Purpose
Lumbar Modic change (MC) can serve as a diagnostic marker as well as an independent source of chronic low back pain (CLBP). This study aimed to test for the existence of serum biomarkers in ...CLBP patients with MC.
Methods
Age- and sex-matched CLBP patients with confirmed MC on lumbar MRI (n = 40) and pain-free controls (n = 40) were assessed. MC was classified into M1, predominating M1, predominating M2 and M2. MC volumes were calculated. Fasting blood samples were assessed for inflammatory mediators, signalling molecules, growth factors and bone turnover markers. Serum concentrations of 46 biomarkers were measured.
Results
Median concentrations of interleukin (IL)-15 (
p
< 0.001), IL-8 (
p
< 0.001), tumour necrosis factor (TNF)-alpha (
p
< 0.001), Eotaxin-1 (
p
< 0.05), Eotaxin-3 (
p
< 0.001), monocyte chemotactic protein (MCP)-1 (
p
< 0.05), macrophage inflammatory protein (MIP)-1alpha (
p
< 0.01), TEK receptor tyrosine kinase (Tie)-2 (
p
< 0.001), vascular cell adhesion molecule (VCAM)-1 (
p
< 0.001), RANTES (
p
< 0.001), C telopeptide of type I collagen (CTX)-1 (
p
< 0.001), vascular endothelial growth factor (VEGF)-C (
p
< 0.001), VEGF-D (
p
< 0.05), fms-related tyrosine kinase (Flt)-1 (
p
< 0.01) and intercellular adhesion molecule (ICAM)-1 (p < 0.01) were significantly higher among controls. IL-1sRII (23.2 vs. 15.5 ng/ml, p < 0.001) and hepatocyte growth factor (HGF)-1 (169 vs. 105 pg/ml,
p
< 0.01) concentrations were significantly higher among patients. Type or volume of MC was not associated with biomarker concentrations.
Conclusions
This is the first study to assess the blood serum biomarker profile in individuals with CLBP with MC. Several biomarkers were suppressed, while two markers (IL-1sRII and HGF) were elevated among MC patients, irrespective of MC type or size, with CLBP compared with asymptomatic controls.
Abstract Background context Modic changes (MC) are associated with low back pain. They represent vertebral endplate and adjacent vertebral marrow changes on magnetic resonance imaging (MRI), ...classified into three types. Because of small sample sizes, patient cohorts, and limited phenotype assessment, the morphology and involvement of MC and their association with other spinal phenotypes remain speculative. Purpose We addressed and proposed a phenotypic profiling of MC and their relationship with lumbar MRI phenotypes in a large-scale population-based study. Study design/setting A cross-sectional study of the Hong Kong Disc Degeneration Cohort. Patient sample The study population consisted of 1,546 Southern Chinese volunteers. Outcome measures Topographical and morphological dimensions of MC, presence of disc degeneration (DD) and displacement, and Schmorl nodes were evaluated. Methods Axial T1-weighted and sagittal T2-weighted MRIs (3T) were assessed. Results Females were 62.4% (mean age, 49 years). The overall prevalence of MC was 21.9% (6.3% Type I and 15.5% Type II). Of all MC, 76% were located at the two lowest lumbar levels. Modic changes at the two lowest lumbar levels were more commonly located laterally (p<.001), less commonly anteriorly (p<.001), and were more extensive horizontally (p=.006) but not in vertical height compared with the upper levels. Type I MC were less common in the anterior part (p=.022), larger in size (height p=.004), and affected more likely the whole horizontal plane (p=.016) than Type II MC. Modic changes were associated with disc displacement, Schmorl nodes, and DD at the affected level (all p<.001), and the strength of association increased with the size of the lesion. Type I MC were associated more strongly with disc displacement (p=.008) and DD (p=.022) than Type II MC. Conclusions Our large-scale MRI study is the first to definitely note that MC were size- and type-dependently significantly associated with disc pathology and endplate abnormalities. Our phenotype profiling of MC may have clinical utility.
To evaluate whether midsagittal (abdominal) obesity in magnetic resonance imaging (MRI), waist circumference (WC) and body fat percentage are associated with lumbar disc degeneration in early ...adulthood.
We obtained the lumbar MRI (1.5-T scanner) of 325 females and 233 males at a mean age of 21 years. Lumbar disc degeneration was evaluated using Pfirrmann classification. We analysed the associations of MRI measures of obesity (abdominal diameter (AD), sagittal diameter (SAD), ventral subcutaneous thickness (VST), and dorsal subcutaneous thickness (DST)), WC and body fat percentage with disc degeneration sum scores using ordinal logistic regression.
A total of 155 (48%) females and 147 (63%) males had disc degeneration. AD and SAD were associated with a disc degeneration sum score of ≥3 compared to disc degeneration sum score of 0-2 (OR 1.67; 95% confidence interval (CI) 1.20-2.33 and OR 1.40; 95% CI 1.12-1.75, respectively) among males, but we found no association among females. WC was also associated with disc degeneration among males (OR 1.03 per one cm; 95% CI 1.00-1.05), but not among females.
Measures of abdominal obesity in MRI and waist circumference were associated with disc degeneration among 21-year-old males.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
The COVID-19 pandemic forced many surgeons to adopt “virtual medicine” practices, defined as telehealth services for patient care and online platforms for continuing medical education. The ...purpose of this study was to assess spine surgeon reliance on virtual medicine during the pandemic and to discuss the future of virtual medicine in spine surgery.
Methods
A comprehensive survey addressing demographic data and virtual medicine practices was distributed to spine surgeons worldwide between March 27, 2020, and April 4, 2020.
Results
902 spine surgeons representing seven global regions responded. 35.6% of surgeons were identified as “high telehealth users,” conducting more than half of clinic visits virtually. Predictors of high telehealth utilization included working in an academic practice (OR = 1.68,
p
= 0.0015) and practicing in Europe/North America (OR 3.42,
p
< 0.0001). 80.1% of all surgeons were interested in online education. Dedicating more than 25% of one’s practice to teaching (OR = 1.89,
p
= 0.037) predicted increased interest in online education. 26.2% of respondents were identified as “virtual medicine surgeons,” defined as surgeons with both high telehealth usage and increased interest in online education. Living in Europe/North America and practicing in an academic practice increased odds of being a virtual medicine surgeon by 2.28 (
p
= 0.002) and 1.15 (
p
= 0.0082), respectively. 93.8% of surgeons reported interest in a centralized platform facilitating surgeon-to-surgeon communication.
Conclusion
COVID-19 has changed spine surgery by triggering rapid adoption of virtual medicine practices. The demonstrated global interest in virtual medicine suggests that it may become part of the “new normal” for surgeons in the post-pandemic era.
Purpose
To utilize data from a global spine surgeon survey to elucidate (1) overall confidence in the telemedicine evaluation and (2) determinants of provider confidence.
Methods
Members of AO Spine ...International were sent a survey encompassing participant’s experience with, perception of, and comparison of telemedicine to in-person visits. The survey was designed through a Delphi approach, with four rounds of question review by the multi-disciplinary authors. Data were stratified by provider age, experience, telemedicine platform, trust in telemedicine, and specialty.
Results
Four hundred and eighty-five surgeons participated in the survey. The global effort included respondents from Africa (19.9%), Asia Pacific (19.7%), Europe (24.3%), North America (9.4%), and South America (26.6%). Providers felt that physical exam-based tasks (e.g., provocative testing, assessing neurologic deficits/myelopathy, etc.) were inferior to in-person exams, while communication-based aspects (e.g., history taking, imaging review, etc.) were equivalent. Participants who performed greater than 50 visits were more likely to believe telemedicine was at least equivalent to in-person visits in the ability to make an accurate diagnosis (OR 2.37, 95% C.I. 1.03–5.43). Compared to in-person encounters, video (versus phone only) visits were associated with increased confidence in the ability of telemedicine to formulate and communicate a treatment plan (OR 3.88, 95% C.I. 1.71–8.84).
Conclusion
Spine surgeons are confident in the ability of telemedicine to communicate with patients, but are concerned about its capacity to accurately make physical exam-based diagnoses. Future research should concentrate on standardizing the remote examination and the development of appropriate use criteria in order to increase provider confidence in telemedicine technology.
Abstract Background Assessment of skeletal maturity in patients with adolescent idiopathic scoliosis (AIS) is important to guide clinical management. Understanding growth peak and cessation is ...crucial to determine clinical observational intervals, timing to initiate or end bracing therapy, and when to instrument and fuse. The commonly used clinical or radiologic methods to assess skeletal maturity are still deficient in predicting the growth peak and cessation among adolescents, and bone age is too complicated to apply. Purpose To address these concerns, we describe a new distal radius and ulna (DRU) classification scheme to assess skeletal maturity. Study design A prospective study. Patient sample One hundred fifty young, female AIS patients with hand x-rays and no previous history of spine surgery from a single institute were assessed. Outcome measures Radius and ulna plain radiographs, and various anthropomorphic parameters were assessed. Methods We identified various stages of radius and ulna epiphysis maturity, which were graded as R1–R11 for the radius and U1–U9 for the ulna. The bone age, development of sexual characteristics, standing height, sitting height, arm span, radius length, and tibia length were studied prospectively at each stage of these epiphysis changes. Results Standing height, sitting height, and arm span growth were at their peak during stages R7 (mean, 11.4 years old) and U5 (mean, 11.0 years old). The long bone growths also demonstrated a common peak at R7 and U5. Cessation of height and arm span growth was noted after stages R10 (mean, 15.6 years old) and U9 (mean, 17.3 years old). Conclusions The new DRU classification is a practical and easy-to-use scheme that can provide skeletal maturation status. This classification scheme provides close relationship with adolescent growth spurt and cessation of growth. This classification may have a tremendous utility in improving clinical-decision making in the conservative and operative management of scoliosis patients.
COVID-19 and its Impact on Back Pain Angotti, Morgan; Mallow, G. Michael; Wong, Arnold ...
Global spine journal,
01/2022, Letnik:
12, Številka:
1
Journal Article
PDF
