Lumbar Spine Radiographs Research Articles

Diffuse Idiopathic Skeletal Hyperostosis, Associated Morbidity, and Healthcare Utilization: A University Hospital Experience.

Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory condition affecting the spine, characterized by ossification of paravertebral ligaments. Our cross-sectional study investigated the frequency, associated morbidity, and healthcare utilization of DISH patients at our university hospital over 1 year. Our university's database of spinal radiographs was searched from 2005 to 2015 for "DISH" or "diffuse idiopathic skeletal hyperostosis." The diagnosis of DISH was made by 2 board-certified radiologists (B.B. and C.Q.) based on the radiographs of cervical, thoracic, or lumbar spine. Patients from 2015 were further analyzed with regards to demographics, comorbidities, and healthcare interventions. Their spinal radiographs were reread by 2 authors. Patients were divided into those who fulfilled the Resnick criteria for DISH (group A), and those who did not fully meet the criteria but had radiographic features suggestive of DISH (group B). Means and proportions were used to describe variables. For group comparisons, t test and χ test were used. Between 2005 and 2015, 3439 radiology records mentioned DISH as a diagnosis. Of 195 patients diagnosed with DISH in 2015, 153 were in group A, 41 were in group B, and 2 had erroneous diagnoses. Chronic back pain was common, and more often reported in group B than in group A (81% vs 63%, p = 0.04). Substantial portions of patients required opioid medications for pain control (51%), spinal surgery (31%), and consultations with various specialists for regional pain (57%). Diffuse idiopathic skeletal hyperostosis is a diagnosis with significant morbidity, despite being commonly viewed as asymptomatic. A majority of DISH patients had chronic back pain, and a large proportion required spinal surgery, although there may be several confounders. Future research is needed to systematically assess healthcare utilization by DISH patients.

Increased radiation dose and projected radiation-related lifetime cancer risk in patients with obesity due to projection radiography

Purpose. Primarily to evaluate the radiation dose delivered to patients with obesity in projection radiography and its relationship to the patient’s size. A secondary purpose is to estimate the subsequent projected radiation-related lifetime cancer risk to patients with obesity compared to normal-weight patients. Method and material. Data from 1964 patients from a bariatric clinic in the UK were reviewed with the relevant permission. 630 patients were identified to have a projection radiography history and were included in the study. Patients’ dose area product (DAP) data were collected for all projection radiography. Multiple exams in one day including a single DAP reading and exams with no records of DAP and exposure factors were excluded. Correlations were calculated and data analysed to yield the third quartile for each examination using STATA 14. Absorbed doses were generated from PCXMC simulation, utilising DAP data from this study and the UK national diagnostic reference level (NDRL), to calculate the effective risk for patients with obesity compared to patients with normal-weight. Results. Patients with obesity received higher DAPs for all examinations included in this study compared to NDRL. Abdominal and lumbar spine radiographs DAPs were the highest (17.6 and 30.31 Gy cm2) compared to the NDRL (2.5 and 4 Gy cm2). Only moderate to low correlations were found between patient’s size and DAPs in the abdomen and chest radiographs. The projected radiation-related lifetime cancer risk for patients with obesity is up to 153% higher than for adult patients with normal weight. Conclusion. Patients with obesity receive higher DAPs than normal-weight adults which may be in excess of that expected due to their size. Therefore, radiation-related lifetime cancer risk is increased in patients with obesity as a result of medical radiation exposures. This indicates more dose optimisation research is needed in this group of patients to reduce dose rate and variation.

Interobserver agreement using Schlapbach graded scale for diffuse idiopathic skeletal hyperostosis (DISH): can we reduce the cut-off point of vertebral affection?

Resnick-Niwayama criteria for diagnosing DISH depict an advanced stage, and a new reduced cut-off point with three contiguous vertebrae affected (two bone bridges) has been proposed. The aim has been to know the interobserver agreement by using a graded scale of DISH in which grade II matches with the new proposed cut-off point and grade III matches with the first criterion of Resnick-Niwayama. Males ≥ 50years and postmenopausal women included in a population-based prospective study (the Camargo Cohort) were analyzed. Sample size was obtained according to an expected kappa of 0.95 and an accuracy of ± 8%. Three physicians applied independently Schlapbach graded scale (ranged from grade 0, no ossification, to grade III, ≥ 3 consecutive bone bridges) on the lateral radiographs of thoracic and lumbar spine of participants. We calculated inter- and intra-observer agreement and correlation. One hundred and fifty eight radiographs (79 patients, 68 ± 9years) were assessed. Kappa values (95% confidence interval) for grades 0, I, II, and III were 0.63 (0.50-0.77), 0.49 (0.37-0.62), 0.32 (0.17-0.47), and 0.69 (0.60-0.77), respectively. Weighted kappa for the three pairs of raters were 0.87 (0.82-0.93), 0.84 (0.77-0.91), and 0.81 (0.72-0.90). Grade III was the image that generated greater agreement, while a significant decrease was noted in grade II, the new proposed criterion. The simultaneous presence of an incomplete DISH and osteoarthritis, in a thoracic spinal segment with peculiar anatomical characteristics (reduced disk spaces, kyphotic curve), is thought to be a major cause of variability in the results.

Assessing the effects of long-term osteoporosis treatment by using conventional spine radiographs: results from a pilot study in a sub-cohort of a large randomized controlled trial

ObjectiveTo evaluate the clinical applicability of a software tool developed to extract bone textural information from conventional lumbar spine radiographs, and to test it in a subset of postmenopausal women treated for osteoporosis with the fully human monoclonal antibody denosumab.MethodsThe software was developed based on the principles of a fractal model using pixel grey-level variations together with a specific machine-learning algorithm. The obtained dimensionless parameter, termed bone structure value (BSV), was then tested and compared to bone mineral density (BMD) in a sub-cohort of postmenopausal women with osteoporosis who were treated with the monoclonal antibody denosumab, within the framework of a large randomized controlled trial and its open-label extension phase.ResultsAfter 3 years and after 8 years of treatment with denosumab, mean lumbar spine BMD as well as mean lumbar BSV were significantly higher compared to study entry (one-way repeated measures ANOVA for DXA: F = 108.2, p < 0.00001; and for BSV: F = 84.3, p < 0.00001). The overall increase in DXA-derived lumbar spine BMD at year 8 was + 42% (mean ± SD; 0.725 ± 0.038 g/cm2 to 1.031 ± 0.092 g/cm2; p < 0.0001), and the overall increase of BSV was 255% (mean ± SD; 0.076 ± 0.022 to 0.270 ± 0.09, p < 0.0001). Overall, BMD and BSV were significantly correlated (R = 0.51; p < 0.0001).ConclusionsThis pilot study provides evidence that lumbar spine BSV as obtained from conventional radiographs constitutes a useful means for the assessment of bone-specific treatment effects in postmenopausal women with osteoporosis.

Plain radiograghs of lumbar spine in patients with low back pain.

Low back pain (LBP) is one of the common symptoms which bring patients to hospital and ultimately to radiology department for medical assistance. Plain radiographs of lumbar spine are usually the initial imaging tools requested by clinicians. The objective of this study is to evaluate commonest finding in patients with LBP to guide physicians for improved management. This work was a retrospective study. Plain films of these patients with LBP at the University of Nigeria Teaching Hospital, Enugu, were assessed by two radiologists. Findings documented and analyzed using IBM'S SPSS 22. Association was determined using chi-square with level of significance, p < 0.05. Total number of radiographs reviewed was 333. One hundred and eighty-three (55.0%) patients were females. Age ranged from 14 to 101years. Mean age of 53.4 ± 15.9years. Disc space was normal in majority (55.3%, 184/333) of patients; narrowing was observed in most others (43.2%, 144/333), about half of the narrowing occurring along with vacuum phenomenon. Osteophytes were commonest finding in a total of 284/333 (85.3%) existing alone or in combination with other findings. Proportion of patients with osteophytes was highest in sixth to eighth decade of life (98.8% of 61-80 age group), followed by 41-60 age group (92.9%). This association between age group and the presence of osteophytes was statistically significant (p < 0.000). Anterior vertebral body was affected in 85.0% (284/333) of patients. Osteophytes are common radiologic features in LBP. Anterior vertebral body is most affected. It is commoner in the older age group. Plain radiograph is an invaluable imaging tool in the management of LBP in this part of the world.

Relationship Between Obesity and Lumbar Spine Degeneration: A Cross-Sectional Study from the Fifth Korean National Health and Nutrition Examination Survey, 2010-2012.

Although several studies have shown that obesity affects low back pain (LBP), the relationship between degenerative lumbar spine (LSD) and obesity has not been fully investigated. This study evaluated whether obesity is independently associated with LSD in the general population. This cross-sectional study used public data from the Fifth Korean National Health and Nutrition Examination Survey (2010-2012). Subjects aged ≥50 years who had completed surveys were included (3668 men and 4966 women). Obesity was classified based on the body mass index, and LSD was assessed by lumbar spine radiographs. Independent associations of obesity with LSD or LBP were determined using odds ratios (OR) adjusted by two regression models. The prevalence of obesity was more frequent in women than in men (38.27% vs. 33.97%, P < 0.001). Compared with normal weight women, the risk of LSD was increased in overweight and obese women following adjustments [OR = 1.227, 95% confidence interval (CI): 1.019-1.477; OR = 1.217, 95% CI: 1.024-1.446, respectively]. When obesity was subdivided, the obese II group showed higher odds for LSD in women (OR = 1.797, 95% CI: 1.287-2.510). However, obesity was not correlated with LSD in men. There was no significant association between obesity and LBP in either men or women. Compared with normal weight women, LSD risk was higher in overweight and obese women, especially those in the obese II subgroup. These findings suggest that maintaining normal body weight may be a preventative factor of LSD.

Detection of high cardiovascular risk patients with ankylosing spondylitis based on the assessment of abdominal aortic calcium as compared to carotid ultrasound

BackgroundThis study aimed to determine whether, besides carotid ultrasound (US), a lateral lumbar spine radiography may also help identify ankylosing spondylitis (AS) patients at high risk of cardiovascular (CV) disease.MethodsA set of 125 AS patients older than 35 years without a history of CV events, diabetes mellitus, or chronic kidney disease was recruited. Carotid US and lateral lumbar spine radiography were performed in all of them. The CV risk was calculated according to the total cholesterol systematic coronary risk evaluation (TC-SCORE) algorithm. Presence of carotid plaques was defined following the Mannheim Carotid Intima-media Thickness and Plaque Consensus. Abdominal aortic calcium (AAC) in a plain radiography was defined as calcific densities visible in an area parallel and anterior to the lumbar spine.ResultsCarotid US showed higher sensitivity than lateral lumbar spine radiography to detect high CV risk in the 54 patients with moderate TC-SCORE (61% versus 38.9%). Using carotid plaques as the gold standard test, a predictive model that included a TC-SCORE ≥ 5% or the presence of AAC in the lateral lumbar spine radiography in patients with both moderate and low CV risk (< 5%) according to the TC-SCORE yielded a sensitivity of 50.9% with a specificity of 95.7% to identify high/very high CV-risk AS patients. A positive correlation between AAC and carotid plaques was observed (r2 = 0.49, p < 0.001).ConclusionsA lateral lumbar spine radiography is a useful tool to identify patients with AS at high risk of CV disease.

Saturday, September 29, 2018 10:30 am–12:00 pm Applying Deformity Concepts in Your Practice

BACKGROUND CONTEXT Recent studies have shown that lumbar fusion procedures are associated with an increased risk of total hip arthroplasty (THA) dislocation. Some authors have speculated that the increased risk of dislocation is caused by mispositioning of the acetabular component due to spinal sagittal imbalance. Unfortunately, the exact relationship between spinal sagittal balance and cup orientation is unknown. Furthermore, hip instability affected by cup orientation changes due to spinal sagittal imbalance remains unclear. PURPOSE To investigate the effect of spinal sagittal alignment on cup anteversion in THA dislocation. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE A total of 29 patients that suffered a THA dislocation and had lumbar radiographs prior to their THA. OUTCOME MEASURES Cup anteversion, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope before THA. METHODS Patients that suffered a THA dislocation were retrospectively identified. Patients were included if they had lumbar radiographs prior to their THA. Patient characteristics were recorded including history of spinal fusion, surgical approach, primary or revision THA, direction of dislocation, and time from THA to dislocation. Cross-table lateral hip radiographs were used to measure cup anteversion with normal acetabular anteversion defined as 15°±10°. Lateral lumbar spine radiographs were used to measure lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Normal sagittal balance was defined as a PI-LL difference of RESULTS Twenty-nine patients had full radiographic imaging. Among these patients, 62.1% dislocated following a primary THA and 37.9% following a revision THA. Abnormal spinal sagittal balance was identified in 20 patients (69.0%). One-fourth (n=8, 27.6%) of patients had undergone spinal fusion prior to THA. Abnormal cup anteversion was demonstrated in 51.7% of all patients (7% with cup anteversion 25°). Presence of a spinal fusion was not associated with cup anteversion, sagittal balance or time to dislocation (p>.05 each). Sagittal balance was not associated with direction of dislocation, time to dislocation, or cup anteversion (p>.05 each). CONCLUSIONS A majority of patients with a THA dislocation demonstrated abnormal sagittal balance. However, sagittal balance was not associated with acetabular cup anteversion. As such, the relationship between spinal deformity and dislocation rates after THA may not be due to inaccurate cup orientation. More work is necessary to further delineate the influence of spinal alignment on THA stability. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The effect of scoliosis on surface landmarks for lumbar plexus block: a MRI-based retrospective case-control series

Degenerative scoliosis (DS) may affect surface landmarks for performance of lumbar plexus (LP) block. We hypothesized the extent of any difference in surface landmarks could be calculated by a formula based on measured degree of DS, body mass index, sex, and age. We retrospectively searched our radiology database until 113 consecutive adult patients with DS were identified with lumbar spine radiographs and magnetic resonance imaging examinations performed. Pertinent surface landmark measurements at the L4 vertebral body level were recorded and compared to 50 controls. In patients with severe DS, there is a mean lateral deviation of the needle tip of 1.53 cm (0-3 cm) on the concave side and mean medial deviation of the needle tip of 0.35 cm (0-1.5 cm) on the convex side using typical bony landmarks. We found a significant correlation between body mass index and LP depth with a correlation coefficient ranging between 0.53 and 0.71. We found potential risk of organ injury in two of 13 patients with severe DS using traditional surface landmarks. There is a larger degree of lateral deviation of the LP on the concave side of scoliosis compared to medial deviation on the convex side. These deviations remained consistent irrespective of the direction of scoliosis. A review of the imaging studies and preprocedural ultrasound assessment of anatomy should be strongly considered prior to needle puncture. In patients with severe DS, an alternative approach may be considered to avoid the possibility of visceral organ injury.

Preoperative full-length standing radiographs and revision rates in lumbar degenerative scoliosis.

OBJECTIVE Full-length (36-inch) standing spine radiographs are commonly used by spine surgeons to evaluate patients with lumbar degenerative scoliosis (LDS). Despite this practice, the impact of these images on preoperative decision making and the rate of revision surgery has not been analyzed. The purpose of this study is to determine if preoperative full-length standing spine radiographs improve surgical decision making by decreasing the rate of revision surgery in patients with LDS. METHODS From the Health Care Service Corporation administrative claims database, the authors identified patients 50-80 years of age with LDS who had undergone surgery including posterior lumbar decompression and fusion over 2-6 levels and with at least 5 years of continuous coverage after the index surgery. Patients were stratified into the following groups, according to the preoperative imaging studies performed within 6 months before their index surgery: lumbar spine MRI studies only, lumbar spine MRI studies and standard lumbar spine radiographs, CT myelograms, and full-length standing spine radiographs. Survival analysis was performed with the occurrence of a revision within 5 years of the index surgery as the outcome of interest. RESULTS A total of 411 patients were included in the study after applying the inclusion and exclusion criteria. Revision surgery within 5 years after the index procedure was most frequent in the patients with preoperative MRI only (41.8%), followed by the patients with a CT myelogram (30.4%) and those with MRI and standard radiographs (24.8%). The lowest revision rate was seen among those with long-cassette standing radiographs (11.1%). Patients whose preoperative evaluation included full-length standing radiographs (OR 0.353, p = 0.034) and MRI studies plus radiographs (OR 0.650, p = 0.022) were less likely to require revision surgery at 5 years after the index procedure. CONCLUSIONS An assessment of standing alignment using full-length (36-inch) standing radiographs may be beneficial in reducing the risk of revision surgery in patients with lumbar scoliosis. This observation was not limited to patients with large curves or substantial deformity.

Correlation between lumbar intervertebral disc height and lumbar spine sagittal alignment among asymptomatic Asian young adults

BackgroundTo investigate the distribution and characteristics of the lumbar intervertebral disc height (IDH) in asymptomatic Asian population and to determine whether the lumbar IDH is related to the lumbar spine sagittal alignment.MethodsA cohort of 169 cases of asymptomatic volunteers was enrolled from January 2014 to July 2016. All participants underwent magnetic resonance imaging of the lumbar spine and panoramic radiography of the spine. Panoramic radiographs of the spine were taken to evaluate pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) using Surgimap® software. Roussouly classification was utilized to categorize all subjects according to the four subtypes of sagittal alignment. The IDH was measured on the MRI mid-saggital section of the vertebral body. The relationships between lumbar IDH and spine-pelvic parameters were also assessed using the Spearman correlation analysis.ResultsThe reference value ranges of IDH in asymptomatic Asian volunteers between L1/2, L2/3, L3/4, L4/5, and L5/S1 were (6.25, 10.99), (6.97, 12.08), (7.42, 13.3), (7.76, 14.57),and (7.11, 13.12) mm, respectively. Based on the above reference value, the high lumbar intervertebral space is defined as more than 14 mm. According to the Roussouly Classification, there are 33 cases in type I, 48 in type II, 66 in type III, and 22 in type IV. According to the definition of the high IDH, there are two cases in type I, three in type II, nine in type III, and eight in type IV. The results indicated that people in the Roussouly III and IV subtypes had greater values for IDH compared to those of Roussouly I and II subtypes, and the spinopelvic parameters were partly correlated with IDH in different subtypes. In addition, levels L4–L5 showed the highest IDH for all four groups followed by the L3–L4 and L5–S1 levels, and the value of L3–L4 is equivalent to that of L5–S1. All type groups showed moderate and positive correlations between the PI and IDH except the level of L1–L2 in type IV.ConclusionsThe IDH may influence the lumbar spine sagittal alignment in asymptomatic Asian adults. Moreover, pre-operative evaluation of IDH is useful for selection of optimal cage size and reconstruction of spinal alignment.

Design and Testing of 2 Novel Scores That Predict Global Sagittal Alignment Utilizing Cervical or Lumbar Plain Radiographs.

Global sagittal deformity is an established cause of disability. However, measurements of sagittal alignment are often ignored when patients present with symptoms localizing to the cervical or lumbar spine. To develop scoring scales to predict the risk of sagittal malalignment in patients with only cervical or lumbar spine radiographs. A retrospective review of a prospectively maintained multicenter adult spinal deformity database was performed. Primary outcome (sagittal malalignment) was defined as a C7 plumbline ≥ 50 mm. Two multivariate logistic regressions were performed using patient characteristics and measurements derived from cervical or lumbar radiographs as covariates. Point scores were assigned to age, body mass index (BMI), and lumbar lordosis or T1 slope by rounding their ß coefficients to the nearest integer. Nine hundred seventy-nine patients were included, with 652 randomly assigned to the derivation cohort (used to build the score) and 327 comprising the validation set. Final cervical score for the primary outcome included BMI ≥ 25 (1 point), age ≥ 55 yr (2 points), and T1 slope ≥ 27o (2 points). Final lumbar score for the primary outcome included BMI ≥ 25 (1 point), age ≥ 55 yr (1 point), and lumbar lordosis ≥ 45o (-1 points). High scores for both the cervical and lumbar spine presented with high specificity and positive likelihood ratios of sagittal malalignment. We developed scoring scales to predict global sagittal malalignment utilizing clinical covariates and cervical or lumbar radiographs. Patients with high scores may prompt imaging with long-cassette plain films to evaluate for global sagittal imbalance.

Relationship Between Radiographic Lumbosacral Spine Mensuration and Chronic Low Back Pain Intensity: A Cross-sectional Study

ObjectiveThe purpose of this study was to investigate correlative factors affecting chronic low back pain (CLBP), with special emphasis on the radiographic postural findings in the sagittal lumbosacral spine. MethodsA cross-sectional study alongside a randomized trial was conducted. Standing lateral lumbar spine radiographs from 352 patients with CLBP enrolled in a randomized trial were analyzed and radiographic mensuration of lumbar lordosis, lumbosacral disc angle, and sacral inclination performed. These angles were correlated with baseline variables, including CLBP intensity, age, and sex. Multiple polynomial regressions were performed in which CLBP intensity was regressed on linear and quadratic terms of lumbar lordosis to investigate the possibility of greater pain with hypo- and/or hyperlordosis. ResultsThere was no significant correlation of the angles with pain and age (r ≤ 0.09, P > .05). Weak but statistically significant correlation was identified between all 3 measurements and sex (r = –0.12 to 0.21, P < .05). Greater pain was not noted for hypo- and hyperlordosis; regression coefficients for the linear and quadratic effects were approximately 0 (P > .05). ConclusionThis study determined that there was no correlation between lumbar lordosis and pain levels for people with CLBP; thus, use of lumbar spine radiographic mensuration in the management of pain for people with CLBP is not recommended.

Radiographic Cobb Angle: A Feature of Congenital Lumbar Spine Stenosis

Purpose: A low cost, reproducible radiographic method of diagnosing congenital lumbar spinal stenosis (CLSS) is lacking. We hypothesized that the Cobb angle for lumbar lordosis would be smaller in patients with CLSS, based on observations in our spine clinic patient population. Here, we compared lumbar lordosis Cobb angles with the radiographic ratio method in patients with normal spine imaging, degenerative spinal stenosis, and with CLSS. Materials and MethodsOrthopedic surgeons categorized patients with low back pain as “Normal,” “Degenerative spinal stenosis,” and “CLSS” based on clinical presentation and findings on lumbar magnetic resonance imaging. We included 30 patients from each cohort who had undergone lateral lumbar spine radiographs and lumbar magnetic resonance imaging. For each lateral radiograph, 2 measurement methods were used (1) 4-line lumbosacral Cobb angle between L2-S1 and (2) the ratio of the anteroposterior vertebral body diameter and spinal canal anteroposterior diameter at the L3 level. We performed logistic regression analyses of CLSS prediction by Cobb angle vs the ratio method in all three cohorts. Covariates included age, gender, and body mass index. ResultsThe radiographic Cobb angles were smaller in CLSS patients when compared to the degenerative disease and normal cohorts: a smaller radiographic Cobb angle showed higher odds ratio (OR) of predicting CLSS diagnosis compared to the radiographic ratio when compared with degenerative disease (OR = 0.28; 95% CI: 0.11-0.78, P = 0.01) and when compared with the normal cohort (OR = 0.46; 95% CI: 0.24-0.92, P = 0.03). Radiographic ratio measurements showed no difference between the three cohorts (P = 0.12). CLSS was associated with male gender (P = 0.04), younger age (P = 0.01), and higher body mass index (P = 0.01). ConclusionThe radiographic Cobb angle method for lumbar lordosis may be useful for raising the possibility of CLSS as the diagnosis.

Novel Genetic Variants Associated with Lumbar Spondylosis in Koreans : A Genome-Wide Association Study.

ObjectiveThe aim of this study was to identify the susceptibility genes responsible for lumbar spondylosis (LS) in Korean patients.MethodsData from 1427 subjects were made available for radiographic grading and genome wide association studies (GWAS) analysis. Lateral lumbar spine radiographs were obtained and the various degrees of degenerative change were semi-quantitatively scored. A pilot GWAS was performed using the AffymetrixGenome-Wide Human single-nucleotide polymorphisms (SNPs), 500K array. A total of 352228 SNPs were analyzed and the association between the SNPs and case-control status was analyzed by stepwise logistic regression analyses.ResultsThe top 100 SNPs with a cutoff p-value of less than 3.7×10−4 were selected for joint space narrowing, while a cutoff p-value of 6.0×10−4 was applied to osteophytes and the Kellgren-Lawrence (K-L) osteoarthritis grade. The SNPs with the strongest effect on disc space narrowing, osteophytes, and K-L grade were serine incorporator 1 (rs155467, odds ratio [OR]=17.58, p=1.6×10−4), stromal interaction molecule 2 (STIM1, rs210781, OR=5.53, p=5×10−4), and transient receptor potential cation channel, subfamily C (rs11224760, OR=3.99, p=4.8×10−4), respectively. Leucine-rich repeat-containing G protein-coupled receptor 4 was significantly associated with both disc space narrowing and osteophytes (rs1979400, OR=2.01, p=1.1×10−4 for disc space narrowing, OR=1.79, p=3×10−4 for osteophytes), while zinc finger and BTB domain containing 7C was significantly and negatively associated with both osteophytes and a K-L grade >2 (rs12457004,OR=0.25, p=5.8×10−4 and OR=0.27, p=5.3×10−4, respectively).ConclusionWe identified SNPs that potentially contribute to the pathogenesis of LS. This is the first report of a GWAS in an Asian population.

COMPARISON OF SURFACE RADIATION DOSE TO THE GONADS BY RADIOGRAPHIC EXAMINATION OF THE LUMBAR SPINE USING COMPUTED RADIOGRAPHY AND DIRECT DIGITAL RADIOGRAPHY

Objectives: The objectives are aimed to study the comparison of SRD to the gonads by radiographic examination of the lumbar spine using computed radiography (CR) and direct digital radiography (DR) and to evaluate dose differences according to gender.Methods: A total of 120 subjects with an equal number of males and females referred for lumbar spine anteroposterior (AP) and lateral was included in the study. Sixty patients had undergone X-ray in CR X-ray unit and 60 in DR X-ray unit. SRD to gonads from a radiographic examination of the lumbar spine was measured in CR and DR using Mult-O-Meter, and obtained value of SRD was in μGy. Statistical analysis was performed using Statistical Package for the Social Sciences. Data were represented as a median and interquartile range. Mann–Whitney U-test was used for the comparison of SRD to gonads. Two-way analysis of variance (ANOVA) test was used to find out the statistically significant difference in SRD to the gonads according to gender from radiography of lumbar spine taken using CR and direct DR.Results: There was a statistically significant difference in SRD to gonads from radiography of lumbar spine AP and lateral taken using CR and direct DR (p&lt;0.001). There was no statistically significant difference in SRD to the gonads in males and females from radiography of lumbar spine AP (p=0.577) and lateral (p=0.164) taken using CR and direct DR.Conclusion: It was found that SRD to gonads from lumbar spine AP was 54% lower in direct DR and SRD to gonads from lumbar spine lateral was 68% lower in direct DR than CR.

Impact of restricting diagnostic imaging reimbursement for uncomplicated low back pain in Ontario: a population-based interrupted time series analysis

In 2012, the Ontario government withdrew public insurance coverage of imaging tests for uncomplicated low back pain. We studied the impact of this restriction on test ordering by physicians. We compared the numbers of lumbar spine radiography, computed tomography (CT) and single-segment magnetic resonance imaging (MRI) studies ordered by physicians in the 3 years before and after the policy change. We linked claims data from the Ontario Health Insurance Program with physician details to calculate rates per test-ordering physician. We compared changes in rates of monthly test ordering by family physicians and specialists before and after the policy change using segmented regression analysis of interrupted time series data. The number of lumbar spine radiography and spine CT studies ordered by family physicians decreased by 98 597 (28.7%) and 17 499 (28.7%), respectively, in the year after the policy change; there was little change in ordering by specialists. The number of lumbar spine radiography studies ordered per family physician by month decreased by 0.81 tests (p < 0.001) after the intervention, followed by a smaller rebound increase that remained below baseline. Monthly ordering of spine CT per family physician declined by 0.1 tests (p < 0.001), and that of limited spine MRI rose before the intervention, decreased by 0.18 tests (p < 0.001) after the intervention, then started to rise again. Monthly ordering of limited spine MRI by specialists, which had been stable before the policy change, decreased by 0.1 tests per specialist (p < 0.001) afterward, then rose to preintervention levels. The restriction in coverage of imaging tests caused a larger decrease in test ordering by family physicians than by specialists and a larger, more sustained reduction in the use of lumbar spine radiography and spine CT than of spine MRI.

The distribution of lumbar intervertebral angles in upright standing and extension is related to low back pain developed during standing

BackgroundLumbar lordosis measures are poorly related to clinical low back pain, however using a controlled exposure such as prolonged standing to identify pain groups may clarify this relationship. The purpose of this study was to determine the distribution of lumbar intervertebral angles in asymptomatic persons who do (pain developers) and do not (non-pain developers) develop low back pain during standing. MethodsSagittal plane lumbar spine radiographs of eight pain developers and eight non-pain developers were taken in three poses: upright standing, full extension and full flexion. Measures of vertebral end plate orientations from L1 to S1 were taken in each pose to compute: intervertebral angles, contribution of each level to the total curve, total lordosis, ranges of motion, relative pose positioning within the range of motion, vertebral shape, and lumbar spine recurve. Measures were compared between pain groups and lumbar levels. FindingsPain group differences in intervertebral angles and level contributions were greatest in the full extension pose, with pain developers having greater contributions from higher lumbar levels and fewer contributions from lower levels than non-pain developers. Pain group differences in intervertebral angle distributions were less pronounced in upright standing and non-existent in full flexion. No other measures differentiated pain groups. InterpretationsAlthough participants had similar gross-lumbar spine curvature characteristics, non-pain developers have more curvature at lower levels in upright standing and full extension. These differences in regional vertebral kinematics may partially be responsible for standing-induced low back pain.

The Discriminative Values of the Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score, C-Reactive Protein, and Erythrocyte Sedimentation Rate in Spondyloarthritis-Related Axial Arthritis.

The aims of this study were to determine the effectiveness of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP), Ankylosing Spondylitis Disease Activity Score-Erythrocyte Sedimentation Rate (ASDAS-ESR), and inflammatory markers in screening for axial-joint inflammation as detected by magnetic resonance imaging (MRI) and to find out factors that could affect scoring of the indices. One hundred fifty-three Chinese spondyloarthritis patients were recruited. Clinical data and BASDAI were collected, and Bath Ankylosing Spondylitis Metrology Index was measured. Serum ESR and CRP were checked, and ASDAS-ESR and ASDAS-CRP were calculated. Radiographs of cervical and lumbar spine were performed for modified Stoke Ankylosing Spondylitis Spinal Score. All patients underwent MRI of the spine and sacroiliac joints. Axial-joint inflammation was evaluated by Spondyloarthritis Research Consortium of Canada MRI indices. Multivariate linear regressions were used to determine potential factors that could affect disease activity indices. Receiver operating characteristic curve was used to determine the effectiveness in screening for axial-joint inflammation. BASDAI was associated with current back pain (B = 0.89, P = 0.01), ASDAS-CRP with current back pain (B = 0.74, P = 0.04), and current dactylitis (B = 0.70, P = 0.03) ASDAS-ESR with current back pain (B = 0.95, P = 0.01), and current dactylitis (B = 0.99, 0.002). The ROC curve revealed that CRP was the only variable that successfully discriminated spondyloarthritis patients with and without axial-joint inflammation by MRI, although it had poor accuracy (area under the curve, 0.63; 95% confident interval, 0.53-0.72; P = 0.01). Based on our results, MRI could be used to supplement traditional disease assessment tools for more accurate disease evaluation.

Beam Collimation during Lumbar Spine Radiography: A Retrospective Study.

Collimating the primary beam to the area of diagnostic interest (ADI) has been strongly recommended as an effective method to reduce patient's radiation dose and to improve image quality during radiology practice. Lack or inadequate collimation results in excessive radiation dose to patients and deterioration image quality. To assess the quality of beam collimation during lumbar spine radiography at two general hospitals in Ahvaz, Iran. We retrospectively reviewed 830 digital antero-posterior (AP) lumbar spine radiographs in term of beam collimation. For each radiograph, the distance between current and optimal collimation was calculated (in cm). The area of ADI and total field size for each radiograph were also calculated (in cm2). The total mean ADI and irradiated region outside ADI for each radiograph were estimated 360 and 454 cm2, respectively. The total irradiated region outside ADI was 1.26 times more than ADI. In contrast to cranial regions outside ADI, caudal regions were more commonly included inside the primary beam (12% vs. 24.4%; P-value <0.005). At least in 62% of radiographs evaluated, ovaries were included in the primary beam. Radiographers should make considerable effort to limit the primary beam to the ADI to reduce patient's exposure and to increase image quality.