My Orthopaedic Surgeon

West J Med. 1989 June; 150(6): 685.
Internal Fixation of Degenerative Disease of the Lumbar Spine
Correspondence from Arthur H. White, MD and James B. Reynolds, MD

Justification of instrumentation in degenerative disease. Internet Journal of Orthopaedic Surgery and Related Subjects Issue 2 - 3 1997
K.- P. Schulitz Orthopaedic Department of Heinrich-Heine-University Düsseldorf, Germany Correspondence: Prof. Dr. Klaus-Peter -Schulitz Heinrich Heine University Dept of Orthopaedic Surgery Moorenstr. 5 40225 Düsseldorf / Germany
Summary: a review of the philosophy behind the treatment of degenerative disorders with intrumented fusions is given. The pros and cons of instrumented fusion as well as results published so far are discussed.

Full Text article in Advances in Clinical Neuroscience and Rehabilitation 2005 Vol 4 #6 p 38
Haden, Whitfield & Moore

Radiology, Vol 164, 83-88, Copyright © 1987
LM Teresi, RB Lufkin, MA Reicher, BJ Moffit, FV Vinuela, GM Wilson, JR Bentson and WN Hanafee
Evidence on magnetic resonance (MR) images of disk degeneration and herniation, as well as of cord and root impingement, may be regarded either as normal, age-related changes or as causative of symptoms. Individuals referred for MR examinations of the larynx without symptoms referable to the cervical spine were studied retrospectively (35 patients) or prospectively (65 patients) over a 2-year period. With a solenoid surface coil, 5-mm-thick sections were acquired in sagittal, axial, and coronal planes with T1-weighted spin-echo pulsing sequences. Disk protrusion (herniation/bulge) was seen in five of 25 (20%) patients aged 45-54 and 24 of 42 (57%) patients older than 64 years of age. Posterolateral protrusions were seen in only nine of 100 patients and occurred with greatest frequency in patients over 64 years of age. In no patient was obliteration of the intraforaminal fat seen. Spinal cord impingement was observed in nine of 58 (16%) patients under 64 years of age, and in 11 of 42 (26%) patients over 64 years of age. Cord compression was observed in seven of 100 patients and occurred solely secondary to disk protrusion in all cases. The percentage of cord area reduction never exceeded 16% and averaged approximately 7%.

In this SpineUniverse patient case presented by Dr. Michael Kaiser, neruosurgeon, Columbia University in New York, NY the patient underwent an anterior cervical discectomy and fusion at C5-C6 and C6-C7 with PEEK/BMP interbody grafting and anterior plate stabilization. Dr. Gerard Girasole, orthopedic surgeon offers a case review.  Each SpineUniverse case features polling of other spine professionals to capture the prevailing treatment recommendations for the spine community at large.

J R Army Med Corps 2003; 149: 260-264 Y Bar-Dayan, M Weisbort,Y Bar-Dayan, GJ Velan, M Ravid, D Hendel, J Shemer
Parachuting, be it static line or sky- diving, places enormous stresses on the human spine. It is, therefore, important to determine the prevalence and severity of degenerative changes in the lumbar spine of subjects who practice this sport activity. Seventy four parachuting instructors, mean age 33 years and with an average of 410 static line and skydiving jumps, were included in the study.
The present findings provide a rationale for considering repeated sheer stress as an etiology of degenerative changes in the spinal cord, and as a possible contributing factor to the pathogenesis of spondylolysis.

The patient is a 55-year-old male, requiring pre-operative evaluation before back surgery. Quiz format.

Site by Yasser Metwally, Professor of neurology, Ain Shams university, Cairo, Egypt.
Illustrated account with references.

A number of pathologic changes have been reported in spinal surgery specimens. The frequency of many of these is not well defined. We retrospectively reviewed the histologic features of 985 extradural spinal surgery specimens. Of the cases, 1.6% were identified clinically as synovial cysts. In addition, synovial tissue was seen in another 5.3% of cases, often embedded within disk material. Neovascularization of disk tissue was present in 8.1% of cases, chondrocyte clusters in 18.3%, and calcium pyrophosphate crystals in 2.8%, predominantly within disk material. With the exception of crystal deposits, all of these changes were significantly more common in the lumbar spine. A better understanding of cell-based degenerative changes will become essential with increasing research into cell-based therapies for spinal disk disease. We report data on the frequency of different pathologic changes and describe synovial metaplasia as a reactive change not previously reported.
Am J Clin Pathol. 2006 Feb;125(2):193-202.
Pytel P, Wollmann RL, Fessler RG, Krausz TN, Montag AG.

The final common pathway of the degenerative cascade is the degenerated motion segment affecting both the intervertebral disc and the posterior elements with end-stage pial stenosis. Since the process has many different stages a standard surgical strategy is not applicable. It is thus imperative to match the treatment to the pathological anatomy of the different stages.
Floman, Pimenta, Khoo & Wilke

Objective: To evaluate the association between lumbar spine facet joint osteoarthritis (FJ OA) identified by multidetector computed tomography (CT) and low back pain (LBP) in the community-based Framingham Heart Study.
Conclusion: There is a high prevalence of FJ OA in the community. Prevalence of FJ OA increases with age with the highest prevalence at the L4-L5 spinal level. At low spinal levels women have a higher prevalence of lumbar FJ OA than men. In the present study, we failed to find an association between FJ OA, identified by multidetector CT, at any spinal level and LBP in a community-based study population.
Spine. 2008;33(23):2560-2565 Leonid Kalichman, PT, PhD; Ling Li, MPH; David H. Kim, MD; Ali Guermazi, MD; Valery Berkin, MD; Christopher J. O´Donnell, MD, MPH; Udo Hoffmann, MD, MPH; Rob Cole; David J. Hunter, MBBS, PhD

Search string allintitle: (degenerative (disease OR spondylitis OR disorder)) OR osteoarthritis spine -disc Returned 367 results August 2007

Health Qual Life Outcomes. 2007; 5: 71.
Karen L Saban, Sue M Penckofer, Ida Androwich, and Fred B Bryant
Over 500,000 spinal surgeries are performed annually in the United States. Although pain relief and improved health-related quality of life (HRQOL) are expectations following lumbar spinal surgery, there is limited research regarding this experience from the individual's perspective. In addition, no studies have examined the HRQOL of persons who have had this surgery using a comprehensive approach. The intent of this study was to address this deficiency by an assessment of both the individual and environmental factors that impact perceived HRQOL using the Wilson and Cleary Model for Health-Related Quality of Life in persons who have undergone lumbar spinal surgery.

Hip-Spine Syndrome: The Effect of Total Hip Replacement Surgery on Low Back Pain in Severe Osteoarthritis of the Hip Posted 09/20/2007
Spine. 2007;32(19):2099-2102
Peleg Ben-Galim, MD; Tal Ben-Galim, MD; Nahshon Rand, MD; Amir Haim, MD; John Hipp, PhD; Shmuel Dekel, MD, PhD; Yizhar Floman, MD
Conclusion: Both LBP and spinal function were improved following THR. This study demonstrates the clinical benefits of THR on back pain and is the first to clinically validate hip-spine syndrome as hypothesized by Offierski and MacNab in 1983.

The following search string searches the NLM PubMed site for articles with degenerative disease of the spine in the title - allintitle: site:www.ncbi.nlm.nih.gov (degenerative (disease OR spondylitis OR disorder)) OR osteoarthritis spine -disc
26 articles August 2007