Intervertebral Joints Research Articles

Dinocephalosaurus orientalis Li, 2003: a remarkable marine archosauromorph from the Middle Triassic of southwestern China

ABSTRACTThe non-archosauriform archosauromorph Dinocephalosaurus orientalis was first described from the Upper Member of the Guanling Formation (late Anisian, Middle Triassic) of Guizhou Province by Li in 2003 on the basis of a complete articulated skull and the first three cervical vertebrae exposed in dorsal to right lateral view. Since then, additional specimens have been discovered in southwestern China. Here, five newly discovered specimens are described for the first time, and redescriptions of the holotype IVPP V13767 and another referred specimen, IVPP V13898, are provided. Together, these permit the description of the complete skeleton of this remarkable long-necked marine reptile. The postcranial skeleton is as much as 6 metres long, and characterised by its long tail and even longer neck. The appendicular skeleton exhibits a high degree of skeletal paedomorphosis recalling that of many sauropterygians, but the skull and neck are completely inconsistent with sauropterygian affinities. The palate does not extend back over the basisphenoid region and lacks any development of the closed condition typical of sauropterygians. The arrangement of cranial elements, including the presence of narial fossae, is very similar to that seen in another long-necked archosauromorph, Tanystropheus hydroides, which at least in part represents a convergence related to an aquatic piscivorous lifestyle. The long and low cervical vertebrae support exceptionally elongate cervical ribs that extend across multiple intervertebral joints and contribute to a ‘stiffening bundle of ribs’ extending along the entire ventral side of the neck, as in many other non-crocopodan archosauromorphs. The functional significance of the extraordinarily elongate neck is hard to discern but it presumably played a key role in feeding, and it is probably analogous to the elongate necks seen in pelagic, long-necked plesiosaurs. Dinocephalosaurus orientalis was almost certainly a fully marine reptile and even gave birth at sea.

Multifidus Denervation After Radiofrequency Ablation of the Medial Nerve Alters the Biomechanics of the Spine-A Computational Study.

Radiofrequency ablation of the medial branch is commonly used to treat chronic low back pain involving facet joints, which accounts for 12% to 37% of the total cases of chronic low back pain. An adverse effect of this procedure is the denervation of the multifidus muscle, which may lead to its atrophy which can affect the spine and possibly disc degeneration. This study aims to quantify changes in joint angles and loading caused by multifidus denervation after radiofrequency ablation. AnyBody model of the torso was used to evaluate intervertebral joints in flexion, lateral bending, and torsion. Force-dependent kinematics was used to calculate joint angles and forces. These dependent variables were investigated in intact multifidus, unilateral, and bilateral ablations of L3L4, L4L5, and L5S1 joints. The results showed pronounced angular joint changes, especially in bilateral ablations in flexion, when compared with other cases. The same changes' trend from intact to unilaterally then bilaterally ablated multifidus occurred in joint angles of lateral bending. Meanwhile, joint forces were not adversely affected. These results suggest that multifidus denervation after radiofrequency ablation affects spinal mechanics. Such changes may be associated with abnormal tissue deformations and stresses that can potentially alter their mechanobiology and homeostasis, thereby possibly affecting the health of the spine.

The functional significance of aberrant cervical counts in sloths: insights from automated exhaustive analysis of cervical range of motion.

Besides manatees, the suspensory extant 'tree sloths' are the only mammals that deviate from a cervical count (CC) of seven vertebrae. They do so in opposite directions in the two living genera (increased versus decreased CC). Aberrant CCs seemingly reflect neck mobility in both genera, suggesting adaptive significance for their head position during suspensory locomotion and especially increased ability for neck torsion in three-toed sloths. We test two hypotheses in a comparative evolutionary framework by assessing three-dimensional intervertebral range of motion (ROM) based on exhaustive automated detection of bone collisions and joint disarticulation while accounting for interacting rotations of roll, yaw and pitch. First, we hypothesize that the increase of CC also increases overall neck mobility compared with mammals with a regular CC, and vice versa. Second, we hypothesize that the anatomy of the intervertebral articulations determines mobility of the neck. The assessment revealed that CC plays only a secondary role in defining ROM since summed torsion (roll) capacity was primarily determined by vertebral anatomy. Our results thus suggest limited neck rotational adaptive significance of the CC aberration in sloths. Further, the study demonstrates the suitability of our automated approach for the comparative assessment of osteological ROM in vertebral series.

Treatment algorithm for chronic vertebrogenic back pain: the role of chondroprotectors

Back pain constitutes one of the major medico-social problems of healthcare. The development of a unified approach to the diagnosis and treatment of back pain is hindered since it is difficult to assess the various approaches to its treatment, especially its chronic forms. Yet recent data witnessing the important role of the neuroinflammatory process in the pathogenesis of the degenerative forms of discopathy suggest that the traditional treatment approach, which includes physical therapy exercises and non-steroidal anti-inflammatory drugs and myorelaxants, could be enhanced by using drugs characterized by slow structure-modifying action on the structure of the cartilaginous tissue of intervertebral discs and joints. Given the intelligent use of manual therapy, needle reflex therapy, kinesiotherapy, as well as modification of psychosocial factors that pre-determine the yellow flag phenomenon, the application of sustained-release symptomatic drugs increases the efficacy of therapy and prevents subsequent pain episodes. As of today, a placebo-controlled study has proven the action of Alflutop, which can be administered both intramuscularly and paravertebrally. This approach not only improves the patients’ condition but also reduces the burden associated with chronic back pain problems for the society.

Degenerative changes in the intervertebral joints of the cervical spine after anterior interbody fusion and intervertebral disc arthroplasty

Objective. To study the effect of arthroplasty and anterior interbody fusion in the cervical spine on degenerative changes in the adjacent intervertebral joints.Material and Methods. A retrospective cohort study included 46 patients (22 with cervical total disc arthroplasy – CTDA, and 24 with anterior cervical discectomy and fusion – ACDF) with symptoms of cervical spondylogenic compression myelopathy and/or radiculopathy. The degree of degeneration of facet joints adjacent to the operated segments was evaluated 12 months after surgical treatment. Degenerative changes in the cervical spine were assessed using CT according to the Okamoto classification. Vidar Dicom Viewer 3.2 software was used to view images and evaluate intervertebral joints. Statistical processing was performed using IBM SPSS Statistics 23. Data were presented as median and 25th and 75th percentiles – Me [Q1; Q3].Results. The mean age of patients in both groups was 47 [39; 52] years (Mann – Whitney U-test, p = 0.047). In the ACDF group it was 48 [42; 55] years and in the CTDA group – 42 [36; 52] years. Comparison of degenerative changes in the ACDF group before and after treatment (Wilcoxon analysis) showed a statistically significant difference in the cranial (p = 0.023), and caudal (p = 0.001) joints, with the progression of degeneration degree. In the CTDA group, no difference between pre- and post-treatment degeneration degree (Wilcoxon analysis) was found in either cranial joints (p = 0.157) or caudal joints (p = 0.161).Conclusion. Surgeries to stabilize spinal segments in degenerative diseases undeniably affect the development of the adjacent level syndrome. However, the use of endoprosthetic technology makes it possible to aggravate the degree of degenerative changes in the intervertebral joints of adjacent segments to a lesser extent.

Heterogeneous Characteristics of the CD90+ Progenitors in the Fibrocartilage of Different Joints.

This study aimed to isolate and compare the mesenchymal stem cell characteristics of CD90+ cells from different fibrocartilage tissues in the temporomandibular joint (TMJ), the knee joint, and the intervertebral joint to further understand the similarities and differences of these 4 fibrocartilage tissues. CD90+ cells were isolated from TMJ disc, condylar cartilage, meniscus, and intervertebral disc by using magnetic-activated cell sorting. Cellular assays including 4.5-ethynyl-2'-deoxyuridine labeling, multilineage differentiation, colony formation, and cell migration were conducted to compare their mesenchymal stem cell characteristics. Immunofluorescent staining was performed for observing the expression of actively proliferating CD90+ cells within the tissues. H&E staining and Safranine O staining were used to compare the histological features. The CD90+ cells derived from these 4 fibrocartilage tissues exhibited comparable cell proliferation abilities. However, the cells from the TMJ disc displayed limited multilineage differentiation potential, colony formation, and cell migration abilities in comparison with the cells from the other fibrocartilage tissues. In vivo, there was relatively more abundant expression of CD90+ cells in the TMJ disc during the early postnatal stage. The limited EDU+ cell numbers signified a low proliferation capacity of CD90+ cells in the TMJ disc. In addition, we observed a significant decrease in cell density and a restriction in the synthesis of extracellular proteoglycans in the TMJ disc. Our study highlights the spatial heterogeneity of CD90+ cells in the fibrocartilages of different joint tissues, which may contribute to the limited cartilage repair capacity in the TMJ disc.

Optimization of Mounting Methods for Tension-Compression Testing of Murine Intervertebral Disc Joints

Optimization of Mounting Methods for Tension-Compression Testing of Murine Intervertebral Disc Joints

Effect of obesity on spinal loads during load-reaching activities: A subject- and kinematics-specific musculoskeletal modeling approach

Obesity has been associated to increase the risk of low back disorders. Previous musculoskeletal models simulating the effect of body weight on intervertebral joint loads have assumed identical body postures for obese and normal-weight individuals during a given physical activity. Our recent kinematic-measurement studies, however, indicate that obese individuals adapt different body postures (segmental orientations) than normal-weight ones when performing load-reaching activities. The present study, therefore, used a subject- and kinematics-specific musculoskeletal modeling approach to compare spinal loads of nine normal-weight and nine obese individuals each performing twelve static two-handed load-reaching activities at different hand heights, anterior distances, and asymmetry angles (total of 12 tasks × 18 subjects = 216 model simulations). Each model incorporated personalized muscle architectures, body mass distributions, and full-body kinematics for each subject and task. Results indicated that even when accounting for subject-specific body kinematics obese individuals experienced significantly larger (by ∼38% in average) L5-S1 compression (2305 ± 468 N versus 1674 ± 337 N) and shear (508 ± 111 N versus 705 ± 150 N) loads during all reaching activities (p < 0.05 for all hand positions). This average difference of ∼38% was similar to the results obtained from previous modeling investigations that neglected kinematics differences between the two weight groups. Moreover, there was no significant interaction effect between body weight and hand position on the spinal loads; indicating that the effect of body weight on L5-S1 loads was not dependent on the position of hands. Postural differences alone appear, hence, ineffective in compensating the greater spinal loads that obese people experience during reaching activities.

A retrospective cohort study on the significance of preoperative radiological evaluation of lumbar degenerative diseases for surgical reference.

Radiography has low radiation exposure and the ability to acquire information. Due to its cost-effectiveness and availability, preoperative radiographic imaging examination is considered to be a valuable method to evaluate the condition of patients with spinal disease. The aim of this cohort study is to analyze the impact of evaluating preoperative X-rays on the surgical management of lumbar degenerative diseases (LDD). We reviewed 49 patients with LDD underwent single-level posterior instrumented lumbar fusion (PILF) between November 2017 and October 2022 in this cohort study. The median iliac angle (MIA), iliac crest height, intervertebral facet joint degeneration, lumbosacral angle (LSA), L5/S1 intervertebral space angle (ISA), intervertebral foramen height (IFH) and intervertebral space height (ISH) were measured on preoperative radiographs. In addition, operative time, intraoperative blood loss and postoperative complications were used to evaluate the surgical management. Correlation analysis was used to determine the correlation between preoperative radiographic presentation and surgical managements. Multivariate linear regression analysis was used for determination of risk factors for surgical management. Correlation analysis showed that the median iliac angle, height of iliac crest, lumbosacral angle and intervertebral facet joint degeneration were significantly correlated with surgical managements (P<0.05). Height of iliac crest, intervertebral facet joint degeneration and lumbosacral angle were positively correlated with surgical management. Meanwhile, MIA was negatively correlated with surgical management. No significant difference was found between the IFH, ISA, ISH and surgical managements in posterior lumbar surgery (P>0.05). After multiple linear regression analysis, height of iliac crest, median iliac angle and intervertebral facet joint degeneration were independent influence factors for the single-level lumbar surgical managements. Some variables measured in radiograph shows that height of iliac crest, median iliac angle and intervertebral facet joint degeneration have a potential influence on surgical managements. The lumbosacral angle was positively associated with surgical management, but it was not statistically significant in multiple linear regression analysis (P>0.05). The above measurements in plain film can reflect the surgical procedure and have some guiding implications for the operation.

The role of ferroptosis in intervertebral disc degeneration.

Nucleus pulposus, annulus fibrosus, and cartilage endplate constitute an avascular intervertebral disc (IVD), which is crucial for spinal and intervertebral joint mobility. As one of the most widespread health issues worldwide, intervertebral disc degeneration (IVDD) is recognized as a key contributor to back and neck discomfort. A number of degenerative disorders have a strong correlation with ferroptosis, a recently identified novel regulated cell death (RCD) characterized by an iron-dependent mechanism and a buildup of lipid reactive oxygen species (ROS). There is growing interest in the part ferroptosis plays in IVDD pathophysiology. Inhibiting ferroptosis has been shown to control IVDD development. Several studies have demonstrated that in TBHP-induced oxidative stress models, changes in ferroptosis marker protein levels and increased lipid peroxidation lead to the degeneration of intervertebral disc cells, which subsequently aggravates IVDD. Similarly, IVDD is significantly relieved with the use of ferroptosis inhibitors. The purpose of this review was threefold: 1) to discuss the occurrence of ferroptosis in IVDD; 2) to understand the mechanism of ferroptosis and its role in IVDD pathophysiology; and 3) to investigate the feasibility and prospect of ferroptosis in IVDD treatment.

Assessment of the impact of DIAM interspinal dynamic stabilization on pain in the lumbar spine - the role of physiotherapy

Pain in the LS segment occurs in both young and old people. Stabilization training is gaining more and more supporters in returning to proper functioning. Central stabilization is the ability to maintain the correct body posture during static and dynamic movements. The DIAM system of dynamic interspinal stabilization of the spine is a minimally invasive procedure which, by inserting a silicone implant between the spinous processes, relieves the intervertebral joints, the intervertebral disc and reduces the pressure on the nerve structures. Continuation after the procedure is systematic physiotherapy. The aim of the study was to assess the impact of the implant and individually adjusted stabilization training of the lumbar-pelvic-hip complex in patients after dynamic interspinal stabilization with the DIAM method. The study was conducted on a group of 56 people who underwent a minimally invasive procedure and qualified from the 10th day after the operation. The stabilization training was selected individually for each patient, including the current state of health. The training was conducted once a week for four weeks. The conducted stabilization training of the lumbar-pelvic-hip complex turned out to be an effective method in recovery. There was a significant decrease in pain in the lower part of the spine among the examined patients. There was an improvement in physical activity and activities of daily living based on the Ronald-Morris scale. A decrease in the number of points was noted in all subjects. Fast, post-surgical rehabilitation therapy after using dynamic stabilization - DIAM, turned out to be a helpful method in faster recovery. It is reasonable to introduce early rehabilitation according to the scheme established by us after the DIAM dynamic stabilization procedure, as the period of return to work is reduced.

Treatment of acute and chronic cervical musculoskeletal pain

Pain in the cervical spine is a widespread condition that significantly disrupts the quality of life, often leads to disability and requires significant economic costs. The most common type of neck pain is nonspecific (vertebrogenic cervicalgia). The most frequent (in 36–67% of cases) anatomical source of nonspecific neck pain is considered to be the lesion of the intervertebral facet joints. Tests to determine the anatomical sources of nonspecific pain are unreliable, in addition, their detection does not significantly affect treatment. Degenerative changes of the spine are often detected during neuroimaging, depend on age, but do not correlate with clinical symptoms and severity of symptoms. In the absence of red flags of anxiety and negative results of neurological examination, neuroimaging or laboratory methods of research are not required. An assessment of prognostic factors is important. Factors contributing to chronization include: female sex, old age, high intensity of pain at the onset of the disease, the presence of psychosocial problems. Modern classifications, the basics of diagnosis, treatment and prevention of nonspecific neck pain are given. Modern effective methods of treatment are physical therapy, manual therapy and psychological programs, a multimodal approach to treatment is optimal. There is a very low level of evidence for electrotherapy, traction, laser therapy, acupuncture, dry needle treatment, thermal or cold procedures. The use of drug therapy is recommended, both separately and in combination with other methods of treatment. The most effective painkillers for neck pain are non-opioid analgesics – NSAIDs and paracetamol. The use of cervical orthosis is not recommended. Clinical cases of patients with acute and chronic nonspecific neck pain are described. The effectiveness of an integrated approach to the management of this category of patients, in accordance with modern recommendations, is shown. The treatment included drug and non-drug methods (therapeutic gymnastics, educational conversation). Dexketoprofen was used as pharmacotherapy according to a step-by-step regimen.

Development of a finite element full spine model with active muscles for quantitatively analyzing sarcopenia effects on lumbar load

Background and objectiveThe musculoskeletal imbalance caused by disease is one of the most critical factors leading to spinal injuries, like sarcopenia. However, the effects of musculoskeletal imbalances on the spine are difficult to quantitatively investigate. Thus, a complete finite element spinal model was established to analyze the effects of musculoskeletal imbalance, especially concerning sarcopenia. MethodsA finite element spinal model with active muscles surrounding the vertebrae was established and validated from anatomic verification to the whole spine model in dynamic loading at multiple levels. It was then coupled with the previously developed neuromuscular model to quantitatively analyze the effects of erector spinae (ES) and multifidus (MF) sarcopenia on spinal tissues. The severity of the sarcopenia was classified into three levels by changing the physiological cross-sectional area (PCSA) of ES and MF, which were mild (60% PCSA of ES and MF), moderate (48% PCSA of ES and MF), and severe (36% PCSA of ES and MF). ResultsThe stress and strain levels of most lumbar tissues in the sarcopenia models were more significant than those of the normal model during spinal extension movement. The sarcopenia caused load concentration in several specific regions. The stress level of the L4-L5 intervertebral disc and L1 vertebra significantly increased with the severity of sarcopenia and showed relatively larger values than other segments. From the normal model to a severe sarcopenia model, the stress value of the L4-L5 intervertebral disc and L1 vertebra increased by 128% and 113%, respectively. The strain level of L5-S1 also inclined significantly with the severity of sarcopenia, and the relatively larger capsule strain values occurred at lower back segments from L3 to S1. ConclusionsIn summary, the validated spinal coupling model can be used for spinal injury risk analysis caused by musculoskeletal imbalance. The results suggested that sarcopenia can primarily lead to high injury risk of the L4-L5 intervertebral disc, L1 vertebrae, and L3-S1 joint capsule regarding significant stress or strain variance.

Posterior paramedian approach combined with a novel inverted V-shaped surgical access for intraspinal schwannomas: a retrospective case series study

ObjectiveTo explore the efficacy and safety of the posterior paramedian approach combined with a novel inverted V-shaped surgical access for the treatment of intraspinal schwannomas.MethodsThis study retrospectively reviewed consecutive patients who underwent surgical resection of the intraspinal schwannomas via the inverted V-shaped approach at our center between January 2016 and May 2021. Changes between the preoperative and postoperative visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed. Secondary outcomes such as success rate of tumor resection, operation time, blood loss, spinal stability, and disruption degree of intervertebral joints. Postoperative complications were also investigated.ResultsOf these 36 consecutive patients, there were 6 cases in the cervical spine, 2 cases at the cervical-thoracic junction, 11 cases in the thoracic spine, 4 cases at the thoracic-lumbar junction and 13 cases in the lumbar spine. The average operation time was 99 min, and the average blood loss was 95.4 mL. The tumor removal rate was 100%. Postoperative CT re-examination showed that the spinous processes were intact in all cases, the facet joint surfaces were intact in 32 cases. At the time of last follow-up, the median JOA score was 25 (9–27), which was significantly improved compared to the preoperative median JOA score of 15 (10–22) (P < 0.01). The overall excellent and good rate were 88.9 %. The median VAS score at post-surgery was 0 (0–2), which was significantly improved compared to the preoperative median VAS score of 4 (2–8) (P < 0.01). As for complications, there were no cases of cerebrospinal fluid leakage or spinal instability. Three patients who had a postoperative fever finally recovered after lumbar cistern drainage.ConclusionThe inverted V-shaped surgical access via the posterior paramedian approach is an effective and safe method for the treatment of intraspinal schwannomas.

A REVIEW OF THE POSTERIOR ASPECT OF GREEVA SHARIR AND ITS IMPORTANCE

Nowadays, many people complain about cervical pain. Everyone is busy with work, which requires long sitting hours and improper posture. The use of mobile and laptops is increasing nowadays. Because of all these reasons, cervical region diseases are increasing in the community. Greeva is called “Uttamang” in Ayurveda. The posterior aspect of greeva contains various structures. It is a complex structure of bones, muscles, vessels, nerves, ligaments, and tendons. It contains the important structure of bone, i.e., cervical vertebrae. They give neck structure, support the head and provide a wide range of neck movement. It also contains various intervertebral joints, which offer movements like flexion, extension, and lateral neck rotation. The cervical spine contains intervertebral discs, which act as shock absorbers to the demands positioned on the spine. They also provide a cushion between the vertebrae during weight-bearing activities. Many muscles are present in the cervical region; not all are attached to the spine, but many do. Krukatika marma is located on the posterior region of the greeva at the junction of the head and neck. Injury to this marma causes ‘Chala Moordhata’, i.e., instability of the head. The neck is covered by numerous muscles which allow a lot of different movements of the head. These muscles contain many tiny and elastic fibres. The complaints we see in everyday life are spasms, strain, headache, and numbness in the neck region. All these complaints are associated with injury to neck muscles. Many vital structures in the posterior of the greeva make it an important topic for study.

Effect of axial compression on stiffness and deformation of human lumbar spine in flexion-extension

Objective The goal of this study was to evaluate the effect of axial compression, employed with a follower-load mechanism, on the response of the lumbar spine in flexion and extension bending. Additional goals include measurement of both the kinetic (stiffness) and kinematic (deformation distribution) responses, evaluating how the responses vary across specimens, and to develop response corridors that can be used to evaluate human body models (HBMs) and anthropomorphic test devices (ATDs). Methods Seven mid-sized male adult lumbar spines (T12-S1) from postmortem human surrogates were tested in subinjurious flexion and extension bending with 0, 900, and 1800 N of superimposed axial compression. Tests were performed in load-control with a 6-DOF robotic test system that applied pure flexion and extension moments to the specimens, and axial compression was directed along the spine’s curvature via a follower load mechanism powered by force-controlled linear actuators. Load-deformation response data were captured and used to characterize the kinetic response of the lumbar spine in flexion/extension, and how it varies with axial compression. Individual vertebral kinematics were captured using 3D motion capture and the data was used to illustrate the distribution of bending deformation across each intervertebral joint of the spine, as well has how that distribution changes with axial compression. These response data were used to develop elliptical path-length parameterized response corridors for surrogate biofidelity evaluation. Results The lumbar spine was found to be generally stiffer in extension than in flexion, but this difference decreased with increasing axial compression. The lumbar spine exhibited a nonlinear kinetic (moment vs. angle) response in flexion that became more linear and stiffer with the addition of axial compression. In flexion without axial load, the majority of the bending deformation occurred at the L5-S1 joint, whereas in extension, deformation was more evenly distributed across the different intervertebral levels, but the locus of deformation was located in the mid-proximal lumbar at L2-L3. Conclusions The superposition of axial compression in the lumbar spine affects the kinetic and kinematic response of the lumbar spine in flexion and extension. The response data and approach detailed in this study permit better assessment of ATD and HBM biofidelity.

A neuromuscular human body model for lumbar injury risk analysis in a vibration loading environment

Background and objectiveLong-term intensive exposure to whole-body vibration substantially increases the risk of low back pain and degenerative diseases in special occupational groups, like motor vehicle drivers, military vehicle occupants, aircraft pilots, etc. This study aims to establish and validate a neuromuscular human body model focusing on improvement of the detailed description of anatomic structures and neural reflex control, for lumbar injury analysis in vibration loading environments. MethodsA whole-body musculoskeletal in Opensim codes was first improved by including a detailed anatomic description of spinal ligaments, non-linear intervertebral disc, and lumbar facet joints, and coupling a proprioceptive feedback closed-loop control strategy with GTOs and muscle spindles modeling in Python codes. Then, the established neuromuscular model was multi-levelly validated from sub-segments to the whole model, from regular movements to dynamic responses to vibration loadings. Finally, the neuromuscular model was combined with a dynamic model of an armored vehicle to analyze occupant lumbar injury risk in vibration loadings due to different road conditions and traveling velocities. ResultBased on a series of biomechanical indexes, including lumbar joint rotation angles, the lumbar intervertebral pressures, the displacement of the lumbar segments, and the lumbar muscle activities, the validation results show that the present neuromuscular model is available and feasible in predicting lumbar biomechanical responses in normal daily movement and vibration loading environments. Furthermore, the combined analysis with the armored vehicle model predicted similar lumbar injury risk to the experimental or epidemiologic studies. The preliminary analysis results also showed that road types and travelling velocities have substantial combined effects on lumbar muscle activities, and indicated that intervertebral joint pressure and muscle activity indexes can need to be jointly considered for lumbar injury risk evaluation. ConclusionIn conclusion, the established neuromuscular model is an effective tool to evaluate vibration loading effects on injury risk of the human body and assist vehicle design vibration comfort by directly concerning the human body injury itself.

Morphometric MRI analysis of lumbar spine intervertebral foramen

The article presents morphometric MRI-analysis of the lumbar intervertebral foramen for anatomical study of the size of Kambin safety triangle and the vulnerability of the exiting spinal nerve during transforaminal interventions. 200 discs were studied in 50 patients after transforaminal endoscopic intervention. Standard DICOM image viewing program for MRI in T1 WI and T2 WI modes was used for the measurement. The most distant location of the exiting spinal nerve from the intervertebral disc was observed at the level of L5S1 vertebrae (9.82 mm, 0.95CI (9,53 10,10), p&lt;0.05). The narrowest safety triangle turned out to be at the level of L2‑L5 vertebrae, where the distance did not differ statistically (1.97–2.28 mm, p&gt; 0.05). A similar pattern was revealed for the distance between the exiting root and the intervertebral joint. The greatest angle between the exiting spinal nerve and the disc plane was found at the level of L5S1 (134.68 °, 0.95CI (132.39 136.97), p&lt;0.001). The angle was close to a straight one at the other levels. The exiting root located dorsal to the disc plane at the cranial levels (L2L3, L3L4) in all cases, in contrast to L5S1 level, where it always located ventrally. Thus, the greatest narrowness of the Kambin safety triangle was revealed in the intervertebral foramen of the cranial lumbar segments (L2L3, L3L4). Transforaminal interventions require special attention to the exiting spinal nerve at these levels, and possibly additional bone resection to widen the foramen.

Comparison of radiological characteristics between diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: a multicenter study

To evaluate the radiological differences between diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) using whole spine computed tomography (CT), including the spine and sacroiliac joint (SIJ). The ossification and bridging of spinal ligament and fusion of the facet joint and SIJ were evaluated in 111 patients who were diagnosed with DISH and 27 patients with AS on the whole spine CT. The number of anterior bridging and shape of bridging (candle-wax-type/ smooth-type) were also evaluated. We further evaluated patients with DISH and AS by matching their age and sex. Complete SIJ fusion was more common in AS, whereas anterior and posterior bony bridging around SIJ was more common in DISH. However, 63% of patients with DISH had a partial or complete fusion. In spinal anterior bony bridging, the majority of patients with AS had the smooth-type, whereas those with DISH had the candle-wax-type. However, some of the patients with DISH (11%) had smooth-type. Intervertebral facet joint fusion is more common in AS. The number of anterior spinal bony bridging was greater in AS than in DISH, especially in the lumbar spine. These results are useful in differentiating DISH from AS and should therefore be considered when making a diagnosis.

Hybrid single-photon emission computed tomography bone imaging for the evaluation of non-specific lower back pain

BackgroundThis is a single-center retrospective study designed to assess the correlation between the location of “hots spots” on single-photon emission computed tomography (SPECT) and the severity of joint degeneration on computed tomography (CT), in addition to understanding whether these hot spots correlate with the pain generating sites causing the non-specific lower back pain. MethodsAll patients who had undergone hybrid SPECT-CT imaging of the lower back over a one-year period at our institution were identified. Twenty joints were assessed from each patient. Joints for assessment were chosen from the intervertebral discs, facet (zygapophysial) and sacroiliac joints. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves and quantified using the area under the receiver operating characteristic curve (AUROC). ResultsOver a one-year period, 111 patients were identified, with the primary indication being non-specific lower back pain in 73 (66%). Hot spots were observed on SPECT in 79% of patients, with 86% having some degree of degeneration in at least one joint on CT. Degeneration was found to be significantly associated with the presence of hot spots for the majority of joints, with the strongest association seen in the L3/L4 intervertebral joint, for which the rates of hot spots were 1% for grade 0, 26% for grade 1 and 78% for grades 2–3 (AUROC: 0.91, p<0.001). Neither the presence of hot spots nor degeneration were found to be significantly predictive of non-specific lower back pain for any of the joints considered. ConclusionsHot spots identified on SPECT are correlated with the presence of degeneration on CT but have limited diagnostic ability to identify potential causes of non-specific lower back pain.