Spine X-ray Research Articles

COVID-19 causing Grisel’s syndrome? A rare case report

Background: Grisel’s syndrome was initially described by Grisel in 1930 to explain the case of a non-traumatic atalanta-axial subluxation (C1 over C2). Exact aetiopathogenesis is unclear with the patient usually presenting as a painful acquired torticollis. Clinical Description: A 9-year-old male child presented with restriction of neck movements, cough for 2 months and tongue deviation for a week. The patient had increased deep tendon reflexes in bilateral upper and lower limbs with bilateral exaggerated plantar reflexes. Power in bilateral lower limbs was 5/5. The patient also had a history of COVID-19 infection 3 weeks back which was managed conservatively. Management: X-ray of the cervical spine revealed subluxation of the atlanto axial joint with an increased atlanto dens interval of 7.5 mm. Magnetic resonance imaging of the Cervical region showed an increased atlanto dens interval of 7.6mm. The patient was immobilised immediately with a hard cervical collar. The patient was started on Inj. Ceftriaxone 850 mg IV twice daily for 21 days, followed by another 21 days of Tab. Cefixime 100 mg twice daily. A repeat X-ray of the cervical spine showed a reduction in atlanto axial dens interval and an improvement in the patient’s condition. Conclusion: Although the diagnosis of Grisel’s syndrome could be challenging at times, it is imperative to manage patients with rare diseases swiftly and precisely to prevent permanent future disabilities. Whether COVID-19 was the trigger for the development of Grisel’s syndrome is up for debate and potential area of new research.

Diagnostic accuracy of Lateral X-Ray of Cervical Spine in detection of fracture in hospitalized patients.

Background: Lateral X-ray of the cervical spine (LCSX) is a common diagnostic tool to detect fractures in hospitalized patients. Its non-invasive nature and cost-effectiveness make it a preferred imaging technique for rapid identification of cervical spine fractures. However, its diagnostic accuracy is still a subject of debate and further research is needed to establish its reliability and validity. This study aimed to determine the diagnostic accuracy of LCSX in detecting fractures in hospitalized patients, using multi-detector computed tomography (MDCT) as the gold standard.
 Methodology: This cross-sectional retrospective study was conducted at a tertiary care hospital in Karachi. The study included 431 male and female patients aged between 18 to 60 years referred by the primary medical team to the Radiology Department for both LCSX and MDCT to detect cervical spine fractures. Patients with known cases of cervical spine fractures determined by history, examination, and previous radiological modalities like LCSX, MDCT, or MRI at the time of imaging were included.
 Results: LCSX identified 63 cases (14.6%) as having cervical spine fractures, while 368 cases (85.3%) were reported as not having cervical spine fractures. However, on MDCT, 116 cases (26.9%) out of the 431 cases were found to have cervical spine fractures, while 315 cases (73.08%) were reported as not having cervical spine fractures. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of LCSX were calculated. The sensitivity of LCSX was found to be 58.35%, specificity was 100%, positive predictive value was 100%, negative predictive value was 85.59%, and diagnostic accuracy was 87.70%.
 Conclusion: LCSX has low sensitivity as a diagnostic tool in detecting cervical spine fractures in trauma patients, resulting in missed diagnoses of critical cervical spine fractures and compromised patient care, which can lead to increased morbidity and mortality.

Co-Administration of nalbuphine to improve morphine tolerance in mice with bone cancer pain.

Kappa-opioid receptor (KOR) agonists are known for having opposite and/or different effects compared with Mu-opioid receptor (MOR) agonists. This study is aimed at clarifying the analgesic effect and tolerance of nalbuphine combined with morphine, and quantifying the mRNA and protein expression of spinal MOR and KOR in a mouse bone cancer pain (BCP) model treated with nalbuphine and morphine. BCP model was prepared in C3H/HeNCrlVr Mice by implanting the sarcoma cells into the intramedullary space of the femur. The paw withdrawal thermal latency (PWL) measured by thermal radiometer was used to assess thermal hyperalgesia. PWL testing was performed after implantation and drug administration according to the protocol. Hematoxylin-eosin staining in the spinal cord and x-ray in the femoral intramedullary canal was detected. Real-time PCR and western blot analysis played a role in detecting spinal MOR and KOR expression changes. In tumor-implanted mice, the spinal MOR and KOR protein and mRNA expression was down-regulated when compared to that in sham-implanted mice (p < 0.05). Morphine therapy can lead to a decrease in spinal μ receptor expression. Similarly, the nalbuphine therapy can lead to a decrease in the expression of κ receptor protein and mRNA at the spinal cord level (p < 0.05). Morphine, nalbuphine, or nalbuphine co-administration with morphine all can extend the paw withdrawal thermal latency (PWL) to radiant thermal stimulation in tumor-implanted mice (p < 0.05). Compared with the morphine treatment group, nalbuphine co-administration with morphine delayed the reduction of PWL value again (p < 0.05). BCP itself may induce down-regulation of the spinal MOR and KOR expression. A low dose of nalbuphine co-administration with morphine led to the delayed emergence of morphine tolerance. The part of the mechanism may be due to the regulation of spinal opioid receptors expression.

A STUDY OF COMPARING EFFICACY OF TANTALUM CAGE IN CERVICAL INTERBODY FUSION WITH TITANIUM CAGE.

Anterior cervical discectomy and fusion (ACDF) can be done to effectively treat symptomatic cervical disc disease which has failed to respond to conservative treatment1,2,3. An ideal surgical outcome includes resolution of pain and neurological deficit including a solid arthrodesis. To help in arthrodesis and maintaining disc height stand alone cage is used. He on comparing clinical and radiological outcome of tantalum and titanium used as stand alone cage in ACDF. Based on our observation clinically patients who had tantalum cage had longer duration of neck pain than that of titanium group. Three patients for whom tantalum was used had longer duration of neck pain and and higher NDI compared to others, but it was not statistically significant. Based on Xray of cervical spine taken pre and post operative for both tantalum and titanium cage usage, the disc height was restored and cage was positioned well in all cases. The radiological fusion appears optimal at follow up without any cage subsidence or collapse of disc height. So based on our study we cannot recommend that tantalum cage is superior to titanium cage for better fusion in ACDF surgery. In-fact tantalum cage had caused longer duration of neck pain when compared to titanium cage, which cannot be proved statistically and a much larger sample size is required to prove it with statistical significance.

Assessment of Biomechanical Advantages in Combined Anterior-Posterior Cervical Spine Surgery by Radiological Outcomes: Pedicle Screws over Lateral Mass Screws.

The combined anterior-posterior approach has shown good clinical outcomes for multilevel cervical diseases. This work describes the biomechanical advantage of cervical-pedicle-screw fixation over lateral-mass-screw fixation in combined anterior-posterior cases. Seventy-six patients who received combined cervical surgery from June 2013 to December 2020 were included. The patients were divided into two groups: the lateral-mass-screw group (LMS) and the pedicle-screw group (PPS). Radiological outcomes were assessed with lateral cervical spine X-rays for evaluating sagittal alignment, subsidence, and bone remodeling. At 1 year postoperatively, the numbers of patients whose C2-C7 cervical lordosis was less than 20 degrees decreased by more in the PPS group (p-value = 0.001). The amount of vertical-length change from immediately to 1 year postsurgery was less in the PPS group than in the LMS group (p-value = 0.030). The mean vertebral-body-width change was larger in the PPS group than in the LMS group during 3 months to 1 year postsurgery (p-value = 0.000). In combined anterior-posterior cervical surgery cases, maintenance of cervical lordosis and protection of the vertebral body from subsidence were better with the pedicle-screw fixation. More bone remodeling occurred when using the pedicle-screw fixation method.

E089 Effect of secukinumab on radiographic progression and inflammation in sacroiliac joints and spine in patients with non-radiographic axial spondyloarthritis: 2-year imaging outcomes from a Phase III randomised trial

E089 Effect of secukinumab on radiographic progression and inflammation in sacroiliac joints and spine in patients with non-radiographic axial spondyloarthritis: 2-year imaging outcomes from a Phase III randomised trial

A novel method for spine ultrasound and X-ray radiograph registration

Ultrasound is a promising imaging method for scoliosis evaluation because it is radiation free and provide real-time images. However, it cannot provide bony details because ultrasound cannot penetrate the bony structure. Therefore, registration of real-time ultrasound images with the previous X-ray radiograph can help physicians understand the spinal deformity of patients. In this study, an improved free-from deformation registration method based on mutual registration and hierarchical adaptive grid (MRHA-FFD) was developed. The method first performed registration grid preprocessing and then optimized control points and conducted mutual registration. Finally, a Blur-aware Attention Network was adopted for image deblurring. The performance of each step was verified by ablation experiments. Comparison experiment between the proposed method and traditional registration methods was also conducted. The qualitative and quantitative results suggested that MRHA-FFD is a promising approach for registering spine ultrasound image and X-ray radiograph.

Reliability Analysis of Vertebral Landmark Labelling on Lumbar Spine X-ray Images.

Vertebral landmark labelling on X-ray images is important for objective and quantitative diagnosis. Most studies related to the reliability of labelling focus on the Cobb angle, and it is difficult to find studies describing landmark point locations. Since points are the most fundamental geometric feature that can generate lines and angles, the assessment of landmark point locations is essential. The aim of this study is to provide a reliability analysis of landmark points and vertebral endplate lines with a large number of lumbar spine X-ray images. A total of 1000 pairs of anteroposterior and lateral view lumbar spine images were prepared, and 12 manual medicine experts participated in the labelling process as raters. A standard operating procedure (SOP) was proposed by consensus of the raters based on manual medicine and provided guidelines for reducing sources of error in landmark labelling. High intraclass correlation coefficients ranging from 0.934 to 0.991 verified the reliability of the labelling process using the proposed SOP. We also presented means and standard deviations of measurement errors, which could be a valuable reference for evaluating both automated landmark detection algorithms and manual labelling by experts.

Appropriateness of lumbar spine radiography and factors influencing imaging ordering patterns: paving the path toward value-driven health care.

The demand for diagnostic imaging continues to rise. Against the backdrop of rising health care costs and finite resources, this has prompted a paradigm shift toward value-driven patient care. Inappropriate imaging is a barrier toward achieving this goal, which runs counter to prevailing evidence-based guidelines and contributes to rising healthcare costs. Our objective was to evaluate the appropriateness of lumbar spine X-rays in a tertiary referral Emergency Department (ED) and assess whether physicians' specialization and years of experience influence appropriateness. A total of 1030 lumbar spine radiographs performed in the ED of an academic medical center over a consecutive 3-month period were reviewed retrospectively. Referral indications were reviewed for adherence to 2021 American College of Radiology appropriateness guidelines for lower back pain, and referral patterns were evaluated among physician groups based on specialists' training and years in practice. 63.8% of lumbar spine radiographs were appropriate, with trauma being the most common indication. 36.2% of orders were inappropriate, with lower back pain of <6 weeks duration being the most common indication. Significant differences in inappropriate orders were found (P < .001) across physician groups: qualified Emergency Medicine specialists (20.9% inappropriate orders), specialists in training (27.8%), and non-specialists with ≥3 (60.0%) and <3 (36.9%) years in practice, respectively. Approximately one-third of lumbar spine radiographs performed in the ED were inappropriately ordered by American College of Radiology guidelines; specialists training and years in practice affected referral patterns. Integrating evidence-based appropriateness guidelines into the physician order workflow and targeting older non-specialists may promote more judicious imaging and reduce health care costs.

Substantial mismatch of skeletal maturity assessment between Risser sign and Simplified Skeletal Maturity Scale/Thumb Ossification Composite Index in patients with adolescent idiopathic scoliosis.

Recently, hand skeletal maturity systems such as the Simplified Skeletal Maturity Scale (SSMS) or Thumb Ossification Composite Index (TOCI) have been introduced to attempt to prospectively predict the occurrence of peak height velocity (PHV) in adolescents. This study aims to compare the frequency of the mismatch in estimation of HV between Risser sign (RS) and SSMS/TOCI stages in adolescent idiopathic scoliosis (AIS) patients. One hundred thirty-three female patients with AIS were included. The mean age of the patients was 13.1years. A whole spine and hand X-rays were obtained to establish skeletal maturity stage according to RS, SSMS, and TOCI systems. A mismatch resulting in overestimation (MOE) with RS compared to SSMS/TOCI was defined as the combination of RS 3-4/SSMS 3-5 or RS 3-4/TOCI 4-6, whereas a mismatch resulting in underestimation (MUE) with RS and SSMS/TOCI was defined as RS 0-1/SSMS 6-8 or RS 0-1/TOCI 7-8. Height velocity (HV) was compared between MOE/non-MOE and MUE/non-MUE groups. Between RS and SSMS, the rates of the MOE and MUE groups were 4.3% and 1.7%, respectively. Between RS and TOCI, rates were 2.8% and 1.7%, respectively. With the combination of RS and SSMS stages, an estimate of HV of 5.6cm/year in the MOE group was significantly larger than that of 2.7cm/year in the non-MOE group, and 3.7cm/year in the MUE group was significantly smaller than 6.9cm/year in the non-MUE group. Likewise, with the combination of RS and TOCI stages, an estimate of HV of 5.8cm/year in the MOE group was significantly greater that of 2.7cm/year in the non-MOE group, and 3.7cm/year in the MUE group was significantly smaller than 6.9cm/year in the non-MUE group. These findings support the use of SSMS/TOCI as the standard for assessing HV and skeletal maturity in patients with AIS.

Clinical features of atlantoaxial involvement in patients with rheumatoid arthritis using 18F-fluorodeoxyglucose-positron emission tomography with computed tomography.

Cervical spine involvement is one of the most serious complications in rheumatoid arthritis (RA). The study aim was to assess the clinical significance of atlantoaxial (AA) joint involvement detected by 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) with computed tomography (CT) in patients with RA. A prospective cross-sectional study was conducted to evaluate AA joint involvement detected by FDG-PET/CT in consecutive RA patients from December 2017 to February 2022. We investigated the relationship between AA joint involvement and clinical data, including disease activity and patients' cervical symptoms. Among 48 patients enrolled, abnormal FDG uptake at AA joint was detected in 13 (27%). Rheumatoid factor titre, initial disease activity score 28-erythrocyte sedimentation rate and total standardized uptake value were significantly higher in the 13 patients than in the others (P = 0.004, P < 0.001 and P = 0.001, respectively). All patients with abnormal FDG uptake at AA joint had some cervical symptoms regardless of cervical spine X-ray abnormalities. Neck pain on movement and at rest were more frequent in the 13 patients than in the others (P = 0.001 and P = 0.004, respectively). The most sensitive symptom associated with AA joint involvement was neck pain on movement (sensitivity, 69%), and the most specific symptom was neck pain at rest (specificity, 100%). AA joint involvement was commonly observed by FDG-PET/CT in patients with active RA, independent of radiographic findings. Specific cervical symptoms can be important surrogate markers for detection of potential AA synovitis associated with active RA. Key Points • AA joint involvement was frequently seen in RA with high disease activity independent of radiographic findings. • Neck pain was a hallmark of AA joint involvement reflecting disease activity, and resting pain was highly specific.

The Analysis of Preoperative Roussouly Classification on Pain Scores and Radiological Data in Lateral Lumbar Interbody Fusion for Patients with Lumbar Degenerative Disease

A retrospective observational study. The type of sagittal profile defined by Roussouly has affected spinal degeneration and surgical outcome. This study aimed to investigate the effect of preoperative Roussouly classification on pain intensity and radiological data of patients with lumbar degenerative disease who underwent indirect decompression with lateral lumbar interbody fusion (LLIF). We retrospectively investigated 102 patients who underwent LLIF without direct decompression. Patients were subdivided into 4 groups according to the Roussouly classification determined from preoperative full-length and lateral spine X-rays, and classified according to Roussouly types I, II, and IV in the nonstandard group and Roussouly type III in the standard group. The nonstandard group showed improved sagittal vertical axis and lumbar lordosis after LLIF surgery, but the midsagittal canal diameter and axial central canal area of the thecal sac using T2-weighted sagittal and axial magnetic resonance imaging were smaller than those in the standard group. On the other hand, each numeric rating scale score 1year after surgery improved in all patients. Changes in numeric rating scale scores in low back pain, leg pain, and numbness were not statistically significant between Roussouly classification types. These results suggest that the nonstandard group may have less indirect decompression effect from LLIF than the standard group. In the short term, we show for the first time after LLIF surgery that preoperative sagittal spinal alignment and the pelvic position may not significantly impact pain improvement.

Compensatory classification in spine sagittal malalignment with lumbar degeneration

ObjectiveTo generate a compensatory classification to evaluate sagittal spinal malalignment with lumbar degeneration.MethodsWe included 162 patients with low back pain who underwent full-length spinal radiography in our hospital from August 2019 to October 2021. Using full-length spine X-rays, we measured pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), thoracic kyphosis (TK), lumbar lordosis (LL), C7 slope (C7S), thoracolumbar kyphosis (TLK), and C7 sagittal vertical axis (SVA). We also recorded the Oswestry Disability Index (ODI) and visual analog scale (VAS). Patients were divided into four groups based on the SRS-Schwab classification and four other groups based on the compensatory classification.ResultsODI correlated with age, SS, LL, TK, C7-SVA, SRS-Schwab classification, and compensatory classification. Lumbar VAS score correlated with LL, TK, C7-SVA, SRS-Schwab classification, and compensatory classification. Leg VAS score only correlated with LL. Hidden imbalance and imbalance with compensation had more significant PT and larger TK than balance patients. The symptoms of the four compensatory classification groups gradually worsened.ConclusionThe spinal-pelvic sagittal balance in patients with lumbar degeneration based on pelvic and thoracic compensation can reflect spinal balance and symptoms. This parameter might help evaluate spine sagittal alignment in elderly patients with lumbar degeneration.

Mild autonomous cortisol secretion in adrenal incidentalomas and risk of fragility fractures: a large cross-sectional study.

Mild autonomous cortisol secretion (MACS) has been associated with a higher prevalence of osteoporosis, although most data rely on single-center studies with limited sample size. We aimed to assess the prevalence of fragility fractures and contributing factors in a large cohort of patients with adrenal incidentalomas. Medical records of 1023 patients with adrenal incidentalomas from 1990 to 2019 were reviewed, and 735 patients were selected. Clinically obtained electronic radiological images closest to first endocrine evaluation, such as lateral views of spine X-rays or CT thoraco-abdominal scans, were reviewed to screen for asymptomatic morphometric vertebral fractures. Clinical fragility fractures, hormonal, and dual-energy x-ray absorptiometry (DXA) indices were also recorded. Four hundred seventy-four patients had nonfunctioning (NF) adrenal incidentalomas, 238 had MACS and 23 adrenal Cushing's syndrome (AC). Prevalence of fragility fractures was different (P = .018) between groups, respectively, 24.1% (NF), 34.0% (MACS), and 30.4% (AC), with significant difference between NF and MACS (P = .012). When analyzed separately by sex and menopausal status, this difference remained significant in postmenopausal women (P = .011), with a fracture prevalence of 22.2% (NF) and 34.6% (MACS). Fracture prevalence was similar in males. Women with MACS aged ≥65 years reported a 48.8% prevalence of fractures, as compared with 29.5% in NF (P < .01). In postmenopausal women, fragility fractures were associated with age (odds ratio [OR] 1.1, P < .001), smoking (OR 1.8, P = .048), and 1 mg-dexamethasone suppression test (DST) cortisol (OR 3.1, P = .029), while in men, only age was associated with fragility fractures. A considerable fracture burden was shown in postmenopausal women with adrenal incidentalomas and MACS, with clinical implications for the evaluation and management of bone metabolism.

Reducing radiation exposure and cancer risk for children with scoliosis: EOS the new gold standard

PurposeChildren are exposed to significant radiation doses during the investigation and treatment phases of scoliosis. EOS is a new form of low-dose radiation scan which also yields great image quality. However, currently its use is discouraged in the UK due to higher costs. We aimed to quantify the additional radiation dose and cancer risk.MethodsWe retrospectively reviewed all paediatric cases who received both standing whole spine roentgenograms and EOS scans as part of their investigations for scoliosis during a six-month period. We compared the radiation doses between the two modalities and estimated the additional mean lifetime cancer risk per study.ResultsWe identified 206 children (mean age 14.4) who met the criteria of having both scans. Dose area products (dGycm2) were converted to estimated effective doses (mSv). The total mean doses were 0.68 mSv (PA 0.49 + Lat 0.19) for plain films, and 0.13 mSv (PA 0.08 + Lat 0.04) for EOS scans (p < 0.001). Additional lifetime cancer risk of a plain film was 543% greater than EOS for both sexes (1/10727 versus 1/5827 in males, 1/34483 versus 1/6350 in females).ConclusionThere is approximately 5.4-fold increase in risk of cancer for both boys and girls with roentgenograms over EOS, with girls being the most impacted. This carries a significant impact when considering the need for repeat imaging on additional lifetime malignancy risk in children. In our opinion, EOS dual planar scanning is the new gold standard when X-ray of the whole spine is required.Level of evidence III.

Clinical characteristics and offspring developmental malformation of 126 patients with septate uterus.

Clinical characteristics and offspring developmental malformation of 126 patients with septate uterus.

Relationship between sex and clinical and imaging features of early axial spondyloarthritis: results from a 48 month follow-up (Italian arm of the SPondyloArthritis Caught Early (SPACE) study)

Objectives To assess the association between sex and clinical and disease activity indices, and X-rays and magnetic resonance imaging (MRI) features, in early-stage axial spondyloarthritis (axSpA). Method Baseline data analysis was conducted on the Italian SPACE cohort, including patients with chronic back pain (duration ≥ 3 months and ≤ 2 years; onset < 45 years). Patients underwent MRI and X-rays of the sacroiliac joints (SIJs) to establish the diagnosis of axSpA, according to Assessment of SpondyloArthritis international Society criteria and physician’s judgement. Clinical features, disease activity and functional indices, and images were collected at baseline and yearly during 48 months. Spinal and SIJ X-rays and MRI images were scored by two readers following Spondyloarthritis Research Consortium of Canada (SPARCC), modified Stoke Ankylosing Spondylitis Spinal Score, and modified New York criteria. Characteristics of axSpA patients according to sex (male/female) were compared over time using descriptive statistics. Results Ninety-one patients had axSpA (83.5% non-radiographic; 16.5% radiographic); 47.3% were male. Males were younger, with shorter duration of axial symptoms, and more frequently had HLA-B27 positivity, radiographic sacroiliitis with a bilateral/symmetric pattern, and more signs of spondylitis. Females more frequently showed peripheral/entheseal involvement and the non-radiographic phenotype. Males showed increased pelvic/spinal radiographic progression and more often had active sacroiliitis on MRI. Although the frequency of inflammatory corner lesions did not differ between males and females, localization varied, with more cervical/thoracic MRI-spine lesions in females and more lumbar lesions in males. We observed a significant downward trend of SPARCC SIJ/spine scores in all patients, irrespective of sex. More fat lesions were observed on MRI-spine in females and on MRI-SIJ in males. Conclusion Sex was associated with distinct axSpA features: females showed low-grade radiographic sacroiliitis and spinal progression, and a higher prevalence of cervical and thoracic spine MRI signs.

Becker’s Nevus Syndrome - Rare entity

Becker’s nevus is a rare non-cancerous hamartoma characterized by hyperpigmentation and hypertrichiosis with ill-defined borders. Becker’s nevus syndrome is an entity in which there is association of Becker’s nevus with few abnormalities like unilateral breast hypoplasia, muscle, skin, and skeletal abnormalities. Here we present a case of 14 year old boy who presented with a large hyper pigmented dark brown patch on his upper back. The patient also had a triangular lesion on his lower back with increased hair growth, which was present since birth. X-Ray spine showed Bifid Spinous process of L4. Histopathological examination of the hyper-pigmented area showed findings which were consistent with Becker’s nevus.

Measurement of Intervertebral Disc Heights in the Lumbar Spine. Comparison of X-Ray and Magnetic Resonance Imaging, Method of Measurement and Determination of Inter-observer Reliability.

Retrospective radiological examination (X-ray and MRI) aims to investigate the diagnostic value of various methods of measurement with regard to the determination of the intervertebral disc heights of the lumbar spine. Of 130 patients without detectable damage to the intervertebral discs, the X-ray and MRI images of the lumbar spine were evaluated. The measurements were made either in the center line (Hurxthal) or in the 2-point method according to Dabbs or in the 3-point method according to Fyllos. The average intervertebral disc height for all measured segments was 8.8mm (SD 1.4mm). In the Hurxthal measurement, the significantly (p<0.001) highest values were measured with an average of 9.1mm (SD 1.3mm). The average readings for the Fyllos method were 7.5mm (SD 1.2mm) and according to Dabbs 6.7mm (SD 1.2mm). The measured values of Observer I were on average 1.2mm (SD 0.3mm) smaller than those of Observer II (p<0.001). The highest interobserver correlation was found in the measurements in projection radiography in the AP method according to Dabbs and Fyllos. The measured values in men were 0.5mm (SD 0.01mm) larger than in women (p<0.001), regardless of the method. The height of the intervertebral discs increases significantly until the age of 40, but beyond the age of 40, the height of the intervertebral discs either remains constant or falls off slightly, but not significantly. The lordosis angle of the lumbar spine and the concavity index of the vertebral bodies showed no correlation with the measured disc heights. The radiological measurements to determine the intervertebral disc height have only moderate reliability. The results of X-rays are superior to those of MRI examination. The most accurate results are provided by measurements based on exact landmarks of the vertebral bodies. The method according to Dabbs seems to be the most accurate at the moment. There is no clear age-atypical chondrosis in patients without intervertebral disc damage.

Fetuin-A: A Novel Biomarker of Bone Damage in Early Axial Spondyloarthritis. Results of an Interim Analysis of the SPACE Study.

Our study aimed to evaluate the association between fetuin-A levels and the presence of radiographic sacroiliitis and syndesmophytes in patients with early axial spondyloarthritis (axSpA) and to identify potential predictors of radiographic damage in the sacroiliac joints (SIJs) after 24 months. Patients diagnosed with axSpA in the Italian cohort of the SpondyloArthritis-Caught-Early (SPACE) study were included. Physical examinations, laboratory tests (including fetuin-A), SIJ,+ and spinal X-rays and MRIs at T0 (diagnosis) and at T24 were considered. Radiographic damage in the SIJs was defined according to the modified New York criteria (mNY). Fifty-seven patients were included in this analysis (41.2% male, median (interquartile range), chronic back pain [CBP] duration of 12 (8-18) months). Fetuin-A levels were significantly lower in patients with radiographic sacroiliitis compared to those without at T0 (207.9 (181.7-215.9) vs. 239.9 (217.9-286.9), respectively, p < 0.001) and at T24 (207.6 (182.5-246.5) vs. 261.1 (210.2-286.6) µg/mL, p = 0.03). At T0, fetuin-A levels were significantly higher in non-smokers, in patients with heel enthesitis and in those with a family history of axSpA; fetuin-A levels at T24 were higher in females, in patients with higher ESR or CRP at T0 and in those with radiographic sacroiliitis at T0. Fetuin-A levels at T0 were independently negatively associated with the likelihood of radiographic sacroiliitis (OR = 0.9 per 10-unit increase (95% CI 0.8, 0.999), p = 0.048); but not with the presence of syndesmophytes. After adjustment for confounders, fetuin-A levels at T0 and T24 were also negatively associated with mNY at T0 (β -0.5, p < 0.001) and at T24 (β -0.3, p < 0.001), respectively. Among other variables at T0, fetuin-A levels did not achieve statistical significance in predicting mNY at T24. Fetuin-A levels were negatively associated with radiographic damage of the SIJs, but not of the spine, in early axSpA and after 2 years of follow-up. Our findings suggest that fetuin-A levels may serve as a biomarker to identify patients with a higher risk of developing severe disease and early structural damage.