STUDY DESIGN: Prospective clinical study. PURPOSE: To observe the usefulness of anterior cervical osteophytes as intrinsic markers for spinal level localization (SLL) during sub-axial cervical spinal surgery via the anterior approach. OVERVIEW OF LITERATURE: Various landmarks, such as the mandibular angle, hyoid bone, thyroid cartilage, first cricoid ring, and C6 carotid tubercle, are used for gross cervical SLL; however, none are used during cervical spinal surgery via the anterior approach. We present our preliminary assessment of SLL over anterior vertebral surfaces (i.e., intrinsic markers) in 48 consecutive cases of anterior cervical spinal surgeries for the disc-osteophyte complex (DOC) in degenerative diseases and granulation or tumor tissue associated with infectious or neoplastic diseases, respectively, at an ill-equipped center. METHODS: This prospective study on patients undergoing anterior cervical surgery for various sub-axial cervical spinal pathologies aimed to evaluate the feasibility and accuracy of SLL via intraoperative palpation of disease-related morphological changes on anterior vertebral surfaces visible on preoperative midline sagittal T1/2-weighted magnetic resonance images. RESULTS: During a 3-year period, 48 patients (38 males,10 females; average age, 43.58 years) who underwent surgery via the anterior approach for various sub-axial cervical spinal pathologies, including degenerative disease (n= 42), tubercular infection (Pott's disease; n=3), traumatic prolapsed disc (n=2), and a metastatic lesion from thyroid carcinoma (n=1), comprised the study group. Intrinsic marker palpation yielded accurate SLL in 79% of patients (n=38). Among those with degenerative diseases (n=42), intrinsic marker palpation yielded accurate SLL in 76% of patients (n=32). CONCLUSIONS: Intrinsic marker palpation is an attractive potential adjunct for SLL during cervical spinal surgeries via the anterior approach in well-selected patients at ill-equipped centers (e.g., those found in developing countries). This technique may prove helpful when radiographic visualization is occasionally inadequate.
Clinical Study ; Female ; Humans ; Hyoid Bone ; Intervertebral Disc Displacement ; Osteophyte ; Palpation ; Pathology ; Prospective Studies ; Spine* ; Spondylosis ; Thyroid Cartilage ; Thyroid Neoplasms

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.
Cervical Vertebrae/*pathology/radiography ; Deglutition ; Deglutition Disorders/diagnosis/*etiology/physiopathology/therapy ; Esophageal Stenosis/diagnosis/*etiology/physiopathology/therapy ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteophyte/diagnosis/*etiology/therapy ; Spondylitis, Ankylosing/*complications/diagnosis/therapy ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVE: To investigate the role of lumbosacral radiculography using 3-dimentional (3D) magnetic resonance (MR) rendering for diagnostic information of symptomatic extraforaminal stenosis in lumbosacral transitional vertebra. MATERIALS AND METHODS: The study population consisted of 18 patients with symptomatic (n = 10) and asymptomatic extraforaminal stenosis (n = 8) in lumbosacral transitional vertebra. Each patient underwent 3D coronal fast-field echo sequences with selective water excitation using the principles of the selective excitation technique (Proset imaging). Morphologic changes of the L5 nerve roots at the symptomatic and asymptomatic extraforaminal stenosis were evaluated on 3D MR rendered images of the lumbosacral spine. RESULTS: Ten cases with symptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. On 3D MR lumbosacral radiculography, indentation of the L5 nerve roots was found in two cases, while swelling of the nerve roots was seen in eight cases at the exiting nerve root. Eight cases with asymptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. Based on 3D MR lumbosacral radiculography, indentation or swelling of the L5 nerve roots was not found in any cases with asymptomatic extraforaminal stenosis. CONCLUSION: Results from 3D MR lumbosacral radiculography Indicate the indentation or swelling of the L5 nerve root in symptomatic extraforaminal stenosis. Based on these findings, 3D MR radiculography may be helpful in the diagnosis of the symptomatic extraforaminal stenosis with lumbosacral transitional vertebra.
Aged ; Aged, 80 and over ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Female ; Humans ; Imaging, Three-Dimensional ; Lumbosacral Region/*pathology ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Nerve Compression Syndromes/*diagnosis/pathology ; Osteophyte/pathology ; Spinal Stenosis/*diagnosis/pathology

Previous case-control studies have shown various degrees of inverse correlation between osteoarthritis (OA) and osteoporosis (OP). The aim of this study was to examine the relationship between osteophytes at the cervical , lumbar vertebrae and knee, and the bone mineral density (BMD) of lumbar spine. We analyzed the data on 4091 female patients (aged 13 to 92 years). Osteophyte was defined by X ray examination. BMD of the lumbar spine (LS) was measured by dual energy X-ray absorptiometry (Lunar DPX). The association of osteophytes with BMD and osteophytes at different sites and different degrees were assessed by covariance analysis. Adjustments were made for age and body mass index. The relationship between osteophytes and BMD was analyzed by Binary Logistic Regression. BMD at each site was greater in the female with osteophytes (L4 BMD: P < 0.01, Mean BMD: P < 0.05); the relationship between osteophytes and osteoporosis and that between duration of osteophytes and osteoporosis were inversely correlated (P < 0.01). It confirms the existence of an inverse relationship between osteophytes and OP while a positive relationship is between age, body mass index and osteoporosis.
Absorptiometry, Photon ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bone Density ; Female ; Humans ; Lumbar Vertebrae ; metabolism ; pathology ; Middle Aged ; Osteophyte ; metabolism ; Osteoporosis ; metabolism ; Young Adult

OBJECTIVETo investigate the gene expression and potential functions of transforming growth factor-beta1 in osteophyte development.

METHODSA total of 25 specimens were obtained from individuals undergoing total knee arthroplasty due to severe primary osteoarthritis. Tissue samples were embedded in paraffin wax and made into sections. Hematoxylin and eosin and toluidine blue stainings were performed. The expressions of collagen I, IIa, IIb, and X were detected by immunohistochemistry. Based on the histomorphology of cellularity and matrix abundance, the glycosaminoglycans content, and the differential expressions of collagen I, IIa, IIb, and X, the osteophytic tissues were classified. For each different type of osteophyte, expressions of transforming growth factor-beta1 were detected by immunohistochemistry and in situ hybridization, and results were analyzed using the image analysis system.

RESULTSFive different types of osteophytes were identified as type I, type II, type III, type IV, and type V. Transforming growth factor-beta1 mRNA was more and intensely expressed in chondrocytes of type II and III osteophytes, and was less in other types of osteophytes. The difference was significant (P<0.05, P<0.01).

CONCLUSIONTransforming growth factor-beta1 mRNA is mainly expressed in early-mid stages of osteophytes and may play an important role in promoting the proliferation and differentiation of chondrocytes in the early stages of osteophyte development.

Chondrocytes ; metabolism ; pathology ; Humans ; Osteoarthritis, Knee ; metabolism ; pathology ; Osteophyte ; metabolism ; pathology ; RNA, Messenger ; biosynthesis ; Transforming Growth Factor beta1 ; biosynthesis ; genetics

Some baseball pichers have the symptom-complex of the elbow joint due to repetitive throwing. The Hyperextension overload syndrome is symptom-complex caused by impingement between olecranon tip and fossa during hyperextension of the elbow. The patients of hyperextension overload syndrome is have some pathology of his elbow such as bony spur on olecranon tip, intra-articular loose body or degenerative arthritis. And they complaint of pain or limitation of extension. The authors diagnosed and treated five cases of hyperextension overload syndrome. All of them had flexion contracture. Three cases of them had cubitus valgus. But no had medial instability of the elbow. Three cases of them had tenderness on the olecranon tip. Four patients treated by excision of osteophyte or loose body with arthroscopic or open operative technique.
Baseball ; Contracture ; Elbow Joint ; Elbow ; Humans ; Olecranon Process ; Osteoarthritis ; Osteophyte ; Pathology

A retrospective study was undertaken to define the factors that cause the neurogenic symptoms in 18 cases of spondylolytic spondylolisthesis who were operated for leg pain and neurologic deficits of motor functions documented by neurologic examination or electromyographic findings in the Department of Orthopaedic Surgery, Fatima Hospital, Daegu for three years since June, 1986. The cases having other combined pathology to cause neurogenic symptoms were excluded. The causes were predetermined by preoperative x-rays, myelograms, electromyograms, and computerized tomograms and the causes were explored at surgery regarding the preoperative findings. The findings were compared with the avilable findings of 13 cases who were operated for low back pain only without any neurogenic pain in the leg during the same period. The cases were quite older and had narrower disc spaces than the back pain group but there were no significant differences in the degree of slipping and stability of slipped level between the two groups. The foraminal stenosis was found in all of the cases and a central stenosis was combined in a case. The intervertebral foramens were narrowed up-down in most of the cases between the bony prominence of proximal pars interarticularis above and the disc and vertebral body below but three cases had soft tissue mass only at the isthmic defect encroaching the foramen. There were hypertrophy of bone and/or soft tissue at the pars interarticularis in all cases. The nerve roots were mainly compressed up-down below pars interarticularis in the foramen in 8 cases and impinged at the anterior foramen in front of the pars interarticularis in 10 cases. The central stenosis was due to marked bony hypertrophy of pars interarticularis and osteophyte of vertebral body. The causes of neurogenic symptoms in spondylolytic spondylolisthesis were foraminal stenosis due to hypertrophy of bone and/or soft tissue at the pars interarticularis combined with narrowing of disc and seemed to be a process of degenerative changes occurring at the motion segment of slipped level.
Back Pain ; Constriction, Pathologic ; Daegu ; Hypertrophy ; Leg ; Low Back Pain ; Neurologic Examination ; Neurologic Manifestations ; Osteophyte ; Pathology ; Pheniramine ; Retrospective Studies ; Spondylolisthesis