Does lumbar spinal degeneration begin with the anterior structures? A study of the observed epidemiology in a community-based population

<p>Abstract</p> <p>Background-</p> <p>Prior studies that have concluded that disk degeneration uniformly precedes facet degeneration have been based on convenience samples of individuals with low back pain. We conducted a study to examine whether the view that spinal degeneration begins with the anterior spinal structures is supported by epidemiologic observations of degeneration in a community-based population.</p> <p>Methods-</p> <p>361 participants from the Framingham Heart Study were included in this study. The prevalences of anterior vertebral structure degeneration (disk height loss) and posterior vertebral structure degeneration (facet joint osteoarthritis) were characterized by CT imaging. The cohort was divided into the structural subgroups of participants with 1) no degeneration, 2) isolated anterior degeneration (without posterior degeneration), 3) combined anterior and posterior degeneration, and 4) isolated posterior degeneration (without anterior structure degeneration). We determined the prevalence of each degeneration pattern by age group < 45, 45-54, 55-64, ≥65. In multivariate analyses we examined the association between disk height loss and the response variable of facet joint osteoarthritis, while adjusting for age, sex, BMI, and smoking.</p> <p>Results-</p> <p>As the prevalence of the no degeneration and isolated anterior degeneration patterns decreased with increasing age group, the prevalence of the combined anterior/posterior degeneration pattern increased. 22% of individuals demonstrated isolated posterior degeneration, without an increase in prevalence by age group. Isolated posterior degeneration was most common at the L5-S1 and L4-L5 spinal levels. In multivariate analyses, disk height loss was independently associated with facet joint osteoarthritis, as were increased age (years), female sex, and increased BMI (kg/m²), but not smoking.</p> <p>Conclusions-</p> <p>The observed epidemiology of lumbar spinal degeneration in the community-based population is consistent with an ordered progression beginning in the anterior structures, for the majority of individuals. However, some individuals demonstrate atypical patterns of degeneration, beginning in the posterior joints. Increased age and BMI, and female sex may be related to the occurrence of isolated posterior degeneration in these individuals.</p

Characterization of outcomes 1 year after endoscopic thermal vapor ablation for patients with heterogeneous emphysema

Felix JF Herth,1 Armin Ernst,2 Kimberly M Baker,3 Jim J Egan,4 Mark H Gotfried,5 Peter Hopkins,6 Franz Stanzel,7 Arschang Valipour,8 Manfred Wagner,9 Christian Witt,10 Steven Kesten,11 Gregory Snell121Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg, Heidelberg, Germany; 2St Elizabeth&amp;#39;s Medical Center, Boston, MA, USA; 3University of Iowa, Iowa City, IA, USA; 4Advanced Lung Disease Program, Mater Misericordiae University Hospital, Dublin, Ireland; 5Pulmonary Associates, Phoenix, AZ, USA; 6Lung Transplant Unit, Prince Charles Hospital, Chermside, Australia; 7Zentrum f&amp;uuml;r Pneumologie, Hemer, Germany; 8Ludwig-Boltzmann-Institute for COPD, Otto-Wagner-Hospital, Vienna, Austria; 9Klinikum N&amp;uuml;rnberg, N&amp;uuml;rnberg, Germany; 10Pneumology, Charit&amp;eacute; Campus-Mitte, Berlin, Germany; 11Uptake Medical Corp, Tustin, CA, USA; 12Allergy Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, AustraliaIntroduction: Endoscopic lung volume reduction has been developed as a therapeutic option for advanced emphysema. Six-month results following treatment with endoscopic thermal vapor ablation (InterVapor&amp;trade;; Uptake Medical, Tustin, CA) were described previously, and here we report observations from the 12-month assessment.Methods: Two multicenter, international, single-arm trials of InterVapor (unilateral upper lobe treatment) in patients with upper lobe predominant emphysema were conducted. Inclusion criteria: forced expiratory volume in 1 second (FEV1) 15%&amp;ndash;45% predicted, residual volume &amp;gt; 150%, total lung capacity &amp;gt; 100%, 6-minute walk distance (6MWD) &amp;gt; 140 m, and diffusing capacity for carbon monoxide &amp;gt; 20% predicted. Efficacy endpoints: spirometry, body plethysmography, lung volumes by high-resolution computed tomography, St George&amp;#39;s Respiratory Questionnaire, modified Medical Research Council dyspnea scale, and 6MWD. All adverse events were collected and independently adjudicated.Results: Forty four patients were treated at a mean (standard deviation) age of 63 (5.6) years, FEV1 0.86 mL (0.25 mL) (n = 22 men and 22 women). Mean (standard deviation) changes from baseline at 12 months were: FEV1 86.2 mL (173.8 mL), St George&amp;#39;s Respiratory Questionnaire -11.0 (14.0) units, treated lobar volume from high-resolution computed tomography -751.8 mL (653.9 mL), residual volume -302.8 mL (775.6 mL), 6MWD 18.5 m (63.7 m), and modified Medical Research Council dyspnea scale score -0.83 (0.97) (P &amp;lt; 0.05 for all except 6MWD). Improvements were numerically larger at 6 versus 12 months. GOLD stage III and IV patients had similar outcomes at 6 months; however, improvements relative to baseline were numerically higher in GOLD stage IV patients. Larger improvements were observed in patients with higher heterogeneity. In total, 39 serious adverse events were reported in 23 patients with 10 events in 8 patients between 6 and 12 months.Conclusion: Unilateral lobar InterVapor treatment of heterogeneous emphysema improved lung function and health outcomes 1 year following treatment. The magnitude of improvement was larger at 6 months compared to 12 months. Improvements relative to baseline continue to be exhibited at 12 months despite the expected disease related decline over time.Clinical trials: NCT 01041586 and NCT 01102712Keywords: emphysema, bronchoscopy, lung volume reduction, thermal energ