OBJECTIVETo assess the correlation between vertebral body deformity and degeneration of the adjacent intervertebral discs in patients with old thoracolumbar compression fractures.

METHODSSeventy-one patients who had been conservatively treated after single segment thoracolumbar compression fractures between April, 2011 and May, 2014 were enrolled in this study. Both radiographic and magnetic resonance (MR) images of the thoracolumbar segment were obtained. The involved vertebral body deformity was rated on radiography according to the Genant criterion, and the degeneration of the adjacent cephalic and caudal discs was assessed on MR images using the Oner and Pfirrmann classification schemes, respectively. The relationship between vertebral body deformity and adjacent disc changes was assessed using correlation analysis, and the changes in the adjacent cranial and caudal discs was compared.

RESULTSThe Genant classification of the involved vertebral bodies was moderately correlated with Oner morphological scores (r=0.48, P<0.01), but not with the Pfirrmann signal scores of the adjacent cephalic discs or with the Genant or Pfirrmann scores of the adjacent caudal discs (P>0.05). The Oner classification of the adjacent cephalic discs was higher than that of the adjacent caudal discs (P<0.01), but their Pfirrmann classification did not differ significantly.

CONCLUSIONThe deformity of vertebral body affects the adjacent cephalic discs proportionally but not the adjacent caudal discs.

Fractures, Compression ; Humans ; Intervertebral Disc ; pathology ; Intervertebral Disc Degeneration ; Magnetic Resonance Imaging ; Spine ; pathology

PURPOSE: To describe the MR imaging findings of lumbar Scheuermann's disease and to determine therelationship between various MR imaging findings of this disease and disk pathologies. MATERIALS AND METHODS: Weretrospectively evaluated the MR imaging findings of 13 patients under the age of 20 with lumbar Scheuermann'sdisease. One hundred and four vertebral bodies and 91 intervertebral disks were included in the study. The imagingfindings were analyzed with particular emphasis on the wedging of vertebral bodies, Schmorl's nodes, and theheight of intervertebral disks. The relationship between these findings and disk degeneration or herniation wasevaluated. RESULTS: Lumbar Scheuermann's disease was classified into two types according to Blumenthal'sclassification. Seven patients were type I and six were type II. Disk degeneration and herniation were identifiedin 28.6% (26/91) and 20.9% (19/91), respectively, of intervertebral disks. In type I, wedging of the vertebralbodies was noted in 48.2% of cases(27/56) and degeneration and herniation of adjacent disks were identified in24.1% (7/29) and 13.8% (4/29), respectively. Central Schmorl's nodes were identified in 29.5% (33/112) ofend-plates and degeneration and herniation of adjacent disks in 34.8% (8/23) and 17.4% (4/23), respectively. Intype II, anterior Schmorl's nodes were found in 11.5% (11/96) of end-plates and degeneration and herniation ofadjacent disks in 100% (10/10) and 70% (7/10), respectively. Decreased height of intervertebral disks was notedadjacent to the anterior Schmorl's nodes ; all were related to disk degeneration and 70% (7/10) to diskherniation. There was statistically significant correlation between anterior Schmorl's node, decreased height ofintervertebral disk and adjacent disk pathologies (p<0.05), but wedged vertebra and central Schmorl's node werenot related to disk pathologies (p>0.05). CONCLUSION: In lumbar Scheuermann's disease, anterior Schmorl's nodeand decreased height of an intervertebral disk are related to disk degeneration and herniation. MR is useful forthe evaluation of disk pathologies as well as changes in vertebral bodies.
Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Magnetic Resonance Imaging* ; Pathology* ; Scheuermann Disease* ; Spine

OBJECTIVES: To study the characteristics of the relationship between injury and disease in forensic identification cases of cervical trauma with cervical vertebra degeneration, and to explore the problems about how to identify the participation rates of injury and disease using the clinical information, forensic examination and imaging examination. METHODS: Seventeen forensic identification cases of cervical trauma with cervical vertebra degeneration were collected. The age distributions, injury formations, injury severities and imaging findings of these cases were analyzed and the relationship between injury and disease was evaluated comprehensively. RESULTS: Middle-aged and elderly were common in 17 cases and every case was involved with intervertebral disc herniation. The main reasons of injuries were hyperextension. The degree of injury severity and vertebra degeneration were graded according to the imaging findings. The participation rates of injury and disease were also calculated comprehensively. CONCLUSIONS The forensic identification cases of cervical trauma with cervical vertebra degeneration should be evaluated with clinical information, forensic examination and imaging finding.
Adult ; Age Distribution ; Aged ; Cervical Vertebrae/pathology* ; Humans ; Intervertebral Disc Degeneration/pathology* ; Intervertebral Disc Displacement/pathology* ; Middle Aged

STUDY DESIGN: A cross-sectional case-control study was designed to compare the sagittal alignment of lumbosacral regions in two groups of patients suffering from low back pain, one with intervertebral disc pathologies and one without. PURPOSE: To evaluate the correlation between lumbosacral sagittal alignment and disc degeneration. OVERVIEW OF LITERATURE: Changes in lumbar lordosis and pelvic parameters in degenerative disc lesions have been assessed in few studies. Overall, patients with discopathy were shown to have lower lumbar lordosis and more vertical sacral profiles. METHODS: From patients with intractable low back pain undergoing lumbosacral magnetic resonance imaging, 50 subjects with disc degeneration and 50 controls with normal scans were consecutively enrolled. A method was defined with anterior tangent-lines going through anterior bodies of L1 and S1 to measure global lumbosacral angle, incorporating both lumbar lordosis and sacral slope. Global lumbosacral angle using the proposed method and lumbar lordosis using Cobb's method were measured in both groups. RESULTS: Lumbar lordosis based on Cobb's method was lower in group with discopathy (20degrees-67degrees; mean, 40.48degrees+/-9.89degrees) than control group (30degrees-62degrees; mean, 44.96degrees+/-7.68degrees), although it was not statistically significant. The proposed global lumbosacral angle in subject group (53degrees-103degrees; mean, 76.5degrees+/-11.018degrees) was less than control group (52degrees-101degrees; mean, 80.18degrees+/-9.95degrees), with the difference being statistically significant (p=0.002). CONCLUSIONS: Patients with intervertebral disc lesions seem to have more straightened lumbosacral profiles, but it has not been proven which comes first: disc degeneration or changes in sagittal alignment. Finding an answer to this dilemma demands more comprehensive long-term prospective studies.
Animals ; Case-Control Studies ; Humans ; Intervertebral Disc Degeneration ; Intervertebral Disc* ; Lordosis ; Low Back Pain ; Lumbosacral Region ; Magnetic Resonance Imaging ; Pathology

A geometrical model of L4-L5 lumbar segment was constructed using a three-dimensional graphics software. Four conditions of the degenerated discs, i. e. light degeneration, moderate degeneration, severe degeneration and complete excision degeneration, were simulated with loading situations using finite element method under the condition of appropriate computational accuracy. By applying a vertical load of 378.93 N on L4 vertebral plate, stress nephograms on joint isthmus under four different working conditions were obtained. The results showed that the contacted area of facet joint was influenced by the degree of intervertebral disc degeneration level, which influenced the mises stress on joint isthmus. It was proved that joint isthmus was the important pressure-proof structure of the back of lumbar vertebra, and the stress values and distribution were related to structural stiffness of the back of lumbar vertebra as well as the contact area of facet joint. The conclusion could be the theoretical reference for the analysis of spinal biomechanics and artificial disc replacement as well.
Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Intervertebral Disc ; pathology ; Intervertebral Disc Degeneration ; Lumbar Vertebrae ; physiopathology ; Models, Anatomic ; Pressure ; Zygapophyseal Joint

Low back pain caused by intervertebral disc degeneration is a common clinical chronic disease. The regenerative ability of intervertebral disc tissue is extremely poor. Meanwhile, current treating methods can not fundamentally solve such problems. With the increasing awareness of the mechanism of disc degeneration and the rapid development of the fields of cellular and molecular biology, gene and materials engineering, using stem cells and tissue engineering technology to slow down or reverse the progress of disc degeneration may become possible. The author reviewed the application of stem cells for treating degenerative discs from present researching status and concepts for the future in the combination of researches reported both at home and abroad.
Humans ; Intervertebral Disc ; pathology ; Intervertebral Disc Degeneration ; therapy ; Low Back Pain ; therapy ; Regeneration ; Stem Cell Transplantation ; Tissue Engineering

OBJECTIVESTo evaluate the relationship between Modic change and disc height together with lumbar hyperosteogeny and study the role of Modic change in lumbar degeneration.

METHODSThe imaging data of 150 elderly patients with chronic low back pain were analysed retrospectively. All patients underwent MRI and lumbar lateral X-ray examination. The lumbar disc from L1-L2 to L5-S1 were selected for this study, including 750 discs, vertebral and endplate close to disc in 150 patients. The incidence rate of lumbar endplate Modic change, disc height and the degree of vertebral bone hyperplasia were recorded. The ratio of disc height/lumbar intervertebral disc height < 50% was defined as disc collapse. The patients were divided into 4 groups in the basis of imaging changes. Group A1:disc collapse without severe lumbar hyperosteogeny; Group A2: disc collapse with severe lumbar hyperosteogeny; Group B1: Neither disc collapse nor severe lumbar hyperosteogeny; Group B2: severe lumbar hyperosteogeny without disc collapse. The incidence rates of Modic change were compared between the 4 groups by χ(2) test. Finally, the influence of disc height and vertebral bone hyperplasia on the incidence rate of Modic change was analysed.

RESULTSFour groups of patients observed a total of 750 discs. The number of intervertebral discs in the group A1 was 208, the incidence rate was 54.3%. The number of intervertebral discs in the group A2 was 135, the incidence rate of group A2 was 34.8%. The number of intervertebral discs in the B1 group was 225, the incidence rate of group B1 was 16.9%. The number of intervertebral discs in the B2 group was 182, the incidence rate of group B2 was 29.7%. There was significant difference of lumbar endplate Modic change incidence rate among the 4 groups(χ(2) = 69.565, P < 0.05). The results of post hoc test showed that the incidence rate of Modic change in group A1 was higher than group A2, B1 and B2 (χ(2) = 12.524, 66.701 and 24.102, P < 0.00714). There was significant difference of Modic change incidence rate between group A2 and B1(χ(2) = 15.032, P < 0.00714), but there was no significant difference of Modic change incidence rate between group A2 and B2 (χ(2) = 0.945, P > 0.00714) . There was significant difference of Modic change incidence rate between group B2 and group B1 (χ(2) = 9.395, P < 0.00714).

CONCLUSIONSThe incidence rate of Modic change with disc collapse but without severe lumbar hyperosteogeny is high in elderly patients with chronic low back pain. There is no significant difference of Modic change incidence between patients with both disc collapse and severe lumbar hyperosteogeny and patients with severe lumbar hyperosteogeny but without disc collapse.

Aged ; Aged, 80 and over ; Female ; Humans ; Intervertebral Disc ; pathology ; Intervertebral Disc Degeneration ; pathology ; Low Back Pain ; pathology ; Lumbar Vertebrae ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies

BACKGROUNDDegenerative lumbar scoliosis is common in older patients. Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis. A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed. The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study.

METHODSFrom January 2001 to August 2010, 96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls. Cobb angle, height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group. The height of L2/L3, L3/L4, L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group. The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups. The bone density of lumbar vertebrae was measured with dual-energy X-ray.

RESULTSIn scoliosis group, the intervertebral disc height on the convex side was greater than the height on the concave side (P < 0.001). The vertebral body height on the convex side was greater than the height on the concave side (P = 0.016). There was a significant difference between the scoliosis group and the control group (P = 0.003), and between T-value and the rate of osteoporosis between the two groups (both P < 0.001).

RESULTSwere verified using multiple linear regression analysis.

CONCLUSIONSDegenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces. There is a positive correlation between the angle of scoliosis and the disc index, the degree of degeneration of the intervertebral disc, and a negative correlation between the angle of scoliosis and bone density.

Aged ; Bone Density ; physiology ; Female ; Humans ; Intervertebral Disc ; pathology ; Intervertebral Disc Degeneration ; pathology ; physiopathology ; Linear Models ; Male ; Middle Aged ; Retrospective Studies ; Scoliosis ; pathology ; Spinal Stenosis ; pathology

STUDY DESIGN: A prospective radiographic study of cervical spine with congenital monosegment fusion. PURPOSE: To evaluate the effect of cervical synostosis on adjacent segments and the vertebral morphology. OVERVIEW OF LITERATURE: There are numerous clinical studies of adjacent segment disease (ASD) after monosegment surgical fusion. However, there was no report on ASD in the cervical spine with congenital monosegment synostosis. METHODS: Radiograms of 52 patients, aged 5 to 90 years, with congenital monosegment synostosis (CMS) between C2 and C6, who complained of neck/shoulder discomfort or pain were studied. 51 were normally aligned and one was kyphotically aligned. RESULTS: Spondylosis was not found in the patients below 35 years of age. Only 12 out of 24 patients with normally aligned C2-3 synostosis had spondylosis in 19 more caudal segments, and only one at C3-4. A patient with kyphotic C2-3 had spondylolysis at C3-4. In 8 patients with C3-4 synostosis, spondylosis was found in only 9 caudal segments (4 at C4-5, 4 at C5-6, and 1 at C6-7). The caudate C4-5 disc was the most liable to degenerate in comparison with other caudate segments. Caudal corporal flaring and inwaisting of the synostotic vertebra were the features that were the most evident. In 2 of 9 C4-5 and 7 out of 10 C5-6 synostosis patients, spondylosis was found at the two adjacent cephalad and caudate segments, respectively. Only corporal inwaisting without flaring was found. In all cases, spondylosis was confined to the adjacent segments. More advanced spondylosis was found in the immediate caudal segment than the cephalad one. CONCLUSIONS: It is concluded that spondylosis at the mobile segments in a synostotic spine is thought to be a fusion-related pathology rather than solely age-related disc degeneration. Those data suggested that CMS definitely precipitated the disc degeneration in the adjacent segments.
Humans ; Intervertebral Disc Degeneration ; Pathology ; Prospective Studies ; Spine* ; Spondylolysis ; Spondylosis ; Synostosis*

STUDY DESIGN: A retrospective study. OBJECTIVE: To evaluate the usefulness of MRI grading of disc degeneration in determining whether L5-S1 fusion is necessary in degenerative lumbar spinal disorders. SUMMARY OF LITERATURE REVIEW: Changes in adjacent segments are not well understood, after floating fusion has been performed. MATERIALS AND METHODS: We reviewed 16 surgical cases of degenerative lumbar spinal disorders from July 1996 to February 2000 with an average follow-up of 41 months. Fusion was done in patients without instability, pathology and narrowing of L5-S1. We measured the disc degeneration of adjacent segments in preoperative MRIs using the Modified Pearce classification. In spine AP, lateral and flexion-extension radiographs, we measured disc height, angular motion and instability changes and correlated these with disc degeneration. RESULTS: Disc height changes decreased in the upper and lower adjacent segments and preoperative disc degeneration above grade IV, decreased more in lower adjacent segment. A statistical correlation was found between disc degeneration and disc height changes in the lower segment (P=0.046), but not in the upper segment (P=0.649). The angular-motion was unchanged in the upper and lower adjacent segments, and no statistical correlation was found between disc degeneration and angular-motion changes (P=0.819, 0.208). Postoperative instability was found in the upper adjacent segment in 2 patients, but no statistical cor-relation was found between disc degeneration and instability (P=0.083, P=1.000). CONCLUSION: L5-S1 might be saved when free of pathology, and when disc degeneration is below grade III and balanced sagit-tally. However, further study is needed because of the short-term follow up and low number of cases in this study.
Classification ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Magnetic Resonance Imaging ; Pathology ; Retrospective Studies ; Spine