Lumbar Segmental Mobility According to the Grade of the Disc, the Facet Joint, the Muscle, and the Ligament Pathology by Using Kinetic Magnetic Resonance Imaging

Kong, Min Ho; Morishita, Yuichiro; He, Wubing; Miyazaki, Masashi; Zhang, Haihong; Wu, Guoqing; Hymanson, Henry J.; Wang, Jeffrey C.

doi:10.1097/brs.0b013e3181b353ea

Cited by 86 publications

(74 citation statements)

References 32 publications

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“…This effect was found to be significantly correlated with all scores, and is coherent with previous in vivo and in vitro data for high degrees of disc degeneration [20,40,49]. However, for mild degeneration instability was found in two studies [20,40], while stiffening was observed in the other one [49]. The present work supported the findings of the latter.…”

Section: Discussionsupporting

confidence: 93%

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The mechanical response of the lumbar spine to different combinations of disc degenerative changes investigated using randomized poroelastic finite element models

et al. 2010

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Degeneration of the intervertebral disc is related to progressive changes in the disc tissue composition and morphology, such as water loss, disc height loss, endplate calcification, osteophytosis. These changes may be present separately or, more frequently, in various combinations. This work is aimed to the biomechanical investigation of a wide range of clinical scenarios of disc degeneration, in which the most common degenerative changes are present in various combinations. A poroelastic non-linear finite element model of the healthy L4-L5 human spine segment was employed and randomly scaled to represent ten spine segments from different individuals. Six different degenerative characteristics (water loss in the nucleus pulposus and annulus fibrosus; calcification and thickness reduction of endplate cartilage; disc height loss; osteophyte formation; diffuse sclerosis) were modeled in 30 randomly generated models, 10 for each overall degree of degeneration (mild, moderate, severe). For each model, a daily loading cycle including 8 h of rest, 16 h in the standing position with superimposed two flexion-extension motion cycles was simulated. A tendency to an increase of stiffness with progressing overall degeneration was observed, in compression, flexion and extension. Hence, instability for mild degeneration was not predicted. Facet forces and fluid loss decreased with disc degeneration. Nucleus, annulus and endplate degeneration, disc height loss, osteophytosis and diffuse sclerosis all induced a statistically significant decrease in the total daily disc height variation, facet force and flexibility in flexion-extension. Therefore, grading systems for disc degeneration should include all the degenerative changes considered in this work, since all of them had a significant influence on the spinal biomechanics.

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Section: Discussionsupporting

confidence: 93%

“…This idea, supported by more recent studies [20,40] had a critical influence on the development of the therapeutic options, e.g. for dynamic stabilization, which is aimed to the reduction of the flexibility to physiological levels.…”

Section: Introductionmentioning

confidence: 91%

The mechanical response of the lumbar spine to different combinations of disc degenerative changes investigated using randomized poroelastic finite element models

et al. 2010

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“…Karadimas et al [17] studied healthy and degenerative discs using positional MR images and found that changes in segmental motion were related to the degree of disc degeneration. Using kMRI, Kong et al [9,10] found that the prevalence of excessive translational motion significantly increased in patients with grade IV discs, but decreased when the disc degeneration advanced to grade V. Angular motion was similar regardless of disc grade, except in grade V degeneration in which angular motion decreased significantly.…”

Section: Discussionmentioning

confidence: 99%

“…Lastly, we have not taken into account the other factors that may affect segmental mobility, such as degenerative changes of the facet joint, ligamentum flavum, and paraspinal muscles. These structures also play an important role in determining abnormal segmental mobility individually or in combination with disc degeneration [3,10]. Despite these limitations, this study evaluates lumbar segmental mobility in a large population of young patients with a safe and practical imaging technique.…”

Section: Discussionmentioning

confidence: 99%

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Kinetic magnetic resonance imaging analysis of lumbar segmental mobility in patients without significant spondylosis

et al. 2012

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Purpose The purpose of this study was to examine lumbar segmental mobility using kinetic magnetic resonance imaging (MRI) in patients with minimal lumbar spondylosis. Methods Mid-sagittal images of patients who underwent weight-bearing, multi-position kinetic MRI for symptomatic low back pain or radiculopathy were reviewed. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, in all lumbar discs from L1-2 to L5-S1 were included for further analysis. Translational and angular motion was measured at each motion segment. Results The mean translational motion of the lumbar spine at each level was 1.38 mm at L1-L2, 1.41 mm at L2-L3, 1.14 mm at L3-L4, 1.10 mm at L4-L5 and 1.01 mm at L5-S1. Translational motion at L1-L2 and L2-L3 was significantly greater than L3-4, L4-L5 and L5-S1 levels (P \ 0.007). The mean angular motion at each level was 7.34°at L1-L2, 8.56°at L2-L3, 8.34°at L3-L4, 8.87°a t L4-L5, and 5.87°at L5-S1. The L5-S1 segment had significantly less angular motion when compared to all other levels (P \ 0.006). The mean percentage contribution of each level to the total angular mobility of the lumbar spine was highest at L2-L3 (22.45 %) and least at L5/S1 (14.71 %) (P \ 0.001). Conclusion In the current study, we evaluated lumbar segmental mobility in patients without significant degenerative disc disease and found that translational motion was greatest in the proximal lumbar levels whereas angular motion was similar in the mid-lumbar levels but decreased at L1-L2 and L5-S1.

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Facet overhang: A novel parameter in the pathophysiology of multifidus muscle atrophy

et al. 2022

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The relationship between degenerative zygapophysial joint (facet) arthropathy and multifidus muscle atrophy has not been rigorously evaluated. The purpose of this study was to determine if specific morphological features of degenerative facet arthropathy are correlated with multifidus muscle atrophy. We retrospectively reviewed medical records and imaging studies of patients with lumbar spinal stenosis. Facet overhang, bridging osteophyte formation, facet effusion, and facet angles were evaluated by univariable and multivariable regression to identify independent associations with deep and superficial parts of the multifidus total cross-sectional area (tCSA), functional cross-sectional area (fnCSA), and fatty infiltration (FI). Facet overhang was classified as severe in 50 females (53.2%) versus 56 males (36.9%) (p = 0.030). Severity of facet overhang and female sex were independently associated with smaller deep part of the multifidus tCSA and fnCSA as well as higher FI, reflecting greater atrophy of the deep region compared to total muscle mass. In comparison, severe facet overhang (p < 0.001; OR = 3.47, 95% CI = 2.13-5.66) and female sex (p < 0.001; OR = 4.19, 95% CI = 2.58-6.79) were independently associated only with higher superficial part of the multifidus FI, reflecting muscle steatosis without significant lean muscle atrophy. In patients with degenerative lumbar spinal stenosis, facet overhang is an independent risk factor for deep part of the multifidus atrophy. Bridging osteophyte formation, facet effusion, and facet angles were not independently associated with deep part of the multifidus atrophy.

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Lumbar Segmental Mobility According to the Grade of the Disc, the Facet Joint, the Muscle, and the Ligament Pathology by Using Kinetic Magnetic Resonance Imaging

Cited by 86 publications

References 32 publications

The mechanical response of the lumbar spine to different combinations of disc degenerative changes investigated using randomized poroelastic finite element models

The mechanical response of the lumbar spine to different combinations of disc degenerative changes investigated using randomized poroelastic finite element models

Kinetic magnetic resonance imaging analysis of lumbar segmental mobility in patients without significant spondylosis

Facet overhang: A novel parameter in the pathophysiology of multifidus muscle atrophy

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