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STUDY DESIGN: A classic twin study with multivariate analyses was conducted. OBJECTIVE: We aimed to further clarify the presence and magnitude of genetic influences on disc degeneration, and to better understand the phenomenon of disc degeneration through comparisons of genetic and environmental influences on specific degenerative signs and different lumbar levels. SUMMARY OF BACKGROUND DATA: Previous studies suggest a substantial genetic influence on disc degeneration, but raise important questions about which disc phenotypes are or are not largely genetically influenced and differential effects on spinal levels. METHODS: The study sample consisted of 152 monozygotic and 148 dizygotic male twin pairs, 35 to 70 years of age, from the population-based Finnish Twin Cohort. Lumbar magnetic resonance imaging was conducted with quantitative or qualitative assessments of disc signal, bulging, and height narrowing at each lumbar level. Data on possible confounding factors were obtained from an extensive, structured interview. Quantitative genetic modeling was conducted using MPlus. RESULTS: Heritability estimates varied from 29% to 54%, depending on the particular disc degeneration phenotype and lumbar level. The same genetic influences affected signal intensity and disc height (genetic correlations of -0.60- -0.66) or bulging (-0.71- -0.72) to a great degree at either the lower or upper lumbar levels and genetic influences on disc height narrowing and bulging were virtually the same. (0.92-0.97). Conversely, genetic correlations (and environmental correlations)were substantially lower for upper and lower lumbar levels, implying largely independent effects. CONCLUSION: Genetic and environmental influences on disc degeneration seem to be of similar importance. Disc signal, narrowing, and bulging had a primarily common genetic pathway, suggesting a common genetic etiopathogenesis. Conversely, genetic and environmental influences differed substantially for upper versus lower lumbar levels, emphasizing the importance of examining these levels separately in studies of associated genes, other constitutional factors, and environmental influences. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: A cross-sectional study of thoracic magnetic resonance image (MRI) findings. OBJECTIVE: To examine the prevalence of different thoracic MRI findings for T6-T12 and their associations with age and one another by level. SUMMARY OF BACKGROUND DATA: There is a dearth of descriptive epidemiology of thoracic MRI findings in the general population. METHODS: Thoracic MRIs of 524 men were assessed qualitatively and quantitatively for a variety of findings, including disc bulging, height and signal, vertebral deformities, endplate irregularities, osteophytes, and hemangiomas. Descriptive statistics, correlation coefficients and STATA's survey analysis were used. RESULTS: In the lower thoracic spine, 5.4% to 9.5% of the discs, depending on level, were qualitatively assessed as moderately to severely narrowed. Anterior bulging was more common than posterior, which was relatively rare and mild when present. Signal was lower in the midthoracic than lower discs. At least 1 moderate or severe vertebral deformity was found in 6.1% of the subjects, suggesting fracture, and hemangiomas were identified in 2.3% of subjects. Disc signal correlated most highly with age (r = 0.31-0.42). Qualitatively assessed disc height narrowing (r = 0.29-0.46) and quantitative disc height (r = 0.11-0.29) were associated with disc signal. Upper and lower endplate irregularities were associated with one another (r = 0.17-0.32), as were bulging and osteophytes, anteriorly (r = 0.35-0.61) and posteriorly (r = 0.26-0.45). CONCLUSION: Degenerative MRI findings beyond a mild grade were not commonly observed in the thoracic spine among 35-70-year-old men. Posterior bulges, in particular, were rare. The highest correlation with age existed for disc signal. Different MRI findings were associated with one another, but the magnitude of association varied by level. The effects of individual judgments and disc level on prevalence rates were apparent. [ABSTRACT FROM AUTHOR]

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%) and bulges (<2%) were small, and included both decreases and increases, with only a few subjects showing more major changes in either direction. The role of genetics was largest except in posterior bulges, but lifting and smoking were also associated with disc height reduction but none of the other studied risk factors were associated with anterior or posterior disc bulging. Different degenerative findings have different determinants of progression. [ABSTRACT FROM AUTHOR]

Study Design. Measurement (validity) study using data from a prospective longitudinal study of lumbar spinal stenosis.Objective. Provide convergent and divergent validity evidence for the use of the Physical Function Scale of the Swiss Spinal Stenosis Questionnaire for the measurement of walking capacity in persons with lumbar spinal stenosis. We were also interested in the association between the Physical Function Scale and the Oswestry Disability Index (ODI).Summary of Background Data. The Physical Function Scale has been used to assess walking capacity in persons with lumbar spinal stenosis; however, there have been limited studies investigating its psychometric properties. No validity studies have compared the Physical Function Scale and the ODI head to head.Methods. The Physical Function Scale was correlated with the ODI, Health Utilities Index, Centres for Epidemiologic Studies Depression Scale, Medical Outcomes Survey Social Support Scale, and an additional item from the Oxford Claudication Score.Results. As hypothesized, the Physical Function Scale was correlated highly with those instruments and items intended to measure walking capacity and minimally with those instruments intended to measure different constructs. The correlation between the Physical Function Scale and the ODI was r = 0.719.Conclusion. Results support construct validity of the Physical Function Scale for the measurement of walking in an lumbar spinal stenosis population. However, it cannot be ascertained from the current study that the construct being measured is, indeed, walking capacity. Further research is warranted to investigate criterion validity evidence for the use of the Physical Function Scale in the measurement of walking capacity in lumbar spinal stenosis, by examining the relationships between self-report and observational measures of walking. [ABSTRACT FROM AUTHOR]

Purpose. Functional Capacity Evaluations (FCEs) are batteries of tests designed to measure patients' ability to perform work-related activities. Although FCEs are used worldwide, it is unknown how patients' performances compare between countries or settings. This study was performed to explore similarities and differences in FCE performance of patients with chronic low back pain (CLBP) between three international settings that utilize the same FCE protocol. Methods. Standardized FCEs were performed on three cohorts of patients with CLBP: A sample from an outpatient rehabilitation context in The Netherlands (n = 121), a Canadian sample in a Worker's Compensation context (n = 273), and a Swiss sample in an inpatient rehabilitation context (n = 170). Patients were undergoing FCE as part of their usual clinical care. Means and standard deviations of maximum performance on the FCE material handling items were calculated and differences compared using ANOVA. Multivariable linear regression was used to determine the relationship between country of origin and FCE performance while controlling for potential confounders including, age, sex, duration of back pain problems, and self-reported pain and disability ratings. Results. Compared to the Dutch sample, the mean performance of patients in the Canadian and Swiss samples was consistently lower on all FCE items. This association remained statistically significant after controlling for potential confounders. Conclusions. Considerable differences were observed between settings in maximum weight handled on the various FCE items. Future FCE research should examine the effects of a number of potentially influential factors, including variability in evaluator judgements across settings, the evaluator-patient interaction and patients' expectations of the influence of FCE results on disability compensation. [ABSTRACT FROM AUTHOR]

Research conducted over the past decade has led to a dramatic shift in the understanding of disc degeneration and its etiology. Previously, heavy physical loading-often associated with occupation-was the main suspected risk factor for disc degeneration, which was commonly viewed as a wear-and-tear phenomenon exacerbated by the precarious nutritional status of the disc. However, results of studies on twins suggest that physical loading specific to occupation and sport plays a relatively minor role in disc degeneration. Recent research indicates that heredity has a dominant role in disc degeneration, which would explain the variance of up to 74% seen in adult populations that have been studied to date. Since 1998, genetic influences have been confirmed by the identification of several gene forms associated with disc degeneration. This research is paving the way for a better understanding of the biologic mechanisms through which disc degeneration occurs, including specific interactions between genes and environment. Research into disc degeneration and genetics has become more limited by phenotypes or definitions and measures of disc degeneration than by DNA analysis. Standardized, universally accepted definitions of disc degeneration are lacking, in part due to limited knowledge of the process. The measurements that are selected depend on the method used to evaluate the disc and are often qualitative ordinal rating scales, lacking in precision. Although it is generally agreed that disc degeneration is common, the prevalence of specific findings is unclear. A review of the epidemiology of disc degeneration reveals wide-ranging prevalence estimates for various signs of disc degeneration in samples of the general population and in patients with back symptoms. The extreme variations in prevalence rates are likely largely due to inconsistencies in the definitions and measurements of disc degeneration. Such inconsistencies and inaccuracies impede epidemiologic research on disc degeneration. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We examined the association between work-related recovery expectations and return-to-work in patients with chronic back pain. METHODS: A prospective cohort of workers receiving time-loss benefits for back pain of at least 6 weeks' duration was studied. Workers completed a battery of measures, including a work-related recovery expectations questionnaire. Outcomes included surrogate indicators of timely return-to-work (days until suspension of time-loss benefits) and recovery (claim closure) censored at 1 year. Analysis included multivariable Cox and logistic regression. RESULTS: The sample was predominantly male (63%), with a mean age of 42 years. Positive work-related recovery expectations predicted a 26% faster suspension of time-loss benefits (95% confidence interval = 8-40%) and explained 7% of the variation in this outcome. CONCLUSION: Recovery expectations provide important information for predicting time to return-to-work, as measured through suspension of time-loss benefits (R approximately 7%) in patients with chronic back pain. [ABSTRACT FROM AUTHOR]

The construct validity of a kinesiophysical Functional Capacity Evaluation (FCE) administered within a worker's compensation context was examined. A cross-sectional study design was employed. Clinical and demographic information on workers' compensation claimants was extracted from a rehabilitation facility's database. Measures of interest were the Isernhagen Work Systems' (Duluth, MN) FCE, the Pain Disability Index (PDI), and a pain visual analogue scale (VAS). A multitrait Pearson correlation matrix was created to observe the pattern of relationships between variables. The sample consisted of 321 subjects with work-related, medically stable low back pain of median duration of 307 days. FCE performance was moderately correlated with the PDI (r = -0.44-0.52) and with the pain VAS (r = 0.34-0.45). Pain intensity was correlated highly with the PDI (r = 0.79). The moderate relationship between FCE and the PDI supports the construct validity of FCE as a functional measure. However, kinesiophysical FCE performance was not unrelated to pain severity ratings as purported. [ABSTRACT FROM AUTHOR]

Background: There has been increasing interest in associations between paraspinal muscle phenotypes and common spinal disorders, including lumbar spinal stenosis (LSS). However, the relation of paraspinal muscle morphology and composition with LSS is unclear., Objectives: To provide a systematic overview and synthesis of current evidence on the association of paraspinal muscle morphology and composition with LSS presence, pain and disability or function., Design: Systematic review., Methods: Relevant studies were identified from a search of EMBASE, PubMed, SPORTDiscuss, Cinahl, Web of Science and PEDro. Relevant studies were selected, data were extracted, and risk of bias was assessed by 2 independent reviewers prior to conducting a narrative synthesis to summarize evidence using GRADE considerations. The study protocol was prospectively registered (Prospero: CRD42021246492)., Results: Of 33 studies included in the review, multifidus (n=22) was most frequently studied, followed by psoas (n=10). Fatty infiltration (20 studies), CSA (n=11) and relative CSA (n=10) were the most studied paraspinal phenotypes. Most studies (n=31) had low risk of bias, with selection and confounding bias (n=13) most common. High variability in approaches used to measure muscle morphology and composition and LSS disability and pain, and variable control of confounding factors, created challenges in synthesizing findings. The only association identified for which there was moderate certainty of evidence was between increased multifidus fatty infiltration and the presence of LSS (4 of 6 studies). All other associations studied with high or moderate strength of evidence demonstrated no association, including no association between multifidus fatty infiltration and pain severity (8 studies), multifidus CSA and LSS disability (7 studies), psoas morphology and LSS anatomical severity (4 studies), or psoas composition and LSS pain severity (4 studies) for which there was high certainty. There was moderate certainty of no association between multifidus morphology and LSS pain severity (5 of 7 studies), and erector spinae morphology and pain severity (3 studies), and erector spinae composition and LSS pain severity (3 studies) and function (3 studies). Other associations remain more unclear., Conclusion: Largely consistent results suggest multifidus fatty infiltration is associated with the presence of LSS. However, other specific associations examined with high or moderate certainty of evidence demonstrated no association, and others remain largely undetermined. Although interest has grown in paraspinal muscle morphology and composition for improved phenotyping, prognosis and treatment of common spinal disorders, the clinical utility of paraspinal muscle imaging in LSS remains unclear., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Study Design: Diagnostic test study., Objective: To determine the reliability and validity or diagnostic accuracy of two previously described endplate structural defect (EPSD) assessment methods., Summary of Background Data: Studies of EPSD may further the understanding of pathoanatomic mechanisms underlying back pain. However, clinical imaging methods used to document EPSD have not been validated, leaving uncertainty about what the observations represent., Materials and Methods: Using an evaluation manual, 418 endplates on CT sagittal slices obtained from 19 embalmed cadavers (9 men and 10 women, aged 62-91 yr) were independently assessed by two experienced radiologists and a novice for EPSD using the two methods. The corresponding micro-CT (µCT) from the harvested T7-S1 spines were assessed by another independent rater with excellent intra-rater reliability (k=0.96)., Results: Inter-rater reliability was good for the presence (k=0.60-0.69) and fair for specific phenotypes (k=0.43-0.58) of EPSD. Erosion, for which the Brayda-Bruno classification lacked a category, was mainly (82.8%) classified as wavy/irregular, while many notched defects (n=15, 46.9%) and Schmorl's nodes (n=45, 79%) were recorded as focal defects using Feng's classification. When compared to µCT, endplate fractures (n=53) and corner defects (n=28) were routinely missed on CT. Endplates classified as wavy/irregular on CT corresponded to erosion (n=29, 21.2%), jagged defects (n=21, 15.3%), calcification (n=19, 13.9%), and other phenotypes on µCT. Some focal defects on CT represented endplate fractures (n=21, 27.6%) on µCT. Overall, with respect to the presence of an EPSD, there was a sensitivity of 70.9% and a specificity of 79.1% using Feng's method, and 79.5% and 57.5% using Brayda-Bruno's method. Poor to fair inter-rater reliability (k=0.26-0.47) was observed for defect dimensions., Conclusion: There was good inter-rater reliability and evidence of criterion validity supporting assessments of EPSD presence using both methods. However, neither method contained all needed EPSD phenotypes for optimal sensitivity, and specific phenotypes were often misclassified., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To determine the characteristics of lumbar foraminal stenosis (LFS) on magnetic resonance (MR) images and their association with back pain and radiating leg pain in a population-based sample of Chinese subjects., Methods: This study was an extension of the Hangzhou Lumbar Spine Study, a cross-sectional study focusing on back pain and lumbar spine MR imaging findings. Questionnaire data, including demographics, lifestyle, occupational exposures, back pain and radiating leg pain were included. On lumbar spine MR images, disc degeneration was assessed using Pfirrmann grade and Modic changes were evaluated. Using Lee's scale, the L3-S1 intervertebral foramina were evaluated, with grade 2-3 representing substantial LFS and grade 0-1 no LFS. Characteristics of LFS were noted, and associations of LFS with back pain and radiating leg pain were examined., Results: Among the 644 study subjects, 141 (21.9%) had at least one LFS, and its occurrence was associated with greater age (OR = 1.93 for each 10 years, p < 0.001). Substantial LFS was associated with the presence of back pain (OR = 1.92, p = 0.001) and the intensity of the worst back pain (Coef = 8.30, p < 0.001) over the past 12 months, and disabling back pain during their lifetime (OR = 2.25, p < 0.001). Substantial LFS was also associated with leg pain (OR = 14.27, p < 0.001), with a sensitivity of 75.7% for the presence of radiating leg pain and a specificity of 81.4%., Conclusion: Substantial LFS on MR images was a common age-related degenerative phenotype in adults, and appears to be an independent risk factor for back pain and leg pain., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: DISH is a common musculoskeletal disorder; however, the imaging features and disease continuum from early to advanced stages is poorly understood. The purpose of this study was to evaluate the prevalence of DISH and early-phase DISH in an American population and to assess the extent and pattern of ectopic mineralization across the thoracic spine., Methods: Data were retrieved in collaboration with the Rochester Epidemiology Project. We conducted a retrospective image evaluation of a sample of individuals over 19 years of age with CT of the thoracic spine from a Northern US catchment area. Stratified random sampling by age and sex was used to populate the study. We examined the prevalence and extent of ectopic mineralization along the thoracic spine using previously established criteria., Results: A total of 1536 unique images (766 female and 770 male individuals) including 16 710 motion segments were evaluated for imaging features of the continuum of DISH. Collectively, 40.5% of all motion segments evaluated displayed evidence of ectopic mineralization in the thoracic spine. The prevalence of early-phase DISH was 13.2% (10.4% of female and 15.8% of male individuals). The prevalence of established DISH was 14.2% (7.4% of female and 20.9% of male individuals). Remarkable heterogeneity was detected in individuals within each disease classification, based on the extent of the thoracic spine affected and degree of mineralization., Conclusions: The continuum of imaging features associated with DISH is detected in more than one in four adults and both sexes in an American population., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: Lumbar spinal stenosis (LSS) is associated with increased levels of psychological distress, including depression; however, the prognostic value of depression remains unclear. The purpose of this systematic review was to synthesize the evidence on the prognostic value of depression for a range of outcomes in patients with LSS., Methods: Inclusion criteria were prospective cohort studies that investigated depression in patients diagnosed with LSS. Searches were conducted in 7 databases. Critical appraisal, data extraction, and judgement of cumulative evidence were conducted independently by two reviewers. A meta-analysis was not conducted due to a lack of unique cohorts for each outcome, varying follow-up times, and differences in measurements for both prognostic factors and outcomes., Results: Twenty-three articles were included. There was evidence for an association between preoperative depression and postoperative disability and symptom severity outcomes for patients with LSS. Odds ratios ranged from 1.15 to 2.94 for postoperative disability and 1.16-1.20 for symptom severity at various follow-up times. Using GRADE, evidence supporting depression as a prognostic factor for these LSS outcomes was deemed to be of moderate quality. Similarly strong evidence suggested depressive symptoms are of no prognostic value for postoperative walking capacity., Conclusion: Depression appears to have small to moderate prognostic value for LSS outcomes, with the strongest evidence for postoperative disability and symptom severity. The prognostic value of depression for LSS outcomes should be further explored using standardized measures in additional cohorts, including patients managing their condition conservatively, who have been neglected in related research., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Lumbar disc herniation (LDH) is rare in juveniles. LDH occurring at age 20 years or younger is referred to as juvenile disc herniation (JDH). While adult LDH is regarded as an advanced stage of disc degeneration, it remains unclear why intervertebral discs rupture in youth. This study aimed to characterize magnetic resonance imaging (MRI) findings of JDH and investigate possible etiological factors. From 2013 to 2020, JDH patients and controls were identified and interviewed to assess demographics, general lifestyles, and family histories. MRIs were evaluated for disc degeneration, epiphyseal ring separation, Modic changes and endplate lesions. The relationships between JDH and suspected risk factors were examined. A total of 297 JDH patients (199 boys and 98 girls, age 17.3 ± 2.1 years) and 185 controls (age 17.1 ± 2.4 years) were studied. Age, body mass index, exposures to daily physical labor, regular exercise, and daily sitting time were similar between JDH cases and controls. A family medical history of serious back pain was more common in JDH patients than in controls (59.4% vs. 26.5%, p < 0.001), as well as family history of clinically established LDH (45.0% vs. 12.4%, p < 0.001). Epiphyseal ring separation was identified in 102 (29.2%) herniated discs in 91 (36.4%) JDH patients, while occurring in only 5 (1.4%) control participants (p < 0.001). Overall, severe disc degeneration was not a prominent finding in JDH patients. In conclusion, epiphyseal ring separation was a common magnetic resonance feature in JDH. Findings suggest a genetically mediated developmental model of JDH, rather than a model of premature disc degeneration., (© 2023 Orthopaedic Research Society.)

Background: Data-driven development of medical biomarkers of bone requires a large amount of image data but physical measurements are generally too restricted in size and quality to perform a robust training., Purpose: This study aims to provide a reliable in silico method for the generation of realistic bone microstructure with defined microarchitectural properties. Synthetic bone samples may improve training of neural networks and serve for the development of new diagnostic parameters of bone architecture and mineralization., Methods: One hundred-fifty cadaveric lumbar vertebrae from 48 different male human spines were scanned with a high resolution peripheral quantitative CT. After prepocessing the scans, we extracted 10,795 purely spongeous bone patches, each with a side length of 32 voxels (5 mm) and isotropic voxel size of 164 μm. We trained a volumetric generative adversarial network (GAN) in a progressive manner to create synthetic microstructural bone samples. We then added a style transfer technique to allow the generation of synthetic samples with defined microstructure and gestalt by simultaneously optimizing two entangled loss functions. Reliability testing was performed by comparing real and synthetic bone samples on 10 well-understood microstructural parameters., Results: The method was able to create synthetic bone samples with visual and quantitative properties that effectively matched with the real samples. The GAN contained a well-formed latent space allowing to smoothly morph bone samples by their microstructural parameters, visual appearance or both. Optimum performance has been obtained for bone samples with voxel size 32 × 32 × 32, but also samples of size 64 × 64 × 64 could be synthesized., Conclusions: Our two-step-approach combines a parameter-agnostic GAN with a parameter-specific style transfer technique. It allows to generate an unlimited anonymous database of microstructural bone samples with sufficient realism to be used for the development of new data-driven methods of bone-biomarkers. Particularly, the style transfer technique can generate datasets of bone samples with specific conditions to simulate certain bone pathologies., (© 2023 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Study Design: A descriptive, cross-sectional cadaver study., Objective: This study aimed to provide a thorough depiction of vertebral endplate defects classified based on their morphologic features and reported with respect to size, location, and prevalence in the human cadaveric spines of older adults., Summary of Background Data: Back pain has been associated with vertebral endplate defects; however, findings have been inconsistent. This is partially due to miscommunication surrounding the classification of endplate defects observed using clinical imaging, and limited knowledge of the types of defects present on the endplate and their prevalence. A comprehensive study of vertebral endplates is needed to clarify types of structural defects, their character, and prevalence., Materials and Methods: Using micro-computed tomography, 3-dimensional reconstructed images were created of 409 endplates from 19 cadaveric spines (9 men and 10 women; aged 62-91; T6-S1). Endplate defects were categorized based on their morphology, size, and location to investigate distribution patterns., Results: Seven types of endplate defects were identified: Schmorl nodes, corner fracture or limbus vertebra, other fractures, erosion, jagged surface, calcification, and depressions. Defects were identified on 63.6% of endplates. Multiple defects were present on 19.1% of endplates. Fracture and erosion were the most common defect types. Defects were more common on the endplate cranial to the intervertebral disc and in male specimens ( P = 0.01). Defects were larger in the lumbar spine and the "total area of endplate defect" was larger on the cranial than the caudal endplate in the thoracic spine ( P < 0.05)., Conclusion: This is the first study of which we are aware that provides a thorough depiction of the morphology and distribution of endplate defects across the entire lower thoracic and lumbar spine (T6-S1) using micro-computed tomography. Results support the presence of several distinct endplate defect phenotypes with different prevalence rates and provide a reference when considering endplate defects in the elderly., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The importance of lumbar findings on magnetic resonance imaging (MRI) remains controversial. Changes in lumbar MRI findings over time may provide important insights into the causes of low back pain. However, the reliability and validity of temporal changes are unknown., Objective: To (1) investigate the interrater reliability of subjective radiologist reporting of temporal changes in lumbar spine MRI findings and (2) determine how commonly temporal changes are reported when two scans are conducted 30 minutes apart (considered false positives)., Design: Cross-sectional study., Setting: Radiology clinic., Participants: Forty volunteers (mean age 40; 53% female) with current (n = 31) or previous (n = 9) low back pain underwent initial lumbar MRI on a single 3T scanner. Participants then lay on a bed for 30 minutes before undergoing an identical MRI. In addition, we purposely selected five participants from a previous study with repeat lumbar MRI scans where temporal changes were reported in at least one MRI finding (1-12 weeks after initial scan) and another five participants where no temporal change was reported. The 10 participants were included in analyses for aim 1 only., Interventions: Not applicable., Main Outcome Measures: Two blinded radiologists reported on temporal changes between the baseline and repeat scan for 12 different MRI findings (eg, disk herniation, annular fissure) at five levels., Results: The interrater reliability of subjective reporting of temporal changes was poor for all MRI findings based on Kappa values (≤ 0.24), but agreement was relatively high (≥ 90.8%). This is explained by the low prevalence of temporal changes as demonstrated by high values for Prevalence and Bias Adjusted Kappa (≥ 0.82). "False positive" temporal changes were reported by at least one radiologist for most MRI findings, but the rate was generally low., Conclusions: Caution is required when interpreting temporal changes in lumbar MRI findings owing to low reliability and some false positive reporting., (© 2021 American Academy of Physical Medicine and Rehabilitation.)

Objectives: The integrity of endplate is important for maintaining the health of adjacent disc and trabeculae. Yet, pathological impacts of traumatic vertebra and endplate fractures were less studied using clinical approaches. This study aims to investigate their effects on the development of adjacent disc degeneration, segmental kyphosis, Modic changes (MCs), and high-intensity zones (HIZs)., Materials and Methods: Magnetic resonance (MR) images of patients with acute traumatic vertebral compression fractures (T11-L5) were studied. On MR images, endplate fractures were evaluated as present or absent. Disc signal, height, bulging area, sagittal Cobb angle, MCs, and HIZs were measured on baseline and follow-up MR images to study the changes of the disc in relation to vertebra fractures and endplate fractures., Results: Ninety-seven patients were followed up for 15.4 ± 14.0 months. There were 123 fractured vertebrae, including 79 (64.2%) with endplate fractures and 44 (35.8%) without. Both the adjacent and control discs decreased in signal and height over time (p < 0.001), and the disc adjacent to vertebral fractures had greater signal and height loss than the control disc (p < 0.05). In the presence of endplate fractures, the adjacent discs had greater signal decrease in follow-up (p < 0.05), as compared to those without endplate fractures. Sagittal Cobb angle significantly increased in segments with endplate fractures (p < 0.05). Vertebra fractures were associated with new occurrence of MCs in the fractured vertebra (p < 0.001) but not HIZs in the adjacent disc., Conclusions: Traumatic vertebral fractures were associated with accelerated adjacent disc degeneration, which appears to be further promoted by concomitant endplate fractures. Endplate fractures were associated with progression of segmental kyphosis., (© 2021. ISS.)

Background: Low frequency vibrations from motorized vehicles and heavy equipment have been associated with musculoskeletal disorders. Spine degeneration on diagnostic imaging provides direct and objective measures of the possible effects of such exposures on the spine., Objective: The objective of this systematic review was to evaluate the association of exposure to whole-body vibration (WBV) with spine degeneration on imaging., Methods: We conducted electronic searches in MEDLINE, CINAHL, EMBASE, and Web of Science to July 2021. Two reviewers independently screened search results, assessed quality, and extracted data. Studies evaluating the exposure to WBV and lumbar spine degeneration on imaging were included., Results: Fifteen studies (16 manuscripts) were included. Seven studies including a meta-demonstrated moderate quality evidence of no association between WBV and disc degeneration. There was also moderate quality evidence of no association between WBV and disc height narrowing and osteophytes. Overall, there was low level evidence of no association between WBV and other degenerations findings., Conclusions: There was moderate to low quality evidence suggesting no association between WBV exposures with spine degeneration on imaging. The results of this study currently do not support assertion that motorized vehicle and WBV exposure accelerates degeneration and causes structural damage to the spine.

Purpose: Paraspinal muscle imaging is of growing interest related to improved phenotyping, prognosis, and treatment of common spinal disorders. We reviewed issues related to paraspinal muscle imaging measurement that contribute to inconsistent findings between studies and impede understanding., Methods: Three key contributors to inconsistencies among studies of paraspinal muscle imaging measurements were reviewed: failure to consider possible mechanisms underlying changes in paraspinal muscles, lack of control of confounding factors, and variations in spinal muscle imaging modalities and measurement protocols. Recommendations are provided to address these issues to improve the quality and coherence of future research., Results: Possible pathophysiological responses of paraspinal muscle to various common spinal disorders in acute or chronic phases are often overlooked, yet have important implications for the timing, distribution, and nature of changes in paraspinal muscle. These considerations, as well as adjustment for possible confounding factors, such as sex, age, and physical activity must be considered when planning and interpreting paraspinal muscle measurements in studies of spinal conditions. Adoption of standardised imaging measurement protocols for paraspinal muscle morphology and composition, considering the strengths and limitations of various imaging modalities, is critically important to interpretation and synthesis of research., Conclusion: Study designs that consider physiological and pathophysiological responses of muscle, adjust for possible confounding factors, and use common, standardised measures are needed to advance knowledge of the determinants of variations or changes in paraspinal muscle and their influence on spinal health., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To clarify the current state of knowledge on the association of endplate structural defects and back pain., Methods: Five databases were searched for studies reporting on the association between endplate structural defects and back pain. Covidence and comprehensive meta-analysis software were used for article screening and selection and pooling of extracted data. Overall quality of evidence was assessed using GRADE., Results: Twenty-six studies comprised of 11,027 subjects met inclusion criteria. The presence of moderate heterogeneity (I 2  = 73%; p = 0.001) prevented the pooling of estimates across all studies. However, it was possible to pool studies of specific endplate defect phenotypes, such as erosion (OR: 2.69; 95% CI: 1.35-5.50) and sclerosis (OR: 1.97; 95% CI: 1.50-2.58), which yielded significant associations with back pain. Schmorl's nodes were also associated with most individual back pain phenotypes (OR: 1.53-1326, I 2  = 0-7.5%) and back pain overall (OR: 1.63, 95% CI: 1.37-1.94, I 2  = 26%) in general population samples. The pooling of data from all studies of specific back pain phenotypes, such as frequent back pain (OR: 2.83; 95% CI: 1.77-4.52) and back pain incidence (OR: 1.65; 95% CI: 1.30-2.10), each yielded significant association with endplate structural defects and was supported by low heterogeneity (I 2  =  < 7.5.%)., Conclusion: Overall, there is moderate quality evidence of an association between back pain and endplate structural defects, which is most evident for erosion, sclerosis and Schmorl's nodes. Going forward, research on specific endplate defect phenotypes and back pain case definitions using strong study designs will be important in clarifying the extent of associations and underlying mechanisms. The study was prospectively registered in Prospero (CRD42020170835) on 02/24/2020., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Growing evidence suggests an association of lumbar paraspinal muscle morphology with low back pain (LBP) and lumbar pathologies. Unilateral spinal disorders provide unique models to study this association, with implications for diagnosis, prognosis, and management. Statistical shape analysis is a technique that can identify signature shape variations related to phenotypes but has never been employed in studying paraspinal muscle morphology. We present the first investigation using this technique to reveal disease-related paraspinal muscle asymmetry, using MRIs of patients with a single posterolateral disc herniation at the L5-S1 spinal level and unilateral leg pain. Statistical shape analysis was conducted to reveal disease- and phenotype-related morphological variations in the multifidus and erector spinae muscles at the level of herniation and the one below. With the analysis, shape variations associated with disc herniation were identified in the multifidus on the painful side at the level below the pathology while no pathology-related asymmetry in cross-sectional area (CSA) and fatty infiltration was found in either muscle. The results demonstrate higher sensitivity and spatial specificity for the technique than typical CSA and fatty infiltration measures. Statistical shape analysis holds promise in studying paraspinal muscle morphology to improve our understanding of LBP and various lumbar pathologies., (© 2021. The Author(s).)

Objective: Back pain is an elusive symptom complicated by a variety of possible causes, precipitating and maintaining factors, and consequences. Notably, the underlying pathology remains unknown in a significant number of cases. Changes to the intervertebral disc (IVD) have been associated with back pain, leading many to postulate that the IVD may be a direct source of pain, typically referred to as discogenic back pain. Yet despite decades of research into the neuroanatomy of the IVD, there is a lack of consensus in the literature as to the distribution and function of neural elements within the tissue. The current scoping review provides a comprehensive systematic overview of studies that document the topography, morphology, and immunoreactivity of neural elements within the IVD in humans., Method: Articles were retrieved from six separate databases in a three-step systematic search and were independently evaluated by two reviewers., Results: Three categories of neural elements were described within the IVD: perivascular nerves, sensory nerves independent of blood vessels, and mechanoreceptors. Nerves were consistently localized within the outer layers of the annulus fibrosus. Neural ingrowth into the inner annulus fibrosus and nucleus pulposus was found to occur only in degenerative and disease states., Conclusion: While the pattern of innervation within the IVD is clear, the specific topographic arrangement and function of neural elements in the context of back pain remains unclear., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: While cartilaginous endplate (CEP) avulsion is a common finding in discectomy due to lumbar disc herniation, its roles in residual back and leg pain, associations with Modic changes (MCs) and endplate defects (EPD) remain unknown., Design: Patients with a single-level lumbar disc herniation who underwent endoscopic discectomy were studied. On MR images, the adjacent endplates of the herniated disc were assessed for MCs and EPD. The presence of CEP avulsion was examined under endoscopic and visualized inspection. Back and leg pain were evaluated by a numeric rating scale (NRS) and the Oswestry Disability Index. Associations of CEP avulsion with adjacent MCs, EPD, and residual back and leg pain were examined. In addition, histological features of avulsed CEP were determined using gross staining and immunohistochemical methods., Results: A total of 386 patients were included. CEP avulsion was found in 166 (43%) patients, and adjacent MCs and EPD were observed in 117 (30.3%) and 139 (36%) patients. The presence of CEP avulsion was associated with greater age, adjacent MCs (OR = 2.60, 95%CI [1.61-4.19]) and EPD (OR = 1.63, 95%CI [1.03-2.57]). Among the 187 patients with ≥2 years follow-up, CEP avulsion was associated with residual back pain (OR = 2.49, 95%CI [1.29-4.82]) and leg pain (OR = 2.25, 95%CI [1.04-4.84]). Histologically, the avulsed CEP was characterized by multiple defects, apparent inflammation, and nucleus invasion, as well as the upregulation of IL-1β, caspase-1, and NLRP3 inflammasome., Conclusion: CEP avulsion was associated with MCs, EPD, and residual back and leg pain after discectomy, which may be attributed to NLRP3 inflammasome related inflammations., (Copyright © 2021 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Background: Intervertebral disc degeneration affects the morphology, biomechanics and biochemistry of the disc. The study aimed to compare the effects of compression and traction on lumbar discs measurements in relation to degeneration., Methods: Thirty-five volunteers (30 (SD 11) yrs.) with and without chronic back pain rested supine 15 min before an unloaded T 2 -mapping MRI, were then loaded 20 min with 50% body weight with imaging during the last 5 min, and then repeated this process under traction. For lumbar discs, height, angle, width, mean-T 2 , and T 2 -weighted centroid locations were calculated. A repeated measure ANCOVA and Cohen's d compared loading conditions. Relations between measurement changes between conditions and degeneration assessed by Pfirrmann ratings were examined graphically., Findings: From compression to traction, we observed significant: decrease in L1-2 mean-T 2 (Effect size = -0.35); inferior and posterior shift in L4-5 (0.4, 0.14) and L5-S1 (0.25, 0.33) T 2 -weighted centroid. From unloaded to compression, we observed a significant: increase in L5-S1 width (Effect Size = 0.22); anterior shift in L1-2 T 2 -weighted centroid (0.39); and L3-4 (mean 2.1°) and L4-5 (1.8°) extension angle. More degeneration was graphically related with larger changes from Compression to Traction (more superior and, anterior position of the T 2 -weighted centroid, increased height, reduced extension of segmental angle) and from Unloaded to Compression larger changes in inferior displacement of the T 2 - weighted centroid, decrease in height) but less anterior displacement of the centroid and less change in segmental angles., Interpretation: The largest loading responses were at lower levels, generally with more degeneration. T 2 -weighted centroid locations, angle and disc height detected the largest loading response., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Diagnostic imaging is routinely used to depict structural abnormalities in people with low back pain (LBP), but most findings are prevalent in people with and without LBP. It has been suggested that LBP is related to changes induced in the spine due to loading. Therefore, new imaging measurements are needed to improve our ability to identify structures relating to LBP., Objectives: To investigate the response of the lumbar spine to compression and traction in participants with and without chronic LBP using MRI T 2 -mapping., Method: Fifteen participants with chronic LBP were matched for age, weight, and gender with 15 healthy volunteers. All participants underwent MRI under three loading conditions maintained for 20 min each: resting supine, followed by compression and traction, both using 50% body weight. Participants were imaged in the last 5 min of each loading condition. Disc morphometric and fluid-based measurements from T 2 -maps were obtained., Results: Traditional MRI measurements (i.e. disc height, width and mean signal intensity) were not able to capture any differences in the changes measured in response to loading between individuals with and without pain. The location of the T 2 weighted centroid (WC) was able to capture the difference between groups in response to compression in the horizontal (p < 0.01) and vertical direction (p < 0.01), and in response to traction in the vertical direction (p < 0.01). While the location of T 2 WC moved anteriorly (Effect Size (ES): 0.44) and inferiorly with compression in those with pain (ES: 0.34), it moved posteriorly (ES: -0.14) and superiorly (ES: -0.05) in the group without pain. In response to traction, the vertical location of T 2 WC moved superiorly in both groups but the change was larger in those with pain (ES Pain  = -0.52; ES No Pain : -0.13)., Conclusion: The novel measurements of the location of the T 2 WC in the intervertebral discs were the only measurements capturing differences in response to loading between those with and without low back pain., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Hypertension is a prevalent condition that is associated with lower health status in patients with lumbar spinal stenosis. The study determined whether hypertension is a prognostic factor associated with functional recovery after spine surgery for lumbar spinal stenosis. This was a secondary analysis of the Alberta Lumbar Spinal Stenosis Study in which patients were identified as participants at the time of lumbosacral magnetic resonance imaging or computed tomography in Calgary, Alberta, Canada. Multivariable linear regression analyses were performed to examine hypertension as a prognostic factor of functional recovery after surgery (Oswestry Disability Index, the Swiss Spinal Stenosis (SSS)-Symptom Severity and SSS-Physical Function scales). Of the 97 surgical participants, 49 who were hypertensive were older (76.8, SD 11.4 years) than the 48 non-hypertensive participants (66.7, SD 12.4 years) ( p < 0.001). No significant associations between hypertension and post-operative function in any of the three multivariable models were seen. The Oswestry Disability Index mean score improved after surgery (effect size: 1.73; 95%CI: 1.39, 2.06), with no differences seen between those with and without hypertension ( p = 0.699). Large changes were seen after surgery for the SSS-Symptom Severity (effect size: 1.0, 95%CI 0.7, 1.3) and SSS-Physical Function (effect size: 0.9, 95%CI 0.6, 1.2) scales. Hypertension alone does not negatively impact functional recovery following surgery.

Intervertebral discs (IVDs) are often referred to as the largest avascular structures of the human body, yet a collective resource characterizing the vascularization of the IVD does not exist. To address this gap, the objective of this study was to conduct a comprehensive search of the literature to review and summarize current knowledge of the prevalence and localization of blood supply in human IVDs, with a scoping review. A comprehensive search of peer-reviewed publications on the topic of IVD vascularization in humans was conducted across six electronic databases: PubMed, EMBASE, MEDLINE, Scopus, Web of Science, and BIOSIS Previews. Studies of humans were included regardless of age, sex, ethnicity, and health status, with the exception of IVD herniation. Two independent reviewers screened titles and abstracts and full-texts according to eligibility criteria. The review was conducted and reported according to Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews guidelines. Our search yielded 3122 articles, with 22 articles meeting the inclusion criteria. The study samples ranged in age from fetal to >90 years and included both sexes, various health statuses, and used different methodologies (eg, histology, medical imaging, and gross dissection) to assess vasculature. Overall, consistent observations were that (a) the nucleus pulposus of the IVD is avascular throughout life, (b) both the cartilage endplates and annulus fibrosus receive considerable blood supply early in life that diminishes over the lifespan, and (c) vascular ingrowth into the cartilage endplates and inner layers of the annulus fibrosus is commonly associated with damaged or disrupted tissue, irrespective of age. Histology and immunohistochemistry are often used to report vascularization of the IVD. The body of the current literature suggests that the IVD should not be generalized as an avascular tissue. Instead, vascularization of the IVD differs based on the constituent tissues, their age, and state of degeneration or damage., Competing Interests: The authors declare no potential conflict of interest., (© 2020 The Authors. JOR Spine published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.)