STUDY DESIGN: Between-session reliability of a magnetic resonance imaging (MRI) based experimental technique to quantify lumbar inter-vertebral motion in humans. PURPOSE: We have developed a novel, dynamic, MRI-based approach for quantifying in vivo lumbar inter-vertebral motion. In this study, we present the protocol's reliability results to quantify inter-vertebral spine motion. OVERVIEW OF LITERATURE: Morphometric studies on intervertebral displacements using static, supine MRI and quantification of dynamic spine motion using different X-ray based radiography techniques are commonly found in the literature. However, reliability testing of techniques assessing real-time lumbar intervertebral motion using weight-bearing MRI has rarely been reported. METHODS: Ten adults without a history of back pain performed a side-bending task on two separate occasions, inside an open-MRI, in a weight-bearing, upright position. The images were acquired during the task using a dynamic magnetic resonance (MR) sequence. The MRI imaging space was externally calibrated before the study to recreate the imaging volume for subsequent use in an animation software. The dynamic MR images were processed to create side-bending movement animations in the virtual environment. Participant-specific three-dimensional models were manually superimposed over vertebral image silhouettes in a sequence of image frames, representing the motion trials. Inter-vertebral axes and translation and rotational displacements of vertebrae were quantified using the animation software. RESULTS: Quantification of inter-vertebral rotations and translations shows high reliability. Between-session reliability results yielded high values for the intra-class correlation coefficient (0.86–0.93), coefficient of variation (13.3%–16.04%), and Pearson's correlation coefficients (0.89–0.98). CONCLUSIONS: This technique may be developed further to improve its speed and accuracy for diagnostic applications, to study in vivo spine stability, and to assess outcomes of surgical and non-surgical interventions applied to manage pathological spine motion.
Adult ; Back Pain ; Humans ; Intervertebral Disc ; Low Back Pain ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Radiography ; Spine ; Translations ; Weight-Bearing

The purpose of this study was to examine the association between the symptoms of temporomandibular joint disorders and lumbar diseases in adults when the prevalence rate of osteoarthritis is increasing and to help develop health policies that can improve oral health and health in general. The study used representative data from the 5th Korea National Health and Nutrition Examination Survey phase 3 (2012). In total, we analyzed the data of 3,017 individuals aged over 50 years who participated in the health-related survey and underwent radiography of the lumbar joints. PASW statistics ver. 18.0 was used for analysis. This study revealed the following results: 16.1% experienced at least one symptom of temporomandibular joint disorders within the recent single year, 20.6% experienced lower back pain in the recent three months, and 30.6% had lumbar osteoarthritis revealed using radiography of the lumbar joints. Symptoms of temporomandibular joint disorders, lower back pain, and lumbar osteoarthritis were correlated with each other; the respondents who experienced symptoms of temporomandibular joint disorders had 1.70 times (95% confidence interval [CI], 1.30∼2.22) higher prevalence of lower back pain and 1.20 times (95% CI, 0.86∼1.68) higher prevalence of lumbar osteoarthritis than in those with no such difficulties. The results of this study confirmed that the symptoms of temporomandibular joint disorders affected lumbar diseases in adulthood. Therefore, adequate treatment and prevention of the symptoms of temporomandibular joint disorders in adults is expected to make crucial contributions to decreases in the prevalence rate of lumbar diseases and an improvement in the quality of life.
Adult* ; Health Policy ; Humans ; Joints ; Korea ; Low Back Pain ; Nutrition Surveys ; Oral Health ; Osteoarthritis ; Osteoarthritis, Spine ; Prevalence ; Quality of Life ; Radiography ; Surveys and Questionnaires ; Temporomandibular Joint Disorders* ; Temporomandibular Joint*

STUDY DESIGN: Descriptive cross-sectional study. PURPOSE: To determine the frequency of lumbosacral transitional vertebrae (LSTV) in patients with low back pain (LBP) and the role of iliolumbar ligament (ILL) origin from L5 in LSTV cases. OVERVIEW OF LITERATURE: Transitional vertebrae are developmental variants of the spine. LSTV is a common congenital abnormality, and failure to recognize this anomaly may result in serious consequences during surgery. METHODS: All patients aged 11–90 years of either gender with LBP for any duration, who presented for X-ray and magnetic resonance imaging (MRI) of the lumbosacral spine, were included. X-rays of the lumbosacral spine in anteroposterior and lateral views were acquired. In addition, T1- and T2-weighted sagittal and axial MRI was performed. Images were evaluated on a workstation. RESULTS: Of 504 patients, transitional vertebrae were observed in 75 patients (15%). Among them, 39 (52%) patients had Castellvi type III and 36 (48%) patients had Castellvi type II. However, on MRI, 42 (56%) patients had O'Driscoll type II, 18 (24%) patients had O'Driscoll type IV, and 15 patients (20%) had O'Driscoll type III. ILL origin from L5 was significantly higher (n=429, 100%) among patients with a normal lumbosacral junction than among patients with a transitional lumbosacral junction (n=22, 29.3%) (p < 0.001). CONCLUSIONS: LSTV occurs at a high frequency in patients with LBP. Furthermore, in the presence of LSTV, the ILL is not a reliable marker for the identification of L5.
Congenital Abnormalities ; Cross-Sectional Studies ; Humans ; Ligaments ; Low Back Pain* ; Lumbar Vertebrae ; Magnetic Resonance Imaging* ; Prevalence* ; Radiography* ; Spine*

OBJECTIVE: To elucidate the association between non-specific low back pain (NSLBP) and spinal X-ray findings in Korean farmers: Farmers' Cohort for Agricultural Work-Related Musculoskeletal disorders (FARM) study. METHODS: A total of 835 farmers (391 males, 444 females; mean age, 56.6±7.4 years) without red-flag signs of specific LBP were recruited. Presence of LBP more than one week or once a month with more than moderate degree of pain severity during the last year was assessed with a binary questionnaire (yes or no). Spinal degenerative changes were classified into disc height change (DHC) of L4-5 and L5-S1 (grade 0–5) and osteophyte formation of L5 (grade 0–5) by a radiologist based on X-ray findings. Additionally, spondylolisthesis, scoliosis and spondylolysis were assessed. RESULTS: General prevalence of NSLBP was 40.7%, revealing a higher incidence of NSLBP in female and younger farmers compared to male and older farmers (χ²=23.3, p<0.001; χ²=4.54, p<05, respectively). Among X-ray findings, DHC (L5–S1) grade 4 revealed significantly higher relative risk of NSLBP compared to grade 0 (odds ratio, 5.00; 95% confidence interval, 2.05–12.20) after adjusting age and sex, while other X-ray findings were not associated with NSLBP. CONCLUSION: The NSLBP of Korean farmers was significantly related to lumbar disc degenerative changes, suggesting clinical usefulness of X-ray findings in assessing LBP in farmers.
Agriculture* ; Cohort Studies ; Farmers* ; Female ; Humans ; Incidence ; Low Back Pain* ; Male ; Osteoarthritis ; Osteophyte ; Prevalence ; Radiography ; Scoliosis ; Spine ; Spondylolisthesis ; Spondylolysis

OBJECTIVE: To assess whether multi-echo Dixon magnetic resonance (MR) imaging with simultaneous T2* estimation and correction yields more accurate fat-signal fraction (FF) measurement of the lumbar paravertebral muscles, in comparison with non-T2*-corrected two-echo Dixon or T2*-corrected three-echo Dixon, using the FF measurements from single-voxel MR spectroscopy as the reference standard. MATERIALS AND METHODS: Sixty patients with low back pain underwent MR imaging with a 1.5T scanner. FF mapping images automatically obtained using T2*-corrected Dixon technique with two (non-T2*-corrected), three, and six echoes, were compared with images from single-voxel MR spectroscopy at the paravertebral muscles on levels L4 through L5. FFs were measured directly by two radiologists, who independently drew the region of interest on the mapping images from the three sequences. RESULTS: A total of 117 spectroscopic measurements were performed either bilaterally (57 of 60 subjects) or unilaterally (3 of 60 subjects). The mean spectroscopic FF was 14.3 +/- 11.7% (range, 1.9-63.7%). Interobserver agreement was excellent between the two radiologists. Lin's concordance correlation between the spectroscopic findings and all the imaging-based FFs were statistically significant (p < 0.001). FFs obtained from the T2*-corrected six-echo Dixon sequences showed a significantly better concordance with the spectroscopic data, with its concordance correlation coefficient being 0.99 and 0.98 (p < 0.001), as compared with two- or three-echo methods. CONCLUSION: T2*-corrected six-echo Dixon sequence would be a better option than two- or three-echo methods for noninvasive quantification of lumbar muscle fat quantification.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Image Processing, Computer-Assisted ; Low Back Pain/*radiography ; Magnetic Resonance Imaging/instrumentation/*methods ; Male ; Middle Aged ; Muscles/radiography ; Spinal Cord

Butterfly vertebra is a rare congenital malformation of the spine, which is usually reported in the literature as an isolated finding. We describe a 40-year-old woman that presented to our emergency department with back pain and sciatica. Initial radiological evaluation revealed an incidental finding of a L4 butterfly vertebra in the anteroposterior and lateral view radiographs. The patient presented with no neurological deficit. This rare congenital anomaly is usually asymptomatic, and awareness of its non-traumatic nature is critical in order to establish a correct diagnosis. Further evaluation of the patient is necessary to exclude pathologic fracture, infection, or associated vertebral anomalies and syndromes, such as Alagille, Jarcho-Levin, Crouzon, and Pfeiffer syndromes. Furthermore, in the emergency setting, awareness of this entity is needed so that a correct diagnosis can be established.
Accidental Falls ; Adult ; Female ; Humans ; Low Back Pain ; Lumbar Vertebrae/*abnormalities/pathology/radiography ; Tomography, X-Ray Computed

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

OBJECTIVETo analyzed the relationship between lumbar endplate Modic area changes rate and low back pain by measuring MRI T2 sagittal image of lumbar endplate Modic area changes rate.

METHODSFrom December 2011 to June 2012,70 patients with low back pain in operation were evaluated on pain by VAS and function by JOA,and examined by MRI including 39 males and 31 females with an average age of (51.00 +/- 11.89) years ranging from 29 to 72 years old. Among them, 54 cases had lumbar endplate Modic changes involving 15 cases in types Modic I ,21 cases in type Modic II, 11 cases in type Modic III ,mixed type Modic in 7 cases (eliminated for too few cases). Modic area changes and corresponding vertebral area were measured on MRI T2 median sagittal. The areas of two ways were compared to yield the rate of changes for Modic, for multisegmental Modic changes to calculate the total ratios. A correlation was observed among JOA, VAS and the rate of Modic changes.

RESULTSThe correlation coefficient of change rate of Modic I with JOA score was r = -0.308, P = 0.048 < 0.05, there was a negative correlation;the correlation coefficient of change rate of Modic I with VAS scores was r = 0.428,P = 0.021 < 0.05, there was a positive correlation. The correlation coefficient of change rate of Modic II with JOA score was r = -0.375, P = 0.043 < 0.05, there was a negative correlation;the correlation coefficient of change rate of Modic II with VAS score was r = 0.352, P = 0.041 < 0.05, there was a positive correlation. The area change rate of Modic III had no significant correlation with low back pain degree (P > 0.05).

CONCLUSIONModic I and II area changes rate of of patients with low back pain is closely related to the degree of pain low back pain, Modic III area changes rate is not significant correlated to the degree of lower back pain.

Adult ; Aged ; Female ; Humans ; Low Back Pain ; diagnosis ; diagnostic imaging ; Lumbar Vertebrae ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography

OBJECTIVETo identify the affect of chronic low back pain on multifidus muscle atrophy and fatty infiltration.

METHODSFrom March 2010 to August 2013, a retrospective study were carried out in the department of orthopedics of patients with low back pain. Finally 31 cases were selected to this study including 19 males and 12 females with an average age of 36.4 years ranging from 23 to 55 years. The main symptoms of these patients were repeated back pain. Duration was more than 1 year. X-ray, CT, MRI showed no obvious abnormalities. The changes of net cross-sectional area of multifidus and T2 signal ratio of the same patient were measured at different time by MRI. VAS and Oswestry disability scores were recorded in two MRI examination. Correlation between these change of multifidus net area and T2 signal ratio in two times measurement and duration of low back pain, VAS, Oswestry disability scores were analyzed to find the affection of low back pain on paraspinal multifidus muscle.

RESULTSThe net multifidus cross-sectional area in same case by the second follow-up MRI is significantly smaller than that of the first follow-up, T2 signal ratio at second was significantly higher than that of the first (P < 0.05). The net cross sectional area of multifidus muscles reduced rate were positively correlated with VAS scores, duration and of Oswestry disabilitry scores (P < 0.001). The rate of increase in T2 signal ratio was not correlated with VAS scores,duration and the Oswestry disability scores (P > 0.05).

CONCLUSIONChronic low back pain is one of the most important reasons of paraspinal multifidus muscle atrophy and fatty. The duration, VAS and Oswestry disability scores of chronic low back pain were positively correlated with the multifidus muscle atrophy.

Adult ; Chronic Disease ; Female ; Humans ; Low Back Pain ; complications ; Male ; Middle Aged ; Muscular Atrophy ; diagnostic imaging ; etiology ; Paraspinal Muscles ; diagnostic imaging ; Radiography ; Retrospective Studies ; Young Adult

OBJECTIVE: To investigate the effects of asymptomatic back muscle weakness and spinal deformity on low back pain (LBP). METHODS: Sixty healthy subjects without LBP participated in this study. Radiography and an isokinetic/isometric dynamometer were used to respectively measure spinal scoliosis/lordosis and the strength of the trunk flexors/extensors. After 2 years, 48 subjects visited the hospital again and LBP episodes, its severity and the Korean version of the Oswestry Disability Index were assessed. Differences between the group with LBP and the group without LBP were evaluated and the association with LBP incidence and severity was determined. RESULTS: Sex, age, and trunk strength were significantly different in both group. Sex and age were significantly positive associated with LBP incidence. The isometric trunk flexor and extensor strength, maximum isokinetic trunk flexor and extensor strength were significantly and negatively associated with the LBP severity. The maximum isokinetic trunk extensor and maximum isometric trunk extensor strength was significantly negative associated with the LBP incidence. CONCLUSION: LBP incidence is associated with isometric and isokinetic trunk extensor weakness, whereas LBP severity is associated with age, sex, isokinetic trunk extensor and flexor weakness, isometric trunk extensor and flexor weakness.
Back Muscles ; Congenital Abnormalities ; Incidence ; Low Back Pain* ; Muscle Strength Dynamometer ; Muscle Weakness ; Muscles* ; Pilot Projects* ; Radiography ; Risk Factors*