association between spinal morning stiffness and lumbar disc degeneration: the rotterdam study....

The Spine Journal 13 (2013) 590–592

Journal Reports

The Spine Journal editors present abstracts from selected articles which may be of interest to TSJ readers.

MRI assessment of lumbar intervertebral disc degeneration with

lumbar degenerative disease using the pfirrmann grading systems.

Yu LP, Qian WW, Yin GY, Ren YX, Hu ZY. PLoS One

2012;7(12):e48074

BACKGROUND: To evaluate by MRI intervertebral disc degeneration in

patients with lumbar degenerative disease using the Pfirrmann grading sys-

tem and to determine whether Modic changes correlated with the Pfirr-

mann grades and modified Pfirrmann grades of disc degeneration.

METHODS: The clinical data of 108 surgical patients with lumbar degen-

erative disease were reviewed and their preoperative MR images were an-

alyzed. Disc degeneration was evaluated using the Pfirrmann grading

system. Patients were followed up and low back pain was evaluated using

the visual analog scale (VAS) and the effect of back pain on the daily qual-

ity of life was assessed using Oswestry disability index (ODI).

RESULTS: Forty-four cases had normal anatomical appearance (Modic

type 0) and their Pfirrmann grades were 3.7760.480 and their modified

Pfirrmann grades were of 5.8161.006. Twenty-seven cases had Modic type

I changes and their Pfirrmann grades were 4.7960.557 and their modified

Pfirrmann grades were 7.0060.832. Thirty-six cases exhibited Modic type

II changes and their Pfirrmann grades and modified Pfirrmann grades were

4.1160.398 and 6.6460.867, respectively. One case had Modic type III

changes. Kruskal-Wallis test revealed significant difference in modified

Pfirrmann grade among Modic type 0, I and II changes (p!.01) but no sig-

nificant difference between Modic type I and II changes (pO.05). Binary re-

gression analysis showed that Modic changes correlated most strongly with

disc degeneration. Follow up studies indicated that the VAS and ODI scores

were markedly improved postoperatively. However, no differencewas noted

in VAS and ODI scores among patients with different Modic types.

CONCLUSION:Modic changes correlate with the Pfirrmann andmodified

Pfirrmann grades of disc degeneration in lumbar degenerative disease. There

is no significant correlation between Modic types and surgical outcomes.

PMID: 23284612 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/23284612]

Reprinted from: Yu LP, Qian WW, Yin GY, Ren YX, Hu ZY. MRI assess-

ment of lumbar intervertebral disc degeneration with lumbar degenerative

disease using the pfirrmann grading systems. PLoS One 2012;7(12):e48074.

http://dx.doi.org/10.1016/j.spinee.2013.03.031

Intervertebral disc cell- and hydrogel-supported and spontaneous

intervertebral disc repair in nucleotomized sheep. Benz K, Stippich

C, Fischer L, et al. Eur Spine J 2012;21(9):1758-68. Epub 2012 Jul 29

PURPOSE: Regenerative repair is a promising new approach in treating

damaged intervertebral discs. An experimental scheme was established

for autologous and/or allogenic repair after massive disc injury.

METHODS: Disc healing was promoted in 11 animals by injecting in vi-

tro expanded autologous/homologous disc cells 2 weeks after stab injury of

lumbar discs L1-2. The following control discs were used in our sheep

injury model: L2-3, vehicle only; L3-4, injury only; L4-5, undamaged;

and lumbar discs from four non-experimental animals. Disc cells were sus-

pended in a biologically supportive albumin/hyaluronan two-component

hydrogel solution that polymerizes when inserted in order to anchor cells

at the injection site. The parameters studied were MRI, DNA, glycosami-

noglycan, collagen content, histology, immunohistology for collagens type

I, II and aggrecan, and mRNA expression of GAPDH, b-actin, collagen

type I, II, X, aggrecan, lubricin, and IL-1b.

RESULTS: All parameters demonstrated almost complete healing of the

injured discs after 6 months, when compared with data from both the en-

dogenous non-injured controls as well as from the healthy animals.

CONCLUSION: Sheep experience spontaneous recovery from disc in-

jury. The process of endogenous repair can be enhanced by means of

hydrogel-supported cells.



Reprinted with permission from: Benz K, Stippich C, Fischer L, et al.

Intervertebral disc cell- and hydrogel-supported and spontaneous interver-

tebral disc repair in nucleotomized sheep. Eur Spine J 2012;21(9):1758-

68. Epub 2012 Jul 29. Available at: http://link.springer.com/article/

10.1007%2Fs00586-012-2443-4


Association between spinal morning stiffness and lumbar disc

degeneration: the Rotterdam Study. Scheele J, de Schepper EI, van

Meurs JB, et al. Osteoarthritis Cartilage 2012;20(9):982-7. Epub

2012 Jun 12

OBJECTIVE: To explore the associations between spinal morning stiff-

ness and lumbar disc degeneration (LDD).

DESIGN: Data from a cross-sectional general population-based study

(Rotterdam Study-I) were used. Intervertebral disc spaces and osteophytes

of people aged$55 years were scored on lumbar lateral radiographs (L1-2

through L5-S1 was scored). Logistic regression analysis was used to ex-

plore associations between spinal morning stiffness and two definitions

of LDD (ie, ‘narrowing’ and ‘osteophytes’). Spinal morning stiffness com-

bined with low back pain and its association with LDD was also analyzed.

Similar analyses were performed for knee and hip pain, morning stiffness

in the legs, and radiographic knee and hip osteoarthritis (OA) in order to

compare these associations with those of LDD. All analyses were adjusted

for age, gender, and body mass index (BMI).

RESULTS: Lumbar lateral radiographs were scored for 2,819 participants.

Both definitions of LDD were associated with spinal morning stiffness: ad-

justed odds ratio (aOR) 1.3; 95% confidence interval (CI): 1.1-1.6 for ‘os-

teophytes’ and aOR 1.8; 95% CI: 1.4-2.2 for ‘narrowing’. Both the odds

ratios increased when spinal morning stiffness was combined with low

back pain: aOR 1.5; 95% CI: 1.1-2.0 for ‘osteophytes’ and aOR 2.5;

95% CI: 1.9-3.4 for ‘narrowing’. When morning stiffness in the legs was

combined with knee or hip pain, the associations with radiographic knee

http://23284612

http://www.ncbi.nlm.nih.gov/pubmed/23284612





http://link.springer.com/article/10.1007&percnt;2Fs00586-012-2443-4




591Journal Reports / The Spine Journal 13 (2013) 590–592

or hip OAwere: aOR 3.0; 95% CI: 2.1-4.1 for knee OA and aOR 3.1; 95%

CI: 1.9-5.0 for hip OA.

CONCLUSIONS: Reported spinal morning stiffness is associated with

LDD. The associations increased when we combined spinal morning stiff-

ness with low back pain. The magnitude of the association for the defini-

tion ‘narrowing’ is similar to the association between morning stiffness in

the legs and knee or hip OA.

PMID: 22698441 [PubMed - indexed for MEDLINE. Available at: http://

www.ncbi.nlm.nih.gov/pubmed/22698441]

Reprinted from: Scheele J, de Schepper EI, van Meurs JB, et al. Association

between spinal morning stiffness and lumbar disc degeneration: the Rotter-

dam Study. Osteoarthritis Cartilage 2012;20(9):982-7. Epub 2012 Jun 12,

with permission from the Osteoarthritis Research Society International.


Intervertebral disc degeneration in the dog. Part 2:

Chondrodystrophic and non-chondrodystrophic breeds. Smolders

LA, Bergknut N, Grinwis GC, et al. Vet J 2012 pii: S1090-0233(12)

00433-9. [Epub ahead of print]

Dogs can be grouped into two distinct types of breed based on the predis-

position to chondrodystrophy, namely, non-chondrodystrophic (NCD) and

chondrodystrophic (CD). In addition to a different process of endochondral

ossification, NCD and CD breeds have different characteristics of intraver-

tebral disc (IVD) degeneration and IVD degenerative diseases. The anat-

omy, physiology, histopathology, and biochemical and biomechanical

characteristics of the healthy and degenerated IVD are discussed in the first

part of this two-part review. This second part describes the similarities and

differences in the histopathological and biochemical characteristics of IVD

degeneration in CD and NCD canine breeds and discusses relevant aetio-

logical factors of IVD degeneration.

PMID: 23154070 [PubMed - as supplied by publisher. Available at: http://


Reprinted from: Smolders LA, Bergknut N, Grinwis GC, et al. Interverte-

bral disc degeneration in the dog. Part 2: Chondrodystrophic and non-

chondrodystrophic breeds. Vet J 2012 pii: S1090-0233(12)00433-9.[Epub

ahead of print], with permission from Elsevier.


Experimental pelvic pain facilitates pain provocation tests and

causes regional hyperalgesia. Palsson TS, Graven-Nielsen T. Pain

2012 Aug 22. [Epub ahead of print]

The extra-articular sacroiliac joint (SIJ) structure is a potential source for

low back and pelvic pain. This study hypothesised that experimental pain

induced in a superficial pelvic ligament causes (1) hyperalgesia to pres-

sure, (2) distinct pain referral, and (3) an increased frequency of positive

pain provocation tests of the SIJ complex. Thirty healthy subjects (15 fe-

males) participated in this study designed as a randomised crossover trial.

Pain was induced in the long posterior sacroiliac ligament by injection of

hypertonic saline, with the contralateral ligament injected with isotonic sa-

line as control. Pain intensity was assessed on an electronic visual ana-

logue scale (VAS). Pressure pain thresholds (PPTs) and pain provocation

tests were assessed on 3 occasions: at baseline, after injection, and when

pain had subsided. PPT sites were located bilaterally at the injection site,

lateral to spinous processes of S2 and L5, and at the gluteus medius and

gastrocnemius muscles. Hypertonic saline caused significantly higher

VAS scores and more extended pain referral than isotonic saline

(p!.001). PPTs at the injection site and lateral to S2 were significantly re-

duced after hypertonic saline compared with baseline and isotonic saline

(p!.002). Significantly more subjects had positive pain provocation tests

after hypertonic (67% of subjects) compared with isotonic saline (20%;

p!.001). These data demonstrate that the extra-articular SIJ structure ac-

commodates nociceptors that are capable of inducing pain referral and re-

gional hyperalgesia sensitive to manual pain provocation tests similar to

what previously have been found in pelvic girdle pain patients.



Reprinted from: Palsson TS, Graven-Nielsen T. Experimental pelvic pain

facilitates pain provocation tests and causes regional hyperalgesia. Pain

2012 Aug 22. [Epub ahead of print]. This abstract has been reproduced

with permission of the International Association for the Study of Pain�(IASP�). The abstract may not be reproduced for any other purpose with-

out permission.


Factors affecting shoulder-pelvic integration during axial trunk

rotation in subjects with recurrent low back pain. Park WH, Kim

YH, Lee TR, Sung PS. Eur Spine J 2012;21(7):1316-23. Epub 2012

Mar 29

INTRODUCTION: Shoulder-pelvic integration could play a central role

in the control of dynamic posture and movement. However, kinematic co-

ordination during axial trunk rotation has not been carefully investigated in

subjects with recurrent low back pain (LBP). The purpose of this study was

to compare the maximum rotational angles of the shoulders and pelvis in

the transverse plane between subjects with and without recurrent LBP.

MATERIALS AND METHODS: A total of 38 age-matched subjects (19

control subjects: 69.0065.75 years old and 19 subjects with LBP:

68.7965.40 years old) participated in the study. The axial trunk rotation

test was conducted in the upright position with bilateral hips and knees

fully extended and both feet shoulder width apart.

RESULTS: The results of this study indicated that there was a difference

in pelvic girdle rotation between groups (100.79626.46 in the control

group, 82.12623.16 in the LBP group; t52.31, p5.02); however, there

was no difference for the shoulder girdle (177.63636.98 in the control

group, 156.42630.09 in the LBP group; t51.91, p5.06). There were inter-

actions with age (F59.27, p5.004) and BMI (F57.50, p5.01) with the ro-

tational angles of the shoulder and pelvis.

CONCLUSION: These results indicated a different pattern of trunk rota-

tion movement with the age and BMI serving as important factors to con-

sider for recurrent LBP. The results of our study also indicated a different

pattern of shoulder and pelvic coordination with age and gender. Clinicians

need to consider the consequences of limited shoulder-pelvic rotational

angles, especially limited rotational angle on the pelvis during trunk axial

rotation. Further studies are required to determine the causes of the under-

lying problems for clinical decision-making and altered shoulder-pelvic

rotation in subjects with recurrent LBP.

PMID: 22456800 [PubMed - indexed for MEDLINE. Available at: http://


Reprinted with permission from: Park WH, Kim YH, Lee TR, Sung PS.

Factors affecting shoulder-pelvic integration during axial trunk rotation

in subjects with recurrent low back pain. Eur Spine J 2012;21(7):1316-

23. Epub 2012 Mar 29. Available at: http://link.springer.com/article/

10.1007%2Fs00586-012-2280-5.


http://22698441




http://23154070




http://22921262




http://22456800






association between spinal morning stiffness and lumbar disc degeneration: the rotterdam study....

Documents