Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part II. Cervical spine

Kettler, Annette; Rohlmann, Friederike; Neidlinger‐Wilke, Cornelia; Werner, Karin; Claes, Lutz; Wilke, Hans‐Joachim

doi:10.1007/s00586-005-1037-9

Cited by 86 publications

(49 citation statements)

References 37 publications

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“…The degrees of degeneration were evaluated from the CT images by two independent radiologists and an orthopedic spine surgeon, who were not informed about this research. According to a fourpoint scale 19) , degeneration was graded as 0 (no signal change), 1 (slight decrease in signal intensity in nucleus pulposus), 2 (distinct decrease in signal intensity in nucleus pulposus with normal disc height), and 3 (severe decrease in signal intensity in nucleus pulposus with disc space narrowing). This scale resulted in a classification of degenerative disorders as non-existent, mild, moderate, and severe, respectively.…”

Section: Subjectsmentioning

confidence: 99%

Matrix Metalloproteinase‐3 and Vitamin D Receptor Genetic Polymorphisms, and Their Interactions with Occupational Exposure in Lumbar Disc Degeneration

Yuan

Ying

Liang

et al. 2010

Journal of Occupational Health

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Objectives: To investigate the occupational and genetic risk factors inducing lumbar disc degeneration in a Chinese population, and to explore their synergistic interactions. Methods: A case-control study involving 178 low back pain patients with lumbar disc degeneration and 284 controls was carried out. Five types of work-related factors were investigated using questionnaires. Polymerase chain reaction and restriction fragments length polymorphism was used to detect the polymorphisms of MMP-3 (matrix metalloproteinase-3)(rs731236), VDR-Taq (vitamin D receptor-Taq) and VDR-Apa (vitamin D receptor-Apa)(rs35068180). Rothman's synergy index was used to measure the synergistic interactions between gene polymorphisms and occupational risk factors. Results: Family history of lumbar disc diseases, back injury history, whole-body vibration, bending/twisting, heavy physical workload, age, mutation alleles 5A of MMP-3 and A of VDR-Apa were significantly associated with lumbar disc degeneration (OR=12. 70, 11.79, 8.96, 5.46, 1.05, 1.96 and 1.70, respectively, p<0.05). Synergistic interactions existed between the mutation allele 5A of MMP-3 and wholebody vibration exposure, the mutation allele 5A of MMP-3 and bending/twisting, and the mutation allele A of VDR-Apa and bending/twisting (SI=13.27, 2.91, 2.35, respectively, p<0.05). Conclusions: The results of this study suggest that gene-occupation interaction might play a certain role in exaggerating lumbar disc degeneration. There is a possibility that subjects who carry mutation alleles 5A of MMP-3 and/or A of VDRApa are more vulnerable to lumbar disc degeneration when they are exposed to whole-body vibration and/or bending/twisting under ergonomic loads. It is estimated that 15% to 20% of adults have back pain during a single year, and 50% to 80% experience at least one episode of back pain during their lifetime 1) . Jin 2) reported that the incidence of low-back pain (LBP) was as high as 50% in an investigation of one population of Chinese workers. Lumbar disc degeneration is considered to be a primary cause of LBP 3,4) . The pathogenesis of lumbar disc degeneration includes radial fissures, rim tears in the annulus, and loss of water content in the nucleus pulpous and annulus. These changes are suspected of underlying many back pain symptoms.The etiology of lumbar disc degeneration is complex, and recent research on the causes of disc degeneration have shed light upon a better understanding of the risk factors contributing to disc degeneration. Magora 5) suggested that occupational factors contributing to the acceleration of spinal degeneration included heavy physical loads, manual materials handling consisting of lifting, bending and twisting, prolonged sitting, sustained non-neutral work postures, and vehicle driving. Videman 6) confirmed that occupational exposures are viewed as the primary source of the mechanical factors

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Section: Subjectsmentioning

confidence: 99%

Matrix Metalloproteinase‐3 and Vitamin D Receptor Genetic Polymorphisms, and Their Interactions with Occupational Exposure in Lumbar Disc Degeneration

Yuan

Ying

Liang

et al. 2010

Journal of Occupational Health

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“…The fifth point on this scale (fissured) was not used because it required fluid to be injected into the intact disc for positive identification. Inspection of the radiographs showed that these four grades are equivalent to grades 0-3 on the scale proposed for radiographic assessment of cervical discs [18]. Disc area was estimated from the anteroposterior and lateral diameters of the lower endplate of the upper vertebra in each motion segment, using the formula for the area of an ellispse (p · a · b/4) where the diameters a and b were measured from radiographs.…”

Section: Morphologymentioning

confidence: 99%

The internal mechanical properties of cervical intervertebral discs as revealed by stress profilometry

et al. 2007

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Extensive anatomical differences suggest that cervical and lumbar discs may have functional differences also. We investigated human cervical discs using ''stress profilometry''. Forty-six cadaveric cervical motion segments aged 48-90 years were subjected to a compressive load of 200 N for 20 s, while compressive 'stress' was recorded along the posterior-anterior midline of the disc using a pressure transducer, side-mounted in a 0.9 mm diameter needle. Stress profiles were repeated with the transducer orientated horizontally and vertically, and with the specimen in neutral, flexed and extended postures. Profiles were repeated again following creep loading (150 N, 2 h) which simulated diurnal water loss in vivo. Stress profiles were reproducible, and measured ''stress'' at each location was proportional to applied load. Stress profiles usually showed a hydrostatic nucleus with regions of higher compressive stress concentrated anteriorly in flexion, and posteriorly in extension. Stress concentrations increased in degenerated discs and following creep. Some features were unique to cervical discs: many showed a stress gradient across their central regions, even though vertical and horizontal stresses were equal to each other, and stress concentrations in the posterior annulus were generally small. Central regions of many cervical discs show the characteristics of a ''tethered fluid'' which can equalise stress over small distances, but not large. This may be attributable to their fibrous texture. The small radial diameter of the cervical posterior annulus may facilitate buckling and thereby prevent it from sustaining high compressive stresses.

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“…21,[31][32][33][34][35] It is worth noting the use of the same parameters for degeneration -the presence of osteophytes, the loss of disc height, and subchondral sclerosis -qualified in such a way as to be used for the composition of grading schemes regarding the severity of the clinical profile presented by the patient. (Table 3) Pathria et al 36 developed a grading system based on degenerative facet changes identified in oblique radiographs and CT. Weishaupt et al 37 correlated changes in CT with those found in MRI, using the parameters of facet joint space, articular hypertrophy, and the presence of osteophytes to define their grades.…”

Section: Resultsmentioning

confidence: 99%

“…Kettler et al 35 proposed a new grading system for cervical degeneration, similar to the one developed for the lumbar spine by Wilke et al 21 They evaluated the loss of disc height and the presence of osteophytes and subchondral sclerosis, and they compared the radiographic scores with the structural changes found macroscopically after dissecting the pieces. The value of the Kappa coefficient found was 0.688.…”

Section: Discussionmentioning

confidence: 99%

Clinical-Radiographic Correlation of Degenerative Changes of the Spine - Systematic Review

Vialle

Simões

et al. 2016

Coluna/Columna

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Systematic review of the literature on the evaluation of images of degenerative changes of the spine and its clinical correlation. A systematic literature review was conducted, and the results evaluated for the presence of clinical correlation, as well as the type of imaging method used. The search terms were "Intervertebral Disc Degeneration", "Intervertebral disc", "Classification", "Anulus fibrosus", "Nucleus pulposus", "Lumbar spine", "Degenerative disc disease", "Degeneration", "Zygapophyseal Joint". We also assessed whether there were inter-and intraobserver agreement in the selected works and possible guidelines regarding the treatment and prognosis of patients. Of the 91 reviewed abstracts, 31 articles were selected that met the inclusion criteria. Six articles were related to the cervical spine, 13 to the lumbar spine and 12 were about changes not related specifically to a single segment of the spine. Articles that determined limiting values considered normal were also included, since variations were considered signs of degeneration or pathology. It was not possible to establish the relationship between the changes identified in imaging and the clinical history of patients, either define treatment and prognosis guidelines.Keywords: Intervertebral disc degeneration; Intervertebral disc; Classification; Spine; Zygapophyseal joint. RESUMO

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Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part II. Cervical spine

Abstract: A new radiographic grading system for a more objective assessment of lumbar intervertebral disc degeneration has been described and tested in Part I of this study.

Cited by 86 publications

References 37 publications

Matrix Metalloproteinase‐3 and Vitamin D Receptor Genetic Polymorphisms, and Their Interactions with Occupational Exposure in Lumbar Disc Degeneration

Matrix Metalloproteinase‐3 and Vitamin D Receptor Genetic Polymorphisms, and Their Interactions with Occupational Exposure in Lumbar Disc Degeneration

The internal mechanical properties of cervical intervertebral discs as revealed by stress profilometry

Clinical-Radiographic Correlation of Degenerative Changes of the Spine - Systematic Review

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