Lateral Lumbar Radiographs Research Articles

Motion Analysis of Lumbar Spine and Hip Joint on Sequential Radiographs Acquired with a Dynamic Flat-panel Detector (FPD) System

To design an evaluation method for lumbar spine and hip joint function using dynamic radiography using a flat-panel detector (FPD) system. Sixteen healthy subjects (males; age range, 22-60 years; median, 27 years) and 9 patients (7 males and 2 females; age range, 67-85 years; median, 73 years) with L4 degenerative spondylolisthesis were examined using a dynamic FPD system (CANON Inc.). Sequential images were captured with the subjects in the standing position with maximal forward bending followed by backward bending for 10 s. The lateral lumbar radiographs were obtained at 2 frames/s (fps). The flexion-extension angles of L1 and S1 were measured on those images. The range of motion (ROM) of the lumbar joints was significantly larger in the healthy group (82.4 ± 8.7°) than in the disease group (50.4 ± 8.5°; p<0.05). The ROM of the pelvic region was significantly smaller in the healthy group (26.9 ± 17.1°) than in the disease group (53.1 ± 17.6°; p<0.05). The healthy subjects exhibited a normal lumbar-pelvic rhythm. In the disease group, hip joint movements tended to be completed earlier compared with those in the healthy group. In the disease group, the loss of lumbar flexibility was compensated by an increase in hip joint motion due to the lumbar disease. The dynamic FPD system is a convenient imaging modality for the diagnosis of lumbar diseases through the assessment of locomotive function in the lumbar spine and hip joints.

Post-operative Radiographs for Degenerative Lumbar Spinal Fusions?

A retrospective review of 70 consecutive lumbar degenerative surgical cases in which intraoperative fluoroscopic imaging was compared with immediate postoperative radiographs using a novel vertebral grid-coordinate system. Same-hospitalization postoperative standing lumbar AP and lateral radiographs do not appear to be cost-effective or to provide additional clinically relevant information when intraoperative fluoroscopy is utilized.

The effect of compensating filter on image quality in lateral projection of thoraco lumbar radiography

The aim of this project was to study the effect of compensating filter on image quality in lateral projection of thoraco lumbar radiography. The specific objectives of this study were to verify the relationship between density, contrast and noise of lateral thoraco lumbar radiography using various thickness of compensating filter and to determine the appropriate filter thickness with the thoraco lumbar density. The study was performed by an X- ray unit exposed to the body phantom where different thicknesses of aluminium were used as compensating filter. The radiographs were processed by CR reader and being imported to KPACS software to analyze the pixel depth value, contrast and noise. Result shows different thickness of aluminium compensating filter improved the image quality of lateral projection thoraco lumbar radiography. The compensating filter of 8.2 mm was considered as the optimal filter to compensate the thoraco lumbar junction (T12-L1), 1 mm to compensate lumbar region and 5.9 mm to compensate thorax region. The addition of aluminium compensating filter is advantageous in terms of efficiency which saving radiograph film, workload of the radiographer and radiation dose to patient.

Lumbosacral transitional vertebrae and its prevalence in the Australian population.

Study Design Retrospective cohort study. Objective Lumbosacral transitional vertebrae (LSTV) are a common congenital anomaly, and they can be accurately identified on anteroposterior (AP) radiographs of the lumbosacral spine. This study attempts to determine the prevalence of this congenital anomaly and to increase awareness among all clinicians to reduce the risk of surgical and procedural errors in patients with LSTV. Methods A retrospective review of 5,941 AP and lateral lumbar radiographs was performed. Transitional vertebrae were identified and categorized under the Castellvi classification. Results The prevalence of LSTV in the study population was 9.9%. Lumbarized S1 and sacralized L5 were seen in 5.8 and 4.1% of patients, respectively. Conclusion LSTV are a common normal variant and can be a factor in spinal surgery at incorrect levels. It is essential that all clinicians are aware of this common congenital anomaly.

Physical performance and radiographic and clinical vertebral fractures in older men.

In men, the association between poor physical performance and likelihood of incident vertebral fractures is unknown. Using data from the MrOS study (N = 5958), we describe the association between baseline physical performance (walking speed, grip strength, leg power, repeat chair stands, narrow walk [dynamic balance]) and incidence of radiographic and clinical vertebral fractures. At baseline and follow-up an average of 4.6 years later, radiographic vertebral fractures were assessed using semiquantitative (SQ) scoring on lateral thoracic and lumbar radiographs. Logistic regression modeled the association between physical performance and incident radiographic vertebral fractures (change in SQ grade ≥1 from baseline to follow-up). Every 4 months after baseline, participants self-reported fractures; clinical vertebral fractures were confirmed by centralized radiologist review of the baseline study radiograph and community-acquired spine images. Proportional hazards regression modeled the association between physical performance with incident clinical vertebral fractures. Multivariate models were adjusted for age, bone mineral density (BMD, by dual-energy X-ray absorptiometry [DXA]), clinical center, race, smoking, height, weight, history of falls, activity level, and comorbid medical conditions; physical performance was analyzed as quartiles. Of 4332 men with baseline and repeat radiographs, 192 (4.4%) had an incident radiographic vertebral fracture. With the exception of walking speed, poorer performance on repeat chair stands, leg power, narrow walk, and grip strength were each associated in a graded manner with an increased risk of incident radiographic vertebral fracture (p for trend across quartiles <0.001). In addition, men with performance in the worst quartile on three or more exams had an increased risk of radiographic fracture (odds ratio [OR] = 1.81, 95% confidence interval [CI] 1.33-2.45) compared with men with better performance on all exams. Clinical vertebral fracture (n =149 of 5813, 2.6%) was not consistently associated with physical performance. We conclude that poorer physical performance is associated with an increased risk of incident radiographic (but not clinical) vertebral fracture in older men.

FRI0120 A Decrease in C-Reactive Protein Does not Guarantee Favorable Treatment Response Enough to Retard Bony Progression in the Patients with Axial Spondyloarthritis

BackgroundAxial spondyloarthritis (aSpA) is a chronic inflammatory disease that can lead to irreversible spinal bone damage and loss of spine mobility. However, it is controversial whether the inflammation is coupled...

The association between mortality and abdominal aortic calcification and relation between its progression and serum calcium concentration in chronic hemodialysis patients

BackgroundThe composite summary score (range, 0–24) of abdominal aortic calcification (AAC) devised by Kauppila et al is a simple method of assessing AAC severity. However, few studies have been conducted to determine an optimal AAC cutoff score for the prediction of mortality or to investigate the relation between mineral metabolism and AAC progression using the scoring system. MethodsThe medical records of 112 patients on hemodialysis who had undergone simple lateral lumbar radiography every 6 months from August 2009 were reviewed. Patients were followed until November 2012, and the relationship between the degree of AAC at baseline and mortality was evaluated. In addition, the relationship between the progression of AAC and serum concentrations of calcium and phosphate was evaluated in the 75 patients who were successfully followed until November 2012. ResultsThe mean AAC score at baseline was 5.5±4.8, and the cutoff calcification score for the prediction of mortality was 7.75 (sensitivity=61%, specificity=81%). Patients were allocated to Group A (baseline total calcification score ≤8.0, n=85) or Group B (baseline total calcification score>8.0, n=27), and multivariate analysis showed that Group B was an independent risk factor of all-cause mortality and cardiovascular events. Of the 75 patients successfully followed, 51 showed AAC progression (Group 1) and 24 showed no change or improvement (Group 2). Group 1 was found to have significantly higher mean serum corrected calcium levels during the 2nd year and 3rd year of follow-up than Group 2. Furthermore, repeated-measures analysis of variance showed higher monthly corrected calcium concentrations (P=0.099) and mean corrected calcium levels during the 1st year, 2nd year, and 3rd year of follow-up (P=0.062) in Group 1, but without statistical significance. The cutoff values of mean corrected calcium of the 2nd year and 3rd year for the prediction of AAC progression during follow-up years were 8.96mg/dL and 9.45mg/dL, respectively. Serum phosphate levels and corrected calcium×phosphate values were similar in Groups 1 and 2. ConclusionPatients with an AAC score of>8 at baseline seem to be at higher risk of mortality during follow-up. Of the serum variables examined, such as corrected calcium, phosphate, and corrected calcium×phosphate, corrected calcium was found to be marginally associated with AAC progression. However, a larger-scale prospective study is required to confirm our findings.

Incidence of and risk factors for non-vertebral and vertebral fracture in female Chinese patients with systemic lupus erythematosus: a five-year cohort study

The objective of this paper is to investigate the incidence of both non-vertebral and vertebral fracture in female patients with systemic lupus erythematosus (SLE) and to identify risk factors for incident fracture. In a five-year prospective study of 127 female Chinese SLE patients with an average age of 46.9 years (SD: 10.1 years), information on potential risk factors, including demographics, clinical data and bone mineral density (BMD) at lumbar spine and hip by dual-energy X-ray absorptiometry was collected at baseline. At follow-up, participants reported incident non-vertebral fracture during the study period. Semi-quantitative analysis was used to determine incident vertebral fracture on lateral thoracic and lumbar radiographs, defined as any vertebral body graded normal at baseline and at least mildly deformed (20%-25% reduction or more in any vertebral height) at follow-up. Nine incident non-vertebral fractures occurred in eight patients during the study period. Six patients had one or more incident vertebral fractures. The incidence of non-vertebral and vertebral fracture was 1.26 and 0.94 per 100 patient-years, respectively. In multivariate logistic analyses, independent variables associated with incident non-vertebral fracture were duration of glucocorticoid use and prevalent lumbar spine osteoporosis, while risk factors associated with incident vertebral fracture were higher organ damage and prevalent lumbar spine osteoporosis. The incidence of fracture in SLE patients is lower than the prevalence reported in cross-sectional studies. Lumbar spine BMD appears to have a stronger relationship with incident fracture than hip BMD. This warrants further investigation regarding the optimal site of BMD measurement when predicting fracture risk in SLE patients.

Necessity of Whole Spine Standing Lateral Radiograph in Adults over 50 Years Old Who Have Degenerative Lumbar Disease: Comparison with Supine Lumbar Lateral Radiograph

Objectives: Sagittal imbalance cannot be predicted depending on the degree of lumbar lordosis. Thus, we tried to evaluate the necessity of whole spine standing lateral radiograph through comparison of the spinal and pelvic parameter between supine lumbar lateral radiograph and whole spine standing lateral radiograph. Summary of the Literature Review: No studies in the literature compare supine lumbar lateral radiograph and whole spine standing lateral radiograph. Materials and Methods: We randomly selected 50 males and 50 females among the patients over the age of 50 who visited our hospital for outpatient due to degenerative lumbar disease. Lumbar lordosis (sLL/wLL), sacral slope (sSS/wSS), and pelvic tilt (sPT/ wPT) were measured and compared respectively by supine lumbar lateral radiograph and whole spine standing lateral radiograph. We categorized as group AI (sLL 5 cm) by whole spine standing lateral radiograph and analyzed them. Results: There were no statistical difference in lumbar lordosis (sLL/wLL: 35.1˚/37.7˚) and pelvic parameter (sSS/wSS: 32˚/31.7˚, sPT/ wPT: 24.3˚/24.2˚. sPI/wPI: 56.3˚/58.2˚) between supine lumbar lateral radiograph and whole spine standing lateral radiograph, and there were also no statistical difference between two groups (group AI & AII) in SVA, lumbar lordosis and pelvic parameter. Pelvic parameter compared by supine lumbar lateral radiograph and whole spine standing lateral radiograph based on sagittal balance was no significant difference, but lumbar lordosis appeared statistical difference. Conclusion: Sagittal imbalance appears quite a lot in patients with degenerative lumbar disease and supine lateral radiograph can’t reflect the whole sagittal imbalance. So, whole spine standing lateral radiograph should be performed routinely to analyze the sagittal alignment.

Development and Validation of the Spondyloarthritis Radiography Module for Calibration of Readers Using the Modified Stoke Ankylosing Spondylitis Spine Score

To develop and validate a reference image module aimed at calibration of readers using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) to assess radiographic progression in spondyloarthritis. Our working group comprised 6 rheumatologists and 3 musculoskeletal radiologists. The following developmental steps were conducted: (1) review of the literature to identify aspects of the mSASSS requiring methodologic clarity; (2) independent assessment of baseline and 2-year radiographs from 25 patients using the mSASSS (pilot exercise); (3) development of a training module (the Spondyloarthritis Radiography [SPAR] module) that clarifies definitions, rules, and scoring methodology and a set of reference radiographic images; (4) scoring exercise 1 by 6 readers on 39 patients, where baseline and 2-year radiographs were scored blinded to time point; and (5) revision of the SPAR module followed by scoring exercise 2 conducted by the same 6 readers on 35 patients. Reliability of status and 2-year change scores was assessed by the intraclass correlation coefficient (ICC) method. ICCs for change scores for the radiologist reader pair improved from 0.46 to 0.62 after minimal calibration with the SPAR module. Recalibration from exercise 1 to exercise 2 with the SPAR module led to substantial improvement in interreader reliability for change in mSASSS score from ICC 0.44 (range 0.31-0.62) to ICC 0.62 (range 0.34-0.84). Simultaneous assessment of anteroposterior and lateral lumbar radiographs did not enhance reliability or detection of progression. Calibration according to the SPAR module led to improved reliability in the scoring of the mSASSS, even for expert readers.

Change in Spinal Alignment after Total Hip Arthroplasty

The study hypotheses were that: (i) there would be a difference in sagittal plane alignment between patients with symptomatic osteoarthritis of the hip and those with lumbar degenerative disk disease; and (ii) that sagittal plane lumbar alignment would change following total hip arthroplasty (THA). In this prospective study, a series of patients without back pain or lumbar complaints who were scheduled to undergo THA underwent lateral lumbar radiography prior to and nine months after elective THA. Radiographic measurements of lumbar alignment included sacral slope, lumbar lordosis, and L1 axis S1 distance (L1 ASD). All measurements were performed on upright, standing, lateral radiographs. A control group of patients underwent serial radiography over the same period for evaluation of lumbar degenerative disease. The independent sample t-test was used to compare the mean sacral slope, lumbar lordosis, and L1 ASD in the THA and control groups. There were 12 patients in the THA group and 34 in the control group. Mean follow-up was 9 months. Average age in the control group was 63 years and in the THA group 64.2 years. The sacral slope was greater in the THA group (mean, 23°) than in the lumbar patients (control group) and this difference was statistically significant (mean, 11°, P = 0.001). There were no statistically significant differences between THA and control patients in lumbar lordosis or L1 ASD. Change before and after THA was measured. There were no statistically significant differences in assessed radiographic variables preoperatively versus postoperatively. There is no significant change in spinal alignment after unilateral THA. At baseline, patients with symptomatic spine complaints have less sacral slope than their hip arthroplasty counterparts.

Prevalence and risk factors of lumbar spondylolisthesis in elderly Chinese men and women

A screening survey for osteoporotic fractures in men and women in Hong Kong represents the first large-scale prospective population-based study on bone health in elderly (≥65 years) Chinese men and women. This study aims to identify the prevalence and potential risk factors of lumbar spondylolisthesis in these subjects. The lateral lumbar radiographs of 1,994 male and 1,996 female patients were analysed using the Meyerding classification. Amongst the men, 380 (19.1%) had at least one spondylolisthesis and 43 (11.3%) had slips at two or more levels; 283 had anterolisthesis, 85 had retrolisthesis, whereas 12 subjects had both anterolisthesis and retrolisthesis. Amongst the women, 499 (25.0%) had at least one spondylolisthesis and 69 (13.8%) had slips at two or more levels; 459 had anterolisthesis, 34 had retrolisthesis, whereas 6 subjects had both anterolisthesis and retrolisthesis. Advanced age, short height, higher body mass index (BMI), higher bone mineral density (BMD) and degenerative arthritis are associated with spondylolisthesis. Lower Physical Activity Scale for the Elderly (PASE) score was associated with spondylolisthesis in men; higher body weight, angina and lower grip strength were associated with spondylolisthesis in women. The male/female ratio of lumbar spondylolisthesis prevalence was 1:1.3 in elderly Chinese. Men are more likely to have retrolisthesis. • The prevalence of spondylolisthesis is 19.1% in elderly Chinese men. • The prevalence of spondylolisthesis is 25.0% in elderly Chinese women. • Men are more likely to have retrolisthesis. • Anterolisthesis is most commonly seen at the L4/L5 level. • Retrolisthesis is most commonly seen at the L3/L4 level.

Clinical and Radiological Characteristics of Concomitant Peripheral Arterial Obstructive Disease in Patients with Lumbar Spinal Stenosis

Background: Intermittent claudication is a typical symptom of lumbar spinal stenosis (LSS) and peripheral arterial obstructive disease (PAD). Because both LSS and PAD are predominantly associated with degenerative conditions, concomitant conditions are not uncommon. However, few reports of the demographic, clinical, and radiological characteristics of concomitant LSS and PAD (LSSPAD) have been published. Objective: To identify the demographic, clinical, and radiological risk factors for concomitant PAD in LSS. Study Design: A retrospective matched-control study. Methods: This study involved a retrospective cohort of 43 consecutive patients with LSSPAD and a control cohort of 45 age- and gender-matched patients diagnosed with LSS without PAD. Each patient in both groups underwent plain lumbar radiographs, magnetic resonance imaging of the lumbar spine, and ankle-brachial index (ABI) measurement. Demographic and clinical parameters were obtained. The abdominal aorta calcification score (AACS) was evaluated on the lateral lumbar radiographs. Computed tomographic angiography (CTA) of the lower limb was performed to confirm PAD. Results: The mean age of the LSSPAD group was 67.7 ± 10.7 years (52 – 88 years). The prevalence of diabetes mellitus (DM) was significantly higher in the LSSPAD group than in the LSS group (P = 0.022). The mean ABI was 0.71 ± 0.22 (0.32 – 0.91) for the LSSPAD group and 0.96 ± 0.18 (0.83 – 1.10) for LSS group (P &lt; 0.001). The prevalence of aortic calcification was significantly higher in the LSSPAD group than in the LSS group (P &lt; 0.001). The mean AACS was 10.2 ± 3.2 (2 – 18) for the LSSPAD group and 3.4 ± 4.1 (0 – 14) for the LSS group (P &lt; 0.001). Limitations: Retrospective design. Conclusion: We found that concomitant PAD in patients with LSS is associated with old age, DM, the presence of aortic calcification, and ABI &lt; 0.9. When these risk factors exist, further work up is needed to exclude the concomitant PAD. Key words: Claudication, lumbar spinal stenosis, peripheral arterial obstructive disease, aortic calcification, ankle-brachial index

Impact of spinal imbalance and BMI on lumbar spinal canal stenosis determined by a diagnostic support tool: cohort study in community-living people

The Japanese Society for Spine Surgery and Related Research (JSSR) developed a diagnostic support tool (score range −2 to 16) for lumbar spinal canal stenosis (LSS). It is well known that patients with LSS have a forward-bending posture while walking. We could find only one study which examined sagittal alignment of LSS patients. The objectives of this study were to screen community-living people with LSS, and to investigate the association between LSS and spinal sagittal alignment, range of motion (ROM), and other spinal or physical factors. We enrolled 286 subjects ≥50 years old in the study. We regarded those with a JSSR diagnostic risk score ≥7 as having LSS. We measured and evaluated lateral lumbar radiographs, sagittal parameters, sagittal balance, and spinal mobility as determined with SpinalMouse®, back muscle strength (BMS), and body mass index (BMI). Spinal inclination angle (SIA) was used as an index of sagittal balance. Multivariate logistic regression analysis indicated that increased BMI (OR 1.121, p < 0.05) and SIA (OR 1.144, p < 0.05) were important relevant factors for LSS. BMI had significant positive correlations with SIA (r = 0.214), and thoracic and lumbar kyphosis angles (r = 0.283, 0.131), and negative correlations with sacral slope angle (r = −0.166), and lumbar and total spinal ROMs (r = −0.270, −0.166). SIA had significant positive correlations with age (r = 0.334), BMI (r = 0.214) and lumbar kyphosis angle (r = 0.525), and negative correlations with BMS (r = −0.268), and lumbar and total spinal ROMs (r = −0.184, −0.171). Increased SIA and BMI might be the most relevant risk factors for LSS.

Radiographic Assessment of Vascular Calcification, Aortic Pulse Wave Velocity, Ankle‐Brachial Index and Fibroblast Growth Factor‐23 in Chronic Hemodialysis Patients

Vascular calcification is a frequent complication of chronic kidney disease and end stage renal disease. In both the general population and patients with end stage renal disease, vascular calcification is related to arterial stiffness and is a predictor of cardiovascular morbidity and mortality. Various diagnostic methods are currently used to assess vascular calcification. There is a preference for simple, reliable methods that can be used in daily practice. Therefore, several imaging and laboratory methods are investigated. Twenty-eight patients with mean age of 62 years on chronic hemodialysis were enrolled in the study. The mean duration of hemodialysis treatment was 70 months (range 3 to 350 months). Vascular calcification was assessed with coronary computed tomography and lateral lumbar, pelvic and hand radiographs. Vascular stiffness was evaluated using aortic pulse wave velocity and ankle-brachial index measurements, and finally serum levels of fibroblast growth factor-23 were followed. A statistically significant correlation was demonstrated between all the following parameters: coronary artery calcification score, aortic pulse wave velocity, abdominal aortic calcification score, simple vascular calcification scores in pelvis and hand. A statistically significant correlation of ankle-brachial index >1.3 to coronary artery calcification score was found. There was no correlation between the previous parameters and fibroblast growth factor-23. The results of our study indicate that simple imaging methods could provide confident vascular damage assessment and therefore potentially guide therapy adjustments. An association between fibroblast growth factor-23 and the other diagnostic modalities in our study was not found.

Serum osteocalcin levels are inversely associated with abdominal aortic calcification in men with type 2 diabetes mellitus

We found that serum osteocalcin (OC) and undercarboxylated OC (ucOC) levels were negatively associated with abdominal aortic calcification in type 2 diabetes mellitus (T2DM) men. This finding suggests that circulating OC and ucOC are not only related to glucose or fat metabolism but also to arteriosclerosis. Recent studies revealed that serum osteocalcin levels were associated with not only bone metabolism but also glucose and fat metabolism. However, the relationship between serum OC levels and arteriosclerosis remains controversial. We examined whether or not bone metabolic markers including OC are associated with abdominal aortic calcification in patients with type 2 diabetes mellitus. We recruited 118 men and 100 postmenopausal women with T2DM. We evaluated the abdominal aortic calcification score (ACS) on a lateral lumbar radiograph and examined the association between serum OC or undercarboxylated OC levels and ACS. The ACS of 3 and greater, which corresponded well to the highest quartile, was significantly and negatively associated with serum OC and ucOC levels in men by logistic regression analyses after adjusting for age, BMI, serum levels of creatinine and LDL cholesterol, radial bone mineral density, smoking, duration of DM, hemoglobin A1c, and the index of insulin resistance [odds ratio (OR) 0.36, 95 % confidence interval (CI) 0.19-0.70, P < 0.005, and OR 0.28, 95 % CI 0.12-0.69, P < 0.01, per standard deviation increase in OC and ucOC, respectively]. These observations were still significant after an additional adjustment for other bone markers. In contrast, there were no significant relationships with serum OC or ucOC levels and ACS in women. These findings suggest that serum OC and ucOC levels are associated with not only bone metabolism but also arteriosclerosis in men, but not in women with type 2 diabetes mellitus.

Prevalence and Sex Difference of Lumbar Disc Space Narrowing in Elderly Chinese Men and Women: Osteoporotic Fractures in Men (Hong Kong) and Osteoporotic Fractures in Women (Hong Kong) Studies

Osteoporotic Fractures in Men (Hong Kong) and Osteoporotic Fractures in Women (Hong Kong) represent the first large-scale prospective population-based studies on bone health in elderly (age≥65 years) Chinese men (n=2,000) and women (n=2,000). We undertook the current study to investigate the prevalence of lumbar disc space narrowing in these subjects, and to identify the potential relationship between disc space narrowing and sex, bone mineral density (BMD), and other demographic and clinical data. On lumbar lateral radiographs, L1/L2-L4/L5 disc space was classified into 4 categories: 0=normal; 1=mild narrowing; 2=moderate narrowing; 3=severe narrowing. We compared demographic and clinical data between subjects with and those without total disc space narrowing scores≥3. Disc space narrowing was more common in elderly women than in elderly men. The mean±SD disc space narrowing score for the 4 discs was 2.71±2.21 for men and 3.08±2.50 for women (P<0.0001). For the 3 age groups of 65-69 years, 70-79 years, and ≥80 years, the average disc space narrowing score increased with increasing age in both men and women, and to a greater degree in women than in men. The average disc space narrowing score differences between women and men were 0.12, 0.40, and 0.90, respectively, in the 3 age groups. For both men and women, a disc space narrowing score≥3 was associated with older age, higher spine and hip BMD, low back pain, and restricted leg mobility. The prevalence and severity of disc space narrowing are higher in elderly women than in elderly men. With increasing age, disc space narrowing progresses at a greater rate in women than in men. A disc space narrowing score≥3 is associated with higher spine and hip BMD.

Continuous long-term anti-TNF therapy does not lead to an increase in the rate of new bone formation over 8 years in patients with ankylosing spondylitis

ObjectiveCompare the radiographic progression of ankylosing spondylitis (AS) patients treated with infliximab (INF) versus historical controls (Herne cohort, HC) never treated with tumour necrosis factor (TNF)-blockers over 8 years.MethodsPatients were...

Impact of back muscle strength and aging on locomotive syndrome in community living Japanese women.

The Japanese Orthopaedic Association has proposed the term locomotive syndrome (LS) to designate a condition of individuals in high-risk groups with musculoskeletal disease who are highly likely to require nursing care. This study investigates the influence of spinal factors on LS in Japanese females. A total of 187 women > or =50 years old were enrolled in the study. Those answering yes to least one of the 7 categories in the self-assessment checklist for LS were defined as having LS. We evaluated lateral lumbar radiographs, sagittal parameters, sagittal balance using the spinal inclination angle (SIA) as an index, spinal range of motion (ROM) as determined with SpinalMouse, back muscle strength (BMS), and body mass index (BMI). Age, BMI, BMS, SIA, sacral slope angle (SSA), and lumbar spinal ROM showed significant correlations with LS. Multiple logistic regression analysis indicated that an increase in age (OR 1.054, p<0.05) and a decrease in BMS (OR 0.968, p<0.01) were significantly associated with LS. Age had significant negative correlations with BMS, SSA, thoracic and lumbar spinal ROM, and it had positive correlations with BMI, SIA, and lumbar kyphosis. BMS had significant negative correlations with age, SIA, thoracic and lumbar kyphosis, and it had positive correlations with SSA, lumbar and total spinal ROM. An increase in age and a decrease in BMS may be the most important risk factors for LS in Japanese women. Back muscle strengthening and spinal ROM exercises could be useful for improving the status of an individual suffering from LS.

Associations between Pulse Wave Velocity, Aortic Vascular Calcification, and Bone Mineral Density in Chronic Hemodialysis Patients and General Population

The aims of this study were to compare PWV, vascular calcification (VC), and bone mineral density (BMD) in chronic hemodialysis patients (CHP) with those of the general population patients (GPP). We evaluated 60 GPP (aged 57.5 ± 10.9) compared with 80 CHP (aged 59.3±11.8). PWV was determined from time diversity propagation of the carotid and femoral artery by Doppler ultrasound. Lateral lumbar radiography (LLR) of the abdominal aorta was used to determine the overall abdominal aortic calcification (AAC) score. BMD of the hip and the spine was assessed by dual energy X-ray absorptiometry (DEXA). Biochemical parameters (PTH, Ca2+, P, albumin, CRP, etc.) were determined in all participants according to standard laboratory procedures. The mean PWV was 9.2±2.0 m/s in the GPP and 12.5±2.0 m/s in the CHP. The mean AAC score was as follows: GPP: 2.2±2.69, CHP: 7.98±5.65. The mean BMD at hip was as follow: GPP: 0.875±0.159 (g/cm2), CHP: 0.729±0.147 (g/cm2). In the GPP, PWV correlate with VC (P&lt;0.001), BMD (P&lt;0.001), albumin (P&lt;0.001), and CRP (P=0.004). In the CHP, PWV correlates with VC (P&lt;0.001), BMD (P&lt;0.098), albumin (P&lt;0.094), and CRP (P=0.004). There is a strong inverse correlation between PWV and BMD and between VC and BMD. There is a positive correlation between PWV and VC.