Is intrinsic lumbar spine shape associated with lumbar disc degeneration? An exploratory study

Adolescent-onset Local Kyphosis with Anterior Column Hypoplasia and Subluxation of the Facet Joints of the Lumbar Spine: A Case Report

Introduction

Hypoplasia of the anterior portion of the vertebral body is a relatively rare subtype of juvenile vertebral deformity. The common manifestations of this type of deformity are scoliosis and kyphoscoliosis, while kyphosis without scoliosis is rare. Here, we present a very rare case of adolescent-onset local kyphosis with anterior column hypoplasia and subluxation of the facet joints of the lumbar spine, as demonstrated by dynamic lateral radiograms, which was successfully treated by spine-shortening osteotomy.

Case Report

A 16-year-old male adolescent presented with low back pain with progressive protrusion of the lumbar spinous process 3 years before the first visit. The protrusion was not found in his back until the age of 13 years. His chief complaint was lower back pain and a protruding spinous process in the upper lumbar spine. The anteroposterior radiogram of the whole spine revealed no obvious scoliosis. The lateral radiogram showed hypoplasia of the anterior portion of the L2 vertebral body with local kyphosis at L1-3 of 23°. The global alignment was posteriorly shifted, with hypokyphosis of the thoracic spine and hyperlordosis of the lower lumbar spine. In the dynamic lateral radiograms, the facet joints at the L2-3 spinal level were subluxated in the flexed position. Computed tomography showed symmetrical hypoplasia of the anterior portion of the vertebral body of L2. Spine-shortening osteotomy at L2 and L1-3 posterior fusion was performed for local stabilization and correction of sagittal malalignment. The lateral radiogram at the 2-year post-operative follow-up demonstrated that the global alignment was normal, with local kyphosis at L1-3 of -2°. The improvement of hypokyphosis of the thoracic spine and hyperlordosis of the lower lumbar spine was achieved.

Conclusions

Adolescent-onset local lumbar kyphosis with anterior column hypoplasia and segmental subluxation of the facet joints is very rare. Local correction by spine-shortening osteotomy with short fusion can also improve the global alignment.

Glycine-Serine-Threonine Metabolic Axis Delays Intervertebral Disc Degeneration through Antioxidant Effects: An Imaging and Metabonomics Study

Although intervertebral disc degeneration (IDD) can be described as different stages of change through biological methods, this long and complex process cannot be defined in stages by single or simple combination of biological techniques. Under the background of the development of nuclear magnetic resonance (NMR) technology and the emerging metabonomics, we based on animal models and expanded to the study of clinical human degeneration models. The characteristics of different stages of IDD were analyzed by omics. Omics imaging combined with histology, cytology, and proteomics was used for screening of the intervertebral disc (IVD) of research subjects. Furthermore, mass spectrometry nontargeted metabolomics was used to explore profile of metabolites at different stages of the IDD process, to determine differential metabolic pathways and metabolites. NMR spectroscopy was used to qualitatively and quantitatively identify markers of degeneration. NMR was combined with mass spectrometry metabolomics to explore metabolic pathways. Metabolic pathways were determined through protein molecular biology and histocytology of the different groups. Distinguishing advantages of magnetic resonance spectroscopy (MRS) for analysis of metabolites and effective reflection of structural integrity and water molecule metabolism through diffusion tensor imaging (DTI) were further used to verify the macrometabolism profile during degeneration. A corresponding model of in vitro metabolomics and in vivo omics imaging was established. The findings of this study show that a series of metabolic pathways associated with the glycine-serine-threonine (Gly-Ser-Thr) metabolic axis affects carbohydrate patterns and energy utilization efficiency and ultimately delays disc degeneration through antioxidant effects.

Statistical morphological analysis reveals characteristic paraspinal muscle asymmetry in unilateral lumbar disc herniation

Growing evidence suggests an association of lumbar paraspinal muscle morphology with low back pain (LBP) and lumbar pathologies. Unilateral spinal disorders provide unique models to study this association, with implications for diagnosis, prognosis, and management. Statistical shape analysis is a technique that can identify signature shape variations related to phenotypes but has never been employed in studying paraspinal muscle morphology. We present the first investigation using this technique to reveal disease-related paraspinal muscle asymmetry, using MRIs of patients with a single posterolateral disc herniation at the L5-S1 spinal level and unilateral leg pain. Statistical shape analysis was conducted to reveal disease- and phenotype-related morphological variations in the multifidus and erector spinae muscles at the level of herniation and the one below. With the analysis, shape variations associated with disc herniation were identified in the multifidus on the painful side at the level below the pathology while no pathology-related asymmetry in cross-sectional area (CSA) and fatty infiltration was found in either muscle. The results demonstrate higher sensitivity and spatial specificity for the technique than typical CSA and fatty infiltration measures. Statistical shape analysis holds promise in studying paraspinal muscle morphology to improve our understanding of LBP and various lumbar pathologies.

Spinal Degeneration and Degenerative Disc Disease correlation identified with Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is the golden standard technique for spine disc disease diagnosis. Vertebral body endplate signal intensity on MRI is confirming lumber spine degenerative disc disease.The study aimed to record the lumbar spine degenerative relation between disc and diseaseusing magnetic resonance imaging. Our prospective and double blind investigation included 142 participants,having lumbar spine degenerativedisease confirmed by MRI. Pfirrmann score was used to record the relation between lumbar spine disc degeneration and lumbar spine degenerative disease. Modic modifications with the Pfirrmann and modified Pfirrmann scores of disc degeneration were assessed.Lumbar spine MRI was done for all participants using sagittal T1 and T2 WI. Modic was scored (0-III) The Pfirrmann scored I-V for disc degeneration. Lumbar disc degeneration was evaluated by modified Pfirrmann scoring from 1-8 according to signal intensity of the nucleus pulposus and inner annulus.Modic was recorded in 41.5%, 24.6%, 32.4% and 1.4% of participants with scores 0, I, II and III, respectively. Pfirrmann score was 13.4%, 73.9% and 12.7% of disc degeneration with scores III, IV and V, respectively, while,the modified Pfirrmann score was 2.1%, 15.5%, 38.7%, 26.8% and 16.9% of disc degeneration with scores of 4, 5, 6, 7 and 8, respectively. The modified Pfirrmann score showed notableinconsistencyin participants with Modic 0, I and II, but no difference between Modic I and II.There was significant relation between Modicand lumbar spine disc degeneration. In conclusion, there is a relation between Modic, Pfirrmann and modified Pfirrmann scores of lumbar spine disc degeneration in participants with lumbar spine degenerative disease.