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Liang H, Wang Y. The mechanism of α2-macroglobulin against oxidative stress and promoting cell proliferation in intervertebral disc degeneration. Bioengineered 2024; 15:2011638. [PMID: 34898372 PMCID: PMC10841023 DOI: 10.1080/21655979.2021.2011638] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022] Open
Abstract
Hui Liang and Yuan Wang. The mechanism of α2-macroglobulin against oxidative stress and promoting cell proliferation in intervertebral disc degeneration. Bioengineered. 2021 Nov. doi: 10.1080/21655979.2021.2011638.Since publication, significant concerns have been raised about the compliance with ethical policies for human research and the integrity of the data reported in the article.When approached for an explanation, the authors provided some original data but were not able to provide all the necessary supporting information. As verifying the validity of published work is core to the scholarly record's integrity, we are retracting the article. All authors listed in this publication have been informed.We have been informed in our decision-making by our editorial policies and the COPE guidelines.The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as 'Retracted.'
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Affiliation(s)
- Hui Liang
- Department of Orthopaedic Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yuan Wang
- Department of Anesthesiology, Affiliated Zhongshan Hospital Dalian University, Dalian, Liaoning Province, China
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Hasegawa T, Akeda K, Yamada J, Kawaguchi K, Takegami N, Fujiwara T, Natsume T, Ide K, Matsuyama Y, Sudo A. Regenerative effects of platelet-rich plasma releasate injection in rabbit discs degenerated by intradiscal injection of condoliase. Arthritis Res Ther 2023; 25:216. [PMID: 37941067 PMCID: PMC10631205 DOI: 10.1186/s13075-023-03200-w] [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: 06/06/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Intradiscal condoliase injection is an alternative therapeutic option for lumbar disc herniation (LDH). However, it is often associated with disc degeneration. Several in vivo studies have demonstrated the regenerative potential of platelet-rich plasma (PRP) in disc degeneration. Thus, we hypothesized that the intradiscal injection of PRP releasate (PRPr), a soluble releasate isolated from PRP, has the potential to regenerate degenerated intervertebral discs (IVDs) induced by condoliase. This study examined the regenerative effects of PRPr on rabbit IVDs degenerated following condoliase injection. METHODS Eleven New Zealand white rabbits were used in this study. Condoliase (12.5 mU/10 μl) was injected into two non-contiguous discs (L2-L3 and L4-L5), and L3-L4 disc was left intact as a non-injection control. Saline (20 μl) or PRPr (20 μl) was randomly injected into L2-L3 and L4-L5 discs 4 weeks after the condoliase injection. Disc height (DH) was radiographically monitored biweekly from the day of condoliase injection to 16 weeks post-injection. Changes in DH were expressed as percentage DH (%DH) normalized to the baseline DH. Sixteen weeks after condoliase injection, all rabbits were euthanized, and subjected to MRI and histological analyses. RESULTS Intradiscal injection of condoliase induced a significant decrease in %DH (L2-L3 and L4-L5) to 52.0% at week 4. However, the %DH began to return to normal after saline injection and reached 76.3% at week 16. In the PRPr group, %DH began to recover to normal after the PRPr injection and was restored to 95.5% at week 16. The MRI-modified Pfirrmann grade of the PRPr group was significantly lower than that of the saline group (P < 0.01). Histological analyses showed progressive degenerative changes, including reduction of the NP area and condensation of the matrix in the saline and PRPr groups. The histological score of the PRPr group was significantly lower than that of the saline group (P < 0.01). CONCLUSIONS PRPr has great potential to enhance the regeneration of degenerated rabbit IVDs induced by condoliase. The results of this preclinical study suggest that PRPr injection therapy may be indicated for patients with LDH who have poor recovery from disc degeneration after chemonucleolysis treatment with condoliase.
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Affiliation(s)
- Takahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Junichi Yamada
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Koki Kawaguchi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Tatsuhiko Fujiwara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Takahiro Natsume
- Hamamatsu Pharma Research, Inc., Pharmacology, Hamamatsu, Shizuoka, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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Bhadouria N, Berman AG, Wallace JM, Holguin N. Raloxifene Stimulates Estrogen Signaling to Protect Against Age- and Sex-Related Intervertebral Disc Degeneration in Mice. Front Bioeng Biotechnol 2022; 10:924918. [PMID: 36032728 PMCID: PMC9404526 DOI: 10.3389/fbioe.2022.924918] [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: 04/22/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Estrogen agonist raloxifene is an FDA-approved treatment of osteoporosis in postmenopausal women, which may also be a promising prophylactic for painful intervertebral disc (IVD) degeneration. Here, we hypothesized that 1) aging and biological sex contribute to IVD degeneration by reducing estrogen signaling and that 2) raloxifene stimulates estrogen signaling to protect against age- and sex-related IVD degeneration in mice. 2.5-month-old (male and female) and 22.5-month-old (female) C57Bl/6J mice were subcutaneously injected with raloxifene hydrochloride 5x/week for 6 weeks (n = 7-9/grp). Next, female mice were ovariectomized (OVX) or sham operated at 4 months of age and tissues harvested at 6 months (n = 5-6/grp). Advanced aging and OVX increased IVD degeneration score, weakened IVD strength, reduced estrogen receptor-α (ER-α) protein expression, and increased neurotransmitter substance P (SP) expression. Similar to aging and compared with male IVDs, female IVDs were more degenerated, mechanically less viscoelastic, and expressed less ER-α protein, but unlike the effect induced by aging or OVX, IVD mechanical force was greater in females than in males. Therapeutically, systemic injection of raloxifene promoted ER-α protein to quell these dysregulations by enlarging IVD height, alleviating IVD degeneration score, increasing the strength and viscoelastic properties of the IVD, and reducing IVD cell expression of SP in young-adult and old female mice. Transcriptionally, injection of raloxifene upregulated the gene expression of ER-α and extracellular matrix-related anabolism in young-adult and old IVD. In vertebra, advanced aging and OVX reduced trabecular BV/TV, whereas injection of raloxifene increased trabecular BV/TV in young-adult and old female mice, but not in young-adult male mice. In vertebra, advanced aging, OVX, and biological sex (females > males) increased the number of SP-expressing osteocytes, whereas injection of raloxifene reduced the number of SP-expressing osteocytes in young-adult female and male mice and old female mice. Overall, injection of estrogen agonist raloxifene in mice normalized dysregulation of IVD structure, IVD mechanics, and pain-related SP expression in IVD cells and osteocytes induced by aging and biological sex. These data suggest that, in addition to bone loss, raloxifene may relieve painful IVD degeneration in postmenopausal women induced by advanced age, biological sex, and estrogen depletion.
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Affiliation(s)
- Neharika Bhadouria
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States,Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Alycia G. Berman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Joseph M. Wallace
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States,Indiana Center of Musculoskeletal Health, Indianapolis, IN, United States
| | - Nilsson Holguin
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States,Indiana Center of Musculoskeletal Health, Indianapolis, IN, United States,Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, United States,*Correspondence: Nilsson Holguin,
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Creating an Optimal In Vivo Environment to Enhance Outcomes Using Cell Therapy to Repair/Regenerate Injured Tissues of the Musculoskeletal System. Biomedicines 2022; 10:biomedicines10071570. [PMID: 35884875 PMCID: PMC9313221 DOI: 10.3390/biomedicines10071570] [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: 03/24/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Following most injuries to a musculoskeletal tissue which function in unique mechanical environments, an inflammatory response occurs to facilitate endogenous repair. This is a process that usually yields functionally inferior scar tissue. In the case of such injuries occurring in adults, the injury environment no longer expresses the anabolic processes that contributed to growth and maturation. An injury can also contribute to the development of a degenerative process, such as osteoarthritis. Over the past several years, researchers have attempted to use cellular therapies to enhance the repair and regeneration of injured tissues, including Platelet-rich Plasma and mesenchymal stem/medicinal signaling cells (MSC) from a variety of tissue sources, either as free MSC or incorporated into tissue engineered constructs, to facilitate regeneration of such damaged tissues. The use of free MSC can sometimes affect pain symptoms associated with conditions such as OA, but regeneration of damaged tissues has been challenging, particularly as some of these tissues have very complex structures. Therefore, implanting MSC or engineered constructs into an inflammatory environment in an adult may compromise the potential of the cells to facilitate regeneration, and neutralizing the inflammatory environment and enhancing the anabolic environment may be required for MSC-based interventions to fulfill their potential. Thus, success may depend on first eliminating negative influences (e.g., inflammation) in an environment, and secondly, implanting optimally cultured MSC or tissue engineered constructs into an anabolic environment to achieve the best outcomes. Furthermore, such interventions should be considered early rather than later on in a disease process, at a time when sufficient endogenous cells remain to serve as a template for repair and regeneration. This review discusses how the interface between inflammation and cell-based regeneration of damaged tissues may be at odds, and outlines approaches to improve outcomes. In addition, other variables that could contribute to the success of cell therapies are discussed. Thus, there may be a need to adopt a Precision Medicine approach to optimize tissue repair and regeneration following injury to these important tissues.
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Wang Y, Wang H, Sun Z, Sun H, Ur-Rehman U, Tian J. Response of Heme Oxygenase-1 in Intervertebral Disc Degeneration by Promoting Autophagy and Apoptosis. INT J PHARMACOL 2022. [DOI: 10.3923/ijp.2022.1278.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Recent Advances in Managing Spinal Intervertebral Discs Degeneration. Int J Mol Sci 2022; 23:ijms23126460. [PMID: 35742903 PMCID: PMC9223374 DOI: 10.3390/ijms23126460] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 02/07/2023] Open
Abstract
Low back pain (LBP) represents a frequent and debilitating condition affecting a large part of the global population and posing a worldwide health and economic burden. The major cause of LBP is intervertebral disc degeneration (IDD), a complex disease that can further aggravate and give rise to severe spine problems. As most of the current treatments for IDD either only alleviate the associated symptoms or expose patients to the risk of intraoperative and postoperative complications, there is a pressing need to develop better therapeutic strategies. In this respect, the present paper first describes the pathogenesis and etiology of IDD to set the framework for what has to be combated to restore the normal state of intervertebral discs (IVDs), then further elaborates on the recent advances in managing IDD. Specifically, there are reviewed bioactive compounds and growth factors that have shown promising potential against underlying factors of IDD, cell-based therapies for IVD regeneration, biomimetic artificial IVDs, and several other emerging IDD therapeutic options (e.g., exosomes, RNA approaches, and artificial intelligence).
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Ju DG, Kanim LE, Bae HW. Is There Clinical Improvement Associated With Intradiscal Therapies? A Comparison Across Randomized Controlled Studies. Global Spine J 2022; 12:756-764. [PMID: 33047622 PMCID: PMC9344499 DOI: 10.1177/2192568220963058] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Post hoc comparison using single-site data from 4 multicenter randomized controlled trials. OBJECTIVES Discogenic back pain is associated with significant morbidity and medical cost. Several terminated, unreported randomized controlled trials have studied the effect of intradiscal biologic injections. Here we report single-center outcomes from these trials to determine if there is clinical improvement associated with these intradiscal injections. METHODS Post hoc comparison was performed using single-site data from 4 similar multi-center randomized controlled trials. All trials evaluated an injectable therapy (growth factor, fibrin sealant, or stem cells) for symptomatic lumbar disc disease with near-identical inclusion and exclusion criteria. Demographics and patient reported outcomes were analyzed across treatment arms postinjection. RESULTS A total of 38 patients were treated with biologic agents and 12 were treated with control saline injections. There was a significant decrease in visual analogue score (VAS) pain for both the investigational and saline groups up to 12 months postinjection (P < .01). There was no significant difference in VAS scores between the saline and investigational groups at 12 months. Similarly, there was significant improvement in patient-reported disability scores in both the investigational and saline groups at all time points. There were no significant differences in disability score improvement between the saline and investigational treatment groups at 12 months postinjection. CONCLUSIONS A single-center analysis of 4 randomized controlled studies demonstrated no difference in outcomes between therapeutic intradiscal agents (growth factor, fibrin sealant, or stem cells) and control saline groups. In all groups, patient reported pain and disability scores decreased significantly. Future studies are needed to evaluate the therapeutic benefit of any intradiscal injections.
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Affiliation(s)
- Derek G. Ju
- Cedars-Sinai Medical Center, Los
Angeles, CA, USA
| | | | - Hyun W. Bae
- Cedars-Sinai Medical Center, Los
Angeles, CA, USA,Hyun W. Bae, Cedars-Sinai Medical Center,
444 South San Vicente Boulevard, Suite 901, Los Angeles, CA, USA.
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Kroon T, Bhadouria N, Niziolek P, Edwards D, Choi R, Clinkenbeard EL, Robling A, Holguin N. Suppression of Sost/Sclerostin and Dickkopf-1 Augment Intervertebral Disc Structure in Mice. J Bone Miner Res 2022; 37:1156-1169. [PMID: 35278242 PMCID: PMC9320845 DOI: 10.1002/jbmr.4546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/02/2022] [Accepted: 03/10/2022] [Indexed: 11/06/2022]
Abstract
Intervertebral disc (IVD) degeneration is a leading cause of low back pain, characterized by accelerated extracellular matrix breakdown and IVD height loss, but there is no approved pharmacological therapeutic. Deletion of Wnt ligand competitor Lrp5 induces IVD degeneration, suggesting that Wnt signaling is essential for IVD homeostasis. Therefore, the IVD may respond to neutralization of Wnt ligand competitors sost(gene)/sclerostin(protein) and/or dickkopf-1 (dkk1). Anti-sclerostin antibody (scl-Ab) is an FDA-approved bone therapeutic that activates Wnt signaling. We aimed to (i) determine if pharmacological neutralization of sclerostin, dkk1, or their combination would stimulate Wnt signaling and augment IVD structure and (ii) determine the prolonged adaptation of the IVD to global, persistent deletion of sost. Nine-week-old C57Bl/6J female mice (n = 6-7/group) were subcutaneously injected 2×/week for 5.5 weeks with scl-Ab (25 mg/kg), dkk1-Ab (25 mg/kg), 3:1 scl-Ab/dkk1-Ab (18.75:6.25 mg/kg), or vehicle (veh). Separately, IVD of sost KO and wild-type (WT) mice (n = 8/group) were harvested at 16 weeks of age. First, compared with vehicle, injection of scl-Ab, dkk1-Ab, and 3:1 scl-Ab/dkk1-Ab similarly increased lumbar IVD height and β-catenin gene expression. Despite these similarities, only injection of scl-Ab alone strengthened IVD mechanical properties and decreased heat shock protein gene expressions. Genetically and compared with WT, sost KO enlarged IVD height, increased proteoglycan staining, and imbibed IVD hydration. Notably, persistent deletion of sost was compensated by upregulation of dkk1, which consequently reduced the cell nuclear fraction for Wnt signaling co-transcription factor β-catenin in the IVD. Lastly, RNA-sequencing pathway analysis confirmed the compensatory suppression of Wnt signaling and revealed a reduction of cellular stress-related pathways. Together, suppression of sost/sclerostin or dkk1 each augmented IVD structure by stimulating Wnt signaling, but scl-Ab outperformed dkk1-Ab in strengthening the IVD. Ultimately, postmenopausal women prescribed scl-Ab injections to prevent vertebral fracture may also benefit from a restoration of IVD height and health. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Tori Kroon
- Department of Biomedical Engineering, IUPUI, Indianapolis, IN, USA
| | - Neharika Bhadouria
- Department of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Paul Niziolek
- Radiology & Imaging Sciences, IUPUI, Indianapolis, IN, USA
| | - Daniel Edwards
- Indiana Center of Musculoskeletal Health, Indianapolis, IN, USA
| | - Roy Choi
- Department for Anatomy and Cell Biology, IUPUI, Indianapolis, IN, USA
| | | | - Alexander Robling
- Indiana Center of Musculoskeletal Health, Indianapolis, IN, USA.,Department for Anatomy and Cell Biology, IUPUI, Indianapolis, IN, USA
| | - Nilsson Holguin
- Indiana Center of Musculoskeletal Health, Indianapolis, IN, USA.,Department for Anatomy and Cell Biology, IUPUI, Indianapolis, IN, USA.,Department of Mechanical and Energy Engineering, IUPUI, Indianapolis, IN, USA
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Muthu S, Jeyaraman M, Chellamuthu G, Jeyaraman N, Jain R, Khanna M. Does the Intradiscal Injection of Platelet Rich Plasma Have Any Beneficial Role in the Management of Lumbar Disc Disease? Global Spine J 2022; 12:503-514. [PMID: 33840260 PMCID: PMC9121148 DOI: 10.1177/2192568221998367] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES We performed this meta-analysis to evaluate whether intradiscal Platelet Rich Plasma(PRP) injection has any beneficial role in the management of lumbar disc disease. METHODS We conducted independent and duplicate electronic database searches including PubMed, Embase, and Cochrane Library till September 2020 for studies investigating the role of intradiscal PRP in the management of lumbar disc disease. The analysis was performed in the R platform using OpenMeta[Analyst] software. RESULTS 13 studies including 2 RCTs, 5 prospective, and 6 retrospective studies involving 319 patients were included in the meta-analysis. A single-arm meta-analysis of the included studies showed a beneficial effect of the intervention in terms of pain relief outcomes like VAS score (p < 0.001), pain component of SF-36 (p = 0.003) while such improvement was not seen in functional outcome measures like ODI score (p = 0.071), the physical component of SF-36 (p = 0.130) with significant heterogeneity noted among the included studies. No structural improvement in magnetic resonance imaging was observed (p = 0.106). No additional procedure-related adverse events were noted in the included studies (p = 0.662). CONCLUSION There is a paucity of high-quality studies to give conclusive evidence on the benefits of intradiscal PRP for lumbar disc disease. Although intradiscal PRP injection has shown some beneficial effect in controlling pain for lumbar disc disease, we could not find structural or functional improvement from the included studies. Hence, we recommend large double-blind double-arm randomized controlled studies to analyze the benefits of the intervention being analyzed.
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Affiliation(s)
- Sathish Muthu
- Indian Orthopaedic Rheumatology Association, Lucknow, Uttar Pradesh, India
- Indian Stem Cell Study Group, Lucknow, Uttar Pradesh, India
- Sathish Muthu, Indian Stem Cell Study Group, Lucknow-226 010, Uttar Pradesh, India.
| | - Madhan Jeyaraman
- Indian Orthopaedic Rheumatology Association, Lucknow, Uttar Pradesh, India
- Indian Stem Cell Study Group, Lucknow, Uttar Pradesh, India
| | - Girinivasan Chellamuthu
- Indian Orthopaedic Rheumatology Association, Lucknow, Uttar Pradesh, India
- Indian Stem Cell Study Group, Lucknow, Uttar Pradesh, India
| | - Naveen Jeyaraman
- Indian Orthopaedic Rheumatology Association, Lucknow, Uttar Pradesh, India
- Indian Stem Cell Study Group, Lucknow, Uttar Pradesh, India
| | - Rashmi Jain
- Indian Stem Cell Study Group, Lucknow, Uttar Pradesh, India
| | - Manish Khanna
- Indian Orthopaedic Rheumatology Association, Lucknow, Uttar Pradesh, India
- Indian Stem Cell Study Group, Lucknow, Uttar Pradesh, India
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Widjaja G, Jalil AT, Budi HS, Abdelbasset WK, Efendi S, Suksatan W, Rita RS, Satria AP, Aravindhan S, Saleh MM, Shalaby MN, Yumashev AV. Mesenchymal stromal/stem cells and their exosomes application in the treatment of intervertebral disc disease: A promising frontier. Int Immunopharmacol 2022. [DOI: https://doi.org/10.1016/j.intimp.2022.108537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Widjaja G, Jalil AT, Budi HS, Abdelbasset WK, Efendi S, Suksatan W, Rita RS, Satria AP, Aravindhan S, Saleh MM, Shalaby MN, Yumashev AV. Mesenchymal stromal/stem cells and their exosomes application in the treatment of intervertebral disc disease: A promising frontier. Int Immunopharmacol 2022; 105:108537. [PMID: 35101851 DOI: 10.1016/j.intimp.2022.108537] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/01/2022] [Accepted: 01/07/2022] [Indexed: 02/07/2023]
Abstract
Today, the application of mesenchymal stromal/stem cells (MSCs) and their exosomes to treat degenerative diseases has received attention. Due to the characteristics of these cells, such as self-renewability, differentiative and immunomodulatory effects, their use in laboratory and clinical studies shows promising results. However, the allogeneic transplantation problems of MSCs limit the use of these cells in the clinic. Scientists propose the application of exosomes to use from the therapeutic effect of MSCs and overcome their defects. These vesicles change the target cell behaviour and transcription profile by transferring various cargo such as proteins, mi-RNAs, and lipids. One of the degenerative tissue diseases in which MSCs and their exosomes are used in their treatment is intervertebral disc disease (IDD). Different factors such as genetics, nutrition, ageing, and environmental factors play a significant role in the onset and progression of this disease. These factors affect the cellular and molecular properties of the disc, leading to tissue destruction. Nucleus pulposus cells (NPCs) are among the most important cells involved in the pathogenesis of disc degeneration. MSCs exert their therapeutic effects by differentiating, reducing apoptosis, increasing proliferation, and decreasing senescence in NPCs. In addition, the use of MSCs and their exosomes also affects the annulus fibrosus and cartilaginous endplate cells in disc tissue and prevents disc degeneration progression.
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Affiliation(s)
- Gunawan Widjaja
- Postgraduate Study, Universitas Krisnadwipayana, Bekasi, Indonesia; Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Abduladheem Turki Jalil
- Faculty of Biology and Ecology, Yanka Kupala State University of Grodno, 230023 Grodno, Belarus; College of Technical Engineering, The Islamic University, Najaf, Iraq; Department of Dentistry, Kut University College, Kut, Wasit 52001, Iraq
| | - Hendrik Setia Budi
- Department of Oral Biology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya 60132, Indonesia.
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia; Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Syahril Efendi
- Fasilkom-TI, Universitas Sumatera Utara, Medan, Indonesia.
| | - Wanich Suksatan
- Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Rauza Sukma Rita
- Department of Biochemistry, Faculty of Medicine, Universitas Andalas, Indonesia
| | - Andri Praja Satria
- Faculty of Nursing, Universitas Muhammadiyah Kalimantan Timur, Samarinda 75124, Indonesia
| | - Surendar Aravindhan
- Department of Pharmacology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Marwan Mahmood Saleh
- Department of Biophysics, College of Applied Sciences, University Of Anbar, Iraq
| | - Mohammed Nader Shalaby
- Biological Sciences and Sports Health Department, Faculty of Physical Education, Suez Canal University, Egypt
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Barbieri M, Colombini A, Stogicza A, de Girolamo L. Effectiveness of plasma rich in growth factors in the management of chronic spinal pain: a case series of 32 patients. Regen Med 2022; 17:175-184. [PMID: 35068201 DOI: 10.2217/rme-2021-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: This prospective, case-series study aimed to assess the clinical effectiveness of plasma rich in growth factors (PRGF) in patients with chronic low back pain (LBP) and to identify the features of the responsive patients. Materials & methods: PRGF was injected into the intervertebral disc, epidural space and/or facet and sacroiliac joints of 32 patients with chronic LBP. The efficacy of the treatment was assessed by algo-functional scores after 3 and 6 months. Results: Overall, the patients did not ameliorate after PRGF treatment, although eight patients showed an algo-functional improvement. They were mainly males treated at two sites who were younger, less sedentary and with fewer musculoskeletal co-morbidities than the nonresponders. Conclusion: PRGF is a potential treatment in a specific subpopulation of difficult-to-treat patients affected by chronic LBP.
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Affiliation(s)
- Massimo Barbieri
- IRCCS Istituto Ortopedico Galeazzi, Terapia del Dolore Interventistica, Milan, 20161, Italy
| | - Alessandra Colombini
- IRCCS Istituto Ortopedico Galeazzi, Laboratorio di Biotecnologie Applicate all'Ortopedia, Milan, 20161, Italy
| | - Agnes Stogicza
- St Magdolna Private Hospital, Department of Anesthesiology & Pain Medicine, Budapest, 1123, Hungary
| | - Laura de Girolamo
- IRCCS Istituto Ortopedico Galeazzi, Laboratorio di Biotecnologie Applicate all'Ortopedia, Milan, 20161, Italy
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Lo WC, Chen YT, Chen CC. The Effects of Elgucare on Degenerated Intervertebral Disc-Induced Low Back Pain and Disc Regeneration: A Clinical Trial. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5824956. [PMID: 34790253 PMCID: PMC8592736 DOI: 10.1155/2021/5824956] [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: 09/11/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Chronic low back pain (LBP) has a wide range of causes. However, most cases are induced by degeneration of the lumbar intervertebral discs (IVDs), and the aching caused by local compression of the affected region has considerable impacts on quality of life. This clinical trial investigated the use of Elgucare, a Chinese herbal formula, as a food supplement to reduce the pain of patients with LBP induced by degeneration of the lumbar IVDs. METHODS The study assessed patient subjective quality of life, functional limitations caused by LBP, and variations in pain. The assessment was done through the visual analogue scale (VAS) and effects on lumbar IVD thickness, water content, and bone mineral density (BMD). These parameters were evaluated before and after the administration of Elgucare or a placebo, one of which was taken by each participant for a 12-month period. RESULTS Elgucare reduced the patients' mean VAS pain score by 2.25 points and improved their mean LBP-hampered mobility as assessed by the Roland-Morris Questionnaire by 5.17 points. The results of another questionnaire indicated that Elgucare slowed the LBP-induced deterioration of patients' quality of life, while objective assessment indices obtained through X-ray and magnetic resonance imaging showed that the height and water retention of their IVDs were increased. However, the BMD results showed no improvements. CONCLUSIONS Elgucare can increase the water retention and height of IVDs and reduce LBP, thereby enhancing quality of life. Therefore, Elgucare can potentially be used as a clinical supplement.
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Affiliation(s)
- Wen-Cheng Lo
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu Ting Chen
- Research and Development of DC Botanical Biotechnology CO., LTD, LDY Chinese Medicine Hospital, New Taipei City, Taiwan
| | - Chen Ching Chen
- DC Botanical Biotechnology CO., LTD, LDY Chinese Medicine Hospital, New Taipei City, Taiwan
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14
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Jerome MA, Lutz C, Lutz GE. Risks of Intradiscal Orthobiologic Injections: A Review of the Literature and Case Series Presentation. Int J Spine Surg 2021; 15:26-39. [PMID: 34376494 DOI: 10.14444/8053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Intervertebral disc disease (IDD) is responsible for a large portion of back pain with historically suboptimal treatments for long-term improvement. IDD pathogenesis is thought to arise at a cellular and biochemical level, making biologically based injections an area of clinical interest. Although human studies have shown promise, emerging data suggest there may be risks inherent to such injections that were previously unrecognized. The aim of this review is to summarize the known risks to date and provide mitigation steps to reduce potential complications in the future. In addition, we present a small case series of serious adverse events (SAEs) from our clinical practice. METHODS A literature review was performed to identify human intradiscal autologous biologic injection studies to date, including mesenchymal signaling cells (MSCs) and platelet-rich plasma (PRP) preparations, which were reviewed for complications. Cases of complication following intradiscal orthobiologic injection were identified from a single outpatient center and reviewed. RESULTS Publications of MSC-based intradiscal injection documented 136 total patients treated with two SAEs reported, one infection and one progressive disc herniation. Publications of PRP intradiscal injection included 194 patients with one SAE reported. We also review three cases of previously unpublished SAEs, including one case of confirmed infection with Cutibacterium acnes (C acnes) and two presumed cases of discitis without pathogen confirmation. Bone marrow concentrate was the injectate in all three cases. CONCLUSIONS Although biologic intradiscal injection shows promise for the treatment of discogenic back pain, there are inherent risks to be considered and mitigated. We currently recommend a leukocyte-rich PRP and a two-needle delivery technique coupled with intradiscal gentamicin to mitigate the risk of postinjection spondylodiscitis. Further research is needed using large registries to not only track clinical outcomes but also complication rates.
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Affiliation(s)
| | - Christopher Lutz
- Regenerative SportsCare Institute, New York, New York.,Department of Physiatry, Hospital for Special Surgery, New York, New York.,Department of Rehabilitation Medicine, Weill Cornell Medical College, New York, New York
| | - Gregory E Lutz
- Regenerative SportsCare Institute, New York, New York.,Department of Physiatry, Hospital for Special Surgery, New York, New York.,Department of Rehabilitation Medicine, Weill Cornell Medical College, New York, New York
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15
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El-Kadiry AEH, Lumbao C, Rafei M, Shammaa R. Autologous BMAC Therapy Improves Spinal Degenerative Joint Disease in Lower Back Pain Patients. Front Med (Lausanne) 2021; 8:622573. [PMID: 33816523 PMCID: PMC8012529 DOI: 10.3389/fmed.2021.622573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/26/2021] [Indexed: 01/08/2023] Open
Abstract
Spinal degenerative joint disease (DJD) is associated with lower back pain (LBP) arising from the degeneration of intervertebral discs (IVD), facet joints, intertransversarii muscles, and interspinous ligaments among other anatomical structures. To circumvent the socioeconomic burdens and often-problematic surgical options imposed by DJD therapy, cell-based biologic modalities like bone marrow aspirate concentrate (BMAC) have been investigated in pre-clinical and clinical settings, mostly for IVD degeneration (IDD), with encouraging outcomes. In this study, we evaluated the differences in therapeutic benefits of BMAC between IVD- and facet joint-originating chronic LBP. Eighteen patients diagnosed with chronic LBP met the selection criteria. Following discography and provocation testing, 13 patients tested positive and were assigned into IDD-associated LBP (1st arm), while the remaining 5 tested negative and were assigned into facetogenic LBP (2nd arm). Autologous BMAC was injected intradiscally in the 1st arm, while the 2nd arm received posterior spinal chain injections. No procedure-related serious events ensued. Clinical improvement was evaluated over 12 months based on pain and functionality questionnaires (VAS, BPI, RAND-36), opioid use, and changes in disc parameters assessed by magnetic resonance imaging (MRI). Ameliorated VAS and BPI scores differed significantly between both arms in favor of IDD patients who also took significantly less opioids. Average RAND-36 scores showed no significant difference between groups albeit a trend suggesting improvement was observed in IDD patients. MRI scans conducted on IDD patients demonstrated marked elevation in disc height and spinal canal space size without worsening disc quality. Overall, this is the first study investigating the potency of BMAC as an IDD treatment in Canada and the first globally for addressing facetogenic pain using cellular therapy.
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Affiliation(s)
- Abed El-Hakim El-Kadiry
- Laboratory of Thrombosis and Hemostasis, Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Department of Biomedical Sciences, Université de Montréal, Montreal, QC, Canada
| | - Carlos Lumbao
- Canadian Centre for Regenerative Therapy, Toronto, ON, Canada
| | - Moutih Rafei
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, QC, Canada
- Department of Microbiology, Infectious Diseases, and Immunology, Université de Montréal, Montreal, QC, Canada
- Molecular Biology Program, Université de Montréal, Montreal, QC, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada
| | - Riam Shammaa
- Canadian Centre for Regenerative Therapy, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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16
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Li H, Li W, Liang B, Wei J, Yin D, Fan Q. Role of AP-2α/TGF-β1/Smad3 axis in rats with intervertebral disc degeneration. Life Sci 2020; 263:118567. [PMID: 33038379 DOI: 10.1016/j.lfs.2020.118567] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 09/11/2020] [Accepted: 10/01/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Studies have proposed the role of AP-2α in human disease. However, few have focused on its effects on intervertebral disc degeneration (IDD). This study intends to discuss the role of AP-2α in IDD by regulating TGF-β1 and Smad3 expression. METHODS The AP-2α and TGF-β1 expression in IDD NP clinical samples was detected. Rat models of IDD were established by acupuncture. The rats were injected with AP-2α low expression adeno-associated virus or TGF-β1 high expression adeno-associated virus to observe their effects on pathological damages, NP cell apoptosis, matrix metalloproteinase-2 (MMP-2), MMP-9, Smad3, Aggrecan and collagen (Col)-2 expression in NP tissues. The NP cells were isolated and transfected with silenced AP-2α or overexpressed TGF-β1 vector to figure out their functions in growth, senescence and apoptosis. RESULTS AP-2α and TGF-β1 were upregulated in NP tissues of patients and rats with IDD. AP-2α silencing limited the activation of TGF-β1 signaling pathway. Reduced AP-2α ameliorated pathological changes, declined MMP-2, MMP-9 and Smad3 expression and elevated Aggrecan and Col-2 expression in NP tissues of rats with IDD, and speeded up the growth and depressed senescence and apoptosis of NP cells of rats with IDD. Up-regulating TGF-β1 weakened the effect of down-regulated AP-2α on NP tissues and cells in IDD. CONCLUSION Collectively, our study demonstrates that knockdown of AP-2α restricts TGF-β1 and Smad3 expression to promote proliferation and depress senescence and apoptosis of NP cells in rats with IDD.
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Affiliation(s)
- Haoxi Li
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China
| | - Wenhao Li
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China
| | - Bin Liang
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China
| | - Jianxun Wei
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China
| | - Dong Yin
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China
| | - Qie Fan
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China.
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17
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Zhang J, Zhang J, Zhang Y, Liu W, Ni W, Huang X, Yuan J, Zhao B, Xiao H, Xue F. Mesenchymal stem cells-derived exosomes ameliorate intervertebral disc degeneration through inhibiting pyroptosis. J Cell Mol Med 2020; 24:11742-11754. [PMID: 32860495 PMCID: PMC7579702 DOI: 10.1111/jcmm.15784] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/03/2020] [Accepted: 07/12/2020] [Indexed: 12/14/2022] Open
Abstract
Mesenchymal stem cell (MSCs)‐based therapies have shown a promised result for intervertebral disc degeneration (IVDD) treatment. However, its molecular mechanisms remain unclear. Exosomes involve cell‐cell communication via transference of its contents among different cells, and the present potential effect on cell death regulation. This study aimed to investigate the role of MSCs‐derived exosomes on IVDD formation. Here, we first found the NLRP3‐mediated nucleus pulposus cell (NP cell) pyroptosis was activated in the IVDD mice model and lipopolysaccharide (LPS)‐induced model. However, MSCs treatment could inhibit NP cell pyroptosis in vitro. We then isolated MSCs‐derived exosomes by differential centrifugation and identified the characteristics. Secondly, we investigated the function of MSCs‐derived exosomes on LPS‐induced NP cell pyroptosis. Finally, we presented evidence that MSCs‐derived exosomal miR‐410 was a crucial regulator of pyroptosis. Results showed that MSCs‐derived exosomes play an anti‐pyroptosis role by suppressing the NLRP3 pathway. Moreover, it suggested that this effect was attributed to miR‐410, which was derived from MSCs‐exosomes and could directly bind to NLRP3mRNA. In conclusion, for the first time, we demonstrated that MSCs‐exosome treatment may inhibit pyroptosis and could be a promising therapeutic strategy for IVDD.
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Affiliation(s)
- Jingwei Zhang
- Department of Orthopedics, Shanghai Fengxian District Central Hospital/Southern Medical University Affiliated Fengxian Hospital, Shanghai, China
| | - Jieyuan Zhang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Yunlong Zhang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Wenjun Liu
- Department of Orthopedics, Shanghai Fengxian District Central Hospital/Southern Medical University Affiliated Fengxian Hospital, Shanghai, China
| | - Weifeng Ni
- Department of Orthopedics, Shanghai Fengxian District Central Hospital/Southern Medical University Affiliated Fengxian Hospital, Shanghai, China
| | - Xiaoyan Huang
- Department of Orthopedics, Shanghai Fengxian District Central Hospital/Southern Medical University Affiliated Fengxian Hospital, Shanghai, China
| | - Junjie Yuan
- Department of Orthopedics, Shanghai Fengxian District Central Hospital/Southern Medical University Affiliated Fengxian Hospital, Shanghai, China
| | - Bizeng Zhao
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Haijun Xiao
- Department of Orthopedics, Shanghai Fengxian District Central Hospital/Southern Medical University Affiliated Fengxian Hospital, Shanghai, China
| | - Feng Xue
- Department of Orthopedics, Shanghai Fengxian District Central Hospital/Southern Medical University Affiliated Fengxian Hospital, Shanghai, China
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18
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Hirase T, Jack RA, Sochacki KR, Harris JD, Weiner BK. Systematic Review: Is Intradiscal Injection of Bone Marrow Concentrate for Lumbar Disc Degeneration Effective? Cureus 2020; 12:e9045. [PMID: 32782864 PMCID: PMC7410505 DOI: 10.7759/cureus.9045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Current studies evaluating the outcomes of an intradiscal injection of bone marrow concentrate (BMC) for lumbar disc degeneration are limited. The purpose of this review was to determine if an intradiscal injection of BMC for lumbar disc degeneration results in a statistically significant improvement in clinical outcomes. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Levels I-IV investigations of intradiscal BMC injections in symptomatic lumbar disc degeneration were included in the analysis. Modified Coleman Methodology Scores (MCMS) were used to analyze study methodological quality. Only outcome measurements used by more than 50% of included studies, with a minimum follow-up of 12 months, were eligible for final data analysis. Pre-injection and post-injection visual analog scale (VAS) and Oswestry disability index (ODI) were compared using two-sample Z-tests. Seven articles (97 subjects (47 males, 38 females, 12 unspecified), mean age 33.9 ± 14.3 years, mean follow-up 44.4 ± 25.4 months) were analyzed. Six articles were level IV evidence and one article was level II. Mean MCMS was 56.6 ± 9.1. All subjects received single injections into the nucleus pulposus of one or more affected discs. VAS (66.0 mm to 20.9 mm; p<0.001) and ODI (44.4 to 19.1; p<0.001) significantly improved following the intradiscal BMC injection. One patient (1.0%) experienced herniated nucleus pulposus (HNP) following treatment. No other complications or re-injections were reported. In conclusion, despite our skepticism regarding the efficacy of the procedure, intradiscal injection of BMC for lumbar disc degeneration resulted in statistically significant improvement in VAS and ODI with low re-injection and complication rates in the studies assessed. Given that this study is limited to level IV evidence, the findings suggest that further randomized controlled studies may be worthwhile to evaluate the true efficacy of this treatment.
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Affiliation(s)
- Takashi Hirase
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Robert A Jack
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Kyle R Sochacki
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Joshua D Harris
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Bradley K Weiner
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
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19
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Hirase T, Jack Ii RA, Sochacki KR, Harris JD, Weiner BK. Systemic Review: Is an Intradiscal Injection of Platelet-Rich Plasma for Lumbar Disc Degeneration Effective? Cureus 2020; 12:e8831. [PMID: 32607308 PMCID: PMC7320640 DOI: 10.7759/cureus.8831] [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] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022] Open
Abstract
Current studies evaluating the outcomes of intradiscal platelet-rich plasma (PRP) injections in degenerative disc disease (DDD) are limited. The purpose of this review was to determine if an intradiscal injection of PRP for degenerative discs results in a statistically significant improvement in clinical outcomes. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Level I-IV investigations of intradiscal PRP injections in DDD were sought in multiple databases. The Modified Coleman Methodology Score (MCMS) was used to analyze the methodological quality of the study. Only the outcome measurements used by more than 50% of the studies were included in the data analysis. The study heterogeneity and nature of evidence (mostly retrospective, non-comparative) precluded meta-analysis. Pre and post-injection pain visual analog scales (VAS) were compared using two sample Z-tests. Five articles (90 subjects, mean age 43.6 ± 7.7 years, mean follow-up 8.0 ± 3.6 months) were analyzed. Four articles were level IV evidence and one article was level II. Mean MCMS was 56.0 ± 10.3. There were 43 males and 37 females (10 unidentified). Pain VAS significantly improved following lumbar intradiscal PRP injection (69.7 mm to 43.3 mm; p<0.01). Two patients (2.2%) experienced lower extremity paresthesia after treatment. One patient (1.1%) underwent re-injection. No other complications were reported. In conclusion, intradiscal injection of PRP for degenerative discs resulted in statistically significant improvement in VAS with low re-injection and complication rates in this systematic review. It is unclear whether the improvements were clinically significant given the available evidence. The low level of evidence available (level IV) does not allow for valid conclusions regarding efficacy; however, the positive results suggest that further higher-quality studies might be of value.
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Affiliation(s)
- Takashi Hirase
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Robert A Jack Ii
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Kyle R Sochacki
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Joshua D Harris
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Bradley K Weiner
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
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20
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Kirchner F, Pinar A, Milani I, Prado R, Padilla S, Anitua E. Vertebral intraosseous plasma rich in growth factor (PRGF-Endoret) infiltrations as a novel strategy for the treatment of degenerative lesions of endplate in lumbar pathology: description of technique and case presentation. J Orthop Surg Res 2020; 15:72. [PMID: 32093768 PMCID: PMC7041261 DOI: 10.1186/s13018-020-01605-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Motivation and necessity to adopt minimally invasive therapies in the field of spinal regenerative medicine is increasing. Autologous platelet-rich plasma (PRP) therapy has recently been used as an effective technological and biological approach to tissue repair and has shown to improve multiple conditions including back pain and degenerative disc pathology. In addition, it is well established that the anatomic elements of the spinal system affected by degenerative pathology include the intervertebral disc (IVD) and vertebral subchondral bone (VSB), which play a crucial role in maintaining a healthy spinal column. Both elements are the target of a novel biological approach to the treatment of low back pain. METHODS A novel minimally invasive regenerative therapeutic approach is presented herein with a protocol based on combining vertebral intraosseous (VIO) and intradiscal (ID) infiltrations of plasma rich in growth factors (PRGF-Endoret), a type of leukocyte-free PRP, for the treatment of disc degeneration pathology. RESULTS We describe a novel technique applied in a patient treated for IVD degeneration and VSB damage, showing significant improvement on magnetic resonance imaging, including partial regression of protruded disc and significant resorption of intravertebral herniations (Schmörl's nodes), after PRGF therapy. CONCLUSIONS To the best of our knowledge, we present the first reported case description of the utilization of VIO and ID PRP infiltrations to treat protruded discs and intravertebral herniations with a successful clinical outcome.
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Affiliation(s)
| | | | | | - Roberto Prado
- Eduardo Anitua Foundation for Biomedical Research, Jacinto Quincoces, 39, 01007, Vitoria, Spain.,BTI-Biotechnology Institute ImasD, Vitoria, Spain
| | - Sabino Padilla
- Eduardo Anitua Foundation for Biomedical Research, Jacinto Quincoces, 39, 01007, Vitoria, Spain.,BTI-Biotechnology Institute ImasD, Vitoria, Spain
| | - Eduardo Anitua
- Eduardo Anitua Foundation for Biomedical Research, Jacinto Quincoces, 39, 01007, Vitoria, Spain. .,BTI-Biotechnology Institute ImasD, Vitoria, Spain.
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21
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Formica M, Vallerga D, Zanirato A, Cavagnaro L, Basso M, Divano S, Mosconi L, Quarto E, Siri G, Felli L. Fusion rate and influence of surgery-related factors in lumbar interbody arthrodesis for degenerative spine diseases: a meta-analysis and systematic review. Musculoskelet Surg 2020; 104:1-15. [PMID: 31894472 DOI: 10.1007/s12306-019-00634-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/21/2019] [Indexed: 12/20/2022]
Abstract
The aim of this meta-analysis and systematic review is to summarize and critically analyze the influence of surgery-related factors in lumbar interbody fusion for degenerative spine diseases. A systematic review of the literature was carried out with a primary search being performed on Medline through PubMed. The 2009 PRISMA flowchart and checklist were taken into account. Sixty-seven articles were included in the analysis: 48 studies were level IV of evidence, whereas 19 were level III. All interbody fusion techniques analyzed have proved to reach a good fusion rate. An overall mean fusion rate of 93% (95% CI 92-95%, p < 0.001) was estimated pooling the selected studies. The influence of sagittal parameters and cages features in fusion rate was not clear. Autograft is considered the gold standard material. The use of synthetic bone substitutes and biological factors alone or combined with bone graft have shown conflicting results. Low level of evidence studies and high heterogeneity (χ2 = 271.4, df = 72, p < 0.001; I2 = 73.5%, τ2 = 0.05) in data analysis could result in the risk of bias. Further high-quality studies would better clarify these results in the future.
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Affiliation(s)
- M Formica
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - D Vallerga
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
| | - A Zanirato
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - L Cavagnaro
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - M Basso
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - S Divano
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - L Mosconi
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - E Quarto
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - G Siri
- Department of Mathematics, University of Genoa, Via Dodecaneso 35, 16146, Genoa, GE, Italy
| | - L Felli
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
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22
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Total disc replacement for lumbar degenerative disc disease: single centre 20 years experience. 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; 29:1518-1526. [DOI: 10.1007/s00586-019-06100-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/10/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022]
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23
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Chen X, Zhang P, Ma X. Rab7 delays intervertebral disc degeneration through the inhibition of the p38MAPK pathway. Biochem Biophys Res Commun 2019; 514:835-841. [DOI: 10.1016/j.bbrc.2019.04.184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/27/2019] [Indexed: 12/25/2022]
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24
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Fujii K, Yamazaki M, Kang JD, Risbud MV, Cho SK, Qureshi SA, Hecht AC, Iatridis JC. Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment. JBMR Plus 2019; 3:e10180. [PMID: 31131347 PMCID: PMC6524679 DOI: 10.1002/jbm4.10180] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/21/2018] [Accepted: 01/30/2019] [Indexed: 12/11/2022] Open
Abstract
Discogenic back pain is multifactorial; hence, physicians often struggle to identify the underlying source of the pain. As a result, discogenic back pain is often hard to treat—even more so when clinical treatment strategies are of questionable efficacy. Based on a broad literature review, our aim was to define discogenic back pain into a series of more specific and interacting pathologies, and to highlight the need to develop novel approaches and treatment strategies for this challenging and unmet clinical need. Discogenic pain involves degenerative changes of the intervertebral disc, including structural defects that result in biomechanical instability and inflammation. These degenerative changes in intervertebral discs closely intersect with the peripheral and central nervous systems to cause nerve sensitization and ingrowth; eventually central sensitization results in a chronic pain condition. Existing imaging modalities are nonspecific to pain symptoms, whereas discography methods that are more specific have known comorbidities based on intervertebral disc puncture and injection. As a result, alternative noninvasive and specific diagnostic methods are needed to better diagnose and identify specific conditions and sources of pain that can be more directly treated. Currently, there are many treatments/interventions for discogenic back pain. Nevertheless, many surgical approaches for discogenic pain have limited efficacy, thus accentuating the need for the development of novel treatments. Regenerative therapies, such as biologics, cell‐based therapy, intervertebral disc repair, and gene‐based therapy, offer the most promise and have many advantages over current therapies. © 2019 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research
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Affiliation(s)
- Kengo Fujii
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA.,Department of Orthopaedic Surgery University of Tsukuba Tsukuba Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery University of Tsukuba Tsukuba Japan
| | - James D Kang
- Department of Orthopaedic Surgery Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Makarand V Risbud
- Department of Orthopaedic Surgery Sidney Kimmel Medical College Thomas Jefferson University Philadelphia PA USA
| | - Samuel K Cho
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery Hospital for Special Surgery New York NY USA
| | - Andrew C Hecht
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA
| | - James C Iatridis
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA
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Current concepts for lumbar disc herniation. INTERNATIONAL ORTHOPAEDICS 2018; 43:841-851. [PMID: 30506088 DOI: 10.1007/s00264-018-4247-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To present the pathophysiology, biology, clinical presentation, diagnosis, and current treatment options for lumbar disc herniation. METHODS A thorough literature search was undertaken in PubMed and Google Scholar to summarize the current knowledge and future perspectives on lumbar disc herniation. RESULTS Several changes in the biology of the intervertebral disc are thought to contribute to disc herniation; nevertheless, the exact inciting event leading to disc herniation is yet to be discovered. Non-operative treatments have stood the test of time as the first-line treatment for most patients with lumbar disc herniation; however, operative treatment remains the current gold standard, with minimally invasive endoscopic microdiscectomy techniques showing best results with respect to postoperative pain and function. CONCLUSIONS The exact event leading to disc herniation remains unclear. Non-operative treatments should be the first-line treatment for most patients with lumbar disc herniation. Operative treatment remains the current gold standard, with minimally invasive endoscopic microdiscectomy techniques showing best results with respect to postoperative pain and function. Regenerative medicine is promising.
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Clinical trials of intervertebral disc regeneration: current status and future developments. INTERNATIONAL ORTHOPAEDICS 2018; 43:1003-1010. [DOI: 10.1007/s00264-018-4245-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022]
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Kolber MJ, Purita J, Paulus C, Carreno JA, Hanney WJ. Platelet Rich Plasma: Postprocedural Considerations for the Sports Medicine Professional. Strength Cond J 2018. [DOI: 10.1519/ssc.0000000000000403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Boisson M, Lefèvre-Colau MM, Rannou F, Nguyen C. Active discopathy: a clinical reality. RMD Open 2018; 4:e000660. [PMID: 29682329 PMCID: PMC5905838 DOI: 10.1136/rmdopen-2018-000660] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 12/19/2022] Open
Abstract
In the late 1980s, the description by Modic and colleagues of elementary discovertebral changes detected on MRI (Modic classification) suggested for the first time a possible correlation between anatomical and clinical features in a subgroup of patients with non-specific chronic low back pain. Degenerative disc disease is frequent and usually asymptomatic, but Modic 1 changes in the vertebral endplates adjacent to a degenerated disc are associated with inflammatory-like chronic low back pain and low-grade local and systemic inflammation, which led to the concept of ‘active discopathy’. Active discopathy shares some similarities with acute flares of peripheral osteoarthritis. Likewise, what triggers disc activation and how it self-limits remain unknown. A better understanding of mechanisms underlying disc activation and its self-limitation is of clinical relevance because it may enable the design of more targeted pharmacological and non-pharmacological interventions for the subgroup of patients with chronic low back pain and active discopathy. Here, we narratively review current disc-centred biomechanical and biochemical hypotheses of disc activation and discuss evidence of interactions with adverse personal and environmental factors.
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Affiliation(s)
- Margaux Boisson
- AP-HP, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Paris, France
| | - Marie-Martine Lefèvre-Colau
- AP-HP, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Paris, France.,Faculté de Médecine de Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,ECaMO Team, INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique, Sorbonne Paris Cité, Paris, France.,Institut Fédératif de Recherche sur le Handicap, Paris, France
| | - François Rannou
- AP-HP, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Paris, France.,Faculté de Médecine de Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, INSERM UMR 1124, UFR Biomédicale des Saints-Pères, Paris, France
| | - Christelle Nguyen
- AP-HP, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Paris, France.,Faculté de Médecine de Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, INSERM UMR 1124, UFR Biomédicale des Saints-Pères, Paris, France
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Abstract
PURPOSE OF REVIEW Substantial advancements have been made in the cause, diagnosis, imaging, and treatment options available for patients with lumbar disc herniation (LDH). We examined the current evidence and highlight the concepts on the frontline of discovery in LDH. RECENT FINDINGS There are a myriad of novel etiologies of LDH detailed in recent literature including inflammatory factors and infectious microbes. In the clinical setting, recent data focuses on improvements in computer tomography as a diagnostic tool and non-traditional injection options including tumor necrosis alpha inhibitors and platelet-rich plasma. Operative treatment outcomes have focused on minimally invasive endoscopic approaches and demonstrated robust 5-year post-operative outcomes. Advances in the molecular etiology of LDH will continue to drive novel treatment options. The role of endoscopic treatment for LDH will continue to evolve. Further research into10-year outcomes will be necessary as this surgical approach continues to gain widespread popularity.
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Affiliation(s)
- Raj M Amin
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Brian J Neuman
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
- Johns Hopkins Orthopaedic and Spine Surgery, 601 N. Caroline Street #5241, Baltimore, MD, 21287, USA.
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