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Schulze F, Määttä J, Grad S, Heggli I, Brunner F, Farshad M, Distler O, Karppinen J, Lotz J, Dudli S. Proteomic analysis of serum in a population-based cohort did not reveal a biomarker for Modic changes. JOR Spine 2024; 7:e1337. [PMID: 39015135 PMCID: PMC11250394 DOI: 10.1002/jsp2.1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/28/2024] [Accepted: 04/24/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Modic changes (MC) are bone marrow lesions of vertebral bones, which can be detected with magnetic resonance imaging (MRI) adjacent to degenerated intervertebral discs. Defined by their appearance on T1 and T2 weighted images, there are three interconvertible types: MC1, MC2, and MC3. The inter-observer variability of the MRI diagnosis is high, therefore a diagnostic serum biomarker complementing the MRI to facilitate diagnosis and follow-up would be of great value. Methods We used a highly sensitive and reproducible proteomics approach: DIA/SWATH-MS to find serum biomarkers in a subset of the Northern Finland Birth Cohort 1966. Separately, we measured a panel of factors involved in inflammation and angiogenesis to confirm some potential biomarkers published before with an ELISA-based method called V-Plex. Results We found neither an association between the serum concentrations of the proteins detected with DIA/SWATH-MS with the presence of MC, nor a correlation with the size of the MC lesions. We did not find any association between the factors measured with the V-Plex and the presence of MC or their size. Conclusion Altogether, our study suggests that a robust and generally usable biomarker to facilitate the diagnosis of MC cannot readily be found in serum.
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Affiliation(s)
- Friederike Schulze
- Center of Experimental Rheumatology, Department of RheumatologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
- Department of Physical Medicine and RheumatologyBalgrist University Hospital, Balgrist Campus, University of ZurichZurichSwitzerland
| | - Juhani Määttä
- Research Unit of Health Sciences and TechnologyUniversity of OuluOuluFinland
| | | | - Irina Heggli
- Center of Experimental Rheumatology, Department of RheumatologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Florian Brunner
- Department of Physical Medicine and RheumatologyBalgrist University Hospital, Balgrist Campus, University of ZurichZurichSwitzerland
| | - Mazda Farshad
- Department of OrthopedicsBalgrist University HospitalZurichSwitzerland
| | - Oliver Distler
- Center of Experimental Rheumatology, Department of RheumatologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Jaro Karppinen
- Research Unit of Health Sciences and TechnologyUniversity of OuluOuluFinland
- Rehabilitation Services of South Karelia Social and Health Care DistrictLappeenrantaFinland
| | - Jeffrey Lotz
- Department of Orthopaedic SurgeryUniversity of California San FranciscoSan FrancsiscoCaliforniaUSA
| | - Stefan Dudli
- Center of Experimental Rheumatology, Department of RheumatologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
- Department of Physical Medicine and RheumatologyBalgrist University Hospital, Balgrist Campus, University of ZurichZurichSwitzerland
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Wong AYL, Mallow GM, Pinto SM, Hornung AL, Rudisill SS, Aboushaala K, Udby PM, An HS, Samartzis D. The efficacy and safety of oral antibiotic treatment in patients with chronic low back pain and Modic changes: A systematic review and meta-analysis. JOR Spine 2024; 7:e1281. [PMID: 38222804 PMCID: PMC10782054 DOI: 10.1002/jsp2.1281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 01/16/2024] Open
Abstract
Background This systematic review and meta-analysis aimed to summarize evidence regarding the effectiveness and safety of oral antibiotic intervention for chronic low back pain (CLBP) patients with/without type-1 Modic changes (MC1). Methods AMED, CINAHL, Cochrane Library, Embase, and Medline were searched from inception to March 3, 2023. Randomized controlled trials (RCTs) or non-RCTs that investigated the effectiveness or safety of oral antibiotics in treating CLBP patients were eligible for inclusion. Two independent reviewers screened abstracts, full-text articles, and extracted data. The methodological quality of each included article were evaluated by RoB2 and NIH quality assessment tools. The quality of evidence was appraised by GRADE. Meta-analyses were performed, where applicable. A subgroup analysis was conducted to evaluate the RCTs and case series separately, and to evaluate the effect of removing a low-quality RCT. Results Three RCTs and four case series were included. All Amoxicillin-clavulanate/Amoxicillin treatments lasted for approximately 3 months. Moderate- and low-quality evidence suggested that antibiotic was significantly better than placebo in improving disability and quality of life in CLBP patients with MC1 at 12-month follow-up, respectively. Low-quality evidence from meta-analyses of RCTs showed that oral antibiotic was significantly better than placebo in improving pain and disability in CLBP patients with MC1 immediately post-treatment. Very low-quality evidence from the case series suggested that oral Amoxicillin-clavulanate significantly improved LBP/leg pain, and LBP-related disability. Conversely, low-quality evidence found that oral Amoxicillin alone was not significantly better than placebo in improving global perceived health in patients with CLBP at the 12-month follow-up. Additionally, oral antibiotic users had significantly more adverse effects than placebo users. Conclusions Although oral antibiotics were statistically superior to placebo in reducing LBP-related disability in patients with CLBP and concomitant MC1, its clinical significance remains uncertain. Future large-scale high-quality RCTs are warranted to validate the effectiveness of antibiotics in individuals with CLBP.
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Affiliation(s)
- Arnold Y. L. Wong
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHung Hom, Hong KongSARChina
| | - G. Michael Mallow
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Sabina M. Pinto
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHung Hom, Hong KongSARChina
| | - Alexander L. Hornung
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Samuel S. Rudisill
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Khaled Aboushaala
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Peter M. Udby
- Spine UnitRigshospitalet, University of CopenhagenCopenhagenDenmark
| | - Howard S. An
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Dino Samartzis
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
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Aboushaala K, Wong AYL, Barajas JN, Lim P, Al-Harthi L, Chee A, Forsyth CB, Oh CD, Toro SJ, Williams FMK, An HS, Samartzis D. The Human Microbiome and Its Role in Musculoskeletal Disorders. Genes (Basel) 2023; 14:1937. [PMID: 37895286 PMCID: PMC10606932 DOI: 10.3390/genes14101937] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Musculoskeletal diseases (MSDs) are characterized as injuries and illnesses that affect the musculoskeletal system. MSDs affect every population worldwide and are associated with substantial global burden. Variations in the makeup of the gut microbiota may be related to chronic MSDs. There is growing interest in exploring potential connections between chronic MSDs and variations in the composition of gut microbiota. The human microbiota is a complex community consisting of viruses, archaea, bacteria, and eukaryotes, both inside and outside of the human body. These microorganisms play crucial roles in influencing human physiology, impacting metabolic and immunological systems in health and disease. Different body areas host specific types of microorganisms, with facultative anaerobes dominating the gastrointestinal tract (able to thrive with or without oxygen), while strict aerobes prevail in the nasal cavity, respiratory tract, and skin surfaces (requiring oxygen for development). Together with the immune system, these bacteria have coevolved throughout time, forming complex biological relationships. Changes in the microbial ecology of the gut may have a big impact on health and can help illnesses develop. These changes are frequently impacted by lifestyle choices and underlying medical disorders. The potential for safety, expenses, and efficacy of microbiota-based medicines, even with occasional delivery, has attracted interest. They are, therefore, a desirable candidate for treating MSDs that are chronic and that may have variable progression patterns. As such, the following is a narrative review to address the role of the human microbiome as it relates to MSDs.
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Affiliation(s)
- Khaled Aboushaala
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Arnold Y. L. Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Juan Nicolas Barajas
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Perry Lim
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Lena Al-Harthi
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Ana Chee
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Christopher B. Forsyth
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Chun-do Oh
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Sheila J. Toro
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | | | - Howard S. An
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
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Moser M, Adl Amini D, Albertini Sanchez L, Oezel L, Haffer H, Muellner M, Zhu J, Carrino JA, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The association between vertebral endplate defects, subchondral bone marrow changes, and lumbar intervertebral disc degeneration: a retrospective, 3-year longitudinal 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 2023; 32:2350-2357. [PMID: 36773077 DOI: 10.1007/s00586-023-07544-4] [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: 10/22/2022] [Revised: 10/22/2022] [Accepted: 01/13/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To investigate the influence of vertebral endplate defects and subchondral bone marrow changes on the development of lumbar intervertebral disc degeneration (DD). METHODS Patients > 18 y/o without any history of lumbar fusion who had repeat lumbar magnetic resonance imaging scans primarily for low back pain (LBP) performed at a minimum of 3 years apart at a single institution, and no spinal surgery in between scans were included. Total endplate score (TEPS), Modic changes (MC), and Pfirrmann grading (PFG) per lumbar disc level were assessed. DD was defined as PFG ≥ 4. RESULTS Three hundred and fifty-three patients (54.4% female) were included in the final analysis, comprising 1765 lumbar intervertebral discs. The patient population was 85.6% Caucasian with a median age of 60.1 years and a body mass index (BMI) of 25.8 kg/m2. A cutoff score of 5 was identified for the TEPS above which both the prevalence of DD and the odds of developing DD increased. The probability of developing DD did not differ significantly between lumbar disc levels (P = 0.419). In the multivariable analysis with adjustments for age, sex, race, body mass index (BMI), MC, TEPS cutoff > 5, and spinal level, only age (OR = 1.020; P = 0.002) was found to be an independent risk factor for developing intervertebral DD. CONCLUSION Our results suggest that TEPS does not unequivocally predict intervertebral DD in patients with LBP, since higher degrees of endplate defects might also develop secondarily to DD, and MC tend to occur late in the cascade of degeneration.
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Affiliation(s)
- Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Leonardo Albertini Sanchez
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jiaqi Zhu
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
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Lambrechts MJ, Issa TZ, Toci GR, Schilken M, Canseco JA, Hilibrand AS, Schroeder GD, Vaccaro AR, Kepler CK. Modic Changes of the Cervical and Lumbar Spine and Their Effect on Neck and Back Pain: A Systematic Review and Meta-Analysis. Global Spine J 2023; 13:1405-1417. [PMID: 36448648 PMCID: PMC10416594 DOI: 10.1177/21925682221143332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To systematically review the current literature and perform a meta-analysis on patients with cervical or lumbar spine Modic changes to determine if their baseline axial back pain and disability are comparable to patients without Modic changes. METHODS A systematic review of the PubMed database was conducted in accordance with PRISMA guidelines. A meta-analysis was performed to compare the mean differences in back pain, leg pain, and disability based on the presence of cervical or lumbar spine Modic changes. A subgroup analysis of the different types of Modic changes was conducted to determine if Modic type affected back pain or disability. RESULTS - After review of 259 articles, 17 studies were included for meta-analysis and ten studies were included for qualitative synthesis. In the lumbar spine, 10 high-quality studies analyzed Visual Analog Scale (VAS) back pain, 10 evaluated VAS leg pain, and 8 analyzed Oswestry Disability Index. VAS back pain (mean difference (MD), -.38; 95% CI, -.61 - .16) and Oswestry disability index (MD -2.52; 95% CI, -3.93 - -1.12) were significantly lower in patients without Modic changes. Modic change subtype was not associated with differences in patient-reported outcomes. Patients with cervical spine Modic changes did not experience more severe pain than those without MC. CONCLUSIONS Modic changes in the lumbar spine are not associated with clinically significant axial low back pain severity or patient disability. Similar to the lumbar spine, Modic changes in the cervical spine are not associated with symptom severity, but they are associated with pain duration.
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Affiliation(s)
- Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Tariq Z. Issa
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory R. Toci
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Meghan Schilken
- College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Lambrechts MJ, Brush P, Issa TZ, Toci GR, Heard JC, Syal A, Schilken MM, Canseco JA, Kepler CK, Vaccaro AR. Evaluating the Impact of Modic Changes on Operative Treatment in the Cervical and Lumbar Spine: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610158. [PMID: 36011795 PMCID: PMC9408205 DOI: 10.3390/ijerph191610158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 05/11/2023]
Abstract
Modic changes (MCs) are believed to be potential pain generators in the lumbar and cervical spine, but it is currently unclear if their presence affects postsurgical outcomes. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies evaluating cervical or lumbar spine postsurgical outcomes in patients with documented preoperative MCs were included. A total of 29 studies and 6013 patients with 2688 of those patients having preoperative MCs were included. Eight included studies evaluated cervical spine surgery, eleven evaluated lumbar discectomies, nine studied lumbar fusion surgery, and three assessed lumbar disc replacements. The presence of cervical MCs did not impact the clinical outcomes in the cervical spine procedures. Moreover, most studies found that MCs did not significantly impact the clinical outcomes following lumbar fusion, lumbar discectomy, or lumbar disc replacement. A meta-analysis of the relevant data found no significant association between MCs and VAS back pain or ODI following lumbar discectomy. Similarly, there was no association between MCs and JOA or neck pain following ACDF procedures. Patients with MC experienced statistically significant improvements following lumbar or cervical spine surgery. The postoperative improvements were similar to patients without MCs in the cervical and lumbar spine.
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The relationship between traction spurs, Modic change, vacuum phenomenon, and segmental instability of the lumbar spine. Sci Rep 2022; 12:9939. [PMID: 35705718 PMCID: PMC9200777 DOI: 10.1038/s41598-022-14244-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/03/2022] [Indexed: 12/04/2022] Open
Abstract
A thorough understanding of lumbar segmental motion is valuable to treat patients with degenerative lumbar disease, but kinematics associated with indicators of lumbar intervertebral instability [traction spur, Modic changes (MCs) and vacuum phenomenon (VP)] in the lumbar spine have not been well understood. The purpose of this study is to evaluate the relationships between traction spur, MCs and VP to radiographic measurements in the lumbar spine. A total of 525 lumbar discs from L1-2 to L5-S1 of 105 patients were evaluated. The sagittal translation (ST) and sagittal angulation were measured from the radiographs taken flexion–extension. The anterior disc height (ADH) was measured from the lateral radiographs, and ΔADH was measured as the difference from supine to sitting position. Logistic regression analyses were used to detect the association between the existence of traction spur, MCs and VP and related factors. Multivariate analysis showed that the traction spur was significantly related to translational motion (ST > 2 mm, OR 4.74) and the VP was significantly related to vertical motion (ΔADH > 3 mm, OR 1.94). These results suggest that the segments with traction spur and VP should be evaluated carefully because these may be a sign of lumbar intervertebral instability.
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