Presence Of Osteophytes Research Articles

Annular Protrusion

The degenerative changes of the lumbar spine in 100 patients with symptomatic low-back pain were reviewed using plain roentgenograms and computed tomographic scans in order to determine the relationship between degeneration and annular protrusion. Additionally, the lumbar spinal units of 25 fresh cadavers were roentgenographed, injected with a mixture of methylene blue and renografin-60, dissected, and studied. The state of degeneration of each of the intervertebral units of both groups was graded on a four-point scale based on the roentgenographic presence or absence of osteophytes and facet joint changes, and the intervertebral disc height. The degree of annular protrusion was measured by dividing the anteroposterior diameter of the intervertebral disc by the anteroposterior diameter of the vertebral plate as determined on the radiographic studies. In the clinical group, 39 intervertebral discs having Grade II and III degeneration exhibited a statistically higher annular/vertebral diameter ratio (A/V index) of 1.30 as compared to the normal invertebral discs, with an A/V index of 1.12 (P less than 0.001). The dissection of the disc spaces of the cadavers with radiographic evidence of disc space narrowing and marginal osteophytosis, Grade II and III degeneration, displayed significant interruption and tearing of the annular fibers and peripheral migration of collagenized nuclear fragments. In both the clinical and pathologic groups, there was a direct correlation between the size of the annular bulge, as indicated in the A/V index, and the degree of narrowing of the disc space. Therefore, this study indicated that annular protrusion is an intricate part of the degeneration process.

Long-term evaluation of meniscectomy of the temporomandibular joint

Meniscectomy for treatment of pain and dysfunction of the temporomandibular joint is a controversial operation because of the possible late complications of limitation of movement and pain. Therefore, the long-term results of this operation were clinically and radiologically investigated in a sample of 15 patients that had had meniscectomies performed during the period from 1947-1960 (mean follow up, 29 years). On clinical examination, all patients were free of pain, none had subjectively experienced dysfunction, and all but one could open their mouths more than 39 mm. Two thirds of the operated joints were crepitant. Radiologically all joints showed structural hard-tissue changes, mainly the presence of osteophytes and flattening of the condyle and tubercle. Absence of joint space was seen in half of the joints. The results indicate that meniscectomy relieves joint pain and eliminates subjectively perceived dysfunction in the long term despite the presence of clinical and radiologic signs of degenerative joint disease; however, as the condition of many patients who have temporomandibular joint disorders improves over time without surgery, there is a need for a controlled study on the value of meniscectomy.

Computed tomogram myelography in cervical spondylosis.

Nine patients with severe and prolonged signs and symptoms due to cervical spondylosis had myelography followed by a CT Scan using the same injection of intrathecal contrast. All patients had radiographic changes of cervical spine degeneration and were being considered for exploration and fusion of the anterior cervical spine. All patients had a full clinical evaluation, EMG studies and plain radiographs taken prior to their CT Scan. EMG readings showed several levels of compression in three patients but did not indicate a single level in any. Plain radiography showed multiple level involvement in every patient. Myelography indicated significant indentation in three of five patients with clinical signs but did not demonstrate root cut off in any case. CT Myelography indicated the degree of Lushka and facet joint involvement, indentation, exit foramen encroachment, and the degree of spinal stenosis at the involved segment. In three patients, the findings at operation correlated closely with the CT Scans. Myelography failed to indicate the presence of significant osteophytes in these two cases.

Osteophytes of the spine compressing the sympathetic trunk and splanchnic nerves in the thorax.

The presence of osteophytes compressing the sympathetic structures in the thorax was found in 655 (65.5%) of 1,000 cadavers. In 60.4% of the affected cases, the compression was on the right side, and in 36.9% it was bilateral, although the right side was more severely affected. In 2%, the compression was on the left only. The highest frequency of compression was at the T8-10 level, the right greater splanchnic nerve being the structure most frequently involved. The sympathetic trunk itself (ganglia and cord) was affected only by osteophytes of vertebrae at the lowest thoracic levels; however, bony excrescences due to costovertebral joint arthritis were frequently found impinging on the sympathetic trunk and its rami communicantes at similar frequencies on both sides. The factors governing the characteristic compression of the sympathetic structures in the thorax are the typical development of the osteophytes and the special relations of the sympathetic structures to the vertebral column at the various levels. It is proposed that these observations are useful in understanding certain observed clinical conditions and act an anatomic baseline for research in the future.

Long-term evaluation of meniscectomy of the temporomandibular joint.

Meniscectomy for treatment of pain and dysfunction of the temporomandibular joint is a controversial operation because of the possible late complications of limitation of movement and pain. Therefore, the long-term results of this operation were clinically and radiologically investigated in a sample of 15 patients that had had meniscectomies performed during the period from 1947-1960 (mean follow up, 29 years). On clinical examination, all patients were free of pain, none had subjectively experienced dysfunction, and all but one could open their mouths more than 39 mm. Two thirds of the operated joints were crepitant. Radiologically all joints showed structural hard-tissue changes, mainly the presence of osteophytes and flattening of the condyle and tubercle. Absence of joint space was seen in half of the joints. The results indicate that meniscectomy relieves joint pain and eliminates subjectively perceived dysfunction in the long term despite the presence of clinical and radiologic signs of degenerative joint disease; however, as the condition of many patients who have temporomandibular joint disorders improves over time without surgery, there is a need for a controlled study on the value of meniscectomy.

Vertebral abnormalities associated with synthetic retinoid use

Frequent symptoms of back and neck stiffness led to a radiographic investigation of the vertebral spine in patients receiving synthetic retinoids, isotretinoin and etretinate. X-ray examination of fifty patients with various skin disorders who received retinoids for at least 2 years were compared with seventy-two age- and sex-matched untreated patients. Differences in frequencies of defined abnormalities, which included anterior spinal ligament calcification and presence of osteophyte at two or more vertebral levels in the absence of joint space narrowing, were determined for treated and untreated patients. When the entire group of treated patients was compared with the entire group of those untreated, no statistically significant differences were observed. When only patients with basal cell nevus syndrome (BCNS) or basal cell carcinoma (BCC) who had never received retinoid were compared with those who received isotretinoin, the frequency of the defined abnormalities was significantly higher in the treated group (p < 0.01). This study suggests that the ingestion of isotretinoin at mean total dose of 150,060 mg for an average of 2.9 years is associated with a statistically significant increase in developing an associated ossifying diathesis in patients with BCNS or BCC, when compared with matched, untreated controls.

A study of vertebral osteophyte formation in the canine spine. I. Spinal survey

ABSTRACTSpinal radiographs were made of fifty‐nine cadavers and examined for the presence of vertebral osteophytes. The osteophytes were classified into two types and examined histologically. It was concluded that the end‐plate osteophyte (type 1) represents spondylosis performans and that the type 2 osteophyte may fit into definition of the human condition, ankylosing hyperostosis.

Radiography of the Temporomandibular Joint Using the Transpharyngeal Projection

A comparison study of the information obtained from transpharyngeal, transmaxillary and oblique lateral transcranial projections of the temporomandibular joint was made. A new technique for the transpharyngeal projection is suggested in order to reduce the radiation dose and to make the projection reproducible. The material comprised 87 patients having a diagnosis of temporomandibular joint disorders. Most structural changes were detected in the transcranial projection, with the transmaxillary projection found to be the most complementary. Radiographic involvement of the fossa and articular eminence was not revealed in the transpharyngeal projection. The presence of osteophytes was found predominantly in the transcranial projection, followed by sclerosis and flat-tenings. Erosions were revealed almost twice as often in the transmaxillary projection than in either of the other two projections. In order of preference, the transcranial projection is recommended if only one of the discussed projections is to be used, followed by the transmaxillary and transpharyngeal projections. It is suggested, however, that more than one projection should be used to increase the required amount of information.

Vertebral osteophytes in rats

The vertebral columns of 38 “Charles River” strain rats, between the ages of 2 and 24 months, were examined for the presence of osteophytes. A characteristic distribution was observed with peaks occurring at C 2-C 4, T 2-T 4, T 12-L 2 and the discal border of S 1. These correspond to the peaks of the spinal curvatures, i.e. where the pressure on the vertebrae is greater. The number of osteophytes among the males was greater and increased with age. The various patterns of distribution of osteophytes in different species of lower animals and in man are reviewed and the possible reasons for these differences are discussed, particularly in relation to pressure as the main cause.

Osteophytes of the Vertebral Column

A series of 400 vertebral columns of whites and Negroes of both sexes and of various ages were examined for the presence of osteophytes. These were classified according to four degrees of development. Osteophytes were first found in the twenties, and the proportion of affected spines increased directly thereafter. In the forties, 100 per cent of skeletons showed first-degree osteophytes. The other degrees of osteophytes were found in 100 per cent of skeletons of people who were over eighty years of age. The distribution of the osteophytes in the different regions of the spine, as well as their localization on each vertebral body, was found to follow characteristic patterns. The most outstanding features of these patterns were: 1. The incidence of osteophytes is greater on the anterior aspect than on the posterior aspect of the vertebral body. 2. Anterior or posterior osteophytes tend to develop more in the concavities of the normal vertebral column or within the concavities of scoliosis or kyphosis. 3. Peaks of regional distribution are seen and are related to the normal curvatures of the vertebral column and to the line of gravity crossing them. The presence of osteophytes on the superior or inferior borders of the vertebrae is also related to the spinal curvatures. These findings indicate that osteophytes tend to appear more where pressure is greatest. This leads to the concept that osteophytes develop as a defense mechanism in response to pressure. Further support for this theory is provided by the fact that osteophytes are composed of more compact, stronger bone than the rest of the vertebral body and by the fact that the form and position of the osteophytes on the vertebral body resemble the capitals and bases of pillars designed by architects to increase the resistance of these pillars to compression. The thoracic spine is characterized especially by the predominance of osteophytes on the right side, a distribution caused by the aorta which runs down on the left. This general pattern of development of osteophytes is similar in all the race and sex groups examined. However, some differences are found: In anterior osteophytes, whites of both sexes show a greater incidence than Negroes, but the difference is not significant; whereas males of both races show a greater prevalence than females, the difference being statistically significant. Regarding posterior osteophytes, a significantly higher incidence is found in whites of both sexes; the slightly higher incidence in males than in females of both races was found to be non-significant. The soft tissues into which osteophytes may grow and the different pathological conditions which may be produced by osteophytes pressing on viscera related to the vertebral column are reviewed.

Radiotherapy in arthritic conditions

EVERYONE admits that radiotherapy is of value in ankylosing spondylitis although no one really knows how it acts. In other types of arthritis the value of X rays has been, in the past, a matter of opinion. In order to try to learn more about this subject, Dr. Desmarais, at that time one of my Unit, collaborated with Dr. Flemming under a grant from the Nuffield Foundation to investigate the problem. Sokolow in 1897 and Stenbeck in i898 were the first to use X rays in the treatment of joint disease. Since then many encouraging but conflicting reports have been published regarding the value of X rays in different arthritic conditions. Most of the reports, however, except for those of Smyth, Freyburg, and Peck (i94I) and Kuhns and Morrison (i946), were not based on carefully controlled experiments. They agreed about the beneficial effects of X rays in ankylosing spondylitis and osteo-arthritis, but they were not in agreement regarding the results in rheumatoid arthritis. In our experiment, routine physical treatment was given to all patients, and I should like to emphasize at this point the need for radiotherapy to be combined with other treatment and general advice on the management of the patients' daily routine for the result to be satisfactory. For instance, if X-ray treatment temporarily eases pain in an osteo-arthrific joint, unless advice is given about the methods required to save yet mobilize the joint, the patient will take advantage of any analgesia, still further to misuse the joint, and the end-result may be worse than at the beginning. Advice will depend, of course, on the joints involved. In the patient who is fair, fat, and forty, with painful knees, weight reduction and quadriceps drill will be the order of the day. The sportsman with a bad hip must cut out his excessive walking and should do some ' back cycling ' to keep up mobility. The housewife with backache must have a stool of the right height in the kitchen and carry out postural, mobilizing, and strengthening exercises regularly each morning. A spinal belt may also help her. Heat will ease pain in an exacerbation and massage may deal with concomitant ' non-articular rheumatism '. Let us remember that radiological changes and pain often do not correlate at all well and that attention to the soft tissues may provoke a cure in spite of the presence of osteophytes. Again in spondylitis, unless the respite obtained by radiotherapy is utilized to improve posture and is followed by the use of a light brace and instruction on the importance of the recumbent posture, the long-term gain will be but slight. In a severe and active case a plaster bed at night, postural and breathing exercises, and a rest, flat on the back on a firm surface, at midday are necessary. Without this the value of radiotherapy will be entirely lost. Team work is required in diagnosis, preparation of the patient, treatment of anaemia, mapping out a general treatment and concomitant physiotherapy, discussion on X-ray dosage, sometimes the application of surgery, and finally, perhaps adjustment of occupation. The physician, orthopaedist, pathologist, radiologist, radiotherapeutist, physiotherapist, and welfare officer should all have their place in the team, though the part they will play will vary according to the particular case under treatment. The present series of 788 cases was first divided into those due to osteo-arthritis, rheumatoid arthritis, ankylosing spondylitis, and spondylitis with peripheral joint involvement. Each group