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Nature Reviews. Rheumatology Apr 2013Osteoarthritis (OA) of the spine involves the facet joints, which are located in the posterior aspect of the vertebral column and, in humans, are the only true synovial... (Review)
Review
Osteoarthritis (OA) of the spine involves the facet joints, which are located in the posterior aspect of the vertebral column and, in humans, are the only true synovial joints between adjacent spinal levels. Facet joint osteoarthritis (FJ OA) is widely prevalent in older adults, and is thought to be a common cause of back and neck pain. The prevalence of facet-mediated pain in clinical populations increases with increasing age, suggesting that FJ OA might have a particularly important role in older adults with spinal pain. Nevertheless, to date FJ OA has received far less study than other important OA phenotypes such as knee OA, and other features of spine pathoanatomy such as degenerative disc disease. This Review presents the current state of knowledge of FJ OA, including relevant anatomy, biomechanics, epidemiology, and clinical manifestations. We present the view that the modern concept of FJ OA is consonant with the concept of OA as a failure of the whole joint, and not simply of facet joint cartilage.
Topics: Aged; Aged, 80 and over; Back Pain; Biomechanical Phenomena; Cervical Vertebrae; Diagnostic Imaging; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Neck Pain; Osteoarthritis; Pain Measurement; Prevalence; Prognosis; Risk Assessment; Severity of Illness Index; Spinal Diseases; Treatment Outcome; Zygapophyseal Joint
PubMed: 23147891
DOI: 10.1038/nrrheum.2012.199 -
Acta Neurochirurgica Mar 2018Spinal infection (SI) is defined as an infectious disease affecting the vertebral body, the intervertebral disc, and/or adjacent paraspinal tissue and represents 2-7% of... (Review)
Review
Spinal infection (SI) is defined as an infectious disease affecting the vertebral body, the intervertebral disc, and/or adjacent paraspinal tissue and represents 2-7% of all musculoskeletal infections. There are numerous factors, which may facilitate the development of SI including not only advanced patient age and comorbidities but also spinal surgery. Due to the low specificity of signs, the delay in diagnosis of SI remains an important issue and poor outcome is frequently seen. Diagnosis should always be supported by clinical, laboratory, and imaging findings, magnetic resonance imaging (MRI) remaining the most reliable method. Management of SI depends on the location of the infection (i.e., intraspinal, intervertebral, paraspinal), on the disease progression, and of course on the patient's general condition, considering age and comorbidities. Conservative treatment mostly is reasonable in early stages with no or minor neurologic deficits and in case of severe comorbidities, which limit surgical options. Nevertheless, solely medical treatment often fails. Therefore, in case of doubt, surgical treatment should be considered. The final result in conservative as well as in surgical treatment always is bony fusion. Furthermore, both options require a concomitant antimicrobial therapy, initially applied intravenously and administered orally thereafter. The optimal duration of antibiotic therapy remains controversial, but should never undercut 6 weeks. Due to a heterogeneous and often comorbid patient population and the wide variety of treatment options, no generally applicable guidelines for SI exist and management remains a challenge. Thus, future prospective randomized trials are necessary to substantiate treatment strategies.
Topics: Anti-Bacterial Agents; Central Nervous System Infections; Humans; Magnetic Resonance Imaging; Spinal Diseases
PubMed: 29356895
DOI: 10.1007/s00701-018-3467-2 -
International Journal of Molecular... Apr 2023Spinal diseases are commonly associated with pain and neurological symptoms, which negatively impact patients' quality of life. Platelet-rich plasma (PRP) is an... (Review)
Review
Spinal diseases are commonly associated with pain and neurological symptoms, which negatively impact patients' quality of life. Platelet-rich plasma (PRP) is an autologous source of multiple growth factors and cytokines, with the potential to promote tissue regeneration. Recently, PRP has been widely used for the treatment of musculoskeletal diseases, including spinal diseases, in clinics. Given the increasing popularity of PRP therapy, this article examines the current literature for basic research and emerging clinical applications of this therapy for treating spinal diseases. First, we review in vitro and in vivo studies, evaluating the potential of PRP in repairing intervertebral disc degeneration, promoting bone union in spinal fusion surgeries, and aiding in neurological recovery from spinal cord injury. Second, we address the clinical applications of PRP in treating degenerative spinal disease, including its analgesic effect on low back pain and radicular pain, as well as accelerating bone union during spinal fusion surgery. Basic research demonstrates the promising regenerative potential of PRP, and clinical studies have reported on the safety and efficacy of PRP therapy for treating several spinal diseases. Nevertheless, further high-quality randomized controlled trials would be required to establish clinical evidence of PRP therapy.
Topics: Humans; Quality of Life; Intervertebral Disc Degeneration; Low Back Pain; Platelet-Rich Plasma; Intercellular Signaling Peptides and Proteins
PubMed: 37108837
DOI: 10.3390/ijms24087677 -
Frontiers in Neural Circuits 2019
Topics: Animals; Health Status; Humans; Locomotion; Neurotransmitter Agents; Pyramidal Tracts; Spinal Cord; Spinal Cord Injuries; Spinal Diseases
PubMed: 32038179
DOI: 10.3389/fncir.2019.00084 -
Journal of Orthopaedic Science :... Jan 2018The number of spinal infections has been increasing due to aging populations and larger numbers of immunocompromised hosts and intravenous drug users. Magnetic resonance... (Review)
Review
The number of spinal infections has been increasing due to aging populations and larger numbers of immunocompromised hosts and intravenous drug users. Magnetic resonance imaging is a useful tool for the early diagnosis of spinal infections, and can yield positive findings just 3-5 days after disease onset. Before antibiotic administration, cultures must be initiated from blood and from specimens collected from the locus of infection. Based on the pathogens identified by culture, appropriate antibiotics should be selected with careful consideration of antimicrobial susceptibility and spinal tissue penetration. Antibiotic treatment of spinal infections should be continued for longer than for most other types of infections, although the optimal duration remains unknown. The indications for surgical treatment include progressive neurologic deficits, progressive deformity, spinal instability, persistent or recurrent infection, and unbearable pain. In most patients with spinal infection, the gold standard surgical treatment is anterior radical debridement followed by autologous strut bone grafting. The addition of posterior instrumentation has recently become popular. This procedure may be performed alone as an alternative surgical option in patients in poor condition, and if it dramatically reduces pain, subsequent observation may be reasonable. If progressive deformity is observed or pain relief is inadequate after posterior instrumentation, additional anterior debridement and bone grafting should be scheduled.
Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Female; Humans; Magnetic Resonance Imaging; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium tuberculosis; Prognosis; Risk Assessment; Severity of Illness Index; Spinal Diseases; Spinal Fusion; Staphylococcus aureus; Treatment Outcome; Young Adult
PubMed: 29066036
DOI: 10.1016/j.jos.2017.09.016 -
Child's Nervous System : ChNS :... Mar 2023Hydatid disease of the central nervous system is relatively rare and comprises about 2-3% of all the hydatid cyst cases reported in the world. Spinal hydatid disease... (Review)
Review
Hydatid disease of the central nervous system is relatively rare and comprises about 2-3% of all the hydatid cyst cases reported in the world. Spinal hydatid disease is an even rarer entity. It is endemic in sheep and cattle-raising regions, seen mainly in Mediterranean countries including Turkey and Syria. Pediatric neurosurgeons in non-endemic countries face a challenge when they encounter children with hydatid cysts of the central nervous system, mostly due to lack of awareness and the ensuing diagnostic dilemmas. It is also a significant socioeconomic problem in developing countries, due to improper hygiene and lack of dedicated veterinary practice. The clinical features are largely nonspecific and very according to location and severity of disease. However, with the advent of advances in MR imaging, the diagnostic accuracy of hydatic disease involving the brain and spine has increased. Intact removal of the cyst/s, without causing any spillage, and appropriate antihelminthic therapy is the goal and key to cure and prevention of recurrence. In this manuscript, the current literature on hydatid cyst of the brain and spine is reviewed to better understand the epidemiology, pathophysiology, diagnostic accuracy, and advances in therapeutic options. A heightened clinical suspicion, awareness of MR imaging features, improved surgical strategies, and options for prevention are discussed.
Topics: Animals; Sheep; Cattle; Echinococcosis; Brain; Spine; Magnetic Resonance Imaging; Spinal Diseases
PubMed: 36443475
DOI: 10.1007/s00381-022-05770-7 -
Medicine Dec 2022Interpretation of the morphology and characteristics of soft tissues, such as paravertebral muscles and fat, has always been a "relative blind spot" in the spine. The... (Review)
Review
Interpretation of the morphology and characteristics of soft tissues, such as paravertebral muscles and fat, has always been a "relative blind spot" in the spine. The imaging features of the non-bony structures of the spine have been studied and reinterpreted, and changes in the non-bony structure are associated with spinal disease. Soft tissue parameters such as, the "paraspinal muscle cross-sectional area," "subcutaneous fat thickness," and the "paraspinal muscle fat infiltration rate" on computed tomography, magnetic resonance imaging and other imaging techniques are reproducible in the diagnosis, treatment and prognosis of spinal disorders and have the potential for clinical application. In addition, focus on the association between sarcopenia and spinal epidural lipomatosis with spinal disorders is increasing. Currently, there is no summary of studies on fat and muscle in the spinal region. Given this, within the context of recent research trends, this article provides a synthesis of research on adipose and muscle tissue in the spine, discusses advances in the study of the imaging manifestations of these structures in spinal disorders, and expands the perspectives.
Topics: Humans; Lumbar Vertebrae; Spinal Diseases; Sarcopenia; Magnetic Resonance Imaging; Muscles; Adipose Tissue; Paraspinal Muscles
PubMed: 36626484
DOI: 10.1097/MD.0000000000032051 -
Molecular Genetics and Metabolism Aug 2016The mucopolysaccharidoses (MPS) are a family of lysosomal storage disorders characterized by deficient activity of enzymes that degrade glycosaminoglycans (GAGs).... (Review)
Review
The mucopolysaccharidoses (MPS) are a family of lysosomal storage disorders characterized by deficient activity of enzymes that degrade glycosaminoglycans (GAGs). Skeletal disease is common in MPS patients, with the severity varying both within and between subtypes. Within the spectrum of skeletal disease, spinal manifestations are particularly prevalent. Developmental and degenerative abnormalities affecting the substructures of the spine can result in compression of the spinal cord and associated neural elements. Resulting neurological complications, including pain and paralysis, significantly reduce patient quality of life and life expectancy. Systemic therapies for MPS, such as hematopoietic stem cell transplantation and enzyme replacement therapy, have shown limited efficacy for improving spinal manifestations in patients and animal models. Therefore, there is a pressing need for new therapeutic approaches that specifically target this debilitating aspect of the disease. In this review, we examine how pathological abnormalities affecting the key substructures of the spine - the discs, vertebrae, odontoid process and dura - contribute to the progression of spinal deformity and symptomatic compression of neural elements. Specifically, we review current understanding of the underlying pathophysiology of spine disease in MPS, how the tissues of the spine respond to current clinical and experimental treatments, and discuss future strategies for improving the efficacy of these treatments.
Topics: Enzyme Replacement Therapy; Glycosaminoglycans; Humans; Mucopolysaccharidoses; Quality of Life; Spinal Diseases; Spine
PubMed: 27296532
DOI: 10.1016/j.ymgme.2016.06.002 -
International Journal of Molecular... Aug 2018In this era of aging societies, the number of elderly individuals who undergo spinal arthrodesis for various degenerative diseases is increasing. Poor bone quality and... (Review)
Review
In this era of aging societies, the number of elderly individuals who undergo spinal arthrodesis for various degenerative diseases is increasing. Poor bone quality and osteogenic ability in older patients, due to osteoporosis, often interfere with achieving bone fusion after spinal arthrodesis. Enhancement of bone fusion requires shifting bone homeostasis toward increased bone formation and reduced resorption. Several biological enhancement strategies of bone formation have been conducted in animal models of spinal arthrodesis and human clinical trials. Pharmacological agents for osteoporosis have also been shown to be effective in enhancing bone fusion. Cytokines, which activate bone formation, such as bone morphogenetic proteins, have already been clinically used to enhance bone fusion for spinal arthrodesis. Recently, stem cells have attracted considerable attention as a cell source of osteoblasts, promising effects in enhancing bone fusion. Drug delivery systems will also need to be further developed to assure the safe delivery of bone-enhancing agents to the site of spinal arthrodesis. Our aim in this review is to appraise the current state of knowledge and evidence regarding bone enhancement strategies for spinal fusion for degenerative spinal disorders, and to identify future directions for biological bone enhancement strategies, including pharmacological, cell and gene therapy approaches.
Topics: Animals; Antibodies, Monoclonal; Bone Density Conservation Agents; Diphosphonates; Drug Delivery Systems; Genetic Therapy; Humans; Prostaglandins; Spinal Diseases; Spinal Fusion; Spine; Stem Cell Transplantation
PubMed: 30126106
DOI: 10.3390/ijms19082430 -
Magnetic Resonance Imaging Clinics of... Aug 2022This article is devoted to the MR imaging evaluation of spine emergencies, defined as spinal pathologic conditions that pose an immediate risk of significant morbidity... (Review)
Review
This article is devoted to the MR imaging evaluation of spine emergencies, defined as spinal pathologic conditions that pose an immediate risk of significant morbidity or mortality to the patient if not diagnosed and treated in a timely manner. MR imaging plays a central role in the timely diagnosis of spine emergencies. A summary of MR imaging indications and MR imaging protocols tailored for a variety of spinal emergencies will be presented followed by a review of key imaging findings for the most-encountered emergent spine pathologic conditions. Pathologic conditions will be broadly grouped into traumatic and atraumatic pathologic conditions. For traumatic injuries, a practical and algorithmic diagnostic approach based on the AO Spine injury classification system will be presented focused on subaxial spine trauma. Atraumatic spinal emergencies will be dichotomized into compressive and noncompressive subtypes. The location of external compressive disease with respect to the thecal sac is fundamental to establishing a differential diagnosis for compressive emergencies, whereas specific patterns of spinal cord involvement on MR imaging will guide the discussion of inflammatory and noninflammatory causes of noncompressive myelopathy.
Topics: Emergencies; Humans; Magnetic Resonance Imaging; Spinal Diseases; Spinal Injuries; Spine
PubMed: 35995469
DOI: 10.1016/j.mric.2022.04.004