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Conventional measures of radiologist efficiency, such as the relative value unit, fail to account for variations in the complexity and difficulty of a given study. For lumbar spine MRI (LMRI), an ideal performance metric should account for the global severity of lumbar degenerative disease (LSDD) which may influence reporting time (RT), thereby affecting clinical productivity. This study aims to derive a global LSDD metric and estimate its effect on RT. A 10-year archive of LMRI reports comprising 13,388 exams was reviewed. Objective reporting timestamps were used to calculate RT. A natural language processing (NLP) tool was used to extract radiologist-assigned stenosis severity using a 6-point scale (0 = “normal” to 5 = “severe”) at each lumbar level. The composite severity score (CSS) was calculated as the sum of each of 18 stenosis grades. The predictive values of CSS, sex, age, radiologist identity, and referring service on RT were examined with multiple regression models. The NLP tool accurately classified LSDD in 94.8% of cases in a validation set. The CSS increased with patient age and differed between men and women. In a univariable model, CSS was a significant predictor of mean RT (R2 = 0.38, p p R2 = 0.83, p 25, R2 = 0.15, p = 0.05). Individual radiologist study volume was negatively correlated with mean RT (Pearson’s R = − 0.35, p

Age-related macular degeneration (AMD) is a degenerative disease of the human retina affecting individuals over the age of 55 years. This heterogeneous condition arises from a complex interplay between age, genetics, and environmental factors including smoking and diet. It is the leading cause of blindness in industrialized countries. Worldwide, the number of people with AMD is predicted to increase from 196 million in 2020 to 288 million by 2040. By this time, Asia is predicted to have the largest number of people with the disease. Distinct patterns of AMD prevalence and phenotype are seen between geographical areas that are not explained fully by disparities in population structures. AMD is classified into early, intermediate, and late stages. The early and intermediate stages, when visual symptoms are typically absent or mild, are characterized by macular deposits (drusen) and pigmentary abnormalities. Through risk prediction calculators, grading these features helps predict the risk of progression to late AMD. Late AMD is divided into neovascular and atrophic forms, though these can coexist. The defining lesions are macular neovascularization and geographic atrophy, respectively. At this stage, visual symptoms are often severe and irreversible, and can comprise profoundly decreased central vision in both eyes. For these reasons, the condition has major implications for individuals and society, as affected individuals may experience substantially decreased quality of life and independence. Recent advances in retinal imaging have led to the recognition of an expanded set of AMD phenotypes, including reticular pseudodrusen, nonexudative macular neovascularization, and subtypes of atrophy. These developments may lead to refinements in current classification systems.

Alzheimer’s is a degenerative disease with changes occurring in different regions of the brain at different rates resulting in progressive deterioration. A lot of functional brain connectivity is altered, the process itself is insufficiently understood. In this work, an attempt is made to understand the progressive deterioration of the brain by locating the regions that show significant changes in the connectivity in the five lobes of the brain at different stages of the disease. Methods available in social network analysis like community and maximal clique analysis along with degree distributions, and centrality measures have been used to observe the network evolution of these regions at different stages. Networks of four diagnostic stages i.e., Normal, Early MCI (eMCI), Late MCI (lMCI), and Alzheimer’s Disease (AD), taken from ADNI (Alzheimer’s Disease Neuroimaging Initiative) database, are used for this study. Nine Regions of Interest (ROIs) from the five lobes are identified and a higher degree of change is observed in the connections of regions from the temporal and frontal lobes. There is a splurge of new connections in the eMCI stage for all regions except for those from the frontal lobe. We also observed more rearrangement among the left hemisphere nodes as compared to the right hemisphere nodes. There is an overall loss of edges between the normal and AD stages. This confirms that the study is able to identify the regions that are affected by the progression of the disease.

Osteoarthritis is a degenerative disease of the entire joint, including the articular cartilage, the subchondral bone, muscles, ligaments, synovium, capsules, and the menisci [1, 2]. It is the most prevalent debilitating joint disorder in the elderly, and its occurrence is continuously increasing with the increasing age and obesity of the global population [3]. Osteoarthritic degeneration is also commonly initiated by previous injuries of the articular cartilage [4].

This chapter will discuss the knee, the largest synovial joint in the body. It will cover the normal bony anatomy and geometry of the knee and how this gives rise to its complex biomechanics which go beyond a simple hinge. The factors stabilising the knee during its motion will be discussed and how these stabilisers have both primary and secondary restraint functions. It will also discuss our current understanding of pathophysiology of the most common degenerative disease affecting the knee, osteoarthritis as well as its clinical and radiological features, with a brief discussion of the various management options available.

Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system, with lesions disseminated in time (relapses) and in space of white (WM) and gray matter (GM), damaging cognition networks and affecting predominantly information processing speed (IPS), attention, executive functions, and episodic memory. Here we deal with methodological issues, insufficiencies, and limitations of current research on MS cognitive dysfunction. For example, the often used timed tasks (SDMT, PASAT), though very sensitive to IPS reduction, may not reflect the real cognitive impairment due to neocortical, hippocampal, and thalamic GM lesions. Besides, the influence of other factors than the lesions, e.g., depression, fatigue, age, education, and MS sensory-motor incapacities, is frequently not considered. Overlapping syndromes as depression and fatigue are not assessed with instruments that might differentiate them (e.g., BDI-FS and FSMC). The often used cognitive screening tests (e.g., MMSE) and classical psychometric batteries are not designed for evaluating MS typical cognitive dysfunction. Therefore, other more suitable and shorter batteries (BRB-N, MACFIMS, BICAMS) were developed. Moreover, control tasks or appropriate multivariable analysis is frequently not used for verifying the influence of confounding variables (e.g., depression, deficit of attention) on performance in these batteries.

Degenerative disease of the spine is the most common indication for spinal imaging. Here, we discuss the degenerative pathology that occurs in all three spinal segments as these changes can be a primary source of the patient’s pain. This includes a discussion about the intervertebral disks and the changes that occur both with normal aging such as desiccation and flattening and pathologically such a herniations and fissures. It also includes a discussion about the different spinal joints such as facet joints and uncovertebral joints which hypertrophy, as well as important ligaments involved in degenerative disease such as the posterior longitudinal ligament and ligamentum flavum. Additionally, these changes occurring in the disks, joints, and ligaments can cause cumulative effects which narrow the spinal canal and neural foramen, potentially adding to the patient’s symptoms.

Lateral lumbar interbody fusion (LLIF) was first described in 2001 and has become increasingly popular as a minimally invasive approach for interbody fusion. An understanding of the iliopsoas muscle and lumbosacral plexus is imperative as this approach involves splitting the psoas muscle while using neuromonitoring to navigate around the plexus. The most common indication includes degenerative disease of the lumbar spine with fusion and biomechanical outcomes similar to the anterior approach.

The purpose of this chapter is to delineate the age-related degenerative changes of the spinal column, sacroiliac joints (SI), and hip joint. The spine has evolved to optimize locomotion by dispersing the associated forces throughout its elements and tissues, however, degeneration caused by repeated sprains, strains, and overuse can lead to painful conditions. Degenerative changes are progressive, irreversible, and often caused by aging and excessive usage. Degeneration of the spine imparts a large socioeconomic cost on the healthcare system. Understanding the pathophysiology of these degenerative changes is essential for targeting and treating the mechanisms of pain, rather than symptomatic treatment. In this chapter, we discuss the normal and pathological anatomy of the facet joints, sacroiliac joint, and hip joint; the primary focus is on the degenerative disease states associated with excess wear and tear and age-related degenerative changes.

Medial knee osteoarthritis (OA) is a progressive and degenerative disease characterized by a gradual and progressive destruction of the cartilage that covers the articular surface. OA has increased dramatically in recent years, mainly among young people basically due to sports injuries and overweight. It is one of the leading causes of the musculoskeletal pain and disability in adulthood. For those cases in which the damage at the medial knee zone with a slight to moderate articular wear, it has been proposed a femorotibial implant design which should stop the progression of the degenerative process and alleviate the pain without altering the anatomy and biomechanics of the knee joint. This study is made through computational programs, using the Finite Element Method (FEM), for modeling a three-dimensional assembly which is applied to analyze an implant with a mechanical function and the behavior of the device is studied. Once the femorotibial implant is designed and modeled, a structural numerical lineal-elastic analysis through FEM was made, with the objective to determine the total displacements, as well as, the stress field on the materials. A suitable device was obtained which produced very good results for the safety factor obtained from the stress analysis of the pieces. Finally, it is expected the patient is to be able to carry on his daily activities without pain and improving the quality of life.

Although cervical spondylosis is ubiquitous with aging, symptomatic cervical radiculopathy or myelopathy is much less common and is better named as cervical degenerative disease. Many people have degenerative radiographic changes without significant clinical symptoms. When symptomatic, cervical axial pain is generally managed nonsurgically. Cervical radiculopathy generally has a benign course, with improvement in days to weeks in the majority of patients. Surgery is reserved for those patients with severe pain refractory to medication and nonsurgical measures or those with progressive, significant neurological deficits. Cervical myelopathy due to spondylotic changes is the most common cause of spinal cord dysfunction in older adults. It is generally treated surgically, especially in those with progressive worsening. Recognizing signs and symptoms of severity are important for early referral of these patients for specific care, since surgical treatment may be necessary in some patients to improve or at least maintain neurological function.

Stenosis due to lumbar degenerative disease is associated with aging and often requires surgical treatment to provide decompression of the neural elements and alleviation of the symptoms. We present an 83-yo female patient, with neurological claudication and bilateral L5 paresis, treated with undercutting and bilateral flavectomy at the level L4-L5 without fusion. With this case we would like to illustrate the decision-making problem for or against fusion and the operative approach for adequate decompression without causing further instability. We discuss the indications of undercutting and the evidence against routinely performing fusion and compare our presentation to the current literature.

Cervical radiculopathy from degenerative disease is a common problem with an incidence of 0.83–1.79 per 1000 person years. It can be caused by a cervical disc herniation, bony foraminal stenosis or spinal canal stenosis. Upon failure of conservative therapy or a significant motor deficit surgical treatment is indicated. A posterior cervical foraminotomy is one surgical option for the treatment of selected patients with lateral cervical disc herniations.

Spondylosis is the term related to the degenerative changes that occur in the spine with aging, in all its segments. The majority of the population will have asymptomatic spondylosis. The most common symptoms of lumbar degenerative disease are back pain and radiculopathy and may be due to lumbar disc herniation and lumbar stenosis—the most common reasons for spinal surgery in the world. Lumbar disc herniation generally occurs in younger adults affecting the lower lumbar levels in most of the cases, whereas lumbar stenosis affects older patients. Lumbar radiculopathy secondary to disc herniation generally has a benign course, with symptomatic recovery in days or weeks with nonsurgical treatment. Surgery is indicated for those patients with severe pain refractory to medication and for those with progressive neurological deficits or cauda equina syndrome. Lumbar stenosis may require surgery in patients with refractory pain, functional limitation, or muscle weakness. Surgical treatment is based on decompressing the nerve roots.

Spinal column deformity is a well-known musculoskeletal complication following laminectomies for various spinal pathologies, such as intraspinal tumors, degenerative disease, or traumatic spinal injury. Post-laminectomy kyphosis is the most common deformity.

Prion disease (Creutzfeldt-Jakobs disease (CJD), bovine spongiform encephalitis (BSE), “mad cow disease”, etc.) is a slowly evolving degenerative disease caused by different types of “infected proteins” that can be found in all tissues and secretions from infected humans and animals (scrapie in sheep, chronic wasting disease of deer, moose, etc.). It is believed that the “infection” may also be associated with special neurodegenerative forms of dementia and other neurological diseases.

Parkinson’s disease, a degenerative neurologic condition, manifests itself differently in women than in men. Women are less likely to develop the disease and, when they do develop it, have a later onset than men. This chapter looks at a number of factors that may impact how the disease affects women differently than men including how genetic and hormonal differences may play a role. The expression of the disease, both motor and nonmotor symptoms, tends to be different in men and women also and treatment may be impacted by these differences. Finally, the data regarding pregnancy in Parkinson’s disease patients is reviewed.

This chapter comprises a quantitative analysis of skeletal lesions in the Gombe chimpanzees. I begin by comparing the skeletal sample with the living population of chimpanzees at Gombe as well as the population of chimpanzees from the Kasekela community who have died from 1960 to 2006. While the skeletal sample diverges from the living sample, there are several similarities between the skeletal sample and the death sample. Differences include that the skeletal sample includes more chimpanzees with a known cause of death. The chapter continues with a short analysis of arthropathy in a sample of 20 adult chimpanzees. The number of joints affected by degenerative disease increases with age. Next, I describe an analysis of dental lesions and related pathologies (n = 23 adult chimpanzees). I report how many chimpanzees are affected by dental lesions and results of tests for sex differences. Males have a statistically higher rate of dental caries than females, while no other lesion type demonstrated a detectable difference. The linear relationship between antemortem tooth loss and age was not significant, nor did the ages of chimpanzees with and without osteoarthritis of the temporomandibular joint (TMJ) differ statistically. The larger-scale analyses of skeletal lesions testing for sex differences, trends related to age, and differences between dominance rank categories examine a sample of 36 complete chimpanzee skeletons. Most animals are affected by skeletal trauma, pathology, or both. I report which body regions were most commonly affected by skeletal lesions, as well as the proportion of observed elements affected by lesions, and note several sex differences in lesion frequency. Age and traumatic lesions are related, but not in a simple, linear way. This is because traumatic lesion rate can depend on cause of death. Pathologic lesions, on the other hand, are strongly related to increased age. While there was some evidence that high-ranking males experience higher rates of skeletal trauma and pathology, the effect size of this relationship was smaller than the effect size for age. Chimpanzees accumulate skeletal lesions as they age, though the rate at which this happens is influenced by individual selective pressures. The chapter ends with a comparison of skeletal lesions in this sample from Gombe versus a chimpanzee skeletal sample from Kibale, Uganda. While there are broad similarities between the two samples, there are several significant differences likely driven by the limited samples. Because chimpanzees are a long-lived species, it is only possible to begin detecting patterns of skeletal lesions and the ways they are influenced by demographic categories after decades of study.

Spinal pain is a common disabling condition, that may often involve healthy individuals as well, for which many people seek medical attention in their lifetime; most of the times, it is an occasional condition which tends to limit itself, but in some cases, radiological investigations may be indicated to reach a certain diagnosis. Spinal pain (cervical, thoracic, and lumbar) can afflict both young and adult people, being an important cause of disability, in particular for working population. Several risk factors have been identified such as physical, occupational, and environmental ones, but also daily habits may be triggering for pain onset and maintenance. Many treatment options have been proposed for the management of spinal pain, i.e., analgesic medications, manipulative treatments, percutaneous interventional procedures, and surgical approaches as well. In this chapter they will be discussing several conditions which may be indicated as the main causes of pain; among these, degenerative disease is surely one of the most important sources of pain.

The neurological exam provides the foundation for clinical decision-making when treating patients with cervical degenerative disease. Clinicians should strive for a systematic and thorough approach, covering cervical alignment, skin, muscle bulk, range of motion, tone, motor, sensory modalities, reflexes, and gait. Special maneuvers are useful in confirming the diagnosis of cervical radiculopathy and/or myelopathy. Other maneuvers may be useful in distinguishing non-neurosurgical entities. Neurosurgeons should be adept in recognizing imitators of cervical pathology during the examination. Radiculopathy and myelopathy may present on a spectrum. Radiculopathy typically presents with pain, weakness, and/or paresthesias in a single or multiple nerve root distribution and has corresponding areas of deficit on examination. Myelopathy often presents with weakness, impaired coordination, and gait disturbance. Physical findings of severe cervical myelopathy include distal arm weakness, hyperreflexia, and gait instability. Radiculopathy and myelopathy are often encountered in neurosurgical practice; over the course of a clinician’s training, he or she should become adept in the cervical neurological exam.

Degenerative cervical myelopathy and radiculopathy are a leading cause of disability in the aging population. The two conditions are distinct but related and can often be seen in tandem. Myelopathy refers to damage to the spinal cord and central nervous system itself. This differs from radiculopathy which is damage or irritation of a nerve root that is part of the peripheral nervous system. In treating degenerative disease of the cervical spine, surgeons often can observe myeloradiculopathy which has characteristics of both central and peripheral nervous system dysfunctions.

The radiological signs that might be identified on conventional radiographs are mainly shape changes due to remodelling and degenerative disease. The most prevalent TMJ disorders produce few or no changes on conventional radiographs.

Spondylolysis and spondylolisthesis are both conditions occurring in pediatric and adult patients. Spondylolysis can lead to isthmic spondylolisthesis, but not all patients with spondylolysis develop spondylolisthesis. Older patients can develop spondylolisthesis from advanced degenerative disease.

Knee Osteoarthritis is a degenerative disease that produces an inflammatory response of the synovial membrane, cartilage and subchondral bone, and consequently produces pain and functional disability.

Although substantial progress has been made in the development of effective drugs for relapsing-remitting multiple sclerosis, no convincingly treatment exists to slow and/or reverse progressive forms of the disease. Advances in the field of cell-based therapies have opened to novel possible application to treat inflammatory and degenerative disease of the central nervous system including progressive MS. Major expectation arises from the use of (i) oligodendrocyte progenitor cells for directly replacing the damaged myelin and (ii) non-haematopoietic stem cells for the potential of influencing host immune response and endogenous mechanisms of repair. Each approach has potential advantages but also safety concerns and unresolved questions that are to be addressed in order to witness further advance in clinics.

OA is a degenerative disease of articular cartilage that occurs even in young people and results in pain, swelling, stiffness, a decreased ability to move and, sometimes, the formation of bone spurs (Arokoski in Scandinavian Journal of Medicine & Science in Sports 10:186–198, 2000; Sharma in Current opinion in rheumatology 13:441–446, 2001).

Nanotechnology has already been used for the purpose of the measurement as well as treatment of great number of ophthalmological diseases. The applications of Nanotechnology to Ophthalmology refer to the following: delivery of drugs, peptides and genes, biomedical imaging and diagnostics of distinct disorders of the eye, study of pathogenesis of the eye disease. Regenerative nanomedicine is considered to be a prospective approach for treating retinal degenerations and the second cranial nerve regeneration. Our manuscript included possible different application for ophthalmological drug using nanotechnology. Also, we described the importance of nanotechnology for imaging, diagnostic and monitoring of ocular diseases. Nanobiotechnology for glaucoma treatment, as well as nanoparticles for gene delivery therapy of retinal degenerative disease, is most attractive approach for the ophthalmological treatment.

Multiple sclerosis (MS) is a chronic, autoimmune, demyelinating, and degenerative disease that affects the central nervous system. The majority of patients are diagnosed between the ages of 20 and 40, and it is a leading cause of disability among young adults (Hauser and Goodin 2015; Lavery et al. 2014). MS typically presents with acute attacks of neurologic symptoms such as weakness, imbalance, vision loss, or numbness that are called “relapses,” and these occur early in the course of the most common form, historically known as relapsing-remitting MS (RRMS). Over time, increasing numbers of relapses contribute to disability accumulation (Fig. 18.1). At 19 years of disease duration, 75% of RRMS patients will have developed a more progressive course, whereby their worsening occurs in a steady decline and with fewer relapses (Confavreux and Vukusic 2006), a disease process historically known as secondary progressive MS (SPMS). In contrast, about 15% of patients will have progressive neurologic decline from the start, and this has been referred to as primary progressive MS (PPMS) (Lublin and Reingold 1996). In a 2013 effort to align the nomenclature with the underlying pathological changes, these diagnoses were renamed simply relapsing MS (RMS) and progressive MS (PMS) along with other, more subtle changes in diagnostic terminology that are beyond the scope of this chapter (Lublin et al. 2014).

The posterior approach to the thoracic spine is well established and is the workhorse for many spine surgeons. Posterior thoracic spinal fixation is used to restore spinal stability when its mechanical functions are disrupted by trauma, tumor, infection, degenerative disease, deformity, or surgical management of these disorders. Safe and effective instrumentation of the thoracic spine requires a thorough understanding of its anatomy and biomechanical properties. Complications associated with posterior thoracic spinal instrumentation can be broken down into several main categories: (1) patient positioning, (2) thoracic spine exposure, (3) instrumentation, and (4) postoperative.

A variety of leukocytes reside and function in the vascular wall in health and disease. Although inflammatory cells are meant to protect from diseases and injuries in general, in the context of atherosclerosis, chronic inflammation mounted by some cell types is actually harmfull. This chapter reviews the multifaceted contribution of inflammatory cells to vascular degenerative disease.

Osteoarthritis (OA) is a degenerative disease of a synovial joint that includes bone loss and progressive articular cartilage loss and may be determined radiographically in conjunction with clinical examination. This chapter highlights nonoperative management options to consider before joint replacement.

A review of the normal anatomy of the cervical spine and degenerative disease of the cervical spine is presented with imaging correlation.

Genes linked to major neurodegenerative diseases, including Alzheimer’s, Parkinson’s, and Huntington’s diseases, were first identified over 15 years ago, but neither a full molecular explanation for the cell loss seen in human patients nor a curative therapy has yet been achieved for any of these diseases. In most model organisms, when new hypotheses are needed to explain a cellular process, genetic screens are the tool of choice. For example, ‘synthetic lethal’ screens can lead to the identification of genes that enhance the toxicity of a particular mutation, revealing pathways critical for surviving the mutation’s effects. To date, however, genome-wide unbiased screens are not feasible in mammalian central nervous system neurons except in vitro, which fails to capture the relevant disease pathologies, and no genome-wide screens have yet been conducted in the mammalian central nervous system. We outline in this short monograph the steps needed to implement a methodology that allows for genome-wide genetic screening in the central nervous system of mice to study both normal and degenerative disease gene function.

Lumbar spinal stenosis (LSS) is a common degenerative disease of the lumbar spine that affects up to 8 % of the US population, particularly those over the age of 60 years [1–3]. If the stenosis is critically significant, neurogenic claudication can result from nerve root ischemia with the underlying causative theory being venous insufficiency as a result of venous constriction that becomes critically aggravated by exertion typically by standing a short time or walking a short distance.

Population ageing is occurring on a global scale, with faster ageing projected for the coming decades than has occurred in the past. The protective effect of moderate wine consumption against diseases associated with ageing such as cardiovascular disease, diabetes, neurodegenerative diseases, and certain cancers has been consistently observed over the past decades. All these diseases have an inflammatory component. Improving anti-inflammatory effects and endothelial function by means of drug and non-drug therapies such as moderate wine consumption might represent an important therapeutic target. There is sufficient epidemiological evidence accumulating plausible biological mechanisms to support an anti-inflammatory role for wine and wine-derived phenolic compounds such as resveratrol. Both the alcohol and phenolic components of wine, for example, have been observed to modulate soluble inflammatory mediators in vitro and in vivo. Further research is required to fully elucidate all the anti-inflammatory biological mechanisms of resveratrol and the other wine-derived phenolic compounds given that inflammation is a complex network of molecular and cellular interactions that facilitates a return to physiological homeostasis and tissue repair. A high level of risk factors for any degenerative disease and cancer may, however, mitigate any protective effects of moderate wine consumption.