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Foltz MH, Johnson CP, Truong W, Polly DW, Ellingson AM. Morphological alterations of lumbar intervertebral discs in patients with adolescent idiopathic scoliosis. Spine J 2024; 24:172-184. [PMID: 37611875 PMCID: PMC10843277 DOI: 10.1016/j.spinee.2023.08.012] [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: 02/09/2023] [Revised: 07/26/2023] [Accepted: 08/13/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND CONTEXT Etiology of adolescent idiopathic scoliosis (AIS) is still unknown. Prior in vitro research suggests intervertebral disc pathomorphology as a cause for the initiation and progression of the spinal deformity, however, this has not been well characterized in vivo. PURPOSE To quantify and compare lumbar disc health and morphology in AIS to controls. STUDY DESIGN/SETTING Cross-sectional study. METHODS All lumbar discs were imaged using a 3T MRI scanner. T2-weighted and quantitative T2* maps were acquired. Axial slices of each disc were reconstructed, and customized scripts were used to extract outcome measurements: Nucleus pulposus (NP) signal intensity and location, disc signal volume, transition zone slope, and asymmetry index. Pearson's correlation analysis was performed between the NP location and disc wedge angle for AIS patients. ANOVAs were utilized to elucidate differences in disc health and morphology metrics between AIS patients and healthy controls. α=0.05. RESULTS There were no significant differences in disc health metrics between controls and scoliotic discs. There was a significant shift in the NP location towards the convex side of the disc in AIS patients compared to healthy controls, with an associated increase of the transition zone slope on the convex side. Additionally, with increasing disc wedge angle, the NP center migrated towards the convex side of the disc. CONCLUSIONS The present study elucidates morphological distinctions of intervertebral discs between healthy adolescents and those diagnosed with AIS. Discs in patients diagnosed with AIS are asymmetric, with the NP shifted towards the convex side, which was exacerbated by an increased disc wedge angle. CLINICAL SIGNIFICANCE Investigation of the MRI signal distribution (T2w and T2* maps) within the disc suggests an asymmetric pressure gradient shifting the NP laterally towards the convexity. Quantifying the progression of these morphological alterations during maturation and in response to treatment will provide further insight into the mechanisms of curve progression and correction, respectively.
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Affiliation(s)
- Mary H Foltz
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota
| | - Casey P Johnson
- Department of Veterinary Clinical Sciences, University of Minnesota; Center for Magnetic Resonance Research, University of Minnesota
| | - Walter Truong
- Gillette Children's Specialty Healthcare; Department of Orthopedic Surgery, University of Minnesota
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota
| | - Arin M Ellingson
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota; Department of Orthopedic Surgery, University of Minnesota; Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota.
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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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Yang L, Sun C, Gong T, Li Q, Chen X, Zhang X. T1ρ, T2 and T2* mapping of lumbar intervertebral disc degeneration: a comparison study. BMC Musculoskelet Disord 2022; 23:1135. [PMID: 36575488 PMCID: PMC9793566 DOI: 10.1186/s12891-022-06040-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Early and accurate assessment of lumbar intervertebral disc degeneration (IVDD) is very important to therapeutic strategy. This study aims to correlate and compare the performances of T1ρ, T2 and T2* mapping for Pfirrmann grades and morphologic changes in the IVDD. METHODS This prospective study included 39 subjects with 195 lumbar discs. T1ρ, T2 and T2* mapping were performed, and T1ρ, T2 and T2* values of nucleus pulposus (NP), and anterior and posterior annulus fibrosus were measured. IVDD was assessed with Pfirrmann grading and morphologic changes (normal, bulging, herniation and annular fissure). The performances of T1ρ, T2 and T2* relaxation times were compared for detecting early (Pfirrmann grade II-III) and advanced degeneration (Pfirrmann grade IV-V), as well as for morphologic changes. RESULTS T2 relaxation times was strongly corelated with T1ρ and T2* relaxation times. Areas under the curves (AUCs) of T1ρ, T2 and T2* relaxation times of NP were 0.70, 0.87 and 0.80 for early degeneration, and 0.91, 0.95 and 0.82 for advanced degeneration, respectively. AUCs of T1ρ, T2 and T2* relaxation times of NP were 0.78, 0.83 and 0.64 for bulging discs, 0.87, 0.89 and 0.69 for herniated discs, and 0.79, 0.82 and 0.69 for annular tearing, respectively. The AUC of T2 relaxation time was significantly higher than those of T1ρ relaxation times (both P < 0.01) for early IVDD, and the AUCs of T1ρ and T2 relaxation times for assessing advanced degeneration and morphologic changes were similar (P > 0.05) but significantly higher than that of T2*relaxation time (P < 0.01). CONCLUSIONS T2 mapping performed better than T1ρ mapping for the detection of early IVDD. T1ρ and T2 mapping performed similarly but better than T2* mapping for advanced degeneration and morphologic changes of IVDD.
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Affiliation(s)
- Li Yang
- grid.413087.90000 0004 1755 3939Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, 200032 People’s Republic of China
| | - Cong Sun
- grid.414350.70000 0004 0447 1045Department of Radiology, Beijing Hospital, National Center of Gerontology, No. 1 Da-Hua Road, Dong Dan, Beijing, 100730 China
| | - Tao Gong
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Quanlin Li
- grid.479672.9Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250012 Shandong China
| | - Xin Chen
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Xinjuan Zhang
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
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Schol J, Sakai D. Comprehensive narrative review on the analysis of outcomes from cell transplantation clinical trials for discogenic low back pain. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 13:100195. [PMID: 36655116 PMCID: PMC9841054 DOI: 10.1016/j.xnsj.2022.100195] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/24/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Background Intervertebral disc (IVD) degeneration is one of the primary causes of low back pain (LBP) and despite a prominent prevalence, present treatment options remain inadequate for a large portion of LBP patients. New developments in regenerative therapeutics offer potentially powerful medical tools to modify this pathology, with specific focus on (stem) cell transplantations. Multiple clinical trials have since reported overall beneficial outcomes favoring cell therapy. Nonetheless, the significance of these improvements is often not (clearly) discussed. As such, this narrative review aims to summarize the significance of the reported improvements from human clinical trials on IVD-targeted cell therapy. Methods Through a comprehensive narrative review we discuss the improvements in pain, disability, quality of life, and imaging modalities and reported adverse events following cell therapy for discogenic pain. Results Most clinical trials were able to report clear and significant improvements in pain and disability outcomes. Imaging and quality of life improvements however were not as clearly reported but did present some enhancements for a select number of patients. Finally, whether cell therapy can outperform placebo treatment remains intangible. Conclusions Our review highlights the clinical significance of observed trends in pain and disability improvement. Nevertheless, reporting quality was found unsatisfactory and large-scale randomized controlled studies remain small in number. Future studies and articles should put more emphasis on improvements in imaging modalities and compare outcomes to (placebo) control groups to fully elucidate the efficacy and safety of cellular therapeutics against LBP.
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Wu LL, Liu LH, Rao SX, Wu PY, Zhou JJ. Ultrashort time-to-echo T2* and T2* relaxometry for evaluation of lumbar disc degeneration: a comparative study. BMC Musculoskelet Disord 2022; 23:524. [PMID: 35650645 PMCID: PMC9161611 DOI: 10.1186/s12891-022-05481-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background To compare potential of ultrashort time-to-echo (UTE) T2* mapping and T2* values from T2*-weighted imaging for assessing lumbar intervertebral disc degeneration (IVDD),with Pfirrmann grading as a reference standard. Methods UTE-T2* and T2* values of 366 lumbar discs (L1/2-L5/S1) in 76 subjects were measured in 3 segmented regions: anterior annulus fibrosus, nucleus pulposus (NP), and posterior annulus fibrosus. Lumbar intervertebral discs were divided into 3 categories based on 5-level Pfirrmann grading: normal (Pfirrmann grade I),early disc degeneration (Pfirrmann grades II-III), and advanced disc degeneration (Pfirrmann grades IV-V). Regional differences between UTE-T2* and T2* relaxometry and correlation with degeneration were statistically analyzed. Results UTE-T2* and T2*value correlated negatively with Pfirrmann grades (P < 0.001). In NP, correlations with Pfirrmann grade were high with UTE-T2* values (r = − 0.733; P < 0.001) and moderate with T2* values (r = -0.654; P < 0.001). Diagnostic accuracy of detecting early IVDD was better with UTE-T2* mapping than T2* mapping (P < 0.05),with receiver operating characteristic analysis area under the curve of 0.715–0.876. Conclusions UTE-T2* relaxometry provides another promising magnetic resonance imaging sequence for quantitatively evaluate lumbar IVDD and was more accurate than T2*mapping in the earlier stage degenerative process.
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Affiliation(s)
- Li-Lan Wu
- Department of Radiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Li-Heng Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, shanghai, China.,Shanghai Institute of Medical Imaging, shanghai, China
| | - Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, shanghai, China.,Shanghai Institute of Medical Imaging, shanghai, China
| | | | - Jian-Jun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, shanghai, China. .,Shanghai Institute of Medical Imaging, shanghai, China.
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Emanuel KS, Kellner LJ, Peters MJM, Haartmans MJJ, Hooijmans MT, Emans PJ. The relation between the biochemical composition of knee articular cartilage and quantitative MRI: a systematic review and meta-analysis. Osteoarthritis Cartilage 2022; 30:650-662. [PMID: 34826570 DOI: 10.1016/j.joca.2021.10.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Early and non-invasive detection of osteoarthritis (OA) is required to enable early treatment and monitoring of interventions. Some of the earliest signs of OA are the change in proteoglycan and collagen composition. The aim of this study is to establish the relations between quantitative magnetic resonance imaging (MRI) and biochemical concentration and organization in knee articular cartilage. METHODS A preregistered systematic literature review was performed using the databases PubMed and Embase. Papers were included if quantitative MRI and a biochemical assay or polarized light microscopy (PLM) was performed on knee articular cartilage, and a quantified correlation was described. The extracted correlations were pooled using a random effects model. RESULTS 21 papers were identified. The strongest pooled correlation was found for delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) vs proteoglycan concentration (r = 0.59). T1ρ relaxation times are inversely correlated to proteoglycan concentration (r = -0.54). A weak correlation between T2 relaxation times and proteoglycans was found (r = -0.38). No correlation between T2 relaxation time and collagen concentration was found (r = -0.02). A heterogeneous set of correlations between T2 relaxation times and PLM were identified, including strong correlations to anisotropy. CONCLUSION DGEMRIC measures are significantly correlated to proteoglycan concentration. The needed contrast agent is however a disadvantage; the T1ρ sequence was found as a non-invasive alternative. Remarkably, no correlation was found between T2 relaxation times and collagen concentration. T2 relaxation times is related to organization, rather than concentration of collagen fibers. PROSPERO ID CRD42020168337.
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Affiliation(s)
- K S Emanuel
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - L J Kellner
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - M J M Peters
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - M J J Haartmans
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - M T Hooijmans
- Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - P J Emans
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands.
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Benedikter C, Abrar DB, Konieczny M, Schleich C, Bittersohl B. Patterns of Intervertebral Disk Alteration in Asymptomatic Elite Rowers: A T2* MRI Mapping Study. Orthop J Sports Med 2022; 10:23259671221088572. [PMID: 35464905 PMCID: PMC9019338 DOI: 10.1177/23259671221088572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Repetitive loading of the back puts elite rowers at risk for acute and chronic back injuries. Hypothesis: That asymptomatic elite rowers would demonstrate characteristic intervertebral disk (IVD) alterations on T2* magnetic resonance imaging (MRI) mapping compared with asymptomatic nonrowers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included 20 asymptomatic elite rowers (mean age, 23.4 ± 3.03 years; 9 women, 11 men) studied at 2 different times, once before (t1) and once after (t2) the competition phase. MRI including T2* mapping was performed on a 3-T scanner. The authors derived normative T2* data from a previous study on 40 asymptomatic volunteers (20 men, 20 women) who were not competitive rowers; based on complete T2* data sets, 37 controls were included. T2* values were compared between groups in 4 lumbar IVDs, and midsagittal T2* values were compared in 5 zones: anterior annulus fibrosus (AF), anterior nucleus pulposus (NP), central NP, posterior NP, and posterior AF. The Pfirrmann grade was used for morphological assessment of disk degeneration. Statistical analysis was conducted using the Mann-Whitney U test, Wilcoxon matched-pairs test, and Spearman rank correlation coefficient. Results: Lower T2* values were noted in the rower group compared with the controls (37.08 ± 33.63 vs 45.59 ± 35.73 ms, respectively; P < .001). The intersegmental comparison revealed lower mean T2* values among rowers (P ≤ .027 for all). The interzonal comparison indicated significantly lower mean T2* values for the rowers in all zones except for the anterior NP (P ≤ .008 for all). Lower mean T2* values were observed for the rowers at t1 versus t2 (39.25 ± 36.19 vs 43.97 ± 38.67 ms, respectively; P = .008). The authors noted a higher level of IVD damage according to Pfirrmann assessment in the rower cohort (P < .001); the Pfirrmann grade distributions of rowers versus controls, respectively, were as follows: 51.3% versus 73.7% (grade 1), 20.5% versus 19.5% (grade 2), 21.8% versus 6.8% (grade 3), 5.1% versus 0% (grade 4), and 1.3% versus 0% (grade 5). The authors also noted a correlation between low T2* and high Pfirrmann grade at t1 (r =–0.48; P < .001) and t2 (r =–0.71; P < .001). Conclusion: The cohort of elite rowers revealed more degenerative IVD changes compared with controls. The T2* values suggest that repetitive loading of the spine has demonstrable short-term and possibly permanent effects on the lumbar IVD.
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Affiliation(s)
- Chiara Benedikter
- Department of Orthopedics and Trauma Surgery, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Markus Konieczny
- Department of Orthopedics and Trauma Surgery, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopedics and Trauma Surgery, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
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Comparison of MRI T1, T2, and T2* mapping with histology for assessment of intervertebral disc degeneration in an ovine model. Sci Rep 2022; 12:5398. [PMID: 35354902 PMCID: PMC8967912 DOI: 10.1038/s41598-022-09348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/21/2022] [Indexed: 11/08/2022] Open
Abstract
An easy, reliable, and time-efficient standardized approach for assessing lumbar intervertebral disc (IVD) degeneration with relaxation times measurements in pre-clinical and clinical studies is lacking. This prospective study aims to determine the most appropriate method for lumbar IVD degeneration (IDD) assessment in sheep by comparing three quantitative MRI sequences (variable-flip-angle T1 mapping, and multi-echo T2 and T2* mapping), correlating them with Pfirrmann grading and histology. Strong intra- and interrater agreements were found for Nucleus pulposus (NP) regions-of-interest (ROI). T1, T2, and T2* mapping correlated with Pfirrmann grading and histological scoring (p < 0.05) except for the most ventral rectangular ROI on T2 maps. Correlations were excellent for all of the T1 ROIs and the T2* NP ROIs. Highly significant differences in T1 values were found between all Pfirrmann grades except between grades I/II and between grades III/IV. Significant differences were identified in the T2 and the T2* values between all grades except between grades I/III. T1, T2, and T2* relaxation times measurements of the NP are an accurate and time-efficient tool to assess lumbar IDD in sheep. Variable-flip-angle T1 mapping may be further considered as a valuable method to investigate IDD and to assess the efficacy of regenerative treatments in longitudinal studies.
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Imaging Evaluation of Intervertebral Disc Degeneration and Painful Discs-Advances and Challenges in Quantitative MRI. Diagnostics (Basel) 2022; 12:diagnostics12030707. [PMID: 35328260 PMCID: PMC8946895 DOI: 10.3390/diagnostics12030707] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/07/2023] Open
Abstract
In recent years, various quantitative and functional magnetic resonance imaging (MRI) sequences have been developed and used in clinical practice for the diagnosis of patients with low back pain (LBP). Until now, T2-weighted imaging (T2WI), a visual qualitative evaluation method, has been used to diagnose intervertebral disc (IVD) degeneration. However, this method has limitations in terms of reproducibility and inter-observer agreement. Moreover, T2WI observations do not directly relate with LBP. Therefore, new sequences such as T2 mapping, T1ρ mapping, and MR spectroscopy have been developed as alternative quantitative evaluation methods. These new quantitative MRIs can evaluate the anatomical and physiological changes of IVD degeneration in more detail than conventional T2WI. However, the values obtained from these quantitative MRIs still do not directly correlate with LBP, and there is a need for more widespread use of techniques that are more specific to clinical symptoms such as pain. In this paper, we review the state-of-the-art methodologies and future challenges of quantitative MRI as an imaging diagnostic tool for IVD degeneration and painful discs.
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Savarese L, Menezes-Reis R, Jorge M, Salmon C, Herrero C, Nogueira-Barbosa M. Sagittal balance and intervertebral disc composition in patients with low back pain. Braz J Med Biol Res 2022; 55:e12015. [DOI: 10.1590/1414-431x2022e12015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- L.G. Savarese
- Universidade de São Paulo, Brasil; Universidade de São Paulo, Brasil
| | | | - M. Jorge
- Universidade de São Paulo, Brasil
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Inoue M, Isa ILM, Orita S, Suzuki-Narita M, Inage K, Shiga Y, Norimoto M, Umimura T, Sakai T, Eguchi Y, Watanabe A, Aoki Y, Pandit A, Ohtori S. An Injectable Hyaluronic Acid Hydrogel Promotes Intervertebral Disc Repair in a Rabbit Model. Spine (Phila Pa 1976) 2021; 46:E810-E816. [PMID: 34228691 DOI: 10.1097/brs.0000000000003921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An in vivo model to study the effect of an injectable hyaluronic acid (HA) hydrogel following puncture-induced lumbar disc injury in rabbits. OBJECTIVES The aim of this study was to determine the efficacy of an injectable HA hydrogel to maintain disc height and tissue hydration, promote structural repair, and attenuate inflammation and innervation in the lumbar discs. SUMMARY OF BACKGROUND DATA Previously, we have demonstrated that HA hydrogel alleviated inflammation, innervation, and pain to promote disc repair. Nevertheless, the effect of an injectable HA hydrogel in the lumbar disc in a weight-bearing animal model was not performed. METHODS We have adopted a surgically puncture-induced disc injury at lumbar levels in a rabbit model. The discs were grouped into sham, puncture with water injection, and puncture with HA hydrogel injection. Postoperatively, we measured changes in disc height using x-ray. We used magnetic resonance imaging to assess disc degeneration on tissue hydration after euthanasia. Post-mortem, we determined histological changes, innervation (PGP9.5) and inflammation (interleukin [IL]-6, IL-1β, and tumor necrosis factor [TNF]-α) in the discs. RESULTS We have demonstrated a significant reduction of disc height and T2/T1ρ mapping with histological evidence of degenerative discs, increase of innervation and inflammation in puncture-induced disc injury over time. In the HA hydrogel group, disc height was increased at weeks four and eight. A slight increase of T2 mapping, but significantly in T1ρ mapping, was observed in the HA hydrogel group at week 8. We observed homogenous NP distribution and organised AF lamellae at week eight and a slight reduced innervation score in the treatment group. HA hydrogel significantly downregulated IL-6 expression at day 1. This, however, was only slightly reduced for IL-1β and TNF-α. CONCLUSION An injectable HA hydrogel had the protective effects in suppressing the loss of disc height, promoting tissue hydration for structural repair, and attenuating inflammation and innervation to prevent further disc degeneration.Level of Evidence: N/A.
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Affiliation(s)
- Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
| | - Isma Liza Mohd Isa
- SFI Research Center for Medical Devices, National University of Ireland Galway, Ireland.,Department of Orthopedic and Traumatology, The National University of Malaysia, Malaysia
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
| | - Miyako Suzuki-Narita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
| | - Masaki Norimoto
- Department of Orthopedic Surgery, Toho University of Sakura Hospital, Sakura, Chiba, Japan
| | - Tomotaka Umimura
- Department of Orthopaedic surgery, Sanmu medical center, Sanmu, Chiba, Japan
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Abhay Pandit
- SFI Research Center for Medical Devices, National University of Ireland Galway, Ireland
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
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Lazzari ZT, Aria KM, Menger R. Neurosurgery and spinal adaptations in spaceflight: A literature review. Clin Neurol Neurosurg 2021; 207:106755. [PMID: 34126454 DOI: 10.1016/j.clineuro.2021.106755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spaceflight places astronauts in multiple environments capable of inducing pathological changes. Alterations in the spine have a significant impact on astronauts' health during and after spaceflight. Low back pain is an established and common intra-flight complaint. Intervertebral disc herniation occurs at higher rates in this population and poses significant morbidity. Morphological changes within intervertebral discs, vertebral bodies, and spinal postural muscles affect overall spine function and astronaut performance. There remains a paucity of research related to spaceflight-induced pathologies, and currently available reviews concern the central nervous system broadly while lacking emphasis on spinal function. OBJECTIVE Our aim was to review and summarize available data regarding changes in spinal health with exposure to spaceflight, especially focusing on effects of microgravity. The authors also present promising diagnostic and treatment approaches wherein the neurosurgeon could positively impact astronauts' health and post-flight outcomes. MATERIALS AND METHODS Articles included in this review were identified via search engine using MEDLINE, PubMed, Cochrane Review, Google Scholar, and references within other relevant articles. Search criteria included "spine and spaceflight", "vertebral column and spaceflight", "vertebral disc and spaceflight", and "muscle atrophy and spaceflight", with results limited to articles written in English from 1961 to 2020. References of selected articles were included as appropriate. RESULTS Fifty-six articles were included in this review. Compositional changes at the intervertebral discs, vertebral bone, and paraspinal muscles contribute to undesirable effects on astronaut spinal function in space and contribute to post-flight pathologies. Risk of intervertebral disc herniation increases, especially during post-flight recovery. Vertebral bone degeneration in microgravity may increase risk for herniation and fracture. Paraspinal muscle atrophy contributes to low back pain, poorer spine health, and reduced stability. CONCLUSION Anatomical changes in microgravity contribute to the development of spinal pathologies. Microgravity impacts sensory neurovestibular function, neuromuscular output, genetic expression, among other systems. Future developments in imaging and therapeutic interventions may better analyze these changes and offer targeted therapeutic interventions to decrease the burden of pain and other diseases of the spine in this population.
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Affiliation(s)
| | - Kevin M Aria
- University of South Alabama College of Medicine, Mobile, AL, USA.
| | - Richard Menger
- Department of Neurosurgery, University of South Alabama, Mobile, AL, USA; Department of Political Science, University of South Alabama, Mobile, AL, USA.
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Ren W, Cui S, Alini M, Grad S, Zhou Q, Li Z, Razansky D. Noninvasive multimodal fluorescence and magnetic resonance imaging of whole-organ intervertebral discs. BIOMEDICAL OPTICS EXPRESS 2021; 12:3214-3227. [PMID: 34221655 PMCID: PMC8221942 DOI: 10.1364/boe.421205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 06/13/2023]
Abstract
Low back pain (LBP) is a commonly experienced symptom posing a tremendous healthcare burden to individuals and society at large. The LBP pathology is strongly linked to degeneration of the intervertebral disc (IVD), calling for development of early-stage diagnostic tools for visualizing biomolecular changes in IVD. Multimodal measurements of fluorescence molecular tomography (FMT) and magnetic resonance imaging (MRI) were performed on IVD whole organ culture model using an in-house built FMT system and a high-field MRI scanner. The resulted multimodal images were systematically validated through epifluorescence imaging of the IVD sections at a microscopic level. Multiple image contrasts were exploited, including fluorescence distribution, anatomical map associated with T1-weighted MRI contrast, and water content related with T2 relaxation time. The developed multimodality imaging approach may thus serve as a new assessment tool for early diagnosis of IVD degeneration and longitudinal monitoring of IVD organ culture status using fluorescence markers.
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Affiliation(s)
- Wuwei Ren
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, University of Zurich and ETH Zurich, 8093 Zurich, Switzerland
- equal contribution
| | - Shangbin Cui
- AO Research Institute Davos, 7270 Davos, Switzerland
- The First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, China
- equal contribution
| | - Mauro Alini
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Sibylle Grad
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Quanyu Zhou
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, University of Zurich and ETH Zurich, 8093 Zurich, Switzerland
| | - Zhen Li
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Daniel Razansky
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, University of Zurich and ETH Zurich, 8093 Zurich, Switzerland
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Helke KL, Meyerholz DK, Beck AP, Burrough ER, Derscheid RJ, Löhr C, McInnes EF, Scudamore CL, Brayton CF. Research Relevant Background Lesions and Conditions: Ferrets, Dogs, Swine, Sheep, and Goats. ILAR J 2021; 62:133-168. [PMID: 33712827 DOI: 10.1093/ilar/ilab005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/17/2020] [Accepted: 01/06/2021] [Indexed: 01/01/2023] Open
Abstract
Animal models provide a valuable tool and resource for biomedical researchers as they investigate biological processes, disease pathogenesis, novel therapies, and toxicologic studies. Interpretation of animal model data requires knowledge not only of the processes/diseases being studied but also awareness of spontaneous conditions and background lesions in the model that can influence or even confound the study results. Species, breed/stock, sex, age, anatomy, physiology, diseases (noninfectious and infectious), and neoplastic processes are model features that can impact the results as well as study interpretation. Here, we review these features in several common laboratory animal species, including ferret, dog (beagle), pig, sheep, and goats.
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Affiliation(s)
- Kristi L Helke
- Department of Comparative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David K Meyerholz
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Amanda P Beck
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Eric R Burrough
- Veterinary Diagnostic and Production Animal Medicine Department, Iowa State University, Ames, Iowa, USA
| | - Rachel J Derscheid
- Veterinary Diagnostic and Production Animal Medicine Department, Iowa State University, Ames, Iowa, USA
| | - Christiane Löhr
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Elizabeth F McInnes
- Toxicologic Pathology, Toxicology Section, Human Safety at Syngenta, in Jealott's Hill, Bracknell, United Kingdom
| | - Cheryl L Scudamore
- ExePathology, Pathologist at ExePathology, Exmouth, Devon, United Kingdom
| | - Cory F Brayton
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Foltz MH, O'Leary RM, Reader D, Rudolph NL, Schlitter KA, Ellermann J, Johnson CP, Polly DW, Ellingson AM. Quantifying the effect of posterior spinal instrumentation on the MRI signal of adjacent intervertebral discs. Spine Deform 2020; 8:845-851. [PMID: 32449035 PMCID: PMC7541587 DOI: 10.1007/s43390-020-00139-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 05/11/2020] [Indexed: 01/08/2023]
Abstract
STUDY DESIGN Ex vivo porcine imaging study. OBJECTIVES Quantitatively evaluate change in MRI signal at the discs caudal to spinal fusion instrumentation. Individuals who receive posterior spinal instrumentation are at risk of developing accelerated disc degeneration at adjacent levels. Degeneration is associated with a loss of biochemical composition and mechanical integrity of the disc, which can be noninvasively assessed through quantitative T2* (qT2*) MRI techniques. However, qT2* is sensitive to magnetic susceptibility introduced by metal. METHODS Nine ex vivo porcine lumbar specimens were imaged with 3 T MRI. Fast spin-echo T2-weighted (T2w) images and gradient-echo qT2* maps were acquired, both without and with posterior spinal fusion instrumentation. Average T2* relaxation times of the nuclei pulposi (NP) were measured at the adjacent and sub-adjacent discs and measurements were compared using t tests before and after instrumentation. The size of the signal void and metal artifact were determined (modified ASTM F2119-07) within the vertebral body and spinal cord for both MRI sequences. The relationship between T2* signal loss and distance from the instrumentation was evaluated using Pearson's correlation. RESULTS There was no significant difference between adjacent and sub-adjacent NP T2* relaxation time prior to instrumentation (p = 0.86). Following instrumentation, there was a significant decrease in the T2* relaxation time at the adjacent NP (average = 20%, p = 0.02), and no significant difference at the sub-adjacent NP (average = - 3%, p = 0.30). Furthermore, there was a significant negative correlation between signal loss and distance to disc (r = - 0.61, p < 0.01). CONCLUSIONS Spinal fusion instrumentation interferes with T2* relaxation time measurements at the adjacent disc but not at the sub-adjacent discs. However, there is sufficient signal at the adjacent disc to quantify changes in the T2* relaxation time following spinal fusion. Hence, baseline MRI scan following spinal fusion surgery are required to interpret and track changes in disc health at the caudal discs. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Mary H Foltz
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Robert M O'Leary
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Diana Reader
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Nicholas L Rudolph
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Krista A Schlitter
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Jutta Ellermann
- Department of Radiology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Casey P Johnson
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
| | - David W Polly
- Department of Orthopaedic Surgery, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Arin M Ellingson
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA.
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA.
- Department of Orthopaedic Surgery, Medical School, University of Minnesota, Minneapolis, MN, USA.
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Takashima H, Yoshimoto M, Ogon I, Terashima Y, Imamura R, Akatsuka Y, Iesato N, Oshigiri T, Morita T, Takebayashi T, Emori M, Teramoto A, Yamashita T. Lumbar disc degeneration assessment using T2* relaxation time with ultra-short TE. Magn Reson Imaging 2020; 73:11-14. [PMID: 32673744 DOI: 10.1016/j.mri.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Hiroyuki Takashima
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan.
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Izaya Ogon
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Rui Imamura
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Yoshihiro Akatsuka
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Noriyuki Iesato
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Tsutomu Oshigiri
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Tomonori Morita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | | | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
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Kolf AK, Konieczny M, Hesper T, Hosalkar H, Schleich C, Antoch G, Krauspe R, Bittersohl B. T2* Mapping of the Adult Intervertebral Lumbar Disc: Normative Data and Analysis of Diurnal Effects. J Orthop Res 2019; 37:1956-1962. [PMID: 31042306 DOI: 10.1002/jor.24327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 04/04/2019] [Indexed: 02/04/2023]
Abstract
In this prospective study, we sought to establish normative data for T2* analysis of lumbar intervertebral discs (IVDs). Further, potential diurnal effects regarding T2* relaxometry of the lower spine were examined. Lumbar IVDs of young, healthy, adult men (n = 20) and women (n = 20; mean age = 24.5 ± 2.9 years) were assessed. Magnetic resonance imaging including T2* mapping was performed on a 3-T scanner. Mid-sagittal T2* values were obtained in five regions: anterior annulus fibrosus (AF), anterior nucleus pulposus (NP), central NP, posterior NP, and posterior AF. Zonal and segmental differences, as well as diurnal variations between the T2* analysis in the morning and the evening and effects of unloading, were analyzed. Discs with signs of degeneration on morphological images or imaging artifacts were excluded. We noted a zonal and segmental T2* distribution with high values in the NP, low T2* values in the AF and a T2* increase towards the caudal NP. We observed no diurnal differences between the mean T2* values in the morning and in the evening (p = 0.748). The effect of unloading the spine was low (maximum T2* difference between four measurements = 13.6 ms; significant difference noted only between the 0 and 15-min measurement). The T2* values obtained in this study will serve as normative values for future T2* measurements. There are no diurnal influences, and we suggest that unloading of the spine has no demonstrable effect after 30 min on the T2* results. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1956-1962, 2019.
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Affiliation(s)
- Anna-Katharina Kolf
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Markus Konieczny
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Tobias Hesper
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - HarishS Hosalkar
- Center for Hip Preservation and Children's Orthopedics, & The Hosalkar Institute for Joint Preservation and Injury Care, San Diego, California
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Krauspe
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
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Rustenburg CME, Faraj SSA, Ket JCF, Emanuel KS, Smit TH. Prognostic factors in the progression of intervertebral disc degeneration: Which patient should be targeted with regenerative therapies? JOR Spine 2019; 2:e1063. [PMID: 31572980 PMCID: PMC6764790 DOI: 10.1002/jsp2.1063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/21/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Possible regenerative treatments for lumbar intervertebral disc degeneration (DD) are rapidly emerging. There is consensus that the patient that would benefit most has early-stage DD, with a predicted deterioration in the near future. To identify this patient, the aim of this study was to identify prognostic factors for progression of DD. STUDY DESIGN Systematic review. METHODS A systematic search was performed on studies evaluating one or more prognostic factor(s) in the progression of DD. The criteria for inclusion were (a) patients diagnosed with DD on MRI, (b) progression of DD at follow-up, and (c) reporting of one or more prognostic factor(s) in progression of DD. Two authors independently assessed the methodological quality of the included studies. Due to heterogeneity in DD determinants and outcomes, only a best-evidence synthesis could be conducted. RESULTS The search generated 3165 references, of which 16 studies met our inclusion criteria, involving 2.423 patients. Within these, a total of 23 clinical and environmental and 12 imaging factors were identified. There was strong evidence that disc herniation at baseline is associated with progression of DD at follow-up. There is limited evidence that IL6 rs1800795 genotype G/C male was associated with no progression of DD. Some clinical or environmental factors such as BMI, occupation and smoking were not associated with progression. CONCLUSIONS Disc herniation is strongly associated with the progression of DD. Surprisingly, there was strong evidence that smoking, occupation, and several other factors were not associated with the progression of DD. Only one genetic variant may have a protective effect on progression, otherwise there was conflicting or only limited evidence for most prognostic factors. Future research into these prognostic factors with conflicting and limited evidence is not only needed to determine which patients should be targeted by regenerative therapies, but will also contribute to spinal phenotyping.
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Affiliation(s)
| | - Sayf S. A. Faraj
- Radboud UMC, Department of Orthopedic SurgeryNijmegenThe Netherlands
| | | | - Kaj S. Emanuel
- Amsterdam UMC, Department of Orthopedic SurgeryAmsterdam Movement SciencesAmsterdamThe Netherlands
- Maastricht UMC+, Department of Orthopaedic SurgeryMaastrichtThe Netherlands
| | - Theodoor H. Smit
- Amsterdam UMC, Department of Orthopedic SurgeryAmsterdam Movement SciencesAmsterdamThe Netherlands
- Amsterdam UMC, Department of Medical BiologyAmsterdam Movement SciencesAmsterdamThe Netherlands
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Novel Application of the Pfirrmann Disc Degeneration Grading System to 9.4T MRI: Higher Reliability Compared to 3T MRI. Spine (Phila Pa 1976) 2019; 44:E766-E773. [PMID: 31205169 DOI: 10.1097/brs.0000000000002967] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Reliability study. OBJECTIVE To evaluate the applicability and reliability of 9.4T magnetic resonance imaging (MRI) in the assessment of degenerative disc disease compared with 3T MRI. SUMMARY OF BACKGROUND DATA MRI is a reliable indicator of biochemical changes in the intervertebral disc (IVD) including hydration status, proteoglycan content, and disc degeneration compared with anatomical and histological studies. High-field 9.4T MRI has been shown to provide superior resolution and anatomical detail. However, it has not been tested against current standard MRI techniques. METHODS Disc degeneration was initiated in 36 skeletally mature ewes 6 months prior to necropsy via validated surgical IVD injury models using either scalpel injury or drill-bit injury techniques at lumbar spine levels L2/3 and L3/4 with L1/2, L4/5, and L5/6 serving as control discs. All ex vivo IVDs were examined with 9.4T MRI and 3T MRI. All scans were analyzed using the Pfirrmann grading system by four independent observers. Intra- and interobserver reliability was assessed using kappa statistics and Spearman correlation. RESULTS Inter- and intraobserver agreement for 9.4T MRI was excellent, both at κ 0.91 (P < 0.001). Comparatively, 3T interobserver reliability demonstrated substantial agreement at κ 0.61 (P < 0.001). Complete agreement was obtained in 92.7% to 100% of discs at 9.4T compared with 69.7% to 83.1% at 3T. A difference of one grade or more occurred in 6.7% at 9.4T and 39.3% at 3T. 9.4T MRI scored 97.3% of discs as grade 1 to 2 compared with 71.3% at 3T. 3T MRI tended to over-score the extent of disc degeneration with 28.6% of discs scored as grade 3 or higher compared with 2.7% at 9.4T MRI. CONCLUSION 9.4T MRI study of IVD degeneration using the Pfirrmann grading system demonstrated excellent inter- and intraobserver reliability. Comparatively, 3T MRI demonstrated a tendency to over score the extent of disc degeneration. This improved reliability of 9.4T MRI holds great potential for its clinical applications. LEVEL OF EVIDENCE 3.
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A comparative study of diffusion kurtosis imaging and T2* mapping in quantitative detection of lumbar intervertebral disk degeneration. 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 2019; 28:2169-2178. [PMID: 31093750 DOI: 10.1007/s00586-019-06007-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/06/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the feasibility of diffusion kurtosis imaging (DKI) for diagnosing lumbar intervertebral disk degeneration (IDD) and to compare the potential of DKI and T2* mapping in the diagnosis of early IDD. METHODS Sagittal T2WI, DKI, and T2* mapping were performed in 75 subjects with 375 lumbar intervertebral disks at a 3.0-T MRI. DKI-related parameters including mean kurtosis (MK), mean diffusivity (MD), fractional anisotropy (FA), and T2* values were calculated for each disk which was segmented into three regions: nucleus pulposus (NP), anterior annulus fibrosus (AAF), and posterior annulus fibrosus (PAF). RESULTS MK and FA were positively correlated with Pfirrmann grade (all P < 0.001). MD and T2* were negatively correlated with Pfirrmann grade (all P < 0.001) except for T2* value of AAF (r = 0.087, P > 0.05). MK and FA values increased, while MD and T2* values decreased with age. No statistical significance was found between men and women (P > 0.05). Cephalic lumbar disks (L1/L2 and L2/L3) got lower MK and FA values than caudal lumbar disks (L4/L5 and L5/S1) (all P < 0.05), while cephalic lumbar disks got higher MD value than caudal lumbar disks (all P < 0.05). ROC analysis demonstrated that MK, MD, and FA showed significantly higher diagnostic accuracies than T2*, especially in NP and PAF. CONCLUSIONS DKI can be used to assess human lumbar IDD. And DKI was more sensitive to the quantitative detection of early lumbar IDD than T2* mapping. These slides can be retrieved under Electronic Supplementary Material.
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Estradiol Alleviates Intervertebral Disc Degeneration through Modulating the Antioxidant Enzymes and Inhibiting Autophagy in the Model of Menopause Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:7890291. [PMID: 30671175 PMCID: PMC6323532 DOI: 10.1155/2018/7890291] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/01/2018] [Indexed: 01/01/2023]
Abstract
Objective To investigate the effects of menopause on redox balance in the intervertebral disc and to examine whether oxidative stress and autophagy were associated with disc degeneration in menopause rats. Methods Thirty female Sprague-Dawley rats were randomly divided into three groups (sham, ovariectomized with vehicle, and ovariectomized with estrogen). At the end of the 3-month treatment, the rats were examined by 3.0 T MRI. Serum estradiol (E2) level was measured. Redox balance of nucleus pulposus was determined by measuring total antioxidant capacity (T-AOC), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), glutathione (GSH), and oxidized glutathione (GSSG). Transmission electron microscopy (TEM), immunohistochemical staining, and Western blot were used to determine the nucleus pulposus autophagy level. At the same time, Spearman's correlation coefficient was used to describe the relationship between intervertebral disc grade, oxidative stress status, serum E2, and autophagy level. Results The level of serum E2 was significantly decreased by ovariectomy and can be corrected by the estrogen replacement therapy (ERT). In OVX rats, an increased oxidative stress and high level of autophagy were observed in nucleus pulposus tissue. ERT prevented the intervertebral disc degeneration (IVDD), restored the redox balance, and reduced autophagy level. Conclusion Ovariectomy induced oxidative stress, autophagy, and intervertebral disc degeneration. Autophagy of the intervertebral disc was negatively correlated with oxidative stress, and the level of autophagy can be reduced by ERT through modulating the redox balance and downregulating the autophagy level. Regulating the redox balance of IVD may be a potential therapeutic option for degeneration of the disc in the postmenopausal women.
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Disc cell therapy with bone-marrow-derived autologous mesenchymal stromal cells in a large porcine disc degeneration model. 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; 27:2639-2649. [PMID: 30141058 DOI: 10.1007/s00586-018-5728-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 06/09/2018] [Accepted: 08/07/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE Disc regeneration through matrix-assisted autologous mesenchymal stromal cell therapy seems promising against disc degeneration with convincing results in small animal models. Whether these positive results can be transferred to larger animal models or humans is unclear. METHODS Fibrin matrix-assisted autologous bone-marrow-derived mesenchymal stromal cell therapy was compared to acellular fibrin matrix therapy in a porcine in vivo model. First, disc degeneration was induced by annular puncture and partial nucleotomy with a large 16G-needle, and 12 weeks later, disc therapy was performed in a second surgery with a thinner 26G needle. Seventy-two lumbar discs from 12 aged adult pigs were evaluated by histology, micro-CT, and gene expression analysis 13 and 24 weeks after nucleotomy and 1 and 12 weeks after treatment, respectively. RESULTS Radiologic disc height was not significantly different in both treatment groups. In the semi-quantitative histologic degeneration score, significant disc degeneration was still evident 1 week after treatment both in the mesenchymal stromal cell group and in the acellular fibrin matrix group. 12 weeks after treatment, degeneration was, however, not further increased and mesenchymal-stromal-cell-treated discs showed significantly less disc degeneration in the annulus fibrosus (p = 0.02), whereas reduction in the nucleus pulposus did not reach statistical significance. Cell treatment compared to matrix alone found less Col1 gene expression as a marker for fibrosis and more expression of the trophic factor BMP2 in the nucleus pulposus, whereas the inflammation marker IL1ß was reduced in the annulus fibrosus. CONCLUSIONS Disc treatment with fibrin matrix-assisted autologous mesenchymal stromal cells reduced degenerative findings compared to acellular fibrin matrix alone. Regenerative changes, however, were not significant for all parameters showing limitations in a large biomechanically demanding model with aged discs. These slides can be retrieved under Electronic Supplementary Material.
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Foltz MH, Kage CC, Johnson CP, Ellingson AM. Noninvasive Assessment of Biochemical and Mechanical Properties of Lumbar Discs Through Quantitative Magnetic Resonance Imaging in Asymptomatic Volunteers. J Biomech Eng 2018; 139:2648280. [PMID: 28779522 DOI: 10.1115/1.4037549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Indexed: 01/07/2023]
Abstract
Intervertebral disc degeneration is a prevalent phenomenon associated with back pain. It is of critical clinical interest to discriminate disc health and identify early stages of degeneration. Traditional clinical T2-weighted magnetic resonance imaging (MRI), assessed using the Pfirrmann classification system, is subjective and fails to adequately capture initial degenerative changes. Emerging quantitative MRI techniques offer a solution. Specifically, T2* mapping images water mobility in the macromolecular network, and our preliminary ex vivo work shows high predictability of the disc's glycosaminoglycan content (s-GAG) and residual mechanics. The present study expands upon this work to predict the biochemical and biomechanical properties in vivo and assess their relationship with both age and Pfirrmann grade. Eleven asymptomatic subjects (range: 18-62 yrs) were enrolled and imaged using a 3T MRI scanner. T2-weighted images (Pfirrmann grade) and quantitative T2* maps (predict s-GAG and residual stress) were acquired. Surface maps based on the distribution of these properties were generated and integrated to quantify the surface volume. Correlational analyses were conducted to establish the relationship between each metric of disc health derived from the quantitative T2* maps with both age and Pfirrmann grade, where an inverse trend was observed. Furthermore, the nucleus pulposus (NP) signal in conjunction with volumetric surface maps provided the ability to discern differences during initial stages of disc degeneration. This study highlights the ability of T2* mapping to noninvasively assess the s-GAG content, residual stress, and distributions throughout the entire disc, which may provide a powerful diagnostic tool for disc health assessment.
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Affiliation(s)
- Mary H Foltz
- Department of Rehabilitation Medicine, University of Minnesota, MMC 388 Mayo, 420 Delaware Street SE, Minneapolis, MN 55455 e-mail:
| | - Craig C Kage
- Department of Rehabilitation Medicine, University of Minnesota, MMC 388 Mayo, 420 Delaware Street SE, Minneapolis, MN 55455 e-mail:
| | - Casey P Johnson
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th Street S.E., Minneapolis, MN 55455 e-mail:
| | - Arin M Ellingson
- Department of Rehabilitation Medicine, University of Minnesota, MMC 388 Mayo, 420 Delaware Street SE, Minneapolis, MN 55455 e-mail:
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Abstract
STUDY DESIGN Disc recovery behavior under hypo- and hyperosmotic pressure. OBJECTIVE To evaluate the effect of osmotic pressure on the unloaded recovery response of healthy discs. SUMMARY OF BACKGROUND DATA The intervertebral disc is a poroviscoelastic material that experiences large fluctuations in water composition throughout a diurnal loading cycle. Fluid flow out of the disc occurs through mechanical loading, whereas fluid flow into the disc occurs through passive diffusion because of an imbalance of ions between the disc and its surrounding environment. Osmotic pressure has been used to alter water uptake and tissue hydration. METHODS Motion segments were prepared from the caudal spine sections of the skeletally mature bovines. A 300-N compressive load was applied for 2 hours before unloaded recovery for 12 hours. Hypo- and hyperosmotic pressure was used to alter the rate of water uptake and disc height recovery during unloaded recovery. A 5-parameter rheological model was used to describe the disc's time-dependent recovery behavior. RESULTS The elastic response was not altered by changes in osmotic pressure; however, viscoelastic recovery was highly dependent on saline osmolarity and recovery time. The fast response of viscoelastic recovery was not dependent on osmotic pressure. The time constant for the slow response decreased whereas the slow response stiffness increased as osmotic pressure increased. CONCLUSION The fast response of viscoelastic recovery is governed by flow-independent recovery, whereas the slow response is related to flow-dependent recovery. The rate and magnitude of flow-dependent recovery are highly sensitive to changes in osmotic pressure of the saline bath. There is an osmotic pressure that reduces disc recovery behavior to an elastic response or flow-independent recovery. LEVEL OF EVIDENCE N/A.
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Huang L, Liu Y, Ding Y, Wu X, Zhang N, Lai Q, Zeng X, Wan Z, Dai M, Zhang B. Quantitative evaluation of lumbar intervertebral disc degeneration by axial T2* mapping. Medicine (Baltimore) 2017; 96:e9393. [PMID: 29390547 PMCID: PMC5758249 DOI: 10.1097/md.0000000000009393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
To quantitatively evaluate the clinical value and demonstrate the potential benefits of biochemical axial T2* mapping-based grading of early stages of degenerative disc disease (DDD) using 3.0-T magnetic resonance imaging (MRI) in a clinical setting.Fifty patients with low back pain and 20 healthy volunteers (control) underwent standard MRI protocols including axial T2* mapping. All the intervertebral discs (IVDs) were classified morphologically. Lumbar IVDs were graded using Pfirrmann score (I to IV). The T2* values of the anterior annulus fibrosus (AF), posterior AF, and nucleus pulposus (NP) of each lumbar IVD were measured. The differences between groups were analyzed regarding specific T2* pattern at different regions of interest.The T2* values of the NP and posterior AF in the patient group were significantly lower than those in the control group (P < .01). The T2* value of the anterior AF was not significantly different between the patients and the controls (P > .05). The mean T2*values of the lumbar IVD in the patient group were significantly lower, especially the posterior AF, followed by the NP, and finally, the anterior AF. In the anterior AF, comparison of grade I with grade III and grade I with grade IV showed statistically significant differences (P = .07 and P = .08, respectively). Similarly, in the NP, comparison of grade I with grade III, grade I with grade IV, grade II with grade III, and grade II with grade IV showed statistically significant differences (P < .001). In the posterior AF, comparison of grade II with grade IV showed a statistically significant difference (P = .032). T2 values decreased linearly with increasing degeneration based on the Pfirrmann scoring system (ρ < -0.5, P < .001).Changes in the T2* value can signify early degenerative IVD diseases. Hence, T2* mapping can be used as a diagnostic tool for quantitative assessment of IVD degeneration.
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Affiliation(s)
- Leitao Huang
- Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University
- Artificial Joints Engineering and Technology Research Center of Jiangxi
| | - Yuan Liu
- Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University
- Artificial Joints Engineering and Technology Research Center of Jiangxi
| | - Yi Ding
- Department of Spine Surgery of Ganzhou People's Hospital, Ganzhou Jiangxi
| | - Xia Wu
- Department of Thoracic and Cardiovascular Surgery
| | - Ning Zhang
- Department of Radiology, the First Affiliated Hospital of Nanchang University,Nanchang Jiangxi, China
| | - Qi Lai
- Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University
- Artificial Joints Engineering and Technology Research Center of Jiangxi
| | - Xianjun Zeng
- Department of Radiology, the First Affiliated Hospital of Nanchang University,Nanchang Jiangxi, China
| | - Zongmiao Wan
- Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University
- Artificial Joints Engineering and Technology Research Center of Jiangxi
| | - Min Dai
- Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University
- Artificial Joints Engineering and Technology Research Center of Jiangxi
| | - Bin Zhang
- Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University
- Artificial Joints Engineering and Technology Research Center of Jiangxi
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26
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Grunert P, Moriguchi Y, Grossbard BP, Ricart Arbona RJ, Bonassar LJ, Härtl R. Degenerative changes of the canine cervical spine after discectomy procedures, an in vivo study. BMC Vet Res 2017. [PMID: 28645289 PMCID: PMC5481861 DOI: 10.1186/s12917-017-1105-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Discectomies are a common surgical treatment for disc herniations in the canine spine. However, the effect of these procedures on intervertebral disc tissue is not fully understood. The objective of this study was to assess degenerative changes of cervical spinal segments undergoing discectomy procedures, in vivo. RESULTS Discectomies led to a 60% drop in disc height and 24% drop in foraminal height. Segments did not fuse but showed osteophyte formation as well as endplate sclerosis. MR imaging revealed terminal degenerative changes with collapse of the disc space and loss of T2 signal intensity. The endplates showed degenerative type II Modic changes. Quantitative MR imaging revealed that over 95% of Nucleus Pulposus tissue was extracted and that the nuclear as well as overall disc hydration significantly decreased. Histology confirmed terminal degenerative changes with loss of NP tissue, loss of Annulus Fibrosus organization and loss of cartilage endplate tissue. The bony endplate displayed sclerotic changes. CONCLUSION Discectomies lead to terminal degenerative changes. Therefore, these procedures should be indicated with caution specifically when performed for prophylactic purposes.
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Affiliation(s)
- Peter Grunert
- Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, Weill Cornell Brain and Spine Institute
- , 525 East 68th Street, Box 99, New York, NY, 10065, USA.,Department of Neurological Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Yu Moriguchi
- Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, Weill Cornell Brain and Spine Institute
- , 525 East 68th Street, Box 99, New York, NY, 10065, USA
| | - Brian P Grossbard
- Department of Orthopedics and Neurosurgery VCA-Animal Specialty, Yonkers, NY, USA
| | - Rodolfo J Ricart Arbona
- Center of Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center & Weill Cornell Medicine, New York City, NY, USA
| | | | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, Weill Cornell Brain and Spine Institute
- , 525 East 68th Street, Box 99, New York, NY, 10065, USA.
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Huang M, Guo Y, Ye Q, Chen L, Zhou K, Wang Q, Shao L, Shi Q, Chen C. Correlation between T2* (T2 star) relaxation time and cervical intervertebral disc degeneration: An observational study. Medicine (Baltimore) 2016; 95:e4502. [PMID: 27893652 PMCID: PMC5134845 DOI: 10.1097/md.0000000000004502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To demonstrate the potential benefits of T2 relaxation time of intervertebral discs (IVDs) regarding the detection and grading of degenerative disc disease using 3.0-T magnetic resonance imaging (MRI) in a clinical setting. MATERIALS AND METHODS Cervical sagittal T2-weighted, T2 relaxation MRI was performed at 3.0-T in 61 subjects, covering discs C2-3 to C6-7. All discs were morphologically assessed based on the Pfirrmann grade, and regions of interests (ROIs) were drawn over the T2 mapping. Receiver operating characteristic (ROC) analysis was performed among grades to determine the cut-off values. RESULTS Cervical intervertebral discs (IVDs) of patients were commonly determined to be at Pfirrmann grades III to V. The nucleus pulposus (NP) values did not differ significantly between sexes at the same anatomic level (P > 0.05). In the NP, the T2 values tended to decrease with increasing grade (P < 0.000), and a significant difference was found in the T2 values between grades I to V (P < 0.05). T2 values based on disc degeneration level classification were as follows: grade I (>30 milliseconds), grade II (24.55-29.99 milliseconds), grade III (21.65-24.54 milliseconds), grade IV (18.35-21.64 milliseconds), and grade V (<18.34 milliseconds). CONCLUSION Our standardized method of region-specific quantitative T2 relaxation time evaluation seems capable of characterizing different degrees of disc degeneration quantitatively. The T2 values obtained in these cervical IVDs may serve as baseline values for future T2 measurements in both healthy and degenerated cervical discs.
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Affiliation(s)
- Minghua Huang
- Department of Orthopaedics, The First Affiliated Hospital, Wenzhou Medical University, Wenzou, Zhejiang
- Department of Radiology, Navy General Hospital, Beijing
| | - Yong Guo
- Department of Radiology, Navy General Hospital, Beijing
| | - Qiong Ye
- Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, Wenzou, Zhejiang
| | - Lei Chen
- Department of Orthopaedics, The First Affiliated Hospital, Wenzhou Medical University, Wenzou, Zhejiang
| | - Kai Zhou
- Department of Orthopaedics, The First Affiliated Hospital, Wenzhou Medical University, Wenzou, Zhejiang
| | - Qingjun Wang
- Department of Radiology, Navy General Hospital, Beijing
| | - Lixin Shao
- Department of Radiology, Navy General Hospital, Beijing
| | - Qinglei Shi
- Siemens Ltd, China Healthcare Sector MR Business Group, Beijing, P.R. China
| | - Chun Chen
- Department of Orthopaedics, The First Affiliated Hospital, Wenzhou Medical University, Wenzou, Zhejiang
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Mader KT, Peeters M, Detiger SEL, Helder MN, Smit TH, Le Maitre CL, Sammon C. Investigation of intervertebral disc degeneration using multivariate FTIR spectroscopic imaging. Faraday Discuss 2016; 187:393-414. [PMID: 27057647 PMCID: PMC5047047 DOI: 10.1039/c5fd00160a] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/14/2016] [Indexed: 12/26/2022]
Abstract
Traditionally tissue samples are analysed using protein or enzyme specific stains on serial sections to build up a picture of the distribution of components contained within them. In this study we investigated the potential of multivariate curve resolution-alternating least squares (MCR-ALS) to deconvolute 2nd derivative spectra of Fourier transform infrared (FTIR) microscopic images measured in transflectance mode of goat and human paraffin embedded intervertebral disc (IVD) tissue sections, to see if this methodology can provide analogous information to that provided by immunohistochemical stains and bioassays but from a single section. MCR-ALS analysis of non-degenerate and enzymatically in vivo degenerated goat IVDs reveals five matrix components displaying distribution maps matching histological stains for collagen, elastin and proteoglycan (PG), as well as immunohistochemical stains for collagen type I and II. Interestingly, two components exhibiting characteristic spectral and distribution profiles of proteoglycans were found, and relative component/tissue maps of these components (labelled PG1 and PG2) showed distinct distributions in non-degenerate versus mildly degenerate goat samples. MCR-ALS analysis of human IVD sections resulted in comparable spectral profiles to those observed in the goat samples, highlighting the inter species transferability of the presented methodology. Multivariate FTIR image analysis of a set of 43 goat IVD sections allowed the extraction of semi-quantitative information from component/tissue gradients taken across the IVD width of collagen type I, collagen type II, PG1 and PG2. Regional component/tissue parameters were calculated and significant correlations were found between histological grades of degeneration and PG parameters (PG1: p = 0.0003, PG2: p < 0.0001); glycosaminoglycan (GAG) content and PGs (PG1: p = 0.0055, PG2: p = 0.0001); and MRI T2* measurements and PGs (PG1: p = 0.0021, PG2: p < 0.0001). Additionally, component/tissue parameters for collagen type I and II showed significant correlations with total collagen content (p = 0.0204, p = 0.0127). In conclusion, the presented findings illustrate, that the described multivariate FTIR imaging approach affords the necessary chemical specificity to be considered an important tool in the study of IVD degeneration in goat and human IVDs.
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Affiliation(s)
- Kerstin T Mader
- Sheffield Hallam University, Materials and Engineering Research Institute, Sheffield, S1 1WB, UK.
| | - Mirte Peeters
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands and Skeletal Tissue Engineering Group Amsterdam (STEGA) and MOVE Research Institute, Amsterdam, The Netherlands
| | - Suzanne E L Detiger
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands and Skeletal Tissue Engineering Group Amsterdam (STEGA) and MOVE Research Institute, Amsterdam, The Netherlands
| | - Marco N Helder
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands and Skeletal Tissue Engineering Group Amsterdam (STEGA) and MOVE Research Institute, Amsterdam, The Netherlands
| | - Theo H Smit
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands and Skeletal Tissue Engineering Group Amsterdam (STEGA) and MOVE Research Institute, Amsterdam, The Netherlands
| | - Christine L Le Maitre
- Sheffield Hallam University, Biomolecular Science Research Centre, Sheffield, S1 1WB, UK
| | - Chris Sammon
- Sheffield Hallam University, Materials and Engineering Research Institute, Sheffield, S1 1WB, UK.
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Rivers WE, Rimmalapudi V, Heit JJ. Progress in Advanced Imaging Techniques for the Lumbar Spine. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Staying connected: structural integration at the intervertebral disc–vertebra interface of human lumbar spines. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:248-258. [DOI: 10.1007/s00586-016-4560-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 02/07/2023]
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Kolf AK, Hesper T, Schleich C, Hosalkar HS, Jankowiak S, Cacchi C, Antoch G, Zilkens C, Krauspe R, Bittersohl B. T2* mapping of ovine intervertebral discs: Normative data for cervical and lumbar spine. J Orthop Res 2016; 34:717-24. [PMID: 26466861 DOI: 10.1002/jor.23071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/12/2015] [Indexed: 02/04/2023]
Abstract
To obtain T2* values in histologically evaluated healthy ovine intervertebral discs of the cervical and lumbar spine. Intervertebral discs of nine sheep and nine lambs underwent histological assessment with the modified Boos score for grading of disc degeneration. Discs with a score <10 points (maximum = 40 points) underwent T2* mapping (n = 64). Mid-sagittal T2* values were obtained in five regions: Anterior annulus fibrosus, anterior nucleus pulposus, central nucleus pulposus, posterior nucleus pulposus, and posterior annulus fibrosus. We noted a zonal T2* distribution with high values in the central nucleus and low T2* values in the anterior and posterior annulus fibrosus. The T2* values were higher in lamb than in sheep IVDs for both cervical and lumbar spine (p < 0.001). The T2* values were also higher in the cervical than in the lumbar spine (p = 0.029 for sheep and p < 0.001 for lamb IVDs). The T2* values obtained in these ovine intervertebral discs can serve as baseline values for future T2* measurements both in health and disease.
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Affiliation(s)
- Anna-Katharina Kolf
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Tobias Hesper
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Harish S Hosalkar
- Center for Hip Preservation and Children's Orthopedics, San Diego, California.,Hosalkar Institute for Joint Preservation and Injury Care, San Diego, California
| | - Silvia Jankowiak
- Department of Pathology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Claudio Cacchi
- Department of Pathology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Christoph Zilkens
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Krauspe
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
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Benoist M. The Michel Benoist and Robert Mulholland yearly European Spine Journal review: a survey of the "medical" articles in the European Spine Journal, 2015. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:14-23. [PMID: 26596729 DOI: 10.1007/s00586-015-4322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 11/08/2015] [Accepted: 11/08/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Michel Benoist
- Département de Rhumatologie, Service de Chirurgie Orthopédique, Hôpital Beaujon, 100 Boulevard Général Leclerc, 92118, Clichy, France.
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Peeters M, Detiger SEL, Karfeld-Sulzer LS, Smit TH, Yayon A, Weber FE, Helder MN. BMP-2 and BMP-2/7 Heterodimers Conjugated to a Fibrin/Hyaluronic Acid Hydrogel in a Large Animal Model of Mild Intervertebral Disc Degeneration. Biores Open Access 2015; 4:398-406. [PMID: 26543683 PMCID: PMC4623986 DOI: 10.1089/biores.2015.0025] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is etiologically associated with low back pain and is currently only treated in severe cases with spinal fusion. Regenerative medicine attempts to restore degenerated tissue by means of cells, hydrogels, and/or growth factors and can therefore be used to slow, halt, or reverse the degeneration of the IVD in a minimally invasive manner. Previously, the growth factors bone morphogenetic proteins 2 and 7 (BMP-2, -7) were shown to enhance disc regeneration, in vitro and in vivo. Since BMPs have only a short in vivo half-life, and to prevent heterotopic ossification, we evaluated the use of a slow release system for BMP-2 homodimers and BMP-2/7 heterodimers for IVD regeneration. BMP growth factors were conjugated to a fibrin/hyaluronic acid (FB/HA) hydrogel and intradiscally injected in a goat model of mild IVD degeneration to study safety and efficacy. Mild degeneration was induced in five lumbar discs of seven adult Dutch milk goats, by injections with the enzyme chondroitinase ABC. After 12 weeks, discs were treated with either FB/HA-hydrogel only or supplemented with 1 or 5 μg/mL of BMP-2 or BMP-2/7. BMPs were linked to the FB/HA hydrogels using a transglutaminase moiety, to be released through an incorporated plasmin cleavage site. After another 12 weeks, goats were sacrificed and discs were assessed using radiography, MRI T2* mapping, and biochemical and histological analyses. All animals maintained weight throughout the study and no heterotopic bone formation or other adverse effects were noted during follow-up. Radiographs showed significant disc height loss upon induction of mild degeneration. MRI T2* mapping showed strong and significant correlations with biochemistry and histology as shown before. Surprisingly, no differences could be demonstrated in any parameter between intervention groups. To our knowledge, this is the first large animal study evaluating BMPs conjugated to an FB/HA-hydrogel for the treatment of mild IVD degeneration. The conjugated BMP-2 and BMP-2/7 appeared safe, but no disc regeneration was observed. Possible explanations include too low dosages, short follow-up time, and/or insufficient release of the conjugated BMPs. These aspects should be addressed in future studies.
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Affiliation(s)
- Mirte Peeters
- Department of Orthopaedic Surgery, VU University Medical Center , Amsterdam, The Netherlands . ; Center for Translational Regenerative Medicine (CTRM), MOVE Research Institute Amsterdam , Amsterdam, The Netherlands
| | - Suzanne E L Detiger
- Department of Orthopaedic Surgery, VU University Medical Center , Amsterdam, The Netherlands . ; Center for Translational Regenerative Medicine (CTRM), MOVE Research Institute Amsterdam , Amsterdam, The Netherlands
| | | | - Theo H Smit
- Department of Orthopaedic Surgery, VU University Medical Center , Amsterdam, The Netherlands . ; Center for Translational Regenerative Medicine (CTRM), MOVE Research Institute Amsterdam , Amsterdam, The Netherlands
| | - Avner Yayon
- ProCore Biomed Ltd. , Weizman Science Park, Nes Ziona, Israel
| | - Franz E Weber
- University Hospital , Cranio-Maxillofacial and Oral Surgery/Bioengineering, Zürich, Switzerland
| | - Marco N Helder
- Department of Orthopaedic Surgery, VU University Medical Center , Amsterdam, The Netherlands . ; Center for Translational Regenerative Medicine (CTRM), MOVE Research Institute Amsterdam , Amsterdam, The Netherlands
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Zhang X, Yang L, Gao F, Yuan Z, Lin X, Yao B, Chen W, Chan Q, Wang G. Comparison of T1ρ and T2* Relaxation Mapping in Patients with Different Grades of Disc Degeneration at 3T MR. Med Sci Monit 2015; 21:1934-41. [PMID: 26141783 PMCID: PMC4501651 DOI: 10.12659/msm.894406] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND T1ρ and T2* relaxation times are capable of providing information about early biochemical changes in intervertebral disk degeneration (IVDD). The purpose of this study was to assess and compare T1ρ and T2* mapping in IVDD with reference to Pfirrmann grade. MATERIAL AND METHODS Lumbar sagittal T2-weighted, T1ρ and T2* relaxation MRI were performed at 3.0T in 42 subjects covering discs L1-L2 to L5-S1. All the discs were morphologically assessed according to the Pfirrmann grade. Regions of interest (ROIs) were drawn over the T1ρ and T2*mappings, including nucleus pulposus (NP) and annulus fibrosus (AF). Wilcoxon signed rank test, Kruskal-Wallis test, and Spearman rank correlation were performed. RESULTS The difference in T1ρ and T2* values between NP and AF were highly significant (P<0.001). The trends of decreasing T1ρ and T2* values of both NP and AF with increasing Pfirrmann grades was significant (P<0.01), particularly between Pfirrmann grade II and III (P<0.001), whereas T2* mapping was additionally able to detect changes in the AF between Pfirrmann grade I and II (P<0.05). Pfirrmann grades were inversely significantly correlated with both T1ρ and T2* values in the NP (r=-0.69, P<0.001; r=-0.56, P<0.001) and AF (r=-0.45, P<0.001; r=-0.26, P<0.001). CONCLUSIONS The process of IVDD can be detected by T1ρ and T2* mapping, particularly at early stage, and both methodologies displayed roughly comparable performance.
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Affiliation(s)
- Xinjuan Zhang
- Department of Radiology, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China (mainland)
| | - Li Yang
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Fei Gao
- Department of Radiology, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China (mainland)
| | - Zhenguo Yuan
- Department of Radiology, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China (mainland)
| | - Xiangtao Lin
- Department of Radiology, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China (mainland)
| | - Bin Yao
- Department of Radiology, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China (mainland)
| | - Weibo Chen
- Philips Healthcare, Shanghai, China (mainland)
| | | | - Guangbin Wang
- Department of Radiology, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China (mainland)
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