The Spatial Relationship between Spinal Osteoarthritis and CSF Venous Fistulas in Patients with Spontaneous Intracranial Hypotension.

BACKGROUND AND PURPOSE: CSF venous fistula leads to spontaneous intracranial hypotension. The exact mechanisms underlying the development of CSF venous fistula remain unclear: Some researchers have postulated that underlying chronic intracranial hypertension may lead to damage to spinal arachnoid granulations, given that many patients with CSF venous fistulas have an elevated body mass index (BMI). However, individuals with higher BMIs are also more prone to spinal degenerative disease, and individuals with CSF venous fistulas also tend to be older. CSF venous fistula tends to occur in the lower thoracic spine, the most frequent location of thoracic degenerative changes. The current study aimed to examine whether CSF venous fistulas are more likely to occur at spinal levels with degenerative changes. MATERIALS AND METHODS: Forty-four consecutive patients with CSF venous fistulas localized on dynamic CT myelography were included in analyses. Whole-spine CT was scrutinized for the presence of degenerative changes at each spinal level. The proportion of levels positive for CSF venous fistula containing any degenerative findings was compared to levels without CSF venous fistula using the Fisher exact test. The Pearson correlation coefficient was calculated to explore the association between the burden of degenerative disease and BMI and age and between BMI and opening pressure. RESULTS: Forty-four patients with 49 total CSF venous fistulas were analyzed (5 patients had 2 CSF venous fistulas). Mean patient age was 62.3 (SD, 9.5) years. Forty-seven CSF venous fistulas were located in the thoracic spine; 1, in the cervical spine; and 1, in the lumbar spine. Within the thoracic spine, 39/49 (79.6%) fistulas were located between levels T7-8 and T12-L1. Forty-four of 49 (89.8%) CSF venous fistulas had degenerative changes at the same level. The levels without CSF venous fistulas demonstrated degenerative changes at 694/1007 (68.9%) total levels. CSF venous fistulas were significantly more likely to be present at spinal levels with associated degenerative changes (OR = 4.03; 95% CI, 1.58-10.27; P = .001). Age demonstrated a positive correlation with the overall burden of degenerative disease (correlation coefficient: 0.573, P < .001), whereas BMI did not (correlation coefficient: 0.076, P = .625). There was a statistically significant positive correlation between BMI and opening pressure (correlation coefficient: 0.321, P = .03). CONCLUSIONS: Results suggest a potential association between spinal degenerative disease and development of CSF venous fistula.

Unilateral high-riding vertebral artery is associated with asymmetric morphological changes of the atlantoaxial joint: a novel risk factor for atlantoaxial osteoarthritis.

PURPOSE: This study aimed to investigate the association between unilateral high-riding vertebral artery (HRVA) and morphological changes in the atlantoaxial joint (AAJ) and to determine whether unilateral HRVA is a risk factor for atlantoaxial osteoarthritis (AAOA). METHODS: We conducted a retrospective analysis of 2496 patients admitted to our medical center between January 2020 and December 2022 who underwent CT imaging of the cervical spine. Two hundred and seventy-two patients with unilateral HRVA (HRVA group) were identified and a respective 2:1 age- and sex-matched control group without HRVA was built. Morphological parameters, including C2 lateral mass settlement (C2 LMS), C1/2 coronal inclination (C1/2 CI), lateral atlanto-dental interval (LADI), and C1/2 relative rotation angle (C1/2 RRA) were measured. The degree of AAOA was recorded. Risk factors associated with AAOA were identified using univariate and multivariable logistic regression analyses. RESULTS: The study included 61.4% women, and the overall average age of the study population was 48.7 years. The morphological parameters (C2 LMS, C1/2 CI, and LADI) in AAJ were asymmetric between the HRVA and the non-HRVA sides in the HRVA group (p < 0.001). These differences in parameters (d-C2 LMS, d-C1/2 CI, and d-LADI) between the HRVA and the non-HRVA sides, and C1/2 RRA were significantly larger than those in the control group. Eighty-three of 816 patients (10.2%) with AAOA had larger values of d-C2 LMS, d-C1/2 CI, d-LADI, and C1/2 RRA compared with the patients without AAOA (p < 0.05). The multivariable logistic regression analysis indicated that unilateral HRVA [adjusted odds ratio (OR) = 2.6, 95% CI: 1.1-6.3, p = 0.029], age in the sixth decade or older (adjusted OR = 30.2, 95% CI: 16.1-56.9, p < 0.001), women (adjusted OR = 2.1, 95% CI: 1.0-5.6, P = 0.034) were independent risk factors for AAOA. CONCLUSION: Unilateral HRVA was associated with asymmetric morphological changes of nonuniform settlement of C2 lateral mass, lateral slip of atlas, and atlantoaxial rotation displacement. Besides age ≥ 60 years and females, unilateral HRVA is an independent risk factor for AAOA.

Spinal osteoarthritis is a risk of vertebral fractures in postmenopausal women.

Recent studies have revealed that despite high bone mineral density (BMD), osteoarthritis (OA) is a risk factor for osteoporotic fractures. However, the relationship between spinal OA and vertebral fractures has not yet been fully investigated. This longitudinal analysis used a subset of ongoing cohort study consist with Japanese postmenopausal women. The prevalence of spinal OA was determined using Kellgren-Lawrence grading method. The incidence of vertebral fractures were determined by semiquantitative analysis of spinal X-ray films. The relationship between the presence of spinal OA and incidence of vertebral fractures was evaluated using the Cox regression analysis. In total, 1480 women were followed up for 8.1 ± 6.4 years. Among them, 923 were diagnosed with spinal OA, and incident vertebral fractures were observed in 473 participants. After adjusting for confounding variables, the spinal OA (≥ grade 2) was a significant predictor of incident vertebral fractures (hazard ratio, 1.52; 95% confidence interval: 1.19-1.93, p = 0.001). Using ROC analysis, the thresholds of lumbar BMD for incident vertebral fractures were 0.952 g/cm2 for patients with spinal OA and 0.753 g/cm2 for patients without spinal OA. The presence of spinal OA is a risk factor for incident vertebral fractures despite high lumbar BMD.

Minimally Invasive Treatment of Facet Osteoarthritis Pain in Spine: A Clinical Approach Evaluating Cryotherapy.

BACKGROUND: Chronic pain management remains a challenging aspect of neurosurgical care, with facet arthrosis being a significant contributor to the global burden of low back pain. This study evaluates the effectiveness of cryotherapy as a minimally invasive treatment for patients with facet arthrosis. By focusing on reducing drug dependency and pain intensity, the research aims to contribute to the evolving field of pain management techniques, offering an alternative to traditional pain management strategies. METHODS: Through a retrospective longitudinal analysis of patients with facet osteoarthritis treated via cryotherapy between 2013 and 2023, we evaluated the impact on medication usage and pain levels, utilizing the Visual Analog Scale for pre- and posttreatment comparisons. RESULTS: The study encompassed 118 subjects, revealing significant pain alleviation, with Visual Analog Scale scores plummeting from 9.0 initially to 2.0 after treatment. Additionally, 67 patients (56.78%) reported decreased medication consumption. These outcomes underscore cryotherapy's potential as a pivotal tool in chronic pain management. CONCLUSIONS: The findings illuminate cryotherapy's efficacy in diminishing pain and curtailing medication dependency among patients with facet arthrosis. This study reaffirms cryotherapy's role in pain management and propels the discourse on nontraditional therapeutic avenues, highlighting the urgent need for personalized and innovative treatment frameworks.

Association between clinical findings and the presence of lumbar spine osteoarthritis imaging features: A systematic review.

OBJECTIVE: Spinal osteoarthritis is difficult to study and diagnose, partly due to the lack of agreed diagnostic criteria. This systematic review aims to give an overview of the associations between clinical and imaging findings suggestive of spinal osteoarthritis in patients with low back pain to make a step towards agreed diagnostic criteria. DESIGN: We searched MEDLINE, Embase, Web of Science, and CINAHL from inception to April 29, 2021 to identify observational studies in adults that assessed the association between selected clinical and imaging findings suggestive of spinal osteoarthritis. Risk of bias was assessed using the Newcastle Ottawa Scale and the quality of evidence was graded using an adaptation of the GRADE approach. RESULTS: After screening 7902 studies, 30 met the inclusion criteria. High-quality evidence was found for the longitudinal association between low back pain (LBP) intensity, and both disc space narrowing and osteophytes, as well as for the association between LBP-related physical functioning and lumbar disc degeneration, the presence of spinal morning stiffness and disc space narrowing and for the lack of association between physical functioning and Schmorl's nodes. CONCLUSIONS: There is high- and moderate-quality evidence of associations between clinical and imaging findings suggestive of spinal osteoarthritis. However, the majority of the studied outcomes had low or very low-quality of evidence. Furthermore, clinical and methodological heterogeneity was a serious limitation, adding to the need and importance of agreed criteria for spinal osteoarthritis, which should be the scope of future research.

Are serum thyroid hormone, parathormone, calcium, and vitamin D levels associated with lumbar spine degeneration? A cross-sectional observational clinical study.

PURPOSE: Low back pain (LBP) impairs the quality of life and rises healthcare costs. The association of spine degeneration and LBP with metabolic disorders have been reported, previously. However, metabolic processes related with spine degeneration remained unclear. We aimed to analyze whether serum thyroid hormones, parathormone, calcium, and vitamin D levels were associated with lumbar intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles. METHODS: We cross-sectionally analyzed a retrospective database. Patients who visited internal medicine outpatient clinics with suspect of endocrine disorders and chronic LBP were searched. Patients with biochemistry results within 1 week before lumbar spine magnetic resonance imaging (MRI) were included. Age- and gender-matched cohorts were made-up and analyzed. RESULTS: Patients with higher serum free thyroxine levels were more likely to have severe IVDD. They were also more likely to have fattier multifidus and erector spinae at upper lumbar levels, less fatty psoas and less Modic changes at lower lumbar levels. Higher PTH levels were observed in patients with severe IVDD at L4-L5 level. Patients with lower serum vitamin D and calcium levels had more Modic changes and fattier paraspinal muscles at upper lumbar levels. CONCLUSION: Serum hormone, vitamin D, and calcium levels were associated with not only IVDD and Modic changes but also with fatty infiltration in the paraspinal muscles, mainly at upper lumbar levels in patients with symptomatic backache presenting to a tertiary care center. Complex inflammatory, metabolic, and mechanical factors present in the backstage of spine degeneration.

A common variant rs2054564 in ADAMST17 is associated with susceptibility to lumbar spondylosis.

The molecular pathophysiology underlying lumbar spondylosis development remains unclear. To identify genetic factors associated with lumbar spondylosis, we conducted a genome-wide association study using 83 severe lumbar spondylosis cases and 182 healthy controls and identified 65 candidate disease-associated single nucleotide polymorphisms (SNPs). Replication analysis in 510 case and 911 control subjects from five independent Japanese cohorts identified rs2054564, located in intron 7 of ADAMTS17, as a disease-associated SNP with a genome-wide significance threshold (P = 1.17 × 10-11, odds ratio = 1.92). This association was significant even after adjustment of age, sex, and body mass index (P = 7.52 × 10-11). A replication study in a Korean cohort, including 123 case and 319 control subjects, also verified the significant association of this SNP with severe lumbar spondylosis. Immunohistochemistry revealed that fibrillin-1 (FBN1) and ADAMTS17 were co-expressed in the annulus fibrosus of intervertebral discs (IVDs). ADAMTS17 overexpression in MG63 cells promoted extracellular microfibrils biogenesis, suggesting the potential role of ADAMTS17 in IVD function through interaction with fibrillin fibers. Finally, we provided evidence of FBN1 involvement in IVD function by showing that lumbar IVDs in patients with Marfan syndrome, caused by heterozygous FBN1 gene mutation, were significantly more degenerated. We identified a common SNP variant, located in ADAMTS17, associated with susceptibility to lumbar spondylosis and demonstrated the potential role of the ADAMTS17-fibrillin network in IVDs in lumbar spondylosis development.

Biomarkers and longitudinal changes in lumbar spine degeneration and low back pain: the Johnston County Osteoarthritis Project.

OBJECTIVE: To determine if baseline biomarkers are associated with longitudinal changes in the worsening of disc space narrowing (DSN), vertebral osteophytes (OST), and low back pain (LBP). DESIGN: Paired baseline (2003-2004) and follow-up (2006-2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for severity of DSN and OST. LBP severity was self-reported. Concentrations of analytes (cytokines, proteoglycans, and neuropeptides) were quantified by immunoassay. Pressure-pain threshold (PPT), a marker of sensitivity to pressure pain, was measured with a standard dolorimeter. Binary logistic regression models were used to estimate odd ratios (OR) and 95% confidence intervals (CI) of biomarker levels with DSN, OST, or LBP. Interactions were tested between biomarker levels and the number of affected lumbar spine levels or LBP. RESULTS: We included participants (n = 723) with biospecimens, PPT, and paired lumbar spine radiographic data. Baseline Lumican, a proteoglycan reflective of extracellular matrix changes, was associated with longitudinal changes in DSN worsening (OR = 3.19 [95% CI 1.22, 8.01]). Baseline brain-derived neuropathic factor, a neuropeptide, (OR = 1.80 [95% CI 1.03, 3.16]) was associated with longitudinal changes in OST worsening, which may reflect osteoclast genesis. Baseline hyaluronic acid (OR = 1.31 [95% CI 1.01, 1.71]), indicative of systemic inflammation, and PPT (OR = 1.56 [95% CI 1.02, 2.31]) were associated with longitudinal increases in LBP severity. CONCLUSION: These findings suggest that baseline biomarkers are associated with longitudinal changes occurring in structures of the lumbar spine (DSN vs OST). Markers of inflammation and perceived pressure pain sensitivity were associated with longitudinal worsening of LBP.

The prevalence of locomotive syndrome and its associated factors in patients with Type 2 diabetes mellitus.

OBJECTIVES: We investigated the prevalence of locomotive syndrome (LS) and related musculoskeletal diseases [osteoarthritis (OA), lumbar spondylosis, and spinal alignment] in Type 2 diabetes mellitus (DM) patients. METHODS: Clinical data were collected from 101 patients (55 males; 46 females) admitted to our hospital for diabetes education from October 2018 to April 2021. Patients underwent full-spine and whole-legs standing radiography and physical measurements (10-m walking and grip strength tests and three LS risk tests). RESULTS: The estimated prevalence of LS was 86.1% (Stage 1: 44.5%, Stage 2: 41.6%), lumbar spondylosis was 11.9%, and hip, knee, and ankle OA were 16.9%, 51.5%, and 12.9%, respectively. Multiple logistic regression analysis identified grip strength [odds ratio (OR) = 0.89, confidence interval (CI) = 0.83-0.94], diabetic retinopathy (OR = 5.85, CI = 1.64-20.78), knee OA (OR = 3.34, CI = 1.11-10.02), and a sagittal vertical axis >40 mm (OR = 3.42, CI = 1.13-10.39) as significantly associated risk factors for worsening LS in Type 2 DM patients. CONCLUSIONS: This study clarified the epidemiological indicators of LS and associated factors in DM patients. Exercise therapy and DM management are effective strategies to reduce the occurrence and progression of LS.

Consensus for Statements Regarding a Definition for Spinal Osteoarthritis for Use in Research and Clinical Practice: A Delphi Study.

OBJECTIVE: To determine consensus among an international, multidisciplinary group of experts regarding definitions of spinal osteoarthritis for research and for clinical practice. METHODS: A 15-member, multidisciplinary steering committee generated 117 statements for a 3-round Delphi study. Experts in back pain and/or osteoarthritis were identified and invited to participate. In round 1, participants could propose additional statements for voting. All statements were rated on a 1-9 Likert scale, and consensus was set at ≥70% of respondents agreeing or disagreeing with the statement and <15% of respondents providing the opposite response. RESULTS: In total, 255 experts from 11 different professional backgrounds were invited. From 173 available experts, 116 consented to participate. In round 1, 103 participants completed the survey, followed by 85 of 111 participants in round 2 (77%) and 87 of 101 participants in round 3 (86%). One-third of participants were from Europe (30%), most were male (58%), one-fifth were physical therapists (21%), and over one-third had been in their profession for 11-20 years (35%). Of 131 statements, consensus was achieved for 71 statements (54%): 53 in agreement (75%) and 18 in disagreement (25%). CONCLUSION: Although there was consensus for statements for definitions of spinal osteoarthritis that were analogous to definitions of osteoarthritis in appendicular joints, a future definition still needs refinement. Importantly, this Delphi highlighted that a future definition should be considered across a spectrum of structural changes and patient symptoms and expressed on a progressive scale.

The Effect of Paraspinal Fatty Muscle Infiltration and Cumulative Lumbar Spine Degeneration on the Outcome of Patients With Lumbar Spinal Canal Stenosis: Analysis of the Lumbar Stenosis Outcome Study (LSOS) Data.

STUDY DESIGN: Prospective. OBJECTIVE: To investigate the influence of paraspinal fatty muscle infiltration (FMI) and cumulative lumbar spine degeneration as assessed by magnetic resonance imaging on long-term clinical outcome measures in patients with lumbar spinal canal stenosis (LSCS) of the Lumbar Stenosis Outcome Study (LSOS) cohort. SUMMARY OF BACKGROUND DATA: Past studies have tried to establish correlations of morphologic imaging findings in LSCS with clinical endpoints. However, the impact of FMI and overall lumbar spinal degeneration load has not been examined yet. MATERIALS AND METHODS: Patients from the LSOS cohort with moderate to severe LSCS were included. Two radiologists assessed the degree of LSCS as well as cumulative degeneration of the lumbar spine. FMI was graded using the Goutallier scoring system. Spinal Stenosis Measure (SSM) was used to measure the severity level of symptoms and disability. European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) was used to measure health-related quality of life. RESULTS: The nonsurgically treated group consisted of 116 patients (age 74.8±8.5 yr), whereas the surgically treated group included 300 patients (age 72.3±8.2 yr). Paraspinal FMI was significantly different between the groups (54.3% vs. 32.0% for Goutallier grade ≥2; P <0.001). Total degeneration score was comparable in both groups (9.5±2.0 vs. 9.3±2.0; P =0.418). FMI was associated with lower SSM function and lower EQ-5D-3L (all P <0.05), but not with SSM symptoms. Total degeneration of the lumbar spine was associated neither with SSM symptoms, nor with SSM function, nor with EQ-5D-3L (all P >0.05). CONCLUSIONS: FMI is associated with higher disability and worse health-related quality of life of LSCS patients in the LSOS cohort. There was no significant association between total cumulative lumbar spine degeneration and the outcome of either surgically or nonsurgically treated patients. LEVEL OF EVIDENCE: 3.

Concentration of Selected Macronutrients and Toxic Elements in the Blood in Relation to Pain Severity and Hydrogen Magnetic Resonance Spectroscopy in People with Osteoarthritis of the Spine.

Macronutrients and toxic elements may play an important role in the pathogenesis of osteoarthritis of the spine. The objective of this study was to evaluate the relationship between the concentrations of Ca, Mg, Pb, Cd and Hg in blood with the results of hydrogen magnetic resonance spectroscopy and the severity of pain. Patients with osteoarthritis of the spine (n = 90) and control subjects (n = 40) were studied. The concentrations of mineral components in blood were determined by atomic absorption spectrometry (ASA). Spinal pain severity was assessed using the Visual Analog Scale (VAS). Hydrogen magnetic resonance spectroscopy (1H-MRS) was used to determine the fat/water ratio in the bodies of L1, L5 and the L4/5 intervertebral disc. The median concentration of Mg in the serum of subjects with spinal degenerative disease was significantly lower (p < 0.001) than that in healthy subjects. The median concentration of Cd in the blood of subjects with osteoarthritis of the spine was significantly higher (p < 0.05) than that in the control group. Significantly lower (p < 0.05) median molar ratios of Ca to Cd and Pb as well as Mg to Pb and Cd were observed among patients with osteoarthritis of the spine. Significant differences (p < 0.05) were observed in the value of the fat/water ratio in selected spinal structures, depending on normal or abnormal serum Ca and Mg concentrations. The study showed some abnormal macronutrient concentrations, as well as disturbed ratios of beneficial elements to toxic elements in the blood of people with osteoarthritis of the spine.

MiR-99a alleviates apoptosis and extracellular matrix degradation in experimentally induced spine osteoarthritis by targeting FZD8.

BACKGROUND: Our previous study identified miR-99a as a negative regulator of early chondrogenic differentiation. However, the functional role of miR-99a in the pathogenesis of osteoarthritis (OA) remains unclear. METHODS: We examined the levels of miR-99a and Frizzled 8 (FZD8) expression in tissue specimens. Human SW1353 chondrosarcoma cells were stimulated with IL-6 and TNF-α to construct an in vitro OA environment. A luciferase reporter assay was performed to analyze the relationship between miR-99a and FZD8. CCK-8 assays, flow cytometry, and ELISA assays were used to assess cell viability, apoptosis, and inflammatory molecule expression, respectively. Percutaneous intra-spinal injections of papain mixed solution were performed to create an OA Sprague-Dawley rat model. Alcian Blue staining, Safranin O Fast Green staining, and Toluidine Blue O staining were performed to detect the degrees of cartilage injury. RESULTS: MiR-99a expression was downregulated in the severe spine OA patients when compared with the mild spine OA patients, and was also decreased in the experimentally induced in vitro OA environment when compared with the control environment. Functionally, overexpression of miR-99a significantly suppressed cell apoptosis and extracellular matrix degradation stimulated by IL-6 and TNF-α. FZD8 was identified as a target gene of miR-99a. Furthermore, the suppressive effects of miR-99a on cell injury induced by IL-6 and TNF-α were reversed by FZD8 overexpression. Moreover, the levels of miR-99a expression were also reduced in the induced OA model rats, and miR-99a agomir injection relieved the cartilage damage. At the molecular level, miR-99a overexpression downregulated the levels of MMP13, ß-catenin, Bax, and caspase-3 protein expression and upregulated the levels of COL2A1 and Bcl-2 protein expression in the in vitro OA-like chondrocyte model and also in the experimental OA model rats. CONCLUSIONS: Our data showed that miR-99a alleviated apoptosis and extracellular matrix degradation by targeting FZD8, and thereby suppressed the development and progression of experimentally induced spine osteoarthritis.

Effects of complex spa therapy in patients with osteoarthritis of the spine receiving treatments in health resorts in south-eastern Poland.

Management of patients with degenerative diseases commonly comprises health-resort based treatment programs, including spa therapies, balneotherapy as well as terrain therapy making use of microclimate factors. The study was designed to assess short- and long-term effects of spa therapy administered to patients with osteoarthritis of the spine who received treatment in health resorts located in Poland. The study involved 102 patients receiving treatment in health resorts, a group of subjects receiving outpatient treatment (100 patients) and a group receiving no therapy (100 patients). The assessment survey included: Pain VAS and Laitinen, LISAT-9 and HAQ-20 questionnaires. The assessments were carried out three times: at the start of the therapy program, as well as one month and six months after the end of the program. Short-term effects showed statistically significant improvement in all the outcome measures in spa group and outpatient treatment group. The long-term effects showed statistically significant improvement in all the outcome measures in spa group only. In conclusion spa therapy reduces pain, improves functional efficiency and increases the level of life satisfaction in patients with osteoarthritis of the spine. Its effects are sustained for at least six months. Spa therapy is more effective long-term, than outpatient treatment.Trial registration: The study was registered at Clinical Trials: NCT03974308. First registration: 04/06/2019.

Rapidly destructive osteoarthritis of the spine: lessons learned from the first reported case.

BACKGROUND: Rapidly Destructive Osteoarthritis (RDOA) has been described for the hip and shoulder joints and is characterized by a quickly developing bone edema followed by extensive remodeling and joint destruction. Confronted with a similarly evolving case of endplate edema and destruction of the disk space, we offer the first described case of spinal RDOA and illustrate the challenges it presented, along with the strategies we put in place to overcome them. CASE PRESENTATION: We present a case of spinal RDOA that, also due to the delay in the diagnoses, underwent multiple revisions for implant failure with consequent coronal and sagittal imbalance. A 37-years-old, otherwise healthy female presented with atraumatic low back pain: after initial conservative treatment, subsequent imaging showed rapidly progressive endplate erosion and a scoliotic deformity. After surgical treatment, the patient underwent numerous revisions for pseudoarthrosis, coronal and sagittal imbalance and junctional failure despite initially showing a correct alignement after each surgery. As a mechanic overload from insufficient correction of the alignement of the spine was ruled out, we believe that the multiple complications were caused by an impairment in the bone structure and thus, reviewing old imaging, diagnosed the patient with spinal RDOA. In case of spinal RDOA, particular care should be placed in the choice of extent and type of instrumentation in order to prevent re-intervention. CONCLUSION: Spinal RDOA is characterized by a quickly developing edema of the vertebral endplates followed by a destruction of the disk space within months from the first diagnosis. The disease progresses in the involved segment and to the adjacent disks despite surgical therapy. The surgical planning should take the impaired bone structure account and the use of large interbody cages or 4-rod constructs should be considered to obtain a stable construct.

Cervical spine degeneration specific segmental angular rotational and displacements: A quantitative study.

BACKGROUND: The objective of the present isolated spine study was to evaluate the kinematic differences between groups of normal and degenerated cervical spine specimens. Previous studies on cervical spine degeneration support the existence of the unstable phase during the degeneration process; however, there is a lack of quantitative data available to fully characterize this early stage of degeneration. METHOD: For this effort five degenerated and eight normal cervical spines (C2-T1) were isolated and were subject to pure bending moments of flexion, extension, axial rotation and lateral bending. The specimen quality was assessed based on the grading scale. In the present study, the degeneration was at the C5-C6 level. A four-camera motion analysis system was used to measure the overall primary and segmental motions. FINDING: In the extension mode, the degenerated group demonstrated a significant larger angular rotation as well as antero-posterior displacement at the degenerated level (C5-C6). In contrast, in flexion mode, the degenerated group measured a drastic decrease in angular rotation, at the adjacent level (C6-C7). In other modes of loading as well as in other segmental levels, the degenerated group had similar segmental motion as the normal group. INTERPRETATION: These preliminary results provide single level degeneration specific cervical spine kinematics. The finding demonstrates the influence of degeneration on the kinematics of the normal sub adjacent segment. The degenerated group observed larger translation displacement in the extension mode, which would potentially be a critical parameter in assisting early detection of cervical spine spondylosis with just a functional X-ray scan.

Novel elemental grading system for radiographic lumbar spondylosis in a population based-cohort study of a Japanese mountain village.

PURPOSE: Lumbar radiography is a primary screening tool for lumbar spondylosis (LS). Kellgren-Lawrence (KL) classification is widely used to evaluate LS; however, it cannot individually evaluate each radiographic feature. The purpose of this study was to 1) evaluate radiographic LS using a novel elemental grading system and 2) investigate the relationship between the grades of radiographic LS and low back pain (LBP) in a population-based cohort study. METHODS: A total of 260 (75 men, 185 women; mean age, 71.5 ± 8.7 years) participants were included in this study. Participants were divided into two groups according to the presence of LBP (LBP- and LBP+ groups). Radiographic features, including osteophyte (OP), disc height narrowing (DHN), vertebral sclerosis (VS), and spondylolisthesis (SL), were classified between grades of 0-2 grades according to the extent of radiographic changes. The sum of grades at each intervertebral level was designated as the intervertebral grade (IG). RESULTS: Intra- and inter-observer reliability (kappa coefficient) of OP, DHN, VS, and SL were 0.82-0.92. OP, DHN, VS, and IG grades were significantly higher in the LBP+ group than in the LBP- group. There were no significant differences in KL grades between the LBP- and LBP+ groups. Logistic regression analysis demonstrated that VS grade was a significant independent factor associated with LBP. CONCLUSION: The novel elemental grading system of LS would reflect LBP more accurately than the KL classification by individually evaluating each radiographic feature.

Upregulation of P2Y12 inhibits chondrocyte apoptosis in lumbar osteoarthritis through the PI3K/AKT signaling pathway.

Lumbar facet osteoarthritis (FJOA) is a major cause of severe lower back pain and disability worldwide. However, the mechanism underlying cartilage degeneration in FJOA remains unclear. The purpose of this study was to investigate the regulation and mechanism of P2Y12 on chondrocyte apoptosis in FJOA. The experimental rats were randomly divided into non-operation (n = 20) and operation groups (n = 20). In the operation group, Sodium iodoacetate (MIA, Sigma, 200 mg/mL) was injected into the right L4/5 facet process using a blunt nanoneedle 26 (WPI, Sarasota, FL, USA) under the control of an injection pump. The final injection volume was 5µL and the injection rate was 2µL/min. The facet joint was removed four weeks after surgery. After the operation, samples were stored at -80 °C until further use, whereby the right facet joints in each group were tested. Hematoxylin and eosin (HE) and iron-red solid green staining were used to observe the degeneration of articular chondrocytes in rats. Immunohistochemistry and western blotting were used to observe the expressions of P2Y12, Matrix metalloproteinase 13 (MMP13), Collagen II (COL2), and other cartilage degeneration and apoptosis-related genes. Co-localization of P2Y12-cleaved caspase-3 in the apoptosis model was detected by dual-standard immunofluorescence staining. Apoptosis was also detected by flow cytometry and TUNEL assay.P2Y12 is highly expressed in OA cartilage tissue, and inhibits IL-1ß -induced chondrocyte apoptosis through PI3K/AKT signaling pathway, thus playing a certain protective role on cartilage.

Riesgo de fracturas vertebrales dorsales osteoporóticas en pacientes con gota / Risk of osteoporotic thoracic vertebral fractures in patients with gout

Objetivos: La osteoporosis causa gran morbilidad y mortalidad por el desarrollo de fracturas por fragilidad, entre ellas las vertebrales. Los pacientes con gota podrían mostrar un incremento de riesgo de fracturas osteoporóticas debido a una mayor resorción ósea por un estado inflamatorio producido por los cristales de urato. El objetivo de este estudio fue evaluar el riesgo de fracturas vertebrales dorsales osteoporóticas asociado a padecer gota. Métodos: Estudio transversal realizado con pacientes ingresados por evento cardiovascular. Se seleccionaron pacientes con radiografía torácica lateral reciente al ingreso o en los seis meses previos, que fueron revisadas de forma simultánea por dos observadores desconocedores de los datos clínicos. Se definió fractura vertebral como reducción de la altura vertebral ≥20%, registrando su presencia, número y grado mediante la escala semicuantitativa de Genant. Para analizar la relación entre gota y fractura vertebral, se calculó la odds ratio (OR) con intervalo de confianza al 95% (IC 95%) mediante regresión logística múltiple. Resultados: Seleccionamos 126 pacientes, de los que 21 (16,67%) padecían gota. Se detectaron 18 casos con fracturas, siendo la prevalencia 14,3%. Se encontró una asociación estadísticamente significativa entre gota y fractura vertebral (28,6% gota, 11,4% no gota; OR 3,10, IC 95% 1,01-9,52). No hubo mayor número de fracturas por grupos, y la severidad fue superior en los controles. La asociación entre gota y fractura vertebral persistió tras ajuste multivariante (OR 5,21, IC 95% 1,32-20,61). Conclusión: Se ha identificado una asociación independiente entre gota y fracturas vertebrales dorsales radiográficas en pacientes con evento cardiovascular.(AU)

Objectives: Osteoporosis causes significant morbidity and mortality by the development of fragility fractures, including vertebral fractures. Patients with gout may show an increased risk of osteoporotic fractures, as accelerated bone resorption is likely linked to urate crystal-led inflammatory state. This study aims to evaluate the risk of osteoporotic dorsal vertebral fractures associated with gout. Methods: Cross-sectional study carried out in patients admitted for cardiovascular events. Patients with available lateral view of chest radiography (on admission or in the previous six months) were selected. Two observers blinded to clinical data reviewed the radiographies simultaneously. Vertebral fracture was defined as a vertebral height loss ≥20%, and presence, number, and severity (by Genant semi-quantitative scale) were registered. To analyse the relationship between gout and the presence of vertebral fractures, the odds ratio (OR) with 95% confidence interval (95%CI) was calculated by multiple logistic regression. Results: 126 patients were analysed, 21 of them (16.67%) suffered from gout. Eighteen cases with fractures were detected, with a prevalence of 14.3%. A significant association was found between gout and vertebral fracture (28.6% gout, 11.4% controls; OR 3.10, 95%CI 1.01-9.52). There were no differences in the number of fractures, while the severity was found to be higher in the controls. The association between gout and vertebral fracture persisted after multivariate adjustment (OR 5.21, 95% CI 1.32-20.61). Conclusion: An independent association between gout and radiological thoracic vertebral fractures was revealed in patients with a cardiovascular event.(AU)