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Wing-Yuk Chan R, Chiang YH, Yang YA, Chen YY, Tsou YS. One-Year Follow-Up Study on Assessing the Range of Segmental Motion and Clinical Outcomes Following Cervical Disc Arthroplasty for Treatment of Severe Cervical Disc Degeneration. World Neurosurg 2024; 183:e276-e281. [PMID: 38128758 DOI: 10.1016/j.wneu.2023.12.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Though previous studies have documented various clinical outcomes after cervical arthroplasty for degenerative cervical disc disease, none of them reported the impact of cervical arthroplasty on severe cervical disc degeneration (CDD). METHODS This retrospective cohort study included severe 40 CDD (C3-C7) patients who underwent single-level cervical arthroplasty using ProDisc-C between January 2017 and December 2019. After surgical intervention, the range of motion (ROM) was determined, whereas clinical outcomes were measured in terms of the Visual Analogue Scale (VAS) and Neck Disability Index (NDI) to evaluate neck pain and disability, respectively. RESULTS Compared to the mean preoperative ROM (6.57 ± 4.85°), the cervical dynamic ROM was increased 3 months after cervical arthroplasty, and the increment was maintained for at least 1 year. The increased ROM is attributed to the extension and not flexion components. The mean preoperative ROM of 6.57 ± 4.85° significantly increased to 11.67 ± 4.98° (P = 0.0005), 10.05 ± 5.18° (P = 0.0426) and 10.46 ± 4.73° (P = 0.0247) after 3 months, 6 months and 1 year, respectively. The extension ROM also revealed a similar trend. VAS for neck and arm decreased from 7.4 and 6.6 to 1.4 and 1.2, respectively. Consistently, the preoperative mean Neck Disability Index (NDI) score of 27.6 decreased to 14.6. We recorded a case of device subsidence, but without extrusion. CONCLUSIONS Cervical arthroplasty can improve clinical outcomes and restore ROM in severe CDD patients.
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Affiliation(s)
- Ryan Wing-Yuk Chan
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Yung-Hsiao Chiang
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-An Yang
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Yu Chen
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Syue Tsou
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
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2
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Davis ZR, Gossett PC, Wilson RL, Kim W, Mei Y, Butz KD, Emery NC, Nauman EA, Avril S, Neu CP, Chan DD. Intervertebral Disc Elastography to Relate Shear Modulus and Relaxometry in Compression and Bending. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.01.555817. [PMID: 37732250 PMCID: PMC10508717 DOI: 10.1101/2023.09.01.555817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Intervertebral disc degeneration is the most recognized cause of low back pain, characterized by the decline of tissue structure and mechanics. Image-based mechanical parameters (e.g., strain, stiffness) may provide an ideal assessment of disc function that is lost with degeneration but unfortunately remains underdeveloped. Moreover, it is unknown whether strain or stiffness of the disc may be predicted by MRI relaxometry (e.g. T1 or T2), an increasingly accepted quantitative measure of disc structure. In this study, we quantified T1 and T2 relaxation times and in-plane strains using displacement-encoded MRI within the disc under physiological levels of compression and bending. We then estimated shear modulus in orthogonal image planes and compared these values to relaxation times and strains within regions of the disc. Intratissue strain depended on the loading mode, and shear modulus in the nucleus pulposus was typically an order of magnitude lower than the annulus fibrosis, except in bending, where the apparent stiffness depended on the loading. Relative shear moduli estimated from strain data derived under compression generally did not correspond with those from bending experiments, with no correlations in the sagittal plane and only 4 of 15 regions correlated in the coronal plane, suggesting that future inverse models should incorporate multiple loading conditions. Strain imaging and strain-based estimation of material properties may serve as imaging biomarkers to distinguish healthy and diseased discs. Additionally, image-based elastography and relaxometry may be viewed as complementary measures of disc structure and function to assess degeneration in longitudinal studies.
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Affiliation(s)
- Zachary R. Davis
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Paull C. Gossett
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Robert L. Wilson
- Paul M. Rady Department of Mechanical Engineering, University of Colorado, Boulder, CO, USA
| | - Woong Kim
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Yue Mei
- State Key Laboratory of Structural Analysis for Industrial Equipment and International Research Center for Computational Mechanics, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
- Mines Saint-Étienne, Université Jean Monnet, INSERM, U 1059 Sainbiose, 42023, SaintÉtienne, France
| | - Kent D. Butz
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Nancy C. Emery
- Department of Ecology and Evolutionary Biology, University of Colorado, Boulder, CO, USA
| | - Eric A. Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Stéphane Avril
- Mines Saint-Étienne, Université Jean Monnet, INSERM, U 1059 Sainbiose, 42023, SaintÉtienne, France
| | - Corey P. Neu
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- Paul M. Rady Department of Mechanical Engineering, University of Colorado, Boulder, CO, USA
- Biomedical Engineering Program, University of Colorado, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado, Boulder, CO, USA
| | - Deva D. Chan
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
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Bhattacharya S, Dubey DK. Insights into the role of water concentrations on nanomechanical behavior of type I collagen-hyaluronan interfaces in annulus fibrosus: A molecular dynamics investigation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023:e3713. [PMID: 37073776 DOI: 10.1002/cnm.3713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/28/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
Multi-faceted deformation capabilities of Annulus Fibrosus (AF) results from an intricate mechanical design by nature. Wherein, organization and interactions between the constituents, collagen type I (CI), collagen type II (C2), hyaluronan, aggrecan, and water are instrumental. However, mechanisms by which such interactions influence AF mechanics at tissue-scale is not well understood. This work investigates nanoscale interfacial interactions between CI and hyaluronan (CI-H) and presents insights into their influence on tissue-scale mechanics of AF. For this, three-dimensional molecular dynamics (MD) simulations of tensile and compressive deformation are conducted on atomistic model of CI-H interface at 0%, 65%, and 75% water concentrations (WC). Results show hyaluronan lowers local hydration around CI component of interface, owing to its hydrophilic nature. Analyses show that increase in WC from 65% to 75% leads to increased interchain sliding in hyaluronan, which further lowers tensile modulus of the interface from 2.1 GPa to 660 MPa, contributing to softening observed from outer to inner AF. Furthermore, increase in WC from 65% to 75%, shifts compressive deformation from buckling-dominant to non-buckling-dominant which contributes towards lower radial bulge at inner AF. Findings provide deeper insights into mechanistic interactions and mechanisms at fundamental length-scale which influence the AF structure-mechanics at tissue-scale.
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Affiliation(s)
- Shambo Bhattacharya
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Devendra K Dubey
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
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4
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Mesregah MK, Repajic M, Mgbam P, Fresquez Z, Wang JC, Buser Z. Trends and patterns of cervical degenerative disc disease: an analysis of magnetic resonance imaging of 1300 symptomatic patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2675-2683. [PMID: 35932332 DOI: 10.1007/s00586-022-07336-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/16/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate the trends and patterns of cervical degenerative disc disease in the cervical spine in different age groups of symptomatic patients. METHODS Overall, 1300 symptomatic patients who had undergone cervical spine MRI from February 2019 to November 2021 were included. Pfirrmann grading was used to evaluate the IVD degeneration. Patients were divided into five groups based on age: group 1 from 20 to 29 years, group 2 from 30 to 39 years, group 3 from 40 to 49 years, group 4 from 50 to 59 years, and group 5 from 60 years and above. The patterns, severity, and the number of degenerated levels in each age group were analysed. RESULTS The total number of degenerated IVDs (grades IV and V) increased significantly with age, ranging from 76 (4.9%) in group 1 to 677 (43.4%) in group 5. The most common degenerated levels were C2/3 (25% of the total degenerated levels) in group 1, C5/6 (29.0%) in group 2, C5/6 (33.1%) in group 3, C5/6 (31.3%) in group 4, C5/6 (24.8%), in group 5. The number of degenerated IVDs increased significantly with age (P < 0.001). In patients with two or more degenerated levels, contiguous-level disc degeneration was more common than skip lesions. CONCLUSION This study evaluated the severity and pattern of cervical disc degeneration at each level in different age groups. The severity and number of degenerated levels increased significantly with increased age. Adjacent-level degeneration is more common than skip lesions in patients with more than one-level degeneration.
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Affiliation(s)
- Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St., HC4 - #5400A, Los Angeles, CA, 90033, USA
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Michael Repajic
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St., HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Paul Mgbam
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St., HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Zoe Fresquez
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St., HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St., HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St., HC4 - #5400A, Los Angeles, CA, 90033, USA.
- Gerling Institute, Brooklyn, USA.
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA.
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5
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Savarese L, Menezes-Reis R, Jorge M, Salmon C, Herrero C, Nogueira-Barbosa M. Sagittal balance and intervertebral disc composition in patients with low back pain. Braz J Med Biol Res 2022; 55:e12015. [DOI: 10.1590/1414-431x2022e12015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- L.G. Savarese
- Universidade de São Paulo, Brasil; Universidade de São Paulo, Brasil
| | | | - M. Jorge
- Universidade de São Paulo, Brasil
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Mesregah MK, Repajic M, Patel K, Gardner C, Roberts S, Buser Z, Wang J. Trends and patterns of thoracic intervertebral disc degeneration in symptomatic subjects: a magnetic resonance imaging analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2221-2230. [PMID: 34114105 DOI: 10.1007/s00586-021-06895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/26/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to analyse the trends and patterns of IVD degeneration in different age groups at each level of the thoracic spine. METHODS This cross-sectional MRI study included 1000 symptomatic patients who had undergone upright thoracic spine MRI. A total of 13,000 thoracic IVDs from C7/T1 to T12/L1 were classified into five grades using Pfirrmann classification. Patients were divided according to their ages into five groups (n = 200/group). The severity and pattern of IVD degeneration were analysed in each age group. A predictive model of the severity and pattern of IVD degeneration in each age group was proposed. RESULTS The total grade of IVD degeneration and the number of degenerated levels increased with increasing age (P < 0.001). The most common degenerated level was T6/7 (13.3%), while the least common degenerated level was T12/L1 (1.8%). The most common grades were grade I in group 1 (60.5%), grade II in groups 2 (39%) and 3 (37.3%), and grade III in groups 4 (42.5%) and 5 (44.6%). Adjacent-level degenerations were more common than skip-level degenerations. Severe disc degeneration (Pfirrmann grades IV or V) could be predicted to occur more in group 5 (patients with 60 years and above) (margin = 0.79, 95% CI = 0.73-0.84, P < 0.001). CONCLUSIONS The severity of thoracic IVD degeneration and the number of degenerated levels increased with age. Disc degeneration was more accelerated in the mid-thoracic spine. Adjacent-level degeneration was more common than skip-level degenerations.
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Affiliation(s)
- Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA.,Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Michael Repajic
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Kishan Patel
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Carson Gardner
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Sidney Roberts
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA.
| | - Jeffrey Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
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Sloan SR, Wipplinger C, Kirnaz S, Delgado R, Huang S, Shvets G, Härtl R, Bonassar LJ. Imaging the local biochemical content of native and injured intervertebral disc using Fourier transform infrared microscopy. JOR Spine 2020; 3:e1121. [PMID: 33392456 PMCID: PMC7770196 DOI: 10.1002/jsp2.1121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022] Open
Abstract
Alterations to the biochemical composition of the intervertebral disc (IVD) are hallmarks of aging and degeneration. Methods to assess biochemical content, such as histology, immunohistochemistry, and spectrophotometric assays, are limited in their ability to quantitatively analyze the spatial distribution of biochemical components. Fourier transform infrared (FTIR) microscopy is a biochemical analysis method that can yield both quantitative and high-resolution data about the spatial distribution of biochemical components. This technique has been largely unexplored for use with the IVD, and existing methods use complex analytical techniques that make results difficult to interpret. The objective of the present study is to describe an FTIR microscopy method that has been optimized for imaging the collagen and proteoglycan content of the IVD. The method was performed on intact and discectomized IVDs from the sheep lumbar spine after 6 weeks in vivo in order to validate FTIR microscopy in healthy and degenerated IVDs. FTIR microscopy quantified collagen and proteoglycan content across the entire IVD and showed local changes in biochemical content after discectomy that were not observed with traditional histological methods. Changes in collagen and proteoglycans content were found to have strong correlations with Pfirrmann grades of degeneration. This study demonstrates how FTIR microscopy is a valuable research tool that can be used to quantitatively assess the local biochemical composition of IVDs in development, degeneration, and repair.
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Affiliation(s)
- Stephen R. Sloan
- Meinig School of Biomedical EngineeringCornell UniversityIthacaNew YorkUSA
| | - Christoph Wipplinger
- Department of Neurological SurgeryWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Sertaç Kirnaz
- Department of Neurological SurgeryWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Robert Delgado
- Applied Engineering and PhysicsCornell UniversityIthacaNew YorkUSA
| | - Steven Huang
- Applied Engineering and PhysicsCornell UniversityIthacaNew YorkUSA
| | - Gennady Shvets
- Applied Engineering and PhysicsCornell UniversityIthacaNew YorkUSA
| | - Roger Härtl
- Department of Neurological SurgeryWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Lawrence J. Bonassar
- Meinig School of Biomedical EngineeringCornell UniversityIthacaNew YorkUSA
- Sibley School of Mechanical and Aerospace EngineeringCornell UniversityIthacaNew YorkUSA
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Temporomandibular joint imaging: current clinical applications, biochemical comparison with the intervertebral disc and knee meniscus, and opportunities for advancement. Skeletal Radiol 2020; 49:1183-1193. [PMID: 32162049 DOI: 10.1007/s00256-020-03412-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/01/2020] [Accepted: 03/01/2020] [Indexed: 02/02/2023]
Abstract
Temporomandibular disorders encompass multiple pathologies of the temporomandibular joint that manifest as middle/inner ear symptoms, headache, and/or localized TMJ symptoms. There is an important although somewhat limited role of imaging in the diagnostic evaluation of temporomandibular disorders. In this manuscript, we provide a comprehensive review of TMJ anatomy, outline potentially important features of TMJ disc ultrastructure and biochemistry in comparison with the intervertebral disc and knee meniscus, and provide imaging examples of the TMJ abnormalities currently evaluable with MRI and CT. In addition, we provide an overview of emerging and investigational TMJ imaging techniques in order to encourage further imaging research based on the biomechanical alterations of the TMJ disc.
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Berg-Johansen B, Han M, Fields AJ, Liebenberg EC, Lim BJ, Larson PE, Gunduz-Demir C, Kazakia GJ, Krug R, Lotz JC. Cartilage Endplate Thickness Variation Measured by Ultrashort Echo-Time MRI Is Associated With Adjacent Disc Degeneration. Spine (Phila Pa 1976) 2018; 43:E592-E600. [PMID: 28984733 PMCID: PMC5882595 DOI: 10.1097/brs.0000000000002432] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A magnetic resonance imaging study of human cadaver spines. OBJECTIVE To investigate associations between cartilage endplate (CEP) thickness and disc degeneration. SUMMARY OF BACKGROUND DATA Damage to the CEP is associated with spinal injury and back pain. However, CEP morphology and its association with disc degeneration have not been well characterized. METHODS Ten lumbar motion segments with varying degrees of disc degeneration were harvested from six cadaveric spines and scanned with magnetic resonance imaging in the sagittal plane using a T2-weighted two-dimensional (2D) sequence, a three-dimensional (3D) ultrashort echo-time (UTE) imaging sequence, and a 3D T1ρ mapping sequence. CEP thicknesses were calculated from 3D UTE image data using a custom, automated algorithm, and these values were validated against histology measurements. Pfirrmann grades and T1ρ values in the disc were assessed and correlated with CEP thickness. RESULTS The mean CEP thickness calculated from UTE images was 0.74 ± 0.04 mm. Statistical comparisons between histology and UTE-derived measurements of CEP thickness showed significant agreement, with the mean difference not significantly different from zero (P = 0.32). Within-disc variation of T1ρ (standard deviation) was significantly lower for Pfirrmann grade 4 than Pfirrmann grade 3 (P < 0.05). Within-disc variation of T1ρ and adjacent CEP thickness heterogeneity (coefficient of variation) had a significant negative correlation (r = -0.65, P = 0.04). The standard deviation of T1ρand the mean CEP thickness showed a moderate positive correlation (r = 0.40, P = 0.26). CONCLUSION This study demonstrates that quantitative measurements of CEP thickness measured from UTE magnetic resonance imaging are associated with disc degeneration. Our results suggest that variability in CEP thickness and T1ρ, rather than their mean values, may serve as valuable diagnostic markers for disc degeneration. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Britta Berg-Johansen
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
- Department of Bioengineering, UC Berkeley/UCSF Joint Program in Bioengineering, Berkeley, CA
| | - Misung Han
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Aaron J Fields
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Ellen C Liebenberg
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Brandon J Lim
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Peder Ez Larson
- Department of Bioengineering, UC Berkeley/UCSF Joint Program in Bioengineering, Berkeley, CA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Cigdem Gunduz-Demir
- Department of Computer Engineering, Bilkent University, Ankara, Turkey
- Neuroscience Graduate Program, Bilkent University, Ankara, Turkey
| | - Galateia J Kazakia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
- Department of Bioengineering, UC Berkeley/UCSF Joint Program in Bioengineering, Berkeley, CA
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Suzuki A, Daubs MD, Hayashi T, Ruangchainikom M, Xiong C, Phan K, Scott TP, Wang JC. Patterns of Cervical Disc Degeneration: Analysis of Magnetic Resonance Imaging of Over 1000 Symptomatic Subjects. Global Spine J 2018; 8:254-259. [PMID: 29796373 PMCID: PMC5958484 DOI: 10.1177/2192568217719436] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES The aim of this study was to evaluate cervical disc degeneration on magnetic resonance imaging (MRI) in a large population of symptomatic patients and to provide baseline data on the pattern of degeneration in order to understand how the cervical spine ages. METHODS We performed a cross-sectional study of 1059 patients who underwent upright cervical MRI for neck pain with and without neurological symptoms. A total of 6354 cervical discs from C2/3 to C7/T1 were evaluated. Cervical disc degeneration was evaluated on T2-weighted MRI and graded into 4 categories (Grades 0-III). Positive degeneration was defined as greater than Grade II. The correlation between age and total grade of degeneration of each patient was evaluated, as well as the prevalence and pattern of degeneration. RESULTS The average number of degenerated disc levels and the total grade of cervical disc degeneration significantly increase with age. In the patient group with 1-level degeneration, C5/6 was the most common degenerated level followed by C4/5 and C6/7. In the group with 2-level degeneration, C5/6 & C6/7 was most common followed by C4/5 & C5/6 and C3/4 & C4/5. Skip level degeneration was significantly rarer than contiguous level degeneration, and C7/T1 and C2/3 were the most unlikely to degenerate in multilevel degeneration. CONCLUSION Disc degeneration is most common in the middle cervical spine (C5/6) and progresses to contiguous levels, except for C7/T1 and C2/3. This pattern may play a role in adjacent-level disc degeneration associated with spinal fusion.
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Affiliation(s)
- Akinobu Suzuki
- Osaka City University, Osaka, Japan
- Akinobu Suzuki, Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| | | | | | | | - Chenjie Xiong
- Wuhan General Hospital of Guangzhou Command, Wuhan, China
| | - Kevin Phan
- Montefiore Medical Center, New York, NY, USA
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11
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Paul CPL, Smit TH, de Graaf M, Holewijn RM, Bisschop A, van de Ven PM, Mullender MG, Helder MN, Strijkers GJ. Quantitative MRI in early intervertebral disc degeneration: T1rho correlates better than T2 and ADC with biomechanics, histology and matrix content. PLoS One 2018; 13:e0191442. [PMID: 29381716 PMCID: PMC5790235 DOI: 10.1371/journal.pone.0191442] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/04/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Low-back pain (LBP) has been correlated to the presence of intervertebral disc (IVD) degeneration on T2-weighted (T2w) MRI. It remains challenging, however, to accurately stage degenerative disc disease (DDD) based on T2w MRI and measurements of IVD height, particularly for early DDD. Several quantitative MRI techniques have been introduced to detect changes in matrix composition signifying early DDD. In this study, we correlated quantitative T2, T1rho and Apparent Diffusion Coefficient (ADC) values to disc mechanical behavior and gold standard early DDD markers in a graded degenerated lumbar IVD caprine model, to assess their potential for early DDD detection. Methods Lumbar caprine IVDs were injected with either 0.25 U/ml or 0.5 U/ml Chondroïtinase ABC (Cabc) to trigger early DDD-like degeneration. Injection with phosphate-buffered saline (PBS) served as control. IVDs were cultured in a bioreactor for 20 days under axial physiological loading. High-resolution 9.4 T MR images were obtained prior to intervention and after culture. Quantitative MR results were correlated to recovery behavior, histological degeneration grading, and the content of glycosaminoglycans (GAGs) and water. Results Cabc-injected IVDs showed aberrancies in biomechanics and loss of GAGs without changes in water-content. All MR sequences detected changes in matrix composition, with T1rho showing largest changes pre-to-post in the nucleus, and significantly more than T2 and ADC. Histologically, degeneration due to Cabc injection was mild. T1rho nucleus values correlated strongest with altered biomechanics, histological degeneration score, and loss of GAGs. Conclusions T2- and T1rho quantitative MR-mapping detected early DDD changes. T1rho nucleus values correlated better than T2 and ADC with biomechanical, histological, and GAG changes. Clinical implementation of quantitative MRI, T1rho particularly, could aid in distinguishing DDD more reliably at an earlier stage in the degenerative process.
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Affiliation(s)
- Cornelis P L Paul
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Theodoor H Smit
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Biology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Magda de Graaf
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Roderick M Holewijn
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Arno Bisschop
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marco N Helder
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Academic Medical Center (AMC), Amsterdam, the Netherlands
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12
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Khan AN, Jacobsen HE, Khan J, Filippi CG, Levine M, Lehman RA, Riew KD, Lenke LG, Chahine NO. Inflammatory biomarkers of low back pain and disc degeneration: a review. Ann N Y Acad Sci 2018; 1410:68-84. [PMID: 29265416 DOI: 10.1111/nyas.13551] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 12/16/2022]
Abstract
Biomarkers are biological characteristics that can be used to indicate health or disease. This paper reviews studies on biomarkers of low back pain (LBP) in human subjects. LBP is the leading cause of disability, caused by various spine-related disorders, including intervertebral disc degeneration, disc herniation, spinal stenosis, and facet arthritis. The focus of these studies is inflammatory mediators, because inflammation contributes to the pathogenesis of disc degeneration and associated pain mechanisms. Increasingly, studies suggest that the presence of inflammatory mediators can be measured systemically in the blood. These biomarkers may serve as novel tools for directing patient care. Currently, patient response to treatment is unpredictable with a significant rate of recurrence, and, while surgical treatments may provide anatomical correction and pain relief, they are invasive and costly. The review covers studies performed on populations with specific diagnoses and undefined origins of LBP. Since the natural history of LBP is progressive, the temporal nature of studies is categorized by duration of symptomology/disease. Related studies on changes in biomarkers with treatment are also reviewed. Ultimately, diagnostic biomarkers of LBP and spinal degeneration have the potential to shepherd an era of individualized spine medicine for personalized therapeutics in the treatment of LBP.
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Affiliation(s)
- Aysha N Khan
- The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Hayley E Jacobsen
- Department of Orthopedic Surgery, Columbia University, New York, New York
| | - Jansher Khan
- The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | | | | | - Ronald A Lehman
- Department of Orthopedic Surgery, Columbia University, New York, New York.,New York-Presbyterian-Spine Hospital, New York, New York
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, New York.,New York-Presbyterian-Spine Hospital, New York, New York
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University, New York, New York.,New York-Presbyterian-Spine Hospital, New York, New York
| | - Nadeen O Chahine
- Department of Orthopedic Surgery, Columbia University, New York, New York.,Department of Biomedical Engineering, Columbia University, New York, New York
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13
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Abstract
UNLABELLED : Imaging is important in the evaluation of patients with degenerative disease and infectious processes. There are numerous conditions that can manifest as low back pain (LBP) or neck pain in a patient, and in many cases, the cause may be multifactorial. Clinical history and physical examination are key components in the evaluation of such patients; however, physical examination has variable sensitivity and specificity. Although studies have demonstrated that uncomplicated acute LBP and/or radiculopathy are self-limited conditions that do not warrant any imaging, neuroimaging can provide clear anatomic delineation of potential causes of the patient's clinical presentation. Various professional organizations have recommendations for imaging of LBP, which generally agree that an imaging study is not indicated for patients with uncomplicated LBP or radiculopathy without a red flag (eg, neurological deficit such as major weakness or numbness in lower extremities, bowel or bladder dysfunction, saddle anesthesia, fever, history of cancer, intravenous drug use, immunosuppression, trauma, or worsening symptoms). Different imaging modalities have a complementary role in the diagnosis of pathologies affecting the spine. In this review, we discuss the standard nomenclature for lumbar disk pathology and the utility of various clinical imaging techniques in the evaluation of LBP/neck pain for potential neurosurgical management. The imaging appearance of spinal infections and potential mimics also is reviewed. Finally, we discuss advanced neuroradiological techniques that offer greater microstructural and functional information. ABBREVIATIONS ADC, apparent diffusion coefficientDTI, diffusion tensor imagingDWI, diffusion-weighted imagingDOM, diskitis-osteomyelitisLBP, low back painMRM, magnetic resonance myelographySNA, spinal neuroarthropathySPECT, single-positron emission computed tomographySTIR, short tau inversion recovery.
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Affiliation(s)
- Lubdha M Shah
- Departments of *Radiology and Imaging Sciences and ‡Neurosurgery, University of Utah, Salt Lake City, Utah; §Department of Radiology, Mayo Clinic Arizona, Scottsdale, Arizona
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14
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Markotić V, Zubac D, Miljko M, Šimić G, Zalihić A, Bogdan G, Radančević D, Šimić AD, Mašković J. Level of Education as a Risk Factor for Extensive Prevalence of Cervical Intervertebral Disc Degenerative Changes and Chronic Neck Pain. Cent Eur J Public Health 2017; 25:245-250. [PMID: 29022686 DOI: 10.21101/cejph.a4897] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/23/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to document the prevalence of degenerative intervertebral disc changes in the patients who previously reported symptoms of neck pain and to determine the influence of education level on degenerative intervertebral disc changes and subsequent chronic neck pain. METHODS One hundred and twelve patients were randomly selected from the University Hospital in Mostar, Bosna and Herzegovina, (aged 48.5±12.7 years) and submitted to magnetic resonance imaging (MRI) of the cervical spine. MRI of 3.0 T (Siemens, Skyrim, Erlangen, Germany) was used to obtain cervical spine images. Patients were separated into two groups based on their education level: low education level (LLE) and high education level (HLE). Pfirrmann classification was used to document intervertebral disc degeneration, while self-reported chronic neck pain was evaluated using the previously validated Oswestry questionnaire. RESULTS The entire logistic regression model containing all predictors was statistically significant, (χ2(3)=12.2, p=0.02), and was able to distinguish between respondents who had chronic neck pain and vice versa. The model explained between 10.0% (Cox-Snell R2) and 13.8% (Nagelkerke R2) of common variance with Pfirrmann classification, and it had the strength to discriminate and correctly classify 69.6% of patients. The probability of a patient being classified in the high or low group of degenerative disc changes according to the Pfirrmann scale was associated with the education level (Wald test: 5.5, p=0.02). Based on the Pfirrmann assessment scale, the HLE group was significantly different from the LLE group in the degree of degenerative changes of the cervical intervertebral discs (U=1,077.5, p=0.001). CONCLUSION A moderate level of intervertebral disc degenerative changes (grade II and III) was equally matched among all patients, while the overall results suggest a higher level of education as a risk factor leading to cervical disc degenerative changes, regardless of age differences among respondents.
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Affiliation(s)
- Vedran Markotić
- Department of Clinical Radiology, University Hospital, Mostar, Bosnia and Herzegovina
| | - Damir Zubac
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
| | - Miro Miljko
- School of Medicine, University Hospital in Mostar, Mostar, Bosnia and Herzegovina
| | - Goran Šimić
- University Hospital, Mostar, Bosnia and Herzegovina
| | - Amra Zalihić
- School of Medicine, University Hospital in Mostar, Mostar, Bosnia and Herzegovina
| | - Gojko Bogdan
- Department of Clinical Radiology, University Hospital, Mostar, Bosnia and Herzegovina
| | - Dorijan Radančević
- Department of Clinical Radiology, University Hospital, Mostar, Bosnia and Herzegovina
| | | | - Josip Mašković
- Department of Clinical Radiology, University Hospital, Mostar, Bosnia and Herzegovina
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15
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Schleich C, Miese F, Müller-Lutz A, Boos J, Aissa J, Nasca A, Zaucke F, Bostelmann T, Schimmöller L, Bittersohl B, Steiger HJ, Antoch G, Bostelmann R. Value of delayed gadolinium-enhanced magnetic resonance imaging of cartilage for the pre-operative assessment of cervical intervertebral discs. J Orthop Res 2017; 35:1824-1830. [PMID: 27699832 DOI: 10.1002/jor.23454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/29/2016] [Indexed: 02/04/2023]
Abstract
The study was performed to preoperatively assess the cartilage integrity of cervical intervertebral discs (IVDs) using Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC). Therefore, 53 cervical intervertebral discs of nine preoperative patients with neck and shoulder/arm pain scheduled for discectomy (five females, four males; mean age: 47.1 ± 8.4 years; range: 36-58 years) were included for biochemical analysis in this retrospective study. The patients underwent 3T magnetic resonance imaging (MRI) including biochemical imaging with dGEMRIC and morphological, sagittal T2 weighted (T2w) imaging. Cervical IVDs were rated using an MRI based grading system for cervical IVDs on T2w images. Region-of-interest measurements were performed in the nucleus pulposus (NP) and annulus fibrosus (AF) and a dGEMRIC index was calculated. Our results demonstrated that IVDs scheduled for discectomy showed significantly lower dGEMRIC index compared to IVDs that did not require surgical intervention in NP and AF (NP: 898.4 ± 191.9 ms vs. 1,150.3 ± 320.7 ms, p = 0.008; AF: 738.7 ± 183.8 ms vs. 984.6 ± 178.9 ms, p = 0.008). For Miyazaki score 3, the dGEMRIC indices were significantly lower in IVDs scheduled for surgery compared to non-operated discs for NP (p = 0.043) and AF (p = 0.018). In conclusion we could demonstrate that biochemical imaging with dGEMRIC is feasible in cervical IVDs. Significantly lower dGEMRIC index suggested GAG depletion in degenerated cervical IVD, scheduled for discectomy. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1824-1830, 2017.
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Affiliation(s)
- Christoph Schleich
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Falk Miese
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Anja Müller-Lutz
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Johannes Boos
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Joel Aissa
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Adrian Nasca
- Neurosurgical Department, University Hospital, Dusseldorf, Germany
| | - Frank Zaucke
- Medical Faculty, Department of Orthopedics, University of Frankfurt/Main, Germany
| | | | - Lars Schimmöller
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Bernd Bittersohl
- Medical Faculty, Department of Orthopedics, University Duesseldorf, Germany
| | | | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
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16
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Jha SC, Higashino K, Sakai T, Takata Y, Abe M, Yamashita K, Morimoto M, Fukuta S, Nagamachi A, Sairyo K. Clinical Significance of High-intensity Zone for Discogenic Low Back Pain: A Review. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 63:1-7. [PMID: 27040045 DOI: 10.2152/jmi.63.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
High-intensity zone (HIZ) was originally described as a high-intensity signal on T2-weighted magnetic resonance (MR) images, located in the posterior annulus fibrosus, clearly separated from the nucleus pulposus. Among symptomatic patients with low back pain, HIZ is present in 28-59% of cases. In morphologically abnormal discs, high sensitivity and specificity of 81% and 79%, respectively, were reported for HIZs and concordant pain during discography. In contrast, another report indicated low rates. Although most papers reported high sensitivity and specificity for this relationship, it remains controversial. Regarding the pathology of HIZs, inflammatory granulation tissues are found at sites showing HIZs. Such inflammatory tissues produce pro-inflammatory cytokines and mediators, which sensitize the nociceptors within the disc and cause pain. An effective treatment for this condition is yet to be established. Recently, minimally invasive surgery using percutaneous endoscopic discectomy (PED) under local anesthesia was introduced. After removal of the degenerated disc material, the HIZ is identified with the endoscope and then coagulated and modulated with a bipolar radio pulse. This technique is called thermal annuloplasty. In conclusion, HIZs is an important sign of painful intervertebral disc disruption, if identified precisely based on factors such as location and intensity.
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17
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Abstract
To better understand what kinds of sports and exercise could be beneficial for the intervertebral disc (IVD), we performed a review to synthesise the literature on IVD adaptation with loading and exercise. The state of the literature did not permit a systematic review; therefore, we performed a narrative review. The majority of the available data come from cell or whole-disc loading models and animal exercise models. However, some studies have examined the impact of specific sports on IVD degeneration in humans and acute exercise on disc size. Based on the data available in the literature, loading types that are likely beneficial to the IVD are dynamic, axial, at slow to moderate movement speeds, and of a magnitude experienced in walking and jogging. Static loading, torsional loading, flexion with compression, rapid loading, high-impact loading and explosive tasks are likely detrimental for the IVD. Reduced physical activity and disuse appear to be detrimental for the IVD. We also consider the impact of genetics and the likelihood of a 'critical period' for the effect of exercise in IVD development. The current review summarises the literature to increase awareness amongst exercise, rehabilitation and ergonomic professionals regarding IVD health and provides recommendations on future directions in research.
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18
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Messner A, Stelzeneder D, Trattnig S, Welsch GH, Schinhan M, Apprich S, Brix M, Windhager R, Trattnig S. Does T2 mapping of the posterior annulus fibrosus indicate the presence of lumbar intervertebral disc herniation? A 3.0 Tesla magnetic resonance study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:877-883. [PMID: 27885476 DOI: 10.1007/s00586-016-4873-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 11/06/2016] [Accepted: 11/09/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE Indicating lumbar disc herniation via magnetic resonance imaging (MRI) T2 mapping in the posterior annulus fibrosus (AF). METHODS Sagittal T2 maps of 313 lumbar discs of 64 patients with low back pain were acquired at 3.0 Tesla (3T). The discs were rated according to disc herniation and bulging. Region of interest (ROI) analysis was performed on median, sagittal T2 maps. T2 values of the AF, in the most posterior 10% (PAF-10) and 20% of the disc (PAF-20), were compared. RESULTS A significant increase in the T2 values of discs with herniations affecting the imaged area, compared to bulging discs and discs with lateral herniation, was shown in the PAF-10, where no association to the NP was apparent. The PAF-20 exhibited a moderate correlation to the nucleus pulposus (NP). CONCLUSIONS High T2 values in the PAF-10 suggest the presence of disc herniation (DH). The results indicate that T2 values in the PAF-20 correspond more to changes in the NP.
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Affiliation(s)
- Alina Messner
- Department of Radiology, MR Center-High-field MR, Medical University of Vienna, Lazarettgasse 14, 1090, Vienna, Austria
| | - David Stelzeneder
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Stefan Trattnig
- Department of Radiology, MR Center-High-field MR, Medical University of Vienna, Lazarettgasse 14, 1090, Vienna, Austria
| | - Götz H Welsch
- Department of Radiology, MR Center-High-field MR, Medical University of Vienna, Lazarettgasse 14, 1090, Vienna, Austria.,UKE Athleticum, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martina Schinhan
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sebastian Apprich
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Martin Brix
- Department of Radiology, MR Center-High-field MR, Medical University of Vienna, Lazarettgasse 14, 1090, Vienna, Austria.,Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Siegfried Trattnig
- Department of Radiology, MR Center-High-field MR, Medical University of Vienna, Lazarettgasse 14, 1090, Vienna, Austria
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19
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T1rho and T2 mapping of lumbar intervertebral disc: Correlation with degeneration and morphologic changes in different disc regions. Magn Reson Imaging 2016; 34:932-9. [DOI: 10.1016/j.mri.2016.04.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/11/2016] [Accepted: 04/17/2016] [Indexed: 11/20/2022]
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20
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Authors' Reply to Wang: "On Magnetic Resonance Imaging of Intervertebral Disc Ageing". Sports Med 2016; 47:189-191. [PMID: 27549103 DOI: 10.1007/s40279-016-0612-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Muriuki MG, Havey RM, Voronov LI, Carandang G, Zindrick MR, Lorenz MA, Lomasney L, Patwardhan AG. Effects of motion segment level, Pfirrmann intervertebral disc degeneration grade and gender on lumbar spine kinematics. J Orthop Res 2016; 34:1389-98. [PMID: 26990567 DOI: 10.1002/jor.23232] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/06/2016] [Indexed: 02/04/2023]
Abstract
MRI allows non-invasive assessment of intervertebral disc degeneration with the added clinical benefit of using non-ionizing radiation. What has remained unclear is the relationship between assessed disc degeneration and lumbar spine kinematics. Kinematic outcomes of 54 multi-segment (L1-Sacrum) lumbar spine specimens were calculated to discover if such an underlying relationship exists with degeneration assessed using the Pfirrmann grading system. Further analyses were also conducted to determine if kinematic outcomes were affected by motion segment level, gender or applied compressive preload. Range of motion, hysteresis, high flexibility zone size and rotational stiffness in flexion-extension, lateral bending and axial rotation were the kinematic outcomes. Caudal intervertebral discs in our study sample were more degenerative than cranial discs. L5-S1 discs had the largest flexion-extension range of motion (p < 0.005) and L1-L2 discs the lowest flexion high flexibility zone size (p < 0.013). No other strict cranial-caudal differences in kinematic outcomes were found. Low flexibility zone rotational stiffness increased with disc degeneration grade in extension, lateral bending and axial rotation (p < 0.001). Trends towards higher hysteresis and lower range of motion with increased degeneration were observed in flexion-extension and lateral bending. Applied compressive preload increased flexion-extension hysteresis and augmented the effect of degeneration on hysteresis (p < 0.0005). Female specimens had about one degree larger range of motion in all rotational modes, and higher flexion extension hysteresis (p = 0.016). These results suggest that gender differences exist in lumbar spine kinematics. Additionally high disc loads, applied compressive preload or applied moment, are needed to kinematically distinguish discs with different levels of degeneration. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1389-1398, 2016.
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Affiliation(s)
- Muturi G Muriuki
- US Department of Veterans Affairs, Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, Illinois
| | - Robert M Havey
- US Department of Veterans Affairs, Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, Illinois.,Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, Illinois
| | - Leonard I Voronov
- US Department of Veterans Affairs, Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, Illinois.,Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, Illinois
| | - Gerard Carandang
- US Department of Veterans Affairs, Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, Illinois
| | - Michael R Zindrick
- US Department of Veterans Affairs, Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, Illinois.,Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, Illinois.,Hinsdale Orthopaedic Associates, Hinsdale, Illinois
| | - Mark A Lorenz
- US Department of Veterans Affairs, Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, Illinois.,Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, Illinois.,Hinsdale Orthopaedic Associates, Hinsdale, Illinois
| | - Laurie Lomasney
- Department of Radiology, Loyola University Chicago, Maywood, Illinois
| | - Avinash G Patwardhan
- US Department of Veterans Affairs, Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, Illinois.,Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, Illinois
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22
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Mok GSP, Zhang D, Chen SZ, Yuan J, Griffith JF, Wang YXJ. Comparison of three approaches for defining nucleus pulposus and annulus fibrosus on sagittal magnetic resonance images of the lumbar spine. J Orthop Translat 2016; 6:34-41. [PMID: 30035081 PMCID: PMC5987025 DOI: 10.1016/j.jot.2016.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 02/08/2016] [Accepted: 02/22/2016] [Indexed: 12/14/2022] Open
Abstract
Objective To compare three methods commonly used in the literature to define intervertebral disc nucleus pulposus (NP) and annulus fibrosus (AF) on magnetic resonance (MR) images. Methods Fifty-two patients (26 males and 26 females; age range, 23-76 years) were recruited for this study; they underwent standard T1/T2-weighted MR imaging, and T2 and T1rho mapping acquisitions. The corresponding midsagittal images were analysed and a total of 256 discs were evaluated, using three different region-of-interest (ROI) drawing methods: (1) radiologist-guided manual ROI (M-ROI); (2) five square ROIs where each measured 20% of the midline disc diameter (5-ROI); and (3) seven square ROIs placed horizontally from anterior to posterior (7-ROI) to define NP and AF. The agreement between the three ROI methods was assessed using intraclass correlation coefficient values and Bland-Altman plots. Results Inner AF and NP could not be differentiated on T1/T2-weighted MR imaging, T2 maps, or T1rho maps. The intraclass correlation coefficient values were all > 0.75 when comparing the 5-/7-ROI methods with the M-ROI methods for NP, and 0.167-0.488 for AF when comparing the 7-ROI method with the M-ROI method. The intraclass correlation coefficient values for AF increased to 0.378-0.582 for the M-ROI method compared with the 5-ROI method. Comparable results were obtained with Bland-Altman plots. Conclusion The 5-/7-ROI methods agreed with the M-ROI approach for NP selection, while the agreement with AF was moderate to poor, with the 5-ROI method showing slight advantage over the 7-ROI method. Cautions should be taken to interpret the MR relaxometry findings when 5-/7-ROI methods are used to select AF.
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Affiliation(s)
- Greta S P Mok
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, University of Macau, Macau Special Administrative Region
| | - Duo Zhang
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, University of Macau, Macau Special Administrative Region
| | - Shu-Zhong Chen
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
| | - Jing Yuan
- Medical Physics and Research Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong Special Administrative Region
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
| | - Yi Xiang J Wang
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
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23
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Davies BM, Atkinson RA, Ludwinski F, Freemont AJ, Hoyland JA, Gnanalingham KK. Qualitative grading of disc degeneration by magnetic resonance in the lumbar and cervical spine: lack of correlation with histology in surgical cases. Br J Neurosurg 2016; 30:414-21. [PMID: 26999322 DOI: 10.3109/02688697.2016.1161174] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Clinically, magnetic resonance (MR) imaging is the most effective non-invasive tool for assessing IVD degeneration. Histological examination of the IVD provides a more detailed assessment of the pathological changes at a tissue level. However, very few reports have studied the relationship between these techniques. Identifying a relationship may allow more detailed staging of IVD degeneration, of importance in targeting future regenerative therapies. OBJECTIVES To investigate the relationship between MR and histological grading of IVD degeneration in the cervical and lumbar spine in patients undergoing discectomy. METHODS Lumbar (N = 99) and cervical (N = 106) IVD samples were obtained from adult patients undergoing discectomy surgery for symptomatic IVD herniation and graded to ascertain a histological grade of degeneration. The pre-operative MR images from these patients were graded for the degree of IVD (MR grade) and vertebral end-plate degeneration (Modic Changes, MC). The relationship between histological and MR grades of degeneration were studied. RESULTS In lumbar and cervical IVD the majority of samples (93%) exhibited moderate levels of degeneration (ie MR grades 3-4) on pre-operative MR scans. Histologically, most specimens displayed moderate to severe grades of degeneration in lumbar (99%) and cervical spine (93%). MR grade was weakly correlated with patient age in lumbar and cervical study groups. MR and histological grades of IVD degeneration did not correlate in lumbar or cervical study groups. MC were more common in the lumbar than cervical spine (e.g. 39 versus 20% grade 2 changes; p < 0.05), but failed to correlate with MR or histological grades for degeneration. CONCLUSIONS In this surgical series, the resected IVD tissue displayed moderate to severe degeneration, but there is no correlation between MR and histological grades using a qualitative classification system. There remains a need for a quantitative, non-invasive, pre-clinical measure of IVD degeneration that correlates with histological changes seen in the IVD.
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Affiliation(s)
- B M Davies
- a Department of Neurosurgery , Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust , Manchester , UK
| | - R A Atkinson
- a Department of Neurosurgery , Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust , Manchester , UK ;,b Regenerative Medicine , Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
| | - F Ludwinski
- b Regenerative Medicine , Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
| | - A J Freemont
- b Regenerative Medicine , Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
| | - J A Hoyland
- b Regenerative Medicine , Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
| | - K K Gnanalingham
- a Department of Neurosurgery , Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust , Manchester , UK ;,b Regenerative Medicine , Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
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Biochemical imaging of cervical intervertebral discs with glycosaminoglycan chemical exchange saturation transfer magnetic resonance imaging: feasibility and initial results. Skeletal Radiol 2016; 45:79-85. [PMID: 26377579 DOI: 10.1007/s00256-015-2251-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/02/2015] [Accepted: 09/07/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate glycosaminoglycan chemical exchange saturation transfer (gagCEST) imaging at 3T in the assessment of the GAG content of cervical IVDs in healthy volunteers. MATERIALS AND METHODS Forty-two cervical intervertebral discs of seven healthy volunteers (four females, three males; mean age: 21.4 ± 1.4 years; range: 19-24 years) were examined at a 3T MRI scanner in this prospective study. The MRI protocol comprised standard morphological, sagittal T2 weighted (T2w) images to assess the magnetic resonance imaging (MRI) based grading system for cervical intervertebral disc degeneration (IVD) and biochemical imaging with gagCEST to calculate a region-of-interest analysis of nucleus pulposus (NP) and annulus fibrosus (AF). RESULTS GagCEST of cervical IVDs was technically successful at 3T with significant higher gagCEST values in NP compared to AF (1.17% ± 1.03% vs. 0.79% ± 1.75%; p = 0.005). We found topological differences of gagCEST values of the cervical spine with significant higher gagCEST effects in lower IVDs (r = 1; p = 0). We could demonstrate a significant, negative correlation between gagCEST values and cervical disc degeneration of NP (r = -0.360; p = 0.019). Non-degenerated IVDs had significantly higher gagCEST effects compared to degenerated IVDs in NP (1.76% ± 0.92% vs. 0.52% ± 1.17%; p < 0.001). CONCLUSION Biochemical imaging of cervical IVDs is feasible at 3T. GagCEST analysis demonstrated a topological GAG distribution of the cervical spine. The depletion of GAG in the NP with increasing level of morphological degeneration can be assessed using gagCEST imaging.
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Oxland TR. Fundamental biomechanics of the spine--What we have learned in the past 25 years and future directions. J Biomech 2015; 49:817-832. [PMID: 26706717 DOI: 10.1016/j.jbiomech.2015.10.035] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/10/2015] [Accepted: 10/23/2015] [Indexed: 12/20/2022]
Abstract
Since the publication of the 2nd edition of White and Panjabi׳s textbook, Clinical Biomechanics of the Spine in 1990, there has been considerable research on the biomechanics of the spine. The focus of this manuscript will be to review what we have learned in regards to the fundamentals of spine biomechanics. Topics addressed include the whole spine, the functional spinal unit, and the individual components of the spine (e.g. vertebra, intervertebral disc, spinal ligaments). In these broad categories, our understanding in 1990 is reviewed and the important knowledge or understanding gained through the subsequent 25 years of research is highlighted. Areas where our knowledge is lacking helps to identify promising topics for future research. In this manuscript, as in the White and Panjabi textbook, the emphasis is on experimental research using human material, either in vivo or in vitro. The insights gained from mathematical models and animal experimentation are included where other data are not available. This review is intended to celebrate the substantial gains that have been made in the field over these past 25 years and also to identify future research directions.
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Affiliation(s)
- Thomas R Oxland
- Departments of Orthopaedics and Mechanical Engineering, University of British Columbia, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada.
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Grunert P, Borde BH, Towne SB, Moriguchi Y, Hudson KD, Bonassar LJ, Härtl R. Riboflavin crosslinked high-density collagen gel for the repair of annular defects in intervertebral discs: An in vivo study. Acta Biomater 2015; 26:215-24. [PMID: 26116448 DOI: 10.1016/j.actbio.2015.06.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 05/06/2015] [Accepted: 06/06/2015] [Indexed: 12/19/2022]
Abstract
Open annular defects compromise the ability of the annulus fibrosus to contain nuclear tissue in the disc space, and therefore lead to disc herniation with subsequent degenerative changes to the entire intervertebral disc. This study reports the use of riboflavin crosslinked high-density collagen gel for the repair of annular defects in a needle-punctured rat-tail model. High-density collagen has increased stiffness and greater hydraulic permeability than conventional low-density gels; riboflavin crosslinking further increases these properties. This study found that treating annular defects with crosslinked high-density collagen inhibited the progression of disc degeneration over 18 weeks compared to untreated control discs. Histological sections of FITC-labeled collagen gel revealed an early tight attachment to host annular tissue. The gel was subsequently infiltrated by host fibroblasts which remodeled it into a fibrous cap that bridged the outer disrupted annular fibers and partially repaired the defect. This repair tissue enhanced retention of nucleus pulposus tissue, maintained physiological disc hydration, and preserved hydraulic permeability, according to MRI, histological, and mechanical assessments. Degenerative changes were partially reversed in treated discs, as indicated by an increase in nucleus pulposus size and hydration between weeks 5 and 18. The collagen gel appeared to work as an instant sealant and by enhancing the intrinsic healing capabilities of the host tissue.
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Affiliation(s)
- Peter Grunert
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Brandon H Borde
- Department of Biomedical Engineering, Cornell University, United States
| | - Sara B Towne
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Yu Moriguchi
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States
| | | | - Lawrence J Bonassar
- Department of Biomedical Engineering, Cornell University, United States; Sibley School of Mechanical and Aerospace Engineering, Cornell University, United States
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States.
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Effect of disc degeneration on lumbar segmental mobility analyzed by kinetic magnetic resonance imaging. Spine (Phila Pa 1976) 2015; 40:316-22. [PMID: 25494318 DOI: 10.1097/brs.0000000000000738] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective radiographical study. OBJECTIVE To define the relationship between the grade of disc degeneration and the motion of the lumbar spine by using kinetic magnetic resonance imaging. SUMMARY OF BACKGROUND DATA Disc degeneration is common after middle age. Lumbar instability has generally been recognized as a potential risk factor of low back pain. However, correlations between the grade of disc degeneration and the motion of the lumbar spine need more investigation. METHODS Kinetic magnetic resonance imaging was performed in 162 patients with symptomatic low back pain without prior history of surgery. The lumbar intervertebral discs were graded by spine surgeons according to the degenerative grading system (grades I-V). Translational motion and angular variation were measured at each segment from L1-L2 through L5-S1. The relationship between the degree of lumbar disc degeneration and extent of lumbar spine mobility was analyzed. RESULTS The translational motion in discs with grade I through IV increased gradually, but decreased with grade V. Compared with other less degenerative grades, grade V discs had significantly decreased total intervertebral translational motion (P < 0.05). The angular variation in discs with grade I through IV was fairly constant, but decreased with grade V. Compared with other degenerative grades (I-IV), grade V discs had significantly decreased total intervertebral translational motion (P < 0.05). For less degenerative grades I and II discs, the L2-L3 and L3-L4 segmental units contributed the majority of total angular mobility of the spine. However, for the severely degenerated segments, grade V discs, the contributions of the L2-L3 and L3-L4 significantly decreased (P < 0.01). CONCLUSION As disc degeneration developed from the normal to an increasingly severe stage, the motion of lumbar spine progressed from the normal stage to an unstable phase with higher mobility and finally to an ankylosed stage where stability was increased. LEVEL OF EVIDENCE 3.
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Alkalay RN, Burstein D, Westin CF, Meier D, Hackney DB. MR diffusion is sensitive to mechanical loading in human intervertebral disks ex vivo. J Magn Reson Imaging 2015; 41:654-664. [PMID: 24889510 PMCID: PMC9205197 DOI: 10.1002/jmri.24624] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/01/2014] [Indexed: 02/26/2024] Open
Abstract
PURPOSE To use T2 and diffusion MR to determine the change in the mechanical function of human disks with increased degenerative state. MATERIALS AND METHODS Spatial changes in T2 and diffusion were quantified in five cadaveric human lumbar disks under compressive loads. Regression models were used to investigate the relationship between the change in MR parameters and the disk's dynamic and viscoelastic properties. RESULTS Compressive loading caused a significant reduction in the disk's mean diffusivity ([11.3 versus 9.7].10(-4) .mm(2) /s, P < 0.001) but little change in T2 (P < 0.05). Diffusivity and T2 were correlated with the disk's dynamic (P < 0.01 and P < 0.05) and long-term viscoelastic (P < 0.05 and P < 0.05) stiffness. Diffusivity but not T2, was correlated with its viscoelastic dampening (r(2) = 0.45, P < 0.01) and instantaneous stiffness (r(2) = 0.44, P < 0.05). Nucleus diffusivity was significantly higher than the annulus's (-21% to -4%, P < 0.01). MR-estimated hydration was correlated with the instantaneous viscoelastic stiffness of the nucleus (r(2) = 0.35, P < 0.05) and the dynamic (r(2) = 0.44, P < 0.05) and long-term viscoelastic (r(2) = 0.42, P < 0.05) stiffness in the annulus. T2 correlated with diffusivity at low load (r(2) = 0.66, P < 0.05), but not at high load. CONCLUSION The strong correlations between diffusivity and the rheological assessments of disk mechanics suggest that MR might permit quantitative assessment of disk functional status and structural integrity.
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Affiliation(s)
- Ron N Alkalay
- Center for Advanced Orthopedic Studies, Department of Orthopedics, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Wang YXJ, Griffith JF, Leung JCS, Yuan J. Age related reduction of T1rho and T2 magnetic resonance relaxation times of lumbar intervertebral disc. Quant Imaging Med Surg 2014; 4:259-64. [PMID: 25202661 DOI: 10.3978/j.issn.2223-4292.2014.07.14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 11/14/2022]
Abstract
This report aims to study the age related T1rho and T2 relaxation time changes in lumbar intervertebral disc. Lumbar sagittal magnetic resonance imaging (MRI) was performed with a 3 Tesla scanner in 52 subjects. With a spin-lock frequency of 500 Hz, T1rho was measured using a rotary echo spin-lock pulse embedded in a 3D balanced fast field echo sequence. A multi-echo turbo spin echo sequence was used for T2 mapping. Regions-of-interest were drawn over the T1rho and T2 maps, including nucleus pulposus and annulus fibrosus. For L1/2-L4/5 discs, results showed the age associated reduction of T1rho of nucleus pulposus had a of slope of -1.06, the reduction of T2 of nucleus pulposus had a slope of -1.47, the reduction of T1rho of annulus fibrosus had a slope of -0.25, and the reduction of T2 of annulus fibrosus had a slope of -0.18, with all the slopes significantly non-zero. In nucleus pulposus the slope of T2 was slightly steeper than that of T1rho (P=0.085), while in annulus fibrosus the slope of T1rho was slightly steeper than that of T2 (P=0.31). We conclude that significant age related reduction of T1rho and T2 magnetic resonance relaxation times of lumbar intervertebral disc was observed, however, the relative performances of T1rho vs. T2 were broadly similar.
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Affiliation(s)
- Yi-Xiang J Wang
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China ; 2 School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - James F Griffith
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China ; 2 School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jason C S Leung
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China ; 2 School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jing Yuan
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China ; 2 School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Ellingson AM, Nagel TM, Polly DW, Ellermann J, Nuckley DJ. Quantitative T2* (T2 star) relaxation times predict site specific proteoglycan content and residual mechanics of the intervertebral disc throughout degeneration. J Orthop Res 2014; 32:1083-9. [PMID: 24788830 PMCID: PMC4136382 DOI: 10.1002/jor.22633] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 03/28/2014] [Indexed: 02/04/2023]
Abstract
Degeneration alters the biochemical composition of the disc, affecting the mechanical integrity leading to spinal instability. Quantitative T2* MRI probes water mobility within the macromolecular network, a potentially more sensitive assessment of disc health. We determined the relationship between T2* relaxation time and proteoglycan content, collagen content, and compressive mechanics throughout the degenerative spectrum. Eighteen human cadaveric lumbar (L4-L5) discs were imaged using T2* MRI. The T2* relaxation time at five locations (nucleous pulposus or NP, anterior annulus fibrosis or AF, posterior AF, inner AF, and outer AF) was correlated with sulfated-glycosaminoglycan (s-GAG) content, hydroxyproline content, and residual stress and strain at each location. T2* relaxation times were significantly correlated with s-GAG contents in all test locations and were particularly strong in the NP (r = 0.944; p < 0.001) and inner AF (r = 0.782; p < 0.001). T2* relaxation times were also significantly correlated with both residual stresses and excised strains in the NP (r = 0.857; p < 0.001: r = 0.816; p < 0.001), inner AF (r = 0.535; p = 0.022: r = 0.516; p = 0.028), and outer AF (r = 0.668; p = 0.002: r = 0.458; p = 0.041). These strong correlations highlight T2* MRI's ability to predict the biochemical and mechanical health of the disc. T2* MRI assessment of disc health is a clinically viable tool showing promise as a biomarker for distinguishing degenerative changes.
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Affiliation(s)
- Arin M. Ellingson
- Department of Biomedical Engineering, University of Minnesota, Nils Hasselmo Hall, Room 7-105, 312 Church Street S.E., Minneapolis, Minnesota
| | - Tina M. Nagel
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - David W. Polly
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Jutta Ellermann
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota
| | - David J. Nuckley
- Department of Biomedical Engineering, University of Minnesota, Nils Hasselmo Hall, Room 7-105, 312 Church Street S.E., Minneapolis, Minnesota,Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, Minnesota,Orthopaedic Biomechanics Laboratory, University of Minnesota, Minneapolis, Minnesota
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31
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Adams TL, Marchiori DM. Arthritides. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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In vivo quantification of T1ρ in lumbar spine disk spaces at 3 T using parallel transmission MRI. AJR Am J Roentgenol 2013; 201:W110-6. [PMID: 23789682 DOI: 10.2214/ajr.12.9523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE T1ρ MRI is an emerging, quantitative imaging modality that has been shown to correlate with proteoglycan content of disk material in vitro at 1.5 T. The purpose of this study is to quantify T1ρ values at all lumbar spine disk space levels at 3 T with parallel-transmission MRI in healthy adult volunteers. SUBJECTS AND METHODS Thirty-four subjects (15 men, ages 21-60 years [mean age, 38.4 years]; and 19 women, ages 20-56 years [mean age, 36.5 years]) with no history of back pain or surgery underwent T1ρ MRI of the lumbar spine at 3 T with parallel transmission and sagittal T2-weighted imaging. Mean T1ρ values of all lumbar spine disk space levels were quantified. Linear regression analysis and Spearman rank correlation were performed on age, sex, degenerative grade (Pfirrmann scores), and T1ρ with significance set at p < 0.05 and correlations considered strong for r > 0.7 and moderate for r = 0.5-0.7. RESULTS There was a statistically significant moderate negative correlation between T1ρ and subject age at disk space levels L1-2 through L4-5 (inclusive) (p < 0.001) and L5-S1 (p < 0.01). There was a statistically significant difference in T1ρ between all age groups sampled (p < 0.01) and a significant difference between T1ρ and Pfirrmann grades 1-3 (p < 0.01). CONCLUSION T1ρ MRI in the lumbar spine with parallel transmission shows signifi-cant negative correlations with age at all disk space levels, which lends support to a potential role for T1ρ as a quantitative, in vivo biomarker of disk degeneration.
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Rodrigues LMR, Oliveira LZD, Pinhal MADS. Expression of heparanase isoforms in intervertebral discs classified according to Pfirrmann grading system for disc degeneration. Spine (Phila Pa 1976) 2013; 38:1112-8. [PMID: 23370684 DOI: 10.1097/brs.0b013e3182894cf4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a quantitative study of heparanase isoforms expression in degenerative and nondegenerative intervertebral discs (IVDs). OBJECTIVE To quantify the expression of both heparanase isoforms (HPSE1 and HPSE2) in IVD tissues as classified by different degeneration grades using the Pfirrmann grading system, and to correlate the expression with the loss of extracellular matrix molecules observed in patients with the disease. SUMMARY OF BACKGROUND DATA The loss of proteoglycans as observed in IVD degeneration may occur due to the enhanced expression of matrix degrading enzymes, such as heparanase. However, the heparanase function in IVD degeneration remains unclear. METHODS This study comprised 53 surgical samples of degenerative discs obtained from patients with lumbar disc degeneration and 12 control samples collected from healthy individuals without any degenerative lumbar disc alterations who had accidental spine fractures.All patients underwent magnetic resonance imaging based on the Pfirrmann grading system for disc degeneration. Only the specimens that were classified according to magnetic resonance imaging evaluations as Pfirrmann grades I, II, III, and IV were analyzed.The tissue sections of the disc samples were subject to immunohistochemical staining with antibodies against the heparanase isoforms and to quantitative real time PCR to amplify heparanase isoforms cDNA. Protein and mRNA expressions were quantified. Analysis of variance and Student t test were used to compare the means of the study populations. RESULTS The data demonstrated a gradual increase in both the heparanase isoform protein expression and disc degeneration progression. Besides, mRNA expression of both heparanase isoforms were significantly higher in degenerative than nondegenerative IVDs. CONCLUSION The overexpression of HPSE1 and HPSE2 in the intervertebral degenerated discs suggests a role for these factors in mediating extracellular matrix remodeling in degenerative discs during disease development.
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Antoniou J, Epure LM, Michalek AJ, Grant MP, Iatridis JC, Mwale F. Analysis of quantitative magnetic resonance imaging and biomechanical parameters on human discs with different grades of degeneration. J Magn Reson Imaging 2013; 38:1402-14. [PMID: 23633131 DOI: 10.1002/jmri.24120] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 02/18/2013] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To establish relationships between quantitative MRI (qMRI) and biomechanical parameters in order to help inform and interpret alterations of human intervertebral discs (IVD) with different grades of degeneration. MATERIALS AND METHODS The properties of the nucleus pulposus (NP) and annulus fibrosus (AF) of each IVD of 10 lumbar spines (range, 32-77 years) were analyzed by qMRI (relaxation times T1 and T2, magnetization transfer ratio [MTR], and apparent diffusion coefficient [ADC]), and tested in confined compression and dynamic shear. RESULTS T1 and T2 significantly decreased in both the NP and AF with increasing degeneration grades while the MTR increased significantly with grade 4. In contrast to the other qMRI parameters, the ADC had a tendency to decrease with increasing grade. Disc degeneration caused a decrease in the aggregate modulus, hydraulic permeability and shear modulus magnitude along with an increase in phase angle in the AF. In contrast, disc degeneration of NPs demonstrated decreases in shear modulus and phase angle. CONCLUSION Our studies indicate that qMRI can be used as a noninvasive diagnostic tool in the detection of IVD properties with the potential to help interpret and detect early, middle, and late stages of degeneration. QMRI of human IVD can therefore become a very important diagnostic assessment tool in determining the functional state of the disc.
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Affiliation(s)
- John Antoniou
- Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, McGill University, Montréal, QC, Canada
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Lotz JC, Haughton V, Boden SD, An HS, Kang JD, Masuda K, Freemont A, Berven S, Sengupta DK, Tanenbaum L, Maurer P, Ranganathan A, Alavi A, Marinelli NL. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology 2012; 264:6-19. [PMID: 22723559 DOI: 10.1148/radiol.12110339] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Magnetic resonance (MR) imaging in patients with persistent low back pain and sciatica effectively demonstrates spine anatomy and the relationship of nerve roots and intervertebral disks. Except in cases with nerve root compression, disk extrusion, or central stenosis, conventional anatomic MR images do not help distinguish effectively between painful and nonpainful degenerating disks. Hypoxia, inflammation, innervation, accelerated catabolism, and reduced water and glycosaminoglycan content characterize degenerated disks, the extent of which may distinguish nonpainful from painful ones. Applied to the spine, "functional" imaging techniques such as MR spectroscopy, T1ρ calculation, T2 relaxation time measurement, diffusion quantitative imaging, and radio nucleotide imaging provide measurements of some of these degenerative features. Novel minimally invasive therapies, with injected growth factors or genetic materials, target these processes in the disk and effectively reverse degeneration in controlled laboratory conditions. Functional imaging has applications in clinical trials to evaluate the efficacy of these therapies and eventually to select patients for treatment. This report summarizes the biochemical processes in disk degeneration, the application of advanced disk imaging techniques, and the novel biologic therapies that presently have the most clinical promise.
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Affiliation(s)
- Jeffrey C Lotz
- Orthopaedic Bioengineering Laboratory, University of California-San Francisco, San Francisco, CA, USA
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Wang YXJ, Zhao F, Griffith JF, Mok GSP, Leung JCS, Ahuja AT, Yuan J. T1rho and T2 relaxation times for lumbar disc degeneration: an in vivo comparative study at 3.0-Tesla MRI. Eur Radiol 2012; 23:228-34. [PMID: 22865227 DOI: 10.1007/s00330-012-2591-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 06/15/2012] [Accepted: 06/29/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the relative performance of T1rho and T2 relaxation times in disc degeneration assessment. METHODS Lumbar sagittal MRI was performed at 3 T in 52 subjects. With a spin-lock frequency of 500 Hz, T1rho was measured using a rotary echo spin-lock pulse embedded in a three-dimensional (3D) balanced fast field echo sequence. A multi-echo TSE sequence was used for T2 mapping. Regions of interest (ROIs) were drawn over the T1rho and T2 maps, including nucleus pulposus (NP) and annulus fibrosus (AF). Eight- and five-level disc degeneration semi-quantitative grading was performed. RESULTS For NP, T1rho and T2 decreased quadratically with disc degeneration grades and had no significant trend difference (P = 0.40). For AF, T1rho decreased linearly as the disc degenerated and had a slope of -3.02 and -4.56 for eight- and five-level gradings respectively; while the slopes for T2 values were -1.43 and -1.84 respectively, being significantly flatter than those of T1rho (P < 0.001). There was no significant difference in T1rho and T2 values for both NP and AF among discs of grade 5/8 to 8/8 degeneration. CONCLUSION T1rho is better suited for evaluating AF in degenerated disc than T2. In NP, T1rho and T2 decrease in a similar pattern following disc degeneration.
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Affiliation(s)
- Yi-Xiang J Wang
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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Cselik Z, Aradi M, von Jako RA, Lelovics Z, Juhász I, Egyházi Z, Bogner P, Repa I, Schwarcz A. Impact of infrared laser light-induced ablation at different wavelengths on bovine intervertebral disc ex vivo: Evaluation with magnetic resonance imaging and histology. Lasers Surg Med 2012; 44:406-12. [DOI: 10.1002/lsm.22034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2012] [Indexed: 11/06/2022]
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Takashima H, Takebayashi T, Yoshimoto M, Terashima Y, Tsuda H, Ida K, Yamashita T. Correlation between T2 relaxation time and intervertebral disk degeneration. Skeletal Radiol 2012; 41:163-7. [PMID: 21424906 DOI: 10.1007/s00256-011-1144-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 02/24/2011] [Accepted: 02/27/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Magnetic resonance T2 mapping allows for the quantification of water and proteoglycan content within tissues and can be used to detect early cartilage abnormalities as well as to track the response to therapy. The goal of the present study was to use T2 mapping to quantify intervertebral disk water content according to the Pfirrmann classification. MATERIALS AND METHODS This study involved 60 subjects who underwent lumbar magnetic resonance imaging (a total of 300 lumbar disks). The degree of disk degeneration was assessed in the midsagittal section on T2-weighted images according to the Pfirrmann classification (grades I to V). Receiver operating characteristic (ROC) analysis was performed among grades to determine the cut-off values. RESULTS In the nucleus pulposus, T2 values tended to decrease with increasing grade, and there was a significant difference in T2 values between each grade from grades I to IV. However, there was no significant difference in T2 values in the anterior or posterior annulus fibrosus. T2 values according to disk degeneration level classification were as follows: grade I (>116.8 ms), grade II (92.7-116.7 ms), grade III (72.1-92.6 ms), grade IV (<72.0 ms). CONCLUSION T2 values decreased with increasing Pfirrmann classification grade in the nucleus pulposus, likely reflecting a decrease in proteoglycan and water content. Thus, T2 value-based measurements of intervertebral disk water content may be useful for future clinical research on degenerative disk diseases.
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Affiliation(s)
- Hiroyuki Takashima
- Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan.
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In vivo intervertebral disc characterization using magnetic resonance spectroscopy and T1ρ imaging: association with discography and Oswestry Disability Index and Short Form-36 Health Survey. Spine (Phila Pa 1976) 2012; 37:214-21. [PMID: 21697767 PMCID: PMC3633556 DOI: 10.1097/brs.0b013e3182294a63] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An in vivo study of intervertebral disc degeneration by using quantitative magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). OBJECTIVE To quantify water and proteoglycan (PG) content in the intervertebral disc by using in vivo MRS and to evaluate the relationship between MRS-quantified water/PG content, T1ρ, Pfirrmann score, clinical self-assessment, and discography. SUMMARY OF BACKGROUND DATA Previous in vitro studies have investigated the relationship between MRS-quantified water/PG content and degenerative grade by using cadaveric intervertebral discs. T1ρ has been shown to relate to Pfirrmann grade and clinical self-assessment. However, the associations between MRS-quantified water/PG content, MRI-based T1ρ, self-assessment of health status, and clinical response to discography have not been studied in vivo. METHODS MRS and MRI were performed in 26 patients (70 discs) with symptomatic intervertebral degenerative disc (IVDD) and 23 controls (41 discs). Patients underwent evaluation of intervertebral discs with provocative discography. All subjects completed the Short Form-36 Health Survey and Oswestry Disability Index questionnaires. RESULTS The water/PG peak area ratio was significantly elevated in (a) patients (compared with controls) and in (b) discs with positive discography (compared with negative discography). Magnetic resonance (MR) T1ρ exhibited similar trends. A significant association was found between T1ρ and normalized PG content (R = 0.61, P < 0.05) but not between T1ρ and normalized water content (R = 0.24, P > 0.05). The water/PG peak area ratio, normalized water, normalized PG, and Pfirrmann grade were significantly associated with patient self-assessment of disability and physical composite score, while disc height was not. CONCLUSION This study demonstrated a relationship between in vivo MRS spectroscopy (water content and PG content), imaging parameters (T1ρ and Pfirrmann grade), discography results, and clinical self-assessment, suggesting that MRS-quantified water, PG, and MR T1ρ relaxation time may potentially serve as biomarkers of symptomatic IVDD.
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Haughton V. The "dehydrated" lumbar intervertebral disk on MR, its anatomy, biochemistry and biomechanics. Neuroradiology 2012; 53 Suppl 1:S191-4. [PMID: 21863429 DOI: 10.1007/s00234-011-0923-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Majumdar S, Link TM, Steinbach LS, Hu S, Kurhanewicz J. Diagnostic tools and imaging methods in intervertebral disk degeneration. Orthop Clin North Am 2011; 42:501-11, viii. [PMID: 21944587 DOI: 10.1016/j.ocl.2011.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Low back pain has a negative impact on the economy and society. Intervertebral disk degeneration is linked to the occurrence of low back pain. MRI provides three-dimensional morphologic and biochemical information regarding the status of the disk. This article reviews new and evolving MRI disk-imaging techniques, including grading, relaxation-time measurements, diffusion, and contrast perfusion. In addition, high-resolution magic-angle spinning methods to correlate in vitro disk degeneration (with pain, etc) and in vivo spectroscopic results are discussed. With the potential for morphologic and biochemical characterization of the intervertebral disk, MRI shows promise as a tool to quantitatively assess disk health.
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Affiliation(s)
- Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94158, USA.
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42
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Haughton V. The "Dehydrated" Lumbar Intervertebral Disk on MR, its Anatomy, Biochemistry and Biomechanics. Neuroradiol J 2011; 24:564-9. [PMID: 24059714 DOI: 10.1177/197140091102400412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/03/2011] [Indexed: 11/16/2022] Open
Abstract
MR imaging of the lumbar spine often is requested to identify the cause of back or radicular pain. Official reports of lumbar spine images tend to focus on changes in the disk margin that may cause nerve root compression. The potential role of the dark disk, in back pain has not been adequately emphasized. The purpose of this review is to discuss the dark disk that has not produced nerve root compression. On T2-weighted images, a disk that has diminished signal intensity is called a dark disk or a dehydrated disk. It corresponds to a stage III disk in the Pfirrmann or the Thompson scale. Such a disk has specific morphologic, chemical and biomechanical properties, which will be reviewed in this presentation. The goal is to suggest the clinical significance of finding a dark disk on an MR image.
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Affiliation(s)
- V Haughton
- Radiology Department, Wisconsin University Hospitals; Madison, Wisconsin, USA -
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43
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Relationships between viscoelastic properties of lumbar intervertebral disc and degeneration grade assessed by MRI. J Mech Behav Biomed Mater 2011; 4:593-9. [DOI: 10.1016/j.jmbbm.2011.01.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 01/14/2011] [Accepted: 01/20/2011] [Indexed: 12/19/2022]
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Hussain M, Natarajan RN, Chaudhary G, An HS, Andersson GBJ. Relative contributions of strain-dependent permeability and fixed charged density of proteoglycans in predicting cervical disc biomechanics: a poroelastic C5-C6 finite element model study. Med Eng Phys 2010; 33:438-45. [PMID: 21167763 DOI: 10.1016/j.medengphy.2010.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 08/04/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
Abstract
Disc swelling pressure (P(swell)) facilitated by fixed charged density (FCD) of proteoglycans (P(fcd)) and strain-dependent permeability (P(strain)) are of critical significance in the physiological functioning of discs. FCD of proteoglycans prevents any excessive matrix deformation by tissue stiffening, whereas strain-dependent permeability limits the rate of stress transfer from fluid to solid skeleton. To date, studies involving the modeling of FCD of proteoglycans and strain-dependent permeability have not been reported for the cervical discs. The current study objective is to compare the relative contributions of strain-dependent permeability and FCD of proteoglycans in predicting cervical disc biomechanics. Three-dimensional finite element models of a C5-C6 segment with three different disc compositions were analyzed: an SPFP model (strain-dependent permeability and FCD of proteoglycans), an SP model (strain-dependent permeability alone), and an FP model (FCD of proteoglycans alone). The outcomes of the current study suggest that the relative contributions of strain-dependent permeability and FCD of proteoglycans were almost comparable in predicting the physiological behavior of the cervical discs under moment loads. However, under compression, strain-dependent permeability better predicted the in vivo disc response than that of the FCD of proteoglycans. Unlike the FP model (least stiff) in compression, motion behavior of the three models did not vary much from each other and agreed well within the standard deviations of the corresponding in vivo published data. Flexion was recorded with maximum P(fcd) and P(strain), whereas minimum values were found in extension. The study data enhance the understanding of the roles played by the FCD of proteoglycans and strain-dependent permeability and porosity in determining disc tissue swelling behavior. Degenerative changes involving strain-dependent permeability and/or loss of FCD of proteoglycans can further be studied using an SPFP model. Future experiments are necessary to support the current study results.
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Affiliation(s)
- Mozammil Hussain
- Division of Research, Logan University, 1851 Schoettler Rd, Chesterfield, MO 63017, USA.
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Stelzeneder D, Trattnig S. Biochemische MR-Bildgebung der Bandscheibe und Facettengelenke der Wirbelsäule. Radiologe 2010; 50:1115-9. [DOI: 10.1007/s00117-010-2033-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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47
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Blumenkrantz G, Zuo J, Li X, Kornak J, Link TM, Majumdar S. In vivo 3.0-tesla magnetic resonance T1rho and T2 relaxation mapping in subjects with intervertebral disc degeneration and clinical symptoms. Magn Reson Med 2010; 63:1193-200. [PMID: 20432290 DOI: 10.1002/mrm.22362] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The purpose of this study is (1) to determine the correlation between T(1rho) and T(2) and degenerative grade in intervertebral discs using in vivo 3.0-T MRI, and (2) to determine the association between T(1rho) and T(2) and clinical findings as quantified by the SF-36 Questionnaire and Oswestry Disability Index. Sixteen subjects participated in this study, and each completed SF-36 and Oswestry Disability Index questionnaires. MRI T(1rho) and T(2) mapping was performed to determine T(1rho) (77 discs) and T(2) (44 discs) in the nucleus of the intervertebral disc, and T(2)-weighted images were acquired for Pfirrmann grading of disc degeneration. Pfirrmann grade was correlated with both T(1rho) (r = -0.84; P < 0.01) and T(2) (r = -0.61; P < 0.01). Mixed-effects models demonstrate that only T(1rho) was associated with clinical questionnaires (R(2) (SF-36) = 0.55, R(2) (O.D.I.) = 0.56; P < 0.05). Although the averaged values of T(1rho) and T(2) were significantly correlated, they presented differences in spatial distribution and dynamic range, thus suggesting different sensitivities to tissue composition. This study suggests that T(1rho) may be sensitive to early degenerative changes (corroborating previous studies) and clinical symptoms in intervertebral disc degeneration.
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Affiliation(s)
- Gabrielle Blumenkrantz
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California 94158, USA.
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Saar G, Zilberman Y, Shinar H, Keinan-Adamsky K, Pelled G, Gazit D, Navon G. Monitoring of the effect of intervertebral disc nucleus pulposus ablation by MRI. NMR IN BIOMEDICINE 2010; 23:554-562. [PMID: 20175140 DOI: 10.1002/nbm.1493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In order to investigate intervertebral disc (IVD) degeneration and repair, a quantitative non-invasive tool is needed. Various MRI methods including qCPMG, which yields dipolar echo relaxation time (T(DE)), magnetization transfer contrast (MTC), and (1)H and (2)H double quantum filtered (DQF) MRI were used in the present work to monitor changes in rat IVD after ablation of the nucleus pulposus (NP), serving as a model of severe IVD degeneration. In the intact IVD, a clear distinction between the annulus fibrosus (AF) and the NP is obtained on T(2) and T(DE) weighted images as well as on MTC maps, reflecting the high concentration of ordered collagen fibers in the AF. After ablation of the NP, the distinction between the compartments is lost. T(2) and T(DE) relaxation times are short throughout the disc and MTC is high. (1)H and (2)H DQF signal, which in intact discs is obtained only for the AF, is now observable throughout the tissue. These results indicate that after ablation, there is an ingression of collagen fibers from the AF into the area that was previously occupied by the NP, as was confirmed by histology.
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Affiliation(s)
- Galit Saar
- School of Chemistry, Tel Aviv University, Tel Aviv, Israel
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Marinelli NL, Haughton VM, Anderson PA. T2 relaxation times correlated with stage of lumbar intervertebral disk degeneration and patient age. AJNR Am J Neuroradiol 2010; 31:1278-82. [PMID: 20360340 DOI: 10.3174/ajnr.a2080] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE T2 relaxation times provide a continuous measure of changes in intervertebral disk biochemistry. The purpose of this study was to correlate T2 relaxation times in lumbar disks with patient age and stage of degeneration. MATERIALS AND METHODS Sagittal T1- and T2-weighted images and axial images were acquired in 20 patients referred for MR imaging for back pain or radiculopathy. Two readers inspected these images and assigned a Pfirrmann grade to each disk. An additional sagittal multiecho FSE image sequence was obtained, and T2 relaxation times were calculated for a each lumbar disk. T2 relaxation times were correlated with Pfirrmann grade. T2 relaxation times in nondegenerated disks were correlated with patient age. Statistical significance was tested by ANOVA, ad hoc tests, and Pearson coefficients. RESULTS T2 relaxation times were calculated for 95 lumbar disks in 19 patients and discarded for 5 disks in 1 patient due to motion artifacts. Forty-four disks were classified as Pfirrmann grade II; 34, as grade III; 14, as grade IV; and 3, as grade V. Mean T2 relaxation times of the central region decreased from 108 ms for grade II to 53 ms for grade IV disks. T2 relaxation times correlated significantly with Pfirrmann grade. For grade II disks, T2 relaxation times of the central region decreased significantly from an average of 132 ms for patients in their 20s to 86 ms for those in their 60s. CONCLUSIONS T2 relaxation times in lumbar disks correlate with stage of degeneration and patient age.
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Affiliation(s)
- N L Marinelli
- University of Wisconsin School of Medicine and Public Health, Health Sciences Learning Center, Madison, Wisconsin 53705, USA
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50
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Zuo J, Saadat E, Romero A, Loo K, Li X, Link TM, Kurhanewicz J, Majumdar S. Assessment of intervertebral disc degeneration with magnetic resonance single-voxel spectroscopy. Magn Reson Med 2010; 62:1140-6. [PMID: 19780173 DOI: 10.1002/mrm.22093] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study examined the feasibility of using short-echo water-suppressed point-resolved spectroscopy (PRESS) on a clinical 3T magnetic resonance (MR) scanner for evaluating biochemical changes in degenerated bovine and cadaveric human intervertebral discs. In bovine discs (N = 17), degeneration was induced with papain injections. Degeneration of human cadaveric discs (N = 27) was assessed using the Pfirrmann grading on T(2)-weighted images. Chemicals in the carbohydrate region (Carb), the choline head group (Cho), the N-acetyl region (N-acetyl), and the lipid and lactate region (Lac+Lip) were quantified using (1)H PRESS, and were compared between specimens with different degrees of degeneration. The correlation between the spectroscopic findings and glycosaminoglycan (GAG) quantification using biochemical assays was determined. Significant differences were found between the ratios (N-acetyl/Cho, N-acetyl/Lac+Lip) acquired before and after papain injection in bovine discs. For human cadaveric discs, significant differences in the ratios (N-acetyl/Carb, N-acetyl/Lac+Lip) were found between discs having high and low Pfirrmann scores. Significant correlations were found between N-acetyl/Lac+Lip and GAG content in bovine discs (R = 0.77, P = 0.0007) and cadaveric discs (R = 0.83, P < 0.0001). Significant correlation between N-acetyl/Cho and GAG content was also found in cadaver discs (R = 0.64, P = 0.0039). This study demonstrates for the first time that short-echo PRESS on a clinical 3T MR scanner can be used to noninvasively and can reproducibly quantify metabolic changes associated with degeneration of intervertebral discs.
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Affiliation(s)
- Jin Zuo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.
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