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Zhou JG. Diagnosis and surgical challenges of extremely severe head and lumbar disc herniation in young patients: A case report. World J Clin Cases 2025; 13:103373. [DOI: 10.12998/wjcc.v13.i16.103373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 12/30/2024] [Accepted: 01/17/2025] [Indexed: 02/10/2025] Open
Abstract
BACKGROUND Lumbar disc extrusion, a common spinal disorder, is particularly uncommon in its severely displaced form, especially in young patients. This condition can pose diagnostic challenges due to its nonspecific presentation.
CASE SUMMARY A 36-year-old male patient presented with persistent low back pain and radiating leg pain lasting half a month, which had worsened over the previous four days. Lumbar magnetic resonance imaging scans showed an abnormal signal within the vertebral canal at the L3 level, suggesting either a disc cyst or an epidural hematoma. Based on these findings, the patient was provisionally diagnosed with either condition. Surgical exploration was conducted, revealing an extruded lumbar disc, which was subsequently excised. Following surgery, the patient's symptoms completely resolved.
CONCLUSION High-grade lumbar disc extrusion in young patients is rare but should be considered in sedentary, physically inactive individuals presenting with lumbocrural pain and abnormal magnetic resonance imaging findings. Early and accurate diagnosis is crucial to avoid misdiagnosis, and prompt open surgery may be necessary in severe cases to alleviate symptoms. The case highlights the impotance of a thorough diagnostic workup and timely surgical intervention in managing such rare but potentially severe spinal disorders.
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Affiliation(s)
- Jun-Ge Zhou
- Department of Neurosurgery, General Hospital of The Yangtze River Shipping, Wuhan Brain Hospital, Wuhan 430010, Hubei Province, China
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Ollila L, Oura P, Karppinen J, Niinimäki J, Junno JA. Association between vertebral cross-sectional area and lumbar disc displacement - a population-based study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:900-905. [PMID: 37452838 DOI: 10.1007/s00586-023-07853-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 05/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Vertebral dimensions may constitute a potential risk factor for degenerative changes in the spine. Previous studies have found a positive association between vertebral height and both type 2 Modic changes and intervertebral disc height loss. Also, vertebral endplate size has been associated with disc degeneration. However, only a few studies have investigated the association between vertebral dimensions and lumbar disc displacement (LDD). This study aimed to investigate the association between vertebral cross-sectional area (CSA) and LDD among the general middle-aged Finnish population. We hypothesized that larger vertebral CSA is associated with LDD. MATERIALS AND METHODS The study was conducted by using data from the Northern Finland Birth Cohort 1966 (NFBC1966). At the age of 46, a subpopulation of NFBC1966 underwent clinical examinations including magnetic resonance imaging (MRI) (n = 1249). MRI scans were used to measure L4 CSA and evaluate the presence of LDD (bulge, protrusion, and extrusion/sequestration) in the adjacent discs. The association between L4 CSA and LDD was analysed using logistic regression, with adjustment for sex, education, body mass index, leisure-time physical activity, smoking, diet, and L4 height. RESULTS Larger L4 CSA was associated with LDD; an increase of 1 cm2 in vertebral CSA elevated the odds of LDD relative to no LDD by 10% (adjusted odds ratio 1.10, 95% CI 1.01-1.19). The association was similar among either sex. CONCLUSIONS Larger L4 vertebral CSA was associated with LDD in our study sample. Even though smaller vertebral size exposes our vertebrae to osteoporotic fractures, it simultaneously seems to protect us from LDD.
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Affiliation(s)
- Laura Ollila
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.
| | - Petteri Oura
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Rehabilitation Services of South Karelia Social and Health Care District, Valto Käkelän Katu 3, 53130, Lappeenranta, Finland
- Finnish Institute of Occupational Health, Aapistie 1, 90220, Oulu, Finland
| | - Jaakko Niinimäki
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Juho-Antti Junno
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Department of Archaeology, Faculty of Humanities, University of Oulu, Oulu, Finland
- Faculty of Medicine, Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland
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Zhou H, Zhou Q, Wang B, Qiu Y, Zhu Z, Liu Z, Sun X. L4/5 Disc Herniation: Not Unusually Accompanied with L5/S1 Low-Grade Spondylolytic Spondylolisthesis. Orthop Surg 2024; 16:444-451. [PMID: 38214088 PMCID: PMC10834192 DOI: 10.1111/os.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/09/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE Isthmic spondylolisthesis (IS) is distinguished by a congenital defect or acquired fracture of the pars interarticularis. Numerous studies on L5 low-grade IS have been carried out; however, there is a paucity of data regarding the condition of L5 IS concomitant with L4/5 disc herniation. This study aimed to identify the incidence rate and to illustrate the possible risk factors for L4/5 disc herniation in L5 low-grade IS patients. METHODS A total of 268 consecutive patients diagnosed as L5/S1 low-grade IS between May 2017 and May 2022 were retrospectively enrolled in this study. Depending on the presence of L4/5 disc herniation or not, patients were divided into an L4/5 disc herniation group (L4/5 DH) and an L4/5 non-disc herniation group (L4/5 non-DH). Radiographic parameters were measured, and the ratios of L4-S1 segmental lordosis (SL) to lumbar lordosis (LDI), L4 inferior endplate (IEP) to L5 superior endplate (SEP) (L4 IEP/L5 SEP), and L5 IEP to S1 SEP (L5 IEP/S1 SEP) were compared between groups. The Pfirrmann grade of the L4/5 disc and the L5/S1 disc, and Roussouly classifications of each patient were also recorded. Univariate analysis (including independent-samples t-test and χ2 -test) and multiple logistic regression analysis were performed to analyze the data. RESULTS There were 40 patients (14.9%) in the L4/5 DH group. The Roussouly classification differed significantly between groups. As demonstrated by the Pfirrmann grade, the L4/5 DH group showed more advanced disc degeneration at L4/5 than the L4/5 non-DH group. In contrast to the L4/5 non-DH group, the L4/5 DH group had a significantly larger L4 IEP, L4 IEP/L5 SEP, S1 SEP, and LDI while smaller L4/5 disc angle, L4/5 disc height, slip percentage, lumbar lordosis, and sacral slope. Multivariate logistic regression analysis revealed that higher L4/5 disc Pfirrmann grade (p = 0.004), decreased L4/5 disc height (p < 0.001), and lower L5 slip percentage (p = 0.022) were significantly associated with the occurrence of L4/5 DH. CONCLUSIONS L4/5 disc herniation is not unusually accompanied by L5/S1 low-grade IS. Advanced L4/5 disc degeneration, decreased L4/5 disc height, and lower L5 slip percentage might be significantly associated with L4/5 disc herniation.
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Affiliation(s)
- Haicheng Zhou
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Qingshuang Zhou
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital Clinical College of Jiangsu UniversityNanjingChina
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
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Hoffeld K, Lenz M, Egenolf P, Weber M, Heck V, Eysel P, Scheyerer MJ. Patient-related risk factors and lifestyle factors for lumbar degenerative disc disease: a systematic review. Neurochirurgie 2023; 69:101482. [PMID: 37586480 DOI: 10.1016/j.neuchi.2023.101482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Back pain is a very widespread disease pattern and is one of the most frequent causes for consultation of a physician in general. In most cases, discogenic changes are the pathomorphological correlate of back pain. Numerous risk factors have been identified for these degenerative changes, but the influence and significance of the risk factors remain unclear, which was the aim of this systematic review. METHODS A systematic literature search of the commonly used Pubmed database was performed using specific MESH terms. Further selection of the included studies was performed according to the PRISMA scheme, taking into account scientific merit as well as the relation to the research question. RESULTS A total of 111 studies out of 1035 found were finally included in the literature search. 134 risk factors for disc degeneration and disc herniation were identified. These were divided into (1) patient-specific risk factors (n░=░34), (2) radiological risk factors (n░=░31), (3) lifestyle risk factors (n░=░6), (4) workplace-related risk factors (n░=░12), (5) genetic risk factors (n░=░50), and (6) other risk factors (n░=░1). Non-adjustable risk factors were age >50 years (OR 1.7/year), female gender (OR 1.41), family disposition (OR 4.0), comorbidities like atherosclerosis (OR 2.24), arthritic changes in other joints (OR 3.1) and history of injuries of the back (OR 3.1). Adjustable factors were elevated BMI (OR 2.77), comorbidities like hypertension (OR 1.25), dyslipidemia (OR 1.26) and diabetes mellitus (OR 6.8), as well as lifestyle habits like smoking (OR 3.8). DISCUSSION In summary, intervertebral disc degenerations and herniations represent multifactorial events whose risk factors can be partly influenced and partly not influenced. This systematic review highlights the current state of knowledge as a basis for creating patient-specific algorithms to calculate risk for the development or progression of degenerative disc changes and disc herniations.
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Affiliation(s)
- Kai Hoffeld
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany.
| | - Maximilian Lenz
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Philipp Egenolf
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Maximilian Weber
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Vincent Heck
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Peer Eysel
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Max J Scheyerer
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany; University of Düsseldorf, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Moorenstraße 5, 40225 Düsseldorf, Germany
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The influence of spinal position on imaging findings: an observational study of thoracolumbar spine upright MRI in elite gymnasts. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:225-232. [PMID: 34613494 DOI: 10.1007/s00586-021-06997-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/18/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate whether upright magnetic resonance imaging (MRI) has a role in defining thoracolumbar spine pathology in elite gymnastics. METHODS A prospective cross-sectional observational study of National Senior and Junior Artistic gymnasts in three MRI positions (standard supine, upright flexed and extended positions). Two specialist musculoskeletal radiologists independently analysed images with neutral as a baseline with the effects of flexion and extension reported in line with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. RESULTS Forty (18 males) gymnasts aged 13-24 years with a mean (SD) of 32 (5.3) training hours per week consented with 75% showing MRI abnormalities. Degenerative disc disease (DDD) was evident in 55% participants with vertebral end plate (VEP) changes in 42.5%. Spondylolysis was present in 40% with an additional 17% showing chronic bilateral complete L5 pars defects. 23% participants demonstrated different MRI findings in upright flexion compared to neutral. CONCLUSION Findings suggest a high levels of MRI abnormalities in elite gymnastics including altered disc morphology and posterior element abnormalities. High prevalence of T11/12 DDD and VEP changes reflects the thoracolumbar junction being a transition zone. Upright MRI and varying spine position offer promise for enhanced visualisation of posterior element abnormalities.
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Li R, Wang Z, Ma L, Yang D, Xie D, Zhang B, Ding W. Lumbar Vertebral Endplate Defects on Magnetic Resonance Imaging in Degenerative Spondylolisthesis: Novel Classification, Characteristics, and Correlative Factor Analysis. World Neurosurg 2020; 141:e423-e430. [PMID: 32461177 DOI: 10.1016/j.wneu.2020.05.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Endplate defects are commonly seen in patients with lumbar degenerative disease. However, little is known about the presence of endplate defects in patients with degenerative spondylolisthesis (DS). In the present study, we have introduced a classification system for endplate defects in patients with DS using routine magnetic resonance imaging findings and explored the correlative factors. METHODS Endplate defects were classified into 3 major categories (rim defects, focal defects, and erosive defects) and 5 subtypes (anterior type, posterior type, arc type at the anterior rim, notch type, and Schmorl's nodes). The incidence rates of the endplate defects were compared between the slippage and nonslippage levels. The correlations between the endplate defects and age, sex, disc degeneration, Modic changes (MCs), body mass index, slippage segment, and slippage degree were analyzed. RESULTS Endplate defects were present in 47.43% of the endplates in DS. The most common endplate defects were rim defects. The occurrence of endplate defects, especially anterior defects, was more common at the slippage levels. Endplate defects were associated with age and closely related to MCs and the severity of disc degeneration. The slippage degree, slippage segment, body mass index, and sex differences were not associated with endplate defects in our study. The results obtained using this novel classification system were stable and consistent. CONCLUSIONS The results from the present study have shown that the novel radiological classification system of endplate defects is reliable. Endplate defects were associated with slippage but not with the slippage degree or slippage segment differences in DS. The correlation between endplate defects and age and between MCs and disc degeneration were important features on the magnetic resonance imaging scans of patients with DS.
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Affiliation(s)
- Ruoyu Li
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiwei Wang
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Ma
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dalong Yang
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dongxiao Xie
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Botong Zhang
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenyuan Ding
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Gokcen HB, Gumussuyu G. A Quality Analysis of Disc Herniation Videos on YouTube. World Neurosurg 2019; 124:e799-e804. [PMID: 30721774 DOI: 10.1016/j.wneu.2019.01.146] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND An increasing number of patients are investigating health information by using the Internet because of its exponential growth. Therefore, it is important to test the accuracy of the information presented to determine which information should not be shared. This study investigated the information available on YouTube with regard to disc herniation. METHODS The first 50 videos found after the keyword "disc herniation" was used in the YouTube search engine were included in the study. Video popularity was evaluated with an index called the video power index (VPI). The quality and accuracy of the information were evaluated by 2 independent spinal surgeons using the Journal of American Medical Association (JAMA) score and the DISCERN scoring system. Interobserver agreement and individual correlations of the data of each video were statistically analyzed. RESULTS Of the 50 videos evaluated, 16 (32%) contained animation and 34 (64%) contained real images. The mean duration was 6.587 minutes, and the mean view was 423.472. The mean DISCERN score was 30.7 (±10.3), and the mean JAMA score was 1.8 (±0.5). There was good agreement between the 2 researchers in terms of DISCERN and JAMA scores. No statistically significant correlation was found between the JAMA and DISCERN scores of both researchers and VPI values, video lengths, animation, or real images. CONCLUSIONS The quality of the disc herniation information offered on YouTube is low. The evaluation of medical information obtained from the Internet by health professionals is an important step in guiding the correct flow of medical information to patients.
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Affiliation(s)
- H Bahadir Gokcen
- Orthopedics and Traumatology Department, Istinye University Medical School, Istanbul, Turkey.
| | - Gurkan Gumussuyu
- Orthopedics and Traumatology Department, Istinye University Medical School, Istanbul, Turkey
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Wang Y, Wang H, Lv F, Ma X, Xia X, Jiang J. Asymmetry between the superior and inferior endplates is a risk factor for lumbar disc degeneration. J Orthop Res 2018; 36:2469-2475. [PMID: 29611881 DOI: 10.1002/jor.23906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/23/2018] [Indexed: 02/04/2023]
Abstract
Endplate pathology plays an important role in the development of lumbar disc degeneration. Previous research paid little attention to differences between the superior and inferior endplates as a possible risk factor for disc degeneration. The purpose of this study was to test the hypothesis that asymmetry between the superior and inferior endplates is a risk factor for the development of lumbar disc degeneration. A total of 134 patients with lumbar disc herniation (LDH) and 100 healthy adults ("Controls") underwent magnetic resonance imaging scans. Each disc was categorized as non-degenerated (Pfirrmann grades I-II) or degenerated (Pfirrmann grades III-V) and get the following three groups: "Degenerated LDH" discs (n = 145), "Non-degenerated LDH" discs (n = 525) and "Non-degenerated Control" discs (n = 500). On mid-sagittal image, the lumbar endplate morphology could be categorized into three types: Flat, concave, and irregular. Superior and inferior endplates of a given disc were "symmetric" if both were of the same type, and "asymmetric" if they were of different types. The proportion of asymmetric endplates at L4-5 was higher in the "Degenerated LDH" discs group (47%) than in the "Non-degenerated LDH" discs group (21%) or "Non-degenerated Control" discs group (7%) (p < 0.05). At L5-S1 the proportions were 73%, 55%, and 38% (p < 0.05). Asymmetry of superior and inferior endplates in the mid-sagittal plane is a risk factor for lumbar disc degeneration. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2469-2475, 2018.
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Affiliation(s)
- Yitao Wang
- Department of Orthopedics, Fudan University, Huashan Hospital, 12 Wulumuqi Road(M), Shanghai, China
| | - Hongli Wang
- Department of Orthopedics, Fudan University, Huashan Hospital, 12 Wulumuqi Road(M), Shanghai, China
| | - Feizhou Lv
- Department of Orthopedics, Fudan University, Huashan Hospital, 12 Wulumuqi Road(M), Shanghai, China.,Fudan University, The Fifth People' s Hospital of Shanghai, Shanghai, China
| | - Xiaosheng Ma
- Department of Orthopedics, Fudan University, Huashan Hospital, 12 Wulumuqi Road(M), Shanghai, China
| | - Xinlei Xia
- Department of Orthopedics, Fudan University, Huashan Hospital, 12 Wulumuqi Road(M), Shanghai, China
| | - Jianyuan Jiang
- Department of Orthopedics, Fudan University, Huashan Hospital, 12 Wulumuqi Road(M), Shanghai, China
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Duran S, Cavusoglu M, Hatipoglu HG, Sozmen Cılız D, Sakman B. Association between Measures of Vertebral Endplate Morphology and Lumbar Intervertebral Disc Degeneration. Can Assoc Radiol J 2017; 68:210-216. [DOI: 10.1016/j.carj.2016.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/28/2016] [Accepted: 11/16/2016] [Indexed: 12/01/2022] Open
Abstract
Purpose The aim of this study was to evaluate the association between vertebral endplate morphology and the degree of lumbar intervertebral disc degeneration via magnetic resonance imaging (MRI). Methods In total, 150 patients who met the inclusion criteria and were 20–60 years of age were retrospectively evaluated. Patients were evaluated for the presence of intervertebral disc degeneration or herniation, and the degree of degeneration was assessed at all lumbar levels. Vertebral endplate morphology was evaluated based on the endplate sagittal diameter, endplate sagittal concave angle (ECA), and endplate sagittal concave depth (ECD) on sagittal MRI. The association between intervertebral disc degeneration or herniation and endplate morphological measurements was analysed. Results In MRI, superior endplates ( ie, inferior endplates of the superior vertebra) were concave and inferior endplates ( ie, superior endplates of the inferior vertebra) were flat at all disc levels. A decrease in ECD and an increase in ECA were detected at all lumbar levels as disc degeneration increased ( P < .05). At the L4-L5 and L5-S1 levels, a decrease in ECD and an increase in ECA were detected in the group with herniated lumbar discs ( P < .05). There was no association between lumbar disc degeneration or herniation and endplate sagittal diameter at lumbar intervertebral levels ( P > .05). At all levels, ECD of women was significantly lesser than that of men and ECA of women was significantly greater than that of men ( P < .05). Conclusions There is an association between vertebral endplate morphology and lumbar intervertebral disc degeneration. Vertebral endplates at the degenerated disc level become flat; the severity of this flattening is correlated with the degree of disc degeneration.
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Affiliation(s)
- Semra Duran
- Ankara Numune Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Mehtap Cavusoglu
- Ankara Numune Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Hatice Gul Hatipoglu
- Ankara Numune Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Deniz Sozmen Cılız
- Ankara Numune Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Bulent Sakman
- Ankara Numune Training and Research Hospital, Department of Radiology, Ankara, Turkey
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Javadrashid R, Golamian M, Shahrzad M, Hajalioghli P, Shahmorady Z, Fouladi DF, Sadrarhami S, Akhoundzadeh L. Visibility of Different Intraorbital Foreign Bodies Using Plain Radiography, Computed Tomography, Magnetic Resonance Imaging, and Cone-Beam Computed Tomography: An in Vitro Study. Can Assoc Radiol J 2017; 68:194-201. [DOI: 10.1016/j.carj.2015.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose The study sought to compare the usefulness of 4 imaging modalities in visualizing various intraorbital foreign bodies (IOFBs) in different sizes. Methods Six different materials including metal, wood, plastic, stone, glass. and graphite were cut in cylindrical shapes in 4 sizes (dimensions: 0.5, 1, 2, and 3 mm) and placed intraorbitally in the extraocular space of fresh sheep's head. Four skilled radiologists rated the visibility of the objects individually using plain radiography, spiral computed tomography (CT), magnetic resonance imaging (MRI), and cone-beam computed tomography (CBCT) in accordance with a previously described grading system. Results Excluding wood, all embedded foreign bodies were best visualized in CT and CBCT images with almost equal accuracies. Wood could only be detected using MRI, and then only when fragments were more than 2 mm in size. There were 3 false-positive MRI reports, suggesting air bubbles as wood IOFBs. Conclusions Because of lower cost and using less radiation in comparison with conventional CT, CBCT can be used as the initial imaging technique in cases with suspected IOFBs. Optimal imaging technique for wood IOFBs is yet to be defined.
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Affiliation(s)
- Reza Javadrashid
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Golamian
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Parisa Hajalioghli
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Shahmorady
- Department of Oral Radiology, Faculty of Dentistry, Birjand University of Medical Sciences, Birjand, Iran
| | - Daniel F. Fouladi
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shohreh Sadrarhami
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Akhoundzadeh
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Daghighi MH, Poureisa M, Arablou F, Fouladi DF. Supine spinal magnetic resonance imaging with straightened lower extremities in spondylolisthesis: a comparison with the conventional technique. Eur J Radiol 2015; 84:921-6. [PMID: 25715663 DOI: 10.1016/j.ejrad.2015.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/31/2014] [Accepted: 01/27/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the degree of slip in spondylolisthesis on supine magnetic resonance (MR) images obtained with flexed and straightened lower extremities. METHODS Supine spinal MR studies were performed in 100 cases of symptomatic spondylolisthesis with flexed and then straightened lower extremities. The angle of lumbar lordosis (by Cobb's method) and the degree of slip (by Taillard's method) were compared between the two sets of images. RESULTS The mean angle of lumbar lordosis increased from 51.65±8.57° on MR images with flexed lower limbs to 57.39±9.05° on MR images with straightened lower limbs (p<0.001; mean percent increase: 11.51%). Similar change was also observed for the mean degree of slip (from 25.80±7.74% to 28.68±7.93%, p<0.001; mean percent increase: 12.60%). After MR imaging with straightened lower extremities 22 out of 54 initially grade I cases had grade II disease (p<0.001). CONCLUSIONS Supine magnetic resonance imaging with straightened lower extremities detects higher degree of slippage in symptomatic patients with spondylolisthesis compared to conventional MRI with flexed lower extremities.
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Affiliation(s)
- Mohammad Hossein Daghighi
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Poureisa
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farid Arablou
- Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Daniel F Fouladi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Javadrashid R, Fouladi DF, Golamian M, Hajalioghli P, Daghighi MH, Shahmorady Z, Niknejad MT. Visibility of different foreign bodies in the maxillofacial region using plain radiography, CT, MRI and ultrasonography: an in vitro study. Dentomaxillofac Radiol 2014; 44:20140229. [PMID: 25426703 DOI: 10.1259/dmfr.20140229] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To compare the usefulness of four imaging modalities in visualizing various foreign bodies of different sizes. METHODS Foreign bodies of four sizes (0.5, 1, 2 and 3 mm) including metal, tooth, wood, plastic, stone, glass and graphite were embedded in six fresh sheep heads on bone surface between the corpus mandible and muscle, and inside the tongue muscle. A human dry skull served as an air-filled space. Plain radiography, CT, MRI and ultrasonography were used, and four skilled radiologists rated the findings individually. RESULTS All embedded foreign bodies except wood were best visualized using CT. Wood could only be detected using ultrasonography, and then only when fragments were >0.5 mm in size. Plain radiography and CT were almost equally accurate in visualizing metal and graphite. MRI was the least useful imaging technique. CONCLUSIONS In cases with suspected foreign bodies in the maxillofacial region, CT seems to be the optimal initial imaging study. Wood, however, could only be detected using ultrasonography.
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Affiliation(s)
- R Javadrashid
- 1 Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
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Daghighi MH, Pouriesa M, Maleki M, Fouladi DF, Pezeshki MZ, Mazaheri Khameneh R, Bazzazi AM. Migration patterns of herniated disc fragments: a study on 1,020 patients with extruded lumbar disc herniation. Spine J 2014; 14:1970-7. [PMID: 24361346 DOI: 10.1016/j.spinee.2013.11.056] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 11/20/2013] [Accepted: 11/26/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Herniated disc fragments are known to migrate in various directions within the spinal canal. To date, no comprehensive studies have been undertaken to examine the migration patterns of herniated disc material using a standard nomenclature and classification system. PURPOSE To report migration patterns of extruded lumbar disc fragments. STUDY DESIGN A review of magnetic resonance (MR) images. PATIENT SAMPLE A total of 1,020 consecutive Azeri patients with symptomatic extruded lumbar intervertebral disc herniation. OUTCOME MEASURES Migration patterns of extruded lumbar disc fragments in vertical and horizontal planes and their association with age, gender, body mass index (BMI), and the level of herniation. METHODS High-quality axial and sagittal MR images of the lumbar spine were used. Disc material that was displaced away from the site of extrusion, regardless of continuity, was considered "migrated." The migration patterns observed were rostral or caudal in the vertical plane and central, paracentral, subarticular, foraminal, or extraforaminal in the horizontal plane. RESULTS In the vertical plane, rostral and caudal migrations were observed in 27.8% and 72.2% of the patients, respectively. The number of rostral migrations increased significantly with increasing age and in higher levels in the lumbar spine (p<.001 for both). Radiculopathy was significantly more frequent in caudal migrations than in rostral migrations (78.9% vs. 65.1%, p<.001). There was no significant association between gender or BMI and migration patterns in the vertical plane. In the horizontal plane, central, paracentral, subarticular, foraminal, and extraforaminal migrations were reported in 17.3%, 74.2%, 4.3%, 2.5%, and 1.8% of the patients, respectively. The youngest (median age 39 years, interquartile range [IQR] 13 years) and the oldest (median age 55 years, IQR 15 years) groups of patients (p<.001) had the most formainal and extraforaminal migrations, respectively. Radiculopathy was present in 66.5%, 76.8%, 88.6%, 96%, and 27.8% of the patients with central, paracentral, subarticular, foraminal, and extraforaminal migrations, respectively (p<.001). No significant association was found between gender, BMI, or the level of herniation and migration pattern in the horizontal plane. CONCLUSIONS Caudal and paracentral migrations are the most common patterns of migration in patients with extruded lumbar disc herniation in the vertical and horizontal planes, respectively. Age and the level of herniation may affect the migration patterns of herniated lumbar disc material.
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Affiliation(s)
| | - Masoud Pouriesa
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz 51656-65811, Iran
| | - Mirjalil Maleki
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz 51656-65811, Iran
| | - Daniel Fadaei Fouladi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Pashmineh Building, Daneshgah St, Tabriz 51656-65811, Iran.
| | | | - Ramin Mazaheri Khameneh
- Department of Radiology, Urmia University of Medical Sciences, Resalat Boulevard, Jahad Street, Urmia 57147-83734, Iran
| | - Amir Mohammad Bazzazi
- Department of Neurosurgery, Urmia University of Medical Sciences, Resalat Boulevard, Jahad Street, Urmia 57147-83734, Iran
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End plate disproportion and degenerative disc disease: a case-control study. Asian Spine J 2014; 8:405-11. [PMID: 25187856 PMCID: PMC4149982 DOI: 10.4184/asj.2014.8.4.405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 10/13/2013] [Accepted: 10/21/2013] [Indexed: 11/08/2022] Open
Abstract
Study Design Case-control. Purpose To determine whether a disproportion between two neighboring vertebral end plates is associated with degenerative disc disease. Overview of Literature Recently, it has been suggested that disproportion of the end plates of two adjacent vertebrae may increase the risk of disc herniation. Methods Magnetic resonance (MR) images (n=160) with evidence of grades I-II lumbar degenerative disc disease (modified Pfirrmann's classification) and normal MR images of the lumbar region (n=160) were reviewed. On midsagittal sections, the difference of anteroposterior diameter of upper and lower end plates neighboring a degenerated (in the case group) or normal (in the control group) intervertebral disc was calculated (difference of end plates [DEP]). Results Mean DEP was significantly higher in the case group at the L5-S1 level (2.73±0.23 mm vs. 2.21±0.12 mm, p=0.03). Differences were not statistically significant at L1-L2 (1.31±0.13 mm in the cases vs. 1.28±0.08 mm in the controls, p=0.78), L2-L3 (1.45±0.12 mm in the cases vs. 1.37±0.08 mm in the controls, p=0.58), L3-L4 (1.52±0.13 mm in the cases vs. 1.49±0.10 mm in the controls, p=0.88), and L4-L5 (2.15±0.21 mm in the cases vs. 2.04±0.20 mm in the controls, p=0.31) levels. The difference at the L5-S1 level did not remain significant after adjusting for body mass index (BMI), which was significantly higher in the patients. Conclusions End plate disproportion may be a significant, BMI-dependent risk factor for lumbar degenerative disc disease.
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Poureisa M, Daghighi MH, Yousefi J, Hagigi A. Correlation of Axial Vertebral Rotation with Nerve Root Involvement: The First Clinical Study in Literature. JOURNAL OF MEDICAL SCIENCES 2014. [DOI: 10.3923/jms.2014.235.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Poureisa M, Soltani S, Fouladi DF, Hagigi A. Etiologies of Recurrent Low Back Pain after Laminectomy with Emphasis on Segmental Instability. JOURNAL OF MEDICAL SCIENCES 2014. [DOI: 10.3923/jms.2014.241.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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M. Forest J, Rafikhah N. Oral Aqueous Green Tea Extract and Acne Vulgaris: A Placebo-Controlled Study. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/ajcn.2014.41.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Johnson M, Rafikhah N. Berberis vulgaris Juice and Acne Vulgaris: A Placebo-Controlled Study. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/ajcn.2014.47.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Poureisa M, Daghighi MH, Navali AM, Shafaeian M. “Floating Meniscus” a Specific Indicator of Anterior Cruciate Ligament Rupture. JOURNAL OF MEDICAL SCIENCES 2013. [DOI: 10.3923/jms.2014.36.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Woo EJ. End-plate measurements as early markers of disc degeneration and herniation. Spine J 2013; 13:1418. [PMID: 24237712 DOI: 10.1016/j.spinee.2013.06.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 06/29/2013] [Indexed: 02/03/2023]
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Ma D, Liang Y, Wang D, Liu Z, Zhang W, Ma T, Zhang L, Lu X, Cai Z. Trend of the incidence of lumbar disc herniation: decreasing with aging in the elderly. Clin Interv Aging 2013; 8:1047-50. [PMID: 23966775 PMCID: PMC3743527 DOI: 10.2147/cia.s49698] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Compelling evidence has shown that the incidence of lumbar disc herniation (LDH) increases with age. In this study, retrospective clinical analysis of 601 cases of LDH has been conducted to investigate the role of age in the incidence of LDH in the elderly. The aim of the study is to investigate the relationship between the process of aging and the occurrence of LDH in old adults. METHODS Clinical cases (n = 601) of LDH were retrospectively analyzed. RESULTS The imaging examination with computed tomography and/or magnetic resonance imaging showed the occurrence of degeneration in LDH patients over 65 years of age. The most common site of LDH is toward the bottom of the spine at L4-L5 and/or L5-S1. The incidence of LDH drops with age in the elderly, especially after the age of 80 years. There is an obvious decrease in LDH in the elderly female. CONCLUSION A decreasing incidence of LDH with aging occurs in the elderly. This investigation indicates that aging is not a contributor to the performance of LDH in the elderly although the incidence of LDH is proportional to age.
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Affiliation(s)
- Daoyou Ma
- Department of Rehabilitation, the Lu'an Affiliated Hospital of Anhui Medical University, Lu'an People's Hospital, Lu'an, Anhui Province, People's Republic of China
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