Precision measurement of disc height, vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine

Frobin, Wolfgang; Brinckmann, Paul; Biggemann, M; Tillotson, Malcolm; Burton, Kim

doi:10.1016/s0268-0033(96)00067-8

Cited by 146 publications

(124 citation statements)

References 28 publications

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“…Disc height is generally not affected [10,18] or even slightly increased [6] in the physiological ageing process, whereas collapse of the intervertebral space is common in pathological disc degeneration [46,52,64,76].…”

Section: Structural Changesmentioning

confidence: 99%

Ageing and degenerative changes of the intervertebral disc and their impact on spinal flexibility

et al. 2014

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Purpose Degeneration of the intervertebral disc is associated with various morphological changes of the disc itself and of the adjacent structures, such as reduction of the water content, collapse of the intervertebral space, disruption and tears, and osteophytes. These morphological changes of the disc are linked to alterations of the spine flexibility. This paper aims to review the literature about the ageing and degenerative changes of the intervertebral disc and their link with alterations in spinal biomechanics, with emphasis on flexibility. Methods Narrative literature review. Results Clinical instability of the motion segment, usually related to increased flexibility and hypothesized to be connected to early, mild disc degeneration and believed to be responsible for low back pain, was tested in numerous in vitro studies. Despite some disagreement in the findings, a trend toward spinal stiffening with the increasing degeneration was observed in most studies. Tests about tears and fissures showed inconsistent results, as well as for disc collapse and dehydration. Vertebral osteophytes were found to be effective in stabilizing the spine in bending motions. Conclusions The literature suggests that the degenerative changes of the intervertebral disc and surrounding structures lead to subtle alteration of the mechanical properties of the functional spinal unit. A trend toward spinal stiffening with the increasing degeneration has been observed in most studies.

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Section: Structural Changesmentioning

confidence: 99%

Ageing and degenerative changes of the intervertebral disc and their impact on spinal flexibility

et al. 2014

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“…The average follow-up time was 12.6 years (range [10][11][12][13][14][15][16][17]. The mean age at the start of the study was 39 years and at the end of the study was 52 years.…”

Section: Radiographic Analysismentioning

confidence: 99%

“…The digital radiographic measurements included disc height and slip on digitalised radiographs using our hospitals standard software system for viewing and measuring distances in radiographs (IDS5, Sectra PACS TM ). The pictures were magnified to increase precision after which the corners of the vertebrae were marked [14]. If the radiograph was oblique, the spot mid distance between the two identifiable corners was used.…”

Section: Radiographic Measurementsmentioning

confidence: 99%

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

et al. 2009

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The existence and importance of an accelerated adjacent segment disc degeneration (ASD) after lumbar fusion have previously not been demonstrated by RCTs. The objectives of this study were, to determine whether lumbar fusion in the long term accelerates degenerative changes in the adjacent disc and whether this affects the outcome, by using a prospective randomised design. A total of 111 patients, aged 18-55, with isthmic spondylolisthesis were randomised to exercise (EX, n = 34) or posterolateral fusion (PLF, n = 77), with (n = 37) or without pedicle screw instrumentation (n = 40). The minimum 10 years FU rate was 72%, with a mean FU time of 12.6 years (range 10-17 years). Three radiographic methods of ASD quantification were used, i.e. two digital radiographic measurement methods and the semi quantitative UCLA grading scale. One digital measurement method showed a mean disc height reduction by 2% in the EX group and by 15% in the PLF group (p = 0.0016), and the other showed 0.5 mm more disc height reduction in the PLF compared to the Ex group (ns). The UCLA grading scale showed normal discs in 100% of patients in the EX group, compared to 62% in the PLF group (p = 0.026). There were no significant differences between instrumented and non-instrumented patients. In patients with laminectomy we found a significantly higher incidence of ASD compared to non laminectomised patients (22/47 vs. 2/16 respectively, p = 0.015). In the longitudinal analysis, the posterior and anterior disc heights were significantly reduced in the PLF group, whereas in the EX group only the posterior disc height was significantly reduced. Except for global outcome, which was significantly better for patients without ASD, the clinical outcome was not statistically different in patients with and without ASD. In conclusion, the long-term RCT shows that fusion accelerates degenerative changes at the adjacent level compared with natural history. The study suggests that not only fusion, but also laminectomy may be of pathogenetic importance. The clinical importance of ASD seems limited, with only the more severe forms affecting the outcome.

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“…where K is a normally distributed random variable having mean value 0.42 and standard deviation 0.05 ( [48], in turn derived from [12]). …”

Section: Models Of the Non-degenerated Spine Segmentsmentioning

confidence: 99%

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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Precision measurement of disc height, vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine

Cited by 146 publications

References 28 publications

Ageing and degenerative changes of the intervertebral disc and their impact on spinal flexibility

Ageing and degenerative changes of the intervertebral disc and their impact on spinal flexibility

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

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

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