Yoga and disc degenerative disease in cervical and lumbar spine: an MR imaging-based case control study

The objective of the current study was to find out whether yoga practice was beneficial to the spine by comparing degenerative disc disease in the spines of long-time yoga practitioners and non-yoga practicing controls, using an objective measurement tool, magnetic resonance imaging. This matched case–control study comprised 18 yoga instructors with teaching experience of more than 10 years and 18 non-yoga practicing asymptomatic individuals randomly selected from a health checkup database. A validated grading scale was used to grade the condition of cervical and lumbar discs seen in magnetic resonance imaging of the spine, and the resulting data analyzed statistically. The mean number of years of yoga practice for the yoga group was 12.9 ± 7.5. The overall (cervical + lumbar) disc scores of the yoga group were significantly lower (indicating less degenerative disc disease) than those of the control group (P < 0.001). The scores for the cervical vertebral discs of the yoga group were also significantly lower than those of the control group (P < 0.001), while the lower scores for the yoga group in the lumbar group approached, but did not reach, statistical significance (P = 0.055). The scores for individual discs of yoga practitioners showed significantly less degenerative disease at three disc levels, C3/C4, L2/L3 and L3/L4 (P < 0.05). Magnetic resonance imaging showed that the group of long-term practitioners of yoga studied had significantly less degenerative disc disease than a matched control group.     

Bent spine syndrome (camptocormia): A retrospective study of 63 patients

ObjectivesBent spine syndrome (BSS) is characterized by involuntary forward flexion of the trunk in the standing position but not in the recumbent position. We assessed the causes of BSS based on findings in 63 patients.MethodsWe retrospectively reviewed the records of all patients with BSS evaluated at a teaching hospital in Toulouse, France, between 1995 and 2006. For each patient, we recorded the findings from the following investigations: physical examination, electromyogram (EMG), creatine phosphokinase (CPK) assay, computed tomography (CT), and surgical muscle biopsy.ResultsWe identified 63 patients, 46 females and 17 males, with a mean age of 70 ± 6.9 years. Among them, 40 had delayed-onset paraspinal myopathy, with fatty infiltration predominantly affecting the paraspinal muscles. In 40% of these patients, CT disclosed mild fatty infiltration of the gluteal and posterior thigh and leg muscles in addition to the paraspinal muscle abnormalities. Paraspinal muscle histology showed lobular endomysial fibrosis, as previously described and ruled out other forms of muscle dystrophy. The remaining 23 patients (14 females and nine males) had either another neurological disease or myopathic involvement of other muscles, with a definite diagnosis; nevertheless, forward bending of the trunk was the most prominent symptom and the reason for the initial physician visit.ConclusionIn our case-series, delayed-onset paraspinal myopathy accounted for 64% of cases of BSS. The most informative investigation was CT, which showed a patchy decrease in paraspinal muscle density.     

Color-coded Duplex sonography of vertebral arteries: 11 cases of blunt cervical spine injury

In 11 patients with locked cervical spine facets after blunt injury, the patency of the vertebral arteries was evaluated by color-coded Duplex sonography (CCDS) up to 11 years after the accident. In 7 patients the dislocations had been reduced, 2 had been treated conservatively, and 9 had been fused.

In 9 patients (3 of them with persistent locking) the mean systolic peak flow velocity was 55 cm/sec and the vessel diameter was 0.35 cm. Only 2 patients had an abnormal CCDS. In 1 with persistent locking the ipsilateral vertebral artery was occluded, and in the other flow signals were abnormal and the vessel diameter was smaller than on the contralateral side. The high coincidence of vertebral artery occlusions and locked dislocations, as well as fracture dislocations reported by others, was not confirmed in our series.     

Intradural disc herniations in the cervical, thoracic, and lumbar spine: report of three cases and review of the literature

The clinical, neuroradiological, and surgical management of three cases of intradural disc herniations--one each in the cervical, thoracic, and lumbar regions--are presented. Intradural disc herniations comprise only 0.27% of all herniated discs. Three percent occur in the cervical, 5% in the thoracic, and 92% in the lumbar spinal canal. Those with cervical or thoracic lesions frequently exhibit profound myelopathy, whereas those with lumbar lesions demonstrate radicular or cauda equina syndromes. Although varying combinations of the MRI, non-contrast CT, myelogram, and myelo-CT scans may at times fail to accurately establish the diagnosis of an intradural disc herniation prior to surgery, the index of suspicion raised by the lack of clinical correlation with surgical findings justifies an intradural exploration.     

Utility of machine learning algorithms in degenerative cervical and lumbar spine disease: a systematic review

Machine learning is a rapidly evolving field that offers physicians an innovative and comprehensive mechanism to examine various aspects of patient data. Cervical and lumbar degenerative spine disorders are commonly age-related disease processes that can utilize machine learning to improve patient outcomes with careful patient selection and intervention. The aim of this study is to examine the current applications of machine learning in cervical and lumbar degenerative spine disease. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of PubMed, Embase, Medline, and Cochrane was conducted through May 31st, 2020, using the following terms: “artificial intelligence” OR “machine learning” AND “neurosurgery” AND “spine.” Studies were included if original research on machine learning was utilized in patient care for degenerative spine disease, including radiographic machine learning applications. Studies focusing on robotic applications in neurosurgery, navigation, or stereotactic radiosurgery were excluded. The literature search identified 296 papers, with 35 articles meeting inclusion criteria. There were nine studies involving cervical degenerative spine disease and 26 studies on lumbar degenerative spine disease. The majority of studies for both cervical and lumbar spines utilized machine learning for the prediction of postoperative outcomes, with 5 (55.6%) and 15 (61.5%) studies, respectively. Machine learning applications focusing on degenerative lumbar spine greatly outnumber the current volume of cervical spine studies. The current research in lumbar spine also demonstrates more advanced clinical applications of radiographic, diagnostic, and predictive machine learning models.

     

Non-contiguous multifocal Staphylococcus aureus discitis: involvement of the cervical, thoracic and lumbar spine

Introduction  

Multilevel discitis is rare, and classically due to granulomatous organisms like Mycobacterium tuberculosis, brucella and fungal species.     

A study of vertebra and disc geometric relations of the human cervical and lumbar spine

Geometric configuration and dimensions of the human vertebra were investigated using x-ray photographs of 157 normal, healthy men. A simplified model of the vertebra in the midsagittal plane is presented and used as a basis for measurements. Geometric considerations and statistical analysis served for correlating significant measurements of vertebral bodies and intervertebral disks of the human spine.     

The porcine cervical spine as a model of the human lumbar spine: an anatomical, geometric, and functional comparison.

Animal models for analysis of spine injury and orthopaedic issues are common given concerns about bone integrity, disc degeneration, and controlled studies of identical specimens matched for age, weight, physical activity and genetic background. Given this asset, the question is asked: "Is the porcine cervical spine a reasonable model of the human lumbar spine?" Three porcine cervical spines (C2-C7) were assessed for geometric characteristics, with a larger cohort (N = 24) loaded to failure under compressive or shear loading. In addition, in vivo loading was estimated and compared between the human low back (biped) and the porcine neck (quadruped). Generally, the porcine vertebrae are smaller in all dimensions. The porcine vertebrae have anterior processes unlike humans; however, they possess similar ligamentous structure and facet joint orientation. Stiffness values (compression and shear) are similar, and comparable injuries resulted from applied compressive and shear loads. Given the scarcity of healthy, young human lumbar spines, porcine cervical spines may be a useful model for studying human lumbar injury because of the similarity of mechanical characteristics and the resulting injuries, particularly of the adolescent or young adult who has not experienced disc degeneration or calcified end-plates.     

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: interbody techniques for lumbar fusion

The majority of reviewed medical evidence suggests that interbody techniques are associated with higher fusion rates compared with PLF when applied to patients with low-back pain due to DDD limited to one or two levels. The evidence is generally of poor quality and retrospective in nature. Conflicting evidence exists supporting the role of interbody graft placement for improvement of functional outcomes; however, there is no Class I or II evidence to suggest that the use of an interbody graft is associated with worse outcomes, and Class II evidence exists to suggest that outcomes are improved. Complication rates of interbody graft placement, particularly of circumferential procedures, are higher in most series. Many complications, however, are associated with pedicle screw fixation and not with interbody graft placement per se. In the context of a single-level stand-alone ALIF or ALIF with posterior instrumentation, there does not appear to be a substantial benefit to the addition of a PLF. The addition of a PLF to a construct that already includes an interbody graft is, however, associated with increased costs and complications. Therefore, although the addition of supplemental fixation (a 270 degrees fusion) may be necessary for biomechanical reasons, it may not be appropriate to subject the patient to the morbidity of a full posterior exposure for placement of graft material. Significant differences in clinical outcomes between the various interbody techniques have not been convincingly demonstrated. No general recommendation can therefore be made regarding the technique that should be used to achieve interbody fusion.     

Treatment of hematomas after anterior cervical spine surgery: A retrospective study of 15 cases

Objective

Postoperative hematoma is a rare and dangerous complication of cervical spine surgery. The aim of this study was to investigate the incidence and related factors of postoperative hematoma, and to report on 15 cases at our institution over a 6-year period.

颈椎及腰椎双处痛风石1例报告

<正>痛风是由尿酸盐结晶沉积所致的系统性疾病,多累积全身各处关节,以跖趾关节多见,易于观察,容易诊断。近些年,少数国内外报道显示,痛风可累及脊柱相关组织并造成髓性神经症状、根性神经症状甚至截瘫等。脊柱痛风的发病率极低,单处脊柱痛风案例国内外少有报道,多处发病案例未查及。脊柱痛风缺乏有效的诊治措施及标准,且症状及影像表现极易与椎间盘突出性疾病混淆,为脊柱痛风诊治带来困难。我院收治1例颈椎合并腰椎椎管     

Advanced imaging of the cervical spine and spinal cord in 22q11.2 deletion syndrome: age-matched, double-cohort, controlled study

Purpose  The 22q11.2 deletion syndrome is a common genetic syndrome with a wide spectrum of abnormalities. We have previously described multiple anomalies of the upper cervical spine in this disorder. The objective of this study was to use advanced imaging to further define the morphology of the cervical spine and spinal cord in the 22q11.2 deletion syndrome, with a comparison to age-matched controls. Methods  A total of 32 patients with a 22q11.2 deletion underwent advanced imaging (computed tomography/magnetic resonance imaging; CT/MRI) of the cervical spine. In 27 patients, space available for the cord (SAC); the sagittal diameter of the vertebral body, spinal canal, cerebrospinal fluid (CSF), and spinal cord; and the cross sectional area of the spinal canal, CSF, and spinal cord were measured at each cervical level and compared to 29 age-matched controls. Statistical analysis was performed and potential implications were hypothesized. Results  In 22q11.2 patients, advanced imaging identified 40 pathologies not evident on plain radiographs with potential mechanical and/or neurological implications. These patients also had significantly smaller values (P ≤ 0.05) of the following parameters at one or more cervical levels, relative to age-matched controls: width of the vertebral body, spinal canal, CSF, and spinal cord; area of the spinal canal, CSF, and spinal cord. Neurologic symptoms were observed in 4/32 patients, with one patient requiring surgical intervention. Conclusions  Advanced imaging of the cervical spine can detect findings not evident on plain radiographs in the 22q11.2 deletion syndrome. CT and/or MRI may be indicated when there is a high index of suspicion for clinical instability or neurologic compromise in order to rule out dynamic encroachment or impending neurologic sequelae. Spinal canal and spinal cord dimensions are reduced in these patients relative to controls with currently unknown clinical significance.