The state of water in intervertebral disks from data of relaxation analysis using an NMR-tomogram

Distribution and dynamical characteristics of water molecules in normal and degeneratively changed rabbit intervertebral discs (ID) are estimated basing on the biexponential relaxation analysis of MR-images. Degenerative-dystrophic changes in a rabbit spine were modelled via a spine segmental blood supply injury and, in some cases, removal of ID nuclei. Extreme distributions of relaxation parameters in the ID plane characteristic of intact IDs are shown to be disturbed in cases of ID degenerative changes. These results allow to link ID fibrosis to a water balance disorder and to give a method for estimating the spine destruction degree for clinical MR-imaging.     

A videofluoroscopy-based tracking algorithm for quantifying the time course of human intervertebral displacements

The motions of individual intervertebral joints can affect spine motion, injury risk, deterioration, pain, treatment strategies, and clinical outcomes. Since standard kinematic methods do not provide precise time-course details about individual vertebrae and intervertebral motions, information that could be useful for scientific advancement and clinical assessment, we developed an iterative template matching algorithm to obtain this data from videofluoroscopy images. To assess the bias of our approach, vertebrae in an intact porcine spine were tracked and compared to the motions of high-contrast markers. To estimate precision under clinical conditions, motions of three human cervical spines were tracked independently ten times and vertebral and intervertebral motions associated with individual trials were compared to corresponding averages. Both tests produced errors in intervertebral angular and shear displacements no greater than 0.4° and 0.055 mm, respectively. When applied to two patient cases, aberrant intervertebral motions in the cervical spine were typically found to correlate with patient-specific anatomical features such as disc height loss and osteophytes. The case studies suggest that intervertebral kinematic time-course data could have value in clinical assessments, lead to broader understanding of how specific anatomical features influence joint motions, and in due course inform clinical treatments.     

Our experiences in treatment of prostate carcinoma in patients over the age of 70

The goal of our study was to present our long-standing experience of the treatment of prostate carcinoma in patients over the age of 70. During the 20 years period (from 1991 to 2010) we diagnosed the prostate carcinoma in 1998 patients. More than 58% of the patients were over 70 years old. The most frequent symptoms of the prostate carcinoma were frequent urination and backache. At the first examination 36% of the patients had both prostate lobes involved, and 27% of them had metastases. The most frequent ones (26%) were those in the bone system (pelvis and spine), while in only 1% metastases were found in solid organs (lungs and liver). According to the TNM classification, T1 and T2 were diagnosed in 818 (71%) patients. Histopathological examination discovered Gleason score 2 in 70% of patients and Gleason score 3 in 24% of them. Most often the combination of castration and antiandrogen therapy (in 68% of the patients) and the combination of castration and Estracyt therapy (in 19% of the patients) were applied. In conclusion, intensified efforts should be made in promoting preventive urological examinations because of the great number of patients (27%) with metastases at the first examination.     

不同体位对肥胖产妇椎间隙定位的影响

目的:探讨体位对肥胖产妇椎间隙定位准确性的影响。方法:选择2018年1月-6月在上海市同仁医院建卡并定期产检且预产期在此期间的209例肥胖产妇,根据不同穿刺体位按随机数字表法将其分为坐位组(n=104)和侧卧位组(n=105),采用超声检测作为金标准进行椎间隙定位,比较不同体位下触诊定位椎间隙的精准性,及肥胖程度与定位准确性的关系。结果:与侧卧位组比较,坐位组L3-4椎间隙定位时间显著缩短,皮肤至腰椎棘突距离、红色(手法定位)与黑色标记(超声定位)距离明显缩小(P0.05)。与侧卧位组比较,坐位组一次穿刺成功率明显升高,穿刺时间明显缩短(P0.05)。随着BMI的增加,椎间隙定位时间显著延长,皮肤至腰椎棘突距离、红色与黑色标记距离、节段误差率明显增加(P0.05)。结论:肥胖产妇椎间隙定位准确性与体位及肥胖程度密切相关,坐位下椎间隙触诊定位的准确性优于侧卧位。     

Cartilage derived morphogenetic protein 2 – A potential therapy for intervertebral disc regeneration?

Low back pain is amongst the top ten risk factors that contribute to disability, ranking higher than diabetes and mental health disease globally as a contributor to years lost to disability (YLD), and escalating as Western societies age. Abundant evidence suggests that intervertebral disc (IVD) damage is central to the origin of pain in the spine. IVD degeneration involves the progressive deterioration of the highly organized disc tissue extracellular matrix, losing its elasticity and hence its' cushioning ability for the spine.Cartilage derived morphogenetic protein-2 (CDMP2) is a small peptide morphogen. Naturally occurring mutations segregate with skeletal defects in IVD development. CDMP2 signalling influences chondrogenic tissue determination, retards osteogenic tissue development and is crucial to early dorso–ventral axis defining events in zebrafish and Xenopus laevis.The potential of biological treatments to offer cutting edge early intervention, tissue regeneration and to preserve spinal motion segments shows great promise. The unique qualities of CDMP2 in IVD tissue formation, delineating discal matrix from vertebral bone, may prove adaptable in therapeutic applications to early discal degeneration.Here we explore the prevalence and origin of backache, the biology of CDMP2 and its potential application as an early intervention to arrest the disc degeneration sequelae.     

Compressed vertebrae in Atlantic salmon Salmo salar: evidence for metaplastic chondrogenesis as a skeletogenic response late in ontogeny

Anterior/posterior (a/p) compression of the vertebral column, referred to as 'short tails', is a recurring event in farmed Atlantic salmon. Like other skeletal deformities, the problem usually becomes evident in a late life phase, too late for preventive measures, making it difficult to understand the aetiology of the disease. We use structural, radiological, histological, and mineral analyses to study 'short tail' adult salmon and to demonstrate that the study of adult fish can provide important insights into earlier developmental processes. 'Short tails' display a/p compressed vertebrae throughout the spine, except for the first post-cranial vertebrae. The vertebral number is unaltered, but the intervertebral space is reduced and the vertebrae are shorter. Compressed vertebrae are characterized by an unchanged central part, altered vertebral end plates (straight instead of funnel-shaped), an atypical inward bending of the vertebral edges, and structural alterations in the intervertebral tissue. The spongiosa is unaffected. The growth zones of adjacent vertebrae fuse and blend towards the intervertebral space into chondrogenic tissue. This tissue produces different types of cartilage, replacing the notochord. The correspondence in location of intervertebral cartilage and deformed vertebral end plates, and the clearly delimited, unaltered, central vertebral parts suggest that the a/p compression of vertebral bodies is a late developmental disorder that may be related to a metaplastic shift of osteogenic tissue into chondrogenic tissue in the vertebral growth zone. Given the lack of evidence for infections, metabolic disorders and/or genetic disorders, we propose that an altered mechanical load could have caused the transformation of the bone growth zones and the concomitant replacement of the intervertebral (notochord) tissue by cartilaginous tissues in the 'short tails' studied here. This hypothesis is supported by the role that notochord cells are known to play in spine development and in maintaining the structure of the intervertebral disk.     

DR全脊柱摄影技术在脊柱侧弯中的应用与优势

目的:探讨数字化X线摄影(DR)全脊柱摄像技术在脊柱侧弯中的应用和优势。方法:收集2012年2月至2013年6月于本院进行治疗的脊柱侧弯病例88例,应用数字化X线摄影(DR)技术对脊柱由上至下进行正位和侧位的扫描,均进行3次曝光,每两次曝光间隔均为9秒,曝光后通过图像拼接技术将患者脊柱图像进行拼接和重叠,形成全景图像,对全部患者的图像质量进行观察和评估。结果:所有入选病例中有84例患者图像清晰显示了脊柱侧弯的方向和角度、椎体和椎间隙、对称的椎弓根、根间距及对脏器的影响程度。其中1例因运动不合作出现伪影,3例曝光不足。全脊柱图像质量正位优秀率为92.43%,侧位优秀率为85.92%;全脊柱图像拼接正位优秀率为83.44%,侧位优秀率为86.58%。结论:数字化X线摄影(DR)技术应用上方便快捷,患者配合时间较短,图像质量较好,能够满足临床医生进行诊断和治疗,有助于患者预后康复情况的评估,值得在临床诊断中推广应用。     

Imaging of blocks in the spine with bone scintigraphy (SPECT)]

INTRODUCTION: One of the most important tasks of manual therapists is the treatment of hypomobile intervertebral joints. Such conditions of the spine are treated with various manipulations or mobilisation. The pathophysiological basis of hypomobility is still under discussion. Objective criteria for the diagnosis of impaired spinal mobility are not available. Nor is any substrate detectable by X-ray, computed tomography or NMR. AIM: To find evidence of a biomechanical alteration of hypomobile intervertebral joints with the aid of SPECT (Single Photon Emission Computed Tomography). STUDY DESIGN: 13 outpatients with back pain but otherwise healthy attending the Orthopaedic University Hospital in Marburg were examined by manual medical means, and were found to have hypomobility of an intervertebral joint. In addition, the spines of these patients were examined with SPECT (bone scanning). RESULTS: Comparison of the results of physical examination and bone scanning revealed that in 75% of all the cases the location (spinal segment) of the hypomobility identified by each of the two methods was identical. In 83%, they were in agreement on which of the sides (facet joint) was affected.     

Validation of single-segment and three-segment spinal models used to represent lumbar flexion

Changes in spinal posture between the erect and flexed positions were calculated using angular measurements from lateral photographs and radiographs of ten adult male subjects. For photographic measurements, the thoracolumbar vertebral column was modelled as either a single segment or as three segments. In the three-segment model, there was a non-significant correlation between the decrease in lumbar concavity and intervertebral motion. In addition, there was a non-significant negative correlation between the increase in thoracic convexity and lumbar motion determined radiographically. In the single-segment model, the decrease in angulation between the thoracolumbar spine and pelvis was a good representation of lumbar spine flexion as determined by the mean lumbar intervertebral angular change. Therefore, modelling the thoracolumbar vertebral column as a single segment allowed better estimation of lumbar intervertebral angular change during flexion than a three-segment model. The results indicate that large range dynamic motion of the lumbar vertebral column can be represented using photographic analysis of the positions of three easily identified anatomical landmarks: the anterior superior iliac spine, posterior superior iliac spine and the spinous process of the first thoracic vertebra.     

Rare causes of scoliosis and spine deformity: experience and particular features

Background

Spine deformity can be idiopathic (more than 80% of cases), neuromuscular, congenital or neurofibromatosis-related. However, there are many disorders that may also be involved. We present our experience treating patients with scoliosis or other spine deformities related to rare clinical entities.

Methods

A retrospective study of the records of a school-screening study in North-West Greece was performed, covering a 10-year period (1992–2002). The records were searched for patients with deformities related to rare disorders. These patients were reviewed as regards to characteristics of underlying disorder and spine deformity, treatment and results, complications, intraoperative and anaesthesiologic difficulties particular to each case.

Results

In 13 cases, the spine deformity presented in relation to rare disorders. The underlying disorder was rare neurological disease in 2 cases (Rett syndrome, progressive hemidystonia), muscular disorders (facioscapulohumeral muscular dystrophy, arthrogryposis) in 2 patients, osteogenesis imperfecta in 2 cases, Marfan syndrome, osteopetrosis tarda, spondyloepiphyseal dysplasia congenita, cleidocranial dysplasia and Noonan syndrome in 1 case each. In 2 cases scoliosis was related to other congenital anomalies (phocomelia, blindness). Nine of these patients were surgically treated. Surgery was avoided in 3 patients.

Conclusion

This study illustrates the fact that different disorders are related with curves with different characteristics, different accompanying problems and possible complications. Investigation and understanding of the underlying pathology is an essential part of the clinical evaluation and preoperative work-up, as clinical experience at any specific center is limited.     

一起农村小学甲型H3N2流感暴发流行的调查分析

目的了解甲型H3N2流感暴发流行特征,为制定预防措施提供依据。方法对和温村小学239名学生流感发病及流感疫苗接种情况进行调查,对发病者逐一个案调查登记,采集患者咽拭子标本送百色市疾病预防控制中心实验室检测确诊。结果该校学生流感发病33例,发病率为13.81%,学前班及1~6年级共7个班均有病例发生,发病班级为100%。发病者中,男性18例,女性15例,男女性别比为1.2∶1,男女发病率分别为14.52%(18/124)、13.04%(15/115),(χ2=0.11,P0.05),男女发病率差异无统计学意义。患者咽拭子标本5人份,经实验室检测甲型H3N2流感病毒核酸阳性率为100%。结论该校学生无流感疫苗免疫接种史,易感人群积累,是本次甲型H3N2流感暴发流行的根本原因。应在每年秋冬流感流行季节前一个月,加强中小学校学生流感疫苗接种,提高易感人群免疫力,防止甲型H3N2流感扩散蔓延。     

X-ray signs of ligamentous cervical injuries from joint manual therapy

X-ray study was conducted in 40 patients undergoing joint manual therapy (MT) to study its impact on the ligamentous apparatus of the cervical spine. The patients who had received rotational manual therapeutic techniques were found to have statodynamic dysfunction (100%), x-ray signs of ligamentous cervical injury (62%), or intervertebral disk protrusions (67%). An algorithm for cervical spine x-ray study in the frontal and lateral projections was compiled to perform after MT in the early and late periods.     

经皮椎弓根空心螺钉微创椎体间融合治疗腰椎间盘突出的临床效果分析

目的：探究经皮椎弓根空心螺钉微创椎体间融合治疗腰椎间盘突出的临床效果及安全性。方法：病例来源于我院2009 年12 月~2013 年12 月收治的确诊为腰椎间盘突出症的病患174 例,依据随机数字表法将其均分为观察组与对照组,每组87 例。其 中,观察组施行Quadrant微创通道经皮椎弓根空心螺钉椎间融合术,对照组施行经后入路开放性椎间融合术。评估和比较两组病 患术前和随访结束时的视觉模拟评分系统(VAS)疼痛评分与Oswestry 功能障碍指数(ODI)的变化及术后并发症的发生情况。结 果：观察组治疗前、出院时及随访一年时的VAS 评分与ODI指数与对照组比较差异均不显著(P>0.05)。观察组手术切口长度、术 后住院时间及术中出血量均明显优于对照组(P<0.01),而其手术所需时间明显长于对照组(P<0.01)。对照组患者术后出现20 例神 经根损伤(22.99%),3 例椎间隙感染(3.45%),其并发症总发生率为(26.44%),而观察组患者术后仅出现3 例神经根损伤,发生率为 3.45%,显著低于对照组(P<0.01)。结论：经皮椎弓根空心螺钉微创椎体间融合治疗的临床效果肯定,能减少对病患的创伤,控制术 后并发症的发生,具有较高的临床应用价值。     

Long term backache after childbirth: prospective search for causative factors.

OBJECTIVES--To assess in a prospective randomised study the association between motor block resulting from high and low dose epidural infusions of bupivacaine in labour and the incidence of long term backache after childbirth, and to compare the incidence of backache in women not receiving epidural analgesia. DESIGN--Women requesting epidural analgesia in labour between October 1991 and March 1994 were randomised to receive infusions of either bupivacaine alone or low dose bupivacaine with opioid. Data were collected during labour and the immediate postpartum period from these women and from women recruited at random over the same time from those who had laboured without epidural analgesia. A postal questionnaire about symptoms was sent three months after childbirth to all women. Further data were collected one year after childbirth from those who had reported new backache at three months. SETTING--St Thomas''s Hospital, London. SUBJECTS--599 women were recruited, of whom 450 (75%) replied to a follow up questionnaire. RESULTS--152 women (33.8% of responders) reported backache lasting three months after delivery and, of these, 33 (7.3%) had not previously suffered with backache. There were no significant differences between the treatment groups in the incidence of postnatal backache overall or of new backache or any symptoms after childbirth. Among all demographic, obstetric, and epidural variables examined the only factors significantly associated with backache after childbirth were backache before and during pregnancy. CONCLUSIONS--The incidence of new long term backache was not significantly increased in women who received epidural analgesia in labour. Motor block resulting from epidural local anaesthetic administration was not a significant factor in the development of backache.     

氧化应激介导的NF-kB 信号转导通路在椎间盘退变中的作用

椎间盘位于两个椎体之间,在脊柱中发挥着连接、减震和固定作用,其发生退变可以引起一系列椎间盘退变性疾病,是多数 脊柱疾病发病的根本原因,探索椎间盘的退变机制是寻找其治疗措施的前提。椎间盘退变机制十分复杂,其最主要的病理基础是 椎间盘活性细胞减少以及其引起的细胞外基质合成减少和成分的改变,而NF-kB 作为一种普遍存在在真核细胞中的多向性转录 因子,通过多种途径在细胞增殖、分化及凋亡方面起着关键的作用,研究表明,抑制NF-kB信号通路可以有效的缓解椎间盘退变; 而引起NF-kB信号通路的异常激活的因素很多,其中氧化应激是一个重要的因素,同时研究证实在椎间盘退变中存在着氧化损 伤。因此,当年龄、营养、外伤等因素引起的椎间盘细胞中发生氧化应激,进而导致NF-资B信号通路的激活,从而使其转录活性增 高,触发凋亡信号,引起髓核细胞的大量凋亡,使其参与到椎间盘退变中。     

Waardenburg syndrome in the Turkish deaf population

Waardenburg Syndrome (WS) is an autosomal, dominantly inherited disorder that accounts for more than 2% cases of congenital deafness. The aim of this study is to determine the WS incidence among deaf pupils. Dysmorphological examination was performed on 720 children who were attending 7 special schools in Turkey and who had hearing disabilities. All subjects in the study were examined for WS diagnostic criteria. We detected 49 patients (6.8%) with WS among the 720 children examined. Six patients had WS type 1 (12.2%) and 43 had type 2 (87.8%). We observed 2 to 5 major diagnostic criteria for WS. Out of all the subjects in the study, only two patients have deaf first degree relatives. All subjects had been previously examined by physicians for deafness but none of them had been then diagnosed to have Waardenburg Syndrome. Instead, they were all misdiagnosed as to have nonsyndromic deafness. Awareness of WS diagnostic criteria by the physicans will provide accurate diagnosis for many deaf pupils and their first degree relatives who are able-to-hear WS patients and whose children are at risk for deafness.     

Paleopathologies of the vertebral column in medieval skeletons

Paleopathological data provide valuable information about health, longevity and mortality in earlier human populations. We investigated the incidence of spinal pathologies on 54 individuals (1045 vertebrae and 18 sacral bones) that belong to a medieval skeletal series discovered in the Dalheim monastery (Northwest Germany) and compared them with contemporary and recent populations. The skeletons were analyzed with anthropological methods (sex and age determination), by macroscopic inspection, and, if pathologies of the spine and the sacrum were visible, also by X-ray. We investigated evidence of trauma, specific and nonspecific infectious diseases, joint diseases, tumors, and congenital as well as metabolic disorders. Radiocarbon determination of four samples of different specimens was also undertaken revealing a historic dating of ca. 1050 AD. The most common pathological findings were degenerative changes of the spine found in 29 individuals (53.3%). Examples of infections of the spine were rare (0.8% of all vertebrae). There were no cases of traumatic injuries of the spine. The prevalence of spondylosis deformans, the most commonly found type of pathology was found to be higher in the lumbar region, in males as well as in individuals of low stature.     

Assessing long term backache after childbirth.

OBJECTIVES--To investigate the factors associated with long term backache after childbirth, to assess all women reporting new onset long term backache, and to investigate any relation with pain relief in labour. DESIGN--Data collected from obstetric records and postal questionnaires or telephone interviews on morbidity after childbirth from all women delivering their first baby between March 1990 and February 1991, followed by analysis of data collected from outpatient consultations. SETTING--St Thomas''s Hospital, London. SUBJECTS--Questionnaires were sent to 1615 women who had delivered their first baby in the defined period; 1015 either replied by post or were contacted by telephone. RESULTS--299 women (29.5% of responders) reported backache lasting more than six months and of these 156 (15.4%) said they had had no back problems previously. Those women who had received epidural analgesia in labour were significantly more likely to report new onset backache (17.8%; 95% confidence interval 14.8% to 20.8%) than those who did not (11.7%; 8.6% to 14.8%). Younger women, unmarried women, and those reporting other antenatal symptoms were significantly more likely to report new long term backache. The 156 women reporting new backache were asked to attend an outpatient clinic and 36 (23%) did so. The majority had a postural backache which was not severe. Psychological factors were present in 14 women. CONCLUSIONS--Though new long term backache is reported more commonly after epidural analgesia in labour, it tends to be postural and not severe. There were no differences in the nature of the backache between those who had or had not received epidural analgesia in labour.     

An hypothesis for the role of the spine in human locomotion: A challenge to current thinking

Locomotion was first achieved by the motion of the spine. The limbs came after, as an improvement, not as a substitute; and yet, analysis of bipedal gait concentrates almost exclusively on the motion of the limbs. The requirements for land locomotion are examined from a general point of view and the evolution of the vertebrate spine is presented as a mechanism designed to move the animal. The necessary spinal movements are also analysed; the role of the musculoskeletal system is discussed and it is shown that the lumbar spine is a key structure in land locomotion, the pelvis being driven by the spine. The optimum control of motion demands that the stress at all the intervertebral joints should be minimized and equalized. This theory of locomotion requires the central nervous system to control the torque at those intervertebral joints and suggests that a breakdown of the control system would result in torsional failure of the spine. The theory is supported by EMG, force and torque data collected from several sources.