BACKGROUND: Several scoring systems for cervical disc and facet joint degeneration, using radiography or computed tomography, have been developed and tested for reliability. However, definitions of disc height and facet joint space narrowing vary. To our knowledge, no study has reported quantitative data for normal radiologic values of the cervical spine in the Korean population. The purpose of this study is to determine normal cervical disc height, disc height ratio, and facet joint space values, and investigate the correlation between demographic data and these values. METHODS: We performed a retrospective study of patients who underwent artificial disc replacement of the cervical spine. Disc heights and facet joint spaces were measured using cervical neutral lateral radiographs and computed tomography. The means, standard deviations, and 95% confidence intervals of the values were determined. RESULTS: We measured 148 intervertebral discs and 352 posterior facet joints. The mean disc height measured by plain radiography and computed tomography was 5.57 ± 0.81 mm and 4.94 ± 0.94 mm, respectively. The mean facet joint space values measured by plain radiography and computed tomography were 1.94 ± 0.45 mm and 1.43 ± 0.39 mm, respectively. The disc heights and facet joint space values measured by plain radiography were greater than those measured by computed tomography. The lower limit of the 95% confidence interval of the disc height ratio calculated by plain radiography and computed tomography was greater than 0.94 at all levels except for C5–6. Patient height and disc height showed a tendency of positive correlation. CONCLUSIONS: In a Korean population, the normal cervical disc height was about 5.0 mm and the normal facet joint space was 1.4 mm. Disc height ratio can reliably identify normal cervical disc height in patients with mild degeneration. Patient height was positively correlated with disc height and facet joint space. Thus, when selecting a cervical implant, surgeons should consider patient height as well as estimated normal disc height.
Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Radiography ; Retrospective Studies ; Spine ; Surgeons ; Total Disc Replacement ; Zygapophyseal Joint

OBJECTIVE: The aim of this study was to predict the relationship between the symptomatic disc herniation level and the osteophyte level or decreased disc height in patients with cervical disc herniation. METHODS: Between January 2011 and December 2012, 69 patients with an osteophyte of the cervical spine underwent surgery at a single center due to soft cervical disc herniation. Data including soft disc herniation level, osteophyte level in the posterior vertebral margin, Cobb's angle, and symptom duration were retrospectively assessed. The patients were divided into three groups according to the relationship between the degenerative change level and the level of reported symptoms. RESULTS: Among the 69 patients, 48 (69.6%) showed a match between osteophyte level and soft disc herniation level. Disc herniation occurred at the adjacent segment to degenerative osteophyte level in 12 patients (17.4%) and at both the adjacent and the osteophyte level in nine (13.0%). There was no significant difference in Cobb's angle or duration among the three groups. Osteophyte type was not significant. The mean disc height of the prominent degenerative change level group was lower than the adjacent segment level, but this was not significant. CONCLUSION: Soft cervical disc herniation usually occurs at the level an osteophyte forms. However, it may also occur at segments adjacent to that of the osteophyte level. Therefore, in patients with cervical disc herniation, although a prominent osteophyte alone may appear on plain radiography, we must suspect the presence of soft disc herniation at other levels.
Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Osteophyte ; Radiography ; Retrospective Studies ; Spinal Fusion ; Spine

OBJECTIVE: To investigate the correlation among age, disc morphology, positive discography, and prognosis in patients with chronic low back pain. METHODS: A total of 183 intervertebral discs in 72 patients with chronic low back pain were studied. Discography was performed using a pressure-controlled manometric technique. The pain reaction during discography at each level was recorded as follows: no pain, dissimilar pain, similar pain, or concordant pain. Discs with similar or concordant pain were classified as positive. All the examined discs were assessed morphologically using axial computed tomography imaging. The grade of general degeneration and annular disruption of the discs were assessed according to the Dallas discogram description (DDD). Intradiscal injection of steroid was tried for patients with symptomatic disc identified during provocative discography and who did not consent to surgical operation. RESULTS: There was a higher correlation between general degeneration and age, as compared with annular disruption and age. Higher general degeneration and annular disruption grades had higher positive rates of discography. However, annular disruption alone was independently associated with positive discography. Age and grade of general degeneration did not affect the prognosis. CONCLUSION: The grade of general degeneration was associated with age, but it was not correlated with positive discography and prognosis. In addition, high grade of annular disruption correlated with positive discography.
Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Low Back Pain* ; Prognosis* ; Radiography

OBJECTIVE: The authors performed lumbar arthrodesis with expandable cage at L3-4 to L5-S1 intervertebral space for one year and report the analysis of the factors influencing the successful results. METHODS: The authors included thirty-five patients whose bony fusion had been watched over the 12 month after a posterior interbody fusion procedure with one-level expandable cage. All patients were classified into group A(satisfactory results) and group B(unsatisfactory results) according to their answers to comprehensive low back questionnairies. The intervertebral disc height, segmental lordosis and total lumbar lordosis in the standing neutral lateral radiography were checked and the comparison in the changes of this radiological profiles before and after the surgery was done. RESULTS: Seventeen cases(48.6%) of "excellent" results, and 14 cases(40.0%) of "good" results were included in Group A. In group B, 2 cases(5.7%) of "fair" results and 2 cases(5.7%) of "poor" results were included. Over twelve months after the operation, the mean intervertebral disc height and segmental lordotic angle in group A significantly increased, but those in group B did not significantly increase; however, the improvement of total lumbar lordotic angle could not be observed on both groups. CONCLUSION: The results indicate that the recovery of both intervertebral disc height and segmental lordosis is absolutely essential in order to get a successful result in addition to the solid arthrodesis. However, significant influences of one-level segmental lordotic improvement on the total lumbar lordosis can not be observed after the expandable cage fusion in the lower lumbar spine.
Animals ; Arthrodesis ; Humans ; Intervertebral Disc ; Lordosis ; Radiography ; Spine

STUDY DESIGN: Retrospective evaluation. PURPOSE: To analyze the effect of T1 slope on degree of degeneration in patients with cervical disc degeneration. OVERVIEW OF LITERATURE: The T1 slope is well known parameter that may be very useful in evaluating sagittal balance. There are no reports on the analysis of the relationship between T1 slope and cervical disc degeneration. We hypothesized that T1 slope has an effect on the degree of cervical degeneration. METHODS: Sixty patients who had cervical spine magnetic resonance imaging (MRI) in our orthopedic clinic were enrolled. Patients were divided into two groups according to T1 slope. Radiologic parameters obtained from radiography and cervical spine MRI were compared between low T1 slope group (< or =25) and high T1 slope group (>25). RESULTS: Among low T1 slope group, average degeneration grade of each cervical segment was 2.65 in C2-3, 2.50 in C3-4, 2.62 in C4-5, 3.23 in C5-6, and 2.81 in C6-7. And that of high T1 group was 2.35 in C2-3, 2.32 in C3-4, 2.59 in C4-5, 2.79 in C5-6, and 2.32 in C6-7. Grade of degeneration of low T1 group was significantly higher, as compared with high T1 group in C5-6 (p=0.028) and C6-7 (p=0.009). Percentage of high grade degeneration of more than grand III was 65.4% in low T1 group and 32.4% in high T1 group (p=0.018). Risk of high grade degeneration of C6-7 was significantly higher in low T1 group (odds ratio, 5.63; 95% confidence interval, 1.665-19.057; p=0.005). CONCLUSIONS: Patients with low T1 slope had higher grade of degeneration regardless of age and gender. Low T1 slope is a potential risk factor of cervical spondylosis especially in the C6-7 cervical segment.
Humans ; Intervertebral Disc Degeneration* ; Magnetic Resonance Imaging ; Orthopedics ; Radiography ; Retrospective Studies ; Risk Factors ; Spine ; Spondylosis

A 6-year-old Dachshund was presented with acute, non-localized pain without neurological dysfunction. Radiography revealed multiple calcifications of intervertebral discs and narrowing of disc space in the thoracolumbar region. Computed tomography and magnetic resonance imaging revealed calcified disc-like material entrapped in the left extraforaminal area and showed a displaced nerve root. Fenestration and removal of the extruded disc material were performed in a routine manner. Histopathological examination showed degenerative disc materials with severe calcification both in the nucleus pulposus and around the annulus fibrosis. Based on imaging, surgical, and histopathologic results, the dog was diagnosed with far lateral lumbar disc extrusion.
Animals ; Child ; Dogs ; Fibrosis ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Radiography

The incidence of low back pain as shown in the literature indicates that approximately 65~80% of the population at one time or another have had significant trouble. Low back pain causes one to lose time from work or other activity if an attack is significant, and it is also an universal problem in all economic and social brackets. The vast majority of etiological causes of low back trouble comes from discogenic origin, such as degenerative change of the intervertebral lumbar disc. Disc degeneration should be interpreted as a more or less physiological process which begins at about the age of 20 and continues throughout life. As disc degeneration proceeds, the normal physiologic biomechanics of low back can be transformed to pathomechanics of the spine as a causes of disability. Clinically plain radiography has been routinely used to substantiate the diagnosis of disc degeneration. The typical radiological abnormalities of degeneration are those of marginal spur, narrowing of disc space, Schmorls nodule and sclerosis of the opposing surfaces of the vertebral bodies, etc. However, these changes generally appear somewhat later when degeneration has eventually progressed and in the early stage are generally considered to be negative. Attention is directed to detection of pathomechanical abnormalities of disc degeneation with radiograms being taken in the standing dynamic position rather than in the supine non-dynamic position. The purpose of the study was to investigate some sigificant evidence of dynamograms to evaluate the changes in motion of the lumbar intervertebral joints, and to obtain comparison of the mobility of the joint involved with that of adjacent joints in the same spine. The case material consisted of one hundred and nine patients with discogenic low back pain. In clinical classification, the cases were separated into groups of lumbar insufficiency, intervertebral disc herniation and degenerative spondylosis for the purpose of analysis. Although this was an investigation of the significance in pathologic spines, ten normal subjects with no symptoms, between the ages of twenty and twenty five years, were included in the study as a control to interpret the findings. Non-dynamograms in the non-weight bearing supine position and dynamograms in the weight bearing standing position were made in each case. Non-dynamograms were taken with antero-posterior and lateral projections of the cases. Dynamograms were taken with antero-postericr and lateral projections, and additional lateral views in flexion and extension of spine. The focal film distance was eighty centimeters with the central ray at the third lumbar vertebra. Roentgenograms were analysed by comparison of non-dynamograms and dynamograms, and of groups of patients classified. The results of the study are as follows. 1. Early degenerative change such as abnormal mobility or primary instability was observed by dynamograms. 2. Dynamograms were helpful to detect the level of disc degeneration involved. 3. By dynamograms it has been found possible to deduce severity of disc degeneration. 4. Flexion-extension radiograms have appeared worthwhile to predict the level at which disc protrusion has occurred. In conclusion it is to be expected that there will be a valuable for dynamoradiological assessment in clinical application not only for diagnostic purposes in which it is possible to detect confirmatory evidence of early degeneration, and to predict the level and severity of disc degeneration, but also in the therapeutic aspect where one has to decide how to manage the lesion when it has occurred.
Classification ; Diagnosis ; Humans ; Incidence ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Joints ; Low Back Pain ; Physiological Processes ; Posture ; Radiography ; Sclerosis ; Spine ; Spondylosis ; Supine Position ; Weight-Bearing

OBJECTIVE: To investigate the changes in water content in the lumbar intervertebral discs by quantitative T2 MR imaging in the morning after bed rest and evening after a diurnal load. MATERIALS AND METHODS: Twenty healthy volunteers were separately examined in the morning after bed rest and in the evening after finishing daily work. T2-mapping images were obtained and analyzed. An equally-sized rectangular region of interest (ROI) was manually placed in both, the anterior and the posterior annulus fibrosus (AF), in the outermost 20% of the disc. Three ROIs were placed in the space defined as the nucleus pulposus (NP). Repeated-measures analysis of variance and paired 2-tailed t tests were used for statistical analysis, with p < 0.05 as significantly different. RESULTS: T2 values significantly decreased from morning to evening, in the NP (anterior NP = -13.9 ms; central NP = -17.0 ms; posterior NP = -13.3 ms; all p < 0.001). Meanwhile T2 values significantly increased in the anterior AF (+2.9 ms; p = 0.025) and the posterior AF (+5.9 ms; p < 0.001). T2 values in the posterior AF showed the largest degree of variation among the 5 ROIs, but there was no statistical significance (p = 0.414). Discs with initially low T2 values in the center NP showed a smaller degree of variation in the anterior NP and in the central NP, than in discs with initially high T2 values in the center NP (10.0% vs. 16.1%, p = 0.037; 6.4% vs. 16.1%, p = 0.006, respectively). CONCLUSION: Segmental quantitative T2 MRI provides valuable insights into physiological aspects of normal discs.
Adult ; Female ; Humans ; Image Processing, Computer-Assisted ; Intervertebral Disc/*radiography ; Lumbar Vertebrae/*radiography ; Magnetic Resonance Imaging ; Male ; Water/*chemistry

OBJECTIVE: The purpose of the study was to evaluate the clinical and radiological results after discectomy and Lubboc bone graft in the surgical management of the cervical diseases with a new titanium interbody implant and integrated screw fixation(PCB) by anterior approach. METHODS: The authors retrospectively analyzed 28 cases of anterior cervical fusion with PCB system and Lubboc bone(xeno graft) from september 1998 to december 2000. Twenty-eight patients with cervical diseases underwent decompression cervical lesion and followed from 5 to 27 months with a mean follow-up of 14 months. There patients were evaluated with clinically and radiologically at immediate postoperative period and at 3, 6, 9, and 12 months. RESULT: The authors investigated the pre- and postoperative intervertebral disc space, clinical outcomes, radiography fusion rate, and Cobb angle in the fixed segments by anterior approach. The lordotic angles and height of disc space were increased after the operation. The clinical outcome of patients follow-up was good or excellent result based on Odom's criteria with improvement of clinical symptom in about 92.9% of the cervical diseases. Two patients showed loosening of the lower and upper cervical screw of PCB instruments, and two patients showed swallowing difficulty and wound infection. CONCLUSION: The PCB system is a new implant for anterior cervical interbody fusion in the degenerative cervical disease and disc herniations. It provides immediate stability and segment distraction. The results of this study indicate that the PCB system is safe, easy handling of hardware, less complications, high fusion rate, and has provide the keeping the intervertebral disc space height and lordotic angles.
Decompression ; Deglutition ; Diskectomy ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Postoperative Period ; Radiography ; Retrospective Studies ; Titanium ; Transplants ; Wound Infection

PURPOSE: A malpositioned endotracheal tube poses a serious threat to the intubated patient. After intubation in newborn infants, the position of the endotracheal tube must be checked by a chest radiograph to ensure a minimum number of complications. The most commonly used reference point for placement is the medial ends of the clavicles, but it is known that the position of clavicles on a chest radiograph can be variable. The purpose of this study was to evaluate whether e body of the first thoracic vertebra (Tl) can be used as the standard reference point for endotracheal intubation instead of the clavicles because its fixed position on the chest radiographs. METHODS: Eighty-one radiographs of newborn who were admitted in NICU during the period from January 1, 1998 to December 31, 1998 at Kangdong Sacred Heart Hospital, Hallym University were reviewed prospectively and the following informations were recorded: ( I ) positions of the clavicles and the carina in relation to the cervical or thoracic vertebra, or intervertebral disc space, and ( ii ) the distances in cm using a ruler on the films, from the carina to the clavicles and Tl. RESULTS: The carina overlay from T2-3 to T5, most commonly at T3 to T4 (74.1%) although the clavicles are placed from C3-4 to T1-2, most commonly at C6 to C7 (62.9%). On 74 (91.4%) examinations the clavicles lay above the Tl. The distance in centimeters from the carina to the clavicles and Tl increases in length as gestational age, birth weight, and height increases. Analysis of variance shows that the position of the clavicles was determined with significantly higher variation than Tl (F=6.92 vs F=3.80, P<0.01). CONCLUSION: Because the clinical sign we describe are unreliable for detecting endotracheal intubation, chest radiographs at the bedside should be obtained routinely immediately after intubation and daily thereafter to determine the position of the tube. In neonatal period, the tip of endotracheal tube should be placed at Tl on chest radiograph, and its use would obviate the need to measure the distance from carina.
Birth Weight ; Clavicle ; Gestational Age ; Heart ; Humans ; Infant, Newborn* ; Intervertebral Disc ; Intubation ; Intubation, Intratracheal* ; Prospective Studies ; Radiography, Thoracic ; Spine