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Article: Spinopelvic alignment predicts disc calcification, displacement, and Modic changes: Evidence of an evolutionary etiology for clinically‐relevant spinal phenotypes

TitleSpinopelvic alignment predicts disc calcification, displacement, and Modic changes: Evidence of an evolutionary etiology for clinically‐relevant spinal phenotypes
Authors
Keywordsincidence
lordosis
lumbar
Modic
MRI
Issue Date2020
PublisherWiley Open Access. The Journal's web site is located at https://onlinelibrary.wiley.com/journal/25721143
Citation
JOR Spine, 2020, Epub 2020-02-19, p. article no. e1083 How to Cite?
AbstractLumbar disc‐displacement, Modic changes (MCs), and UTE Disc Sign (UDS) on MRI are clinically relevant spinal phenotypes that can lead to sciatica/LBP. Not all degenerated discs result in disc‐displacement, MCs and UDS, suggesting varied etiologies. Spinopelvic parameters have been implicated in various spinal disorders. Pelvic incidence (PI) is “fixed parameter” since skeletal maturity. No study has addressed disc‐displacement, MCs and UDS in context of spinopelvic parameters. Therefore, the aim of study was to determine if spinopelvic parameters are associated and predict clinically‐relevant MRI‐phenotypes. One hundred and eight population‐based subjects (mean age: 52.3 years) were recruited. Spondylolisthesis and scoliosis individuals were excluded. Lumbar lordosis (LL), PI, sacral slope (SS), and pelvic tilt (PT) were assessed on lateral plain radiographs. Disc degeneration was assessed and summated, and presence or not of disc‐displacement and MCs were noted on T2W MRI. UDS was detected on UTE. Following exclusion criteria, 95 subjects were assessed. Disc‐displacement (82.1%), MCs (52.6%), and UDS (37.9%) were associated with lower PI, SS, LL, and LL/PI index. On multivariate analyses, lower PI was significantly related to development of these MRI phenotypes (adjusted OR range:0.95‐0.92; P < .05), with critical PI value of 42° or lower exhibiting fourfold increase risk of combined phenotypes (P = .020). Of UDS discs, 39.3% had adjacent MCs and 83.6% had disc‐displacement. 87.5% of MC had directly adjacent UDS. The first study to note that PI may “predict” the development of disc‐displacement, MCs and UDS, suggesting potential sub‐variants and mechanistic susceptibility that may be grounded in spinopelvic evolution. An “evolutionary etiological pathway” of spinal phenotype development is proposed.
Persistent Identifierhttp://hdl.handle.net/10722/281226
ISSN

 

DC FieldValueLanguage
dc.contributor.authorZehra, U-
dc.contributor.authorCheung, JPY-
dc.contributor.authorBow, C-
dc.contributor.authorCrawford, RJ-
dc.contributor.authorLuk, KDK-
dc.contributor.authorLu, W-
dc.contributor.authorSamartzis, D-
dc.date.accessioned2020-03-09T09:51:50Z-
dc.date.available2020-03-09T09:51:50Z-
dc.date.issued2020-
dc.identifier.citationJOR Spine, 2020, Epub 2020-02-19, p. article no. e1083-
dc.identifier.issn2572-1143-
dc.identifier.urihttp://hdl.handle.net/10722/281226-
dc.description.abstractLumbar disc‐displacement, Modic changes (MCs), and UTE Disc Sign (UDS) on MRI are clinically relevant spinal phenotypes that can lead to sciatica/LBP. Not all degenerated discs result in disc‐displacement, MCs and UDS, suggesting varied etiologies. Spinopelvic parameters have been implicated in various spinal disorders. Pelvic incidence (PI) is “fixed parameter” since skeletal maturity. No study has addressed disc‐displacement, MCs and UDS in context of spinopelvic parameters. Therefore, the aim of study was to determine if spinopelvic parameters are associated and predict clinically‐relevant MRI‐phenotypes. One hundred and eight population‐based subjects (mean age: 52.3 years) were recruited. Spondylolisthesis and scoliosis individuals were excluded. Lumbar lordosis (LL), PI, sacral slope (SS), and pelvic tilt (PT) were assessed on lateral plain radiographs. Disc degeneration was assessed and summated, and presence or not of disc‐displacement and MCs were noted on T2W MRI. UDS was detected on UTE. Following exclusion criteria, 95 subjects were assessed. Disc‐displacement (82.1%), MCs (52.6%), and UDS (37.9%) were associated with lower PI, SS, LL, and LL/PI index. On multivariate analyses, lower PI was significantly related to development of these MRI phenotypes (adjusted OR range:0.95‐0.92; P < .05), with critical PI value of 42° or lower exhibiting fourfold increase risk of combined phenotypes (P = .020). Of UDS discs, 39.3% had adjacent MCs and 83.6% had disc‐displacement. 87.5% of MC had directly adjacent UDS. The first study to note that PI may “predict” the development of disc‐displacement, MCs and UDS, suggesting potential sub‐variants and mechanistic susceptibility that may be grounded in spinopelvic evolution. An “evolutionary etiological pathway” of spinal phenotype development is proposed.-
dc.languageeng-
dc.publisherWiley Open Access. The Journal's web site is located at https://onlinelibrary.wiley.com/journal/25721143-
dc.relation.ispartofJOR Spine-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectincidence-
dc.subjectlordosis-
dc.subjectlumbar-
dc.subjectModic-
dc.subjectMRI-
dc.titleSpinopelvic alignment predicts disc calcification, displacement, and Modic changes: Evidence of an evolutionary etiology for clinically‐relevant spinal phenotypes-
dc.typeArticle-
dc.identifier.emailCheung, JPY: cheungjp@hku.hk-
dc.identifier.emailLu, W: wwlu@hku.hk-
dc.identifier.authorityCheung, JPY=rp01685-
dc.identifier.authorityLuk, KDK=rp00333-
dc.identifier.authorityLu, W=rp00411-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1002/jsp2.1083-
dc.identifier.hkuros309257-
dc.identifier.volumeEpub 2020-02-19-
dc.identifier.spagearticle no. e1083-
dc.identifier.epagearticle no. e1083-
dc.publisher.placeUnited States-

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