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Tripathi G, Guha L, Kumar H. Seeing the unseen: The role of bioimaging techniques for the diagnostic interventions in intervertebral disc degeneration. Bone Rep 2024; 22:101784. [PMID: 39040156 PMCID: PMC11261287 DOI: 10.1016/j.bonr.2024.101784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
Intervertebral Disc Degeneration is a pathophysiological condition that primarily affects the spinal discs, causing back pain and neurological deficits. It is caused by the contribution of several factors such as genetic predisposition, age-related degeneration, and lifestyle choices like obesity and physical activity. Even though there are medications to treat pain, there is a lack of medicines for a complete cure. The main difficulty lies in poor diagnosis of the morphological and functional changes in the disc. With the ever-increasing research on bioimaging techniques, new techniques are being developed and repurposed to evaluate disc shape and composition, and their defects like thinning or deformities on the disc, leading to the proper diagnostic intervention in intervertebral disc degeneration. In this review, we aim to present a comprehensive overview of the imaging techniques used in the pre-clinical and clinical stages for the diagnosis of intervertebral disc degeneration. First, we will discuss about patho-anatomy and the pathophysiology of degenerative disc disease with the significance and a brief description of various dyes and tracers utilized for bioimaging. Then we will shed light on the latest advancements in diagnostic modalities in intervertebral disc degeneration; concluded by an analysis of the repercussions of the methodologies and experimental systems employed in identifying mechanisms and developing therapeutic strategies in intervertebral disc degeneration.
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Affiliation(s)
- Gyanoday Tripathi
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education And Research (NIPER)-Ahmedabad, Gandhinagar, Gujarat, India
| | - Lahanya Guha
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education And Research (NIPER)-Ahmedabad, Gandhinagar, Gujarat, India
| | - Hemant Kumar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education And Research (NIPER)-Ahmedabad, Gandhinagar, Gujarat, India
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2
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Wang D, Lu K, Zou G, Wu D, Cheng Y, Sun Y. Attenuating intervertebral disc degeneration through spermidine-delivery nanoplatform based on polydopamine for persistent regulation of oxidative stress. Int J Biol Macromol 2024; 274:132881. [PMID: 38838900 DOI: 10.1016/j.ijbiomac.2024.132881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 05/20/2024] [Accepted: 06/02/2024] [Indexed: 06/07/2024]
Abstract
As one of the most widespread musculoskeletal diseases worldwide, intervertebral disc degeneration (IVDD) remains an intractable clinical problem. Currently, oxidative stress has been widely considered as a significant risk factor in the IVDD pathological changes, and targeting oxidative stress injury to improve the harsh microenvironment may provide a novel and promising strategy for disc repair. It is evident that spermidine (SPD) has the ability to attenuate oxidative stress across several disease models. However, limited research exists regarding its impact on oxidative stress within the intervertebral disc. Moreover, enhancing the local utilization rate of SPD holds great significance in IVDD management. This study aimed to develop an intelligent biodegradable mesoporous polydopamine (PDA) nanoplatform for sustained release of SPD. The obtained PDA nanoparticles with spherical morphology and mesoporous structure released loaded-therapeutic molecules under low pH and H2O2. Combined treatment with SPD loaded into PDA nanoparticles (SPD/PDA) resulted in better therapeutic potential than those with SPD alone on oxidative stress injury. Furthermore, both SPD and SPD/PDA could induce anti-inflammatory M2 macrophage polarization. Upon injection into degenerative IVDs, the SPD/PDA group achieved a good repair efficacy with a long-term therapeutic effect. These findings indicated that the synergized use of SPD with responsive drug delivery nanocarriers may steadily scavenge reactive oxygen species and provide an effective approach toward the treatment of IVDD.
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Affiliation(s)
- Dongliang Wang
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Orthopedics, Yancheng First People's Hospital of Jiangsu Province, Yancheng, Jiangsu, China
| | - Kun Lu
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Orthopedics, Yancheng First People's Hospital of Jiangsu Province, Yancheng, Jiangsu, China
| | - Guoyou Zou
- Department of Orthopedics, Yancheng First People's Hospital of Jiangsu Province, Yancheng, Jiangsu, China
| | - Duanrong Wu
- Department of Orthopedics, Yancheng First People's Hospital of Jiangsu Province, Yancheng, Jiangsu, China
| | - Yi Cheng
- Department of Orthopedics, Yancheng First People's Hospital of Jiangsu Province, Yancheng, Jiangsu, China
| | - Yongming Sun
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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3
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Varga M, Štulík J, Pivarči F, Geri G, Malík J, Lang O, Srikandarajah N, Kaiser R. Correlation of MRI-Evaluated Degenerative Disc Disease with Positivity on Single-Photon Emission Computed Tomography Imaging in Patients with Chronic Low Back Pain. World Neurosurg 2024:S1878-8750(24)01304-4. [PMID: 39074580 DOI: 10.1016/j.wneu.2024.07.163] [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: 02/04/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE Chronic low back pain, affecting up to 58% of the population, often stems from intervertebral disc degeneration. Although magnetic resonance imaging (MRI) is commonly used for diagnostics, challenges arise in pinpointing pain sources due to frequent asymptomatic findings. Single-photon emission tomography (SPECT) integrated with computed tomography (CT) offers a promising approach, enhancing sensitivity and specificity. METHODS In this retrospective study, spanning 2016 to 2022, SPECT/CT imaging was performed on 193 patients meeting specific criteria. We correlated SPECT/CT findings with lumbar MRI results, utilizing Pfirrmann and Rajasekaran classifications for disc degeneration and endplate damage assessment. Logistic regression analysis adjusted for age and sex evaluated associations. RESULTS Of 965 spinal levels assessed, SPECT/CT positivity strongly correlated with higher Pfirrmann grades and Rajasekaran endplate classifications. Notably, Modic changes (MCs) on MRI displayed a nonsignificant relationship with SPECT/CT positivity. Significant associations were observed in older patients with positive MCs, Pfirrmann grades, and Rajasekaran classifications. CONCLUSIONS This comprehensive study, the largest of its kind, establishes a significant link between SPECT/CT positivity and advanced lumbar degenerative changes. Higher Pfirrmann grades and increased Rajasekaran endplate damage demonstrated substantial correlations with SPECT/CT positivity. Notably, MCs did not exhibit such association. Our findings underscore the potential of SPECT/CT in identifying pain generators in degenerative spinal conditions, offering valuable insights for future interventions.
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Affiliation(s)
- Michal Varga
- Department of Spinal Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
| | - Jan Štulík
- Department of Spinal Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Filip Pivarči
- Department of Spinal Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Gábor Geri
- Department of Spinal Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jozef Malík
- Department of Radiodiagnostics, Military University Hospital Prague, Prague, Czech Republic
| | - Otto Lang
- Department of Nuclear Medicine, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Nisaharan Srikandarajah
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK; Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic; Spinal Surgery Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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4
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Suthar PP, Ozen M, Bhanot S, Dua SG. Imaging review of the atypical spinal epidural space pathologies. Curr Probl Diagn Radiol 2024; 53:507-516. [PMID: 38341368 DOI: 10.1067/j.cpradiol.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 01/28/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
Pathologies affecting the spinal epidural space (SES) comprise various abnormalities. However, they all have the potential to cause thecal sac narrowing or spinal cord compression. In this review, we group these pathologies into degenerative, infective, neoplastic, vascular, traumatic, and others, focusing on their imaging features. Degenerative pathologies of the SES range from disc to facet disease, with a particular emphasis on the less common degenerative pathologies in this review. Infective pathologies affecting the epidural space include spondylodiscitis and associated epidural phlegmon and abscess. Neoplasms arising from typical SES components include neurofibroma, hemangioma, and liposarcoma. MRI is the best modality to assess the anatomy and abnormalities of the epidural space. MRI, combined with computed tomography, or a radiograph, is useful for the evaluation of bones or radiopaque foreign bodies.
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Affiliation(s)
- Pokhraj Prakashchandra Suthar
- Rush University Medical Center, Diagnostic Radiology and Nuclear Medicine, 1653 West Congress Parkway, Chicago, IL 60612, USA
| | - Merve Ozen
- Assistant Professor of Radiology, Surgery, Obstetrics and Gynecology, University of Kentuky College of Medicine, Faculty, Vascular & Interventional Radiology, 800 Ross Steet, Room HX-318, Lexington, KY 40536-0293, USA
| | - Shelly Bhanot
- Rush University Medical Center, Vascular & Interventional Radiology, 1653 West Congress Parkway, Chicago, IL 60612, USA
| | - Sumeet G Dua
- Rush University Medical Center, Diagnostic Radiology and Nuclear Medicine, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Sofoluke N, Leyendecker J, Barber S, Reardon T, Bieler E, Patel A, Kashlan O, Bredow J, Eysel P, Gardocki RJ, Hasan S, Telfeian AE, Hofstetter CP, Konakondla S. Endoscopic Versus Traditional Thoracic Discectomy: A Multicenter Retrospective Case Series and Meta-Analysis. Neurosurgery 2024:00006123-990000000-01222. [PMID: 38899868 DOI: 10.1227/neu.0000000000003034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/25/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Surgical treatment for symptomatic thoracic disc herniations (TDH) involves invasive open surgical approaches with relatively high complication rates and prolonged hospital stays. Although advantages of full endoscopic spine surgery (FESS) are well-established in lumbar disc herniations, data are limited for the endoscopic treatment of TDH despite potential benefits regarding surgical invasiveness. The aim of this study was to provide a comprehensive evaluation of potential benefits of FESS for the treatment of TDH. METHODS PubMed, MEDLINE, EMBASE, and Scopus were systematically searched for the term "thoracic disc herniation" up to March 2023 and study quality appraised with a subsequent meta-analysis. Primary outcomes were perioperative complications, need for instrumentation, and reoperations. Simultaneously, we performed a multicenter retrospective evaluation of outcomes in patients undergoing full endoscopic thoracic discectomy. RESULTS We identified 3190 patients from 108 studies for the traditional thoracic discectomy meta-analysis. Pooled incidence rates of complications were 25% (95% CI 0.22-0.29) for perioperative complications and 7% (95% CI 0.05-0.09) for reoperation. In this cohort, 37% (95% CI 0.26-0.49) of patients underwent instrumentation. The pooled mean for estimated blood loss for traditional approaches was 570 mL (95% CI 477.3-664.1) and 7.0 days (95% CI 5.91-8.14) for length of stay. For FESS, 41 patients from multiple institutions were retrospectively reviewed, perioperative complications were reported in 4 patients (9.7%), 4 (9.7%) required revision surgery, and 6 (14.6%) required instrumentation. Median blood loss was 5 mL (IQR 5-10), and length of stay was 0.43 days (IQR 0-1.23). CONCLUSION The results suggest that full endoscopic thoracic discectomy is a safe and effective treatment option for patients with symptomatic TDH. When compared with open surgical approaches, FESS dramatically diminishes invasiveness, the rate of complications, and need for prolonged hospitalizations. Full endoscopic spine surgery has the capacity to alter the standard of care for TDH treatment toward an elective outpatient surgery.
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Affiliation(s)
- Nelson Sofoluke
- Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania, USA
| | - Jannik Leyendecker
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Sean Barber
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, USA
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, USA
| | - Eliana Bieler
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| | - Akshay Patel
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Osama Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
- University Hospital Cologne, Cologne, Germany
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Raymond J Gardocki
- Department of Orthopedic Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Saqib Hasan
- Golden State Orthopedics and Spine, Oakland, California, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| | - Sanjay Konakondla
- Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania, USA
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Vilanilam GK, Kumar S, Vattoth S. MR imaging differentiating features between lytic and degenerative lumbosacral spondylolisthesis. Neuroradiol J 2024; 37:276-284. [PMID: 37212542 PMCID: PMC11138341 DOI: 10.1177/19714009231177409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Spondylolisthesis is characterized by the displacement of one vertebral body in relation to the adjacent vertebra. It is commonly observed in the lower lumbar region and can be caused by a variety of factors, including spondylolysis (a fracture in the pars interarticularis) or degenerative disease. Magnetic resonance imaging (MRI) is becoming increasingly popular as the primary modality for evaluation of low back pain and is often used in the absence of radiographs or Computed Tomography. However, it can be challenging for radiologists to differentiate between the two types of spondylolisthesis based on MRI alone. The goal of this article is to identify key imaging features on MRI that can aid radiologists in differentiating between spondylolysis and degenerative spondylolisthesis on MRI. Five key concepts are discussed: the "step-off" sign, the "wide canal" sign, T2 cortical bone signal on MRI, epidural fat interposition, and fluid in the facet joints. The utility, limitations and potential pitfalls of these concepts are also discussed to provide a comprehensive understanding of their use in differentiating between the two types of spondylolisthesis on MRI.
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Affiliation(s)
- George K Vilanilam
- Division of Neuroradiology, Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Shruti Kumar
- Division of Neuroradiology, Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Surjith Vattoth
- Division of Neuroradiology, Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Li H, Tang Y, Liu Z, Chen K, Zhang K, Hu S, Pan C, Yang H, Li B, Chen H. Lumbar instability remodels cartilage endplate to induce intervertebral disc degeneration by recruiting osteoclasts via Hippo-CCL3 signaling. Bone Res 2024; 12:34. [PMID: 38816384 PMCID: PMC11139958 DOI: 10.1038/s41413-024-00331-x] [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: 08/29/2023] [Revised: 02/29/2024] [Accepted: 04/01/2024] [Indexed: 06/01/2024] Open
Abstract
Degenerated endplate appears with cheese-like morphology and sensory innervation, contributing to low back pain and subsequently inducing intervertebral disc degeneration in the aged population.1 However, the origin and development mechanism of the cheese-like morphology remain unclear. Here in this study, we report lumbar instability induced cartilage endplate remodeling is responsible for this pathological change. Transcriptome sequencing of the endplate chondrocytes under abnormal stress revealed that the Hippo signaling was key for this process. Activation of Hippo signaling or knockout of the key gene Yap1 in the cartilage endplate severed the cheese-like morphological change and disc degeneration after lumbar spine instability (LSI) surgery, while blocking the Hippo signaling reversed this process. Meanwhile, transcriptome sequencing data also showed osteoclast differentiation related gene set expression was up regulated in the endplate chondrocytes under abnormal mechanical stress, which was activated after the Hippo signaling. Among the discovered osteoclast differentiation gene set, CCL3 was found to be largely released from the chondrocytes under abnormal stress, which functioned to recruit and promote osteoclasts formation for cartilage endplate remodeling. Over-expression of Yap1 inhibited CCL3 transcription by blocking its promoter, which then reversed the endplate from remodeling to the cheese-like morphology. Finally, LSI-induced cartilage endplate remodeling was successfully rescued by local injection of an AAV5 wrapped Yap1 over-expression plasmid at the site. These findings suggest that the Hippo signaling induced osteoclast gene set activation in the cartilage endplate is a potential new target for the management of instability induced low back pain and lumbar degeneration.
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Affiliation(s)
- Hanwen Li
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Orthopedic Institute, Suzhou Medical College, Soochow University, Suzhou, P.R. China
| | - Yingchuang Tang
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Orthopedic Institute, Suzhou Medical College, Soochow University, Suzhou, P.R. China
| | - Zixiang Liu
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Kangwu Chen
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Kai Zhang
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Sihan Hu
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Orthopedic Institute, Suzhou Medical College, Soochow University, Suzhou, P.R. China
| | - Chun Pan
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, P.R. China
| | - Huilin Yang
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China.
- Orthopedic Institute, Suzhou Medical College, Soochow University, Suzhou, P.R. China.
| | - Bin Li
- Orthopedic Institute, Suzhou Medical College, Soochow University, Suzhou, P.R. China.
| | - Hao Chen
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, P.R. China.
- Department of Orthopedic Surgery, Affiliated Hospital of Yangzhou University, Yangzhou, P.R. China.
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Yoshida S, Nakamura S, Saita K, Oya S, Ogihara S. Differences in the Demographics and Clinical Characteristics between the Ossification of the Posterior Longitudinal Ligament and Ossification of the Ligamentum Flavum in Patients Who Underwent Thoracic Spinal Surgery for Compressive Myelopathy. Neurol Med Chir (Tokyo) 2024; 64:184-191. [PMID: 38403719 PMCID: PMC11153844 DOI: 10.2176/jns-nmc.2023-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/22/2023] [Indexed: 02/27/2024] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) are related diseases associated with the ossification of spinal ligaments that can occasionally lead to thoracic myelopathy. We retrospectively analyzed the clinical data of 34 consecutive patients who underwent thoracic spinal surgeries for OPLL and/or OLF at our hospital between July 2010 and June 2022, and statistically compared data between patients with thoracic OPLL (TOPLL; n = 12) and those with thoracic OLF (TOLF; n = 22). The mean age of the TOPLL group was significantly lower than that of the TOLF group (53.7 vs. 68.4 years). The TOPLL group exhibited a greater female predominance than the TOLF group (58.3% vs. 18.2%). The median body mass index of the TOPLL group was significantly higher than that of the TOLF group (33.0 vs. 26.0 kg/m2). Patients with TOPLL significantly required instrumented fusion and repetitive surgical intervention more than those with TOLF (83.3% vs. 9.1%; 50.0% vs. 0.0%). Although neurological deterioration just after the intervention was more common in patients with TOPLL (41.7% vs. 4.6%), no difference was observed in thoracic Japanese Orthopaedic Association score and recovery rate in the chronic phase between TOPLL and TOLF. The TOPLL group had a younger onset, female dominance, and a greater degree of obesity when compared with the TOLF group. The surgery for TOPLL is challenging, considering that it requires long-range decompression and fusion, subsequent operations, careful management, and long-term follow-up, when compared to TOLF, which necessitates only simple decompression.
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Affiliation(s)
- Shinsuke Yoshida
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University
| | - Sho Nakamura
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University
| | - Satoshi Ogihara
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University
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Lorio MP, Watters WC, Grunch BH, Metzger AK, Lewandrowski KU, Block JE, Andersson GBJ. Utilization of Bone-Anchored Annular Defect Closure to Prevent Reherniation Following Lumbar Discectomy: Overcoming Barriers to Clinical Adoption and Market Access. Int J Spine Surg 2024; 18:222-230. [PMID: 38569929 PMCID: PMC11287817 DOI: 10.14444/8592] [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: 04/05/2024] Open
Abstract
While achieving premarket approval from the US Food and Drug Administration represents a significant milestone in the development and commercialization of a Class III medical device, the aftermath endeavor of gaining market access can be daunting. This article provides a case study of the Barricaid annular closure device (Barricaid), a reherniation reduction device, which has been demonstrated to decrease the risk of suffering a recurrent lumbar intervertebral disc herniation. Following Food and Drug Administration approval, clinical adoption has been slow due to barriers to market access, including the perception of low-quality clinical evidence, questionable significance of the medical necessity of the procedure, and imaging evidence of increased likelihood of vertebral endplate changes. The aim of this article is to provide appropriate examination, rationale, and rebuttal of these concerns. Weighing the compendium of evidence, we offer a definition of a separate and unique current procedural terminology code to delineate this procedure. Adoption of this code will help to streamline the processing of claims and support the conduct of research, the evaluation of health care utilization, and the development of appropriate medical guidelines.
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10
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Meng Z, Xiong A, Liu M, Guo Y, Zhu X, Luo T, Tian X, Meng X, Li X, Lin X, Wang X, Qin J. Quantitative evaluation of disc degeneration using dual-energy CT: advantages of R-VH, D-VH values and the IVNCa + CT model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2022-2030. [PMID: 38431753 DOI: 10.1007/s00586-024-08176-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 12/21/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To evaluate the correlation between dual-energy CT (DECT) virtual calcium free (VNCA), CT attenuation, the ratio and difference of VNCA to CT attenuation, and Pfirrmann grading of lumbar disc degeneration. METHODS A retrospective analysis on 135 intervertebral discs from 30 patients who underwent DECT and MR. Discs was graded using the Pfirrmann system. ROIs on the sagittal plane assessed HU value, VNCA value, Rho value, Z value, R-VH value, and D-VH value. Correlation, grade differences, and multivariate regression models were assessed. Diagnostic performance and cut-off values were determined using AUC. RESULTS VNCA (r = 0.589, P < 0.001), R-VH (r = 0.622, P < 0.001), and D-VH (r = 0.613, P < 0.001) moderately correlated with Pfirrmann grading. HU (r = 0.388, P < 0.001), Rho (r = 0.142, P = 0.102), and Z (r = -0.125, P = 0.153) showed a weak correlation. R-VH, D-VH, and VNCA had significantly higher correlation than HU. Statistically significant differences were observed in P values of VNCA, HU, R-VH, and D-VH in relative groups (P < 0.05), but not in Rho and Z values (P > 0.05). R-VH and D-VH had significant differences between Pfirrmann grades 1 and 2, and grades 2 and 3 (early stage) (P < 0.05). AUC readings of R-VH and D-VH (≥2, ≥3, ≥4) were higher. The multivariate model IVNCa + CT had the highest AUC. CONCLUSION The new quantitative indices R-VH value and D-VH value of DECT have advantages over VNCA value and HU value in evaluating early-stage disc degeneration (≥2 grades, ≥3 grades). The multivariate model IVNCa + CT has the best AUC values for evaluating disc degeneration at all stages.
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Affiliation(s)
- Zhanao Meng
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Anni Xiong
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Mengmeng Liu
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Yahao Guo
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xuan Zhu
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Tao Luo
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xiangjie Tian
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xiangbo Meng
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xiaolei Li
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xue Lin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xiaohong Wang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China.
| | - Jie Qin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China.
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11
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Wu T, Wang C, Li K. Quantitative analysis and stochastic modeling of osteophyte formation and growth process on human vertebrae based on radiographs: a follow-up study. Sci Rep 2024; 14:9393. [PMID: 38658644 PMCID: PMC11043460 DOI: 10.1038/s41598-024-60212-5] [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: 06/28/2023] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
Osteophytes are frequently observed in elderly people and most commonly appear at the anterior edge of the cervical and lumbar vertebrae body. The anterior osteophytes keep developing and will lead to neck/back pain over time. In clinical practice, the accurate measurement of the anterior osteophyte length and the understanding of the temporal progression of anterior osteophyte growth are of vital importance to clinicians for effective treatment planning. This study proposes a new measuring method using the osteophyte ratio index to quantify anterior osteophyte length based on lateral radiographs. Moreover, we develop a continuous stochastic degradation model with time-related functions to characterize the anterior osteophyte formation and growth process on cervical and lumbar vertebrae over time. Follow-up data of anterior osteophytes up to 9 years are obtained for measurement and model validation. The agreement test indicates excellent reproducibility for our measuring method. The proposed model accurately fits the osteophyte growth paths. The model predicts the mean time to onset of pain and obtained survival function of the degenerative vertebrae. This research opens the door to future quantification and mathematical modeling of the anterior osteophyte growth on human cervical and lumbar vertebrae. The measured follow-up data is shared for future studies.
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Affiliation(s)
- Tong Wu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Changxi Wang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Sichuan University - Pittsburgh Institute, Sichuan University, Chengdu, 610207, China.
| | - Kang Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Orthopedics Department of West China Hospital, Sichuan University, Chengdu, 610041, China.
- Sichuan University - Pittsburgh Institute, Sichuan University, Chengdu, 610207, China.
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12
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Chong EY, Tong Tan LY, Chong CS, Yeo W, Siang Koh DT, Jiang L, Guo CM, Cheong Soh RC. Radiological and Clinical Outcomes comparing 2-level MIS Lateral and MIS Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Spinal Stenosis. Global Spine J 2024; 14:986-997. [PMID: 36202133 PMCID: PMC11192119 DOI: 10.1177/21925682221132745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES To compare early postoperative radiological and clinical outcomes between 2-level minimally invasive (MIS) trans-psoas lateral lumbar interbody fusion (LLIF) and MIS transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spinal stenosis. METHODS Fifty three consecutive patients undergoing 2-level lumbar interbody fusion from L3-L5 for degenerative lumbar spinal stenosis were enrolled. Twenty four patients underwent LLIF and 29 underwent TLIF. RESULTS Operative time and length of stay were similar between LLIF and TLIF (272.8 ± 82.4 vs 256.1 ± 59.4 minutes; 5.5 ± 2.8 vs 4.7 ± 3.3 days, P > .05), whereas blood loss was lower for LLIF (229.0 ± 125.6 vs 302.4 ± 97.1mls, P = .026). Neurological deficits were more common in LLIF (9 vs 3, P = .025), whereas persistent deficits were rare for both (1 vs 1, P = 1). For both groups, all patient reported outcomes visual analogue scale (VAS back pain, VAS leg pain, ODI, SF-36 physical) improved from preoperative to 2-years postoperative (P < .05), with both groups showing no significant differences in extent of improvement for any outcome. Lateral lumbar interbody fusion demonstrated superior restoration of disc height (L3-L4: 4.1 ± 2.4 vs 1.2 ± 1.9 mm, P < .001; L4-L5: 4.6 ± 2.4 vs .8 ± 2.8 mm, P < .001), foraminal height (FH) (L3-L4: 3.5 ± 3.6 vs 1.0 ± 3.6 mm, P = .014; L4-L5: 3.0 ± 3.5 vs -.1 ± 4.4 mm, P = .0080), segmental lordosis (4.1 ± 6.4 vs -2.1 ± 8.1°, P = .005), lumbar lordosis (LL) (4.1 ± 7.0 vs -2.3 ± 12.6°, P = .026) and pelvic incidence-lumbar lordosis (PI-LL) mismatch (-4.1 ± 7.0 vs 2.3 ± 12.6°, P = .019) at 2-years follow-up. CONCLUSION The superior radiological outcomes demonstrated by 2-level trans-psoas LLIF did not translate into difference in clinical outcomes compared to 2-level TLIF at the 2-years follow-up, suggesting both approaches are reasonable for 2-level lumbar interbody fusion in degenerative lumbar spinal stenosis.
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Affiliation(s)
- Elliot Yeung Chong
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Lenice Yue Tong Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Christoph Sheng Chong
- Lee Kong Chian School of Medicine, National Technological University (NTU), Singapore
| | - William Yeo
- Orthopaedic Diagnostic Centre, Singapore General Hospital (SGH), Singapore
| | - Don Thong Siang Koh
- Department of Orthopaedic Surgery, Singapore General Hospital (SGH), Singapore
| | - Lei Jiang
- Department of Orthopaedic Surgery, Singapore General Hospital (SGH), Singapore
| | - Chang Ming Guo
- Department of Orthopaedic Surgery, Singapore General Hospital (SGH), Singapore
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13
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Lorio MP, Tate JL, Myers TJ, Block JE, Beall DP. Perspective on Intradiscal Therapies for Lumbar Discogenic Pain: State of the Science, Knowledge Gaps, and Imperatives for Clinical Adoption. J Pain Res 2024; 17:1171-1182. [PMID: 38524692 PMCID: PMC10959304 DOI: 10.2147/jpr.s441180] [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: 09/20/2023] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Specific clinical diagnostic criteria have established a consensus for defining patients with lumbar discogenic pain. However, if conservative medical management fails, these patients have few treatment options short of surgery involving discectomy often coupled with fusion or arthroplasty. There is a rapidly-emerging research effort to fill this treatment gap with intradiscal therapies that can be delivered minimally-invasively via fluoroscopically guided injection without altering the normal anatomy of the affected vertebral motion segment. Viable candidate products to date have included mesenchymal stromal cells, platelet-rich plasma, nucleus pulposus structural allograft, and other cell-based compositions. The objective of these products is to repair, supplement, and restore the damaged intervertebral disc as well as retard further degeneration. In doing so, the intervention is meant to eliminate the source of discogenic pain and avoid surgery. Methodologically rigorous studies are rare, however, and based on the best clinical evidence, the safety as well as the magnitude and duration of clinical efficacy remain difficult to estimate. Further, we summarize the US Food and Drug Administration's (FDA) guidance regarding the interpretation of the minimal manipulation and homologous use criteria, which is central to designating these products as a tissue or as a drug/device/biologic. We also provide perspectives on the core evidence and knowledge gaps associated with intradiscal therapies, propose imperatives for evaluating effectiveness of these treatments and highlight several new technologies on the horizon.
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14
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Humphreys SC, Hodges SD, Sielatycki JA, Sivaganesan A, Block JE. Are We Finally Ready for Total Joint Replacement of the Spine? An Extension of Charnley's Vision. Int J Spine Surg 2024; 18:24-31. [PMID: 38071570 PMCID: PMC11265502 DOI: 10.14444/8538] [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: 03/06/2024] Open
Abstract
Professor Sir John Charnley has been rightfully hailed as a visionary innovator for conceiving, designing, and validating the Operation of the Century-the total hip arthroplasty. His groundbreaking achievement forever changed the orthopedic management of chronically painful and dysfunctional arthritic joints. However, the well-accepted surgical approach of completely removing the diseased joint and replacing it with a durable and anatomically based implant never translated to the treatment of the degenerated spine. Instead, decompression coupled with fusion evolved into the workhorse intervention. In this commentary, the authors explore the reasons why arthrodesis has remained the mainstay over arthroplasty in the field of spine surgery as well as discuss the potential shift in the paradigm when it comes to treating degenerative lumbar disease.
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Affiliation(s)
| | - Scott D Hodges
- Center for Sports Medicine and Orthopedics, Chattanooga, TN, USA
| | - J Alex Sielatycki
- Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO, USA
| | | | - Jon E Block
- Independent Consultant, San Francisco, CA, USA
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15
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Tumko V, Kim J, Uspenskaia N, Honig S, Abel F, Lebl DR, Hotalen I, Kolisnyk S, Kochnev M, Rusakov A, Mourad R. A neural network model for detection and classification of lumbar spinal stenosis on MRI. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:941-948. [PMID: 38150003 DOI: 10.1007/s00586-023-08089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/30/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES To develop a three-stage convolutional neural network (CNN) approach to segment anatomical structures, classify the presence of lumbar spinal stenosis (LSS) for all 3 stenosis types: central, lateral recess and foraminal and assess its severity on spine MRI and to demonstrate its efficacy as an accurate and consistent diagnostic tool. METHODS The three-stage model was trained on 1635 annotated lumbar spine MRI studies consisting of T2-weighted sagittal and axial planes at each vertebral level. Accuracy of the model was evaluated on an external validation set of 150 MRI studies graded on a scale of absent, mild, moderate or severe by a panel of 7 radiologists. The reference standard for all types was determined by majority voting and in case of disagreement, adjudicated by an external radiologist. The radiologists' diagnoses were then compared to the diagnoses of the model. RESULTS The model showed comparable performance to the radiologist average both in terms of the determination of presence/absence of LSS as well as severity classification, for all 3 stenosis types. In the case of central canal stenosis, the sensitivity, specificity and AUROC of the CNN were (0.971, 0.864, 0.963) for binary (presence/absence) classification compared to the radiologist average of (0.786, 0.899, 0.842). For lateral recess stenosis, the sensitivity, specificity and AUROC of the CNN were (0.853, 0.787, 0.907) compared to the radiologist average of (0.713, 0.898, 805). For foraminal stenosis, the sensitivity, specificity and AUROC of the CNN were (0.942, 0.844, 0.950) compared to the radiologist average of (0.879, 0.877, 0.878). Multi-class severity classifications showed similarly comparable statistics. CONCLUSIONS The CNN showed comparable performance to radiologist subspecialists for the detection and classification of LSS. The integration of neural network models in the detection of LSS could bring higher accuracy, efficiency, consistency, and post-hoc interpretability in diagnostic practices.
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Affiliation(s)
- Vladislav Tumko
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Jack Kim
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA.
| | - Natalia Uspenskaia
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Shaun Honig
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Frederik Abel
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Darren R Lebl
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Irene Hotalen
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | | | - Mikhail Kochnev
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Andrej Rusakov
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Raphaël Mourad
- University of Toulouse, 118 Rte de Narbonne, 31062, Toulouse, France.
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16
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Yang S, Jing S, Wang S, Jia F. From drugs to biomaterials: a review of emerging therapeutic strategies for intervertebral disc inflammation. Front Cell Infect Microbiol 2024; 14:1303645. [PMID: 38352058 PMCID: PMC10861683 DOI: 10.3389/fcimb.2024.1303645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024] Open
Abstract
Chronic low back pain (LBP) is an increasingly prevalent issue, especially among aging populations. A major underlying cause of LBP is intervertebral disc degeneration (IDD), often triggered by intervertebral disc (IVD) inflammation. Inflammation of the IVD is divided into Septic and Aseptic inflammation. Conservative therapy and surgical treatment often fail to address the root cause of IDD. Recent advances in the treatment of IVD infection and inflammation range from antibiotics and small-molecule drugs to cellular therapies, biological agents, and innovative biomaterials. This review sheds light on the complex mechanisms of IVD inflammation and physiological and biochemical processes of IDD. Furthermore, it provides an overview of recent research developments in this area, intending to identify novel therapeutic targets and guide future clinical strategies for effectively treating IVD-related conditions.
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Affiliation(s)
- Shuhan Yang
- Department of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Shaoze Jing
- Department of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Shanxi Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Fajing Jia
- Department of General Practice, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
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17
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Byvaltsev VA, Kalinin AA, Shepelev VV, Pestryakov YY, Biryuchkov MY, Jubaeva BA, Boddapati V, Lehman RA, Riew KD. The Relationship of Radiographic Parameters and Morphological Changes at Various Stages of Degeneration of the Lumbar Facet Joints: Cadaver Study. Global Spine J 2024; 14:195-203. [PMID: 35499552 PMCID: PMC10676162 DOI: 10.1177/21925682221099471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Cadaveric specimens. OBJECTIVE To perform a pathomorphological analysis of the degree of facet joint (FJ) degeneration utilizing fresh cadaveric models and correlating these structural changes with imaging findings. METHODS L1-L5 FSU including all tissue between the anterior longitudinal ligament to the posterior spinal structures were obtained on 28 patients at a mean of 5.7 hours post-mortem. The samples were fixed in an agar medium and CT and MRI were performed. The level of FJ degeneration was identified based on prior classifications Osteoarthritis Research Society International (OARSI), as was the facet angle and tropism. Pathomorphological assessment including articular cartilage cell density was performed according to prior established methodology. RESULTS Radiographically, a direct association was identified between FJ degeneration and patient age. Facet angle and tropism did not significantly vary by patient age. Pathomorphologically, there was a decrease in the cellular density of articular cartilage with increasing patient age. Similarly, there was a significant direct correlation between radiographic degree of degenerative changes in FJs with the age of cadavers and the degree of degeneration of FJs according to the morphological classification of OARSI, as well as a significant inverse correlation with cell density. CONCLUSION A comprehensive assessment of various signs of FJ degeneration using cadaveric material has established that, based on radiographic imaging, it is possible to assess the microstructural state of FJ, including at an early stage of the disease. This data may be useful for surgeons in guiding therapeutic strategies based on individual biometric parameters of the FJ.
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Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
- Department of Traumatology, Orthopedics and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Valerii V Shepelev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Yurii Ya Pestryakov
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Mikhail Y Biryuchkov
- Department of Neurosurgery, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Bagdat A Jubaeva
- Department of Neurosurgery, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Venkat Boddapati
- Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Ronald A Lehman
- Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medical School
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18
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Kulesza M, Kicman A, Motyka J, Guszczyn T, Ławicki S. Importance of Metalloproteinase Enzyme Group in Selected Skeletal System Diseases. Int J Mol Sci 2023; 24:17139. [PMID: 38138968 PMCID: PMC10743273 DOI: 10.3390/ijms242417139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Bone tissue is a dynamic structure that is involved in maintaining the homeostasis of the body due to its multidirectional functions, such as its protective, endocrine, or immunological role. Specialized cells and the extracellular matrix (ECM) are responsible for the remodeling of specific bone structures, which alters the biomechanical properties of the tissue. Imbalances in bone-forming elements lead to the formation and progression of bone diseases. The most important family of enzymes responsible for bone ECM remodeling are matrix metalloproteinases (MMPs)-enzymes physiologically present in the body's tissues and cells. The activity of MMPs is maintained in a state of balance; disruption of their activity is associated with the progression of many groups of diseases, including those of the skeletal system. This review summarizes the current understanding of the role of MMPs in bone physiology and the pathophysiology of bone tissue and describes their role in specific skeletal disorders. Additionally, this work collects data on the potential of MMPs as bio-markers for specific skeletal diseases.
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Affiliation(s)
- Monika Kulesza
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15269 Bialystok, Poland; (M.K.); (J.M.)
| | - Aleksandra Kicman
- Department of Aesthetic Medicine, Medical University of Bialystok, 15267 Bialystok, Poland;
| | - Joanna Motyka
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15269 Bialystok, Poland; (M.K.); (J.M.)
| | - Tomasz Guszczyn
- Department of Pediatric Orthopaedics and Traumatology, Medical University of Bialystok, 15274 Bialystok, Poland;
| | - Sławomir Ławicki
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15269 Bialystok, Poland; (M.K.); (J.M.)
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19
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Hesni S, Baxter D, Saifuddin A. The imaging of cervical spondylotic myeloradiculopathy. Skeletal Radiol 2023; 52:2341-2365. [PMID: 37071191 DOI: 10.1007/s00256-023-04329-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
This review provides a detailed description of the imaging features of cervical spondylotic myelopathy and radiculopathy, with a focus on MRI. Where relevant, we will outline grading systems of vertebral central canal and foraminal stenosis. Whilst post-operative appearances of the cervical spine are outside the scope of this paper, we will touch on imaging features recognised as predictors of clinical outcome and neurological recovery. This paper will serve as a reference for both radiologists and clinicians involved in the care of patients with cervical spondylotic myeloradiculopathy.
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Affiliation(s)
- Susan Hesni
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK.
| | - David Baxter
- Department of Surgery, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
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20
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Crump KB, Alminnawi A, Bermudez‐Lekerika P, Compte R, Gualdi F, McSweeney T, Muñoz‐Moya E, Nüesch A, Geris L, Dudli S, Karppinen J, Noailly J, Le Maitre C, Gantenbein B. Cartilaginous endplates: A comprehensive review on a neglected structure in intervertebral disc research. JOR Spine 2023; 6:e1294. [PMID: 38156054 PMCID: PMC10751983 DOI: 10.1002/jsp2.1294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 12/30/2023] Open
Abstract
The cartilaginous endplates (CEP) are key components of the intervertebral disc (IVD) necessary for sustaining the nutrition of the disc while distributing mechanical loads and preventing the disc from bulging into the adjacent vertebral body. The size, shape, and composition of the CEP are essential in maintaining its function, and degeneration of the CEP is considered a contributor to early IVD degeneration. In addition, the CEP is implicated in Modic changes, which are often associated with low back pain. This review aims to tackle the current knowledge of the CEP regarding its structure, composition, permeability, and mechanical role in a healthy disc, how they change with degeneration, and how they connect to IVD degeneration and low back pain. Additionally, the authors suggest a standardized naming convention regarding the CEP and bony endplate and suggest avoiding the term vertebral endplate. Currently, there is limited data on the CEP itself as reported data is often a combination of CEP and bony endplate, or the CEP is considered as articular cartilage. However, it is clear the CEP is a unique tissue type that differs from articular cartilage, bony endplate, and other IVD tissues. Thus, future research should investigate the CEP separately to fully understand its role in healthy and degenerated IVDs. Further, most IVD regeneration therapies in development failed to address, or even considered the CEP, despite its key role in nutrition and mechanical stability within the IVD. Thus, the CEP should be considered and potentially targeted for future sustainable treatments.
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Affiliation(s)
- Katherine B. Crump
- Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical FacultyUniversity of BernBernSwitzerland
- Department of Orthopaedic Surgery and Traumatology, InselspitalBern University Hospital, Medical Faculty, University of BernBernSwitzerland
- Graduate School for Cellular and Biomedical Sciences (GCB)University of BernBernSwitzerland
| | - Ahmad Alminnawi
- GIGA In Silico MedicineUniversity of LiègeLiègeBelgium
- Skeletal Biology and Engineering Research Center, KU LeuvenLeuvenBelgium
- Biomechanics Research Unit, KU LeuvenLeuvenBelgium
| | - Paola Bermudez‐Lekerika
- Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical FacultyUniversity of BernBernSwitzerland
- Department of Orthopaedic Surgery and Traumatology, InselspitalBern University Hospital, Medical Faculty, University of BernBernSwitzerland
- Graduate School for Cellular and Biomedical Sciences (GCB)University of BernBernSwitzerland
| | - Roger Compte
- Twin Research & Genetic EpidemiologySt. Thomas' Hospital, King's College LondonLondonUK
| | - Francesco Gualdi
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)BarcelonaSpain
| | - Terence McSweeney
- Research Unit of Health Sciences and TechnologyUniversity of OuluOuluFinland
| | - Estefano Muñoz‐Moya
- BCN MedTech, Department of Information and Communication TechnologiesUniversitat Pompeu FabraBarcelonaSpain
| | - Andrea Nüesch
- Division of Clinical Medicine, School of Medicine and Population HealthUniversity of SheffieldSheffieldUK
| | - Liesbet Geris
- GIGA In Silico MedicineUniversity of LiègeLiègeBelgium
- Skeletal Biology and Engineering Research Center, KU LeuvenLeuvenBelgium
- Biomechanics Research Unit, KU LeuvenLeuvenBelgium
| | - Stefan Dudli
- Center of Experimental RheumatologyDepartment of Rheumatology, University Hospital Zurich, University of ZurichZurichSwitzerland
- Department of Physical Medicine and RheumatologyBalgrist University Hospital, Balgrist Campus, University of ZurichZurichSwitzerland
| | - Jaro Karppinen
- Research Unit of Health Sciences and TechnologyUniversity of OuluOuluFinland
- Finnish Institute of Occupational HealthOuluFinland
- Rehabilitation Services of South Karelia Social and Health Care DistrictLappeenrantaFinland
| | - Jérôme Noailly
- BCN MedTech, Department of Information and Communication TechnologiesUniversitat Pompeu FabraBarcelonaSpain
| | - Christine Le Maitre
- Division of Clinical Medicine, School of Medicine and Population HealthUniversity of SheffieldSheffieldUK
| | - Benjamin Gantenbein
- Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical FacultyUniversity of BernBernSwitzerland
- Department of Orthopaedic Surgery and Traumatology, InselspitalBern University Hospital, Medical Faculty, University of BernBernSwitzerland
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21
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Li Y, Zhang K, Ai X, Zhang Q, Jiang L, Long J, Xu H, Feng C, Zhang Y, Tang G, Chong F, Wang L, Huang B. A Biomimetic Peptide Functions as Specific Extracellular Matrix for Quiescence of Stem Cells against Intervertebral Disc Degeneration. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2300578. [PMID: 37423970 DOI: 10.1002/smll.202300578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/03/2023] [Indexed: 07/11/2023]
Abstract
Maintaining quiescence of stem cells is a potential way to decrease cell nutrition demand for restoring the organization. Herein, a biomimetic peptide to maintain quiescence of stem cells through C-X-C motif chemokine ligand 8 (CXCL8)-C-X-C motif chemokine receptor 1 (CXCR1) pathway against intervertebral disc degeneration (IVDD) is developed. First, it is confirmed that quiescence can be induced via inhibiting phosphatidylinositol 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway in nucleus pulposus stem cells (NPSCs). Meanwhile, it is well known that CXCR1, a chemokine receptor, can be targeted by CXCL8, resulting in cell proliferation via activating PI3K/Akt/mTOR pathway. Second, a biomimetic peptide (OAFF) that can bind to CXCR1 and form fibrous networks on NPSCs, mimicking extracellular matrix formation is developed. The multivalent effect and long-term binding to CXCR1 on NPSCs of OAFF fibers offer forcefully competitive inhibition with natural CXCL8, which induces NPSCs quiescence and ultimately overcomes obstacle in intradiscal injection therapy. In rat caudal disc puncture model, OAFF nanofibers still maintain at 5 weeks after operation and inhibit degeneration process of intervertebral disc in terms of histopathology and imageology. In situ fibrillogenesis of biomimetic peptide on NPSCs provides promising stem cells for intradiscal injection therapy against IVDD.
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Affiliation(s)
- Yuan Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, P. R. China
| | - Kuo Zhang
- CAS Center for Excellence in Nanoscience, CAS Key Laboratory for Biological Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology (NCNST), Beijing, 100190, P. R. China
| | - Xuezheng Ai
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, P. R. China
| | - Qingshi Zhang
- CAS Center for Excellence in Nanoscience, CAS Key Laboratory for Biological Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology (NCNST), Beijing, 100190, P. R. China
| | - Lu Jiang
- Clinical Medicine Research Center, Xinqiao Hospital, Army Medical University, Chongqing, 400037, P. R. China
| | - Jiang Long
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, P. R. China
| | - Huange Xu
- CAS Center for Excellence in Nanoscience, CAS Key Laboratory for Biological Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology (NCNST), Beijing, 100190, P. R. China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, P. R. China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, P. R. China
| | - Guoke Tang
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, 200080, P. R. China
| | - Fanli Chong
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, P. R. China
| | - Lei Wang
- CAS Center for Excellence in Nanoscience, CAS Key Laboratory for Biological Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology (NCNST), Beijing, 100190, P. R. China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, P. R. China
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22
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Ohtake Y, Yasaka K, Hamada A, Fujita N, Abe O. Effect of Deep Learning Reconstruction on Evaluating Cervical Spinal Canal Stenosis With Computed Tomography. J Comput Assist Tomogr 2023; 47:996-1001. [PMID: 37948377 DOI: 10.1097/rct.0000000000001490] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is commonly used to evaluate cervical spinal canal stenosis; however, some patients are ineligible for MRI. We aimed to assess the effect of deep learning reconstruction (DLR) in evaluating cervical spinal canal stenosis using computed tomography (CT) compared with hybrid iterative reconstruction (hybrid IR). METHODS This retrospective study included 33 patients (16 male patients; mean age, 57.7 ± 18.4 years) who underwent cervical spine CT. Images were reconstructed using DLR and hybrid IR. In the quantitative analyses, noise was recorded by placing the regions of interest on the trapezius muscle. In the qualitative analyses, 2 radiologists evaluated the depiction of structures, image noise, overall image quality, and degree of cervical canal stenosis. We additionally evaluated the agreement between MRI and CT in 15 patients for whom preoperative cervical MRI was available. RESULTS Image noise was less with DLR than hybrid IR in the quantitative ( P ≤ 0.0395) and subjective analyses ( P ≤ 0.0023), and the depiction of most structures was improved ( P ≤ 0.0052), which resulted in better overall quality ( P ≤ 0.0118). Interobserver agreement in the assessment of spinal canal stenosis with DLR (0.7390; 95% confidence interval [CI], 0.7189-0.7592) was superior to that with hybrid IR (0.7038; 96% CI, 0.6846-0.7229). As for the agreement between MRI and CT, significant improvement was observed for 1 reader with DLR (0.7910; 96% CI, 0.7762-0.8057) than hybrid IR (0.7536; 96% CI, 0.7383-0.7688). CONCLUSIONS Deep learning reconstruction provided better quality cervical spine CT images in the evaluation of cervical spinal stenosis than hybrid IR.
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Affiliation(s)
- Yuta Ohtake
- From the Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
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23
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Subramanian P, Ramachandran K, Arumugam T, Shetty AP, Kanna RM, Shanmuganathan R. Evaluation of Disc and Endplate Degeneration in AO Type A Fractures Using Magnetic Resonance Imaging Analysis. World Neurosurg 2023; 178:e758-e765. [PMID: 37562684 DOI: 10.1016/j.wneu.2023.08.005] [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: 06/22/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Disc degeneration after trauma has been the focus of several investigations, although vertebral endplate changes have received comparatively less attention. The main aim of the present study is to radiologically evaluate the prevalence of the degree of degeneration of the adjacent discs and endplates after AO type A thoracolumbar fractures. METHODS We retrospectively reviewed 25 patients with an AO type A injury (50 discs and 150 endplates). The type of disc lesion adjacent to the fractured vertebra was classified using the Pfirrmann and Oner classifications immediately after trauma and at the 1-year follow-up. The endplate defects were assessed using the endplate scoring system (total endplate score 1-6) in T1-weighted images. The kyphosis angle and vertebral body height were also measured. RESULTS The study population consisted of 18 men (72%) and 7 women (28%), with a mean age of 38.9 ± 11.3 years. Overall, 28% of the fractures were type A1, 4% were type A2, 24% were type A3, and 44% were type A4. On statistical analysis, a significant change was found in the degree of degeneration in the cranial adjacent disc using both the Oner (P = 0.004) and Pfirrmann (P = 0.001) classifications at the end of 1 year. The morphological changes at the cranial adjacent discs at 1 year of follow-up showed a strong positive correlation with superior endplate degeneration. CONCLUSIONS The results from the present study indicate that endplate fractures of vertebrae in patients with thoracolumbar burst fractures can cause disc degeneration, especially at the cranial endplate.
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Affiliation(s)
- Preetish Subramanian
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Thirumurugan Arumugam
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India.
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
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24
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Martel Villagrán J, Martínez-Sánchez RT, Cebada-Chaparro E, Bueno Horcajadas AL, Pérez-Fernández E. Diagnostic accuracy of lumbar CT and MRI in the evaluation of chronic low back pain without red flag symptoms. RADIOLOGIA 2023; 65 Suppl 2:S59-S70. [PMID: 37858354 DOI: 10.1016/j.rxeng.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/01/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Low back pain (LBP) is one of the most frequent reasons for medical consultation. Most of the patients will have nonspecific LBP, which usually are self-limited episodes. It is unclear which of the diagnostic imaging pathways is most effective and costeffective and how the imaging impacts on patient treatment. Imaging techniques are usually indicated if symptoms remain after 6 weeks. Magnetic resonance imaging (MRI) is the diagnostic imaging examination of choice in lumbar spine evaluation of low back pain; however, availability of MRI is limited. OBJECTIVES To evaluate the diagnostic accuracy of computed tomography (CT) with MRI (as standard of reference) in the evaluation of chronic low back pain (LBP) without red flags symptoms. To compare the results obtained by two radiologists with different grades of experience. MATERIALS AND METHODS Patients with chronic low back pain without red flags symptoms were retrospectively reviewed by two observers with different level of experience. Patients included had undergone a lumbar or abdominal CT and an MRI within a year. Once the radiological information was collected, it was then statistically reviewed. The aim of the statistical analysis is to identify the equivalence between both diagnostic techniques. To this end, sensitivity, specificity and validity index were calculated. In addition, intra and inter-observer reliability were measured by Cohen's kappa values and also using the McNemar test. RESULTS 340 lumbar levels were evaluated from 68 adult patients with chronic low back pain or sciatica. 63.2% of them were women, with an average age of 60.3 years (SD 14.7). CT shows high values of sensitivity and specificity (>80%) in most of the items evaluated, but sensitivity was low for the evaluation of density of the disc (40%) and for the detection of disc herniation (55%). Moreover, agreement between MRI and CT in most of these items was substantial or almost perfect (Cohen's kappa-coefficient > 0'8), excluding Modic changes (kappa = 0.497), degenerative changes (kappa0.688), signal of the disc (kappa = 0.327) and disc herniation (kappa = 0.639). Finally, agreement between both observers is mostly high (kappa > 0.8). Foraminal stenosis, canal stenosis and the grade of the canal stenosis were overdiagnosed by the inexperienced observer in the evaluation of CT images. CONCLUSIONS AND SIGNIFICANCE CT is as sensitive as lumbar MRI in the evaluation of most of the items analysed, excluding Modic changes, degenerative changes, signal of the disc and disc herniation. In addition, these results are obtained regardless the experience of the radiologist. The rising use of diagnostic medical imaging and the improvement of image quality brings the opportunity of making a second look of abdominal CT in search of causes of LBP. Thereby, inappropriate medical imaging could be avoided (2). In addition, it would allow to reduce MRI waiting list and prioritize other patients with more severe pathology than LBP.
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Affiliation(s)
- J Martel Villagrán
- Radiología musculoesquelética, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - E Cebada-Chaparro
- Radiología musculoesquelética, Hospital Universitario de Cáceres, Cáceres, Spain
| | - A L Bueno Horcajadas
- Radiología musculoesquelética, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - E Pérez-Fernández
- Metodología de la Investigación, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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25
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Tu J, Li W, Hansbro PM, Yan Q, Bai X, Donovan C, Kim RY, Galvao I, Das A, Yang C, Zou J, Diwan A. Smoking and tetramer tryptase accelerate intervertebral disc degeneration by inducing METTL14-mediated DIXDC1 m 6 modification. Mol Ther 2023; 31:2524-2542. [PMID: 37340635 PMCID: PMC10422004 DOI: 10.1016/j.ymthe.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/24/2023] [Accepted: 06/14/2023] [Indexed: 06/22/2023] Open
Abstract
Although cigarette smoking (CS) and low back pain (LBP) are common worldwide, their correlations and the mechanisms of action remain unclear. We have shown that excessive activation of mast cells (MCs) and their proteases play key roles in CS-associated diseases, like asthma, chronic obstructive pulmonary disease (COPD), blood coagulation, and lung cancer. Previous studies have also shown that MCs and their proteases induce degenerative musculoskeletal disease. By using a custom-designed smoke-exposure mouse system, we demonstrated that CS results in intervertebral disc (IVD) degeneration and release of MC-restricted tetramer tryptases (TTs) in the IVDs. TTs were found to regulate the expression of methyltransferase 14 (METTL14) at the epigenetic level by inducing N6-methyladenosine (m6A) deposition in the 3' untranslated region (UTR) of the transcript that encodes dishevelled-axin (DIX) domain-containing 1 (DIXDC1). That reaction increases the mRNA stability and expression of Dixdc1. DIXDC1 functionally interacts with disrupted in schizophrenia 1 (DISC1) to accelerate the degeneration and senescence of nucleus pulposus (NP) cells by activating a canonical Wnt pathway. Our study demonstrates the association between CS, MC-derived TTs, and LBP. These findings raise the possibility that METTL14-medicated DIXDC1 m6A modification could serve as a potential therapeutic target to block the development of degeneration of the NP in LBP patients.
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Affiliation(s)
- Ji Tu
- Spine Labs, St. George & Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Wentian Li
- Spine Labs, St. George & Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Philip M Hansbro
- Faculty of Science, School of Life Sciences, Centre for Inflammation, Centenary Institute, University of Technology Sydney, Sydney, NSW, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Qi Yan
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xupeng Bai
- Center for Innovation and Translational Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, First Affiliated Hospital, and Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Chantal Donovan
- Faculty of Science, School of Life Sciences, Centre for Inflammation, Centenary Institute, University of Technology Sydney, Sydney, NSW, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Richard Y Kim
- Faculty of Science, School of Life Sciences, Centre for Inflammation, Centenary Institute, University of Technology Sydney, Sydney, NSW, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Izabela Galvao
- Faculty of Science, School of Life Sciences, Centre for Inflammation, Centenary Institute, University of Technology Sydney, Sydney, NSW, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Abhirup Das
- Spine Labs, St. George & Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cao Yang
- Department of Orthopedic Surgery, Wuhan Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China.
| | - Jun Zou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Ashish Diwan
- Spine Labs, St. George & Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Spine Service, Department of Orthopedic Surgery, St. George Hospital, Kogarah, NSW, Australia.
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26
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MD MYY, MD CHG, MD CYW, MSc YPC, MSc HRJ, MD IHH, MD CDC. An Analysis of the Clinical and Radiological Prognostic Factors Affecting the Outcomes of Lumbar Intradiscal Biacuplasty. Int J Med Sci 2023; 20:1115-1122. [PMID: 37484806 PMCID: PMC10357441 DOI: 10.7150/ijms.85777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose: Intradiscal biacuplasty (IDB) has been proven to be effective for treating lumbar degenerative disc disease (DDD). However, there has not been a reported prognostic factor for IDB. The present study meticulously evaluates the general and radiographic features that may serve as markers for predicting the therapeutic outcome of IDB. Methods: A prospective case series study was conducted, following time-series analysis moving averages models, with forty-one patients suffering from chronic discogenic lower back pain for more than six months. These patients subsequently received lumbar cool radiofrequency IDB and were enrolled in the study. Thirty-seven patients completed follow-up questionnaires at 1, 3, 6, and 12 months. The surgical outcomes were reported using visual analogue scale (VAS), Oswestry disability index (ODI), and the consumption of nonsteroidal anti-inflammatory drugs (NSAID). Furthermore, a univariate analysis was performed to identify prognostic factors associated with pain relief from age, gender, body mass index (BMI), and pre-operative lumbar magnetic resonance imaging reading. Results: Significant reductions were found in estimated VAS and ODI at the post-operative period at 1, 3, 6, and 12 months (P < 0.001). The NSAID dosage was significantly decreased at 3-month and 1-year follow-up (P < 0.05). No procedure-related complications were detected. The prognosis of IDB was not related to disc height, Pfirrmann grading or Modic endplate change. However, disc extrusions were associated with promising outcomes (VAS improvement ≥ 50%) on pain relief (P < 0.05). Conclusion: IDB is a good alternative choice for treating lumbar DDD. Patients with a painful extrusion lumbar disc may gain some benefits after receiving IDB following a period of failed conservative treatment. These findings may also add some references for physicians in the decision making when treating lumbar DDD.
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Affiliation(s)
- Meng-Yin Yang MD
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- College of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chin-Hwee Goh MD
- Department of Neurosurgery, Sarawak General Hospial, Kuching, Sarawak, East Malaysia
| | - Chin-Ying Wu MD
- Department of Neurosurgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - You-Pen Chiu MSc
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Hui-Ru Ji MSc
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - I-Han Hsiao MD
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
- Spine Center, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Di Chiu MD
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Spine Center, China Medical University Hospital, Taichung, Taiwan
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27
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Sun SP, Phang CR, Tzou SC, Chen CM, Ko LW. Integration of MRI and somatosensory evoked potentials facilitate diagnosis of spinal cord compression. Sci Rep 2023; 13:7861. [PMID: 37188786 DOI: 10.1038/s41598-023-34832-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
This study aimed to integrate magnetic resonance imaging (MRI) and related somatosensory evoked potential (SSEP) features to assist in the diagnosis of spinal cord compression (SCC). MRI scans were graded from 0 to 3 according to the changes in the subarachnoid space and scan signals to confirm differences in SCC levels. The amplitude, latency, and time-frequency analysis (TFA) power of preoperative SSEP features were extracted and the changes were used as standard judgments to detect neurological function changes. Then the patient distribution was quantified according to the SSEP feature changes under the same and different MRI compression grades. Significant differences were found in the amplitude and TFA power between MRI grades. We estimated three degrees of amplitude anomalies and power loss under each MRI grade and found the presence or absence of power loss occurs after abnormal changes in amplitude only. For SCC, few integrated approach combines the advantages of both MRI and evoked potentials. However, integrating the amplitude and TFA power changes of SSEP features with MRI grading can help in the diagnosis and speculate progression of SCC.
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Affiliation(s)
- Shu-Pin Sun
- International Ph.D. Program in Interdisciplinary Neuroscience (UST), College of Biological Science and Technology, National Yang Ming Chiao Tung University, 734, Engineering Bldg. 5, 1001 Daxue Road, Hsinchu, 30010, Taiwan, ROC
- Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 300, Taiwan, ROC
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, 300, Taiwan, ROC
| | - Chun-Ren Phang
- International Ph.D. Program in Interdisciplinary Neuroscience (UST), College of Biological Science and Technology, National Yang Ming Chiao Tung University, 734, Engineering Bldg. 5, 1001 Daxue Road, Hsinchu, 30010, Taiwan, ROC
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, 300, Taiwan, ROC
| | - Shey-Cherng Tzou
- Institute of Molecular Medicine and Bioengineering, National Yang Ming Chiao Tung University, Hsinchu, 300, Taiwan, ROC
- Department of Biomedical Science and Environment Biology, and the Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, ROC
| | - Chang-Mu Chen
- Department of Surgery, College of Medicine and Hospital, National Taiwan University, No. 7, Zhongshan South Road, Taipei, 10002, Taiwan, ROC.
| | - Li-Wei Ko
- International Ph.D. Program in Interdisciplinary Neuroscience (UST), College of Biological Science and Technology, National Yang Ming Chiao Tung University, 734, Engineering Bldg. 5, 1001 Daxue Road, Hsinchu, 30010, Taiwan, ROC.
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, 300, Taiwan, ROC.
- Institute of Electrical and Control Engineering, Department of Electronics and Electrical Engineering, National Yang Ming Chiao Tung University, Hsinchu, 300, Taiwan, ROC.
- Department of Biomedical Science and Environment Biology, and the Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, ROC.
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28
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Lorio MP, Beall DP, Calodney AK, Lewandrowski KU, Block JE, Mekhail N. Defining the Patient with Lumbar Discogenic Pain: Real-World Implications for Diagnosis and Effective Clinical Management. J Pers Med 2023; 13:jpm13050821. [PMID: 37240991 DOI: 10.3390/jpm13050821] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
There is an enormous body of literature that has identified the intervertebral disc as a potent pain generator. However, with regard to lumbar degenerative disc disease, the specific diagnostic criteria lack clarity and fail to capture the primary components which include axial midline low back pain with or without non-radicular/non-sciatic referred leg pain in a sclerotomal distribution. In fact, there is no specific ICD-10-CM diagnostic code to classify and define discogenic pain as a unique source of pain distinct from other recognized sources of chronic low back pain including facetogenic, neurocompressive including herniation and/or stenosis, sacroiliac, vertebrogenic, and psychogenic. All of these other sources have well-defined ICD-10-CM codes. Corresponding codes for discogenic pain remain absent from the diagnostic coding vernacular. The International Society for the Advancement of Spine Surgery (ISASS) has proposed a modernization of ICD-10-CM codes to specifically define pain associated with lumbar and lumbosacral degenerative disc disease. The proposed codes would also allow the pain to be characterized by location: lumbar region only, leg only, or both. Successful implementation of these codes would benefit both physicians and payers in distinguishing, tracking, and improving algorithms and treatments for discogenic pain associated with intervertebral disc degeneration.
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Affiliation(s)
- Morgan P Lorio
- Advanced Orthopedics, 499 E. Central Pkwy., Ste. 130, Altamonte Springs, FL 32701, USA
| | - Douglas P Beall
- Clinical Radiology of Oklahoma, 1800 S. Renaissance Blvd., Ste. 110, Edmond, OK 73013, USA
| | | | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona, 4787 E. Camp Lowell Drive, Tucson, AZ 85712, USA
| | - Jon E Block
- Independent Consultant, 2210 Jackson Street, Ste. 401, San Francisco, CA 94115, USA
| | - Nagy Mekhail
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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29
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Duculan R, Fong AM, Cammisa FP, Sama AA, Hughes AP, Lebl DR, Farmer JC, Huang RC, Sandhu HS, Mancuso CA, Girardi FP. Emerging Need for PROMs to Measure the Impact of Spine Disorders on Overall Health and Well-being: Measuring Expectations as an Example for Lumbar Degenerative Spondylolisthesis. HSS J 2023; 19:163-171. [PMID: 37065099 PMCID: PMC10090837 DOI: 10.1177/15563316221146123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/02/2022] [Indexed: 01/15/2023]
Abstract
Background: Assessing the impact of spine disorders such as lumbar degenerative spondylolisthesis (LDS) on overall health is a component of quality of care that may not be comprehensively captured by spine-specific and single-attribute patient-reported outcome measures (PROMs). Purpose: We sought to compare PROMs to the Lumbar Surgery Expectations Survey ("Expectations Survey"), which addresses multiple aspects of health and well-being, and to compare the relevance of surgeon-selected versus survey-selected Patient-Reported Outcomes Measurement Information System (PROMIS) items to LDS. Methods: In a cross-sectional study, 379 patients with LDS preoperatively completed the Expectations Survey, Numerical Rating Pain Scales, Oswestry Disability Index (ODI), and PROMIS computer-adaptive physical function, pain, and mental health surveys. Expectations Survey scores were compared to PROMs with correlation coefficients (indicating strengths of relationships) and probability values (indicating associations by chance). Surgeons reviewed physical function questions to identify those particularly relevant to LDS. Results: Patients' mean age was 67 years, 64% were women, and 83% had single-level and 17% had multiple-level LDS. Probability values between the Expectations Survey and PROMs were reliable, but strengths of relationships were only mild to moderate, indicating PROMs did not comprehensively capture the impact of LDS. None of the surgeon-selected PROMIS physical function questions were posed to patients. Conclusion: This cross-sectional study found PROMs to be reliably associated but not strongly correlated with the Expectations Survey, which addresses the whole-patient impact of LDS. New measures that complement PROMIS and ODI should be developed to capture the whole-person effects of LDS and permit attribution of LDS treatments to overall health.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Carol A. Mancuso
- Hospital for Special Surgery, New York,
NY, USA
- Weill Cornell Medical College, New
York, NY, USA
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30
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Mesregah MK, Formanek B, Liu JC, Buser Z, Wang JC. Perioperative Complications of Surgery for Degenerative Cervical Myelopathy: A Comparison Between 3 Procedures. Global Spine J 2023; 13:432-442. [PMID: 33709809 PMCID: PMC9972283 DOI: 10.1177/2192568221998306] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVES To compare the perioperative complications of propensity score-matched cohorts of patients with degenerative cervical myelopathy (DCM), who were treated with anterior cervical discectomy and fusion (ACDF), posterior laminectomy with fusion, or laminoplasty. METHODS The Humana PearlDiver Patient Record Database was queried using the International Classification of Diseases (ICD-9 and ICD-10) and the Current Procedural Terminology (CPT) codes. Propensity score-matched analysis was done using multiple Chi-squared tests with Bonferroni correction of the significance level. RESULTS Cohorts of 11,790 patients who had ACDF, 2,257 patients who had posterior laminectomy with fusion, and 477 patients who had laminoplasty, were identified. After propensity score matching, all the 3 groups included 464 patients. The incidence of dysphagia increased significantly following ACDF compared to laminoplasty, P < 0.001, and in laminectomy with fusion compared to laminoplasty, P < 0.001. The incidence of new-onset cervicalgia was higher in ACDF compared to laminoplasty, P = 0.005, and in laminectomy with fusion compared to laminoplasty, P = 0.004. The incidence of limb paralysis increased significantly in laminectomy with fusion compared to ACDF, P = 0.002. The revision rate at 1 year increased significantly in laminectomy with fusion compared to laminoplasty, P < 0.001, and in ACDF compared to laminoplasty, P < 0.001. CONCLUSIONS The incidence of dysphagia following laminectomy with fusion was not different compared to ACDF. Postoperative new-onset cervicalgia and revisions were least common in laminoplasty. The highest rate of postoperative limb paralysis was noticed in laminectomy with fusion.
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Affiliation(s)
- Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA,Department of Orthopaedic Surgery,
Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Blake Formanek
- Department of Orthopaedic Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA
| | - John C. Liu
- Department of Neurosurgery, Keck School
of Medicine, University of Southern
California, Los Angeles, CA, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA,Zorica Buser, Department of Orthopaedic
Surgery, Keck School of Medicine, University of Southern California, 1450 San
Pablo St, HC4-#5400A, Los Angeles, CA 90033, USA.
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA
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31
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Zangpo D, Uehara K, Kondo K, Yoshimiya M, Nakatome M, Iino M. A novel method to estimate adult age from the lumbar vertebral body using 3D PMCT images in Japanese. Leg Med (Tokyo) 2023; 61:102215. [PMID: 36812806 DOI: 10.1016/j.legalmed.2023.102215] [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: 10/03/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
This study evaluated the age-related changes in the vertebral body using 3D Postmortem CT (PMCT) images and proposed an alternative age estimation formula. The PMCT images of 200 deceased individuals aged 25 to 99 years (126 males, 74 females) were retrospectively reviewed and included in the study. Using the open-source software ITK-SNAP and MeshLab, a 3D surface mesh of the fourth lumbar vertebral body (L4) and its convex hull models were created from the PMCT data. Using their inbuilt tools, volumes (in mm3) of the L4 surface mesh and convex hull models were subsequently computed. We derived VD, defined as the difference in volumes between the convex hull and L4 surface mesh normalized by L4 mesh volume, and VR, defined as the ratio of L4 mesh volume to convex hull volume based on individual L4. Correlation and regression analyses were performed between VD, VR, and chronological age. A statistically significant positive correlation (P < 0.001) between chronological age and VD, (rs = 0.764, males; rs = 0.725, females), and a significant negative correlation between chronological age and VR (rs = -0.764, males; rs = -0.725, females) was obtained in both sexes. The lowest standard error of the estimate was demonstrated by the VR at 11.9 years and 12.5 years for males and females, respectively. As such, their regression models to estimate adult age were Age = 248.9-2.5VR years, males; Age = 258.1-2.5VR years, females. These regression equations may be useful for estimating age in Japanese adults in forensic settings.
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Affiliation(s)
- Dawa Zangpo
- Division of Forensic Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan; Department of Forensic Medicine & Toxicology, Jigme Dorji Wangchuk National Referral Hospital, Thimphu 11001, Bhutan
| | - Kazutake Uehara
- Department of Mechanical Engineering, National Institute of Technology, Yonago College, Yonago 683-8502, Japan
| | - Katsuya Kondo
- Department of Electrical Engineering & Computer Science, Faculty of Engineering, Tottori University, Tottori 680-8552, Japan
| | - Motoo Yoshimiya
- Division of Forensic Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Masato Nakatome
- Division of Forensic Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Morio Iino
- Division of Forensic Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan.
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Martel Villagrán J, Martínez-Sánchez R, Cebada-Chaparro E, Bueno Horcajadas A, Pérez-Fernández E. Validez de la TC lumbar frente a la RM lumbar en el estudio de la lumbalgia y la lumbociatalgia crónica sin criterios de alarma. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Fine N, Lively S, Séguin CA, Perruccio AV, Kapoor M, Rampersaud R. Intervertebral disc degeneration and osteoarthritis: a common molecular disease spectrum. Nat Rev Rheumatol 2023; 19:136-152. [PMID: 36702892 DOI: 10.1038/s41584-022-00888-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/27/2023]
Abstract
Intervertebral disc degeneration (IDD) and osteoarthritis (OA) affecting the facet joint of the spine are biomechanically interdependent, typically occur in tandem, and have considerable epidemiological and pathophysiological overlap. Historically, the distinctions between these degenerative diseases have been emphasized. Therefore, research in the two fields often occurs independently without adequate consideration of the co-dependence of the two sites, which reside within the same functional spinal unit. Emerging evidence from animal models of spine degeneration highlight the interdependence of IDD and facet joint OA, warranting a review of the parallels between these two degenerative phenomena for the benefit of both clinicians and research scientists. This Review discusses the pathophysiological aspects of IDD and OA, with an emphasis on tissue, cellular and molecular pathways of degeneration. Although the intervertebral disc and synovial facet joint are biologically distinct structures that are amenable to reductive scientific consideration, substantial overlap exists between the molecular pathways and processes of degeneration (including cartilage destruction, extracellular matrix degeneration and osteophyte formation) that occur at these sites. Thus, researchers, clinicians, advocates and policy-makers should consider viewing the burden and management of spinal degeneration holistically as part of the OA disease continuum.
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Affiliation(s)
- Noah Fine
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Starlee Lively
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Cheryle Ann Séguin
- Department of Physiology & Pharmacology, Schulich School of Medicine & Dentistry, Bone and Joint Institute, University of Western Ontario London, London, Ontario, Canada
| | - Anthony V Perruccio
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohit Kapoor
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Raja Rampersaud
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada. .,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. .,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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34
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Quan H, Zuo X, Huan Y, Wang X, Yao Z, Wang C, Ren F, Wang H, Qin H, Hu X. A systematic morphology study on the effect of high glucose on intervertebral disc endplate degeneration in mice. Heliyon 2023; 9:e13295. [PMID: 36816302 PMCID: PMC9932476 DOI: 10.1016/j.heliyon.2023.e13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
To explore the relationship between diabetes and intervertebral disc degeneration in mice and the associated underlying mechanism. Four-week-old male Kunming mice were used to model diabetes using a high-fat diet combined with streptozotocin injection. After 6 months, morphological and pathological changes in L4-L6 intervertebral discs were detected by magnetic resonance imaging, micro-CT and histological staining. Immunostaining of CD31, F4/80 and CD16/32 receptors was used to detect vascular invasion and inflammatory infiltration in endplates; the exact changes were then explored by the transmission electron microscopy. The nucleus pulposus of the control and the diabetic group had a clear boundary and regular shape without collapse, while endplate calcification and chondrocyte abnormality in the diabetic group were more obvious. Immunofluorescence confirmed that compared to control, expression levels of CD31 (vascular endothelial marker) and F4/80 (monocyte/macrophage marker) in the diabetic group were significantly increased (P < 0.05), with an elevated number of F4/80 (+)/CD16/32 (+) cells (P < 0.05). The morphology of endplates was observed by transmission electron microscopy, which showed monocytes/macrophage accumulation in the endplate of the diabetic group, accompanied by increased vascular density, collagen fiber distortion and chondrocyte abnormality. In a conclusion, diabetes promotes endplate degeneration with vascular invasion, monocyte/macrophage infiltration and inflammation in mice.
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Affiliation(s)
- Huilin Quan
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Xiaoshuang Zuo
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Yu Huan
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Xuankang Wang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Zhou Yao
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Chunmei Wang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Fang Ren
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Hong Wang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Hongyan Qin
- State Key Laboratory of Cancer Biology, Department of Medical Genetics and Developmental Biology, Fourth Military Medical University, Xi'an, 710032 Shaanxi China,Corresponding author.
| | - Xueyu Hu
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China,Corresponding author.
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Hsu TL, Lee YH, Wang YH, Chang R, Wei JCC. Association of Hallux Valgus with Degenerative Spinal Diseases: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1152. [PMID: 36673906 PMCID: PMC9858771 DOI: 10.3390/ijerph20021152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Background: Although hallux valgus is known to cause lower-back pain, the association between hallux valgus and spinal degenerative disease remains unclear. Methods: A retrospective cohort study was conducted between 1 January 2000 and 31 December 2015 using data from the Longitudinal Health Insurance Database in Taiwan. After propensity score matching for age, sex, and some potential comorbidities, 1000 individuals newly diagnosed with hallux valgus were enrolled in the study group, while 1000 individuals never diagnosed with hallux valgus served as the control group. Both groups were followed up until 2015 to evaluate the incidence of hallux valgus. Kaplan-Meier analysis was used to determine the cumulative incidence of hallux valgus, while the Cox proportional hazard model was adopted to estimate the hazard ratio (HR) and adjusted hazard ratio (aHR) with 95% confidence intervals (CIs). Results: The incidence densities of spinal degeneration in the hallux valgus and non-hallux valgus groups were 73.10 and 42.63 per 1000 person-years, respectively. An increased risk of spinal degenerative changes was associated with hallux valgus (adjusted HR = 1.75, 95% CI = 1.50−2.05). Age- and sex-stratified analyses showed a significantly higher risk of spinal degeneration in the hallux valgus group. Moreover, sub-outcome evaluations revealed significantly higher risks of spondylosis (aHR = 2.01, 95% CI = 1.55−2.61), intervertebral disorder (aHR = 2.27, 95% CI = 1.62−3.17), and spinal stenosis (aHR = 1.24, 95% CI = 1.47−1.76). There was also an increased risk of spinal degenerative change in those with hallux valgus without surgical intervention (aHR = 1.95, 95% CI = 1.66−2.99, p < 0.001). Conclusions: Hallux valgus was associated with increased risk of degenerative spinal changes and other spinal disorders.
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Affiliation(s)
- Ta-Li Hsu
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Yung-Heng Lee
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu 304, Taiwan
- Department of Recreation and Sport Management, Shu-Te University, Kaohsiung 824, Taiwan
- Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung 842, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Department of Recreation Sports Management, Tajen University, Pingtung 907, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 404, Taiwan
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36
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Liu Z, Zhu J, Liu H, Fu C. Natural products can modulate inflammation in intervertebral disc degeneration. Front Pharmacol 2023; 14:1150835. [PMID: 36874009 PMCID: PMC9978229 DOI: 10.3389/fphar.2023.1150835] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
Intervertebral discs (IVDs) play a crucial role in maintaining normal vertebral anatomy as well as mobile function. Intervertebral disc degeneration (IDD) is a common clinical symptom and is an important cause of low back pain (LBP). IDD is initially considered to be associated with aging and abnormal mechanical loads. However, over recent years, researchers have discovered that IDD is caused by a variety of mechanisms, including persistent inflammation, functional cell loss, accelerated extracellular matrix decomposition, the imbalance of functional components, and genetic metabolic disorders. Of these, inflammation is thought to interact with other mechanisms and is closely associated with the production of pain. Considering the key role of inflammation in IDD, the modulation of inflammation provides us with new options for mitigating the progression of degeneration and may even cause reversal. Many natural substances possess anti-inflammatory functions. Due to the wide availability of such substances, it is important that we screen and identify natural agents that are capable of regulating IVD inflammation. In fact, many studies have demonstrated the potential clinical application of natural substances for the regulation of inflammation in IDD; some of these have been proven to have excellent biosafety. In this review, we summarize the mechanisms and interactions that are responsible for inflammation in IDD and review the application of natural products for the modulation of degenerative disc inflammation.
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Affiliation(s)
- Zongtai Liu
- Department of Spine Surgery, First Hospital of Jilin University, Changchun, China.,Department of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Jiabo Zhu
- Department of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Haiyan Liu
- Department of Orthopedics, Baicheng Central Hospital, Baicheng, China
| | - Changfeng Fu
- Department of Spine Surgery, First Hospital of Jilin University, Changchun, China
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37
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The current state of radiodiagnostics of degenerative changes in the lumbar spine (literature review). ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.6.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Examination of the spine using radiological methods remains the most frequently conducted study in the outpatient practice of almost any radiologist. In most cases, changes in the spine are degenerative and dystrophic in nature. These changes in the spine are the leading cause of loss of activity among adults and the elderly, and cover a wide range of age-related structural changes. It is of great importance to understand the possibilities and limitations of radiological methods of diagnostics. The description of morphological changes observed in degenerative and dystrophic changes requires the use of unified terminology and classifications among clinicians and radiologists.The aim. To present modern concepts in the assessment of degenerative changes of the spine using radiological methods. A description of the standardized international nomenclature of intervertebral disc pathology and current classifications of spinal canal stenosis are presented.Material and methods. For literature search, we used electronic databases MEDLINE (PubMed), eLibrary, EMBASE and Cochrane Library with a selection of sources published from 2000 to 2021. We analyzed the works devoted to the diagnosis of degenerative changes in lumbar spine and to degenerative stenosis.Conclusion. The key to productive communication between physicians is the uniformity or standardization of terminology and definitions used. It is important that the protocol of description, its terms, semantic expressions be uniform and understandable to specialists who are involved in the diagnosis and treatment of the spine. Magnetic resonance imaging is a valuable method in the diagnosis of degenerative changes of the spinal column, but it has its limitations.
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Murgoci N. The impact of perception regarding therapeutic exercises and dietary changing adherence of subjects known with low back pain. BALNEO AND PRM RESEARCH JOURNAL 2022. [DOI: 10.12680/balneo.2022.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract: Debates regarding the role of therapeutic exercises and diet as modulators of an anti-inflammatory state occurred in the last years in the medical environment. The syner-gy between moderate-intensity exercise and a proper diet targeting decreasing IL-1 inhib-its the production of the pro-inflammatory cytokine TNF-α, the key regulator of local and systemic inflammation. One of the most important causes of short and long-term disabil-ity in all occupational groups is back pain, impacting the quality of life. Degeneration of the intervertebral disc (IVD) causes low back pain that intensifies with age. Assessment of the Oswestry Disability Index was applied on 23 subjects with low back pain to investigate the degree of disability. Nutrition of IVD, implying therapeutic exercises, and a customized diet may be crucial adjuvants for the rehabilitation process. The appropriate diet and therapeutic exercise approach are meant to evaluate the impact of awareness regarding the possibility of improving health outcomes. In this present study, women have a strong positive Pearson correlation (p<0.05) with minimal (66-70 years) disability and moderate disability (r=1.000, CI =99%). Subjects with moderate disability conditions have “no” intention to implement diet changes and maintain therapeutic exercise adher-ence (r=0.902, CI = 95%). Men (71-75 years, r=0.995, CI =99%) registered a positive strong correlation with maximum deficiency (r=1.000, CI =99%) and “possible no” change in diet and exercise adherence will be applied (r=0.866, CI = 95%). Total disability responders an-swered with a “probable yes” option (r=0.884, CI=95%) but the dependence on their ca-reers is decisive. The education strategy is essential because diet change implementation can cause resistive behavior as well as adherence to exercise therapy. A key to effectively managing the inflammatory state due to different comorbidities is to use the cumulative effects of health professionals' prescriptions. The challenge is to ensure adherence to these actions for each patient.
Keywords: anti-inflammatory, therapeutic exercises, rehabilitation, diet, Oswestry Disability In-dex (ODI), back pain, intervertebral disc, nutrition, perception, disability.
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Affiliation(s)
- Nicolae Murgoci
- 1 “Dunărea de Jos” University, Faculty of Physical Education and Sports, Department of Individual Sports and Kinetotherapy, 63-65 Gării Street, Galați, Romania
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Yamaguchi T, Morino K. Perivascular mechanical environment: A narrative review of the role of externally applied mechanical force in the pathogenesis of atherosclerosis. Front Cardiovasc Med 2022; 9:944356. [PMID: 36337892 PMCID: PMC9629355 DOI: 10.3389/fcvm.2022.944356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/26/2022] [Indexed: 12/04/2022] Open
Abstract
Atherosclerosis is promoted by systemic factors, such as dyslipidemia, hypertension, diabetes, and smoking, which cause atherosclerosis in blood vessels throughout the body. However, atherosclerotic lesions are characterized by their frequent occurrence in specific vessels and sites. Blood vessels are exposed to various mechanical forces related to blood pressure and flow. Although shear stress promotes the initiation and progression of atherosclerotic lesions, the pathogenesis of site specificity of atherosclerosis is not sufficiently explained by shear stress. We propose the concept of a perivascular mechanical environment (PVME). Compelling evidence suggests that site specificity in atherosclerotic lesions depends on a distinct local PVME. Atheroprone arteries, such as the coronary artery, are markedly affected by externally applied mechanical force (EMF), whereas atheroprotective arteries, such as the internal thoracic artery, are less affected. Recent studies have shown that the coronary artery is affected by cardiac muscle contraction, the carotid artery by the hyoid bone and the thyroid cartilage, and the abdominal aorta and lower extremity arteries by musculoskeletal motion. We speculate that the thoracic cage protects the internal thoracic artery from EMF owing to a favorable PVME. Furthermore, evidence suggests that plaque eccentricity is provided by EMF; plaques are frequently observed on an external force-applied side. In each vascular tree, site-specific characteristics of the PVME differ substantially, inducing individual atherogenicity. From the perspective of the mechanical environment, hemodynamic stress occurs in an inside-out manner, whereas EMF occurs in an outside-in manner. These inward and outward forces apply mechanical load individually, but interact synergistically. The concept of a PVME is a novel pathogenesis of atherosclerosis and also might be a pathogenesis of other arterial diseases.
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Affiliation(s)
| | - Katsutaro Morino
- Institutional Research Office, Shiga University of Medical Science, Otsu, Japan
- *Correspondence: Katsutaro Morino,
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40
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Elfadle AA, Zarad CA, Elmaaty AAA, El-Nagaa BFA, Soliman AY. Correlation between lumbar spinal canal magnetic resonance imaging grading systems and parameters in lumbar spinal canal compromise. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is a need to assess how commonly used classification systems of intervertebral disc degeneration reflect the compromise of neural elements. This study aims to explore the relationship between lumbar discs degenerative diseases using the Pfirrmann and the Combined Task Forces (CTF) of the North American Spine Society (NASS) grading systems as well as qualitative and quantitative grades of lumbar spinal stenosis. This retrospective cohort study included adult patients undergoing non-contrast MR imaging of lumbosacral spine. The radiological assessment included the Pfirrmann grading system, Van Rijn classification, Combined Task Force (CTF) classification, measurement of the cross-sectional area of the dural sac, mid-sagittal antero-posterior diameter of the thecal sac, the degree of dural sac compression at disc level, lateral recesses heights, and intervertebral foramina diameters. The degree of stenosis of the spinal canal and intervertebral foramina was assessed.
Results
One hundred patients were included in the study. At all levels, Pfirrmann grades had a moderate, significant, positive correlation with the severity of stenosis of the central and lateral spinal canals as well as foraminal stenosis. The grades of lumbar spinal canal and foraminal stenosis had a significant positive correlation with degree of disc displacement as assessed by CTF classification and had a significant negative correlation with the quantitative lumbar spinal canal and foraminal measures.
Conclusions
There is a good correlation between Pfirrmann classification, CTF classification of NASS, qualitative grading and quantitative measures of lumbar spinal canal that reflects the severity of lumbar spinal canal stenosis and nerve root compression.
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Sharma S, Neelavalli J, Shah T, Gupta RK. Susceptibility-weighted imaging: an emerging technique for evaluation of the spine and spinal cord. Br J Radiol 2022; 95:20211294. [PMID: 35830235 PMCID: PMC9815740 DOI: 10.1259/bjr.20211294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/13/2022] [Accepted: 06/28/2022] [Indexed: 01/13/2023] Open
Abstract
We present the application of three-dimensional susceptibility-weighted imaging technique for evaluation of pathologies of the spine and spinal cord. This work focuses on the advantage of this imaging technique as an adjunct to the conventional imaging to evaluate various disorders of the spine and spinal cord like trauma, degenerative diseases, vascular malformations, and tumours, where susceptibility-weighted imaging may offer valuable harmonising evidence that may be helpful in the diagnosis and management of the patients with these pathologies.
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Affiliation(s)
- Shalini Sharma
- Department of Radiology, Fortis Memorial Research Institute, Gurgaon, India
| | | | | | - Rakesh Kumar Gupta
- Department of Radiology, Fortis Memorial Research Institute, Gurgaon, India
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42
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In-vitro models of disc degeneration - A review of methods and clinical relevance. J Biomech 2022; 142:111260. [PMID: 36027637 DOI: 10.1016/j.jbiomech.2022.111260] [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: 03/09/2022] [Revised: 07/22/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022]
Abstract
The intervertebral disc (IVD) provides flexibility, acts as a shock absorber, and transmits load. Degeneration of the IVD includes alterations in the biomechanics, extracellular matrix (ECM), and cellular activity. These changes are not always perceived, however, IVD degeneration can lead to severe health problems including long-term disability. To understand the pathogenesis of IVD degeneration and suitable testing methods for emerging treatments and therapies, this review documents in-vitro models of IVD degeneration including physical disruption, hyperphysiological loading, ECM degradation by enzyme digestion, or a combination of these methods. This paper reviews and critically analyses the models of degeneration published since the year 2000 in either in human or animal specimens. The results are categorised in terms of the IVD biomechanics, physical attributes, ECM composition, tissue damage and cellularity to evaluate the models with respect to natural human degeneration, and to provide recommendations for clinically relevant models for the various stages of degeneration. There is no one model that replicates the wide range of degenerative changes that occur as part of normal degeneration. However, cyclic overloading replicates many aspects of degeneration, with the advantage of a dose-response allowing the tuning of damage initiated. Models of severe degeneration are currently lacking, but there is potential that combining cyclic overloading and enzymatic digestion will provide model that closely resembles human IVD degeneration. This will provide an effective way to investigate the effects of severe degeneration, and the evaluation of treatments for the IVD, which would generally be indicated at this advanced stage of degeneration.
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McDonnell JM, Rigney B, Storme J, Ahern DP, Cunniffe G, Butler JS. Pharmacogenetic profiling and individualised therapy in the treatment of degenerative spinal conditions. Ir J Med Sci 2022:10.1007/s11845-022-03112-9. [PMID: 35962253 DOI: 10.1007/s11845-022-03112-9] [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: 06/11/2022] [Accepted: 07/20/2022] [Indexed: 10/15/2022]
Abstract
Patients presenting with degenerative spinal changes are often poor surgical candidates due to associated co-morbidities, frailty, or sarcopenia. Additionally, surgeries of a degenerative spine can prove difficult due to the distortion of normal surgical anatomy. Therefore, many patients are managed conservatively with a variety of modalities, including over-the-counter and prescription medications. Nevertheless, several patients do not experience adequate relief from pain with analgesic medications, precipitating multiple hospital visits, and usage of resources. As a result, back pain is regarded as a major economic burden, with total costs of associated treatment exceeding $100 billion annually. Pharmacogenetics is a relatively novel method of evaluating an individual's response to analgesic medications, through analysis of germline polymorphisms. It entails obtaining a genetic sample, often via buccal swab or peripheral blood sample, and genetic analysis achieved through either polymerase chain reaction +/- Sanger sequencing, microassays, restriction length fragment polymorphism analysis, or genetic library preparation and next generation sequencing. The potential efficacy of pharmacogenetic analysis has been highlighted across several specialities to date. However, a paucity of evidence exists regarding spine surgery populations. Nevertheless, regular prospective pharmacogenetic analysis may ultimately prove beneficial when concerning degenerative spinal cohorts due to aforementioned surgical and economic considerations. The purpose of this narrative review is to outline how metaboliser profile variants affect the pharmacokinetics of specific analgesia used to treat back pain, and to discuss the current potential and limitations of employing regular pharmacogenetic analysis for spine surgery populations with degenerative conditions.
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Affiliation(s)
- Jake M McDonnell
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland.
| | - Brian Rigney
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland
| | - James Storme
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland
| | - Daniel P Ahern
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland.,School of Medicine, Trinity College, Dublin, Ireland
| | - Gráinne Cunniffe
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland
| | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Impact of Patient-specific Factors and Spinopelvic Alignment on the Development of Adjacent Segment Degeneration After Short-segment Lumbar Fusion. Clin Spine Surg 2022:01933606-990000000-00056. [PMID: 35945667 PMCID: PMC10368217 DOI: 10.1097/bsd.0000000000001369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Prospective cross-sectional cohort study. OBJECTIVES The main purpose of this study was to evaluate the association between demographical, surgery-related and morphologic parameters, and the development or progress of adjacent segment degeneration (ASD) after short-segment lumbar fusions. SUMMARY OF BACKGROUND DATA ASD is a major long-term complication after lumbar fusions. Possible risk factors are related to the patients' demographics, spinopelvic anatomy, or preoperative lumbar intervertebral disk conditions, but the role of these parameters is still not clear. METHODS A prospective cross-sectional study of 100 patients who underwent 1- or 2-level open lumbar transforaminal interbody fusions due to a lumbar degenerative pathology was conducted. Demographical, radiologic findings, and magnetic resonance imaging features were analyzed to identify factors associated with ASD in 5-year follow-up. RESULTS ASD patients showed higher level of pain ( P =0.004) and disability ( P =0.020) at follow-up. In univariate analysis, older age ( P =0.007), upper-level lumbar fusion ( P =0.007), lower L4-S1 lordosis ( P =0.039), pelvic incidence-lumbar lordosis mismatch ( P =0.021), Pfirrmann grade III or higher disk degeneration ( P =0.002), and the presence of disk bulge/protrusion ( P =0.007) were associated with ASD. In multivariate analysis, the presence of major degenerative sign (disk degeneration and/or disk bulge) was the significant predictor for developing ASD (odds ratio: 3.85, P =0.006). CONCLUSION By examining the role of different patient- and procedure-specific factors, we found that preoperative major degenerative signs at the adjacent segment increase the risk of ASD causing significantly worse outcome after short-segment lumbar fusion. On the basis of our results, adjacent disk conditions should be considered carefully during surgical planning.
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Lacroix M, Nguyen C, Burns R, Laporte A, Rannou F, Feydy A. Degenerative Lumbar Spine Disease: Imaging and Biomechanics. Semin Musculoskelet Radiol 2022; 26:424-438. [PMID: 36103885 DOI: 10.1055/s-0042-1748912] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Chronic low back pain (CLBP) is one of the most common diagnoses encountered when considering years lived with disability. The degenerative changes of the lumbar spine include a wide spectrum of morphological modifications visible on imaging, some of them often asymptomatic or not consistent with symptoms. Phenotyping by considering both clinical and imaging biomarkers can improve the management of CLBP. Depending on the clinical presentation, imaging helps determine the most likely anatomical nociceptive source, thereby enhancing the therapeutic approach by targeting a specific lesion. Three pathologic conditions with an approach based on our experience can be described: (1) pure painful syndromes related to single nociceptive sources (e.g., disk pain, active disk pain, and facet joint osteoarthritis pain), (2) multifactorial painful syndromes, representing a combination of several nociceptive sources (such as lumbar spinal stenosis pain, foraminal stenosis pain, and instability pain), and (3) nonspecific CLBP, often explained by postural (muscular) syndromes.
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Affiliation(s)
- Maxime Lacroix
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France.,Department of Radiology, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Christelle Nguyen
- Department of Physical and Rehabilitation Medicine, Hôpital Cochin, Université de Paris, Paris, France
| | - Robert Burns
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France
| | - Amandine Laporte
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France
| | - François Rannou
- Department of Physical and Rehabilitation Medicine, Hôpital Cochin, Université de Paris, Paris, France
| | - Antoine Feydy
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France
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Mańko G, Jekiełek M, Ambroży T, Rydzik Ł, Jaszczur-Nowicki J. Physiotherapeutic Methods in the Treatment of Cervical Discopathy and Degenerative Cervical Myelopathy: A Prospective Study. Life (Basel) 2022; 12:life12040513. [PMID: 35455004 PMCID: PMC9032857 DOI: 10.3390/life12040513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 01/14/2023] Open
Abstract
Spinal dysfunctions are very common in the population. However, there is still a lack of information on how to diagnose and treat them properly. The common causes of spinal dysfunctions are cervical discopathy and degenerative cervical myelopathy. The aims of the study are to examine whether a combination of manual therapy and stabilometer platform exercises can be effective in treating cervical discopathy and degenerative cervical myelopathy, and the possibility of observing the differences between patients suffering from the above diseases. The study involved 40 patients referred for rehabilitation, who formed two groups of 20 people. The first group consisted of patients suffering from cervical discopathy, the second group consisted of patients affected by degenerative cervical myelopathy. During therapy, manual therapy techniques and a stabilometric platform were used. The Neck Disability Index and Pain Numeric Rating Scale were used for clinical evaluation. The correlation between the existing diseases and the results obtained in the Neck Disability Index and Pain Numeric Rating Scale was examined. The distribution of patient responses in questions of the Neck Disability Index was also checked. Clinical evaluation was performed twice, before the start of therapy and after a two-week rehabilitation treatment. The study showed a significant difference between the patients’ results before the start of therapy and after the end of the rehabilitation stay in both used questionnaires (p = 0.00). A difference in the distribution of responses between the two groups after therapy was also found in the Neck Disability Index (p = 0.018) and in the Pain Numeric Rating Scale (p = 0.043). The study shows that manual therapy and exercises using the stabilometric platform are effective methods of treating both patients with cervical discopathy and patients with degenerative cervical myelopathy. It was also noted that, when comparing groups of patients, patients with degenerative cervical myelopathy tend to have greater disturbances in concentration-related activities, such as reading, focusing, driving, sleeping, and resting.
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Affiliation(s)
- Grzegorz Mańko
- Department of Biomechanics and Kinesiology, Institute of Physiotherapy, Jagiellonian University Collegium Medicum, 31-126 Kraków, Poland;
- ORNR “Krzeszowice”, Rehabilitation Center, Daszyńskiego 1, 32-065 Krzeszowice, Poland
| | - Małgorzata Jekiełek
- Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, 31-008 Kraków, Poland;
| | - Tadeusz Ambroży
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland;
| | - Łukasz Rydzik
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland;
- Correspondence: (Ł.R.); (J.J.-N.)
| | - Jarosław Jaszczur-Nowicki
- Department of Tourism, Recreation and Ecology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
- Correspondence: (Ł.R.); (J.J.-N.)
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DiStefano TJ, Vaso K, Danias G, Chionuma HN, Weiser JR, Iatridis JC. Extracellular Vesicles as an Emerging Treatment Option for Intervertebral Disc Degeneration: Therapeutic Potential, Translational Pathways, and Regulatory Considerations. Adv Healthc Mater 2022; 11:e2100596. [PMID: 34297485 PMCID: PMC8783929 DOI: 10.1002/adhm.202100596] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/08/2021] [Indexed: 12/14/2022]
Abstract
Emergent approaches in regenerative medicine look toward the use of extracellular vesicles (EVs) as a next-generation treatment strategy for intervertebral disc (IVD) degeneration (IVDD) because of their ability to attenuate chronic inflammation, reduce apoptosis, and stimulate proliferation in a number of tissue systems. Yet, there are no Food and Drug Administration (FDA)-approved EV therapeutics in the market with an indication for IVDD, which motivates this article to review the current state of the field and provide an IVD-specific framework to assess its efficacy. In this systematic review, 29 preclinical studies that investigate EVs in relation to the IVD are identified, and additionally, the regulatory approval process is reviewed in an effort to accelerate emerging EV-based therapeutics toward FDA submission and timeline-to-market. The majority of studies focus on nucleus pulposus responses to EV treatment, where the main findings show that stem cell-derived EVs can decelerate the progression of IVDD on the molecular, cellular, and organ level. The findings also highlight the importance of the EV parent cell's pathophysiological and differentiation state, which affects downstream treatment responses and therapeutic outcomes. This systematic review substantiates the use of EVs as a promising cell-free strategy to treat IVDD and enhance endogenous repair.
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Affiliation(s)
- Tyler J. DiStefano
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Keti Vaso
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, New York NY, USA
| | - George Danias
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Henry N. Chionuma
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Jennifer R. Weiser
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, New York NY, USA
| | - James C. Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York NY, USA
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Chiapparelli E, Bowen E, Okano I, Salzmann SN, Reisener MJ, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Spinal Cord Medial Safe Zone for C2 Pedicle Instrumentation: An MRI Measurement Analysis. Spine (Phila Pa 1976) 2022; 47:E101-E106. [PMID: 34091562 DOI: 10.1097/brs.0000000000004137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE The aim of this study was to investigate the spinal cord safety margins for C2 instrumentation. SUMMARY OF BACKGROUND DATA Intraoperative spinal cord injury during C2 spine surgery is a rare, but potentially life-threatening complication. Preoperative planning for C2 instrumentation mainly focuses on C2 pedicle bony dimensions on CT and the vertebral artery location and few studies have evaluated C2 spinal cord safety margins. METHODS We measured two distances in C2 bilaterally: C2 pedicle to dura distance (P-D), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and the dural sac, and C2 pedicle to spinal cord (P-SC), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and spinal cord. We defined the distances >4 mm as safe for instrumentation. RESULT A total of 146 patients (mean age 71.2, 50.7% female) were included. The average distances were 5.5 mm for C2 left PD, 5.9 mm for C2 right P-D, 10.1 mm for C2 left P-SC, and 10.6 mm for C2 right P-SC. Twenty-eight (21.4%) patients had C2 P-D distances <4 mm and of those two (7%) patients had distances <2 mm. There were more female patients with C2 P-D distances under 4 mm compared to males. No patient had C2 P-SC distances <4 mm. CONCLUSION We demonstrated that around 20% of patients had C2 P-D distance <4 mm, but no patient had C2 P-SC distance <4 mm. Since a lateral misplacement can lead to a potentially fatal vertebral artery injury, medial screw trajectory is recommended for C2 pedicle instrumentation with consideration of these safety margins.Level of Evidence: 3.
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Udby PM, Samartzis D, Carreon LY, Andersen MØ, Karppinen J, Modic M. A definition and clinical grading of Modic changes. J Orthop Res 2022; 40:301-307. [PMID: 34910328 DOI: 10.1002/jor.25240] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/14/2021] [Accepted: 12/11/2021] [Indexed: 02/04/2023]
Abstract
To provide an up-to-date description of knowledge and pitfalls related to the classification, definition and grading of Modic changes (MC) visualized on magnetic resonance imaging (MRI). State-of-the-art review of current knowledge regarding the definition and grading of MC on MRI. MC on MRI have been reported to be associated with low back pain and disability. However, previous studies have shown heterogeneous results in regards to the impact of MC and its clinical relevance in patients with back pain. MC is a term used with considerable variation in the literature. No strict definition has been provided previously, this has contributed to varying diagnostic inclusion criteria, heterogeneous study populations, and discrepancy in results. A definition of MC and a proposal for grading is provided in this state-of-the-art review. MC are important, clinically relevant findings. However, issues with the nomenclature, definition and grading of these changes need to be addressed. Our current review highlights relevant issues related to MC, and provides a definition and grading score for the term MC that includes the Modic type and the extent of vertebral body involvement. Future studies should seek to validate the MC grading score in clinically relevant populations.
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Affiliation(s)
- Peter M Udby
- Spine Unit, Department of Orthopedic Surgery, Zealand University Hospital, Roskilde, Denmark.,Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, Illinois, USA
| | - Leah Y Carreon
- Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | | | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Michael Modic
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Lambrechts M, Karamian B, DiMaria S, D'Antonio N, Sawires A, Canseco J, Kaye ID, Woods B, Kurd M, Rihn J, Lee J, Hilibrand A, Kepler C, Vaccaro A, Schroeder G. Does change in focal lordosis after spinal fusion affect clinical outcomes in degenerative spondylolisthesis? JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:127-139. [PMID: 35837437 PMCID: PMC9274667 DOI: 10.4103/jcvjs.jcvjs_144_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/01/2022] [Indexed: 11/06/2022] Open
Abstract
Study Design: Retrospective cohort study. Objective: The objective of this study is to determine the effect of focal lordosis and global alignment and proportion (GAP) scores on patient reported outcome measures (PROMs) after posterior lumbar fusion for patients with 1- or 2-level lumbar degenerative spondylolisthesis (DS). Summary of Background Data: In patients with DS, improvements in spinopelvic parameters are believed to improve clinical outcomes. However, the effect of changing focal lordosis in patients with 1-or 2-level degenerative lumbar spondylolisthesis is unclear. Materials and Methods: Postoperative spinopelvic parameters and perioperative focal lordosis changes were measured for 162 patients at a single academic center from January 2013 to December 2017. Patients were divided into three groups: >2° (lordotic group), between 2° and −2° (neutral group), and −2°° (kyphotic group). Patients were then reclassified based on GAP scores. Recovery ratios (RR) and the number of patients achieving the minimal clinically important difference (MCID) were calculated for PROMs. Standard descriptive statistics were reported for patient demographics and outcomes data. Multiple linear regression analysis controlled for confounders. Alpha was set at P < 0.05. Results: There was no significant association between change in focal lordosis and surgical complications including adjacent segment disease (P = 0.282), instrumentation failure (P = 0.196), pseudarthrosis (P = 0.623), or revision surgery (P = 0.424). In addition, the only PROM affected by change in focal lordosis was Mental Component Scores (ΔMCS-12) (lordotic = 2.5, neutral = 8.54, and kyphotic = 5.96, P = 0.017) and RR for MCS-12 (lordotic = 0.02, neutral = 0.14, kyphotic 0.10, P = 0.008). Linear regression analysis demonstrated focal lordosis was a predictor of decreased improvement in MCS-12 (β = −6.45 [−11.03- −1.83], P = 0.007). GAP scores suggested patients who were correctly proportioned had worse MCID compared to moderately disproportioned and severely disproportioned patients (P = 0.024). Conclusions: The change in focal lordosis not a significant predictor of change in PROMs for disability, pain, or physical function. Proportioned patients based on the GAP score had worse MCID for Oswestry Disability Index. Level of Evidence: III
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