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Background: As the elderly population grows, the increasing prevalence of osteoporosis presents a unique challenge for surgeons. Decreased bone strength and quality are associated with hardware failure and impaired bone healing, which may increase the rate of revision surgery and the development of complications. The purpose of this review is to determine the impact of osteoporosis on postoperative outcomes for patients with cervical degenerative disease or deformity. Methods: A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Medical Subject Headings terms involving spine surgery for cervical degenerative disease and osteoporosis were performed. This review focused on radiographic outcomes, as well as surgical and medical complications. Results: There were 16 studies included in the degenerative group and 9 in the deformity group. Across degenerative studies, lower bone mineral density was associated with increased rates of cage subsidence in osteoporotic patients undergoing operative treatment for cervical degenerative disease. Most studies reported varied results on the relationship between osteoporosis and other outcomes such as revision and readmission rates, costs, and perioperative complications. Our meta-analysis suggests that osteoporotic patients carry a greater risk of reduced fusion rates at 6 months and 1 year postoperatively. With respect to cervical deformity correction, although individual complication rates were unchanged with osteoporosis, the collective risk of incurring any complication may be increased in patients with poor bone stock. Conclusions: Overall, the literature suggests that outcomes for osteoporotic patients after cervical spine surgery are multifactorial. Osteoporosis seems to be a significant risk factor for developing cage subsidence and pseudarthrosis postoperatively, whereas reports on medical and hospital-related metrics were inconclusive. Our findings highlight the challenges of caring for osteoporotic patients and underline the need for adequately powered studies to understand how osteoporosis changes the risk index of patients undergoing cervical spine surgery. Clinical Relevance: In patients undergoing cervical spine surgery for degenerative disease, osteoporosis is a significant risk factor for long-term postoperative complications--notably cage subsidence and pseudarthrosis. Given the elective nature of these procedures, interdisciplinary collaboration between providers should be routinely implemented to enable medical optimization of patients prior to cervical spine surgery. Level of Evidence: 1. [ABSTRACT FROM AUTHOR]

Background: This review outlines clinical data and characteristics of current Food and Drug Administration (FDA)-approved implants in cervical disc replacement/cervical disc arthroplasty (CDR/CDA) to provide a centralized resource for spine surgeons. Methods: Randomized controlled trials (RCTs) on CDR/CDA were identified using a search of the PubMed, Web of Science, and Google Scholar databases. The initial search identified 69 studies. Duplicates were removed, and the following inclusion criteria were applied when determining eligibility of RCTs for the current review: (1) discussing CDR/CDA prosthesis and (2) published within between 2010 and 2020. Studies without clinical data or that were not RCTs were excluded. All articles were reviewed independently by 2 authors, with the involvement of an arbitrator to facilitate consensus on any discrepancies. Results: A total of 34 studies were included in the final review. Findings were synthesized into a comprehensive table describing key features and clinical results for each FDA-approved CDR/CDA implant and are overall suggestive of expanding indications and increasing utilization. Conclusions: RCTs have provided substantial evidence to support CDR/CDA for treating single- and 2-level cervical degenerative disc disease in place of conventional anterior cervical discectomy and fusion. Clinical Relevance: This review provides a resource that consolidates relevant clinical data for current FDA-approved implants to help spine surgeons make an informed decision during preoperative planning. Level of Evidence: 5 [ABSTRACT FROM AUTHOR]

Study Design: Narrative review. Objectives: The purpose of this review is to outline the role of sex hormones, particularly estrogen, in the pathogenesis of degenerative disc disease (DDD). Methods: A narrative review of studies discussing sex hormones and intervertebral disc (IVD) degeneration was conducted through a search of bibliographic databases to identify various mechanisms involved in effectuating DDD. Results: Estrogen-deficient states negatively impact various aspects of IVD function. These internal hormone environments reflect routine changes that commonly arise with physiologic aging and can compromise IVD structural integrity through a host of processes. Additionally, allosteric molecules such as micro-RNAs (mi-RNAs) and G protein-coupled estrogen receptors (GPER) antagonists can bind to estrogen receptors and inhibit protective downstream effects with estrogen receptor signaling. Furthermore, cursory studies have observed chondrogenic effects with testosterone supplementation, although the specific mechanism remains unclear. Conclusions: Regulation of sex hormones, namely estrogen and testosterone, significantly impacts the structural integrity and function of IVDs. Uncovering underlying interactions driving these regulatory processes can facilitate development of novel, clinical therapies to treat DDD. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the trends and patterns of cervical degenerative disc disease in the cervical spine in different age groups of symptomatic patients.Methods: Overall, 1300 symptomatic patients who had undergone cervical spine MRI from February 2019 to November 2021 were included. Pfirrmann grading was used to evaluate the IVD degeneration. Patients were divided into five groups based on age: group 1 from 20 to 29 years, group 2 from 30 to 39 years, group 3 from 40 to 49 years, group 4 from 50 to 59 years, and group 5 from 60 years and above. The patterns, severity, and the number of degenerated levels in each age group were analysed.Results: The total number of degenerated IVDs (grades IV and V) increased significantly with age, ranging from 76 (4.9%) in group 1 to 677 (43.4%) in group 5. The most common degenerated levels were C2/3 (25% of the total degenerated levels) in group 1, C5/6 (29.0%) in group 2, C5/6 (33.1%) in group 3, C5/6 (31.3%) in group 4, C5/6 (24.8%), in group 5. The number of degenerated IVDs increased significantly with age (P < 0.001). In patients with two or more degenerated levels, contiguous-level disc degeneration was more common than skip lesions.Conclusion: This study evaluated the severity and pattern of cervical disc degeneration at each level in different age groups. The severity and number of degenerated levels increased significantly with increased age. Adjacent-level degeneration is more common than skip lesions in patients with more than one-level degeneration. [ABSTRACT FROM AUTHOR]

Study Design: Systematic review Objective: Examine the clinical evidence for the use of osteobiologics in hybrid surgery (combined anterior cervical discectomy and fusion (ACDF) and total disc replacement (TDR)) in patients with multilevel cervical degenerative disc disease (DDD). Methods: PubMed and Embase were searched between January 2000 and August 2020. Clinical studies investigating 18-80 year old patients with multilevel cervical DDD who underwent hybrid surgery with or without the use of osteobiologics were considered eligible. Two reviewers independently screened and assessed the identified articles. The methodological index for non-randomized studies (MINORS) tool and the risk of bias (RoB 2.0) assessment tool were used to assess risk of bias. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to evaluate quality of evidence across studies per outcome. Results: Eleven studies were included. A decrease in cervical range of motion was observed in most studies for both the hybrid surgery and the control groups consisting of stand-alone ACDF or TDR. Fusion rates of 70-100% were reported in both the hybrid surgery and control groups consisting of stand-alone ACDF. The hybrid surgery group performed better or comparable to the control group in terms of adjacent segment degeneration. Studies reported an improvement in visual analogue scale for pain and neck disability index values after surgery compared to preoperative scores for both treatment groups. The included studies had moderate methodological quality. Conclusions: There is insufficient evidence for assessing the use of osteobiologics in multilevel hybrid surgery and additional high quality and controlled research is deemed essential. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate facet joint parameters and osteoarthritis grades, and segmental angular and translational motions among different grades of L5/S1 intervertebral disc (IVD) degeneration. Methods: This retrospective study analysed kinematic magnetic resonance imaging (kMRI) images of the lumbar spine of 214 patients with low back pain. Degenerations of the L5/S1 IVDs and facet joints osteoarthritis were assessed using the Pfirrmann and Pathria grading scales, respectively. Facet joint parameters included facet joint angle and facet joint space width. Angular and translation segmental motions were measured using MRI Analyzer software. Results: The mean age of the studied patients was 44.1 ± 13.9 years. Patients with L5/S1 disc degeneration were associated with higher odds of facet joint osteoarthritis (odds ratio = 2.28, 95% confidence interval = 1.23–4.23, P = 0.008). There was a positive correlation between L5/S1 disc degeneration grade and the facet joint grade (r = 0.365, P > 0.001). Grade IV facet joint osteoarthritis did not appear in grades I or II disc degeneration (P > 0.001). The average facet joint width decreased significantly with increasing Pfirrmann grading (P = 0.017). The difference in facet joint angle between groups was not statistically significant (P = 0.532). The differences in the angular and translational motions were not statistically significant (P = 0.530, and 0.510, respectively). Conclusion: A positive correlation exists between L5/S1 disc degeneration and facet joint osteoarthritis grades. The facet joint space width decreases significantly with increasing grade of disc degeneration. [ABSTRACT FROM AUTHOR]

Purpose: Recent research shows an increasing recognition that organisms not traditionally considered infectious in nature contribute to disease processes. Propionibacterium acnes (P. acnes) is a gram-positive, aerotolerant anaerobe prevalent in the sebaceous gland-rich areas of the human skin. A ubiquitous slow-growing organism with the capacity to form biofilm, P. acnes, recognized for its role in acne vulgaris and medical device-related infections, is now also linked to a number of other human diseases. While bacterial culture and molecular techniques are used to investigate the involvement of P. acnes in such diseases, definitive demonstration of P. acnes infection requires a technique (or techniques) sensitive to the presence of biofilms and insensitive to the presence of potential contamination. Fortunately, there are imaging techniques meeting these criteria, in particular, fluorescence in situ hybridization and immunofluorescence coupled with confocal laser scanning microscopy, as well as immunohistochemistry.Methods: Our literature review considers a range of microscopy-based studies that provides definitive evidence of P. acnes colonization within tissue from a number of human diseases (acne vulgaris, degenerative disc and prostate disease and atherosclerosis), some of which are currently not considered to have an infectious etiology.Results/conclusion: We conclude that P. acnes is an opportunistic pathogen with a likely underestimated role in the development of various human diseases associated with significant morbidity and, in some cases, mortality. As such, these findings offer the potential for new studies aimed at understanding the pathological mechanisms driving the observed disease associations, as well as novel diagnostic strategies and treatment strategies, particularly for degenerative disc disease. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

Purpose: This study defined the incidence and trends of surgeries performed for patients with cervical disc degeneration with and without tobacco use disorder (TUD).Methods: This study utilized the Humana Inc. database between 2007 and 2013 to identify patients with cervical disc degeneration with or without myelopathy. International Classification of Diseases, ninth revision (ICD-9) and Current Procedural Terminology (CPT) codes determined the initial diagnosis of disc degeneration, myelopathy status and TUD, whether patients received surgery, and TUD status at surgery.Results: The prevalence of disc degeneration with myelopathy increased by 32.8% between 2007 and 2013, while disc disease with myelopathy and TUD increased by 91.6%. For patients without myelopathy, the prevalence of disc degeneration alone increased by 65.4%, and disc degeneration with myelopathy increased by 148.7%. Of myelopathy patients, 1717 (6.4%) had TUD and 1024 (59.6%) received surgery, compared to 6508 patients without TUD (26.1%). For patients without myelopathy, 11,337 (3.5%) had TUD and 787 (6.9%) underwent surgery, compared to 9716 patients (3%) without TUD. Of surgical patients, 781 (76.3%) with myelopathy and TUD still had a TUD diagnosis at surgery, and 542 (68.9%) of patients without myelopathy still had a TUD diagnosis at surgery.Conclusions: The prevalence of degenerative disc disease and TUD has increased more than disc disease alone. Patients with TUD were more likely to get surgery, and to have surgeries earlier than patients without TUD. Patients with TUD at the time of the diagnosis of their disc degeneration likely still had a TUD diagnosis at the time of surgery. [ABSTRACT FROM AUTHOR]

Posterior spinal ligament pathology is becoming increasingly recognized as a significant cause of low back pain. Despite the growing clinical importance of interspinous ligament degeneration in low back pain patients, formal reliability studies for the magnetic resonance imaging (MRI) evaluation of interspinous ligaments have not been performed. We proposed an MRI classification system for interspinous ligament degeneration and conducted a comprehensive reliability and reproducibility assessment. Fifty patients who had low back pain with or without leg discomfort (26 males and 24 females) with a mean age of 48.8 years (range 23-85 years) were studied. The classification for lumbar interspinous ligament degeneration was developed on the basis of the literature using mid-sagittal T1- and T2-weighted images. Three spine surgeons independently graded a total of 200 interspinous ligament levels. Intraobserver and interobserver reliability were assessed by kappa statistics. The frequency of disagreement was also identified. The intraobserver agreement was excellent in all readers (kappa range 0.840-0.901). The interobserver agreement was lower as expected, and was substantial to excellent (kappa range 0.726-0.818). Overall complete agreement was obtained in 87.8% of all interspinous ligament levels. A difference of 1, 2, and 3 grades occurred in 8.1, 3.0, and 1.1% of readings, respectively. This proposed MRI classification of interspinous ligament degeneration was simple, reliable, and reproducible. Its use as a standardized nomenclature in clinical and radiographic research may be recommended. [ABSTRACT FROM AUTHOR]

Millions of people worldwide suffer from degenerative disk disease. When conservative measures fail, patients often pursue more aggressive treatment options, including surgery. Lumbar fusion is the standard surgical treatment for this malady, but it is imperfect. Many forward-thinking spine surgeons have been drawn to the concept of lumbar disc arthroplasty. Herein we review the available literature on in vivo human clinical trials involving the currently available prostheses for lumbar disc arthroplasty. During this review, we hope to put in context both the achievements and the failures of these prostheses. [ABSTRACT FROM AUTHOR]

Abstract: Background context: Painful lumbar disc degeneration is one of the most common ailments treated by spine surgeons. Currently, early disc disease and herniation are often treated with microdiscectomy. Late disc degeneration is usually treated with arthrodesis. With the advent of new technology and techniques in lumbar disc arthroplasty, interest in preserving spinal motion at degenerated motion segments has increased. The goals of lumbar disc arthroplasty are to provide long-term pain relief at the degenerated disc level, to restore disc height to protect neural elements and to preserve motion to prevent posterior facet arthropathy and adjacent segment disease. Purpose: The purpose of this review is to examine the anatomy and biomechanics of the lumbar motion segment to determine the features that successful disc arthroplasty prosthesis must possess. In addition, the early clinical results of three prostheses currently being used in humans are reviewed. Study design/setting: Review of the literature. Methods: A systematic review of Medline for articles related to lumbar disc arthroplasty was conducted up to and including journal articles published in August 2003. In addition, the abstracts from the annual meetings of the North American Spine Society and Scoliosis Research Society from 1998 to 2003 were searched. The literature was then reviewed and summarized. Results/conclusions: Short-term results of lumbar disc arthroplasty as measured by pain relief and disability are good in some studies. Implants are relatively safe in the short term, and with newer designs complications are usually related to the surgical approach rather than early implant failure. Recovery times appear to be shorter than arthrodesis. Despite the relatively good early clinical results of these devices, questions remain about the long-term efficacy in pain relief and maintenance of motion, the results of randomized comparative trials with fusion and the life span of the devices. In addition, late sequelae and revision options are unknown. Current indications for lumbar disc arthroplasty are in the setting of a Food and Drug Administration trial in young, nonosteoporotic patients with one or two level symptomatic disc degeneration without severe facet arthropathy, segmental instability or neural element compression requiring a posterior decompression. [Copyright &y& Elsevier]

Background: A primary concern after posterior lumbar spine arthrodesis is the potential for adjacent segment degeneration cephalad or caudad to the fusion segment. There is controversy regarding the subsequent degeneration of adjacent segments, and we are aware of no long-term studies that have analyzed both cephalad and caudad degeneration following posterior arthrodesis. A retrospective investigation was performed to determine the rates of degeneration and survival of the motion segments adjacent to the site of a posterior lumbar fusion. Methods: Two hundred and fifteen patients who had undergone posterior lumbar arthrodesis were included in this study. The study group included 126 female patients and eighty-nine male patients. The average duration of follow-up was 6.7 years. Radiographs were analyzed with regard to arthritic degeneration at the adjacent levels both preoperatively and at the time of the last follow-up visit. Disc spaces were graded on a 4-point arthritic degeneration scale. Correlation analysis was used to determine the contribution of independent variables to the rate of degeneration. Survivorship analysis was performed to describe the degeneration of the adjacent motion segments. Results: Fifty-nine (27.4%) of the 215 patients had evidence of degeneration at the adjacent levels and elected to have an additional decompression (fifteen patients) or arthrodesis (forty-four patients). Kaplan-Meier analysis predicted a disease-free survival rate of 83.5% (95% confidence interval, 77.5% to 89.5%) at five years and of 63.9% (95% confidence interval, 54.0% to 73.8%) at ten years after the index operation. Although there was a trend toward progression of the arthritic grade at the adjacent disc levels, there was no significant correlation, with the numbers available, between the preoperative arthritic grade and the need for additional surgery. Conclusions: The rate of symptomatic degeneration at an adjacent segment warranting either decompression or arthrodesis was predicted to be 16.5% at five years and 36.1% at ten years. There appeared to be no correlation with the length of fusion or the preoperative arthritic degeneration of the adjacent segment. Level of Evidence: Prognostic study, Level IV (case series). See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background Context: High quality evidence is difficult to generate, leaving substantial knowledge gaps in the treatment of spinal conditions. Appropriate use criteria (AUC) are a means of determining appropriate recommendations when high quality evidence is lacking.Purpose: Define appropriate use criteria (AUC) of cervical fusion for treatment of degenerative conditions of the cervical spine.Study Design/setting: Appropriate use criteria for cervical fusion were developed using the RAND/UCLA appropriateness methodology. Following development of clinical guidelines and scenario writing, a one-day workshop was held with a multidisciplinary group of 14 raters, all considered thought leaders in their respective fields, to determine final ratings for cervical fusion appropriateness for various clinical situations.Outcome Measures: Final rating for cervical fusion recommendation as either "Appropriate," "Uncertain" or "Rarely Appropriate" based on the median final rating among the raters.Methods: Inclusion criteria for scenarios included patients aged 18 to 80 with degenerative conditions of the cervical spine. Key modifiers were defined and combined to develop a matrix of clinical scenarios. The median score among the raters was used to determine the final rating for each scenario. The final rating was compared between modifier levels. Spearman's rank correlation between each modifier and the final rating was determined. A multivariable ordinal regression model was fit to determine the adjusted odds of an "Appropriate" final rating while adjusting for radiographic diagnosis, number of levels and symptom type. Three decision trees were developed using decision tree classification models and variable importance for each tree was computed.Results: Of the 263 scenarios, 47 (17.9 %) were rated as rarely appropriate, 66 (25%) as uncertain and 150 (57%) were rated as appropriate. Symptom type was the modifier most strongly correlated with the final rating (adjusted ρ2 = 0.58, p<.01). A multivariable ordinal regression adjusting for symptom type, diagnosis, and number of levels and showed high discriminative ability (C statistic = 0.90) and the adjusted odds ratio (aOR) of receiving a final rating of "Appropriate" was highest for myelopathy (aOR, 7.1) and radiculopathy (aOR, 4.8). Three decision tree models showed that symptom type and radiographic diagnosis had the highest variable importance.Conclusions: Appropriate use criteria for cervical fusion in the setting of cervical degenerative disorders were developed. Symptom type was most strongly correlated with final rating. Myelopathy or radiculopathy were most strongly associated with an "Appropriate" rating, while axial pain without stenosis was most associated with "Rarely Appropriate." [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Anterior Cervical Discectomy and Fusion (ACDF) and Posterior Cervical Fusion (PCF) are surgical techniques for the treatment of degenerative disc disease with established efficacy and safety. However, patients with Obstructive Sleep Apnea (OSA) present with additional risk due to preexisting airway obstruction. Pulmonary complications of patients with OSA who undergo cervical fusion have not been well studied. PURPOSE This study aims to review rates of pulmonary complications following one- or two-level cervical fusion within patients with preexisting OSA. STUDY DESIGN/SETTING Retrospective database study. PATIENT SAMPLE Patients who were diagnosed with OSA within 1 year prior to undergoing one- or two-level ACDFor one- or two-level PCF. OUTCOME MEASURES Postoperative pulmonary complications that developed within three months following surgery, including: bronchitis, bronchiectasis, chronic airway obstruction, lung diseases, dyspnea, respiratory complications, and pneumonia. METHODS The PearlDiver insurance database was queried for Humana patients who were diagnosed with OSA within 1 year prior to undergoing one- or two-level ACDF (CPT-22548, CPT-22551, CPT-22552, CPT-22554, CPT-22585) or one- or two-level PCF (CPT-22590, CPT-22595, CPT-22600, CPT-22614) between 2005 and 2015. The search resulted in 3,748 patients who had OSA prior to ACDF, 24,838 patients who did not have OSA prior to ACDF, 543 patients who had OSA prior to PCF, and 4,034 patients who did not have OSA prior to PCF. Postoperative pulmonary complications that developed within three months following surgery, including: bronchitis, bronchiectasis, chronic airway obstruction, lung diseases, dyspnea, respiratory complications, and pneumonia were then compared between the four groups. RESULTS Patients who were diagnosed with OSA within 1 year prior to undergoing cervical fusion were at a significantly greater risk for developing postoperative pulmonary complications. Patients with OSA who underwent ACDF showed greater rates of chronic airway obstruction 17.4% versus 8.9% (odds ratio [OR]=2.163, p<.001), bronchitis 7.6% versus 3.9% (OR=2.059, p<.001), dyspnea 16.1% versus 9.7% (OR=2.004, p<.001), lung diseases 8.1% versus 5.5% (OR=1.534, p<.001), and pneumonia 3.9% versus 2.7% (OR=1.476, p<.001). Patients with OSA who underwent PCF also showed greater risk of developing chronic airway obstruction 22.8% versus 14.1% (OR=1.799, p<.001) and bronchitis 9.2% versus 6.2% (OR=1.532, p=.008). CONCLUSIONS Prior diagnosis of OSA within 1 year prior to patients undergoing one- or two-level cervical fusion is associated with greater rates of postoperative pulmonary complications within three months following surgery. Patients with OSA who underwent ACDF were at a greater risk of developing pulmonary complications than patients with OSA who underwent PCF. [ABSTRACT FROM AUTHOR]

The objective of the study is to identified the correlation between Modic changes (MCs), disc degeneration, motions (translation and angulation) and facet osteoarthritis in lumbar spine. 425 patients who underwent multi-positional lumbar MRI were reviewed. A total of 2250 lumbar spinal segments in neutral position were evaluated for MCs, disc degeneration grading, translation and angulation motion, and facet osteoarthritis. The chi-square test, Kruskal-Wallis, Mann-Whitney U test, Pearson's correlation and linear regression were used to test for statistically significant difference between parameters. MCs type 2 showed the most translational motion. The presence of MCs was significantly correlated with advanced disc degeneration (grade 4-5, Odds ratio 6.29, 95% CI 4.48-8.83) and the presence of facet osteoarthritis (Odds ratio 9.50, 95% CI 6.18-14.62). The presence of facet osteoarthritis had significantly more translation motion than non-osteoarthritis facet (p=0.04). The facet osteoarthritis grade was positively correlated with disc degeneration grade (r=0.309, p-value<0.001). The facet osteoarthritis correlated with the presence of MCs and more translation motion. The severity of facet osteoarthritis was correlated with the advanced disc degeneration. The MCs, translation motion, and disc degeneration were the significant parameters which affected lumbar facet osteoarthritis. [ABSTRACT FROM AUTHOR]

Background Context: T1 slope is a novel thoracic parameter used to assess cervical spine sagittal balance. Thoracic index (TI) parameters including T1 slope and cervical sagittal alignment parameters may play an important role in degenerative cervical spondylolisthesis (DCS). Current literature regarding the relationship between TI and cervical sagittal alignment parameters in patients with DCS is limited.Purpose: (1) To evaluate the T1 slope, cervical sagittal alignment, and thoracic inlet parameter in patients with DCS using kinematic magnetic resonance imaging (kMRI), and (2) to find a correlation between the T1 slope, TI, and other cervical sagittal parameters in patients with DCS.Design/setting: Retrospective kMRI study, Level III.Patient Sample: Fifty-two patients with DCS from 1,128 patients from a cervical kMRI database.Outcome Measures: T1 slope, C2-C7 angle, sagittal vertical axis C2-C7 (SVA C2-C7), cranial tilt, cervical tilt, neck tilt, and thoracic inlet angle (TIA).Methods: Cervical spine kMRIs of 52 patients with DCS (mean age 51.7±standard deviation) were analyzed in neutral, flexion, and extension positions. Patients with DCS were divided into two groups: anterolisthesis (N=33) and retrolisthesis (N=19). Each listhesis group was subclassified into grade 1 (slip 2-3 mm) and grade 2 (slip>3 mm).Results: Grade 2 retrolisthesis had the largest T1 slope followed by grade 1 retrolisthesis, grade 2 anterolisthesis, and grade 1 anterolisthesis. Significant differences were found between the anterolisthesis and the retrolisthesis groups in the neutral position (p=.025). The flexion position had the largest T1 slope and showed a significant difference with anterolisthesis in the neutral position (p=.041). Sagittal vertical axis C2-C7 showed strong correlation with cranial tilt in all DCS groups and all positions.Conclusions: In our study, T1 slope was larger in grade 2 DCS, and the retrolisthesis group had larger T1 slope than the anterolisthesis group. Presence of larger T1 slope was significantly correlated with larger cervical lordosis curvature. Furthermore, cranial tilt was strongly correlated with SVA C2-C7. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between the facet fluid sign (FFS) and kinematics of affected lumbar segment in patients with low-grade, single-level lumbar degenerative spondylolisthesis using kinematic magnetic resonance imaging (kMRI).Materials and methods Ninety-two patients diagnosed with low-grade (Grade 1 or 2), single level lumbar degenerative spondylolisthesis L3 to S1. Angular and translational motion, whole lumbar motion, slip percentage, and facet angle were measured. Disc degeneration and degrees of osteoarthritis were graded, facet effusion was evaluated and classified as Positive or Negative FFS (PosFFS or NegFFS).Results There were significant differences in the facet degeneration, translational motion, percentage of total angular motion, and flexion-extension slip difference between the PosFFS and NegFFS group. 28.3% of the patients in PosFFS group had anterolisthesis in flexion, but not extension.There was a significant difference in the incidence of FFS between the dynamic and static spondylolisthesis (75% vs 35%, p < 0.001). If FFS was present on kMRI, a positive predictive value for dynamic spondylolisthesis was 75.6%. with the sensitivity and specificity of 0.75 and 0.65 for posFFS to diagnose dynamic DS. The likelihood ratio for dynamic slips in the presence of FFS was 2.1, and the likelihood ratio for static slips in the presence of FFS was 1.1.Conclusion Facet fluid sign was present in weight-bearing neutral position, and the presence of FFS in kMRI increased the probability of having dynamic spondylolisthesis. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective kinematic magnetic resonance imaging (kMRI) study. Objective: To evaluate the utility of kMRI in determining the relationship between cervical sagittal balance and TI alignment. Summary Of Background Data: Thoracic inlet parameters play an important role in cervical spine sagittal balance. However, most of the literature is based on lower resolution cervical X-rays or CT scans in the supine position. Methods: Cervical spine kMRI of 83 patients with degenerative cervical spine conditions (20-68 yr of age) was analyzed for: (1) cervical spine parameters: C2-C7 angle, C2-C7 sagittal vertical axis (SVA), cranial tilt, and cervical tilt; and (2) T1 parameters: thoracic inlet angle (TIA), T1 slope, and neck tilt (NT). Multiple logistic regression analysis and Pearson correlation coefficients were performed. Results: The mean TIA, T1 slope, and NT were 78.0, 33.2, and 44.8°, respectively. The mean C2-7 angle, SVA of C2-C7, cervical tilt, and cranial tilt were -15.4°, 22.0 mm, 18.1°, and 15.1°, respectively. The ratio of cervical:cranial tilt was maintained as 55:45%. A significant correlation was found between the C2-C7 angle and T1 slope (r = 0.731), TIA and C2-C7 angle (r = 0.406), cervical tilt with C2-C7 angle (r = 0.671), T1 slope with TIA (r = 0.429), TIA with neck tilt (r = 0.733), TIA with cervical tilt (r = 0.377), SVA C2-C7 with cervical tilt (r = -0.480), SVA C2-C7 with cranial tilt (r = 0.912), and C2-7 SVA with the ratio of cranial tilt to cervical tilt (r = 0.694). Conclusion: An individual with a large T1 slope required large cervical lordosis to preserve physiologic sagittal balance of the cervical spine. Cranial tilt was the cervical parameter most strongly correlated with SVA C2-C7, and thus may be a good parameter to assess decompensation of cervical sagittal balance. Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background context There is a lack of agreement among spine surgeons as to the best surgical treatment modality for many degenerative lumbar diseases. Although there are many studies examining trends in spinal surgery, specific studies reporting the variations in surgical treatment in the United States for these diseases are lacking. Purpose The aim of this study was to analyze trends in lumbar spinal fusion methods for common lumbar pathologies in the United States. Study design/setting National insurance database review: 2004–2009. Patient sample Data is taken from United Healthcare and represents more than 25 million patients. Outcome measures No outcomes were measured in this study. Methods Using a private insurance database, we identified patients who underwent one of five types of instrumented single-level lumbar spinal fusion for the 10 most common primary diagnoses. Surgery rates were reviewed from 2004 to 2009 and were stratified according to patient age, patient gender, and region in the United States. Poisson regression analysis was performed to determine regional and demographic differences in treatment modality. The authors received no funds in support of this work. Results A total of 23,986 patients met our search criteria. Of the five fusion types, posterior lumbar interbody fusion (PLIF) with posterolateral fusion (PLF) was the most common (45%), followed by PLF (19%), anterior lumbar interbody fusion (ALIF, 16%), PLIF (10%), and ALIF with PLF (9%). There was a significant increase in PLIF with PLF (p<.0001), PLIF (p<.0001), PLF (p=.012), ALIF (p<.0001), and ALIF with PLF (p<.0001) from 2004 to 2009. After controlling for gender, there were significant differences between regions for all fusion types (p<.0001). The likelihood of a posterior fusion increased with age. Anterior fusions were more common in the 30- to 49-year-old age range than in patents older than 50. For patients in age groups older than 30, there was an increased number who underwent a circumferential fusion or an ALIF (p<.022). Fusion types were significantly different between genders (p<.026). Both genders had an overall increase in the number of fusions (p<.001) over the time period studied. Conclusions There are large differences in the United States for surgical treatment methods for lumbar spine pathology. These differences are likely multifactorial, with both patient and surgeon traits playing a role. Illustrating these differences will hopefully lead to outcomes research to determine the indications, efficacy, and appropriateness of these surgical methods, an important step on the path toward standardization of care. [ABSTRACT FROM AUTHOR]

Background context Degenerative spondylolisthesis is a common pathologic condition that leads to lumbar instability and significant clinical symptoms. The effect of this pathology on adjacent lumbar motion segments, however, has not yet been studied. Purpose To characterize the motion characteristics of lumbar degenerative spondylolisthesis at both the diseased and adjacent levels in patients with low-grade, single-level lumbar degenerative spondylolisthesis using kinetic magnetic resonance imaging (kMRI). Study design Retrospective study of patient kMRIs. Patient sample One-hundred twelve patient MRIs with low-grade, single-level lumbar spondylolisthesis were included. Outcome measures Angular and translational motion. Methods This study compared 112 patients diagnosed with low-grade (Grade 1 or 2), single-level lumbar degenerative spondylolisthesis at L3–L4, L4–L5, or L5–S1 with 296 control patients without spondylolisthesis. Angular and translational motion were measured using patient kMRIs. The level of slip was graded according to the Meyerding classification system, and disc degeneration was classified according to the Pfirrmann system. Instability was defined as translational motion greater than 4 mm. Results Lumbar hypomobility was often present regardless of the level of degenerative spondylolisthesis. A slip at L3–L4 resulted in the largest decrease in lumbar range of motion. Instability at the diseased level was most common at L3–L4 (36%), followed by L5–S1 (31%) and L4–L5 (30%). Instability at the adjacent segments was most frequent at L4–L5 (49%), followed by L5–S1 (34%) and L3–L4 (23%). Patients with stable spondylolisthesis generally had decreased angular motion at all lumbar levels. Translational motion at the diseased level was consistently increased. Disc degeneration was significantly greater at the level of slip for the L3–L4 and L4–L5 spondylolisthesis groups and equal to the control group in the L5–S1 group. There was no significant difference in disc degeneration at adjacent segments in L3–L4 and L4–L5 degenerative spondylolisthesis patients, but there was a significant decrease with an L5–S1 slip. Conclusions There were a similar percentage of patients in each degenerative spondylolisthesis group with lumbar instability. Angular motion decreased at the diseased level with L3–L4 and L5–S1 spondylolisthesis, but increased with L4–L5 spondylolisthesis. Translational motion, however, increased at the diseased level in all three groups. There was compensatory hypermobility at adjacent levels in patients with unstable spondylolisthesis at L3–L4 and L4–L5, but not at L5–S1. [ABSTRACT FROM AUTHOR]

Study Design. A kinematic magnetic resonance imaging study. Objective. To investigate the distribution of Schmorl nodes (SNs) in the lumbar spine in healthy adults, and determine the association with lumbar disk degeneration and lumbar spine motion. Summary of Background Data. SNs have been associated with several pathologies of the lumbar spine, although it has been demonstrated that they also occur in the healthy adult population without a clearly identified cause. A thorough understanding of SN distribution may help reveal reasons for their formation. How disk degeneration and lumbar spine motion relate to SNs is poorly understood. Methods. Kinematic magnetic resonance images (0.6 T) were available for 1179 healthy individuals from 15 to 85 years of age. Spine specialists performed computer-based measurements. All parameters were measured and calculated automatically using the eRAD PACS Viewer (eRAD Inc., version 6.2.1.1). Lumbar disk degeneration was documented according to the Pfirrmann classification system. Lumbar spine lordosis was quantified as the angle between the inferior endplate of L1 and superior endplate of S1 .The level of significance was defined as P≤ 0.05. The distribution of SNs along the lumbar spine and their relationship with age and sex was investigated using the single factor analysis of variance χ² test. The relationship between SNs, age group, disk location, and overall grades of lumbar disk degeneration were investigated by multiple logistic regression analysis. Lumbar spine motion was compared between patients with and without SNs via independent f test among 585 individuals with qualified kinematic images. Multiple logistic regression analysis was performed on associations of lumbar motion range among the SN population. Results. The prevalence of SNs in our study population was 28.4%, and SNs were observed to be present more frequently in males (34.6%) than in females (20.2%) (ρ < 0.01). There was no significant difference in the incidence of SNs between age groups (ρ = 0.18). SNs were more common at the L2 and L3 vertebral bodies (14.3% and 14.4%), whereas SNs were least common at S1 vertebral bodies (1.5%). The highest incidences of SNs presentation was on disks with degeneration grade III (41.9%) and grade IV (45.3%). SN occurrence, aging, and disk location were positively correlated with lumbar disk degeneration grade. The lumbar spine range of motion was significantly different between individuals with and without SNs (31.4° vs. 37.9°, ρ < 0.01). The frequency of SNs was associated with decreased lumbar range of motion in all age groups except 51 to 60 years and 61 to 70 years. Conclusion. SNs have a high incidence in individuals without persistent lumbar disorders and were found in disks at all degrees of degeneration. SNs occurrence were positively associated with lumbar disk degeneration In addition, the presence of SNs was correlated with decreased overall lumbar motion across all age groups. [ABSTRACT FROM AUTHOR]

The article reports on a study on the effects of total sagittal lordosis on spinal kinematics and degree of disc degeneration in the lumbar spine using positional magnetic resonance imaging (MRI) . The study is on the relationship between segmental mobility and degeneration of the lumbar spine as changes in sagittal lordosis alter the load on the spine. It showed the likely reciprocal influence of sagittal alignment, disc degeneration and segmental mobility on one another.

Abstract: Background context: The rat caudal disc has been increasingly used in studying of disc degeneration because of its simplicity, low cost, and efficiency. However, the reproducibility and standardization are essential to facilitate the investigations of biologic therapeutics at different stages of degeneration. Purpose: To identify the effect of different needle gauges to the degenerative response in rat caudal discs and to examine its pathogenesis by looking at the cellular and matrix changes. Study design: In vivo study of injury-induced rat caudal disc degeneration using needle puncture. Patient sample: Thirty-six Lewis rats aged 12–14 weeks. Outcome measures: The induced degenerative discs were analyzed by plain radiograph, magnetic resonance imaging (MRI) and histological examination. Proteoglycan content was assessed by alcian blue stain. Immunohistochemistry using aggrecan, collagen II, and Sox-9 was also evaluated to investigate cell differentiation and matrix changes. Methods: All rats were divided into three groups according to different needle gauges (18G, 20G, and 22G). Caudal discs were punctured percutaneously under image guidance. Radiographs and MRI were obtained at 2 weeks interval until 8 weeks. At each time point, three rats from each group were sacrificed for histological analysis and immunohistochemistry. Results: Larger needle gauges, especially 18G, produced more deterioration of the disc when compared with smaller sizes, particularly with time. Significant differences were identified in almost all parameters compared between 18G and 22G at the 8-week time point. For the effect of time in the same needle size, the differences occurred between 2- or 4-week and 8-week time point in the 18G and 20G groups. The proteoglycan and aggrecan stain gradually decreased over time. Chondrogenic differentiation was identified within the degenerative disc by detecting Sox-9 positive cells and collagen II accumulation increased as degeneration progressed. Conclusions: The puncture-induced degenerative changes in rat caudal discs can imitate the human degenerative cascade as observed in plain radiograph, MRI, histology, and immunohistochemistry. We suggest that needle size affects the occurrence of progression of degeneration; thus, the large needle size was required to accelerate the deterioration. The size of needle and time point after injury should be considered when investigating the effect of therapeutic materials to retard degeneration or regenerate the intervertebral disc. [Copyright &y& Elsevier]

The article presents a study which uses novel kinematic magnetic resonance imaging (kMRI) to examine the effect of postural change on degenerative lumbar discs. It analyses the effects of disc degeneration on the biomechanical and kinematic behaviors of the spine among patients with symptomatic back pain. Results show that bulging of degenerative intervertebral lumbar disc increases with the severity of disc degeneration and kinematic patterns were affected by the degenerative changes.

The article presents a study on the effects of cervical disc herniation on kinematics at adjacent vertebral motion segments. Four-hundred seven patients with neck pain were assessed using kinetic magnetic resonance imaging (kMRI). The study also examined translational motion, angular variation, and disc height at each segment from C2-C3 through C7-T1. Results show that disc herniation had no impact on disc height at adjacent levels regardless of the degree of disc degeneration.

The article presents a medical research on the relationship between the grade of disc degeneration and motion unit of the cervical spine. It has shown that as the degenerative process progresses, the motion moves from a normal stable disc to a more unstable phase with early degeneration. It has also demonstrated the contribution of different levels to overall motion that occurs with degeneration.

BACKGROUND CONTEXT Although posterior decompression is the most common approach for surgical treatment of degenerative thoracic spine disease, anterior approach is gaining interest due to its advantage in disc visualization. Considering the substantial similarity in neurologic outcomes following the two approaches, complication rates seem to be the key determinants in resolving the controversy over the optimal approach. PURPOSE To compare the complication rates between anterior and posterior decompression for degenerative thoracic spine disease. STUDY DESIGN/SETTING Retrospective database. PATIENT SAMPLE Patients with degenerative thoracic spine disease who had undergone anterior or posterior decompression between 2007 and 2015. OUTCOME MEASURES Charlson Comorbidity Index (CCI) as a broad measure of comorbidity; Intra-operative complications, including accidental organ puncture or laceration, hemorrhage and dural laceration; and major medical complications on the day of surgery, one month and three months after the surgery, including cardiovascular, central nervous system, infectious, respiratory and wound complications as well as organ failure and minor complications. METHODS A private insurance database (Humana) containing the medical records of over 68 million patients in United States was queried using the PearlDiver Patient Records Database (PearlDiver Technologies, Colorado Springs, CO, USA). Patients who had undergone anterior or posterior thoracic decompression were identified using the Current Procedural Terminology codes. Subsequently, records were screened for patients with degenerative diagnoses using the International Classification of Diseases 9th edition codes, and patients diagnosed with spinal neoplasm, trauma, fracture and infection were excluded. CCI was compared between groups using the Mann-Whitney U test. Incidence rates of complications were compared between the two approaches using the Chi-square statistics, and crude odds ratios (OR) with 95% confidence intervals (CI) were reported. RESULTS A total of 1,495 patients were included in this study, consisting of 1,030 patients in the posterior group and 465 patients in the anterior group. CCI was significantly higher in the posterior group (Md=2, IQR: 1-4) compared to the anterior group (Md=2, IQR: 2-2, p<.001). Two groups were comparable in terms of cardiovascular, central nervous system, infectious and wound complications, as well as major organ failure. However, patients in the anterior group were more likely to develop intra-operative complications (6.45% vs. 3.40%, OR=1.88, 95% CI: 1.14-3.10, p<.05) and respiratory complications on the day of surgery (13.98% vs. 9.51%, OR=1.55, 95% CI: 1.11-2.16, p<.05), during the first month (23.66% vs. 16.31%, OR=1.59, 95% CI: 1.21-2.08, p<.01) and within three months after surgery (24.95% vs. 18.45%, OR=1.47, 95% CI: 1.13-1.91, p<.01). Furthermore, patients in this group were more likely to develop minor complications on the day of surgery (5.81% vs. 2.62%, OR=2.29, 95% CI: 1.33-3.95, p<.01), within one month (9.89% vs. 6.21%, OR=1.66, 95% CI: 1.12-2.46, p<.05) and three months after surgery (10.97% vs. 7.48%, OR=1.52, 95% CI: 1.05-2.21, p<.05). CONCLUSIONS Despite having a lower overall comorbidity score, patients with degenerative thoracic spine diseases undergoing anterior decompression were more likely to develop intraoperative, respiratory and minor complications when compared to the posterior approach. High rates of respiratory complications following the anterior approach underline the importance of special respiratory care for these patients. Future studies may focus on predictive factors of respiratory compromise following thoracic decompression, aiming to identify the patients at risk who may benefit from posterior decompression. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]