Michele C Battié

University of Alberta, Edmonton, Alberta, Canada

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Publications (105)291.28 Total impact

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    ABSTRACT: Objectives: Lumbar spinal stenosis is one of the most commonly diagnosed spinal disorders in older adults. Although the pathophysiology of the clinical syndrome is not well understood, a narrow central canal or intervertebral foramen is an essential or defining feature. The aim of the present study was to estimate the magnitude of genetic versus environmental influences on central lumbar spinal stenosis, and investigate disc degeneration and stature or bone development as possible genetic pathways.Methods: A classic twin study with multivariate analyses considering lumbar level and other covariates was conducted. The study sample comprised 598 male twins (147 monozygotic and 152 dizygotic pairs), 35-70 years of age, from the population-based Finnish Twin Cohort. Primary phenotypes were central lumbar stenosis assessed qualitatively on MRI and quantitatively measured dural sac cross-sectional area. Additional phenotypes to examine possible genetic pathways included disc bulging and standing height, as an indicator of overall skeletal size or development.Results: The heritability estimate (h2) for qualitatively assessed central lumbar spinal stenosis on MRI was 67% (95%CI: 56.8-74.5). The broad sense heritability estimate for dural sac cross-sectional area was 81.2% (95%CI: 74.5 – 86.1%), with a similar magnitude of genetic influences across lumbar levels (h2=72.4-75.6). The additive genetic correlation of quantitatively assessed stenosis and disc bulging was extremely high. There was no indication of shared genetic influences between stenosis and stature.Conclusion: Central lumbar spinal stenosis and associated dural sac dimensions are highly genetic, and disc degeneration (bulging) appears to be one pathway through which genes influence spinal stenosis.The clinical syndrome of lumbar spinal stenosis (LSS) is a commonly diagnosed spinal disorder in older adults seeking care for back related symptoms. Although the pathophysiology of symptomatic lumbar spinal stenosis is not well understood, a narrow central canal, lateral recess or neuroforaminal canal is an essential or defining feature. In the case of degenerative lumbar spinal stenosis, the most common form of lumbar stenosis, disc degeneration, thickening and buckling of the ligamentum flavum and facet hypertrophy contribute to canal narrowing, which is generally greatest at the level of the disc. While disc degeneration is recognized as having a substantial genetic component (1), less is known about the degree to which genes influence other contributors to degenerative stenosis or associated central spinal canal dimensions.The aim of the present study was to estimate the magnitude of genetic influences on qualitatively assessed central canal lumbar spinal stenosis and quantitatively assessed central canal dimensions in a general population sample of men. We were also interested in estimating the proportion of genetic influences on canal capacity attributable to shared genetic influences with disc degeneration (bulging), as well as on bone size or development, as indicated through stature. © 2014 American College of Rheumatology.
    Arthritis & Rheumatology. 08/2014;
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    ABSTRACT: Objective To examine whether use of FCE leads to better outcomes for injured workers. Functional capacity evaluations (FCE) are commonly used to identify work abilities and to inform return-to-work (RTW) decisions. FCE results therefore have important consequences. Design A cluster randomised controlled trial was conducted with analysis at level of claimant (registration ISRCTN61284905). Setting The study was conducted at a workers’ compensation rehabilitation facility in Edmonton, Canada. Participants Data were collected on all claimants undergoing RTW assessment at the facility for musculoskeletal conditions. Participants were predominantly employed (59%) males (73%) with chronic musculoskeletal conditions (median duration 496 days). Interventions Clinicians who were trained and experienced in performing FCE were randomised into two groups. One group included 14 clinicians who were trained to conduct a semi-structured functional interview, while the control group continued to use standard FCE procedures. Main Outcome Measures Outcomes included RTW recommendations following assessment, functional work level at time of assessment and 1, 3, and 6 months after assessment, as well as compensation outcomes. Analysis included Mann-Whitney U, Chi square and t tests. Results Participants included 203 claimants of whom 103 were tested with FCE. All outcomes were similar between groups and no statistically or clinically significant differences were observed. Mean differences between groups on functional work levels at assessment and follow-up ranged from 0.1 to 0.3 out of 4 (3% to 8% difference, p>0.05). Conclusions Performance-based FCE does not appear to enhance RTW outcomes beyond information gained from semi-structured functional interviewing. Use of functional interviewing has the potential to improve efficiency of RTW assessment without compromising clinical, RTW, or compensation outcomes.
    Archives of physical medicine and rehabilitation 01/2014; · 2.18 Impact Factor
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    ABSTRACT: Purpose Functional capacity evaluations (FCE) are used to identify work abilities and are commonly integrated into rehabilitation programs. We studied whether integrating FCE into rehabilitation leads to better outcomes for injured workers. Methods A cluster randomised controlled trial was conducted at a workers' compensation rehabilitation facility (registration ISRCTN61284905). Clinicians were randomised into 2 groups: 1 group used FCE while another conducted semi-structured functional interviews. Outcomes included recommendations following assessment, rehabilitation program outcomes including functional work levels and pain intensity, as well as compensation outcomes at 1, 3, and 6 months after assessment. Analysis included Mann-Whitney U, Chi square and t tests. Results Subjects included 225 claimants of whom 105 were tested with FCE. Subjects were predominantly employed (84 %) males (63 %) with sub-acute musculoskeletal conditions (median duration 67 days). Claimants undergoing FCE had ~15 % higher average functional work levels recommended at time of assessment (Mann-Whitney U = 4,391.0, p < 0.001) but differences at other follow-up times were smaller (0-8 %), in favour of functional interviewing, and not statistically significant. Clinically important improvement during rehabilitation in functional work level (0.9/4, SRM = 0.94), pain intensity (2.0/10, SRM = 0.88) and self-reported disability (21.8/100, SRM = 1.45) were only observed in those undergoing the functional interview. Conclusions Performance-based FCE integrated into occupational rehabilitation appears to lead to higher baseline functional work levels compared to a semi-structured functional interview, but not improved RTW rates or functional work levels at follow-up. Functional interviewing has potential for efficiency gains and higher likelihood of clinically important improvement following rehabilitation, however further research is needed.
    Journal of Occupational Rehabilitation 12/2013; · 2.80 Impact Factor
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    ABSTRACT: There is no clear picture of pathoanatomy in clinically diagnosed LSS. Findings in the literature regarding imaging in LSS are heterogeneous. Characterize the pathoanatomy of LSS, as reported in the radiology reports, for a large community-based sample of patients with the clinical diagnosis of LSS. Retrospective review of clinical radiology reports. The sample comprised patients 40 years of age or older, with clinically diagnosed LSS. Radiology reports for lumbar MRI were obtained and data were extracted pertaining to the type and location of LSS. 173 subjects with a mean age of 66.2 ± 11.7 years were included (61% women). 68.2% had mixed stenosis, 19.1% had central stenosis only, and 12.7% had lateral stenosis only. By level, the most prevalent findings were at L4/5 (93%), L3/4 (66%) and L5/S1 (48%). This pattern was different in those with lateral stenosis only, where the proportion of findings at L5/S1 was higher than at L3/4. 156 subjects (90.2%) had findings of at least moderate severity. Considering moderate-severe findings only, 31% had mixed stenosis and 40.0% had multi-level findings (90.5% at adjacent segments). When mild findings were included for subjects with at least one moderate-severe finding the rate of mixed stenosis increased to 59%, and multi-level stenosis to 68.6%. The most common multi-level combinations were L3/4 and L4/5 for two-level stenosis and L2/3 through L4/5 for three-level. Results of this study confirm a number of pathoanatomical patterns in people diagnosed with LSS, including a high proportion of stenosis at L4/5, followed by L3/4 and L5/S1. Results also suggest a high prevalence of multi-levels stenosis at adjacent segments. The prevalence of mixed stenosis varied from 31% to 68.2%; inclusion of mild findings resulted in a higher rate of both mixed and multi-level stenosis, compared to analysis of moderate-severe findings only. These results may guide future studies on LSS pathophysiology, by focusing attention toward the most prevalent radiological findings.
    Journal of Back and Musculoskeletal Rehabilitation 11/2013; · 0.61 Impact Factor
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    ABSTRACT: Walking capacity is a primary outcome indicator for individuals with lumbar spinal stenosis (LSS). Therefore, there is a demand for psychometrically sound measures of walking that are responsive to change. The primary objective of this study was to examine longitudinal construct validity of the Physical Function Scale of the Swiss Spinal Stenosis Questionnaire, the Oswestry Disability Index (ODI), and the walking capacity items from these scales specifically for the assessment of walking capacity in LSS using the objective Self-Paced Walking Test as the external standard. A secondary objective was to examine responsiveness of measures of walking using a self-reported walking capacity change scale as the external criterion standard. Prospective cohort PATIENT SAMPLE: Twenty six patients were included in this study (17 women and 9 men), with an average age of 68.5 (9.2) years. All participants had LSS diagnosed by a spine specialist surgeon based on both clinical examination and imaging, as well as self-reported walking limitations (neurogenic claudication). Self-report Measures: Physical Function Scale of the Swiss Spinal Stenosis Questionnaire (PF Scale), Oswestry Disability Index (ODI), self-reported walking capacity change score. Self-Paced Walking Test (SPWT). Longitudinal construct validity was assessed using the correlational method. Internal responsiveness was examined using Guyatt's responsiveness index (GRI) and external responsiveness using Receiver Operating Characteristics analysis (ROC). Change in the SPWT and the self-reported walking capacity change score were both used as external criteria for analysis. This study was funded by the Health Research Fund administered by Alberta Innovates Health Solutions, as well as the EFF Small Faculties Grant from the University of Alberta. There are no conflicts of interest. The highest correlations with change in the SPWT were 0.78 for the ODI walking item, and 0.78 for the walking capacity change score. Change in the PF Scale and ODI score were correlated with change in the criterion SPWT at r=0.56 and r=0.70 respectively. There were no differences observed between the PF Scale and ODI for any of the responsiveness indices. The PF Scale, ODI, and walking capacity change score are able to detect changes in walking capacity in people with LSS. The individual walking capacity item from the ODI appears to be the most valid and responsive to changes in measured walking and may be a reasonable alternative for measuring walking when an objective test such as the SPWT is not feasible.
    The spine journal: official journal of the North American Spine Society 11/2013; · 2.90 Impact Factor
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    ABSTRACT: Many studies have focused on either the intervertebral disc, as a culprit in back pain problems, or the vertebral body, but very few studies have examined both structures and their relation. The goals were to measure the concordant changes in morphology of the discs and vertebrae during 5, 10 and 15-year follow-ups. Longitudinal study. Among a general population sample of 232 men that had been scanned in 1992-1993, 105 men were re-examined in 1997-1998 and 2007-2008. Mean age at 15-year follow-up was 63 years. A confirmatory sample with 10-year follow-up was also included. 1.5 Tesla scanners with surface coils were used at baseline and follow-up. Image analysing software was used to measure distances and areas of interest of mid-sagittal and mid-axial spine images. The disc heights decreased at 5 years by 3.4% (0.4 mm) and 3.3 % (0.4 mm) and at 15 years 8.7 % (1.0 mm) and 11.3 % (1.3 mm) in the upper and the lower discs respectively (p<0.001). While not clear after 5years, vertebra heights increased in mean by 3.1 % (0.8 mm) in the upper lumbar levels and by 4.7 % (1.1 mm) in the lower vertebrae after 15 years (p<0.001). Vertebra height increases were associated with disc narrowing (P=0.001). The mean annual shortening of the lumbar spine L1-S1 block was 0.13 mm/year, which was in line with the mean standing height, which decreased little (174.7 cm at baseline and 174.4 cm at follow-up). Discs and vertebrae degenerate or remodel in concert: decreases in disc height appear to be compensated, in part, by accompanying increases in adjacent vertebra heights. The mechanism behind this novel finding and its implications require further study.
    The spine journal: official journal of the North American Spine Society 11/2013; · 2.90 Impact Factor
  • Ashley B McKillop, Linda J Carroll, Michele C Battié
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    ABSTRACT: The clinical syndrome of lumbar spinal stenosis (LSS) is a commonly diagnosed lumbar condition associated with pain and disability. Psychological factors, including depression, also affect these and other health-related outcomes. Yet, the prognostic value of depression specifically in the context of LSS is unclear. The aim of this systematic review was to examine the literature on depression as a prognostic factor of outcomes in patients with LSS. Best-evidence synthesis. Patients receiving the diagnosis of LSS and surgery. A best-evidence synthesis was conducted, including articles published between 1980 and May 2012. Each article meeting inclusion criteria, including a longitudinal design, was critically appraised on its methodological quality by two authors independently, who then met to reach consensus. Only studies deemed scientifically admissible were included in the review. Among the 20 articles that met the inclusion criteria, 13 were judged scientifically admissible. The evidence supports an association between preoperative depression and postoperative LSS-related symptom severity (a combination of pain, numbness, weakness and balance issues) and disability. The effect size for these associations was variable, ranging from no effect to a moderate effect. For example, an increase of 5 points on a 63-point depression scale doubled the odds of being below the median in LSS-related symptom severity at follow-up. Findings on the association between preoperative depression and postoperative pain alone and walking capacity were more variable. Findings support that preoperative depression is likely a prognostic factor for postoperative LSS-related symptom severity and disability at various follow-up points. The prognostic value of depression on the outcomes of pain and walking capacity is less clear. Nonetheless, depression should be considered in the clinical care of this population.
    The spine journal: official journal of the North American Spine Society 10/2013; · 2.90 Impact Factor
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    ABSTRACT: The purpose of this study was to define the natural progression of age-related changes of the lumbar paraspinal muscles during adulthood, and investigate the influence of lifestyle and individual factors (e.g. physical activity levels at work and leisure, body mass index (BMI), and low back pain (LBP)). This population-based longitudinal study included a sample of 99 adult male twins. Data were collected through a structured interview, physical examination, and magnetic resonance imaging (MRI). Measurements of the lumbar multifidus and erector spinae muscles were obtained from T2-weighted axial images at L3-L4 and L5-S1 at baseline and 15-year follow-up. Muscle cross-sectional area (CSA), functional CSA (FCSA) (fat-free mass) and FCSA/CSA (composition), as well as CSA and FCSA asymmetry, and FCSA/CSA side-to-side differences, were measured. Subjects' mean age was 47.3±7.4 at baseline and 62.3±8.0 at follow-up. Over the 15-year period, both muscles exhibited a decrease in CSA and FCSA and an increase in fatty infiltration and side-to-side differences in size and composition at both spinal levels. Both muscles displayed greater changes at L5-S1 than L3-L4. Age and BMI were found to be significantly associated with the degree of paraspinal muscle changes over time. However, there was no association between the change in paraspinal muscle size, composition or asymmetry with the level of physical demands at work or leisure, or LBP history. The present longitudinal study suggests that over adulthood the multifidus and erector spinae undergo similar morphological changes. Moreover, our findings suggest that the long-term progression of lumbar paraspinal muscle changes evaluated through MRI are not associated with the range of physical demand levels as were typical of Finnish men, or LBP history.
    Medicine and science in sports and exercise 10/2013; · 4.48 Impact Factor
  • Bone 09/2013; · 4.46 Impact Factor
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    ABSTRACT: The phenotype, or observable trait of interest, is at the core of studies identifying associated genetic variants and their functional pathways, as well as diagnostics. Yet, despite remarkable technological developments in genotyping and progress in genetic research, relatively little attention has been paid to the equally important issue of phenotype. This is especially true for disc degeneration-related disorders, and the concept of degenerative disc disease, in particular, where there is little consensus or uniformity of definition. Greater attention and rigour are clearly needed in the development of disc degeneration-related clinical phenotypes if we are to see more rapid advancements in knowledge of this area. When selecting phenotypes, a basic decision is whether to focus directly on the complex clinical phenotype (e.g. the clinical syndrome of spinal stenosis), which is ultimately of interest, or an intermediate phenotype (e.g. dural sac cross-sectional area). While both have advantages, it cannot be assumed that associated gene variants will be similarly relevant to both. Among other considerations are factors influencing phenotype identification, comorbidities that are often present, and measurement issues. Genodisc, the European research consortium project on disc-related clinical pathologies has adopted a strategy that will allow for the careful characterisation and examination of both the complex clinical phenotypes of interest and their components.
    European Spine Journal 07/2013; · 2.47 Impact Factor
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    ABSTRACT: Physical therapy (PT) is commonly prescribed for patients with lumbar spinal stenosis (LSS); however, little is known about its effectiveness. To systematically review randomized controlled trials (RCT), controlled trials and cohort studies evaluating the effectiveness of PT for LSS. Studies were searched on electronic databases to January 2012. Inclusion criteria were: clinical diagnosis of LSS with confirmatory imaging, evaluation of PT treatment, presence of a comparison group and outcomes of pain, disability, function or quality of life. Outcomes were extracted and when possible pooled using RevMan 5. Ten studies were included: 5 RCTs, 2 controlled trials, 2 mixed design and 1 longitudinal cohort study. Pooled effects of 2 studies revealed that the addition of a PT modality to exercise had no statistically significant effect on outcome. Pooled effects results of RCTs evaluating surgery versus PT demonstrated that surgery was better than physical therapy for pain and disability at long term (2 years) only. Other results suggested that exercise is significantly better than no exercise, that cycling and body weight supported treadmill walking have similar effects, and that corsets are better than no corsets. The limitations of this review include the low quality and small number of studies, as well as the heterogeneity in outcomes and treatments. We were unable to draw conclusions on which PT treatment is superior for LSS. There was low quality evidence suggesting that modalities have no additional effect to exercise and that surgery leads to better long term (2 years) outcomes for pain and disability, but not walking distance, than PT in patients with LSS.
    Physical Therapy 07/2013; · 2.78 Impact Factor
  • Annu Näkki, Michele C Battié, Jaakko Kaprio
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    ABSTRACT: Disc-related disorders are highly genetic conditions with heritability estimates of up to 75 % and yet, few genomic locations have been moderately associated with the disorders. Candidate gene studies have shown possible disease associations on loci and genes of 1p21.1 (COL11A1), 6q27 (THBS2), 9q22.31 (ASPN), 10p12.31 (SKT), 20q11.2 (GDF5) and 20q13.12 (MMP9). More recently, in 2012, the first genome-wide association study revealed variants on loci and genes of 3p26.2, 6p21.32 (HLA region) and 6q26 (PARK2) that associate with disc-related disorders. In many other complex diseases, large meta-analyses of hundreds of thousands of study subjects and loci have revealed remarkable pathways. As methodology is evolving rapidly, we have already stepped into the era of routinely sequencing all bases in all human exons and we are approaching the era of sequencing the entire genome of study subjects with common diseases. The past decade has taught us that the common variants seen throughout populations seem to have low effects in many common diseases, explain relatively little of the overall heritability of the diseases and demand thousands of study subjects to identify associations. It seems that familial rare variants play an important role in many common diseases leading us back to valuing studies with large families and isolated populations. Moreover, careful characterization of environmental conditions are needed to explore and determine gene-environment interactions as genes that increase disease risk in one context may not do so under another context.
    European Spine Journal 07/2013; · 2.47 Impact Factor
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    ABSTRACT: Previous studies suggest that age and disc degeneration are associated with variations in vertebral trabecular architecture. In particular, disc space narrowing, a severe form of disc degeneration, may predispose the anterior portion of a vertebra to fracture. We studied 150 lumbar vertebrae and 209 intervertebral discs from 48 cadaveric lumbar spines of middle-aged men to investigate regional trabecular differences in relation to age, disc degeneration and disc narrowing. The degrees of disc degeneration and narrowing were evaluated using radiography and discography. The vertebrae were dried and scanned on a μCT system. The μCT images of each vertebral body were processed to include only vertebral trabeculae, which were first divided into superior and inferior regions, and further into central and peripheral regions, and then anterior and posterior regions. Structural analyses were performed to obtain trabecular microarchitecture measurements for each vertebral region. On average, the peripheral region had 12-15% greater trabecular bone volume fraction and trabecular thickness than the central region (P<0.01). Greater age was associated with better trabecular structure in the peripheral relative to the central region. Moderate and severe disc degeneration were associated with higher trabecular thickness in the peripheral region of the vertebral trabeculae (P<0.05). The anterior region was of lower bone quality than the posterior region, which was not associated with age. Slight to moderate narrowing was associated with greater trabecular bone volume fraction in the anterior region of the inferior vertebra (P<0.05). Similarly, greater disc narrowing was associated with higher trabecular thickness in the anterior region (P<0.05). Better architecture of peripheral trabeculae relative to central trabeculae was associated with both age and disc degeneration. In contrast to the previous view that disc narrowing stress-shields the anterior vertebra, disc narrowing tended to associate with better trabecular architecture in the anterior region, as opposed to posterior region.
    Bone 06/2013; · 4.46 Impact Factor
  • Maryse Fortin, Yan Yuan, Michele C Battié
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    ABSTRACT: Paraspinal muscle asymmetry in cross-sectional area (CSA) and composition have been associated with low back pain (LBP) and pathology. Yet, substantial multifidus asymmetry has also been reported in asymptomatic men and little is known about other factors influencing asymmetry. The goal of this study was to identify a range of behavioral, environmental and constitutional factors associated with paraspinal muscle asymmetry. A cross-sectional study of a general population sample of 202 adult male twins was conducted. Data were collected through a structured interview, physical examination and magnetic resonance imaging. Measurements of multifidus and erector spinae CSA and the ratio of fat-free CSA to total CSA were obtained from T2-weighted axial images at the L3-L4 and L5-S1 spinal levels. In multivariable analyses, greater asymmetry in multifidus CSA at L3-L4 was associated with less occupational physical demands and disc narrowing. Handedness was the only factor associated with multifidus CSA asymmetry at L5-S1. For erector spinae, greater age, handedness and disc narrowing were associated with CSA asymmetry at L3-L4 and sports activity, handedness, disc narrowing and familial aggregation at L5-S1. In multivariable analyses of asymmetry in muscle composition, familial aggregation explained 7-20% of the variance in side-to-side differences for the multifidus and erector spinae at both levels measured. Handedness and pain severity also entered the model for erector spinae asymmetry at L5-S1, and disability, handedness and disc narrowing for multifidus at L5-S1. We relied on subjects' recall for LBP history, occupation and physical activity participation. Few of the factors investigated were associated with paraspinal muscle asymmetry, and associations were inconsistent and modest, explaining little of the variance in paraspinal muscle asymmetry.
    Physical Therapy 06/2013; · 2.78 Impact Factor
  • Article: Letters.
    Luciana G Macedo, Yue Wang, Michele C Battié
    Spine 05/2013; 38(11):969. · 2.16 Impact Factor
  • Christy C Tomkins-Lane, Michele C Battié
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    ABSTRACT: Identifying factors associated with walking capacity in people with lumbar spinal stenosis (LSS) may provide a better understanding of neurogenic claudication and inform future rehabilitation research. To examine factors associated with objectively measured walking capacity in a sample of people with LSS and self-reported walking limitations. Participants included 49 individuals (65.8 years ± 10) who were at least 45 years of age with clinically diagnosed lumbar spinal stenosis (LSS) confirmed on MRI or CT imaging. All participants completed a Self-Paced Walking Test with visual analog pain scales and body diagrams before and immediately after walking. Questionnaires included the Physical Function and Symptom Severity Scales of the Swiss Spinal Stenosis Questionnaire, the Oswestry Disability Index (ODI) and the Health Utilities Index. Univariate linear relationships were examined, followed by development of a multivariate linear regression model with walking distance (m) as the dependent variable. A post-hoc analysis was also conducted including post-test symptom variables. Variables retained from univariate analyses included years of leg pain, pre-test leg pain severity, the ODI, balance problems, and quality of life. When these variables were considered for a final model, only the ODI and balance problems were retained (R ^{2} =0.33). Other than balance, none of the pre-test symptom variables entered into the final model. Post-hoc analysis including post-test symptom variables found the presence and severity of post-test leg pain to be most highly associated with walking distance. In an explanatory model considering the ODI, balance and these two post-walking factors, only presence of post-test leg pain added to the model (R ^{2} =0.42). Factors found to be most highly associated with walking capacity in LSS were self-reported, pain-related function (ODI), balance problems, and presence of leg pain immediately following walking.
    Journal of Back and Musculoskeletal Rehabilitation 03/2013; · 0.61 Impact Factor
  • Yue Wang, Tapio Videman, Michele C Battié
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    ABSTRACT: Prior studies have suggested that vertebral end plate morphometrics and lesions may play a role in disc degeneration. However, most prior end plate studies have been based on radiographic images, and findings of associations between end plate morphometrics (measurements of size and shape) and disc degeneration remain controversial. The present study investigated the prevalence of vertebral end plate lesions and determined end plate morphometrics through direct measurements of cadaveric spines, and it examined the association of these factors with disc degeneration. We studied 600 vertebral end plates and 313 intervertebral discs from the cadaveric lumbosacral spines of seventy-six men (mean age, fifty-one years). Discography was performed to evaluate disc degeneration as indicated by disruption of the anulus fibrosus. The shape of the vertebral end plate and the presence of any lesions were visually evaluated. Lesions were rated as absent, small to moderate, or large. In addition, each end plate was digitized to quantify its area, circularity, and concavity. The association of end plate morphometrics and lesions with disc degeneration was examined. Vertebral end plate lesions were found in 72% (fifty-five) of the seventy-six lumbar spines and in 32.8% (197) of the 600 end plates. The presence of end plate lesions was associated with disc degeneration, with larger lesions being associated with more severe disc degeneration (odds ratio, 2.31 for small to moderate lesions [p < 0.01] and 3.54 for large lesions [p < 0.001]). Greater end plate area was also associated with more severe disc degeneration (odds ratio, 1.2 per cm2 [p < 0.05]). Vertebral end plate lesions were common and were associated with adjacent disc degeneration, with greater lesion size being associated with more severe disc degeneration. End plate morphometrics, particularly greater end plate size, may also play a role in the pathogenesis of disc degeneration. This study suggests that the integrity of the vertebral end plate is essential to maintaining disc health. The prevalence of end plate lesions may be underestimated on standard clinical images.
    The Journal of Bone and Joint Surgery 03/2013; 95(5):e261-7. · 3.23 Impact Factor
  • Yue Wang, Tapio Videman, Michele C Battié
    Spine 01/2013; 38(1):94-5. · 2.16 Impact Factor
  • Luciana Gazzi Macedo, Yue Wang, Michele C Battié
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    ABSTRACT: Study Design: Cross-sectional cohort study.Objective: To further evaluate the diagnostic value of the sedimentation sign by assessing its performance on the differential diagnosis of patients with lumbar spinal stenosis (LSS) and other lumbar conditions with similar clinical presentations.Summary of Background Data: Recently, a new test using MR imaging, the sedimentation sign, was introduced to aid in the diagnosis of LSS. The initial testing demonstrated that the sign was positive in 100% of patients with LSS with decreased walking ability and dural sac cross-sectional areas (CSA) less than 80mm, and negative in 94% of patients with non-specific low back pain, no leg pain or claudication and dural sac CSA greater than 120 mm.Methods: Fifty patients with central or combined LSS, 22 with lateral stenosis only and 43 with posterolateral disc herniation with unilateral radiculopathy were included. Using axial MR images of the lumbar spine, the sedimentation sign was assessed by two observers independently, without knowledge of participant clinical history or diagnosis. Frequencies of a positive sign in each patient group were calculated.Results: The sedimentation sign was positive in 2% of patients with disc herniation, 23% with lateral stenosis and 54% with central or combined stenosis. When the analysis included only LSS patients with dural sac CSA <80mm and walking limitations similar to the original study introducing the sedimentation sign (n = 17), the proportion of patients presenting with a positive sign increased to 82%.Conclusion: The sedimentation sign is more prevalent in patients with the clinical diagnosis of central or combined LSS than in patients with lateral stenosis only or posterolateral disc herniation. Yet, whether it enhances current diagnostic practices remains undetermined.
    Spine 11/2012; · 2.16 Impact Factor
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    ABSTRACT: BACKGROUND CONTEXT: Several reports suggest that level- and side-specific multifidus atrophy or fat infiltration may be related to localized spinal pathology and symptoms. In particular, a study using a porcine model reported rapid level- and side-specific multifidus atrophy and adipocyte enlargement resulting from anterolateral disc or nerve root lesions. PURPOSE: To investigate asymmetry in cross-sectional area (CSA) and fat infiltration in multifidus and other paraspinal muscles in patients with acute or subacute unilateral symptoms of radiculopathy and concordant posterolateral disc herniation. If multifidus asymmetry is indeed related to local pathology, this may serve as a marker for helping to target the search for less clearly identifiable pathology responsible for low back-related symptoms, which currently remains elusive in approximately 85% of those seeking care. STUDY DESIGN: Cross-sectional observational study. PATIENT SAMPLE: Subjects were patients referred to magnetic resonance imaging (MRI) with unilateral leg symptoms of less than 6 weeks onset suggestive of radiculopathy, with a consistent posterolateral lumbar disc herniation verified on imaging. METHODS: Using T2-weighted axial MRI, measurements were obtained for total muscle CSA and signal intensity, functional (fat-free) CSA, and the ratio of functional CSA to total CSA. RESULTS: Forty-three subjects met the inclusion criteria. The ratio of functional CSA to total muscle CSA was smaller on the side of the herniation than on the unaffected side, both below (mean 0.69 vs. 0.72, p=.007) and at the level of herniation (mean 0.78 vs. 0.80, p=.031). Multifidus signal intensity (fat infiltration) was greater on the side of the herniation at the level below the herniation (p=.014). Contrary to expectation, greater total multifidus CSA was found ipsilateral to the pathology at the level of herniation (p=.033). No asymmetries were found at the level above the herniation or in any other paraspinal muscles, with the exception of higher signal in the erector spinae at the level and side of herniation. CONCLUSIONS: Multifidus may be particularly responsive to, or indicative of, localized lumbar disc or nerve root pathology within the first 6 weeks of symptoms as expressed through fat infiltration, but not through CSA asymmetry on MRI. However, such measurements are not reliable markers of lumbar pathology on an individual basis for use in clinical or research settings.
    The spine journal: official journal of the North American Spine Society 10/2012; · 2.90 Impact Factor

Publication Stats

2k Citations
291.28 Total Impact Points


  • 1997–2014
    • University of Alberta
      • • Department of Physical Therapy
      • • Faculty of Rehabilitation Medicine
      Edmonton, Alberta, Canada
  • 2010–2013
    • Mount Royal University
      • Department of Physical Education & Recreation Studies
      Calgary, Alberta, Canada
  • 2004–2013
    • University of Helsinki
      • • Institute for Molecular Medicine Finland (FIMM)
      • • Department of Dental Public Health
      Helsinki, Province of Southern Finland, Finland
  • 2011
    • University of Eastern Finland
      • School of Medicine
      Joensuu, Province of Eastern Finland, Finland
  • 2004–2008
    • University of Kuopio
      • Department of Physiology
      Kuopio, Eastern Finland Province, Finland
  • 2001
    • University of Jyväskylä
      • Department of Health Sciences
      Jyväskylä, Western Finland, Finland
  • 1995
    • University of Washington Seattle
      Seattle, Washington, United States