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Ujigo S, Kamei N, Yamada K, Nakamae T, Imada H, Adachi N, Fujimoto Y. Balancing ability of patients with lumbar spinal canal stenosis. 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 2023; 32:4174-4183. [PMID: 37217822 DOI: 10.1007/s00586-023-07782-6] [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: 01/10/2023] [Revised: 05/04/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE To determine the relationship between postural sway and the severity of lumbar spinal canal stenosis as well as the effect on postoperative improvement. METHODS Stabilometry was performed before and 6 months after surgery in 52 patients (29 men and 23 women; mean age, 74.1 ± 7.8 years) who underwent decompression surgery for lumbar spinal canal stenosis. The environmental area (EA; the area surrounding the circumference of the stabilogram) and locus length per EA (L/EA) were evaluated. The patients were divided into moderate (n = 22) and severe (n = 30) groups according to the severity of canal stenosis. Patient characteristics and parameters were compared between the groups before and after surgery, including the visual analog scale (VAS) score for leg pain, Oswestry Disability Index (ODI), EA, and L/EA. In addition, factors affecting EA and L/EA were evaluated using multiple regression analysis. RESULTS Age (p = 0.031), preoperative EA (p < 0.001), preoperative L/EA (p = 0.032), and sagittal vertical axis (p = 0.033) were significantly different between groups. The VAS score and ODI significantly improved postoperatively in both groups (p < 0.001). The EA significantly improved postoperatively only in the severe group (p < 0.001), whereas the L/EA did not significantly improve in either group. Multiple regression analysis showed that only the severity of canal stenosis was significantly associated with preoperative EA (p = 0.030), whereas age (p = 0.040) and severity of canal stenosis (p = 0.030) were significantly associated with preoperative L/EA. Diabetes was significantly associated with postoperative EA (p = 0.046) and L/EA (p = 0.030). CONCLUSION The severity of canal stenosis affected abnormal postural sway, which improved after decompression surgery.
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Affiliation(s)
- Satoshi Ujigo
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Kiyotaka Yamada
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Toshio Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideaki Imada
- Department of Orthopaedic Surgery, Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshinori Fujimoto
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan
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Tennant IJ, Yau YH, Yull D, Murphy P, Whittle IR. Imaging incidence and type in primary care patients with low back pain: a cross-sectional study on new referrals to an Australian specialist spinal surgical centre. J Prim Health Care 2023; 15:262-266. [PMID: 37756235 DOI: 10.1071/hc22127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/16/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Low back pain (LBP) is common and a significant cause of morbidity. Many patients receive inappropriate imaging for LBP in primary care. Aim To explore the incidence and type of spinal imaging conducted for LBP patients referred from general practice for specialist surgical opinion, and evaluate whether imaging conformed to clinical guidelines. Methods Audit of a sequential cohort (n = 100) of new LBP patients referred from primary care for specialist opinion at a suburban Australian capital city independent Spinal Centre. Results In the 6 months before referral, 90% (95% CI 83-95%) of patients underwent spinal imaging. Imaging was performed in 95% of those who did and 79% of those who did not meet guidelines for radiological investigation. 35% of patients were inappropriately imaged and 3% inappropriately not imaged. Spinal computed tomography (CT) imaging was used in 52% of patients, magnetic resonance imaging (MRI) in 42% and image-guided lumbar spinal interventional procedures in 28%. Discussion Most patients with LBP referred for surgical opinion have diagnostic radiological investigations whether or not it is indicated by clinical guidelines. The more frequent use of spinal CT compared to MRI may be due to idiosyncrasies of the Australian Medicare Benefits Schedule (MBS) rebate system. The findings of this pilot study provide support for the changes recommended by the 2016 MBS Review Taskforce on LBP that permit GP access to subsidised lumbar MRI, while constraining access to lumbar CT, and provide novel data about spinal imaging and practice in this cohort of patients.
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Affiliation(s)
- Isaac J Tennant
- Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia
| | - Yun-Hom Yau
- Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia; and The International Spine Centre, Norwood, SA 5067, Australia; and The Spinal Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Derek Yull
- Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia; and The International Spine Centre, Norwood, SA 5067, Australia
| | - Peter Murphy
- The International Spine Centre, Norwood, SA 5067, Australia
| | - Ian R Whittle
- Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia; and The International Spine Centre, Norwood, SA 5067, Australia; and The Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK
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Yamakuni R, Seino S, Ishii S, Ishikawa H, Kikori K, Ando T, Kakamu T, Fukushima K, Otani K, Ito H. Lumbar intradural space reduction during the Valsalva maneuver observed using cine MRI and MR myelography: a single-case experimental study. Acta Neurochir (Wien) 2023; 165:2111-2120. [PMID: 37341825 DOI: 10.1007/s00701-023-05678-4] [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: 04/23/2023] [Accepted: 06/13/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Previous studies have shown that the Valsalva maneuver (VM) causes spinal canal object movements. We hypothesized that this occurs because of cerebrospinal fluid (CSF) flow generated from intradural space reduction. Previous studies using myelograms reported lumbar CSF space changes during inspiration. However, no similar studies have been conducted using modern MRI. Therefore, this study analyzed intradural space reduction during the VM using cine magnetic resonance imaging (MRI). METHODS The participant was a 39-year-old, healthy, male volunteer. Cine MRI involved fast imaging employing steady-state acquisition cine sequence during three resting and VM sets for 60 s each. The axial plane was at the intervertebral disc and vertebral body levels between Th12 and S1 during cine MRI. This examination was performed on 3 separate days; hence, data from nine resting and VM sets were available. Additionally, two-dimensional myelography was performed during rest and the VM. RESULTS Intradural space reduction was observed during the VM using cine MRI and myelography. The intradural space cross-sectional area during the VM (mean: 129.3 mm2; standard deviation [SD]: 27.4 mm2) was significantly lower than that during the resting period (mean: 169.8; SD: 24.8; Wilcoxon signed-rank test, P < 0.001). The reduction rate of the vertebral body level (mean: 26.7%; SD: 9.4%) was larger than that of the disc level (mean: 21.4%; SD: 9.5%; Wilcoxon rank sum test, P = 0.0014). Furthermore, the reduction was mainly observed on the ventral and bilateral intervertebral foramina sides at the vertebral body and intervertebral disc levels, respectively. CONCLUSION The intradural space was reduced during the VM, possibly because of venous dilatation. This phenomenon may be associated with CSF flow, intradural object movement, and nerve compression, potentially leading to back pain.
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Affiliation(s)
- Ryo Yamakuni
- Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan.
| | - Shinya Seino
- Department of Radiology, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Shiro Ishii
- Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Hironobu Ishikawa
- Department of Radiology, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Katsuyuki Kikori
- Department of Radiology, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Tatsuya Ando
- Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Kenji Fukushima
- Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Koji Otani
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Hiroshi Ito
- Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
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Sekiguchi M. The Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 2. Diagnosis and Evaluation. Spine Surg Relat Res 2023; 7:300-305. [PMID: 37636148 PMCID: PMC10447202 DOI: 10.22603/ssrr.2022-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/13/2022] [Indexed: 08/29/2023] Open
Affiliation(s)
- Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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Miyo R, Yasaka K, Hamada A, Sakamoto N, Hosoi R, Mizuki M, Abe O. Deep-learning reconstruction for the evaluation of lumbar spinal stenosis in computed tomography. Medicine (Baltimore) 2023; 102:e33910. [PMID: 37335676 DOI: 10.1097/md.0000000000033910] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
To compare the quality and interobserver agreement in the evaluation of lumbar spinal stenosis (LSS) on computed tomography (CT) images between deep-learning reconstruction (DLR) and hybrid iterative reconstruction (hybrid IR). This retrospective study included 30 patients (age, 71.5 ± 12.5 years; 20 men) who underwent unenhanced lumbar CT. Axial and sagittal CT images were reconstructed using hybrid IR and DLR. In the quantitative analysis, a radiologist placed regions of interest within the aorta and recorded the standard deviation of the CT attenuation (i.e., quantitative image noise). In the qualitative analysis, 2 other blinded radiologists evaluated the subjective image noise, depictions of structures, overall image quality, and degree of LSS. The quantitative image noise in DLR (14.8 ± 1.9/14.2 ± 1.8 in axial/sagittal images) was significantly lower than that in hybrid IR (21.4 ± 4.4/20.6 ± 4.0) (P < .0001 for both, paired t test). Subjective image noise, depictions of structures, and overall image quality were significantly better with DLR than with hybrid IR (P < .006, Wilcoxon signed-rank test). Interobserver agreements in the evaluation of LSS (with 95% confidence interval) were 0.732 (0.712-0.751) and 0.794 (0.781-0.807) for hybrid IR and DLR, respectively. DLR provided images with improved quality and higher interobserver agreement in the evaluation of LSS in lumbar CT than hybrid IR.
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Affiliation(s)
- Rintaro Miyo
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
- Department of Radiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Koichiro Yasaka
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Akiyoshi Hamada
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoya Sakamoto
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
- Department of Radiology, Toranomon Hospital, Tokyo, Japan
| | - Reina Hosoi
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
- Department of Radiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Masumi Mizuki
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
- Department of Radiology, Nerimahikarigaoka Hospital, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
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Bharadwaj UU, Christine M, Li S, Chou D, Pedoia V, Link TM, Chin CT, Majumdar S. Deep learning for automated, interpretable classification of lumbar spinal stenosis and facet arthropathy from axial MRI. Eur Radiol 2023; 33:3435-3443. [PMID: 36920520 PMCID: PMC10566647 DOI: 10.1007/s00330-023-09483-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/09/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To evaluate a deep learning model for automated and interpretable classification of central canal stenosis, neural foraminal stenosis, and facet arthropathy from lumbar spine MRI. METHODS T2-weighted axial MRI studies of the lumbar spine acquired between 2008 and 2019 were retrospectively selected (n = 200) and graded for central canal stenosis, neural foraminal stenosis, and facet arthropathy. Studies were partitioned into patient-level train (n = 150), validation (n = 20), and test (n = 30) splits. V-Net models were first trained to segment the dural sac and the intervertebral disk, and localize facet and foramen using geometric rules. Subsequently, Big Transfer (BiT) models were trained for downstream classification tasks. An interpretable model for central canal stenosis was also trained using a decision tree classifier. Evaluation metrics included linearly weighted Cohen's kappa score for multi-grade classification and area under the receiver operator characteristic curve (AUROC) for binarized classification. RESULTS Segmentation of the dural sac and intervertebral disk achieved Dice scores of 0.93 and 0.94. Localization of foramen and facet achieved intersection over union of 0.72 and 0.83. Multi-class grading of central canal stenosis achieved a kappa score of 0.54. The interpretable decision tree classifier had a kappa score of 0.80. Pairwise agreement between readers (R1, R2), (R1, R3), and (R2, R3) was 0.86, 0.80, and 0.74. Binary classification of neural foraminal stenosis and facet arthropathy achieved AUROCs of 0.92 and 0.93. CONCLUSION Deep learning systems can be performant as well as interpretable for automated evaluation of lumbar spine MRI including classification of central canal stenosis, neural foraminal stenosis, and facet arthropathy. KEY POINTS • Interpretable deep-learning systems can be developed for the evaluation of clinical lumbar spine MRI. Multi-grade classification of central canal stenosis with a kappa of 0.80 was comparable to inter-reader agreement scores (0.74, 0.80, 0.86). Binary classification of neural foraminal stenosis and facet arthropathy achieved favorable and accurate AUROCs of 0.92 and 0.93, respectively. • While existing deep-learning systems are opaque, leading to clinical deployment challenges, the proposed system is accurate as well as interpretable, providing valuable information to a radiologist in clinical practice.
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Affiliation(s)
- Upasana Upadhyay Bharadwaj
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA.
| | - Miranda Christine
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Steven Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Cynthia T Chin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
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Huang W, Gong Z, Wang H, Zheng C, Chen Y, Xia X, Ma X, Jiang J. Use of MRI-based vertebral bone quality score (VBQ) of S1 body in bone mineral density assessment for patients with lumbar degenerative diseases. 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 2023; 32:1553-1560. [PMID: 36935451 DOI: 10.1007/s00586-023-07643-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/23/2023] [Accepted: 03/05/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE To evaluate the use of the modified and simplified vertebral bone quality (VBQ) method based on T1-weighted MRI images of S1 vertebrae in assessing bone mineral density (BMD) for patients with lumbar degenerative diseases. METHODS We reviewed the preoperative data of patients with lumbar degenerative diseases undergoing lumbar spine surgery between January 2019 and June 2022 with available non-contrast T1-weighted magnetic resonance imaging (MRI), computed tomography (CT) images and dual-energy X-ray absorptiometry (DEXA). S1 vertebral bone quality scores (S1 VBQ) and S1 CT Hounsfield units were measured with picture archiving and communication system (PACS). One-way ANOVA was applied to present the discrepancy between the S1 VBQ of patients with normal bone density (T-score ≥ - 1.0), osteopenia (- 2.5 < T-score < - 1.0) and osteoporosis (T-score ≤ - 2.5). The receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic performance of S1 VBQ in distinguishing low BMD. Statistical significance was set at p < 0.05. RESULTS A total of 207 patients were included. The S1 VBQ were significantly different between groups (p < 0.001). Interclass correlation coefficient for inter-rater reliability was 0.86 (95% CI 0.78-0.94) and 0.94(95% CI 0.89-0.98) for intra-rater reliability. According to the linear regression analysis, the S1 VBQ has moderate-to-strong correlations with DEXA T-score (r = - 0.48, p < 0.001). The area under the ROC curve indicated a predictive accuracy of 82%. A sensitivity of 77.25% with a specificity of 70% could be achieved for distinguishing low BMD by setting the S1 VBQ cutoff as 2.93. CONCLUSIONS The S1 VBQ was a promising tool in distinguishing poor bone quality in patients with lumbar degenerative diseases, especially in cases where the previously reported VBQ method based on L1-L4 was not available. S1 VBQ score could be useful as opportunistic assessment for screening and complementary evaluation to DEXA T-score before surgery.
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Affiliation(s)
- Weibo Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Zhaoyang Gong
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Chaojun Zheng
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Yu Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Xinlei Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China.
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Relationship between lumbar spinal stenosis and cauda equina movement during the Valsalva maneuver. Skeletal Radiol 2023; 52:1349-1358. [PMID: 36609720 DOI: 10.1007/s00256-022-04274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To confirm the relationship between lumbar spinal stenosis (LSS) and cauda equina movement during the Valsalva maneuver. MATERIALS AND METHODS Two radiologists at our institution independently evaluated cauda equina movement on pelvic cine MRI, which was performed for urethrorrhea after prostatectomy or pelvic prolapse in 105 patients (99 males; mean age: 69.0 [range: 50-78] years), who also underwent abdominopelvic CT within 2 years before or after the MRI. The qualitative assessment of the cine MRI involved subjective determination of the cauda equina movement type (non-movement, flutter, and inchworm-manner). The severity of LSS on abdominopelvic CT was quantified using our LSS scoring system and performed between L1/2 and L5/S1. We calculated the average LSS scores of two analysts and extracted the worst scores among all levels. RESULTS Cauda equina movement was observed in 15 patients (14%), inchworm-manner in 10 patients, and flutter in five patients. Participants with cauda equina movement demonstrated significantly higher LSS scores than those without movement (P < 0.001, Wilcoxon's rank-sum test). A significant difference was observed in the worst LSS scores between participants without movement and those with inchworm-manner movement (P < 0.001, Bonferroni's corrected). There were no significant differences between participants without movement and those with flutter movement (P = 0.3156) and between participants with flutter movement and those with inchworm-manner movement (P = 0.4843). CONCLUSION Cauda equina movement in cine MRI during the Valsalva maneuver is occasionally observed in patients with severe LSS, and may be associated with pathogenesis of redundant nerve roots.
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Kawakami M, Takeshita K, Inoue G, Sekiguchi M, Fujiwara Y, Hoshino M, Kaito T, Kawaguchi Y, Minetama M, Orita S, Takahata M, Tsuchiya K, Tsuji T, Yamada H, Watanabe K. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar spinal stenosis, 2021 - Secondary publication. J Orthop Sci 2023; 28:46-91. [PMID: 35597732 DOI: 10.1016/j.jos.2022.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Japanese Orthopaedic Association (JOA) guideline for the management of lumbar spinal stenosis (LSS) was first published in 2011. Since then, the medical care system for LSS has changed and many new articles regarding the epidemiology and diagnostics of LSS, conservative treatments such as new pharmacotherapy and physical therapy, and surgical treatments including minimally invasive surgery have been published. In addition, various issues need to be examined, such as verification of patient-reported outcome measures, and the economic effect of revised medical management of patients with lumbar spinal disorders. Accordingly, in 2019 the JOA clinical guidelines committee decided to update the guideline and consequently established a formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline, incorporating the recent advances of evidence-based medicine. METHODS The JOA LSS guideline formulation committee revised the previous guideline based on the method for preparing clinical guidelines in Japan proposed by the Medical Information Network Distribution Service in 2017. Background and clinical questions were determined followed by a literature search related to each question. Appropriate articles based on keywords were selected from all the searched literature. Using prepared structured abstracts, systematic reviews and meta-analyses were performed. The strength of evidence and recommendations for each clinical question was decided by the committee members. RESULTS Eight background and 15 clinical questions were determined. Answers and explanations were described for the background questions. For each clinical question, the strength of evidence and the recommendation were both decided, and an explanation was provided. CONCLUSIONS The 2021 clinical practice guideline for the management of LSS was completed according to the latest evidence-based medicine. We expect that this guideline will be useful for all medical providers as an index in daily medical care, as well as for patients with LSS.
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Affiliation(s)
| | | | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | - Yasushi Fujiwara
- Department of Orthopaedic Surgery, Hiroshima City Asa Citizens Hospital, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City General Hospital, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University, Japan
| | | | - Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Japan
| | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University, Japan
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Bharadwaj UU, Ben-Natan AR, Huang J, Pedoia V, Chou D, Majumdar S, Link TM, Chin CT. Evaluation of 2 Novel Ratio-Based Metrics for Lumbar Spinal Stenosis. AJNR Am J Neuroradiol 2022; 43:1530-1538. [PMID: 36109122 PMCID: PMC9575539 DOI: 10.3174/ajnr.a7638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/25/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Quantitative metrics of the dural sac such as the cross-sectional area are commonly used to evaluate central canal stenosis. The aim of this study was to analyze 2 new metrics to measure spinal stenosis on the basis of the ratio between the dural sac and disc cross-sectional areas (DDRCA) and the dural sac and disc anterior-posterior diameters (DDRDIA) and compare them with established quantitative metrics of the dural sac. MATERIALS AND METHODS T2-weighted axial MR images (n = 260 patients) were retrospectively evaluated, graded for central canal stenosis as normal (no stenosis), mild, moderate, or severe from L1/L2 through L5/S1 with 1 grade per spinal level and annotated to measure the DDRCA and DDRDIA. Thresholds were obtained using a decision tree classifier on a subset of patients (n = 130) and evaluated on the remaining patients (n = 130) for accuracy and consistency across demographics, anatomic variation, and clinical outcomes. RESULTS DDRCA and DDRDIA had areas under the receiver operating characteristic curve of 98.6 (97.4-99.3) and 98.0 (96.7-98.9) compared with dural sac cross-sectional area at 96.5 (95.0-97.7) for binary classification. DDRDIA and DDRCA had κ scores of 0.75 (0.71-0.79) and 0.80 (0.75-0.83) compared with dural sac cross-sectional area at 0.62 (0.57-0.66) for multigrade classification. No significant differences (P > .1) in the area under the receiver operating characteristic curve were observed for the DDRDIA across variations in the body mass index. The DDRDIA also had the highest area under the receiver operating characteristic curve among symptomatic patients (visual analog scale ≥ 7) or patients who underwent surgery. CONCLUSIONS Ratio-based metrics (DDRDIA and DDRCA) are accurate and robust to anatomic and demographic variability compared with quantitative metrics of the dural sac and better correlated with symptomatology and surgical outcomes.
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Affiliation(s)
- U U Bharadwaj
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
| | - A R Ben-Natan
- Neurological Surgery (A.R.B.-N., J.H., D.C.), University of California San Francisco, San Francisco, California
| | - J Huang
- Neurological Surgery (A.R.B.-N., J.H., D.C.), University of California San Francisco, San Francisco, California
| | - V Pedoia
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
| | - D Chou
- Neurological Surgery (A.R.B.-N., J.H., D.C.), University of California San Francisco, San Francisco, California
| | - S Majumdar
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
| | - T M Link
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
| | - C T Chin
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
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11
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Yamakuni R, Ishikawa H, Hasegawa O, Sekino H, Ishii S, Otani K, Ito H. Cauda equina movement during the Valsalva maneuver in two patients with Lumbar spinal canal stenosis. Fukushima J Med Sci 2022; 68:135-141. [PMID: 35979579 PMCID: PMC9493334 DOI: 10.5387/fms.2022-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lumbar spinal canal stenosis (LSS) is a common spinal disorder among older people. Some LSS patients say that their pain worsens when they lift heavy objects. The Valsalva maneuver is the optimal breathing pattern for producing maximal force. Herein, we present two cases of LSS where the movement of the cauda equina was observed during the Valsalva maneuver.
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Affiliation(s)
- Ryo Yamakuni
- Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | | | - Osamu Hasegawa
- Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | - Hirofumi Sekino
- Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | - Shiro Ishii
- Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | - Koji Otani
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine
| | - Hiroshi Ito
- Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
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12
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Weisenthal BW, Glassman SD, Mkorombindo T, Nelson L, Carreon LY. When does CT myelography add value beyond MRI for lumbar degenerative disease? Spine J 2022; 22:787-792. [PMID: 34848342 DOI: 10.1016/j.spinee.2021.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In patients with lumbar spinal stenosis, it is crucial for clinicians to identify all symptomatic levels. Prior studies have demonstrated that CT myelography has a greater sensitivity in revealing stenosis (94.4%) compared to MRI (75.9%). However, this is an invasive test that should be used judiciously. No study has identified subgroups of patients that do or do not benefit from this additional invasive testing. PURPOSE The objective of this study was to identify subgroups of patients with lumbar stenosis for whom CT myelogram could be expected to provide additional information following an MRI scan. STUDY DESIGN Retrospective chart review. PATIENT SAMPLE Consecutive series of patients with lumbar degenerative disease seen at a single multisurgeon tertiary spine center. OUTCOME MEASURES Degree of stenosis on MRI or CT myelo. METHODS Medical records were reviewed to collect standard demographic and surgical data and patient diagnoses. MRI and CT myelo obtained within 6 months of each other in patients >45 years old with a diagnosis of central stenosis, spondylolisthesis or degenerative scoliosis were reviewed. Each lumbar level was recorded as mild, moderate, or severe based on the radiologist's report. Fisher exact test was performed with change in recorded severity of stenosis from MRI to CT myelo as the primary outcome of interest. RESULTS Of 269 patients, 207 (80%) had at least one level of moderate or severe central stenosis on MRI and 62 had mild or no stenosis on MRI. Of the 207, 139 (67%) had multilevel stenosis and 68 (33%) had single level stenosis. CT myelo identified a greater proportion of additional stenotic levels in patients with multilevel stenosis (80/139, 58%) compared to patients with single-level stenosis (27/68, 40%, p=.018). In 62 patients with a clinical diagnosis of lumbar stenosis but no moderate to severe stenosis on MRI, CT myelogram identified three additional stenotic levels (3/65, 5%, p=.836). CONCLUSIONS CT myelography is not as useful in providing additional information in patients with no stenosis or single level stenosis as compared to patients with multilevel stenosis.
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Affiliation(s)
- Benjamin W Weisenthal
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA
| | - Tino Mkorombindo
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA
| | - Lauren Nelson
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA.
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13
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Deer TR, Grider JS, Pope JE, Lamer TJ, Wahezi SE, Hagedorn JM, Falowski S, Tolba R, Shah JM, Strand N, Escobar A, Malinowski M, Bux A, Jassal N, Hah J, Weisbein J, Tomycz ND, Jameson J, Petersen EA, Sayed D. Best Practices for Minimally Invasive Lumbar Spinal Stenosis Treatment 2.0 (MIST): Consensus Guidance from the American Society of Pain and Neuroscience (ASPN). J Pain Res 2022; 15:1325-1354. [PMID: 35546905 PMCID: PMC9084394 DOI: 10.2147/jpr.s355285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Methods Results Discussion Conclusion
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Affiliation(s)
- Timothy R Deer
- Centers for Pain Relief, Charleston, WV, USA
- Correspondence: Timothy R Deer, The Spine and Nerve Centers of the Virginias, 400 Court Street, Suite 100, Charleston, WV, 25301, USA, Tel +1 304 347-6141, Email
| | - Jay S Grider
- UK HealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Tim J Lamer
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Sayed E Wahezi
- Montefiore Medical Center, SUNY-Buffalo, Buffalo, NY, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Steven Falowski
- Director Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Reda Tolba
- Pain Management Department, Anesthesiology Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Jay M Shah
- SamWell Institute for Pain Management, Colonia, NJ, USA
| | - Natalie Strand
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Alex Escobar
- Department of Anesthesiology and Pain Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | | | - Anjum Bux
- Bux Pain Management, Lexington, KY, USA
| | | | - Jennifer Hah
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | | | - Nestor D Tomycz
- Department of Neurological Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Dawood Sayed
- Pain Medicine, Multidisciplinary Pain Fellowship, The University of Kansas Health System, Kansas City, KS, USA
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14
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Diagnostic accuracy of color-coded virtual noncalcium reconstructions derived from portal venous phase dual-energy CT in the assessment of lumbar disk herniation. Eur Radiol 2021; 32:2168-2177. [PMID: 34820684 PMCID: PMC8921028 DOI: 10.1007/s00330-021-08354-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/02/2021] [Accepted: 09/24/2021] [Indexed: 11/03/2022]
Abstract
Objectives To investigate the diagnostic accuracy of color-coded contrast-enhanced dual-energy CT virtual noncalcium (VNCa) reconstructions for the assessment of lumbar disk herniation compared to unenhanced VNCa imaging. Methods A total of 91 patients were retrospectively evaluated (65 years ± 16; 43 women) who had undergone third-generation dual-source dual-energy CT and 3.0-T MRI within an examination interval up to 3 weeks between November 2019 and December 2020. Eight weeks after assessing unenhanced color-coded VNCa reconstructions for the presence and degree of lumbar disk herniation, corresponding contrast-enhanced portal venous phase color-coded VNCa reconstructions were independently analyzed by the same five radiologists. MRI series were additionally analyzed by one highly experienced musculoskeletal radiologist and served as reference standard. Results MRI depicted 210 herniated lumbar disks in 91 patients. VNCa reconstructions derived from contrast-enhanced CT scans showed similar high overall sensitivity (93% vs 95%), specificity (94% vs 95%), and accuracy (94% vs 95%) for the assessment of lumbar disk herniation compared to unenhanced VNCa images (all p > .05). Interrater agreement in VNCa imaging was excellent for both, unenhanced and contrast-enhanced CT (κ = 0.84 vs κ = 0.86; p > .05). Moreover, ratings for diagnostic confidence, image quality, and noise differed not significantly between unenhanced and contrast-enhanced VNCa series (all p > .05). Conclusions Color-coded VNCa reconstructions derived from contrast-enhanced dual-energy CT yield similar diagnostic accuracy for the depiction of lumbar disk herniation compared to unenhanced VNCa imaging and therefore may improve opportunistic retrospective lumbar disk herniation assessment, particularly in case of staging CT examinations. Key Points • Color-coded dual-source dual-energy CT virtual noncalcium (VNCa) reconstructions derived from portal venous phase yield similar high diagnostic accuracy for the assessment of lumbar disk herniation compared to unenhanced VNCa CT series (94% vs 95%) with MRI serving as a standard of reference. • Diagnostic confidence, image quality, and noise levels differ not significantly between unenhanced and contrast-enhanced portal venous phase VNCa dual-energy CT series. • Dual-source dual-energy CT might have the potential to improve opportunistic retrospective lumbar disk herniation assessment in CT examinations performed for other indications through reconstruction of VNCa images.
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15
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Assessment of thoracic disk herniation by using virtual noncalcium dual-energy CT in comparison with standard grayscale CT. Eur Radiol 2021; 31:9221-9231. [PMID: 34076743 PMCID: PMC8589804 DOI: 10.1007/s00330-021-07989-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/04/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
Objectives To determine the diagnostic accuracy of dual-energy CT (DECT) virtual noncalcium (VNCa) reconstructions for assessing thoracic disk herniation compared to standard grayscale CT. Methods In this retrospective study, 87 patients (1131 intervertebral disks; mean age, 66 years; 47 women) who underwent third-generation dual-source DECT and 3.0-T MRI within 3 weeks between November 2016 and April 2020 were included. Five blinded radiologists analyzed standard DECT and color-coded VNCa images after a time interval of 8 weeks for the presence and degree of thoracic disk herniation and spinal nerve root impingement. Consensus reading of independently evaluated MRI series served as the reference standard, assessed by two separate experienced readers. Additionally, image ratings were carried out by using 5-point Likert scales. Results MRI revealed a total of 133 herniated thoracic disks. Color-coded VNCa images yielded higher overall sensitivity (624/665 [94%; 95% CI, 0.89–0.96] vs 485/665 [73%; 95% CI, 0.67–0.80]), specificity (4775/4990 [96%; 95% CI, 0.90–0.98] vs 4066/4990 [82%; 95% CI, 0.79–0.84]), and accuracy (5399/5655 [96%; 95% CI, 0.93–0.98] vs 4551/5655 [81%; 95% CI, 0.74–0.86]) for the assessment of thoracic disk herniation compared to standard CT (all p < .001). Interrater agreement was excellent for VNCa and fair for standard CT (ϰ = 0.82 vs 0.37; p < .001). In addition, VNCa imaging achieved higher scores regarding diagnostic confidence, image quality, and noise compared to standard CT (all p < .001). Conclusions Color-coded VNCa imaging yielded substantially higher diagnostic accuracy and confidence for assessing thoracic disk herniation compared to standard CT. Key Points • Color-coded VNCa reconstructions derived from third-generation dual-source dual-energy CT yielded significantly higher diagnostic accuracy for the assessment of thoracic disk herniation and spinal nerve root impingement compared to standard grayscale CT. • VNCa imaging provided higher diagnostic confidence and image quality at lower noise levels compared to standard grayscale CT. • Color-coded VNCa images may potentially serve as a viable imaging alternative to MRI under circumstances where MRI is unavailable or contraindicated.
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16
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Kim HJ, Kim H, Kim YT, Sohn CH, Kim K, Kim DJ. Cerebrospinal fluid dynamics correlate with neurogenic claudication in lumbar spinal stenosis. PLoS One 2021; 16:e0250742. [PMID: 33979373 PMCID: PMC8115821 DOI: 10.1371/journal.pone.0250742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
Neurogenic claudication is a typical manifestation of lumbar spinal stenosis (LSS). However, its pathophysiology is still unclear. The severity of clinical symptoms has been shown not to correlate with the degree of structural stenosis. Altered cerebrospinal fluid (CSF) flow has been suggested as one of the causative factors of LSS. The objectives of this study were to compare CSF dynamics at the lumbosacral level between patients with LSS and healthy controls and to investigate whether CSF dynamics parameters explain symptom severity in LSS. Phase-contrast magnetic resonance imaging (PC-MRI) was conducted to measure CSF dynamics in 18 healthy controls and 9 patients with LSS. Cephalic peak, caudal peak, and peak-to-peak CSF velocities were evaluated at the lumbosacral level in the patients and controls. The power of CSF dynamics parameters to predict symptom severity was determined using a linear regression analysis adjusted for demographic and structural variables. Significantly attenuated CSF flow velocity was observed in the patients compared with the controls. The cephalic peak, caudal peak, and peak-to-peak velocities at the lumbar level were greater in the controls than in the patients (p<0.001). The predictive power increased most when the peak-to-peak velocity was added (adjusted R2 = 0.410) to the model with age, body mass index, and the minimum anterior-posterior diameter (adjusted R2 = 0.306), and the peak-to-peak velocity was the only statistically significant variable. CSF dynamics variables showed an association with the severity of LSS symptoms, independent of structural stenosis. PC-MRI can help to further our understanding of the pathophysiology of neurogenic claudication and support the diagnosis of LSS.
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Affiliation(s)
- Hyun-Ji Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Hakseung Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Young-Tak Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, College of Medicine, Seoul, South Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, College of Medicine, Seoul, South Korea
- * E-mail: (DJK); (KK)
| | - Dong-Joo Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
- * E-mail: (DJK); (KK)
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17
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Booz C, Yel I, Martin SS, Lenga L, Eichler K, Wichmann JL, Vogl TJ, Albrecht MH. Incremental Diagnostic Value of Virtual Noncalcium Dual-Energy Computed Tomography for the Depiction of Cervical Disk Herniation Compared With Standard Gray-Scale Computed Tomography. Invest Radiol 2021; 56:207-214. [PMID: 33109918 DOI: 10.1097/rli.0000000000000734] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigative the diagnostic accuracy of colored dual-energy computed tomography (CT) virtual noncalcium (VNCa) series for analyzing cervical disk herniation compared with standard gray-scale CT images, with magnetic resonance imaging (MRI) serving as standard of reference. MATERIALS AND METHODS Data from 57 patients who underwent noncontrast dual-source CT and 3.0-Tesla (T) MRI within 2 weeks between January 2017 and December 2018 were retrospectively analyzed. Five radiologists analyzed standard gray-scale dual-energy CT scans for the presence and degree of cervical disk herniation and spinal nerve root impingement. Readers reassessed scans after 8 weeks using colored VNCa series. Two experienced radiologists set the reference standard in consensus MRI reading sessions. Primary indices of diagnostic accuracy for both CT approaches were sensitivity and specificity, which were compared by application of the McNemar test. RESULTS A total of 57 patients (mean age, 64 ± 11 years; 30 women) were evaluated (337 intervertebral disks). Magnetic resonance imaging indicated a total of 103 cervical disk herniations. The VNCa reconstructions had higher overall sensitivity compared with gray-scale CT (487/515 [95%; 95% confidence interval (CI), 91%-98%] vs 392/515 [76%; 95% CI, 70%-83%]), as well as higher specificity (1107/1170 [95%; 95% CI, 90%-99%] vs 906/1170 [77%; 95% CI, 72%-82%]) for assessing cervical disk herniation (all P < 0.001). The VNCa reconstructions had higher diagnostic accuracy for analyzing spinal nerve root impingement in comparison with gray-scale CT (sensitivity, 195/230 [85%; 95% CI, 79%-90%] vs 115/230 [50%; 95% CI, 40%-59%]; specificity, 1430/1455 [98%; 95% CI, 94%-100%] vs 1325/1455 [91%; 95% CI, 88%-98%]; accuracy, 1625/1685 [96%; 95% CI, 93%-99%] vs 1440/1685 [86%; 95% CI, 82%-90%]; all P < 0.001). CONCLUSIONS Color-coded VNCa series improved the diagnostic accuracy for assessing cervical disk herniation and spinal nerve root impingement compared with standard gray-scale CT.
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Affiliation(s)
- Christian Booz
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology
| | - Ibrahim Yel
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology
| | - Simon S Martin
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology
| | - Lukas Lenga
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Julian L Wichmann
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Moritz H Albrecht
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology
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Shepard N, Samim M, Kim Y, Razi A. A Practical Approach to Spine Magnetic Resonance Imaging. JBJS Rev 2021; 8:e0099. [PMID: 32224632 DOI: 10.2106/jbjs.rvw.19.00099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Magnetic resonance imaging (MRI) plays an important role in the evaluation of patients with spine disorders, providing excellent evaluation of both normal and pathologic anatomy. Interpreting MRI findings can be difficult as anatomic abnormalities may not correlate with clinical symptoms and MRI may show abnormal findings in asymptomatic individuals. Using a systematic approach to interpreting a spinal MRI can help to achieve an accurate diagnosis and guide therapeutic decision-making, surgical intervention, and treatment monitoring.
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Affiliation(s)
- Nicholas Shepard
- Departments of Orthopedic Surgery (N.S. and Y.K.) and Radiology (M.S.), NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Mohammad Samim
- Departments of Orthopedic Surgery (N.S. and Y.K.) and Radiology (M.S.), NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Yong Kim
- Departments of Orthopedic Surgery (N.S. and Y.K.) and Radiology (M.S.), NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Afshin Razi
- Department of Orthopedic Surgery, Maimonides Hospital Center, Brooklyn, New York
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Abstract
The spine is an anchoring structure that is the base for mechanical motion of the body and a protector of neuroelements. Spinal disorders continue to plague generations with issues. Management options continue to evolve, allowing for operative and nonoperative pathways to treat underlying causes. Positive patient outcomes and long-term relief are achieved through evidence-based practice and innovative trends. The future of spine care will continue to push boundaries, allowing patients to return to activity at a much faster rate, with decreased restrictions and lower rates of future complications.
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Affiliation(s)
- Dorothy Pietrowski
- Department of Orthopaedic Surgery and Rehabilitative Services, University of Chicago, 5841 South Maryland MC3079, Chicago, IL 60637, USA.
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20
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Khalsa SS, Kim HS, Singh R, Kashlan ON. Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis. Neurosurg Focus 2019; 46:E10. [DOI: 10.3171/2019.2.focus18617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/26/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVELumbar central stenosis can theoretically be decompressed with minimal bone removal via an endoscopic approach. Although multiple studies have demonstrated an adequate radiographic decompression, none has quantified the volume of bone removal after endoscopic decompression. The objective of this study was to quantify the 3D volume of bone removed from the lamina and facet joints during endoscopic decompression for lumbar central and lateral recess stenosis.METHODSThis retrospective study included adults with lumbar spinal stenosis who underwent endoscopic decompression of a single level or 2 noncontiguous lumbar levels. Central stenosis on MRI was graded preoperatively and postoperatively using the Schizas scale. A computer program was developed in MATLAB to semiautomatically perform a 3D volumetric analysis of preoperative and postoperative lumbar CT scans. The volumetric percentage of bone removed from the lamina and facet joints ipsilateral and contralateral to the side of approach was quantified.RESULTSNineteen patients with 21 treated lumbar levels were included in the study. Preoperatively, the number of levels with Schizas stenosis grades B, C, and D were 5, 12, and 4, respectively. Stenosis grades improved postoperatively to grades A, B, C, and D for 17, 3, 1, and 0 levels, respectively. All levels improved by at least 1 stenosis grade. The volumetric percentage of laminar bone removed was 15.5% (95% CI 11.2%–19.8%, p < 0.001) from the ipsilateral lamina and 8.8% (95% CI 5.7%–11.8%, p < 0.001) from the contralateral lamina. The percentage of facet joint resection was 5.3% (95% CI 4.2%–6.4%, p < 0.001) and 4.3% (95% CI 2.2%–6.4%, p < 0.001) for the ipsilateral and contralateral facet joints, respectively. Average pain scores, as measured by the visual analog scale, improved from 7.9 preoperatively to 2.2 by 3–10 months postoperatively (p < 0.001).CONCLUSIONSEndoscopic lumbar decompression achieves improvement in the radiographic grade of lumbar central stenosis with minimal bone removal from the lamina and facet joints. Future prospective studies are needed to validate the findings of this study with more comprehensive clinical outcomes.
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Affiliation(s)
- Siri Sahib Khalsa
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and
| | - Hyeun Sung Kim
- 2Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Ravindra Singh
- 2Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Osama Nezar Kashlan
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and
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Lee BS, Nault R, Grabowski M, Whiting B, Tanenbaum J, Knusel K, Poturalski M, Emch T, Mroz TE, Steinmetz MP. Utility of repeat magnetic resonance imaging in surgical patients with lumbar stenosis without disc herniation. Spine J 2019; 19:191-198. [PMID: 30600156 DOI: 10.1016/j.spinee.2018.06.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/24/2018] [Accepted: 06/26/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Routine use of magnetic resonance imaging (MRI) as a diagnostic tool in lumbar stenosis is becoming more prevalent due to the aging population. Currently, there is no clinical guideline to clarify the utility of repeat MRI in patients with lumbar stenosis, without instability, neurological deficits, or disc herniation. PURPOSE To evaluate the utility of routine use of MRI as a diagnostic tool in lumbar stenosis, and to help formulate clinical guidelines on the appropriate use of preoperative imaging for lumbar stenosis. STUDY DESIGN/SETTING Retrospective radiographic analysis. PATIENT SAMPLE Retrospective chart review was performed to review patients with lumbar stenosis, who underwent lumbar decompression without fusion from 2011 to 2015 at a single institution. OUTCOME MEASURES Previously established stenosis grading systems were used to measure and compare the initial and the subsequent repeat lumbar MRIs performed preoperatively. If patients were found to have a moderate or severe grade change, and if the surgical plan was altered due to such exacerbated radiographic findings, then their grade changes were considered clinically meaningful. METHODS We identified patients with lumbar stenosis without radiographic instability or neurological deficits, who had at least two preoperative lumbar MRIs performed and underwent decompressive surgeries. At each pathologic disc level, the absolute value of the change in grade for central and lateral recess stenosis, right foraminal stenosis, and left foraminal stenosis from the first preoperative MRI to the repeated MRI was calculated. These changed data were then used to calculate the mean and median changes in each of the three types of stenosis for each pathologic disc level. Identical calculations were carried out for the subsample of patients who only underwent discectomy or had a discectomy included as part of their surgery. RESULTS Among the 103 patients who met the inclusion criteria, 37 of those patients had more than one level surgically addressed, and a total of 161 lumbar levels were reviewed. Among the subset of patients that had any grade change, the majority of the grades only had a mild change of 1 (36 out of 42 patients, 85.7%, 95% confidence interval [CI]: 73.1%-94.1%); there was a moderate grade change of 2 in two patients (4.8%, CI: 0.8%-14.0%), and a severe change of 3 in one patient (2.4%, CI: 0.2%-10.1%). There were three patients with decreased grade change (7.1%, CI: 1.8%-17.5%). All clinically meaningful grade changes were from the subset of patients who had only discectomy or discectomy as part of the procedure. Lastly, both patients that had a clinically meaningful grade change had their MRIs performed at an interval of greater than 360 days. CONCLUSIONS The radiographic evaluation of the utility of routinely repeated MRIs in lumbar stenosis without instability, neurological deficits, or disc herniations demonstrated that there were no significant changes found in the repeated MRI in the preoperative setting, especially if the MRIs were performed less than one year apart. The results of this present study can help to standardize the diagnostic evaluation of lumbar stenosis and to formulate clinical guidelines on the appropriate use of preoperative imaging for lumbar stenosis patients.
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Affiliation(s)
- Bryan S Lee
- Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Rod Nault
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Matthew Grabowski
- Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin Whiting
- Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Tanenbaum
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Department of Population and Quantitative Health Science, Case Western Reserve University, Cleveland, OH, USA
| | - Konrad Knusel
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Matthew Poturalski
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Todd Emch
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas E Mroz
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael P Steinmetz
- Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Çelebi UO, Burulday V, Özveren MF, Doğan A, Akgül MH. Sonoelastographic evaluation of the sciatic nerve in patients with unilateral lumbar disc herniation. Skeletal Radiol 2019; 48:129-136. [PMID: 29982854 DOI: 10.1007/s00256-018-3020-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/21/2018] [Accepted: 06/24/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to compare strain elastography (SE) and shear wave elastography (SWE) findings of the sciatic nerve in patients with unilateral lumbar disc herniation (LDH) and healthy control subjects. MATERIALS AND METHODS The study group included patients with complaints of unilateral sciatica for 3-12 months, with foraminal stenosis due to one level of LDH (L4-L5 or L5-S1). An age- and gender-matched control group was formed of healthy subjects. Evaluations were performed on both the axial and longitudinal planes from the bilateral gluteal region using a 5-9 MHz multifrequency convex probe. RESULTS There were 40 patients (20 male, 20 female) with a mean age of 43.1 ± 12.7 years in the study group, and 40 healthy subjects (22 male, 18 female) with a mean age of 42.9 ± 10.7 years in the control group (p > 0.05). The sciatic nerve stiffness assessed on both the axial (12.3 ± 3.7 kPA) and longitudinal (14.3 ± 3.8 kPA) planes of the involved side was significantly higher than non-involved side (axial: 6.8 ± 2.1 and longitudinal: 8.3 ± 2.3 kPA) in the patient group (p < 0.001). CONCLUSIONS Patients with unilateral LDH have increased stiffness of the sciatic nerve compared to healthy control subjects. Although the findings in this preliminary study show that shear wave elastography can detect a change in sciatic nerve stiffness in patients with unilateral LDH, larger studies are required to determine the clinical utility of this technique.
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Affiliation(s)
- Umut Orkun Çelebi
- Department of Radiology, Kirikkale University School of Medicine, Yahsihan, 71450, Kirikkale, Turkey
| | - Veysel Burulday
- Department of Radiology, Kirikkale University School of Medicine, Yahsihan, 71450, Kirikkale, Turkey.
| | - Mehmet Faik Özveren
- Department of Neurosurgery, Kirikkale University School of Medicine, Yahsihan, 71450, Kirikkale, Turkey
| | - Adil Doğan
- Department of Radiology, Kirikkale University School of Medicine, Yahsihan, 71450, Kirikkale, Turkey
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Booz C, Nöske J, Martin SS, Albrecht MH, Yel I, Lenga L, Gruber-Rouh T, Eichler K, D'Angelo T, Vogl TJ, Wichmann JL. Virtual Noncalcium Dual-Energy CT: Detection of Lumbar Disk Herniation in Comparison with Standard Gray-scale CT. Radiology 2018; 290:446-455. [PMID: 30615548 DOI: 10.1148/radiol.2018181286] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess the diagnostic performance of dual-energy CT with reconstruction of virtual noncalcium (VNCa) images for the detection of lumbar disk herniation compared with standard CT image reconstruction. Materials and Methods For this retrospective study, 41 patients (243 intervertebral disks; overall mean age, 68 years; 24 women [mean age, 68 years] and 17 men [mean age, 68 years]) underwent clinically indicated third-generation, dual-source, dual-energy CT and 3.0-T MRI within 2 weeks between March 2017 and January 2018. Six radiologists, blinded to clinical and MRI information, independently evaluated conventional gray-scale dual-energy CT series for the presence and degree of lumbar disk herniation and spinal nerve root impingement. After 8 weeks, readers reevaluated examinations by using color-coded VNCa reconstructions. MRI evaluated by two separate experienced readers, blinded to clinical and dual-energy CT information, served as the standard of reference. Sensitivity and specificity were the primary metrics of diagnostic performance. Results A total of 112 herniated lumbar disks were depicted at MRI. VNCa showed higher overall sensitivity (612 of 672 [91%] vs 534 of 672 [80%]) and specificity (723 of 786 [92%] vs 665 of 786 [85%]) for detecting lumbar disk herniation compared with standard CT (all comparisons, P < .001). Interreader agreement was excellent for VNCa and substantial for standard CT (κ = 0.82 vs 0.67; P < .001). VNCa achieved superior diagnostic confidence, image quality, and noise scores compared with standard CT (all comparisons, P < .001). Conclusion Color-coded dual-energy CT virtual noncalcium reconstructions show substantially higher diagnostic performance and confidence for depicting lumbar disk herniation compared with standard CT. © RSNA, 2018.
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Affiliation(s)
- Christian Booz
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Jochen Nöske
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Simon S Martin
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Moritz H Albrecht
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Ibrahim Yel
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Lukas Lenga
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Tatjana Gruber-Rouh
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Katrin Eichler
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Tommaso D'Angelo
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Thomas J Vogl
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Julian L Wichmann
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
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Is there a Correlation Between Degree of Radiologic Lumbar Spinal Stenosis and its Clinical Manifestation? Clin Spine Surg 2018; 31:E403-E408. [PMID: 29939845 DOI: 10.1097/bsd.0000000000000681] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN This was an observational cross-sectional study. OBJECTIVE The purpose of this study was to evaluate whether the degree of stenosis on magnetic resonance imaging (MRI) relates to the severity of clinical symptoms, disability, or neurological deficit in patients with symptomatic central lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA The relationship between radiologic findings and the clinical manifestations of LSS remains unclear. MATERIALS AND METHODS A total of 84 patients (42 men, median age 70 y) with neurogenic claudication and central degenerative LSS were included in the study. The MRI parameters describing severity (anteroposterior diameter of dural sac, cross-sectional area of the dural sac, stenosis ratio, and Schizas qualitative morphologic classification were evaluated at maximum stenotic level) and the extent of stenosis (the number of central stenotic levels) were correlated to symptoms (pain intensity, walking capacity), functional disability (measured in terms of the Oswestry Disability Index), and neurological signs of LSS (neurological status was evaluated and scored by Neurological Impairment Score in LSS). RESULTS A statistically significant correlation emerged only between the Neurological Impairment Score in LSS and Schizas morphologic classification (P=0.006). Pain intensity, walking capacity, and functional disability displayed no correlation with the MRI parameters of LSS. CONCLUSIONS LSS is a clinicoradiologic syndrome with complex relationships between degree of radiologic stenosis disclosed by MRI and clinical manifestations. Neurological impairment in the lower extremities reflects the degree of morphologic LSS on MRI. This study did not identify any association between the degree of stenosis and functional disability, pain intensity, or walking capacity. LEVEL OF EVIDENCE Level II.
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The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "surgical and research" articles in the European Spine Journal, 2017. 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 2018; 27:28-39. [PMID: 29313092 DOI: 10.1007/s00586-017-5435-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
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Li H, Yan JZ, Chen YJ, Kang WB, Huang JX. Non-invasive quantification of age-related changes in the vertebral endplate in rats using in vivo DCE-MRI. J Orthop Surg Res 2017; 12:169. [PMID: 29121960 PMCID: PMC5680764 DOI: 10.1186/s13018-017-0669-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/22/2017] [Indexed: 03/19/2023] Open
Abstract
Background Small animal models that can mimic degenerative disc disease (DDD) are commonly used to examine DDD progression. However, assessments such as histological studies and macroscopic measurements do not allow for longitudinal studies because they can only be completed after the animal is sacrificed. Dynamic contrast-enhanced MRI (DCE-MRI) may provide a reliable, non-invasive in vivo method for detecting the progression. Methods The present study investigated the progression of changes in lumbar discs and the effect of endplate conditions on diffusion into the lumbar discs of aging sand rats after intravenous administration of gadolinium-containing contrast medium through the tail vein. Contrast enhancement was measured in the lumbar intervertebral discs on each image. The results were compared with those from conventional histological characterizations. Results T2-weighted images revealed that with aging, the shape of L3–L4, L4–L5, L5–L6, and L6–S1 nucleus pulposus (NP) became irregular, while the mean areas, signal intensities, and T2 values of the NP were significantly decreased. Each of the observed disc changes demonstrated a progressive increase in phase during 2-min scout scans. Post-contrast MRI showed impaired endplate nutritional diffusion to the disc with aging, enhancement was significantly greater in young animals than in old animals. Endplate calcification or sclerosis was histologically confirmed; histologic score was correlated with the age. We found the histological score of the endplate negatively corresponded to the DCE-MRI results. Conclusions DCE-MRI studies offer a non-invasive in vivo method for investigating the progress of diffusion into the discs and the functional conditions of the endplate. We conclude that quantitative DCE-MRI can identify the severity of disc degeneration and efficiently reflect the progression of vertebral endplate changes in the aging sand rat lumbar spine via the NP contrast enhancement patterns.
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Affiliation(s)
- Hui Li
- The Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, 100050, China
| | - Jia-Zhi Yan
- The Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, 100050, China.
| | - Yong-Jie Chen
- The Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, 100050, China
| | - Wei-Bo Kang
- The Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, 100050, China
| | - Jia-Xi Huang
- The Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, 100050, China
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Kim MS, Jeong TY, Cheong YS, Jeon YW, Lim SY, Kang SS, Kim IN, Chang TB, Seong HH, Hwang BM. Effect of epidural corticosteroid injection on magnetic resonance imaging findings. Korean J Pain 2017; 30:281-286. [PMID: 29123623 PMCID: PMC5665740 DOI: 10.3344/kjp.2017.30.4.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/25/2017] [Accepted: 09/19/2017] [Indexed: 01/31/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain. Methods We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015.All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air. Results The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later. Conclusions Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine.
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Affiliation(s)
- Min Soo Kim
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - Tae Yoon Jeong
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - Yu Seon Cheong
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - Young Wook Jeon
- Department of Radiology, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - So Young Lim
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Hallym University Hospital, School of Medicine, Chuncheon, Korea
| | - Seong Sik Kang
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - In Nam Kim
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - Tsong Bin Chang
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - Hyun Ho Seong
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - Byeong Mun Hwang
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
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Surgical versus nonsurgical treatment of lumbar degenerative kyphosis. 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 2017; 26:2153-2159. [PMID: 28247076 DOI: 10.1007/s00586-017-5008-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 02/04/2017] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Surgery is widely performed for lumbar degenerative kyphosis (LDK), but its effectiveness as compared with nonsurgical treatment has not been demonstrated. METHODS In this prospective study, surgical candidates with LDK were enrolled at three spine centres. Two treatment options were performed either surgery using a pedicle subtraction osteotomy or nonsurgical care. Outcomes were measured using a Visual analogue scale (VAS) of back pain as a primary endpoint, the Oswestry disability index (ODI), the 36-item short-form health survey (SF-36), sagittal vertical axis (SVA) and treatment-related complications. RESULTS Of the 126 LDK patients treated during the reference period, 97 patients were enrolled (47 in the surgical group and 50 in the nonsurgical group). Surgical group produced statistically reduced VAS of back pain and better functional outcomes than nonsurgical group since 12 months after treatment, but the rate of serious complications was higher after surgery. Interestingly, both surgical and nonsurgical groups had improved outcomes in terms of pain intensity and function at the 2-year follow-up period. CONCLUSIONS Surgery might be a preferred treatment option for LDK, but great caution is needed. And conservative treatment could be the considerable treatment option for LDK who is unwilling or has poor medical condition to operate.
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Kuligowski T, Cieślik B, Nowicka Z. Functional outcomes in relation with the progression level in young degenerative disc disease patients. Physiotherapy 2017. [DOI: 10.1515/physio-2016-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractIntroduction. The aim of the study was to evaluate the functional outcomes in degenerative disc disease patients by the type of herniation. Methods. The study covered 48 individuals (28 females and 20 males) aged 18-35 years who were found with a degenerative disc disease in lumbar spine (protrusion or extrusion according to the American Society of Neuroradiology). The participants were divided into two groups by the type of herniation: the protrusion and the extrusion group. The functional outcome was assessed with the Oswestry Disability Index (ODI) questionnaire and the Numeric Rating Scale (NRS). Results. Statistically significant differences were shown in ODI scores in both groups. The extrusion group demonstrated a 7.6% higher level of functional disability related to lumbar spine pain when compared with the protrusion group. The NRS results were not statistically significant between the groups. A statistically significant difference was observed between the groups during standing position, during sleep and in sex life. Respectively a 27%, 32%, and 28% greater number of individuals in the extrusion group reported problems related to these three daily activities when compared with the protrusion group. Conclusions. Our study results revealed statistically significant differences in general ODI scores between the groups. Moreover, patients with protruded lumbar disc showed better outcomes in routine activities when compared with the extrusion group.
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