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Li T, Liu Y, Cao J, Pan C, Ding R, Zhao J, Liu J, He D, Jia J, Cheng X. LTF ameliorates cartilage endplate degeneration by suppressing calcification, senescence and matrix degradation through the JAK2/STAT3 pathway. J Cell Mol Med 2024; 28:e18267. [PMID: 39392081 PMCID: PMC11467740 DOI: 10.1111/jcmm.18267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/16/2024] [Accepted: 03/11/2024] [Indexed: 10/12/2024] Open
Abstract
Intervertebral disc degeneration (IDD)-induced cervical and lumbar herniations are debilitating diseases. The function of intervertebral disc (IVD) mainly depends on the cartilage endplate (CEP), which provides support and waste removal. Therefore, IDD stems from the degeneration of CEP. Our study shows that the expression of lactotransferrin (LTF), an iron-binding protein, is significantly decreased in degenerated human and rat CEP tissues. In addition, we found that LTF knockdown promoted calcification, senescence, and extracellular matrix (ECM) degradation in human endplate chondrocytes. Furthermore, the in vivo experiment results confirmed that the JAK2/STAT3 pathway inhibitor AG490 significantly reversed these effects. In addition to investigating the role and mechanism of LTF in CEP degeneration, this study provides a theoretical basis and experimental evidence to improve IDD treatment.
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Affiliation(s)
- Tao Li
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Yuchi Liu
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Jian Cao
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
- Institute of Orthopedics of Jiangxi ProvinceThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Chongzhi Pan
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Rui Ding
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Jiangminghao Zhao
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Jiahao Liu
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Dingwen He
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
- Institute of Orthopedics of Jiangxi ProvinceThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
- Institute of Minimally Invasive OrthopedicsNanchang UniversityNanchangChina
| | - Jingyu Jia
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
- Institute of Orthopedics of Jiangxi ProvinceThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
- Institute of Minimally Invasive OrthopedicsNanchang UniversityNanchangChina
| | - Xigao Cheng
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
- Institute of Orthopedics of Jiangxi ProvinceThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
- Institute of Minimally Invasive OrthopedicsNanchang UniversityNanchangChina
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Inomata K, Takasawa E, Mieda T, Tsukui T, Takakura K, Tomomatsu Y, Honda A, Chikuda H. Posterior Cartilage Endplate Disruption on T1-weighted Magnetic Resonance Imaging as a Predictor for Postoperative Recurrence of Lumbar Disk Herniation. Clin Spine Surg 2024:01933606-990000000-00351. [PMID: 39212306 DOI: 10.1097/bsd.0000000000001657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 06/28/2024] [Indexed: 09/04/2024]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE This study aimed to investigate the relationship between disruption of cartilage endplates and postoperative recurrence of lumber disk herniation (LDH) using preoperative T1-weighted magnetic resonance imaging (MRI-T1WI). SUMMARY OF BACKGROUND DATA Recurrence of LDH is a relatively common complication after discectomy. Although several risk factors have been identified, their predictive capability remains limited. Previous histologic studies reported that cartilage endplates were present in 85% of patients with recurrent LDH. METHODS Patients with a single level of LDH who underwent open or microendoscopic discectomy were retrospectively reviewed. On the basis of preoperative sagittal MRI-T1WI, cartilage endplates were divided into anterior and posterior portions at the center of the disk and evaluated for discontinuity. Patient background characteristics, spinopelvic sagittal parameters, degrees of disk degeneration, and recurrence level were also evaluated. RESULTS A total of 100 patients were included in this study (mean age, 50.5 years old; 41% female). Symptomatic recurrence of LDH occurred in 15 patients (15%). There were no significant differences in patient background characteristics (age, 46.9 vs. 51.2 years old; %female, 60% vs. 38%; smoking, 33% vs. 41%; diabetes mellitus, 27% vs. 29%) or spinopelvic parameters (PI, 44.1 vs. 47.0 degrees; PT, 16.8 vs. 19.4 degrees; SS, 27.3 vs. 27.6 degrees; LL, 37.7 vs. 33.7 degrees). In the recurrence group, MRI-T1WI showed a higher rate of cartilage endplate disruption in the posterior portion than in the no-recurrence group (73% vs. 34%, P=0.01). A multivariate analysis demonstrated that the disruption of the posterior cartilage endplate remained an independent predictor of recurrence. CONCLUSIONS Disruption in the posterior cartilage endplate on preoperative MRI-T1WI was closely associated with recurrence after LDH surgery. These results suggest that this MRI finding is a practical and useful predictor of LDH recurrence. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kazuhiro Inomata
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
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Naresh-Babu J, Gajendra, Prajwal GS. ISSLS prize in clinical/bioengineering science 2024: How standing and supine positions influence nutrient transport in human lumbar discs?-A serial post-contrast MRI study evaluating interplay between convection and diffusion. 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 2024; 33:1728-1736. [PMID: 38662214 DOI: 10.1007/s00586-024-08243-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/27/2024] [Accepted: 03/31/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE The intervertebral disc being avascular depends on diffusion and load-based convection for essential nutrient supply and waste removal. There are no reliable methods to simultaneously investigate them in humans under natural loads. For the first time, present study aims to investigate this by strategically employing positional MRI and post-contrast studies in three physiological positions: supine, standing and post-standing recovery. METHODS A total of 100 healthy intervertebral discs from 20 volunteers were subjected to a serial post-contrast MR study after injecting 0.3 mmol/kg gadodiamide and T1-weighted MR images were obtained at 0, 2, 6, 12 and 24 h. At each time interval, images were obtained in three positions, i.e. supine, standing and post-standing recovery supine. The signal intensity values at endplate zone and nucleus pulposus were measured. Enhancement percentages were calculated and analysed comparing three positions. RESULTS During unloaded supine position, there was slow gradual increase in enhancement reaching peak at 6 h. When the subjects assumed standing position, there was immediate loss of enhancement at nucleus pulposus which resulted in reciprocal increase in enhancement at endplate zone (washout phenomenon). Interestingly, when subjects assumed the post-standing recovery position, the nucleus pulposus regained the enhancement and endplate zone showed reciprocal loss (pumping-in phenomenon). CONCLUSIONS For the first time, present study documented acute effects of physiological loading and unloading on nutrition of human discs in vivo. While during rest, solutes diffused gradually into disc, the diurnal short loading and unloading redistribute small solutes by convection. Standing caused rapid solute depletion but promptly regained by assuming resting supine position.
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Affiliation(s)
- J Naresh-Babu
- Director and Chief Spine Surgeon, Mallika Spine Centre, Guntur, AP, India.
| | - Gajendra
- Fellow in Spine Surgery, Mallika Spine Centre, Guntur, AP, India
| | - G S Prajwal
- Fellow in Spine Surgery, Mallika Spine Centre, Guntur, AP, India
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Qin T, Yan J, Li S, Lin X, Wu J, Huang Z, Zhang C, Zhang Y, Deng Z, Xiao D, Jin S, Xiao Y, Xu K, Ye W. MicroRNA-155 suppressed cholesterol-induced matrix degradation, pyroptosis and apoptosis by targeting RORα in nucleus pulposus cells. Cell Signal 2023; 107:110678. [PMID: 37062437 DOI: 10.1016/j.cellsig.2023.110678] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/18/2023]
Abstract
Intervertebral disc degeneration (IDD) is associated with low back pain, yet its inherent mechanism remains obscure. Hypercholesteremia was regarded as a risk factor for IDD, and our previous study showed that cholesterol accumulation could elicit matrix degradation in the nucleus pulposus (NP). MicroRNA-155 (miR-155) was substantiated as protective in IDD, but its role in cholesterol-induced IDD was unclear. The present study investigated whether miR-155 could mediate cholesterol-related IDD and its internal mechanisms. In vivo experiments revealed high-fat diet-induced hypercholesteremia in wild-type (WT) mice along with the occurrence of IDD, whereas Rm155LG transgenic mice showed milder NP degeneration, as evidenced by Safranin O-fast green (SF) staining and immunohistochemistry (IHC). Meanwhile, IHC showed that NLRP3 and Bax expression was also suppressed in Rm155LG mice. In vitro studies using Western blotting (WB) and immunofluorescence (IF) confirmed that the miR-155 mimic could alleviate cholesterol-induced matrix degradation, apoptosis and pyroptosis in NP. Moreover, RORα was upregulated in severely degenerated NP compared to mild IDD. It was also noted that RORα was suppressed in Rm155LG mice. In this study, we demonstrated that miR-155 could target RORα and that inhibition of RORα could prevent cholesterol-induced matrix degradation, apoptosis, and pyroptosis in NP, indicating the protective effect of miR-155 in cholesterol-induced IDD by targeting RORα.
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Affiliation(s)
- Tianyu Qin
- Department of Orthopedics, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 528406, China; Department of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jiansen Yan
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; Department of Orthopedics, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 528406, China
| | - Shuangxing Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; Department of Orthopedics, Sun Yat-sen Memorial Hospital Shenshan Central Hospital of Sun Yat-sen University, Shanwei 516621, China; Department of Orthopedics, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 528406, China
| | - Xiaolin Lin
- Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510315, China; Institute of Comparative Medicine & Laboratory Animal Center, Southern Medical University, Guangzhou 510515, China
| | - Jiajun Wu
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zhengqi Huang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Chao Zhang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yangyang Zhang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zhihuai Deng
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Dong Xiao
- Institute of Comparative Medicine & Laboratory Animal Center, Southern Medical University, Guangzhou 510515, China
| | - Song Jin
- Department of Orthopedics, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 528406, China
| | - Yin Xiao
- School of Medicine and Dentistry & Menzies Health Institute Queensland, Griffith University, QLD 4222, Australia; Australia-China Centre for Tissue Engineering and Regenerative Medicine, Griffith University and Queensland University of Technology, Brisbane, QLD 4222, Australia
| | - Kang Xu
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
| | - Wei Ye
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
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Hebelka H, Brisby H, Erkmar A, Lagerstrand K. Loading of the Spine in Low Back Pain Patients Does Not Induce MRI Changes in Modic Lesions: A Prospective Clinical Study. Diagnostics (Basel) 2022; 12:diagnostics12081815. [PMID: 36010166 PMCID: PMC9406333 DOI: 10.3390/diagnostics12081815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/22/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Modic changes (MCs) are gaining increased interest as potential generators of low back pain (LBP). The current aim was to investigate possible spinal loading effects on the MRI signal in MCs in patients with LBP. Supine lumbar MRIs were performed and immediately repeated with axial loading in 100 LBP patients. A total of 43 patients (23 male, mean age 45.7 years) had MCs. Each Modic was outlined on all sagittal T2-weighted images (>25% affected vertebrae). For reference, regions of interest were placed in both vertebrae without Modic and in Modic-free tissue in vertebrae with Modic. The Modic signal intensity, normalized to cerebrospinal fluid, and Modic volume were compared between MRIs with and without spinal loading. Of the 94 MCs, 36.2% (n = 34) were type I, 58.5% (n = 55) were type II, and 5.3% (n = 5) were type III. No differences in Modic volume (mean 0.046 cm3; p = 0.25) between the MRIs with and without spinal loading were found. In addition, no significant changes in Modic signal were induced by loading (mean 1.5% difference; p = 0.308). Loading increased the signal in the reference regions of interest in vertebrae both with Modic (mean 5.5%; p = 0.002) and without (mean 3.5%; SD 0.09; p = 0.02). To conclude, MRIs performed with and without spinal loading showed no change in either volume or signal of MCs, suggesting that most MCs are not instantaneously influenced by biomechanical load.
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Affiliation(s)
- Hanna Hebelka
- Department of Radiology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (H.B.); (A.E.); (K.L.)
- Correspondence: ; Tel.: +46-(0)-31-3436494
| | - Helena Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (H.B.); (A.E.); (K.L.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Alfred Erkmar
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (H.B.); (A.E.); (K.L.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (H.B.); (A.E.); (K.L.)
- Department of Medical Physics and Biomedicine, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
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Din RU, Cheng X, Yang H. Diagnostic Role of Magnetic Resonance Imaging in Low Back Pain Caused by Vertebral Endplate Degeneration. J Magn Reson Imaging 2021; 55:755-771. [PMID: 34309129 DOI: 10.1002/jmri.27858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/25/2022] Open
Abstract
Low back pain (LBP) is a common health issue worldwide with a huge economic burden on healthcare systems. In the United States alone, the cost is estimated to be $100 billion each year. Intervertebral disc degeneration is considered one of the primary causes of LBP. Moreover, the critical role of the vertebral endplates in disc degeneration and LBP is becoming apparent. Endplate abnormalities are closely correlated with disc degeneration and pain in the lumbar spine. Imaging modalities such as plain film radiography, computed tomography, and fluoroscopy are helpful but not very effective in detecting the causes behind LBP. Magnetic resonance imaging (MRI) can be used to acquire high-quality three-dimensional images of the lumbar spine without using ionizing radiation. Therefore, it is increasingly being used to diagnose spinal disorders. However, according to the American College of Radiology, current referral and justification guidelines for MRI are not sufficiently clear to guide clinical practice. This review aimed to evaluate the role of MRI in diagnosing LBP by considering the correlative contributions of vertebral endplates. The findings of the review indicate that MRI allows for fine evaluations of endplate morphology, endplate defects, diffusion and perfusion properties of the endplate, and Modic changes. Changes in these characteristics of the endplate were found to be closely correlated with disc degeneration and LBP. The collective evidence from the literature suggests that MRI may be the imaging modality of choice for patients suffering from LBP. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Rahman Ud Din
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | | | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
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Chen X, Guo W, Li H, Li X, Han Z, Chu X, Lao Z, Xie J, Cai D. Evaluation of Cartilaginous Endplate Degeneration Based on Magnetic Resonance Imaging. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5534227. [PMID: 33859806 PMCID: PMC8009704 DOI: 10.1155/2021/5534227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/26/2021] [Accepted: 03/07/2021] [Indexed: 12/02/2022]
Abstract
In order to carry out the evaluation of cartilaginous endplate degeneration based on magnetic resonance imaging (MRI), this paper retrospectively analyzed the MRI data from 120 cases of patients who were diagnosed as lumbar intervertebral disc degeneration and underwent MRI examinations in the designated hospital of this study from June 2018 to June 2020. All cases underwent conventional sagittal and transverse T1WI and T2WI scans, and some cases were added with sagittal fat-suppression T2WI scans; then, the number of degenerative cartilaginous endplates and its ratio to degenerative lumbar intervertebral discs were counted and calculated, and the T1WI and T2WI signal characteristics of each degenerative cartilage endplate and its correlation with cartilaginous endplate degeneration were summarized, compared, and analyzed to evaluate the cartilaginous endplate degeneration by those magnetic resonance information. The study results show that there were 33 cases of cartilaginous endplate degeneration, accounting for 27.50% of all those 120 patients with lumbar intervertebral disc degeneration (54 degenerative endplates in total), including 9 cases with low T1WI and high T2WI signals, 5 cases with high T1WI and low T2WI signals, 12 cases with high and low mixed T1WI and high or mixed T2WI signals, and 4 cases with both low T1WI and T2WI signals. Therefore, MRI scanning can clearly present the abnormal signals of lumbar intervertebral disc and cartilaginous endplate degeneration, accurately identity their lesion locations, and type their degenerative characteristics, which may be best inspection method for the evaluation of cartilaginous endplate degeneration in the early diagnosis of intervertebral disc degeneration. The study results of this paper provide a reference for further researches on the evaluation of cartilaginous endplate degeneration based on magnetic resonance imaging.
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Affiliation(s)
- Xiaofeng Chen
- Department of Orthopedics, Panyu Hospital of Chinese Medicine, Guangzhou City, Guangdong Province 511400, China
| | - Weijun Guo
- Department of Orthopedics, Panyu Hospital of Chinese Medicine, Guangzhou City, Guangdong Province 511400, China
| | - Hao Li
- Department of Orthopedics, Panyu Hospital of Chinese Medicine, Guangzhou City, Guangdong Province 511400, China
| | - Xi Li
- Department of Dermatology, Panyu Hospital of Chinese Medicine, Guangzhou City, Guangdong Province 511400, China
| | - Zhuangxun Han
- Department of Orthopedics, Panyu Hospital of Chinese Medicine, Guangzhou City, Guangdong Province 511400, China
| | - Xueyuan Chu
- Department of Orthopedics, Panyu Hospital of Chinese Medicine, Guangzhou City, Guangdong Province 511400, China
| | - Zehui Lao
- Department of Orthopedics, Panyu Hospital of Chinese Medicine, Guangzhou City, Guangdong Province 511400, China
| | - Junxian Xie
- Department of Orthopedics, Panyu Hospital of Chinese Medicine, Guangzhou City, Guangdong Province 511400, China
| | - Dongling Cai
- Department of Orthopedics, Panyu Hospital of Chinese Medicine, Guangzhou City, Guangdong Province 511400, China
- Guangzhou University of Traditional Chinese Medicine, Guangzhou City, Guangdong Province 510006, China
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Cao Y, Guo QW, Wan YD. Significant Association between the T2 Values of Vertebral Cartilage Endplates and Pfirrmann Grading. Orthop Surg 2020; 12:1164-1172. [PMID: 32583598 PMCID: PMC7454146 DOI: 10.1111/os.12727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/24/2020] [Accepted: 05/17/2020] [Indexed: 12/13/2022] Open
Abstract
Objective The T2 value of lumbar cartilage endplates was measured using the T2 mapping imaging technique, aiming to explore the correlation between the T2 value and Pfirrmann grading of intervertebral discs. Methods A total of 130 patients with lumbar spine MR examination due to persistent low back pain were enrolled, including 71 men and 59 women (age: 21–63 years). Lumbar Modic changes and Schmorl nodules were recognized by conventional T1WI and T2WI images in 49 patients, and these patients were excluded from the study. A total of 81 patients were enrolled in this study, including 45 men (45.16 ± 12.20 years) and 36 women (43.33 ± 11.27 years). Pfirrmann (Pm) grading of each lumbar disc was performed based on conventional T2WI median sagittal images and the position of cartilage endplates (CEP) was determined by IDEAL‐SPGR images. Meanwhile, the T2 mapping technique was used to obtain T2 values of cartilage endplates. The T2 values of CEP corresponding to different Pm grade discs were compared, and the correlation between the T2 value and the Pm grade of intervertebral discs was analyzed. Results The T2 values of cephalic and caudal CEP of L1–2 in Pm grades I–II, Pm grades III, and Pm grades IV–V were 61.96 ± 5.89 ms, 54.45 ± 3.29 ms, 42.47 ± 3.69 ms and 64.35 ± 5.93 ms, 55.28 ± 3.97 ms, 44.75 ± 2.12 ms, respectively. For cephalic and caudal CEP of L2–3, the T2 values in Pm grades I–II, Pm grades III, and Pm grades IV–V were 62.96 ± 6.93 ms, 55.19 ± 4.02 ms, 48.67 ± 4.56 ms and 65.51 ± 6.49 ms, 57.16 ± 5.55 ms, 52.05 ± 4.20 ms, respectively. The T2 values of cephalic and caudal CEP from L3–4 to L5–S1 in Pm grades I–II, Pm grades III, and Pm grades IV–V were (63.72 ± 5.76 ms, 53.96 ± 6.52 ms, 48.05 ± 5.00 ms), (65.46 ± 6.37 ms, 55.70 ± 7.50 ms, 48.10 ± 3.27 ms); (66.34 ± 7.68 ms, 56.76 ± 9.48 ms, 47.80 ± 4.33 ms), (64.44 ± 4.65 ms, 59.30 ± 8.80 ms, 47.30 ± 5.78 ms), (65.32 ± 5.11 ms, 55.33 ± 6.65 ms, 48.18 ± 5.37 ms), and (63.47 ± 4.92 ms, 50.32 ± 8.86 ms, 44.77 ± 4.69 ms), respectively. There were significant differences in T2 values of cartilage endplates between the Pm grades I–II, III, and IV–V of intervertebral discs (P = 0.000). T2 values corresponding to Pm I–II grades were higher than those in Pm III grade, while T2 values in Pm grades IV–V were lowest. The T2 value of the L4–5, L5–S1 segment endplates was highly correlated with the Pm grades (r = −0.711, −0.721, −0.796, −0.745; P = 0.000) and that of L1–2, L2–3 endplates were moderately correlated (r = −0.542, −0.562, −0.637, −0.612; P = 0.000). Conclusion The T2 values of cartilage endplates revealed varying degrees of degeneration of intervertebral discs, and more severe degeneration corresponded to lower T2 values. Measurement of changes in the T2 value through cartilage endplates can be useful for the diagnosis of early intervertebral disc degeneration and the prevention of disc degeneration.
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Affiliation(s)
- Yi Cao
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Qing-Wei Guo
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ye-da Wan
- Department of Radiology, Tianjin Hospital, Tianjin, China
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Ma J, Stefanoska D, Stone LS, Hildebrand M, van Donkelaar CC, Zou X, Basoli V, Grad S, Alini M, Peroglio M. Hypoxic stress enhances extension and branching of dorsal root ganglion neuronal outgrowth. JOR Spine 2020; 3:e1090. [PMID: 32613165 PMCID: PMC7323469 DOI: 10.1002/jsp2.1090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 12/27/2022] Open
Abstract
It has been shown that painful intervertebral discs (IVDs) were associated with a deeper innervation. However, the effect of the disc's degenerative microenvironment on neuronal outgrowth remains largely unknown. The focus of this study was to determine the influence of hypoxia on dorsal root ganglion (DRG) neurite outgrowth. Toward this aim, the DRG-derived cell line ND7/23 was either directly subjected to 2% or 20% oxygen conditions or exposed to conditioned medium (CM) collected from IVDs cultured under 2% or 20% oxygen. Viability and outgrowth analysis were performed following 3 days of exposure. Results obtained with the cell line were further validated on cultures of rabbit spinal DRG explants and dissociated DRG neurons. Results showed that hypoxia significantly increased neurite outgrowth length in ND7/23 cells, which was also validated in DRG explant and primary cell culture, although hypoxia conditioned IVD did not significantly increase ND7/23 neurite outgrowth. While hypoxia dramatically decreased the outgrowth frequency in explant cultures, it significantly increased collateral sprouting of dissociated neurons. Importantly, the hypoxia-induced decrease of outgrowth frequency at the explant level was not due to inhibition of outgrowth branching but rather to neuronal necrosis. In summary, hypoxia in DRG promoted neurite sprouting, while neuronal necrosis may reduce the density of neuronal outgrowth at the tissue level. These findings may help to explain the deeper neo-innervation found in the painful disc tissue. HIGHLIGHTS Hypoxia promoted elongation and branching of neurite outgrowth at single cell level, but reduced outgrowth density at tissue level, possibly due to hypoxia-induced neuronal necrosis; these findings may help to explain the deeper neo-innervation found in clinically painful tissues.
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Affiliation(s)
- Junxuan Ma
- AO Research Institute DavosDavosSwitzerland
| | - Despina Stefanoska
- AO Research Institute DavosDavosSwitzerland
- Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Laura S. Stone
- Alan Edwards Centre for Research on Pain, Faculty of DentistryMcGill UniversityMontreal, QuebecCanada
| | | | | | - Xuenong Zou
- Department of Spine Surgery, Orthopedic Research InstituteThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyGuangzhouChina
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Intervertebral Disc Diseases PART 2: A Review of the Current Diagnostic and Treatment Strategies for Intervertebral Disc Disease. Int J Mol Sci 2020; 21:ijms21062135. [PMID: 32244936 PMCID: PMC7139690 DOI: 10.3390/ijms21062135] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/12/2020] [Accepted: 03/18/2020] [Indexed: 12/25/2022] Open
Abstract
With an aging population, there is a proportional increase in the prevalence of intervertebral disc diseases. Intervertebral disc diseases are the leading cause of lower back pain and disability. With a high prevalence of asymptomatic intervertebral disc diseases, there is a need for accurate diagnosis, which is key to management. A thorough understanding of the pathophysiology and clinical manifestation aids in understanding the natural history of these conditions. Recent developments in radiological and biomarker investigations have potential to provide noninvasive alternatives to the gold standard, invasive discogram. There is a large volume of literature on the management of intervertebral disc diseases, which we categorized into five headings: (a) Relief of pain by conservative management, (b) restorative treatment by molecular therapy, (c) reconstructive treatment by percutaneous intervertebral disc techniques, (d) relieving compression and replacement surgery, and (e) rigid fusion surgery. This review article aims to provide an overview on various current diagnostic and treatment options and discuss the interplay between each arms of these scientific and treatment advancements, hence providing an outlook of their potential future developments and collaborations in the management of intervertebral disc diseases.
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程 傲, 何 鹏, 张 俊, 郑 伟, 杨 民. [Expression and correlation analysis of hypoxia inducible factor 1α and autophagy related molecules in rat nucleus pulposus cells under hypoxia]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:318-322. [PMID: 32174076 PMCID: PMC8171651 DOI: 10.7507/1002-1892.201908088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 12/27/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the expression and correlation of hypoxia inducible factor 1α (HIF-1α) and autophagy related molecules (Beclin1 and LC3B) in rat nucleus pulposus cells under hypoxia in vitro. METHODS The nucleus pulposus cells were extracted from the nucleus pulposus of healthy adult Sprague Dawley rats and passaged. The 3rd generation cells were identified by HE staining and collagenase type Ⅱ immunofluorescence staining and randomly divided into 4 groups. The cells in group A were cultured for 8 hours under normal oxygen condition (37℃, 5%CO 2, 20%O 2); the cells in group B were cultured for 8 hours under hypoxia condition (37℃, 5%CO 2, 1%O 2); the cells in group C were transfected with HIF-1α-small interfering RNA and cultured for 8 hours under hypoxia condition; and the cells in group D were cultured with autophagy inhibitor 3-MA for 8 hours under hypoxia condition. Western blot and real-time fluorescence quantitative PCR (qRT-PCR) were used to detect the expressions of HIF-1α and autophagy related molecules (Beclin1 and LC3B) in all groups. RESULTS HE staining of the 3rd generation nucleus pulposus cells showed that the cytoplasm was light pink and the nucleus was blue black, and the collagenase type Ⅱ immunofluorescence staining was positive. Western blot and qRT-PCR results showed that the relative expressions of HIF-1α, Beclin1, and LC3B proteins and genes in group B were significantly higher than those in group A ( P<0.05); the relative expressions of HIF-1α, Beclin1, and LC3B proteins and genes in group C were significantly lower than those in group B ( P<0.05). There was no significant difference in the relative expression of HIF-1α protein and gene between groups B and D ( P>0.05); while the relative expressions of Beclin1 and LC3B proteins and genes in group D were significant lower than those in group B ( P<0.05). CONCLUSION Hypoxia can induce the expressions of HIF-1α and autophagy related molecules (Beclin1 and LC3B) in rat nucleus pulposus cells, and HIF-1α in rat nucleus pulposus cells under hypoxia is related to the expression of autophagy related molecules, that is, down-regulation of HIF-1α can significantly reduce the expression of autophagy related molecules, while the down-regulation of autophagy levels under hypoxia has no or little effect on the expression of HIF-1α.
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Affiliation(s)
- 傲 程
- 皖南医学院附属弋矶山医院创伤骨科(安徽芜湖 241001)Department of Orthopedics and Traumatology, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu Anhui, 241001, P.R.China
| | - 鹏杰 何
- 皖南医学院附属弋矶山医院创伤骨科(安徽芜湖 241001)Department of Orthopedics and Traumatology, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu Anhui, 241001, P.R.China
| | - 俊宇 张
- 皖南医学院附属弋矶山医院创伤骨科(安徽芜湖 241001)Department of Orthopedics and Traumatology, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu Anhui, 241001, P.R.China
| | - 伟伟 郑
- 皖南医学院附属弋矶山医院创伤骨科(安徽芜湖 241001)Department of Orthopedics and Traumatology, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu Anhui, 241001, P.R.China
| | - 民 杨
- 皖南医学院附属弋矶山医院创伤骨科(安徽芜湖 241001)Department of Orthopedics and Traumatology, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu Anhui, 241001, P.R.China
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Arpinar VE, Gliedt JA, King JA, Maiman DJ, Muftuler LT. Oswestry Disability Index scores correlate with MRI measurements in degenerating intervertebral discs and endplates. Eur J Pain 2019; 24:346-353. [DOI: 10.1002/ejp.1490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/12/2019] [Accepted: 09/30/2019] [Indexed: 11/11/2022]
Affiliation(s)
- V. Emre Arpinar
- Center for Imaging Research Medical College of Wisconsin Milwaukee WI USA
| | - Jordan A. Gliedt
- Department of Neurosurgery Medical College of Wisconsin Milwaukee WI USA
| | - Jeffrey A. King
- Department of Neurosurgery Medical College of Wisconsin Milwaukee WI USA
| | - Dennis J. Maiman
- Department of Neurosurgery Medical College of Wisconsin Milwaukee WI USA
| | - L. Tugan Muftuler
- Center for Imaging Research Medical College of Wisconsin Milwaukee WI USA
- Department of Neurosurgery Medical College of Wisconsin Milwaukee WI USA
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Splendiani A, Bruno F, Marsecano C, Arrigoni F, Di Cesare E, Barile A, Masciocchi C. Modic I changes size increase from supine to standing MRI correlates with increase in pain intensity in standing position: uncovering the “biomechanical stress” and “active discopathy” theories in low back pain. 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; 28:983-992. [DOI: 10.1007/s00586-019-05974-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 02/22/2019] [Accepted: 03/14/2019] [Indexed: 12/11/2022]
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Schol J, Sakai D. Cell therapy for intervertebral disc herniation and degenerative disc disease: clinical trials. INTERNATIONAL ORTHOPAEDICS 2018; 43:1011-1025. [PMID: 30498909 DOI: 10.1007/s00264-018-4223-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/29/2018] [Indexed: 01/07/2023]
Abstract
Low back pain is the primary cause of disability and is highly associated with progression of intervertebral disc degeneration. Current treatment options are limited and fail to address the origin of the problem. New advancements in cellular therapies might offer novel and potent strategies for low back pain patients. In this review, we summarize and discuss the contemporary status of in-human trials investigating cellular transplantation for treatment of low back pain. We aim to highlight current trends, shortcomings, and hurdles for effective clinical trials and consecutive commercialization.
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Affiliation(s)
- Jordy Schol
- Department for Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasya, Isehara, Kanagawa, 259-1143, Japan.
| | - Daisuke Sakai
- Department for Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasya, Isehara, Kanagawa, 259-1143, Japan.
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Hebelka H, Miron A, Kasperska I, Brisby H, Lagerstrand K. Axial loading during MRI induces significant T2 value changes in vertebral endplates-a feasibility study on patients with low back pain. J Orthop Surg Res 2018; 13:18. [PMID: 29378613 PMCID: PMC5789539 DOI: 10.1186/s13018-018-0727-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The function of the endplate (EP) is the most important factor influencing nutritional supply to the avascular intervertebral disc (IVD). It is desired to have a non-invasive method to assess functional EP characteristics in vivo. Assessment of functional EP characteristics is important in order to understand its relation to IVD degeneration, which in turn might deepen the understanding of the pathophysiology behind low back pain (LBP). It was hypothesized that, by comparing quantitative MRI of EPs performed with conventional supine MRI (unloaded MRI) with axial loading during MRI (alMRI), dynamical properties of the EP can be displayed. The aim was therefore to investigate the feasibility of axial loading during MRI (alMRI) to instantaneously induce quantitative EP changes. METHODS T2 mapping of 55 vertebral EPs (L1-S1) in five LBP patients was performed during conventional supine MRI (unloaded MRI) and subsequent alMRI. With T2 mapping, the cartilaginous EP and bony EP cannot be separated; hence, the visualized EP was termed EP zone (EPZ). Each EPZ was segmented at multiple midsagittal views, generating volumetric regions of interest. EPZs demonstrating signal inhomogeneity and/or adjacent Modic changes (MC) were termed abnormal EPZs. EPZ mean T2 values were compared between unloaded MRI and alMRI, and their relationship with abnormal EPZs was determined. RESULTS alMRI induced significantly higher (p = 0.01) EPZ mean T2 values compared with unloaded MRI. Significantly higher mean T2 values were seen in inferior EPZs compared with superior EPZs, both with unloaded MRI (35%, p < 0.001) and with alMRI (26%, p = 0.04). Significant difference between unloaded MRI and alMRI was seen in normal (p = 0.02), but not in abnormal EPZs (p = 0.5; n = 12). CONCLUSIONS alMRI induces changes in human EPZ characteristics in vivo. The T2 value significantly increased in normal EPZs, with lack of such in abnormal EPZs. Combining T2 mapping with alMRI provides a clinical feasible, non-invasive method with potential to reveal biochemical behavioral patterns, thus adding another dimension of the EPZs characteristics compared with information obtained with solely unloaded MRI.
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Affiliation(s)
- Hanna Hebelka
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Andreia Miron
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Izabela Kasperska
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Department of Medical Physics and Techniques, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Li H, Yan JZ, Chen YJ, Kang WB, Huang JX. Non-invasive quantification of age-related changes in the vertebral endplate in rats using in vivo DCE-MRI. J Orthop Surg Res 2017; 12:169. [PMID: 29121960 PMCID: PMC5680764 DOI: 10.1186/s13018-017-0669-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/22/2017] [Indexed: 03/19/2023] Open
Abstract
Background Small animal models that can mimic degenerative disc disease (DDD) are commonly used to examine DDD progression. However, assessments such as histological studies and macroscopic measurements do not allow for longitudinal studies because they can only be completed after the animal is sacrificed. Dynamic contrast-enhanced MRI (DCE-MRI) may provide a reliable, non-invasive in vivo method for detecting the progression. Methods The present study investigated the progression of changes in lumbar discs and the effect of endplate conditions on diffusion into the lumbar discs of aging sand rats after intravenous administration of gadolinium-containing contrast medium through the tail vein. Contrast enhancement was measured in the lumbar intervertebral discs on each image. The results were compared with those from conventional histological characterizations. Results T2-weighted images revealed that with aging, the shape of L3–L4, L4–L5, L5–L6, and L6–S1 nucleus pulposus (NP) became irregular, while the mean areas, signal intensities, and T2 values of the NP were significantly decreased. Each of the observed disc changes demonstrated a progressive increase in phase during 2-min scout scans. Post-contrast MRI showed impaired endplate nutritional diffusion to the disc with aging, enhancement was significantly greater in young animals than in old animals. Endplate calcification or sclerosis was histologically confirmed; histologic score was correlated with the age. We found the histological score of the endplate negatively corresponded to the DCE-MRI results. Conclusions DCE-MRI studies offer a non-invasive in vivo method for investigating the progress of diffusion into the discs and the functional conditions of the endplate. We conclude that quantitative DCE-MRI can identify the severity of disc degeneration and efficiently reflect the progression of vertebral endplate changes in the aging sand rat lumbar spine via the NP contrast enhancement patterns.
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Affiliation(s)
- Hui Li
- The Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, 100050, China
| | - Jia-Zhi Yan
- The Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, 100050, China.
| | - Yong-Jie Chen
- The Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, 100050, China
| | - Wei-Bo Kang
- The Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, 100050, China
| | - Jia-Xi Huang
- The Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, 100050, China
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Xiao L, Ni C, Shi J, Wang Z, Wang S, Zhang J, Lu A. Analysis of Correlation Between Vertebral Endplate Change and Lumbar Disc Degeneration. Med Sci Monit 2017; 23:4932-4938. [PMID: 29032381 PMCID: PMC5655151 DOI: 10.12659/msm.904315] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background To evaluate the correlation between vertebral endplate change and the level of lumbar disc degeneration via magnetic resonance imaging (MRI). Material/Methods A total of 345 patients who were recruited from our hospital from May 2012 to May 2016 were evaluated for the presence of intervertebral disc degeneration or herniation. The degree of degeneration was assessed according to Pfirrmann grade. Vertebral endplate change was evaluated based on the endplate concave angle (ECA), and Modic change on sagittal MRI. The correlation between ECA and lumbar disc degeneration or Modic change and lumbar disc degeneration was analyzed. Results The results showed that there was no statistically significant difference in comparison of the ECAs in adjacent L3–5 vertebra between males and females. With the aggravation in degenerative changes of L3–5 discs, the ECAs of adjacent L3 superior endplate, L4 inferior and superior endplates and L5 inferior endplate were gradually enlarged, indicating the positive correlation between the lumbar disc degeneration and ECAs. The rate of Modic change in females was higher than that in males without a statistically significant difference. Area of Modic change was positively correlated with the degree of lumbar disc degeneration. Additionally, we also identified the positive correlation between the rate of Modic change and the degree of lumbar disc degeneration. Conclusions Endplate angle and lumbar disc degeneration are positively correlated. The endplates and endplate signal changes can reflect the degree of disc degeneration and Modic changes can reflect the rate of clinical lumbar disc degeneration degree.
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Affiliation(s)
- Long Xiao
- Department of Orthopaedics, Zhangjiagang Hospital of Traditional Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China (mainland)
| | - Chunlin Ni
- Department of Orthopaedics, Zhangjiagang Hospital of Traditional Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China (mainland)
| | - Jiandong Shi
- Department of Orthopaedics, Zhangjiagang Hospital of Traditional Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China (mainland)
| | - Zhirong Wang
- Department of Orthopaedics, Zhangjiagang Hospital of Traditional Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China (mainland)
| | - Suchun Wang
- Department of Orthopaedics, Zhangjiagang Hospital of Traditional Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China (mainland)
| | - Jianwei Zhang
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou, Jiangsu, China (mainland)
| | - Aiqing Lu
- Department of Orthopaedics, Zhangjiagang Hospital of Traditional Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China (mainland)
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Sujlana P, Skrok J, Fayad LM. Review of dynamic contrast‐enhanced MRI: Technical aspects and applications in the musculoskeletal system. J Magn Reson Imaging 2017; 47:875-890. [DOI: 10.1002/jmri.25810] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/20/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Parvinder Sujlana
- The Russell H. Morgan Department of Radiology and Radiological ScienceBaltimore Maryland USA
| | - Jan Skrok
- The Russell H. Morgan Department of Radiology and Radiological ScienceBaltimore Maryland USA
| | - Laura M. Fayad
- The Russell H. Morgan Department of Radiology and Radiological ScienceBaltimore Maryland USA
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Sakai D, Schol J. Cell therapy for intervertebral disc repair: Clinical perspective. J Orthop Translat 2017; 9:8-18. [PMID: 29662795 PMCID: PMC5822958 DOI: 10.1016/j.jot.2017.02.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 12/22/2022] Open
Abstract
Low back pain is the main cause of disability and is associated with intervertebral disc degeneration. Contemporary treatments are limited to palliative therapeutics or aggressive surgical interventions; however, current advancements in cell therapy offer to fill this breach. Clinical data suggest that cell transplantation can accomplish pain relief without any observed adverse effects. Despite a large variety of preclinical studies and preliminary clinical investigations, controversy remains on the optimal cell type and transplantation strategies. The translational potential of this article lies in the aim to update on the current state of intervertebral disc cell therapy and to identify current obstacles.
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Affiliation(s)
- Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
| | - Jordy Schol
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
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Deletion of Opg Leads to Increased Neovascularization and Expression of Inflammatory Cytokines in the Lumbar Intervertebral Disc of Mice. Spine (Phila Pa 1976) 2017; 42:E8-E14. [PMID: 27196016 DOI: 10.1097/brs.0000000000001701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Neovascularization and expression of inflammatory cytokines were examined in Osteoprotegerin (Opg) knockout (KO) mice that show intervertebral disc (IVD) degeneration. OBJECTIVE The aim of this study was to clarify the pathological changes in lumbar IVD degeneration in Opg KO mice. SUMMARY OF BACKGROUND DATA Osteoporosis is a controversial risk factor for IVD degeneration. Deletion of Opg resulted in IVD degeneration in mice. Neovascularization and inflammatory cytokines are key factors in IVD degeneration. METHODS Opg KO mice and their wild-type (WT) littermates were euthanized. Lumbar IVDs were harvested. Safranin O/Fast Green staining was performed to examine the pathological changes. Microcomputed tomographic (micro-CT) analysis was performed to determine the structural changes at the junction of lumbar IVD cartilage and vertebrae. Tartrate-resistant acid phosphatase (TRAP) staining was performed to evaluate osteoclast formation. Protein expression of vascular endothelial growth factor A (VEGF-A), CD31, VE-cadherin, CD 34, interleukin-1β (IL-1β), and tumor necrosis factors α (TNF-α) were analyzed by immunohistochemistry (IHC) assays. Gene expressions of IL-1β, IL-6, and TNF-α were analyzed by real-time polymerase chain reaction (RT-PCR). RESULTS In 12-week-old Opg KO mice, new bone was formed in the endplate cartilage of lumbar IVDs and this became more obvious in 24-week-old Opg KO mice. Three-dimensional (3D) μCT reconstruction analyses showed that the edges of the L4 and L5 vertebrae were rugged with bone marrow cavities in it. Protein expression of VEGF-A, CD31, VE-cadherin, and CD34 was increased in the endplate and growth plate of lumbar IVDs of Opg KO mice. Gene expression of IL-1β, IL-6, and TNF-α as well as protein expression of IL-1β and TNF-α were highly expressed in the lumbar IVDs of Opg KO mice. CONCLUSION Deletion of Opg leads to increased neovascularization and expression of inflammatory cytokines in the lumbar disc in Opg KO mice, which may play important roles in IVD degeneration. LEVEL OF EVIDENCE N/A.
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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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Urrutia J, Besa P, Campos M, Cikutovic P, Cabezon M, Molina M, Cruz JP. The Pfirrmann classification of lumbar intervertebral disc degeneration: an independent inter- and intra-observer agreement assessment. 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; 25:2728-33. [PMID: 26879918 DOI: 10.1007/s00586-016-4438-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Grading inter-vertebral disc degeneration (IDD) is important in the evaluation of many degenerative conditions, including patients with low back pain. Magnetic resonance imaging (MRI) is considered the best imaging instrument to evaluate IDD. The Pfirrmann classification is commonly used to grade IDD; the authors describing this classification showed an adequate agreement using it; however, there has been a paucity of independent agreement studies using this grading system. The aim of this study was to perform an independent inter- and intra-observer agreement study using the Pfirrmann classification. METHODS T2-weighted sagittal images of 79 patients consecutively studied with lumbar spine MRI were classified using the Pfirrmann grading system by six evaluators (three spine surgeons and three radiologists). After a 6-week interval, the 79 cases were presented to the same evaluators in a random sequence for repeat evaluation. The intra-class correlation coefficient (ICC) and the weighted kappa (wκ) were used to determine the inter- and intra-observer agreement. RESULTS The inter-observer agreement was excellent, with an ICC = 0.94 (0.93-0.95) and wκ = 0.83 (0.74-0.91). There were no differences between spine surgeons and radiologists. Likewise, there were no differences in agreement evaluating the different lumbar discs. Most differences among observers were only of one grade. Intra-observer agreement was also excellent with ICC = 0.86 (0.83-0.89) and wκ = 0.89 (0.85-0.93). CONCLUSIONS In this independent study, the Pfirrmann classification demonstrated an adequate agreement among different observers and by the same observer on separate occasions. Furthermore, it allows communication between radiologists and spine surgeons.
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Affiliation(s)
- Julio Urrutia
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile.
| | - Pablo Besa
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile
| | - Mauricio Campos
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile
| | - Pablo Cikutovic
- Department of Radiology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Mario Cabezon
- Department of Radiology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Marcelo Molina
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile
| | - Juan Pablo Cruz
- Department of Radiology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Tang R, Gungor C, Sesek RF, Foreman KB, Gallagher S, Davis GA. Morphometry of the lower lumbar intervertebral discs and endplates: comparative analyses of new MRI data with previous findings. 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; 25:4116-4131. [DOI: 10.1007/s00586-016-4405-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 11/24/2022]
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Changes in perfusion and diffusion in the endplate regions of degenerating intervertebral discs: a DCE-MRI study. 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 2015; 24:2458-67. [PMID: 26238936 DOI: 10.1007/s00586-015-4172-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Dynamic contrast-enhanced MRI (DCE-MRI) was used to investigate the associations between intervertebral disc degeneration and changes in perfusion and diffusion in the disc endplates. METHODS 56 participants underwent MRI scans. Changes in DCE-MRI signal enhancement in the endplate regions were analyzed. Also, a group template was generated for the endplates and enhancement maps were registered to this template for group analysis. RESULTS DCE-MRI enhancement changed significantly in cranial endplates with increased degeneration. A similar trend was observed for caudal endplates, but it was not significant. Group-averaged enhancement maps revealed major changes in spatial distribution of endplate perfusion and diffusion with increasing disc degeneration especially in peripheral endplate regions. CONCLUSIONS Increased enhancement in the endplate regions of degenerating discs might be an indication of ongoing damage in these tissues. Therefore, DCE-MRI could aid in understanding the pathophysiology of disc degeneration. Moreover, it could be used in the planning of novel treatments such as stem cell therapy.
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