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Background: The aim of this study was to understand how facet joint orientation (FJO) and facet joint tropism (FJT) affected severe intervertebral disc degeneration (IVDD) process at lower lumbar levels in patients with LBP. Methods: This study is a cross-sectional analysis of a retrospective database. Patients were evaluated in terms of IVDD, FJO, and FJT at all lumbar levels on magnetic resonance imaging. Results: In this study (n: 123) facet joints were aligned more coronal in men than in women at upper lumbar levels. Men had less FJT compared to women, significantly at L2-L3 and L3-L4 levels. Severe IVDD at L4-L5 was associated with more coronal aligned L1-L2 (29.0 ± 2.5° vs. 23.3 ± 2.3°, p = 0.006) and misaligned L5-S1 (8.3 ± 1.9° vs. 4.5 ± 1.7°, p = 0.008). Besides, severe IVDD at L3-L4 was associated with more coronal aligned L4-L5 (49.1 ± 3.2° vs. 41.4 ± 2.8°, p = 0.014). Conclusion: There is a close association between FJO/FJT with lumbar IVDD. Facet joint orientation and FJT do not affect the disc at only the corresponding level; the lumbar spine should be evaluated as a whole. [ABSTRACT FROM AUTHOR]

Purpose: Intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles are possible causes of low back pain (LBP). Multifidus has been the most commonly blamed paraspinal muscle in the etiology of LBP. However, it contributes to 20% of the extensor moment on the lumbar spine. In the present study, we aimed to identify whether patients with LBP and asymptomatic subjects differed in terms of intervertebral discs, end‐plates, and fatty infiltration in their paraspinal muscles. Methods: Consecutive women and men, who visited the spine outpatient clinics with chronic LBP and had lumbar spine MRI for their LBP without leg pain were included. Asymptomatic subjects without LBP/leg pain for the last year were recruited. Modic changes, IVDD, and fatty infiltration in the paraspinal muscles were evaluated on lumbar spine magnetic resonance imagings of the patients with LBP and age‐, gender‐ and BMI‐matched asymptomatic controls. Results: Low back pain was closely associated with fatty infiltration in the paraspinal muscles at all lumbar levels whereas it had association with severe IVDD and Modic changes at lower lumbar levels. Multifidus at the lower lumbar levels was the fattiest paraspinal muscle in both asymptomatic subjects and patients with LBP. Patients with LBP had severe fatty infiltration in the erector spinae at the upper lumbar levels. Conclusion: Severe IVDD and Modic changes were more common at lower lumbar levels in patients with LBP. Both asymptomatic subjects and those with LBP had fatty multifidus at lower lumbar levels, whereas those with LBP had fatty infiltration in the erector spinae at upper lumbar levels. We suggest that fatty infiltration could have started in the multifidus. The erector spinae had greater contribution to the lumbar extension compared to the multifidus. Thus, LBP could develop when the quality of the erector spinae at the upper lumbar levels impairs due to fatty infiltration. [ABSTRACT FROM AUTHOR]

Mechanical and inflammatory factors were suggested as the causes of spine degeneration and low back pain (LBP). Previous studies partly reported the association of LBP with inflammation. However, none of them compared patients with LBP and asymptomatic subjects in terms of complete blood count and inflammatory markers in detail. We aimed to analyze the association of serum white blood cell (WBC) count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) with chronic LBP by comparing the patients with chronic LBP and age- and gender-matched asymptomatic subjects. Lumbar intervertebral disc degeneration and vertebral end-plates were evaluated using Pfirrmann grading and Modic classification on lumbar spine magnetic resonance images, respectively. Serum WBC counts, CRP levels, and ESRs were recorded from chart reviews. We included 147 patients with chronic LBP and 101 asymptomatic subjects. Patients with chronic LBP had significantly higher serum neutrophil, monocyte, and basophil counts, higher neutrophil-to-lymphocyte ratio, higher ESR, and lower serum CRP levels compared to the asymptomatic subjects. Serum monocyte and basophil cell counts and ESR were the most remarkable predictive factors for chronic LBP, severe IVDD, and Modic changes. Higher serum monocyte and basophil cell counts and higher serum ESR above cut-off values of 0.42 × 103/μL, 0.025 × 103/μL, and 3.5 mm/hour could be used as screening tools for subjects with persistent LBP in primary care. Higher serum monocyte and basophil counts and serum ESR above new cut-off values should highlight the need to obtain early spinal imaging to prevent chronicity in patients with LBP. [ABSTRACT FROM AUTHOR]

Intradiscal vacuum phenomenon (IVP) is the collection of gas within the intervertebral discs. It has been reported with various spinal disorders. The exact role of IVP in spinal degeneration leading to low back pain (LBP) is unclear. We aimed to obtain the prevalence of IVP in patients with LBP. Our second aim was to understand whether IVP was associated with intervertebral disc degeneration (IVDD), Modic changes, and subchondral sclerosis (SS). A total of 12.450 consecutive patients with chronic LBP were evaluated in terms of having abdominal computed tomography (CT) scan concomitant with lumbar spine magnetic resonance imaging (MRI) using radiological database of three spine centers. We excluded the patients with a history of malignancy, metabolic disease, spinal infection, traumatic or osteoporotic spine fracture, and spine surgery. All lumbar levels were evaluated in terms of IVDD and Modic changes on MRI, while they were evaluated in terms of IVP and SS on CT scans. We included 219 patients. Severe IVDD, Modic changes, IVP, and SS were seen in 53.9% (n: 118), 38.8% (n: 85), 26.5% (n: 58), and 16% (n: 35) of the patients, respectively. Intradiscal vacuum phenomenon was closely associated with severe IVDD (OR: 8.204), Modic changes (OR: 3.547) and SS (OR: 4.231). Intradiscal vacuum phenomenon was closely associated with severe IVDD, Modic changes, and SS. Further prospective clinical and laboratory studies are necessary to better delineate the pathogenesis of IVP. [ABSTRACT FROM AUTHOR]

Background Low back pain (LBP) may originate from different sources such as intervertebral disc degeneration (IVDD), end-plate and paraspinal muscle changes. Our aim is to explore the relevance of paraspinal muscles' fat-infiltration in women with LBP and its association with IVDD and Modic changes. Methods Consecutive female patients presenting with chronic LBP to the outpatient clinics were included. Patients were evaluated in terms of IVDD, vertebral end-plate changes, and fatty infiltration in the paraspinal muscles at all lumbar levels on lumbar spine magnetic resonance imaging (MRI). Visual Analogue Scale (VAS) scores were recorded using our prospectively collected database. Results Patients with higher VAS scores were significantly more likely to have more fatty infiltration in the multifidus and less fatty infiltration in the psoas at L4-L5 level when compared to those with lower VAS scores (69.1 vs. 31.8%, p = 0.003). To predict LBP, fatty infiltration in the multifidus and psoas had odds ratio (OR) of 4 (p = 0.010), and 0.3 (p = 0.013), respectively; whereas disc degeneration had an OR of 0.5 (p = 0.028). Conclusion This is the first clinical cross-sectional study suggested that women with chronic low back pain could have less fat-infiltrated psoas to compensate more fat-infiltrated multifidus at L4-L5 disc level. [ABSTRACT FROM AUTHOR]

Aim: School scoliosis screening programs (SSSPs) are valuable and common tools to depict scoliosis prevalence and to take appropriate measures to prevent scoliosis. Prevalence of small angle scoliosis (10-20°) could be underestimated via SSSPs due to inter-rater variability of the physical examination after which possible candidates are sent to radiographic work-up. In this study, we aimed to detect the prevalence of thoracic scoliosis in adolescent patients via analysis of posteroanterior chest radiographs. Methods: Adolescent patients, who had been admitted for reasons other than spine and whose posteroanterior chest radiographs had been obtained, were included in the study. Demographics and chest radiographs were screened through picture archiving and communication system of the hospital. Results: Chest radiographs of 326 (163 female, 163 male) adolescents were evaluated (mean age: 15.54±2.12 years; mean coronal Cobb angle: 5.25±7.14°). Thoracic scoliosis was present in 7.36% (sixteen female, eight male) of the adolescents. Thoracic scoliosis was more prevalent in females, yet the difference was insignificant (9.82% vs 4.91%; p=0.09). Females and males were similar in respect of age and coronal Cobb angle (mean age: 15.00±1.41 vs 16.00±0 years, p=0.96; mean Cobb angle: 12,30±14.43° vs 7.00±7.60°, p=0.19). Conclusion: Chest radiographs could be adjuvant to SSSPs in determining the true prevalence of scoliosis in the populations. [ABSTRACT FROM AUTHOR]

Background Low back pain is a common public health problem associated with lumbar intervertebral disc degeneration. It is still unclear, however, whether intervertebral disc degeneration is an isolated process or accompanied by other degenerative events. We analyzed whether disc degeneration was associated with vertebral end-plate changes and fatty infiltration in the paraspinal muscles. We also aimed to identify whether the severity of disc degeneration influenced this association. Methods Intervertebral disc degeneration, vertebral end-plate changes, and fatty infiltration in the multifidus, erector spinae, and psoas muscles at all lumbar intervertebral disc levels were evaluated on lumbar spine magnetic resonance images of 50 symptomatic women and 50 age-matched symptomatic men. Results The women had greater lumbar intervertebral disc degeneration scores at L4-L5 and L5-S1 and in total. The women had more fatty infiltration in the multifidus and erector spinae muscles at L4-L5 and L5-S1. The men had more fatty infiltration in the psoas muscle at L5-S1. Patients with severe intervertebral disc degeneration were more likely to have increased fatty infiltration in the multifidus and erector spinae muscles. The rate of vertebral end-plate changes was also greater in the patients with severe intervertebral disc degeneration. Conclusions Severe disc degeneration in the lumbar spine is closely associated with Modic changes and fatty infiltration in the multifidus and erector spinae muscles. We suggest that disc degeneration is not an isolated event but, rather, a continuum of events that could more clearly be shown in future prospective, large sample-size studies. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to compare ankylosing spondylitis (AS) patients with healthy subjects in terms of posture and balance, and to identify the factors correlated with balance in AS. Patients and methods: Thirty patients (17 males, 13 females; mean age 41.7±7.7 years; range 31 to 57 years) with AS and 33 healthy subjects (18 males, 15 females; mean age 41.3±7.0 years; range 26 to 56 years) were included in the study. Participants were assessed in terms of posture and balance. Posture was assessed using tragus-wall distance, modified Schober's test, and chest expansion. Balance was assessed using device-assisted balance tests. Pain (visual analog scale) and disease activity (Bath Ankylosing Spondylitis Disease Activity Index) were assessed only in AS patients. Results: Ankylosing spondylitis patients walked more slowly when compared to healthy subjects (p=0.002). As the modified Schober's test was restricted, AS patients had greater step width in tandem walk and higher sway velocity on foam base (r=-0.418 p=0.022; r=-0.473 p=0.008). Neither Bath Ankylosing Spondylitis Disease Activity Index nor visual analog scale was correlated with balance. Conclusion: Static and dynamic balance are impaired in AS patients when compared to healthy subjects. Restricted mobility of the spine and advanced kyphosis impaired balance, while pain and disease activity had no correlations with balance. [ABSTRACT FROM AUTHOR]