Clinical Relationship of Degenerative Changes between the Cervical and Lumbar Spine

Yuichiro Morishita,Zorica Buser,Anthony D’Oro,Keiichiro Shiba,Jeffrey C. Wang 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.2

Study Design: Retrospective, observational, case series. Purpose: To elucidate the prevalence of degenerative changes in the cervical and lumbar spine and estimate the degenerative changes in the cervical spine based on the degeneration of lumbar disc through a retrospective review of magnetic resonance (MR) images. Overview of Literature: Over 50% of middle-aged adults show evidence of spinal degeneration. However, the relationship between degenerative changes in the cervical and lumbar spine has yet to be elucidated. Methods: A retrospective review of positional MR images of 152 patients with symptoms related to cervical and lumbar spondylosis with or without a neurogenic component was conducted. The degree of intervertebral disc degeneration (IDD) was assessed on a grade of 1–5 for each segment of the cervical and lumbar spine using MR T2-weighted sagittal images. The grades across all segments were summed to produce the degenerative disc score (DDS) for the cervical and lumbar spine. The patients were divided into two groups based on the IDD grade for each lumbar segment: normal (grades 1 and 2) and degenerative (grades 3–5). Results: DDSs for the cervical and lumbar spine were positively correlated. Significant differences in cervical DDSs between the groups were observed in all lumbar segments. Although there were no significant differences in cervical DDSs among the degenerative lumbar segment, cervical DDSs at the L1–2 and L2–3 segments tended to be higher than those at the L3–4, L4–5, and L5–S degenerative segments. Conclusions: Our study shows that participants with degenerative changes in the upper lumbar segments are more likely to have a certain amount of cervical spondylosis. This information could be used to lower the incidence of a missed diagnosis of cervical spine disorders in patients presenting with lumbar spine symptomology.

스마트폰 사용시간이 목뼈 및 허리뼈의 굽힘각도와 목뼈의 재현오차에 미치는 영향

김양곤(Yang-gon Kim),강민혁(Min-hyeok Kang),김지원(Ji-won Kim),장준혁(Jun-hyeok Jang),오재섭(Jae-seop Oh) 한국전문물리치료학회 2013 한국전문물리치료학회지 Vol.20 No.1

The purpose of this study was to assess the influence of the duration of smartphone usage on cervical and lumbar spine flexion angles and reposition error in the cervical spine. The study included 18 healthy smartphone users (7 males and 11 females). We measured the kinematics of the upper and lower cervical and lumbar spine flexion angles and the reposition error of the upper and lower cervical spine after 3 s and 300 s smartphone use in sitting. A paired t-test was used to compare the effects of the duration of smartphone usage on the kinematics of cervical and lumbar spine flexion angles and reposition error. The flexion angles of the lower cervical and lumbar spine and the reposition error in the upper and lower cervical spine were significantly increased after 300 s smartphone of use (p<.05). However, the flexion angle of the upper cervical spine was not significantly different between the 3 s and 300 s smartphone of use (p>.05). These findings suggest that prolonged use of smartphones can induce changes in cervical and lumbar spine posture and proprioception in the cervical spine.

Effects of Resistance Footrest on Spine Posture in Visual Display Terminal Workers

Won-gyu Yoo 한국전문물리치료학회 2021 한국전문물리치료학회지 Vol.28 No.2

Background: Flat-back posture refers to a posture in which the pelvis is tilted backward, the lumbar spine is bent, the upper thoracic spine is increasingly bent, and the lower thoracic spine is straight. Given that most of the day is spent sitting, we need to develop exercise programs and devices that are suitable for people who spend less time exercising than sitting.Objects: This study investigated the effects of resistance footrest exercise on spine posture angles in visual display terminal (VDT) workers with flat back.Methods: We measured the upper lumbar angle (ULA) and lower lumbar angle (LLA) using a flexible ruler for the ULA and LLA. Then, after 1 week of resistance footrest exercise designed to strengthen the lumbar spine musculature, we measured these angles again. We measured each angle three times and then compared measurements from before and after exercise.Results: There were no significant differences in the ULA following the strengthening exer-cise, but significant differences were observed in LLA.Conclusion: The resistance footrest exercise strengthened the muscles affecting the pelvic and lumbar lordotic angles, and increases in the LLA were changed. This suggests that the role of the lower lumbar spine in the lumbar lordotic curve is greater than that of the upper lumbar spine. In addition, considering the contemporary tendency to lead fairly sedentary lives, these results indicate that exercising while seated can be effective.

송아지와 사람의 요추 모델의 생역학적 비교

손홍문,유재원,임만택 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

Background and Objectives: Calf spines are commonly used in biomechanical research as a substitute for human cadaveric spines. Despite widespread use, the validity of this model has not been thoroughly investigated. The purpose of this study was to perform biomechanical flexibility tests using identical methods and instrumentation on calf and cadaveric lumbar spines to determine whether significant differences exist between the results from the two models. Materials and Methods: Five fresh calf spines and five cadaver lumbar spines (L2-L5) were used for flexibility testing. The L2 and L5 vertebrae were used to attach the loading and base frames, respectively. Three reflective markers were attached to L3 and L4. Specimens underwent nondestructive biomechanical testing using the VICON 3-D motion analysis system. Maximum moments of 6.4 Nm were achieved in five increments of 1.6 Nm. The rotations of L3 with respect to L4 were measured to determine the stability of the specimens in five cases : 1) intact ; 2) partial discectomy, including partial laminectomy and partial facetomy ; 3) partial discectomy with ISOLA pedicle screw instrumentation ; 4) total discectorny with instrumentation and 5) instrumentation with inter body graft. Rotational angles were normalized to the intact case to determine the overall stabilizing effects. Data were analyzed using ANoVA to determine if significant differences existed. Results: In both models an increase in motion was observed after the partial discectorny, instrumentation reduced motion beyond the intact, and the total discectomy increased motion in all cases. Placement of the inter body graft decreased motion in axial rotation, flexion, and extension, but increased motion in lateral bending. A two-way ANoVA showed no significant differences between the two models during flexion and extension (p)O. 05) however, differences were noted during axial rotation and lateral bending (p<0.05). In all loading cases there were differences between the various testing cases (p<.05). Conclusion: This study demonstrated that calf lumbar spines can serve as a substitute for human cadaveric spines in biomechanical testing. Motion trends were similar for the two models in flexion and extension ; however, significant differences were found in axial rotation and lateral bending. These results suggest that the calf lumber spine can be a good model for in vitro biomechanical evalution of spinal instrumentation. The extrapolation of calf spine data to the in vivo case, especially during axial ratation and lateral bending, should carefully consider the variations between the two models.

퇴행성 요추부 질환의 병태생리

유재원,손홍문 朝鮮大學校 附設 醫學硏究所 2003 The Medical Journal of Chosun University Vol.28 No.2

Age-related changes in the lumbar spine manifest as a pathologic, symptomatic disease process in some patients. As the population ages and symptomatic spine diseases are becoming- ubiquitous, much more concern has been concentrated on the cause of spine degeneration. Many asymptomatic population shows spine degeneration on MRI study. So, the degeneration itself is not the only pain generator. The spectrum of changes seen in the normal aging spine anatomically, biochemically, biomechanically, and radiographically may also occur, to an exaggerated extent in the pathologically degenerated spine. But the precise cause and sequence of spine degeneration in the spine remain unknown. The degenerative changes of spine causes many symptomatic diseases such as disc hei-niation, spinal stenosis, internal disc disruption, and degenerative scoliosis. Clinical manifestations of these diseases are low back pain, radiating pain and referred pain. The degenerative changes that occur in the various components of the spine are reviewed here along with various mechanisms that might cause these changes.

Radiological Assessment of Morphological Changes of Lumbar Spine: From First to 9th Decade of Life

문명상,Moon Paul S.,Kim Chae-Yeon 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.5

Study Design: Analysis of lumbar spine radiograms of 1,496 Jeju islanders of Korea.Purpose: To look into the age- and gender-matched incidences of morphological changes and their severities.Overview of Literature: There have been several prior research on the prevalence and severity of age-related diseases, both related and unrelated. Those offer some fundamental clinical data for clinicians.Methods: Radiograms of 1,496 patients (555 males and 941 females) from the first to 9th decade were examined for this study. Sagittal and coronal alignment, disc space narrowing, spur formation including diffuse idiopathic spinal hyperostosis (DISH), spondylolisthesis, and ballooned discs associated with biconcave bodies due to osteoporosis were among the parameters of lumbar spine morphologies examined on high-quality radiographs by both human observers and computers.Results: The alignment of the lumbar spine altered after birth and set at growth maturity, and then the curve was maintained till the end of the 5th decade afterward and the curve gradually hypolordotic. There were three types of coronal alignment abnormalities can be seen: idiopathic, osteopathic, and discogenic (degenerative lumbar scoliosis [DLS]). DLS developed after 6th decade. There was no scoliosis associated with spondylolysis or the post-laminofacetectomy period. Disc space narrowing and corporal spur formation were not seen till the end of 3rd decade comparatively speaking, the corporal spurs generated in the non-scoliotic spine were smaller than those in the scoliotic spine. DISH began to appear in the 5th-decade patients and its incidences increased gradually afterward. Porosis-related vertebral body collapse started to happen after 6th decade. There are three different types of spondylolisthesis: anterior, posterior, and lateral. The lateral slip occurred only in the scoliotic spine. All types were related to degenerative discs.Conclusions: It has been shown that the morphology of the lumbar spine changes throughout time.

A musculoskeletal lumbar and thoracic model for calculation of joint kinetics in the spine

Yongcheol Kim,Ducmanh Ta,Moonki Jung,Seungbum Koo 대한기계학회 2016 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.30 No.6

The objective of this study was to develop a musculoskeletal spine model that allows relative movements in the thoracic spine for calculation of intra-discal forces in the lumbar and thoracic spine. The thoracic part of the spine model was composed of vertebrae and ribs connected with mechanical joints similar to anatomical joints. Three different muscle groups around the thoracic spine were inserted, along with eight muscle groups around the lumbar spine in the original model from AnyBody. The model was tested using joint kinematics data obtained from two normal subjects during spine flexion and extension, axial rotation and lateral bending motions beginning from a standing posture. Intra-discal forces between spine segments were calculated in a musculoskeletal simulation. The force at the L4-L5 joint was chosen to validate the model’s prediction against the lumbar model in the original AnyBody model, which was previously validated against clinical data.

척추의 중심점과 Modified U-Net을 활용한 딥러닝 기반 척추 자동 분할

임성주,김휘영 대한의용생체공학회 2023 의공학회지 Vol.44 No.2

Osteoporosis is a disease in which the risk of bone fractures increases due to a decrease in bone density caused by aging. Osteoporosis is diagnosed by measuring bone density in the total hip, femoral neck, and lumbar spine. To accurately measure bone density in the lumbar spine, the vertebral region must be segmented from the lumbar X-ray image. Deep learning-based automatic spinal segmentation methods can provide fast and precise infor- mation about the vertebral region. In this study, we used 695 lumbar spine images as training and test datasets for a deep learning segmentation model. We proposed a lumbar automatic segmentation model, CM-Net, which combines the center point of the spine and the modified U-Net network. As a result, the average Dice Similarity Coeffi- cient(DSC) was 0.974, precision was 0.916, recall was 0.906, accuracy was 0.998, and Area under the Precision-Recall Curve (AUPRC) was 0.912. This study demonstrates a high-performance automatic segmentation model for lumbar X-ray images, which overcomes noise such as spinal fractures and implants. Furthermore, we can perform accurate measurement of bone density on lumbar X-ray images using an automatic segmentation methodology for the spine, which can prevent the risk of compression fractures at an early stage and improve the accuracy and efficiency of oste- oporosis diagnosis.

Recent Developments in Finite Element Analysis of the Lumbar Spine

Batbayar Khuyagbaatar,Kyungsoo Kim,Yoon Hyuk Kim 한국정밀공학회 2024 International Journal of Precision Engineering and Vol.25 No.2

Finite element (FE) modeling is widely used to study the biomechanical effect of material properties, surgical procedures, and loading and boundary conditions on the lumbar spine. Since several studies have presented FE analyses of the lumbar spine in relation to spine biomechanics, soft tissue modeling, intervertebral discs, facet joints, load-sharing behaviors of lumbar motion segments, and FE modeling methods, detailed analyses of disc degeneration or muscle force prediction have been little considered. This study focused on recent developments in FE modeling of the lumbar spine, including disc degeneration, muscle force prediction, and clinical applications. Modeling and analysis from the bone to soft tissue and muscle forces, as well as the validation and application of these models were provided and discussed with material properties, element types, loading and boundaries, geometric parameters, and muscle force modeling. Experimental data was summarized for validation of the FE model. Application studies were briefly reviewed, in which the majority of FE models focused on spinal degeneration diseases and surgical instrumentation techniques. Although muscle force prediction and optimization are challenging with FE modeling due to their complexity and redundancy, several studies have predicted muscle activation and spinal forces for injury prevention assessments and treatment strategies. The level of modeling prediction and representation can be improved with subject-specific data, and integration of FE and musculoskeletal models could generate a comprehensive analysis of the lumbar spine in clinical applications.

Sagittal Radiographic Parameters of the Spine in Three Physiological Postures Characterized Using a Slot Scanner and Their Potential Implications on Spinal Weight-Bearing Properties

Hey Hwee Weng Dennis,Ng Nathaniel Li-Wen,Loh Khin Yee Sammy,Tan Yong Hong,Tan Kimberly-Anne,Moorthy Vikaesh,Lau Eugene Tze Chun,Liu Gabriel Ka-Po,Wong Hee-Kit 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.1

Study Design: Prospective radiographic comparative study.Purpose: To compare and understand the load-bearing properties of each functional spinal unit (FSU) using three commonly assumed, physiological, spinal postures, namely, the flexed (slump sitting), erect (standing) and extended (backward bending) postures. Overview of Literature: Sagittal spinal alignment is posture-dependent and influences the load-bearing properties of the spine. The routine placement of intervertebral cages “as anterior as possible” to correct deformity may compromise the load-bearing capabilities of the spine, leading to complications.Methods: We recruited young patients with nonspecific low back pain for <3 months, who were otherwise healthy. Each patient had EOS images taken in the flexed, erect and extended positions, in random order, as well as magnetic resonance imaging to assess for disk degeneration. Angular and disk height measurements were performed and compared in all three postures using paired t-tests. Changes in disk height relative to the erect posture were caclulated to determine the alignment-specific load-bearing area of each FSU.Results: Eighty-three patients (415 lumbar intervertebral disks) were studied. Significant alignment changes were found between all three postures at L1/2, and only between erect and flexion at the other FSUs. Disk height measurements showed that the neutral axis of the spine, marked by zones where disk heights did not change, varied between postures and was level specific. The load-bearing areas were also found to be more anterior in flexion and more posterior in extension, with the erect spine resembling the extended spine to a greater extent.Conclusions: Load-bearing areas of the lumbar spine are sagittal alignment-specific and level-specific. This may imply that, depending on the surgical realignment strategy, attention should be paid not just to placing an intervertebral cage “as anterior as possible” for generating lordosis, but also on optimizing load-bearing in the lumbar spine.