Evaluation of Bone Mineral Density in Patients with Chronic Low Back Pain

STUDY DESIGN: This was designed as a retrospective study. PURPOSE: We investigated the relationship between bone mineral density (BMD) and chronic lower back pain (LBP). OVERVIEW OF LITERATURE: In spite of a large number of epidemiological surveys on the prevalence of LBP and BMD measurements completed separately in the general population, the relationship between the two has not been well documented. METHODS: The study included 171 patients with chronic LBP who underwent the BMD study. The control group was selected from our database regarding BMD without LBP. RESULTS: A total of 678 subjects, aged 18 to 100 years (mean, 49.9+/-12.9 years) were included in the study, 25% (n=171) of the subjects had LBP. Compared to those patients without LBP, patients exhibiting LBP had statistically significant lower mean weight, hip and spine BMD and T-score. Lower BMD and T-scores were significant regardless of the age group, gender, menopausal status, and obesity classification. CONCLUSIONS: Chronic LBP has a negative correlation with hip and spine bone mineral density.

Magnetic Resonance Imaging of the Lumbar Spine in Young Arabs with Low Back Pain

STUDY DESIGN: A prospective study. PURPOSE: To Investigate the prevalence of magnetic resonance imaging (MRI) changes of the lumbar spine in low back pain (LBP) and the associated risk factors in young Arab population. OVERVIEW OF LITERATURE: Studies on the prevalence of MRI findings and their relationship with LBP have been conducted; these have occurred in adult populations in developed countries. The prevalence of MRI changes in the young Arab population with LBP is not known. METHODS: Two hundred and fourteen patients of Arab origin in the 16 to 29 year age group with LBP symptoms underwent MRI examinations. The prevalence of MRI changes in the lumbar spine and associated risk factors were determined and compared to age, race, and gender-matched controls. RESULTS: A majority (64%) of the patients with LBP (138 out of 214) were found to have MRI evidence of degenerative disc disease (DD) compared to 10% (22 out of 214) in the control group. The majority (61%) of patients had multiple level disease, most commonly involving the lowest 2 disc levels. Reduced signal of the disc followed by disc bulge was the most common MRI features seen in the symptomatic subjects. Obesity correlated with MRI prevalence of abnormalities, while activity demonstrated a positive trend. CONCLUSIONS: The MRI prevalence of DD among the young Arab patients with LBP is high when compared to other reports in literature. Obesity correlated with MRI prevalence of abnormalities while activity demonstrated a positive trend.

Ossification of ligamentum flavum in middle east Arabs: a hospital-based study

To investigate the frequency of ossification of the ligamentum flavum [OLF] in the spine among the Arab population in Kuwait using magnetic resonance imaging [MRI] surveillance of the whole spine. A consecutive series of 102 patients with low back pain were recruited from the outpatient clinic of Mubarak Al-Kabeer Hospital, Kuwait. MRI of the whole spine in the sagittal plane was obtained in at least two sequences [T[1] and T[2]]. The OLF was defined as low signal intensity thickening of the ligament in both T[1] and T[2] sequences on the posterior margin of the spinal canal, causing indentation of the theca with or without cord compression. Of the 102 cases, 19 [18.6%] patients had OLF. Of the 19 positive cases, 12 [63.2%] were present at a single level, and 7 [36.8%] at multiple levels. A total of 26 OLF segments were identified in the following anatomical distribution: cervical: 15 [57.7%]; upper thoracic [T1-T4]: 1 [3.8%]; mid thoracic [T5-T8]: 4 [15.4%]; lower thoracic [T9-T12]: 4 [15.4%], and lumbar region: 2 [7.7%]. Of the 19 OLF patients, 2 [10.5%] had tandem ossification of the posterior longitudinal ligament in the cervical spine and were symptomatic. The frequency of OLF appears to be high among this hospital-based cohort of the Arab population. OLF should be kept in mind if a patient presents with radiculopathy, particularly in the cervical region, for which surgical intervention is contemplated

Significance of virchow-robin spaces in patients newly diagnosed with multiple sclerosis: a case-control study in an arab population

To assess the frequency and extent of dilatation of Virchow-Robin [VR] spaces at three levels of the brain in patients of Arab ethnicity in Kuwait recently diagnosed with multiple sclerosis [MS] and compare the results with age-and gender-matched controls. Methods:The magnetic reso-nance imaging [MRI] scans performed within 3 months of the clinical diagnosis of 80 patients recently diagnosed with active MS were compared to those of 80 age- and gender-matched controls with headache but without any neurological deficits for the frequency and size of VR spaces. MRI was done with noncontrast axial and coronal T[1]W FSE, axial T[2]W FSE, axial T[2]W FLAIR and sagittal FLAIR sequences followed by postcontrast axial and coronal T

Inter- and intraobserver variation between radiologists in the detection of abnormal parenchymal lung changes on high-resolution computed tomography

Radiological and histological evaluations are affected by subjective interpretation. This study determined the level of inter- and intraobserver variation among radiologists for detection of abnormal parenchymal lung changes on high resolution computed tomography [HRCT]. HRCT images of 65 patients known to have systemic lupus erythematosus [with clinical pulmonary involvement] were retrospectively reviewed by four nonthoracic radiologists [two with expertise in magnetic resonance [MR] and two general radiologists]. Each radiologist read the scans twice, with an interval between readings of at least 6 months. The interobserver variation among the first and second readings of the four radiologists and the intraobserver variation of each radiologist's two readings were assessed by the kappa statistic. There was good agreement between the first and second readings of each radiologist. There was moderate agreement between the two readings of one MR radiologist [kappa=0.482]; the other three radiologists had kappa values that were good to excellent [0.716, 0.691, and 0.829]. There was a clinically acceptable level of interobserver variability between all radiologists. The agreement was fair to moderate between the MR radiologist and the other observers [kappa range: 0.362-0.519] and moderate to good between the other three radiologists [0.508-0.730]. The interpretation of imaging findings of abnormal parenchymal lung changes on HRCT is reproducible and the agreement between general radiologists is clinically acceptable. There is reduced agreement when the radiologist is not involved on a regular basis with thoracic imaging. Difficult or indeterminate cases may benefit from review by a chest radiologist