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Adjacent level degeneration and facet arthropathy after disc prosthesis surgery or rehabilitation in patients with chronic low back pain and degenerative disc: second report of a randomized study.

https://arctichealth.org/en/permalink/ahliterature123374
Source
Spine (Phila Pa 1976). 2012 Dec 1;37(25):2063-73
Publication Type
Article
Date
Dec-1-2012
Author
Christian Hellum
Linda Berg
Øivind Gjertsen
Lars Gunnar Johnsen
Gesche Neckelmann
Kjersti Storheim
Anne Keller
Oliver Grundnes
Ansgar Espeland
Author Affiliation
Department of Orthopaedics, Oslo University Hospital and University of Oslo, Oslo, Norway. christian.hellum@medisin.uio.no
Source
Spine (Phila Pa 1976). 2012 Dec 1;37(25):2063-73
Date
Dec-1-2012
Language
English
Publication Type
Article
Keywords
Adult
Chronic Pain - diagnosis - etiology - rehabilitation - surgery - therapy
Disability Evaluation
Female
Humans
Intervertebral Disc - pathology - surgery
Intervertebral Disc Degeneration - diagnosis - etiology - rehabilitation - surgery - therapy
Low Back Pain - diagnosis - etiology - rehabilitation - surgery - therapy
Lumbar Vertebrae - pathology - surgery
Magnetic Resonance Imaging
Male
Middle Aged
Norway
Pain Measurement
Postoperative Complications - etiology - pathology
Predictive value of tests
Sacrum - pathology - surgery
Time Factors
Total Disc Replacement - adverse effects
Treatment Outcome
Zygapophyseal Joint - pathology
Abstract
Randomized clinical trial with 2-year follow-up.
To assess the development of adjacent level degeneration (ALD) and index level facet arthropathy (FA) in patients treated with disc prosthesis compared with patients treated with rehabilitation.
There is controversy about the natural history of disc degeneration and the development of ALD and FA in patients who undergo disc prosthesis surgery.
The study included 116 patients with a history of low back pain for at least 1 year, Oswestry Disability Index 30 points or more, and degenerative changes in 1 or 2 lower lumbar spine levels. Magnetic resonance imaging was performed before treatment and at the 2-year follow-up. ALD and index level FA were determined on the basis of the majority assessment of 3, independent, experienced radiologists. ALD was assessed by evaluating Modic changes, posterior high intensity zone in the disc, nucleus pulposus signal, disc height, disc contour, and FA. Data were analyzed with Fischer exact test and t test.
ALD developed with similar frequencies in patients who were (n = 59) and were not (n = 57) treated with surgery. In patients treated with surgery, index level FA appeared or increased in 20 patients (34%) and decreased in 1 patient. In patients treated with rehabilitation, 2 (4%) had new or increased FA at the index/degenerated disc level and 1 had decreased FA (P
PubMed ID
22706091 View in PubMed
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Associations between back pain history and lumbar MRI findings.

https://arctichealth.org/en/permalink/ahliterature186216
Source
Spine (Phila Pa 1976). 2003 Mar 15;28(6):582-8
Publication Type
Article
Date
Mar-15-2003
Author
Tapio Videman
Michele C Battié
Laura E Gibbons
Kenneth Maravilla
Hannu Manninen
Jaakko Kaprio
Author Affiliation
University of Alberta, Edmonton, Alberta, Canada. tapio.videman@ualberta.ca
Source
Spine (Phila Pa 1976). 2003 Mar 15;28(6):582-8
Date
Mar-15-2003
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Back Pain - diagnosis - epidemiology
Causality
Cluster analysis
Cohort Studies
Comorbidity
Finland - epidemiology
Humans
Intervertebral Disc - pathology
Intervertebral Disc Displacement - diagnosis - epidemiology
Lumbosacral Region
Magnetic Resonance Imaging
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Prevalence
Retrospective Studies
Risk factors
Spinal Diseases - diagnosis - epidemiology
Twins, Monozygotic
Abstract
Retrospective monozygotic twin cohort study.
Our goal was to investigate the associations between different spinal MRI findings and current, past year, and lifetime low back pain after adjusting for occupational physical loading, smoking, genetics, and early family influences.
The role of spinal pathology in back symptoms continues to be controversial.
The study participants consisted of 115 monozygotic male twin pairs 35 to 69 years of age. The qualitatively assessed MRI parameters were as follows: disc height, bulging, herniations, anular tears, osteophytes, spinal stenosis, and endplate changes. Signal intensity was measured quantitatively.
After controlling for age, disc height was associated with all back pain variables studied and anular tears with LBP frequency and intensity during the 12 months before imaging. Both were associated with lifetime frequency of low back pain interfering with daily activities, disability, and intensity of the worst lifetime pain episode. Other MRI findings did not explain the various symptom histories. Adjusting for physical loading in the past 12 months increased the associations of anular tears and "low back pain today" and 12-month low back pain parameters. After controlling for genotype and other familial influences, the within-pair differences in disc height and anular tears accounted for 6% to 12% of the total variance in the within-pair differences of low back pain variables.
These findings raise new questions about the underlying mechanisms of LBP. The sensitivities of the only significant MRI parameters, disc height narrowing and anular tears, are poor, and these findings alone are of limited clinical importance.
PubMed ID
12642766 View in PubMed
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Characteristics and natural course of vertebral endplate signal (Modic) changes in the Danish general population.

https://arctichealth.org/en/permalink/ahliterature149899
Source
BMC Musculoskelet Disord. 2009;10:81
Publication Type
Article
Date
2009
Author
Tue S Jensen
Tom Bendix
Joan S Sorensen
Claus Manniche
Lars Korsholm
Per Kjaer
Author Affiliation
The Back Research Center, Ringe, Denmark. Tue.Secher.Jensen@shf.regionsyddanmark.dk
Source
BMC Musculoskelet Disord. 2009;10:81
Date
2009
Language
English
Publication Type
Article
Keywords
Adult
Denmark
Disease Progression
Female
Health Surveys
Humans
Intervertebral Disc - pathology
Logistic Models
Lumbar Vertebrae - pathology
Magnetic Resonance Imaging
Male
Observer Variation
Predictive value of tests
Prospective Studies
Reproducibility of Results
Spinal Diseases - pathology
Time Factors
Abstract
Vertebral endplate signal changes (VESC) are more common among patients with low back pain (LBP) and/or sciatica than in people who are not seeking care for back pain. The distribution and characteristics of VESC have been described in people from clinical and non-clinical populations. However, while the clinical course of VESC has been studied in patients, the natural course in the general population has not been reported. The objectives of this prospective observational study were to describe: 1) the distribution and characteristics of VESC in the lumbar spine, 2) its association with disc degeneration, and 3) its natural course from 40 to 44 years of age.
Three-hundred-and-forty-four individuals (161 men and 183 women) sampled from the Danish general population had MRI at the age of 40 and again at the age of 44. The following MRI findings were evaluated using standardised evaluation protocols: type, location, and size of VESC, disc signal, and disc height. Characteristics and distribution of VESC were analysed by frequency tables. The association between VESC and disc degeneration was analysed by logistic regression analysis. The change in type and size of VESC was analysed by cross-tabulations of variables obtained at age 40 and 44 and tested using McNemar's test of symmetry.
Two-thirds (67%) of VESC found in this study were located in the lower part of the spine (L4-S1). VESC located at disc levels L1-L3 were generally small and located only in the anterior part of the vertebra, whereas those located at disc levels L4-S1 were more likely to extend further into the vertebra and along the endplate. Moreover, the more the VESC extended into the vertebra, the more likely it was that the adjacent disc was degenerated. The prevalence of endplate levels with VESC increased significantly from 6% to 9% from age 40 to 44. Again, VESC that was only observed in the endplate was more likely to come and go over the four-year period compared with those which extended further into the vertebra, where it generally persisted.
The prevalence of VESC increased significantly over the four-year period. Furthermore, the results from this study indicate that the distribution of VESC, its association with disc degeneration and its natural course, is dependent on the size of the signal changes.
Notes
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PubMed ID
19575784 View in PubMed
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[Degeneration of the cervical vertebral disk is seldom the only cause of disk herniation. Cause of disk herniation is a common dispute in insurance cases after whiplash injuries].

https://arctichealth.org/en/permalink/ahliterature200808
Source
Lakartidningen. 1999 Aug 25;96(34):3540-1
Publication Type
Article
Date
Aug-25-1999
Author
B. Johansson
Author Affiliation
Svensk förening för ortopedisk medicin. drbengt@algonet.se
Source
Lakartidningen. 1999 Aug 25;96(34):3540-1
Date
Aug-25-1999
Language
Swedish
Publication Type
Article
Keywords
Cervical Vertebrae - injuries - pathology
Humans
Insurance Claim Review
Intervertebral Disc - pathology
Intervertebral Disc Displacement - diagnosis - etiology - pathology
Sweden
Whiplash Injuries - complications - diagnosis - pathology
PubMed ID
10492559 View in PubMed
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Disc degeneration in low back pain: a 17-year follow-up study using magnetic resonance imaging.

https://arctichealth.org/en/permalink/ahliterature164258
Source
Spine (Phila Pa 1976). 2007 Mar 15;32(6):681-4
Publication Type
Article
Date
Mar-15-2007
Author
Eero Waris
Marja Eskelin
Heikki Hermunen
Olli Kiviluoto
Hannu Paajanen
Author Affiliation
Department of Surgery and Radiology, Central Military Hospital, Helsinki, Finland. eero.waris@helsinki.fi
Source
Spine (Phila Pa 1976). 2007 Mar 15;32(6):681-4
Date
Mar-15-2007
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Disability Evaluation
Disease Progression
Finland
Follow-Up Studies
Humans
Intervertebral Disc - pathology
Intervertebral Disc Displacement - etiology - pathology
Low Back Pain - etiology - pathology
Lumbar Vertebrae - pathology
Magnetic Resonance Imaging
Male
Predictive value of tests
Prospective Studies
Risk assessment
Severity of Illness Index
Spinal Diseases - complications - pathology
Time Factors
Abstract
A prospective, cohort clinical and magnetic resonance imaging (MRI) study of patients with low back pain.
To study if lumbar disc degeneration (DD), diagnosed in young patients with low back pain by using MRI will predict chronic pain, disc herniation, or functional disability after a 17-year follow-up.
In 1987, 75 male Finnish conscripts aged 20 years, with low back pain hindering their military service, were studied using MRI at 0.02 T.
In 2003, 32 patients were reexamined with MRI at 1.0 T. The history of low back illness during the follow-up and current functional outcome were recorded.
In 1987, 69% of the 32-patient cohort had DD in one or more lumbar discs. In 2003, all subjects had DD in MRI. The mean number of degenerated discs in each subject increased from 1.1 to 3.0. A total of 76% of discs degenerated in 1987 were herniated in 2003, whereas only 29% of well-hydrated discs in 1987 were herniated at the time of follow-up (P = 0.0002). During 17 years of follow-up, 3 patients had undergone spinal surgery.
Early DD in adolescent patients with low back pain predicted the evolution of enhanced DD and herniation in adulthood, but it was not associated with severe low back pain or increased frequency of spinal surgery.
PubMed ID
17413474 View in PubMed
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Heritability of lumbar flexibility and the role of disc degeneration and body weight.

https://arctichealth.org/en/permalink/ahliterature160067
Source
J Appl Physiol (1985). 2008 Feb;104(2):379-85
Publication Type
Article
Date
Feb-2008
Author
Michele C Battié
Esko Levalahti
Tapio Videman
Kim Burton
Jaakko Kaprio
Author Affiliation
Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada. mc.battie@ualberta.ca
Source
J Appl Physiol (1985). 2008 Feb;104(2):379-85
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Back Pain - genetics - pathology - physiopathology
Body Weight - genetics
Cohort Studies
Finland
Humans
Intervertebral Disc - pathology - physiopathology
Life Style
Lumbar Vertebrae - physiopathology
Magnetic Resonance Imaging
Male
Middle Aged
Range of Motion, Articular - genetics
Spinal Diseases - genetics - pathology - physiopathology
Twins, Dizygotic - genetics
Twins, Monozygotic - genetics
Abstract
Spinal range of motion is evaluated in assessing patients with back problems and monitoring outcomes, as well as in general fitness assessments. Yet, determinants of the substantial interindividual variation in spinal range of motion are not well understood. Substantial genetic effects on global measures of range of motion and hypermobility have been suggested from earlier studies, but genetic influences specifically on spinal range of motion have not been previously studied. The objectives of the present study were to investigate the relative role of genetic and environmental influences on lumbar range of motion in adult men and the pathways through which genes may influence range of motion. Thus we conducted a classic twin study of 300 monozygotic and dizygotic male twin pairs with consideration of covariates, using standard statistical methods. All subjects underwent a clinical examination, including general anthropometrics, lumbar range of motion, and lumbar MRI to assess disc degeneration, as well as an extensive interview on environmental and behavioral exposures and back pain history. We found the proportion of variance in lumbar range of motion attributable to genetic influences (heritability estimate) to be 47%. The extent of lumbar range of motion in flexion was predominantly determined by genetic influences (64%), while extension was influenced to a somewhat greater degree by environmental and behavioral factors. Statistically significant age-adjusted genetic correlations were found between lumbar extension and disc degeneration variables (r(a) = -0.38 to -0.43) and between flexion and body weight (r(a) = -0.33), suggesting two pathways through which genes influence lumbar range of motion.
PubMed ID
18048587 View in PubMed
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Incidence of unusual and clinically significant histopathological findings in routine discectomy.

https://arctichealth.org/en/permalink/ahliterature166397
Source
J Neurosurg Spine. 2006 Nov;5(5):410-3
Publication Type
Article
Date
Nov-2006
Author
Adam S Wu
Daryl R Fourney
Author Affiliation
Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Source
J Neurosurg Spine. 2006 Nov;5(5):410-3
Date
Nov-2006
Language
English
Publication Type
Article
Keywords
Databases, Factual
Diskectomy
Humans
Incidence
Intervertebral Disc - pathology
Retrospective Studies
Saskatchewan
Spinal Diseases - epidemiology - pathology - surgery
Abstract
Routine histopathological examination of discectomy specimens remains common practice in many hospitals, although it rarely detects unsuspected clinically significant disease. Controversy exists as to the effectiveness of this practice. The objectives of this study were to compare the authors' experience with a review of the literature.
In a retrospective database analysis the authors identified all intervertebral disc specimens obtained during spinal procedures over an 8-year period (1996-2004). Cases of benign (nonneoplastic and noninfectious) indications for surgery were included in the study, whereas cases of nonbenign indications were excluded. The final pathological diagnoses were reviewed, and a chart review was performed to determine whether any unexpected findings affected subsequent patient care. A total of 1858 discectomy specimens were identified: 1775 of these were obtained in 1719 routine discectomy procedures. Unexpected histopathological findings were identified in four cases, and none was clinically significant.
Routine histopathological examination of disc specimens is not justified. The decision to send specimens for pathological examination should be determined on a case-by-case basis after consideration of the clinical presentation, results of laboratory and imaging studies, and intraoperative findings.
PubMed ID
17120890 View in PubMed
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Lumbar spinal fusion patients' demands to the primary health sector: evaluation of three rehabilitation protocols. A prospective randomized study.

https://arctichealth.org/en/permalink/ahliterature174422
Source
Eur Spine J. 2006 May;15(5):648-56
Publication Type
Article
Date
May-2006
Author
Rikke Soegaard
Finn B Christensen
Ida Lauerberg
Ida Lauersen
Cody E Bünger
Author Affiliation
Orthopaedic Research Laboratory, University Hospital of Aarhus, Nørrebrogade 44, 8000 Aarhus C, Denmark. rikke.sogaard@ki.au.dk
Source
Eur Spine J. 2006 May;15(5):648-56
Date
May-2006
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - psychology
Adult
Cost-Benefit Analysis
Denmark
Exercise Therapy - economics - statistics & numerical data - trends
Female
Follow-Up Studies
Humans
Intervertebral Disc - pathology - surgery
Intervertebral Disc Displacement - rehabilitation - surgery
Lumbar Vertebrae - pathology - surgery
Male
Middle Aged
Needs Assessment
Patient Acceptance of Health Care - statistics & numerical data
Physical Fitness - psychology
Physical Therapy Modalities - economics - utilization
Primary Health Care - economics - statistics & numerical data - utilization
Prospective Studies
Rehabilitation Centers - economics - statistics & numerical data - utilization
Social Support
Spinal Fusion - economics - rehabilitation - statistics & numerical data
Treatment Outcome
Abstract
Very few studies have investigated the effects or costs of rehabilitation regimens following lumbar spinal fusion. The effectiveness of in-hospital rehabilitation regimens has substantial impact on patients' demands in the primary health care sector. The aim of this study was to investigate patient-articulated demands to the primary health care sector following lumbar spinal fusion and three different in-hospital rehabilitation regimens in a prospective, randomized study with a 2-year follow-up. Ninety patients were randomized 3 months post lumbar spinal fusion to either a 'video' group (one-time oral instruction by a physiotherapist and patients were then issued a video for home exercise), or a 'café' group (video regimen with the addition of three café meetings with other fusion-operated patients) or a 'training' group (exercise therapy; physiotherapist-guided; two times a week for 8 weeks). Register data of service utilization in the primary health care sector were collected from the time of randomization through 24 months postsurgery. Costs of in-hospital protocols were estimated and the service utilization in the primary health care sector and its cost were analyzed. A significant difference (P=0.023) in number of contacts was found among groups at 2-year follow-up. Within the periods of 3-6 months and 7-12 months postoperatively, the experimental groups required less than half the amount of care within the primary health care sector as compared to the video group (P=0.001 and P=0.008). The incremental costs of the café regimen respectively, the training regimen were compensated by cost savings in the primary health care sector, at ratios of 4.70 (95% CI 4.64; 4.77) and 1.70 (95% CI 1.68; 1.72). This study concludes that a low-cost biopsychosocial rehabilitation regimen significantly reduces service utilization in the primary health care sector as compared to the usual regimen and a training exercise regimen. The results stress the importance of a cognitive element of coping in a rehabilitation program.
Notes
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Erratum In: Eur Spine J. 2006;15(5):657Lauersen, Ida [corrected to Lauerberg, Ida]
PubMed ID
15937676 View in PubMed
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MRI criteria of developmental lumbar spinal stenosis revisited.

https://arctichealth.org/en/permalink/ahliterature128515
Source
Bull NYU Hosp Jt Dis. 2011;69(4):303-7
Publication Type
Article
Date
2011
Author
Deep S Chatha
Mark E Schweitzer
Author Affiliation
Diagnostic Imaging, CML Healthcare, 790 Bay Street, Suite 418, Toronto, Ontario, Canada. dchatha@hotmail.com
Source
Bull NYU Hosp Jt Dis. 2011;69(4):303-7
Date
2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Female
Humans
Intervertebral Disc - pathology
Lumbar Vertebrae - pathology
Magnetic Resonance Imaging
Male
Middle Aged
Observer Variation
Ontario
Predictive value of tests
Prognosis
Reproducibility of Results
Retrospective Studies
Spinal Stenosis - diagnosis - pathology
Young Adult
Abstract
It is somewhat surprising that radiographic criteria for lumbar stenosis have been transposed from radiography and CT to MR without scientific validation. As these radiographic criteria were developed via population studies with criteria defined by two standard deviations from the mean, we sought to perform the same methodology via MR.
The study was approved by the institutional review board; the requirement for informed consent was waived. One-hundred patients referred for possible metastatic disease, aged 4 to 94 were studied. Measurements were obtained on a midline sagittal T2-weighted (6000/120) image at each disc level, as well as at the mid-vertebral level. The distributive mean, and standard deviations were calculated and -2 SD was used as a "cutoff" for spinal stenosis. To assess for interobserver variation, 20% of the measurements were repeated by a second observer. To assess for intraobserver variation, another 20% of the measurements were repeated a second time at a minimum of a two month interval.
The spinal canal was narrowest at L5-S1 (mean: 1.16 cm), and widest at L1-L2 (mean: 1.56 cm). Overall the narrowest measurements were at the intervertebral disc space and were narrower at the lower disc spaces. In our population, the lowest cutoff limit (two standard deviations below the mean) had a range between 0.38 cm at the L3-L4 disc space and 0.9 cm at the L1 vertebral level. Notably at the L3 level the size range was from 0.77 to 1.75
Traditional measurements of canal diameters may be too large when applied to soft tissue analysis on MR. We suggest using a cutoff of smaller than 0.90 cm for developmental stenosis.
PubMed ID
22196386 View in PubMed
Less detail

Narrowing of lumbar spinal canal predicts chronic low back pain more accurately than intervertebral disc degeneration: a magnetic resonance imaging study in young Finnish male conscripts.

https://arctichealth.org/en/permalink/ahliterature170926
Source
Mil Med. 2005 Nov;170(11):926-30
Publication Type
Article
Date
Nov-2005
Author
Tuomo Visuri
Jaana Ulaska
Marja Eskelin
Pekka Pulkkinen
Author Affiliation
Medical Corps, Finnish Defence Forces, Helsinki, Finland. tuomo.visuri@helsinki.fi
Source
Mil Med. 2005 Nov;170(11):926-30
Date
Nov-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Finland
Humans
Intervertebral Disc - pathology
Low Back Pain - diagnosis - etiology
Lumbar Vertebrae
Magnetic Resonance Imaging
Male
Military Medicine
Military Personnel
Spinal Stenosis - complications - physiopathology
Abstract
The objective of this magnetic resonance imaging study was to evaluate the role of degenerative changes, developmental spinal stenosis, and compression of spinal nerve roots in chronic low back (CLBP) and radicular pain in Finnish conscripts. The degree of degeneration, protrusion, and herniation of the intervertebral discs and stenosis of the nerve root canals was evaluated, and the midsagittal diameter and cross-sectional area of the lumbar vertebrae canal were measured in 108 conscripts with CLBP and 90 asymptomatic controls. The midsagittal diameters at L1-L4 levels were significantly smaller in the patients with CLBP than in the controls. Moreover, degeneration of the L4/5 disc and protrusion or herniation of the L5/S1 disc and stenosis of the nerve root canals at level L5/S1 were more frequent among the CLBP patients. Multifactorial analysis of the magnetic resonance imaging findings provided a total explanatory rate of only 33%. Narrowing of the vertebral canal in the anteroposterior direction was more likely to produce CLBP and radiating pain than intervertebral disc degeneration or narrowing of the intervertebral nerve root canals.
PubMed ID
16450819 View in PubMed
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12 records – page 1 of 2.