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Huang Y, Wei S, Shen Y, Zhan S, Yi P, Tang X. A new technique for low back pain in lumbar disc herniation: percutaneous endoscopic lumbar discectomy combined with sinuvertebral nerve ablation. J Orthop Surg Res 2024; 19:341. [PMID: 38849922 PMCID: PMC11162081 DOI: 10.1186/s13018-024-04831-8] [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: 05/02/2024] [Accepted: 06/02/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has demonstrated efficacy in alleviating leg pain among patients with lumbar disc herniation. Nonetheless, residual back pain persists as a troubling issue for surgeons following the procedure. In the treatment of discogenic back pain, sinuvertebral nerve radiofrequency ablation has shown promising results. Nevertheless, the potential benefit of simultaneously implementing sinuvertebral nerve radiofrequency ablation during PELD surgery to address residual back pain has not been thoroughly investigated in current literature. METHODS This retrospective study reviewed Lumbar disc herniation (LDH) patients with low back pain who underwent combined PELD and sinuvertebral nerve ablation in our department between January 2021 and September 2023. Residual low back pain post-surgery was assessed and compared with existing literature. RESULTS A total of 80 patients, including 53 males and 27 females, were included in the study. Following surgical intervention, patients demonstrated remarkable improvements in pain and functional parameters. One month post-operatively, the VAS score for low back pain exhibited a 75% reduction (6.45 ± 1.3 to 1.61 ± 1.67), while the VAS score for leg pain decreased by 85% (7.89 ± 1.15 to 1.18 ± 1.26). Notably, the JOA score increased from 12.89 ± 5.48 to 25.35 ± 4.96, and the ODI score decreased form 59.48 ± 9.58 to 20.3 ± 5.37. These improvements were sustained at three months post-operatively. According to the modified Mac Nab criteria, the excellent and good rate was 88.75%. Residual low back pain is observed to be comparatively reduced compared to the findings documented in earlier literature. CONCLUSION The combination of percutaneous endoscopic lumbar discectomy and sinuvertebral nerve ablation demonstrates effective improvement in low back pain for LDH patients.
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Affiliation(s)
- Yanjun Huang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shangshu Wei
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yanzhu Shen
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Sizheng Zhan
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China
| | - Ping Yi
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China
| | - Xiangsheng Tang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China.
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Menon RG, Monga A, Kijowski R, Regatte RR. Characterization of Age-Related and Sex-Related Differences of Relaxation Parameters in the Intervertebral Disc Using MR-Fingerprinting. J Magn Reson Imaging 2024; 59:1312-1324. [PMID: 37610269 PMCID: PMC10935608 DOI: 10.1002/jmri.28925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Multiparameter characterization using MR fingerprinting (MRF) can quantify multiple relaxation parameters of intervertebral disc (IVD) simultaneously. These parameters may vary by age and sex. PURPOSE To investigate age- and sex-related differences in the relaxation parameters of the IVD of the lumbar spine using a multiparameter MRF technique. STUDY TYPE Prospective. SUBJECTS 17 healthy subjects (8 male; mean age = 34 ± 10 years, range 20-60 years). FIELD STRENGTH/SEQUENCE 3D-MRF sequence for simultaneous acquisition of proton density, T1 , T2 , and T1ρ maps at 3.0T. ASSESSMENT Global mean T1 , T2 , and T1ρ of all lumbar IVDs and mean T1 , T2 , and T1ρ of each individual IVD (L1-L5) were measured. Gray level co-occurrence matrix was used to quantify textural features (median, contrast, correlation, energy, and homogeneity) from T1 , T2 , and T1ρ maps. STATISTICAL TESTS Spearman rank correlations (R) evaluated the association between age and T1 , T2 , and T1ρ of IVD. Mann-Whitney U-tests evaluated differences between males and females in T1 , T2 , and T1ρ of IVD. Statistical significance was defined as P-value <0.05. RESULTS There was a significant negative correlation between age and global mean values of all IVDs for T1 (R = -0.637), T2 (R = -0.509), and T1ρ (R = -0.726). For individual IVDs, there was a significant negative correlation between age and mean T1 at all IVD segments (R range = -0.530 to -0.708), between age and mean T2 at L2-L3, L3-L4, and L4-L5 (R range = -0.493 to 0.640), and between age and mean T1ρ at all segments except L1-L2 (R range = -0.632 to -0.763). There were no significant differences between sexes in global mean T1 , T2, and T1ρ (P-value = 0.23-0.76) The texture features with the highest significant correlations with age for all IVDs were global T1ρ mean (R = -0.726), T1 energy (R = -0.681), and T1 contrast (R = 0.709). CONCLUSION This study showed that the 3D-MRF technique has potential to characterize age-related differences in T1 , T2, or T1ρ of IVD in healthy subjects. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Rajiv G. Menon
- Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine
| | - Anmol Monga
- Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine
| | - Richard Kijowski
- Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine
| | - Ravinder R. Regatte
- Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine
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Bhattacharya S, Dubey DK. A multiscale investigation into the role of collagen-hyaluronan interface shear on the mechanical behaviour of collagen fibers in annulus fibrosus - Molecular dynamics-cohesive finite element-based study. J Mech Behav Biomed Mater 2023; 147:106147. [PMID: 37812947 DOI: 10.1016/j.jmbbm.2023.106147] [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: 04/13/2023] [Revised: 06/30/2023] [Accepted: 09/23/2023] [Indexed: 10/11/2023]
Abstract
Multi-directional deformation exhibited by annulus fibrosus (AF) is contributed by chemo-mechanical interactions among its biomolecular constituents' collagen type I (COL-I), collagen type II (COL-II), proteoglycans (aggrecan and hyaluronan) and water. However, the nature and role of such interactions on AF mechanics are unclear. This work employs a molecular dynamics-cohesive finite element-based multiscale approach to investigate role of COL-I-COL-II interchanging distribution and water concentration (WC) variations from outer annulus (OA) to inner annulus (IA) on collagen-hyaluronan (COL-HYL) interface shear, and the mechanisms by which interface shear impacts fibril sliding during collagen fiber deformation. At first, COL-HYL interface atomistic models are constructed by interchanging COL-I with COL-II and increasing COL-II and WC from 0 to 75%, and 65%-75% respectively. Thereafter, a multiscale approach is employed to develop representative volume elements (RVEs) of collagen fibers by incorporating COL-HYL shear as traction-separation behaviour at fibril-hyaluronan contact. Results show that increasing COL-II and WC increases interface stiffness from 0.6 GPa/nm to 1.2 GPa/nm and reduces interface strength from 155 MPa to 58 MPa from OA to IA, contributed by local hydration alterations. A stiffer and weaker interface enhances fibril sliding with increased straining at the contact - thereby contributing to reduction in modulus from 298 MPa to 198 MPa from OA to IA. Such reduction further contributes to softer mechanical response towards IA, as reported by earlier studies. Presented multiscale analysis provides deeper understanding of hierarchical structure-mechanics relationships in AF and can further aid in developing better substitutes for AF repair.
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Affiliation(s)
- Shambo Bhattacharya
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, Haus Khas, New Delhi, 110016, India
| | - Devendra K Dubey
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, Haus Khas, New Delhi, 110016, India.
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Compte R, Granville Smith I, Isaac A, Danckert N, McSweeney T, Liantis P, Williams FMK. Are current machine learning applications comparable to radiologist classification of degenerate and herniated discs and Modic change? A systematic review and meta-analysis. 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; 32:3764-3787. [PMID: 37150769 PMCID: PMC10164619 DOI: 10.1007/s00586-023-07718-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/08/2023] [Accepted: 04/09/2023] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Low back pain is the leading contributor to disability burden globally. It is commonly due to degeneration of the lumbar intervertebral discs (LDD). Magnetic resonance imaging (MRI) is the current best tool to visualize and diagnose LDD, but places high time demands on clinical radiologists. Automated reading of spine MRIs could improve speed, accuracy, reliability and cost effectiveness in radiology departments. The aim of this review and meta-analysis was to determine if current machine learning algorithms perform well identifying disc degeneration, herniation, bulge and Modic change compared to radiologists. METHODS A PRISMA systematic review protocol was developed and four electronic databases and reference lists were searched. Strict inclusion and exclusion criteria were defined. A PROBAST risk of bias and applicability analysis was performed. RESULTS 1350 articles were extracted. Duplicates were removed and title and abstract searching identified original research articles that used machine learning (ML) algorithms to identify disc degeneration, herniation, bulge and Modic change from MRIs. 27 studies were included in the review; 25 and 14 studies were included multi-variate and bivariate meta-analysis, respectively. Studies used machine learning algorithms to assess LDD, disc herniation, bulge and Modic change. Models using deep learning, support vector machine, k-nearest neighbors, random forest and naïve Bayes algorithms were included. Meta-analyses found no differences in algorithm or classification performance. When algorithms were tested in replication or external validation studies, they did not perform as well as when assessed in developmental studies. Data augmentation improved algorithm performance when compared to models used with smaller datasets, there were no performance differences between augmented data and large datasets. DISCUSSION This review highlights several shortcomings of current approaches, including few validation attempts or use of large sample sizes. To the best of the authors' knowledge, this is the first systematic review to explore this topic. We suggest the utilization of deep learning coupled with semi- or unsupervised learning approaches. Use of all information contained in MRI data will improve accuracy. Clear and complete reporting of study design, statistics and results will improve the reliability and quality of published literature.
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Affiliation(s)
- Roger Compte
- Department of Twin Research, King's College London, St Thomas' Hospital Campus, 4th Floor South Wing, Block D, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Isabelle Granville Smith
- Department of Twin Research, King's College London, St Thomas' Hospital Campus, 4th Floor South Wing, Block D, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Nathan Danckert
- Department of Twin Research, King's College London, St Thomas' Hospital Campus, 4th Floor South Wing, Block D, Westminster Bridge Road, London, SE1 7EH, UK
| | - Terence McSweeney
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Panagiotis Liantis
- Guy's and St Thomas' National Health Services Foundation Trust, London, UK
| | - Frances M K Williams
- Department of Twin Research, King's College London, St Thomas' Hospital Campus, 4th Floor South Wing, Block D, Westminster Bridge Road, London, SE1 7EH, UK
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Russo F, Ambrosio L, Giannarelli E, Vorini F, Mallio CA, Quattrocchi CC, Vadalà G, Papalia R, Denaro V. Innovative quantitative magnetic resonance tools to detect early intervertebral disc degeneration changes: a systematic review. Spine J 2023; 23:1435-1450. [PMID: 37247638 DOI: 10.1016/j.spinee.2023.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is the leading cause of disability worldwide, with a tremendous socioeconomic burden. It is mainly caused by intervertebral disc degeneration (IDD), a progressive and age-related process. Due to its ability to accurately characterize intervertebral disc morphology, magnetic resonance imaging (MRI) has been established as one of the most valuable tools in diagnosing IDD. Innovative quantitative MRI (qMRI) techniques able to detect the earliest signs of IDD have been increasingly reported. PURPOSE To systematically review available reports on the application of novel qMRI techniques to detect early IDD changes. STUDY DESIGN Systematic literature review. METHODS A systematic search of PubMed/MEDLINE, Scopus, CINAHL, EMBASE, CENTRAL and Cochrane databases was performed through January 21, 2023. Randomized and nonrandomized studies on innovative qMRI tools able to diagnose early biochemical and architectural IDD changes in patients with or without discogenic LBP were searched. Data on study population, follow-up time (when applicable) and MRI sequence used were recorded. The QUADAS-2 tool was utilized to assess the risk of bias of included studies. RESULTS A total of 39 articles published between 2005 and 2022 resulted from the search. All novel qMRI techniques showed an increased capacity to detect early IDD changes thanks to the ability to assess subtle alterations of water content, proteoglycan and glycosaminoglycan concentration, and increased levels of catabolic biomarkers compared to conventional MRI. CONCLUSIONS Innovative qMRI techniques have proven effective in identifying premature IDD changes. Further studies are needed to validate their application in wider populations and confirm their applicability in the clinical setting.
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Affiliation(s)
- Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - Eugenio Giannarelli
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo A Mallio
- Department of Diagnostic Imaging and Interventional Radiology, Research Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo C Quattrocchi
- Department of Diagnostic Imaging and Interventional Radiology, Research Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Bhattacharya S, Dubey DK. Insights into the role of water concentrations on nanomechanical behavior of type I collagen-hyaluronan interfaces in annulus fibrosus: A molecular dynamics investigation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023:e3713. [PMID: 37073776 DOI: 10.1002/cnm.3713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/28/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
Multi-faceted deformation capabilities of Annulus Fibrosus (AF) results from an intricate mechanical design by nature. Wherein, organization and interactions between the constituents, collagen type I (CI), collagen type II (C2), hyaluronan, aggrecan, and water are instrumental. However, mechanisms by which such interactions influence AF mechanics at tissue-scale is not well understood. This work investigates nanoscale interfacial interactions between CI and hyaluronan (CI-H) and presents insights into their influence on tissue-scale mechanics of AF. For this, three-dimensional molecular dynamics (MD) simulations of tensile and compressive deformation are conducted on atomistic model of CI-H interface at 0%, 65%, and 75% water concentrations (WC). Results show hyaluronan lowers local hydration around CI component of interface, owing to its hydrophilic nature. Analyses show that increase in WC from 65% to 75% leads to increased interchain sliding in hyaluronan, which further lowers tensile modulus of the interface from 2.1 GPa to 660 MPa, contributing to softening observed from outer to inner AF. Furthermore, increase in WC from 65% to 75%, shifts compressive deformation from buckling-dominant to non-buckling-dominant which contributes towards lower radial bulge at inner AF. Findings provide deeper insights into mechanistic interactions and mechanisms at fundamental length-scale which influence the AF structure-mechanics at tissue-scale.
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Affiliation(s)
- Shambo Bhattacharya
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Devendra K Dubey
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
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Takashima H, Yoshimoto M, Ogon I, Takebayashi T, Imamura R, Akatsuka Y, Yamashita T. T1rho, T2, and T2* relaxation time based on grading of intervertebral disc degeneration. Acta Radiol 2023; 64:1116-1121. [PMID: 35876305 DOI: 10.1177/02841851221113936] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies have explored the biochemical changes of disc degeneration and its relevance in low back pain using various quantitative magnetic resonance imaging (MRI) techniques. However, quantitative evaluation of intervertebral disc (IVD) with MRI such as T1rho, T2, and T2* have not been previously analyzed and compared directly in the same patients. PURPOSE To investigate T1rho, T2, and T2* of IVD degeneration in the same patients, reveal the correlation coefficients of these values, and evaluate which values are more sensitive to detect the degree of IVD degeneration. MATERIAL AND METHODS The participants were 55 patients who underwent MRI examinations which the investigator classified the degree of IVD degeneration according to the Pfirrmann classification. The T1rho, T2, and T2* values of IVD were analyzed for their classification and were compared. RESULTS T1rho, T2, and T2* values were 74.3 ± 7.1, 61.2 ± 6.7, and 46.5 ± 16.3 ms (grade II); 61.6 ± 11.8, 48.9 ± 8.2, and 34.1 ± 11.8 ms (grade III); 50.8 ± 10.8, 38.9 ± 9.8, and 25.4 ± 8.1 ms, (grade IV); 44.5 ± 13.3, 34.8 ± 9.5, and 11.2 ± 6.6 ms (grade V), respectively. Those values significantly decreased with increasing grades, but T1rho and T2 values for grades IV and V were not different. CONCLUSION The T1rho and T2 values were excellent for the evaluation of initial to moderate IVD degeneration with water and proteoglycan content. In contrast, the T2* value was suitable for detailed evaluation of progressive IVD, even with poor water content.
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Affiliation(s)
- Hiroyuki Takashima
- Division of Radiology and Nuclear Medicine, 13035Sapporo Medical University Hospital, Sapporo, Japan
- Department of Orthopedic Surgery, 13035Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopedic Surgery, 13035Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Izaya Ogon
- Department of Orthopedic Surgery, 13035Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | - Rui Imamura
- Division of Radiology and Nuclear Medicine, 13035Sapporo Medical University Hospital, Sapporo, Japan
| | - Yoshihiro Akatsuka
- Division of Radiology and Nuclear Medicine, 13035Sapporo Medical University Hospital, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, 13035Sapporo Medical University School of Medicine, Sapporo, Japan
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Sudo H, Miyakoshi T, Watanabe Y, Ito YM, Kahata K, Tha KK, Yokota N, Kato H, Terada T, Iwasaki N, Arato T, Sato N, Isoe T. Protocol for treating lumbar spinal canal stenosis with a combination of ultrapurified, allogenic bone marrow-derived mesenchymal stem cells and in situ-forming gel: a multicentre, prospective, double-blind randomised controlled trial. BMJ Open 2023; 13:e065476. [PMID: 36731929 PMCID: PMC9896178 DOI: 10.1136/bmjopen-2022-065476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION In patients with combined lumbar spinal canal stenosis (LSCS), a herniated intervertebral disc (IVD) that compresses the dura mater and nerve roots is surgically treated with discectomy after laminoplasty. However, defects in the IVD after discectomy may lead to inadequate tissue healing and predispose patients to the development of IVD degeneration. Ultrapurified stem cells (rapidly expanding clones (RECs)), combined with an in situ-forming bioresorbable gel (dMD-001), have been developed to fill IVD defects and prevent IVD degeneration after discectomy. We aim to investigate the safety and efficacy of a new treatment method in which a combination of REC and dMD-001 is implanted into the IVD of patients with combined LSCS. METHODS AND ANALYSIS This is a multicentre, prospective, double-blind randomised controlled trial. Forty-five participants aged 20-75 years diagnosed with combined LSCS will be assessed for eligibility. After performing laminoplasty and discectomy, participants will be randomised 1:1:1 into the combination of REC and dMD-001 (REC-dMD-001) group, the dMD-001 group or the laminoplasty and discectomy alone (control) group. The primary outcomes of the trial will be the safety and effectiveness of the procedure. The effectiveness will be assessed using visual analogue scale scores of back pain and leg pain as well as MRI-based estimations of morphological and compositional quality of the IVD tissue. Secondary outcomes will include self-assessed clinical scores and other MRI-based estimations of compositional quality of the IVD tissue. All evaluations will be performed at baseline and at 1, 4, 12, 24 and 48 weeks after surgery. ETHICS AND DISSEMINATION This study was approved by the ethics committees of the institutions involved. We plan to conduct dissemination of the outcome data by presenting our data at national and international conferences, as well as through formal publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER jRCT2013210076.
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Affiliation(s)
- Hideki Sudo
- Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Takashi Miyakoshi
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yudai Watanabe
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M Ito
- Data Science Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Kaoru Kahata
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Khin Khin Tha
- Global Center for Biomedical Science and Engineering, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Nozomi Yokota
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroe Kato
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Tomoko Terada
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Teruyo Arato
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Norihiro Sato
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Toshiyuki Isoe
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
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Bhattacharya S, Dubey DK. Impact of Variations in Water Concentration on the Nanomechanical Behavior of Type I Collagen Microfibrils in Annulus Fibrosus. J Biomech Eng 2022; 144:1120715. [PMID: 34820681 DOI: 10.1115/1.4052563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Indexed: 11/08/2022]
Abstract
Radial variation in water concentration from outer to inner lamellae is one of the characteristic features of annulus fibrosus (AF). In addition, water concentration changes are also associated with intervertebral disc (IVD) degeneration. Such changes alter the chemo-mechanical interactions among the biomolecular constituents at molecular level, affecting the load-bearing nature of IVD. This study investigates mechanistic impacts of water concentration on the collagen type I microfibrils in AF using molecular dynamics simulations. Results show, in axial tension, that increase in water concentration (WC) from 0% to 50% increases the elastic modulus from 2.7 GPa to 3.9 GPa. This is attributed to combination of shift in deformation from backbone straightening to combined backbone stretching- intermolecular sliding and subsequent strengthening of tropocollagen-water (TC-water-TC) interfaces through water bridges and intermolecular electrostatic attractions. Further increase in WC to 75% reduces the modulus to 1.8 GPa due to shift in deformation to polypeptide straightening and weakening of TC-water-TC interface due to reduced electrostatic attraction and increase in the number of water molecules in a water bridge. During axial compression, increase in WC to 50% results in increase in modulus from 0.8 GPa to 4.5 GPa. This is attributed to the combination of the development of hydrostatic pressure and strengthening of the TC-water-TC interface. Further increase in WC to 75% shifts load-bearing characteristic from collagen to water, resulting in a decrease in elastic modulus to 2.8 GPa. Such water-mediated alteration in load-bearing properties acts as foundations toward AF mechanics and provides insights toward understanding degeneration-mediated altered spinal stiffness.
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Affiliation(s)
- Shambo Bhattacharya
- Department of Mechanical Engineering, Indian Institute of Technology, Delhi, New Delhi 110016, India
| | - Devendra K Dubey
- Department of Mechanical Engineering, Indian Institute of Technology, Delhi, New Delhi 110016, India
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Jia H, Lin X, Wang D, Wang J, Shang Q, He X, Wu K, Zhao B, Peng P, Wang H, Wang D, Li P, Yang L, Luo Z, Yang L. Injectable hydrogel with nucleus pulposus-matched viscoelastic property prevents intervertebral disc degeneration. J Orthop Translat 2022; 33:162-173. [PMID: 35415072 PMCID: PMC8980713 DOI: 10.1016/j.jot.2022.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 02/07/2023] Open
Abstract
Background/Objective Intervertebral disc (IVD) degeneration (IVDD) that greatly affected by regional biomechanical environment is a major cause of low back pain. Injectable hydrogels have been commonly studied for treatment of IVDD due to their capability of mimicking extracellular matrix structure to support cellular behavior and clinical prospects in minimally invasive treatment. However, most hydrogels suffer from complicated chemistry, potential uncertainty and toxicity from in-situ gelation, and mismatch with IVD mechanical environment that limit their therapeutic effects or clinical translation in IVDD or intervertebral disc defect repair. For IVD lesion repair, the study aims to develop a novel hydrogel with shear-thinning enabled injectability, high bio-safety, and mechanical properties adaptable to the IVD environment, using a simple chemistry and method. And therapeutic efficacy of the novel hydrogel in the treatment of IVDD or intervertebral disc defect will be revealed. Methods A glycerol cross-linked PVA gel (GPG) was synthesized based on multiple H-bonds formation between glycerol molecules and PVA chains. The rheological and mechanical properties were tested. The swelling ratio was measured. The micro-architecture was observed through scanning and transmission electron microscopes. Nucleus pulposus (NP) cells were cultured in GPG-coated plates or silicone chambers treated under hydrostatic or dynamic loading in vitro, and examined for proliferation, vitality, apoptosis, expression of catabolic and anabolic markers. GPG was injected in needle puncture (IDD) or NP discectomy (NPD) models in vivo, and examined through magnetic resonance imaging, micro-computed tomography scanning and histological staining. Results GPG had a highly porous structure consisting of interconnected pores. Meanwhile, the GPG had NP-like viscoelastic property, and was able to withstand the cyclic deformation while exhibiting a prominent energy-dissipating capability. In vitro cell tests demonstrated that, the hydrogel significantly down-regulated the expression of catabolic markers, maintained the level of anabolic markers, preserved cell proliferation and vitality, reduced apoptotic rate of NP cells under pathologically hydrostatic and dynamic loading environments compared to cells cultured on untreated plate or silicone chamber. In vivo animal studies revealed that injection of GPG efficiently maintained NP structural integrity, IVD height and relative water content in IDD models, and stimulated the fibrous repair in NPD models. Conclusion This study showed that GPG, with high injectability, NP-like viscoelastic characteristics, good energy-dissipating properties and swelling capacities, preserved NP cells vitality against pathological loading, and had therapeutic effects on IVD repair in IDD and NPD models. The translational potential of this article Effective clinical strategy for treatment of intervertebral disc degeneration (IVDD) is still lacking. This study demonstrates that injection of a hydrogel with nucleus pulposus-matched viscoelastic property could remarkably prevent the IVDD progress. Prepared with simple chemistry and procedure, the cell/drug-free GPG with high bio-safety and shear-thinning enabled injectability bears great translational potential for the clinical treatment of IVDD via a minimally invasive approach.
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Affiliation(s)
- Haoruo Jia
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xiao Lin
- Orthopedic Institute and Department of Orthopedics, The First Affiliated Hospital, Soochow University, Suzhou, 215000, China
| | - Dong Wang
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Jingwei Wang
- Department of Medicine Chemistry and Pharmaceutical Analysis, School of Pharmacy, Fourth Military Medical University, Xi'an, 710032, China
| | - Qiliang Shang
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xin He
- Department of Medicine Chemistry and Pharmaceutical Analysis, School of Pharmacy, Fourth Military Medical University, Xi'an, 710032, China
- Air Force Hospital of Eastern Theater Command, Nanjing, 210000, China
| | - Kang Wu
- Orthopedic Institute and Department of Orthopedics, The First Affiliated Hospital, Soochow University, Suzhou, 215000, China
| | - Boyan Zhao
- Department of Neurosurgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Pandi Peng
- Institute of Flexible Electronics, Northwestern Polytechnical University, Xi'an, 710129, China
| | - Han Wang
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Di Wang
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Pan Li
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
- Medical Research Institute, Northwestern Polytechnical University, Xi′an, 710032, China
| | - Liu Yang
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
- Medical Research Institute, Northwestern Polytechnical University, Xi′an, 710032, China
| | - Zhuojing Luo
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
- Medical Research Institute, Northwestern Polytechnical University, Xi′an, 710032, China
| | - Lei Yang
- Orthopedic Institute and Department of Orthopedics, The First Affiliated Hospital, Soochow University, Suzhou, 215000, China
- Center for Health Science and Engineering (CHSE), School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300130, China
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11
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Lagerstrand K, Brisby H, Hebelka H. Associations between high-intensity zones, endplate, and Modic changes and their effect on T2-mapping with and without spinal load. J Orthop Res 2021; 39:2703-2710. [PMID: 33751635 DOI: 10.1002/jor.25024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 02/04/2023]
Abstract
The purpose was to investigate if high intensity zones (HIZ), Modic (MC), and endplate changes (EPC) display different behaviors measured with quantitative magnetic resonance imaging (MRI) with and without loading of the spine and if there is a simultaneous presence of these features in the same motion segment. 130 motion segments in patients with chronic low back pain (n = 26, 25-69 year, mean 38 year, 11 males) were examined. HIZs, MCs, and EPCs (i.e., structural findings, reflecting calcifications, erosions, and fissures) were determined with standardized MRI. Different T2-values with and without loading for these features were then determined with the quantitative MRI method T2-mapping. Significantly different behaviors were found in the spinal tissues with associated HIZs, MC, and EPC (p < 0.004). HIZ (62% of patients, 1-2/patient) was associated with EPC (100% of patients, 1-7/patient) (p = 0.0003 and 0.0004 for upper and lower EPs), with an occurrence of 91% for upper and 71% for lower endplates adjacent to discs with HIZ. MC (81% of patients, 1-3/patient) were associated with EPC (p < 0.0001) with an occurrence of 87% for endplates adjacent to vertebrae with MC. The occurrence of both HIZ and MC was 43% (p = 0.0001) for upper and 29% (p = 0.003) for lower vertebrae. HIZ was associated with simultaneous presence of both MC and EPC in the same motion segment. T2-mapping was found to objectively reflect changes in the spinal tissues associated with HIZs, MC, and EPC.
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Affiliation(s)
- Kerstin Lagerstrand
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helena Brisby
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Hebelka
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Abdollah V, Parent EC, Dolatabadi S, Marr E, Croutze R, Wachowicz K, Kawchuk G. Texture analysis in the classification of T 2 -weighted magnetic resonance images in persons with and without low back pain. J Orthop Res 2021; 39:2187-2196. [PMID: 33247597 DOI: 10.1002/jor.24930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/30/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
Magnetic resonance imaging findings often do not distinguish between people with and without low back pain (LBP). However, there are still a large number of people who undergo magnetic resonance imaging to help determine the etiology of their back pain. Texture analysis shows promise for the classification of tissues that look similar, and machine learning can minimize the number of comparisons. This study aimed to determine if texture features from lumbar spine magnetic resonance imaging differ between people with and without LBP. In total, 14 participants with chronic LBP were matched for age, weight, and gender with 14 healthy volunteers. A custom texture analysis software was used to construct a gray-level co-occurrence matrix with one to four pixels offset in 0° direction for the disc and superior and inferior endplate regions. The Random Forests Algorithm was used to select the most promising classifiers. The linear mixed-effect model analysis was used to compare groups (pain vs. pain-free) at each level controlling for age. The Random Forest Algorithm recommended focusing on intervertebral discs and endplate zones at L4-5 and L5-S1. Differences were observed between groups for L5-S1 superior endplate contrast, homogeneity, and energy (p = .02). Differences were observed for L5-S1 disc contrast and homogeneity (p < .01), as well as for the inferior endplates contrast, homogeneity, and energy (p < .03). Magnetic resonance imaging textural features may have potential in identifying structures that may be the target of further investigations about the reasons for LBP.
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Affiliation(s)
- Vahid Abdollah
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Eric C Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Samin Dolatabadi
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Erica Marr
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Roger Croutze
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Keith Wachowicz
- Department of Oncology, Medical Physics Division, University of Alberta, Edmonton, Alberta, Canada.,Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Greg Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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13
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Wang L, Han M, Wong J, Zheng P, Lazar AA, Krug R, Fields AJ. Evaluation of human cartilage endplate composition using MRI: Spatial variation, association with adjacent disc degeneration, and in vivo repeatability. J Orthop Res 2021; 39:1470-1478. [PMID: 32592504 PMCID: PMC7765737 DOI: 10.1002/jor.24787] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/02/2020] [Accepted: 06/24/2020] [Indexed: 02/04/2023]
Abstract
Cartilage endplate (CEP) biochemical composition may influence disc degeneration and regeneration. However, evaluating CEP composition in patients remains a challenge. We used T2* mapping from ultrashort echo-time (UTE) magnetic resonance imaging (MRI), which is sensitive to CEP hydration, to investigate spatial variations in CEP T2* values and to determine how CEP T2* values correlate with adjacent disc degeneration. Thirteen human cadavers (56.4 ± 12.7 years) and seven volunteers (36.9 ± 10.9 years) underwent 3T MRI, including UTE and T1ρ mapping sequences. Spatial mappings of T2* values in L4-S1 CEPs were generated from UTE images and compared between subregions. In the abutting discs, mean T1ρ values in the nucleus pulposus were compared between CEPs with high vs low T2* values. To assess in vivo repeatability, precision errors in mean T2* values, and intraclass correlation coefficients (ICC) were measured from repeat scans. Results showed that CEP T2* values were highest centrally and lowest posteriorly. In the youngest individuals (<50 years), who had mild-to-moderately degenerated Pfirrmann grade II-III discs, low CEP T2* values associated with severer disc degeneration: T1ρ values were 26.7% lower in subjects with low CEP T2* values (P = .025). In older individuals, CEP T2* values did not associate with disc degeneration (P = .39-.62). Precision errors in T2* ranged from 1.7 to 2.6 ms, and reliability was good-to-excellent (ICC = 0.89-0.94). These findings suggest that deficits in CEP composition, as indicated by low T2* values, associate with severer disc degeneration during the mild-to-moderate stages. Measuring CEP T2* values with UTE MRI may clarify the role of CEP composition in patients with mild-to-moderate disc degeneration.
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Affiliation(s)
- Linshanshan Wang
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Misung Han
- Department of Radiology & Biomedical ImagingUniversity of CaliforniaSan FranciscoCalifornia
| | - Jason Wong
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Patricia Zheng
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Ann A. Lazar
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCalifornia,Department of Preventive and Restorative Dental SciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Roland Krug
- Department of Radiology & Biomedical ImagingUniversity of CaliforniaSan FranciscoCalifornia
| | - Aaron J. Fields
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
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14
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Yamada K, Kenichiro M, Ito YM, Inage F, Isoe T, Yokota N, Sugita O, Sato N, Tha KK, Iwasaki N, Arato T, Sudo H. Exploratory clinical trial on the safety and capability of dMD-001 in lumbar disc herniation: Study protocol for a first-in-human pilot study. Contemp Clin Trials Commun 2021; 23:100805. [PMID: 34278043 PMCID: PMC8261539 DOI: 10.1016/j.conctc.2021.100805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 01/08/2023] Open
Abstract
Herniated nucleus pulposus (NP), one of the most common diseases of the spine, is surgically treated by removing the sequestered NP. However, intervertebral disc (IVD) defects may remain after discectomy, leading to inadequate tissue healing and predisposing patients to IVD degeneration. An acellular, bioresorbable, ultra-purified alginate (UPAL) gel (dMD-001) implantation system can be used to fill any IVD defects in order to prevent IVD degeneration after discectomy. This first-in-human pilot study aims to determine the feasibility, safety, and perceived patient response to a combined treatment involving discectomy and UPAL gel implantation for herniated NP. We designed a one-arm, double-centre, open-label, pilot trial. The study started in November 2018 and will run until a sample of 40 suitable participants is established. Patients aged 20-49 years, diagnosed with isolated lumbar IVD herniation and scheduled for discectomy represent suitable candidates. All eligible participants who provide informed consent undergo standard discectomy followed by UPAL gel implantation. The primary outcomes of the trial will be the feasibility and safety of the procedure. Secondary outcomes will include self-assessed clinical scores and magnetic resonance imaging-based measures of morphological and compositional quality of the IVD tissue. Initial outcomes will be published at 24 weeks. Analysis of feasibility and safety will be performed using descriptive statistics. Both intention-to-treat and per-protocol analyses of treatment trends of effectiveness will be conducted.
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Affiliation(s)
- Katsuhisa Yamada
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N14W5, Sapporo, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, and Graduate School of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Maeda Kenichiro
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Yoichi M Ito
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, N14W5, Sapporo, Hokkaido, Japan
| | - Fujio Inage
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Toshiyuki Isoe
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Nozomi Yokota
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Osamu Sugita
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Norihiro Sato
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Khin Khin Tha
- Department of Diagnostic Imaging, Hokkaido University Hospital, N14W5, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N14W5, Sapporo, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, and Graduate School of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Teruyo Arato
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Hideki Sudo
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N14W5, Sapporo, Japan.,Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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15
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Coppock JA, Danyluk ST, Englander ZA, Spritzer CE, Goode AP, DeFrate LE. Increasing BMI increases lumbar intervertebral disc deformation following a treadmill walking stress test. J Biomech 2021; 121:110392. [PMID: 33819699 DOI: 10.1016/j.jbiomech.2021.110392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/22/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
High body mass index (BMI) and obesity have been implicated as risk factors for lumbar degenerative disc disease and low back pain. Despite this, there is limited in vivo data to quantify how obesity influences the mechanical function of intervertebral discs (IVD) in response to activities of daily living. Recently, our lab has developed methodologies to non-invasively measure in vivo IVD deformation resulting from activities of daily living using magnetic resonance (MR) imaging and solid modeling techniques. This pilot study expands on these methodologies to assess how BMI influences IVD deformation following treadmill walking in eight asymptomatic individuals. Ordinary least squares regression analyses revealed a statistically significant relationship between BMI and compressive deformation (strain (%)) in the L5-S1 IVD (R2 = 0.61, p < 0.05). This relationship was weaker in the L3-L4 (R2 = 0.28, p > 0.05) and L4-L5 IVDs (R2 = 0.28, p > 0.05). Importantly, no relationship between pre-exercise disc height and BMI was identified (p > 0.05). Therefore, the results of this study suggest that BMI may alter the mechanical response of lumbar spine IVDs, particularly at the L5-S1 level. Furthermore, the observed relationship between increased BMI and IVD compressive deformation, in the absence of a detected relationship between pre-exercise disc height and BMI, suggests that changes in IVD mechanical function may be more sensitive to alterations in disc health than static clinical imaging alone. This finding highlights the importance of quantifying disc mechanical function when examining the relationship between BMI and IVD degeneration.
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Affiliation(s)
- James A Coppock
- Department of Orthopedic Surgery, Duke University School of Medicine, United States; Department of Biomedical Engineering, Duke University, United States
| | - Stephanie T Danyluk
- Department of Orthopedic Surgery, Duke University School of Medicine, United States
| | - Zoë A Englander
- Department of Orthopedic Surgery, Duke University School of Medicine, United States; Department of Biomedical Engineering, Duke University, United States
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, United States
| | - Adam P Goode
- Department of Orthopedic Surgery, Duke University School of Medicine, United States; Duke Clinical Research Institute, Duke University School of Medicine, United States; Department of Population Health Sciences, United States
| | - Louis E DeFrate
- Department of Orthopedic Surgery, Duke University School of Medicine, United States; Department of Biomedical Engineering, Duke University, United States; Department of Mechanical Engineering and Materials Science, Duke University, United States.
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16
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Lyu FJ, Cui H, Pan H, MC Cheung K, Cao X, Iatridis JC, Zheng Z. Painful intervertebral disc degeneration and inflammation: from laboratory evidence to clinical interventions. Bone Res 2021; 9:7. [PMID: 33514693 PMCID: PMC7846842 DOI: 10.1038/s41413-020-00125-x] [Citation(s) in RCA: 189] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 10/01/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023] Open
Abstract
Low back pain (LBP), as a leading cause of disability, is a common musculoskeletal disorder that results in major social and economic burdens. Recent research has identified inflammation and related signaling pathways as important factors in the onset and progression of disc degeneration, a significant contributor to LBP. Inflammatory mediators also play an indispensable role in discogenic LBP. The suppression of LBP is a primary goal of clinical practice but has not received enough attention in disc research studies. Here, an overview of the advances in inflammation-related pain in disc degeneration is provided, with a discussion on the role of inflammation in IVD degeneration and pain induction. Puncture models, mechanical models, and spontaneous models as the main animal models to study painful disc degeneration are discussed, and the underlying signaling pathways are summarized. Furthermore, potential drug candidates, either under laboratory investigation or undergoing clinical trials, to suppress discogenic LBP by eliminating inflammation are explored. We hope to attract more research interest to address inflammation and pain in IDD and contribute to promoting more translational research.
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Affiliation(s)
- Feng-Juan Lyu
- grid.79703.3a0000 0004 1764 3838School of Medicine, South China University of Technology, Guangzhou, China
| | - Haowen Cui
- grid.12981.330000 0001 2360 039XDepartment of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hehai Pan
- grid.12981.330000 0001 2360 039XGuangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China ,grid.12981.330000 0001 2360 039XBreast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kenneth MC Cheung
- grid.194645.b0000000121742757Department of Orthopedics & Traumatology, The University of Hong Kong, Hong Kong, SAR China
| | - Xu Cao
- grid.21107.350000 0001 2171 9311Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD USA
| | - James C. Iatridis
- grid.59734.3c0000 0001 0670 2351Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Zhaomin Zheng
- grid.12981.330000 0001 2360 039XDepartment of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China ,grid.12981.330000 0001 2360 039XPain Research Center, Sun Yat-sen University, Guangzhou, China
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17
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Minimum 2-Year Efficacy of Percutaneous Endoscopic Lumbar Discectomy versus Microendoscopic Discectomy: A Meta-Analysis. World Neurosurg 2020; 138:19-26. [DOI: 10.1016/j.wneu.2020.02.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/17/2020] [Indexed: 12/13/2022]
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18
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Ling Z, Li L, Chen Y, Hu H, Zhao X, Wilson J, Qi Q, Liu D, Wei F, Chen X, Lu J, Zhou Z, Zou X. Changes of the end plate cartilage are associated with intervertebral disc degeneration: A quantitative magnetic resonance imaging study in rhesus monkeys and humans. J Orthop Translat 2020; 24:23-31. [PMID: 32542179 PMCID: PMC7281301 DOI: 10.1016/j.jot.2020.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/10/2020] [Accepted: 04/09/2020] [Indexed: 02/04/2023] Open
Abstract
Background The end plate plays an important role in intervertebral disc degeneration progression. The aim of the study was to examine the compositional and structural changes of the end plate with age and to investigate the correlation between end plate and disc degeneration by T1ρ and T2 map magnetic resonance imaging. Methods There were 12 young monkeys (6-7 years old), 20 aged monkeys (14-17 years old) and 12 human participants (30-50 years old) in this study. T1ρ or T2 map values of the nucleus pulposus and end plate cartilage were analyzed according to Pfirrmann grades and age. Afterwards, micro computed tomography and histological analysis were used to confirm the end plate changes in monkeys. Pearson’s correlation was performed to investigate the relationship between end plate and disc degeneration. Results In monkeys, T1ρ (r=-0.794, P<0.001) and T2 map values (r=-0.8, P<0.001) of the nucleus pulposus were negatively associated with Pfirrmann grades. Moreover, the T2 map was more suitable than T1ρ for the evaluation of end plate degeneration. Age was an important influence factor of end plate and disc degeneration, which was confirmed by microcomputed tomography, Safranin O/fast green staining, and collagen II staining. The T2 map value of lower end plate degeneration positively correlated with that of the intervertebral discs in monkeys (R2=0.3133, P<0.001) and humans (R2=0.2092, P<0.001). Conclusion This study suggests that the compositional and structural changes of the end plate can be quantitatively evaluated by T2 map. Furthermore, cartilage end plate degeneration is associated with disc degeneration during ageing. The translational potential of this article A better understanding of how the cartilage end plate affects disc degeneration is needed, which may propose a new clinical application using T2 map to evaluate end plate degeneration.
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Affiliation(s)
- Zemin Ling
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Liangping Li
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Chen
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Hao Hu
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaoxiao Zhao
- Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University, China
| | - Jordan Wilson
- Department of Orthopaedics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Qihua Qi
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Delong Liu
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Fuxin Wei
- Department of Orthopaedic Surgery, The Seventh Affiliated Hospital and Orthopedic Research, Institute of Sun Yat-sen University, Shenzhen, China
| | - Xiaoying Chen
- Department of Emergency, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jianhua Lu
- Department of Radiology, Johns Hopkins Hospital, Baltimore, USA
| | - Zhiyu Zhou
- Department of Orthopaedic Surgery, The Seventh Affiliated Hospital and Orthopedic Research, Institute of Sun Yat-sen University, Shenzhen, China
| | - Xuenong Zou
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
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19
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Abstract
UNLABELLED MINI: Circulating microRNAs provide an insight into current disease states. Comparing patients with degenerative disc disease to healthy controls, patients with disc disease were found to have significantly downregulated levels of miR-155-5p. This marker was found to be an accurate diagnostic predictor for the presence of degeneration (P = 0.006). STUDY DESIGN Case-control study measuring differential gene expression of circulating microRNA (miRNA) in patients with degenerative disc disease (DDD). OBJECTIVE To identify miRNA dysregulation in serum samples of patients with DDD compared to healthy controls (HC). SUMMARY OF BACKGROUND DATA Early DDD can be a difficult diagnosis to make clinically, with lack of positive and specific findings on physical exam or advanced imaging. miRNAs are a class of molecules that act as gene regulators and have been shown to be dysregulated in local degenerative disc tissue. However, to date no studies have identified dysregulation of serum miRNA in patients with DDD. METHODS Whole blood samples were obtained from 69 patients with DDD and 16 HC. Patient-reported outcomes were collected preoperatively and degree of DDD was classified using Pfirrmann grade on preoperative imaging. Differential gene expression analysis using a screening assay for several hundred miRNAs and further characterization for five specific miRNAs (miR-16-5p, miR-21-5p, miR-142-3p, miR-146a-5p, and miR-155-5p) was performed. In addition, a pro-inflammatory cytokine multiplex assay and bioinformatics analysis were done. RESULTS The initial screening assay showed 13 miRNA molecules that were significantly dysregulated in DDD patients, with miR-155-5p showing significant downregulation (p = 0.027) and direct interactions with the pro-inflammatory cytokine IL-1β, and the tumor suppressor genes p53 and BRAF. Analyzing the whole cohort, miR-155 showed an almost four-fold downregulation in DDD patients (-3.94-fold, P < 0.001) and was the sole miRNA that accurately predicted the presence of disc degeneration (P = 0.006). Downregulation of miR-155 also correlated with increased leg pain (P = 0.018), DDD (P = 0.006), and higher Pfirrmann grade (P = 0.039). On cytokine analysis, TNF-α (0.025) and IL-6 (P < 0.001) were significantly higher in DDD patients. CONCLUSION Serum miR-155-5p is significantly downregulated in patients with DDD and may be a diagnostic marker for degenerative spinal disease. LEVEL OF EVIDENCE N/A.
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Iriondo C, Pedoia V, Majumdar S. Lumbar intervertebral disc characterization through quantitative MRI analysis: An automatic voxel-based relaxometry approach. Magn Reson Med 2020; 84:1376-1390. [PMID: 32060963 PMCID: PMC7318328 DOI: 10.1002/mrm.28210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 12/19/2022]
Abstract
Purpose To develop an automated pipeline based on convolutional neural networks to segment lumbar intervertebral discs and characterize their biochemical composition using voxel‐based relaxometry, and establish local associations with clinical measures of disability, muscle changes, and other symptoms of lower back pain. Methods This work proposes a new methodology using MRI (n = 31, across the spectrum of disc degeneration) that combines deep learning–based segmentation, atlas‐based registration, and statistical parametric mapping for voxel‐based analysis of T1ρ and T2 relaxation time maps to characterize disc degeneration and its associated disability. Results Across degenerative grades, the segmentation algorithm produced accurate, high‐confidence segmentations of the lumbar discs in two independent data sets. Manually and automatically extracted mean disc T1ρ and T2 relaxation times were in high agreement for all discs with minimal bias. On a voxel‐by‐voxel basis, imaging‐based degenerative grades were strongly negatively correlated with T1ρ and T2, particularly in the nucleus. Stratifying patients by disability grades revealed significant differences in the relaxation maps between minimal/moderate versus severe disability: The average T1ρ relaxation maps from the minimal/moderate disability group showed clear annulus nucleus distinction with a visible midline, whereas the severe disability group had lower average T1ρ values with a homogeneous distribution. Conclusion This work presented a scalable pipeline for fast, automated assessment of disc relaxation times, and voxel‐based relaxometry that overcomes limitations of current region of interest–based analysis methods and may enable greater insights and associations between disc degeneration, disability, and lower back pain.
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Affiliation(s)
- Claudia Iriondo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.,University of California, San Francisco, and University of California, Berkeley, Joint Graduate Group in Bioengineering, California
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
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Yang B, O'Connell GD. Intervertebral disc swelling maintains strain homeostasis throughout the annulus fibrosus: A finite element analysis of healthy and degenerated discs. Acta Biomater 2019; 100:61-74. [PMID: 31568880 DOI: 10.1016/j.actbio.2019.09.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
Tissues in the intervertebral disc have a large capacity to absorb water, partially due to the high glycosaminoglycan (GAG) content, which decreases linearly from the nucleus pulposus (NP) in the center to the outer annulus. Our recent work showed that fiber network and GAG distribution contributes to development of residual stresses and strains that were compressive in the inner annulus to tensile in the outer annulus. GAG loss in the inner annulus, as observed with early to moderate degeneration, reduced swelling capacity and circumferential-direction stress by over 50%. However, our previous model was not capable of evaluating interactions between the NP and annulus fibrosus (AF) during swelling. In this study, we evaluated the effect of degeneration (GAG content or swelling capacity) on residual stress development throughout the disc. Simulations of moderate to severe degeneration showed a 40% decrease in NP swelling capacity, with a 25% decrease in AF and cartilaginous endplate swelling. Together, these changes in tissue swelling resulted in a decrease in NP pressure (healthy = 0.21 MPa; severe degeneration = 0.03 MPa) that was comparable to observations in human discs. There was a 60% decrease in circumferential-direction residual deformations with early degeneration. Radial-direction stretch switched from compressive to tensile with degeneration, which may increase the risk for tears or delamination. Degeneration had a significant impact on residual stress/stretch and fiber stretch in the posterior AF, which is important for understanding herniation risk. In conclusion, degenerative changes in disc geometry and intradiscal deformations was recreated by only altering NP and AF GAG composition. Since most computational models simulate degeneration by altering material stiffness, this work highlights the importance of directly simulating biochemical composition and distribution to study disc biomechanics with degeneration. STATEMENT OF SIGNIFICANCE: Tissues in the intervertebral disc have a large swelling capacity, due to its high glycosaminoglycan content. Our recent work demonstrated the importance of fiber network and glycosaminoglycan distribution residual stresses and strains development. In this study, we evaluated the effect of swelling on intradiscal deformations between the nucleus pulposus and annulus fibrosus. We also investigated the effect of degenerative glycosaminoglycan loss on swelling-based intradiscal deformations of the intact disc and its subcomponents. Decreases in nucleus glycosaminoglycan content resulted in morphological changes observed with degenerated discs and may help to explain mechanisms behind the increases in annular tears and mechanical dysfunction with degeneration.
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22
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Abou Khadrah RS, Dawoud MF, Abo-Elsafa AA, Elkilany AM. Advanced trends in magnetic resonance imaging in assessment of lumbar intervertebral degenerative disk disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0042-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundT2 mapping and DWI are newly quantitated method for disk degeneration assessment; they were used in the determination of an early stage of intervertebral disk degeneration. T2 mapping was quantitatively sensitive for detecting the early stage and aging-related changes in intervertebral disk degeneration. Furthermore, T2 mapping and apparent diffusion coefficient values (ADC) in lumbar intervertebral disks indirectly correlated with the Pfirrmann grades in IVDD and age-related disk degeneration. The aim of this study is to evaluate the sensitivity of T2 mapping and apparent diffusion coefficient in the determination of an early stage of intervertebral disk degeneration.ResultsT2 relaxometry values were found to decrease with the increased disk degeneration except in grade V where it was found to be increased again. There was a negative correlation between T2 values and semi-quantitative grading (Pfirrmann Grading) of disk degeneration and T2 values were significantly different when comparing grade I to V. A T2 value of nucleus pulposus (NP) was more sensitive than annulus fibrosus (AF) and entire of the disk. ADC values were found to decrease with the increased degree of disk degeneration; there was a weakly significant negative correlation between age and T2 mapping values, ADC values of nucleus pulposus, and entire of disk.ConclusionT2 mapping was significantly different when comparing grade I to V while ADC value had a significant weak negative correlation with age, so T2 mapping and to a little extent ADC can be used for quantitative analysis of early disk generation seeking for early diagnosis and better management.
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23
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Imanishi T, Akeda K, Murata K, Sudo A. Effect of diminished flow in rabbit lumbar arteries on intervertebral disc matrix changes using MRI T2-mapping and histology. BMC Musculoskelet Disord 2019; 20:347. [PMID: 31351455 PMCID: PMC6661094 DOI: 10.1186/s12891-019-2721-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/15/2019] [Indexed: 12/17/2022] Open
Abstract
Background Impaired lumbar artery flow has been reported in clinical and epidemiological studies to be associated with low back pain and lumbar disc degeneration. However, it has not been experimentally demonstrated that impaired lumbar artery flow directly induces intervertebral disc (IVD) degeneration by affecting IVD matrix metabolism. The purpose of this study was to evaluate whether ligation of the lumbar artery can affect degenerative changes in the rabbit IVD. Methods New Zealand White rabbits (n = 20) were used in this study. Under general anesthesia, the third and fourth lumbar arteries were double-ligated using vascular clips. The blood flow to the L3/L4 disc (cranial disc) was reduced by ligation of the third lumbar artery and that of the L5/L6 disc (caudal disc) by ligation of the fourth lumbar artery. The blood flow to the L4/L5 disc (bilateral disc) was decreased by ligation of both the third and fourth lumbar arteries. The L2/L3 disc was used as the control. Disc height was radiographically monitored biweekly until 12 weeks after surgery. The rabbits were sacrificed at 4, 8, and 12 weeks after surgery and magnetic resonance imaging (MRI) T2-mapping, histology and immunohistochemistry were assessed. Results Lumbar artery ligation did not induce significant changes in disc height between control and ischemic discs (cranial, bilateral and caudal discs) during the 12-week experimental period. T2-values of ischemic discs had no significant trend to be lower than those of the control L2/L3 discs. Histologically, Safranin-O staining changed following ligation of corresponding IVD lumbar arteries. Histological grading scores for disc degeneration, which correlated significantly with MRI T2-values, had significant changes after the surgery. Immunohistochemical analysis showed that the ligation of lumbar arteries significantly affected a change in the percentage of HIF-1α immunoreactive cells of ischemia discs compared to that of control discs four weeks after the surgery (p < 0.05). Conclusions The MRI and histology results suggest that diminished flow in lumbar arteries induce mild changes in the extracellular matrix metabolism of rabbit IVDs. These matrix changes, however, were not progressive and differed from the degenerative disc changes seen in the process of human IVD degeneration.
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Affiliation(s)
- Takao Imanishi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Koichiro Murata
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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24
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McCoy DB, Dupont SM, Gros C, Cohen-Adad J, Huie RJ, Ferguson A, Duong-Fernandez X, Thomas LH, Singh V, Narvid J, Pascual L, Kyritsis N, Beattie MS, Bresnahan JC, Dhall S, Whetstone W, Talbott JF. Convolutional Neural Network-Based Automated Segmentation of the Spinal Cord and Contusion Injury: Deep Learning Biomarker Correlates of Motor Impairment in Acute Spinal Cord Injury. AJNR Am J Neuroradiol 2019; 40:737-744. [PMID: 30923086 DOI: 10.3174/ajnr.a6020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/11/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to use 2D convolutional neural networks for automatic segmentation of the spinal cord and traumatic contusion injury from axial T2-weighted MR imaging in a cohort of patients with acute spinal cord injury. MATERIALS AND METHODS Forty-seven patients who underwent 3T MR imaging within 24 hours of spinal cord injury were included. We developed an image-analysis pipeline integrating 2D convolutional neural networks for whole spinal cord and intramedullary spinal cord lesion segmentation. Linear mixed modeling was used to compare test segmentation results between our spinal cord injury convolutional neural network (Brain and Spinal Cord Injury Center segmentation) and current state-of-the-art methods. Volumes of segmented lesions were then used in a linear regression analysis to determine associations with motor scores. RESULTS Compared with manual labeling, the average test set Dice coefficient for the Brain and Spinal Cord Injury Center segmentation model was 0.93 for spinal cord segmentation versus 0.80 for PropSeg and 0.90 for DeepSeg (both components of the Spinal Cord Toolbox). Linear mixed modeling showed a significant difference between Brain and Spinal Cord Injury Center segmentation compared with PropSeg (P < .001) and DeepSeg (P < .05). Brain and Spinal Cord Injury Center segmentation showed significantly better adaptability to damaged areas compared with PropSeg (P < .001) and DeepSeg (P < .02). The contusion injury volumes based on automated segmentation were significantly associated with motor scores at admission (P = .002) and discharge (P = .009). CONCLUSIONS Brain and Spinal Cord Injury Center segmentation of the spinal cord compares favorably with available segmentation tools in a population with acute spinal cord injury. Volumes of injury derived from automated lesion segmentation with Brain and Spinal Cord Injury Center segmentation correlate with measures of motor impairment in the acute phase. Targeted convolutional neural network training in acute spinal cord injury enhances algorithm performance for this patient population and provides clinically relevant metrics of cord injury.
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Affiliation(s)
- D B McCoy
- From the Departments of Radiology and Biomedical Imaging (D.B.M., S.M.D., J.N., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - S M Dupont
- From the Departments of Radiology and Biomedical Imaging (D.B.M., S.M.D., J.N., J.F.T.)
| | - C Gros
- NeuroPoly Lab (C.G., J.C.-A.), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada
| | - J Cohen-Adad
- NeuroPoly Lab (C.G., J.C.-A.), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada
| | - R J Huie
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - A Ferguson
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - X Duong-Fernandez
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - L H Thomas
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - V Singh
- Departments of Neurology (V.S.)
| | - J Narvid
- From the Departments of Radiology and Biomedical Imaging (D.B.M., S.M.D., J.N., J.F.T.)
| | - L Pascual
- Orthopedic Surgery (L.P.), Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California
| | - N Kyritsis
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - M S Beattie
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - J C Bresnahan
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - S Dhall
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - W Whetstone
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - J F Talbott
- From the Departments of Radiology and Biomedical Imaging (D.B.M., S.M.D., J.N., J.F.T.) .,Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.)
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Krug R, Joseph GB, Han M, Fields A, Cheung J, Mundada M, Bailey J, Rochette A, Ballatori A, McCulloch CE, McCormick Z, O'Neill C, Link TM, Lotz J. Associations between vertebral body fat fraction and intervertebral disc biochemical composition as assessed by quantitative MRI. J Magn Reson Imaging 2019; 50:1219-1226. [PMID: 30701594 DOI: 10.1002/jmri.26675] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is an interplay between the intervertebral disc (IVD) and the adjacent bone marrow that may play a role in the development of IVD degeneration and might influence chronic lower back pain (CLBP). PURPOSE To apply novel quantitative MRI techniques to assess the relationship between vertebral bone marrow fat (BMF) and biochemical changes in the adjacent IVD. STUDY TYPE Prospective. SUBJECTS Forty-six subjects (26 female and 20 male) with a mean age of 47.3 ± 12.0 years. FIELD STRENGTH/SEQUENCE 3 T MRI; a combined T1ρ and T2 mapping pulse sequence and a 3D spoiled gradient recalled sequence with six echoes and iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) reconstruction algorithm. ASSESSMENT Using quantitative MRI, the vertebral BMF fraction was measured as well as the biochemical composition (proteoglycan and collagen content) of the IVD. Furthermore, clinical Pfirrmann grading, Oswestry disability index (ODI), and visual analog scale (VAS) was assessed. STATISTICAL TESTS Mixed random effects models accounting for multiple measurements per subject were used to assess the relationships between disc measurements and BMF. RESULTS The relationships between BMF (mean) and T1ρ /T2 (mean and SD) were significant, with P < 0.05. Significant associations (P < 0.001) were found between clinical scores (Pfirrmann, ODI, and VAS) with T1ρ /T2 (mean and SD). BMF mean was significantly related to ODI (P = 0.037) and VAS (P = 0.043), but not with Pfirrmann (P = 0.451). In contrast, BMF SD was significantly related to Pfirrmann (P = 0.000) but not to ODI (P = 0.064) and VAS (P = 0.13). DATA CONCLUSION Our study demonstrates significant associations between BMF and biochemical changes in the adjacent IVD, both assessed by quantitative MRI; this may suggest that the conversion of hematopoietic bone marrow to fatty bone marrow impairs the supply of available nutrients to cells in the IVD and may thereby accelerate disc degeneration. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:1219-1226.
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Affiliation(s)
- Roland Krug
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gabrielle B Joseph
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Misung Han
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Aaron Fields
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Justin Cheung
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Maya Mundada
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jeannie Bailey
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Alice Rochette
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Alexander Ballatori
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Zachary McCormick
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Conor O'Neill
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey Lotz
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
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26
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Lagerstrand K, Hebelka H, Brisby H. Low back pain patients and controls display functional differences in endplates and vertebrae measured with T2-mapping. 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 2018; 28:234-240. [PMID: 30448986 DOI: 10.1007/s00586-018-5824-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/06/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim was to (1) verify our previous finding that endplates (EPs) display load-induced T2-changes, (2) investigate whether vertebrae display load-induced T2-changes and (3) investigate whether EPs and vertebrae in LBP patients and controls display T2-differences during conventional unloaded MRI and axial loaded MRI (alMRI). METHODS Twenty-seven patients (mean 39 years) and 12 (mean 38 years) controls were examined with T2-mapping on a 1.5 T scanner during conventional unloaded MRI and subsequently during alMRI (Dynawell® loading device), separated by approximately 20 min. For determination of EP and vertebral T2-values, volumetric regions of interest were manually segmented. Each vertebra was then divided into half to obtain superior and inferior units. The presence of EP changes (visual inhomogeneity in the EP zone), Schmorl's nodules and Modic changes were registered. RESULTS For conventional unloaded MRI, the T2-values in the superior and inferior vertebral units and the EPs were significantly higher in the patients compared with controls (p < 0.03, p < 0.006) even when adjusted for the presence of Modic changes, Schmorl's nodules and EP signal changes. alMRI induced significant changes in the superior EPs of the patients (p < 0.001). Additionally, the T2-value differed significantly between the superior and inferior EP, as well as between the superior and inferior vertebra with higher values in the inferior units (p < 0.001). CONCLUSION This study demonstrated significantly higher EP and vertebral T2-values in LBP patients in comparison with controls. In addition, alMRI induced significant T2-changes in the superior EPs for patients but not for controls. Importantly, the T2-differences between the groups may indicate that EPs and vertebrae in LBP patients have altered biodynamical characteristics compared to controls and the higher T2-values measured in patients may represent early inflammation or impaired nutritional transport. These slides can be retrieved from electronic supplementary material.
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Affiliation(s)
- K Lagerstrand
- Department of Medical Physics and Biomedicine, Sahlgrenska University Hospital, Göteborg, Sweden. .,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
| | - H Hebelka
- Department of Radiology, Sahlgrenska University Hospital, Göteborg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - H Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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27
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Emanuel KS, Mader KT, Peeters M, Kingma I, Rustenburg CME, Vergroesen PPA, Sammon C, Smit TH. Early changes in the extracellular matrix of the degenerating intervertebral disc, assessed by Fourier transform infrared imaging. Osteoarthritis Cartilage 2018; 26:1400-1408. [PMID: 29935308 DOI: 10.1016/j.joca.2018.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/09/2018] [Accepted: 06/07/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Mechanical overloading induces a degenerative cell response in the intervertebral disc. However, early changes in the extracellular matrix (ECM) are challenging to assess with conventional techniques. Fourier Transform Infrared (FTIR) imaging allows visualization and quantification of the ECM. We aim to identify markers for disc degeneration and apply these to investigate early degenerative changes due to overloading and katabolic cell activity. DESIGN Three experiments were conducted; Exp 1.: In vivo, lumbar spines of seven goats were operated: one disc was injected with chondroitinase ABC [cABC (mild degeneration)] and compared to the adjacent disc (control) after 24 weeks. Exp 2a: Ex vivo, caprine discs received physiological loading (n = 10) or overloading (n = 10) in a bioreactor. Exp 2b: Cell activity was diminished prior to testing by freeze-thaw cycles, 18 discs were then tested as in Exp 2a. In all experiments, FTIR images (spectral region: 1000-1300 cm-1) of mid-sagittal slices were analyzed using multivariate curve resolution. RESULTS In vivo, FTIR was more sensitive than biochemical and histological analysis in identifying reduced proteoglycan content (P = 0.046) and increased collagen content in degenerated discs (P < 0.01). Notably, FTIR analysis additionally showed disorganization of the ECM, indicated by increased collagen entropy (P = 0.011). Ex vivo, the proteoglycan/collagen ratio decreased due to overloading (P = 0.047) and collagen entropy increased (P = 0.047). Cell activity affected collagen content only (P = 0.044). CONCLUSION FTIR imaging allows a more detailed investigation of early disc degeneration than traditional measures. Changes due to mild overloading could be assessed and quantified. Matrix remodeling is the first detectable step towards intervertebral disc degeneration.
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Affiliation(s)
- K S Emanuel
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands.
| | - K T Mader
- Materials and Engineering Research Institute, Sheffield Hallam University, Sheffield, UK.
| | - M Peeters
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands.
| | - I Kingma
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands.
| | - C M E Rustenburg
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands.
| | - P-P A Vergroesen
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands; Department of Orthopaedic Surgery, NoordWest Ziekenhuisgroep, Alkmaar, The Netherlands.
| | - C Sammon
- Materials and Engineering Research Institute, Sheffield Hallam University, Sheffield, UK.
| | - T H Smit
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
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28
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Berg-Johansen B, Han M, Fields AJ, Liebenberg EC, Lim BJ, Larson PE, Gunduz-Demir C, Kazakia GJ, Krug R, Lotz JC. Cartilage Endplate Thickness Variation Measured by Ultrashort Echo-Time MRI Is Associated With Adjacent Disc Degeneration. Spine (Phila Pa 1976) 2018; 43:E592-E600. [PMID: 28984733 PMCID: PMC5882595 DOI: 10.1097/brs.0000000000002432] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A magnetic resonance imaging study of human cadaver spines. OBJECTIVE To investigate associations between cartilage endplate (CEP) thickness and disc degeneration. SUMMARY OF BACKGROUND DATA Damage to the CEP is associated with spinal injury and back pain. However, CEP morphology and its association with disc degeneration have not been well characterized. METHODS Ten lumbar motion segments with varying degrees of disc degeneration were harvested from six cadaveric spines and scanned with magnetic resonance imaging in the sagittal plane using a T2-weighted two-dimensional (2D) sequence, a three-dimensional (3D) ultrashort echo-time (UTE) imaging sequence, and a 3D T1ρ mapping sequence. CEP thicknesses were calculated from 3D UTE image data using a custom, automated algorithm, and these values were validated against histology measurements. Pfirrmann grades and T1ρ values in the disc were assessed and correlated with CEP thickness. RESULTS The mean CEP thickness calculated from UTE images was 0.74 ± 0.04 mm. Statistical comparisons between histology and UTE-derived measurements of CEP thickness showed significant agreement, with the mean difference not significantly different from zero (P = 0.32). Within-disc variation of T1ρ (standard deviation) was significantly lower for Pfirrmann grade 4 than Pfirrmann grade 3 (P < 0.05). Within-disc variation of T1ρ and adjacent CEP thickness heterogeneity (coefficient of variation) had a significant negative correlation (r = -0.65, P = 0.04). The standard deviation of T1ρand the mean CEP thickness showed a moderate positive correlation (r = 0.40, P = 0.26). CONCLUSION This study demonstrates that quantitative measurements of CEP thickness measured from UTE magnetic resonance imaging are associated with disc degeneration. Our results suggest that variability in CEP thickness and T1ρ, rather than their mean values, may serve as valuable diagnostic markers for disc degeneration. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Britta Berg-Johansen
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
- Department of Bioengineering, UC Berkeley/UCSF Joint Program in Bioengineering, Berkeley, CA
| | - Misung Han
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Aaron J Fields
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Ellen C Liebenberg
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Brandon J Lim
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Peder Ez Larson
- Department of Bioengineering, UC Berkeley/UCSF Joint Program in Bioengineering, Berkeley, CA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Cigdem Gunduz-Demir
- Department of Computer Engineering, Bilkent University, Ankara, Turkey
- Neuroscience Graduate Program, Bilkent University, Ankara, Turkey
| | - Galateia J Kazakia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
- Department of Bioengineering, UC Berkeley/UCSF Joint Program in Bioengineering, Berkeley, CA
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29
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Hebelka H, Miron A, Kasperska I, Brisby H, Lagerstrand K. Axial loading during MRI induces significant T2 value changes in vertebral endplates-a feasibility study on patients with low back pain. J Orthop Surg Res 2018; 13:18. [PMID: 29378613 PMCID: PMC5789539 DOI: 10.1186/s13018-018-0727-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The function of the endplate (EP) is the most important factor influencing nutritional supply to the avascular intervertebral disc (IVD). It is desired to have a non-invasive method to assess functional EP characteristics in vivo. Assessment of functional EP characteristics is important in order to understand its relation to IVD degeneration, which in turn might deepen the understanding of the pathophysiology behind low back pain (LBP). It was hypothesized that, by comparing quantitative MRI of EPs performed with conventional supine MRI (unloaded MRI) with axial loading during MRI (alMRI), dynamical properties of the EP can be displayed. The aim was therefore to investigate the feasibility of axial loading during MRI (alMRI) to instantaneously induce quantitative EP changes. METHODS T2 mapping of 55 vertebral EPs (L1-S1) in five LBP patients was performed during conventional supine MRI (unloaded MRI) and subsequent alMRI. With T2 mapping, the cartilaginous EP and bony EP cannot be separated; hence, the visualized EP was termed EP zone (EPZ). Each EPZ was segmented at multiple midsagittal views, generating volumetric regions of interest. EPZs demonstrating signal inhomogeneity and/or adjacent Modic changes (MC) were termed abnormal EPZs. EPZ mean T2 values were compared between unloaded MRI and alMRI, and their relationship with abnormal EPZs was determined. RESULTS alMRI induced significantly higher (p = 0.01) EPZ mean T2 values compared with unloaded MRI. Significantly higher mean T2 values were seen in inferior EPZs compared with superior EPZs, both with unloaded MRI (35%, p < 0.001) and with alMRI (26%, p = 0.04). Significant difference between unloaded MRI and alMRI was seen in normal (p = 0.02), but not in abnormal EPZs (p = 0.5; n = 12). CONCLUSIONS alMRI induces changes in human EPZ characteristics in vivo. The T2 value significantly increased in normal EPZs, with lack of such in abnormal EPZs. Combining T2 mapping with alMRI provides a clinical feasible, non-invasive method with potential to reveal biochemical behavioral patterns, thus adding another dimension of the EPZs characteristics compared with information obtained with solely unloaded MRI.
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Affiliation(s)
- Hanna Hebelka
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Andreia Miron
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Izabela Kasperska
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Department of Medical Physics and Techniques, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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30
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Sharafi A, Chang G, Regatte RR. Bi-component T1ρ and T2 Relaxation Mapping of Skeletal Muscle In-Vivo. Sci Rep 2017; 7:14115. [PMID: 29074883 PMCID: PMC5658335 DOI: 10.1038/s41598-017-14581-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/12/2017] [Indexed: 12/26/2022] Open
Abstract
The goal of this paper was to evaluate the possibility of bi-component T1ρ and T2 relaxation mapping of human skeletal muscle at 3 T in clinically feasible scan times. T1ρ- and T2-weighted images of calf muscle were acquired using a modified 3D-SPGR sequence on a standard 3 T clinical MRI scanner. The mono- and biexponential models were fitted pixel-wise to the series of T1ρ and T2 weighted images. The biexponential decay of T1ρ and T2 relaxations was detected in ~30% and ~40% of the pixels across all volunteers, respectively. Monoexponential and bi-exponential short and long T1ρ relaxation times were estimated to be 26.9 ms, 4.6 ms (fraction 22%) and 33.2 ms (fraction: 78%), respectively. Similarly, the mono- and bi-exponential short and long T2 relaxation times were 24.7 ms, 4.2 ms (fraction 15%) and 30.4 ms (fraction 85%) respectively. The experiments had good repeatability with RMSCV < 15% and ICC > 60%. This approach could potentially be used in exercise intervention studies or in studies of inflammatory myopathies or muscle fibrosis, permitting greater sensitivity and specificity via measurement of different water compartments and their fractions.
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Affiliation(s)
- Azadeh Sharafi
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA.
| | - Gregory Chang
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Ravinder R Regatte
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
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31
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Sharafi A, Xia D, Chang G, Regatte RR. Biexponential T 1ρ relaxation mapping of human knee cartilage in vivo at 3 T. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3760. [PMID: 28632901 PMCID: PMC5597480 DOI: 10.1002/nbm.3760] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The purpose of this study was to demonstrate the feasibility of biexponential T1ρ relaxation mapping of human knee cartilage in vivo. A three-dimensional, customized, turbo-flash sequence was used to acquire T1ρ -weighted images from healthy volunteers employing a standard 3-T MRI clinical scanner. A series of T1ρ -weighted images was fitted using monoexponential and biexponential models with two- and four-parametric non-linear approaches, respectively. Non-parametric Kruskal-Wallis and Mann-Whitney U-statistical tests were used to evaluate the regional relaxation and gender differences, respectively, with a level of significance of P = 0.05. Biexponential relaxations were detected in the cartilage of all volunteers. The short and long relaxation components of T1ρ were estimated to be 6.9 and 51.0 ms, respectively. Similarly, the fractions of short and long T1ρ were 37.6% and 62.4%, respectively. The monoexponential relaxation of T1ρ was 32.6 ms. The experiments showed good repeatability with a coefficient of variation (CV) of less than 20%. A biexponential relaxation model showed a better fit than a monoexponential model to the T1ρ relaxation decay in knee cartilage. Biexponential T1ρ components could potentially be used to increase the specificity to detect early osteoarthritis by the measurement of different water compartments and their fractions.
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Affiliation(s)
- Azadeh Sharafi
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Ding Xia
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Gregory Chang
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Ravinder R Regatte
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
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32
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Song HP, Sheng HF, Xu WX. A case-control study on the treatment of protrusion of lumbar intervertebral disc through PELD and MED. Exp Ther Med 2017; 14:3708-3712. [PMID: 29042967 PMCID: PMC5639406 DOI: 10.3892/etm.2017.4929] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/20/2017] [Indexed: 11/08/2022] Open
Abstract
We compared the clinical effects between the percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) treatments for protrusion of lumbar intervertebral disc. We conducted a retrospective analysis on 60 patients who were diagnosed with single-segment protrusion of lumbar intervertebral disc during the period from January 2009 to June 2016. Patients were divided into two groups, the PELD and MED groups, which contained 30 cases each. We evaluated the operation results according to oswestry dysfunction index (ODI), visual analogue scale (VAS) and the improved MacNab standard. The average follow-up visit period after the operation was 18 months and the operation time of the two groups was not statistically different. The cadaverine quantity of bleeding in the PELD group is less than that in the MED group. Moreover, the average length of incision and the length of stay were shortened for the PELD group compared to the MED group. The ODI and VAS after operation for the two groups improved significantly compared to that before operation (P<0.05). The qualified rates of the PELD and MED groups were 93.0 and 90.0%, respectively, as of the improved MacNab method. The complication occurrence rates for the two groups during perioperative period were not different. Therefore, the short-term efficacy of the two minimally invasive operation methods (PELD and MED) on the treatment of protrusion of lumbar intervertebral disc is satisfactory. In cases where operation indications are chosen strictly, PELD can be regarded as a method of safety and efficiency due to the advantages of minimal incision, less bleeding, minimal trauma and faster postoperative recovery.
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Affiliation(s)
- Hong-Pu Song
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Hong-Feng Sheng
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Wei-Xing Xu
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
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Iatridis JC, Kang J, Kandel R, Risbud MV. New Horizons in Spine Research: Disc biology, spine biomechanics and pathomechanisms of back pain. J Orthop Res 2016; 34:1287-8. [PMID: 27571441 PMCID: PMC5072778 DOI: 10.1002/jor.23375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- James C. Iatridis
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - James Kang
- Department of Orthopedic
Surgery, Brigham and Women’s Hospital, Boston, MA 02115
| | - Rita Kandel
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Ontario, Canada M5G1X5
| | - Makarand V. Risbud
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107
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