The MRI-detected osteophyte score is a predictor for undergoing joint replacement in patients with end-stage knee osteoarthritis

Objectives: The aim of this prospective cohort study was to examine whether MRI-detected osteoarthritis (OA)-structural changes at baseline could predict knee OA patients who would undergo total knee arthroplasty (TKA).

Methods: In total, 128 end-stage medial-type knee OA patients were enrolled and followed up for 6 months. MRI using the whole-organ MRI scoring (WORMS) method, radiographic findings, visual analog scale (VAS) for pain and a patient-oriented outcome measure, and the Japanese Knee Osteoarthritis Measure (JKOM) were recorded at baseline. The area under the curve (AUC) was estimated to determine the discriminative value of the prediction models.

Results: While 74 patients (57.8%) did not undergo TKA, the remaining 54 patients (42.2%) underwent TKA during this period. The AUCs of the receiver operating characteristic (ROC) curve for the activities of daily living (ADL) score evaluated by the JKOM ADL score [0.70 (95% CI: 0.60–0.79)] and osteophyte score [0.72 (0.64–0.81)] were 0.70 or greater. The JKOM ADL score (17/40) and the osteophyte score (30/98) showed relative risks (RR) of 2.61 (1.32–5.15) and 3.01 (1.39–6.52) for undergoing TKA, respectively.

Conclusion: The osteophyte score detected by MRI, in addition to ADL score, was found to be an important factor in determining whether the patient should undergo TKA.     

Long-Term Follow-Up Radiologic and Clinical Evaluation of Cylindrical Cage for Anterior Interbody Fusion in Degenerative Cervical Disc Disease

Objective

Various procedures have been introduced for anterior interbody fusion in degenerative cervical disc disease including plate systems with autologous iliac bone, carbon cages, and cylindrical cages. However, except for plate systems, the long-term results of other methods have not been established. In the present study, we evaluated radiologic findings for cylindrical cervical cages over long-term follow up periods.

Methods

During 4 year period, radiologic findings of 138 patients who underwent anterior cervical fusion with cylindrical cage were evaluated at 6, 12, 24, and 36 postoperative months using plain radiographs. We investigated subsidence, osteophyte formation (anterior and posterior margin), cage direction change, kyphotic angle, and bone fusion on each radiograph.

Results

Among the 138 patients, a minimum of 36 month follow-up was achieved in 99 patients (mean follow-up : 38.61 months) with 115 levels. Mean disc height was 7.32 mm for preoperative evaluations, 9.00 for immediate postoperative evaluations, and 4.87 more than 36 months after surgery. Osteophytes were observed in 107 levels (93%) of the anterior portion and 48 levels (41%) of the posterior margin. The mean kyphotic angle was 9.87° in 35 levels showing cage directional change. There were several significant findings : 1) related subsidence [T-score (p=0.039) and anterior osteophyte (p=0.009)], 2) accompanying posterior osteophyte and outcome (p=0.05).

Conclusion

Cage subsidence and osteophyte formation were radiologically observed in most cases. Low T-scores may have led to subsidence and kyphosis during bone fusion although severe neurologic aggravation was not found, and therefore cylindrical cages should be used in selected cases.     

Joint reaction to polyethylene implantation: a method for inducing osteoarthritic change and osteophyte formation in the rabbit knee joint

Joint lesions were induced by implantation of a rigid piece of polyethylene sutured under the patella and quadriceps tendon of the rabbit's right knee. Compared to the left sham-operated knee, follow-up studies revealed progressive changes that consisted of early and transient synovial hyperemia and proliferation and late osteoarthritis. By day 7 after surgery, soft synovial-like tissue proliferated around the implant and the articular margins of the femoral trochlea indicating primitive "osteophytic" protuberances (synoviophytes). By day 15 after surgery, the synoviophytes had acquired a more solid consistency and were composed mostly of fibrocartilage covered by a fibro-cellular synovial lining (chondrophytes). By that time, this tissue was invaded with vascular channels; signs of ossification were already present in the deepest layer adjacent to bone. Between the 2nd and 12th weeks, this fibro-cartilaginous tissue, except for the surface fibrous or fibrocartilaginous layer, was progressively replaced by immature bone (osteophyte). Secondary bone remodeling started soon after the first lamellae of immature bone were deposited. Complete integration of the osteophyte into the distal femur occurred during the 2nd and 3rd month.     

An unusual cause of cervical kyphosis

Background Context

Acute fixed cervical kyphosis may be a rare presentation of conversion disorder, psychogenic dystonia, and potentially as a side effect from typical antipsychotic drugs. Haldol has been associated with acute dystonic reactions. In some cases, rigid deformities ensue. We are reporting a case of a fixed cervical kyphosis after the use of Haldol.

Ligament Preserving Technique for a Locked Metacarpophalangeal Joint of the Index Finger

BackgroundLocking of metacarpophalangeal joint (MPJ) of the index finger occurs when volar radial osteophytes of the metacarpal head catch the accessory collateral ligament. We devised a ligament-preserving approach to quickly restore the MPJ motion while protecting the radial collateral ligament.MethodsWe retrospectively reviewed the results of nine patients treated for a locked MPJ of the index finger. In three patients, closed reduction was successful. In six cases, volar radial osteophytes were excised from the metacarpal head using a ligament-preserving technique through a longitudinal incision on the radial side. We analyzed osteophyte shape and height as demonstrated by X-ray and computed tomography (CT). Function was evaluated by examining the range of motion, recurrence, Disabilities of the Arm, Shoulder and Hand (DASH) score, and MPJ stability based on the key pinch strength. One male and eight female patients were followed for an average of 33 months (range, 12 to 65 months); the average age of patients was 41 years (range, 34 to 47 years). The average duration of locking of the MPJ was 23 days (range, 1 to 53 days).ResultsThe sharp type of osteophytes was identified in six patients and the blunt type of osteophytes was indentified in three patients. The average height of radial osteophytes on the index finger metacarpal was 4.6 ± 0.4 mm in the axial CT image. At the final follow-up, the average extension limitation decreased from 26° (range, 10° to 45°) to 0°, and further flexion increased from 83° (range, 80° to 90°) to 86°. There was no recurrent locking after surgery. The DASH score improved from 24.3 to 7.2. Key pinch strength improved from 67.3% to 90.4%.ConclusionsWe obtained satisfactory outcomes in irreducible locking of the MPJ of the index finger by excising volar radial osteophytes of the metacarpal head using a ligament-preserving approach.     

Giant Cervical Osteophytes Their Significance in ENT Practice

Foresteir’s disease or Diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical vertebrae in two patients is being presented as an uncommon cause of snoring and dysphagia. The radiological features of the giant osteophytes involving the cervical vertebrae are detected on routine skiagrams of the neck. A review of literature over ten years showed no such record of such a lesion occurring in C1-C2 vertebrae, whereas the occurrence in the lower cervical vertebrae is occasionally seen causing dysphagia. The relative merits of the surgical approaches are discussed.     

脊柱颈段的年龄变化及其临床意义

目的 为临床应用提供脊柱颈段年龄性变化的解剖学资料。方法 观察并测量了颈椎干骨标本50套(G3-7)、脊柱颈段标本正中矢状切标本15例(30侧,其中童尸2例,青年5例,中老年8例)、脊柱颈段X线正侧位片320张、CT片50张,分年龄段作统计,对特例作摄影和绘图记录。结果 (1)青少年时期同一椎体的前后面接近平行,并基本等高。随着年龄增加,前面逐渐变斜,朝向前上,前高则逐渐缩短,特别以C4-C6椎为显著,而后面的高度和斜度无显著变化。(2)在老年侧位片上,对同一椎的前、后面分别作垂线,两线相夹的角度C5-6均超过4°,而两端各椎则为3°。(3)颈椎间盘的前高和后高均随年龄老化而降低,但前高降低的总量约为后高者的2倍。(4)钩突年青时呈尖棘状,随着年龄老化向后扩展,变成矢状位的嵴状,此嵴前后长度在上位椎可超过同椎椎体的正中矢状径。(5)骨赘多见于钩突和C4-6椎体前面的上下缘,也可见于关节突和钩椎关节的斜坡,椎体后面可偶见后纵韧带骨化所成的骨赘或骨刺,罕见与前面相当的上、下缘骨唇形成。结论 颈曲随年龄增加而减小,决定因素是椎体前份和椎间盘前份高度的持续降低。     

“椎骨错缝”大鼠模型的影像学研究

目的利用腰椎X线摄片技术观察大鼠腰椎部分节段固定对椎间隙前、后径和棘突间距的影响。方法120只体质量为350~450g的SPF级雄性SD大鼠随机分为单纯固定组、旋转固定组和假手术组。单纯固定组大鼠腰椎L ₄-L ₆节段植入椎体外部连接固定装置；旋转固定组大鼠则在此基础上于连接钢板和棘突钢板之间放置金属垫片，使L ₅棘突向右侧旋转，造成L ₅棘突与L ₄和L ₆棘突不共线；假手术组则只切开皮肤后缝合。造模1周、4周、8周和12周时大鼠腰椎X线摄片，测量各组固定节段椎间隙前、后径和棘突间距的距离。 结果造模4周后，单纯固定组固定节段L ₃-L ₄、L ₄-L ₅、L ₅-L ₆和L ₆-S ₁椎间隙前径分别为28.11±3.94、25.73±4.70、29.51±6.34和34.97±4.65像素；椎间隙后径分别为7.39±1.63、6.65±1.76、7.02±1.52和9.62±2.50像素；棘突间距分别为39.33±11.74、14.11±5.75、21.32±6.84和77.43±13.69像素，均小于假手术组( P < 0.05)。造模8周及12周后，单纯固定组固定节段L ₃-L ₄、L ₄-L ₅、L ₅-L ₆和L ₆-S ₁椎间隙前、后径和棘突间距与假手术组相比继续减小( P < 0.05)。旋转固定组与单纯固定组的测量结果一致，在造模4周、8周和12周后，其固定节段L ₃-L ₄、L ₄-L ₅、L ₅-L ₆和L ₆-S ₁椎间隙前、后径和棘突间距也均小于假手术组( P < 0.05)。造模8周后，单纯固定组和旋转固定组腰椎固定节段出现了较明显的骨赘。 结论腰椎部分节段固定可造成椎间隙减小并导致骨赘形成。     

Updated management strategy for patients with cervical osteophytic dysphagia

Anterior cervical osteophytes impinging upon the pharynx or esophagus constitute a rare cause of dysphagia. In severe cases, surgical removal of these osteophytes can provide symptomatic relief. We describe a patient of this type who failed to improve postoperatively, only to be found subsequently to have a carcinoma of the base of the tongue. To assist other clinicians in evaluating similar patients, and also to emphasize the great utility of modern radiologic techniques in these cases, we propose a diagnostic algorithm that incorporates magnetic resonance or computerized tomographic imaging.