bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diffusion Tensor Imaging: New Diagnostic Tool for Degenerated Lumbar Disease
Authors: Oikawa Y. , Eguchi Y. , Ohtori S. , Inoue G. , Ishikawa T. , Miyagi M. , Kamoda H. , Suzuki M. , Sakuma Y. , Kubota G. , Sato H. , Ando H. , Okumura K. , Masuda Y. , Watanabe A. , Takahashi K. 
Published: June 2012

Introduction It is difficult to correctly diagnose lumbar degenerated disease with foraminal stenosis using conventional X-ray imaging, CT, and MRI. This difficulty can sometimes result in failed back syndrome. Diffusion Tensor Imaging (DTI) was reported as a potential tool for the diagnosis for foraminal stenosis. The purpose of this study is to evaluate the efficacy of DTI for diagnosis of degenerated lumbar disease. Materials and Methods Total 27 patients (20 men, mean age, 68.5 years) with degenerated lumbar disease who underwent 3.0 T MRI and surgical treatment were included. DTI (tractography), fractional anisotropy (FA), and improvement in Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) pain score were investigated. Results The diagnoses by conventional imaging were lumbar spinal stenosis without foraminal stenosis in 11 cases, with foraminal stenosis in 10 cases, lumbar disk herniation in 3 cases, spondylolisthesis in 2 cases, and discogenic low back pain in 1 case. We classified the patients into following four groups by the shape of the tractography; disruption, narrowing, tapering, and no abnormalities. The mean preoperative JOA and VAS score were 14 and 88, and postoperative score were 21 and 12, respectively. The JOA score was improved by 46%. Tractography of the ipsilateral side showed disruption, narrowing, and tapering, and a lower FA compared with the contralateral side. There was no significant correlation between FA and symptoms. Conclusion Although there is no significant correlation between DTI and postsurgical symptoms, DTI has the possibility of detecting lesions of nerve damage, and to be a new diagnostic tool for the degenerated lumbar disease. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Is there a Value in Repeated Computer Tomography Testing in Patients with Lumbar Spine Symptoms?
Authors: Schroeder J. E. , Hiller N. , Kaplan L. , Hasharoni A. , Barzilay Y. 
Published: June 2012

Introduction CT scans of the lumbar spine are indicated in the search of neural compressive lesions and in search of a cause for specific low back pain (LBP). They are associated with a high radiation exposure of 700 to 1500 mREMs per exam. The goal of the study was to investigate whether repeat spine CT scans, in patients who are symptomatic 2 years after the initial exam, contribute new clinical data. Materials and Methods Repeated CT scans performed for LBP or radiculopathy between 2008 and 2010 were identified in our radiology department. Only patients 60 years of age and below were included. Patients with a history of trauma or surgery between exams were excluded. All scan (original and repeat) were reviewed by a senior musculoskeletal radiologist. Interval changes between scans were rated as: no change, worsening of the pathology, improvement of the pathology, or new pathology. Results Total 6000 lumbar spine CT scans were performed between the years 2008 and 2010. Total 550 were repeatedly examined. Total 108 repeated CT scans met the inclusion criteria; 35 scans were ordered to investigate LBP, 46 for radiculopathy and in 27 exams the indication was not stated. The average age of the patients was 48.1 (range: 18 to 60). The average interval between the scans was 24.1 months (SD = 6 months). Spine pathology was identified in 287 levels. In 10 patients, the spine was without any pathology. Total 274 pathologies did not changed (92.3%; p < 0.05), 10 improved, and 10 worsened (disk herniation or spinal stenosis). Three new pathologies were identified (one fracture two disk herniations). In case of worsening, no substantial therapeutic change was required. In patients who were sent for a repeated CT for LBP, only two pathologies changed between exams. Conclusion CT scans cause 1% of annual cancer mortality in the USA. The repeated radiation from unnecessary exams accumulates and causes secondary malignant changes. In the time frame of 2 to 3 years, in patients suffering chronic or recurrent LBP or radiculopathy, there is a little added diagnostic value for repeated CT scans. Repeated scan should be considered only in patients with progressive neurologic deficits or signs implying serious underlying conditions. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared Aaron Sodickson, Pieter F. Baeyens, Katherine P. Andriole, et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 2009;251:175–184
Correlation between MMP-3 Activity and Intervertebral Disk Degeneration According to Radiologic Data
Authors: Canbay S. , caglar S. , turhan N. , Arda K. 
Published: June 2012

Introduction During the degeneration process, tissue resorption causes a progressive and important decrease in intervertebral disk height. The main characteristics of disk degeneration are intradiscal clefts and teardrops. It is accepted that matrix-degrading enzymes, such as matrix metalloproteinases (MMPs), play an important role in disk tissue degeneration and destruction. Materials and Methods This study involved 42 patients between 26 and 69 years of age who underwent surgery for lumbar disk herniation (46 disk spaces). Tissue sections were used to immunolocalize MMP-3. The number of labeled cells was determined using morphometric analysis. Cell proliferation, cleft and teardrop formation, granular matrix changes, and mucosal degeneration were statistically assessed. Additionally, enzymatic gelatinolytic activity was determined using zymography. MMP-3 levels and histological degeneration scores were compared using the Pfirrmann classification, a radiologic disk degeneration grading system. Results The intradiscal expression of MMPs in the nucleus pulposus and annulus fibrosus cells was confirmed using immunohistochemistry, and gelatinolytic enzymatic activity was confirmed with in situ zymography. A significant relationship was determined between disk degeneration, characterized by intradiscal cleft and teardrop formation, and MMP-3 levels. Disk cell proliferation and matrix degeneration (granular changes and mucosal degeneration) were also found to be related to MMP-3 expression. Similarly, a relationship between enzymatic activity and cleft formation was determined. Conclusion Our findings support the hypothesis that MMP-3 enzyme levels play an important role in IVD degeneration. This association is supported by the high correlation between cleft and teardrop formation and MMP expression. These findings indicate the important role of MMPs in the loss of normal disk function as a result of IVD degeneration, which causes lumbar pain. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared Kanemoto M, Hukuda S, Komiya Y, Katsuura A, Nishioka J. Immunohistochemical study of matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1 human intervertebral discs. Spine 1996;21(1):1–8 Kang JD, Stefanovic-Racic M, McIntyre LA, Georgescu HI, Evans CH. Toward a biochemical understanding of human intervertebral disc degeneration and herniation. Contributions of nitric oxide, interleukins, prostaglandin E2, and matrix metalloproteinases. Spine 1997;22(10):1065–073 Crean JK, Roberts S, Jaffray DC, Eisenstein SM, Duance VC. Matrix metalloproteinases in the human intervertebral disc: role in disc degeneration and scoliosis. Spine 1997;22(24):2877–2884
Determinants of Health Care Use for Low Back Pain in Adolescence
Authors: Tiira A. , Paananen M. , Taimela S. , Zitting P. , Järvelin M. R. , Karppinen J. 
Published: June 2012

Introduction Recent studies have indicated that LBP is already common in adolescence, but only a few studies have evaluated the factors that determine LBP-related health care use at this age. Materials and Methods The study population included 1987 adolescents aged 18 from the Oulu Back Study (OBS), a subcohort of the 1986 Northern Finland Birth Cohort (NFBC 1986). We used logistic regression to evaluate whether enabling resources need factors; personal health habits or psychological problems are associated with seeking health care for LBP, among adolescents reporting LBP during the last year. Results Of the 1987 respondents, 50% of the women and 42% of the men reported having had LBP during the previous year. Of the 921 respondents with LBP, 89 (16%) women and 59 (16%) men had consulted a health care professional. In both the genders, pain intensity was strongly associated with seeking care (VAS 8–10 vs. VAS 0–3; men: OR 16.6, 95% CI, 3.8–72.5, women: OR 18.8 95% CI, 6.3–56.1). In addition, LBP-related daily activity limitations (impairment index 4–6 vs. 0 OR 15.7 95% CI, 1.7–142.5) were associated with care seeking among males. Student status was also associated with care-seeking among males (OR 2.34 95% CI, 1.02–5.36). (Fig. proportion of adolescents seeking medical care for LBP according to pain intensity in VAS.) Conclusion Approximately one out of six adolescents with LBP seeks medical care. Intensity of pain and daily activity limitations appear to be the main determinants of seeking care for LBP in adolescence. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Frequency of Antidepressant Medication in Spine Surgery Patients
Authors: Kuittinen P. , Savolainen S. , Nyyssönen T. , Kröger H. , Sipola P. , Airaksinen O. , Leinonen V. 
Published: June 2012

Introduction Previous studies have shown that preoperative depression is associated with poorer outcome of lumbar spinal stenosis. However, much is still not known about the prevalence of antidepressant treatment among spine surgery patients. The purpose of this study was to analyze the prevalence of antidepressant treatment in the different spine surgery groups. Materials and Methods We evaluated retrospectively 3145 spine surgery patients treated between the years 2003 and 2007 in Kuopio University Hospital. Patients mean age was 51.7 years, range: 18 to 84 years. Total 56.5% were male. We collected the medication data from the patient records, and compared the prevalence of antidepressant treatment at the time of operation in spine surgery groups. Results The prevalence antidepressant treatment was highest in the posterior cervical decompression surgery group (14.3%) followed by LSS (10.1%), anterior cervical decompression (ACD, 9.8%), and lumbar spondylolisthesis (8.5%). The lowest prevalence for antidepressant treatment was in the lumbar disk herniation group (5.6%) and this group differed significantly from other groups (LSS p < 0.001, ACD p = 0.001 and posterior cervical decompression p = 0.004). Conclusion Our results indicate that the frequency of antidepressant treatment varies significantly between different spine surgery groups. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
May Extraspinal Lumbar Compression Mimic Lumbar Pain and Sciatica? A Presentation of Unusual Cases
Authors: Velnar T. , Bunc G. , Ravnik J. , Vorsic M. 
Published: June 2012

Introduction Compression of sciatic nerve may often cause symptoms of lumbar radiculopathy. In 90% of patients with sciatica, spinal causes may be found. On the other hand, extraspinal compression of the sciatic nerve is very rare, found only in 10%. Most frequently, the lesion is in the pelvis due to tumors and bony compression. Clinical features are very similar to the usual causes of sciatica. Precise diagnosis is difficult to establish with standard diagnostic procedures due to absence of specific tests. We present cases of extraspinal sciatic nerve compression. Materials and Methods At our department, patients with concomitant intra- and extraspinal sciatic nerve compression were treated. All had typical sciatica that was unresponsive to conservative treatment in the beginning, as well as to standard surgical spinal decompression. Results Extraspinal origin was found as a cause for the pain: in one case, the tumor in presacral region behind the bladder with destruction of sacrum and compression of sacral plexus; in the second, femoral vein thrombosis, which resulted in massive pulmonary embolism; in the third, abscess of the Douglas pouch, involving the sacral plexus; in the fourth, abscess of psoas muscle and in the fifth, paravertebral muscle abscess. Conclusion Clinically, extraspinal compressive pain may hardly be distinguished from intraspinal radicular pain. In contemporary double compressions particularly, the diagnosis is aggravated. The candidates are patients with no improvement after appropriate intraspinal surgery as a result of initial sciatic pain. Early diagnosis of extraspinal compression leads to effective treatment and additional extended diagnostic workup is therefore important. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared Kleiner JB, Donaldson WF, Curd JG, et al. Extraspinal causes of lumbosacral radiculopathy. Journal of Bone and Joint Surgery 1991;73:817–821 Paksoy Y, Gormus N. Epidural venous plexus enlargements presenting with radiculopathy and back pain in patients with inferior vena cava obstruction or occlusion. Spine 2004;29:2419–2424 Servant CT. An unusual cause of sciatica: a case report. Spine 1998;23:2134–2136 Doniec J, Gaździk T, Folta K, et al. Extraspinal sciatica. Chir Narzadow Ruchu Ortop Pol 1988; 53(5):359–361 Arct W. Extraspinal symptomatic sciatica. Chir Narzadow Ruchu Ortop Pol 1980;45:71–75
Primary Ewing's Sarcoma of Spine Mimicking Nerve Sheath Tumor
Authors: Aydin E. H. , Özbek Z. , Çiftçi E. , Arslantaş A. 
Published: June 2012

Introduction A 32-year-old man admitted to our clinic after 1 month history of progressively worsening back pain. He had no previous pain or systemic symptoms before this history. Neurological examination revealed paraparesis at lower extremity. Sensibility was decreased below the level Th 12. Bladder dysfunction was admitted. Laboratory assessments including erythrocyte sedimentation rate are normal limits. Magnetic resonance imaging demonstrated an epidural mass at the T5-7. Lesion invading chest and soft tissues. Sagittal projection of T2 MRI image demonstrating tumor 7 × 5 × 4 cm size, displacing the spinal cord to the left side and invasion of mediastinum (Fig. 1). PET CT shows increased activity in T5-6 level. The patient underwent surgery as the first line of management. The tumor was removed mostly by the combined anterior and posterior approach. Anterior reconstruction was carried out using a titanium cage. Materials and Methods Histopathological examinations confirmed an Ewing's sarcoma arising from the thoracic epidural space. After 1 week of surgery, the patient was referred to the oncology department. He underwent a combined radiotherapy and chemotherapy protocol. Results Occurrence of primary Ewing's sarcoma of the spine has been rarely reported in the literature. It occurs from 12 to 24 years of age and is very rare after 30 years. Local back pain usually is the first and typical complaint occur like a schwannoma. MRI of the thoracal spine revealed lesion at the right neural foramen appearing to originate from the nerve root and invading mediastinum, suspicious for a giant spinal schwannomas. Conclusion In ES cases, vertebrae are affected in less than 5%. Unlike schwannomas, the ES prognosis is usually poor. After surgery, radiation therapy, and chemotherapy the mean survival time was 2.9 years. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Comparison between Anterior Lumbar Interbody Fusion and Posterolateral Fusion in a Punctured Disk Model in Rats
Authors: Kamoda H. , Ohtori S. , Inoue G. , Yamauchi K. , Eguchi Y. , Miyagi M. , Ishikawa T. , Suzuki M. , Sakuma Y. , Oikawa Y. , Saino T. , Inage K. , Kubota G. , Orita S. , Takahashi K. 
Published: June 2012

Introduction Conservative treatments are sufficient for patients with discogenic pain; however, fusion surgery is performed to relieve unresolved pain. Of several available fusion techniques, the method remains controversial. This study used pain assessment to compare anterior lumbar interbody fusion (ALIF) versus posterolateral fusion (PLF) in a rat-punctured disk model. Materials and Methods Total 80 male Sprague-Dawley rats (200 to 250 g) were divided into four groups, nonpuncture group( n = 20), puncture group( n = 20), puncture + ALIF group( n = 20), and puncture + PLF group( n = 20). The neurotracer fluoro-gold was applied to detect dorsal root ganglion (DRG) neuron disk innervation. After 1 week of the procedure, surgical treatment was performed in ALIF and PLF groups. After 4 and 8 weeks of surgery, bone union was verified using micro CT, pain behavior was analyzed using CatWalk system, and the proportion of calcitonin gene-related peptide (CGRP) (pain neuropeptide)-immunoreactive, FG-labeled DRG neurons were determined. Results Bone union was confirmed at 4 and 8 weeks in both fusion groups. In CatWalk analysis, ALIF animals significantly improved over 8 weeks compared to PLF animals ( p < 0.05). CGRP-immunoreactive DRG neurons increased in all puncture groups compared to nonpuncture group ( p < 0.01); however, these decreased in the fusion groups to control levels at 8 weeks, and the significant difference between ALIF and PLF animals was observed only at 2 weeks ( p < 0.05). Conclusion After completion of bone union, punctured disk-related pain decreased to control levels in both fusion groups; however, ALIF animals showed faster recovery of pain behavior than PLF animals. These results suggest that both ALIF and PLF are similarly effective for pain originated from degenerated disks, but posterior muscle injury might influence postoperative healing. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Influence of Mechanical Stress on Low Back Pain Related to Osteoporosis: Dynamics of Sensory Nerve Transmission of Pain in the Caudal Vertebrae under Compression using a Rat Model of Osteoporosis
Authors: Suzuki M. , Ohtori S. , Inoue G. , Orita S. , Miyagi M. , Ishikawa T. , Kamoda H. , Arai G. , Sakuma Y. , Oikawa Y. , Takahashi K. 
Published: June 2012

Introduction We have previously reported that inflammatory mediators secreted by osteoclasts increased the expression of calcitonin gene-related peptide (CGRP), a marker of inflammatory pain in dorsal root ganglia (DRG) neurons innervating lumbar vertebrae of osteoporotic rats. We sought to determine whether osteoporotic pain is simply inflammatory pain. We focused on the possibility that pain is exacerbated by mechanical stress on the vertebral body, particularly in elderly people. The purpose of this study was to examine the dynamics of sensory nerve transmission of pain and the effect of mechanical stress on osteoporotic pain using a caudal vertebrae compression model in osteoporotic rats. Materials and Methods As an osteoporosis model, we used female rats ovariectomized (OVX) at 5 weeks ( n = 24). Fluoro-Gold (FG) was applied to the periosteal surface of a caudal vertebra to detect DRG neuronal cells innervating the caudal vertebra. After FG-labeling, we divided into two groups: OVX  + CMP group (n = 12) with K-wires inserted above and below a caudal vertebral body compressed using rubber bands and OVX group (n = 12) without compression. After 1, 2, 4, and 8 weeks of FG-labeling, bilateral S1 to S3 DRGs were resected ( n = 3 for each). In FG-labeled neurons, expression of CGRP and activating transcription factor 3 (ATF3), a marker of neuropathic pain, were compared between two groups using immunohistochemistry. Results The proportions of FG-labeled CGRP immunoreactive neurons in the OVX  + CMP group were significantly elevated at 4 and 8 weeks compared with the OVX group ( p < 0.05). The proportion of FG-labeled ATF3 immunoreactive neurons significantly increased compared with the FG-positive OVX group at 8 weeks ( p < 0.05). Conclusion The rat caudal vertebra compression model with osteoporosis expressed significantly more ATF3 in DRG cells at 8 weeks. This suggests that micronerve injury occurred in sensory neurons innervating caudal vertebra of these osteoporotic rats. Therefore, mechanical stress may possibly exacerbate osteoporotic pain. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Baseline MRI Characteristics in Asymptomatic Subjects as Predictors for Future First-Time LBP Episode
Authors: Samartzis D. , Karppinen J. , Luk K. , Cheung K. 
Published: June 2012

Introduction Previously, it has been noted that there is no predictive value of MRI findings of degenerative changes of the lumbar spine in asymptomatic individuals in the development of first time episodes of low back pain (LBP). In a population-based cohort, this study addressed if radiographic findings on MRI in asymptomatic individuals are predictive in the development of first-time episodes of LBP and pain severity. Materials and Methods A prospective, radiographic and clinical study was performed in 248 asymptomatic individuals of Southern Chinese origin with no previous history of LBP. All subjects underwent sagittal MRI assessment of the lumbar spine. Assessment of disk degeneration was based on the Schneiderman et al radiographic criteria to determine the presence, extent, and severity of disk degeneration. A summated degenerative disk disease (DDD) score of the lumbar spine was obtained, representing the global severity of disk degeneration. The presence of disk bulge/extrusion, Schmorl's nodes (SN), and Modic changes were also noted. At 2 years minimum follow-up, clinical assessment was performed and subject demographics were noted to identify the development of LBP and functional outcome status (e.g., Oswestry disability index). Results There were 93 males and 155 females with a mean age at MRI of 42.9 years ( ± SD = 7.6, range: 21.1 to 54.6 years). Overall presence of disk degeneration, disk space narrowing, and disk bulge/extrusion was noted in 60.5, 19.0, and 34.3% of individuals, respectively. The mean DDD score was 2.2 ( ± SD = 2.9; range: 0 to 12). SN and Modic changes were noted in 10.5 and 1.2%, respectively. Clinical follow-up was performed at a mean of 4.3 years ( ± SD = 1.9, range: 2.2 to 10.0 years). The incidence rate of first-time LBP episodes on clinical follow-up was 34.7%. The mean age of first-time LBP episode was 44.8 years ( ± SD = 8.5; range: 22 to 57 years). Regression modeling noted that the presence of disk bulge/extrusion (OR: 2.37; 95% CI, 1.30–4.32) and increasing DDD score (>7 score OR: 6.90; 95% CI, 1.86–25.52), in particular if segments involved the mid lumbar region, demonstrated significant predictive utility for developing first-time LBP episode. DDD score and disk bulge/extrusion were found predictive to the severity of LBP, greater functional disability, and increased frequency of future LBP episodes ( p < 0.05). Conclusion This large-scale prospective study substantiates that spinal changes are found in asymptomatic subjects on MRI; however, the “global severity” of disk degeneration on initial MRI may be predictive in the development of first-time LBP episodes. I confirm having declared any potential conflict of interest for all authors listed on this abstract No Disclosure of Interest None declared