SCENARIO OF CERVICAL PAIN IN YOUNG IT PROFESSIONALS DUE TO SPONDYLOTIC CHANGES, PREVENTION, CONTROL AND MANAGEMENT

There was increasing number of cases about neck pain in last few years at IT places. The reason behind the pain was prolonged neck flexing which leads to early Cervical Spondylosis, nerve root compression and radiculopathy to arms. Young IT professionals were affected major by this unavoidable condition due to lot of pressure, stress and postural dysfunctions. These mechanical changes can cause severe damage in future. Young generations should be cautious and aware about the symptom and nature of pain, which might be cured by early preventions, control measures and physiotherapy management.

Hemorrhagic Ligamentum Flavum Cyst Associated with Adjacent Bone Erosion: an Uncommon Subtype of Juxta-Facet Cyst—a Case Presentation

Ligamentum flavum cyst of the lumbar spine has seldom been described. The mechanism of formation of these cysts remains unknown, but it is thought to be part of the degenerative process. Although they are clearly visible on imaging studies, these cysts are frequently wrongly diagnosed as ganglion or synovial cysts. Bone erosion is rarely associated with this pathology. Most common symptom is back and radicular pain due to nerve root compression. We report a case of ligamentum flavum cyst associated with bone remodeling presented with back and radicular pain. It was correctly diagnosed pre-operatively and treated surgically with satisfactory clinical outcome.

Using the Compressed Sensing Technique for Lumbar Vertebrae Imaging: Comparison with Conventional Parallel Imaging

Objective: To compare conventional sensitivity encoding turbo spin-echo (SENSE-TSE) with compressed sensing plus SENSE turbo spin-echo (CS-TSE) in lumbar vertebrae magnetic resonance imaging (MRI). Methods: This retrospective study of lumbar vertebrae MRI included 600 patients; 300 patients received SENSE-TSE and 300 patients received CS-TSE. The SENSE acceleration factor was 1.4 for T1WI, 1.7 for T2WI, and 1.7 for PDWI. The CS total acceleration factor was 2.4, 3.6, 4.0, and 4.0 for T1WI, T2WI, PDWI sagittal, and T2WI transverse, respectively. The image quality of each MRI sequence was evaluated objectively by the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) and subjectively on a five-point scale. Two radiologists independently reviewed the MRI sequences of the 300 patients receiving CS-TSE, and their diagnostic consistency was evaluated. The degree of intervertebral foraminal stenosis and nerve root compression was assessed using the T1WI sagittal and T2WI transverse images. Results: The scan time was reduced from 7 min 28 s to 4 min 26 s with CSTSE. The median score of nerve root image quality was 5 (p > 0.05). The diagnostic consistency using CS-TSE images between the two radiologists was high for diagnosing lumbar diseases (κ > 0.75) and for evaluating the degree of lumbar foraminal stenosis and nerve root compression (κ = 0.882). No differences between SENSE-TSE and CS-TSE were observed for sensitivity, specificity, positive predictive value, or negative predictive value. Conclusion: CS-TSE has potential for diagnosing lumbar vertebrae and disc disorders.

Non-Resolving Sciatica Due to Sacroiliac Joint Osteophyte Compressing the Sciatic Nerve in a Young Patient: A Case Report and Literature Review

Sciatica is a common syndrome mostly affecting adults. It has a wide range of etiologies, classified into intra- and extra-spinal, with intra-spinal being the most common, usually due to lumbar disc herniation causing nerve root compression. Sacroiliac (SI) joint pathologies are a known cause of extra-spinal sciatica syndrome, following multiple possible mechanisms. We report a case of a 33-year-old female patient who presented for non-resolving sciatica symptoms, found to have an inferior SI joint osteophyte compressing the sciatic nerve, who underwent surgical excision due to failure of conservative measures. All causes of sciatica related pain should be subjected to further investigations if not attributed clinically and radiologically to intra-spinal etiologies. SI joint imaging play an important role in the diagnosis of SI joint related sciatica, with the gold standard being an intra-articular anesthetic injection, to monitor for symptom relief in order to confirm the diagnosis, and choose the optimal treatment modality.

Weight-Bearing MRI of the Lumbosacral Spine: Difference between Supine and Weight Bearing Positions and Additional Value in Patients with Low Back Pain

Objective: To study the difference of magnetic resonance imaging (MRI) parameters of the lumbosacral spine between weight-bearing and supine positions, and evaluate whether there is additional value in patients with low back pain. Materials and Methods: Eight-six patients with low back pain with or without leg pain who underwent MRI of the lumbosacral spine in weight-bearing and supine positions were included in the present retrospective study. The patients’ characteristics and MRI parameters were measured. The data were analyzed to find significant differences between these two positions. Results: MRI parameters which significantly increased in weight-bearing position compared to supine position (p<0.05) included lumbar lordotic angle, lumbosacral angle, presence of spondylolisthesis (at L4/L5 level), and presence of nerve root compression (at L3/L4, L4/L5, and L5/S1 levels). Parameters or findings that significantly decreased were spinal canal diameter (at L2/L3, L4/L5, and L5/S1 levels), and intervertebral disk height (at L2/L3, L4/L5, and L5/S1 levels). Older age group (mean age of 54.3 years versus 45.6 years as younger group) showed a significant change in number of nerve root compression. Forty-three percent of patients with radiating symptom showed a changed number of nerve root compression but this was not statistically significant. Conclusion: Multiple MRI parameters of the lumbosacral spine show significant change in weight-bearing compared to supine position. Increased presence of spondylolisthesis and nerve root compression might be beneficial in patients with radiating symptom unexplained by conventional MR studies in supine position. Older age group showed a significant change in number of nerve root compression. Keywords: Weight-bearing, MRI, Lumbar spine, Back pain

Ligamentum Flavum Hematoma Associated with L5–S1 Pars Interarticularis Defect: A Case Report and Review of the Literature

Ligamentum flavum hematoma (LFH) is an extremely rare compressive epidural lesion of the spine. The clinical manifestations of LFH are similar to that caused by other more common pathologies of nerve root compression like disc herniation. In the diagnosis, magnetic resonance imaging (MRI) is very important but challenging due to the changing intensities of the hematoma in relation to the stages of the aging blood. Herein, we report a case of LFH compressing the spinal canal in a 60-year-old man with pars interarticularis defect. He presented with low back pain radiating to the left leg. The neurological examination was consistent with left S1 nerve root compression. The MRI revealed a left posterior epidural mass compressing the thecal sac and S1 nerve root at the left L5–S1 level near the pars interarticularis defect. After surgical removal of the lesion, histopathological examination confirmed the diagnosis of LFH. Following surgery, he recovered rapidly. LFH due to spinal instability is important in terms of the understanding of the pathophysiological mechanisms related with LFH.