Link to journal online
Takatalo, Jani MSc ; Karppinen, Jaro MD, PhD ; Niinimaki, Jaakko MD ; Taimela, Simo et al
Prevalence of Degenerative Imaging Findings in Lumbar Magnetic Resonance Imaging Among Young Adults.
Spine. 34(16):1716-1721, July 15, 2009.
Abstract
Study Design. A cross-sectional imaging study of young adults.Objective. To investigate the prevalence of disc degeneration (DD) and displacement, anular tears, and Modic changes in lumbar magnetic resonance imaging (MRI) among young adults.Summary of Background Data. Although low back pain in young adulthood is common, the prevalence of spinal MRI findings at this age remains virtually unknown.Methods. The study population was a subcohort of the Northern Finland Birth Cohort 1986. Subjects living within 100 km of Oulu (n = 874) were invited to participate in lumbar MRI at 20 to 22 years of age (mean: 21.2 years). Degree of DD, type of Modic changes, and presence of disc bulges, herniations, high intensity zone (HIZ) lesions, and radial tears at all lumbar levels were assessed.Results. Three hundred twenty-five women and 233 men (n = 558) attended the MR imaging. DD was significantly more frequent in men (54% vs. 42%, P = 0.005), as was multiple DD (21% vs. 14%, P = 0.036). The prevalences of disc bulges and radial tears were 25% and 9.1%, respectively, without gender differences. HIZ lesions were more common among women than men (8.6% vs. 4.3%, P = 0.046), whereas herniations were significantly more common among men (5.6% vs. 2.5%, P = 0.047). Only 2 disc extrusions were observed, one in each gender. All degenerative disc findings were more common at the L5-S1 level except HIZ lesions, which were most likely at L4-L5. The prevalence of the Modic changes was 1.4%, without gender difference, type I being more common than type II. Typically, Modic changes were located adjacent to a DD Grade 4 disc and at the 2 lowest levels.Conclusion. Almost half of young Finnish adult aged 21 years had at least one degenerated disc, and a quarter had a bulging disc. Modic changes and disc herniations were, however, relatively rare.(C) 2009 Lippincott Williams & Wilkins, Inc.
Showing posts with label Spine [journal]. Show all posts
Showing posts with label Spine [journal]. Show all posts
Monday, 27 July 2009
Monday, 8 June 2009
Articles from Spine
Link to journal online
Cheung, Kenneth M. C. ; Karppinen, Jaro; Chan, Danny; Ho, Daniel W. H. et al
Prevalence and Pattern of Lumbar Magnetic Resonance Imaging Changes in a Population Study of One Thousand Forty-Three Individuals.
Spine. 34(9):934-940, April 20, 2009.
Abstract
Study Design. A cross-sectional population study of magnetic resonance imaging (MRI) changes.Objective. To examine the pattern and prevalence of lumbar spine MRI changes within a southern Chinese population and their relationship with back pain.Summary of Background Data. Previous studies on MRI changes and back pain have used populations of asymptomatic individuals or patients presenting with back pain and sciatica. Thus, the prevalence and pattern of intervertebral disc degeneration within the population is not known.Methods. Lumbar spine MRIs were obtained in 1043 volunteers between 18 to 55 years of age. MRI changes including disc degeneration, herniation, anular tears (HIZ), and Schmorl's nodes were noted by 2 independent observers. Differences were settled by consensus. Disc degeneration was graded using Schneiderman's classification, and a total score (DDD score) was calculated by the summation of the Schneiderman's score for each lumbar level. A K-mean clustering program was used to group individuals into different patterns of degeneration.Results. Forty percent of individuals under 30 years of age had lumbar intervertebral disc degeneration (LDD), the prevalence of LDD increasing progressively to over 90% by 50 to 55 years of age. There was a positive correlation between the DDD score and low back pain. L5-S1 and L4-L5 were the most commonly affected levels. Apart from the usual patterns of degeneration, some uncommon patternsof degeneration were identified, comprising of subjects with skip level lesions (intervening normal levels) and isolated upper or mid lumbar degeneration.Conclusion. LDD is common, and its incidence increases with age. In a population setting, there is a significant association of LDD on MRI with back pain
Morphological Analysis in Patients With Sciatica: A Magnetic Resonance Imaging Study Using Three-Dimensional High-Resolution Diffusion-Weighted Magnetic Resonance Neurography Techniques.
Spine. 34(7):E245-E250, April 1, 2009.
Abstract
Study Design. A prospective observational study of patients with sciatica.Objective. We investigated the effectiveness of 3-dimensional high-spatial resolution diffusion-weighted MR neurography based on steady state free precession (3-dimensional diffusion-weighted steady-state free precession [DW-SSFP]) in the diagnosis of sciatica.Summary of Background Data. Patients with sciatica challenge a physician who desires a precise diagnosis for the etiology of the pain. Direct imaging of the sciatic nerve with high resolution and high contrast may contribute to accurate localization and help to find the causes of sciatica and provide reliable information to clinicians in treatment choice. Thus, we supposed that 3-dimensional DW-SSFP method have the ability to confirm the etiologies of sciatica.Methods. The 3-dimensional DW-SSFP sequence was performed on 137 patients with sciatica and 32 patients in control group. The postprocessing techniques were used to generate images of lumbosacral plexus and sciatic nerve, and the images acquired were assessed based on the presence or absence of nerve abnormality. The certainty of identifying the lumbosacral plexus and main branches from all cases was determined in each of the reconstruction planes for each case individually and assessed by using a 3-score scale.Results. All subjects were successfully performed. The sciatic nerve and its main branches were differentiated and a clear picture was obtained in all subjects. Compared with the control group, the presence of nerve root compression or increased T2 signal intensity changes can be observed in all patients. The mean score of certainty of identifying the sciatic nerve and main branches was 1.76 +/- 0.4, which indicate that the sciatic nerve and main branches can be identified with certainty.Conclusion. The 3-dimensional DW-SSFP MRI with high spatial and sufficient contrast is an excellent technique to define the nature of sciatica and assists in prognostication and possibly in management.
Okada, Eijiro MD ; Matsumoto, Morio MD ; Ichihara, Daisuke MD ; Chiba, Kazuhiro MD et al
Aging of the Cervical Spine in Healthy Volunteers: A 10-Year Longitudinal Magnetic Resonance Imaging Study
Spine. 34(7):706-712, April 1, 2009.
Abstract
Study Design. Prospective longitudinal study, mean follow-up period; 11.7 +/- 0.8 years was conducted from 1995 to 2007.Objective. To clarify normal aging process of cervical spine and correlation between progression of disc degeneration and development of clinical symptoms.Summary of Background Data. Aging of the cervical spine can inevitably occur in anyone. Long-term longitudinal studies following the same individuals are necessary to elucidate the accurate aging processes of the cervical spine.Methods. Two hundred twenty-three subjects of 497 original cohorts (123 men, 100 women, mean age: 39.0 +/- 15.0, follow-up rate: 44.9%). Subjects, who underwent MRI 10 years ago, underwent another MRI, neurologic examination, and questionnaire survey regarding symptoms related to cervical spine and life style. Following 5 MR findings representing intervertebral disc degeneration were evaluated: (1) decrease in signal intensity of disc, (2) anterior compression of dura and spinal cord, (3) posterior disc protrusion (PDP), (4) disc space narrowing (DSN), and (5) foraminal stenosis (FS).Results. Progression of degenerative findings was observed in 189 subjects (81.1%). Progression of decrease in signal intensity of disc was observed in 59.6%, anterior compression of dura and spinal cord in 61.4%, PDP in 70.0%, DSN in 26.9%, and FS in 9.0%. Logistic regression analysis revealed that incidence of progression of PDP, DSN, FS was higher in elderly subjects. There were no correlations between any degenerative MR findings and sex, smoking, alcohol, sport, or body mass index. Neck pain, shoulder stiffness, and numbness in upper extremities were recognized in 9.9%, 30.0%, and 4.0% of subjects, and 1 or more clinical symptoms have developed in 34.1% during 10 years.Conclusion. Progression of degeneration of cervical spine on MRI was frequently observed during 10-year period, with development of symptoms in 34% of subjects. No factor related to progression of degeneration of cervical spine was identified except for age.
Lurie, Jon D. ; Doman, David M. ; Spratt, Kevin F. PhD; Tosteson, Anna N. A. ; Weinstein, James N. et al
Magnetic Resonance Imaging Interpretation in Patients With Symptomatic Lumbar Spine Disc Herniations: Comparison of Clinician and Radiologist Readings.
Spine. 34(7):701-705, April 1, 2009.
Abstract
Study Design. Retrospective review of imaging data from a clinical trial.Objective. To compare the interpretation of lumbar spine magnetic resonance imaging (MRIs) by clinical spine specialists and radiologists in patients with lumbar disc herniation.Summary of Background Data. MRI is the imaging modality of choice for evaluation of the lumbar spine in patients with suspected lumbar disc herniation. Guidelines provide standardization of terms to more consistently describe disc herniation. The extent to which these guidelines are being followed in clinical practice is unknown.Methods. We abstracted data from radiology reports from patients with lumbar intervertebral disc herniation enrolled in the Spine Patient Outcomes Research Trial. We evaluated the frequency with which morphology (e.g., protrusions, extrusions, or sequestrations) was reported as per guidelines and when present we compared the morphology ratings to those of clinicians who completed a structured data form as part of the trial. We assessed agreement using percent agreement and the [kappa] statistic.Results. There were 396 patients with sufficient data to analyze. Excellent agreement was observed between clinician and radiologist on the presence and level of herniation (93.4%), with 3.3% showing disagreement regarding level, of which a third could be explained by the presence of a transitional vertebra. In 3.3% of the cases in which the clinician reported a herniation (protrusion, extrusion, or sequestration), the radiologist reported no herniation on the MRI.The radiology reports did not clearly describe morphology in 42.2% of cases. In the 214 cases with clear morphologic descriptions, agreement was fair ([kappa] = 0.24) and the disagreement was asymmetric (Bowker's test of symmetry P <>
Uchida, Kenzo ; Nakajima, Hideaki ; Yayama, Takafumi ; Kobayashi, Shigeru et al
High-Resolution Magnetic Resonance Imaging and 18FDG-PET Findings of the Cervical Spinal Cord Before and After Decompressive Surgery in Patients With Compressive Myelopathy.
Status
Publish Ahead of Print, POST AUTHOR CORRECTIONS, 30 April 2009
Abstract
Study Design. Evaluation of cervical spinal cord (CSC) of patients with compressive myelopathy by magnetic resonance imaging (MRI) and high-resolution (18F)fluoro-deoxyglucose (18FDG) positron emission tomography (PET).Objective. To determine changes in morphology, intramedullary signal intensity, and glucose metabolic rate in CSC after decompression, and to assess the utility of 18FDG-PET in evaluation of patients with cervical myelopathy.Summary of Background Data. The significance of CSC enlargement after decompression and signal intensity changes within the cord remain elusive. No data are available on metabolic activity of the compressed CSC. Only a few studies have examined correlation between high-resolution MRI and 18FDG-PET neuroimaging in cervical myelopathy.Methods. We studied 24 patients who underwent cervical decompressive surgery in terms of postoperative neurologic improvement and changes in MRI and 18FDG-PET. Neurologic status was assessed by the Japanese Orthopedic Association scoring system (17-point scale). Signal intensity change in the cord was qualitatively assessed on both T1- and T2-weighted images. The transverse area of the CSC on MRIs and glucose metabolic rate (standardized uptake value [SUV]) from 18FDG-PET were measured digitally.Results. Neurologic improvement correlated with preoperative CSC transverse area at maximal compression (P <>
Cheung, Kenneth M. C. ; Karppinen, Jaro; Chan, Danny; Ho, Daniel W. H. et al
Prevalence and Pattern of Lumbar Magnetic Resonance Imaging Changes in a Population Study of One Thousand Forty-Three Individuals.
Spine. 34(9):934-940, April 20, 2009.
Abstract
Study Design. A cross-sectional population study of magnetic resonance imaging (MRI) changes.Objective. To examine the pattern and prevalence of lumbar spine MRI changes within a southern Chinese population and their relationship with back pain.Summary of Background Data. Previous studies on MRI changes and back pain have used populations of asymptomatic individuals or patients presenting with back pain and sciatica. Thus, the prevalence and pattern of intervertebral disc degeneration within the population is not known.Methods. Lumbar spine MRIs were obtained in 1043 volunteers between 18 to 55 years of age. MRI changes including disc degeneration, herniation, anular tears (HIZ), and Schmorl's nodes were noted by 2 independent observers. Differences were settled by consensus. Disc degeneration was graded using Schneiderman's classification, and a total score (DDD score) was calculated by the summation of the Schneiderman's score for each lumbar level. A K-mean clustering program was used to group individuals into different patterns of degeneration.Results. Forty percent of individuals under 30 years of age had lumbar intervertebral disc degeneration (LDD), the prevalence of LDD increasing progressively to over 90% by 50 to 55 years of age. There was a positive correlation between the DDD score and low back pain. L5-S1 and L4-L5 were the most commonly affected levels. Apart from the usual patterns of degeneration, some uncommon patternsof degeneration were identified, comprising of subjects with skip level lesions (intervening normal levels) and isolated upper or mid lumbar degeneration.Conclusion. LDD is common, and its incidence increases with age. In a population setting, there is a significant association of LDD on MRI with back pain
Morphological Analysis in Patients With Sciatica: A Magnetic Resonance Imaging Study Using Three-Dimensional High-Resolution Diffusion-Weighted Magnetic Resonance Neurography Techniques.
Spine. 34(7):E245-E250, April 1, 2009.
Abstract
Study Design. A prospective observational study of patients with sciatica.Objective. We investigated the effectiveness of 3-dimensional high-spatial resolution diffusion-weighted MR neurography based on steady state free precession (3-dimensional diffusion-weighted steady-state free precession [DW-SSFP]) in the diagnosis of sciatica.Summary of Background Data. Patients with sciatica challenge a physician who desires a precise diagnosis for the etiology of the pain. Direct imaging of the sciatic nerve with high resolution and high contrast may contribute to accurate localization and help to find the causes of sciatica and provide reliable information to clinicians in treatment choice. Thus, we supposed that 3-dimensional DW-SSFP method have the ability to confirm the etiologies of sciatica.Methods. The 3-dimensional DW-SSFP sequence was performed on 137 patients with sciatica and 32 patients in control group. The postprocessing techniques were used to generate images of lumbosacral plexus and sciatic nerve, and the images acquired were assessed based on the presence or absence of nerve abnormality. The certainty of identifying the lumbosacral plexus and main branches from all cases was determined in each of the reconstruction planes for each case individually and assessed by using a 3-score scale.Results. All subjects were successfully performed. The sciatic nerve and its main branches were differentiated and a clear picture was obtained in all subjects. Compared with the control group, the presence of nerve root compression or increased T2 signal intensity changes can be observed in all patients. The mean score of certainty of identifying the sciatic nerve and main branches was 1.76 +/- 0.4, which indicate that the sciatic nerve and main branches can be identified with certainty.Conclusion. The 3-dimensional DW-SSFP MRI with high spatial and sufficient contrast is an excellent technique to define the nature of sciatica and assists in prognostication and possibly in management.
Okada, Eijiro MD ; Matsumoto, Morio MD ; Ichihara, Daisuke MD ; Chiba, Kazuhiro MD et al
Aging of the Cervical Spine in Healthy Volunteers: A 10-Year Longitudinal Magnetic Resonance Imaging Study
Spine. 34(7):706-712, April 1, 2009.
Abstract
Study Design. Prospective longitudinal study, mean follow-up period; 11.7 +/- 0.8 years was conducted from 1995 to 2007.Objective. To clarify normal aging process of cervical spine and correlation between progression of disc degeneration and development of clinical symptoms.Summary of Background Data. Aging of the cervical spine can inevitably occur in anyone. Long-term longitudinal studies following the same individuals are necessary to elucidate the accurate aging processes of the cervical spine.Methods. Two hundred twenty-three subjects of 497 original cohorts (123 men, 100 women, mean age: 39.0 +/- 15.0, follow-up rate: 44.9%). Subjects, who underwent MRI 10 years ago, underwent another MRI, neurologic examination, and questionnaire survey regarding symptoms related to cervical spine and life style. Following 5 MR findings representing intervertebral disc degeneration were evaluated: (1) decrease in signal intensity of disc, (2) anterior compression of dura and spinal cord, (3) posterior disc protrusion (PDP), (4) disc space narrowing (DSN), and (5) foraminal stenosis (FS).Results. Progression of degenerative findings was observed in 189 subjects (81.1%). Progression of decrease in signal intensity of disc was observed in 59.6%, anterior compression of dura and spinal cord in 61.4%, PDP in 70.0%, DSN in 26.9%, and FS in 9.0%. Logistic regression analysis revealed that incidence of progression of PDP, DSN, FS was higher in elderly subjects. There were no correlations between any degenerative MR findings and sex, smoking, alcohol, sport, or body mass index. Neck pain, shoulder stiffness, and numbness in upper extremities were recognized in 9.9%, 30.0%, and 4.0% of subjects, and 1 or more clinical symptoms have developed in 34.1% during 10 years.Conclusion. Progression of degeneration of cervical spine on MRI was frequently observed during 10-year period, with development of symptoms in 34% of subjects. No factor related to progression of degeneration of cervical spine was identified except for age.
Lurie, Jon D. ; Doman, David M. ; Spratt, Kevin F. PhD; Tosteson, Anna N. A. ; Weinstein, James N. et al
Magnetic Resonance Imaging Interpretation in Patients With Symptomatic Lumbar Spine Disc Herniations: Comparison of Clinician and Radiologist Readings.
Spine. 34(7):701-705, April 1, 2009.
Abstract
Study Design. Retrospective review of imaging data from a clinical trial.Objective. To compare the interpretation of lumbar spine magnetic resonance imaging (MRIs) by clinical spine specialists and radiologists in patients with lumbar disc herniation.Summary of Background Data. MRI is the imaging modality of choice for evaluation of the lumbar spine in patients with suspected lumbar disc herniation. Guidelines provide standardization of terms to more consistently describe disc herniation. The extent to which these guidelines are being followed in clinical practice is unknown.Methods. We abstracted data from radiology reports from patients with lumbar intervertebral disc herniation enrolled in the Spine Patient Outcomes Research Trial. We evaluated the frequency with which morphology (e.g., protrusions, extrusions, or sequestrations) was reported as per guidelines and when present we compared the morphology ratings to those of clinicians who completed a structured data form as part of the trial. We assessed agreement using percent agreement and the [kappa] statistic.Results. There were 396 patients with sufficient data to analyze. Excellent agreement was observed between clinician and radiologist on the presence and level of herniation (93.4%), with 3.3% showing disagreement regarding level, of which a third could be explained by the presence of a transitional vertebra. In 3.3% of the cases in which the clinician reported a herniation (protrusion, extrusion, or sequestration), the radiologist reported no herniation on the MRI.The radiology reports did not clearly describe morphology in 42.2% of cases. In the 214 cases with clear morphologic descriptions, agreement was fair ([kappa] = 0.24) and the disagreement was asymmetric (Bowker's test of symmetry P <>
Uchida, Kenzo ; Nakajima, Hideaki ; Yayama, Takafumi ; Kobayashi, Shigeru et al
High-Resolution Magnetic Resonance Imaging and 18FDG-PET Findings of the Cervical Spinal Cord Before and After Decompressive Surgery in Patients With Compressive Myelopathy.
Status
Publish Ahead of Print, POST AUTHOR CORRECTIONS, 30 April 2009
Abstract
Study Design. Evaluation of cervical spinal cord (CSC) of patients with compressive myelopathy by magnetic resonance imaging (MRI) and high-resolution (18F)fluoro-deoxyglucose (18FDG) positron emission tomography (PET).Objective. To determine changes in morphology, intramedullary signal intensity, and glucose metabolic rate in CSC after decompression, and to assess the utility of 18FDG-PET in evaluation of patients with cervical myelopathy.Summary of Background Data. The significance of CSC enlargement after decompression and signal intensity changes within the cord remain elusive. No data are available on metabolic activity of the compressed CSC. Only a few studies have examined correlation between high-resolution MRI and 18FDG-PET neuroimaging in cervical myelopathy.Methods. We studied 24 patients who underwent cervical decompressive surgery in terms of postoperative neurologic improvement and changes in MRI and 18FDG-PET. Neurologic status was assessed by the Japanese Orthopedic Association scoring system (17-point scale). Signal intensity change in the cord was qualitatively assessed on both T1- and T2-weighted images. The transverse area of the CSC on MRIs and glucose metabolic rate (standardized uptake value [SUV]) from 18FDG-PET were measured digitally.Results. Neurologic improvement correlated with preoperative CSC transverse area at maximal compression (P <>
Tuesday, 24 March 2009
Articles from Spine
Link to journal online
Zuhlke, Todd ; Fine, Jason ; Haughton, Victor M.; Anderson, Paul A.
Accuracy of Dynamic Computed Tomography to Calculate Rotation Occurring at Lumbar Spinal Motion Segments
Spine. 34(6):E215-E218, March 15, 2009.
Abstract
Study Design. Reliability study comparing computed tomography (CT) to biomechanics.Objective. To measure the accuracy and precision of such measurements in comparison with a standard method.Summary of Background Data. Rotations of lumbar spinal motion segments can be measured with dynamic CT imaging. This may be a useful tool to measure intersegmental motion. Validation of its use is lacking.Methods. Human cadaveric lumbar spines were fixed in a rigid rotation device and rotated, whereas rotation at each level was measured with extensiometers. Rotation at each level was calculated as a percent of total rotation. The spines were placed in a CT scanner and imaged after rotation of the spine in each direction. The percent of total rotation that occurred at each level was calculated with a software program. Accuracy of the CT method was calculated as the average difference between methods. Precision was measured as the standard deviation of the CT measurement. Biomechanical testing and CT were repeated after the posterior anulus fibrosus at L3-L4 was incised with a scalpel. The power of the CT method to detect a change in rotation was tested by calculating the difference between the pre- and postsurgery rotation at L3-L4 and testing it for significance with a Student t test of paired samples.Results. Differences between CT and biomechanical measurements averaged 0.2%. Precision was 6.0% ( Table 1). Postanular injury, percent rotation at the L3-L4 level increased, whereas it decreased at the other 4 levels. The change at L3-L4 was statistically significant (P = 0.047).(C) 2009 Lippincott Williams & Wilkins, Inc.
Takahashi, Shinobu ; Saruhashi, Yasuo ; Odate, Seiichi ; Matsusue, Yoshitaka ; Morikawa, Shigehiro
Percutaneous Aspiration of Spinal Terminal Ventricle Cysts Using Real-Time Magnetic Resonance Imaging and Navigation
Spine. 34(6):629-634, March 15, 2009.
Abstract
Study Design. Clinical case series.Objective. To present a new innovative treatment option for cysts of the terminal ventricle.Summary of Background Data. Invasive surgery including laminectomy and cyst fenestration has been the sole reported method of treatment for this rare pathology.Methods. Four cases of symptomatic cyst of the terminal ventricle of the spinal cord were treated by percutaneous aspiration using real-time guidance with magnetic resonance imaging (MRI) and optically-tracking navigation.Results. Three patients were treated successfully by this percutaneous method, and for 1 patient the treatment was converted to conventional surgery after a single unsuccessful trial of percutaneous puncture. All patients were relieved of their symptoms without any complication. Follow-up MRI revealed continued shrinkage of the cysts after both surgery and MRI-guided percutaneous fenestration.Conclusion. MRI-navigated percutaneous aspiration can be a minimally-invasive treatment option for symptomatic cysts of the terminal ventricle, and therefore, can be indicated before more invasive surgery might be scheduled.(C) 2009 Lippincott Williams & Wilkins, Inc.
Benz, Becky K. ; Gemery, John M. ; McIntyre, John J. ; Eskey, Clifford J.
Value of Immediate Preprocedure Magnetic Resonance Imaging in Patients Scheduled to Undergo Vertebroplasty or Kyphoplasty
Spine. 34(6):609-612, March 15, 2009.
Abstract
Study Design. Retrospective case series.Objective. To determine the incidence of additional vertebral compression fractures diagnosed with repeat MRI immediately before vertebroplasty or kyphoplasty.Summary of Background Data. Vertebral compression fractures, which occur frequently in the elderly, are more likely in patients with prior vertebral compression fracture. When patients are evaluated for vertebroplasty, it is important to identify all unhealed fractures for effective treatment planning.Methods. In a retrospective study, we reviewed the records of all patients (n = 194) treated with vertebroplasty or kyphoplasty over a 6-year period at our institution, and identified all patients who had undergone a repeat MRI within 7 days of vertebroplasty or kyphoplasty. These studies were obtained as part of a clinical protocol prescribing a repeat MRI for any patient whose MRI had been obtained more than 3 months before the evaluation, or who had a change in their pain between referral and evaluation.Results. Twenty patients met inclusion criteria for the immediate preprocedure MRI protocol. A total of 14 new fractures in 11 patients were discovered on the immediate preprocedure MRI. Of these 14, 6 had less than 15% loss of height, making them potentially occult on radiographs; 3 fractures developed in 2 patients who had no change in back pain.Conclusion. In select candidates for vertebroplasty or kyphoplasty, a repeat preprocedure MRI obtained within 1 week can help ensure that all painful fractures are treated. There is demonstrable value in this protocol for patients with an imaging evaluation over 3 months old or who have had any change in symptoms since the initial imaging workup.(C) 2009 Lippincott Williams & Wilkins, Inc.
Freedman, Brett A. Horton, William C. Rhee, John M. Edwards, Charles C. II Kuklo, Timothy R.
Reliability Analysis for Manual Radiographic Measures of Rotatory Subluxation or Lateral Listhesis in Adult Scoliosis.
Spine. 34(6):603-608, March 15, 2009.
Abstract
Study Design. Retrospective observational study.Objective. To define the inter- and intraobserver reliability of 3 measures of rotatory subluxation (RS) in adult scoliosis (AS).Summary of Background Data. RS is a hallmark of AS. To accurately track this measure, one must know its reliability. Reliability testing has not been performed.Methods. PA 36" films of 29 AS patients were collected from one surgeon's practice. Three observers on 2 separate occasions measured all levels with >=3-mm RS (60 levels, 360 measurements) on the convexity of the involved segment using 3 different techniques-midbody (MB), endplate (EP), and centroid (C). These data were then analyzed to determine the intraclass correlation coefficient (ICC) for inter- and intraobserver reliability.Results. The thoracolumbar/lumbar curve (average 58[degrees]) was the major curve for the majority (62%) of patients. RS at L3/4 was most common (35%). The overall inter- and intraobserver reliability was good-excellent for all methods, but the centroid method consistently had the highest ICC. ICC correlated with observer experience. Moderate-severe arthritic change (present in 55%) and poor image quality (52%) decreased ICC, but it still remained good-excellent for each measure. The reproducibility coefficient for each measure was 4 mm for MB and 2.8 mm for C and EP.Conclusion. MB, EP, and C are reliable techniques to measure RS even in elderly arthritic spines, but the methods inherently produce different values for a given level. The centroid method is most reliable and least influenced by experience. The EP method is easy to perform and very reliable. Spine surgeons should pick their preferred method and apply it consistently. Changes >3 mm suggest RS progression. RS may be a useful measure in addition to Cobb angle in AS. Having defined measurement reliability, the role of RS progression in surgical indications and patient outcomes can be evaluated.
Zuhlke, Todd ; Fine, Jason ; Haughton, Victor M.; Anderson, Paul A.
Accuracy of Dynamic Computed Tomography to Calculate Rotation Occurring at Lumbar Spinal Motion Segments
Spine. 34(6):E215-E218, March 15, 2009.
Abstract
Study Design. Reliability study comparing computed tomography (CT) to biomechanics.Objective. To measure the accuracy and precision of such measurements in comparison with a standard method.Summary of Background Data. Rotations of lumbar spinal motion segments can be measured with dynamic CT imaging. This may be a useful tool to measure intersegmental motion. Validation of its use is lacking.Methods. Human cadaveric lumbar spines were fixed in a rigid rotation device and rotated, whereas rotation at each level was measured with extensiometers. Rotation at each level was calculated as a percent of total rotation. The spines were placed in a CT scanner and imaged after rotation of the spine in each direction. The percent of total rotation that occurred at each level was calculated with a software program. Accuracy of the CT method was calculated as the average difference between methods. Precision was measured as the standard deviation of the CT measurement. Biomechanical testing and CT were repeated after the posterior anulus fibrosus at L3-L4 was incised with a scalpel. The power of the CT method to detect a change in rotation was tested by calculating the difference between the pre- and postsurgery rotation at L3-L4 and testing it for significance with a Student t test of paired samples.Results. Differences between CT and biomechanical measurements averaged 0.2%. Precision was 6.0% ( Table 1). Postanular injury, percent rotation at the L3-L4 level increased, whereas it decreased at the other 4 levels. The change at L3-L4 was statistically significant (P = 0.047).(C) 2009 Lippincott Williams & Wilkins, Inc.
Takahashi, Shinobu ; Saruhashi, Yasuo ; Odate, Seiichi ; Matsusue, Yoshitaka ; Morikawa, Shigehiro
Percutaneous Aspiration of Spinal Terminal Ventricle Cysts Using Real-Time Magnetic Resonance Imaging and Navigation
Spine. 34(6):629-634, March 15, 2009.
Abstract
Study Design. Clinical case series.Objective. To present a new innovative treatment option for cysts of the terminal ventricle.Summary of Background Data. Invasive surgery including laminectomy and cyst fenestration has been the sole reported method of treatment for this rare pathology.Methods. Four cases of symptomatic cyst of the terminal ventricle of the spinal cord were treated by percutaneous aspiration using real-time guidance with magnetic resonance imaging (MRI) and optically-tracking navigation.Results. Three patients were treated successfully by this percutaneous method, and for 1 patient the treatment was converted to conventional surgery after a single unsuccessful trial of percutaneous puncture. All patients were relieved of their symptoms without any complication. Follow-up MRI revealed continued shrinkage of the cysts after both surgery and MRI-guided percutaneous fenestration.Conclusion. MRI-navigated percutaneous aspiration can be a minimally-invasive treatment option for symptomatic cysts of the terminal ventricle, and therefore, can be indicated before more invasive surgery might be scheduled.(C) 2009 Lippincott Williams & Wilkins, Inc.
Benz, Becky K. ; Gemery, John M. ; McIntyre, John J. ; Eskey, Clifford J.
Value of Immediate Preprocedure Magnetic Resonance Imaging in Patients Scheduled to Undergo Vertebroplasty or Kyphoplasty
Spine. 34(6):609-612, March 15, 2009.
Abstract
Study Design. Retrospective case series.Objective. To determine the incidence of additional vertebral compression fractures diagnosed with repeat MRI immediately before vertebroplasty or kyphoplasty.Summary of Background Data. Vertebral compression fractures, which occur frequently in the elderly, are more likely in patients with prior vertebral compression fracture. When patients are evaluated for vertebroplasty, it is important to identify all unhealed fractures for effective treatment planning.Methods. In a retrospective study, we reviewed the records of all patients (n = 194) treated with vertebroplasty or kyphoplasty over a 6-year period at our institution, and identified all patients who had undergone a repeat MRI within 7 days of vertebroplasty or kyphoplasty. These studies were obtained as part of a clinical protocol prescribing a repeat MRI for any patient whose MRI had been obtained more than 3 months before the evaluation, or who had a change in their pain between referral and evaluation.Results. Twenty patients met inclusion criteria for the immediate preprocedure MRI protocol. A total of 14 new fractures in 11 patients were discovered on the immediate preprocedure MRI. Of these 14, 6 had less than 15% loss of height, making them potentially occult on radiographs; 3 fractures developed in 2 patients who had no change in back pain.Conclusion. In select candidates for vertebroplasty or kyphoplasty, a repeat preprocedure MRI obtained within 1 week can help ensure that all painful fractures are treated. There is demonstrable value in this protocol for patients with an imaging evaluation over 3 months old or who have had any change in symptoms since the initial imaging workup.(C) 2009 Lippincott Williams & Wilkins, Inc.
Freedman, Brett A. Horton, William C. Rhee, John M. Edwards, Charles C. II Kuklo, Timothy R.
Reliability Analysis for Manual Radiographic Measures of Rotatory Subluxation or Lateral Listhesis in Adult Scoliosis.
Spine. 34(6):603-608, March 15, 2009.
Abstract
Study Design. Retrospective observational study.Objective. To define the inter- and intraobserver reliability of 3 measures of rotatory subluxation (RS) in adult scoliosis (AS).Summary of Background Data. RS is a hallmark of AS. To accurately track this measure, one must know its reliability. Reliability testing has not been performed.Methods. PA 36" films of 29 AS patients were collected from one surgeon's practice. Three observers on 2 separate occasions measured all levels with >=3-mm RS (60 levels, 360 measurements) on the convexity of the involved segment using 3 different techniques-midbody (MB), endplate (EP), and centroid (C). These data were then analyzed to determine the intraclass correlation coefficient (ICC) for inter- and intraobserver reliability.Results. The thoracolumbar/lumbar curve (average 58[degrees]) was the major curve for the majority (62%) of patients. RS at L3/4 was most common (35%). The overall inter- and intraobserver reliability was good-excellent for all methods, but the centroid method consistently had the highest ICC. ICC correlated with observer experience. Moderate-severe arthritic change (present in 55%) and poor image quality (52%) decreased ICC, but it still remained good-excellent for each measure. The reproducibility coefficient for each measure was 4 mm for MB and 2.8 mm for C and EP.Conclusion. MB, EP, and C are reliable techniques to measure RS even in elderly arthritic spines, but the methods inherently produce different values for a given level. The centroid method is most reliable and least influenced by experience. The EP method is easy to perform and very reliable. Spine surgeons should pick their preferred method and apply it consistently. Changes >3 mm suggest RS progression. RS may be a useful measure in addition to Cobb angle in AS. Having defined measurement reliability, the role of RS progression in surgical indications and patient outcomes can be evaluated.
Sunday, 15 February 2009
Articles from Spine
Link to journal online
Linn, Jennifer ; Birkenmaier, Christof ; Hoffmann, Ralf T.; Reiser, Maximilian ; Baur-Melnyk, Andrea
The Intravertebral Cleft in Acute Osteoporotic Fractures: Fluid in Magnetic Resonance Imaging-Vacuum in Computed Tomography?
Spine. 34(2):E88-E93, January 15, 2009.
Abstract
Study Design. The study consisted of a retrospective and a prospective study part.Objective. We aimed to investigate the nature of the intravertebral vacuum clefts (IVC) in computed tomography (CT) in acute osteoporotic vertebral fractures in correlation with magnetic resonance imaging (MRI).Summary of Background Data. IVC and intravertebral fluid accumulations have been shown to be indicative of benign vertebral fractures in CT and MRI, respectively.Methods. Twenty-eight patients (30 osteoporotic fractures) associated with intravertebral vacuum in CT in whom MRI of the spine was performed were retrospectively analyzed. Moreover, we prospectively performed MRI examinations in 12 consecutive patients with 13 osteoporotic fractures with an intravertebral vacuum in CT. T1-w SE, STIR, and 5 repetitive T2-w TSE studies were performed (1.5 Tesla system, Siemens). Two experienced readers assessed the examinations in consensus with regard to the occurrence and location of the intravertebral and intradiscal vacuum on CT and the corresponding signal alterations in MRI.Results. Twenty-seven (90%) of the retrospectively analyzed fractures with intravertebral vacuum in CT showed a fluid like signal in the location of the vacuum in MRI. In the prospective group, a small fluid-like signal was initially present on T2-weighted sequences in 11 of 13 fractures (84.6%). During the repeated T2-weighted measurements, the fluid occurred or increased markedly in all cases. An intradiscal fluid was present either initially and/or during the course of the examination in 46% of the prospective cases and in 50% of the retrospectively evaluated fractures.Conclusion. The occurrence of the fluid in MRI within intravertebral clefts is a dynamic process, which is dependent on the position of the patient and is presumably secondary to the extension momentum in the supine position. This may be due to the negative pressure in the horizontal position in which the fracture site is distracted. intravertebral.
Samdani, Amer F. ; Fayssoux, Reginald S. ; Asghar, Jahangir ; McCarthy, James J. et al
Chronic Spinal Cord Injury in the Pediatric Population: Does Magnetic Resonance Imaging Correlate With the International Standards for Neurological Classification of Spinal Cord Injury Examination?
Spine. 34(1):74-81, January 1, 2009.
Abstract
Study Design. Prognostic, retrospective case series.Objective. This study is part of a larger investigation to develop and validate a standardized and reliable method to evaluate and classify the neurologic consequence of spinal cord injury (SCI) in children. Such an instrument may also find use in the evaluation of patients with concomitant brain injury and/or cognitive impairment. We examined the relationship between the International Standards for Neurologic Classification of Spinal Cord Injury (ISCSCI) examination and magnetic resonance imaging (MRI) findings in a pediatric SCI population.Summary of Background Data. Recently, the reliability of the ISCSCI in young children with SCI who are unable to cognitively engage in the examination has been called into question. This has important implications as appropriate classification of these patients is necessary for prognostication, follow-up care, and appropriate placement into clinical trials.Methods. Our longitudinal pediatric SCI database was reviewed for children with chronic SCI (>6 months), ISCSCI examinations performed by experienced testers, and adequate MRIs of the spine. ISCSCI results were correlated with MRI findings. Twenty-six subjects were identified.Results. Overall, good to excellent relationships between ISCSCI neurologic level (NL) and MRI level of injury were found [Kendall [tau] correlation coefficient 0.90
Lehman, Ronald A. Jr ; Helgeson, Melvin D. ; Keeler, Kathryn A. et al
Comparison of Magnetic Resonance Imaging and Computed Tomography in Predicting Facet Arthrosis in the Cervical Spine
Spine. 34(1):65-68, January 1, 2009.
Abstract
Study Design. Retrospective review.Objective. To determine the ability of magnetic resonance imaging (MRI) and computed tomography (CT) to predict the presence of cervical facet arthrosis.Summary of Background Data. In the Food and Drug Administration Investigational Device Exemption trials of cervical disc arthroplasty (CDA), the presence of facet arthrosis on CT was a contraindication to the insertion of a CDA. Most surgeons routinely obtain an MRI, but not necessarily a CT before performing surgery in the cervical spine. We sought to determine if the MRI alone is adequate to assess for the presence of facet arthrosis.Methods. Three experienced spine surgeons retrospectively evaluated CT scans and MRIs of the same patients, obtained within 30 days of each other in a blinded, random fashion. Reviewers graded each of the MRI and CT scan as normal or abnormal on 3 separate occasions and if the facet was abnormal, each reviewer graded the degree of arthrosis. The radiologist's evaluation for each study was compared with our results.Results. Of 594 facets analyzed, 43.1% were categorized as normal on CT, and of those, MRI concordance was only 63.7% with moderate/substantial intermethod agreement. Furthermore, MRI was concordant only 15.9% of the time in patients with ankylosed facet joints on CT. CT inter-rater reliability showed substantial agreement for diagnoses of both normal and ankylosis and fair agreement for lesser degrees of facet arthrosis. MRI inter-rater reliability showed fair/moderate agreement in normal and ankylosed segments and only slight agreement with lesser degrees of facet arthrosis. CT intrarater reliability showed substantial agreement in normal or ankylosed joints, but only fair agreement for all other categories; MRI showed only fair agreement.Conclusion. The ability of MRI to adequately determine the presence or amount of facet arthrosis is not reliable. Additionally, for abnormal facets, MRI was not reliable in adequately determining the degree of arthrosis. Our data suggest that computed tomography remains necessary in diagnosing facet arthrosis before CDA.
Linn, Jennifer ; Birkenmaier, Christof ; Hoffmann, Ralf T.; Reiser, Maximilian ; Baur-Melnyk, Andrea
The Intravertebral Cleft in Acute Osteoporotic Fractures: Fluid in Magnetic Resonance Imaging-Vacuum in Computed Tomography?
Spine. 34(2):E88-E93, January 15, 2009.
Abstract
Study Design. The study consisted of a retrospective and a prospective study part.Objective. We aimed to investigate the nature of the intravertebral vacuum clefts (IVC) in computed tomography (CT) in acute osteoporotic vertebral fractures in correlation with magnetic resonance imaging (MRI).Summary of Background Data. IVC and intravertebral fluid accumulations have been shown to be indicative of benign vertebral fractures in CT and MRI, respectively.Methods. Twenty-eight patients (30 osteoporotic fractures) associated with intravertebral vacuum in CT in whom MRI of the spine was performed were retrospectively analyzed. Moreover, we prospectively performed MRI examinations in 12 consecutive patients with 13 osteoporotic fractures with an intravertebral vacuum in CT. T1-w SE, STIR, and 5 repetitive T2-w TSE studies were performed (1.5 Tesla system, Siemens). Two experienced readers assessed the examinations in consensus with regard to the occurrence and location of the intravertebral and intradiscal vacuum on CT and the corresponding signal alterations in MRI.Results. Twenty-seven (90%) of the retrospectively analyzed fractures with intravertebral vacuum in CT showed a fluid like signal in the location of the vacuum in MRI. In the prospective group, a small fluid-like signal was initially present on T2-weighted sequences in 11 of 13 fractures (84.6%). During the repeated T2-weighted measurements, the fluid occurred or increased markedly in all cases. An intradiscal fluid was present either initially and/or during the course of the examination in 46% of the prospective cases and in 50% of the retrospectively evaluated fractures.Conclusion. The occurrence of the fluid in MRI within intravertebral clefts is a dynamic process, which is dependent on the position of the patient and is presumably secondary to the extension momentum in the supine position. This may be due to the negative pressure in the horizontal position in which the fracture site is distracted. intravertebral.
Samdani, Amer F. ; Fayssoux, Reginald S. ; Asghar, Jahangir ; McCarthy, James J. et al
Chronic Spinal Cord Injury in the Pediatric Population: Does Magnetic Resonance Imaging Correlate With the International Standards for Neurological Classification of Spinal Cord Injury Examination?
Spine. 34(1):74-81, January 1, 2009.
Abstract
Study Design. Prognostic, retrospective case series.Objective. This study is part of a larger investigation to develop and validate a standardized and reliable method to evaluate and classify the neurologic consequence of spinal cord injury (SCI) in children. Such an instrument may also find use in the evaluation of patients with concomitant brain injury and/or cognitive impairment. We examined the relationship between the International Standards for Neurologic Classification of Spinal Cord Injury (ISCSCI) examination and magnetic resonance imaging (MRI) findings in a pediatric SCI population.Summary of Background Data. Recently, the reliability of the ISCSCI in young children with SCI who are unable to cognitively engage in the examination has been called into question. This has important implications as appropriate classification of these patients is necessary for prognostication, follow-up care, and appropriate placement into clinical trials.Methods. Our longitudinal pediatric SCI database was reviewed for children with chronic SCI (>6 months), ISCSCI examinations performed by experienced testers, and adequate MRIs of the spine. ISCSCI results were correlated with MRI findings. Twenty-six subjects were identified.Results. Overall, good to excellent relationships between ISCSCI neurologic level (NL) and MRI level of injury were found [Kendall [tau] correlation coefficient 0.90
Lehman, Ronald A. Jr ; Helgeson, Melvin D. ; Keeler, Kathryn A. et al
Comparison of Magnetic Resonance Imaging and Computed Tomography in Predicting Facet Arthrosis in the Cervical Spine
Spine. 34(1):65-68, January 1, 2009.
Abstract
Study Design. Retrospective review.Objective. To determine the ability of magnetic resonance imaging (MRI) and computed tomography (CT) to predict the presence of cervical facet arthrosis.Summary of Background Data. In the Food and Drug Administration Investigational Device Exemption trials of cervical disc arthroplasty (CDA), the presence of facet arthrosis on CT was a contraindication to the insertion of a CDA. Most surgeons routinely obtain an MRI, but not necessarily a CT before performing surgery in the cervical spine. We sought to determine if the MRI alone is adequate to assess for the presence of facet arthrosis.Methods. Three experienced spine surgeons retrospectively evaluated CT scans and MRIs of the same patients, obtained within 30 days of each other in a blinded, random fashion. Reviewers graded each of the MRI and CT scan as normal or abnormal on 3 separate occasions and if the facet was abnormal, each reviewer graded the degree of arthrosis. The radiologist's evaluation for each study was compared with our results.Results. Of 594 facets analyzed, 43.1% were categorized as normal on CT, and of those, MRI concordance was only 63.7% with moderate/substantial intermethod agreement. Furthermore, MRI was concordant only 15.9% of the time in patients with ankylosed facet joints on CT. CT inter-rater reliability showed substantial agreement for diagnoses of both normal and ankylosis and fair agreement for lesser degrees of facet arthrosis. MRI inter-rater reliability showed fair/moderate agreement in normal and ankylosed segments and only slight agreement with lesser degrees of facet arthrosis. CT intrarater reliability showed substantial agreement in normal or ankylosed joints, but only fair agreement for all other categories; MRI showed only fair agreement.Conclusion. The ability of MRI to adequately determine the presence or amount of facet arthrosis is not reliable. Additionally, for abnormal facets, MRI was not reliable in adequately determining the degree of arthrosis. Our data suggest that computed tomography remains necessary in diagnosing facet arthrosis before CDA.
Wednesday, 9 July 2008
Spine - online articles
Link to journal
Park, Chun-Kun ; Ryu, Kyeong-Sik ; Jee, Won-Hee
Degenerative Changes of Discs and Facet Joints in Lumbar Total Disc Replacement Using ProDisc II: Minimum Two-Year Follow-up
Publish Ahead of Print, POST AUTHOR CORRECTIONS, 23 June 2008
Abstract
Study Design. A retrospective clinical and radiologic data analysis. Objective. To determine the radiologic changes in the discs at the adjacent levels and facets at the index and adjacent levels after total disc replacement (TDR) using ProDisc II in a minimum 2-year follow-up.Summary of the Background Data. The main purposes of TDR are to preserve the physiologic segmental motion at index level, and to prevent accelerated degeneration at the index and adjacent segments. However, there are few reports dealing with the effects of TDR on the degenerative changes in a long-term follow-up.Methods. After TDR using ProDisc II, the degree of disc and facets degeneration at the index and adjacent levels was assessed by observing lumbar magnetic resonance imaging (MRI) and computed tomography (CT) images before surgery and at minimum 26 months after operations. The degenerative changes of the discs and facets were determined in relation to the clinical outcome, various perioperative factors, and prosthesis factors.Results. Thirty-two patients with 41 TDR included in this investigation. The progression of facets degeneration (PFA) was observed in 12 of 41 TDR levels. Among 47 adjacent segments, the progression of disc degeneration and PFA were observed in 2 levels (4.3%), and 3 levels (6.4%), respectively. All cases of PFA occurred only in those with preoperative degeneration of grade 1. PFA at the index segments was positively related with female in gender (P = 0.008), the malposition of prosthesis on frontal plane (P = 0.025), and 2-level TDR in the number of TDR level (P = 0.008).Conclusion. After TDR using ProDisc II, the degenerative changes in the discs and facets at the adjacent segments appeared to be minimal. However, in 29.3% of the TDR segments, the facet joints presented PFA, which was more common in female, malposition of prosthesis on frontal plane, and 2-level TDR in a minimum 2-year follow-up.
Park, Chun-Kun ; Ryu, Kyeong-Sik ; Jee, Won-Hee
Degenerative Changes of Discs and Facet Joints in Lumbar Total Disc Replacement Using ProDisc II: Minimum Two-Year Follow-up
Publish Ahead of Print, POST AUTHOR CORRECTIONS, 23 June 2008
Abstract
Study Design. A retrospective clinical and radiologic data analysis. Objective. To determine the radiologic changes in the discs at the adjacent levels and facets at the index and adjacent levels after total disc replacement (TDR) using ProDisc II in a minimum 2-year follow-up.Summary of the Background Data. The main purposes of TDR are to preserve the physiologic segmental motion at index level, and to prevent accelerated degeneration at the index and adjacent segments. However, there are few reports dealing with the effects of TDR on the degenerative changes in a long-term follow-up.Methods. After TDR using ProDisc II, the degree of disc and facets degeneration at the index and adjacent levels was assessed by observing lumbar magnetic resonance imaging (MRI) and computed tomography (CT) images before surgery and at minimum 26 months after operations. The degenerative changes of the discs and facets were determined in relation to the clinical outcome, various perioperative factors, and prosthesis factors.Results. Thirty-two patients with 41 TDR included in this investigation. The progression of facets degeneration (PFA) was observed in 12 of 41 TDR levels. Among 47 adjacent segments, the progression of disc degeneration and PFA were observed in 2 levels (4.3%), and 3 levels (6.4%), respectively. All cases of PFA occurred only in those with preoperative degeneration of grade 1. PFA at the index segments was positively related with female in gender (P = 0.008), the malposition of prosthesis on frontal plane (P = 0.025), and 2-level TDR in the number of TDR level (P = 0.008).Conclusion. After TDR using ProDisc II, the degenerative changes in the discs and facets at the adjacent segments appeared to be minimal. However, in 29.3% of the TDR segments, the facet joints presented PFA, which was more common in female, malposition of prosthesis on frontal plane, and 2-level TDR in a minimum 2-year follow-up.
Wednesday, 18 June 2008
Link to journal
Lurie, Jon D. ; Tosteson, Anna N. ; Tosteson, Tor D. ; Carragee, Eugene ; Carrino, John et al
Reliability of Readings of Magnetic Resonance Imaging Features of Lumbar Spinal Stenosis
Spine. 33(14):1605-1610, June 15, 2008.
Abstract
Study Design. A reliability assessment of standardized magnetic resonance imaging (MRI) interpretations and measurements.Objective. To determine the intra- and inter-reader reliability of MRI features of lumbar spinal stenosis (SPS), including severity of central, subarticular, and foraminal stenoses, grading of nerve root impingement, and measurements of cross-sectional area of the spinal canal and thecal sac.Summary of Background Data. MRI is commonly used to assess patients with spinal stenosis. Although a number of studies have evaluated the reliability of certain MRI characteristics, comprehensive evaluation of the reliability of MRI readings in spinal stenosis is lacking.Methods. Fifty-eight randomly selected MR images from patients with SPS enrolled in the Spine Patient Outcomes Research Trial were evaluated. Qualitative ratings of imaging features were performed according to defined criteria by 4 independent readers (3 radiologists and 1 orthopedic surgeon). A sample of 20 MRIs was reevaluated by each reader at least 1 month later. Weighted [kappa] statistics were used to characterize intra- and inter-reader reliability for qualitative rating data. Separate quantitative measurements were performed by 2 other radiologists. Intraclass correlation coefficients and summaries of measurement error were used to characterize reliability for quantitative measurements.Results. Intra-reader reliability was higher than inter-reader reliability for all features. Inter-reader reliability in assessing central stenosis was substantial, with an overall [kappa] of 0.73 (95% CI 0.69-0.77). Foraminal stenosis and nerve root impingement showed moderate to substantial agreement with overall [kappa] of 0.58 (95% CI 0.53-0.63) and 0.51 (95% CI 0.42-0.59), respectively. Subarticular zone stenosis yielded the poorest agreement (overall [kappa] 0.49; 95% CI 0.42-0.55) and showed marked variability in agreement between reader pairs. Quantitative measures showed inter-reader intraclass correlation coefficients ranging from 0.58 to 0.90. The mean absolute difference between readers in measured thecal sac area was 128 mm2 (13%).Conclusion. The imaging characteristics of spinal stenosis assessed in this study showed moderate to substantial reliability; future studies should assess whether these findings have prognostic significance in SPS patients.
Lurie, Jon D. ; Tosteson, Anna N. ; Tosteson, Tor D. ; Carragee, Eugene ; Carrino, John et al
Reliability of Readings of Magnetic Resonance Imaging Features of Lumbar Spinal Stenosis
Spine. 33(14):1605-1610, June 15, 2008.
Abstract
Study Design. A reliability assessment of standardized magnetic resonance imaging (MRI) interpretations and measurements.Objective. To determine the intra- and inter-reader reliability of MRI features of lumbar spinal stenosis (SPS), including severity of central, subarticular, and foraminal stenoses, grading of nerve root impingement, and measurements of cross-sectional area of the spinal canal and thecal sac.Summary of Background Data. MRI is commonly used to assess patients with spinal stenosis. Although a number of studies have evaluated the reliability of certain MRI characteristics, comprehensive evaluation of the reliability of MRI readings in spinal stenosis is lacking.Methods. Fifty-eight randomly selected MR images from patients with SPS enrolled in the Spine Patient Outcomes Research Trial were evaluated. Qualitative ratings of imaging features were performed according to defined criteria by 4 independent readers (3 radiologists and 1 orthopedic surgeon). A sample of 20 MRIs was reevaluated by each reader at least 1 month later. Weighted [kappa] statistics were used to characterize intra- and inter-reader reliability for qualitative rating data. Separate quantitative measurements were performed by 2 other radiologists. Intraclass correlation coefficients and summaries of measurement error were used to characterize reliability for quantitative measurements.Results. Intra-reader reliability was higher than inter-reader reliability for all features. Inter-reader reliability in assessing central stenosis was substantial, with an overall [kappa] of 0.73 (95% CI 0.69-0.77). Foraminal stenosis and nerve root impingement showed moderate to substantial agreement with overall [kappa] of 0.58 (95% CI 0.53-0.63) and 0.51 (95% CI 0.42-0.59), respectively. Subarticular zone stenosis yielded the poorest agreement (overall [kappa] 0.49; 95% CI 0.42-0.55) and showed marked variability in agreement between reader pairs. Quantitative measures showed inter-reader intraclass correlation coefficients ranging from 0.58 to 0.90. The mean absolute difference between readers in measured thecal sac area was 128 mm2 (13%).Conclusion. The imaging characteristics of spinal stenosis assessed in this study showed moderate to substantial reliability; future studies should assess whether these findings have prognostic significance in SPS patients.
Wednesday, 28 May 2008
Recent articles from Spine journal
Link to journal
Videman, Tapio MD; Battie, Michele C.; Parent, Eric; Gibbons, Laura E.; Vainio, Pauli; Kaprio, Jaakko
Progression and Determinants of Quantitative Magnetic Resonance Imaging Measures of Lumbar Disc Degeneration: A Five-Year Follow-up of Adult Male Monozygotic Twins
Publish Ahead of Print, POST AUTHOR CORRECTIONS, 9 May 2008
Abstract
Study Design. A longitudinal study.Objective. Our goal was to explore the role of digital magnetic resonance imaging (MRI) data, by extending our earlier 5-year follow-up study of progression of lumbar spine degeneration with quantitative measures of disc degeneration.Summary of Background Data. A longitudinal study is optimal for investigating disc degeneration but only a few studies (with small sample sizes) or short follow-up studies include repeated MRI data.Methods. Subjects consisted of 134 male monozygotic twins (age 35-69 years). Quantitative MRI measures included changes in disc bulging and height. Inter-rater reliability coefficients were between 0.77 and 0.96. At baseline and follow-up, an extensive interview about exposures to suspected determinants was conducted.Results. Reduction in disc height and increases in bulges (worsening) were seen in 2/3 of subjects. The mean reduction in disc height was 2.2% to 3.6%. A mean increase in bulging of 7% to 10% was found in the L1-L4 discs and 4% in L4-S1 discs. Although the mean changes were small, few reverse changes were observed. Familial aggregation, a proxy for genetic influences, explained 17% of changes in disc height, and 11% and 0% of changes in the sizes of anterior and posterior bulges in the regression models. Higher maximal occupational lifting (AR2 = 4.9%) and smoking (AR2 = 3.5%) during follow-up predicted more disc height reduction. Greater increases in bulging (AR2 = 7.4%-10.2%) were predicted by smaller bulges at baseline.Conclusion. The mean annual changes in disc heights (<1%)>
Kanayama, Masahiro; Togawa, Daisuke; Terai, Tomoya; Hashimoto, Tomoyuki et al
RISK FACTORS FOR LUMBAR DISC DEGENERATION: AN MRI ANALYSIS OF 130 HEALTHY VOLUNTEERS. [Abstract]
Spine. (Supplement 2008 Meeting Abstracts):101, August 2008.
Davis, Rick
ROUTINE DYNAMIC IMAGING FOR EVALUATING DEGENERATIVE LUMBAR STENOSIS: INCIDENCE OF DEGENERATIVE SPONDYLOLISTHESIS MISSED ON SUPINE MRI.[Abstract]
Spine. (Supplement 2008 Meeting Abstracts):6, August 2008.
Videman, Tapio MD; Battie, Michele C.; Parent, Eric; Gibbons, Laura E.; Vainio, Pauli; Kaprio, Jaakko
Progression and Determinants of Quantitative Magnetic Resonance Imaging Measures of Lumbar Disc Degeneration: A Five-Year Follow-up of Adult Male Monozygotic Twins
Publish Ahead of Print, POST AUTHOR CORRECTIONS, 9 May 2008
Abstract
Study Design. A longitudinal study.Objective. Our goal was to explore the role of digital magnetic resonance imaging (MRI) data, by extending our earlier 5-year follow-up study of progression of lumbar spine degeneration with quantitative measures of disc degeneration.Summary of Background Data. A longitudinal study is optimal for investigating disc degeneration but only a few studies (with small sample sizes) or short follow-up studies include repeated MRI data.Methods. Subjects consisted of 134 male monozygotic twins (age 35-69 years). Quantitative MRI measures included changes in disc bulging and height. Inter-rater reliability coefficients were between 0.77 and 0.96. At baseline and follow-up, an extensive interview about exposures to suspected determinants was conducted.Results. Reduction in disc height and increases in bulges (worsening) were seen in 2/3 of subjects. The mean reduction in disc height was 2.2% to 3.6%. A mean increase in bulging of 7% to 10% was found in the L1-L4 discs and 4% in L4-S1 discs. Although the mean changes were small, few reverse changes were observed. Familial aggregation, a proxy for genetic influences, explained 17% of changes in disc height, and 11% and 0% of changes in the sizes of anterior and posterior bulges in the regression models. Higher maximal occupational lifting (AR2 = 4.9%) and smoking (AR2 = 3.5%) during follow-up predicted more disc height reduction. Greater increases in bulging (AR2 = 7.4%-10.2%) were predicted by smaller bulges at baseline.Conclusion. The mean annual changes in disc heights (<1%)>
Kanayama, Masahiro; Togawa, Daisuke; Terai, Tomoya; Hashimoto, Tomoyuki et al
RISK FACTORS FOR LUMBAR DISC DEGENERATION: AN MRI ANALYSIS OF 130 HEALTHY VOLUNTEERS. [Abstract]
Spine. (Supplement 2008 Meeting Abstracts):101, August 2008.
Davis, Rick
ROUTINE DYNAMIC IMAGING FOR EVALUATING DEGENERATIVE LUMBAR STENOSIS: INCIDENCE OF DEGENERATIVE SPONDYLOLISTHESIS MISSED ON SUPINE MRI.[Abstract]
Spine. (Supplement 2008 Meeting Abstracts):6, August 2008.
Wednesday, 30 April 2008
Spine. 33(9): April 20, 2008
Link to journal and full text
Hay, Douglas FRCS; Izatt, Maree T. BPhty; Adam, Clayton J. PhD; Labrom et al
The Use of Fulcrum Bending Radiographs in Anterior Thoracic Scoliosis Correction: A Consecutive Series of 90 Patients
p. 999-1005
Abstract
Study Design. A prospective, consecutive series of 90 patients receiving fulcrum bending radiographs before endoscopic anterior scoliosis correction.Objective. To assess the effectiveness of fulcrum bending radiographs in predicting correction of the structural curve in anterior scoliosis surgery for a series of 90 consecutive patients.Summary of Background Data. The fulcrum bending radiograph is highly predictive of scoliosis curve correction for posterior instrumented fixation. However, its use has been questioned in relation to anterior scoliosis surgery due to the disc removal in anterior procedures.Methods. Fulcrum bending radiographs were performed before endoscopic anterior scoliosis correction following the protocol of Cheung and Luk. All patients received a single anterior rod and vertebral body screws using a standard compression technique. In all cases, cleared disc spaces were packed with mulched femoral head allograft. Surgical correction was assessed using 6- to 8-week postoperative standing radiographs. Paired t tests and least squares linear regression analysis were used to compare the preoperative major Cobb angle achieved on the fulcrum bending radiograph with the postoperative Cobb angles for each patient.Results. Mean (+/-SD) major curve correction rate was 60.1% +/- 12.4%. Mean instrumented curve correction rate was 63.7% +/- 11.7%. Mean fulcrum flexibility was 60.8% +/- 15.5%. Mean fulcrum bending correction index was 104%. There was no statistically significant difference between the mean fulcrum bending radiograph Cobb angle (20.4 +/- 9[degrees]) and the mean postoperative major Cobb angle for the structural curve (20.5 +/- 7.1[degrees]).Conclusion. The results of this study show that fulcrum bending radiographs are predictive of surgical correction for anterior scoliosis surgery.
Lurie, Jon D.; Tosteson, Anna N. A. ; Tosteson, Tor D. et al
Reliability of Magnetic Resonance Imaging Readings for Lumbar Disc Herniation in the Spine Patient Outcomes Research Trial (SPORT)
p. 991-998
Abstract
Study Design. Assessment of the reliability of standardized magnetic resonance imaging (MRI) interpretations and measurements.Objective. To determine the intra- and inter-reader reliability of MRI parameters relevant to patients with intervertebral disc herniation (IDH), including disc morphology classification, degree of thecal sac compromise, grading of nerve root impingement, and measurements of cross-sectional area of the spinal canal, thecal sac, and disc fragment.Summary of Background Data. MRI is increasingly used to assess patients with sciatica and IDH, but the relationship between specific imaging characteristics and patient outcomes remains uncertain. Although other studies have evaluated the reliability of certain MRI characteristics, comprehensive evaluation of the reliability of readings of herniated disc features on MRI is lacking.Methods. Sixty randomly selected MR images from patients with IDH enrolled in the Spine Patient Outcomes Research Trial were each rated according to defined criteria by 4 independent readers (3 radiologists and 1 orthopedic surgeon). Quantitative measurements were performed separately by 2 other radiologists. A sample of 20 MRIs was re-evaluated by each reader at least 1 month later. Agreement for rating data were assessed with kappa statistics using linear weights. Reliability of the quantitative measurements was assessed using intraclass correlation coefficients (ICCs) and summaries of measurement error.Results. Inter-reader reliability was substantial for disc morphology [overall kappa 0.81 (95% confidence interval (CI): 0.78, 0.85)], moderate for thecal sac compression [overall kappa 0.54 (95% CI: 0.37, 0.68)], and moderate for grading nerve root impingement [overall kappa 0.47 (95% CI: 0.36, 0.56)]. Quantitative measures showed high ICCs of 0.87 to 0.96 for spinal canal and thecal sac cross-sectional areas. Measures of disc fragment area had moderate ICCs of 0.65 to 0.83. Mean absolute differences between measurements ranged from approximately 15% to 20%.Conclusion. Classification of disc morphology showed substantial intra- and inter-reader agreement, whereas thecal sac and nerve root compression showed more moderate reader reliability. Quantitative measures of canal and thecal sac area showed good reliability, whereas measurement of disc fragment area showed more modest reliability.
Hay, Douglas FRCS; Izatt, Maree T. BPhty; Adam, Clayton J. PhD; Labrom et al
The Use of Fulcrum Bending Radiographs in Anterior Thoracic Scoliosis Correction: A Consecutive Series of 90 Patients
p. 999-1005
Abstract
Study Design. A prospective, consecutive series of 90 patients receiving fulcrum bending radiographs before endoscopic anterior scoliosis correction.Objective. To assess the effectiveness of fulcrum bending radiographs in predicting correction of the structural curve in anterior scoliosis surgery for a series of 90 consecutive patients.Summary of Background Data. The fulcrum bending radiograph is highly predictive of scoliosis curve correction for posterior instrumented fixation. However, its use has been questioned in relation to anterior scoliosis surgery due to the disc removal in anterior procedures.Methods. Fulcrum bending radiographs were performed before endoscopic anterior scoliosis correction following the protocol of Cheung and Luk. All patients received a single anterior rod and vertebral body screws using a standard compression technique. In all cases, cleared disc spaces were packed with mulched femoral head allograft. Surgical correction was assessed using 6- to 8-week postoperative standing radiographs. Paired t tests and least squares linear regression analysis were used to compare the preoperative major Cobb angle achieved on the fulcrum bending radiograph with the postoperative Cobb angles for each patient.Results. Mean (+/-SD) major curve correction rate was 60.1% +/- 12.4%. Mean instrumented curve correction rate was 63.7% +/- 11.7%. Mean fulcrum flexibility was 60.8% +/- 15.5%. Mean fulcrum bending correction index was 104%. There was no statistically significant difference between the mean fulcrum bending radiograph Cobb angle (20.4 +/- 9[degrees]) and the mean postoperative major Cobb angle for the structural curve (20.5 +/- 7.1[degrees]).Conclusion. The results of this study show that fulcrum bending radiographs are predictive of surgical correction for anterior scoliosis surgery.
Lurie, Jon D.; Tosteson, Anna N. A. ; Tosteson, Tor D. et al
Reliability of Magnetic Resonance Imaging Readings for Lumbar Disc Herniation in the Spine Patient Outcomes Research Trial (SPORT)
p. 991-998
Abstract
Study Design. Assessment of the reliability of standardized magnetic resonance imaging (MRI) interpretations and measurements.Objective. To determine the intra- and inter-reader reliability of MRI parameters relevant to patients with intervertebral disc herniation (IDH), including disc morphology classification, degree of thecal sac compromise, grading of nerve root impingement, and measurements of cross-sectional area of the spinal canal, thecal sac, and disc fragment.Summary of Background Data. MRI is increasingly used to assess patients with sciatica and IDH, but the relationship between specific imaging characteristics and patient outcomes remains uncertain. Although other studies have evaluated the reliability of certain MRI characteristics, comprehensive evaluation of the reliability of readings of herniated disc features on MRI is lacking.Methods. Sixty randomly selected MR images from patients with IDH enrolled in the Spine Patient Outcomes Research Trial were each rated according to defined criteria by 4 independent readers (3 radiologists and 1 orthopedic surgeon). Quantitative measurements were performed separately by 2 other radiologists. A sample of 20 MRIs was re-evaluated by each reader at least 1 month later. Agreement for rating data were assessed with kappa statistics using linear weights. Reliability of the quantitative measurements was assessed using intraclass correlation coefficients (ICCs) and summaries of measurement error.Results. Inter-reader reliability was substantial for disc morphology [overall kappa 0.81 (95% confidence interval (CI): 0.78, 0.85)], moderate for thecal sac compression [overall kappa 0.54 (95% CI: 0.37, 0.68)], and moderate for grading nerve root impingement [overall kappa 0.47 (95% CI: 0.36, 0.56)]. Quantitative measures showed high ICCs of 0.87 to 0.96 for spinal canal and thecal sac cross-sectional areas. Measures of disc fragment area had moderate ICCs of 0.65 to 0.83. Mean absolute differences between measurements ranged from approximately 15% to 20%.Conclusion. Classification of disc morphology showed substantial intra- and inter-reader agreement, whereas thecal sac and nerve root compression showed more moderate reader reliability. Quantitative measures of canal and thecal sac area showed good reliability, whereas measurement of disc fragment area showed more modest reliability.
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