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Wang S, Shi J. Three Stages on Magnetic Resonance Imaging of Lumbar Degenerative Spine. World Neurosurg 2024:S1878-8750(24)00706-X. [PMID: 38679375 DOI: 10.1016/j.wneu.2024.04.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
PURPOSES To propose a new lumbar degenerative staging system using the current radiological classification system. METHODS A cross-sectional analysis of retrospective databases between January 2018 and December 2022 was performed. Total of 410 patients for Modic changes, paravertebral muscle fat infiltration, disc degeneration, articular process degeneration, vertebral endplate degeneration and other structures, and disc displacement, Spondylolisthesis, and stenosis, and grouped patients according to stage were assessed. Visual analog scale, Japanese Orthopaedic Association, and Oswestry Disability Index scores were used to assess low back pain strength, neurological function, and quality of life, respectively. RESULTS The lumbar degeneration staging system consists of 8 variables, which can be divided into 3 steps: early, middle and late, and the correlation between each variable is strong (P < 0.05). The later the staging, the worse the Japanese Orthopaedic Association, visual analog scale, and Oswestry Disability Index scores. CONCLUSIONS Patients with later stages have worse clinical scores. This staging system recommends a uniform classification to assess lumbar degeneration.
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Affiliation(s)
- Shunmin Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China; 910 Hospital of China Joint Logistics Support Force, Quanzhou City, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China.
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Miscusi M, Serrao M, Ricciardi L, Conte C, Castiglia SF, Ippolito G, Coppola G, Forcato S, Scerrati A, Raco A. Gait analysis, trunk movements, and electromyographic patterns after minimally invasive spine surgery for lumbar instability: An observational prospective study. World Neurosurg X 2024; 21:100262. [PMID: 38193093 PMCID: PMC10772388 DOI: 10.1016/j.wnsx.2023.100262] [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: 02/26/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Objective The aim of the present study was to investigate trunk kinematics and spine muscle activation during walking after minimally invasive surgery in patients with L4-L5 degenerative spondylolisthesis suffering from lumbar instability (LI). Methods Eleven patients suffering from LI and 13 healthy controls (HC) were enrolled. Trunk kinematics and spine muscle activation patterns during walking were collected. Maximal trunk ranges of motion were also recorded from standing position. Assessments were performed pre-operatively (T0), 1 month (T1) and 3 months (T2) after MIS. Results We found significant improvement in spine muscle activation during walking at T2 compared to T0, mainly involving right/left symmetry at the operated level (L4-L5) and up-down synchronization from L3 to S1. Significant improvements in trunk rotation nearing to the HC group during walking were also found at T2 after surgery, though no changes were observed in the maximal range of motion of the trunk during standing. Furthermore, trunk rotation improvement correlated with a lower grade of residual disability. Conclusions Our findings indicate that trunk rotation improves after surgery, and impaired aspects of spine muscle activation can be improved with surgery. These biomechanical parameters could represent novel tools for monitoring the effect of surgery in LI and preventing impaired spine mobility and muscle activation.
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Affiliation(s)
- Massimo Miscusi
- Department of NESMOS, Sapienza University, via di Grottarossa 1035-1039, Rome, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, University of Rome – Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
- Movement Analysis LAB, Policlinico Italia, Piazza del Campidano 6, 00162, Rome Italy
| | - Luca Ricciardi
- Department of NESMOS, Sapienza University, via di Grottarossa 1035-1039, Rome, Italy
| | - Carmela Conte
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, University of Rome – Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
- Movement Analysis LAB, Policlinico Italia, Piazza del Campidano 6, 00162, Rome Italy
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, University of Rome – Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Giorgio Ippolito
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, University of Rome – Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Gianluca Coppola
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, University of Rome – Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Stefano Forcato
- UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinale G. Panico, Via San Pio X 4, 73039, Tricase, Italy
| | - Alba Scerrati
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara, via Luigi Borsari 46, 44121 Ferrara, Italy
| | - Antonino Raco
- Department of NESMOS, Sapienza University, via di Grottarossa 1035-1039, Rome, Italy
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Ricciardi L, Piazza A, Capobianco M, Della Pepa GM, Miscusi M, Raco A, Scerrati A, Somma T, Lofrese G, Sturiale CL. Lumbar interbody fusion using oblique (OLIF) and lateral (LLIF) approaches for degenerative spine disorders: a meta-analysis of the comparative studies. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:1-7. [PMID: 34825987 DOI: 10.1007/s00590-021-03172-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/18/2021] [Indexed: 01/07/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Historically, posterior approaches to the lumbar spine have allowed surgeons to manage degenerative conditions affecting the lumbar spine. However, spinal muscles injury, post-surgical vertebral instability, cerebrospinal fluid (CSF) leakage, and failed back surgery syndrome (FBSS) represent severe complications that may occur after these surgeries. Lumbar interbody fusion using anterior (ALIF), oblique (OLIF), or lateral (LLIF) approaches may represent valuable surgical alternatives, in case fusion is indicated on single or multiple levels. METHODS The present study is a systematic review, conducted according to the PRISMA statement, of comparative studies on OLIF, and LLIF for degenerative spine disorders, and a meta-analysis of their clinical-radiological outcomes and complications. RESULTS After screening 1472 papers on PubMed, Scopus, and Cochrane Library, only 3 papers were included in the present study. 318 patients were included for data meta-analysis, 128 in OLIF group, and 190 in LLIF group. There were no significative differences in terms of surgical (intraoperative blood loss and surgical duration) and clinical (VAS-back, VAS-leg, and ODI scores) outcomes, or fusion rates at last follow-up (> 2 years). Significantly higher rates of abdominal complications, system failure, and vascular injuries were recorded in the OLIF group. Conversely, postoperative neurological symptoms and psoas weakness were significatively more common in LLIF group. CONCLUSIONS The meta-analysis suggests that OLIF and LLIF are both effective for lumbar degenerative disorders, although each of them presents specific complications and this should represent a relevant element in the surgical planning.
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Affiliation(s)
- Luca Ricciardi
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | - Amedeo Piazza
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | - Mattia Capobianco
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | | | - Massimo Miscusi
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | - Antonino Raco
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | - Alba Scerrati
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Giorgio Lofrese
- Division of Neurosurgery, Ospedale Bufalini, Cesena, Italy. .,Dipartimento Neuroscienze, Unità Operativa Complessa di Neurochirurgia, Ospedale "M.Bufalini", Viale Ghirotti 286, 47521, Cesena, Italy.
| | - Carmelo Lucio Sturiale
- Operative Unit of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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The Effect of Cutibacterium acnes Infection on Nerve Penetration in the Annulus Fibrosus of Lumbar Intervertebral Discs via Suppressing Oxidative Stress. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9120674. [PMID: 35265268 PMCID: PMC8898795 DOI: 10.1155/2022/9120674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/14/2022] [Accepted: 01/29/2022] [Indexed: 11/18/2022]
Abstract
Modic changes (MCs) and low back pain are highly correlated and an economic burden to the society. Previous studies have shown that Cutibacterium acnes (C. acnes) infection can lead to MCs. The purpose of this study was to clarify whether and how C. acnes contributes to oxidative stress and nerve growth that potentially leads to low back pain. Neurons from the hippocampus or dorsal root ganglion (DRG) of Sprague-Dawley (SD) rats were cocultured with annulus fibrosus cells (AFCs) with or without the presence of the C. acnes supernatant in vitro. Cell viability, neurite length, oxidative stress, and neuro-related gene expression were examined. Furthermore, samples from the patients with MCs and SD rat model of MCs were used to validate the nerve growth results. Neurons from both the hippocampus and DRG showed neurites when cocultured with AFCs in the environment with/without the C. acnes supernatant. The average neurite length was significantly longer when exposed to the C. acnes supernatant in the hippocampal neuron (217.1 ± 90.0 μm versus 150.1 ± 68.1 μm in the control group) and in the DRG neuron (229.1 ± 91.3 μm versus 149.2 ± 64.8 μm in the control group). Hippocampal neurons showed upregulated expression levels of NeuN, Map2, and Psd95, while upregulation was only seen in Tuj-1 in DRG neurons. Suppressed oxidative stress could be observed using axon growth symbols. Degenerated disc structures and abnormal bone remodelling were found in animal models and clinical samples of MCs, with astrocytes, microglia, and neurons in the disc. Therefore, C. acnes infection was found to cause back pain in the presence of MCs by promoting nerve penetration into the annulus fibrosus by suppressing oxidative stress.
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The Roles of circRNAs in Intervertebral Disc Degeneration: Inflammation, Extracellular Matrix Metabolism, and Apoptosis. Anal Cell Pathol (Amst) 2022; 2022:9550499. [PMID: 35186669 PMCID: PMC8856834 DOI: 10.1155/2022/9550499] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/19/2022] [Indexed: 12/15/2022] Open
Abstract
Low back pain (LBP) is seriously harmful to human health and produces heavy economic burden. And most scholars hold that intervertebral disc degeneration (IDD) is the primary cause of LBP. With the study of IDD, aberrant expression of gene has become an important pathogenic factor of IDD. Circular RNAs (circRNAs), as a kind of noncoding RNA (ncRNA), participate in the regulation of genetic transcription and translation and further affect the expression of inflammatory cytokine, metabolism of extracellular matrix (ECM), the proliferation and apoptosis of cells, etc. Therefore, maybe it will become a new therapeutic target for IDD. At present, our understanding of the mechanism of circRNAs in IDD is limited. The purpose of this review is to summarize the mechanism and related signaling pathways of circRNAs in IDD reported in the past. Particularly, the roles of circRNAs in inflammation, ECM metabolism, and apoptosis are emphasized.
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