Mimics and Pitfalls of Imaging Assessment

Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder that predominantly involves the axial skeleton. Imaging findings of axSpA can be divided into active changes, which include bone marrow edema, synovitis, enthesitis, capsulitis, and intra-articular effusion, and structural changes, which include erosions, sclerosis, bone fatty infiltration, fat deposition in an erosion cavity, and bone bridging or ankylosis. The ability to distinguish between imaging lesions suggestive of axSpA and artifacts or lesions suggestive of other disorders is critical for the accurate diagnosis of axSpA. Diagnosis may be challenging, particularly in early-stage disease and magnetic resonance imaging (MRI) plays a key role in the detection of subtle or inflammatory changes. MRI also allows the detection of structural changes in the subchondral bone marrow that are not visible on conventional radiography and is of prognostic and monitoring value. However, bone structural changes are more accurately depicted using computed tomography. Conventional radiography, on the other hand, has limitations, but it is easily accessible and may provide insight on gross changes as well as rule out other pathological features of the axial skeleton. This review outlines the imaging evaluation of axSpA with a focus on imaging mimics and potential pitfalls when assessing the axial skeleton.publishersversionpublishe

An initial evaluation of the relationship between human pelvic size and shape and the distribution, type and severity of vertebral degenerative disease in archaeological material

Keyývords bipedal adaptation;pelvic shape; pelvic dimensions;vertebral degenerative disease. In order to adopt an efficient bipedal postureand method of locomotion, tile human skeleton has evolved a curved vertebral column and a stable, compact male pelvic girdle. Adaptive vertebral curves and the force of gravity render it susceptible to injury and degenerative change. This study examines if there is any association between pelvic size and shape and the distribution, type and severity of vertebral degenerative disease. Four documented North- west European, middle-class skeletal samples from the eighteenth and nineteenth century were examined. Pelvic shape and size were recorded, the latter of which necessitated the measurementof 93 dimensions. The severity and distribution of osteophytes, porosity and eburnation in the vertebral column were recorded. Statistical analysis was undertaken of relationships between pelvic measurements and tile sex and age at death of individuals as well as correlations between the measurements themselves. The relationship between pelvic shape and degenerative disease was also investigated. The correlation between measurements in the pelvis and disease were examined and a mechanism was created to display this relationship. Results demonstrated that this sample exhibited significant din-iorphic differcrices in pelvic measurements and pelvic shape between the sexes. Significant correlations were found between age and pelvic dirriensions in five (331/o)sacral, 29 (94%) innominate and four (25%) reconstructed pelvis measurements. Correlations were small but positive for both sexes in the sacrum and innorninate. In the reconstructed pelvis, significant correlations were again small, but Positive in females and negative in males, suggesting that although a larger pelvis may be selected for in older females, the opposite is occurring with males. This supports the theory of an evolutionary effect selecting for females with larger pelves and males with more compact pelves. Statistical analyses of tile relationship between pelvic shape and the severity or presence/absence of degenerative disease were limited and not deemed to have any statistical ment. A 'signpost' configuration was created to graphically display results of correlations between individual measurements and disease. Results suggest that osteophytosis was the most common type of disease encountered and the superior and inferior body surfaces were the main areas affected, particularly in the lower half of the thoracic and lumbar regions. All, correlations, except one, were positive, implying a positive association between those measurements and the degree of degenerative change. Patterning of the correlations was identified and discussed and statistical differences between correlations at levels of maximum and minimum curvature were examined. Results suggest that particular pelvimetry plays a significant role in this at levels of maximum and minimuni curvature. Discriminant function analysis was employed to explore the predictive ability of combinations of measurements to predispose to the development and severity of osteophytosis on the superior vertebral body surface. Contrived data was then used to test this model and was successful in predicting an expected level of expression of pathological change

Low Back Pain Pathogenesis and Treatment

Low back pain is a common disorder which affects the lumbar spine, and is associated with substantial morbidity for about 80% of the general population at some stages during their lives. Although low back pain usually is a self-limiting disorder that improves spontaneously over time, the etiology of low back pain is generally unknown and the diagnostic label, "non-specific low back pain", is frequently given. This book contains reviews and original articles with emphasis on pathogenesis and treatment of low back pain except for the rehabilitative aspect. Consisting of three sections, the first section of the book has a focus on pathogenesis of low back pain, while the second and third sections are on the treatment including conservative and surgical procedure, respectively

An initial evaluation of the relationship between human pelvic size and shape and the distribution, type and severity of vertebral degenerative disease in archaeological material

In order to adopt an efficient bipedal posture and method of locomotion, the human skeleton has evolved a curved vertebral column and a stable, compact male pelvic girdle. Adaptive vertebral curves and the force of gravity render it susceptible to injury and degenerative change. This study examines if there is any association between pelvic size and shape and the distribution, type and severity of vertebral degenerative disease. Four documented North- west European, middle-class skeletal samples from the eighteenth and nineteenth century were examined. Pelvic shape and size were recorded, the latter of which necessitated the measurementof 93 dimensions. The severity and distribution of osteophytes, porosity and eburnation in the vertebral column were recorded. Statistical analysis was undertaken of relationships between pelvic measurements and tile sex and age at death of individuals as well as correlations between the measurements themselves. The relationship between pelvic shape and degenerative disease was also investigated. The correlation between measurements in the pelvis and disease were examined and a mechanism was created to display this relationship. Results demonstrated that this sample exhibited significant din-iorphic differcrices in pelvic measurements and pelvic shape between the sexes. Significant correlations were found between age and pelvic dirriensions in five (331/o)sacral, 29 (94%) innominate and four (25%) reconstructed pelvis measurements. Correlations were small but positive for both sexes in the sacrum and innorninate. In the reconstructed pelvis, significant correlations were again small, but Positive in females and negative in males, suggesting that although a larger pelvis may be selected for in older females, the opposite is occurring with males. This supports the theory of an evolutionary effect selecting for females with larger pelves and males with more compact pelves. Statistical analyses of tile relationship between pelvic shape and the severity or presence/absence of degenerative disease were limited and not deemed to have any statistical ment. A 'signpost' configuration was created to graphically display results of correlations between individual measurements and disease. Results suggest that osteophytosis was the most common type of disease encountered and the superior and inferior body surfaces were the main areas affected, particularly in the lower half of the thoracic and lumbar regions. All, correlations, except one, were positive, implying a positive association between those measurements and the degree of degenerative change. Patterning of the correlations was identified and discussed and statistical differences between correlations at levels of maximum and minimum curvature were examined. Results suggest that particular pelvimetry plays a significant role in this at levels of maximum and minimuni curvature. Discriminant function analysis was employed to explore the predictive ability of combinations of measurements to predispose to the development and severity of osteophytosis on the superior vertebral body surface. Contrived data was then used to test this model and was successful in predicting an expected level of expression of pathological change.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

DEVELOPMENT, VALIDATION, AND APPLICATION OF A NONINVASIVE SPINAL MOTION MEASUREMENT SYSTEM

Spontaneous vertebral fractures are a large and growing health care problem. Biomechanical factors, specifically, abnormal posture or gait‐related spinal motion may interact with age‐weakened bone to induce altered spinal biomechanics that in turn increase the likelihood of vertebral body fracture. This research takes steps towards the goal of reducing the number of vertebral fractures in two phases: 1) Validation of a noninvasive spinal motion measurement system in cadaver torsos and 2) Application of the measurement system in human subjects. The cadaver study compared vertebral motion at 4 levels (T7,T12,L3,L5) as measured by adhesive skin markers versus motion measured by bone pins implanted into the vertebrae. Cadaver torsos were tested in lateral‐bending, flexion and axialrotation. Mean differences in vertebral body angular motion between skin markers and bone pin markers were \u3c0.5° around the anterior‐posterior and medial‐lateral axes and \u3c0.9° around the superior‐inferior axis. This measurement method was able to accurately quantify vertebral body motion in cadaver torsos thus allowing for application to human subject testing. X‐rays and 3D motion capture were employed to quantify spinal posture and motion parameters during gait in 12 older and 12 younger normal, females. Vertebral motion around 3 axes was measured at 4 levels (T7,T10,T12,L2) using noninvasive retroreflective markers during treadmill gait at 3 speeds (0.5,0.7,0.9m/s). The average angular motion of all gait cycles at each speed was determined for each level. The triplanar ranges of motion and variability of motion were compared as a function of age. Older subjects had 31.7% larger frontal Cobb angles and up to 30.9% and 33.5% smaller ranges of spinal motion in the frontal and sagittal planes. Variability of motion in the sagittal plane was up to 42.9% less in older subjects. Decreased ranges of motion and variability of spinal motion observed in older subjects may imply that vertebral loading in these subjects may not be as uniformly distributed across the vertebrae as in younger subjects. Greater stresses may result from the abnormal motion, thus increasing fracture risk. Confirmation of this hypothesis requires a longitudinal study, but if verified, may lead to the development of inexpensive countermeasures to prevent fractures