Neck Solutions

Association between cervical pillar hyperplasia and degenerative joint disease

Segment-specific association between cervical pillar hyperplasia and degenerative joint disease

From: Chiropractic & Osteopathy 2006, 14:21

Cervical pillar hyperplasia is a radiological finding which first made its appearance in the literature less than 30 years ago. Its etiology and clinical significance are presently unknown; nevertheless, studies have shown that cervical pillar hyperplasia is a frequently overlooked etiology for the loss of the cervical lordosis. While these findings were disputed by several authors, other consequences of cervical pillar hyperplasia are not known at the present time. It has been theorized that the architectural difference that the presence of hyperplasia introduces into the cervical pillar may cause segmental biomechanical changes and may lead to a higher prevalence of degenerative joint disease at the hyperplastic or adjacent cervical levels. The clinical significance of this phenomenon, if found to be related to degenerative joint disease, should prompt an astute clinician into evaluating the articular pillars on all cervical spine radiographs – particularly because there could be a chance that the patient may develop degeneration at the specific cervical levels and may experience associated neck pain. The architecture of the cervical pillars cannot be modified by conservative therapy; therefore, clinicians should be aware that some of the symptoms may be attributed to degeneration and may influence the expected prognosis of the management of neck pain in those particular patients.

Continue reading Association between cervical pillar hyperplasia and degenerative joint disease…

Magnetic Resonance Imaging for the assessment of degenerative disc disease of the lumbar spine

Advances in Magnetic Resonance Imaging for the assessment of degenerative disc disease of the lumbar spine

From: Semin Spine Surg. 2007 June; 19(2): 65–71

The intervertebral disc is characterized by a tension-resisting annulus fibrosus, and a compression-resisting nucleus pulposus composed largely of proteoglycan. Both the annulus and the nucleus function in concert to provide the disc with mechanical stability. Early disc degeneration begins in the nucleus with proteoglycan depletion. Quantitative MRI techniques have been developed to non-invasively quantify the earliest degenerative changes that occur within the disc. Our ability to identify and quantify these early biochemical changes will provide a better understanding of the pathophysiology of disc degeneration and facilitate the study of interventions that aim to halt or reverse the degenerative process.

Degenerative disc disease of the intervertebral disc is the most common cause of back-related disability among North American adults. This sometimes debilitating condition affects nearly 12 million people in the United States, and may generate direct and indirect costs exceeding 50 billion dollars annually in health-related expenditures. The radiographic evaluation of patients with degenerative disc disease often begins with plain film radiography and a standard T1- and T2-weighted MRI to assess for structural changes within the nucleus and annulus indicative of disc degeneration including a loss of T2-weighted MRI signal, loss of disc height, disc bulge or herniation, posterior element arthrosis, stenosis, and potential vertebral body compromise. While standard MRI is able to detect these later stage developments, it is not able to provide a quantitative measure of the early changes that characterize early degenerative disc disease. This limitation has led to the search for quantitative, non-invasive measures to evaluate the earliest changes involved in the initiation of the degenerative cascade. Such an imaging tool will be important for the evaluation of the patients with early degenerative disc disease, and also in the assessment of disc regenerative or restorative technologies that aim to halt or reverse the degenerative process.

Continue reading Magnetic Resonance Imaging for the assessment of degenerative disc disease of the lumbar spine…

Caveolin-1 stress induced premature senescence in intervertebral disc degeneration

Caveolin-1 expression and stress induced premature senescence in human intervertebral disc degeneration

From: Arthritis Res Ther. 2008 Aug 5;10(4):R87 [Epub ahead of print]

Chronic and debilitating low back pain is a common condition and a huge economic burden. Many cases are attributed to age related degeneration of the intervertebral disc, however, age related degeneration appears to occur at an accelerated rate in some individuals. We have previously demonstrated biomarkers of cellular senescence within the human intervertebral disc and suggested a role for senescence in intervertebral disc degeneration. Senescence occurs with ageing, but can also occur prematurely in response to stress. We hypothesised that stress induced premature senescence occurs within the intervertebral disc and here we have investigated the expression and production of caveolin-1, a protein that has been shown previously to be upregulated in stress induced premature senescence.

Caveolin-1 gene expression in human nucleus pulposus cells was assessed by conventional and quantitative real-time PCR and caveolin-1 protein expression examined within human intervertebral discs using immunohistochemistry. Correlation between caveolin-1 and p16INK4a biomarker of cellular senescence gene expression was investigated using quantitative real-time PCR.

Caveolin-1 gene and protein expression were demonstrated within the human intervertebral disc for the first time. Nucleus pulposus cells from degenerate discs exhibited elevated levels of caveolin-1 that did not relate to increasing chronological age. A negative correlation was observed between gene expression for caveolin-1 and donor age and no correlation was found between caveolin-1 protein expression and age. A positive correlation was identified between gene expression of caveolin-1 and biomarker of cellular senescence.

Our findings are consistent with a role for caveolin-1 in degenerative rather than age induced changes in the nucleus pulposus. Its expression in intervertebral disc tissue and its association with the senescent phenotype suggests that caveolin-1 and stress induced premature senescence may play a prominent role in the pathogenesis of intervertebral disc degeneration.

Continue reading Caveolin-1 stress induced premature senescence in intervertebral disc degeneration…

Painful disc lesion in biplanar magnetic resonance imaging and discography

Painful Disc Lesion: Can Modern Biplanar Magnetic Resonance Imaging Replace Discography?

From: J Spinal Disord Tech 2008; 21:430–435

Internal disc disruption’’ is one of the prominent somatic sources of low back pain. MRI is the most common investigation performed to evaluate discogenic pain. Though MRI has advantages of being a sensitive investigation for identifying pathologic anatomy of disc degeneration, its value is limited by its inability to evaluate the physiologic status of the disc. Studies have questioned the specificity of MRI in diagnosing discogenic pain and have reported degenerative changes in 26% to 57% of asymptomatic volunteers. Discography is a useful tool to identify the painful disc responsible for patient’s symptoms. In evaluation of discogenic low back pain there has been a debate as to whether discography should replace MRI. Proponents of discography believe that it is an invaluable tool for identifying the pathologic disc producing pain. Critics believe that discography is an invasive investigation and has no place in modern practice.

Over the last decade there has been a vast improvement in the quality of MR images. Attempts have been made to identify features on MRI scans that would correlate with patient’s symptoms and would potentially eliminate the need for discography. Such features are the vertebral end plate changes described by Modic and the high intensity zone described by Aprill and Bogduk. The implications of these findings have been a subject of controversy.

This is a prospective study aimed at correlating the results of discography with new MRI classification in a consecutive series of patients with disabling low back pain considered for spinal surgery. In addition, we also aimed to compare vertebral end plate changes and high intensity zones seen on MRI with discography findings.

Continue reading Painful disc lesion in biplanar magnetic resonance imaging and discography…

Characterization of intervertebral disc aging

Characterization of intervertebral disc aging: longitudinal analysis of a rabbit model by magnetic resonance imaging, histology, and gene expression

From: Spine. 2008 Aug 1;33(17):1821-8.

A cohort of young, healthy New Zealand White rabbits was followed longitudinally with serial magnetic resonance imaging analysis and terminal analysis of histologic changes and gene expression to examine the changes observed during normal aging in the intervertebral disc. Although there is a correlation between aging and the onset of intervertebral disc degeneration, evidence suggests that distinct pathways are involved in these processes. Our group has characterized a reproducible rabbit model of intervertebral disc degeneration by magnetic resonance imaging, radiograph, histology, and mRNA expression. However, no similar analysis has been performed longitudinally for intervertebral disc aging to allow comparison of these 2 important processes.

Four skeletally mature female NZW rabbits were housed for 122 weeks, and lumbar spine MRIs were characterized serially. Histologic and quantitative gene expression analysis of the nucleus pulposus of these aging animals was performed, and compared with adult and young rabbits. Mean magnetic resonance imaging index decreased by <25% through 120 weeks. The histologic analysis showed changes in cell composition, with abundant notochordal cells in the young, chondrocyte-like cells and notochordal cells in the adult, and clusters of hypertrophic chondrocytes in the aging discs. The PCR analysis of the nucleus pulposus showed that gene expression of collagen decreased, whereas that for proteoglycans increased with aging. BMP-2, TIMP-1, and SOX-9 expression was significantly lower in the young compared with adult discs and TGF-beta1 demonstrated lower gene expression in young and aging animals.

Although dramatic cellular changes were observed, age-related magnetic resonance imaging changes occurred in this rabbit model of normal aging at a much slower rate than in a previous injury model of degeneration. In addition, the gene expression analysis of the nucleus pulposus demonstrated remarkable differences between aging and injury induced degeneration. These results suggest that aging and injury contribute uniquely to the process of intervertebral disc degeneration.

Lumbar disc degeneration: association between osteophytes, end-plate sclerosis and disc space narrowing

Lumbar disc degeneration: association between osteophytes, end-plate sclerosis and disc space narrowing

From: Annals of the Rheumatic Diseases 2007;66:330-333

Peripheral joint osteoarthritis is characterised radiologically by the presence of osteophytes, subchondral sclerosis and joint space narrowing. Joint space narrowing is due to cartilage loss, whereas both subchondral sclerosis and osteophytes are hypertrophic responses of bone, thought to arise directly either to cartilage loss or to biomechanical stress. The pathophysiology and hence the inter-relationship of these features are however not well understood. Recently, strong associations between the presence of enthesophytes, osteophytes and bone sclerosis at various joint sites have been shown. Partly on the basis of these observations, it has been suggested that some individuals may be more likely to develop bone formation in response to disease occurrence. We looked at a series of lumbar spine radiographs and characterised the severity of the component radiographic features. Although the pathology of disc degeneration differs from peripheral joint osteoarthritis, we hypothesised that if there was a predisposition to develop new bone formation in the form of osteophyte or sclerosis in response to mechanical stress, there would be a strong association between increasing severity of the features of new bone formation. The aim of this study was to determine the strength of the association between increasing severity of osteophytes and end-plate sclerosis, and the association between both these features and disc space narrowing in the lumbar spine.

Continue reading Lumbar disc degeneration: association between osteophytes, end-plate sclerosis and disc space narrowing…

Segmental instability in cervical spondylotic myelopathy with severe disc degeneration

Segmental instability in cervical spondylotic myelopathy with severe disc degeneration

From: Spine. 2006 May 20;31(12):1327-31

A retrospective study was conducted to investigate relationships between severe disc degeneration and segmental instability in cervical spondylotic myelopathy and to discuss surgical treatment for cervical spondylotic myelopathy with severe disc degeneration. Information on relationships between segmental instability and spinal cord compression in cervical spondylotic myelopathy with severe disc degeneration is scarce. Radiographs and magnetic resonance images of patients with cervical spondylotic myelopathy with (n = 42) and without (n = 75) severe disc degeneration were reviewed retrospectively. Cervical instability and spinal cord compression factors were analyzed. Outcomes of anterior cervical decompression and fusion and expansive laminoplasty were evaluated in medical records of follow-up clinics.

Segmental instability was found in 71.4% of patients with severe disc degeneration and 22.7% of patients without severe disc degeneration. Spinal cord compression was found at the intervertebral space of severe disc degeneration and upper adjacent disc space. The recovery rate of anterior cervical decompression and fusion and expansive laminoplasty was 60.8% and 57.1%, respectively. The upper adjacent vertebra above severe disc degeneration has inclination of segmental instability. There is static spinal cord compression in intervertebral spaces of severe disc degeneration and dynamic compression in upper adjacent intervertebral spaces. Multilevel anterior cervical decompression and fusion or expansive laminoplasty should be used for surgical treatment.

Neck muscle fatigue in osteoarthritis of the cervical spine

Electromyographic analysis of neck muscle fatigue in patients with osteoarthritis of the cervical spine

From: Spine. 1994 Mar 1;19(5):502-6

Median frequency parameters of myoelectric signals were studied in 25 patients with osteoarthritis of the cervical spine and in 25 normal subjects. The median frequency parameters included initial median frequency and slope of the median frequency during 20%, 50%, 80%, and 100% of maximum voluntary contractions. The subjects performed sustained, isometric constant-force contractions of forward and backward bend of the cervical spine. The median frequency signals were obtained from the anterior (sternocleidomastoid) and posterior (upper trapezius) neck muscles. The results showed that at moderate and high forces (i.e., 50%, 80%, and 100% maximum voluntary contractions ) the anterior neck muscles in patients with osteoarthritis of the cervical spine fatigued faster than those of normal subjects. The posterior neck muscles in patients fatigued faster compared to normal subjects at high force levels (i.e., 80% and 100% maximum voluntary contractions ). This indicates a higher fatigue of the anterior and posterior neck muscles associated with arthritic changes of the cervical spine. Rehabilitation programs must consider these muscular changes to obtain optimal outcomes.

Degenerative joint disease in apophyseal joints

Biomechanical Implications of Degenerative Joint Disease in the Apophyseal Joints of Human Thoracic and Lumbar Vertebrae

From: Am J of Physical Anthrop. 136:318–326 (2008) The extent to which degenerative joint disease in bone may be seen as an indicator of mechanical or occupational stress has long been a focus of debate within osteoarchaeology. While some studies of paleopathology continue to use degenerative joint disease as a predictor of specific activity patterns, most urge caution. Clinical studies have failed to demonstrate a simple relationship between degenerative joint disease and specific patterns of movement or activity. Certain aspects of degenerative joint disease appear to be related to age, whereas others appear to be related to sex, genetic inheritance, or body weight. degenerative joint disease is probably best thought of as resulting from a combination of ‘‘systemic’’ risk factors (which can lead to degenerative changes to many joints within an individual) and localized factors which may be more closely related to the mechanical loading experienced at a particular joint. An additional complication is that skeletal tissues are able to strengthen in response to mechanical loading which does not damage them, so that moderate loading appears to be better for the joints than either low or high loading. Not surprisingly, this complexity has tended to discourage consideration of the biomechanical implications of degenerative joint disease, even where the presence and pattern of such pathology is well documented.

Continue reading Degenerative joint disease in apophyseal joints…

Balneotherapy effect on pain from degenerative knee and chronic low back pain

Balneotherapy in elderly patients: effect on pain from degenerative knee and spine conditions and on quality of life

From: Isr Med Assoc J. 2008 May;10(5):365-9

Balneotherapy is an established treatment modality for musculoskeletal disease, but few studies have examined the efficacy of spa therapy in elderly patients with degenerative spine and joint diseases. To assess the effects of balneotherapy on chronic musculoskeletal pain, functional capacity, and quality of life in elderly patients with osteoarthritis of the knee or with chronic low back pain. The 81 patients in the study group underwent a 1 day course of 30 minute daily baths in mineral water. Changes were evaluated in the following parameters: pain intensity, functional capacity, quality of life, use of non-steroidal anti-inflammatory or analgesic drugs, subjective disease severity perceived by the patients, investigator-rated disease severity, and severity of pain perceived by the patients. We analyzed the results of 76 subjects as 5 did not complete the study.

Compared to baseline, all monitored parameters were significantly improved by balneotherapy in both investigated groups. Moreover, the favorable effect was prolonged for 3 months after treatment. This study showed that balneotherapy is an effective treatment modality in elderly patients with osteoarthritis of the knee or with chronic low back pain, and its benefits last for at least 3 months after treatment.