Sagittal endplate morphology of the lower lumbar spine.

By London Spine
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Sagittal endplate morphology of the lower lumbar spine.

Eur Spine J. 2012 May;21 Suppl 2:S160-4

Authors: Lakshmanan P, Purushothaman B, Dvorak V, Schratt W, Thambiraj S, Boszczyk M

Abstract
SUMMARY OF BACKGROUND DATA: The sagittal profile of lumbar endplates is discrepant from current simplified disc replacement and fusion device design. Endplate concavity is symmetrical in the coronal plane but shows considerable variability in the sagittal plane, which may lead to implant-endplate mismatch.
OBJECTIVE: The aim of this investigation is to provide further analysis of the sagittal endplate morphology of the mid to lower lumbar spine study (L3–S1), thereby identifying the presence of common endplate shape patterns across these levels and providing morphological reference values complementing the findings of previous studies.
STUDY DESIGN: Observational study.
METHODS: A total of 174 magnetic resonance imaging (MRI) scans of the adult lumbar spine from the digital archive of our centre, which met the inclusion criteria, were studied. Superior (SEP) and inferior (IEP) endplate shape was divided into flat (no concavity), oblong (homogeneous concavity) and ex-centric (inhomogeneous concavity). The concavity depth (ECD) and location of concavity apex (ECA) relative to endplate diameter of the vertebrae L3–S1 were determined.
RESULTS: Flat endplates were only predominant at the sacrum SEP (84.5%). The L5 SEP was flat in 24.7% and all other endplates in less than 10%. The majority of endplates were concave with a clear trend of endplate shape becoming more ex-centric from L3 IEP (56.9% oblong vs. 37.4% ex-centric) to L5 IEP (4% oblong vs. 94.3% ex-centric). Ex-centric ECA were always found in the posterior half of the lumbar endplates. Both the oblong and ex-centric ECD was 2-3 mm on average with the IEP of a motion segment regularly possessing the greater depth. A sex- or age-related difference could not be found.
CONCLUSION: The majority of lumbar endplates are concave, while the majority of sacral endplates are flat. An oblong and an ex-centric endplate shape can be distinguished, whereby the latter is more common at the lower lumbar levels. The apex of the concavity of ex-centric discs is located in the posterior half of the endplate and the concavity of the inferior endplate is deeper than that of the superior endplate. Based on the above, the current TDR and ALIF implant design does not sufficiently match the morphology of lumbar endplates in the sagittal plane.

PMID: 22315035 [PubMed – indexed for MEDLINE]

Bertolotti’s syndrome: an underdiagnosed cause for lower back pain.

By London Spine

Related Articles Bertolotti’s syndrome: an underdiagnosed cause for lower back pain. J Surg Case Rep. 2018 Oct;2018(10):rjy276 Authors: Alonzo F, Cobar A, Cahueque M, Prieto JA Abstract Bertolotti’s syndrome refers to the presence of pain associated to the anatomical variant of sacralization of the last lumbar vertebra. It is often a factor that is not…

Prediction of core and lower extremity strains and sprains in collegiate football players: a preliminary study.

By London Spine
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Prediction of core and lower extremity strains and sprains in collegiate football players: a preliminary study.

J Athl Train. 2012;47(3):264-72

Authors: Wilkerson GB, Giles JL, Seibel DK

Abstract
CONTEXT: Poor core stability is believed to increase vulnerability to uncontrolled joint displacements throughout the kinetic chain between the foot and the lumbar spine.
OBJECTIVE: To assess the value of preparticipation measurements as predictors of core or lower extremity strains or sprains in collegiate football players.
DESIGN: Cohort study.
SETTING: National Collegiate Athletic Association Division I Football Championship Subdivision football program. Patients or Other Participants: All team members who were present for a mandatory physical examination on the day before preseason practice sessions began (n = 83). Main Outcome Measure(s): Preparticipation administration of surveys to assess low back, knee, and ankle function; documentation of knee and ankle injury history; determination of body mass index; 4 different assessments of core muscle endurance; and measurement of step-test recovery heart rate. All injuries were documented throughout the preseason practice period and 11-game season. Receiver operating characteristic analysis and logistic regression analysis were used to identify dichotomized predictive factors that best discriminated injured from uninjured status. The 75th and 50th percentiles were evaluated as alternative cutpoints for dichotomization of injury predictors.
RESULTS: Players with ≥2 of 3 potentially modifiable risk factors related to core function had 2 times greater risk for injury than those with <2 factors (95% confidence interval = 1.27, 4.22), and adding a high level of exposure to game conditions increased the injury risk to 3 times greater (95% confidence interval = 1.95, 4.98). Prediction models that used the 75th and 50th percentile cutpoints yielded results that were very similar to those for the model that used receiver operating characteristic-derived cutpoints.
CONCLUSIONS: Low back dysfunction and suboptimal endurance of the core musculature appear to be important modifiable football injury risk factors that can be identified on preparticipation screening. These predictors need to be assessed in a prospective manner with a larger sample of collegiate football players.

PMID: 22892407 [PubMed – indexed for MEDLINE]

Fracture of the lower cervical spine in patients with ankylosing spondylitis: Retrospective study of 19 cases.

By London Spine
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Fracture of the lower cervical spine in patients with ankylosing spondylitis: Retrospective study of 19 cases.

Orthop Traumatol Surg Res. 2012 Sep;98(5):543-51

Authors: Kouyoumdjian P, Guerin P, Schaelderle C, Asencio G, Gille O

Abstract
INTRODUCTION: Controversy exists surrounding optimal treatment of cervical spine fractures secondary to ankylosing spondylitis (AS).
HYPOTHESIS: The anterior approach is an effective surgical technique for these fractures and can be used to correct the AS-induced cervical-thoracic kyphosis.
MATERIALS AND METHODS: This continuous, retrospective series between 1990 and 2010 included 19 patients aged 33 to 84 years who presented with a lower cervical spine fracture in the context of AS. The average follow-up was 45 months. Sixteen of these patients were surgically treated using an anterior approach and anterior fixation. In five patients without any neurological deficit, their cervical-thoracic kyphosis was corrected during the same surgery. Regional kyphosis was measured before the surgery, immediately after the surgery and at the last follow-up.
RESULTS: Five deaths occurred; these were all patients with post-traumatic complete quadriplegia. Most the incomplete neurological problems improved (66%). In no cases did the neurological condition worsen. Among the 16 patients operated with the anterior approach, two patients also required an additional procedure with a posterior approach because of a persistent neurological deficit. The fractures in the operated patients who survived (14 patients) had healed within an average 4-month delay (range 3-7 months), without worsening of the kyphosis at final follow-up. In the five cases where the kyphosis was corrected, the correction averaged 26° (range 18-36°); there were no neurological complications.
DISCUSSION: Based on these results, we suggest using the anterior approach to perform internal fixation as a treatment for cervical fractures secondary to AS and to correct the cervical-thoracic kyphosis in patients without neurological deficits.
LEVEL OF EVIDENCE: Level IV – retrospective study.

PMID: 22858111 [PubMed – indexed for MEDLINE]

Morphological changes in disc herniation in the lower cervical spine: an ultrastructural study.

By London Spine
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Morphological changes in disc herniation in the lower cervical spine: an ultrastructural study.

Eur Spine J. 2012 Jul;21(7):1396-409

Authors: Sitte I, Kathrein A, Pedross F, Freund MC, Pfaller K, Archer CW

Abstract
INTRODUCTION: The basis of disc degeneration is still unknown, but is believed to be a cell-mediated process. Apoptosis might play a major role in degenerative disc disease (DDD). The aim of this study was to correlate the viability of disc cells with the radiological degeneration grades (rDG) in disc herniation.
MATERIALS AND METHODS: Forty anterior IVD’s (C4-C7) from 39 patients with DDD were studied histologically and ultrastructurally to quantify healthy, “balloon”, chondroptotic, apoptotic and necrotic cells. Patients were classified to their rDG, as having either prolapse (P: DGII + III) and/or osteochondrosis (O: DGIV + V). Similar studies were undertaken on eight control discs.
RESULTS: Cell death by necrosis (mean 35%) was common but differed not significantly in both groups. All patients with a disc prolapse DGII + III revealed balloon cells (iAF: mean 32%). All appeared alive and sometimes were hypertrophic. However, significantly less balloon cells were found in the O-Group. Control samples revealed no evidence of “balloon” cells in DGII and only a minor rate in DGIII.
CONCLUSION: According to the different rDG, quantitative changes were obvious in healthy and “balloon” cells, but not for cell death. At the moment it can only be hypothesized if “balloon” cells are part of a repair strategy and/or cause of disc herniation.

PMID: 22407261 [PubMed – indexed for MEDLINE]

Central QCT reveals lower volumetric BMD and stiffness in premenopausal women with idiopathic osteoporosis, regardless of fracture history.

By London Spine
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Central QCT reveals lower volumetric BMD and stiffness in premenopausal women with idiopathic osteoporosis, regardless of fracture history.

J Clin Endocrinol Metab. 2012 Nov;97(11):4244-52

Authors: Cohen A, Lang TF, McMahon DJ, Liu XS, Guo XE, Zhang C, Stein EM, Dempster DW, Young P, Saeed I, Lappe JM, Recker RR, Shane E

Abstract
CONTEXT: Idiopathic osteoporosis (IOP) affects otherwise healthy young individuals with intact gonadal function and no secondary cause of bone fragility. In premenopausal women with IOP, a low trauma fracture is evidence of impaired bone quality and strength. The extent to which low bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) reflects low volumetric BMD, bone microstructure, and strength is uncertain in the absence of low trauma fracture.
OBJECTIVE: The objective of the study was to compare three-dimensional volumetric BMD and bone stiffness in premenopausal women with IOP based on fracture history, those with idiopathic low BMD (Z score ≤ -2.0) and no low trauma fracture, and normal age-matched controls.
DESIGN: We measured volumetric BMD and bone geometry by central quantitative computed tomography (cQCT) scans of the spine and hip and estimated bone stiffness by finite element analysis of cQCT data sets in 32 premenopausal women with IOP, 12 with idiopathic low BMD, and 34 controls.
RESULTS: Subjects had comparable decreases in total and trabecular volumetric BMD, cortical thickness, and whole-bone stiffness compared with controls, regardless of fracture history. These differences remained significant after controlling for age, body mass index, and bone size. The positive predictive values of a DXA Z score of -2.0 or less for a cQCT volumetric BMD Z score of -2.0 or less were 95% at the lumbar spine, 90% at the total hip, and 86% at the femoral neck.
CONCLUSION: Women with idiopathic low BMD alone and those with low trauma fractures had comparable deficits in bone mass, structure, and stiffness. Low areal BMD by DXA is fairly accurate for predicting low volumetric BMD by cQCT. These results are consistent with three-dimensional bone imaging at the iliac crest, radius, and tibia in premenopausal IOP and suggest that the term osteoporosis may be appropriate in women with Z scores below -2.0, whether or not there is a history of fracture.

PMID: 22962425 [PubMed – indexed for MEDLINE]

Increased pain catastrophizing associated with lower pain relief during spinal cord stimulation: results from a large post-market study

By London Spine

BACKGROUND: Pain catastrophizing is a negative cognitive distortion to actual or anticipated pain. Our aim was to determine if greater catastrophizing has a deleterious relationship with pain intensity and efficacy outcomes in patients receiving SCS. METHODS: As part of an ongoing Institutional Review Board-approved, multi-site, single arm post-market study, 386 patients were implanted with an…