Endplate Irregularities Research Articles

P-22 INSIDIOUS, RARE, AND MIMICKING BONE DISEASE: PROGRESSIVE PSEUDORHEUMATOID DYSPLASIA

Abstract Introduction Progressive pseudorheumatoid dysplasia (PPD) is a rare autosomal recessive skeletal dysplasia that primarily affects joint cartilage, leading to progressive stiffness and enlargement without inflammation. Symptoms typically manifest between ages 3 and 6. Here we report a case of PPD with a prolonged undiagnosed period, despite early symptom onset. Clinical Case A 43-year-old female office manager presented with significant joint mobility limitations and walking difficulties. Her medical history revealed that she first sought medical attention at the age of two due to leg deformities, where genu varum was detected and initially treated as rickets with vitamin D supplementation. At ages 7 and 9, the patient underwent limb lengthening and corrective surgeries for bilateral lower extremity deformities. By age 12, worsening gait required assistive devices. At age 33, a right femoral head fracture necessitated prosthesis implantation, followed by a similar procedure on the left hip at age 36. In the last five years, mobility limitations and pain in the left shoulder and knee have increased. Her medical history was otherwise unremarkable, though her parents were noted to be consanguineous. Physical exam revealed 147 cm height and significant scoliosis. Flexion contractures were observed in the proximal and distal interphalangeal joints of both hands, along with significant mobility limitations in the metacarpophalangeal joints, wrists, and elbows, especially in extension. Additionally, there was limited extension in both knees, more severe on the left, and contractures in the left ankle. No signs of arthritis were present. Laboratory results showed a 25-OH Vitamin D level of 17.53 µg/L, leading to replacement therapy initiation. Acute phase reactants were normal. Radiographic imaging (Figure 1) showed osteoporotic bones, platyspondyly, scoliosis, vertebral endplate irregularities, narrowed disc spaces, and peripheral osteophytes in the vertebral column. Furthermore, epiphyseal enlargement, uniform joint space narrowing, irregular joint surfaces, and periarticular osteopenia were observed bilaterally in the shoulders, elbows, knees, ankles, radiocarpal, midcarpal, carpometacarpal, metacarpophalangeal, and interphalangeal joints. Despite these findings, bone mineral density (BMD) of the L1-L4 vertebrae measured 1.337 g/cm² (Z-score: 1.2) via dual-energy X-ray absorptiometry (DEXA). Based on the clinical, laboratory, and imaging findings, a diagnosis of PPD was established, and the patient was referred for physical therapy and rehabilitation. Conclusion This case illustrates a patient with PPD, marked by significant involvement of the hand joints, large joints, and spine, accompanied by short stature. Patients with PPD are frequently undiagnosed or misdiagnosed. The absence of inflammatory features is crucial in distinguishing PPD from juvenile idiopathic arthritis. The lack of extraskeletal involvement further characterizes this disease.Figure 1Figure 1a shows osteoporotic bones, platyspondyly, scoliosis, vertebral endplate irregularities, narrowed disc spaces, and peripheral osteophytes in the vertebral column. Figure 1b and 1c show epiphyseal enlargement, uniform joint space narrowing, irregular joint surfaces, and periarticular osteopenia in both knees and hands.

Prevalence of presumed endplate junction failure at the lumbosacral intervertebral junction in dogs on computed tomography.

Lumbosacral intervertebral disc herniation (IVDH) is a common cause of lower back pain in dogs and humans. In humans, the vertebral endplate to annulus fibrosus (AF) attachment was implicated as an alternative failure site besides rupture through the dorsal AF (AFF). Endplate junction failure (EPJF) is characterized by IVDH, accompanied by endplate irregularities (type A), rim avulsions (type B), or larger bony avulsions on one (type C) or both endplates (type D), associated with an adjacent endplate defect. This retrospective study reports the CT prevalence of presumed EPJF in dogs and its associations with signalment and other lumbosacral CT abnormalities. CT scans, including the lumbosacral spine of dogs obtained at two institutions, were assessed, yielding 324 scans. Presumed EPJF was found in 69 dogs (21%) and AFF in 68 dogs (21%), commonly at the caudal endplate of the last lumbar vertebra (71%). The remaining 187 dogs did not show presumed EPJF or AFF. Presumed EPJF type A occurred in 49/69, type B in 19/69, and type C in 1/69 dogs. Univariable logistic regression showed that presumed EPJF was associated with significantly higher IVDH grades than AFF. In the multiple regression model, presumed EPJF and AFF remained associated with increasing age and spondylosis deformans. Presumed EPJF was associated with vertebral endplate sclerosis and AFF with zygapophyseal joint osteoarthritis. In conclusion, presumed EPJF was observed on CT in 21% of dogs with lumbosacral IVDH. Prospective studies correlating EPJF on CT with clinical, surgical, and histopathological findings are needed for a better understanding of the underlying pathology and clinical relevance.

Correlation between sagittal morphology of lower lumbar end plate and degenerative changes in patients with lumbar disc herniation.

As an important anatomic factor in the process of lumbar disc herniation (LDH), the correlation between end plate sagittal morphology and intervertebral disc degeneration (IDD) is unclear. Moreover, research on imaging data of lumbar end plate in patients with LDH is still insufficient. Our study aimed to observe the morphological change of the lower lumbar end plate (L3-S1) in patients with LDH on magnetic resonance imaging (MRI) and analyze its correlation with the degree of IDD. A total of 116 patients were included in the study. Based on their MRI, we divided end plates into three types (concave, flat, and irregular), assigned intervertebral discs with Grade I-V given 1-5 points successively according to the Pfirrmann system, and determined whether there was Modic change of each end plate. The correlation between the morphology of the end plate and the degree of IDD was analyzed. There was an excellent interobserver agreement for each item we analyzed (interclass correlation coefficient >0.75). Concave end plate appeared most frequently (187, 53.7%) and was mainly distributed in L3/4 and L4/5, whereas irregular end plate was the least common type (54, 15.5%) and mainly concentrated in L5/S1. The IDD degree of the corresponding disc increased gradually from concave (3.27 ± 0.81) to irregular end plates (4.25 ± 0.79) (P < 0.05). Irregular end plates were more likely to have Modic changes than concave and flat end plates (P < 0.05). The sagittal morphology of the lower lumbar end plate is related to modic changes and degree of IDD (based on the Pfirrmann grading system) in patients with LDH, and the concave end plate mostly reflects a lower degree of lumbar disc degeneration, which has substantial clinical significance.

Histology and chronological magnetic resonance images of congenital spinal deformity: An experimental study in mice model

BackgroundThe natural history of the congenital spinal deformity and its clinical magnitude vary widely in human species. However, we previously reported that the spinal deformities of congenital scoliosis mice did not progress throughout our observational period according to soft X-ray and MRI data. In this study, congenital vertebral and intervertebral malformations in mice were assessed via magnetic resonance (MR) and histological images.MethodsCongenital spinal anomalies were chronologically assessed via soft X-ray and 7 T MR imaging. MR images were compared to the histological images to validate the findings around the malformations.ResultsSoft X-ray images showed the gross alignment of the spine and the contour of the malformed vertebrae, with the growth plate and cortical bone visible as higher density lines, but could not be used to distinguish the existence of intervertebral structures. In contrast, MR images could be used to distinguish each structure, including the cortical bone, growth plate, cartilaginous end plate, and nucleus pulposus, by combining the signal changes on T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI). The intervertebral structure adjacent to the malformed vertebrae also exhibited various abnormalities, such as growth plate and cartilaginous end plate irregularities, nucleus pulposus defects, and bone marrow formation. In the chronological observation, the thickness and shape of the malformed structures on T1WI did not change.ConclusionsSpinal malformations in mice were chronologically observed via 7 T MRI and histology. MR images could be used to distinguish the histological structures of normal and malformed mouse spines. Malformed vertebrae were accompanied by adjacent intervertebral structures that corresponded to the fully segmented structures observed in human congenital scoliosis, but the intervertebral conditions varied. This study suggested the importance of MRI and histological examinations of human congenital scoliosis patients with patterns other than nonsegmenting patterns, which may be used to predict the prognosis of patients with spinal deformities associated with malformed vertebrae.

Investigating the impact of cartilaginous endplate herniation on recovery from percutaneous endoscopic lumbar discectomy

ObjectiveThis study aimed to evaluate the influence of herniation of cartilaginous endplates on postoperative pain and functional recovery in patients undergoing percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation (LDH).MethodsA retrospective analysis was conducted on 126 patients with LDH treated with PELD at the Third Hospital of Hebei Medical University from January 2021 to January 2022. Whether cartilaginous endplates had herniated was identified by analyzing these specific findings from MRI scans: posterior marginal nodes, posterior osteophytes, mid endplate irregularities, heterogeneous low signal intensity of extruded material, and Modic changes in posterior corners and mid endplates. Patients were assessed for postoperative pain using the Visual Analogue Scale (VAS) and functional recovery using the Oswestry Disability Index (ODI) and Modified MacNab criteria. Statistical analyses compared outcomes based on the presence of herniation of cartilaginous endplates.ResultsPatients with herniation of cartilaginous endplates experienced higher pain scores early postoperatively but showed significant improvement in pain and functional status over the long term. The back pain VAS scores showed significant differences between the groups with and without herniation of cartilaginous endplates on postoperative day 1 and 1 month (P < 0.05). Leg pain VAS scores showed significant differences on postoperative day 1 (P < 0.05). Modic changes were significantly associated with variations in postoperative recovery, highlighting their importance in predicting patient outcomes. In patients with herniation of cartilaginous endplates, there were statistically significant differences in the back pain VAS scores at 1 month postoperatively and the ODI functional scores on postoperative day 1 between the groups with and without Modic changes (P < 0.05). There were no significant differences in the surgical outcomes between patients with and without these conditions regarding the Modified MacNab criteria (P > 0.05).ConclusionHerniation of cartilaginous endplates significantly affect early postoperative pain and functional recovery in LDH patients undergoing PELD. These findings emphasize the need for clinical consideration of these imaging features in the preoperative planning and postoperative management to enhance patient outcomes and satisfaction.

Spinal Involvement in Patients with Chronic Non-Bacterial Osteomyelitis (CNO): An Analysis of Distinctive Imaging Features

Spinal involvement by chronic non-bacterial osteomyelitis (CNO) has been increasingly reported in recent years, often being presented as a diagnostic dilemma requiring differential diagnosis with bacterial spondylodiscitis and/or neoplasia. This study was aimed at identifying the imaging features of CNO facilitating its differentiation from other spinal diseases. Two radiologists assessed the imaging studies of 45 patients (16 male and 29 female, aged from 6 to 75 years, 15 children) with CNO collected from 5 referential centers. Spinal lesions were found in 17 patients (2 children and 15 adults), most often in the thoracic spine. In children, the lesions involved short segments with a destruction of vertebral bodies. In adults, the main findings were prominent bone marrow edema and osteosclerosis, endplate irregularities, and ankylosing lesions extending over long segments; paraspinal inflammation was mild and abscesses were not observed. In both children and adults, the involvement of posterior elements (costovertebral and facet joints) emerged as an important discriminator between CNO and neoplasia/other inflammatory conditions. In conclusion, a careful inspection of imaging studies may help to reduce the number of biopsies performed in the diagnostic process of CNO.

Predictors of conversion surgery after conservative treatment for pyogenic spondylitis

BackgroundPatient demographic and clinical characteristics may be factors associated with the success of conservative treatment for pyogenic spondylitis. The ability of imaging findings at initial diagnosis to predict patient outcomes remains unclear. The aim of this study was to investigate the risk factors associated with conversion surgery after conservative treatment for pyogenic spondylitis, with a special focus on the initial computed tomography (CT) findings. MethodsThis study enrolled 35 patients with pyogenic spondylitis who underwent CT and magnetic resonance imaging (MRI) at diagnosis and were followed-up for more than 6 months. Patients were diagnosed by MRI, and the degree of bone destruction was assessed on CT cross-sectional images. Vertebral body destruction was classified as grades 0 (almost normal), 1 (endplate irregularity), 2 (vertebral body destruction not involving the posterior wall), and 3 (destruction involving the posterior wall). Patients were divided into four groups based on grade of bone destruction and their clinical characteristics were compared. Results1, 11, 11, and 12 patients were classified as grades 0, 1, 2, and 3, respectively. Univariate analysis showed no significant differences in the demographic and clinical characteristics of the four groups. Eighteen (51.4 %) patients had been treated surgically, with the rate of surgical treatment being significantly higher in patients with grade 3 (83.3 %) than in those with grades 0 + 1 (25 %) and grade 2 (45.5 %) (P < 0.05). Multivariate analysis showed that epidural abscess on MRI (odds ratio [OR] 10.8, 95 % confidence interval [CI] 1.68–69.7), grade 3 bone destruction on CT (OR 3.97, 95 % CI 1.21–13.0), and C-reactive protein (CRP) improvement rate after 1 week of treatment (OR 0.95, 95 % CI 0.91–0.99) were risk factors for surgery. ConclusionsEarly surgical treatment should be considered for patients with pyogenic spondylitis who present with an epidural abscess on MRI and bone destruction extending to the posterior wall on CT at the time of diagnosis.

Scheuermann's Disease.

Scheuermann's disease is a rigid progressive kyphosis occurring in late childhood to adolescence. It is the most common cause of sagittal imbalance and angular progressive kyphosis in adolescents associated with back pain. The exact etiology of the disease is unclear, but it is characterized by defective growth of the end plate that may result from excessive mechanical stress on a weakened end plate during spinal growth. Several other theories have been proposed, and it is thought to be a multifactorial disease occurring as a result of the interplay of multiple factors. The radiographic features consist of anterior vertebral body wedging, irregular end plates, Schmorl's nodes, and intervertebral disk degeneration. The natural history and evolution of this disease is also unknown. Conservative management with physiotherapy, rehabilitation, and bracing is the first line of treatment. Mechanical bracing helps prevent further progression of the kyphotic deformity. Surgery is mostly indicated in patients with failure of conservative management, with neurologic compromise, and for cosmetic reasons.

Relationship between vertebral endplate degeneration (Modic changes, Schmorl nodes, endplate irregularities) and Bone Mineral Density

ObjectiveThe end plate plays an important role in maintaining the structural integrity, balancing biomechanical and supplying nutrition, how dose it changes with the reduced bone mineral density (BMD) remains unknown. The objective of this study is to investigate the relationship between lumbar end plate degeneration and normal BMD, osteopenia and osteoporosis. MethodsA retrospective analysis of 362 patients equal or over 55 years old who underwent both lumbar MRI and dual-energy x-ray absorptiometry(DXA) examinations due to lumbar discomfort or a healthy physical examination. Two Radiologists reported the Modic changes, Schmorl node, and end plate irregularities of 11 end plates from L1 to S1. Data were separated by sex, and then the summed results were grouped in age matching. ResultsIn women, with the decrease of hip BMD, the positive rate and severity of Modic changes and the severity of end plate irregularities showed an increasing trend; Among men, the number of Modic changes and end plate irregularities increased in osteoporosis subjects and osteopenia subjects compared with normal BMD subjects. While the positive rate of Schmorl nodes incremental trend was not obvious in female and male subjects. ConclusionsOsteoporosis in the elderly will aggravate the degeneration of the lumbar end plate Modic changes and end plate irregularities.

A novel homozygous variant of COL2A1 in a Chinese male with type II collagenopathy: a case report

BackgroundType II collagenopathies are a spectrum of diseases and skeletal dysplasia is one of the prominent features of collagenopathies. Molecular defects of the COL2A1 gene cause type II collagenopathies that is mainly an autosomal dominant disease, whereas some rare cases with autosomal recessive inheritance of mode have also been identified.Case presentationThe patient was a 5-year-old male with a short neck, flat face, epiphyseal dysplasia, irregular vertebral endplates, and osteochondritis. Sequencing result indicated NM_001844.4: c.3662C > T; p. (Ser1221Phe) a novel missense variant, leading to a serine-to-phenylalanine substitution. Sanger sequencing confirmed the variant compared to his parents and brother.ConclusionsWe identified a novel homozygous variant of the COL2A1 gene as the cause of type II collagenopathies in a Chinese male, enriching the spectrum of genotypes. This is the first case of type II collagenopathies inherited in an autosomal recessive manner in China and East Asia, and it is the first case that resulted from serine substitution in the world.

Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation

For chronic low back pain, the causal mechanisms between pathological features from imaging and patient symptoms are unclear. For instance, disc herniations can often be present without symptoms. There remains a need for improved knowledge of the pathophysiological mechanisms that explore spinal tissue damage and clinical manifestations of pain and disability. Spaceflight and astronaut health provides a rare opportunity to study potential low back pain mechanisms longitudinally. Spaceflight disrupts diurnal loading on the spine and several lines of evidence indicate that astronauts are at a heightened risk for low back pain and disc herniation following spaceflight.To examine the relationship between prolonged exposure to microgravity and the elevated incidence of postflight disc herniation, we conducted a longitudinal study to track the spinal health of twelve NASA astronauts before and after approximately 6 months in space. We hypothesize that the incidence of postflight disc herniation and low back complaints associates with spaceflight-included muscle atrophy and pre-existing spinal pathology.This is a prospective longitudinal study.Our sample included a cohort of twelve astronaut crewmembers.From 3T MRI, we quantified disc water content (ms), disc degeneration (Pfirrmann grade), vertebral endplate irregularities, facet arthropathy and/ fluid, high intensity zones, disc herniation, multifidus total cross-sectional area (cm2), multifidus lean muscle cross-sectional area (cm2), and muscle quality/composition (%). From quantitative fluoroscopy we quantified, maximum flexion-extension ROM (°), maximum lateral bending ROM (°), and maximum translation (%). Lastly, patient outcomes and clinical notes were used for identifying postflight symptoms associated with disc herniations from 3T MRI.Advanced imaging data from 3T MRI were collected at three separate time points in relation to spending six months in space: (1) within a year before launch ("pre-flight"), (2) within a week after return to Earth ("post-flight"), and (3) between 1 and 2 months after return to Earth ("recovery"). Fluoroscopy of segmental kinematics was collected at preflight and postflight timepoints. We assessed the effect of spaceflight and postflight recovery on longitudinal changes in spinal structure and function, as well as differences between crew members who did and did not present a symptomatic disc herniation following spaceflight.Half of our astronauts (n=6) experienced new symptoms associated with a new or previously asymptomatic lumbar disc protrusion or extrusion following spaceflight. We observed decreased multifidus muscle quality following spaceflight in the lower lumbar spine, with a reduced percentage of lean muscle at L4L5 (-6.2%, p=.009) and L5S1 (-7.0%, p=.006) associated with the incidence of new disc herniation. Additionally, we observed reduced lumbar segment flexion-extension ROM for L2L3 (-17.2%, p=.006) and L3L4 (-20.5%, p=.02) following spaceflight, and furthermore that reduced ROM among the upper three lumbar segments (-24.1%, p=.01) associated with the incidence of disc herniation. Existing endplate pathology was most prevalent in the upper lumbar spine and associated with reduced segmental ROM (-20.5%, p=.02).In conclusion from a 10-year study investigating the effects of spaceflight on the lumbar spine and risk for disc herniation, we found the incidence of lumbar disc herniation following spaceflight associates with compromised multifidus muscle quality and spinal segment kinematics, as well as pre-existing spinal endplate irregularities. These findings suggest differential effects of spinal stiffness and muscle loss in the upper versus lower lumbar spine regions that may specifically provoke risk for symptomatic disc herniation in the lower lumbar spine following spaceflight. Results from this study provide a unique longitudinal assessment of mechanisms and possible risk factors for developing disc herniations and related low back pain. Furthermore, these findings will help inform physiologic countermeasures to maintain spinal health in astronauts during long-duration missions in space.

Lumbar Scheuermann\u2019s disease found in a patient with osteogenesis imperfecta (OI) caused by a heterozygous mutation in COL1A2 (c.4048G\u2009>\u2009A): a case report

BackgroundOsteogenesis imperfecta (OI) is a heterogeneous connective tissue disorder characterized by increased bone fragility and a series of extraskeletal manifestations. Approximately 90 % of OI cases are caused by type I collagen variants encoded by the collagen type I alpha 1 (COL1A1) or type I alpha 2 (COL1A2) gene. Lumbar Scheuermann’s disease is an atypical type of Scheuermann’s disease accompanied by Schmorl’s nodes and irregular endplates but without pronounced kyphosis. Although the etiology of Scheuermann’s disease is unclear, genetic and environmental factors are likely.Case presentationHere, we report a 32-year-old male patient who experienced multiple brittle fractures. Gene sequencing revealed a heterozygous mutation, c.4048G > A (p.G1350S), in the COL1A2 gene, and the patient was diagnosed with OI. Magnetic resonance imaging of his thoracolumbar spine revealed multiple Schmorl’s nodes.ConclusionsThis is the first reported case of OI coexisting with the spinal presentation of Scheuermann’s disease. It is speculated that the COL1A2 gene mutation might be an underlying novel genetic cause of Scheuermann’s disease. In conclusion, this case demonstrates the relationship between Scheuermann’s disease and OI for the first time and enriches the genotype-phenotype spectrum of OI.

Anatomical changes of the thoracic vertebrae in asymptomatic individuals – A cross-sectional study

AbstractPurposeThe purpose of the present cross-sectional study is to examine the degree of degenerative patho-anatomical changes in the thoracic vertebrae in asymptomatic adult patients.Materials and MethodsA total of 150 adult patients were examined with computed tomography (CT) because of various health conditions (e.g., tumour risk). The images were revised with post-processing procedures to detect bony changes in the thoracic vertebrae. Three types of degenerations (osteophytes, arthrosis, and irregular endplates) were examined and graded using appropriate grading systems. Correlational investigations were carried out in relation to age, BMI, and degenerations. Moreover, to examine the value of the degenerations the frequencies of the grading categories were assessed in each segment.ResultsThe total number of the patients included was 41, who had no trunk symptoms. We found no convincing correlations in terms of age, BMI, and degenerations, however, age and facet joint arthrosis showed a tentative association. The degree of the degenerations was the largest in the Th7-8, Th8-9, Th9-10 segments for osteophytes, in the Th4-5, Th5-6 for arthrosis, and in the Th8-9, Th9-10 for irregular endplates.ConclusionsThis study found that there are several progressive degenerative changes in the thoracic spine without any clinical symptoms. Accordingly, it can be advised that clinicians should avoid labelling the disorders and planning their treatment based on the results of diagnostic imaging only.

Relationship between diffuse idiopathic skeletal hyperostosis and fragility vertebral fracture: a prospective study in older men.

To analyse the risk of incident vertebral and non-vertebral fracture in men with DISH. In 782 men ages 50-85 years, DISH was diagnosed using Resnick's criteria. In men followed prospectively for 7.5 years, a radiographic incident vertebral fracture was defined by a decrease of ≥20% or ≥4mm in any vertebral height vs baseline. Self-reported incident non-vertebral fractures were confirmed by medical records. Men with DISH had higher BMD at the lumbar spine (P < 0.05), but not at other skeletal sites. After adjustment for confounders including disc space narrowing (DSN) and endplate irregularity, the risk of vertebral fracture was higher in men with DISH vs men without DISH [10/164 (6.1%) vs 16/597 (2.7%), P < 0.05; odds ratio (OR) 2.89 (95% CI 1.15, 7.28), P < 0.05]. DISH and low spine BMD were each associated with a higher vertebral fracture risk. The vertebral fracture risk was higher in men who had both DISH and severe DSN. DISH and endplate irregularities (EIs) were each associated with higher vertebral fracture risk. DISH, DSN and EIs define the intervertebral space dysfunction, which was associated with higher vertebral fracture risk [OR 3.99 (95% CI 1.45, 10.98), P < 0.01]. Intervertebral space dysfunction improved the vertebral fracture prediction (ΔAUC = +0.111, P < 0.05), mainly in men with higher spine BMD (>0.9 g/cm2; ΔAUC = +0.189, P < 0.001). DISH was not associated with the risk of non-vertebral fracture. DISH is associated with higher vertebral fracture risk, independently of other risk factors. Assessment of the intervertebral space dysfunction components may improve the vertebral fracture prediction in older men.

Structural spinal abnormalities on MRI and associations with weight status in a general pediatric population

BACKGROUND CONTEXTSeveral spinal abnormalities have been studied using magnetic resonance imaging (MRI). However, in children these studies were sparsely performed in general populations. Examining young children's spines is important since the shape of the bone is largely determined during the growth spurt. Furthermore, it is so far unknown if associations between weight status and spinal abnormalities, which are known for adolescents and adults, are already present in young children. PURPOSEWe aimed to present the prevalence of structural abnormalities in the prepubertal pediatric spine on MRI and their association with measures of the children's body weight and body composition. STUDY DESIGNCross-sectional study embedded in a prospective population-based birth cohort study. PATIENT SAMPLEFor this study, participants from the Generation R Study were selected based on the availability of MRI data of the lumbar spine and accelerometry data at the age of 9 years. OUTCOME MEASURESThe presence of structural abnormalities of intervertebral discs and vertebrae was scored on MRI. The body mass index-standard deviation [BMI-SD] score was calculated from objectively measured weight and height, and body composition measurements were obtained by a dual-energy X-ray absorptiometry scan. METHODSA semiquantitative scoring tool to assess the intervertebral discs and vertebrae of the lumbar spine on conventional MRI was designed for this purpose. Proportions of children with spinal abnormalities on at least one lumbar vertebral level were presented. Logistic regression was used to analyze associations between abnormalities and weight and body composition. We declare not to have any financial conflicts of interests. RESULTSWe included 559 children (median age of 9.88 years (interquartile range 6.74–10.02), 48.5% boys). Most frequently observed abnormalities of the intervertebral discs were abnormal signal intensity (24.9%), decreased or collapsed disc height (37.6%), disc bulging (73.3%), and abnormal nuclear shape (29.1%). Vertebral endplate irregularities and lumbosacral transitional vertebrae were seen in respectively 40% and 9.3% of the participants. Except for disc bulging, all abnormalities were predominantly present at the L5 level. Only the presence of endplate irregularities was associated with a higher body weight (BMI SD score (odds ratio [OR] 1.50 [95% confidence interval [CI] 1.21–1.86]) and BMI SD change (OR 1.48 [95% CI 1.07–2.03])) and increased body mass values in body composition measurements (% body fat (OR 1.05 [95% CI 1.02–1.09), fat mass index (OR 1.23 [95% CI 1.09–1.39]), and fat-free mass index (OR 1.30 [95% CI 1.06–1.59])) in adjusted analyses. CONCLUSIONSStructural spinal abnormalities, especially disc bulging, endplate irregularities, and an abnormal disc height, are already present in children aged 9 years from a Dutch population-based cohort. Of those abnormalities, endplate irregularities are associated with various weight and body composition measurements.

The skeletal phenotype of intermediate GM1 gangliosidosis: Clinical, radiographic and densitometric features, and implications for clinical monitoring and intervention.

GM1 gangliosidosis is a lysosomal storage disorder caused by mutations in GLB1 encoding a lysosomal β-galactosidase. This disease is a continuum from the severe infantile form with rapid neurological decline to the chronic adult form, which is not life-limiting. The intermediate or type 2 form can be further classified into late infantile and juvenile forms. The frequency and severity of skeletal outcomes in late infantile and juvenile patients have not been characterized. Our goals are to describe the radiological skeletal abnormalities, bone mineral density (BMD), and frequency of fractures in patients with intermediate GM1 gangliosidosis. We evaluated 13 late infantile and 21 juvenile patients as part of an ongoing natural history study. Average time from onset of symptoms to diagnosis was 1.9 and 6.3 years for late infantile and juvenile patients, respectively. All late infantile patients had odontoid hypoplasia and pear-shaped vertebral bodies, the frequency of which was significantly different than in patients with juvenile disease (none and 14%, respectively). Juvenile patients had irregular endplates of the vertebral bodies (15/21), central indentation of endplates (10/21), and squared and flat vertebral bodies (10/21); all allowed radiographic differentiation from late infantile patients. Lumbar spine, femoral neck, and total hip BMD were significantly decreased (-2.1, -2.2, and -1.8 Z-scores respectively). Lumbar spine BMD peaked at 19 years, while distal forearm BMD peaked at 30 years. Despite low BMD, no patients exhibited fractures. We have demonstrated that all late infantile patients have some degree of odontoid hypoplasia suggesting the need for cervical spine evaluation particularly prior to anesthesia, whereas juvenile patients had variable skeletal involvement often affecting activities of daily living. Type 2 GM1 gangliosidosis patients have skeletal abnormalities that are both an early indication of their diagnosis, and require monitoring and management to ensure the highest possible quality of life.

Comparison of MRI with x-ray in the evaluation of tuberculosis of spine

Introduction: MRI is the most valuable method for detecting early disease and is preferred technique to define the activity and extent of infection followed by x–ray. Aim: To evaluate MRI as a valuable noninvasive diagnostic tool in spinal tuberculosis and to correlate with plain radiograph for the early detection of spinal tuberculosis. Material and method: This cross-sectional study was carried out on 40 patients who were suspected as cases of spinal tuberculosis. Plain X-ray were done before the MRI examination. Results: The comparison of X-ray and MRI for evaluating spinal TB on the basis of end plate irregularity, thecal sac compression, cord compression and cord changes was statistically highly significant. It was statistically significant on the basis of Disk Space Narrowing/Disk Involvement, paravertebral Widening/Psoas abscess and Posterior Element Involvement. X-ray when compared to MRI was found to have a sensitivity of 48.72% and a specificity of 100% in detection of end plate irregularities, sensitivity of 89.47% and specificity of 100% in detection of vertebral height reduction, sensitivity of 78.79% and specificity of 100% in detection of disk Space narrowing / disk Involvement and sensitivity of 28.57% and specificity of 92.31% in detection of paravertebral widening/psoas abscess. Conclusion: MRI is a better and more Informative imaging modality in evaluation of patients of Pott’s spine providing the diagnosis earlier than conventional methods.

Does Vertebral End Plate Morphology Affect Cage Subsidence After Transforaminal Lumbar Interbody Fusion?

To investigate the effect of end plate morphology on cage subsidence and to compare the surgical outcomes among patients with different vertebral end plate morphologies. We reviewed a series of consecutive patients from January 2009 to January 2016 who had undergone monosegment L4/5 transforaminal lumbar interbody fusion (TLIF) with a follow-up >2 years. The enrolled patients were divided into 3 groups based on the preoperative vertebral end plate morphology on T1-weighed sagittal magnetic resonance scans: concave group (C group), flat group (F group), and irregular group (Ir group). Lumbar lordosis (LL), segmental lordosis (SL), and disc height (DH) were measured on the plain image at each follow-up, and three-dimensional computed tomography (3D-CT) was obtained at 1 year follow-up to evaluate the cage subsidence and solid fusion. A total of 145 consecutive patients (41 males and 104 females) were included in this study, with a mean follow-up of 33.8 ± 12.3 months. The age was significantly older in the Ir group than in the C group or F group (P < 0.05). Cage subsidence was detected in 23 patients (15.9%) at 1 year follow-up through 3D-CT. The incidence of cage subsidence was significantly higher in the Ir group than in the F group or C group (P < 0.05). Patients in the Ir group had significant loss of DH, SL, and LL at the latest follow-up, compared with those in the C group and F group (P<0.05). Patients with cage subsidence had a significantly older age (P < 0.05). The presence of cage subsidence was associated with end plate morphology as shown by logistic regression analysis (P < 0.05). Before surgery, Oswestry Disability Index and visual analog scale back pain scores were significantly higher in the Ir group than in the C and F groups (P < 0.05). After surgery and until the latest follow-up, each group experienced significant improvement in contrast to preoperative scores regardless of end plate morphology (P < 0.05). Morphology of the end plate plays an important role in the development of cage subsidence after TLIF surgery. Fused segments with irregular end plates are prone to cage subsidence. Although cage subsidence does not affect short-term clinical outcomes, measures should be taken to prevent cage subsidence-related loss of SL and total LL.

Disc Degeneration in Unfused Caudal Motion Segments Ten Years Following Surgery for Adolescent Idiopathic Scoliosis

HypothesisThe frequency of disc degeneration (DD) in the distal mobile segments will increase over time following surgery for adolescent idiopathic scoliosis (AIS). DesignRetrospective review of a prospective AIS registry. IntroductionDurability of surgical outcomes is essential for maintenance of quality of life as well as for family decision making and for assessment of the value of a healthcare intervention. We assessed DD, its risk factors, and association with health-related quality of life 10 years after AIS surgery. MethodsFive radiographic indicators of DD, previously validated, were evaluated preoperatively and 1 month, 2, 5, and 10 years postoperatively by a radiologist in operative AIS patients. A composite radiographic score (CRS; range 0-10) was calculated using the sum of each of the DD indicators. The severity of CRS in relation to the time point after surgery and various risk factors were assessed using linear regression or Pearson χ2 test. CRS ≥3 was chosen to indicate significant DD. Association of CRS with SRS-22 outcome was evaluated by linear regression. Results193 consecutive patients (mean age at surgery 14.4 years; 86% female) were assessed. Surgical approach included 102 posterior and 91 anterior fusions. Contributors to maximum CRS at 10 years were Schmorl’s nodes (7.3% of patients), osteophytes (40.4%), sclerosis (29%), and irregular endplate (8.3%). CRS ≥3 occurred in 1.6%, 0.54%, 3.7%, 6.8%, and 7.3% of patients at the various time points (r2=0.83, p=.0313), respectively. More than 50% of DD occurred at the second (35.5%) and third (20%) disc caudal to the LIV. LIV of L4 compared with more cephalad LIV had the highest risk of developing significant DD (27.3%; p=.0267). It was found that disc wedging subjacent to the LIV (≥5°) and LIV translation (≥2 cm) lead to a sixfold increase in significant DD (odds ratio=6.71 and 6.13, respectively). Severity of DD was not associated with the number of levels fused (p=.2131), the surgical approach (p=.8245), or the construct type (p=.2922). No significant association was established between 10-year CRS and SRS-22 scores. ConclusionIn the first study of its kind, we found that only 7.3% of patients had significant DD 10 years after surgical correction of AIS. Rates of DD increased over time. Our data provide evidence to support recommendations to save as many caudal motion segments as possible, to avoid fusing to L4, and maintain the LIV tilt angle below 5° and LIV translation less than 2 cm.

Skeletal Anomalies in Senegalese Sole (Solea senegalensis), an Anosteocytic Boned Flatfish Species

Skeletal anomalies affect animal welfare and cause important economic problems in aquaculture. Despite the high frequency of skeletal problems in reared Solea senegalensis, there is lack of information regarding the histological features of normal and deformed vertebrae in this flatfish. The aim of this study was to describe the histopathological and radiographical appearance of vertebral body anomalies. Sixty-seven juvenile fish were radiographically examined 104 or 105 days after hatching. Through radiographic images, vertebral segments were selected and processed for histopathological examination from 7 normal and 7 affected fish. Alterations in bone shape and vertebral fusion were the most significant anomalies in the vertebral bodies. These alterations occurred most frequently between the last 3 abdominal vertebrae and the first 10 caudal centra. Radiographically, deformed vertebrae showed flattening of the endplates and narrowing of the intervertebral spaces. The radiographic findings concurred with the histological lesions where affected vertebrae exhibited irregular endplates and changes in trabecular bone. Radiolucent cartilaginous tissue was evident in the endplates of the deformed vertebra and, in some cases, the cartilaginous material extended from the growth zone into the intervertebral space. These changes were likely the primary alterations that led to vertebral fusion. Fused vertebrae were often reshaped and showed a reorganization of the trabeculae. The formation of metaplastic cartilage is frequent in a variety of anomalies affecting teleost species.