had the grade V patterns of degenerated discs based Pffirman grading system. The most affected disc was the L4/L5 disc followed by the L3/L4 disc. There were negative correlations but not statistically significant between weight and BMI respectively and patterns of the disc degeneration diseases. There exist positive correlations but not statistically significant between age and height respectively, and patterns of the disc degeneration diseases. There is no statistically significant association between gender and pattern of disc degeneration.

Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: a systematic review and meta-analysis.

The objective of this meta-analysis was to determine the incidence of disc degeneration in patients with surgically treated adolescent idiopathic scoliosis (AIS) and identify the associated risk factors. PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched. The outcomes of interest were the incidence of disc degeneration, SRS-22, and radiological risk factors. The lower instrumented vertebra (LIV) was also evaluated. Fixed effects were used if there was no evidence of heterogeneity. Statistical analysis was performed using Review Manager. A meta-analysis was conducted including nine studies with a total of 565 patients. The analysis revealed that the global incidence of intervertebral disc degeneration in patients with surgically treated AIS patients was 24.78% (95% CI 16.59-32.98%) 10years after surgery, which significantly increased to 32.32% (95% CI 21.16-43.47% at an average of 13.8years after surgery. Among patients with significant degenerative disc changes, the SRS-22 functional, self-image, and satisfaction domains showed significantly worse results (MD - 0.25, 95% CI - 0.44 to - 0.05; MD - 0.50, 95% CI - 0.75 to - 0.25; and MD - 0.34, 95% CI - 0.66 to - 0.03, respectively). Furthermore, instrumentation at or above the L3 level was associated with a lower incidence of intervertebral disc degeneration compared to instrumentation below the L3 level (OR 0.25, 95% CI 0.10-0.64). It was also found that the preoperative and final follow-up lumbar curve magnitudes (MD 8.11, 95% CI 3.82-12.41) as well as preoperative and final follow-up lumbar lordosis (MD 0.42, 95% CI - 3.81 to 4.65) were associated with adjacent disc degeneration. This meta-analysis demonstrated that the incidence of intervertebral disc degeneration significantly increased with long-term follow-up using fusion techniques, reaching up to 32% when patients were 28years of age. Incomplete correction of deformity and fusion of levels below L3, were identified as negative prognostic factors. Furthermore, patients with disc degeneration showed worse functional outcomes.

Study and analysis of the correlation between lumbar spondylolisthesis and Modic changes.

This study aimed to explore the risk factors of Modic changes in lumbar spondylolisthesis. The distribution of Modic changes in different types of lumbar spondylolisthesis, degree of spondylolisthesis, and degree of intervertebral disc degeneration in patients with lumbar spondylolisthesis was observed and analyzed. Statistical analysis was conducted to assess whether intervertebral disc degeneration, local mechanical changes, etc. affect the occurrence of Modic changes. The risk factors of Modic changes in lumbar spondylolisthesis were further illustrated. The age in the lumbar spondylolisthesis with Modic changes group was younger than that in the lumbar spondylolisthesis without Modic changes group, and the bone mineral density was better in the lumbar spondylolisthesis with Modic changes group than that in the lumbar spondylolisthesis without Modic changes group, P < 0.05. The two groups statistically differed in intervertebral disc height (IDH) and disc angle on magnetic resonance imaging (MRI). In the classification of Modic changes, the incidence of type II was the highest. The incidence of Modic changes is higher in isthmic spondylolisthesis than in degenerative spondylolisthesis. With the aggravation of lumbar spondylolisthesis and intervertebral disc degeneration, the incidence of Modic changes gradually increased. Modic changes are most commonly seen in both the upper and lower endplates. Logistic regression analysis showed that the occurrence of Modic changes in lumbar spondylolisthesis was significantly correlated with IDH, disc angle on MRI, type of spondylolisthesis, degree of spondylolisthesis, and degree of intervertebral disc degeneration, P < 0.05. The occurrence of Modic changes is related to the type of spondylolisthesis, the degree of spondylolisthesis, the degree of disc degeneration, the decrease of intervertebral disc height, and local stress angulation.

Deep-learning-based biomarker of spinal cartilage endplate health using ultra-short echo time magnetic resonance imaging.

T2* relaxation times in the spinal cartilage endplate (CEP) measured using ultra-short echo time magnetic resonance imaging (UTE MRI) reflect aspects of biochemical composition that influence the CEP's permeability to nutrients. Deficits in CEP composition measured using T2* biomarkers from UTE MRI are associated with more severe intervertebral disc degeneration in patients with chronic low back pain (cLBP). The goal of this study was to develop an objective, accurate, and efficient deep-learning-based method for calculating biomarkers of CEP health using UTE images. Multi-echo UTE MRI of the lumbar spine was acquired from a prospectively enrolled cross-sectional and consecutive cohort of 83 subjects spanning a wide range of ages and cLBP-related conditions. CEPs from the L4-S1 levels were manually segmented on 6,972 UTE images and used to train neural networks utilizing the u-net architecture. CEP segmentations and mean CEP T2* values derived from manually- and model-generated segmentations were compared using Dice scores, sensitivity, specificity, Bland-Altman, and receiver-operator characteristic (ROC) analysis. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated and related to model performance. Compared with manual CEP segmentations, model-generated segmentations achieved sensitives of 0.80-0.91, specificities of 0.99, Dice scores of 0.77-0.85, area under the receiver-operating characteristic curve values of 0.99, and precision-recall (PR) AUC values of 0.56-0.77, depending on spinal level and sagittal image position. Mean CEP T2* values and principal CEP angles derived from the model-predicted segmentations had low bias in an unseen test dataset (T2* bias =0.33±2.37 ms, angle bias =0.36±2.65°). To simulate a hypothetical clinical scenario, the predicted segmentations were used to stratify CEPs into high, medium, and low T2* groups. Group predictions had diagnostic sensitivities of 0.77-0.86 and specificities of 0.86-0.95. Model performance was positively associated with image SNR and CNR. The trained deep learning models enable accurate, automated CEP segmentations and T2* biomarker computations that are statistically similar to those from manual segmentations. These models address limitations with inefficiency and subjectivity associated with manual methods. Such techniques could be used to elucidate the role of CEP composition in disc degeneration etiology and guide emerging therapies for cLBP.

ISSLS Prize in Bioengineering Science 2023: Age- and sex-related differences in lumbar intervertebral disc degeneration between patients with chronic low back pain and asymptomatic controls

PurposeClinical management of disc degeneration in patients with chronic low back pain (cLBP) is hampered by the challenge of distinguishing pathologic changes relating to pain from physiologic changes related to aging. The goal of this study was to use imaging biomarkers of disc biochemical composition to distinguish degenerative changes associated with cLBP from normal aging.MethodsT1ρ MRI data were acquired from 133 prospectively enrolled subjects for this observational study (80 cLBP, 53 controls; mean ± SD age = 43.9 ± 13.4 years; 61 females, 72 males). The mean T1ρ relaxation time in the nucleus pulposus (NP-T1ρ; n = 650 discs) was used as a quantitative biomarker of disc biochemical composition. Linear regression was used to assess associations between NP-T1ρ and age, sex, spinal level, and study group, and their interactions.ResultsNP-T1ρ values were lower in cLBP patients than controls (70.8 ± 22.8 vs. 76.4 ± 22.2 ms, p = 0.009). Group differences were largest at L5–S1 (ΔT1ρcLBP-control = −11.3 ms, p < 0.0001), representing biochemical deterioration typically observed over a 9–12 year period (NP-T1ρ declined by 0.8–1.1 ms per year [95% CI]). Group differences were large in younger patients and diminished with age. Finally, the age-dependence of disc degeneration was stronger in controls than cLBP patients.ConclusionAging effects on the biochemical composition of the L5–S1 disc may involve a relatively uniform set of factors from which many cLBP patients deviate. NP-T1ρ values at L5–S1 may be highly relevant to clinical phenotyping, particularly in younger individuals.

Application of oblique lateral interbody fusion in the treatment of lumbar intervertebral disc degeneration in patients with Modic change and endplate sclerosis

To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis. A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L2,3 in 2 cases, L3,4 in 5 cases, and L4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed. There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved. As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.

Correlation between posterior paraspinal muscle atrophy and lumbar intervertebral disc degeneration in patients with chronic low back pain.

Although enormous studies have been devoted to solving the problem of intervertebral disc degeneration/herniation, little attention is paid to the effect of paraspinal muscles on it. We aimed to investigate the correlation between paraspinal muscle atrophy and lumbar disc degeneration to recognize paraspinal muscle atrophy and its importance to the spine. A total of 107 patients were enrolled in the study (65 females, 42 males; age 50.87 ± 15.391years old). Cross-sectional area, functional cross-sectional area, and fatty infiltration of the posterior paraspinal muscles were measured at the level of L4/5, and the degree of facet joint degeneration was evaluated at the levels of L3/4, L4/5, and L5/S1 by MRI. After controlling the confounding factors by multiple linear regression, the correlations among paraspinal muscle atrophy, disc degeneration, and facet joint degeneration were analyzed. Meanwhile, Pearson/Spearson rank analysis was used to analyze the correlation between clinical symptoms (VAS and ODI) and paraspinal muscle atrophy. There was a strong correlation between paraspinal muscle atrophy and disc degeneration after controlling the confounding factors (p < 0.05, R > 0.5). There was a weak correlation between paraspinal muscle atrophy and facet joint degeneration (p < 0.05, R < 0.5). There was a significant correlation between facet joint degeneration and intervertebral disc degeneration (p < 0.05, R > 0.7). The fatty infiltration of paraspinal muscle was weakly correlated with ODI (p < 0.05, R < 0.3), but VAS was not. The degree of paraspinal muscle atrophy increased with lumbar disc degeneration and facet joint degeneration and fatty infiltration of multifidus was more susceptible to weight.

The Evaluation of The Relationship Between Psoas Muscle Atrophy and Intervertebral Disc and Facet Joint Degeneration in Patients With Lumbar Pain Using Lumbar Spine MRI

Objective: The purpose of the present study was to determine the relationship between psoas muscle lipoatrophy and facet and disc degeneration in patients&#x0D; with low back pain with lumbar spinal Magnetic Resonance Imaging (MRI).&#x0D; Material and Methods: A total of 304 patients who had low back pain were included in this retrospective cross-sectional study. The lumbar MRIs of all patients were evaluated for signs of psoas muscle atrophy. Fat content for each muscle was graded semi-quantitatively (Grade 0-4). The disc and facet joint&#x0D; degenerations of each patient were also graded. Psoas muscle thickness was measured in the mediolateral axial plane parallel to the vertebra.&#x0D; Results: It was found that the mean right psoas muscle thickness score of the patients was 35.9±7.2 mm on average, and the mean left psoas muscle thickness score was 35.8±7.1 mm. It was also found that 41.8% of the right psoas muscle degeneration was grade 1, 41.1% was grade 2, 33.6% of the left psoas muscle degeneration was grade 1, 45.1% was grade 2, 64.1% of the right facet degeneration was grade 1, 23.4% was grade 2, and 53.9% of the left facet degeneration was grade 1, and 30.3% was grade 2.&#x0D; Conclusion: When lumbar spine MRI examinations are evaluated, psoas muscles must also be evaluated in terms of atrophy. Indicating psoas muscle lipoatrophy in patients with low back pain may be useful for better rehabilitation planning.

Anemia was associated with multilevel lumbar disc degeneration in patients with low back pain: a single-center retrospective study

It has not been determined which factors were related to multilevel lumbar disc degeneration (MLDD). The objective of this study was to determine the prevalence of MLDD among symptomatic patients using the magnetic resonance imaging method. The study also aimed to clarify the associations between MLDD and suspected risk factors through a multivariate model. A total of 530 young and middle-aged patients, suffered from low back pain were retrospectively assessed by 2 independent observers, who used sagittal T2-weighted MR imaging. Subjects were divided into two groups, MLDD group and non-MLDD group, according to the number of degenerated discs. Demographic and radiological data included age, gender, weight, height, body mass index, smoking status, alcohol drinking, lumbar lordosis, presence of hypertension (HT), diabetes mellitus and anemia. There were 309 men and 221 women with an average age of 37.5 ± 8.5 years. In general, 37.7% of patients were diagnosed with disc degeneration (DD) at more than two levels. Triple level DD was the most common pattern and was more prevalent in women (p<0.05). Using multivariate analyses, age (odds ratio [OR]: 1.14; 95% confidence interval [CI] 1.11-1.18; p<0.001), hypertension (OR: 2.67; 95% CI 1.38-5.16; p = 0.03) and anemia (OR: 3.84; 95% CI 2.03-7.28; p<0.001) were significantly associated with MLDD. Despite the young age of this cohort, MLDD is common among patients with low back pain. A significant independent association exists between age, HT, anemia and multilevel disc degeneration in the lumbar region.

The contributions of cartilage endplate composition and vertebral bone marrow fat to intervertebral disc degeneration in patients with chronic low back pain

PurposeThe composition of the subchondral bone marrow and cartilage endplate (CEP) could affect intervertebral disc health by influencing vertebral perfusion and nutrient diffusion. However, the relative contributions of these factors to disc degeneration in patients with chronic low back pain (cLBP) have not been quantified. The goal of this study was to use compositional biomarkers derived from quantitative MRI to establish how CEP composition (surrogate for permeability) and vertebral bone marrow fat fraction (BMFF, surrogate for perfusion) relate to disc degeneration.MethodsMRI data from 60 patients with cLBP were included in this prospective observational study (28 female, 32 male; age = 40.0 ± 11.9 years, 19–65 [mean ± SD, min–max]). Ultra-short echo-time MRI was used to calculate CEP T2* relaxation times (reflecting biochemical composition), water-fat MRI was used to calculate vertebral BMFF, and T1ρ MRI was used to calculate T1ρ relaxation times in the nucleus pulposus (NP T1ρ, reflecting proteoglycan content and degenerative grade). Univariate linear regression was used to assess the independent effects of CEP T2* and vertebral BMFF on NP T1ρ. Mixed effects multivariable linear regression accounting for age, sex, and BMI was used to assess the combined relationship between variables.ResultsCEP T2* and vertebral BMFF were independently associated with NP T1ρ (p = 0.003 and 0.0001, respectively). After adjusting for age, sex, and BMI, NP T1ρ remained significantly associated with CEP T2* (p = 0.0001) but not vertebral BMFF (p = 0.43).ConclusionPoor CEP composition plays a significant role in disc degeneration severity and can affect disc health both with and without deficits in vertebral perfusion.

Effect of endplate reduction on endplate healing morphology and intervertebral disc degeneration in patients with thoracolumbar vertebral fracture.

To determine the effect of endplate reduction on the final healing morphology and degenerative changes in intervertebral discs. Forty-eight patients with single-level thoracolumbar fractures with endplate injury were included. All patients underwent posterior reduction and pedicle screw fixation, and postoperative imaging was used to determine whether endplate reduction was successful. The healing morphology of the endplate was divided into three types: increased endplate curvature, irregular healing and traumatic Schmorl node. MRI was performed at baseline and at the last follow-up evaluation to observe changes in disc degeneration (disc height and nucleus pulposus signal) and Modic changes. The reduction rate in the central area was significantly lower than that in the peripheral area (P = 0.017). In patients with successful reduction, 90.9% (20/22) of the endplates healed with increased curvature. In patients with an unsuccessful endplate reduction, 63.4% (26/41) of the endplates healed irregularly, and 34.1% (14/41) of the endplates formed traumatic Schmorl nodes. Endplate reduction was closely related to the final healing morphology of the endplate (P < 0.001), which had a significant protective effect on the degeneration of the intervertebral disc. At the last follow-up evaluation, there was no statistically significant correlation between different endplate healing morphologies and new Modic changes. The reduction rate in the central area is significantly lower than that in the peripheral area. Although all of the intervertebral discs corresponding to fractured endplates had degenerated to different degrees, successful endplate fracture reduction can obviously delay the degeneration of intervertebral discs.

Evaluation of Cervical Disc Degeneration in Patients with Neck Pain on Magnetic Resonance Imaging

Background : Cervical disc degeneration is the most common pathology that in most of the cases clinically present as Objective : To evaluate the cervical region abnormalities in patients with neck pain on magnetic resonance imaging. Methodology : In this descriptive study 180 adult patients were included. All patients had been collected from DHQ hospital Gilgit and Ghurki Trust teaching hospital. After informed consent, data were collected through 1.5 tesla GE (closed bore) and 0.35 tesla Hitachi (open bore) MRI machines. Results : Findings show that among 180 adult patients, 136 presented with disc degeneration among which 81 were males and 55 were females. Among 81 males, 63 had disc degeneration at multiple levels while 18 had single disc degeneration. In females 35 patients showed multiple disc degeneration while 20 involved a single disc. Conclusion : It is concluded that disc degeneration is prevalent in males than females. Disc degeneration at multiple levels is higher than single disc degeneration in both genders. Keywords : Disc degeneration, magnetic resonance imaging. DOI : 10.7176/JHMN/99-03 Publication date : April 30 th 2022

Histological Changes of Cervical Disc Tissue in Patients with Degenerative Ossification.

ObjectiveTo explore the histological feature of the cervical disc degeneration in patients with degenerative ossification (DO) and its potential mechanisms. MethodsA total of 96 surgical segments, from cervical disc degenerative disease patients with surgical treatment, were divided into ossification group (group O, n=46) and non-ossification group (group NO, n=50) based on preoperative radiological exams. Samples of disc tissues and osteophytes were harvested during the decompression operation. The hematoxylin-eosin staining, Masson trichrome staining and Safranin O-fast green staining were used to compare the histological differences between the two groups. And the distribution and content of transforming growth factor (TGF)-β1, p-Smad2 and p-Smad3 between the two groups were compared by a semi-quantitative immunohistochemistry (IHC) method. ResultsFor all the disc tissues, the content of disc cells and collagen fibers decreased gradually from the outer annulus fibrosus (OAF) to the central nucleus pulposus (NP). Compared with group NO, the number of disc cells in group O increased significantly. But for proteoglycan in the inner annulus fibrosus (IAF) and NP, the content in group O decreased significantly. IHC analysis showed that TGF-β1, p-Smad2, and p-Smad3 were detected in all tissues. For group O, the content of TGF-β1 in the OAF and NP was significantly higher than that in group NO. For p-Smad2 in IAF and p-Smad3 in OAF, the content in group O were significantly higher than group NO. ConclusionHistologically, cervical disc degeneration in patients with DO is more severe than that without DO. Local higher content of TGF-β1, p-Smad2, and p-Smad3 are involved in the disc degeneration with DO. Further studies with multi-approach analyses are needed to better understand the role of TGF-β/Smads signaling pathway in the disc degeneration with DO.

Lumbar spine abnormalities in patients with obstructive sleep apnoea

Previous studies suggested cervical spondylosis as a risk factor for development of obstructive sleep apnoea (OSA). We aimed to assess lumbar disc degeneration in patients with OSA and correlate the findings with symptoms and disease severity. Twenty-seven patients with OSA and 29 non-OSA controls underwent sleep studies and lumbar magnetic resonance imaging (MRI), and completed the Epworth Sleepiness Scale and the 24-item Roland‐Morris Disability Questionnaire (RMDQ) questionnaires. Plasma klotho was determined with enzyme-linked immunosorbent assay. Patients with OSA had higher number of disc bulges (4.6 ± 3.7 vs. 1.7 ± 2.5, p < 0.01) and anterior spondylophytes (2.7 ± 4.2 vs. 0.8 ± 2.1, p < 0.01), increased disc degeneration (total Pfirrmann score 16.7 ± 4.7 vs. 13.2 ± 4.1, p < 0.01) and vertebral fatty degeneration (7.8 ± 4.7 vs. 3.8 ± 3.7, p < 0.01). There was no difference in the RMDQ score (0/0–3.5/ vs. 0/0–1/, p > 0.05). Markers of OSA severity, including the oxygen desaturation index and percentage of total sleep time spent with saturation < 90% as well as plasma levels of klotho were correlated with the number of disc bulges and anterior spondylophytes (all p < 0.05). OSA is associated with lumbar spondylosis. Our study highlights the importance of lumbar imaging in patients with OSA reporting lower back pain.

Role of growth plate (apophyseal ring fracture) in causing modic type changes in pediatric low back pain patients.

We investigated the prevalence of Modic changes (MCs) and associated pathologies in pediatric patients. A total of 368 MRI obtained for 240 male and 128 female patients under the age of 18years with complaints of low back/leg pain were retrospectively examined. All changes in signal intensity in the vertebral endplate and subchondral bone on MRI were defined as MCs. We investigated the relationship between MCs and underlying diseases, including lumbar spondylolysis/spondylolisthesis, and conditions of the growth plate in cases with MCs. The degree of disc degeneration in patients with MCs was evaluated using the Pfirrmann grading system. MCs were identified in six patients (1.6%). In five of the six patients, the signal intensity changes were localized to the anterosuperior endplate of the affected vertebra; the MCs were associated with anterior apophyseal ring fracture and an open growth plate in all these cases. Disc degeneration was classified as Pfirrmann grade I in three patients and grade II and III in one patient each. One patient had type I changes associated with grade IV disc degeneration and herniation and no sign of an open growth plate. The prevalence of MCs in pediatrics patients was much lower than the rates reported in adults. Most MCs were associated with an anterior apophyseal ring fracture. If Modic type changes are seen in immature vertebrae of pediatric patients, growth plate lesions such as apophyseal ring fractures should be considered. Diagnostic: individual l cross-sectional studies with consistently applied reference standard and blinding.

Prevalence of High Intensity Zone in Lumbar Spine and its Correlation with Lumbar Disc Degeneration in Patients Attending Tertiary Hospital of Eastern Nepal

Introduction: A high intensity zone (HIZ) in intervertebral disc (IVD) of lumbar spine is a high intensity signal located in the annulus fibrosus of T2-weighted magnetic resonance (MR) imaging. There is limited information on the prevalence of HIZ in lumbar spine in Nepalese population. The aim of this cross-sectional study was to identify the prevalence of HIZ according to the age and its correlation with degenerated disc, disc herniation &amp; bulge and modic changes.&#x0D; Methods: This was a prospective MR based study in 268 patients (1380 IVD) with LBP, Leg pain or numbness. The prevalence and correlation of HIZ , degenerated disc, disc herniation and bulge and modic change was evaluated in 5 age groups (&lt;20, 20-39, 40-59, 60-79, &gt;80).&#x0D; Results: The prevalence of HIZ in patients with LBP was 30.5%. Total 1340 IVD were examined out of which122 had HIZ, 742 had degenerated disc, 688 had disc herniation and bulge and 182 had modic changes. Degenerated disc was observed in 95% (116/122) and 51.3% (626/1218) of disc with and without HIZ respectively. Disc herniation and bulge were observed in 98.3% (120/122) and 46.6% (568/1218) of the disc with and without HIZ, respectively. Modic changes were observed in 11.4% (14/122) and 13.7% (168/1218) of disc with and without HIZ respectively.&#x0D; Conclusions: There was statistically significant correlation between existence of HIZ and degenerated discand disc herniation and bulge, but there was no correlation with the existence of modic changes.&#x0D;

Correlation between kinematic sagittal parameters of the cervical lordosis or head posture and disc degeneration in patients with posterior neck pain.

The purpose of this retrospective cross-sectional study was to examine the degrees of the cervical disc degeneration and the parameters of cervical sagittal balance in plain radiographs, representing cervical lordosis or head posture in subjects with posterior neck pain. A total of 113 patients with posterior neck pain with or without radiating pain were analyzed. The kinematic sagittal parameters of cervical radiographs were obtained at the occipito–cervical (O–C2) angle, sagittal Cobb’s angles of C1–C2, C2–C7, and sagittal vertical axis (SVA) of C1–C7 and C2–C7. Cervical disc degeneration was evaluated using the sum of Pfirrmann grades and total modified Matsumoto scores calculated from MRI of the cervical spine. A significant positive correlation was found for the C2–C7 angle using the sum of the Pfirrmann grades and total modified Matsumoto scores, whereas the O–C2 angle and the C1–C2 angle were negatively correlated. The sagittal cervical parameters representing cervical kyphosis and jaw lifting posture were found to be significantly correlated with the degree of cervical disc degeneration. These findings suggest that the loss of the natural sagittal lordosis of the cervical spine may contribute to the progression of disc degeneration, rather than the forward head posture.

The dervan upper limb dermatome syndrome pilot study of high incidence of cervical disc disease in patients presenting with primary shoulder pain &amp; restriction of movements

Introduction: Shoulder pain is among the most common complaints in the orthopedic outpatient department. It can be due to local pathology or a referred pain from cervical disc degeneration. Frequently, neck and shoulder pathologies may co-exist causing a dilemma regarding treatment approach. Although there are many studies published in literature, we think ours is the first published Indian study to make the observation of concomitant cervical disc degeneration in patients with ipsilateral shoulder pain.Materials & Methods: 39 patients with shoulder pain without any history of trauma, attended the OPD of Walawalkar hospital, Dervan. Of the 3 patients 32 agreed to be part of this pilot study. They underwent x rays & MRI of the shoulder as well as cervical spine.Results: All patients who presented in the orthopaedicopd with complaints of atraumatic shoulder pain, showed varying degrees of cervical disc disease. The commonest affected cervical spine pathological segment was C5-C6 i.e 92 % with two patients having C6-C7 disc disease i.e 8 %.Grading of disc disease was 78.1 % grade 28, 6 patients had grade 3 disc disease, 18.75 %, and only 1 patient had a grade 1 disease with typical signs of chemical radiculopathy with shoulder pain & restriction.X Ray of shoulder showed normal acromiohumeral distance of more than 7 mm in more than 70 % of patients and less than 2 mm in only 1 patient who also incidentally had grade 3 disc disease.MRI of shoulder showed 78 % patients with grade 2 or less of Goutallier grading [9] and all patients of Grade 3 disc disease having grade 3 Goutallier grading and a positive Tangent sign [10]. (18.75 %)This may open another vista in investigation of degenerative rotator cuff disease mimicking grading and severity of cervical disc disease although that is not the primary objective of this paper. We aimed to bring to light the concomitant cervical spine pathology in patients presenting with shoulder pain in this original research. Conclusion: This study found an unusually high rate of coexistent shoulder and cervical spine pathologies. Almost all patients had some form of cervical disc disease and on deeper questioning related signs and symptoms of cervical spondylosis concurrently or a few weeks ago. It undermines the need for investigating this important contributor, the cervical spine, to clinically diagnose the enigma of shoulder pain.

Impact of the Severity of Endplate Fracture on the Development of Intervertebral Disc Degeneration in Patients Treated with Instrumented Fusion for Unstable Traumatic Thoracic and Lumbar Fractures

Impact of the Severity of Endplate Fracture on the Development of Intervertebral Disc Degeneration in Patients Treated with Instrumented Fusion for Unstable Traumatic Thoracic and Lumbar Fractures