Lumbar Disc Bulging Research Articles

Navigating Complex Comorbidities: A Case of Behcet?s Syndrome with Lumbar Disc Bulging and Cardiovascular Disease

Navigating Complex Comorbidities: A Case of Behcet?s Syndrome with Lumbar Disc Bulging and Cardiovascular Disease

Development of a Machine Learning Algorithm to Correlate Lumbar Disc Height on X-rays with Disc Bulging or Herniation.

Lumbar disc bulging or herniation (LDBH) is one of the major causes of spinal stenosis and related nerve compression, and its severity is the major determinant for spine surgery. MRI of the spine is the most important diagnostic tool for evaluating the need for surgical intervention in patients with LDBH. However, MRI utilization is limited by its low accessibility. Spinal X-rays can rapidly provide information on the bony structure of the patient. Our study aimed to identify the factors associated with LDBH, including disc height, and establish a clinical diagnostic tool to support its diagnosis based on lumbar X-ray findings. In this study, a total of 458 patients were used for analysis and 13 clinical and imaging variables were collected. Five machine-learning (ML) methods, including LASSO regression, MARS, decision tree, random forest, and extreme gradient boosting, were applied and integrated to identify important variables for predicting LDBH from lumbar spine X-rays. The results showed L4-5 posterior disc height, age, and L1-2 anterior disc height to be the top predictors, and a decision tree algorithm was constructed to support clinical decision-making. Our study highlights the potential of ML-based decision tools for surgeons and emphasizes the importance of L1-2 disc height in relation to LDBH. Future research will expand on these findings to develop a more comprehensive decision-supporting model.

Quantitative Analysis of Lumbar Disc Bulging in Patients with Lumbar Spinal Stenosis: Implication for Surgical Outcomes of Decompression Surgery.

This study aimed to quantitatively assess disc bulging using computed tomography (CT) in patients with lumbar spinal stenosis (LSS) and to examine whether disc bulging affects the surgical outcomes of patients with LSS after posterior decompression surgery. Sixty-three patients who underwent posterior decompression surgery for LSS were included. The extent of disc bulging was evaluated as the percentage of the extended area of the disc against the endplate area (%EAD) on axial CT images. The participants completed the following clinical outcome assessments (COAs) preoperatively and 12 months postoperatively: the JOA Back Pain Evaluation Questionnaire (JOABPEQ), Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RDQ). The mean %EAD of 315 intervertebral discs was 18.9 ± 8.0. The %EAD was highest at L4/L5, followed by L3/L4, L2/L3, L1/L2, and L5/S1. The %EAD of the surgical level showed no significant correlation with all the preoperative COAs, but it had significant correlation with lumbar function, walking ability, social function domains of the JOABPEQ, ODI score, and RDQ score 12 months postoperatively. %EAD was significantly associated with the postoperative score in the walking ability domain of the JOABPEQ. %EAD affects postoperative clinical outcomes, including low back pain-related quality of life after decompression surgery.

Evaluation of asymptomatic lumbar disc herniation and endplate failure in general population and their significance in development of low backache

Introduction: Despite being the most common cause of low back pain, there are wide variations in the pathogenesis and management of lumbar disc herniation (LDH). Previously the nucleus pulposus was being implicated for most of the symptoms, but recent papers propose the endplate failure (EPF) as the most important component of symptomatic LDH. However considering the abundance of the asymptomatic LDH in normal population, it is important to study the association of endplate failure in general population to understand it’s contribution in symptomatic LDH.Aim: To evaluate the incidence of asymptomatic LDH and EPF in normal population and note development of any low back pain in them. Material and Methods: Adult patients presenting outdoor with complains other than present or past history of low backache were evaluated clinically and radiologically [x-ray, CT scan, MRI scan including the fat suppressed 3D fast spoiled gradient sequences (3DFSPGR)] to note status of lumbar disc and endplate. They were then, prospectively followed up for 3 years for any occurrence of backache.Results: Twenty volunteers (13 males, 7 females) were studies from age 19-50 years (mean 33.6±10.3). Six volunteers (30%) had desiccation of one or more lumbar disc and 8 volunteers (40%) had LDH at one or more levels. However all of the LDH were broad based disc bulge. Three volunteers had cartilaginous EPF and 1 had bony EPF. None of the EPFs were associated with disc desiccation, but 2 were associated with LDH. The presence of disc desiccations and LDH were significantly correlated to the increasing age but the EPF had no such age correlation. Subsequently 2 volunteers developed low backache.Conclusion: Asymptomatic disc desiccation and lumbar disc bulge is fairly common. Their mere presence may not be the cause of the low backache and should be carefully considered for any surgical planning. However presence bony EPF is rare and may have some significance in development of symptomatic LDH

Isolation of Brucella abortus biovar 1 from human lumbar disc bulging: a case report of brucellar discitis

BackgroundBrucellosis is an endemic zoonotic disease with rising health and economic concerns in many areas worldwide. Musculoskeletal pains are among the main complications of human brucellosis, which are often difficult to diagnose due to the variability of clinical symptoms. Brucellar discitis is a very disabling problem in some chronic forms of the disease which may lead to serious vertebral and neurological consequences.Case presentationIn this case report, we reported the isolation of Brucella abortus from lumbar disc bulging in a woman who had rheumatoid arthritis and diabetes mellitus as underlying conditions. The patient had several negative brucellosis serological tests and dorsolumbar pains with urinary incontinence over a 2-month period. The diagnosis was confirmed by magnetic resonance imaging (MRI) examination of lumbar spine as well as disc culture. MRI examination was performed without intravenous contrast and revealed the presence of disc bulging, left foraminal narrowing at L5-S1, left foraminal narrowing, anterolisthesis grade II at L4-L5. The diagnosis was also confirmed by isolation of B. abortus biovar 1 from bulging disc culture. The isolate was characterized by AMOS PCR, Bruce-ladder PCR and biotyping, resulting in the identification of B. abortus from L4-L5 and L5-S1 disc bulging regions. The patient was treated with two drugs i.e. doxycycline and rifampin for 3 months. In the follow-up, in addition to improving the patient’s general condition, low-back pain was also significantly reduced.ConclusionsMRI, serology, cultural and molecular test along with patient history are important to make a rapid diagnosis of brucellosis’ discitis, thereby decreasing the delay for the brucellosis treatment. The present report suggests that the infection by Brucella spp. should be fundamentally considered among the causative agents of back pain especially in the endemic areas of Brucella infections.

Prediction of Lumbar Disc Bulging and Protrusion by Anthropometric Factors and Disc Morphology.

The relationship between reduced disc height and disc bulging and/or protrusion has been controversial. The purposes of this study were to examine the relationship between disc morphology and disc bulging and protrusion and to establish a model for predicting disc bulging and protrusion. This is a retrospective study. A total of 452 MRI scans from a spine study were analysed, 210 (46.5%) were men. Logistic regression analysis was applied to identify the association between anthropometric factors, disc morphology factors, and outcome. Model 1 was constructed using anthropometric variables to investigate the capacity for predicting outcomes. Model 2 was constructed using anthropometric and disc morphology variables. Age, body weight, body height, disc height, and disc depth were significantly associated with outcome. The area under the curve (AUC) statistics of Model 2 were significantly better than those of Model 1 at the L3-L4 and L4-L5 levels but not at the L5-S1 level. The results showed an association between disc morphology and disc bulging and/or protrusion at the L3-L4, L4-L5, and L5-S1 levels. The model utilizing both anthropometric factors and disc morphology factors had a better capacity to predict disc bulging and/or protrusion compared with the model using only anthropometric factors.

A comparative study between laminectomy and laminotomy in patient of lumbar disc prolapse

Introduction and Objective: The study aims to compare the effectiveness of laminectomy and laminotomy for treating lumbar disc prolapse. Materials and Methods: A prospective study of comparative study between laminectomy and laminotomy. In patient of lumbar disc bulge will be conducted in the department of Orhtopaedics, Sir Takhtsinhji Hospital, Bhavnagar, after getting permission from Institutional Review Board, Government Medical College, Bhavnagar. The Study will compose of 30 patients of lumbar disc bulge admitted in the Department of Orhtopaedics, Sir Takhtsinhji General Hospital, Bhavnagar. Patients will be included after approval of Institutional Review Board, Government Medical College, Bhavnagar. Detailed history regarding personal date, history of mechanism, pre- injury ambulatory status, preexisting local and systemic condition, menopausal status that may affect recovery. Full clinical examination will be done to assess the general condition of the patient, range of movement and any associated complains. MRI whole spine screening will be taken. After deciding the appropriate plan, patient will be prepared for surgery. Every patient will be operated upon as early as possible or within two days of getting fitness for anesthesia. All patients will be assessed with regard to operative time day of getting fitness for anesthesia. All patients will be assessed with regard to operative time, blood loose, hospital stay and post operative complications. Dressing will be checked on the 2nd , 4th, 6th post – operative day. Patients will be discharged and then after will be followed on 2nd wk, 6th wk, 12th wk, and 6th month. On follow up visits patients’ will be evaluated with odoms criteria, general and systemic examination. Results: Laminotomy has definitive advantages over leminectomy in terms of SHORT hospital stay an average of 5 days, less blood loss, Less postoperative pain and Epidural hematomas and Fibrosis, It has the advantage that it’s shorter length

Prone-positioned upside-done arch exercise, a kind of lumbodorsal muscles training, curbs the progression of lumbar disc bulge

Prone-positioned upside-done arch exercise, a kind of lumbodorsal muscles training, curbs the progression of lumbar disc bulge

Two subtypes of intervertebral disc degeneration distinguished by large-scale population-based study

Background ContextLumbar disc degeneration (LDD) is a major cause of low back pain, and is a common and disabling condition worldwide. It has been defined and measured by multiple spine magnetic resonance imaging (MRI) features, but the heterogeneity among them has never been fully addressed. PurposeThis study examined the intercorrelations, risk factor associations, and single nucleotide polymorphism (SNP) heritabilities of lumbar disc MRI features in a large-scale sample to classify the different intervertebral disc phenotypes associated with LDD. Study DesignA cross-sectional study was conducted consisting of 2,943 volunteers of Southern Chinese origin (mean age: 41.1 years; range: 15–55 years; 59.6% women). Outcome MeasuresThe outcome measures were MRI phenotypic spinal patterns and their risk factor profiles in relation to developmental or degenerative origins of disc degeneration. MethodsSagittal T2-weighted MRI of the lumbar spine from L1 to S1 was assessed. The MRI features of lumbar intervertebral disc changes, such as disc signal intensity loss and disc bulges or extrusions, as well as additional imaging phenotypes of end plate changes, high-intensity zones, and bone marrow changes, were evaluated. Blood samples were taken for genotyping using the HumanOmni-ZhongHua-8 BeadChip. Subject demographics, environmental, and lifestyle factors were assessed by questionnaires. Multivariate statistical techniques were used for phenotype evaluation. Polychoric correlations and local regression statistical analyses were performed. The genetic components contributed by common SNPs were estimated by comparing genetic correlations and phenotypic correlations using the Genome-Wide Complex Trait Analysis (GCTA) tool. ResultsThe study noted that lumbar disc MRI features separated into two groups with differential patterns of risk factor associations. A subset of lumbar disc abnormalities, including end plate changes but also upper lumbar disc bulging and signal intensity loss, may have a developmental origin. Subsequent degenerative changes, typically affecting the lower lumbar discs, then emerge as individuals age and are associated with body mass index. ConclusionsThis is the first large-scale study to identify two distinct patterns of lumbar disc alterations, noting degenerative changes and a possible developmental component affecting the lumbar spine. This new classification provides a starting point for a more homogeneous phenotype definition, which may provide greater statistical power and precision in future genetic and epidemiologic studies. In addition, such insights may have direct clinical implications in the prevention, therapeutics, and prognostics of patients with disc degeneration.

The Use of Lumbar Spine Magnetic Resonance Imaging in Eastern China: Appropriateness and Related Factors.

Back pain is common and costly. While a general scene of back pain related practice in China remains unknown, there are signs of excessive use of lumbar spine magnetic resonance (MR). We retrospectively studied 3107 lumbar spine MRIs in Eastern China to investigate the appropriateness of lumbar spine MR use. Simple back pain is the most common chief complaint for ordering a lumbar MR study. Only 41.3% of lumbar spine MR studies identified some findings that may have potential clinical significance. Normal lumbar spine is the most common diagnosis (32.7%), followed by lumbar disc bulging and lumbar disc herniation. Walk difficulties, back injury and referred leg pain as chief complaints were associated with greater chance of detecting potentially clinically positive lumbar MR image findings, as compare with simple back pain. There was no difference in positive rates among orthopedic surgeon and specialists of other disciplines. Lumbar spine MR imaging was generally overused in Eastern China by various specialists, particularly at health assessment centers. For appropriate use of lumbar spine MR, orthopedic surgeons are no better than physicians of other disciplines. Professional training and clinical guidelines are needed to facilitate evidence-based back pain practice in China.

A Case of Change in Work Out as the Presenting Symptoms of Multiple Myeloma

HISTORY: A 56 year-old active black male presented with 5 months of worsening chronic pain: right hip pain changed location and low back pain flared. His pain had not responded to maintenance exercises (weightlifting, running, stationary cycling), dry needle, massage, stretch, or anti-inflammatories. Past medical history included lumbar disc bulge, lumbar spondylolysis, right superior labral tear, sports lifting-related Osgood-Schlatter’s, cervical laminectomy, chronic right rectus femoris strain. PHYSICAL EXAMINATION: Compared to examination seven months prior, physical examination was significant for decrease in lumbar spine flexion, extension, lateral lean, and rotation and normal symmetric strength testing over the bilateral lower extremities. Forward bending as if to tie shoes, lifting objects, and walking several blocks reproduced his pain. DIFFERENTIAL DIAGNOSIS: 1.Lumbar vertebral body fracture 2.Herniated disc 3.Lumbar or sacroiliac joint sprain or dysfunction 4.Lumbar paraspinal muscles strain 5.Malignancy - primary or secondary 6.Infection - osteomyelitis TESTS AND RESULTS: Serum protein electrophoresis: elevated IgM level Bone marrow biopsy #1: smoldering multiple myeloma Bone scan #1: negative. Lumbosacral x-ray: stable spondylolysis MRI lumbosacral spine: stable lumbar disc bulge, new L2 infiltrative lesion. Non-contrast CT: L2 lytic process with pathologic fracture Bone scan #2: photopenic foci at L2 and right scapula Skeletal survey #1: negative Bone marrow biopsy #2: plasma cell neoplasm Skeletal survey #2: lesions at L2, left pelvis, bilateral proximal femurs as well as bilateral osteoarthrosis of glenohumeral joints and left sacroiliitis FINAL WORKING DIAGNOSIS: Stage 2 multiple myeloma TREATMENT AND OUTCOMES: 1.Radiation and chemotherapy 2.Clamshell TLSO for lumbar lordosis 3.Simplifed exercise program: upright stationary cycle, overhead reach, back extension stretches. Focus on core strength, hip flexibility. 4.Advance to stairs, pool running, captain’s chair, bird dog, and abdominal press 5.Avoid overhead lifting and compressive spine exercises 6.Treatment complicated by pulmonary embolism. 7.Tolerance of bending and lifting improved participation in household activities. 8.Goal: to return to weight lifting exercises and outdoor biking.

Factors affecting dynamic foraminal stenosis in the lumbar spine

Background contextLumbar foraminal stenosis is a common clinical problem and a significant cause of lower extremity radiculopathy. Minimal in vivo data exists quantifying changes in foraminal area (FA) as the spine moves from flexion to extension in the lumbar spine or on the relationship between FA and lumbar segmental angular motion, translational motion (TM), or disc bulge migration. PurposeTo use kinetic magnetic resonance imaging (kMRI) to evaluate changes in dimensions of lumbar neural foramina during weight bearing in neutral, flexion, and extension positions. To evaluate the relationship between foraminal stenosis and lumbar segmental angular motion, TM, and disc bulge migration. Study designA retrospective radiographic study. Patient sampleForty-five patients with a mean age of 44 years undergoing kMRI for symptoms of low back pain or radiculopathy. Outcome measuresMagnetic resonance imaging measurements of FA, angular motion, TM, and disc bulge migration. MethodsKinetic magnetic resonance imaging of the lumbar spine was reviewed in 45 patients with low back pain or radiculopathy, and parasagittal images were evaluated for changes in neural foraminal dimensions in various degrees of motion with weight bearing. The changes in foraminal dimension were correlated to the amount of segmental angular motion, TM, and disc bulge migration at each level. Neural foramina were also assessed qualitatively by Wildermuth criteria. Only those foramina that were clearly visualized with well-defined anatomic boundaries in all three positions were taken into consideration. Patients with previous surgery, tumor, and scoliosis were excluded from the study. ResultsThere was a significant decrease in the FA from flexion to neutral (p<.05) at all levels except L5–S1 and from neutral to extension at all levels (p<.05). The average percent decrease in FA was 30.0% with the greatest decrease from flexion to extension occurring at L2–L3 (167–107 mm2) and the smallest change occurring at L5–S1 (135–106 mm2) (p<.05). The magnitude of change in FA increased as angular motion at a segment increased. The mean change in FA was 32.3 mm2 when angular motion was less than 5° and was 75.16 mm2 when angular motion exceeded 15°. The extent of disc bulging posteriorly in the neural foramen was also correlated with the reduction in the FA from flexion to extension, but TM had no effect. ConclusionsForaminal area decreased significantly in extension compared with flexion and neutral on MRI. Lumbar disc bulge migration and angular motion at each level contributed independently to the decrease in FA in extension, whereas TM had no effect on FA.

Kinematic Evaluation of Association between Disc Bulge Migration, Lumbar Segmental Mobility, and Disc Degeneration in the Lumbar Spine Using Positional Magnetic Resonance Imaging

Degenerative disc disease and disc bulge in the lumbar spine are common sources of lower back pain. Little is known regarding disc bulge migration and lumbar segmental mobility as the lumbar spine moves from flexion to extension. In this study, 329 symptomatic (low back pain with or without neurological symptoms) patients with an average age of 43.5 years with varying degrees of disc degeneration were examined to characterize the kinematics of the lumbar intervertebral discs through flexion, neutral, and extension weight-bearing positions. In this population, disc bulge migration associated with dynamic motion of the lumbar spine significantly increased with increased grade of disk degeneration. Although no obvious trends relating the migration of disc bulge and angular segmental mobility were seen, translational segmental mobility tended to increase with disc bulge migration in all of the degenerative disc states. It appears that many factors, both static (intervertebral disc degeneration or disc height) and dynamic (lumbar segmental mobility), affect the mechanisms of lumbar disc bulge migration.

Creep associated changes in intervertebral disc bulging obtained with a laser scanning device

Lumbar disc bulging has been determined with different methods in the past. Reported methods of bulging assessment were limited to a direct physical contact, were two-dimensional and were time-consuming. Assessing the three-dimensional contour of a biological object under load would imply that the tissue would creep and therefore changes its contour. For that purpose, we were interested how fast the contour has to be assessed and how creeping would counteract on the intradiscal pressure and disc height. For that purpose, a laser based three-dimensional contour scanner was developed. This scanner was especially designed to be mounted in a spine tester. For 15 min a static compression of 500 N was applied to seven human lumbar segments having all ligaments, facets and arches removed. Disc height, intradiscal pressure and disc contour were time dependently measured. Load application reduced the disc height by 1.14 mm. The further decrease showed a typical creep behavior whereas the intradiscal pressure slightly but significantly decreased from 0.49 to 0.48 MPa. Cross-sectional disc contours showed that bulging was largest anterolateral followed by the anterior region. The creeping also increased the disc circumference. This effect varied region dependently having a maximum of 0.1 mm posterolateral. Results suggest that geometries of biological tissues should be obtained within one minute avoiding superimposing creep effects. This new method might be used to evaluate disc injuries, degeneration and disc treatments. Measuring disc contours under different loads and conditions yields the outer annular strain distribution. This is a prerequisite for the development of cell seeded and tissue engineered implants.