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Bielewicz J, Daniluk B, Kamieniak P. Metalloproteinase-2 in failed back surgery syndrome caused by epidural fibrosis: can it play a role in persistent pain? Front Hum Neurosci 2023; 17:1248943. [PMID: 37799188 PMCID: PMC10549923 DOI: 10.3389/fnhum.2023.1248943] [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: 06/27/2023] [Accepted: 08/25/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose Failed Back Surgery Syndrome (FBSS) occurs in 10-40% of patients treated surgically due to disk herniation (DH). There are several factors that can cause a predisposition to FBSS, but the exact pathomechanism has not been elucidated. The aim of this study was to investigate Metalloproteinase-2 (MMP-2) and Tissue Inhibitor of Metalloproteinase-2 (TIMP-2) activities in a homogeneous group of FBSS patients with epidural fibrosis in comparison to its activity in patients with surgically treated DH. Methods DH, FBSS, and control (CG) groups consisted of 30 subjects. The patients were assessed clinically by the Numerical Rating Scale (NRS), McGill Pain Questionnaire (SF -MPQ), Oswestry Disability Index (ODI), and Beck Depression Inventory (BDI). Serum concentrations of MMP-2 and TIMP-2 were measured by using the immunoenzymatic method. Results There was a significantly higher MMP-2 expression (medians: 4797.49 vs. 2656.65; p < 0.0001) and TIMP-2 concentration (medians: 166.40 vs. 109.60; p < 0.0001) in the DH compared to the CG. Significantly higher MMP-2 expression (4219.95 vs. 2656.65; p < 0.0001) and TIMP-2 concentration (medians: 150.17 vs. 109.60; p = 0.0003) were also found in the FBSS compared to the CG. The activity of MMP-2, measured as MMP-2/TIMP-2, did not significantly change between the DH, FBSS, and CG. MMP2 expression (p < 0.0001) and TIMP-2 concentration (p < 0.0001) were significantly higher in the DH than FBSS. Conclusion Results indicate the presence of a contribution of MMP-2 and TIMP-2 in DH and FBSS. Unchanged activity of MMP-2 can indicate an insufficiency in the MMP-2 repair system in both diseases. Lower MMP-2 expression and TIMP-2 concentration in the FBSS group can reflect the chronicity of the process.
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Affiliation(s)
- Joanna Bielewicz
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Beata Daniluk
- Institute of Psychology, Marie Curie-Skłodowska University in Lublin, Lublin, Poland
| | - Piotr Kamieniak
- Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
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Supra R, Agrawal DK. Mechanobiology of MicroRNAs in Intervertebral Disk Degeneration. JOURNAL OF SPINE RESEARCH AND SURGERY 2023; 5:1-9. [PMID: 36777190 PMCID: PMC9912327 DOI: 10.26502/fjsrs0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Intervertebral disk degeneration (IDD) is an intricate pathological process contributing to one of the major causes of low back pain. The degradation of the extracellular matrix (ECM), inflammation, and apoptosis have all been investigated as critical factors involved in the pathology of degenerative disk disease. Additionally, the presence of aberrant microRNAs (miRNAs), conserved molecules that regulate the amount protein post-transcriptionally, may play a crucial role in the pathogenesis of IDD. Research regarding the dysfunction of miRNAs in IDD has been well researched over the past five years. Here, we provide a critical overview of the current knowledge of miRNAs, emphasizing the processes involved in the degenerative disk pathology.
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Affiliation(s)
- Rajiv Supra
- College of Osteopathic Medicine, Touro University, Henderson, Nevada
| | - Devendra K Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Pomona, California
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Yu P, Mao F, Chen J, Ma X, Dai Y, Liu G, Dai F, Liu J. Characteristics and mechanisms of resorption in lumbar disc herniation. Arthritis Res Ther 2022; 24:205. [PMID: 35999644 PMCID: PMC9396855 DOI: 10.1186/s13075-022-02894-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 07/26/2022] [Indexed: 12/12/2022] Open
Abstract
Lumbar disc herniation (LDH) can be spontaneously absorbed without surgical treatment. However, the pathogenesis and physiological indications for predicting protrusion reabsorption are still unclear, which prevents clinicians from preferentially choosing conservative treatment options for LDH patients with reabsorption effects. The purpose of this review was to summarize previous reports on LDH reabsorption and to discuss the clinical and imaging features that favor natural absorption. We highlighted the biological mechanisms involved in the phenomenon of LDH reabsorption, including macrophage infiltration, inflammatory responses, matrix remodeling, and neovascularization. In addition, we summarized and discussed potential clinical treatments for promoting reabsorption. Current evidence suggests that macrophage regulation of inflammatory mediators, matrix metalloproteinases, and specific cytokines in intervertebral disc is essential for the spontaneous reabsorption of LDH.
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Affiliation(s)
- Pengfei Yu
- Department of Orthopaedic Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, People's Republic of China
| | - Feng Mao
- Department of Orthopaedic Surgery, Kunshan Integrated TCM and Western Medicine Hospital, Suzhou, 215332, People's Republic of China
| | - Jingyun Chen
- State Key Laboratory of Bioreactor Engineering & Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, People's Republic of China
| | - Xiaoying Ma
- State Key Laboratory of Bioreactor Engineering & Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, People's Republic of China
| | - Yuxiang Dai
- Department of Orthopaedic Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, People's Republic of China
| | - Guanhong Liu
- Department of Orthopaedic Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, People's Republic of China
| | - Feng Dai
- Department of Orthopaedic Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, People's Republic of China
| | - Jingtao Liu
- Department of Orthopaedic Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, People's Republic of China.
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Ohba T. The Essence of Clinical Practice Guidelines for Lumbar Disc Herniation, 2021: 2. Pathological Condition. Spine Surg Relat Res 2022; 6:322-324. [PMID: 36051688 PMCID: PMC9381077 DOI: 10.22603/ssrr.2022-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi
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5
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Hui Medicine Moxibustion Promotes the Absorption of Lumbar Disc Herniation and the Recovery of Motor Function in Rats through Fas/FasL Signaling Pathway. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9172405. [PMID: 35915787 PMCID: PMC9338866 DOI: 10.1155/2022/9172405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022]
Abstract
Objectives To study the resorption of the herniated lumbar disc (RHLD) and its mechanism in the SD rats of lumbar intervertebral disc herniation treated with Hui medicine moxibustion (HMM). Methods Forty SD rats were randomly divided into four groups, normal group, lumbar disc herniation (LDH) group, HMM group, and antagonist (HMM+Met12) group, with 10 rats in each group. The rat model of LDH was prepared with the method of lumbar epidural emplacement of the caudal intervertebral disc. In the HMM group and HMM+Met12 groups, 4 weeks after modeling, HMM therapy was performed in the lumbar spine for 3 months with 1 time per day and 20 min each time, the samples were collected 8 weeks after the treatment. The histological degeneration was observed through HE staining, and the neovascularization of intervertebral disc tissues was detected by the expression of CD34 and vascular endothelial growth factor (VEGF). The apoptosis of nucleus pulpous cells was detected by TUNEL assay, and the activity of caspase-3, -8, and -9 and extracellular matrix enzymes was detected by western blotting. Results HMM treatment significantly improved the behavioral ability of rats with LDH surgery. The morphological structure was obviously destroyed in the LDH group, but disc structure was significantly repaired in the HMM group, and mild structure alterations were observed in the HMM+Met12 group. Higher levels of CD34 and VEGF were detected in the HMM group indicating that neovascularization is formed. The expression level of FasL was significantly increased in the HMM group. The protein expression levels of cleaved-caspase-3, cleaved-caspase-8, and cleaved-caspase-9 in nucleus pulposus (NP) tissues were also elevated when treated with HMM, and the TUNEL staining showed the same results. The protein expression levels of matrix metalloproteinases- (MMP-) 1, MMP-2, MMP-3, MMP-13, and ADAMTS-4 were markedly promoted in the HMM group. Met12, a small peptide antagonist of FasL, significantly reduced the effects of HMM. Conclusion HMM can promote the formation of neovascularization of lumbar intervertebral disc, support the apoptosis of NP cells through Fas/FasL signaling, and regulate the degradation of extracellular matrix enzyme, which then accelerates the absorption of lumbar intervertebral disc herniation and the recovery of motor function in rats.
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Reuschel V, Scherlach C, Pfeifle C, Krause M, Struck MF, Hoffmann KT, Schob S. Treatment Effect of CT-Guided Periradicular Injections in Context of Different Contrast Agent Distribution Patterns. Diagnostics (Basel) 2022; 12:diagnostics12040787. [PMID: 35453835 PMCID: PMC9028051 DOI: 10.3390/diagnostics12040787] [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: 02/06/2022] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
Acutely manifesting radicular pain syndromes associated with degenerations of the lower spine are frequent ailments with a high rate of recurrence. Part of the conservative management are periradicular infiltrations of analgesics and steroids. The purpose of this study is to evaluate the dependence of the clinical efficacy of CT-guided periradicular injections on the pattern of contrast distribution and to identify the best distribution pattern that is associated with the most effective pain relief. Using a prospective study design, 161 patients were included in this study, ensuring ethical standards. Statistical analysis was performed, with the level of statistical significance set at p = 0.05. A total of 37.9% of patients experienced significant but not long-lasting (four weeks on average) complete pain relief. A total of 44.1% of patients experienced prolonged, subjectively satisfying pain relief of more than four weeks to three months. A total of 18% of patients had complete and sustained relief for more than six months. A significant correlation exists between circumferential, large area contrast distribution including the zone of action between the disc and affected nerve root contrast distribution pattern with excellent pain relief. Our results support the value of CT-guided contrast injection for achieving a good efficacy, and, if necessary, indicative repositioning of the needle to ensure a circumferential distribution pattern of corticosteroids for the sufficient treatment of radicular pain in degenerative spine disease.
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Affiliation(s)
- Vera Reuschel
- Institut für Neuroradiologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany; (V.R.); (C.S.); (K.-T.H.)
- Institut für Diagnostische und Interventionelle Neuroradiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Cordula Scherlach
- Institut für Neuroradiologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany; (V.R.); (C.S.); (K.-T.H.)
| | - Christian Pfeifle
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Matthias Krause
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Manuel Florian Struck
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Karl-Titus Hoffmann
- Institut für Neuroradiologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany; (V.R.); (C.S.); (K.-T.H.)
| | - Stefan Schob
- Abteilung für Neuroradiologie, Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle (Saale) Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
- Correspondence: ; Tel.: +49-34-5557-2432
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Ishino H, Sakonju I. Expression of metalloproteinases and their inhibitors in degenerated and extruded intervertebral disks in chondrodystrophic dogs. J Vet Med Sci 2021; 83:637-642. [PMID: 33551382 PMCID: PMC8111347 DOI: 10.1292/jvms.20-0317] [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] [Indexed: 11/22/2022] Open
Abstract
We analyzed the mRNA expression of matrix metalloproteinases (MMPs), metalloproteinases with thrombospondin motifs (ADAMTSs), and tissue inhibitors of metalloproteinases (TIMPs) in degenerated and herniated intervertebral disks (IVDs) in chondrodystrophic dogs. In degenerated IVDs, MMP3, 7, 13, and 14; ADAMTS4 and 5; and TIMP1-3 expression was significantly higher vs healthy controls (P<0.05). In herniated IVDs, MMP2, 3, 9, 13, and 14; ADAMTS4 and 5; and TIMP1 expression was significantly greater, and MMP7 expression was significantly lower vs degenerated IVDs (P<0.05). These results suggest that metalloproteinase may play a role in extracellular matrix degradation in IVD degeneration. Decreased MMP7 transcription may prevent proteoglycan degradation and reduces macrophage infiltration, which might affect the resorption process of herniated IVDs.
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Affiliation(s)
- Hirokazu Ishino
- Laboratory of Small Animal Surgery 1, School of Veterinary Medicine, Kitasato University, 23-35-1 Higashi, Towada, Aomori 034-8628, Japan
| | - Iwao Sakonju
- Laboratory of Small Animal Surgery 1, School of Veterinary Medicine, Kitasato University, 23-35-1 Higashi, Towada, Aomori 034-8628, Japan
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Liu J, Zhu Y, Wang Z, Yu P, Xue C, Jiang H, Li X, Tang D. Clinical research for whether the Traditional Chinese medicine could promote the resorption of lumbar disc herniation: a randomized controlled trial. Medicine (Baltimore) 2020; 99:e21069. [PMID: 32629737 PMCID: PMC7337462 DOI: 10.1097/md.0000000000021069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED Lumbar disc herniation (LDH) is a common, disabling musculoskeletal disorder. Magnetic resonance imaging has clarified the natural history of lumbar disc lesions and has documented that disc lesions can become smaller and can even be completely resorbed. Previous studies have confirmed that some traditional Chinese medicine (TCM) therapies can promote resorption of the protrusion. However, high-quality research evidence is needed to support the effectiveness of the protocol. OBJECTIVE This clinical trial aims to establish whether TCM can promote the resorption of LDH and to assess the efficacy of such therapy for LDH, thereby evaluating its clinical effect. METHODS The present study design is for a single-center, 2-arm, open-label randomized controlled trial. A total of 150 eligible LDH patients will be randomly assigned to either a TCM treatment group or a control group in a 1:1 ratio. Patients in the TCM group will be administered a TCM decoction for 4 weeks. Patients in the conventional drug control group will be instructed to take a specific daily dose of celecoxib. The primary outcome measure is the change from baseline in the volume of the protrusion, as assessed using MR images. Secondary outcome measures include visual analog scale pain scores and Japanese Orthopaedic Association scores assessed at 3 and 6 months. DISCUSSION The design and methodological rigor of this trial will allow evaluation of the basic clinical efficacy and safety data for TCM in the treatment of patients with LDH. The trial will also assess whether TCM can promote the resorption of LDH. This research will therefore help provide a solid foundation for the clinical treatment of LDH and for future research in TCM therapy. TRIAL REGISTRATION ChiCTR1900022377.
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Affiliation(s)
- Jintao Liu
- Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu
| | - Yu Zhu
- Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu
| | - Zhiqiang Wang
- Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu
| | - Pengfei Yu
- Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu
| | - Chunchun Xue
- Shanghai Traditional Chinese Medicine Hospital, PR China
| | - Hong Jiang
- Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu
| | - Xiaofeng Li
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Dezhi Tang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
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Ohba T, Haro H. TWEAK and TSLP in disc degeneration and spontaneous hernia resorption. JOR Spine 2020; 3:e1068. [PMID: 32211586 PMCID: PMC7084051 DOI: 10.1002/jsp2.1068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/04/2019] [Accepted: 10/19/2019] [Indexed: 11/07/2022] Open
Abstract
Spontaneous degeneration of an intervertebral disc is caused by inflammation that accompanies exposure of the avascular nucleus pulposus to circulation, triggering an autoimmune inflammatory reaction. Both intrinsic and extrinsic mechanisms of IVD regulation by various cytokines are involved in disc degeneration and spontaneous hernia resorption through inflammatory responses. The major goal of this narrative review was to assemble our past findings about the potential role of cytokines in disc diseases and to clarify directions for future research. A member of the tumor necrosis factor-α (TNF-α) superfamily, TNF-like weak inducer of apoptosis (TWEAK) is constitutively expressed in the intervertebral disc, and induces a chronic, but relatively weak inflammatory response, thereby suppressing the formation of cartilage matrix and inducing production of matrix metalloproteinases (MMPs). Previously we indicated that TWEAK is involved in intervertebral disc degeneration by inhibiting the production of cartilage matrix in the intervertebral disc, and inducing the further expression of MMP-3. Thymic stromal lymphopoietin (TSLP) is expressed primarily by epithelial cells, and induces inflammation at the time of tolerance failure in allergic disease. We found TSLP induced migration of immunocompetent cells to the disc in intervertebral disc disease by promoting the production of monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-1 alpha (MIP-1α) by the intervertebral disc and these cells may be involved in the resorption of herniated disc tissue. Considering the pivotal role of TWEAK and TSLP we review our current understanding of these factors and their involvement in disc degeneration.
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Affiliation(s)
- Tetsuro Ohba
- Department of Orthopaedic SurgeryUniversity of YamanashiYamanashiJapan
| | - Hirotaka Haro
- Department of Orthopaedic SurgeryUniversity of YamanashiYamanashiJapan
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10
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Kamieniak P, Bielewicz J, Kurzepa J, Daniluk B, Kocot J, Trojanowski T. The impact of changes in serum levels of metalloproteinase-2 and metalloproteinase-9 on pain perception in patients with disc herniation before and after surgery. J Pain Res 2019; 12:1457-1464. [PMID: 31190955 PMCID: PMC6512951 DOI: 10.2147/jpr.s201199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/02/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose: The aim of our research was to investigate the link between serum levels of metalloproteinase-2 (MMP-2) and MMP-9, and the degree of pain experienced before and 1 and 3 months after microdiscectomy in 70 patients with disc herniation (DH). Patients and methods: The control group (group C) consisted of 70 healthy subjects and the DH group consisted of 70 patients with sciatica pain caused by lumbar DH. Before (DH0) and 1 and 3 months after surgery, the patients were assessed in terms of the following biochemical parameters: MMP-2, tissue inhibitors of metalloproteinases-2 (TIMP-2), MMP-2/TIMP-2, MMP-9, TIMP-1, and MMP-9/TIMP1, and the following clinical parameters: Numeric Rating Scale for the back (NRS-B) and the leg (NRS-L) and the Pain Rating Index (PRI) and Present Pain Intensity (PPI) of the McGill Pain Questionnaire. Results: No statistically significant correlations were observed following the biochemical and clinical assessments performed in group C and the DH group before surgery. After surgery (1 month), higher levels of TIMP-1 correlated with higher levels of NRS-B (rs =0.27; p<0.05). At 3 months after surgery higher levels of TIMP-2 and lower levels of MMP-2/TIMP-2 were correlated with higher levels of NRS-L (rs =0.27, p<0.05 and rs =-0.31, p<0.05, respectively) and higher levels of TIMP-2 were correlated with higher PRI scores (rs =0.27; p<0.005) and PPI scores (rs =0.35; p<0.01). Conclusion: The results showed that MMPs are involved in DH and play a significant role in the perception of pain after DH surgery. However, the value of MMPs as a potential therapeutic target in pain treatment should be considered cautiously.
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Affiliation(s)
- Piotr Kamieniak
- Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Joanna Bielewicz
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Jacek Kurzepa
- Department of Medical Chemistry, Medical University of Lublin, Lublin, Poland
| | - Beata Daniluk
- Institute of Psychology, Marie Curie-Skłodowska University in Lublin, Lublin, Poland
| | - Joanna Kocot
- Department of Medical Chemistry, Medical University of Lublin, Lublin, Poland
| | - Tomasz Trojanowski
- Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
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Ivanova MA, Parfenov VA, Isaikin AI. [Disc hernia regression as a natural course of discogenic lumbosacral radiculopathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:58-62. [PMID: 30499498 DOI: 10.17116/jnevro201811810158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disc herniation with radiculopathy is a common cause of severe back pain leading to significant disability and a decrease in patients' quality of life. The authors report a case of 38-year-old female patient with radiculopathy of the first sacral root due to a large (11 mm) sequestered disc herniation between the fifth lumbar and the first sacral vertebrae. Conservative treatment with fluoroscopically-guided epidural steroid injection provided a significant clinical improvement, the patient was able to return to normal daily and professional activity in a short time. MRI in 9 months showed the regression of disc herniation. Possible predictors and timing of disc herniation regression are discussed, as well as the proposed mechanisms, the main one of which is considered to be immune-mediated lysis.
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Affiliation(s)
- M A Ivanova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V A Parfenov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A I Isaikin
- Sechenov First Moscow State Medical University, Moscow, Russia
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12
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Cunha C, Silva AJ, Pereira P, Vaz R, Gonçalves RM, Barbosa MA. The inflammatory response in the regression of lumbar disc herniation. Arthritis Res Ther 2018; 20:251. [PMID: 30400975 PMCID: PMC6235196 DOI: 10.1186/s13075-018-1743-4] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Lumbar disc herniation (LDH) is highly associated with inflammation in the context of low back pain. Currently, inflammation is associated with adverse symptoms related to the stimulation of nerve fibers that may lead to pain. However, inflammation has also been indicated as the main factor responsible for LDH regression. This apparent controversy places inflammation as a good prognostic indicator of spontaneous regression of LDH. This review addresses the molecular and cellular mechanisms involved in LDH regression, including matrix remodeling and neovascularization, in the scope of the clinical decision on conservative versus surgical intervention. Based on the evidence, a special focus on the inflammatory response in the LDH context is given, particularly in the monocyte/macrophage role. The phenomenon of spontaneous regression of LDH, extensively reported in the literature, is therefore analyzed here under the perspective of the modulatory role of inflammation.
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Affiliation(s)
- Carla Cunha
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- INEB—Instituto de Engenharia Biomédica, Universidade do Porto, Rua do Campo Alegre 823, 4150-180 Porto, Portugal
| | - Ana J. Silva
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- INEB—Instituto de Engenharia Biomédica, Universidade do Porto, Rua do Campo Alegre 823, 4150-180 Porto, Portugal
| | - Paulo Pereira
- Department of Neurosurgery, Centro Hospitalar São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
- Neurosciences Center, CUF Porto Hospital, Porto, Portugal
| | - Rui Vaz
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Department of Neurosurgery, Centro Hospitalar São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
- Neurosciences Center, CUF Porto Hospital, Porto, Portugal
| | - Raquel M. Gonçalves
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- INEB—Instituto de Engenharia Biomédica, Universidade do Porto, Rua do Campo Alegre 823, 4150-180 Porto, Portugal
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Mário A. Barbosa
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- INEB—Instituto de Engenharia Biomédica, Universidade do Porto, Rua do Campo Alegre 823, 4150-180 Porto, Portugal
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
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Du W, Li H, Omisore OM, Wang L, Chen W, Sun X. Co-contraction characteristics of lumbar muscles in patients with lumbar disc herniation during different types of movement. Biomed Eng Online 2018; 17:8. [PMID: 29361944 PMCID: PMC5781330 DOI: 10.1186/s12938-018-0443-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 01/16/2018] [Indexed: 01/24/2023] Open
Abstract
Background Muscular performance is an important factor for the mechanical stability of lumbar spine in humans, in which, the co-contraction of lumbar muscles plays a key role. We hypothesized that when executing different daily living motions, the performance of the lumbar muscle co-contraction stabilization mechanism varies between patients with lumbar disc herniation (LDH) and healthy controls. Hence, in this study, co-contraction performance of lumbar muscles between patients with LDH and healthy subjects was explored to check if there are significant differences between the two groups when performing four representative movements. Methods Twenty-six LDH patients (15 females, 11 males) and a control group of twenty-eight subjects (16 females, 12 males) were recruited. Surface electromyography (EMG) signals were recorded from the external oblique, lumbar multifidus, and internal oblique/transversus abdominis muscles during the execution of four types of movement, namely: forward bending, backward bending, left lateral flexion and right lateral flexion. The acquired EMG signals were segmented, and wavelet decomposition was performed followed by reconstruction of the low-frequency components of the signal. Then, the reconstructed signals were used for further analysis. Co-contraction ratio was employed to assess muscle coordination and compare it between the LDH patients and healthy controls. The corresponding signals of the subjects in the two groups were compared to evaluate the differences in agonistic and antagonistic muscle performance during the different motions. Also, sample entropy was applied to evaluate complexity changes in lumbar muscle recruitment during the movements. Results Significant differences between the LDH and control groups were found in the studied situations (p < 0.05). During the four movements considered in this study, the participants of the LDH group exhibited a higher level of co-contraction ratio, lower agonistic, and higher antagonistic lumbar muscle activity (p < 0.01) than those of the control group. Furthermore, the co-contraction ratio of LDH patients was dominated by the antagonistic muscle activity during the movements, except for the forward bending motion. However, in the healthy control group, the agonistic muscle activity contributed more to the co-contraction ratio with an exception for the backward bending motion. Conversely, the sample entropy value was significantly lower for agonistic muscles of LDH group compared to the control group (p < 0.01) while the entropy value was significantly greater in antagonistic muscles (p < 0.01) during the four types of movement, respectively. Conclusions Lumbar disc herniation patients exhibited numerous variations in the evaluated parameters that reflect the co-contraction of lumbar muscles, the agonistic and antagonistic muscle activities, and their respective sample entropy values when compared with the healthy control group. These variations could be due to the compensation mechanism that was required to stabilize the spine. The results of this study could facilitate the design of efficient rehabilitation methods for treatment of lumbar muscle dysfunctions.
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Affiliation(s)
- Wenjing Du
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Boulevard, University Town of Shenzhen, Xili Nanshan, Shenzhen, 518055, China
| | - Huihui Li
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Boulevard, University Town of Shenzhen, Xili Nanshan, Shenzhen, 518055, China
| | - Olatunji Mumini Omisore
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Boulevard, University Town of Shenzhen, Xili Nanshan, Shenzhen, 518055, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Lei Wang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Boulevard, University Town of Shenzhen, Xili Nanshan, Shenzhen, 518055, China.
| | - Wenmin Chen
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Boulevard, University Town of Shenzhen, Xili Nanshan, Shenzhen, 518055, China.,Jiangxi University of Science and Technology, Jiangxi, China
| | - Xiangjun Sun
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Boulevard, University Town of Shenzhen, Xili Nanshan, Shenzhen, 518055, China.,Jiangxi University of Science and Technology, Jiangxi, China
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Zhu Y, Liu JT, Yang LY, Du WP, Li XC, Qian X, Yu PF, Liu JW, Jiang H. p38 mitogen-activated protein kinase inhibition modulates nucleus pulposus cell apoptosis in spontaneous resorption of herniated intervertebral discs: An experimental study in rats. Mol Med Rep 2016; 13:4001-6. [PMID: 27035219 DOI: 10.3892/mmr.2016.5039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 03/09/2016] [Indexed: 11/06/2022] Open
Abstract
The present study was performed to investigate the role of p38 mitogen‑activated protein kinase (MAPK) in the resorption of herniated intervertebral discs in 30 rats. In the non‑contained and p38 MAPK inhibition (p38i) groups, two coccygeal intervertebral discs (IVDs) were removed and wounded prior to relocation into the subcutaneous space of the skin of the back. In the contained group, the cartilage endplates maintained their integrity. Furthermore, SB203580 was injected intraperitoneally into the p38i group, whereas saline was injected into the other two groups. In the non‑contained group, the weight of the relocated IVDs decreased to a greater extent over time when compared with the contained and p38i groups. Phosphorylated p38, tumor necrosis factor‑α, and interleukin‑1β were observed to exhibit higher expression levels in the non‑contained group compared with the contained and p38i groups, at weeks 1 and 4 post‑surgery. The expression level of caspase‑3 and the densities of apoptotic disc cells were significantly higher in the non‑contained group compared with the contained and p38i groups at 4 weeks post‑surgery. In conclusion, p38 MAPK induces apoptosis in IVDs, while also accelerating the resorption of the relocated IVDs. Thus, p38 MAPK may be important in spontaneous resorption of IVDs.
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Affiliation(s)
- Yu Zhu
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China
| | - Jin-Tao Liu
- Department of Orthopaedic Surgery, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu 215009, P.R. China
| | - Li-Yan Yang
- State Key Laboratory of Bioreactor Engineering and School of Pharmacy, East China University of Science and Technology, Shanghai 200237, P.R. China
| | - Wen-Pei Du
- State Key Laboratory of Bioreactor Engineering and School of Pharmacy, East China University of Science and Technology, Shanghai 200237, P.R. China
| | - Xiao-Chun Li
- Department of Orthopaedic Surgery, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu 215009, P.R. China
| | - Xiang Qian
- Department of Orthopaedic Surgery, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu 215009, P.R. China
| | - Peng-Fei Yu
- Department of Orthopaedic Surgery, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu 215009, P.R. China
| | - Jian-Wen Liu
- State Key Laboratory of Bioreactor Engineering and School of Pharmacy, East China University of Science and Technology, Shanghai 200237, P.R. China
| | - Hong Jiang
- Department of Orthopaedic Surgery, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu 215009, P.R. China
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