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      Lumbar spinal degenerative “microinstability”: hype or hope? Proposal of a new classification to detect it and to assess surgical treatment

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          Modified Pfirrmann grading system for lumbar intervertebral disc degeneration.

          A reliability study was conducted. OBJECTIVE.: To modify a grading system for lumbar disc degeneration and to test the reliability of this modified grading system. The 5-level Pfirrmann grading system for disc degeneration did not prove discriminatory when used to assess disc degeneration in the elderly spine. Such discriminatory power is necessary to test the association between other variables and severity of disc degeneration. An 8-level modified grading system for lumbar disc degeneration was developed including a description of the changes expected for each grade and a 24-image reference panel. The reliability of the modified grading system was tested on 260 lumbar intervertebral discs in 52 subjects (26 men, 26 female) with a mean age of 73 years (range, 67-83 years). All examinations were analyzed independently by 3 readers. Intraobserver and interobserver reliabilities were assessed by calculating weighted kappa statistics. On average, for all 3 readers, 0.39% of the 260 discs were classified as Grade 2, 22% were classified as Grade 3, 21.5% were classified as Grade 4, 25.3% were classified as Grade 5, 19.1% were classified as Grade 6, 7.1% were classified as Grade 7, and 4.8% were classified as Grade 8. Intraobserver agreement was excellent (weighted kappa range, 0.79-0.91) with substantial interobserver agreement (weighted kappa range, 0.65-0.67). Complete intraobserver agreement was obtained, on average, in 85% of all discs with 84% of disagreement being as a result of a 1 grade difference. Complete interobserver agreement was obtained, on average, in 66% of all discs with 91% of disagreement being as a result of a 1 grade difference. The modified Pfirrmann grading system is useful at discriminating severity of disc degeneration in elderly subjects. The system can be applied with good intra- and interobserver agreement.
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            Instability of the lumbar spine.

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              Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy.

              To prospectively evaluate the fat content of paraspinal muscles by using proton magnetic resonance (MR) spectroscopy in patients with chronic low back pain (LBP) and in asymptomatic volunteers matched with regard to age, sex, and body mass index. The study was approved by the responsible institutional review board. Informed consent was obtained from each patient and each volunteer. Single-voxel proton MR spectroscopy was used to measure the fat content of the lumbar multifidus and longissimus muscles in 25 patients (13 women, 12 men; mean age, 40.5 years) with chronic LBP and in 25 matched asymptomatic volunteers (13 women, 12 men; mean age, 39.8 years). The fat content was also graded semiquantitatively (grades 0-4). The relationship between fat content and LBP duration, LBP intensity, and self-rated disability was assessed (Pearson correlation). The mean percentage fat content of the multifidus muscle was 23.6% (95% confidence interval [CI]: 17.5%, 29.7%) in patients with chronic LBP and 14.5% (95% CI: 10.8%, 18.3%) in the volunteers (P = .014). The corresponding values for the longissimus muscle were 29.3% (95% CI: 23.4%, 35.3%) in patients with LBP and 26.0% (95% CI: 21.9%, 30.0%) in the volunteers (P = .66). The semiquantitative grading of the fat content of the multifidus muscle was 0 in 12 (48%) of 25 patients and in 14 (56%) of 25 volunteers, 1 in 11 (44%) patients and in eight (32%) volunteers, and 2 in two (8%) patients and three (12%) volunteers. The semiquantitative grading of the fat content of the longissimus muscle was 0 in nine (36%) of 25 patients and 15 (60%) of 25 volunteers, 1 in 13 (52%) patients and nine (36%) volunteers, and 2 in three (12%) patients and one (4%) volunteer. Neither grade 3 nor grade 4 was assigned to any muscle. The grading differences were not significant between patients and volunteers. No significant correlation was found between fat content and pain intensity, pain duration, or self-rated disability. Proton MR spectroscopy demonstrates a significantly higher fat content in the multifidus muscle in patients with chronic LBP than in asymptomatic volunteers. No difference was detected with a semiquantitative grading system. (c) RSNA, 2006.
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                Author and article information

                Journal
                European Spine Journal
                Eur Spine J
                Springer Nature
                0940-6719
                1432-0932
                November 2015
                October 20 2015
                : 24
                : S7
                : 872-878
                Article
                10.1007/s00586-015-4274-6
                88535218-3f39-4abc-8bd2-836ba86ff228
                © 2015

                http://www.springer.com/tdm

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