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Pariente E, Olmos JM, Landeras R, Nan D, González-Macías J, Hernández JL. Relationship between spinal osteoarthritis and vertebral fractures in men older than 50 years: data from the Camargo Cohort Study. J Bone Miner Metab 2017; 35:114-121. [PMID: 26825659 DOI: 10.1007/s00774-016-0735-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
Spinal osteoarthritis has been suggested as a risk factor for vertebral fractures. However, results are conflicting: most of the data are focused on the lumbar region, and referred to postmenopausal women, whereas data for men are scarce. The aim of this study is to assess the relationship between spinal osteoarthritis and vertebral fractures in men over 50 years of age. We conducted a cross-sectional study, nested in a prospective population-based cohort, including 507 community-dwelling men, 93 of them with at least one vertebral fracture. Vertebral fractures, osteophytosis, and disc space narrowing (DSN) were assessed by lateral thoracic and lumbar radiographs. Anthropometric, clinical, and densitometric variables were also analyzed. A multiple logistic regression model was performed. Eighty-five percent of vertebral fractures were located at the thoracic spine. Osteophytosis and DSN showed a bimodal distribution, with major frequency peaks at mid- and distal lumbar spine. The three distributions overlapped around the T9 vertebra. We did not find any relationship between lumbar osteoarthritis and vertebral fractures. Nevertheless, thoracic osteophytosis (OR, 1.84; 95 % CI, 1.05-3.17; p = 0.03) and DSN (OR, 2.52; 95 % CI, 1.43-4.46; p = 0.001) were found to be independently associated with prevalent vertebral fractures, after adjusting for confounders. Our results suggest a positive relationship between radiologic osteoarthritic changes at the thoracic spine and prevalent vertebral fractures in men more than 50 years of age. Osteoarthritis may act as a local risk factor, in addition to other mechanical factors, resulting in a greater propensity to fracture, especially at the mid-thoracic region.
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Affiliation(s)
- Emilio Pariente
- "Camargo-Interior" Primary Care Center, Servicio Cántabro de Salud, OSPC, Muriedas, Cantabria, Spain
| | - José M Olmos
- Bone Metabolism Unit, Department of Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, IDIVAL, RETICEF, 39008, Santander, Cantabria, Spain
| | - Rosa Landeras
- Department of Radiology, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Daniel Nan
- Bone Metabolism Unit, Department of Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, IDIVAL, RETICEF, 39008, Santander, Cantabria, Spain
| | - Jesús González-Macías
- Bone Metabolism Unit, Department of Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, IDIVAL, RETICEF, 39008, Santander, Cantabria, Spain
| | - José Luis Hernández
- Bone Metabolism Unit, Department of Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, IDIVAL, RETICEF, 39008, Santander, Cantabria, Spain.
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Jensen RK, Kjaer P, Jensen TS, Albert H, Kent P. Degenerative Pathways of Lumbar Motion Segments--A Comparison in Two Samples of Patients with Persistent Low Back Pain. PLoS One 2016; 11:e0146998. [PMID: 26807697 PMCID: PMC4725847 DOI: 10.1371/journal.pone.0146998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/28/2015] [Indexed: 11/19/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persistent low back pain. However, the clinical relevance of spinal degenerative MRI findings remains uncertain. Although multiple MRI findings are almost always present at the same time, research into the association with clinical outcomes (such as pain) has predominantly focused on individual MRI findings. This study aimed to: (i) investigate how multiple MRI lumbar spine findings cluster together within two different samples of patients with low back pain, (ii) classify these clusters into hypothetical pathways of degeneration based on scientific knowledge of disco-vertebral degeneration, and (iii) compare these clusters and degenerative pathways between samples. Methods We performed a secondary cross-sectional analysis on two dissimilar MRI samples collected in a hospital department: (1) data from the spinal MRI reports of 4,162 low back pain patients and (2) data from an MRI research protocol of 631 low back pain patients. Latent Class Analysis was used in both samples to cluster MRI findings from lumbar motion segments. Using content analysis, each cluster was then categorised into hypothetical pathways of degeneration. Results Six clusters of MRI findings were identified in each of the two samples. The content of the clusters in the two samples displayed some differences but had the same overall pattern of MRI findings. Although the hypothetical degenerative pathways identified in the two samples were not identical, the overall pattern of increasing degeneration within the pathways was the same. Conclusions It was expected that different clusters could emerge from different samples, however, when organised into hypothetical pathways of degeneration, the overall pattern of increasing degeneration was similar and biologically plausible. This evidence of reproducibility suggests that Latent Class Analysis may provide a new approach to investigating the relationship between MRI findings and clinically important characteristics such as pain and activity limitation.
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Affiliation(s)
- Rikke K. Jensen
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- * E-mail:
| | - Per Kjaer
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Tue S. Jensen
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Hanne Albert
- Department of Orthopaedics, Bartholomew's Hospital, London, England
| | - Peter Kent
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Kotrych D, Bohatyrewicz A, Zietek P, Kołodziej Ł, Kedzierski M, Karaczun M, Antoniak K. [The prevalence of spinal osteoporosis in relation to the clinical forms and advance of cervical spondylosis in male patients]. Chir Narzadow Ruchu Ortop Pol 2010; 75:178-182. [PMID: 21038637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The research was performed on 36 male patients between 65 and 83 years who were either hospitalised or treated in the out-patients clinic due to cervical spondylosis. The aim of the research was to evaluate the frequency of spinal osteoporosis relating to the type and severity of degenerative lesions in cervical spine. The study showed significant relation between the degree of advance of cervical spondylosis and the prevalence of osteoporosis in the study group. The authors have emphasized the need of precise evaluation and differentiation of presented forms of degenerative spine disease.
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Affiliation(s)
- Daniel Kotrych
- Katedra i Klinika Ortopedii i Traumatologii, Pomorska Akademia Medyczna w Szczecinie.
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Abstract
It is believed lumbar degeneration begins in the disc, where desiccation and collapse lead to instability and compensatory facet arthrosis. We explored the contrary contention that facet degeneration precedes disc degeneration by examining 647 skeletal lumbar spines. Using facet osteophytosis as a measure of facet degeneration and vertebral rim osteophytosis as a measure of disc degeneration, we assumed bone degeneration in both locations equally reflected the progression of those in the soft tissues. We graded arthrosis Grade 0 to 4 on a continuum from no arthritis to ankylosis. The data were analyzed for different age groups to examine patterns of degeneration with age. Specimens younger than 30 years of age had a higher prevalence of facet osteophytosis compared with vertebral rim osteophotosis at L1-L2 and L2-L3. Specimens aged 30 to 39 years showed more facet osteophytosis than vertebral rim osteophytosis at L4-L5. Specimens older than 40 years, however, showed more vertebral rim osteophytosis compared with facet osteophytosis at all levels except L4-L5 and L5-S1. This skeletal study suggests facet osteophytosis appears early in the degenerative process, preceding vertebral rim osteophytosis of degenerating intervertebral discs. However, once facets begin deteriorating with age, vertebral rim osteophytosis overtakes continued facet osteophytosis. These data challenge the belief that facet osteophytosis follows vertebral rim osteophytosis; rather, it appears vertebral rim osteophytosis progresses more rapidly in later years, but facet osteophotosis occurs early, predominating in younger individuals.
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Affiliation(s)
- Jason David Eubanks
- Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA.
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Chaiwanichsiri D, Jiamworakul A, Jitapunkul S. Lumbar disc degeneration in Thai elderly: a population-based study. J Med Assoc Thai 2007; 90:2477-2481. [PMID: 18181337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Determine the prevalence and related factors of lumbar disc degeneration in the Thai elderly. MATERIAL AND METHOD A population-based study was done at Rom Klao community, Bangkok. Seven hundred and ninety-two cases (306 males, and 486 females) out of 1166 elderly people aged > or =50 (mean age of 61.07 +/- 7.8 years) were assessed. The lateral spinal radiographs were interpreted as spondylosis grade 0-3 according to the degree of severity. RESULTS Males had more prevalence of grade 2-3 spondylosis than females (58.8% vs. 52.9%), but females had higher prevalence of spinal listhesis (14.4% vs. 8.8%). Age was a strong predicting factor for disc degeneration (OR = 1.088, 95% CI = 1.065-1.111, p = 0.000). Females had more risk to develop spinal listhesis (OR = 1.84, 95% CI = 1.11-3.05, p = 0.020) and low back pain (OR = 1.82, 95% CI = 1.29-2.56, p = 0.001). BMI was a predicting factor for spondylosis (OR = 1.066, 95% CI = 1.02-1.10, p = 0.000). About 27% of the cases reported moderate-severe low back pain and had lower Barthel ADL index (p = 0.018). CONCLUSION Lumbar disc degeneration and low back pain were highly prevalent among the Thai elderly. Therefore, they need proper health care for disability prevention.
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Affiliation(s)
- Dootchai Chaiwanichsiri
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Abstract
OBJECTIVES To determine (1) the frequency of osteoporosis at the hip and lumbar spine in a postpolio clinic population and (2) the association of lower-extremity muscle strength and other potential contributing factors to osteoporosis with bone density measured at the hip. DESIGN Cross-sectional study involving a chart review. SETTING A university-affiliated hospital postpolio clinic. PARTICIPANTS Patient charts (N=379) were reviewed; 164 (26%) were included, and 215 (74%) were not included primarily (74%) because of the unavailability of bone density results. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Bone density (in g/cm(2)) and T score were assessed at the femoral neck and lumbar spine. Muscle strength was evaluated by manual muscle testing in 7 bilateral lower-extremity muscles. RESULTS The occurrence of osteoporosis at the hip and lumbar spine was 20 (32%) of 62 and 6 (10%) of 61 in men, 3 (9%) of 33 and 2 (6%) of 32 in premenopausal women, and 18 (27%) of 67 and 7 (11%) of 65 in postmenopausal women, respectively. In a logistic regression model, the presence of osteoporosis at the hip was significantly associated with strength sum score in the same extremity in which the bone density was performed after adjusting for other important risk factors (age, body mass index, time since polio). CONCLUSIONS Osteoporosis occurred commonly at the hip in a postpolio clinic population. Hip bone density was associated with muscle strength in the same lower extremity.
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Affiliation(s)
- Muriel Haziza
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
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Abstract
The incidence of ALS in Wakayama Prefecture has been markedly higher than that elsewhere in the world. Recently, however, the incidence has gradually decreased, especially in men, and the age at onset has shifted to the elderly, indicating the possible role of exogenous factors in the development of ALS. To evaluate factors related to the disease, we conducted a retrospective study. This study examined 108 patients with definite ALS diagnosed according to El Escorial criteria and 302 neurological controls (older than 40 years old) consecutively admitted to Wakayama Medical Hospital between 1999 and 2004. Having past history of cervical spondylosis or spinal spondylotic myelopathy (CS/SSM) with/without surgical treatment, cervical MRI findings, history of bone fracture, and occupation at onset were compared between the ALS patients and the neurological controls. Among 108 ALS patients, 45.4% had past history of CS/SSM compared to 19.4% of the neurological controls (p<0.0001, OR: 3.725, 95% CI 2.173-6.387). Among the ALS patients, 13% had had surgical treatment for CS/SSM, which was significantly higher than the 4.3% of the neurological controls (p<0.003, OR: 4.333, 95% CI 1.647-11.401). Cervical MRI findings were classified into four grades according to the severity of canal narrowing and compression of the spinal cord. Regarding cervical MRI findings, the percentage of ALS patients who showed canal narrowing and compression of the spinal cord was significantly higher than that of the controls (ALS: 72.0%, the controls: 29.5%, OR: 4.799, 95% CI 2.65-8.70). Comparison of the occupation at disease onset revealed that primary and secondary industrial occupations significantly increased the risk of ALS (2.69, 95% CI 1.40-5.16, 2.81, 95% CI 1.45-5.46, respectively). Conversely, tertiary industrial occupations significantly decreased the risk of ALS (age- and sex-adjusted OR: 0.54, 95% CI 0.30-0.98). In conclusion, CS/SSM, surgical treatment for CS/SSM and occupation at onset are suspected to be risk factors for developing/triggering or worsening ALS.
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Affiliation(s)
- Tameko Kihira
- Department of Neurology, Wakayama Medical University, Wakayama City, Japan.
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Sakai Y, Matsuyama Y, Hasegawa Y, Yoshihara H, Nakamura H, Katayama Y, Imagama S, Ito Z, Ishiguro N, Hamajima N. Association of gene polymorphisms with intervertebral disc degeneration and vertebral osteophyte formation. Spine (Phila Pa 1976) 2007; 32:1279-86. [PMID: 17515815 DOI: 10.1097/brs.0b013e318059af8a] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional cohort study of elderly people. OBJECTIVES To examine the factors influencing osteophyte formation without lumbar disc degeneration and to estimate the implications of osteophytes from the viewpoint of low back pain and gene polymorphisms. SUMMARY OF BACKGROUND DATA The degenerative changes that occur in the intervertebral discs are the point of departure of osteophyte formation. Several studies on factors associated with genetic susceptibility to spinal osteophyte formation, such as VDR and TGF-beta1. However, there are no detailed studies concerning osteophytes not accompanied with disc degeneration. METHODS A total of 387 elderly persons were recruited, and disc degeneration and osteophyte formation were evaluated. The cases with osteophyte formation were classified into 3 groups: osteophyte formation with disc height narrowing (n = 217), osteophyte formation without disc height narrowing (n = 99), and control group defined as the cases without osteophyte formation (n = 71). Twelve genotypes were characterized. Correlations between these degenerative factors and the polymorphisms were analyzed. RESULTS The prevalence of low back pain was significantly greater in the group of osteophyte formation with disc height narrowing than the other 2 groups. In the polymorphism of alcohol dehydrogenase (ADH2), prevalence of osteophyte formation without disc height narrowing was less in His/Arg (odds ratio = 0.57, P = 0.041) and Arg/Arg (odds ratio = 0.41, P = 0.18) than His/His. CONCLUSIONS Patients with osteophyte formation preceding intervertebral disc narrowing had a lower risk of low back pain compared with those without osteophytes. The 47Arg polymorphism in the ADH2 may act to suppress osteophyte formation unaffected by disc degeneration.
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Affiliation(s)
- Yoshihito Sakai
- Department of Orthopaedic Surgery, Nagoya University School of Medicine, Nagoya, Japan.
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Harzy T, Allali F, Bennani-Othmani M, Hajjaj-Hassouni N. [Radiological characteristics of the lumbar spine in patients with rheumatoid arthritis]. Presse Med 2007; 36:1385-9. [PMID: 17509810 DOI: 10.1016/j.lpm.2007.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Accepted: 02/01/2007] [Indexed: 10/22/2022] Open
Abstract
AIM The aim of this study was to assess the prevalence and severity of lumbar lesions on radiography of patients with rheumatoid arthritis (RA) and of population controls and to study the correlation between lumbar lesions and RA severity. METHODS RA patients who met the revised American College of Rheumatology criteria were matched with population controls for age, sex, and the presence (or absence) of low back pain. Thoracolumbar radiographs were read by two observers looking for vertebral fractures, disc space narrowing, endplate erosion, facet joint involvement, and osteophytosis. A severity score was assigned to each lesion. RESULTS This study included 60 RA patients and 60 controls, matched for sex (54 women and 6 men in each group) and age (mean age was 47.8+/-14 years in the RA group and 48.4+/-14 years in the control group). Prevalence of lumbar lesions was 83% in RA patients and 85% in the control subjects (p=0.8). Vertebral fractures were significantly more frequent in RA patients (p=0.042). In the RA group, disc space narrowing and the severity of endplate erosion were both correlated with higher Larsen grades (p=0.02 and 0.007 respectively), and the severity of endplate erosion was correlated with coxitis (p=0.03). DISCUSSION In our study, radiological lumbar lesions, except for vertebral fractures, were no more common among RA patients than among population controls. Endplate erosion and vertebral disc destruction were correlated with RA severity scores.
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Affiliation(s)
- Taoufik Harzy
- Service de rhumatologie, Hôpital El Ayachi, CHU Ibn Sina, Rabat-Salé, Maroc.
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Peters KM. [Non-infective inflammations of the vertebral spine]. ACTA ACUST UNITED AC 2007; 145:R1-19; quiz R20-4. [PMID: 17345531 DOI: 10.1055/s-2007-965035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Non-infective inflammations of the vertebral spine can be caused by seronegative spondylarthropathies or rheumatoid arthritis, respectively. Seronegative spondylarthropathies include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel diseases and undifferentiated arthritis. This review discusses etiology and pathogenesis, epidemiology, clinical features, diagnosis and differential diagnoses of these chronic inflammatory diseases with a special focus on vertebral involvement.
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MESH Headings
- Arthritis, Psoriatic/diagnosis
- Arthritis, Psoriatic/epidemiology
- Arthritis, Psoriatic/etiology
- Arthritis, Reactive/diagnosis
- Arthritis, Reactive/epidemiology
- Arthritis, Reactive/etiology
- Cross-Sectional Studies
- Diagnosis, Differential
- Diagnostic Imaging
- HLA-B27 Antigen/analysis
- Humans
- Inflammatory Bowel Diseases/diagnosis
- Inflammatory Bowel Diseases/epidemiology
- Inflammatory Bowel Diseases/etiology
- Sacroiliac Joint/pathology
- Spinal Osteophytosis/diagnosis
- Spinal Osteophytosis/epidemiology
- Spinal Osteophytosis/etiology
- Spine/pathology
- Spondylarthropathies/diagnosis
- Spondylarthropathies/epidemiology
- Spondylarthropathies/etiology
- Spondylitis, Ankylosing/diagnosis
- Spondylitis, Ankylosing/epidemiology
- Spondylitis, Ankylosing/etiology
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Affiliation(s)
- K M Peters
- Orthopädie und Osteologie, Rhein-Sieg-Klinik, Nümbrecht, Germany.
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Abstract
STUDY DESIGN Retrospective review of lateral spinal thoracolumbar radiographs, obtained to rule out spinal injury after trauma, were scored for osteoarthritis. OBJECTIVES The extent, prevalence, and distribution of spinal osteoarthritis in women aged 20-80 years was determined. SUMMARY OF BACKGROUND DATA Radiographic evidence of disc space narrowing and osteophytosis is one method of assessing osteoarthritis, but population-based surveys of osteoarthritis have been limited due the dangers of exposing human subjects to radiographs. Consequently, the prevalence and the distribution of osteoarthritis in women have not been established. METHODS Average individual disc space narrowing and osteophytosis scores were assessed using an atlas method. Prevalence was determined for decadal age groups and spinal level (T4-L7). RESULTS The extent of osteoarthritis is weakly associated with age, while the prevalence of osteoarthritis increases with age. Two peaks in osteoarthritis prevalence are apparent: in the mid thoracic and lower lumbar spines. CONCLUSIONS Although few younger women have high average scores, some older women have no radiographic sign of osteoarthritis, while others are severely affected. While the peak in osteoarthritis in the lumbar spine parallels the clinical symptom of low back pain, the more pronounced peak in the mid thoracic does not have a reported corresponding clinical symptom.
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Affiliation(s)
- Patricia Ann Kramer
- Department of Anthropology, University of Washington, Seattle, WA 98195-3100, USA.
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Mahbub MH, Laskar MS, Seikh FA, Altaf MH, Inoue M, Yokoyama K, Wakui T, Harada N. Prevalence of cervical spondylosis and musculoskeletal symptoms among coolies in a city of Bangladesh. J Occup Health 2006; 48:69-73. [PMID: 16484766 DOI: 10.1539/joh.48.69] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To assess the prevalence of cervical spondylosis and musculoskeletal symptoms among coolies a cross-sectional study was performed in Narayangonj City of Bangladesh on a random sample of 98 male coolies, using a questionnaire and the results of cervical spine X-rays. Statistical associations were investigated using the chi-square test. The results show a considerably higher prevalence of cervical spondylosis among the coolies (39.8%). More than half (51.3%) of the cases of cervical spondylosis were in subjects below the age of 40 yr, and a significant association was found between age group and prevalence of cervical spondylosis. The study also observed a significant association between duration of occupation and prevalence of cervical spondylosis. Coolies who had worked for 10 to 15 yr, or more than 15 yr, had higher rates of cervical spondylosis. In this study it was found that those who carried heavier loads suffered more from cervical spondylosis. Musculoskeletal symptoms in multiple body regions (two or more) were more prevalent (61.2%) than those in single body region (29.6%). Symptoms in the hands/fingers were the most frequent followed by the back and arms/forearms. In conclusion, the high prevalence of cervical spondylosis and musculoskeletal symptoms among professional coolies may be associated with the practice of carrying heavy loads on the head. Further study with a large sample of population is required to investigate this problem and to explore preventive measures.
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Affiliation(s)
- Md H Mahbub
- Department of Hygiene, Yamaguchi University School of Medicine, Minamikoguchi, Ube, Japan.
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Abstract
STUDY DESIGN The incidence of risk factors for cerebrovascular diseases was investigated in patients with diffuse idiopathic skeletal hyperostosis (DISH) and patients with cervical spondylosis. OBJECTIVES To investigate the association between DISH and cerebrovascular disease. SUMMARY OF BACKGROUND DATA DISH is a common skeletal disease mainly affecting the anterior and lateral spinal longitudinal ligaments. The principal clinical features are nonradicular pain, stiffness, dysphagia (cervical portion), and associated ossification of the posterior longitudinal ligament. METHODS Age- and sex-matched patients were divided into three groups: 45 patients with DISH, 45 patients with cervical spondylosis Grade I and II, and 45 patients with cervical spondylosis Grade III and IV. Anthropometric, laboratory, and magnetic resonance (MR) imaging findings were analyzed. RESULTS The values of uric acid (P = 1.60 x 10) and alkaline phosphatase (P = 2.00 x 10) were significantly greater in patients with DISH than in the other groups. Patients with DISH had a significantly higher incidence of ossification of the posterior longitudinal ligament (P = 5.21 x 10). Stiffness was significantly more common in patients with DISH and patients with spondylosis Grade III and IV than in patients with spondylosis Grade I and II (P = 0.000232). The incidence of infarction on MR imaging was significantly higher in patients with DISH than in the other groups (P = 0.0120). The incidence of stenosis or occlusion of a major cerebral artery on MR angiography was significantly higher in patients with DISH than in the other groups (P = 0.00264). CONCLUSIONS DISH is associated with increased incidences of risk factors for stroke and cerebrovascular disease.
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Affiliation(s)
- Nobuhiko Miyazawa
- Department of Neurosurgery, Akiyama Neurosurgical Clinic, Nirasaki, Yamanashi, Japan.
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Singh A, Gnanalingham K, Casey A, Crockard A. Quality of life assessment using the Short Form-12 (SF-12) questionnaire in patients with cervical spondylotic myelopathy: comparison with SF-36. Spine (Phila Pa 1976) 2006; 31:639-43. [PMID: 16540866 DOI: 10.1097/01.brs.0000202744.48633.44] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Clinical outcome study comparing the Short Form-36 (SF-36) and Short Form-12 (SF-12) assessment scales in patients with cervical spondylotic myelopathy (CSM). OBJECTIVES To compare the validity, reliability, and sensitivity to change of the SF-12 and SF-36 scales in CSM patients undergoing decompressive surgery. SUMMARY OF BACKGROUND DATA The SF-36 is a generic Health Related Quality of Life (HRQoL) questionnaire, consisting of 36 questions that can be reported as a Physical (PCS) and Mental Component Summary (MCS). Recently, an abbreviated version of SF-36, the SF-12, which uses only 12 questions drawn from the SF-36, has been described. METHODS In this prospective study, patients with CSM undergoing decompressive surgery, self-completed the SF-36 questionnaire before surgery and at 6 months after surgery. SF-12 item responses were abstracted from the responses given to the SF-36 questionnaire. The validity, reliability, and sensitivity to change of the PCS and MCS components of SF-12 and SF-36 scales were compared. RESULTS Overall, 105 patients underwent anterior (N = 58) or posterior (N = 47) decompressive surgery. After surgery, there were improvements in the PCS components of both the SF-36 (40 +/- 2 to 54 +/- 2) and SF-12 (34 +/- 2 to 48 +/- 3), as well as in the MCS component of the SF-36 (48 +/- 2 to 63 +/- 2) and SF-12 (43 +/- 2 to 59 +/- 2) (P < 0.001). The sensitivity to change and absolute sensitivity for both SF-12 and SF-36 were comparable, but the reliability of SF-36 was marginally greater. There were close and linear correlations between the SF-36 and SF-12 scores for both the PCS and MCS components, before and after surgery (R = 0.86 to 0.93; P < 0.0001). CONCLUSIONS Both the SF-12 and SF-36 scales are valid and sensitive to changes in physical and mental health status in CSM patients, undergoing decompressive surgery. Despite its abbreviated nature, the SF-12 appears to be an adequate substitute for SF-36, and its brevity should increase its attractiveness to both clinicians and patients.
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Affiliation(s)
- Anoushka Singh
- Department of Surgical Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
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Levine GJ, Levine JM, Walker MA, Pool RR, Fosgate GT. Evaluation of the association between spondylosis deformans and clinical signs of intervertebral disk disease in dogs: 172 cases (1999–2000). J Am Vet Med Assoc 2006; 228:96-100. [PMID: 16426177 DOI: 10.2460/javma.228.1.96] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the association between spondylosis deformans and clinical signs of intervertebral disk disease (IVDD) in dogs. DESIGN Retrospective case series. ANIMALS 210 dogs. PROCEDURE Records of 172 dogs with clinical signs of IVDD and 38 dogs with other neurologic disorders were reviewed. Signalment, sites of spondylosis, severity of associated osteophytosis, type of disk herniation, and duration of signs were recorded. RESULTS Dogs with IVDD had significantly fewer sites of involvement and lower grades of spondylosis deformans, compared with those in the non-IVDD group. When groups were adjusted for age and weight via multivariate linear regression, there were no differences in severity of osteophytosis or number of affected sites. Dogs with type II disk disease had higher numbers of affected sites and more severe changes, compared with dogs with type I disk herniation. There was no difference between groups in the rate at which IVDD was diagnosed at sites of spondylosis, compared with the rate at which IVDD was diagnosed in unaffected disk spaces. Areas of spondylosis were closer to sites of IVDD that elicited clinical signs than to randomly chosen intervertebral spaces, and distances between sites of spondylosis and sites of IVDD had a bimodal appearance. CONCLUSIONS AND CLINICAL RELEVANCE An association may exist between radiographically apparent spondylosis and type II disk disease; type I disk disease was not associated with spondylosis. Spondylosis in radiographs of dogs with suspected type I disk disease is not clinically important. Spatial associations among sites of spondylosis and sites of IVDD may be coincidental or associated with vertebral column biomechanics.
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Affiliation(s)
- Gwendolyn J Levine
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
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16
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Abstract
ABSTRACT
OBJECTIVE:
To determine the prevalence of depressed and anxious mood states in patients with cervical spondylotic myelopathy (CSM), a degenerative spine condition with symptoms of neck pain, numb clumsy hands, gait difficulties, sphincter dysfunction, and impotence. To examine the relation between mood and functional deficits produced by CSM.
METHODS:
We surveyed a cohort of 89 patients with CSM recruited during 1 year from a neurosurgery clinic. Patients underwent a structured interview to collect information on demographics, personal habits, CSM symptoms, comorbid diseases, and symptoms of depression and anxiety. Patients self-completed the Hospital Anxiety and Depression scale and were scored on the Nurick, Cooper, Harsh, and modified Japanese Orthopaedic Association (mJOA) scales.
RESULTS:
According to the Hospital Anxiety and Depression scale threshold value of 11, 29% of the cohort had a depressed mood and 38% had an anxious mood. Higher depression scores were associated with worse myelopathy, as measured by the Nurick scale (P = 0.01), the Cooper leg subscale (P = 0.006), the Harsh scale (P = 0.02), the mJOA arm subscale (P = 0.006), and the mJOA leg subscale (P = 0.004). There was no relation between depression scores and the Cooper arm subscale, Harsh sphincter scale, mJOA sensory subscale, or mJOA bladder subscale. Similar patterns were seen in the relations between myelopathy and anxiety.
CONCLUSION:
More than one-third of patients with CSM have a depressed or anxious mood. In patients with CSM, depression and anxiety scores are strongly associated with decreased mobility, inconsistently associated with arm dysfunction, and not associated with sensory deficits or sphincter dysfunction, suggesting that ambulatory dysfunction may cause or exacerbate the symptoms of depression and anxiety in patients with CSM.
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Affiliation(s)
- Michael R Stoffman
- Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
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17
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Abstract
Degenerative disorders in the spine are normal, age-related phenomena and largely asymptomatic in most cases. Conservative management of lumbar and cervical spondylosis is the mainstay of treatment, and most patients with symptomatic degenerative changes respond appropriately with nonsurgical management. Surgical intervention can be considered an appropriate and viable option when conservative measures have failed. Treatment options should always be directed toward the specific nature and location of the patient's individual pathology. Although current standards in the surgical management of lumbar and cervical degenerative disorders include discectomy, neural decompression, and instrumented spinal arthrodesis, new approaches that address this often-challenging clinical entity are on the horizon.
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Affiliation(s)
- Jeffrey S Roh
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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18
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Abstract
Spondylolysis and spondylolisthesis commonly are diagnosed in children and adolescents. The diagnostic workup and treatment plan vary widely among physicians. Although the orthopaedic literature is extensive on the topic, it is our opinion that a lack of clarity exists with regards to etiology, terminology, subtypes of spondylolysis and spondylolisthesis, and treatment. Important basic principles regarding spondylolysis and spondylolisthesis, with emphasis on clinical evaluation and nonsurgical treatment, serve as the basis for a new classification. We propose a new classification for pediatric spondylolysis and spondylolisthesis that is comprehensive, simple, and easily applied. This scheme is based on clinical presentation and spinal morphology and is more appropriate for the child and adolescent than the existing classification schemes of Wiltse-Newman and Marchetti-Bartolozzi. Algorithms for evaluation and treatment of spondylolysis and spondylolisthesis in children and adolescents, based on this new classification, are presented.
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Affiliation(s)
- Martin J Herman
- Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, PA, USA.
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19
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Jordan KM, Syddall H, Dennison EM, Cooper C, Arden NK. Birthweight, vitamin D receptor gene polymorphism, and risk of lumbar spine osteoarthritis. J Rheumatol 2005; 32:678-83. [PMID: 15801025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To investigate risk factors for adult lumbar spine osteoarthritis (OA) including polymorphisms of the vitamin D receptor gene (VDR) and birthweight. METHODS Plain radiographs of the lumbar spine were taken in 392 healthy subjects and graded for osteophytes and disc space narrowing (DSN); demographic data were collected. Details of birthweight and weight at 1 year were retrieved from historical records. VDR gene allelic variation was analyzed in 291 subjects. RESULTS The mean age of the cohort was 65.8 years; mean weight was 68.9 kg in women and 80.1 kg and men. Osteophytes of grade >/= 2 were found in 63.5% of this cohort; DSN >/= 2 was present in 14.3% of subjects. Increasing osteophyte severity was significantly associated with age, adult weight, and manual social class; DSN was not. Presence and severity of osteophytes were associated with low birthweight and lower weight at 1 year in men, but not in women. No associations were found for DSN. The B allele of the VDR gene was associated with increasing severity of osteophyte. There was a significant interaction between birthweight and VDR gene in determining risk of osteophytosis in men (p for interaction = 0.04). The VDR-birthweight interaction pattern was similar but not statistically significant in women. CONCLUSION Lumbar spine OA was a prevalent finding in this cohort. Both birthweight and polymorphisms in the VDR gene were associated with the presence of lumbar spine osteophytes and a significant interaction was observed between these 2 factors in men.
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Affiliation(s)
- Kelsey M Jordan
- MRC Epidemiology Resource Centre, Southampton University Hospitals NHS Trust, Southampton, England
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20
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Kotrych D, Bohatyrewicz A, Gusta A. [The prevalence and character of neurologic deficit relating to clinical forms of cervical spondylosis]. Chir Narzadow Ruchu Ortop Pol 2005; 70:353-60. [PMID: 16617768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The research was performed on 86 male patients between 41 and 83 years who were either hospitalised or treated in the out-patients clinic due to cervical spondylosis. The aim of the research was to evaluate the frequency and advance of neurologic, complications relating to the type and severity of lesions in cervical spine. The study showed significant relation between the degree of advance of cervical spondylosis and age, pain as well as prevalence and severity of neurologic deficit in the tested group. The authors have emphasized the need of precise evaluation and differentiation of presented forms of degenerative spine disease.
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Affiliation(s)
- Daniel Kotrych
- Katedra i Klinika Ortopedii i Traumatologii, Pomorska Akademia Medyczna w Szczecinie
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21
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Carnier P, Gallo L, Sturaro E, Piccinini P, Bittante G. Prevalence of spondylosis deformans and estimates of genetic parameters for the degree of osteophytes development in Italian Boxer dogs. J Anim Sci 2004; 82:85-92. [PMID: 14753351 DOI: 10.2527/2004.82185x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to assess the prevalence of spondylosis deformans and to investigate genetic aspects of the degree of osteophytes development (DOD) in the Italian Boxer dog population. A total of 849 Boxer dogs was radiographed on the thoracic, lumbar, and sacral regions of the spine and scored for DOD. Grading of DOD was performed for all 20 intervertebral sites comprised within the first thoracic site (site T1-T2) and the site between the seventh lumbar and the first sacral vertebra (site L7-S1). Scores for DOD ranged from 0 (no osteophytes development) to 3 (presence of a bony spur formed by osteophytes on adjoining vertebrae). The first five thoracic sites exhibited no variation for DOD and were not considered in the analysis. The prevalence of spondylosis deformans was 84%, and frequency of dogs showing at least one intervertebral site that scored 3 for DOD was 50%. Scores for DOD at different sites were analyzed as different traits. Nongenetic effects influencing DOD scores were sex, age at screening, and the kennel. Posterior densities of heritability (h2) were estimated using a univariate Bayesian analysis. Eight sites exhibited a posterior probability greater than 0.8 for h2 > 10% and were considered in a multivariate restricted maximum likelihood analysis. Estimated h2 from multivariate analysis ranged from 25 to 48% (SE from 5 to 7%). Three sites exhibited h2 estimates greater than 40%. Genetic correlations for DOD scored at different sites ranged from 0.07 to 0.96. All thoracic sites had estimated correlations larger than 0.85 with other thoracic sites. Genetic correlation between the first and the second lumbar site was 0.91. Correlations between thoracic sites and the first two lumbar sites ranged from 0.5 to 0.9. Sites L6-L7 and L7-S1 also exhibited weak relationships with all remaining sites. Breeding values of dogs for DOD at the eight sites were predicted using estimated covariance matrices. A selection index for DOD was computed from predicted breeding values and a set of relative weighting factors produced by a panel of veterinarians. The index was the most important effect influencing phenotypic differences between dogs for average DOD score, number of affected sites, and number of sites with a DOD score > 1 (P < 0.001). The degree of osteophytes development is a trait showing exploitable additive genetic variance, and breeding programs for decreasing prevalence and severity of spondylosis deformans might focus on this trait.
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Affiliation(s)
- P Carnier
- Department of Animal Science, University of Padova, 35020 Legnaro, Italy.
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22
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Wang B, Duan YP, Zhang YC, Wang QM, Huang ZM, Fan ZY, Zhuo SP. [Epidemiologic research on the clinical features of patients with cervical spondylosis]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2004; 29:472-4. [PMID: 16134610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To investigate the clinical features of patients with cervical spondylosis. METHODS Questionnaires were provided and X rays were examined in 1 009 people with different occupations, ages, and sexes. RESULTS All the patients were diagnozed as cervical spondylosis. Of them, cadres occupied 78.83%, technologists made up 74.21%, and accountants 58.70%; nervous and long-time working people accounted for 59.75%; high and middle pillow-lovers occupied 80.03%. Imaging features: most of the degenerative changes of cervical spine were located between C5-6 (40.79%), C4-5 (26.29%), and C6-7 (18.20%). Patients with vertebral osteophyte were 65.75%, intervertebral space narrow 36.87%, intervertebral foramen narrow 29.19%, and physiological curve change 31.03%. CONCLUSION This epidemiologic investigation is important, which can further understand the cause of cervical spondyiosis, and strengthen its prevention and treatment.
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Affiliation(s)
- Bing Wang
- Department of Spine Second Xiangya Hospital, Central South University, Changsha 410011, China.
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23
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Bar-Dayan Y, Weisbort M, Bar-Dayan Y, Velan GJ, Ravid M, Hendel D, Shemer J. Degenerative disease in lumbar spine of military parachuting instructors. J ROY ARMY MED CORPS 2004; 149:260-4. [PMID: 15015796 DOI: 10.1136/jramc-149-04-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Parachuting, be it static line or skydiving, places enormous stresses on the human spine. It is, therefore, important to determine the prevalence and severity of degenerative changes in the lumbar spine of subjects who practice this sport activity. Seventy four parachuting instructors, mean age 33 years and with an average of 410 static line and skydiving jumps, were included in the study. Past radiographs were examined and compared to current anterolateral and lateral views of the lumbar spine, in order to determine the prevalence of degenerative changes and document possible progression. Doubtful radiographic changes in the lumbar spine were identified in 47.4 percent of the parachuting instructors, mild degeneration in 9.6 percent, moderate degenerative disease in 10.9 percent and severe radiographic changes in 5.5 percent. Schmorll nodes were found in 8.1 percent of the subjects. Traction spurs--osteophytes were identified in 6.8 percent. The degenerative changes correlated with age and the number of jumps. Spondylolysis of L5-S1 and L3-L4 segments were observed in 12.2 and 1.4 percent respectively. Progressive spondylolisthesis was found in 2 subjects. No correlation was found between the severity of radiographic changes and either the prevalence and the severity of low back pain. The present findings provide a rational for considering repeated sheer stress as an etiology of degenerative changes in the spinal cord, and as a possible contributing factor to the pathogenesis of spondylolysis. Further study has to be done comparing parachuting instructors to a non-parachuting group, or equivalent physically active individuals, in order to assess the effect of sport-background on the development of degenerative changes.
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Affiliation(s)
- Y Bar-Dayan
- Department of Medicine, Meir Hospital, Kfar-Sava, Israel.
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24
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Abstract
Cervical spondylosis is associated with myelopathy and radiculopathy, which sometimes mimic clinical manifestations of amyotrophic lateral sclerosis (ALS), a fatal neurodegenerative disorder that affects upper and lower motor neurons. Cervical spondylosis may coexist with ALS because both diseases preferentially affect individuals of middle or old age. We investigated 63 patients with ALS to clarify the complications of cervical spondylosis and other spinal disorders and to explore the history of surgical treatment for them. We found cervical spondylosis in 30 patients (48%), lumbar spondylosis in 7 (13%), ossification of the posterior longitudinal ligament (OPLL) in 4 (6.3%), and ossification of the yellow ligament (OYL) in 4 (6.3%). Surgery was performed early in the course of the disease on the cervical spine in five patients (7.9%) and on the lumbar spine in one (1.6%); these patients consulted our clinic because their motor symptoms had progressed even after the spinal surgery. Our results indicate that nearly half of all ALS patients have their disease complicated by cervical spondylosis, and that a careful differential diagnosis for ALS is necessary before making decisions about spinal surgery.
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Affiliation(s)
- Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Japan
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25
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Chanchairujira K, Chung CB, Kim JY, Papakonstantinou O, Lee MH, Clopton P, Resnick D. Intervertebral disk calcification of the spine in an elderly population: radiographic prevalence, location, and distribution and correlation with spinal degeneration. Radiology 2004; 230:499-503. [PMID: 14752191 DOI: 10.1148/radiol.2302011842] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the prevalence, distribution, and location of intervertebral disk calcification (IDC) in the thoracic and lumbar spine and the association of IDC with radiographically evident spinal degenerative changes in cadavers. MATERIALS AND METHODS Anterior vertebral columns comprising T1 through L5 were removed from 223 cadavers (183 men, 40 women; mean age at death, 67 years; range, 37-94 years). Approximately 5-mm-thick parasagittal sections were investigated with high-contrast radiography. The presence of IDC, osteophytes, vertebral endplate abnormalities, and vacuum phenomena was recorded, and the height of disk space was measured at 3,568 intervertebral levels. Logistic regression analysis was performed. RESULTS IDC was identified in 178 (80%) of the 223 cadavers. Of 3,568 disks, 459 (13%) had IDC, and 289 cases (63%) were located in the annulus fibrosus. IDC was most common in the lower thoracic spine, occurring in 275 (60%) of 459 disks. IDC occurred in 159 (87%) of 183 men and 19 (48%) of 40 women. Logistic regression analysis was adjusted for age, and results showed that the frequency of IDC was significantly higher in men in upper, middle, and lower segments of the thoracic spine (P <.05) but not in the lumbar spine (P =.09). IDC correlated with increasing age (P <.001) and disk space loss (P <.001) at all spinal levels. There was no association of IDC with vacuum phenomena or vertebral endplate abnormalities at any spinal level. CONCLUSION IDC is common in elderly persons, especially in the annulus fibrosus and lower thoracic spine. The prevalence of IDC increases with age and extent of disk space loss.
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Affiliation(s)
- Kullanuch Chanchairujira
- Department of Radiology, Veterans Administration Medical Center, University of California San Diego, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
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26
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Rinella A, Bridwell K, Kim Y, Rudzki J, Edwards C, Roh M, Lenke L, Berra A. Late complications of adult idiopathic scoliosis primary fusions to L4 and above: the effect of age and distal fusion level. Spine (Phila Pa 1976) 2004; 29:318-25. [PMID: 14752356 DOI: 10.1097/01.brs.0000111838.98892.01] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED STUDY DESIGN A retrospective analysis of primary cases of adult idiopathic scoliosis treated with long instrumented fusions from the thoracic spine proximally to segments that range from T11 to L4 distally. OBJECTIVE To analyze whether patients requiring revision surgery had lower postoperative SRS-24 scores; age >or=40 years correlated with higher rates of revision surgery; disc degeneration below the fusion occurred more commonly with a more distal lowest instrumented vertebra or older patient age (>or=40 years); and whether smokers had higher rates of major complications or revision surgery. SUMMARY OF BACKGROUND DATA Few reports describe complications related to primary long fusions using modern 2+ rods, hook/pedicle screw instrumentation methods in the treatment of adult idiopathic scoliosis. METHODS Sixty-seven patients were analyzed with an average age of 38.8 years (range 21-61 years). The average clinical follow-up was 7.8 years (range 2-16 years): 42 patients had >5 years follow-up, including 23 patients with >10 years follow-up. Patients were categorized by age (< or >or=40 years) and level of the lowest instrumented vertebra (T11-L2 vs. L3-L4). Upright radiographs and postoperative SRS-24 questionnaires from the latest follow-up date were analyzed. RESULTS Patients requiring revision surgery had lower total score (average 72.0) than those that did not (total score = 94.2; P = 0.01). More specifically, patients with pseudarthrosis had lower total scores (average 74.7) than those without (average total score = 93.5; P = 0.02). When analyzing age, there were similar rates of pseudarthrosis, but higher rates of transition syndrome (2) and sagittal/coronal imbalance (1 each) in patients >or=40 years. Subsequent distal disc degeneration did not correlate significantly with more distal lowest instrumented vertebra or older patient age. Smokers did not have higher rates of major complications or revision surgery than nonsmokers. CONCLUSIONS Patients with adult idiopathic scoliosis and long fusions had similar pseudarthrosis rates, but higher rates of transition syndrome when lowest instrumented vertebra was L3-L4 relative to levels T11-L2. When categorized by age, complication rates were similar in each group. Patients with pseudarthroses or other diagnoses requiring revision surgery had lower SRS-24 total scores than those without (P = 0.02 and P = 0.01, respectively).
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Affiliation(s)
- Anthony Rinella
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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27
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Zejda JE, Stasiów B. Cervical spine degenerative changes (narrowed intervertebral disc spaces and osteophytes) in coal miners. Int J Occup Med Environ Health 2003; 16:49-53. [PMID: 12705717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
A series of 685 x-ray films of the cervical spine obtained in coal miners was analyzed to explore the occurrence of narrowed disc spaces and osteophytes in this occupational group, and to examine the association of x-ray changes with age, duration of employment, and duration of occupational exposure to hand-arm vibration. All data were extracted from individual medical files of coal miners examined for suspected hand-arm vibration-related disorders in 1989-1999 at the Occupational Medicine Center in Katowice. The narrowed intervertebral disc spaces were found in 188 coal miners (26.9%) and osteophytes in 332 coal miners (47.5%). The occurrence of degenerative changes in coal miners was similar to that observed in a small group of 68 blue-collar workers (no exposure to hand-arm vibration) employed in the coal industry. Univariate comparisons showed that narrowed intervertebral disc spaces and osteophytes were more frequent among older subjects and among subjects with longer duration of employment. The prevalence of changes also showed some relationship with the number of years of exposure to hand-arm vibration. The results of logistic regression analysis confirmed statistically significant effect of age, but not of other factors included in the model. When both x-ray changes were grouped together (a combined dependent variable) age remained the only statistically significant explanatory variable. The findings do not support the view that the examined degenerative changes in the cervical spine are more prevalent in coal miners and depend on duration of physical work or local exposure to hand-arm vibration in this occupational group.
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Affiliation(s)
- Jan E Zejda
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Silesia, Katowice, Poland.
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28
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Hartwig E, Schultheiss M, Krämer S, Ebert V, Kinzl L, Kramer M. [Occupational disease 2108. Degenerative changes of the cervical spine as a causality criterion in the assessment of discogenic diseases according to BeKV 2108]. Unfallchirurg 2003; 106:306-12. [PMID: 12719851 DOI: 10.1007/s00113-002-0561-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
With the second amendment to the Ordinance on Occupational Diseases (BeKV) of 18 December 1992, discogenic diseases of the spine are included in the disease register of occupational diseases for the first time. If occupations that impose stress on the spine have been practised for many years, the possibility exists of recognizing degenerative diseases as an occupational disease. In assessment practice, the radiological data on the spine exposed to stress is compared with that of regions which are remote from the stress (cervical/thoracic spine). This pattern of the distribution of degenerative disease is then used as the basis for determining a causal relationship between the occupation causing the stress and disease of the axial skeleton. The pattern of degeneration of the cervical spine was investigated in two groups, one with ( n =153) and one without ( n =333) occupations that impose stress on the lumbar spine. A cumulative score of degenerative changes was elaborated and presented as a new classification. No differences were found between the groups with regard to either the frequency of occurrence, segmental distribution or severity of disease. In both groups, degenerative changes correlated with age. The prevailing assessment practice is discussed on the basis of these data.
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Affiliation(s)
- E Hartwig
- Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie der Universität Ulm.
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29
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Walsh TL, Hanscom B, Lurie JD, Weinstein JN. Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary? The responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36. Spine (Phila Pa 1976) 2003; 28:607-15. [PMID: 12642770 DOI: 10.1097/01.brs.0000050654.97387.df] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Analysis of longitudinal data collected prospectively from patients seen in 27 National Spine Network member centers across the United States. OBJECTIVE To evaluate the responsiveness of the Oswestry Disability Index, MODEMS scales, and all scales and summary scales of the MOS Short-Form 36 (SF-36) for patients with low back pain/leg symptoms. SUMMARY OF BACKGROUND DATA The responsiveness of general and condition-specific health status instruments is a key concept for clinicians and scientists. Various authors have explored responsiveness in common surveys used to assess spine patients. Although it is generally believed that condition-specific measures are more responsive to change in the condition under study, in the case of low back pain, most authors agree that further exploration is necessary. METHODS Patients with diagnoses of herniated disc, spinal stenosis, and spondylosis from the National Spine Network database who completed baseline and 3-month follow-up surveys were analyzed. Patient-provider consensus regarding improvement, worsening, or no change in the condition was selected as the external criterion. Responsiveness was evaluated using ROC curve analysis and effect size calculations. RESULTS Nine hundred and seventy patients had complete data at baseline and 3 months. At follow-up, 68% of the patients had consensus improvement. Based on ROC analysis, scales assessing pain were significantly more responsive than scales assessing function. There were no significant differences between the condition-specific scales and their equivalent general-health counterpart. The scales with the highest probabilities of correctly identifying patient's improvement were: the condition-specific pain scale from MODEMS (PAIN, ROC = 0.758); the combined pain and function scale from MODEMS (MPDL, ROC = 0.755); the general pain scale from the SF-36 (BP, ROC = 0.753); the combined pain and function scale from the SF-36 (PCS, ROC = 0.745); the condition-specific function measure from the Oswestry (ODI, ROC = 0.723); and the physical function measure from the SF-36 (PF, ROC = 0.721). A similar rank order was typically maintained with effect size calculations. Results were nearly identical in patients with multiple non-spine-related comorbidities and in patients with high degrees of perceived disability. The BP scale was most responsive to worsening of symptoms. CONCLUSION For studies of patients with low back problems, the general SF-36 may be a sufficient measure of health status and patient function, without the need for additional condition-specific instruments. Pain scales appear to be the most responsive measures in patients with low back pain.
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Affiliation(s)
- Thomas L Walsh
- The Spine Center at Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA.
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Leino-Arjas P, Kaila-Kangas L, Notkola V, Ilmo K, Mutanen P. Inpatient hospital care for back disorders in relation to industry and occupation in Finland. Scand J Work Environ Health 2002; 28:304-13. [PMID: 12432983 DOI: 10.5271/sjweh.679] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The variation in hospital admission rates was studied for back disorders by industry and occupational title among gainfully employed Finns. METHODS Admissions to Finnish hospitals in 1996 among 25- to 64-year-olds, based on the Hospital Discharge Register, were linked with sociodemographic data from the 1995 population census for the following primary diagnoses [International Classification of Diseases, 10th revision (ICD-10)]: all back disorders (M40.0-54.9; N (individual patients) 7,253), lumbar intevertebral disc disorders (M51.0-M51.9, N = 3,863), and other common back disorders (ICD-10: M47.1-47.2, M47.8-47.9, M48.0, M54.1, M54.3-54.5, M54.8-54.9; N = 2,433), with the total occupationally active workforce (same age range and gender) as reference. Age-standardized hospitalization rate ratios (SRR) were calculated. RESULTS The highest SRR values for hospitalization for any back disorder were found for fishing (SRR 195), "other" mining and carrying (SRR 168), and sewage and refuse disposal (SRR 152) among the men and water transport (SRR 158), wood product (SRR 149) and pulp, paper and paper product (SRR 145) manufacturing among the women. Computer activities (SRR 44) among the men and insurance and pension funding (SRR49) among the women had the lowest SRR values. The occupations reindeer breeders and herders (SRR 495), agricultural workers (SRR 232), and paper product workers (SRR 205) among the men and plastic product (SRR 233), laundry (SRR 224), and agricultural (SRR 219) workers among the women had the highest SRR values. The lowest SRR values were observed for upper white-collar employees in public administration [men (SRR 40) and women (SRR 61)]. CONCLUSIONS Hospitalization rates for back disorders were high for several physically strenuous industries and occupations.
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Affiliation(s)
- Pävi Leino-Arjas
- Department of Epidemiology and Biostatistics, Finnish Institute of Occupational Health, Helsinki.
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Weber M. [Is lumbar disk disease an occupational disease? Scientific background, radiological findings, and medical legal interpretations]. Z Orthop Ihre Grenzgeb 2002; 140:512-7. [PMID: 12226775 DOI: 10.1055/s-2002-34003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM It should be cleared whether or not the interpretation of lumbar disk disease as an occupational disease is justifiable. Which disc changes follow whole-body vibration and can they be distinguished from those which occur constitutionally while aging? METHOD Orthopedic meta-analysis of epidemiological and occupational studies concerning the influence of whole- body vibration. RESULTS Reliable studies are rare. Severe methodological problems limit the interpretation of difficult relationships. The role of age when working influences begin as well as the stress and behaviour of exposed persons away from the work-place before and while working with whole-body vibration is not known. There is no study which could be called exact according orthopedic criteria. It is therefore not evident that whole-body vibration causes lumbar disc disease. CONCLUSIONS After whole-body vibration similar to long term heavy lifting an earlier beginning of disk degeneration in X-ray-studies can be observed. This leads to prevalence differences, which diminish with increasing age. Deviation to the left of the prevalence curve lasts for five to ten years. Whole-body vibration leads to a topographic modification of disk degeneration of the lumbar spine. After long duration exposition an increased amount of spondylotic changes at the thoracolumbar junction and the middle half of lumbar spine can be observed (up to the upper plate of the fourth vertebral body). This can be explained by biomechanic means: whole-body vibration caused by tractor driving and similar long-term exposures leads to traction of the disks of the lower thoracic spine and the upper and middle parts of lumbar spine.
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Affiliation(s)
- M Weber
- Department für Orthopädie und Traumatologie, Klinik für Orthopädie, Universitätsklinikum Freiburg, Germany
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Abstract
Spinal degenerative disk disease (DDD) in a radiographic, cross-sectional sample of 192 female macaque monkeys, approximately 5-30 years old, is described. The presence and extent of disk space narrowing (DSN) and anterior osteophytosis were assessed with reference to age, average lifetime body mass. and distribution within the thoracolumbar spine. Age was a strong correlate of disk narrowing and osteophytosis, with early signs appearing at equivalent ages in both species and increasing in prevalence thereafter. Macaques showed a far greater prevalence of DDD, especially in the oldest age group, than has been reported in the human data. Body mass was associated with disk narrowing in the macaque, but not with osteophytosis. The two species differed little in the pattern of distribution of DDD along the spine. Our results suggest that bipedality is not the singular, or even the most important, biomechanical factor in the development of human DDD. Rather, others shared postural regimes, e.g., sitting, may be responsible for the onset and progression of DDD in both species. The macaque model could substantially add to the understanding and, potentially, treatment of this oftentimes debilitating condition.
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Affiliation(s)
- Patricia Ann Kramer
- Department of Anthropology and Orthopaedics, Harborview Medical Center, Seattle, WA 98104-2499, USA.
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Abstract
STUDY DESIGN Plain lateral radiographs of the lumbar spines of 607 women (age range 20-87 years) and 633 men (age range 20-92 years) were studied. OBJECTIVE To study the radiographic changes in the lumbar intervertebral discs and lumbar vertebrae with age. To compile a database of reference values for the age-dependent height of lumbar discs and concavity index of lumbar vertebral bodies as well as prevalence of vertebral osteophytes by age and sex. SUMMARY OF BACKGROUND DATA There is a general agreement that changes induced by aging lead to alterations in the thickness of the disc, but there are differences in the accounts of the effect of aging on the thickness of the lumbar discs. Published methods to measure disc height yield, except for some exceptional cases, inaccurate results. Reference values of disc height and concavity index of lumbar vertebral bodies, suitable for quantitative comparison with a given disc and lumbar vertebral body, have yet to be established. METHODS Using a new protocol with a precision of 3.9%, the anulus heights of lumbar discs were measured from sets of lateral radiographic views of 607 women and 633 men. The measurement of concavity index of vertebrae was established for each vertebral body by dividing the central vertebral height by the anterior vertebral height. RESULTS The heights of lumbar discs T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, and L5-S1 of men and women within the age 20-69 years increased with increasing age (4.6-6.9% in men and 4.7-8.4% in women). The concavity index of vertebrae T12, L1, L2, L3, L4, and L5 of men within age 20-87 years and of women within age 20-92 years decreased linearly with increasing age (0.9-1.5% in men and 1.6-3.2% in women). In other words, the vertebral body endplates became more concave with age. The prevalence of osteophytes was greater in men than in women in lumbar spine and increased with age. CONCLUSIONS Using the new procedure and the database of reference values, it is possible to measure the height of lumbar discs and concavity of vertebrae objectively and precisely and to compare the results quantitatively with reference values.
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Affiliation(s)
- Zengwu Shao
- Orthopaedic Hospital, University of Heidelberg, Heidelberg, Germany
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Cvijetić S, McCloskey E, Korsić M. Vertebral osteophytosis and vertebral deformities in an elderly population sample. Wien Klin Wochenschr 2000; 112:407-12. [PMID: 10849952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
AIM OF THE STUDY We investigated the association between vertebral osteophytosis and vertebral deformities in an elderly population sample, and the influence of some risk factors on spinal osteophytosis and deformities. SUBJECTS AND METHODS A population sample of 280 women and 263 men, all Zagreb residents older than 45 years, participated in the study. Radiographs of the thoracic and lumbar spine were evaluated for the presence of osteophyte formation and vertebral deformities. Osteophyte size was graded on a scale from 0 to 4. Vertebral deformities were determined by the semiquantitative method of McCloskey. The chi-square test was used to analyse the association between vertebral osteophytes and deformities, and the influence of several risk factors was investigated by discriminate analysis. RESULTS The prevalence of vertebral osteophytosis was 47.9% in men (36.5% in the thoracic and 21.3% in the lumbar spine) and 56.0% in women (36.0% in the thoracic and 23.9% in the lumbar spine). The prevalence of vertebral deformities was 8.3% in men (5.3% in the thoracic and 3.4% in the lumbar spine) and 12.5% in women (7.9% in the thoracic and 5.4% in the lumbar segment). There was a significant association between deformities and osteophytosis on the lumbar segment of the spine (P = 0.0240 men, P = 0.0152 women). Analysing the influence of several risk factors, age was found to be the most associated with both vertebral deformities and osteophytosis. Obesity was significantly associated with osteophytosis. CONCLUSIONS We found a significant association between vertebral osteophytosis and deformities in the lumbar segment and no relationship in the thoracic segment. This implicates different etiologies of vertebral deformities in the thoracic and lumbar spine.
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Affiliation(s)
- S Cvijetić
- Institute for Medical Research and Occupational Health, Zagreb, Croatia.
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Abstract
Degenerative spinal disorders, including intervertebral disc disease and spondylosis, seldom occur in domestic cats. In contrast, a retrospective study of 13 lions (Panthera leo), 16 tigers (Panthera tigris), 4 leopards (Panthera pardis), 1 snow leopard (Panthera uncia), and 3 jaguars (Panthera onca) from the Knoxville Zoo that died or were euthanatized from 1976 to 1996 indicated that degenerative spinal disease is an important problem in large nondomestic felids. The medical record, radiographic data, and the necropsy report of each animal were examined for evidence of intervertebral disc disease or spondylosis. Eight (three lions, four tigers, and one leopard) animals were diagnosed with degenerative spinal disease. Clinical signs included progressively decreased activity, moderate to severe rear limb muscle atrophy, chronic intermittent rear limb paresis, and ataxia. The age at onset of clinical signs was 10-19 yr (median = 18 yr). Radiographic evaluation of the spinal column was useful in assessing the severity of spinal lesions, and results were correlated with necropsy findings. Lesions were frequently multifocal, included intervertebral disc mineralization or herniation with collapsed intervertebral disc spaces, and were most common in the lumbar area but also involved cervical and thoracic vertebrae. Marked spondylosis was present in the cats with intervertebral disc disease, presumably subsequent to vertebral instability. Six of the animals' spinal cords were examined histologically, and five had acute or chronic damage to the spinal cord secondary to disc protrusion. Spinal disease should be suspected in geriatric large felids with decreased appetite or activity. Radiographic evaluation of the spinal column is the most useful method to assess the type and severity of spinal lesions.
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Affiliation(s)
- C Kolmstetter
- Department of Comparative Medicine, College of Veterinary Medicine, University of Tennessee, Knoxville 37901-1071, USA
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Yamada Y, Okuizumi H, Miyauchi A, Takagi Y, Ikeda K, Harada A. Association of transforming growth factor beta1 genotype with spinal osteophytosis in Japanese women. Arthritis Rheum 2000; 43:452-60. [PMID: 10693888 DOI: 10.1002/1529-0131(200002)43:2<452::aid-anr28>3.0.co;2-c] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the possible relationship between a T-->C polymorphism at nucleotide position 29 of the transforming growth factor beta1 (TGFbeta1) gene and genetic susceptibility to radiographic spinal osteophytosis. METHODS A total of 540 postmenopausal Japanese women were subjected to radiography of the spine and determination of bone mineral density (BMD) for the lumbar spine and total body. Changes in lumbar intervertebral discs were examined in 67 individuals with either osteoporosis or spinal osteophytosis by magnetic resonance imaging (MRI). TGFbeta1 genotype was determined with an allele-specific polymerase chain reaction assay. The serum concentration of TGFbeta1 was measured in 29 control subjects and in 36 patients with spinal osteophytosis. RESULTS Among all study subjects, the prevalence of radiographic spinal osteophytosis in individuals with the CC genotype was greater than that in those with the TC or TT genotype. Logistic regression analysis, adjusted for age, height, body weight, time since menopause, smoking status, body fat, lean mass, and either lumbar spine or total body BMD, demonstrated that the frequency of the C allele in subjects with spinal osteophytosis was significantly greater than that in those without this condition. Comparison among control, osteoporosis, and spinal osteophytosis groups also revealed that the C allele was more prevalent in subjects with osteophytosis than in controls, even after adjustment for BMD. In contrast, as previously shown, the frequency of the C allele was lower in osteoporosis patients than in controls. The intervertebral disc area and the ratio of disc area to vertebral body area, as determined by MRI, were also lowest in subjects with the CC genotype. The serum concentration of TGFbeta1 increased with the number of C alleles in both controls and patients with spinal osteophytosis. CONCLUSION The T29-->C polymorphism of the TGFbeta1 gene exhibited inverse patterns of association with genetic susceptibility to spinal osteophytosis and with osteoporosis. Although radiographic evaluation of osteophytes might not reflect the actual disease severity, the C allele, which protects against osteoporosis, may be a risk factor for genetic susceptibility to spinal osteophytosis.
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Affiliation(s)
- Y Yamada
- Department of Geriatric Research, National Institute for Longevity Sciences, Morioka, Obu, Japan
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Yoshimura N, Dennison E, Wilman C, Hashimoto T, Cooper C. Epidemiology of chronic disc degeneration and osteoarthritis of the lumbar spine in Britain and Japan: a comparative study. J Rheumatol 2000; 27:429-33. [PMID: 10685810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To compare the prevalence of spinal osteoarthritis (OA) in Britain and Japan. METHODS A total of 206 men and 188 women living in Hertfordshire, UK, and a total of 100 men and 100 women living in Miyama, Japan, aged 60-79 years were studied. Participants completed a lifestyle questionnaire, and anteroposterior and lateral radiographs of the thoracic and lumbar spine were obtained under standardized conditions. Each lumbar radiograph was graded for osteoarthritic changes according to the overall Kellgren-Lawrence (K-L) score. Gradings were also recorded separately for disc narrowing and osteophyte formation. RESULTS British subjects were much more likely to have lumbar spine radiographs graded as K-L grade 4 severity (p = 0.05 in men, p < 0.001 in women). British men displayed a greater prevalence of disc narrowing (p = 0.08), but less severe osteophytosis (p = 0.06) than their Japanese counterparts. British women displayed more severe disc narrowing (p < 0.001) and osteophyte formation (p < 0.001). On multiple regression analysis, a higher body mass index (BMI) was associated with excess risk in the British population (OR 1.84, 95% CI 1.12-3.02), but not in the Japanese population. Differences between countries in K-L severity persisted after allowing for age and BMI, suggesting that differences in body build could not fully explain differences in lumbar spine OA in the 2 countries. CONCLUSION We found that severe lumbar degenerative disease is more common in the UK than in a mountain village in Japan, and that differences exist in the prevalence of both osteophytosis and disc degeneration between the 2 countries.
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Affiliation(s)
- N Yoshimura
- Department of Public Health, Wakayama Medical College, City, Japan
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Abstract
OBJECTIVES To investigate the consequences of rally driving on lumbar degenerative changes. BACKGROUND Vehicular driving is suspected to accelerate disc degeneration through whole-body vibration, leading to back problems. However, in an earlier well-controlled study of lumbar MRI findings in monozygotic twins, significant effects of lifetime driving on disc degeneration were not demonstrated. Another study of machine operators found only long-term exposure to vibration on unsprung seats led to a reduction in disc height. DESIGN Case-control study comparing rally drivers with population sample. METHODS Eighteen top rally drivers and co-drivers, mean age 43 yrs (SD, 10), volunteered for the study. The subjects were interviewed and imaged with a MR scanning and lumbar images were analyzed for degenerative findings using a standard scoring protocol previously published. The reference group was composed of 14 men, mean age 55 yrs (SD, 10), selected from a population sample. RESULTS Overall results showed no significant differences in lumbar degenerative findings as assessed from MR images between the rally drivers and the reference group; age-adjusted differences were not statistically significant for disc heights, bulges, herniations, end-plate irregularities, or osteophytes. CONCLUSION Even extreme vehicular vibration as experienced in rally driving does not appear to have significant effects on disc generation. RELEVANCE The study results do not support driving, and its associated whole body vibration, as a significant cause of disc degeneration and question the theory that the higher incidence of back pain among drivers is due to accelerated disc degeneration. Other driving-related factors, such as postural stress, may deserve more attention.
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Affiliation(s)
- T Videman
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
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Obisesan KA, Obajimi MO. Radiological ageing process in the cervical spine of Nigerian women. Afr J Med Med Sci 1999; 28:189-91. [PMID: 11205829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The study was designed to determine the age of commencement of ageing process in Nigerian women Four hundred (400) consecutive women requesting for cervical spine radiographs where recruited for this study. A study chart was made showing different variables like osteoarthrosis, detached osteophytes, postural ulterations and disk degenerations in a four year period from 1st January, 1993 to 31st December, 1996 the modified Kellgren and Lawrence grading system was used to assess radiographic changes. The highest rate of osteoarthrosis (31.13%) was found in the fifth decade. Incidence of postural alterations of the cervical spine rose sharply in the 5th and 6th decades of life. Grade 2 osteoarthrosis (Kellgren and Lawrence) was commonest (61.3%); Grades 3 and 4 had the lowest incidence (3.45%). Disc degeneration was commonest in the 5th; the most involved disc was C5/C6 and the least involved was C2/C3. It is concluded that the ageing process in the Nigerian women commences in the fourth decade of life, and apparently shows no difference with caucasian women.
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Affiliation(s)
- K A Obisesan
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
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Nakai S, Yoshizawa H, Kobayashi S. Long-term follow-up study of posterior lumbar interbody fusion. J Spinal Disord 1999; 12:293-9. [PMID: 10451044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
To see whether degenerative changes of the adjacent disks are accelerated by fixation of a lumbar segment, 48 patients who had undergone posterior lumbar interbody fusion (PLIF) more than 5 years previously were investigated radiographically and clinically. Narrowing of disk spaces was observed in 31% of the subjects, but it usually occurred at levels proximal to the fusion. The incidence of adjacent disk narrowing was not significantly higher after PLIF, compared with reports on degenerative changes of lumbar disks with aging. Some subjects showed narrowing of disks that were not adjacent to the fused level, suggesting that individual predisposition played a role in disk narrowing. Instability was not seen in any of the subjects. New development or elongation of the traction spurs at adjacent segments occurred at the disks proximal to the fusion. The clinical results were generally satisfactory, despite progression of degenerative changes on radiographs.
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Affiliation(s)
- S Nakai
- Department of Orthopaedics, School of Medicine, Fujita Health University, Toyoake City, Japan
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O'Neill TW, McCloskey EV, Kanis JA, Bhalla AK, Reeve J, Reid DM, Todd C, Woolf AD, Silman AJ. The distribution, determinants, and clinical correlates of vertebral osteophytosis: a population based survey. J Rheumatol 1999; 26:842-8. [PMID: 10229405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Vertebral osteophytes are a characteristic feature of intervertebral disc degeneration. There are, however, few population data concerning the occurrence of and clinico-biological correlates of vertebral osteophytes in both the dorsal and lumbar spine. Our purpose was to determine the frequency and distribution of anterior osteophytes in the thoracic and lumbar spine, and their relationship with both various putative risk factors, including physical activity and obesity, and self-reported back pain. METHODS Men and women aged 50 years and over were recruited from primary care based registers in 5 UK centers. They were invited to attend for an interviewer administered lifestyle questionnaire, assessment of height and weight, and lateral spinal radiographs. Lateral spinal radiographs were evaluated by a single observer for the presence of osteophytes from T4 to L5 using a semiquantitative score (grade): 0 = none, 1 = doubtful, 2 = mild, 3 = moderate, 4 = severe. Based on these data 2 summary statistics were derived: the maximum osteophyte grade at any vertebral level (MAX), and the sum of the osteophyte grades at the individual vertebral levels (TOT). RESULTS In total, 681 women, mean age 63.3 years, and 499 men, mean age 63.7 years, were studied; 84% of men and 74% of women had at least one vertebral level with a grade 1 or higher osteophyte. Both the sum of the individual grades (TOT) and the proportion of subjects with MAX > or =2 were greater in men than in women in both the dorsal and lumbar spine, and both increased with age. The pattern of spinal involvement was similar in the sexes, with osteophytes occurring most frequently at T9-10 and L3. Increasing body mass index was associated with more frequent osteophytes at both dorsal and lumbar spine, although the relationship was stronger at the dorsal spine. Heavy physical activity, particularly in young adult life, was associated with osteophytosis in men. Self-reported back pain, both ever and in the past year, was linked with lumbar osteophytes in men. CONCLUSION The distribution within the spine in our study and the relationship with heavy physical activity points to mechanical factors being important in pathogenesis of vertebral osteophytosis. Prospective studies are needed to explore the types of physical activity that increase susceptibility to vertebral osteophytosis. In men, osteophytes affecting the lumbar spine are associated with back pain.
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Affiliation(s)
- T W O'Neill
- ARC Epidemiology Research Unit, Manchester University, United Kingdom
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Kinoshita H, Tamaki T, Hashimoto T, Kasagi F. Factors influencing lumbar spine bone mineral density assessment by dual-energy X-ray absorptiometry: comparison with lumbar spinal radiogram. J Orthop Sci 1998; 3:3-9. [PMID: 9654549 DOI: 10.1007/s007760050015] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A study was conducted to determine the effect of radiographic findings of lumbar spinal changes upon bone mineral density measurements obtained by dual energy X-ray absorptiometry (DXA). Four hundred subjects were chosen from among 1543 community residents, aged 40-79 years. Study groups of 50 subjects each were selected by sex and 10-year age groups. This study investigated 390 of the 400 subjects who agreed to the conduct of spine bone mineral density measurement and spinal radiography. Lumbar spine radiograms were examined for findings of osteophyte formation, facet joint osteoarthritis, vertebral fracture, and aortic calcification. The prevalence of osteophyte formation, facet joint osteoarthritis, vertebral fracture, and aortic calcification increased with age in both men and women. On multiple regression analysis, bone mineral density was significantly higher (P < 0.001) in subjects with osteophyte formation or facet joint osteoarthritis than in those without these conditions, while bone mineral density was significantly lower in subjects with vertebral fracture. This study demonstrated that osteophyte formation, facet joint osteoarthritis, and vertebral fracture should be taken into account in the evaluation of bone mineral density by DXA in people in older age groups, since these conditions occur at a considerable rate in such subjects.
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Affiliation(s)
- H Kinoshita
- Department of Orthopaedic Surgery, Wakayama Medical College, 27, 7- Bancho, Wakayama 640, Japan
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Abstract
STUDY DESIGN Three transaxial slices, dividing each disc into four layers of equal thickness, were made in each of 19 T12-L1 discs. Naked-eye and stereoscopic examination was used to record abnormalities of the T12 (superior) surface of the upper slice, opposing surfaces of the central slice, and the L1 (inferior) surface of the lower slice. OBJECTIVES To characterize and quantify structural abnormalities to determine their incidence and three-dimensional arrangement, and to test the hypotheses 1) that the frequency and location of tears of the anulus are related to age and nucleus condition; and 2) that rim lesions initiate the development of concentric tears. SUMMARY OF BACKGROUND DATA Most previous studies of disc disease have been based on the examination of single sagittal slices, some on single transaxial slices, and a few have used both. This single-slice approach underrecords abnormalities that have not involved the disc center, and may inhibit the interpretation of magnetic resonance imaging and computed tomography images. METHODS Spines from 19 human cadavers (mean age, 47.4 years; range, 20-79 years) were used. An initial transaxial slice through the center of the T12-L1 disc was followed by cranial and caudal transaxial slices midway between the center and endplate. Soft tissues were then removed to allow examination of the endplate. Abnormalities recorded at each stage were summated for all disc levels. The incidence of the abnormalities in each disc sector was analyzed using the Spearman-Rank correlation coefficient and the Bonferroni correction. RESULTS With the exception of radiating tears, which most commonly affected the posterior disc, the right anterior quadrant tended to show abnormalities more frequently than the other quadrants. Although concentric tears (in 74%), rim lesions (in 47%), and radiating tears (in 47%) were frequent, no correlations were found between these three types of anulus tear. Concentric tears were present after approximately 10% of the anulus had undergone some delamination. Rim lesions correlated with focal thickening of anulus lamellae. One fifth of radiating tears extended to involve the outer anulus zone. CONCLUSIONS Neither hypothesis was substantiated. Because lesions of the nucleus and anulus lack uniform shape and are three-dimensionally complex, it is inappropriate to interpret cadaver disc disease on single, mid-disc slices. The three different types of anulus tears appear to evolve independent of age and each other.
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Affiliation(s)
- B Vernon-Roberts
- Institute of Medical and Veterinary Science, Department of Pathology, University of Adelaide, South Australia
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Côté P, Cassidy JD, Yong-Hing K, Sibley J, Loewy J. Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine. Can they be measured reliably on radiographs? Spine (Phila Pa 1976) 1997; 22:859-64. [PMID: 9127918 DOI: 10.1097/00007632-199704150-00007] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Interexaminer reliability study. OBJECTIVES To determine the reliability of grading apophysial joint and disc degenerative changes and the reliability of measuring sagittal curves on lateral cervical spine radiographs. SUMMARY OF BACKGROUND DATA Several authors have proposed that the presented of degenerative changes and the absence of lordosis in the cervical spine are indicators of poor recovery from neck injuries caused by motor vehicle collisions. The validity of those conclusions is questionable because the reliability of the methods used in their studies to measure the presence of degenerative changes and the absence of lordosis has not been determined. METHODS Kellgren's classification system for apophysial joint and disc degeneration, as well as the pattern and magnitude of the sagittal curve on 30 lateral cervical spine radiographs were assessed independently by three examiners. RESULTS Moderate reliability was demonstrated for classifying apophysial joint degeneration with an intraclass correlation coefficient of 0.45 (95% confidence interval, 0.09-0.71). Classifying degenerative disc disease had substantial reliability, with an intraclass correlation coefficient of 0.71 (95% confidence interval, 0.23-0.88). Measuring the magnitude of the sagittal curve from C2 to C7 had excellent interexaminer agreement, with an intraclass correlation coefficient of 0.96 (95% confidence interval, 0.88-0.98) and an interexaminer error of 8.3 degrees. CONCLUSIONS The classification system for degenerative disc disease proposed by Kellgren et al and the method of measurement of sagittal curves from C2 to C7 demonstrated an acceptable level of reliability and can be used in outcomes research.
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Affiliation(s)
- P Côté
- Division of Orthopaedics, University of Saskatchewan, Canada
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Kadanka Z, Bednarík J, Vohánka S, Vlach O. [Surgical treatment of cervical spondylotic myelopathy in the Czech and Slovak Republic in 1994]. Rozhl Chir 1996; 75:535-40. [PMID: 9072834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The authors investigated the state of surgery on account of cervical spondylosis and in particular spondylogenic cervical myelopathy in the Czech and Slovak Republic in 1994. They assessed the number of operated patients, surgical methods, indication criteria and the diagnostic strategy of different departments. The total number of patients operated on account of cervical spondylosis in 1994 was 347, incl. 113 on account of cervical spondylogenic myelopathy. As to surgical techniques in the majority the anterior approach was selected (Smith-Robinson's method). Laminectomy was performed in 14 and laminoplasty in 22 cases. The number of operated patients is, as compared with the frequency of similar operations in the United States, six times lower. As all departments where enquiries were made operate every cervical compression regardless of the degree of functional deficiency, this may reflect inadequate diagnosis of the disease.
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Affiliation(s)
- Z Kadanka
- Neurologická klinika, FN Brno-Bohunice
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Gäre BA. Epidemiology of rheumatic disease in children. Curr Opin Rheumatol 1996; 8:449-54. [PMID: 8941448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Major problems associated with interpreting and comparing epidemiologic studies on chronic arthropathies in children include the diversity of classification criteria and selection bias. A new set of classification criteria for peripheral arthritis in children, aiming toward defining biologically homogeneous subgroups, was recently proposed and should be further tested. Descriptive studies from all over the world are now emerging on childhood rheumatic diseases, increasing the potential for comparing the impact of genetic and environmental factors on disease frequency and manifestations. Awareness about pain syndromes in children, such as juvenile primary fibromyalgia and reflex sympathetic dystrophy, has increased, and this population now forms a substantial portion of clinic visits in pediatric rheumatology. The impact of the rheumatic diseases in children on disability and quality of life during childhood and in adult life is still to a large extent unknown and must be further studied in an epidemiologic context.
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Affiliation(s)
- B A Gäre
- Department of Pediatrics, University of Göteborg, Sweden
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Salemi G, Savettieri G, Meneghini F, Di Benedetto ME, Ragonese P, Morgante L, Reggio A, Patti F, Grigoletto F, Di Perri R. Prevalence of cervical spondylotic radiculopathy: a door-to-door survey in a Sicilian municipality. Acta Neurol Scand 1996; 93:184-8. [PMID: 8741140 DOI: 10.1111/j.1600-0404.1996.tb00196.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Because of the limited information on cervical spondylotic radiculopathy, we conducted a door-to-door two-phase survey in a Sicilian municipality. MATERIAL AND METHODS We first screened for cervical spondylotic radiculopathy among the inhabitants of the municipality: (N = 7653, as of the prevalence day, November 1, 1987). Study neurologists then investigated those subjects suspected to have had a cervical spondylotic radiculopathy. Diagnoses were bases on specified criteria. RESULTS We found 27 subjects affected by CSR (17 definite, 10 possible). Prevalence (cases per 1000 population) was 3.5 in the total population; it increased to a peak at age 50-59 years, and decreased thereafter. The age-specific prevalence was consistently higher in women. CONCLUSIONS Comparison with other prevalence studies shows similar age-specific patterns, but different magnitudes, which may partly reflect methodologic differences across studies.
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Affiliation(s)
- G Salemi
- Department of Neurology, University of Palermo, Italy
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Jones G, White C, Nguyen T, Sambrook PN, Kelly PJ, Eisman JA. Prevalent vertebral deformities: relationship to bone mineral density and spinal osteophytosis in elderly men and women. Osteoporos Int 1996; 6:233-9. [PMID: 8783298 DOI: 10.1007/bf01622740] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aims of this study were to ascertain vertebral deformity prevalence in elderly men and women and to describe the association between bone mineral density (BMD) at the lumbar spine and femoral neck, severity of spinal degenerative disease and vertebral deformity prevalence. We performed standardized spinal radiographs in a random sample of 300 elderly men and women participating in the Dubbo Osteoporosis Epidemiology Study, a population-based study of fracture risk factors. Radiographs were read independently by masked observers for the prevalence of vertebral deformity and severity of osteophytosis. BMD was measured by dual-energy X-ray absorptiometry. The prevalence of vertebral deformities was critically dependent on the criterion used. The less strict criteria seemed to overestimate deformities at either end of the spine region analysed. However, irrespective of the criterion used, prevalence of deformity was higher in men than in women (25% vs 20% for the 3 SD criterion, 17% vs 12% for the 4 SD criterion and 27% vs 25% for the 25% criterion). Femoral neck BMD was more strongly associated with vertebral deformities than spinal BMD for the 25% criterion (OR/SD change in BMD 1.39 (p = 0.02) vs 1.20 (p = 0.19)), 3 SD criterion (OR/SD change in BMD 1.45 (p = 0.01) vs 1.10 (p = 0.34)) and 4 SD criterion (OR/SD change in BMD 1.98 (p = 0.0002) vs 1.68 (p = 0.008)). BMD was also more strongly associated with biconcave deformities than either wedge or crush deformities and more so in men than in women. Severity of spinal osteophytosis was not associated with vertebral deformity. In conclusion, femoral neck BMD is at least equivalent to the lumbar spine BMD in strength of association with prevalent vertebral fractures. Spinal osteophytosis falsely elevates BMD without a concomitant decrease in fracture risk, indicating that any interpretation of spinal BMD needs to be adjusted for osteophytosis. These findings support the use of femoral neck bone densitometry in older men and women. Moreover, these data indicate that current criteria for radiological assessment of vertebral deformity are sufficiently loose to include a substantial proportion of non-fractures in the elderly, with important implications for the design of clinical trials. However, irrespective of the criterion used, vertebral deformities in men are at least as common, if not more so, than in women, suggesting that vertebral osteoporotic fractures are overlooked in men.
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Affiliation(s)
- G Jones
- Garvan Institute of Medical Research, Sydney, Australia
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Abstract
STUDY DESIGN This was a retrospective prevalence study. OBJECTIVE A review of structural cervical spine injuries (fracture or dislocation) treated at a regional spine injury referral center from 1987 to 1992 was undertaken to identify and analyze patients who had secondary neurologic deterioration after they had arrived and had primary assessment in stable neurologic condition (intact or compromised, but not evolving). SUMMARY OF BACKGROUND DATA Multiple case reports and cohort studies have suggested possible risk factors for late neurologic deterioration without probabilities analysis. METHODS Information was obtained retrospectively from clinical records and radiographs. Three-hundred-twelve cases were reviewed. Thirty-one were excluded and 281 were analyzed. RESULTS An index group of 15 patients (5%) had motor neurologic deterioration after primary assessment at the referral center. Control group "A" was composed of 70 patients (25%) who had a motor neurologic deficit on admission and did not deteriorate. Control group "B" was the balance of 196 patients (70%) with structural cervical injuries, but no neurologic compromise. Factors distinguishing the index group from control subjects included flexural mechanism of injury and chronic multilevel spinal arthritis with ankylosis. All secondary deteriorations occurred with the injury level caudad to the fourth cervical vertebra. Routine three-view cervical radiographs were relatively insensitive in detecting injury in the index group compared with the pooled control subjects. Patients' ability to comply with recommended treatment was not a factor in secondary deteriorations and there generally was no identifiable precipitant event before secondary deterioration. CONCLUSION Cervical traumatized patients with flexural injury or chronic multilevel spinal arthritis with ankylosis are at increased risk of having secondary motor neurologic deterioration.
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Affiliation(s)
- N R Colterjohn
- Department of Surgery, University of Toronto, Ontario, Canada
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Brigham CD, Tsahakis PJ. Anterior cervical foraminotomy and fusion. Surgical technique and results. Spine (Phila Pa 1976) 1995; 20:766-70. [PMID: 7701387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
STUDY DESIGN This study retrospectively reviewed the clinical and radiographic results of a series of patients who underwent osteophyte resection during anterior discectomy and fusion. OBJECTIVE To determine whether resection of the posterior uncinate process at the time of anterior cervical discectomy is safe and effective. SUMMARY OF BACKGROUND DATA Previous studies have described techniques of osteophyte resection, but safety and outcome have not been supported by a clinical series of patients. METHODS Forty-three consecutive patients with radiculopathy due to spondylosis or lateral herniated nucleus pulposus had 68 foraminotomies done at the time of anterior cervical disc foraminotomy for radiculopathy. All patients were followed-up until radiographic union. All patients were examined, and Odom's criteria were used to assess postoperative pain and function in the neck, arm, and iliac donor site. RESULTS The results were consistent with previous reports of anterior cervical disc foraminotomy for radiculopathy. Excellent and good results occurred in 77% and 14% of the patients, respectively. Three patients had no relief and no patient had worsening of radiculopathy. The fusion rate was 93%. Thirty-one patients (72%) reported being very satisfied. Three patients required a re-operation--one for bone graft dislodgment and two for pseudoarthrosis. No vascular injuries occurred. CONCLUSIONS Resection of the posterior portion of the uncinate process to remove osteophytes that narrow the neural foraman or to allow direct visualization of laterally herniated disc material can be done safely. When combined with an autogenous interbody bone graft, good results can be expected.
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Affiliation(s)
- C D Brigham
- Miller Orthopaedic Clinic, Inc., Charlotte, North Carolina, USA
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