Lumbar Spinal Degeneration Research Articles

Assessing paraspinal muscle atrophy with electrical impedance myography: Limitations and insights.

Paraspinal muscle atrophy is gaining attention in spine surgery due to its link to back pain, spinal degeneration and worse postoperative outcomes. Electrical impedance myography (EIM) is a noninvasive diagnostic tool for muscle quality assessment, primarily utilized for patients with neuromuscular diseases. However, EIM's accuracy for paraspinal muscle assessment remains understudied. In this study, we investigated the correlation between EIM readings and MRI-derived muscle parameters, as well as the influence of dermal and subcutaneous parameters on these readings. We retrospectively analyzed patients with lumbar spinal degeneration who underwent paraspinal EIM assessment between May 2023 to July 2023. Paraspinal muscle fatty infiltration (FI) and functional cross-sectional area (fCSA), as well as the subcutaneous thickness were assessed on MRI scans. Skin ultrasound imaging was assessed for dermal thickness and the echogenicities of the dermal and subcutaneous layers. All measurements were performed on the bilaterally. The correlation between EIM readings were compared with ultrasound and MRI parameters using Spearman's correlation analyses. A total of 20 patients (65.0% female) with a median age of 69.5 years (IQR, 61.3-73.8) were analyzed. The fCSA and FI did not significantly correlate with the EIM readings, regardless of frequency. All EIM readings across frequencies correlated with subcutaneous thickness, echogenicity, or dermal thickness. With the current methodology, paraspinal EIM is not a valid alternative to MRI assessment of muscle quality, as it is strongly influenced by the dermal and subcutaneous layers. Further studies are required for refining the methodology and confirming our results.

The Role of Vitamin D3 and Trace Elements of Lumbar Spinal Degeneration in Patients Undergoing Lumbar Spinal Surgery

The Role of Vitamin D3 and Trace Elements of Lumbar Spinal Degeneration in Patients Undergoing Lumbar Spinal Surgery

Lumbar overlordosis — towards the better understanding of the May-Thurner syndrome pathogenesis

Introduction: May-Thurner Syndrome (MTS) is a condition in which the left common iliac vein is compressed by the right common iliac artery, which together with intraluminal vein changes can lead to clinically symptomatic venous outflow obstruction. Patients having such pathology may suffer from symptoms of venous hypertension as well as lower leg deep venous thrombosis. In most of the MTS cases, static and continuous compression is observed which can also lead to the intraluminal spur formation. According to the literature, among the factors which can influence the severity of iliac vein compression, lumbar spinal degeneration can also be mentioned. Considering the aortic bifurcation anatomical conditions, also other, non — degenerative changes of the lumbar vertebral column segment can be taken into consideration. Aim: This study aimed to reveal the prevalence of the left common iliac vein compression in young healthy individuals as well as to assess the severity of the left iliac vein compression provoked by lumbar hyperlordosis. Material and methods: The study was performed on a group of 207 volunteers of both sexes, aged 21–27 yrs. using ultrasound examination to measure the diameter of the right common iliac vein as well as the diameter of the left common iliac vein in the area of the possible compression by the right iliac artery. In all the patients the measurements were performed in the supine position as well as in the provoked lumbar hyperlordosis position. In all the individuals the presence of the symptoms and signs of the lower leg chronic venous disease were investigated. Results: The mean anterior-posterior diameter of the right common iliac vein in the standard supine position in the whole study group was 5.71 mm (± 0.6 mm). The mean diameter of the left common iliac vein in a normal horizontal position was 4.87 mm (± 0.6 mm) with a range from 3.8 mm to 6.2 mm. In most of the cases, the difference between the left and iliac common vein diameter (when measured in the place of the right iliac artery crossing) did not exceed 20%. In 15.9% of the study subjects, the right and left iliac vein diameter difference ranges between 20–30% and in 2.41% only, the diameter difference over 30% was noticed (in none of the cases the stenosis exceeding 40% of the vein diameter was found). Looking for the effect of the overlordosis on the proclivity to decrease left iliac vein diameter, in the provoked hyperlordosis position the changes of the iliac vein diameter in the range of 21–30% were observed in 15.9% and over 30% in 2.4% of the study subjects. Hyperlordosis presence was also responsible for the shift towards lower left iliac vein diameter — in 36.2% of the patients, the left iliac vein diameter below 4 mm was noticed including 1.9% of individuals with a diameter not exceeding 3 mm. In the analysis, there was no statistically significant correlation between the presence of the reported CVD symptoms in the left leg and the reported diameter reduction between the right and left iliac veins in the population of the studied young individuals. Conclusions: Left common iliac vein compression may be anatomically conditioned at least in some of the young population individuals. Lumbar hyperlordosis influence on the left common iliac vein diameter suggests that also in healthily individuals, an incorrect spinal position can promote the occurrence of the left iliac vein compression. Further studies are needed to assess the haemodynamic influence of these findings on the lower leg venous outflow.

The Effect of Paraspinal Fatty Muscle Infiltration and Cumulative Lumbar Spine Degeneration on the Outcome of Patients With Lumbar Spinal Canal Stenosis: Analysis of the Lumbar Stenosis Outcome Study (LSOS) Data.

Prospective. To investigate the influence of paraspinal fatty muscle infiltration (FMI) and cumulative lumbar spine degeneration as assessed by magnetic resonance imaging on long-term clinical outcome measures in patients with lumbar spinal canal stenosis (LSCS) of the Lumbar Stenosis Outcome Study (LSOS) cohort. Past studies have tried to establish correlations of morphologic imaging findings in LSCS with clinical endpoints. However, the impact of FMI and overall lumbar spinal degeneration load has not been examined yet. Patients from the LSOS cohort with moderate to severe LSCS were included. Two radiologists assessed the degree of LSCS as well as cumulative degeneration of the lumbar spine. FMI was graded using the Goutallier scoring system. Spinal Stenosis Measure (SSM) was used to measure the severity level of symptoms and disability. European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) was used to measure health-related quality of life. The nonsurgically treated group consisted of 116 patients (age 74.8±8.5yr), whereas the surgically treated group included 300 patients (age 72.3±8.2yr). Paraspinal FMI was significantly different between the groups (54.3% vs. 32.0% for Goutallier grade ≥2; P <0.001). Total degeneration score was comparable in both groups (9.5±2.0 vs. 9.3±2.0; P =0.418). FMI was associated with lower SSM function and lower EQ-5D-3L (all P <0.05), but not with SSM symptoms. Total degeneration of the lumbar spine was associated neither with SSM symptoms, nor with SSM function, nor with EQ-5D-3L (all P >0.05). FMI is associated with higher disability and worse health-related quality of life of LSCS patients in the LSOS cohort. There was no significant association between total cumulative lumbar spine degeneration and the outcome of either surgically or nonsurgically treated patients. 3.

Unexpected Sex Differences in the Relationship of Sacroiliac Joint and Lumbar Spine Degeneration.

The relationship between degenerative changes of the sacroiliac joints and the lumbar spine on CT has not been studied yet. The aim of this analysis is to determine the nature of their association as well as the influence of fixed anatomical spinopelvic parameters on sacroiliac joint degeneration. For this institutional review-board-approved investigation, imaging datasets as well as electronic medical records of 719 patients without back pain from the clinical routine of our department of radiology were included. Age, sex, weight category (slim, normal, obese), parity in women and indication for imaging were noted for all patients. The presence of degenerative lesions of the lumbar spine (disc degeneration, endplate degeneration, spondylophytes, and facet joint osteoarthritis) was noted separately at each lumbar segment (L1 to L5). Sacroiliac joints were assessed for sclerosis and osteophytes. Fixed anatomical spinopelvic parameters were measured: pelvic radius = PR; pelvic incidence = PI; sacral table angle = STA. Correlation as well as regression analyses were performed; data were analyzed for males and females separately. PI increased significantly with age in both women and men, while STA decreased and PR remained constant; neither of them was associated with SIJ degeneration. SIJ degeneration correlated with disc degeneration (tau = 0.331; p < 0.001), spondylophytes (tau = 0.397; p < 0.001), and facet joint degeneration (tau = 0.310; p < 0.001) in men, but with no parameter of spinal degeneration in women. Lumbar spinal degeneration increased the risk of sacroiliac joint degeneration in men significantly (OR 7.2; 95%CI 2.8–19.0), but it was not a significant covariable in women. Fixed spinopelvic parameters have little impact on sacroiliac joint degeneration. The degeneration of the sacroiliac joints and the lumbar spine appear to be parallel processes in men, but are largely unrelated in women.

Association Between Lumbar Spinal Degeneration and Anatomic Pelvic Parameters.

Retrospective cohort study. The objective was to prove the association between anatomic pelvis parameters and specific types of lumbar spinal degeneration. Different spinopelvic sagittal profile types are suggested to be associated with specific degenerative lumbar spine pathologies. Because pelvic morphology plays a key role defining the spinal shape as well as its load and function it thereby potentially predisposes the development of spinal degeneration. Patients with symptomatic lumbar spinal degeneration who were surgically treated in 2 spine departments from March 2011 until August 2016 were included in this retrospective analysis. Single-level degenerative pathologies were classified as lumbar disc herniation (LDH), degenerative disc disease (DDD), lumbar spinal stenosis (LSS), and degenerative spondylolisthesis (DSPL). The constant anatomic pelvic parameters pelvic incidence (PI), pelvic radius (PR), and sacral table angle (STA) were assessed in lateral radiographs of the lumbar spine and compared between the pathologies. In total, 249 patients were assigned to the LDH (n=73), DDD (n=67), LSS (n=42), and DSPL (n=67) groups. Group comparisons revealed significant differences in the anatomic pelvic parameters PR (LDH, 139.5±10.8 mm; DDD, 135.9±14.0 mm; LSS, 127.8±14.3 mm; DSPL, 135.8±12.7 mm; P<0.001), PI (LDH, 53.1±10.0 degrees; DDD, 50.0±9.9 degrees; LSS, 54.5±9.6 degrees; DSPL, 57.1±10.8 degrees; P=0.001), and STA (LDH, 95.3±12.7 degrees; DDD, 105.4±9.0 degrees; LSS, 105.9±11.5 degrees; DSPL, 98.6±9.5 degrees; P<0.001). Post hoc tests indicated significant differences between the PR of the LSS group and that of all other subgroups (P<0.012), the PI of the DDD group and that of DSPL (P<0.001), and the STA of the LDH/DSPL groups and that of the LSS/DDD group (P<0.005). We found all the constant anatomic parameters to be specific for distinct types of degeneration, suggesting pelvis shape is a predisposing factor for their development. Level III.

Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation

BackgroundTo assess the correlation between lumbar disc degeneration (LDD), multifidus muscle atrophy (LMA), and facet joints degeneration in patients with L4-L5 lumbar disc herniation (LDH).MethodsSixty patients with L4-L5 LDH diagnosed by a 1.5 T MRI scanner were enrolled in the study group and another 60 patients with non-specific back pain were enrolled in the control group. LDD, LMA, and facet joints degeneration were examined and analyzed independently by two independent orthopedic surgeons using T2-weighted images. Wilcoxon test was used for analyzing the difference of LDD and facet joints degeneration between L3-L4 and L5-S1 and difference of LMA between the herniated and control groups. Correlation analysis of the three degeneration grades at the same level was determined by Spearman rank correlation test.ResultsIn the herniated group, most LMA at L3-L4 level was grade 1 (42, 70.0%); grade 2 (33, 55.0%) at L4-L5 level; and grade 3 (27, 45.0%) at L5-S1 level. LMA and LDD grading were significantly different between L3-L4 and L5-S1 levels (P < 0.05). In the herniation group, the Spearman value for LDD and LMA grading were 0.352 (P < 0.01) at L3-L4 and 0.036 (P > 0.05) at the L5-S1 level. The differences in LMA between the herniated and control groups at the three levels were significant (P < 0.05).ConclusionsDisc degeneration and multifidus muscles atrophy were positively correlated at the L3-L4 disc level. A lumbar extension muscle strengthening program could be helpful in preventing muscle atrophy and lumbar spinal degeneration.

Diffusion tensor imaging of lumbar spinal nerve in subjects with degenerative lumbar disorders

Recently several authors have reported that diffusion tensor imaging (DTI) might provide a new understanding of sciatica. The purpose of this study was to investigate the clinical feasibility of DTI for the evaluation of lumbar spinal nerve of patients with sciatica associated with lumbar degenerative disorders. Thirty-four patients (25men, mean age63. 3years) with degenerated lumbar disease, 14 patients with lumbar spinal stenosis with foraminal stenosis, 12 with lumbar spinal stenosis without foraminal stenosis, five with lumbar disc herniation, two with discogenic low back pain, and one with spondylolysis who underwent 3.0T magnetic resonance (MR) imaging and surgical treatment were included in the present study. Fractional anisotropy (FA) was calculated from an FA map, and tractography was investigated. In asymptomatic nerves, tractography showed all L3–S1 spinal nerve roots clearly. Abnormalities of tractography were classified into three types by shape; “Disrupted”, “Narrowing”, and “Tapering”. More abnormalities of tractography were found in patients with lumbar spinal stenosis, and especially in patients with foraminal stenosis. The disrupted type was the most common. The mean FA of entrapped symptomatic nerves was less than seen on the intact side. This study demonstrates that tractography shows abnormal findings for nerve roots in lumbar spinal degeneration and that FA decreases in symptomatic roots. DTI may offer not only morphological evaluation, but also quantitative evaluation. We believe that DTI can be used as a tool for the diagnosis of lumbar spinal degenerative disease.

Mini-Open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lateral Interbody Fusion for Lumbar Spinal Degeneration Disease

PurposeSurgery for lumbar spinal degeneration disease is widely performed. While posterior decompression and fusion are popular, anterior lumbar interbody fusion (ALIF) is also used for treatment. Extreme lateral interbody fusion (XLIF) is commonly used for noninvasive ALIF; however, several complications, such as spinal nerve and psoas muscle injury, have been reported. In the current study, we examined the clinical efficacy and complications of oblique lateral interbody fusion (OLIF) for lumbar spinal degeneration disease.Materials and MethodsThirty-five patients with degenerated spondylolisthesis, discogenic pain, and kyphoscoliosis were examined. All patients underwent OLIF surgery (using a cage and bone graft from the iliac crest) with or without posterior decompression, without real-time electromyography monitoring. Posterior screws were used in all patients. Visual analog scale (VAS) score and Oswestry Disability Index (ODI) were evaluated before and 6 months after surgery. Surgical complications were also evaluated.ResultsPain scores significantly improved after surgery, compared to those before surgery (p<0.05). There was no patient who underwent revision surgery. There was no spinal nerve, major vessel, peritoneal, or urinary injury. Few patients showed symptoms from psoas invasion.ConclusionOLIF surgery produced good surgical results without any major complication.

Lumbar spine stability after combined application of interspinous fastener and modified posterior lumbar interbody fusion: a biomechanical study

Posterior lumbar interbody fusion (PLIF) and internal fixation are commonly performed for the treatment of lower back pain due to lumbar spinal degeneration. We have developed a novel interspinous fixation device, the interspinous fastener (ISF) for potential use in the surgical management of degenerative spinal disease. The aim of this study was to assess the in vitro biomechanical characteristics of calf lumbar spine specimens after ISF fixation with modified PLIF. Ten lumbar spine (L3-L6) specimens from ten fresh calf cadavers (8-10weeks of age) were used. Each specimen underwent sequential testing for each of the following four groups: no instrumentation (INTACT); interspinous fusion device fixation+PLIF (ISF); unilateral pedicle screw and titanium rod fixation+PLIF (UPS); bilateral pedicle screw and titanium rod fixation+PLIF (BPS). Outcome measures included angular range of motion (ROM) during unloaded and loaded (8Nm) flexion, extension, left bending, right bending, left torsion and right torsion. For all unloaded and loaded assessments, ROM was significantly higher in the INTACT group compared with all other groups (P<0.05). Similarly, ROM was significantly higher in the UPS group (indicating decreased stability) compared with the ISF and BPS groups (P<0.05). The only significant difference between the ISF and BPS groups was in the ROM with unloaded extension (higher in the BPS group, P=0.006). We found that ISF fixation with PLIF of the lower lumbar spine provided biomechanical stability that was equivalent to that associated with bilateral pedicle screw/rod fixation with PLIF. The ISF shows potential as an alternative means of fixation in the surgical management of degenerative spinal disease.

Does lumbar spinal degeneration begin with the anterior structures? A study of the observed epidemiology in a community-based population

Background-Prior studies that have concluded that disk degeneration uniformly precedes facet degeneration have been based on convenience samples of individuals with low back pain. We conducted a study to examine whether the view that spinal degeneration begins with the anterior spinal structures is supported by epidemiologic observations of degeneration in a community-based population.Methods-361 participants from the Framingham Heart Study were included in this study. The prevalences of anterior vertebral structure degeneration (disk height loss) and posterior vertebral structure degeneration (facet joint osteoarthritis) were characterized by CT imaging. The cohort was divided into the structural subgroups of participants with 1) no degeneration, 2) isolated anterior degeneration (without posterior degeneration), 3) combined anterior and posterior degeneration, and 4) isolated posterior degeneration (without anterior structure degeneration). We determined the prevalence of each degeneration pattern by age group < 45, 45-54, 55-64, ≥65. In multivariate analyses we examined the association between disk height loss and the response variable of facet joint osteoarthritis, while adjusting for age, sex, BMI, and smoking.Results-As the prevalence of the no degeneration and isolated anterior degeneration patterns decreased with increasing age group, the prevalence of the combined anterior/posterior degeneration pattern increased. 22% of individuals demonstrated isolated posterior degeneration, without an increase in prevalence by age group. Isolated posterior degeneration was most common at the L5-S1 and L4-L5 spinal levels. In multivariate analyses, disk height loss was independently associated with facet joint osteoarthritis, as were increased age (years), female sex, and increased BMI (kg/m2), but not smoking.Conclusions-The observed epidemiology of lumbar spinal degeneration in the community-based population is consistent with an ordered progression beginning in the anterior structures, for the majority of individuals. However, some individuals demonstrate atypical patterns of degeneration, beginning in the posterior joints. Increased age and BMI, and female sex may be related to the occurrence of isolated posterior degeneration in these individuals.

Magnetic Resonance Imaging in Patients with Low Back Pain

Objective: The objective of this study was to analyze lumbar spine MRI findings and investigate their association factors with lumbar spinal degeneration. Methods: Between March 2008 and December 2008, we retrospectively analyzed lumbar spine MRI scans of 246 patients with LBP. We used a modified MRI score for evaluation of spinal degeneration, which was obtained by modifying the Meyerding classical system. We performed Mantel Haenszel chi-square tests to compare the MRI score and associated factors. Results: The mean MRI score was 12.05. The main level at which the pathological condition existed was L4-5 in 123 patients (50.2%). Statistical analysis showed that an age of over 40 years (p-value <0.0001) and symptom duration of over 5 years (p=0.0122, which is <0.05) were significantly related to a high MRI score. Annular tear, irregular nucleus shape, and reduced disc height in the lumbar spine were strongly associated with LBP. Conclusion: Annular tear, irregular nucleus shape, and reduced disc height in the lumbar spine were strongly associated with LBP. Especially, MRI finding in patients aged over 40 years and who experienced symptoms for 5 years or more showed higher MRI score.

Inflammatory cytokines released from the facet joint tissue in degenerative lumbar spinal disorders.

A prospective study of surgical cases of degenerative lumbar spinal disorders demonstrated inflammatory cytokines in the facet joint tissue. To quantify various inflammatory cytokines released from the facet joint tissue in surgical cases of degenerative lumbar spinal disorders. In degenerative lumbar spinal disorders, pain is often caused by osteoarthritis of a facet joint. There are inflammatory mediators such as prostaglandins and leukotrienes in facet joint tissue in lumbar spinal degeneration. However, no reports have studied if there are also inflammatory cytokines in the facet joint, which generated arthropathic changes in degenerative lumbar spinal disorder and if pain is caused by chemical factors associated with inflammation such as inflammatory cytokines. Forty patients with degenerative lumbar disorders who had undergone operative treatment were included in this study. Fifty-five joint cartilages and 67 synovia were harvested from the lumbar facet joints in responsible intervertebral levels of patients. There were 24 male and 16 female subjects with average ages of 50 and 67 years, respectively, in 11 cases of lumbar disc herniation and 29 cases of lumbar spinal canal stenosis. Using ELISA and CLEIA methods, joint cartilage and synovial tissues were harvested during surgery from the facet joint at the responsible upper levels to measure IL-1beta, TNF-alpha, and IL-6 in individual tissues. IL-1beta was detected in joint cartilage and synovium in both groups and its positive reaction rate was higher in LSCS than in LDH. There was no difference in IL-1beta concentration in cartilage tissue between the two groups. There was TNF-alpha in the synovium of LSCS. IL-6 was high in joint cartilage and synovium in both groups. The concentration was significantly higher in LSCS than in LDH. There are inflammatory cytokines in facet joint tissue at high levels in degenerative lumbar spinal disorders. Inflammatory cytokines have a higher concentration rate in lumbar spinal canal stenosis than in lumbar disc herniation. This finding suggests that inflammatory cytokines in degenerated facet joints may have some relation to the cause of pain in degenerative lumbar disorders.

The Relationship Between Degenerative Changes and Osteoporosis in the Lumbar Spine

Degenerative changes in the spine, specifically disc degeneration and facet arthrosis, and osteoporosis are conditions that primarily affect the elderly and may significantly impact the quality of life. The relationship between osteoporosis and degenerative changes in the hip joint has been studied, but their correlation in the spine is not entirely clear. Two hundred ninety-four subjects older than 50 years of age were retrospectively studied for the existence of lumbar spinal degeneration and osteoporosis through radiologic examination for 3 clinical manifestations: (1) disc degeneration, (2) facet joint arthrosis, and (3) lumbar osteoporosis. Peripheral osteoporosis in the distal radius of the nondominant hand was measured using a single-photon bone absorptiometer. Results indicated that subjects with severe osteoporosis in the distal radius also had severe degenerative changes in the discs and the facets; those with mild osteoporosis in the distal radius showed a tendency to have a lesser degree of degenerative changes than the subjects without osteoporosis.