scholarly journals PROSPECTIVE STUDY OF CORREALTION OF MRI FINDINGS AND CLINCAL SYMPTOMS IN LUMBAR SPINE DEGENERATIVE DISEASE

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Solanki Kunal G ◽  
Matadar Hadin M
Keyword(s):  
Lumbar Spine ◽  
Disc Degeneration ◽  
Disc Herniation ◽  
Nerve Root ◽  
Facet Joint ◽  
Modic Changes ◽  
Degenerative Disease ◽  
Nerve Root Compression ◽  
Canal Stenosis ◽  
Disc Bulge

Introduction: Degenerative disease of the lumbar spine is a broad terminology which includes disc degeneration, Modic changes, disc displacement, facet joint arthropathy and associated complications. The modality of choice for imaging degenerative disease of lumbar spine is Magnetic Resonance Imaging (MRI) due to excellent soft tissue spatial resolution and better tissue segregation.The aim of this study was to establish correlation of MRI Findings and Clinical symptoms in lumbar spine degenerative disease. Material and Methods: This descriptive cross-sectional study involved 100 patients; lumbar MRI scans were performed through L1 to S1 Intervertebral disc spaces. Clinical presenting symptoms of the patients were noted , followed by MRI in which mainly six degenerative findings were looked at which were disc degeneration, Modic changes, disc bulge, disc herniation, central canal stenosis and nerve root compression. Results:   Most frequent degenerative finding on MRI, in markedly symptomatic patients was disc degeneration seen in 100% of patients, followed by diffuse disc bulge (92.5%) and nerve root compression (82.5%). The least common finding was Facet Joint Hypertrophy seen in 22.9% of patients. In Degenerative imaging findings there was no significant sex difference. Degenerative findings were more common at lower lumbar levels (L4/L5&L5/S1). Disc degeneration, disc herniations, central canal stenosis and nerve root compression were common in patients with radiculopathy than in patients with low back pain only. In Minimally symptomatic patients disc herniation  was not seen in any patient. Conclusion:. The most frequent degenerative finding in  markedly symptomatic patients  was disc degeneration followed by diffuse disc bulge and nerve root compression. Posterolateral was the most common location for disc herniation. Disc herniation, disc degeneration, canal stenosis and nerve root compression were significantly seen in patients with radiculopathy. There were no sequestered discs found in the studied patients. All degenerative findings excluding disc herniation were also seen in lesser prevalence in minimally symptomatic patients. Keywords: Degenerative Disease, Lumbar Spine, MRI, Disc Degeneration, Disc Herniation, Modic Changes, Clinical Symptoms, Back pain

scholarly journals Gender differences in the surgical management of lumbar degenerative disease: a scoping review

2020 ◽  
Vol 32 (6) ◽  
pp. 799-816
Author(s):  
Mark A. MacLean ◽  
Charles J. Touchette ◽  
Jae H. Han ◽  
Sean D. Christie ◽  
Gwynedd E. Pickett
Keyword(s):  
Gender Differences ◽  
Disc Degeneration ◽  
Disc Herniation ◽  
Spinal Canal ◽  
Spinal Canal Stenosis ◽  
Degenerative Disease ◽  
Preoperative Pain ◽  
Lumbar Degenerative Disease ◽  
Canal Stenosis ◽  
Pain Disability

OBJECTIVEDespite efforts toward achieving gender equality in clinical trial enrollment, females are often underrepresented, and gender-specific data analysis is often unavailable. Identifying and reducing gender bias in medical decision-making and outcome reporting may facilitate equitable healthcare delivery. Gender disparity in the utilization of surgical therapy has been exemplified in the orthopedic literature through studies of total joint arthroplasty. A paucity of literature is available to guide the management of lumbar degenerative disease, which stratifies on the basis of demographic factors. The objective of this study was to systematically map and synthesize the adult surgical literature regarding gender differences in pre- and postoperative patient-reported clinical assessment scores for patients with lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis).METHODSA systematic scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. MEDLINE, Embase, and the Cochrane Registry of Controlled Trials were searched from inception to September 2018. Study characteristics including patient demographics, diagnoses, procedures, and pre- and postoperative clinical assessment scores (pain, disability, and health-related quality of life [HRQoL]) were collected.RESULTSThirty articles were identified, accounting for 32,951 patients. Six studies accounted for 84% of patients; 5 of the 6 studies were published by European groups. The most common lumbar degenerative conditions were disc herniation (59.0%), disc degeneration (20.3%), and spinal canal stenosis (15.9%). The majority of studies reported worse preoperative pain (93.3%), disability (81.3%), and HRQoL (75%) among females. The remainder reported equivalent preoperative scores between males and females. The majority of studies (63.3%) did not report preoperative duration of symptoms, and this represents a limitation of the data. Eighty percent of studies found that females had worse absolute postoperative scores in at least one outcome category (pain, disability, or HRQoL). The remainder reported equivalent absolute postoperative scores between males and females. Seventy-three percent of studies reported either an equivalent or greater interval change for females.CONCLUSIONSFemale patients undergoing surgery for lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis) have worse absolute preoperative pain, disability, and HRQoL. Following surgery, females have worse absolute pain, disability, and HRQoL, but demonstrate an equal or greater interval change compared to males. Further studies should examine gender differences in preoperative workup and clinical course.

scholarly journals Detection of Degenerative Changes on MR Images of the Lumbar Spine with a Convolutional Neural Network: A Feasibility Study

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 902
Author(s):  
Nils Christian Lehnen ◽  
Robert Haase ◽  
Jennifer Faber ◽  
Theodor Rüber ◽  
Hartmut Vatter ◽  
...  
Keyword(s):  
Neural Network ◽  
Lumbar Spine ◽  
Diagnostic Accuracy ◽  
Nerve Root ◽  
Spinal Canal ◽  
Spinal Canal Stenosis ◽  
Degenerative Changes ◽  
High Diagnostic Accuracy ◽  
Canal Stenosis ◽  
Disc Herniations

Our objective was to evaluate the diagnostic performance of a convolutional neural network (CNN) trained on multiple MR imaging features of the lumbar spine, to detect a variety of different degenerative changes of the lumbar spine. One hundred and forty-six consecutive patients underwent routine clinical MRI of the lumbar spine including T2-weighted imaging and were retrospectively analyzed using a CNN for detection and labeling of vertebrae, disc segments, as well as presence of disc herniation, disc bulging, spinal canal stenosis, nerve root compression, and spondylolisthesis. The assessment of a radiologist served as the diagnostic reference standard. We assessed the CNN’s diagnostic accuracy and consistency using confusion matrices and McNemar’s test. In our data, 77 disc herniations (thereof 46 further classified as extrusions), 133 disc bulgings, 35 spinal canal stenoses, 59 nerve root compressions, and 20 segments with spondylolisthesis were present in a total of 888 lumbar spine segments. The CNN yielded a perfect accuracy score for intervertebral disc detection and labeling (100%), and moderate to high diagnostic accuracy for the detection of disc herniations (87%; 95% CI: 0.84, 0.89), extrusions (86%; 95% CI: 0.84, 0.89), bulgings (76%; 95% CI: 0.73, 0.78), spinal canal stenoses (98%; 95% CI: 0.97, 0.99), nerve root compressions (91%; 95% CI: 0.89, 0.92), and spondylolisthesis (87.61%; 95% CI: 85.26, 89.21), respectively. Our data suggest that automatic diagnosis of multiple different degenerative changes of the lumbar spine is feasible using a single comprehensive CNN. The CNN provides high diagnostic accuracy for intervertebral disc labeling and detection of clinically relevant degenerative changes such as spinal canal stenosis and disc extrusion of the lumbar spine.

scholarly journals Appropriateness of Lumbar Spine Referrals to a Neurosurgical Service

2010 ◽  
Vol 37 (6) ◽  
pp. 843-848 ◽  
Author(s):  
J. Max Findlay ◽  
Nathan Deis
Keyword(s):  
Lumbar Spine ◽  
Neurological Deficit ◽  
Nerve Root ◽  
Leg Pain ◽  
Lumbar Spine Surgery ◽  
Nerve Root Compression ◽  
Clinical Criteria ◽  
University Of Alberta ◽  
Radiological Evidence ◽  
The University

AbstractBackground:Patients with lumbar spine complaints are often referred for surgical assessment. Only those with clinical and radiological evidence of nerve root compression are potential candidates for surgery and appropriate for surgical assessment. This study examines the appropriateness of lumbar spine referrals made to neurosurgeons in Edmonton, Alberta.Methods:Lumbar spine referrals to a group of ten neurosurgeons at the University of Alberta were reviewed over three two month intervals. Clinical criteria for “appropriateness” for surgical assessment were as follows: •“Appropriate” referrals were those that stated leg pain was the chief complaint, or those that described physical exam evidence of neurological deficit, and imaging reports (CT or MRI) were positive for nerve root compression. •“Uncertain” referrals were those that reported both back and leg pain without specifying which was greater, without mention of neurologic deficit, and when at least possible nerve root compression was reported on imaging. •“Inappropriate” referrals contained no mention of leg symptoms or signs of neurological deficit, and/or had no description of nerve root compression on imaging.Results:Of the 303 referrals collected, 80 (26%) were appropriate, 92 (30%) were uncertain and 131 (44%) were inappropriate for surgical assessment.Conclusions:Physicians seeking specialist consultations for patients with lumbar spine complaints need to be better informed of the criteria which indicate an appropriate referral for surgical treatment, namely clinical and radiological evidence of nerve root compression. Avoiding inappropriate referrals could reduce wait-times for both surgical consultation and lumbar spine surgery for those patients requiring it.

scholarly journals The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study

1999 ◽  
Vol 8 (5) ◽  
pp. 396-401 ◽  
Author(s):  
Atsushi Fujiwara ◽  
Kazuya Tamai ◽  
Minoru Yamato ◽  
Howard S. An ◽  
Hiroyuki Yoshida ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Disc Degeneration ◽  
Facet Joint ◽  
Facet Joint Osteoarthritis ◽  
Mri Study ◽  
The Relationship

Evaluation of the post-operative lumbar spine with MR imaging

1997 ◽  
Vol 38 (6) ◽  
pp. 1035-1042 ◽  
Author(s):  
P. Grane ◽  
M. Lindqvist
Keyword(s):  
Lumbar Spine ◽  
Contrast Enhancement ◽  
Disc Herniation ◽  
Nerve Root ◽  
Clinical Symptoms ◽  
Lumbar Disc ◽  
Nerve Roots ◽  
Contrast Administration ◽  
Repeat Surgery ◽  
Lumbar Nerve Root

Purpose: Two new signs of lumbar nerve-root affection have been reported in recent years on the basis of MR examinations, namely: thickening in nerve roots; and contrast enhancement in nerve roots. the aim of this study was to assess contrast enhancement in nerve roots in a standardised way, and to evaluate the clinical significance of contrast enhancement and of nerve-root thickening in the symptomatic post-operative lumbar spine Material and Methods: A total of 121 patients (who had previously been operated on for lumbar disc herniation) underwent 152 MR examinations, mainly on a 1.5 T system. Focal nerve-root enhancement was identified by visual assessment. Intradural enhancement was also quantified by pixel measurements that compared the affected nerve roots before and after contrast administration. Non-affected nerve roots were used as reference Results: Enhanced nerve roots in the dural sac increased at least 40–50% in signal intensity after contrast administration compared to pre-contrast images and also compared to non-affected nerve roots. Intradural nerve-root enhancement was seen in 10% of the patients and focal enhancement in the root sleeve was seen in a further 26%. Nerve-root thickening was seen in 30%. Good correlation with clinical symptoms was found in 59% of the patients with intradural enhancement, in 84% with focal enhancement, and in 86% with nerve-root thickening. the combination of thickening and enhancement in the nerve root correlated with symptoms in 86% of the patients Conclusion: Nerve-root enhancement (whether focal or intradural) and thickening in the nerve root are significant MR findings in the post-operative lumbar spine. in combination with disc herniation or nerve-root displacement, these two signs may strengthen the indication for repeat surgery. However, root enhancement within 6 months of previous surgery may be a normal post-operative finding

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