High-intensity zones in dogs with lumbosacral intervertebral disc degeneration: insights from MRI and histopathological findings

The diagnosis and management of lumbosacral pain in dogs is challenging, requiring thorough examination, with MRI playing a crucial diagnostic role. This retrospective study investigates the presence of high-intensity zones (HIZ) in the dorsal annulus fibrosus (AF) of the lumbosacral region on MRI and describes the corresponding histopathological features in dogs with intervertebral disc (IVD) degeneration. T2-weighted (T2W) and T1-weighted (T1W) sagittal MRI scans were evaluated using a classification system developed in human medicine to analyze HIZ characteristics. Among 836 dogs with IVD degeneration, 57 (6.8%) exhibited T2W HIZ, with a median age of 7 years and median weight of 33.7 kg. All cases with HIZ consistently exhibited radiological degenerative lumbosacral stenosis. The most common T2W HIZ shape was round (43%), while 14% of lesions also appeared hyperintense on T1W. Histopathological analysis of 11 dorsal AF samples collected during standard-of-care decompressive surgery revealed two patterns: reactive cystic structures (3/11) and granulation tissue (8/11), with differential MRI presentation. This is the first study to document HIZ in the lumbosacral level of dogs with IVD degeneration. With this recognition, prospective analyses and their correlation with clinical presentations will be essential in determining the role and prognostic significance of HIZ.

TIGAR attenuates intervertebral disc degeneration via autophagy-mediated Keap1 degradation and Nrf2 nuclear translocation to suppress nucleus pulposus pyroptosis

Pyroptosis plays a pivotal role in intervertebral disc degeneration (IVDD) driven by oxidative-inflammatory cascades, inducing nucleus pulposus (NP) cell lysis through gasdermin-mediated pore formation and subsequent release of proinflammatory cytokines, including IL-1β and IL-18. TP53-induced glycolysis and apoptosis regulator (TIGAR) alleviates oxidative stress by scavenging reactive oxygen species (ROS); however, its involvement in the autophagy-pyroptosis axis mediating IVDD remains unclear. In this study, we aimed to investigate how TIGAR delays IVDD progression via the autophagy-pyroptosis axis. First, we discovered from the NP tissues collected from patients undergoing lumbar spine surgeries and mice with needle puncture-induced models that the expression of TIGAR was reduced in severely degenerated tissues. In the IL-1β-induced human NP cell, TIGAR knockdown exacerbated the degradation of the extracellular matrix and pyroptosis, whereas TIGAR overexpression reversed this phenomenon. Ultrastructural analysis via transmission electron microscopy (TEM) and autophagic flux quantification revealed TIGAR-mediated autophagy in NP cells under inflammatory conditions. Co-immunoprecipitation assays validated the formation of a Keap1-p62-ubiquitin ternary complex, which directed Keap1 toward lysosome-dependent degradation and enhanced Nrf2 nuclear translocation. Therapeutic intradiscal delivery of AAV-TIGAR attenuated IVDD progression in mouse models, evidenced by preserved disc height index and reduced histopathological scores. Collectively, this work identified TIGAR as a redox-sensitive molecular switch that mitigated oxidative stress and inflammasome-driven pyroptosis through Keap1 autophagic clearance, offering a novel therapeutic paradigm for precision-targeted IVDD intervention.

The occurrence of cervicogenic headache: A mapping review

BACKGROUND

Occurrence of cervicogenic headache (CeH), mostly expressed by estimates of the prevalence, ranges between 0.4% and 42%. However, transparency on such estimates is lacking, which hinders generalizing results.

OBJECTIVE

Mapping the occurrence (expressed by incidence/prevalence) of CeH.

DESIGN

Mapping review.

METHOD

A systematic literature search of PubMed, EMBASE, Web of Science, Scopus databases (last search update January 28th, 2025). The search query comprised terminology relating to "CeH", "prevalence", "incidence".

RESULTS

Thirty-four publications were included (prevalence n = 32, incidence n = 2). The prevalence of CeH varied depending on the geographical location (Norway: 0.17% - USA: 69%), population (age: 0.17%-56.7%, chronic headache: 0.17% - computer users: 64.5%), setting (inpatient: 13.8%-69%, outpatient: 0.38%-10%), diagnostic criteria (International Headache Society: 0.38%-40%, Cervicogenic Headache International Study Group: 0.17%-64.5%), and diagnostic process (questionnaires: 5.3%-64.5%, clinical examination: 0.17%-56.7%, diagnostic block: 0.17%-16.1%).

CONCLUSION

Most publications were retrieved from Europe, Asia, and the United States. One multicentre study provided results for the African continent. No conclusion could be drawn on the incidence of CeH. The populations studied (e.g., general, age-stratified, specific), settings (e.g., hospital, private practice, clinics, emergency services), diagnostic criteria (e.g., International Headache Society or Cervicogenic Headache International Study Group) and processes (e.g., questionnaires, clinical examination) were heterogeneous. Four publications required a diagnostic block in the diagnostic process. A standardized methodology, especially regarding the diagnostic criteria and process, is needed to compare studies, guarantee quality, and provide estimates to inform policy makers.

Neuroinflammation and nociception in intervertebral disc degeneration: a review of precision medicine perspective

Intervertebral disc (IVD) degeneration is a major cause of low back pain (LBP), which results in disability worldwide. However, the pathogenesis of IVD degeneration mediating LBP remains unclear. Current conservative treatments and surgical interventions are both to relieve the symptoms and minimise pain; nevertheless, they are unable to reverse the degeneration. Previous studies have shown that inflammation and nociception markers are important indicators of pain mechanisms in IVD degeneration underlying LBP. As such, multiomics profiling allows the discovery of these target markers to understand the key pathological mechanisms mediating IVD degeneration underpinnings of LBP. This article provides insights into a precision medicine approach for identifying and understanding the pathophysiology of IVD degeneration associated with LPB based on the severity of the disease from early and mild to severe degenerative stages. Molecular profiling of key markers in degenerative IVDs based on patient stratification at early, mild, and severe stages will contribute to the identification of target markers associated with signalling pathways in mediating neuroinflammation, innervation, and nociception underlying painful IVD degeneration. This approach will offer an understanding of establishing personalised clinical strategies tailored to the severity of IVD degeneration for the treatment of LBP.

Interventions used in control group against cupping therapy for chronic nonspecific low back pain: A systematic review and network meta-analysis

INTRODUCTION

The evidence for the effect of cupping therapy on chronic nonspecific low back pain (CLBP) remains controversial, and existing researches didn't consider outcomes influenced by factor of selection of interventions in control group. This review and network meta-analysis is to compare the effects of diverse interventions in cupping therapy control groups for CLBP, with the objective of identifying the suitable control intervention against cupping therapy for CLBP.

METHODS

Studies were identified by a comprehensive search of databases, such as PubMed, Embase, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI), up to June, 2024. A total of 10 randomized control trials (RCT) were included in this network meta-analysis (NMA).

RESULTS

The results showed that compared with cupping therapy, minimum negative pressure cupping therapy (MNPCT) (SMD = - 0.01; 95 %CI: - 0.92 to 0.89), air circulating cupping therapy (ACCT) (SMD = - 0.05; 95 %CI: - 0.63 to 0.54) and diclofenac (SMD = - 0.13; 95 %CI: - 1.13 to - 0.87) was no significantly different from improvement of pain intensity. But there was significant difference between cupping therapy and D-ibuprofen (SMD = - 1.11; 95 %CI: - 2.08 to - 0.13), paracetamol (SMD = - 1.12; 95 %CI: - 1.80 to - 0.43) or usual care (SMD = - 1.18; 95 %CI: - 2.56 to - 1.06). The order of intervention effect by SUCRA diagram was as follows: cupping therapy (77.7 %) > MNPCT (75.2 %) > ACCT (73.8 %) > diclofenac (68.8 %) > D-ibuprofen (26.3 %) > paracetamol (24.5 %) > usual care (3.8 %). The quality of evidence for network estimates was moderate to very low due to the risk of bias and imprecision.

CONCLUSIONS

The results of this study suggest that usual care was the least effective in alleviating the pain intensity of CLBP, which might serve as the most appropriate intervention in the control group in cupping-related RCTs. MNPCT and ACCT have similar effects with cupping therapy for CLBP. Future research may be based on some objective clinical outcomes and control interventions with physiological inertia to isolate the true effect of cupping therapy or SCT from psychological biases.

TRIAL REGISTRATION

The protocol was registered on the international prospective register of systematic reviews (http://www.crd.york.ac.uk/PROSPERO), registration number: CRD42024527513.

Bacterial cellulose: Is it really a promising biomedical material?

Bacterial cellulose (BC) is currently considered a promising biomaterial due to its specific structure and properties. However, despite extensive research, questions about its fundamental properties, especially biocompatibility, remain. Thus, the purpose of this review is to analyze the results of in vivo trials from different areas of biomedicine, including wound healing, tissue engineering, drug delivery, and biomedical implants. The primary question guiding our review was "Why is bacterial cellulose still not used in clinical practice?" Analysis of the literature has shown that the results of in vivo studies often contradict each other. For example, BC caused and did not cause an immune response in an equal number of reviewed articles. Its efficacy in pure form generally does not differ significantly from that of materials already on the market. Conversely, BC may prove to be a valuable material in the long term, not because of its efficacy, but rather because of its affordability and ease of use. Additionally, challenges associated with immune reactions, long-term biocompatibility, and the necessity for standardized experimental protocols must be addressed. We expect that this review will encourage a more thoughtful investigation of BC to bring it into practical medicine.

Biomimetic Microchannel Integrated Silk Fibroin Scaffold for Regeneration of Intervertebral Disc Degeneration

Intervertebral disc degeneration (IVDD) is the primary cause of low back pain, and patients with severe degeneration usually require lumbar fusion or total disc arthroplasty. Lumbar fusion carries the risk of accelerated degeneration of the adjacent intervertebral disc (IVD), and total disc arthroplasty could reduce the risk. However, the clinical application of artificial IVD whose nondegradable properties make it difficult to restore the biological function of the IVD. Therefore, we intend to fabricate a novel biomimetic microchannel integrated silk fibroin scaffold (BMI-SF scaffold) containing annulus fibrosus with oriented cross-microchannels and nucleus pulposus with interconnected porous structure. The BMI-SF scaffold exhibits controllable microchannels as well as excellent biocompatibility and biodegradability. In vitro and in vivo studies have demonstrated that microchannels can direct cells into the BMI-SF scaffold and enhance neovascularization, supplying adequate nutritional support for tissue regeneration. The IVD replacement model showed that the BMI-SF scaffold has superior regenerative effects, such as restoring IVD height and providing motion segments with dynamic mechanical properties akin to the natural IVD. In this study, the BMI-SF scaffold developed using controlled microchannels provides a new strategy for patients with severe IVDD and has broad clinical application prospects.

Long-term effectiveness of non-surgical interventions for chronic low back pain: a systematic review and meta-analysis

BACKGROUND

Chronic low back pain is a long-term recurrent condition. Interventions with sustained benefits are needed to reduce the associated personal and societal burden. We aimed to assess the long-term effectiveness of non-surgical interventions for reducing pain intensity and disability in adults with chronic low back pain.

METHODS

We performed a systematic review and meta-analysis. MEDLINE, EMBASE, and CINAHL were searched from inception until May 22, 2024, for randomised controlled trials assessing non-surgical interventions in adults with chronic low back pain. Studies assessing pain intensity outcomes, disability outcomes, or both at long-term (1-2 years) and very long-term (≥2 years) follow-up were included. Comparators included placebo, adjuvant intervention, no intervention, or usual care. Study characteristics and outcome measures were extracted and risk of bias assessed. Random effects meta-analysis was performed for studies with similar populations, interventions, and outcome measures. We involved people with experience living with or treating chronic low back pain in the design and interpretation of this review. The review protocol was prospectively registered in PROSPERO (CRD42023408537).

FINDINGS

75 trials (15 395 participants) were included. Risk of bias was rated high for the majority of studies (51 [68%] of 75). In people with non-specific chronic low back pain at long-term follow-up, there was moderate certainty evidence that cognitive behavioural therapy and mindfulness probably result in reductions in pain intensity (mean difference -7·2 [95% CI -9·8 to -4·6]; I2 =0·0 for cognitive behavioural therapy and -10·0 [-14·4 to -5·6]; I2 =0·1 for mindfulness) and disability (-5·7 [-7·7 to -3·7]; I2 =0·0 and -9·3 [-14·4 to -4·1]; I2 =11·1). Goal setting (-8·3 [-12·8 to -3·9]; I2 =4·8) and needling (-4·8 [-8·1 to -1·5]; I2 =0·0) probably reduce disability at long-term follow-up. There was low certainty evidence that multidisciplinary care could reduce pain intensity (-10·1 [-16·6 to -3·7; I2 =0·0) and exercise might reduce disability (-10·2 [-17·5 to -2·9]; I2 =33·5) at very long-term follow-up. Heterogeneity was evident in several of the meta-analyses, and results should be interpreted with caution.

INTERPRETATION

Some interventions, including cognitive behavioural therapy, mindfulness, exercise, and multidisciplinary care could produce the long-term benefits required to reduce the global burden due to non-specific chronic low back pain; however, the effects are mostly small, and the strength of evidence is relatively uncertain. Greater attention is needed on developing and testing interventions with long-term effects for chronic low back pain.

FUNDING

None.

Clinical Efficacy of Multimodal Exercise Telerehabilitation Based on AI for Chronic Nonspecific Low Back Pain: Randomized Controlled Trial

Background

Exercise therapy is strongly recommended as a treatment for chronic nonspecific low back pain (CNSLBP). However, therapist-guided exercise therapy requires significant medical resources. Ordinary digital telerehabilitation affects efficacy due to a lack of guidance and dynamic support. Artificial intelligence (AI)-assisted interactive health promotion systems may solve these problems.

Objective

We aimed to explore whether AI-assisted multimodal exercise telerehabilitation is superior to conventional telerehabilitation in the treatment of people with CNSLBP.

Methods

This study was a prospective, double-arm, open-label, randomized clinical controlled trial. People with CNSLBP were randomly allocated to either the AI or video group, receiving AI-assisted multimodal exercise therapy or conventional video guidance, respectively, via a WeChat application add-in. The multimodal exercise consisted of deep core muscle, flexibility, Mackenzie, and breathing exercises. The exercises were performed for 30-45 minutes per session, 3 times a week, for 4 weeks. Participants underwent face-to-face assessment at baseline and week 4, and web-based assessment at weeks 2 and 8. The primary outcome was the change in Numerical Rating Scale (NRS) relative to baseline at week 4. Secondary outcomes included changes in the Roland-Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), Pain Castastrophizing Scale (PCS), Timed Up-and-Go (TUG) test, and thickness of the transverse abdominus (TrA) and multifidus (MF) muscles relative to baseline at week 4. Generalized estimating equation and covariance were used to examine the efficacy of the interventions.

Results

A total of 38 participants (19 participants per group) were recruited. Eighteen participants in the AI group and 16 participants in the video group completed and were included in the final analysis. There was a significant difference in NRS at week 4 between the AI group and video group (most severe NRS: -3.00 vs -1.50; adjusted mean difference -1.08, 95% CI -1.68 to -0.49; P<.001; mean NRS: -2.61 vs -1.62; adjusted mean difference -0.67, 95% CI -1.19 to -0.15; P=.01). The difference in most severe NRS persisted until week 8 (-3.06 vs -1.69; adjusted mean difference -0.95, 95% CI -1.73 to -0.18; P=.02). Compared with the video group at week 4, the AI group showed significant improvement in secondary outcomes, including RMDQ, PCS, and core muscle thickness of left TrA, right TrA, left MF, and right MF.

Conclusions

We showed that 4 weeks of telerehabilitation based on AI-assisted multimodal exercise has better therapeutic effects compared to conventional exercise telerehabilitation in people with CNSLBP. This study provides guidance for developing effective real-time home-based exercise therapies for people with CNSLBP, which may help reduce economic and human resource costs associated with treatment.

Exploring the differences in resting state functional magnetic resonance imaging brain activity in patients with chronic low back pain based on ALE meta-analysis

Chronic low back pain (cLBP) is a prevalent condition, yet neuroimaging findings across studies remain inconsistent. This inconsistency may stem from overreliance on a priori regions of interest (ROI) hypotheses in prior studies, which neglected the spatial distribution of true functional abnormalities in cLBP. To address methodological heterogeneity, this study conducted an activation likelihood estimation (ALE) meta-analysis, guided by high-quality neuroimaging meta-analysis guidelines, to identify reliable neural features across 17 eligible cLBP studies, providing more robust conclusions than individual neuroimaging studies. Significantly, the cLBP group exhibited enhanced activity in the bilateral medial frontal gyrus (MFG), right precentral gyrus, and right cingulate gyrus. Based on the data-driven and objective ROI, we further analyzed the functional interactions or connectivity between brain regions by including a cohort of 30 patients with chronic non-specific low back pain (CNLBP) and 30 age- and sex-matched healthy controls. The results revealed decrease functional connectivity in the cortico-limbic circuit in the CNLBP group, particularly between the left MFG and the right hippocampus. Furthermore, effective connectivity from the right to left MFG was significantly reduced in the CNLBP group. Multivariate regression analysis established significant associations between cortico-limbic circuit connectivity alterations and pain catastrophizing. These findings highlight the cortico-limbic circuit as a key biomarker for cLBP, suggesting its targeted modulation could inform novel therapeutic strategies. This study provides novel neurobiological insights into cLBP pathophysiology, while underscoring the necessity for replication in larger cohorts to validate clinically valuable. PERSPECTIVE: This study utilized ALE meta-analysis to investigate abnormal activation regions in cLBP patients, and further analysis revealed functional interactions or connectivity between brain regions. The results highlighted the cortico-limbic circuit as a key biomarker of cLBP, suggesting that modulating this circuit may provide insights into potential therapeutic strategies.

Identifying Cervical Predictors of Recreational Mixed Martial Arts Participation: A Case-Control Study

Background: Recreational participation in Mixed Martial Arts (MMA) has rapidly increased. Despite consistent evidence of a high injury prevalence in MMA athletes, the neuromuscular implications of regular MMA training remain underexplored. The cervical spine is particularly vulnerable to trauma due to repetitive impacts and high mechanical demands in combat sports. Methods: This case-control study compared cervical spine function and self-reported symptoms between 25 recreational MMA athletes and 25 matched individuals who engaged in general fitness training. Outcome measures included Neck Disability Index (NDI), Post-Concussion Symptom Scale (PCSS), pain and headache reports, cervical range of motion (ROM), proprioception, isometric strength, and endurance. Multivariate logistic regression analysis was used to identify the predictors of group classification. Results: The MMA group exhibited significantly higher values for post-concussion symptoms (p = 0.012), cervical flexor endurance (p = 0.031), and the number of concussions (p = 0.001) but lower flexion ROM (p = 0.031). No significant differences were observed in strength, proprioception, or NDI scores. Logistic regression identified the number of concussions, age, total cervical ROM, and average rotation strength as significant predictors of group membership (model AUC = 0.96; Nagelkerke R2 = 0.797). Conclusions: Recreational MMA athletes demonstrated higher rates of concussion-related symptoms and reduced cervical flexion ROM than noncontact exercisers despite no statistically significant differences in strength and proprioception. These findings suggest that cumulative exposure to amateur MMA is associated with alterations in cervical neuromuscular characteristics. These results support the implementation of targeted mobility, endurance, and injury prevention programs in recreational MMA training.

Does the degree of stenosis affect cervical proprioception in patients with cervical pain?

BackgroundCervical stenosis is an important problem in patients with cervical pain, which may cause proprioception problems.ObjectiveThis study aims to evaluate the effect of the degree of cervical stenosis on cervical proprioception and cervical range of motion (ROM).MethodA total of 111 patients presenting with cervical pain and undergoing cervical magnetic resonance imaging were included in the study. The ROM of the patients was measured with the Pa Cervical Range of Motion (CROM) device. Proprioception was evaluated with measurement of joint position error (JPE). JPE was assessed with neutral head position and target head position tests. The severity of stenosis was detected according to the Kang grading system. The Kruskal-Wallis test is used to compare joint position error in patients with different cervical stenosis stages.ResultsTwenty nine(%26) patients had no stenosis, 31 (28%) had mild stenosis, 31 (28%) had moderate stenosis, and 20 (18%) had severe stenosis. According to the neutral head positioning test, there was a significant difference in right lateral flexion between patients with different degrees of stenosis (grade 0: 1.67[0.67-4.67] vs. grade 2: 4.67[2.3-10.0], p = 0.009) and in flexion (grade 0: 8.0[2.67-10.0] vs. grade 3: 12.66[8.33-17.67], p = 0.011). There was also a significant difference in head-to-target JPEs in all motion planes(p < 0.05).ConclusionDegree of cervical stenosis significantly affects cervical proprioception and cervical ROM. The study's findings may guide clinicians in developing effective rehabilitation programs for proprioception in cervical stenosis and encourage further research on intervention effects at different stages of the disease.

Assessing the association between degenerative disc disease and spinal mobility

OBJECTIVE

Degenerative disc disease (DDD) is commonly associated with chronic low back pain (cLBP) and disability, yet its impact on spinal mobility remains underexplored. This study investigates the association between lumbar disc degeneration and spinal mobility to assess its functional consequences.

METHODS

In this cross-sectional study, participants were recruited from the general population. Individuals with specific LBP were excluded. Intervertebral disc degeneration was graded using the Pfirrmann classification, and an overall lumbar Pfirrmann grade (PG) was calculated. Uni- and multivariable linear regression models were performed to analyze the relationship between disc degeneration and spinal mobility, accounting for age, sex, BMI, physical activity, and pain intensity, with additional subgroup analysis by sex, cLBP status, and age.

RESULTS

909 participants (44.1% female) were included in the study; 421 (46.3%) were affected by cLBP. After accounting for confounders, a higher lumbar PG was significantly associated with reduced sagittal lumbar and rotational mobility (p < 0.001) and increased thoracic sagittal mobility (p = 0.005)in males. Subgroup analyses indicated that associations with mobility impairments were more pronounced in individuals with cLBP and older patients.

DISCUSSION

This study providesevidence linking lumbar disc degeneration to reductions in spinal mobility, particularly in individuals with chronic low back pain. The pronounced mobility loss in cLBP patients suggests that chronic pain may disrupt compensatory mechanisms. These findings validate the role of disc degeneration within the context of cLBP and highlight the need for targeted interventions.

Spinal phenotypes on MRI and X-ray alone cannot predict short-term progression of lumbar disc degeneration

INTRODUCTION

Different lumbar phenotypes impact the biomechanical properties and might lead to progressive degeneration of the spine. This study aims to investigate whether lumbar phenotypes observed through X-rays and MRIs can predict the progression of intervertebral disc degeneration (IVDD).

METHODS

A retrospective longitudinal cohort study was conducted to identify important variables for the progression of intervertebral disc degeneration (IVDD). The study included n = 279 patients (n = 1395 discs), who respectively underwent two lumbar magnetic resonance imaging (MRI) exams with an interval between 1 and 4 years. The Pfirrmann grade was allocated to score IVDD. Lateral standing X-rays evaluated sacral slope, lumbar lordosis, spondylolisthesis, and osteophytes. Anteroposterior X-rays examined lumbar scoliosis and pelvic obliquity. Sagittal MRI T2 imaging assessed muscle atrophy, intervertebral disc level (IVD), end plate defects, Modic changes, annular tears, disc protrusion, extrusion, sequestration, IVD height, and Pfirrmann grade. Axial T2 imaging evaluated facet joint angles. The study used correlation analysis and conditional logistic regression analysis to identify significant variables.

RESULTS

The likelihood to contribute to the progression IVDD was 100% for end plate defect. Protrusion follows closely at 88%, the female gender shows a likelihood of 72%, lower IVD level has a likelihood of 45%, the sacral slope is present at 40%, osteophytes have a possibility of 37%, suggesting they also play a role in the progression of IVDD. Weak positive correlations with IVDD progression are noted: r =.056 (sacral slope), 0.146 (disc level), 0.057 (osteophytes), 0.066 (end plate defect), 0.130 (protrusion), and 0.068 (sequesters).

CONCLUSION

Lumbar phenotypes like sacral slope, disc level, osteophytes, end plate defect, and protrusion were the most predictive phenotypes for IVDD progression. Relying solely on lumbar phenotypes may not provide, however, enough specificity and sensitivity for predicting IVDD progression.

Developmental neurotoxicity of anesthetic etomidate in zebrafish larvae: Alterations in motor function, neurotransmitter signaling, and lipid metabolism

Etomidate (ETO), a widely used anesthetic, has emerged as a concerning environmental contaminant due to its increasing misuse and demonstrated neurotoxicity in aquatic organisms. This study employed an integrated multi-omics strategy to investigate the developmental neurotoxic effects of ETO in zebrafish (Danio rerio). ETO exposure induced dose-dependent toxicity in zebrafish embryos, characterized by decreased hatching rates (10-20 %), elevated mortality (up to 30 %), and morphological abnormalities such as scoliosis and pericardial edema. Behavioral assays revealed marked locomotor suppression (40-65 % reduction) and disrupted circadian rhythmicity. Neurochemical profiling indicated a 2.1-fold increase in dopamine levels, accompanied by significant reductions in GABAergic (38 %) and serotonergic (42 %) signaling, consistent with transcriptomic downregulation of related pathway genes. Metabolomic analysis revealed dysregulated lipid metabolism, including a 3.2-fold increase in eicosapentaenoic acid (EPA), and perturbations in phenylalanine metabolism. Transgenic zebrafish models (Tg(hb9:eGFP), Tg(coro1a:DsRed), Tg(elavl3:GCaMP6f)) further demonstrated motor neuron damage, inflammatory cell infiltration in the brain, and disrupted Ca2 + dynamics, indicating blood-brain barrier disruption and neuroinflammation responses. Molecular docking analysis confirmed ETO's binding affinity for GABA-A receptors, aligning with observed neurotransmitter imbalances. These findings elucidate ETO's neurotoxic mechanisms, involving neurotransmitter imbalance, metabolic disruption, and neuroinflammatory. The results underscore the dual threat of ETO as both an emerging aquatic pollutant and a developmental neurotoxicant, highlighting the urgent need for stricter environmental monitoring and a reevaluation of its safety profile, particularly during critical developmental windows.

Six-Axis, Physiological Activity Profiles Create a More Challenging Cellular Environment in the Intervertebral Disc Compared to Single-Axis Loading

Bioreactors provide a valuable way to explore interactions between the mechanical and biological environments of the intervertebral disc (IVD), but the replication of ecologically valid loading protocols is a huge challenge. The aim of this study was to address this through the combination of time use survey data and six-axis load data from in vivo measurements during functional movements and activities of daily living to create population-based activity profiles, which were employed using a unique six-axis bioreactor and a whole-organ bovine tail IVD model. The results of the study show that six-axis activity profiles create a more challenging environment compared to single-axis loading or unloaded controls, resulting in lower cell viability in both the nucleus pulposus and annulus fibrosus regions of the IVD. Additionally, the six-axis activity profile representing a more active lifestyle led to an even lower cell viability in the annulus fibrosus, which may be due to the increased strains in this region of the IVD during activities of daily living. These findings highlight the importance of considering a wide range of activities and lifestyles in the development and evaluation of regenerative therapies and preventative interventions for IVD, if they are to be successfully translated to the clinical setting.

Unveiling the role of TCF19 in intervertebral disc degeneration with single-cell and bulk RNA sequencing

Intervertebral disc degeneration (IDD) is a prevalent cause of low back pain, significantly impacting health worldwide. While IDD is associated with aging, its precise molecular mechanisms remain inadequately understood, limiting the development of targeted therapies. Nucleus pulposus cells (NPCs) are crucial to maintaining disc integrity and are central to understanding IDD progression. This study used single-cell and bulk RNA sequencing to dissect the cellular landscape and gene expression profiles in IDD. By analyzing these data, we identified distinct NPC subtypes and their roles in the degenerative disc microenvironment. Pseudotime and cellular communication network analyses further elucidated the temporal progression and signaling interactions of NPCs during disc degeneration. Four critical genes-TCF19, GDF15, RNMT, and C12orf45-were identified as significantly upregulated in IDD. TCF19 emerged as a key gene in the transitional states of NPCs, suggesting its pivotal role in IDD progression. In vivo experiments using a rat model indicated that Tcf19 knockdown significantly mitigated disc degeneration, reducing both abnormal collagen deposition and inflammation markers. This study unveils the complex molecular dynamics within IDD, providing new insights into distinct NPC subtypes and key genetic players. TCF19, in particular, holds promise as a therapeutic target for IDD. Our findings lay the groundwork for developing targeted treatment strategies, potentially improving the management and outcomes for individuals suffering from disc degeneration.

Suspension bioprinted whole intervertebral disc analogues enable regional stiffness- and hypoxia-regulated matrix secretion by primary human nucleus pulposus and annulus fibrosus cells

Intervertebral disc (IVD) degeneration is a leading cause of back pain, and while studies have revealed the roles resident nucleus pulposus (NP) and annulus fibrosus (AF) cells play in degeneration, tissue-engineered IVD models are needed to better investigate the mechanisms underpinning these cell-driven changes. This study therefore integrated suspension baths with bioprinting to create four multi-material, whole IVD analogues and investigated the combined effect of reduced oxygen tension and increased regional matrix stiffness on disc cell phenotype since these factors correlate with IVD degeneration. Primary NP and AF cells were seeded into alginate-collagen hydrogels and bioprinted into biphasic IVD structures. The nascent area, intensity, and integrated density of pro-collagen type I, collagen type VI, aggrecan, and hyaluronic acid were quantified using immunofluorescence staining in each region. Stiffness-mediated collagen and glycosaminoglycan production was observed in the AF, and increased stiffness downregulated collagen type VI in the AF but upregulated it in NP. Oxygen tension impacted proteoglycan production, with hypoxia increasing aggrecan and hyaluronic acid in both regions. This work represents a step towards the automated biofabrication of whole IVD analogues and expands the state-of-the-art in suspension bioprinting using regionally specific matrix cues. The findings provide important insights into two key microenvironmental factors driving IVD degeneration. STATEMENT OF SIGNIFICANCE: This manuscript outlines an original application of suspended layer additive manufacturing to biofabricate novel, biphasic intervertebral disc analogues containing patient-derived primary human cells. Significantly, the bioprinted models demonstrated biological function and were used to assess the effect of stiffness and oxygen concentration on regional matrix production using a range of internationally-recognized phenotypic intervertebral disc cell markers. The study therefore furthers the state-of-the-art in suspended bioprinting using regionally specific matrix cues and paves the way for future bioprinted disc models that can serve as biosimulators capable of generating insights into key mechanisms governing tissue development, homeostasis, and degeneration.

Pulsed Radiofrequency Alleviates Acute Soft Tissue Injury in Rats by Regulating the TNF/mTOR Signaling Pathway

Objective: Acute traumatic muscle injuries are common and result in substantial loss of time and risk of recurrence. Pulsed radiofrequency (PR) is a strategy that has been gradually adopted for treating muscle injuries in clinical practice. However, the molecular mechanism underlying its therapeutic effects is currently unclear. Materials and Methods: In this study, we screened the gene expression profiles of rats with muscle contusion obtained from the online dataset GSE162565. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses of the differentially expressed genes were conducted. Further, we established an acute soft tissue injury (ASTI) rat model and applied PR treatment. Muscle swelling rate analysis, malondialdehyde (MAD) and superoxide dismutase (SOD) content, inflammatory cytokine release, and hematoxylin and eosin staining of the gastrocnemius muscles of ASTI and ASTI + PR rats were performed, and the results were compared with those of control rats. Further, we evaluated the gene expression of Ccl1, interleukin-6 (IL-6), nuclear factor-kappa-B-inhibitor alpha (Nfkbia), Akt1, Jun, Fos, and Caps3 in the model and PR-treated groups, all of which are key genes in the tumor necrosis factor (TNF)/mechanistic target of rapamycin (mTOR) signaling pathway according to the KEGG analysis. Results: The results revealed that 52 genes involved in the TNF/mTOR signaling pathway were closely associated with ASTI progression in rats. PR treatment significantly reduced the malondialdehyde content but increased the SOD content in ASTI model rat muscles, efficiently alleviated muscle contusions and reduced TNF-α and IL-1β production. Moreover, PR treatment significantly decreased Ccl1, IL-6, and Nfkbia expression but increased Akt1, Jun, Fos, and Caps3 levels in ASTI models. These data indicate that PR alleviated ASTI in rats by mediating redox homeostasis and the inflammatory response, which might be modulated by the TNF/mTOR signaling pathway. Conclusions: Thus, this study contributes to the understanding of ASTI progression and provides more substantial information about the genetic mechanism underlying the therapeutic effects of PR on ASTI.

PDGF-Releasing Hydrogels for Enhanced Proliferation of Human Nucleus Pulposus Cells

Hydrogels offer a promising solution for sustained and controlled drug delivery and cell-tissue biocompatibility. In the intervertebral disc (IVD), delivering growth factors faces challenges due to the antagonistic inflammatory environment and continuous mechanical stress, which can degrade biological agents and may reduce their local activity. To address this, we investigated the prolonged release of platelet-derived growth factor isoforms BB (PDGF-BB) and AB (PDGF-AB) by using N-desulfated heparin methacrylamide (Hep-N) crosslinked within matrix-metalloproteinase sensitive poly(ethylene glycol) (PEG) hydrogels. Using electrostatic interactions between the heparin derivative and PDGF, we optimized a sustained release dose of PDGF-BB from the hydrogel in the presence of collagenase to mimic the in vivo environment. We then assessed the effects of PDGF released from PEG-hydrogel on human nucleus pulposus (NP) Cells. The MTT assay confirmed that 100 and 200 ng doses significantly increased cell viability by 2.52-fold and 2.46-fold on Day 3, respectively. RT-qPCR analysis revealed that PDGF-AB and PDGF-BB upregulated the expression of proliferation marker Ki-67 (MKI67) on both Day 3 and Day 5. Additionally, collagen type II alpha 1 chain (COL2A1) was significantly upregulated in the PDGF-AB group on Day 5, indicating potential anabolic effects. These findings could pave the way for long-term in vivo studies on sustainable PDGF treatment for IVD degeneration.

Updates in Degenerative Joint Disease of the Lumbar Spine

Degenerative joint disease (DJD) of the lumbar spine represents a complex pathologic process influenced by mechanical stress, structural degeneration, and inflammatory changes rather than normal aging. Imaging features of lumbar DJD are outlined, with emphasis on the importance of recognizing pathologic changes that contribute to patient symptoms. Additionally, recent advancements in the understanding and imaging of DJD are discussed.

Research progress on intervertebral disc repair strategies and mechanisms based on hydrogel

Intervertebral disc degeneration (IDD) arises from a complex interplay of genetic, environmental, and age-related factors, culminating in a spectrum of low back pain (LBP) disorders that exert significant societal and economic impact. The present therapeutic landscape for IDD poses formidable clinical hurdles, necessitating the exploration of innovative treatment modalities. The hydrogel, as a biomaterial, exhibits superior biocompatibility compared to other biomaterials such as bioceramics and bio-metal materials. It also demonstrates mechanical properties closer to those of natural intervertebral discs (IVDs) and favorable biodegradability conducive to IVD regeneration. Therefore, it has emerged as a promising candidate material in the field of regenerative medicine and tissue engineering for treating IDD. Hydrogels have made significant strides in the field of IDD treatment. Particularly, injectable hydrogels not only provide mechanical support but also enable controlled release of bioactive molecules, playing a crucial role in mitigating inflammation and promoting extracellular matrix (ECM) regeneration. Furthermore, the ability of injectable hydrogels to achieve minimally invasive implantation helps minimize tissue damage. This article initially provides a concise exposition of the structure and function of IVD, the progression of IDD, and delineates extant clinical interventions for IDD. Subsequently, it categorizes hydrogels, encapsulates recent advancements in biomaterials and cellular therapies, and delves into the mechanisms through which hydrogels foster disc regeneration. Ultimately, the article deliberates on the prospects and challenges attendant to hydrogel therapy for IDD.

Quantitative assessment of cervical disc degeneration using disc signal intensity index

BACKGROUND/CONTEXT

The assessment of disc degeneration remains a significant challenge in clinical research. Pfirrmann grade is a frequently used classification for lumbar disc degeneration on MRI. However, there has been no gold standard for cervical spine disc degeneration. Recently, we introduced the Disc Signal Intensity Index (DSI2) as a quantitative disc assessment for the lumbar spine, which is easily measurable in the cervical spine.

PURPOSE

The aim of this study was to apply DSI2 in the cervical intervertebral disc and investigate the factors associated with the cervical disc degeneration.

STUDY DESIGN/SETTING

Cross-sectional study using retrospectively collected data.

PATIENT SAMPLE

Cervical MRIs from a database of patients undergoing ACDF between 2015 and 2018 were retrospectively reviewed.

OUTCOME MEASURES

Demographic variables included age, sex, body mass index (BMI), race, smoking status, and comorbidities such as diabetes, chronic kidney disease, and coronary artery disease.

METHODS

DSI2 measurements were performed on midsagittal T2-weighted MRI images by determining the intensity within regions of interest (ROI). One ROI was set in the cerebrospinal fluid (CSF) and three ROIs were set per disc at the anterior, middle, and posterior third. The mean of the three measurements per disc was then divided by that of the CSF to calculate the DSI2 score. Multivariable linear regression analyses with mixed model were conducted to determine the potential contributing factors for disc degeneration.

RESULTS

A total of 149 patients and 770 discs were included in the final analysis. Ninety-three patients (37.6%) were female and the mean (SD) age was 55.6 (11.7) years. The distribution of DSI2 scores among the different Pfirrmann grades was as follows: Grade 1: 0.259±NA; Grade 2: 0.226±0.090; Grade 3: 0.175±0.070; Grade 4: 0.136±0.060; Grade 5: 0.131±0.050. Multivariable linear mixed-effect regression analysis, setting with DSI2 as the objective variable, demonstrated that age (β=-0.130, p<.05), BMI (β=-2.06, p<.05), Modic changes (Type1 β= -2.70, p<.01) were independent contributors to disc degeneration. The segments C4/5 and C7/T1 were less prone to disc degeneration (C4/5: β=1.37, p<.001; C7/T1: β=2.63, p<.001) and the history of diabetes (β=5.31, p<.01) was associated with high DSI2.(p<.01).

CONCLUSIONS

The present study provides valuable insights for identifying risk factors in degenerative cervical conditions utilizing the DSI2. The DSI2 method emerges as a promising alternative for future disc research, excelling in the detection of subtle progressions of degeneration and distinguishing itself from the subjective Pfirrmann grading system.

Intradiscal Injections of Bone Marrow Concentrate or Leukocyte-Rich Platelet-Rich Plasma for the Treatment of Cervical Discogenic Pain: A Case Series

PURPOSE

Cervical discogenic pain is a prevalent and debilitating condition. In recent years, autologous regenerative therapies such as bone marrow concentrate (BMC) and platelet-rich plasma (PRP) have gained attention as potential alternatives to traditional interventional pain management. This study investigates the safety and efficacy of these treatments when delivered intradiscally as part of a comprehensive cervical functional spinal unit (FSU) approach.

METHODS

This is a retrospective case series utilizing registry data, with 18 participants meeting the inclusion criteria. Intradiscal injections of BMC or leukocyte-rich PRP were guided by ultrasound and fluoroscopy with contrast confirmation. Patient-reported outcome measures (PROMs), including the Functional Rating Index (FRI), Numeric Pain Scale (NPS), and a modified Single Assessment Numeric Evaluation (SANE), were collected at baseline and at a minimum of three months post-treatment, with a mean follow-up of one year.

RESULTS

Eleven participants received BMC injections, and seven received leukocyte-rich PRP injections. No adverse events were reported during the study period. Statistical analysis revealed a significant reduction in the NPS in half of the patients (9 of 18) (mean difference = -1.0, P = 0.024), while a majority (14 of 18) reported improvement in FRI scores (mean difference = -10.9, P = 0.015). The average SANE score was 60%, with most patients (14 of 18) reporting 50% or greater improvement.

CONCLUSION

Intradiscal injections of BMC or LR-PRP as part of a comprehensive cervical FSU approach appear to be safe and effective for improving patient-reported pain and function. These findings support the potential of autologous biologics as an alternative treatment modality for cervical discogenic pain.

Evaluating the effectiveness of six exercise interventions for low back pain: a systematic review and meta-analysis

OBJECTIVE

To validate the effectiveness of six exercise therapies in treating low back pain using Meta-analysis methods, and to propose optimal exercise duration, frequency, and cycle.

METHODS

Databases such as PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, VIP Data, and SinoMed were searched. The RevMan 5.4 tool was utilized to conduct subgroup analyses on eight moderating variables, including types of exercise, duration, frequency, cycle, sample size, study quality, outcome indicator, and comparisons of different intervention methods with the control group from 42 included studies. Random effects models were employed to test for overall effects, heterogeneity, and bias.

RESULTS

The overall effect size for six exercise therapies for low back pain was significant (SMD= -1.21, P < 0.00001). Subgroup analyses showed yoga had the largest effect (SMD= -1.97, P = 0.0001). Exercise duration ≤ 30 min (SMD= -1.31, P < 0.0001), frequencies > 4 times/week (SMD= -1.56, P < 0.00001), and cycles ≤ 4 weeks (SMD= -1.61, P < 0.00001) were most effective. Sample sizes of 30~60 cases (SMD= -1.36, P < 0.00001) and studies with moderate bias risk (SMD= -1.37, P < 0.00001) also showed large effects. The Oswestry Disability Index scores demonstrated the most significant effect size (SMD= -3.35, P < 0.00001). The effect size of the physical factors in the control group was the largest (SMD= -1.85, P < 0.00001).

CONCLUSION

All six exercise therapies effectively alleviated low back pain, with yoga showing the best results. The optimal exercise intervention protocol involved exercise duration not exceeding 30 min per session, frequency of more than 4 times per week, and cycle not exceeding 4 weeks. Additionally, exercise interventions exhibited the most significant improvements in Oswestry Disability Index scores for low back pain.

Associations between insulin resistance and low back pain risk in US adults: a cross-sectional study

Background

Insulin resistance is one of the major pathophysiological features of type 2 diabetes mellitus. Studies have revealed the association between type 2 diabetes mellitus and low back pain. However, few studies explored the relationship between insulin resistance and low back pain directly. Therefore, this study selected HOMA-IR, TyG, TyG-BMI, TyG-WC, and TyG-WtHR as indicators of insulin resistance to comprehensively investigate the association between insulin resistance and low back pain.

Methods

The data for this cross-sectional study were from NHANES. Multivariate logistic regression was used to assess the association of insulin resistance with low back pain, and the stability of the results was evaluated by stratified analysis.

Results

A total of 6,126 adult participants were included in the study, including 3,657 non-LBP participants and 2,469 LBP patients. All of these five indices showed significant association with low back pain after full adjustment for all covariates (Model 3), HOMA-IR [OR = 1.052, 95% CI (1.018, 1.087), p = 0.003], TyG [OR = 1.431, 95% CI (1.013, 2.021), p = 0.042], TyG-BMI [OR = 1.003, 95% CI (1.002, 1.005), p < 0.0001], TyG-WC [OR = 1.001, 95% CI (1.001, 1.002), p < 0.0001], TyG-WtHR [OR = 1.268, 95% CI (1.155, 1.393), p < 0.0001]. The relationship between insulin resistance and low back pain is stable in most stratified populations (p-interaction >0.05).

Conclusion

Insulin resistance is associated with an increased risk of low back pain. The HOMA-IR, TyG, TyG-WC, TyG-BMI, and TyG-WtHR all showed a stable correlation with low back pain. TyG-BMI, TyG-WC, and TyG-WtHR are more stable in their associations with low back pain than TyG alone.

Biomechanical effects of upper articular process resection proportion on lumbar after transforaminal endoscopic spine system surgery

Transforaminal endoscopic spine system resection of upper articular process with different proportions often has different effects on lumbar spine biomechanics. Therefore, finite element method was used to explore this problem in this study. The Finite Element (FE) model constructed and validated in this study was a 3D heterogeneous model of the L1-S1 lumbar spine. Nine groups of models with different resect proportions were constructed and compared in six physiological movements. Following the experiment, we reached the following main results. The peak Von Mises stress of the left upper articular process of L5 increased most significantly when the resection proportion increased from 40% to 50% under flexion-extension and bending conditions, with an increase value of 6.04-11.47 MPa. When the resection proportion increased from 70% to 80% under rotation conditions, the peak Von Mises stress of the left articular process of L5 increased most significantly, with an increase value of 26.89 and 37.43 MPa. When the resection proportion increased from 70% to 80% under rotation conditions, the peak Von Mises stress of L4-L5 disc increased by 0.69 and 1.84 MPa. The stress concentration area was mainly located in the junction area of articular process and articular cartilage. Based on the above results, we draw the following conclusions. The resection of 50% of the upper articular process is the critical value of lumbar spine biomechanical change. Especially when the proportion of upper articular process resection exceeds 80%, lumbar instability and postoperative pain may occur during rotation. The postoperative pain is related to the stress concentration stimulation of the articular process and articular cartilage junction.

Water Transport-Modulated Highly Compressive Hydrogel for Total Biomimetic Sensing Intervertebral Disc

Degenerative disc disease (DDD) affects millions globally, with artificial total disc replacement (A-TDR) emerging as a key surgical intervention to restore spinal function and mobility. Current implantable prostheses incorporating multi-component architectures to replicate the functional heterogeneity of natural intervertebral discs (IVD) face challenges in achieving mechanical and physiological compatibility. Inspired by the natural IVD's structure, where a soft nucleus pulposus (NP) is encased by a tough annulus fibrosus (AF), a water transport-modulated directional annealing casting (DAC) approach has been developed to construct bulk hydrogels with tunable mechanical properties (up to ≈36.69 MPa compressive strength with ≈5.35 MPa modulus). This strategy enables the fabrication of an integrated hydrogel-based IVD (H-IVD) with biomechanically gradient structures, featuring a high-strength AF region (compressive modulus ≈2.77 MPa) seamlessly transitioning to a compliant NP core (modulus ≈0.26 MPa) while maintaining physiological water content throughout. The H-IVD exhibits excellent biocompatibility and load-bearing capacity, with inherent stress-sensing capabilities enabling dynamic functional assessment of spinal biomechanics. Furthermore, this integrated design strategy demonstrates broad applicability for engineering various dimensionally-controlled biomimetic tissues, from simple 1D structures to complex 3D organs requiring precise spatial control of material properties.

Prenatal and differential diagnosis of fetal thoracolumbar lymphangioma

We present a case of a woman in her mid-30s at 21 weeks of gestation referred to our tertiary medical center by an outside clinic with an ultrasound finding of a cystic septated lesion on the left side of the fetal chest.The differential diagnosis included, among others, foetal nuchal oedema, cystic hygroma, meningocele, encephalocele, cervical teratoma, haemangioma and subchorionic placental cyst. The sonographic finding of lack of intralesional vascularity on Doppler, seemingly without communication with the spinal canal, pointed us towards a diagnosis of foetal cystic lymphangioma. Our diagnosis was confirmed postnatally.Foetal cystic lymphangiomas are rare benign congenital tumours of the vascular and lymphatic systems. The differential diagnosis is broad, and a timely diagnosis positively affects the prognosis. If a lymphangioma is suspected, we suggest referral to specialists in maternal-foetal medicine with expertise in the field.

Enhancement of in vitro and in vivo bone repair performance of decalcified bone/gelma by desferrioxamine

Autologous and allogeneic bone grafting is currently the clinical gold standard for the treatment of bone defects; however, it is limited by the scarcity of autologous sources and the risk of secondary trauma, as well as the complications of disease transmission and immune rejection associated with allogeneic grafts. The clinical management of bone defects remains a significant challenge. In this study, we prepared a demineralized bone matrix/gelatin methacrylate composite hydrogel loaded with deferoxamine (GelMA/DBM/DFO) using a freeze-drying method and investigated its properties. Assessments using CCK-8, live-dead fluorescence staining, alkaline phosphatase staining, and Alizarin Red staining indicated that the GelMA/DBM/DFO composite hydrogel demonstrated superior biocompatibility and in vitro osteogenic differentiation capacity compared with the GelMA/DBM composite hydrogel. We established a cranial defect model in Sprague-Dawley (SD) rats and examined peripheral blood indices, micro-computed tomography (Micro-CT), hematoxylin and eosin (HE) staining, Masson's trichrome staining, and immunohistochemical staining for bone morphogenetic protein-2 (BMP-2) and collagen type I (COL-1). Both hydrogels exhibited good biosafety and the GelMA/DBM/DFO hydrogel showed more effective repair of cranial defects in SD rats. This study provides a novel material for bone-defect repair.

The proprioceptive puzzle: An observational study investigating the effects of cervical proprioceptive errors on quantitative sensory testing and body awareness in young individuals

OBJECTIVE

The present study investigates the effects of cervical proprioceptive errors (CPE) on body awareness and quantitative sensory testing (QST), including the pressure pain threshold, temporal summation, and conditioned pain modulation in young individuals.

MATERIALS AND METHODS

Included in this prospective cross-sectional study were 78 participants who were divided into two groups based on the presence or absence of CPE. The study was registered on ClinicalTrials.gov with the clinical trial number [NCT06559397]. Cervical proprioception was measured using the "head position error test", body awareness was assessed using the "Body Awareness Questionnaire", QST was assessed using a mechanical pressure algometer, and conditioned pain modulation was evaluated using cold stimulus.

RESULTS

The study revealed a significant reduction in body awareness among those with CPE (p < 0.001), while no significant differences were found between the groups in terms of QST, including the pressure pain threshold, temporal summation, and conditioned pain modulation (p > 0.05).

CONCLUSIONS

CPE can have a significant impact on body awareness, leading to a decrease in the ability to perceive one's own body. While the present study offers no significant findings related to QST, it provides new insights into the relationship between proprioception, body awareness, and pain processing mechanisms. Clinically, the results suggest the importance of integrating interventions aimed at enhancing body awareness into the treatment protocols of patients with CPE.

Advancements in Degenerative Disc Disease Treatment: A Regenerative Medicine Approach

Regenerative medicine represents a transformative approach to treating nucleus pulposus degeneration and offers hope for patients suffering from chronic low back pain due to disc degeneration. By focusing on restoring the natural structure and function of the nucleus pulposus rather than merely alleviating symptoms, these innovative therapies hold the potential to significantly improve patient outcomes. As research continues to advance in this field, we may soon witness a paradigm shift in how we approach spinal health and degenerative disc disease. The main purpose of this review is to provide an overview of the various regenerative approaches that target the restoration of the nucleus pulposus, a primary site for initiation of intervertebral disc degeneration.

Effect of acupuncture combined with Western medicine on vertebrobasilar artery hemodynamics and efficacy in patients with CV: a systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the effect of acupuncture combined with Western medicine on vertebrobasilar artery hemodynamics and its clinical efficacy in patients with cervical vertigo. To provide a reliable evidence-based medical basis for the clinical treatment of CV.

METHODS

This systematic review and meta-analysis will be reported in agreement with the Meta-Analyses (PRISMA2020) statement. MEDLINE, Embase, Web of Science, the Cochrane Library, CNKI, VIP, Wan Fang, and China Biology Medicine Disc (CBM) were searched until August 20, 2024. The quality of the included studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias, and the data were analyzed using Revman5.4, StataMP 18, and TSA0.9.5.10Beta software.

RESULTS

A total of 7 randomized controlled trials involving 714 patients were included. The meta-analysis results showed that acupuncture combined with Western medication was superior to simple Western medication in improving the blood flow velocity of the left vertebral artery, right vertebral artery, and basilar artery in patients with CV, improving the symptoms of cervical vertigo and improving its function and clinical efficacy. TSA analysis results again confirmed the robustness of the results of this meta-analysis.

CONCLUSION

Acupuncture combined with Western medicine has measurable benefits in improving vertebrobasilar hemodynamics and clinical efficacy in patients with CV, with certain safety. However, there are still methodological defects such as small sample size, different acupuncture treatment methods, and information on minimal clinically relevant differences is missing. In the future, RCTs with larger sample sizes and longer observations are still needed to further verify the efficacy of acupuncture combined with Western medicine, and an updated meta-analysis can be conducted to analyze the efficacy of acupuncture combined with Western medicine in the treatment of CV.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42024592131.

Recent Advances in Modeling Tissues Using 3D Bioprinted Nanocellulose Bioinks

Bioprinting creates 3D tissue models by depositing cells encapsulated in biocompatible materials. These 3D printed models can better emulate physiological conditions in comparison with traditional 2D cell cultures or animal models. Such models can be produced from human cells, possessing human genetics and replicating the 3D microenvironment found in vivo. Many different types of biocompatible materials serve as bioinks, including gelatin methacryloyl (GelMA), alginate, fibrin, and gelatin. Nanocellulose has emerged as a promising addition to these materials. Nanocellulose─composed of cellulose chain bundles with lateral dimensions ranging from a few to several tens of nanometers─possesses key properties for 3D bioprinting applications. It can form biocompatible hydrogels, which have excellent physical properties, and its structure resembles collagen, making it useful for modeling tissues with high collagen content such as bone, cartilage, sink, and muscle. Here we review some of the recent advances in the use of nanocellulose in bioinks for the creation of bone, cartilage, skin, and muscle tissue specific models and identify areas for future progress.

Risk factors of chronic low back pain among Syrian patients: across- sectional study

BACKGROUND

Chronic low back pain is a global health issue that leads to disability and significant economic costs. However, it has received limited attention in low- and middle-income countries. This study aimed to determine the prevalence of chronic low back pain and identify its associated risk factors among the Syrian population.

METHOD

This cross-sectional study included adults aged 18 years and above who visited neurology outpatient clinics in seven centers across four provinces (Damascus, Aleppo, Homs, and Latakia) between November 2021 and January 2022. A self-administered questionnaire was utilized to collect data on socio-demographic factors, work-related characteristics, and information about chronic low back pain. Descriptive statistics were employed to summarize the demographic characteristics of the participants. Multivariate logistic regression analysis was conducted to assess the risk factors for chronic low back pain.

RESULTS

A total of 830 adults participated in the study. The overall prevalence of chronic low back pain was estimated to be 16.7% (95% CI: 13.6-25.5), with females having a higher prevalence 17.8%, (95% CI: 14.8-27.5) compared to males 15.4%, (95% CI: 14.8-23.1). Multivariate regression analysis revealed several risk factors associated with chronic low back pain. These included being overweight (aOR: 5.2, 95% CI: 1.9-8.4, p = 0.041), having no formal education (aOR: 4.6, 95% CI: 1.6-8.4, p = 0.001), lack of regular physical exercise (aOR: 3.7, 95% CI: 1.8-6.3, p = 0.003), smoking more than 11 cigarettes per day (aOR: 4.8, 95% CI: 2.4-12.6, p = 0.003), leading a sedentary lifestyle (aOR: 8.3, 95% CI: 3.5-18.9, p = 0.002), manual work (aOR: 7.9, 95% CI: 5.9-16.7, p = 0.003), and adopting a stooped sitting posture (aOR: 3.5, 95% CI: 0.9-8.2, p = 0.039).

CONCLUSION

This study demonstrates that the prevalence of chronic low back pain in Syria is higher compared to other regions, and it is associated with several risk factors. These risk factors include a lack of formal education, being overweight, insufficient regular physical exercise, smoking, leading a sedentary lifestyle, manual work, and adopting a stooped sitting posture. These findings underscore the importance of addressing these modifiable risk factors to prevent and manage chronic low back pain in the Syrian population.

The Positive Side Effect of Anterior Cervical Decompression and Fusion on Axial Neck Pain

Study DesignObservational Cohort Study.ObjectivesThis study aims to comprehensively assess the outcomes of anterior cervical spine surgery in patients who have undergone surgical intervention for radiculopathy or myelopathy, with a specific focus on the surgery's impact on axial neck pain.MethodsData from an institutional spine surgery registry were analyzed for patients who underwent anterior cervical spine surgery between January 2016 and March 2022. Patient demographics, clinical variables, and outcome measures, including the Neck Disability Index (NDI), numeric rating scales for neck and arm pain (NRS-Neck and NRS-Arm), and 36-Item Short Form Health Survey (SF-36) scores, were collected. Statistical analysis included paired t-tests, chi-squared tests, and multivariate linear regression.ResultsOf 257 patients, 156 met the inclusion criteria. Patients showed significant improvement in NDI, NRS-Neck, NRS-Arm, SF-36 (Physical and Mental components), and all changes exceeded the minimum clinically important difference. Multivariate regression revealed that lower preoperative physical and mental component scores and higher preoperative NRS-Neck predicted worse NDI scores at follow-up.ConclusionsThis study underscores that anterior cervical fusion not only effectively alleviates arm pain and disability but also has a positive impact on axial neck pain, which may not be the primary target of surgery. Our findings emphasize the potential benefits of surgical intervention when neck pain coexists with neurologic compression. This contribution adds to the growing body of evidence emphasizing the importance of precise diagnosis and patient selection. Future research, ideally focusing on patients with isolated neck pain, should further explore alternative surgical approaches to enhance treatment options.

Complementary Repair Therapy as a Trending Topic in Discogenic Pain: A Bibliometric Study Over the Past 40 Years

Background and Aims

Bibliometric analysis has been frequently employed for visualizing trends within a particular scientific domain. The pain associated with discogenic origins has a significant impact on one's quality of life, but there is currently a lack of bibliometric analysis in the literature. Hence, this study aimed to examine related research in the field and identify the latest topics that are currently trending by conducting a bibliometric analysis.

Methods

The Bibliometrix which developed in the statistical R-packages was used for the data analysis. All related eligible publications were identified, and studies published from 1982 to 2023 were extracted from the Web of Science database.

Results

Disc repair, bone marrow cells, platelet-rich plasma, and the activation of inflammatory responses were identified as the trending topics after analyzing 977 journal articles. The most productive and influential journal was SPINE (Phila Pa 1976), which accounted for the largest publications and highest H index. The most productive and locally cited authors were Takahashi K., Ohtori S., and Aoki Y. from Chiba University. The top three productive and globally cited institutions were Chiba University, followed by University of California San Francisco and Korea University. The USA, China, and Japan were demonstrated as the most productive and globally cited countries.

Conclusion

This study performed the first bibliometric analysis on discogenic pain and provided valuable insights into the latest trending topics in the field. Analysis reveals that recent research has primarily focused on complementary and regenerative approaches for repairing painful discs, as well as the role of inflammatory responses in disc pathology.

Exploring the Causes of Intervertebral Disc Annulus Fibrosus Impairment

Scope

The annulus fibrosus (AF), as an important component of the intervertebral disc (IVD), contributes to the structural integrity and functional normality of IVD. Degenerative disc diseases (DDD), due to AF impairment, are common problems that could lead to low back pain or neck pain, resulting in considerable disability and financial costs globally. The exact causes and underlying mechanisms of AF impairment, however, remain complex and unclear.

Methods

A literature search was conducted to identify relevant articles published between 1952 and 2024. We summarize the current literature on the potential etiologies of AF damage, while also providing a brief overview of the basic characteristics of the AF and current therapeutic strategies for AF impairment.

Results

The findings suggest that several factors could induce or exacerbate AF impairment. We categorize them into distinct groups as physical and chemical stimuli, nutritional or metabolic disorders, immune and inflammatory responses, and genetic abnormalities.

Conclusion

Various factors could lead to AF impairment, such as particular physical and chemical stimuli, nutritional or metabolic disorders, immune and inflammatory responses, and genetic abnormalities. Meanwhile, enhancing our understanding and management of AF impairment could help discover potential preventive or therapeutic interventions for DDD.

Ultrasonographic characteristics of masseter muscle myalgia: a comparative study

OBJECTIVE

To compare the ultrasonographic characteristics of masseter muscles in temporomandibular disorder (TMD) subjects with a diagnosis of myalgia of the masticatory muscles to a control population.

METHOD

In total, 45 TMD subjects with masseter muscle myalgia according to the Diagnostic Criteria for Temporomandibular Disorders were compared with 45 control subjects. The masseter muscles of each subject were examined by ultrasonography (US) to assess the quantitative characteristic of local cross-sectional dimension (LCSD) and the qualitative parameters of intramuscular ultrasonographic appearance, anechoic areas, and isoechogenic areas.

RESULTS

Differences in mean LCSD between TMD and control subjects were not statistically significant (P = .565). Similarly, mean LCSD in the unilateral TMD subjects was not significantly different than in the bilateral TMD subjects (P = .808). The type I ultrasonographic appearance, in which fine bands are clearly visible in the muscle, was the most prevalent pattern, detected in 57.2% of muscles. Anechoic areas were present in 16.1% of muscles, and isoechogenic areas were found in 15.6% of muscles, but differences between TMD subjects and control subjects for qualitative ultrasonographic characteristics were not statistically significant (P ≥ .156).

CONCLUSION

None of the ultrasonographic characteristics were significantly different between TMD subjects and controls. Considering the limitations of the study, future research is required to assess the utility and reliability of US as a diagnostic tool for masticatory muscle myalgia.

3D printing in musculoskeletal interface engineering: Current progress and future directions

The musculoskeletal system relies on critical tissue interfaces for its function; however, these interfaces are often compromised by injuries and diseases. Restoration of these interfaces is complex by nature which renders traditional treatments inadequate. An emerging solution is three-dimensional printing, which allows for precise fabrication of biomimetic scaffolds to enhance tissue regeneration. This review summarizes the use of 3D printing in creating scaffolds for musculoskeletal interfaces, mainly focusing on advanced techniques such as multi-material printing, bioprinting, and 4D printing. We emphasize the significance of mimicking natural tissue gradients and the selection of appropriate biomaterials to ensure scaffold success. The review outlines state-of-the-art 3D printing technologies, varying from extrusion, inkjet and laser-assisted bioprinting, which are crucial for producing scaffolds with tailored mechanical and biological properties. Applications in cartilage-bone, intervertebral disc, tendon/ligament-bone, and muscle-tendon junction engineering are discussed, highlighting the potential for improved integration and functionality. Furthermore, we address challenges in material development, printing resolution, and the in vivo performance of scaffolds, as well as the prospects for clinical translation. The review concludes by underscoring the transformative potential of 3D printing to advance orthopedic medicine, offering a roadmap for future research at the intersection of biomaterials, drug delivery, and tissue engineering.

Hyaluronan composite bioink preserves nucleus pulposus cell phenotype in a stiffness-dependent manner

Intervertebral disc degeneration is a major cause of neck and back pain, representing a significant global socioeconomic burden. The polysaccharide hyaluronan is key to maintaining disc physiology and mediating disc disease through its structural and biological roles in the nucleus pulposus, a component of the intervertebral disc highly susceptible to degeneration. In this study, we introduce a novel composite bioink designed for extrusion bioprinting of structures resembling the nucleus pulposus. Our bioink combines levels of hyaluronic acid and collagen that approach physiological concentrations and effectively mimics the disc's hydrated and mechanically resilient environment. We modulated the composite's mechanical properties through the tyramination of hyaluronic acid and subsequent photocrosslinking, influencing morphology and gene expression of embedded bovine nucleus pulposus cells. This allows us to replicate a range of properties from healthy to degenerated human nucleus pulposus, which would be challenging to achieve with traditional cell culture and in vivo models. Our results show that modulating hyaluronan physico-chemical properties influenced embedded cell phenotype. The outcomes of this study inform the future design of biomaterials for the modelling of disc disease and regeneration, and present a versatile platform that can be readily integrated with other biofabricated components to form engineered intervertebral disc-like structures.

Research on non-invasive monitoring of biomechanical and viscoelastic properties of myotendinous complex in patients with herniated disk with radiculopathy (pre- and post-surgery) in the in order to optimize the neurorehabilitation approach – a systematic literature review

Low back pain is considered to have "epidemic proportions in Western societies", so that it is obvious that discovertebral pathology, especially severe (as is the case with neurosurgical indications), which is our subject research, succita a major and constantly growing interest due to, including to the numerical pressure, which places it among public health problems. This is also reflected by the fact that, for example, in the United States, in recent decades, healthcare costs allocated to prescription drugs to combat lumbosacralgia have risen at a higher rate than in any other category of health services [1]. In our study, we consider that evaluating the viscoelastic properties of muscles provides valuable information about muscle health, function, and progress in recovery. This innovative approach involves assessing the muscle's ability to resist deformation and return to its original shape, which reflects its characteristics of elasticity and viscosity. [2] We previously conducted a systematic review of the related literature using the method of filtering and selecting profile documentary material, a widely accepted and internationally recognized approach: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Thus, we searched using contextually relevant combinations and syntaxes of search keywords in the following international databases: Elsevier, PubMed, PMC, PEDro, and articles published in English in ISI-indexed journals in Web of Knowledge/Science, from January 1, 2021, to December 31, 2023.

Efficacy and safety of allogeneic mesenchymal precursor cells with and without hyaluronic acid for treatment of chronic low back pain: A prospective, randomized, double blind, concurrent-controlled 36-month study

BACKGROUND CONTEXT

Low back pain (LBP) associated with degenerative disc disease (DDD) is a serious condition resulting in significant morbidity, disability, and reduced quality of life for millions of people each year. Patients who fail to improve with conservative/noninvasive treatments including physical therapy and nonopioid analgesic medications have limited options, which include opioid analgesics with their associated significant risks; epidural steroid injections with limited supporting evidence; or surgical interventions such as spine fusion or artificial disc replacement. A safe, minimally invasive, nonopioid treatment that provides prolonged improvement in pain, function, and quality of life is needed for such patients.

PURPOSE

Evaluate the efficacy and safety of a single injection of mesenchymal precursor cells (MPCs) with or without hyaluronic acid (HA) compared to an intradiscal saline injection through 36 months follow-up in subjects with chronic low back pain (CLBP) associated with moderate DDD (mDDD).

STUDY DESIGN/SETTING

A prospective, multicenter, randomized, double-blind, concurrent-controlled study conducted at 49 clinical sites.

SUBJECT SAMPLE

A total of 404 subjects with CLBP associated with mDDD at one level from L1 to S1 received MPCs without HA (MPC), MPCs with HA (MPC+HA), or saline control (control) treatment.

OUTCOME MEASURES

Subjects were clinically and radiographically evaluated at 1, 3, 6, 12, 18, 24, and 36 months postinjection. Clinical evaluation included adverse events, neurologic evaluation, laboratory tests, LBP intensity measured by Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and EQ-5D-5L Index. Radiographic assessments used Magnetic Resonance (MR) imaging and X-ray imaging studies.

METHODS

The primary efficacy endpoint was a composite responder analysis for overall treatment success at both 12 and 24 months that was comprised of:[1] at least a 50% reduction from baseline in low back pain VAS score (average pain over 24 h);[2] at least a 15-point decrease from baseline in ODI score; and[3] no adjudicated posttreatment interventions at the treated level. To assess superiority, a Bayesian analysis used a probability threshold of 0.9875. Additional analyses were performed on a prespecified subpopulation of subjects with CLBP duration at baseline less than the median baseline duration of 68 months (CLBPLTM). Statistical assessments included least squares (LS) mean, LS mean change from baseline (CFB) using the mixed model for repeated measures (MMRM) and categorical responder analyses using stratified Cochran Mantel Haenszel row means score test with p<.05 defined as statistically significant. This study was conducted under a US Food and Drug Administration (FDA) Investigational New Drug (IND) application sponsored and funded by Mesoblast.

RESULTS

All treatment groups showed substantial improvement from baseline in LS Mean LBP and ODI. The primary efficacy endpoint for the trial did not reach significance for either treatment group compared to control in all subjects. Furthermore, none of the secondary endpoints showed a significant difference between treatment and control in all subjects. While the primary and secondary responder efficacy endpoints were not reached, MPC+HA significantly reduced LS mean LBP compared to control at 12 and 24 months in all subjects. The results observed in all subjects were enhanced for MPC+HA and MPC in the prespecified CLBPLTM subgroup with MPC+HA having significantly greater reduction in LBP at all time points compared to control and MPC having significantly greater reduction in LBP at 6, 12 and 36 months. In the CLBPLTM subgroup, MPC+HA also showed significantly greater proportion of pain responders at 12, 24 and 36 compared to control. MPC+HA also showed significantly greater function improvement at 12 and 18 months compared to control in the CLBPLTM subgroup. Furthermore, MPC+HA subjects in the CLBPLTM subgroup showed significantly greater improvement in quality of life (QOL) compared to control at 12, 24 and 36 months. MPC+HA baseline opioid users had greater reduction in daily average morphine equivalent dose (MED) compared to control at 6 through 36 months. Furthermore, significantly more MPC+HA baseline opioid users (27.8%) were not taking opioids at 36 months compared to (7.8%) control. The injection procedure and MPC treatment were well tolerated with no appreciable differences in Treatment Emergent Adverse Events (TEAEs). No Serious Adverse Events (SAEs) were related to the treatment or procedure. The number of subjects that received posttreatment interventions (PTI) at the treated level were comparable among groups.

CONCLUSIONS

While the primary and secondary efficacy endpoints were not met in all subjects, MPC+HA treatment showed a significant reduction in pain compared to control that was enhanced in subjects with CLBP duration less than 68 months. Intra-discal injection of MPC+HA is a minimally invasive nonopioid therapy that appears to be safe and demonstrates reduction in pain through 24 months compared to control with enhanced results in subjects with mDDD that have had CLBP less than 68 months.

Quantifying Impairments in the Subacute Phase of Whiplash Associated Disorders-A Cross-Sectional Study

Whiplash-Associated Disorders (WADs) often result from traffic accidents, leading to persistent symptoms, including neck pain, disability, dizziness, and central sensitization (CS). A key concern is cervical range of motion (cROM) impairment and sensorimotor dysfunction, which contribute to prolonged disability. This study assessed functional performance in individuals with subacute (>1, <3 months) WADs (n = 122) compared to healthy controls (n = 45). Clinical measures included cROM, movement control (Butterfly test), and position sense (Head-Neck Relocation Test, HNRT). Patient-reported outcomes included neck disability, pain intensity, central sensitization, and dizziness. Mixed and linear models evaluated group differences and the influence of demographic and symptom-related factors. WAD patients had significantly reduced cROM and impaired movement control (p < 0.001). Neck disability (p < 0.001) and pain intensity (p = 0.015) affected cROM within the WAD group. Interaction effects revealed greater amplitude accuracy (AA) impairments at greater difficulty levels (p = 0.043), while time on target (TOT) differences decreased (p < 0.001). Dizziness was associated with increased undershoot (p < 0.001), while pain negatively impacted both AA (p = 0.003) and TOT (p = 0.037). Position sense did not differentiate WAD patients from controls. Findings suggest task-dependent sensorimotor deficits, highlighting the need for multimodal assessment. Early CS screening may optimize rehabilitation and prevent chronic disability.

Intra-discal vacuum phenomenon with advanced lumbar spine disc degeneration: complementary findings from both MRI and CT

OBJECTIVE

Intra-Discal Vacuum phenomenon (IDVP) is associated with advanced disc degeneration, representing persistent intra-segmental movement. Our objective is to further characterise IDVP patterns from both MRI and CT thus informing on an otherwise poorly understood phenomenon.

METHODS

An observational analysis was performed, including an over-60s population sample of 325 lumbar discs in 65 subjects (29 M, 36 F) with low back pain +/- leg symptoms, with MRI of the lumbar spine and concomitant CT abdomen. Exclusion criteria were those with insufficient quality, non-degenerative or destructive spinal pathology, previous neuromodulation or spine instrumentation.

RESULTS

49 subjects (94 levels) displayed IDVP, including 11/184 Pfirrmann grade 3/IVDP positive, 49/79 grade 4/IVDP positive and 34/39 grade 5/IVDP positive discs. Increased severity of IDVP significantly correlated with increased Pfirrmann grade and decreased disc height (p <.05). Affected IDVP levels within the L1L2 & L2L3 region when compared to the L4L5 & L5S1 region, displayed similar Pfirrmann grade (4.1 v 4.3) and disc height (0.52 v 0.51) but with greater severity of IDVP in the latter (1.5 v 1.98, p <.002). While 83/105 (81%) of levels with Pfirrmann 4/5 with reduced disc height, displayed IDVP, a small minority did not, where instead they displayed a significantly higher risk of adjacent IDVP (p <.05).

CONCLUSION

CT and MRI complement each other through the identification of IDVP, allowing the diagnostician further insight on disc degeneration. Worsening severity of IDVP on CT correlates with increased disc degeneration and reduced disc height on MRI, particularly in the lower lumbar spine. A small minority of advanced degenerate discs do not display IDVP and quiesce, mostly where there is presence of an adjacent IDVP.

CLINICAL TRIAL NUMBER

Not applicable.

A Mendelian randomization study to reveal gut-disc axis: causal associations between gut microbiota with intervertebral disc diseases

PURPOSE

Emerging evidence suggests a link between gut microbiota and intervertebral disc diseases (IDDs); however, the causal relationships remain unclear. This study aimed to evaluate the causal effects of gut microbiota on the risk of cervical disc disorders (CDD), other intervertebral disc disorders (OIDD), pyogenic intervertebral disc infections, and discitis, shedding light on the potential "gut-disc axis".

METHODS

Genetic variation data for 202 gut microbiota taxa were obtained from the Dutch Microbiome Project, and disease outcome data were sourced from the FinnGen consortium. A Mendelian Randomization (MR) approach was employed to assess causal relationships, using genetic variants as instrumental variables. Sensitivity analyses, including tests for pleiotropy, heterogeneity, and reverse causation, ensured robust findings.

RESULTS

The study identified 20 gut microbial taxa with significant associations to IDDs. Notably, taxa within the Erysipelotrichaceae family showed consistent protective effects against OIDD after Bonferroni correction (P < 0.05). Associations between several species and specific diseases, such as Alistipes senegalensis with CDD and Ruminococcus lactaris with discitis, were also observed. Sensitivity analyses confirmed no evidence of confounding or reverse causation.

CONCLUSION

This study provides evidence of causal relationships between specific gut microbiota and IDDs, supporting the existence of a "gut-disc axis." The findings suggest that microbial dysbiosis may influence spinal health through systemic inflammation and immune regulation. These insights open new possibilities for microbiota-targeted interventions, such as probiotics or dietary modifications, to prevent or manage IDDs. However, further research is required to validate these therapeutic strategies.

A Narrative Review of Bioactive Hydrogel Microspheres: Ingredients, Modifications, Fabrications, Biological Functions, and Applications

Hydrogel microspheres are important in regenerative medicine and tissue engineering, acting as cargos of cells, drugs, growth factors, bio-inks for 3D printing, and medical devices. The antimicrobial and anti-inflammatory characteristics of hydrogel microspheres are good for treating injured tissues. However, the biological properties of hydrogel microspheres should be modified for optimal treatment of various body parts with different physiological and biochemical environments. In addition, specific preparation methods are required to produce customized hydrogel microspheres with different shapes and sizes for various clinical applications. Herein, the advances in hydrogel microspheres for biomedical applications are reviewed. Synthesis methods for hydrogel precursor solutions, manufacturing methods, and strategies for enhancing the biological functions of these hydrogel microspheres are described. The involvement of bioactive hydrogel microspheres in tissue repair is also discussed. This review anticipates fostering more insights into the design, production, and application of hydrogel microspheres in biomedicine.

The triadic relationship between spinal posture, loading, and degeneration

Introduction

Degenerative changes in the lumbar spine may affect many structures, among them the intervertebral discs and the facet joints. The individual load distribution within the spine linked to posture and mass distribution is a probable cause of disease. This study had a dual aim: first, to systematically summarize previously reported associations between sagittal balance parameters and the occurrence of lumbar spine degeneration. Second, to complement these insights with additional biomechanical findings meant to elucidate the link between spine load and alignment as well as selected demographic descriptors.

Methods

A systematic literature search was performed on PubMed to identify clinical studies that quantified the association between spinal alignment and the occurrence of disc herniation, disc degeneration, facet joint degeneration, and spondylolisthesis. Further, a previously published musculoskeletal model was used to link sagittal spinal alignment and subject characteristics to joint loading within the lumbar spine for a cohort of 144 subjects.

Results

The literature review yielded 49 publications evaluating the relationship between spinal alignment and the occurrence of pathologies in the lumbar spine. The results indicate that a straight spine might negatively affect the health status of the intervertebral disc, likely because of a lack of damping and associated high compressive loads. These loads further show a major dependence on body weight. On the other hand, facet degeneration and spondylolisthesis may be linked to higher anterior-posterior shear forces acting on the relevant spinal structures because of a generally more sagittally curved spine. A straight lumbar spine is more likely to stress the disc, whereas highly curved spines with a high pelvic incidence are more likely to stress the posterior structures. The biggest influencing factors on the resulting force and consequently potentially the wear of the anatomical structures are the intervertebral inclination from an anatomical point of view and the weight from a demographic point of view.

Discussion

Information concerning spinal loading resulting from spinal alignment and body descriptors could impact both conservative treatment and operative planning for patients afflicted by spine disease through targeted changes in posture.

Dizziness and neck pain: a perspective on cervicogenic dizziness exploring pathophysiology, diagnostic challenges, and therapeutic implications

Dizziness and vertigo affect up to 20% of adults annually. Cervicogenic dizziness (CGD), a debated clinical entity, is characterized by dizziness associated with cervical pain or dysfunction, stemming from altered proprioceptive input from the cervical spine. Despite its recognition in clinical practice, CGD remains controversial due to its reliance on exclusionary diagnosis and the absence of specific diagnostic criteria or gold-standard tests. This perspective explores the pathophysiology of CGD, emphasizing the sensory mismatch theory, where disrupted cervical proprioception interacts maladaptively with vestibular and visual systems, leading to postural instability and dizziness. Central mechanisms, including sensory reweighting and maladaptation, further complicate symptom resolution, particularly in the context of chronic cervical dysfunction. Current diagnostic approaches provide insights but lack specificity. Management strategies, including manual therapy and sensorimotor exercises, show promise in alleviating symptoms by targeting cervical dysfunction and enhancing proprioceptive integration. However, these interventions highlight the need for an integrated approach that addresses both cervical and vestibular contributions to dizziness. This paper underscores the importance of advancing CGD research, particularly understanding central maladaptation mechanisms. By bridging gaps in clinical and research knowledge, a more comprehensive framework for diagnosing and managing CGD can emerge, benefiting patients with persistent dizziness and cervical involvement.