Simulation of an anterior spine instrumentation in adolescent idiopathic scoliosis using a flexible multi-body model

Anterior spinal instrumentation is an alternative option to posterior instrumentation for surgical treatment of adolescent idiopathic scoliosis (AIS). However, optimal instrumentation configuration and strategies are not yet clearly defined. A biomechanical kinematic model using flexible mechanism was developed to study instrumentation strategies. Preoperative 3D reconstruction of scoliotic patient’s spine was used to define the patient-specific geometry of the model. Mechanical properties were adjusted to consider the discectomy and surgical manoeuvres were reproduced. Anterior spine surgeries of ten patients were simulated and results were compared to immediate post-operative data and showed differences of <5° for the Cobb angles. The validated model was used to find optimal instrumentation configurations for one patient prior to surgery. Six strategies were tested out of which the optimal one was identified while two were not recommended for surgery since screw forces exceeded published pullout forces. This study demonstrates the possibility to simulate anterior spine instrumentations.     

Biomechanical modelling of segmental instrumentation for surgical correction of 3D spinal deformities using Euler-Bernoulli thin-beam elastic deformation equations

A simplified computer-modelling technique intended to analyse 3D spinal deformity correction with segmental instrumentation is presented. The spine was modelled as a thin beam-composed structure linked by implants to two deformable rods. The Landau vector representation of Euler-Bernoulli beam elastic deformation equations was used to formulate the simulation approach. All types of essential deformation (bending, torsion, tension, compression) were considered. An iterative numerical method was proposed to obtain an appropriate load, able to deform the spine axial curve to the desired post-operative shape. A simulation based on the spine of a real scoliotic patient (thoracic and lumbar Cobb angles: 39° and 8°), corrected using surgical instrumentation intervention, is presented. Force loads within the range of 20–350N were able to deform the pre-operational spine axial curve to the post-operational one with a root mean square approximation error of 3.7 mm. Similarly good corrections were obtained using different force patterns. This highlights the uncertainty of which corresponding surgical instrumentation to use. Such uncertainty is related to the ‘ill-posed problems’ property of mechanical systems.     

Electromyogram and kinematic analysis of lateral bending in idiopathic scoliosis patients

In adolescent idiopathic scoliosis (AIS), surgical planning currently relies on spinal flexibility evaluation using lateral bending radiographs. The aim was to evaluate the feasibility of non-invasive dynamic analysis of trunk kinematics and muscle activity in patients with AIS before surgical correction. During various lateral trunk bending tasks, erector spinae (18 sites) and abdominal (four sites) muscle activity was sampled using surface electrodes in ten AIS patients and in ten controls. Simultaneously, the spatial displacements of infrared emitting diodes located on the trunk were sampled. Parameters considered were the heterolateral-to-homolateral root-mean-square EMG ratios R at each site and total lateral bending and thoracic and lumbar curvature angle courses. Main alterations concerned apical muscle activity during left bending tasks. ANOVA results showed a significant effect of side (p=2.1×10⁻⁹), EMG recording site (p=1.9×10⁻¹⁶), pathology (p=3.9×10⁻¹⁶) and task (p=2.2×10⁻¹¹) on R ratios. The R ratio at T10 and L1 for a simple lateral bending task during left bending averaged 4.8 (SD 4.3) and 3.0 (SD 3.1) in AIS patients, and 2.3 (SD 2.8) and 1.3 (SD 0.4) in controls (p=6.4×10⁻⁴ and 2.5×10⁻³, LSD post hoc). This preliminary study allowed the development of a functional, noninvasive, non-irradiating dynamic tool for pre-operative evaluation in AIS.     

Computer simulation for the optimization of patient positioning in spinal deformity instrumentation surgery

Studies have shown that scoliosis curves correct when patients are positioned on the operating table prior to instrumentation. However, biomechanical aspects of positioning have not been widely studied. The objective of this study was to simulate patient positioning during instrumentation surgery and test various adjustment parameters of the trunk and recommend optimal patient positioning prior to, and during spine surgery based on the results of finite element simulations. A scoliotic patient was simulated using a finite element model and six different positioning parameters were modified while ten geometric measures were recorded. Statistical analysis determined which model parameter had a significant effect on the geometric measures. Geometric measures were individually and simultaneously optimized, while corresponding model parameters were documented. Every model parameter had a significant effect on at least five of the geometric measures. When optimizing a single measure, others would often deteriorate. Simultaneous optimization resulted in improved overall correction of the patient’s geometry by 75% however ideal correction was not possible for every measure. Finite element simulations of various positioning parameters enabled the optimization of ten geometric measures. Positioning is an important surgical step that should be exploited to achieve maximum correction.     

Computer simulation for the optimization of instrumentation strategies in adolescent idiopathic scoliosis

Recent studies reveal a large variability of instrumentation strategies in adolescent idiopathic scoliosis (AIS). Determination of the optimal configuration remains controversial. This study aims to develop a method to define the optimal surgical instrumentation strategy using a computer model implemented in a spine surgery simulator (S3). A total of 702 different strategies were simulated on a scoliotic patient using S3. Each configuration was assessed using objective functions that represented different correction objectives. Twelve geometric parameters were used in the three anatomic planes and mobility, and their relative weights were defined by a spine surgeon according to his objectives for correction of scoliosis. Six instrumentation parameters were manipulated in a uniform experimental design framework. An interpolation technique was used to build an approximation model from the simulation results and to locate instrumentation parameters minimizing the objective function. Small or no differences in the correction between the simulated optimal strategy and the real postoperative results of the instrumented segments were observed in the three planes. But the same overall correction was obtained by using fewer implants (only screws) and less instrumented levels. This study demonstrates the potential and feasibility of using a spine surgery simulator to optimize the planning of surgical instrumentation in AIS.     

Finding line of action of the force exerted on erect spine based on lateral bending test in personalization of scoliotic spine models

In multi-body models of scoliotic spine, personalization of mechanical properties of joints significantly improves reconstruction of the spine shape. In personalization methods based on lateral bending test, simulation of bending positions is an essential step. To simulate, a force is exerted on the spine model in the erect position. The line of action of the force affects the moment of the force about the joints and thus, if not correctly identified, causes over/underestimation of mechanical properties. Therefore, we aimed to identify the line of action, which has got little attention in previous studies. An in-depth analysis was performed on the scoliotic spine movement from the erect to four spine positions in the frontal plane by using pre-operative X-rays of 18 adolescent idiopathic scoliosis (AIS) patients. To study the movement, the spine curvature was considered as a 2D chain of micro-scale motion segments (MMSs) comprising rigid links and 1-degree-of-freedom (DOF) rotary joints. It was found that two MMSs representing the inflection points of the erect spine had almost no rotation (0.0028° ± 0.0021°) in the movement. The small rotation can be justified by weak moment of the force about these MMSs due to very small moment arm. Therefore, in the frontal plane, the line of action of the force to simulate the left/right bending position was defined as the line that passes through these MMSs in the left/right bending position. Through personalization of a 3D spine model for our patients, we demonstrated that our line of action could result in good estimates of the spine shape in the bending positions and other positions not included in the personalization, supporting our proposed line of action.     

Vertebral pedicle anatomy in relation to pedicle screw fixation: a cadaver study

New techniques to stabilize and correct the thoracic and lumbar spine have been developed in recent years. In view of the wide variety and complexity of fixation devices, the optimum configuration of spinal instrumentation systems needs to be defined. Linear and angular measurements of both vertebral pedicles were made in ten complete thoracic and lumbar cadaveric spines using callipers and a goniometer. The vertical interpedicular distance gradually increased along the spine up to L5. The transverse interpedicular distance was larger at both ends of the spine. Pedicular height gradually increased from T1 to L5, plateauing between T3 and T9, being widest at the thoracolumbar junction. Pedicular width was greatest at the three junctional regions of the spine. The sagittal pedicular angle decreased along the length of the spine to zero at L5. The transverse pedicular angle decreased from T1 to T12 and then increased to L5.Of the pedicular measurements only width limits the diameter of fixation screws. The vertical interpedicular distance determines the distance between the holes of plates, while the length of the transfixator is related to the transverse interpedicular distance. The pedicular angles enable triangulation of screws and determine the stability of the fixation.     

后路椎弓根螺钉系统治疗特发性腰椎侧凸的有限元分析

目的通过有限元计算与刚体动力学相结合的方法,模拟后路椎弓根螺钉系统治疗脊柱侧凸的矫形过程,研究矫形过程中的生物力学特性,探讨不同矫形策略对临床结果的影响,为脊柱侧凸的手术规划提供依据。方法通过病体腰椎CT切片进行三维几何重构,利用ANSYS有限元软件建立了右凸40o腰椎L1-L5和椎弓根螺钉器械的三维有限元模型,联合ADAMS刚体动力学软件模拟了矫形手术中的反旋转与回弹,得到了矫形全过程中植入物所受载荷以及脊椎的应力应变场。结果不同矫形手术过程中,植入器械承受的最大反力范围约为1961099N,椎骨的极少数单元应力超过强度极限120MPa。结论后路椎弓根螺钉系统矫正腰椎侧凸具有较好的治疗效果,脊椎骨性结构的应力水平整体较低。在满足矫形效果的前提下,临床上可考虑选择不同的矫形策略,以减少需植入螺钉的腰椎节段数量并提高手术质量。     

Functional anatomy of the deer spine: an appropriate biomechanical model for the human spine?

The object of this study was to create a database for the biomechanical and certain functional anatomical parameters of the deer spine, for comparison with the human spine. This was done with a view toward using the deer spine as an alternative model for various biomechanical experiments, as it is difficult to procure nonembalmed, fresh human spine specimens. Bovine spongiform encephalopathy (BSE) and its human variant, Creutzfeld Jakob disease (CJD), prevent us from using bovine and sheep spine. There is a risk of transmission of disease through direct inoculation to the researcher working with infected bovine or sheep spine, and a theoretical possibility of transmission through the food chain if proper precautions for specimen disposal are not taken. We chose deer spine as an alternative for testing nonembalmed fresh human spine because, to date, there have been no reported cases of deer being carriers of prion diseases. Fifteen deer spine specimens were sectioned appropriately to obtain six functional spinal units for each level in the thoracic and lumbar spine. Each unit was tested in a Dartec materials testing machine (Dartec Ltd., Stourbridge, UK) under pure moments in three main anatomical planes. The range of motion (ROM), neutral zone (NZ), and stiffness parameters of the functional unit were determined in flexion-extension, right/left lateral bending, and axial rotation. The data obtained were compared with the corresponding human spine data in the literature. Deer spine specimens were also studied for bone mineral density (BMD) using a DEXA scan. The results revealed the overall ROM was greater for deer spine compared to the human spine in the upper thoracic region, but less compared to human spine in the lower lumbar spine region. The only comparable region for ROM was in the lower thoracic/upper lumbar region. The stiffness coefficients were also comparable in this region. The BMD was also comparable in the two species. We conclude that the lower thoracic/upper lumbar region in the deer spine can be used as a model for some human biomechanical experiments because of its biomechanical and material similarities to the human spine of the corresponding region.     

Registration and geometric modelling of the spine during scoliosis surgery: a comparison study of different preoperative reconstruction techniques and intra-operative tracking systems

During scoliosis instrumentation surgery, it is difficult for surgeons fully to track vertebral motion in 3D, because only the posterior elements of the spine are exposed. Different intra-operative modelling approaches are evaluated using a registration technique that matches intra-operative measurements with a 3D preoperative model of the spine. Two tracking systems (magnetic digitiser and mechanical arm) and two pre-operative reconstruction techniques (multiplanar radiography and CT scan) are sequentially combined to build four intra-operative models. Their accuracy is assessed by comparison with the pre-operative geometry. The most minimally invasive approach (multiplanar radiographic reconstruction and magnetic digitiser) has an accuracy of 5.9 mm in translation, and errors on vertebral rotations are 4.4^o, 6.7^o and 5.0^o in the frontal, sagittal and transverse planes, respectively. With CT scan reconstruction, the accuracy is significantly increased by about 2 mm in translation and as much as 4.5^o for vertebral rotations in the sagittal plane. For the mechanical arm, the accuracy is increased by less than 1 mm in translation and 1^o for vertebral rotations. CT scan is the most accurate reconstruction technique, but its use for long spinal segments is generally not allowed because of the high radiation exposure. Multiplanar radiographic reconstruction may be an alternative solution for long spinal segments when great accuracy is not necessary. Considering the small increase in accuracy and its awkwardness, the use of the mechanical arm may not be appropriate during surgical manoeuvres. Department of Automated Production Engineering, école de Technologie Supérieure 1100 Notre-Dame West, Montréal, Québec, Canada, H3C 1K3     

Ultra high molecular weight polyethylene (UHMWPE) model can provide results comparable to cadaveric models

The in vitro biomechanical models using a cadaveric spine specimen have long been used in understanding normal and abnormal functions of spines as well as for strength and stability testing of the spine specimen or spinal construct. Little effort has been made to describe the similarities or differences between UHMWPE and cadaveric models. Eight cadaveric lumbar spines were harvested generating six FSU and three corpectomy models. Six UHMWPE blocks were fabricated to form FSU and corpectomy models. All were tested intact, with posterior instrumentation, and with anterior instrumentation consisting of Moss-Miami 4.0 mm stainless steel rods, uni-axial stainless steel screws and DePuy Harm's cages. All models were tested in axial compression. The cadaveric model and UHMPWE model yielded axial stiffness values of comparable magnitude with respect to instrumentation applied using the posterior approach (P>0.05). Under an FSU configuration, only in the case of anterior instrumentation without the addition of a Harm's cage did both the cadaveric and UHMPWE models provide comparable axial stiffness results (P>0.05). While in vitro cadaveric models are considered the gold standard for biomechanical testing of the spine, the data suggests that under specific approaches and surgical models UHMWPE can be used to infer mechanical performance of instrumentation in cadaveric material.     

A new method to include the gravitational forces in a finite element model of the scoliotic spine

The distribution of stresses in the scoliotic spine is still not well known despite its biomechanical importance in the pathomechanisms and treatment of scoliosis. Gravitational forces are one of the sources of these stresses. Existing finite element models (FEMs), when considering gravity, applied these forces on a geometry acquired from radiographs while the patient was already subjected to gravity, which resulted in a deformed spine different from the actual one. A new method to include gravitational forces on a scoliotic trunk FEM and compute the stresses in the spine was consequently developed. The 3D geometry of three scoliotic patients was acquired using a multi-view X-ray 3D reconstruction technique and surface topography. The FEM of the patients’ trunk was created using this geometry. A simulation process was developed to apply the gravitational forces at the centers of gravity of each vertebra level. First the “zero-gravity” geometry was determined by applying adequate upwards forces on the initial geometry. The stresses were reset to zero and then the gravity forces were applied to compute the geometry of the spine subjected to gravity. An optimization process was necessary to find the appropriate zero-gravity and gravity geometries. The design variables were the forces applied on the model to find the zero-gravity geometry. After optimization the difference between the vertebral positions acquired from radiographs and the vertebral positions simulated with the model was inferior to 3 mm. The forces and compressive stresses in the scoliotic spine were then computed. There was an asymmetrical load in the coronal plane, particularly, at the apices of the scoliotic curves. Difference of mean compressive stresses between concavity and convexity of the scoliotic curves ranged between 0.1 and 0.2 MPa. In conclusion, a realistic way of integrating gravity in a scoliotic trunk FEM was developed and stresses due to gravity were explicitly computed. This is a valuable improvement for further biomechanical modeling studies of scoliosis.     

Posterior distraction forces of the posterior longitudinal ligament stratified according to vertebral level

Introduction Although considered significant in resisting midline intervertebral disc herniation, the posterior longitudinal ligament (PLL) has had relatively few studies performed regarding its morphology and function. We performed the present experiment to discern the amount of posterior tensile force necessary to disrupt the PLL at each vertebral level. Materials and methods Twenty-five adult cadavers underwent laminectomies of vertebrae C1 to S1. After removal of the spinal cord, nerve roots, and dura mater, the PLL was identified for each vertebral level and a steel wire placed around its waist in the midline and a tensile gauge attached and posterior tension applied perpendicular to the spine. Forces necessary to failure of the PLL were noted for each vertebral level. Results The PLL was found to be stronger in the thoracic spine compared to the cervical and lumbar vertebrae (P < 0.05). Dividing the vertebral levels in this manner, we found an average posterior distraction force to failure of 48.3 N in the cervical region, 61.3 N in the thoracic region, and 48.8 N in the lumbar region. Conclusions These findings support clinical observations that thoracic disc herniation is rare. We hypothesize that this clinical observation is partially due to a stronger PLL in the thoracic spine.     

一种新型经椎弓根螺钉动力内固定系统的设计和力学测试

[摘要]目的设计一种新型经椎弓根螺钉动力内固定系统，并测试其对失稳腰椎的稳定性效果及对相邻节段的作用。方法 1采用6具人新鲜尸体腰椎标本，测试各个节段的活动度，为新型动力内固定系统的设计提供参数支持。2以钛合金棒、钛缆和钛合金碟片弹簧为主要结构，根据正常腰椎各节段的活动度，参照文献报道的相关测试结果，设定动态连接棒屈曲范围0~10°，旋转范围0~5°，并对其进行了相关力学测试。3制作腰椎失稳模型，测试新型动力内固定系统固定后失稳腰椎固定节段及相邻节段的运动范围（ROM）和中性区（NZ），并与坚强固定对比，同时测定其上邻节段软骨终板下压力，探讨其稳定性及对相邻节段的作用。结果 与完整脊柱相比，新型动力内固定系统固定后屈伸和侧屈方向的ROM和NZ较完整脊柱减小（P<0.05），但旋转方向的ROM和NZ与完整脊柱无显著性差异（P>0.05）。与坚强固定组相比，新型动力内固定组三个主方向的ROM和NZ均显著增加，差异有显著性意义（P<0.01）。疲劳试验后的结果表明，固定节段在三个主方向上的ROM和NZ均较疲劳前显著增加（P <0.05），但与失稳脊柱相比，差异仍具有显著性意义，与完整脊柱相比，动力内固定屈伸方向的ROM和NZ仍较小，两组相比差异显著（P <0.05），侧屈与旋转方向的ROM和NZ与完整脊柱无显著性差异（P >0.05）。结论 新型动力内固定系统可控性强、可靠性好、能够提供足够的活动度。新型动力内固定系统能对失稳腰椎提供各方向上的稳定性，尤其对前屈后伸的稳定效果最好，疲劳试验后也能提供足够的稳定性。相邻节段的ROM和上邻节段终板下压力与固定方式无显著相关。     

Analysis of biomechanical changes after removal of instrumentation in lumbar arthrodesis by finite element analysis

The purpose of this study is to investigate the change in biomechanical milieu following removal of pedicle screws in instrumented single level lumbar arthrodesis. Using a validated finite element (FE) model of the intact lumbar spine (L2–5), two scenarios of L3–4 lumbar fusion were simulated: posterolateral fusion (PLF) at L3–4 using pedicle screws (PLF with pedicle screws; WiP) and L3–4 lumbar posterolateral fusion state after removal of pedicle screws (PLF without pedicle screws; WoP). The WiP model had greater range of motion (ROM) at each adjacent segment than the WoP model. This phenomenon became pronounced at the proximal adjacent segment under flexion moment. Similarly, removal of pedicle screws (the WoP model) relieved the maximal von Mises stress at adjacent segments under 4 moments compared to the WiP model. This study demonstrated that removal of pedicle screws could decrease stiffness of fusion segments, which would reduce the disk stress of adjacent segments.     

Estimation of 3D location and orientation of human vertebral facet joints from standing digital radiographs

This study provides a biplanar radiographic reconstruction method of volumes of interest to evaluate the location, dimensions and orientation of human facet joints. Visibility of facet anatomical landmarks and areas of interest was evaluated on digital radiographs of 20 idiopathic scoliotic adolescents. Areas of interest have provided the most reliable evaluation of facet joints on postero-anterior and lateral digital radiographs. Volumes of interest of a thoracic and lumbar spinal segment (T1 to L3) were computed using the proposed biplanar 3D reconstruction method and compared with serial tomographic reconstructed models. Differences of 1.5±0.7 mm in 3D location and 1.8±1.2° in sagittal orientation of volumes of interest were observed between both representations. This in vivo geometric information on human vertebral facet joints will help us to understand their role in spinal disorders and will provide important data for personalised biomechanical simulations.     

单侧椎弓根钉棒固定单节段腰椎及其邻近节段生物力学研究

目的分析单侧椎弓根钉棒固定对单节段腰椎的生物力学稳定性及其对邻近节段活动度的影响。方法新鲜成人尸体腰椎标本6具,测定L4～5不稳固定节段及其上下邻近节段屈伸、左右侧弯、左右旋转6个方向ROM,按4组顺序依次测试:A组(完整组);B组(模拟L4～5不稳组);C组(单侧椎弓根钉棒固定+椎间单枚cage);D组(双侧椎弓根钉棒固定+椎间单枚cage)。结果L4～5节段除左侧弯外,C组与D组相比各运动方向ROM差异无统计学意义(P0.05);L3～4、L5～S1节段除左、右侧弯外,C组与D组相比各运动方向ROM差异无统计学意义(P0.05)。结论单侧椎弓根钉棒固定对单节段腰椎在大部分运动方向上具有与双侧固定相似的即刻稳定性,邻近节段侧弯活动度较双侧固定后更少。     

Bone metabolism in elite male rowers: adaptation to volume-extended training

We examined the effect of 6-month volume-extended training on bone metabolism in elite male rowers. Twelve elite male rowers (20.8±3.0 years; 192.9±4.7 cm; 91.9±5.3 kg; body fat 10.1±2.3%; 6.2±0.5 l min⁻¹) participated in this study. Bone biochemical markers, hormones, bone mineral content (BMC), and bone mineral density (BMD) were assessed before and after training. Average weekly training volume was significantly higher (P<0.05) during the 6 months of heavy training compared to relative rest (11.6±0.4 h week⁻¹ vs. 16.8±0.6 h week⁻¹), while intensity remained the same. At the end of training, only arm BMD was significantly increased by 5.7%. Osteocalcin (16.6%), insulin-like growth factor-1 (IGF-1) (20.2%) and the bioavailability IGF-1 index (17.9%) were significantly increased. Before heavy training, relationships were observed between the whole body BMD and growth hormone (r=0.64; P≤0.02), lumbar spine BMD and 1.25(OH)₂ vitamin D (r=0.69; P≤0.04), arm BMD and testosterone (r=0.59; P≤0.05), and arm BMD and adiponectin (r=0.59; P≤0.05). No relationship was found between BMC or BMD and blood biochemical measures 6 months later (r=0.56; P≥0.05). In addition, osteocalcin was related to IGF-1 (r>0.58; P<0.048) and bioavailability IGF-1 index (r>0.59; P≤0.055) before and after training. In summary, heavy training had a moderately favorable effect on BMD. Bone tissue at specific skeleton sites is sensitive to changes in training volume even in athletes with already high BMD values. Changes in BMD and bone formation may be caused by changes in specific hormones such as IGF-1 and adiponectin in male athletes.     

Coexisting Spine Lesions on Whole Spine T2 Sagittal MRI in Evaluating Spinal Degenerative Disease

BackgroundStudies have reported on the usefulness of whole spine magnetic resonance imaging (MRI) in evaluating specific diseases such as spinal tuberculosis, spinal trauma, spondyloarthropathies, and multiple myeloma. In studies concerning degenerative spinal disease, sample sizes were small and some did not provide information on how symptomatic coexisting lesions were treated. We evaluated the types and prevalence of coexisting spine lesions found on whole spine T2 sagittal screening performed at the time of routine cervical and lumbar spine MRI and evaluated the efficacy of such screening in degenerative diseases of the cervical and lumbar spine.MethodsWe reviewed 1,757 and 2,266 consecutive cases where whole spine T2 sagittal screening had been performed with routine cervical and lumbar spine MRI, respectively, in patients with cervical and lumbar spinal degenerative diseases. Coexisting spine lesions were documented and statistical analysis was performed to investigate significant differences according to sex, age, and initial diagnosis. Electronic medical records were reviewed to determine whether additional interventions were necessary following such findings.ResultsWe reviewed 1,252 and 1,689 consecutive cases of routine cervical and lumbar spine MRI respectively, with whole spine T2 sagittal screening. Of the 1,252, 419 (33.5%) patients with cervical spinal degenerative disease had coexisting lesions in the thoracolumbar spine. Patients with ligament ossification disease of the cervical spine showed a higher prevalence of coexisting spine lesions. Sixty of the 419 (14.3%) patients with coexisting spine lesions warranted additional intervention or surgical treatment. Four hundred and eighty-one of 1,689 (28.5%) patients with lumbar degenerative disease had coexisting spine lesions in the cervicothoracic spine. Forty-eight of the 481 (10.0%) patients with coexisting spine lesions warranted additional intervention. In both patient groups, older patients showed a significantly higher prevalence of coexisting spine lesions than younger patients.ConclusionConsidering the minimal extra time and cost in performing whole spine screening, its application to routine spine MRI can be considered in evaluating cervical and lumbar spinal degenerative diseases.