Disc Pathology Research Articles

Sudden cardiac death, arrhythmogenic cardiomyopathy and intercalated disc pathology due to reduced filamin C protein levels: a matter of life and death.

Mutations in the human FLNC gene encoding filamin C (FLNc) cause a broad spectrum of sporadic and familial cardiomyopathies and myopathies. We report on the genetic, clinical, morphological and biochemical findings in a German family harboring an FLNC variant that leads to severe cardiac disease comprising sudden cardiac death and arrhythmogenic cardiomyopathy. Genetic analysis identified a novel heterozygous FLNC variant in exon 16 (NM_001458.4:c.2495_2498delAGTA, het; p.K832TfsX45) in i) the index patient suffering from dilated cardiomyopathy necessitating heart transplantation, ii) a son, who died from sudden cardiac death, iii) a second son, who survived an episode of sudden cardiac arrest and iv) a third son affected by isolated skeletal muscle myopathy. FLNc protein levels were markedly reduced in cardiac tissue obtained from the index patient, implying that the p.K832TfsX45 FLNc variant most probably caused nonsense-mediated decay of the corresponding mRNA. Morphological analysis of the diseased cardiac tissue revealed extensive fibrotic remodeling, and marked degenerative changes of the contractile apparatus of cardiomyocytes and severe structural alterations of intercalated discs. Connexin-43 signal intensity at intercalated discs was diminished and FLNc labelling of myofibrils was attenuated or even absent. Proteome analyses demonstrated complex alterations of extracellular matrix and intercalated disc proteins. Our findings demonstrate that this novel, truncating FLNC mutation likely leads to haploinsufficiency, thereby causing a deleterious sequence of degenerative changes of cardiac tissue with extensive fibrotic remodeling and intercalated disc pathology as the structural basis for FLNC-related cardiomyopathy with life-threatening cardiac arrhythmias.

Comparing the clinical efficacy of preganglionic and preganglionic plus ganglionic transforaminal epidural steroid injections for lumbosacral radicular pain.

To compare the effectiveness of preganglionic transforaminal epidural steroid injection (TFESI) with preganglionic plus postganglionic TFESI. Patients with unilateral radicular pain and disc pathology were randomly assigned to either the preganglionic group or the preganglionic plus postganglionic group. All patients were evaluated using a numeric rating scale (NRS) and a patient satisfaction scale (PSS) at the third week and the third month after treatment. There were significant differences between the patients' NRS scores after TFESI for both groups. In terms of >50% pain relief at three weeks and 3 months post-treatment, no significant differences were found between the groups (p>0.05). The PSS scores of the preganglionic plus postganglionic group were significantly lower at third month than at the third week (p=0.046). The PSS scores of the two groups were similar at third week and third month (p>0.05). A weak negative correlation was found between age and meaningful pain relief at the third month (Rho=.278, p=0.024). A moderate positive correlation was found between meaningful pain relief at the third week and meaningful pain relief the third month (Rho=.465, p<0.001). Male gender showed a weak positive correlation with meaningful pain relief at the third week (Rho=.281, p=0.022) and the third month (Rho=.256, p=0.038) CONCLUSION: The combined preganglionic plus postganglionic approach for TFESI did not affect the outcomes in patients with unilateral discogenic radicular pain. The preganglionic TFESI approach alone at the disc level was sufficient to achieve pain relief.

Incidence and predictors of readmission following hospitalization for thoracic disc herniation.

Symptomatic thoracic disc herniations (TDH) are relatively rare and can be discovered incidentally on neuroimaging. Surgical interventions for TDH represent only 4 % of all surgeries performed for intervertebral disc pathologies, which are most commonly indicated for myelopathy and radiculopathy. Given the absence of publications on rates of readmissions following hospitalization for TDH, we aim to establish baseline metrics for the 90-day all-cause readmission rates and pertinent risk factors. The 2020 Nationwide Readmissions Database was used to screen for patients with a primary diagnosis of TDH and disc degeneration within the first 9 months of the year. Demographic information, admission details, clinical data, comorbidities, and surgical treatment were extracted. Patients were divided into two groups based on readmission status. A sub-analysis was performed by treatment. Overall, 970 patients met our inclusion criteria. Of these, 183 patients (18.9 %) were readmitted within a mean of 34.58 days. The readmission group was significantly older and more likely to have been admitted non-electively. Surgical treatment was associated with a lower readmission rate. Eight comorbidities differed significantly between the groups. Independent risk factors for readmission included non-surgical treatment, Medicare insurance, hypertension, and depression. We established a 90-day all-cause readmission rate of 18.9 % for TDH. There was no difference in readmission based on patients' initial neurological presentation. Non-surgical treatment was identified as an independent risk factor for readmission, suggesting that timely surgical interventions may reduce the risk of readmission. Medicare insurance, hypertension and depression were also identified as independent risk factors.

Does the Level of the Conus Medullaris Affect CSF Leak Incidence During Spinal Surgery?

Background and Aims: This study examines whether the level of the conus medullaris affects the incidence of cerebrospinal fluid (CSF) leaks in spinal surgery. Material and Methods: Retrospective analysis was performed on 55 patients who had suffered from CSF leaks post-operatively. The data was stratified by spinal pathology, age, and sex using patient records and MRI scans/reports. Results: The results show that more patients with a CSF leak had surgery for disc pathologies as opposed to spinal stenosis. Additionally, patients with spinal stenosis were generally older, and there were more women in the CSF leak cohort. Notably, patients with disc pathologies had a higher conus level than those with spinal stenosis, with no CSF leaks occurring in patients with low-lying conus levels at or below L3. Conclusion: We did not find any correlation between level of conus and CSF leaks.

Evaluation of the retina and optic discs of patients with chronic and episodic migraine using optical coherence tomography and optical coherence tomography angiography

Objective: Migraine is a very common, recurring, usually unilateral, severe, pulsating, and transient headache disorder, which causes temporary disability. Abnormal retinal and optic disc pathologies in migraine patients were previously reported by using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). In the present study, it was hypothesized that the changes found in the retina and optic disc might indicate a functional disorder in migraine. It is also emphasized that these changes might be useful for early diagnosis and follow-up of the disease, as well as for the development of new treatments. Method: In total, 60 individuals were involved in the present study, including 28 chronic migraine patients (24 female, 4 male) and 32 episodic migraine patients (26 female, 6 male), whose migraine types were determined by using the criteria set by the International Headache Society (IHS) in 2013. The control group consisted of 48 healthy volunteers (34 female, 14 male) aged between 18 and 45 years, who applied to the ophthalmology clinic. The retinas and optic discs of the patients were examined by OCT and OCTA at our ophthalmology clinic. A double-blind randomized analysis was performed for the patient data and the data were compared to control group of similar gender and age. Results: Examining the demographic data, no statistically significant difference was found between the migraine patients and the healthy controls in terms of age and gender However, using OCT, it was determined that the mean vertical and horizontal cup- to-disk (c/d) ratios at the optic disc were significantly impaired in patients compared to the control group. Moreover, using OCTA, significant reductions in vessel density were detected in the foveal, parafoveal, perifoveal areas and in the superficial and deep capillary plexuses of the patients. Conclusion: Migraine patients have statistically significant differences in retinal thickness and vascularity, which is consistent with an increased risk.

External validation of SpineNetV2 on a comprehensive set of radiological features for grading lumbosacral disc pathologies

BackgroundIn recent years, the integration of Artificial Intelligence (AI) models has revolutionized the diagnosis of Low Back Pain (LBP) and associated disc pathologies. Among these, SpineNetV2 stands out as a state-of-the-art, open-access model for detecting and grading various intervertebral disc pathologies. However, ensuring the reliability and applicability of AI models like SpineNetV2 is paramount. Rigorous validation is essential to guarantee their robustness and generalizability across diverse patient cohorts and imaging protocols. MethodsWe conducted a retrospective analysis of MRI images of 1747 lumbosacral intervertebral discs (IVDs) from 353 patients (mean age, 54 ± 15.4 years, 44.5% female) with various spinal disorders, collected between September 2021 and February 2023 at X-Ray Service s.r.l. The SpineNetV2 system was used to grade 11 distinct lumbosacral disc pathologies, including Pfirrmann grading, disc narrowing, central canal stenosis, spondylolisthesis, (upper & lower) endplate defects, (upper & lower) marrow changes, (right & left) foraminal stenosis, and disc herniation, using T2-weighted sagittal MR images. Performance metrics included accuracy, balanced accuracy, precision, F1 score, Matthew's Correlation Coefficient, Brier Score Loss, Lin's concordance correlation coefficients, and Cohen's kappa coefficients. Two expert radiologists provide annotations for these discs. The evaluation of SpineNetV2′s grading is compared against expert radiologists' assessments. ResultsSpineNetV2 demonstrated strong performance across various metrics, with high agreement scores (Cohen's Kappa, Lin's Concordance, and Matthew's Correlation Coefficient exceeding 0.7) for most pathologies. However, lower agreement was found for foraminal stenosis and disc herniation, underscoring the limitations of sagittal MR images for evaluating these conditions. ConclusionsThis study highlights the importance of external validation, emphasizing the need for comprehensive assessments of deep learning models. SpineNetV2 exhibits promising results in predicting disc pathologies, with findings guiding further improvements. The open-source release of SpineNetV2 enables researchers to independently validate and extend the model's capabilities. This collaborative approach promotes innovation and accelerates the development of more reliable and comprehensive deep learning tools for the assessment of spine pathology.

Imprint of preterm birth with very low birth weight on optic disc OCT in adulthood-A two-country birth cohort study.

To determine the pattern, degree and prevalence of optic disc optical coherence tomography (OCT) alterations in adults born preterm with very low birth weight (VLBW; birth weight < 1500 g). Optic disc OCT was assessed in 98 VLBW participants and 139 term-born controls from birth cohorts in Finland and Norway at the mean age of 36 years. The participants had not been treated for retinopathy of prematurity and had no diagnosed brain abnormality. OCT assessment included parameters for optic disc size, neural rim and peripapillary retinal nerve fibre layer thickness (pRNFLT), and for the foveal developmental stage. Background data, visual acuity, refractive error and intraocular pressure were recorded. In the VLBW group, optic disc neural rim and pRNFLT were significantly decreased, most frequently in the nasal and inferior sectors. In 40% (95% CI: 33-47) of the VLBW eyes, nerve fibre thickness of at least one optic disc sector was below the fifth percentile of the control group, including 9% (95% CI: 6-14) subgroup falling below the first percentile, that is, clinically below normal limits. VLBW participants with nerve fibre thickness below the fifth percentile did not differ by perinatal data or foveal developmental stage from the other VLBW participants. All participants had normal visual acuity. A moderate decrease of the optic disc neural rim and pRNFLT is frequently seen in clinically healthy adults born preterm with VLBW. Awareness of the VLBW-related optic disc nerve fibre shallowness especially in the inferior and nasal sectors is important while evaluating acquired optic disc pathology in adulthood.

Optic Disc Features in Pathological Myopia And Myopic Optic Neuropathy

Pathological myopia is defined as excessive axial elongation accompanied by various structural changes in the fundus and optic disc, leading to a decrease in best-corrected visual acuity. Today, with the widespread use of optical coherence tomography (OCT) in ophthalmology, optic disc pathologies have been identified in addition to fundus findings. Due to axial elongation, large optic disc, tilted optic disc, retinal nerve fiber changes, peripapillary atrophy, intachoroidal cavitation and peripapillary-prelaminar schisis are observed. Optic neuropathy occurs in some cases secondary to all these changes occurring in the optic disc. Myopic optic neuropathy can be examined under two headings: glaucomatous/glaucoma-like and nonglaucomatous. In this review, optic disc changes and myopic optic neuropathy, which are important causes of vision loss, are discussed.

Outcome prediction following lumbar disc surgery: a longitudinal study of outcome trajectories, prognostic factors, and risk models.

This study aimed to 1) describe the 2-year postoperative trajectories of leg pain and overall clinical outcome after surgery for radiculopathy, 2) identify the preoperative prognostic factors that predict trajectories representing poor clinical outcomes, and 3) develop and internally validate multivariable prognostic models to assist with clinical decision-making. This retrospective cohort study included patients enrolled in the Canadian Spine Outcomes and Research Network who were diagnosed with lumbar disc pathology and radiculopathy and had undergone lumbar discectomy at one of 18 spine centers. Potential outcome predictors included preoperative demographic, health-related, and clinical prognostic factors. Clinical outcomes were 1) 2-year univariable latent trajectories of leg pain intensity (numeric pain rating scale) and 2) overall outcomes comprising multivariable trajectories showing the combined postoperative courses of leg and back pain intensity (numeric pain rating scale) together with pain-related disability (Oswestry Disability Index). Each outcome model identified a subgroup of patients classified as experiencing a poor outcome based on minimal change in their clinical status after surgery. Multivariable risk model performance and internal validity were evaluated with discrimination and calibration statistics based on bootstrap shrinkage with 500 resamplings. The authors included data from 1142 patients (47.6% female). The trajectory models identified 3 subgroups based on the patients' postoperative courses of pain or disability: 88.6% of patients in the leg pain model and 71.9% in the overall outcome model experienced a good-to-excellent outcome. The models classified 11.4% (leg pain outcome) and 28.2% (overall outcome) of patients as experiencing a poor clinical outcome, which was defined as minimal improvement in pain or disability after surgery. Eleven individual demographic, health, and clinical factors predicted patients' poor leg pain and overall outcomes. The performance of the multivariable risk model for leg pain was inadequate, while the overall outcome model had acceptable discrimination, calibration, and internal validity for predicting a poor surgical outcome. Patients with lumbar radiculopathy experience heterogeneous postoperative trajectories of pain and disability after lumbar discectomy. Individual preoperative factors are associated with postoperative outcomes and can be combined within a multivariable risk model to predict overall patient outcome. These results may inform clinical practice but require external validation before confident clinical implementation.

Accuracy of smartphone imaging versus clinical examination in the diagnosis of ocular disorders in a rural-based hospital: A descriptive study

Background: In India, there is an unequal distribution of eye health care, and tele-ophthalmology promises to be a potential tool to provide accessible, affordable, and good-quality health care to the population residing in the rural and remote areas of our country. Aims: The aim of the study was to study the accuracy of smartphone imaging versus clinical examination in the diagnosis of ocular disorders at a rural-based hospital. Setting and Design: A hospital-based descriptive study was conducted for 18 months. The study was carried out in the outpatient department (OPD) of ophthalmology at a rural health training center (RHTC), attached to a tertiary care hospital. Materials and Methods: Inclusion-A routine examination was carried out in the ophthalmology OPD at the RHTC. The off-site assessment was done based on the smartphone camera (iPhone Xs Max) images and videos captured on-site, which were remotely shared with two independent blinded observers to make the diagnosis which was compared with the clinical (on-site) diagnosis. Statistical Analysis: The agreement between the expert’s finding and the clinical examination finding was determined using Light’s Kappa coefficient. Accuracy of the photographic method was carried out in terms of sensitivity and specificity, considering clinical findings as the gold standard. Results and Conclusion: The diagnostic accuracy of smartphone imaging was the highest for the diagnosis of cataracts, followed by anterior segment conditions. The clinical diagnosis and smartphone imaging agreement were almost perfect for anterior segment disorders, while it was moderate for glaucoma and other disc pathologies.

An Optimized CT Protocol for Detecting Suspected Cauda Equina Syndrome: A Comparative Analysis with MRI.

Lumbar disc herniation, potentially leading to nerve root compression and cauda equina syndrome, is typically evaluated using MR imaging. However, the limited availability of MR imaging outside regular hours in certain health care systems poses considerable challenges. This purpose of this study was to prospectively evaluate the diagnostic accuracy of an optimized CT lumbar spine protocol as a potential alternative to MR imaging in assessing suspected neural compression. Patients presenting to the emergency department with suspected cauda equina syndrome or acute radicular symptoms secondary to lumbar disc herniation referred for MR imaging were prospectively enrolled for an additional CT optimized to assess spinal stenosis. An expert radiologist, blinded to clinical data, graded canal stenosis at each lumbar level on CT. The same grading process was applied to MR imaging after a 4-week interval to maintain blinding. Fifty-nine individuals were included in the final analysis. In 22 (39%) cases, no significant stenosis was identified. In a further 22 (37%) cases, disc pathology was identified that was managed conservatively. Thirteen (22%) individuals proceeded to urgent surgical decompression. In 1 (2%) instance, an alternative diagnosis was identified. Compared with MR imaging, the sensitivity, specificity, and positive and negative predictive values for CT in detecting disc pathology in patients presenting with symptoms suggestive of acute neural compression were 97% (95% CI, 82%-99%), 97% (95% CI, 83%-99%), 97% (95% CI, 92%-99%), and 97% (95% CI, 83%-99%), respectively. CT accurately identified all cases requiring urgent decompression. CT accurately predicted MR imaging findings in patients with suspected cauda equina and nerve root compression, demonstrating its utility as an adjunct tool for patient triage in emergency settings with limited MR imaging access. This protocol could enhance the allocation of emergency resources by appropriately selecting patients for emergent MR imaging.

The relationship between intervertebral disc pathologies and the use of digital devices and lack of physical activity in adolescents

Background/Aim: Existing research on herniated discs in adolescents primarily focuses on surgical interventions and outcomes, with fewer studies investigating the effectiveness of non-surgical therapies. The correlation between obesity, facet tropism, lumbosacral transitional vertebrae, trauma, certain sports activities, and herniated discs in adolescents is well-documented. Comparable to adults, a sedentary lifestyle in adolescents potentially carries a significant risk of developing disc degeneration and herniation. Consequently, this study aims to examine the relationship between increased digital device usage, decreased physical activity, and the onset of disc pathologies in adolescents. Methods: The study group included 94 patients aged between 10 and 16 years diagnosed with cervical (CDH), thoracic (TDH), and lumbar (LDH) disc disease. For each participant, the individual daily usage time spent on desktop computers, tablets, laptops, and mobile phones and the total time spent on all digital devices were evaluated. Their level of physical activity was also assessed using the International Physical Activity Questionnaire – Short Form (IPAQ-SF). The study eliminated causes such as listhesis, facet tropism, lumbosacral transitional vertebra, trauma, and sports injuries that could prompt the development of these spinal pathologies. Additionally, other conditions that might cause spinal pain, such as scoliosis, rheumatological diseases with spinal involvement, tumors, and myofascial pain, were also ruled out. Results: The average age of all patients was 13.44 (2.07) years. A majority were women (n=55), comprising 58.50% of the sample. Of the patients, 60.64% had CDH, 12.77% had TDH, and 75.53% had LDH. The amount of physical activity and time spent on digital devices were similar across both genders (P=0.194 and P=0.770). A significant correlation was found between CDH and the time spent on tablets, laptops, and mobile phones (P&lt;0.001). Again, a significant correlation was observed between LDH, usage of desktop computers, total time spent on all digital devices, and the IPAQ-SF score for low physical activity (P&lt;0.001). Conclusion: The prevalence and duration of digital device use among adolescents are increasing, while physical activity is decreasing. Our study indicates that this situation may be linked to the development of disc degeneration and hernias. Understanding this association can help reduce treatment and rehabilitation costs and prevent the potential loss of workability and quality of life resulting from a herniated disc. Consequently, additional comparative research on this topic is crucial.

Decoding the Genetic Threads of Disc Degeneration

Abstract Degenerative disc disease (DDD) is a prevalent musculoskeletal disorder characterized by the progressive degeneration of intervertebral discs, often leading to chronic low back pain and disability. While the etiology of DDD is multifactorial, genetic factors play a significant role in disease susceptibility and progression. This review provides a comprehensive overview of the genetic aspects of DDD, summarizing previously reported genes and variations associated with the disease. Through an analysis of animal studies and molecular pathways implicated in disc degeneration, including the lipid kinase phoshoinositide-3-kinase signaling pathway (PI3K-Akt), mitogen-activated protein kinase/extracellular signal-regulated kinase signaling pathway (MAPK-ERK), Wingless-related integration (Wnt)/β-catenin, Sonic Hedgehog (Shh), and mammalian target of rapamycin (mTOR) pathways, this review elucidates the intricate interplay between genetic factors and disc pathology. Several candidate genes have been identified in association with DDD, including those involved in extracellular matrix regulation, inflammation, and cell signaling. Genome-wide association studies have further expanded our understanding of the genetic architecture underlying DDD, revealing novel susceptibility loci and pathways. Animal studies utilizing genetically modified models have provided valuable insights into the molecular mechanisms driving disc degeneration and have validated the relevance of specific genetic pathways in disease pathogenesis. Understanding the genetic basis of DDD holds promise for identifying individuals at risk, developing predictive biomarkers, and informing personalized treatment approaches. Furthermore, elucidating the molecular pathways involved in disc degeneration may lead to the identification of novel therapeutic targets for DDD management. Overall, this review consolidates current knowledge on DDD genetics and pathways, providing a foundation for future research endeavors aimed at unraveling the intricate genetic mechanisms underlying this prevalent musculoskeletal disorder.

DISTRIBUTION OF INTERVERTEBRAL DISC DISEASES IN DAСHSHUND DOGS

Intervertebral disc disease is one of the most common pathologies, which leads to spinal cord lesions in dogs. Review of the results of a retrospective analysis of the prevalence of intervertebral disc diseases and the degree of neurological deficit in dachshund dogs over a three-year period is provided in this article. During the analyzed period, 273 owners with dogs of this breed applied to the veterinary clinic, of which 26.4 % were admitted to a neurological appointment with causes of neurological deficits of varying degrees and localization. Intervertebral disc pathology was find in 57 (20.9 %) patients, using additional diagnostics (MRI, x-ray, myelography). The prevalence of diseases in males is higher on 12.3 %, than in females. Older dogs are more prone to developing the disease; the onset of disc disease in dogs occurs at the age of 2 years, with the maximum peak in the incidence of the pathology reached at the age of 5 years. Dachshund dogs are less prone to developing lower motor neuron disc disease of the thoracic limbs. Diseases of the upper motor neuron discs of the pelvic limbs are much more common compared to other parts of the nervous system.

A comprehensive review on anterior endoscopic cervical discectomy

Anterior endoscopic cervical discectomy (AECD) represents a groundbreaking surgical technique that has garnered considerable interest in recent times due to its minimally invasive nature for addressing cervical disc herniation. This review endeavours to conduct a thorough examination of the existing literature concerning AECD, encompassing its indications, surgical technique, clinical outcomes, advantages, limitations, and potential complications. Through a meticulous analysis of the available data, this review aims to evaluate the effectiveness, safety, and overall viability of AECD as a substitute for conventional open surgical methods in addressing cervical disc issues. By delving into these aspects, the review seeks to provide insights into the potential role of AECD in enhancing patient outcomes and optimizing the management of cervical disc pathology.

Intervertebral disc degeneration and regenerative medicine

AbstractIntervertebral disc (IVD) degeneration is a common phenomenon that affects patients with increasing prevalence with increasing age. Both conservative treatments, such as the use of pain medication or physical therapy, and surgical treatments, such as fusion or disc replacement therapies, are offered to patients. Both non‐invasive and invasive treatments have been shown to improve pain and quality of life for patients. This review explores the role of regenerative medicine techniques as a promising therapeutic intervention that can be used before or in combination with conservative therapy and surgery to enhance the treatment process in patients with IVD degeneration or disc pathology. Currently, there are four major modules of regenerative medicine: genetic therapy, platelet‐rich plasma therapy, stem cell transplantation and tissue engineering. Several research studies have shown promising outcomes of stem cell transplantation and tissue engineering when combined with either surgical or conservative treatment, resulting in improved pain outcomes. The additional benefit of regenerative medicine techniques, specifically stem cell transplantation, is the potential for treating the root pathology of degeneration. Regenerative medicine techniques also have the potential to either halt or reverse degeneration as opposed to current standards of care for managing symptoms. There is a plethora of current research highlighting the benefits of regenerative medicine techniques; however, there remains clinical concerns and ethical concerns regarding the use of regenerative therapy techniques such as stem cell transplantation in the context of IVD degeneration.

Evaluation of optical coherence tomography findings in patients with multiple sclerosis and glaucoma.

Glaucoma and multiple sclerosis (MS) can cause optic disc pathology and, in this way, affect optical coherence tomography (OCT) data. In this context, the objective of this study is to investigate the changes in the mean, quadrant, and sector data measured by OCT in glaucoma and MS patients. The sample of this prospective cohort study consisted of 42 MS patients (84 eyes), 34 Primary open-angle glaucomas patients (67 eyes), and 24 healthy control subjects (48 eyes). The MS group was divided into two groups according to the presence of a history of optic neuritis. Accordingly, those with a history of optic neuritis were included in the MS ON group, and those without a history of optic neuritis were included in the MS NON group. The differences between these groups in the mean, quadrant, and sector data related to the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) were evaluated. Superior nasal (SN), superior temporal (ST), inferior nasal (IN), and superior quadrant (SUP) values were significantly lower in the glaucoma group than in the MS group (p < 0.05). The mean superior GCC (GCC SUP) value was significantly lower in the MS ON group than in the glaucoma group (p < 0.05). On the other hand, SN, ST, inferior temporal (IT), IN, average RNFL (AVE RNFL), semi-average superior RNFL (SUP AVE RNFL), semi-average inferior RNFL (INF AVE RNFL), SUP, and inferior quadrant RNFL (INF) values were significantly lower in the glaucoma group than in the MS NON group (p < 0.05). RNFL and GCC parameters get thinner in MS and glaucoma patients. While the inferior and superior RNFL quadrants are more frequently affected in glaucoma patients, the affected quadrants vary according to the presence of a history of optic neuritis in MS patients. It is noteworthy that the GCC superior quadrant was thin in MS ON patients. The findings of this study indicate that OCT data may be valuable in the differential diagnosis of glaucoma and MS.

CAN AN INTERVAL-BASED RUNNING EXERCISE INTERVENTION IMPROVE LUMBAR INTERVERTEBRAL DISC HEALTH? THE ASTEROID RANDOMISED CONTROL TRIAL

BACKGROUND AND AIMS Low back pain is the leading cause of global disability, with lumbar disc pathologies estimated to contribute to up to 40% of cases. Exercise training is an established treatment to reduce pain intensity and disability in individuals with low back pain; however, the effect of exercise training on intervertebral discs is unknown. Cross-sectional studies have shown that endurance running (&amp;gt;50km per week) is associated with healthier intervertebral discs, as evidenced by greater T2-relaxation (hydration) and intervertebral disc height. However, no studies have explored the relationship between running and disc health prospectively. This study aims to examine the impact of a 12-week progressive run-walk exercise intervention on intervertebral disc health in individuals with chronic low back pain. METHODS Forty individuals with non-specific low back pain were enrolled in a 12-week parallel randomised control trial and allocated to either a digitally-delivered progressive run-walk interval exercise intervention (supervised by an accredited exercise physiologist) or waitlist control. All participants underwent magnetic resonance imaging at baseline, 6 and 12 weeks to examine intervertebral disc health (e.g. T2-relaxation, intervertebral disc height, Pfirrmann grade). RESULTS Thirty-nine participants (20 intervention and 19 waitlist control; mean [SD] age: 33 [6] years, female: 50%) underwent MRI at baseline, 6 and 12 weeks. At baseline, intervertebral disc outcomes were no different in either group (T2-relaxation[ms] mean[SD]:81.07[6.61] and 85.11[9.33]; p=0.939, height[mm] mean[SD]: 8.77[0.87] and 9.03[0.90]; p=0.819, respectively). Six and 12-week outcomes are currently being analysed and results will be available for presentation at the conference. CONCLUSION This randomised control trial will provide world-first evidence on the effects of a progressive run-walk exercise intervention on lumbar intervertebral disc health in adults with non-specific chronic low back pain. Should this intervention prove effective, findings will have marked implications for current guidelines and clinical management of this debilitating chronic condition.

Incidental findings of cervical magnetic resonance imaging: A retrospective reinterpretation of a large adult population.

Magnetic resonance imaging (MRI) of the cervical spine is one of the routine MRI scans of the cervical region in investigating spinal disc pathologies, spinal stenosis, and the detection of spinal lesions, which are the major parameters to be evaluated in this examination. The authors of this study are focused on a different aspect of cervical MRI, revealing the incidences and reporting rates of extraspinal incidental findings. A total of 1000 patients (324 males, 676 females, mean age 47 ± 14) who had undergone an MRI of the cervical spine were enrolled in this study. The magnetic resonance (MR) images of these patients were re-interpreted with respect to the incidental extraspinal imaging findings. The incidence and reporting rate of each incidental finding encountered during the evaluation were presented in percentages. 726 patients in this study had at least one incidental lesion. The results of this study revealed that the most common incidental lesions encountered during the reinterpretation of cervical MRI were nasopharyngeal mucosal thickening (n = 442) and thyroid hypertrophy (n = 231). The total reporting rate of incidental findings was 5.29%. There are many data to be reported and evaluated by MR imaging of the cervical spine, not only the main parameters of MRI scanning in the routine daily practice of radiologists. All our colleagues should be aware and careful of these incidental findings, which may be the initial medical data of the patients' diagnoses, or to avoid undesirable medicolegal problems.

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.