Assessment of In Vivo Lumbar Inter-Vertebral Motion: Reliability of a Novel Dynamic Weight-Bearing Magnetic Resonance Imaging Technique Using a Side-Bending Task

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.

Recurrent Lumbar Disc Herniation: Results of Revision Surgery and Assessment of Factors that May Affect the Outcome. A Non-Concurrent Prospective Study

STUDY DESIGN: Non-concurrent prospective study. PURPOSE: To determine the functional outcome after open 'fragment' discectomy for recurrent lumbar disc herniation, and to analyze the factors that may affect the outcome. OVERVIEW OF LITERATURE: Literature search revealed only four studies where the factors affecting the outcome of a revision surgery for recurrent disc herniation have been evaluated. None of these studies analyzed for diabetes, disc degeneration and facet arthropathy. We have analyzed these features, in addition to the demographic and clinical factors. METHODS: Thirty-four patients who underwent the procedure were followed up for an average period of 27.1 months. The Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were used to assess the functional outcome. Age, gender, smoking, diabetic status, duration of recurrent symptoms, the side of leg pain, level and type of disc herniation, degree of disc degeneration on magnetic resonance imaging, and facet joint arthritis before first and second surgeries, were analyzed as factors affecting the outcome. RESULTS: The average Hirabayashi improvement in JOA was 56.4%. The mean preoperative ODI was 74.5% and the mean ODI at final follow-up was 32.2%, the difference being statistically significant (p<0.01). Patients with diabetes, all of whom had poor long term glycemic control, were found to have a poor outcome in terms of ODI improvement (p=0.03). CONCLUSIONS: Open fragment discectomy is a safe and effective surgical technique for the treatment of recurrent disc herniation. However, patients with uncontrolled diabetes may have a less favorable outcome.