Biomedical subjects

H Vanharanta

Publications and source records attributed to H Vanharanta.

At least 37 records · Page 2Linked to original sources

PubMed1998

Why do we need more information about the risk factors of the musculoskeletal pain disorders in childhood and adolescence?

Musculoskeletal pain disorders such as low back pain, neck pain and shoulder pain are a major and ever increasing public health problem among the working population in industrialized countries with social insurance. Especially the economic impact of these diseases on society has been rising, but the disorders do also produce a lot of pain and suffering to the people. It is an important challenge to the health care systems to prevent and treat these disorders, but at the moment poor understanding of the risk factors of these diseases has failed in giving any effective tools to control the musculoskeletal pain disorder epidemic. Most of the epidemiological studies made are cross-sectional and they do not extend to childhood and adolescence, when the organs are developing, achieving their loading strength and possibly being traumatized and starting their degenerative process. The longitudinal Northern Finland 1966 birth cohort study offers a unique opportunity to find early risk factors for musculoskeletal pain syndromes.

Adolescent↗

PubMed1998

Neck training and +Gz-related neck pain: a preliminary study.

This study compared the effects of two neck training methods on workdays lost or flying under +Gz restrictions because of +Gz-related neck pain, and on neck muscle strength and the passive cervical range of motion among fighter pilots. One group (n = 10) participated in dynamic neck and shoulder muscle training, and another (n = 10) participated in helmet training with additional weights. The measurements were done at 0, 3, 6, and 12 months. The loss of workdays or restrictions in +Gz flights were recorded during the 1-year training period and the year preceding it. Neck muscle strength increased similarly in both groups. Nevertheless, during the training year, the pilots doing dynamic exercises had fewer sick leaves and +Gz restrictions than the pilots doing helmet exercises. Because the number of subjects was small and the study included no control group, firm conclusions on the effects of the training methods cannot be drawn.

Absenteeism↗

PubMed1997

Degree of disc disruption and lower extremity pain.

STUDY DESIGN: Data were collected prospectively from patient-completed pain drawings, lumbar discographic pain responses, and computed tomographic-discographic images. OBJECTIVES: To determine if there were differences in pain location or the type of pain associated with the severity of symptomatic disc disruption. SUMMARY OF BACKGROUND DATA: Lower extremity pain related to spinal pathology was for a long time attributed primarily to nerve root compression. However, this simple model could not explain all lower extremity pain. Other mechanisms such as biochemical agents have been implicated. Also, nerve endings have been found in the outer layers of the anulus. Such endings could be associated with pain referred from the disc into the lower extremities. Pain drawings have been used in several studies to investigate various back pain origins and provide an easily administered method to document pain location. METHODS: Pain drawings were completed by 187 patients undergoing discography at the three lowest levels. The study group consisted of 118 men and 69 women with an average age of 37.2 years (range, 18-62 years). Computed tomographic discograms were scored using the Dallas discogram description, which assigns separate scores for discs with disruption of outer anular fibers (Grade 2) and those with disruption of the outermost anular layers associated with deformation or herniation of the outer anular well (Grade 3). The pain response provoked with each disc injection was recorded as pressure only or painless, pain dissimilar to clinical symptoms, similar to symptoms, or the exact reproduction of clinical pain, in this study, the similar and exact reproduction responses were combined and considered to be "symptomatic." The drawings were classified based on the presence or absence of pain in three regions: low back or buttocks, thigh, and leg. The drawings were also scored using the system described by Ransford, and those that were likely to be indicative of psychological problems were analyzed separately (N = 43). RESULTS: There was no significant difference in the distal location of lower extremity pain among patients whose most severe symptomatic disc disruption was a Grade 2 compared with those with symptomatic Grade 3 disruption (62.2% vs. 61.7%; P > 0.75; chi-square). The figure was similar for patients with both symptomatic Grade 2 and 3 disruption (72.7%). However, patients with symptomatic Grade 2 disruption used significantly more symbols to describe their pain, and in particular aching pain, than did those with symptomatic Grade 3 disruption. CONCLUSIONS: These results indicate that disc disruption passing into the outer layers of the anulus, but not resulting in deformation of the outer anular wall, was as frequently associated with lower extremity pain as were discs with more severe disruption deforming the outer anular wall; however, they were associated with a greater degree of aching pain. These findings support that lower extremity pain may be referred from the disc.

Adolescent↗

PubMed1997

Low synthesis rate of type I procollagen is normalized during active back rehabilitation.

STUDY DESIGN: Open, prospective trial with patients participating in an active back restoration program. OBJECTIVES: To compare the concentrations of biochemical indicators of Type I and III collagen synthesis and Type I collagen degradation in the serum of patients with chronic low back pain and healthy control subjects and to evaluate the effect of active back rehabilitation based on vigorous exercise on collagen metabolism. SUMMARY OF BACKGROUND DATA: The aim of active back rehabilitation is to restore the physical function of low back pain patients falling into the so-called "deconditioning syndrome." The changes in functional muscle strength measurements during the restoration rehabilitation program always depend on motivation, learning phenomena, and fear of pain and injury, so that even more objective ways of showing changes in physical activity are needed. METHODS: Specific radioimmunoassays for the amino-terminal (PINP) and carboxy-terminal (PICP) propeptides of Type I procollagen, the amino-terminal propeptide of Type III procollagen (PIIINP), and the cross-linked carboxy-terminal telopeptide of Type I collagen (ICTP) were used for serum samples obtained from 41 patients before, during, and after an active back restoration program and from 16 age- and sex-matched healthy control subjects. RESULTS: The circulating concentrations of PINP and PICP were initially lower in the patients ([mean +/- SD] 35.3 +/- 12.5 micrograms/L and 119.0 +/- 32.6 micrograms/L, respectively) than in the control subjects (47.9 +/- 18.0 micrograms/L and 136.7 +/- 47.7 micrograms/L, respectively; P < 0.05 for PINP). Toward the end of the active back rehabilitation program, both PINP and PICP increased in the patients (P < 0.001 for the increase between the initial level and the end of rehabilitation). There was a significant difference in the time courses of these changes, with the circulating PICP concentration increasing earlier than that of PINP. In the intervention group, the PIIINP concentration also increased (P < 0.01), whereas the ICTP concentration remained unchanged, with a tendency to decrease. No changes occurred in the control subjects. CONCLUSIONS: Active back rehabilitation based on vigorous exercise increases. Type I collagen synthesis in patients with chronic low back pain; this may provide a means of objectively verifying the effects of such rehabilitation.

Adult↗

PubMed1997

Bony vibration stimulation test combined with magnetic resonance imaging. Can discography be replaced?

STUDY DESIGN: The results of two noninvasive methods, magnetic resonance imaging and a bony vibration test, were compared with discographic pain provocation findings. OBJECTIVES: To evaluate whether the combination of magnetic resonance imaging and vibration pain provocation tests could be used to replace discography in low back pain diagnostics. SUMMARY OF BACKGROUND DATA: Magnetic resonance imaging gives a wealth of visual information on anatomic changes of the spine with often unknown clinical significance. Discographic examination of the spine is still the only widely accepted diagnostic method that can relate the pathoanatomic changes to the patient's clinical pain. Internal anular rupture has been shown to be one of the sources of back pain. The bony vibration test of the spinal processes has been shown correlate well with discographic pain provocation tests in cases of internal anular rupture. METHODS: The three lowest lumbar discs of 33 patients with back pain were examined by means of magnetic resonance imaging and a bony vibration stimulation test, and the results were compared with those from computed tomography-discography. RESULTS: In cases of intradiscal magnetic resonance imaging findings, the vibration provocation test showed a sensitivity of 0.88 and a specificity of 0.50 compared with the discographic pain provocation test. If the patients with previous back surgery were excluded, the specificity was 0.75. In the cases of total anular rupture, the sensitivity was 0.50, and the specificity was 0.33. CONCLUSION: The combination of the two noninvasive methods, vibration stimulation and magnetic resonance imaging, gives more information on the origin of the back pain than magnetic resonance imaging alone. The pathoanatomic changes seen in magnetic resonance imaging can be correlated with the patient's disorder more reliably using the vibration provocation test in the cases of partial anular ruptures. The use of discography can be limited mostly to cases with total anular ruptures detected by magnetic resonance imaging.

Adult↗

PubMed1997

Bilaterally decreased motor performance of arms in patients with chronic tennis elbow.

OBJECTIVE: To measure the motor performance of arms in patients with chronic unilateral tennis elbow. DESIGN: Cross-sectional case-control study. SETTING: University hospital clinic admitting chronic hand patients. SUBJECTS: Thirty-two patients with chronic unilateral tennis elbow syndrome and 32 age- and gender-matched controls. MAIN OUTCOME MEASURES: The motor performance of arms was measured with the Human Performance Measurement/Basic Elements of Performance system using the module for hands and the protocol of the device. Reaction times, speed of movement, and coordination as a combination of speed of movement and accuracy (number of correct hits) were measured. The results were compared between patients and controls. RESULTS: Simple one-choice and two-choice reaction times were 19% to 36% slower in the patients than in the controls, and speed of movement was 31% to 32% slower in the patients than in the controls. The differences were statistically significant. The coordination results were 9.6bits/sec in the patients and 9.7bits/sec in the controls. The difference was not statistically significant. The reaction times and speed of movement did not differ significantly between the patients' involved and healthy arms. The patients' healthy arms showed significantly slower reaction times and speed of movement than the corresponding arms of the controls. CONCLUSIONS: Unilateral chronic tennis elbow patients have bilaterally decreased reaction times and speed of movement of arms compared with age- and gender-matched controls. The cause for this phenomenon is unclear; the decreased motor performance may be primary and show an increased susceptibility to develop the tennis elbow syndrome or it may be a result of chronicity.

Adult↗

PubMed1997

Height changes among chronic low back pain patients during intense physical exercise.

The possible effects of intense physical exercise on the total body stature of low back pain patients were monitored by circadian total body height measurements. The height was measured with a statiometer, and the change in height was correlated with the changes in the range of motion, pain and subjective disability and degree of disc degeneration seen on magnetic resonance imaging (MRI) pictures. The stature of 24 low back pain patients was measured during a 3-week period. There was an increase of about 3 mm in height after only 4 days of exercise, and by the end of the programme the morning height increased on average by 7.2 mm. There were also 12 non-rehabilitated low back pain patients but no such increase was noted among them. The gain of height and reduction of pain were found to be statistically significantly correlated (P = 0.0001, r = -0.41), as did the gain of height and the decrease of back disability (Oswestry index) (P < 0.0001, r = -0.39). Circadian total height measures but not the MR images will change due to the active back rehabilitation programme.

Adult↗

PubMed1997

The effect of strapping on the motor performance of the ankle and wrist joints.

The purpose of this study was to examine the effect of strapping on different components of motor performance of wrist and ankle joints. The subjects were 14 healthy volunteers (12 females, two males), aged 21-33 years, with no known previous injuries of the ankle and wrist joints. The measurements were made with the HPM/BEP system and Isokinetic Lido Active Multi-joint system. First, the subjects performed the test without strapping and then, on the following day, with strapped right wrist and ankle joints. The strapping of the wrist increased the simple reaction time by 9%, choice reaction time by 9% and decreased the wrist tapping speed by 21%. Wrist strength decreased in flexion (180 degrees/s) by 14% and ulnar deviation (180 degrees/s) by 8%. The strapping of the ankle increased the simple reaction time by 12%, choice reaction time by 9% and decreased foot tapping speed by 14%. Ankle strength in plantar flexion decreased in 60 degrees/s by 22% and 180 degrees/s by 14% and in inversion in 60 degrees/s by 28% and 180 degrees/s by 15%. These results suggest the strapping of ankle and wrist joints reduces motor performance in the above-mentioned directions as measured by the following parameters: simple reaction time, choice reaction time, tapping speed, and muscle strength.

Adult↗

PubMed1996

A controlled biochemical and immunohistochemical study of human synovial-type (group II) phospholipase A2 and inflammatory cells in macroscopically normal, degenerated, and herniated human lumbar disc tissues.

STUDY DESIGN: Group II phospholipase A2 enzyme activity was studied biochemically and immunohistochemically in tissue samples from disc prolapses, degenerated discs, and macroscopically normal discs. In parallel, phospholipase A2 and inflammatory cells were studied by indirect immunocytochemistry. OBJECTIVES: To compare phospholipase A2 activity in normal discs and abnormal discs by an identical assay for phospholipases A2, and to compare the occurrence of inflammatory cells with phospholipase A2 activity and immunoreactivity. SUMMARY OF BACKGROUND DATA: It has been suggested that a high phospholipase A2 enzyme activity in herniated disc tissue could be significant in abnormal states such as sciatica and discogenic pain. No comparison between healthy disc tissue and samples of abnormal discs (degenerated or herniated) has been carried out. In particular, an identical assay for phospholipase A2 for such tissue samples, supported by immunohistochemical staining data, has never been applied in parallel to normal and abnormal disc tissue, and neither have such results been compared with the demonstration of inflammatory cells. METHODS: Group II phospholipase A2 enzyme activity was determined, in parallel, using an identical assay for tissue samples from 11 macroscopically normal discs, 33 disc herniations, and six discs showing degeneration by discography. For determination of phospholipase A2 enzyme activity, a radioassay using 1-palmitoyl-2-(1-14C)linoleoyl-L-3-phosphatidylethanolamine as the phospholipid substrate was used. Total tissue DNA as an estimate of total tissue cell number was measured in parallel with phospholipase A2 activity. All tissue samples also were studied by indirect immunocytochemistry, locating phospholipase A2 and T and B lymphocytes. RESULTS: Neither degenerated nor herniated disc tissue samples demonstrated a higher phospholipase A2 activity than control disc tissue samples. Average phospholipase A2 activity was actually higher in the control samples than in herniated disc samples (Mann-Whitney test, P < 0.001), possibly a result of a higher total DNA (P < 0.005). The observed level of phospholipase A2 activity was lower than that of inflammatory human synovial fluid. Neither was there marked immunoreactivity for phospholipase A2, which was observed in chondrocytes in areas of cartilage and occasional disc cells, supporting the biochemical results. Lymphocytes were more numerous only in herniated disc samples (15%), and their presence showed little overlap with phospholipase A2 immunoreactivity. CONCLUSIONS: Synovial-type (Group II) phospholipase A2 enzyme activity is not particularly high in disc tissue and does not appear to be higher in herniated or degenerated discs than control disc tissue. Immunoreactivity to phospholipase A2 is seen only occasionally and is strong only when cartilage tissue is present. Neither are inflammatory lymphocytes commonly observed.

Adult↗

PubMed1996

Ultrasonic imaging of lumbar discs combined with vibration pain provocation compared with discography in the diagnosis of internal anular fissures of the lumbar spine.

STUDY DESIGN: The diagnostic information achieved by a combination of ultrasonographic imaging of discs and local bony vibration of lumbar vertebrae was compared to that obtained by discographic imaging and pain provocation. OBJECTIVES: The purpose of this study was to find a noninvasive method for spine diagnostics to replace expensive and invasive methods such as discography. SUMMARY OF BACKGROUND DATA: Internal anular fissures of the lumbar discs have been shown to be a source of back pain. Intradiscal changes associated with disc degeneration can be imaged by ultrasonography. The bony vibration test of spinal processes has shown to correlate well with discographic pain provocation tests in cases of internal anular ruptures. Discographic examination of the spine is the only widely accepted diagnostic method that combines pathoanatomic changes and patients' pain. METHODS: Patients with back pain in this study were examined by means of ultrasonography, bony vibration stimulation, and discography. The three lowest lumbar discs were examined. RESULTS: In the cases of intradiscal ultrasound findings, the vibration provocation test showed a sensitivity of 0.90 and a specificity of 0.75 compared to the discographic pain provocation test. In cases of total anular ruptures seen in ultrasound examination, the sensitivity and the specificity of the vibration pain provocation test were much lower, being 0.50 and 0.50, respectively. CONCLUSION: The combination of the two noninvasive methods provides a useful screening test for the evaluation of low back pain. The combination test can accurately depict painful disc degeneration with internal disc rupture and the use of discography can be limited to the cases suggesting total anular rupture in ultrasound examination.

Adult↗

PubMed1996

Discographic pain report. Influence of psychological factors.

STUDY DESIGN: The possibility of a relationship between discographic pain responses and Minnesota Multiphasic Personality inventory scores was investigated. OBJECTIVES: To determine if patients with elevated Minnesota Multiphasic Personality Inventory scale scores were more likely to report pain on the injection of a nondisrupted disc than were patients without such high scores. SUMMARY OF BACKGROUND DATA: In general, injection into disrupted discs provokes pain, whereas injection into nondisrupted discs does not. However, discordant results are sometimes obtained and create a more difficult diagnostic challenge. METHODS: The primary study group was composed of 72 patients who underwent computed tomography/discography at the three lowest lumbar levels for diagnostic purposes and completed the Minnesota Multiphasic Personality Inventory. RESULTS: The mean scores on the Minnesota Multiphasic Personality Inventory hypochondriasis and hysteria scales were significantly greater for patients reporting reproduction of clinical pain than for patients not reporting pain on injection of a nondisrupted disc (hypochondriasis: 77.2 vs. 68.6, P < 0.01; hysteria: 74.5 vs. 68.3, P < 0.05). The scores on the depression scale followed a similar trend (68.6 vs. 63.6, P < 0.15). Multivariate analysis, adjusting the means for possible confounding effects of age, symptom duration, and sex, did not alter the results. CONCLUSIONS: Discographic pain reports are not only related to anatomic abnormalities, but are influenced by personality as assessed by the Minnesota Multiphasic Personality Inventory. Patients with elevated scores on the hypochondriasis, hysteria, and depression scales may tend to overreport pain during discographic injection. Among such patients, even those with a concordant computed tomography/discographic image, selection of therapeutic modalities should be made with caution.

Adult↗

PubMed1996

Isokinetic evaluation of calf muscle performance after Achilles rupture repair.

The purposes of this study was 1) to assess the plantar flexion and dorsiflexion peak torques (PT) of the ankles at 30, 90 and 240.. s-1 in 101 patients (86 men, 15 women) who had been operated on for unilateral, complete closed Achilles tendon (AT) rupture at Oulu University Hospital, Oulu, Finland, in the period 1987-1992, 2) to determine whether comparison between the legs shows any impairment, 3) to study whether the weakness is speed-dependent, 4) to determine at what angular displacement of the ankle the weakness is manifested, 5) to study how the results correlate with age, type of operation and follow-up time. The Lido Multi-joint II dynamometer was used for the measurements. There was no significant dorsiflexion weakness detectable upon comparison between the legs, but the mean relative peak torque deficits in the injured limb were 8.4, 9.0 and 3.0% at 30, 90 and 240.. s-1 respectively for the men and 15.0, 16.6 and 6.4% for the women. The mean percentage torque differences were significantly greater in the women at all the test speeds (p < 0.05). The difference in PT was significantly greater at the two low test speeds (30 and 90.. s-1) than at the high speed (240.. s-1, p < 0.001). The weakness was manifested at an angular displacement of 80-120 degrees, where the average peak work (PW) difference between the two legs was significant in both sexes (p < 0.05). The patient's age (21-63), the type of operation (Lindholm or Silfverskiöld technique) and the follow-up time (0.7-6.7 years) did not significantly affect the results. In conclusion, and AT rupture implied an average 3.0 to 16.6% impairment in isokinetic plantar flexion muscle strength. The impairment was greater in the women, was manifested at an angular displacement of 80-120 degrees, and was greater at low test speeds. Age, type of operation and follow-up time did not account for the PT differences between the patients.

Achilles Tendon↗

PubMed1996

Quantification of muscle strength in recessive myotonia congenita.

In order to quantify muscle strength in recessive myotonia congenita (MC) the peak and average peak torques (PT and APT, respectively) of knee flexion and extension of 19 MC patients were measured at speeds of 60 degrees/s and 200 degrees/s. Muscle endurance was measured at a speed of 200 degrees/s. No differences were found between the patient and control groups for PT and APT values for flexion at the high speed, nor were there any differences between the patients and the controls for PT and APT measured at the low speed for knee flexion and extension or muscle endurance at the high speed. However, PT and APT values of the patients for extension at the high speed, 100 +/- 41 Nm (mean +/- SD) and 95 +/- 39, were significantly lower than those of the controls, 129 +/- 43 and 124 +/- 42, respectively. There was no correlation between muscle strength or endurance and disease severity. The muscle strength of the patient group was diminished (p < 0.0001) during the beginning of the measurement at the high speed. The results suggest that after myotonic inhibition subsides the muscle strength of MC patients ranges within normal limits except in rapid and powerful motor activities.

Adult↗

PubMed1996

Influences of aging, gender, and handedness on motor performance of upper and lower extremities.

The purpose of this study was to collect reference data on different aspects of performance, including reaction time, speed of movement, tapping speed, and coordination of hands and feet using Human Performance Measurement/Basic Elements of Performance equipment and reports of reference data findings. Also, the reliability of the measurements is presented. 200 healthy, randomly selected subjects (100 men, 100 women; aged 21-70 years) were categorized by gender and by age decade into ten groups. The test battery consisted of six tests for both hands and feet. In general, the performance decreased clearly after 50 years in both genders. There were statistically significant differences between hands and feet, dominant and non-dominant sides, age groups, and number of choices, and especially between men and women.

Adult↗

PubMed1996

Spinal shrinkage due to +Gz forces.

BACKGROUND: Fighter pilots frequently complain of inflight pain in the cervical or lumbar spine. As to the cervical spine, there is evidence that repeated exposures to high +Gz forces and inflight neck pain may cause premature cervical disk degeneration. Whether inflight lumbar pain caused by high +Gz forces has a similar effect on the lumbar spine has not been studied. HYPOTHESIS: The aim of the study was to investigate whether high +Gz forces during aerial combat maneuvering reduces the body height. Investigation to determine whether any long-term degenerative changes occur in the lumbar spine was beyond the scope of this study. METHODS: The body height of 20 junior fighter pilots was measured before and after 30 min of recumbent rest and after high-G flights. A special measuring device was used. Measurements were also made with the pilots sitting fully equipped in a fighter aircraft on the ground. RESULTS: Maneuvering under high +Gz forces for 40 min caused a 4.9 mm decrease in body height. Recumbent rest before flights increased body height by 2.5-3.5 mm, and sitting in an aircraft returned body height to the values measured before rest. CONCLUSIONS: The findings indicate that +Gz forces place a high stress on the spinal column. Therefore, the work of a fighter pilot can be considered to be physically demanding with respect to the spinal column.

Adult↗

PubMed1995

Effects of tiaprofenic acid and indomethacin on proteoglycans in the degenerating porcine intervertebral disc.

STUDY DESIGN: Eighteen pigs were stabbed with a scalpel in the anterior part of the anulus fibrosus of a lumbar disc. After surgery, the pigs received either tiaprofenic acid or indomethacin daily, and a third group did not receive any medication. OBJECTIVES: Nonsteroidal anti-inflammatory agents are widely used in the treatment of low back patients, but their long-term effects on the matrix molecules in the degenerate disc are unknown. SUMMARY OF BACKGROUND DATA: Several in vitro and in vivo studies on articular cartilage have suggested that tiaprofenic acid may not have adverse effects on matrix metabolism, whereas indomethacin probably does. METHODS: Uronic acid, DNA, and water contents were determined from five different locations in each injured disc. Transport and incorporation of sulfate were examined by in vivo radioactive tracer analysis, and proteoglycan structures were analyzed by gel electrophoresis. RESULTS: Morphologically, there were no differences between the treatments. Tiaprofenic acid maintained a higher uronic acid content in the nucleus pulposus and outer anulus compared with that of the nonmedicated animals. Tiaprofenic acid decreased the incorporation of sulfate in the injured area and the water content at most sites. Indomethacin had no adverse effects compared with the nonmedicated group, and it increased water content in the posterior anulus fibrosus. CONCLUSIONS: Long-term administration of tiaprofenic acid and indomethacin did not have harmful effects on matrix metabolism after disc injury. On the contrary, tiaprofenic acid may slightly protect proteoglycans in the degenerating disc.

Animals↗

PubMed1995

The association between pain drawings and computed tomographic/discographic pain responses.

STUDY DESIGN: Pain drawings were scored and their relationship to discographic pain responses was investigated. OBJECTIVES: The purpose of this study was to determine if there was a relationship between patients indicating pain in nonanatomic patterns on pain drawings (possibly suggestive of a tendency to overreport pain) and discographic pain responses, and in particular, if patients with abnormal drawings were more likely to provide false-positive discographic pain reports. SUMMARY OF BACKGROUND DATA: Patients with abnormal pain drawings have been found to have elevated scores on the hysteria and hypochondriasis scales of the Minnesota Multiphasic Personality Inventory. Elevations on these same two scales have been related to discordant discographic pain reports. METHODS: Pain drawings were completed by 170 patients the day of, but before computed tomography/discography. The drawings were scored as described by Ransford et al and classified as normal or abnormal. The number of levels at which a patient reported pain and the incidence of false-positive computed tomographic/discographic pain reports were compared for the two pain drawing groups. RESULTS: Patients with abnormal drawings reported pain at more levels than patients with normal ones. When dealing specifically with false-positive pain reports (pain reproduction on the injection of a nondisrupted disc), among the 105 patients in the normal group, only 13 (12.3%) reported false-positive pain. This was significantly less than the 50.0% (18 of 36) reporting false-positive pain in the abnormal group. The overall accuracy of pain drawings in differentiating patients with false-positive pain reports was 78.0% (110 of 141). CONCLUSIONS: There is a relationship between pain drawings and discographic pain responses. Pain drawings can help identify patients who may be likely to report pain on injection of a nondisrupted disc. While it was not totally sensitive to this occurrence, it can help identify at least some of the patients in whom pain responses should be interpreted cautiously.

Adult↗

PubMed1995

Collagen synthesis and types I, III, IV, and VI collagens in an animal model of disc degeneration.

STUDY DESIGN: The present study sought to elucidate the changes that occur in collagen chemistry in the early phases of disc degeneration. OBJECTIVE: To monitor the healing process of the injured anulus fibrosus and the secondary degenerative reactions in the nucleus pulposus. SUMMARY OF BACKGROUND DATA: Despite the importance of collagen chemistry under pathologic conditions in the intervertebral disc, knowledge of this aspect is very limited. METHODS: Fourteen pigs were stabbed with a scalpel blade in the anterior part of the anulus fibrosus of a lumbar disc. The animals were killed 2 weeks to 5 months after injury. The activities of prolyl 4-hydroxylase and galactosylhydroxylysyl glucosyltransferase, the total collagen content, and staining patterns for Types I, III, IV, and VI collagens were analyzed from different parts of the disc. RESULTS: The most active phase of the healing process, assessed from the activities of enzymes involved in collagen biosynthesis, took place during the first month postoperatively. The anular lesion was found to cicatrize through formation of disorganized granulation tissue in which Type I, III, and, IV collagens were deposited. In the nucleus pulposus, activities of prolyl 4-hydroxylase and galactosylhydroxylysyl glucosyltransferase and total collagen content increased, and the originally rounded cells became more elongated, resembling fibroblasts. CONCLUSIONS: The results of this study suggest that the altered composition of collagens observed in the degenerate porcine nucleus pulposus results from changes in cell phenotype: Notochondral cells were replaced by fibroblast-like cells. It is likely that trauma to the anulus fibrosus can initiate a progressive degenerative process in the disc tissue.

Animals↗