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Li W, Zhao H, Zhou S, Xiong Z, Zhong W, Guan J, Liu T, Yang Y, Yu X. Does vertebral osteoporosis delay or accelerate lumbar disc degeneration? A systematic review. Osteoporos Int 2023; 34:1983-2002. [PMID: 37578509 PMCID: PMC10651704 DOI: 10.1007/s00198-023-06880-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023]
Abstract
The effect of vertebral osteoporosis on disc degeneration is still debated. The purpose of this study was to provide a systematic review of studies in this area to further reveal the relationship between the two. Relevant studies were searched in electronic databases, and studies were screened according to inclusion and exclusion criteria, and finally, basic information of the included studies was extracted and summarized. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A total of 34 publications spanning 24 years were included in our study. There were 19 clinical studies, including 12 prospective studies and 7 retrospective studies. Of these, 7 considered vertebral osteoporosis to be positively correlated with disc degeneration, 8 considered them to be negatively correlated, and 4 considered them to be uncorrelated. Two cadaveric studies were included, one considered the two to be negatively correlated and one considered them not to be correlated. Seven animal studies were included, of which five considered a positive correlation between vertebral osteoporosis and disc degeneration and two considered a negative correlation between the two. There were also 6 studies that used anti-osteoporosis drugs for intervention, all of them were animal studies. Five of them concluded that vertebral osteoporosis was positively associated with disc degeneration, and the remaining one concluded that there was no correlation between the two. Our systematic review shows that the majority of studies currently consider an association between vertebral osteoporosis and disc degeneration, but there is still a huge disagreement whether this association is positive or negative. Differences in observation time and follow-up time may be one of the reasons for the disagreement. A large number of clinical and basic studies are still needed in the future to further explore the relationship between the two.
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Affiliation(s)
- Wenhao Li
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - He Zhao
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China.
| | - Shibo Zhou
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Zhencheng Xiong
- West China Medical School, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Wenqing Zhong
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jianbin Guan
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Tao Liu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yongdong Yang
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xing Yu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China.
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Talukdar RG, Saviour CM, Dhara S, Gupta S. Biomechanical analysis of functionally graded porous interbody cage for lumbar spinal fusion. Comput Biol Med 2023; 164:107281. [PMID: 37481948 DOI: 10.1016/j.compbiomed.2023.107281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
Functionally graded porous (FGP) interbody cage might offer a trade-off between porosity-based reduction of stiffness and mechanical properties. Using finite element models of intact and implanted lumbar functional spinal unit (FSU), the study investigated the quantitative deviations in load transfer and adaptive changes in bone density distributions around FGP interbody cages. The cage had three graded porosities: FGP-A, -B, and -C corresponded to a maximum porosity levels of 48%, 65% and 78%, respectively. Efficacy of the FGP cages were evaluated by comparing the numerically predicted results of solid-Ti and uniformly porous 78% porosity (P78) cage. Variations in stiffness and interface condition affected the strain distribution and bone remodelling around the cages. Peak strains of 0.5-1% were observed in less number of peri-prosthetic bone elements for the FGP cages as compared to the solid-Ti cage. Strains and bone apposition were considerably higher for the bonded implant-bone interface condition than the debonded case. For the FGP-C with bonded interface condition, bone apposition of 11-20% was predicted in the L4 and L5 regions of interest (ROIs); whereas the debonded model exhibited 6-10% increase in bone density. The deviations in bone density change between FGP-C and P78 model were 3-8% for L4 and L5 ROIs. FGP resulted in a reduced average micromotion (∼70-106 μm) as compared to solid-Ti (116 μm), for all physiologic movements. Compared to solid-Ti and uniformly porous cages, the FGP cage seems to be a viable alternative considering the conflicting nature of strength and porosity.
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Affiliation(s)
- Rahul Gautam Talukdar
- Advanced Technology Development Centre, Indian Institute of Technology Kharagpur, Kharagpur, 721 302, West Bengal, India
| | - Ceby Mullakkara Saviour
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, 721 302, West Bengal, India
| | - Santanu Dhara
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, 721 302, West Bengal, India
| | - Sanjay Gupta
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, 721 302, West Bengal, India.
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Zhang Z, Zhang J, He B, Dong Q, Hao D. Effect of bone cement distribution on adjacent disc degeneration after vertebral augmentation for osteoporotic vertebral compression fractures in aging patients. Front Surg 2023; 10:1256401. [PMID: 37719887 PMCID: PMC10503132 DOI: 10.3389/fsurg.2023.1256401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023] Open
Abstract
Background The influence of vertebral augmentation on adjacent intervertebral discs remains controversial. The purpose of this study is to evaluate the effect of bone cement distribution on adjacent disc degeneration after vertebral augmentation for osteoporotic vertebral compression fractures (OVCFs). Methods Patients with single level OVCF and upper endplate injury who underwent vertebral augmentation were enrolled. The patients were divided into four groups: Group A: bone cement contacted both the cranial and the distal endplates; Group B: bone cement only contacted the cranial endplate; Group C: bone cement only contacted the distal endplate; and Group D: bone cement contacted neither the cranial nor the distal endplates. The cranial discs of the fractured vertebrae were defined as adjacent discs and the upper discs proximally to the adjacent discs were defined as control discs. Degenerative disc change (DDC) was defined as a deteriorated postoperative Pfirrmann score compared with the preoperative score on MR images. The number of DDC cases and the disc heights were analyzed among the groups. Results A total of 184 patients with an average follow-up time of 28.6 months were included. The number of DDC cases in the adjacent discs was significantly higher than in the control discs in groups A (p < 0.001), B (p = 0.002), and D (p = 0.028), whereas the difference in group C was not statistically significant (p = 0.237). The incidence of adjacent disc degeneration was significantly higher in group A than that in group C (p = 0.06). The adjacent disc heights decreased significantly in groups A, B, and D (p < 0.001, p < 0.001, and p = 0.012, respectively), but did not decrease significantly in group C (p = 0.079). However, no statistical differences were detected among the four groups with respect to the preoperative adjacent disc height, follow-up adjacent disc height, preoperative control disc height, or follow-up control disc height. Conclusion Bone cement distribution influences adjacent disc degeneration after vertebral augmentation in OVCFs. Cement distribution proximal to the injured endplate can accelerate adjacent disc degeneration, and cement in contact with both the cranial and distal endplates can induce a higher incidence of adjacent disc degeneration.
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Affiliation(s)
| | | | | | | | - Dingjun Hao
- Department of Spine Surgery, Xi'an Honghui Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
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Geng J, Huang P, Wang L, Li Q, Liu Y, Yu A, Blake GM, Pei J, Cheng X. The association of lumbar disc degeneration with lumbar vertebral trabecular volumetric bone mineral density in an urban population of young and middle-aged community-dwelling Chinese adults: a cross-sectional study. J Bone Miner Metab 2023; 41:522-532. [PMID: 36949139 DOI: 10.1007/s00774-023-01422-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION Lumbar intervertebral disc degeneration (LDD) and osteoporosis (OP) are age-related conditions that induce low back pain and have an impact on quality of life. The relationship between LDD and changes in bone mineral density (BMD) is, however, contentious and ever-changing. The purpose of this study is to investigate the relationship between lumbar vertebral volumetric BMD (vBMD) and LDD in an urban population of young and middle-aged community-dwelling Chinese adults. MATERIALS AND METHODS 719 participants were recruited from among the subjects enrolled in a 10-year longitudinal study of degeneration of the spine and knee being conducted at the Beijing Jishuitan Hospital. The severity of LDD was graded using the five-grade Pfirrmann classification, and lumbar vertebral vBMD was measured using quantitative computed tomography (QCT). The relationship between the grade of intervertebral disc degeneration and lumbar vertebral vBMD was analyzed, and multiple linear regression was performed to adjust for covariates. RESULTS The mean lumbar vBMD decreased as the grade of LDD increased (171.5 g/cm3, 147.8 g/cm3, and 124.3 g/cm3, respectively; P < 0.001). After adjusting for age, a higher LDD stage was associated with a lower mean L2-L4 vBMD, although a statistically significant correlation was observed only in men (standardized coefficient β = - 0.656, P = 0.004). In men, there was a negative correlation between single-vertebra vBMD and degeneration of adjacent intervertebral discs, particularly those involving the L3 vertebra (L2-3 disc: β = - 0.333, P < 0.001, L3-4 disc: β = - 0.398, P < 0.001), as well as the mean grade of the L2-4 discs (β = - 0.448, P < 0.001). However, the L5-S1 disc had a smaller correlation with age than others, and no statistically significant associations with lumbar vBMD were observed in either men (β = - 0.024, P = 0.729) or women (β = - 0.057, P = 0.396). CONCLUSION Our study found that the degree of LDD was negatively associated with lumbar trabecular vBMD, although (excepting the L5-S1 disc), the relationship was statistically significant only in men.
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Affiliation(s)
- Jian Geng
- Beijing Jishuitan Hospital and Fourth Medical College of Peking University Department of Radiology, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Pengju Huang
- Beijing Jishuitan Hospital and Fourth Medical College of Peking University Department of Radiology, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Ling Wang
- Beijing Jishuitan Hospital and Fourth Medical College of Peking University Department of Radiology, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Qing Li
- Beijing Jishuitan Hospital and Fourth Medical College of Peking University Department of Radiology, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Yandong Liu
- Beijing Jishuitan Hospital and Fourth Medical College of Peking University Department of Radiology, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Aihong Yu
- Beijing Jishuitan Hospital and Fourth Medical College of Peking University Department of Radiology, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Glen M Blake
- School of Biomedical Engineer and Imaging Science, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Jingzhe Pei
- Beijing Jishuitan Hospital and Fourth Medical College of Peking University Department of Radiology, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Xiaoguang Cheng
- Beijing Jishuitan Hospital and Fourth Medical College of Peking University Department of Radiology, 31 Xinjiekou East Street, Xicheng District, Beijing, China.
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Sharma A, Martin PR, Rodriguez FR. Lumbar osteoporotic fractures develop in segments with less degenerated discs which then become more degenerated. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1437-1445. [PMID: 36795180 DOI: 10.1007/s00586-023-07573-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/16/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Our aim was to study the influence of segmental variations in intervertebral disc degeneration on the location of acute osteoporotic compression fractures and to investigate chronic effect of such fractures on adjacent discs. METHODS This retrospective study included 83 patients (69 females; mean ± SD age: 72.3 ± 14.0 years) with osteoporotic vertebral fractures. Using lumbar MRI, two neuroradiologists evaluated 498 lumbar vertebral segments for the presence and acuity of fractures and graded adjacent intervertebral disc degeneration on Pfirrmann's scale. Absolute and relative (to average patient-specific degeneration grade) segmental degeneration grades were compared against the presence and chronicity of vertebral fractures for all segments and for upper (T12-L2) and lower (L3-L5) subgroups. Intergroup analysis was conducted using Mann-Whitney U tests, with p value of < .05 considered significant. RESULTS Fractures involved 149/498 (29.9%; 15.1% acute) vertebral segments, majority (61.1%) involving T12-L2 segments. Segments with acute fractures had significantly lower degeneration grades (mean ± SD: absolute: 2.72 ± 0.62; relative: 0.91 ± 0.17) than those with no (absolute: 3.03 ± 0.79, p = 0.003; relative: 0.99 ± 0.16, p < 0.001) or chronic fractures (absolute: 3.03 ± 0.62, p = 0.003; relative: 1.02 ± 0.16, p < 0.001). Degeneration grades were higher in the lower lumbar spine (p < 0.001) in the absence of fractures, but comparable to upper spine for segments with acute or chronic fractures (p = 0.28 and 0.56, respectively). CONCLUSIONS Osteoporotic vertebral fractures favour segments with lower burden of disc degeneration, but likely contribute to subsequent worsening of adjacent disc degeneration.
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Affiliation(s)
- Aseem Sharma
- Department of Radiology, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Parker R Martin
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Francisco Rivas Rodriguez
- Department of Radiology, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
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Ding Y, Chen JY, Yang JC, Li RY, Yin YJ, Chen JT, Zhu QA. Disc degeneration contributes to the denser bone in the subendplate but not in the vertebral body in patients with lumbar spinal stenosis or disc herniation. Spine J 2023; 23:64-71. [PMID: 36202206 DOI: 10.1016/j.spinee.2022.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND CONTEXT It is commonly believed that decreased bone quality would lead to endplate degeneration and arthritic changes in the facet joints, and thus accelerated disc degeneration (DD). However, some more detailed studies of vertebral bone structure have found that bone mineral density (BMD) in the vertebral body is increased rather than decreased in moderate or greater disc degeneration. The relationship between BMD and DD still needs further study. MRI-based vertebral bone quality scores have been shown to be effective in reflecting BMD, rendering a new way to evaluate the changes of vertebral body bone with DD using MRI alone. PURPOSE To evaluate MRI-based vertebral bone quality and Pfirrmann grades in patients with lumbar spinal stenosis or disc herniation, and to identify if DD is associated with denser bone around the endplate. STUDY DESIGN/SETTING A single-center, retrospective cohort study. PATIENT SAMPLE A total of 130 patients with lumbar disc herniation and lumbar spinal stenosis from January 2019 to November 2020 who had a complete dual-energy X-ray absorptiometry scan and noncontrast lumbosacral spine MRI data. OUTCOME MEASURES The vertebral bone quality score (VBQ) and sub-endplate bone quality score (EBQ) was calculated as a ratio of the signal intensity of the vertebral bodies and sub-endplate regions to the signal intensity of the cerebrospinal fluid at L3 on the mid-sagittal T1-weighted MRI images, respectively. The Pfirrmann grades of the lumbar discs were assessed as well. METHODS The age, gender, body mass index, and T-score of the lumbar spine of the patients were collected. The degeneration grades of the lumbar discs were evaluated according to the Pfirrmann classification. VBQ and EBQ were measured through T1-weighted lumbar MRI. The VBQ and EBQ scores were compared between cranial and caudal sides. The correlation between MRI-based bone quality and DD was calculated. A linear regression model was used to examine the association between DD and adjacent EBQ and VBQ. RESULTS This study included 569 lumbar segments from 130 inpatients. Cranial and caudal EBQ decreased with the increase of the Pfirrmann grade. The discs with Pfirrmann grade 5 had significantly lower caudal EBQ than the discs with Pfirrmann grades 2, 3, and 4. In the osteoporosis patients, the Pfirrmann grades negatively correlated both with the cranial EBQ and caudal EBQ. Pfirrmann grade greater than 4 was an independent contributor to the cranial EBQ, whereas greater than 3 was an independent contributor to the caudal EBQ. CONCLUSIONS Disc degeneration grades correlated with the EBQ but not with the VBQ. In patients with lumbar spinal stenosis or disc herniation, DD contributes to the denser bone in the sub-endplate, but not in the whole vertebral body.
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Affiliation(s)
- Yin Ding
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China; Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou, China
| | - Jia-Yu Chen
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
| | - Jia-Chen Yang
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
| | - Ruo-Yao Li
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
| | - Yong-Jie Yin
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
| | - Jian-Ting Chen
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
| | - Qing-An Zhu
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China.
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Li R, Zhang W, Xu Y, Ma L, Li Z, Yang D, Ding W. Vertebral endplate defects are associated with bone mineral density in lumbar degenerative disc disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2935-2942. [PMID: 35881201 DOI: 10.1007/s00586-022-07329-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/03/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Evidence has shown that lumbar vertebral endplate defects are clinically relevant and closely related to disc degeneration, but the relationship between endplate defects and bone mineral density (BMD) remains unclear. This study aimed to explore the association between endplate defects and BMD-related values in patients with lumbar degenerative disc disease (LDD). METHODS Three hundred and twenty-five Chinese adult subjects diagnosed with LDD underwent dual energy X-ray absorptiometry. Endplate defects were classified using lumbar MRI. Groups were subdivided based on the occurrence rates of defect endplates. BMD at the lumbar vertebral and bilateral femur necks was compared between groups, and the association between endplate defects and lumbar BMD-related values was analyzed and adjusted for confounders including age, sex, serum levels of 25-hydroxy vitamin D (25(OH)D), calcium (Ca) and phosphorus (P). RESULTS Of 325 patients and 3250 endplates, 59.72% had defects, and 188 patients were divided into the higher defect rate group (occurrence rate > 50%). The higher defect rate group was associated with older age, more common postmenopausal females, higher osteoporosis rates and lower serum Ca and P levels. Lumbar BMD was greater than that at bilateral femur necks and was not equal to osteoporosis diagnosis. Endplate defects were more prevalent in lower segments. The occurrence of endplate defects was positively associated with lumbar BMD-related values in the partial correlation analysis. The association between endplate defects and lumbar BMD varies for subtypes and segments, with a trend of positive association in rim and erosive subtypes after adjusting for confounders. CONCLUSIONS The present study demonstrated that the occurrence of endplate defects was associated with greater lumbar BMD values in patients with LDD. This association varies for different defect subtypes and segments. The results indicated that endplate defects should be taken into consideration in osteoporosis treatment to alleviate disc degeneration.
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Affiliation(s)
- Ruoyu Li
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Wei Zhang
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Yafei Xu
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Lei Ma
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Zhaohui Li
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Dalong Yang
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Wenyuan Ding
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
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Zhang Y, Patiman, Liu B, Zhang R, Ma X, Guo H. Correlation between intervertebral disc degeneration and bone mineral density difference: a retrospective study of postmenopausal women using an eight-level MRI-based disc degeneration grading system. BMC Musculoskelet Disord 2022; 23:833. [PMID: 36057596 PMCID: PMC9440522 DOI: 10.1186/s12891-022-05793-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose To explore the correlation between intervertebral disc degeneration (IDD) and bone mineral density (BMD) difference between adjacent vertebrae. Methods A retrospective analysis of 114 postmenopausal women who were treated in our hospital from January 2021 to December 2021. The degree of lumbar(L)1–5 IDD was scored according to an 8-grade scoring system. The lumbar vertebrae BMD was detected, and the BMD difference was calculated. The subjects were grouped according to age and whether the disc was severe IDD. Data were collected for statistical analysis. Results The prevalence of osteoporosis in the 51–60-year-old group was lower than that in the other groups, while the prevalence of modic changes in the 71–80-year-old group was higher than that in the 51–70-year-old group (P < 0.05). At the L1/2 level, the prevalence of severe IDD in the 81-90y group was higher than that in the 51-70y group (P < 0.05). At the L2/3 level, the prevalence of severe IDD in the 71-90y group was higher than that in the 51-60y group, and the prevalence of severe IDD in the 71-80y group was higher than that in the 61-70y group (P < 0.05). The L2/3 disc score was positively correlated with the L3-L2 BMD difference (P < 0.05). At the level of L1-2, the BMD difference in the non-severe IDD group was smaller than that in the severe IDD group (P < 0.05). Conclusion For postmenopausal women, an increase in BMD difference is correlated with IDD. Osteoporosis is more common in people over 60 years old, and the possibility of modic change in 71-80y is higher than in other age groups. The incidence of severe IDD also increases with aging, especially for the L1/2 and L2/3 discs.
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Talukdar RG, Saviour CM, Tiwarekar K, Dhara S, Gupta S. Bone Remodelling Around Solid and Porous Interbody Cages in the Lumbar Spine. J Biomech Eng 2022; 144:1140536. [PMID: 35484999 DOI: 10.1115/1.4054457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Indexed: 11/08/2022]
Abstract
Spinal fusion is an effective surgical treatment for intervertebral disc degeneration. However, the consequences of implantation with interbody cages on load transfer and bone remodelling in the vertebral bodies has scarcely been investigated. Using detailed 3D models of an intact and implanted lumbar spine and the strain energy density based bone remodelling algorithm, this study investigated the evolutionary changes in bone density distributions around porous and solid interbody cages. Follower load technique and submodelling approach were employed to simulate applied loading conditions on the lumbar spine models. The study determined the relationship between mechanical properties and parametrical characteristics of porous Body-centered-cubic (BCC) models, which corroborated well with Gibson-Ashby and exponential regression models. Variations in porosity affected the peri-prosthetic stress distributions and bone remodelling around the cages. In comparison to the solid cage, stresses and strains in the cancellous bone decreased with an increase in cage porosity; whereas the range of motion increased. For the solid cage, increase in bone density of 20-28% was predicted in the L4 inferior and L5 superior regions; whereas the model with 78% porosity exhibited a small 3-5% change in bone density. An overall increase of 9-14% bone density was predicted in the L4 and L5 vertebrae after remodelling for solid interbody cages, which may influence disc degeneration in the adjacent segment. In comparison to the solid cage, an interbody cage with 65-78% porosity could be a viable and promising alternative, provided sufficient mechanical strength is offered.
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Affiliation(s)
- Rahul Gautam Talukdar
- Advanced Technology and Development Centre, Indian Institute of Technology Kharagpur, Kharagpur 721 302, West Bengal, India
| | - Ceby Mullakkara Saviour
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur 721 302, West Bengal, India
| | - Kaustubh Tiwarekar
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur 721 302, West Bengal, India
| | - Santanu Dhara
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721 302, West Bengal, India
| | - Sanjay Gupta
- Advanced Technology and Development Centre, Indian Institute of Technology Kharagpur, Kharagpur 721 302, West Bengal, India; Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur 721 302, West Bengal, India
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Zhou L, Li C, Zhang H. Correlation between bone mineral density of different sites and lumbar disc degeneration in postmenopausal women. Medicine (Baltimore) 2022; 101:e28947. [PMID: 35421060 PMCID: PMC9276261 DOI: 10.1097/md.0000000000028947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 02/09/2022] [Indexed: 01/04/2023] Open
Abstract
Osteoporosis and lumbar disc degeneration (LDD) have been common causes that make increasing patients suffer from different degrees of low back pain. At present, whether osteoporosis degenerates or protects disc is still controversial, and the correlation between hip bone mineral density (BMD) and LDD still remains unclear. Our study aims to analyze the correlation between BMD of different sites and LDD in postmenopausal women, and explore the potential pathophysiological mechanism of them.One hundred ninety-five postmenopausal female patients were enrolled and divided into osteoporosis, osteopenia, and normal bone mass groups. Their BMD and lumbar spine magnetic resonance imaging were retrospectively analyzed. Two spine surgeons were selected to assess LDD according to Pfirrmann grading system.Based on lumbar BMD, LDD of normal bone mass group was more severe than the other 2 groups in L1/2 and L2/3 segments (P < .05). Based on hip BMD, LDD of each disc from L1/2 to L5/S1 had no significant difference among the 3 groups (P > .05). Lumbar BMD (L1-L4) was positively correlated with corresponding degree of LDD (L1/2-L4/5) (P < .05), whereas there was no correlation between hip BMD and degree of LDD (P = .328).There is a positive correlation between lumbar BMD and LDD in postmenopausal women, which is more obvious in the upper lumbar spinal segments (L1, L2). However, there is no correlation between hip BMD and LDD, suggesting that in postmenopausal women with lumbar degenerative disease, hip BMD is more suitable for the diagnosis of osteoporosis.
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Li X, Xie Y, Lu R, Zhang Y, Li Q, Kober T, Hilbert T, Tao H, Chen S. Q-Dixon and GRAPPATINI T2 Mapping Parameters: A Whole Spinal Assessment of the Relationship Between Osteoporosis and Intervertebral Disc Degeneration. J Magn Reson Imaging 2021; 55:1536-1546. [PMID: 34664744 DOI: 10.1002/jmri.27959] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The relationship between osteoporosis and intervertebral disc (IVD) degeneration remains controversial. Novel quantitative Dixon (Q-Dixon) and GRAPPATINI T2 mapping techniques have shown potential for evaluating the biochemical components of the spine. PURPOSE To investigate the correlation of osteoporosis with IVD degeneration in postmenopausal women. STUDY TYPE Prospective. SUBJECTS A total of 105 postmenopausal females (mean age, 65 years; mean body mass index, 26 kg/m2 ). FIELD STRENGTH/SEQUENCE 3 T; sagittal; 6-echo Q-Dixon, multiecho spin-echo GRAPPATINI T2 mapping, turbo spin echo (TSE) T1-weighted and TSE T2-weighted sequences. ASSESSMENT The subjects were divided into normal (N = 47), osteopenia (N = 28), and osteoporosis (N = 30) groups according to quantitative computed tomography examination. The Pfirrmann grade of each IVD was obtained. Region of interest analysis was performed separately by two radiologists (X.L., with 10 years of experience, and S.C., with 20 years of experience) on a fat fraction map and T2 map to calculate the bone marrow fat fraction (BMFF) from the L1 to L5 vertebrae and the T2 values of each adjacent IVD separately. STATISTICAL TESTS One-way analysis of variance, post-hoc comparisons, and Kruskal-Wallis H tests were performed to evaluate the differences in the magnetic resonance imaging parameters between the groups. The relationships between BMFF and the IVD features were analyzed using the Spearman correlation analysis and linear regression models. RESULTS There were significant differences in BMFF among the three groups. The osteoporosis group had higher BMFF values (64.5 ± 5.9%). No significant correlation was found between BMFF and Pfirrmann grade (r = 0.251, P = 0.06). BMFF was significantly negatively correlated with the T2 of the adjacent IVD from L1 to L3 (r = -0.731; r = -0.637; r = -0.547), while significant weak correlations were found at the L4 to L5 levels (r = -0.337; r = -0.278). DATA CONCLUSION This study demonstrated that osteoporosis is associated with IVD degeneration. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Xiangwen Li
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuxue Xie
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Lu
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyang Zhang
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Qing Li
- MR Collaborations, Siemens Healthineers Ltd., Shanghai, China
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Hongyue Tao
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuang Chen
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
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12
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Hong SW, Park KT, Chung YS, Choi YJ, Kang JH. Bone mineral density, cervical spine degeneration, head and neck posture, and neck pain in the post-menopausal females: A pilot study. PLoS One 2021; 16:e0257735. [PMID: 34543361 PMCID: PMC8452041 DOI: 10.1371/journal.pone.0257735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
The purpose of the present study was to reveal the relationship between degenerative changes in the cervical spine, head and neck postures, neck pain, and bone mineral density (BMD) of the total hip, femoral neck, and lumbar spine in post-menopausal females. In total, 116 females (mean age 60.4 ± 7.1 years; age range 50–80 years) were included. Participants were classified into three groups based on the T-score criteria of the total hip, femoral neck, and lumbar spine set by World Health Organization, respectively. The degree of neck pain was assessed using self-administered questionnaire, the Neck Disability Index. Cervical spine degeneration and head and neck postures were identified using the lateral cephalograms. Grading system for cervical degeneration included three categories of the radiographic alterations including disc height loss, osteophyte formation, and diffuse sclerosis. The areal BMD of the total hip, femoral neck, and lumbar spine were determined using dual-energy x-ray absorptiometry. Females with lower BMD exhibited lesser degree of neck pain and forward head posture (FHP) compared to those with normal BMD. Higher BMD seemed to be associated with more notable loss of the disc height at the level of C4-5. More prominent degenerative changes in the cervical spine were associated with higher areal BMD of the hip, femoral neck, and lumbar spine, altered head posture, and development of neck pain.
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Affiliation(s)
- Seok Woo Hong
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (ROK)
| | - Ki Tae Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (ROK)
| | - Yoon-Sok Chung
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea (ROK)
| | - Yong Jun Choi
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea (ROK)
| | - Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea (ROK)
- * E-mail:
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13
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Auger JD, Frings N, Wu Y, Marty AG, Morgan EF. Trabecular Architecture and Mechanical Heterogeneity Effects on Vertebral Body Strength. Curr Osteoporos Rep 2020; 18:716-726. [PMID: 33215364 PMCID: PMC7891914 DOI: 10.1007/s11914-020-00640-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW We aimed to synthesize the recent work on the intra-vertebral heterogeneity in density, trabecular architecture and mechanical properties, its implications for fracture risk, its association with degeneration of the intervertebral discs, and its implications for implant design. RECENT FINDINGS As compared to the peripheral regions of the centrum, the central region of the vertebral body exhibits lower density and more sparse microstructure. As compared to the anterior region, the posterior region shows higher density. These variations are more pronounced in vertebrae from older persons and in those adjacent to degenerated discs. Mixed results have been reported in regard to variation along the superior-inferior axis and to relationships between the heterogeneity in density and vertebral strength and fracture risk. These discrepancies highlight that, first, despite the large amount of study of the intra-vertebral heterogeneity in microstructure, direct study of that in mechanical properties has lagged, and second, more measurements of vertebral loading are needed to understand how the heterogeneity affects distributions of stress and strain in the vertebra. These future areas of study are relevant not only to the question of spine fractures but also to the design and selection of implants for spine fusion and disc replacement. The intra-vertebral heterogeneity in microstructure and mechanical properties may be a product of mechanical adaptation as well as a key determinant of the ability of the vertebral body to withstand a given type of loading.
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Affiliation(s)
- Joshua D Auger
- Department of Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA, 02215, USA
| | - Neilesh Frings
- Department of Biomedical Engineering, Boston University, Boston, MA, 02215, USA
| | - Yuanqiao Wu
- Department of Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA, 02215, USA
| | - Andre Gutierrez Marty
- Department of Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA, 02215, USA
| | - Elise F Morgan
- Department of Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA, 02215, USA.
- Department of Biomedical Engineering, Boston University, Boston, MA, 02215, USA.
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Potential association of metabolic and musculoskeletal disorders with lumbar intervertebral disc degeneration: Cross-sectional study using medical checkup data. J Orthop Sci 2020; 25:384-388. [PMID: 31176515 DOI: 10.1016/j.jos.2019.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/02/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The pathogenesis of intervertebral disc (IVD) degeneration is complex and involves the interaction of multiple factors. However, few systemic studies have explored the associations of metabolic disorders and age-related musculoskeletal disorders with the development of IVD degeneration. METHODS We analyzed clinical data obtained from healthy individuals who had undergone a musculoskeletal checkup. In total, 276 subjects comprising 142 males and 134 females were enrolled. The subjects were divided into two groups based on the degree of IVD degeneration according to Pfirrmann grading: those with grades 1-3, the group with non-degenerative discs; and grades 4 and 5, the group with degenerative discs. The subjects underwent examinations including abdominal circumference, blood pressure, bilateral hand grip strength, abdominal computed tomography, magnetic resonance imaging of the lumbar spine, and dual X-ray absorptiometry. To examine the independent association with IVD degeneration at L3/4, L4/5, and L5/S levels, we constructed a Poisson regression model and estimated relative risks (RRs) and 95% confidence intervals (CIs) of IVD degeneration. RESULTS Multivariable analysis showed that advanced age was markedly associated with IVD degeneration at all levels and that men had an inverse association with the IVD degeneration, particularly at the L4/5 level (RR = 0.7, 95% CI = 0.6-0.9). In addition, metabolic syndrome was significantly associated with IVD degeneration at the L5/S level (RR = 1.4, 95% CI = 1.1-1.8). Meanwhile, sarcopenia showed no significant association with IVD degeneration at any level. Osteoporosis was inversely associated with IVD degeneration, particularly at the L4/5 level (RR = 0.7, 95% CI = 0.6-0.9). CONCLUSIONS Our data suggest that advanced age, female sex, and metabolic syndrome are associated with IVD degeneration. In addition, osteoporosis showed an inverse association with IVD degeneration. Our data should promote understanding of the etiology of lumbar IVD degeneration.
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15
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Okano I, Salzmann SN, Jones C, Ortiz Miller C, Shirahata T, Rentenberger C, Shue J, Carrino JA, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The impact of degenerative disc disease on regional volumetric bone mineral density (vBMD) measured by quantitative computed tomography. Spine J 2020; 20:181-190. [PMID: 31125693 DOI: 10.1016/j.spinee.2019.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT It has been reported that degenerative disc disease (DDD) is associated with higher spinal bone mineral density (BMD) based on previous studies that used dual X-ray absorptiometry (DXA). However, DDD is often associated with proliferative bone changes and can lead to an overestimation of BMD measured with DXA. Trabecular volumetric BMD (vBMD) in the vertebral body measured with quantitative computed tomography (QCT) is less affected by those changes and can be a favorable alternative to DXA for patients with degenerative spinal changes. PURPOSE The purpose of this study is to investigate the effect of DDD on regional trabecular vBMDs in the vertebral body measured by QCT. STUDY DESIGN/SETTING Cross-sectional observational study at a single academic institution. PATIENTS SAMPLE Consecutive patients undergoing posterior lumbar spinal fusion between 2014 and 2017 who had a routine preoperative CT scan and magnetic resonance imaging (MRI) within a 90-day interval. OUTCOME MEASURES Regional trabecular vBMDs in the vertebral body by QCT. METHODS QCT measurements were conducted in L1-S1 vertebral trabecular bone. Any apparent sclerotic lesions that might affect vBMD values were excluded from the region of interest. The vBMDs of each level were defined as the average vBMD of the upper and lower vertebrae. To evaluate DDD, Pfirrmann grade, Modic grade, total end plate score, and vacuum phenomenon were documented. Univariate regression analysis and multivariate analyses with a linear mixed model adjusted with individual variability of segmental vBMDs were conducted with vBMD as the response variable. RESULTS Of 143 patients and 715 disc levels, 125 patients and 596 discs met our inclusion criteria. Mean vBMD (±standard deviation [SD]) of all levels was 119.0±39.6 mg/cm3. After adjusting for all covariates, Pfirrmann grade was not an independent contributor to vBMD, but the presence of any Modic change (type 1, β=6.8, p≤.001; type 2, β=6.7, p<.001; type 3, β=43.6, p<.001), high TEPS (score 10-12, β=14.2, p<.001), or vacuum phenomenon (β=9.0, p<.001) was shown to be independent contributors to vBMD. CONCLUSIONS Our results showed that the presence of certain end plate lesions (Modic changes and high TEPS) on MRI was significantly associated with increased regional QCT-vBMDs in the vertebral body, but no significant association was observed with disc nucleus pathology, unless it was associated with a vacuum phenomenon. When end plate lesions with Modic changes and high TEPS are present at the measuring level, care must be taken to interpret vBMD values, which might be overestimations even if the trabecular area appears normal.
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Affiliation(s)
- Ichiro Okano
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Stephan N Salzmann
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Conor Jones
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Courtney Ortiz Miller
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Toshiyuki Shirahata
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA; Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Colleen Rentenberger
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA.
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16
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Maerz T, Newton M, Marek AA, Planalp M, Baker K. Dynamic adaptation of vertebral endplate and trabecular bone following annular injury in a rat model of degenerative disc disease. Spine J 2018; 18:2091-2101. [PMID: 29886163 DOI: 10.1016/j.spinee.2018.05.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/26/2018] [Accepted: 05/31/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Degenerative disc disease (DDD) is associated with longitudinal remodeling of paravertebral tissues. Although chronic vertebral changes in advanced stages of DDD are well-studied, very little data exists on acute vertebral bone remodeling at the onset and progression of DDD. PURPOSE To longitudinally characterize bony remodeling in a rodent model of disc injury-induced DDD. STUDY DESIGN In vivo animal study involving a rat annulus fibrosus injury model of DDD. METHODS Eight female Lewis rats were assigned to intervertebral disc (IVD) injury (Puncture) or sham surgery (Sham). All rats underwent anterior, transperitoneal approach to the lumbar spine, and Puncture rats underwent annulus fibrosus injury at the L3-L4 and L5-L6 IVDs (n = 8 per group). Live micro computed tomography imaging (10-μm voxel size) was performed 1 week before surgery and postoperatively at 2-week intervals up to a 12-week endpoint. Bone morphology and densitometry of the cranial vertebral body and bony endplate were analyzed and reported with respect to the preoperative baseline scan. Sagittal Safranin-O/Fast-Green and Toluidine Blue histology evaluated using the Rutges IVD score and a custom vertebral endplate score. RESULTS Vertebral trabecular tissue mineral density (TMD), vertebral trabecular spacing, endplate TMD, and endplate apparent bone mineral density were all significantly greater in Puncture compared with Sham at 4 weeks and each subsequent timepoint. Puncture rats exhibited marginally lower endplate total volume. Anterior endplate osteophyte formation and central physeal ossification were observed in Puncture rats. Endpoint histological analysis demonstrated moderate evidence of IVD degeneration, indicating that vertebral bone adaptation occurs in the acute phases of DDD onset and progression. CONCLUSIONS Annulus injury-induced DDD leads to acute and progressive changes to the morphology and densitometry of bone in the adjacent vertebral bodies and endplates.
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Affiliation(s)
- Tristan Maerz
- Department of Orthopaedic Surgery & MedSport, University of Michigan, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48106, USA; Department of Orthopaedic Surgery, William Beaumont Hospital, 3811 West 13 Mile Rd, Suite 404, Royal Oak, MI 48073, USA; Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI 48309, USA
| | - Michael Newton
- Department of Orthopaedic Surgery, William Beaumont Hospital, 3811 West 13 Mile Rd, Suite 404, Royal Oak, MI 48073, USA
| | - Abigail A Marek
- Department of Orthopaedic Surgery, William Beaumont Hospital, 3811 West 13 Mile Rd, Suite 404, Royal Oak, MI 48073, USA
| | - Michael Planalp
- Department of Orthopaedic Surgery, William Beaumont Hospital, 3811 West 13 Mile Rd, Suite 404, Royal Oak, MI 48073, USA; Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI 48309, USA
| | - Kevin Baker
- Department of Orthopaedic Surgery, William Beaumont Hospital, 3811 West 13 Mile Rd, Suite 404, Royal Oak, MI 48073, USA; Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI 48309, USA.
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Comparison of patient-specific computational models vs. clinical follow-up, for adjacent segment disc degeneration and bone remodelling after spinal fusion. PLoS One 2018; 13:e0200899. [PMID: 30161138 PMCID: PMC6116979 DOI: 10.1371/journal.pone.0200899] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 07/04/2018] [Indexed: 11/21/2022] Open
Abstract
Spinal fusion is a standard surgical treatment for patients suffering from low back pain attributed to disc degeneration. However, results are somewhat variable and unpredictable. With fusion the kinematic behaviour of the spine is altered. Fusion and/or stabilizing implants carrying considerable load and prevent rotation of the fused segments. Associated with these changes, a risk for accelerated disc degeneration at the adjacent levels to fusion has been demonstrated. However, there is yet no method to predict the effect of fusion surgery on the adjacent tissue levels, i.e. bone and disc. The aim of this study was to develop a coupled and patient-specific mechanoregulated model to predict disc generation and changes in bone density after spinal fusion and to validate the results relative to patient follow-up data. To do so, a multiscale disc mechanoregulation adaptation framework was developed and coupled with a previously developed bone remodelling algorithm. This made it possible to determine extra cellular matrix changes in the intervertebral disc and bone density changes simultaneously based on changes in loading due to fusion surgery. It was shown that for 10 cases the predicted change in bone density and degeneration grade conforms reasonable well to clinical follow-up data. This approach helps us to understand the effect of surgical intervention on the adjacent tissue remodelling. Thereby, providing the first insight for a spine surgeon as to which patient could potentially be treated successfully by spinal fusion and in which patient has a high risk for adjacent tissue changes.
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18
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Zhou X, Cheung CL, Karasugi T, Karppinen J, Samartzis D, Hsu YH, Mak TSH, Song YQ, Chiba K, Kawaguchi Y, Li Y, Chan D, Cheung KMC, Ikegawa S, Cheah KSE, Sham PC. Trans-Ethnic Polygenic Analysis Supports Genetic Overlaps of Lumbar Disc Degeneration With Height, Body Mass Index, and Bone Mineral Density. Front Genet 2018; 9:267. [PMID: 30127800 PMCID: PMC6088183 DOI: 10.3389/fgene.2018.00267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/02/2018] [Indexed: 01/08/2023] Open
Abstract
Lumbar disc degeneration (LDD) is age-related break-down in the fibrocartilaginous joints between lumbar vertebrae. It is a major cause of low back pain and is conventionally assessed by magnetic resonance imaging (MRI). Like most other complex traits, LDD is likely polygenic and influenced by both genetic and environmental factors. However, genome-wide association studies (GWASs) of LDD have uncovered few susceptibility loci due to the limited sample size. Previous epidemiology studies of LDD also reported multiple heritable risk factors, including height, body mass index (BMI), bone mineral density (BMD), lipid levels, etc. Genetics can help elucidate causality between traits and suggest loci with pleiotropic effects. One such approach is polygenic score (PGS) which summarizes the effect of multiple variants by the summation of alleles weighted by estimated effects from GWAS. To investigate genetic overlaps of LDD and related heritable risk factors, we calculated the PGS of height, BMI, BMD and lipid levels in a Chinese population-based cohort with spine MRI examination and a Japanese case-control cohort of lumbar disc herniation (LDH) requiring surgery. Because most large-scale GWASs were done in European populations, PGS of corresponding traits were created using weights from European GWASs. We calibrated their prediction performance in independent Chinese samples, then tested associations with MRI-derived LDD scores and LDH affection status. The PGS of height, BMI, BMD and lipid levels were strongly associated with respective phenotypes in Chinese, but phenotype variances explained were lower than in Europeans which would reduce the power to detect genetic overlaps. Despite of this, the PGS of BMI and lumbar spine BMD were significantly associated with LDD scores; and the PGS of height was associated with the increased the liability of LDH. Furthermore, linkage disequilibrium score regression suggested that, osteoarthritis, another degenerative disorder that shares common features with LDD, also showed genetic correlations with height, BMI and BMD. The findings suggest a common key contribution of biomechanical stress to the pathogenesis of LDD and will direct the future search for pleiotropic genes.
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Affiliation(s)
- Xueya Zhou
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.,Department of Systems Biology, Department of Pediatrics, Columbia University Medical Center, New York, NY, United States
| | - Ching-Lung Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.,Li Ka Shing Faculty of Medicine, Center for Genomic Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tatsuki Karasugi
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto City, Japan
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yi-Hsiang Hsu
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, United States.,Harvard Medical School, Boston, MA, United States.,Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA, United States
| | - Timothy Shin-Heng Mak
- Li Ka Shing Faculty of Medicine, Center for Genomic Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - You-Qiang Song
- Li Ka Shing Faculty of Medicine, Center for Genomic Sciences, The University of Hong Kong, Hong Kong, Hong Kong.,Li Ka Shing Faculty of Medicine, School of Biomedical Science, The University of Hong Kong, Hong Kong, Hong Kong
| | - Kazuhiro Chiba
- Department of Orthopedic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Toyama University, Toyama Prefecture, Japan
| | - Yan Li
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Danny Chan
- Li Ka Shing Faculty of Medicine, School of Biomedical Science, The University of Hong Kong, Hong Kong, Hong Kong
| | - Kenneth Man-Chee Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Shiro Ikegawa
- Laboratory of Bone and Joint Diseases, Center for Integrative Medical Sciences, RIKEN, Tokyo, Japan
| | - Kathryn Song-Eng Cheah
- Li Ka Shing Faculty of Medicine, School of Biomedical Science, The University of Hong Kong, Hong Kong, Hong Kong
| | - Pak Chung Sham
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.,Li Ka Shing Faculty of Medicine, Center for Genomic Sciences, The University of Hong Kong, Hong Kong, Hong Kong
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19
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, China
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20
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Luo Y, Li SY, Tian FM, Song HP, Zhang YZ, Zhang L. Effects of human parathyroid hormone 1-34 on bone loss and lumbar intervertebral disc degeneration in ovariectomized rats. INTERNATIONAL ORTHOPAEDICS 2018; 42:1183-1190. [PMID: 29442158 DOI: 10.1007/s00264-018-3821-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/29/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Lumbar intervertebral disc degeneration is a common cause of lower back pain that affects the physical and mental health of patients and increases social burden. Parathyroid hormone has been reported to be effective at inhibiting disc degeneration; however, these effects have not been fully established in vivo in ovariectomized (OVX) rats. Thus, in this study, we aimed to address this issue and examine the effects of parathyroid hormone treatment in OVX rats. METHODS Thirty female Sprague-Dawley rats, three months-old, were subjected to sham or ovariectomy surgery. Twelve weeks postsurgery, OVX rats were treated with either human parathyroid hormone [hPTH(1-34), 30 μg/kg/day] or vehicle (normal saline (NS)) treatment. The L3-6 spinal segments were harvested after 12 weeks treatment. Bone mineral density (BMD), micro-architectural parameters, and biomechanical assessment were measured at the lumbar vertebral bodies. Histology and immunohistochemistry were performed to analyze the characteristics of the lumbar intervertebral discs. RESULTS OVX + PTH rats had significantly higher BMD, percentage bone volume density, trabecular thickness, and biomechanical strength compared with those in Sham and OVX + NS rats. Histology and immunostaining revealed that disc degeneration was not significantly different between the OVX + NS rats and the OVX + PTH rats, compared with the Sham group; the structure of nucleus pulposus was disordered, the expression of collagen I was increased, and collagen II and aggrecan were decreased. CONCLUSIONS These findings confirmed that hPTH(1-34) treatment has substantial anabolic effects on bone mass and trabecular micro-architecture, while the excessively enhanced bone mass and strength were coupled with a non-significant effect on the disc degeneration in ovariectomized rats.
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Affiliation(s)
- Yang Luo
- Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd, Tangshan, 063000, Hebei, People's Republic of China.,Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Shu-Yang Li
- College of Traditional Chinese Medicine, Inner Mongolia Medical University, Huhehaote, People's Republic of China
| | - Fa-Ming Tian
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Hui-Ping Song
- Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd, Tangshan, 063000, Hebei, People's Republic of China
| | - Ying-Ze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Liu Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd, Tangshan, 063000, Hebei, People's Republic of China.
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Lumbar disc degeneration was not related to spine and hip bone mineral densities in Chinese: facet joint osteoarthritis may confound the association. Arch Osteoporos 2017; 12:20. [PMID: 28210985 DOI: 10.1007/s11657-017-0315-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 02/06/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED A sample of 512 Chinese was studied and we observed that greater disc degeneration on MRI was associated with greater spine DXA BMD. Yet, this association may be confounded by facet joint osteoarthritis. BMD may not be a risk factor for lumbar disc degeneration in Chinese. PURPOSE Evidence suggested that lumbar vertebral bone and intervertebral disc interact with each other in multiple ways. The current paper aims to determine the association between bone mineral density (BMD) and lumbar disc degeneration using a sample of Chinese. METHODS We studied 165 patients with back disorders and 347 general subjects from China. All subjects had lumbar spine magnetic resonance (MR) imaging and dual- energy X-ray absorptiometry (DXA) spine BMD studies, and a subset of general subjects had additional hip BMD measurements. On T2-weighted MR images, Pfirrmann score was used to evaluate the degree of lumbar disc degeneration and facet joint osteoarthritis was assessed as none, slight-moderate, and severe. Regression analyses were used to examine the associations between lumbar and hip BMD and disc degeneration, adjusting for age, gender, body mass index (BMI), lumbar region, and facet joint osteoarthritis. RESULTS Greater facet joint osteoarthritis was associated with greater spine BMD (P < 0.01) in both patients and general subjects. For general subjects, greater spine BMD was associated with severe disc degeneration, controlling for age, gender, BMI, and lumbar region. When facet joint osteoarthritis entered the regression model, however, greater spine BMD was associated with greater facet joint osteoarthritis (P < 0.01) but not greater disc degeneration (P > 0.05). No statistical association was observed between spine BMD and lumbar disc degeneration in patients with back disorders (P > 0.05), and between hip BMD and disc degeneration in general subjects (P > 0.05). CONCLUSION BMD may not be a risk factor for lumbar disc degeneration in Chinese. Facet joint osteoarthritis inflates DXA spine BMD measurements and therefore, may confound the association between spine BMD and disc degeneration.
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Association between menopause and lumbar disc degeneration: an MRI study of 1,566 women and 1,382 men. Menopause 2017; 24:1136-1144. [DOI: 10.1097/gme.0000000000000902] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Song H, Luo Y, Wang W, Li S, Yang K, Dai M, Shen Y, Zhang Y, Zhang L. Effects of alendronate on lumbar intervertebral disc degeneration with bone loss in ovariectomized rats. Spine J 2017; 17:995-1003. [PMID: 28288923 DOI: 10.1016/j.spinee.2017.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 02/15/2017] [Accepted: 03/08/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Osteoporosis adversely affects disc degeneration cascades, and prophylactic alendronate (ALN) helps delay intervertebral disc degeneration (IDD) in ovariectomized (OVX) rats. However, there remains no information regarding whether ALN affects IDD with bone loss. PURPOSE This study aimed to observe the effects of ALN on degenerative discs with bone loss induced by OVX in rats. STUDY DESIGN This study used controlled in vivo experiments in rodents. METHODS Thirty female Sprague-Dawley rats were randomly assigned to undergo sham surgery (n=10) or OVX surgery (n=20); 3 months later, the OVX animals were injected with either ALN (OVX+ALN, 15 µg/kg/2w, n=10) or normal saline (OVX+vehicle treatment [V], n=10). At 3 months after the ALN intervention, van Gieson staining and immunohistochemistry were used to investigate histologic and metabolic changes in the discs. Bone mineral density (BMD), micro-computed tomography, and biomechanical tests were conducted to determine the biological properties of the vertebrae. RESULTS The OVX+ALN group exhibited significantly reduced morphologic degenerative alterations in both the nucleus pulposus and annulus fibrosus, with a markedly lower IDD score than that of the OVX+V group. The OVX+ALN samples showed increased disc height and decreased cartilage end plate thickness and bony area compared with the OVX+V group. Compared with saline, ALN administration markedly inhibited the type I collagen, matrix metalloprotease (MMP)-1, and MMP-13 expression levels while increasing the type II collagen and aggrecan expression levels in the disc matrix. Compared with the OVX+V group, OVX+ALN vertebrae revealed significantly enhanced BMD with increased biomechanical strength, as well as increased percent bone volume and trabecular thickness. CONCLUSIONS ALN has favorable effects on disc degeneration with bone loss and helps to alleviate IDD while enhancing the biological and mechanical properties of vertebrae and end plates.
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Affiliation(s)
- Huiping Song
- Department of Orthopaedic Surgery, The Affiliated Hospital of North China University of Science and Technology, 73 Jianshe Rd, Tangshan 063000, China
| | - Yang Luo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang, 050051, China
| | - Wenya Wang
- Department of Pathology, School of Basic Medical Sciences, North China University of Science and Technology, 73 Jianshe Rd, Tangshan, 063000, China
| | - Shuyang Li
- Department of Orthopaedic Surgery, The Affiliated Hospital of North China University of Science and Technology, 73 Jianshe Rd, Tangshan 063000, China
| | - Kai Yang
- Department of Orthopaedic Surgery, The Affiliated Hospital of North China University of Science and Technology, 73 Jianshe Rd, Tangshan 063000, China
| | - Muwei Dai
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang, 050051, China
| | - Yong Shen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang, 050051, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang, 050051, China
| | - Liu Zhang
- Department of Orthopaedic Surgery, The Affiliated Hospital of North China University of Science and Technology, 73 Jianshe Rd, Tangshan 063000, China.
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Yang G, Battié MC, Boyd SK, Videman T, Wang Y. Cranio-caudal asymmetries in trabecular architecture reflect vertebral fracture patterns. Bone 2017; 95:102-107. [PMID: 27876503 DOI: 10.1016/j.bone.2016.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
Clinically, vertebral fractures often occur in the upper lumbar spine and involve the superior endplate of a vertebra (which is immediately caudal to a disc). Knowledge that the cranial endplate of a disc is thicker and has greater bone mineral density (BMD) than the corresponding caudal endplate helps to explain this phenomenon. In this study, we investigated structural differences in vertebral trabeculae on either side of a lumbar disc to provide further insight into vertebral fracture risk. As the focus is trabecular difference within a spinal motion segment, we define cranial and caudal vertebral trabeculae relative to the disc. Ninety-two spinal motion segments from 46 cadaveric lumbar spines (males, mean age 50years, range 21-63years) were studied. Disc narrowing on radiography and spread of barium sulfate (BaSO4) on discography were measured to indicate disc degeneration. Micro-computed tomography (μCT) images were obtained at a resolution of 82μm for each vertebra and processed to include only vertebral trabeculae. Using image processing, the vertebral trabeculae were divided into superior and inferior halves, and then into central and peripheral regions which were approximately opposite to the disc pulposus and annulus, and further into anterior and posterior sub-regions. Microarchitecture measurements for each vertebral region were obtained to determine the differences between the cranial and caudal trabeculae (relative to disc) and their associations with age and disc degeneration within each spinal motion segment. Data from the upper (L1/2-L3/4) and lower (L4/5) lumbar segments were analyzed separately. In the upper lumbar region, the trabeculae cranial to a disc on average had 5.3% greater BMD and trabecular bone volume, 3.6% greater trabecular number, 9.7% greater connectivity density, and 3.7% less trabecular separation than the corresponding caudal trabeculae (P<0.05 for all). Similar trends were observed in peripheral, anterior and posterior regions, but not in central region. No structural difference was observed in the trabeculae of L4/5 segment. Structural asymmetries of vertebral trabeculae were not associated with age, disc degeneration, or disc narrowing. Vertebral trabecular parameters cranial to the disc were greater than caudally in the upper but not in the lower lumbar region. Findings further explain why vertebral fractures are more common in the upper lumbar region and more frequently involve the endplate caudal to a disc.
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Affiliation(s)
- Ge Yang
- Spine lab, Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Michele C Battié
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Steven K Boyd
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tapio Videman
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Yue Wang
- Spine lab, Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou, China.
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The effects of intervertebral disc degeneration combined with osteoporosis on vascularization and microarchitecture of the endplate in rhesus monkeys. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2705-15. [PMID: 27220969 DOI: 10.1007/s00586-016-4593-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the influence of osteoporosis on the microarchitecture and vascularization of the endplate in rhesus monkeys with or without intervertebral disc (IVD) degeneration using micro-computerized tomography (micro-CT), and to further analyze the correlation between osteoporosis and IVD degeneration. METHODS Twelve rhesus monkeys were randomly divided into the ovariectomy (OVX, n = 6) and the sham group (n = 6). The subchondral bone adjacent to the lumbar IVDs (from L4/5 to L6/7) of each monkey was randomly injected with 4 ml pingyangmycin (PYM) solution (1.5 mg/ml, PYM), or 4 ml phosphate buffered saline (PBS) as vehicle treatment, or exteriorized but not injected anything as control (Cntrl). Degenerative and osteoporotic processes were evaluated at different time points. Micro-CT and histology were performed to analyze microarchitecture, calcification area and vascularization of the endplate. RESULTS OVX resulted in significant decrease of bone mineral density (BMD). PYM injection induced progressively IVD degeneration, which was more progressive when combined with OVX. There was a negative correlation between BMD and Pfirrmann grade in the subgroups with PYM injection. The micro-CT analysis showed the combination of osteoporosis and IVD degeneration led to more calcification of endplate than any one thereof. The decrease of vascular volume percent in the endplate of the OVX-PYM subgroup was significantly greater than that in the Sham-PYM subgroup, both of which showed significant less vascularization compared to the other subgroups. CONCLUSION In conclusion the osteoporosis could accumulate the calcification and decrease the vascularization in the endplates adjacent to the degenerated IVDs, which subsequently exacerbated degeneration of the degenerated IVDs.
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Kamper M, Hamann N, Prein C, Clausen-Schaumann H, Farkas Z, Aszodi A, Niehoff A, Paulsson M, Zaucke F. Early changes in morphology, bone mineral density and matrix composition of vertebrae lead to disc degeneration in aged collagen IX −/− mice. Matrix Biol 2016; 49:132-143. [DOI: 10.1016/j.matbio.2015.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/25/2015] [Accepted: 09/26/2015] [Indexed: 01/26/2023]
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Parizel P, Van Hoyweghen A, Bali A, Van Goethem J, Van Den Hauwe L. The degenerative spine. HANDBOOK OF CLINICAL NEUROLOGY 2016; 136:787-808. [DOI: 10.1016/b978-0-444-53486-6.00039-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Tian FM, Yang K, Wang WY, Luo Y, Li SY, Song HP, Zhang YZ, Shen Y, Zhang L. Calcitonin suppresses intervertebral disk degeneration and preserves lumbar vertebral bone mineral density and bone strength in ovariectomized rats. Osteoporos Int 2015; 26:2853-61. [PMID: 26104796 DOI: 10.1007/s00198-015-3202-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED We investigated the effect of calcitonin (CT) on lumbar intervertebral disk degeneration (LIDD) in rats with ovariectomy-induced osteopenia. CT protected ovariectomized rats from LIDD by, at least in part, modifying extracellular matrix metabolism of the disks and preserving the microarchitecture and biomechanical properties of adjacent vertebrae. INTRODUCTION The present study aimed to investigate the effect of CT on lumbar vertebral bone mineral density and intervertebral disk degeneration in ovariectomized (OVX) rats. METHODS We first subjected 50 3-month-old female rats to either OVX (n = 30) or sham (n = 20). Twelve weeks later, ten OVX and ten sham rats were necropsied. The remaining OVX rats began to receive either saline vehicle (OVX + V, n = 10), or salmon CT (OVX + CT, 16 IU/kg/2 days, n = 10). After 12 weeks of treatment, necropsy was conducted and bone mineral density was determined in L3-4 and L5-6 vertebrae. The microstructure and biomechanical properties of L3 vertebrae were detected by micro-computed tomography and compression test, respectively. L5-6 was also used to measure intervertebral disk height and observe intervertebral disk histological changes by Van Gieson staining and histological scores, as well as immunohistochemistry (IHC) analysis of matrix metalloprotease (MMP)-1, MMP-13, and collagen II expression. RESULTS At 12 weeks post-OVX, OVX rats had lower BV/TV and Tb.N and higher intervertebral disk histological score than sham rats. After 24 weeks, OVX + CT rats had higher BMD, BV/TV, Tb.N, and bone biomechanical strength values than OVX + V rats. Histological analysis showed OVX + CT rats had significantly lower disk degeneration scores than OVX + V rats. IHC analysis revealed CT treatment decreased expression of MMP-1 and MMP-13 and increased expression of collagen II compared with OVX + V rats. CONCLUSIONS Our data demonstrate that CT-treated OVX rats display less intervertebral disk degeneration and favorable changes in intervertebral disk metabolism, associated with higher trabecular bone mass, better trabecular microarchitecture, and better biomechanical strength when compared to vehicle-treated OVX rats.
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Affiliation(s)
- F-m Tian
- Medical Research Center, Affiliated Hospital of Hebei United University, Tangshan, People's Republic of China
| | - K Yang
- Department of Orthopedic Surgery, Affiliated Hospital of Hebei United University, No. 73 Jianshe South Rd, Tangshan, 063000, Hebei, People's Republic of China
| | - W-y Wang
- Department of Pathology of Basic Medical Sciences School, Hebei United University, Tangshan, People's Republic of China
| | - Y Luo
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - S-y Li
- Department of Orthopedic Surgery, Affiliated Hospital of Hebei United University, No. 73 Jianshe South Rd, Tangshan, 063000, Hebei, People's Republic of China
| | - H-p Song
- Department of Orthopedic Surgery, Affiliated Hospital of Hebei United University, No. 73 Jianshe South Rd, Tangshan, 063000, Hebei, People's Republic of China
| | - Y-z Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Y Shen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - L Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of Hebei United University, No. 73 Jianshe South Rd, Tangshan, 063000, Hebei, People's Republic of China.
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Liu CC, Tian FM, Zhou Z, Wang P, Gou Y, Zhang H, Wang WY, Shen Y, Zhang YZ, Zhang L. Protective effect of calcitonin on lumbar fusion-induced adjacent-segment disc degeneration in ovariectomized rat. BMC Musculoskelet Disord 2015; 16:342. [PMID: 26552386 PMCID: PMC4640157 DOI: 10.1186/s12891-015-0788-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/23/2015] [Indexed: 02/06/2023] Open
Abstract
Background Intervertebral disc (IVD) degeneration and pathological changes in the spinal cord are major causes of back pain. In addition to its well-established anti-resorptive effect on bone, calcitonin (CT) potentially exerts protective effects on IVD degeneration in ovariectomized rats. However, possible therapeutic effects of CT on lumbar fusion-induced adjacent-segment disc degeneration (ASDD) have not been investigated yet. In this study, we examined the effects of CT on IVD degeneration adjacent to a lumbar fusion in ovariectomized rats. Methods Posterolateral lumbar fusion (PLF) at L4–5 was performed 4 weeks after ovariectomy (OVX) or sham surgery in female Sprague–Dawley rats. Following PLF + OVX, rats received either salmon CT (OVX + PLF + sCT, 16 IU/Kg/2d) or vehicle (OVX + PLF + V) treatment for 12 weeks; the remaining rats were divided into Sham + V, OVX + V, and PLF + V groups. Fusion status was analyzed by manual palpation and radiography. Adjacent segment disc was assessed by histological, histomorphometric, immunohistochemical analysis. L6 vertebrae microstructures were evaluated by micro-computed tomography. Results Histological analysis showed more severe ASDD occurred in OVX + PLF + V rats compared with the OVX + V or PLF + V groups. CT treatment suppressed the score for ASDD, increased disc height, and decreased the area of endplate calcification. Immunohistochemical staining demonstrated that CT decreased the expression of collagen type-I, matrix metalloproteinase-13, and a disintegrin and metalloproteinase with thrombospondin motifs-4, whereas it increased the expression of collagen type-II and aggrecan in the disc. Micro-computed tomography indicated that CT increased bone mass and improved the microstructure of the L6 vertebrae. Conclusions These results suggest that CT can prevent ASDD, induce beneficial changes in IVD metabolism, and inhibit deterioration of the trabecular microarchitecture of vertebrae in osteoporotic rats with lumbar fusion.
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Affiliation(s)
- Chang-Cheng Liu
- Orthopaedic Research Institution of Hebei, Third Hospital of Hebei Medical University, Shijiazhuang, 050017, P.R. China
| | - Fa-Ming Tian
- Medical Research Center, North China University of Science and Technology, Tangshan, 063000, P. R. China.
| | - Zhuang Zhou
- Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd., Tangshan, Hebei, 063000, P.R. China.
| | - Peng Wang
- Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd., Tangshan, Hebei, 063000, P.R. China.
| | - Yu Gou
- Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd., Tangshan, Hebei, 063000, P.R. China.
| | - Heng Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd., Tangshan, Hebei, 063000, P.R. China.
| | - Wen-Ya Wang
- Department of Pathology, School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, 063000, P. R. China.
| | - Yong Shen
- Orthopaedic Research Institution of Hebei, Third Hospital of Hebei Medical University, Shijiazhuang, 050017, P.R. China.
| | - Ying-Ze Zhang
- Orthopaedic Research Institution of Hebei, Third Hospital of Hebei Medical University, Shijiazhuang, 050017, P.R. China.
| | - Liu Zhang
- Orthopaedic Research Institution of Hebei, Third Hospital of Hebei Medical University, Shijiazhuang, 050017, P.R. China. .,Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd., Tangshan, Hebei, 063000, P.R. China.
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Enneman AW, Swart KMA, van Wijngaarden JP, van Dijk SC, Ham AC, Brouwer-Brolsma EM, van der Zwaluw NL, Dhonukshe-Rutten RAM, van der Cammen TJM, de Groot LCPGM, van Meurs J, Lips P, Uitterlinden AG, Zillikens MC, van Schoor NM, van der Velde N. Effect of Vitamin B12 and Folic Acid Supplementation on Bone Mineral Density and Quantitative Ultrasound Parameters in Older People with an Elevated Plasma Homocysteine Level: B-PROOF, a Randomized Controlled Trial. Calcif Tissue Int 2015; 96:401-9. [PMID: 25712255 PMCID: PMC4415946 DOI: 10.1007/s00223-015-9968-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/09/2015] [Indexed: 11/03/2022]
Abstract
High plasma homocysteine (Hcy) levels are associated with increased osteoporotic fracture incidence. However, the mechanism remains unclear. We investigated the effect of Hcy-lowering vitamin B12 and folic acid treatment on bone mineral density (BMD) and calcaneal quantitative ultrasound (QUS) parameters. This randomized, double-blind, placebo-controlled trial included participants aged ≥65 years with plasma Hcy levels between 12 and 50 µmol/L. The intervention comprised 2-year supplementation with either a combination of 500 µg B12, 400 µg folic acid, and 600 IU vitamin D or placebo with 600 IU vitamin D only. In total, 1111 participants underwent repeated dual-energy X-ray assessment and 1165 participants underwent QUS. Femoral neck (FN) BMD, lumbar spine (LS) BMD, calcaneal broadband ultrasound attenuation (BUA), and calcaneal speed of sound (SOS) were assessed. After 2 years, FN-BMD and BUA had significantly decreased, while LS-BMD significantly increased (all p < 0.01) and SOS did not change in either treatment arm. No statistically significant differences between the intervention and placebo group were present for FN-BMD (p = 0.24), LS-BMD (p = 0.16), SOS (p = 0.67), and BUA (p = 0.96). However, exploratory subgroup analyses revealed a small positive effect of the intervention on BUA at follow-up among compliant persons >80 years (estimated marginal mean 64.4 dB/MHz for the intervention group and 61.0 dB/MHz for the placebo group, p = 0.04 for difference). In conclusion, this study showed no overall effect of treatment with vitamin B12 and folic acid on BMD or QUS parameters in elderly, mildly hyperhomocysteinemic persons, but suggests a small beneficial effect on BUA in persons >80 years who were compliant in taking the supplement.
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Affiliation(s)
- Anke W. Enneman
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Karin M. A. Swart
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | | | - Suzanne C. van Dijk
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Annelies C. Ham
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Elske M. Brouwer-Brolsma
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
| | - Nikita L. van der Zwaluw
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
| | | | - Tischa J. M. van der Cammen
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | | | - Joyce van Meurs
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Paul Lips
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Endocrinology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - André G. Uitterlinden
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - M. Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Natasja M. van Schoor
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, P.O. Box 22700, 1100 DD Amsterdam, The Netherlands
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Salo S, Leinonen V, Rikkonen T, Vainio P, Marttila J, Honkanen R, Tuppurainen M, Kröger H, Sirola J. Association between bone mineral density and lumbar disc degeneration. Maturitas 2014; 79:449-55. [PMID: 25266266 DOI: 10.1016/j.maturitas.2014.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Higher vertebral bone mineral density (BMD) has been found to be related with lumbar disc degeneration (LDD), while relationship between femoral neck BMD and LDD remains controversial. The aim of our research was to study the relationship between LDD and BMD of the lumbar spine and femoral neck. STUDY DESIGN The study population consisted of 168 postmenopausal women (aged 63.3-75.0 years, mean 68.6 years) from the prospective OSTPRE and OSTPRE-FPS study cohorts. The severity of LDD was graded from T2-weighted MRI images using the five-grade Pfirrmann classification. Four vertebral levels (L1-L4) were studied (total 672 discs). The association between lumbar BMD and Z-score and the severity of LDD was studied separately for each vertebral level with AN(C)OVA analysis, using potential confounders as covariates. RESULTS Higher lumbar BMD and Z-score were associated with more severe LDD at all studied levels (L1-L4): between L4-L5 disc and L4 BMD (p=0.044) and L4 Z-score (p=0.052), between L2-L3 disc and L3 BMD (p=0.001) and at all other levels (p<0.001). The mean degeneration grade of the studied discs was associated with the mean L1-L4 BMD and Z-score (p<0.001). Statistical significance of any result did not alter after controlling for confounding factors. There was no significant association between femoral neck BMD and LDD. CONCLUSIONS Higher lumbar BMD/Z-score were associated with more severe LDD. There was no significant association between femoral neck BMD and disc degeneration. Femoral neck BMD may be a more reliable measurement for diagnosing osteoporosis in postmenopausal women with degenerative changes in the lumbar spine.
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Affiliation(s)
- Sami Salo
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Ville Leinonen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Toni Rikkonen
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pauli Vainio
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Jarkko Marttila
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Lapland Hospital District, Rovaniemi, Finland
| | - Marjo Tuppurainen
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Obstetrics and Gynecology, Kuopio University Hospital, Finland
| | - Heikki Kröger
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Joonas Sirola
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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Aging changes in lumbar discs and vertebrae and their interaction: a 15-year follow-up study. Spine J 2014; 14:469-78. [PMID: 24262855 DOI: 10.1016/j.spinee.2013.11.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 10/31/2013] [Accepted: 11/07/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Many studies have focused on either the intervertebral disc as a culprit in back pain problems, or the vertebral body, but very few studies have examined both structures and their relationship. PURPOSE To measure the concordant changes in morphology of the discs and vertebrae during 5-, 10-, and 15-year follow-ups. STUDY DESIGN Longitudinal study. PATIENT SAMPLE Among a general population sample of 232 men that had been scanned in 1992-1993, 105 men were reexamined in 1997-1998 and 2007-2008. Mean age at the 15-year follow-up was 63 years. A confirmatory sample with 10 years follow-up was also included. METHODS Scanners (1.5 Tesla) with surface coils were used at baseline and follow-up. Image analyzing software was used to measure distances and areas of interest of midsagittal and midaxial spine images. RESULTS The disc heights decreased at 5 years by 3.4% (0.4 mm) and 3.3% (0.4 mm) and at 15 years by 8.7% (1.0 mm) and 11.3% (1.3 mm) in the upper and lower discs, respectively (p<.001). Although not clear after 5 years, vertebra heights increased in mean by 3.1% (0.8 mm) in the upper lumbar levels and by 4.7% (1.1 mm) in the lower vertebrae after 15 years (p<.001). Vertebra height increases were associated with disc narrowing (p=.001). The mean annual shortening of the lumbar spine L1-S1 block was 0.13 mm/y, which was in line with the mean standing height that decreased little (174.7 cm at baseline and 174.4 cm at the follow-up). CONCLUSIONS Discs and vertebrae degenerate or remodel in concert: decreases in disc height appear to be compensated, in part, by accompanying increases in adjacent vertebra heights. The mechanism behind this novel finding and its implications require further study.
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Wang Y, Owoc JS, Boyd SK, Videman T, Battié MC. Occupational loading may not affect the association between vertebral trabecular bone and intervertebral disc narrowing. Bone 2013; 57:375-6. [PMID: 24056251 DOI: 10.1016/j.bone.2013.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Yue Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
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Marquezan M, Lima I, Lopes RT, Sant'Anna EF, de Souza MMG. Is trabecular bone related to primary stability of miniscrews? Angle Orthod 2013; 84:500-7. [PMID: 24245816 DOI: 10.2319/052513-39.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare the primary stability of miniscrews inserted into bone blocks of different bone mineral densities (BMDs) with and without cortical bone, and investigate whether some trabecular properties could influence primary stability. MATERIALS AND METHODS Fifty-two bone blocks were extracted from fresh bovine pelvic bone. Four groups were created based on bone type (iliac or pubic region) and presence or absence of cortical bone. Specimens were micro-computed tomography imaged to evaluate trabecular thickness, trabecular number, trabecular separation, bone volume density (BV/TV), BMD, and cortical thickness. Miniscrews 1.4 mm in diameter and 6 mm long were inserted into the bone blocks, and primary stability was evaluated by insertion torque (IT), mini-implant mobility (PTV), and pull-out strength (PS). RESULTS Intergroup comparison showed lower levels of primary stability when the BMD of trabecular bone was lower and in the absence of cortical bone (P≤.05). The Pearson correlation test showed correlation between trabecular number, trabecular thickness, BV/TV, trabecular BMD, total BMD, and IT, PTV, and PS. There was correlation between cortical thickness and IT and PS (P≤.05). CONCLUSION Cancellous bone plays an important role in primary stability of mini-implants in the presence or absence of cortical bone.
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Affiliation(s)
- Mariana Marquezan
- a PhD Student, Department of Pedodontics and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Wang Y, Owoc JS, Boyd SK, Videman T, Battié MC. Regional variations in trabecular architecture of the lumbar vertebra: associations with age, disc degeneration and disc space narrowing. Bone 2013; 56:249-54. [PMID: 23810839 DOI: 10.1016/j.bone.2013.06.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/16/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
Previous studies suggest that age and disc degeneration are associated with variations in vertebral trabecular architecture. In particular, disc space narrowing, a severe form of disc degeneration, may predispose the anterior portion of a vertebra to fracture. We studied 150 lumbar vertebrae and 209 intervertebral discs from 48 cadaveric lumbar spines of middle-aged men to investigate regional trabecular differences in relation to age, disc degeneration and disc narrowing. The degrees of disc degeneration and narrowing were evaluated using radiography and discography. The vertebrae were dried and scanned on a μCT system. The μCT images of each vertebral body were processed to include only vertebral trabeculae, which were first divided into superior and inferior regions, and further into central and peripheral regions, and then anterior and posterior regions. Structural analyses were performed to obtain trabecular microarchitecture measurements for each vertebral region. On average, the peripheral region had 12-15% greater trabecular bone volume fraction and trabecular thickness than the central region (p<0.01). Greater age was associated with better trabecular structure in the peripheral region relative to the central region. Moderate and severe disc degeneration were associated with higher trabecular thickness in the peripheral region of the vertebral trabeculae (p<0.05). The anterior region was of lower bone quality than the posterior region, which was not associated with age. Slight to moderate narrowing was associated with greater trabecular bone volume fraction in the anterior region of the inferior vertebra (p<0.05). Similarly, greater disc narrowing was associated with higher trabecular thickness in the anterior region (p<0.05). Better architecture of peripheral trabeculae relative to central trabeculae was associated with both age and disc degeneration. In contrast to the previous view that disc narrowing stress-shields the anterior vertebra, disc narrowing tended to associate with better trabecular architecture in the anterior region, as opposed to the posterior region.
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Affiliation(s)
- Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China.
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Chiba K, Burghardt AJ, Osaki M, Majumdar S. Heterogeneity of bone microstructure in the femoral head in patients with osteoporosis: an ex vivo HR-pQCT study. Bone 2013; 56:139-46. [PMID: 23748104 PMCID: PMC3740186 DOI: 10.1016/j.bone.2013.05.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Trabecular bone in the femoral head has a complicated and heterogeneous structure with few studies having analyzed heterogeneity in this structure quantitatively. We analyze trabecular bone microstructure in the femoral head with osteoporosis (OP) using high resolution peripheral quantitative CT (HR-pQCT) to investigate its regional characteristics. METHODS Fifteen femoral heads extracted from female OP patients with femoral neck fracture (85 ± 7, 67-94 years) were scanned by HR-pQCT at 41 μm voxel size. The femoral head was segmented into 15 regions (3 longitudinal regions: superior, center, and inferior, and 5 axial subregions: center, medial, lateral, anterior, posterior). Of these 15 regions, five were excluded due to overlap with the fracture site, leaving a total of 10 regions of cancellous bone microstructures to be quantitatively assessed using the following parameters: bone volume fraction, trabecular thickness, number, separation, connectivity density, structure model index, and degree and orientation of anisotropy. These parameters were compared among each region. RESULTS Trabecular bone at the center, superior, and supero-posterior regions of the femoral head had higher bone volume, trabecular number, thickness, narrower bone marrow spaces, higher connectivity and anisotropy, and more plate-like structure. This plate-like structure ran supero-inferiorly and antero-posteriorly at the superior and center regions. Bone volume at the anterior, posterior, and medial regions was almost half of the central and superior regions. CONCLUSION Significant heterogeneity of the trabecular bone microstructure in the OP femoral head was showed quantitatively in this study. These data offer new insight into bone microstructural anatomy and may prove to provide useful information on clinical medicine such as hip surgeries.
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Affiliation(s)
- Ko Chiba
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
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Lee S, Nam CM, Yoon DH, Kim KN, Yi S, Shin DA, Ha Y. Association between low-back pain and lumbar spine bone density: a population-based cross-sectional study. J Neurosurg Spine 2013; 19:307-13. [PMID: 23829289 DOI: 10.3171/2013.5.spine12473] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors undertook this study to investigate the relationships between low-back pain (LBP) and spinal bone density. Low-back pain is a major health issue and contributes to increases in medical and economic costs. Epidemiological studies have identified individual, sociodemographic, psychosocial, and occupational risk factors for LBP. However, there have been limited studies addressing the relationships between LBP and spinal bone density. METHODS Data were obtained from the population-based Fourth Korea National Health and Nutrition Examination Survey (K-NHANES IV, 2009). From 10,533 K-NHANES participants, the authors identified 7144 (3099 men and 4045 women) 21 years of age or older who underwent dual-energy x-ray absorptiometry and anthropometric measurements for inclusion in this study. Low-back pain patients were defined as those who had been diagnosed with LBP by a medical doctor. Chi-square tests, t-tests, and multivariable logistic regression analyses were used to examine the relationships between LBP and spinal bone density. RESULTS The total prevalence of LBP in the patient sample was 17.1%. More females (21.0%) reported LBP than males (12.1%). A number of sociodemographic and medical factors-sex, age, place of residence, occupation, education, hypertension, diabetes mellitus, and depression-were all associated with LBP, while LBP was not associated with income or exercise levels. Regression analyses indicated that higher lumbar spine T-scores (OR 1.11, 95% CI 1.02-1.20) were associated with LBP. CONCLUSIONS Higher bone density in the lumbar spine is associated with LBP, independent of confounding factors such as sociodemographic status, education, and medical-psychiatric disorders. Cause and effect relationship between higher bone density and LBP, such as degenerative changes in spine, requires further investigation.
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Affiliation(s)
- Sungkyu Lee
- Center for Tobacco Control Research and Education, University of California, San Francisco, USA
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Zhang D, Jin L, Reames DL, Shen FH, Shimer AL, Li X. Intervertebral disc degeneration and ectopic bone formation in apolipoprotein E knockout mice. J Orthop Res 2013; 31:210-7. [PMID: 22915292 PMCID: PMC3535577 DOI: 10.1002/jor.22216] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 08/02/2012] [Indexed: 02/04/2023]
Abstract
Cardiovascular risk factors are known to be associated with intervertebral disc degeneration, but the underlying mechanism is still unclear. The ApoE knockout (KO) mouse is a well-established model for atheroscelorosis. We hypothesized that ApoE is involved in maintaining disc health and that ApoE KO mice will develop early disc degeneration. Discs of ApoE KO and wild-type (WT) mice were characterized with histological/immunological, biochemical, and real-time RT-PCR assays. A comparison of the extracellular matrix production was also performed in disc cells. We demonstrated that ApoE was highly expressed in the endplates of WT discs, and ectopic bone formed in the endplates of ApoE KO discs. Glycosaminoglycan content was decreased in both ApoE KO annulus fibrosus (AF) and nucleus pulposus (NP) cells. Collagen levels were increased in AF and decreased in NP cells. Matrix metalloproteinase-3, -9, and -13 expressions were increased, which may partially explain the impaired matrix production. We also found collagen I, II, aggrecan, and biglycan mRNA expressions were increased in AF cells but decreased in NP cells. Apoptosis was increased in the ApoE KO NP tissue. These results suggest early disc degeneration changes in the ApoE KO mice. ApoE may play a critical role in disc integrity and function.
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Affiliation(s)
- Dawei Zhang
- Department of Orthopedic Surgery University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Li Jin
- Department of Orthopedic Surgery University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Davis L. Reames
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Francis H. Shen
- Department of Orthopedic Surgery University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Adam L. Shimer
- Department of Orthopedic Surgery University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Xudong Li
- Department of Orthopedic Surgery University of Virginia Health System, Charlottesville, Virginia, United States of America
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