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ABSTRACT: Prospective in vivo study of meniscoids in the cervical zygapophyseal joints.
To generate reference data for in vivo magnetic resonance (MR) imaging properties of meniscoids in the cervical zygapophyseal joints.
Meniscoids, also called synovial folds, are tiny anatomic structures within the zygapophyseal joints. It has been suggested that pathologic conditions of meniscoids may be a potential source of cervical pain. Prior studies were limited to in vitro observations. To identify pathologic conditions of the meniscoids, it is necessary to obtain reference data of basic in vivo MR imaging properties of meniscoids in a healthy population.
Fifty-six healthy volunteers (33 women, 23 men; mean age 42.0 +/- 17.1 years) were investigated in a 3.0 Tesla MR scanner using high resolution isotropic 3-dimensional sequences. Presence, size, location, and signal intensity of the meniscoids were assessed, and their dependence on sex, age, body mass index, and degenerative changes were analyzed by t test and correlation analysis.
There was no significant difference in presence (20.3 +/- 4.8 vs. 19.7 +/- 4.8) and size (3.8 +/- 0.7 mm vs. 4.1 +/- 0.5 mm) of meniscoids between women and men. Presence of meniscoids decreased with increasing age (r = -0.38, P = 0.004). Size of meniscoids did not significantly depend on age (r = 0.02, P = 0.91). Meniscoid entrapment (location) was a rare condition (0.4%). Tissue composition (signal intensities) of the meniscoids was 61.6% mainly fatty, 15.8% mainly fibrous, and 22.6% mixed.
Basic data about in vivo MR imaging properties of cervical meniscoids in a healthy population have been successfully generated. Subsequent studies may use these data as reference for the identification of meniscoid pathologies.
Spine 11/2008; 33(21):E778-83. · 2.08 Impact Factor
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ABSTRACT: Prospective in vitro study of meniscoids in the cervical zygapophysial joints. OBJECTIVES.: To assess the use of high-field magnetic resonance imaging (MRI) as a potential tool for evaluating meniscoids of the cervical zygapophysial joints.
Pain originating from the cervical spine is a frequent condition. It has been suggested that pathologic conditions of meniscoids within the zygapophysial joints may cause pain.
Six zygapophysial joints from one embalmed human body were investigated with a 3.0-T MR unit, equipped with a microimaging-set. MRIs were correlated with microanatomical sections.
High-quality images of the meniscoids were obtained for all joints examined. There was a good correlation between the anatomic features derived from MRI and the microanatomical sections.
High-field MRI was successfully implemented as a noninvasive method for imaging the meniscoids in cervical zygapophysial joints. The results of this in vitro study indicate that high-field MRI may be feasible in evaluating patients with cervical pain possibly related to meniscoid pathology.
Spine 02/2007; 32(2):244-8. · 2.08 Impact Factor
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ABSTRACT: The aim of this study was to investigate associations between the location of osteoporotic vertebral fractures and the patient's localization of pain. Fifty-one consecutive patients (m 6, f 45; average age 74.8 years) with diagnosed osteoporotic vertebral fractures between T8 and L2 were included in the study. Exclusion criteria were fractures above T8 and below L2, spondylolisthesis, disc herniations, tumors, infections, and instability. Pain location was assessed by pain drawing, subdivided into thoracic, lumbar, and thoracic plus lumbar pain areas, and pain intensity using a 101 numeric rating scale. Furthermore, the onset of back pain and the lack or the indication of a trigger event at the onset of pain were documented. Only four of 20 patients with thoracic fractures reported thoracic pain, while the other 16 (80%) reported only lumbar pain. The location of the fracture and the patient's pain report were not related (Cohens Kappa=0.046; P=0.438). Patients with thoracic or lumbar osteoporotic fractures report pain mainly in the lumbosacrogluteal area. Therefore, the complaint of low back pain (LBP) in persons at risk for osteoporotic fractures may require both thoracic and lumbar X-rays. LBP patients with a suspect history of an osteoporotic vertebral fracture should also be given an X-ray of the thoracic and lumbar spine. Patients with a thoracic vertebral fracture had more severe pain than patients with a lumbar vertebral fracture. Onset not related to a fall or a false movement related to a significantly longer pain duration.
European Spine Journal 01/2007; 15(12):1797-800. · 1.97 Impact Factor
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ABSTRACT: A prospective clinical randomized controlled trial.
To determine the long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic and recurrent low back pain (LBP).
There is agreement on the importance of exercise during the course of chronic LBP. However, it is well known that long-term adherence with exercises is particularly low.
A total of 93 patients with LBP were randomly assigned to the control group (standard exercise program) or the motivational group (combined exercise and motivational program). Follow-up assessments were performed at 3.5 weeks, 4 months, 12 months, and 5 years. Main outcome measures were disability scores, pain intensity, and working ability. In addition to classic statistics, the sophisticated linear partial credit model was used to test the effects of treatment on disability scores.
In both groups, significant improvements in the disability scores were found at all points of follow-up assessment, however, the cumulative effect of the treatment in the motivational group was more than twice as much as in the control group. This result is in accordance with the increasing divergence in pain intensity between groups between 12 months and 5 years after intervention. A significant, positive long-term effect at the 5-year reassessment in working ability was only seen in the motivational group. All statistically significant results were confirmed by intention-to-treat analyses.
Regarding long-term efficacy, the combined exercise and motivation program was superior to the standard exercise program. Five years after the supervised combined exercise and motivational program, patients had significant improvements in disability, pain intensity, and working ability.
Spine 06/2005; 30(9):995-1000. · 2.08 Impact Factor
