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Zhang X, Li H, Chen L, Wu Y, Li Y. NRF2 in age-related musculoskeletal diseases: Role and treatment prospects. Genes Dis 2024; 11:101180. [PMID: 39281838 PMCID: PMC11400624 DOI: 10.1016/j.gendis.2023.101180] [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: 05/10/2023] [Revised: 10/06/2023] [Accepted: 10/31/2023] [Indexed: 09/18/2024] Open
Abstract
The NRF2 pathway is a metabolic- and redox-sensitive signaling axis in which the transcription factor controls the expression of a multitude of genes that enable cells to survive environmental stressors, such as oxidative stress, mainly by inducing the expression of cytoprotective genes. Basal NRF2 levels are maintained under normal physiological conditions, but when exposed to oxidative stress, cells activate the NRF2 pathway, which is crucial for supporting cell survival. Recently, the NRF2 pathway has been found to have novel functions in metabolic regulation and interplay with other signaling pathways, offering novel insights into the treatment of various diseases. Numerous studies have shown that targeting its pathway can effectively investigate the development and progression of age-related musculoskeletal diseases, such as sarcopenia, osteoporosis, osteoarthritis, and intervertebral disc degeneration. Appropriate regulation of the NRF2 pathway flux holds promise as a means to improve musculoskeletal function, thereby providing a new avenue for drug treatment of age-related musculoskeletal diseases in clinical settings. The review summarized an overview of the relationship between NRF2 and cellular processes such as oxidative stress, apoptosis, inflammation, mitochondrial dysfunction, ferroptosis, and autophagy, and explores the potential of targeted NRF2 regulation in the treatment of age-related musculoskeletal diseases.
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Affiliation(s)
- Xiangyu Zhang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Hengzhen Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Lin Chen
- Department of Health and Physical Education, Jianghan University, Wuhan, Hubei 430056, China
| | - Yuxiang Wu
- Department of Health and Physical Education, Jianghan University, Wuhan, Hubei 430056, China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
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Chan TCW, Wong JSH, Wang F, Fang CX, Yung CSY, Chan MTH, Chan WSH, Wong SSC. Addition of Liposomal Bupivacaine to Standard Bupivacaine versus Standard Bupivacaine Alone in the Supraclavicular Brachial Plexus Block: A Randomized Controlled Trial. Anesthesiology 2024; 141:732-744. [PMID: 38696340 PMCID: PMC11389883 DOI: 10.1097/aln.0000000000005035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
BACKGROUND The analgesic effect of adding liposomal bupivacaine to standard bupivacaine in supraclavicular brachial plexus block is not known. The authors hypothesized that addition of liposomal bupivacaine would reduce acute postoperative pain compared to standard bupivacaine alone. METHODS A randomized controlled trial was conducted. Patients and outcome assessors were blinded. Eighty patients undergoing distal radial fracture fixation during regional anesthesia with supraclavicular brachial plexus block were randomized into two groups. The liposomal bupivacaine group received 10 ml 0.5% plain bupivacaine immediately followed by 10 ml 1.33% liposomal bupivacaine (n = 40). The standard bupivacaine group received 20 ml 0.5% plain bupivacaine (n = 40). The primary outcome was weighted area under curve (AUC) numerical rating scale pain score at rest during the first 48 h after surgery. Secondary outcomes included weighted AUC scores for pain with movement, overall benefit with analgesia score, and other functional scores. RESULTS For the primary outcome, the liposomal bupivacaine group was associated with statistically significantly lower weighted AUC pain score at rest (0.6 vs. 1.4; P < 0.001) in the first 48 h. Of the secondary outcomes, no difference between treatment groups reached statistical significance with the exception of weighted AUC score for pain with movement (2.3 vs. 3.7; adjusted P < 0.001) and overall benefit with analgesia score (1.1 vs. 1.7; adjusted P = 0.020) in the first 48 h, as well as numerical rating scale pain score at rest (0.5 vs. 1.9; adjusted P < 0.001) and with movement (2.7 vs. 4.9; adjusted P < 0.001) on postoperative day 1. Differences in numerical rating scale pain scores on postoperative days 2, 3, and 4 did not reach the level of statistical significance. There were no statistically significant differences in sensory function. CONCLUSIONS Liposomal bupivacaine given via supraclavicular brachial plexus block reduced pain at rest in the early postoperative period. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Timmy Chi Wing Chan
- Department of Anaesthesiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; Department of Anaesthesia, Pain & Perioperative Medicine, Queen Mary Hospital, Hong Kong, China
| | - Janus Siu Him Wong
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Fengfeng Wang
- Department of Anaesthesiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Christian Xinshuo Fang
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Colin Shing-Yat Yung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong, China
| | - Manson Tak Hei Chan
- Department of Anaesthesia, Pain & Perioperative Medicine, Queen Mary Hospital, Hong Kong, China
| | - Will Shing Him Chan
- Department of Anaesthesia, Pain & Perioperative Medicine, Queen Mary Hospital, Hong Kong, China
| | - Stanley Sau Ching Wong
- Department of Anaesthesiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
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Baur D, Bieck R, Berger J, Schöfer P, Stelzner T, Neumann J, Neumuth T, Heyde CE, Voelker A. Automated Three-Dimensional Imaging and Pfirrmann Classification of Intervertebral Disc Using a Graphical Neural Network in Sagittal Magnetic Resonance Imaging of the Lumbar Spine. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01251-2. [PMID: 39266913 DOI: 10.1007/s10278-024-01251-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 08/25/2024] [Accepted: 08/27/2024] [Indexed: 09/14/2024]
Abstract
This study aimed to develop a graph neural network (GNN) for automated three-dimensional (3D) magnetic resonance imaging (MRI) visualization and Pfirrmann grading of intervertebral discs (IVDs), and benchmark it against manual classifications. Lumbar IVD MRI data from 300 patients were retrospectively analyzed. Two clinicians assessed the manual segmentation and grading for inter-rater reliability using Cohen's kappa. The IVDs were then processed and classified using an automated convolutional neural network (CNN)-GNN pipeline, and their performance was evaluated using F1 scores. Manual Pfirrmann grading exhibited moderate agreement (κ = 0.455-0.565) among the clinicians, with higher exact match frequencies at lower lumbar levels. Single-grade discrepancies were prevalent except at L5/S1. Automated segmentation of IVDs using a pretrained U-Net model achieved an F1 score of 0.85, with a precision and recall of 0.83 and 0.88, respectively. Following 3D reconstruction of the automatically segmented IVD into a 3D point-cloud representation of the target intervertebral disc, the GNN model demonstrated moderate performance in Pfirrmann classification. The highest precision (0.81) and F1 score (0.71) were observed at L2/3, whereas the overall metrics indicated moderate performance (precision: 0.46, recall: 0.47, and F1 score: 0.46), with variability across spinal levels. The integration of CNN and GNN offers a new perspective for automating IVD analysis in MRI. Although the current performance highlights the need for further refinement, the moderate accuracy of the model, combined with its 3D visualization capabilities, establishes a promising foundation for more advanced grading systems.
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Affiliation(s)
- David Baur
- Department for Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Richard Bieck
- Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Germany
| | - Johann Berger
- Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Germany
| | - Patrick Schöfer
- Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Germany
| | - Tim Stelzner
- Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Germany
| | - Juliane Neumann
- Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Germany
| | - Christoph-E Heyde
- Department for Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Anna Voelker
- Department for Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
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Wang H, Wang K, Zheng Y, Deng Z, Yu Z, Zhan H, Zhao Y. Kinematic patterns in performing trunk flexion tasks influenced by various mechanical optimization targets: A simulation study. Clin Biomech (Bristol, Avon) 2024; 120:106344. [PMID: 39260048 DOI: 10.1016/j.clinbiomech.2024.106344] [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: 07/04/2024] [Revised: 09/05/2024] [Accepted: 09/08/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Low back pain is the most prevalent and disabling condition worldwide, with a high recurrence rate in the general adult population. METHODS A set of open-sourced trunk musculoskeletal models was used to investigate trunk flexion kinematics under different motor control strategies, including minimizing shearing or compressive loads at the L4/L5 or L5/S1 level. FINDINGS A control strategy that minimizes the load on the lower lumbar intervertebral disc can result in two kinematic patterns-the "restricted lumbar spine" and the "overflexed lumbar spine"-in performing the trunk flexion task. The "restricted" pattern can reduce the overall load on the lower lumbar levels, whereas the "overflexed" pattern can reduce the shearing force only at the L4/L5 level and increase the compressive and shearing forces at the L5/S1 level and the compressive force at the L4/L5 level. INTERPRETATION This study investigated the relationships between specific trunk kinematics in patients with low back pain and lumbar intervertebral loading via musculoskeletal modelling and simulation. The results provide insight into individualized treatment for patients with low back pain.
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Affiliation(s)
- Huihao Wang
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Kuan Wang
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China
| | - Yuxin Zheng
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Zhen Deng
- Shanghai Baoshan District Hosptial of Integrated Traditional Chinese and Western Medicine, Shanghai 201999, China
| | - Zhongxiang Yu
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Hongsheng Zhan
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yongfang Zhao
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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Liu MY, Tsai CW, Niu CC, Tsai TT, Fu CJ, Luo CA. The footprint mismatch of cervical disc arthroplasty comes from degenerative factor besides ethnic factor. Sci Rep 2024; 14:20673. [PMID: 39237767 PMCID: PMC11377700 DOI: 10.1038/s41598-024-71786-5] [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: 06/27/2024] [Accepted: 08/30/2024] [Indexed: 09/07/2024] Open
Abstract
A mismatch in footprints of cervical total disc arthroplasty (CTDA) implants occasionally occurred in Asian population and it had been attributed solely to ethnic factor. Yet, cervical degeneration process may play a role. Our purpose was to compare the cervical vertebra morphometric data with and without degeneration. The study included patients with CT scans of cervical spine from our hospital between January, 2019, and September, 2021. The total cervical degenerative index (TCDI) of each patient were collected by adding CDI score for 5 disc-levels. Patients were categorized into normal (TCDI 0-5) and degeneration groups (TCDI 6-60). Various measurements of the C3-C7 vertebral body and endplate were taken. Forty-nine patients in the normal group and 55 in the degeneration group were included. No significant difference was noted in gender, BH, BW, or BMI except age and TCDI (p < .001). During degeneration, disproportional endplate size changes were observed, with an increment ratio of 12-20% in the anteroposterior and 5-17% in the mediolateral plane throughout C3-C7, while vertebral body height remained constant. In conclusion, degeneration process, besides ethnic factor, causes the endplate size and shape mismatch. This information can help spine surgeon choose appropriate implants in CTDA surgery.
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Affiliation(s)
- Ming-Yen Liu
- Chang Gung University College of Medicine, No.259, Wenhua First Road, Guishan District, Taoyuan City, 333, Taiwan
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
| | - Ching-Wen Tsai
- National Applied Research Laboratories, Taiwan Instrument Research Institute, No. 8, Section 2Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Chi-Chien Niu
- Chang Gung University College of Medicine, No.259, Wenhua First Road, Guishan District, Taoyuan City, 333, Taiwan
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
| | - Tsung-Ting Tsai
- Chang Gung University College of Medicine, No.259, Wenhua First Road, Guishan District, Taoyuan City, 333, Taiwan
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
| | - Chen-Ju Fu
- Division of Emergency and Critical Care Radiology, Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
| | - Chi-An Luo
- Chang Gung University College of Medicine, No.259, Wenhua First Road, Guishan District, Taoyuan City, 333, Taiwan.
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan.
- Department of Orthopaedic Surgery, New Taipei Municipal Tucheng Hospital (Built and Operated By Chang Gung Medical Foundation), No. 6, Section 2, Jincheng Road, Tucheng District, New Taipei City, 236, Taiwan.
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Deguchi T, Hashizume H, Terao C, Nakajima M, Teraguchi M, Yamada H, Tanaka S, Yoshimura N, Yoshida M, Ikegawa S. A longitudinal population-based study identifies THBS2 as a susceptibility gene for intervertebral disc degeneration. 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; 33:3334-3342. [PMID: 38918228 DOI: 10.1007/s00586-024-08152-6] [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: 11/15/2022] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Intervertebral disc degeneration (IDD) is a common degenerative disease associated with ageing. Additionally, IDD is recognized as one of the leading causes of low back pain and disability in the working-age population and is the first step in the process leading to degenerative spinal changes. However, the genetic factors and regulatory mechanisms of IDD remain unknown. Therefore, we selected eight single nucleotide polymorphisms of genes to reveal the progression of IDD in a 7-year longitudinal study of the general population in Japan. METHODS IDD was evaluated in the Wakayama Spine Study (WSS), which is a population-based cohort study. Overall, 574 participants from the general population cohort who underwent whole spine magnetic resonance imaging and provided clinical information were included in this longitudinal survey. RESULTS The progression of IDD was affected only by THBS2 at the lumbar region, T12-L1 (p = 0.0044) and L3-4 (p = 0.0045). The significant interaction between THBS2 and age with IDD negatively affected the thoracic spines and passively influenced both the thoracolumbar junction and thoracic spines. The higher progression per year of Pfirrmann's score was rapid in young people with age; however, this decelerated the IDD progression per year in different ages. CONCLUSION Our longitudinal study found the genes associated with IDD progression and that genetic factors' impact on IDD differs depending on disc level and age.
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Affiliation(s)
- Tsuyoshi Deguchi
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, 1-1 Yamadaoka, Suita-City, Japan
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan.
- School of Health and Nursing Science, Wakayama Medical University, 590 Mikazura, Wakayama City, Wakayama, 641-0011, Japan.
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, RIKEN, Suehiro-cho 1-7-22, Tsurumi-ku, Yokohama City, Japan
| | - Masahiro Nakajima
- Laboratory of Bone and Joint Diseases, Center for Integrative Medical Sciences, RIKEN, 4-6-1 Shirokane, Minato-ku, Tokyo, 108-8639, Japan
| | - Masatoshi Teraguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Shiro Ikegawa
- Laboratory of Bone and Joint Diseases, Center for Integrative Medical Sciences, RIKEN, 4-6-1 Shirokane, Minato-ku, Tokyo, 108-8639, Japan.
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Dhiman MS, Bader TJ, Ponjevic D, Salo PT, Hart DA, Swamy G, Matyas JR, Duncan NA. Collagen integrity of the annulus fibrosus in degenerative disc disease individuals quantified with collagen hybridizing peptide. JOR Spine 2024; 7:e1359. [PMID: 39092166 PMCID: PMC11291301 DOI: 10.1002/jsp2.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/27/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction Degenerative disc disease (DDD) is accompanied by structural changes in the intervertebral discs (IVD). Extra-cellular matrix degradation of the annulus fibrosus (AF) has been linked with degeneration of the IVD. Collagen is a vital component of the IVD. Collagen hybridizing peptide (CHP) is an engineered protein that binds to degraded collagen, which we used to quantify collagen damage in AF. This method was used to compare AF samples obtained from donors with no DDD to AF samples from patients undergoing surgery for symptomatic DDD. Methods Fresh AF tissue was embedded in an optimal cutting temperature compound and cryosectioned at a thickness of 8 μm. Hematoxylin and Eosin staining was performed on sections for general histomorphological assessment. Serial sections were stained with Cy3-conjugated CHP and the mean fluorescence intensity and areal fraction of Cy3-positive staining were averaged for three regions of interest (ROI) on each CHP-stained section. Results Increases in mean fluorescence intensity (p = 0.0004) and percentage of positively stained area (p = 0.00008) with CHP were detected in DDD samples compared to the non-DDD samples. Significant correlations were observed between mean fluorescence intensity and percentage of positively stained area for both non-DDD (R = 0.98, p = 5E-8) and DDD (R = 0.79, p = 0.0012) samples. No significant differences were detected between sex and the lumbar disc level subgroups of the non-DDD and DDD groups. Only tissue pathology (non-DDD versus DDD) influenced the measured parameters. No three-way interactions between tissue pathology, sex, and lumbar disc level were observed. Discussion and Conclusions These findings suggest that AF collagen degradation is greater in DDD samples compared to non-DDD samples, as evidenced by the increased CHP staining. Strong positive correlations between the two measured parameters suggest that when collagen degradation occurs, it is detected by this technique and is widespread throughout the tissue. This study provides new insights into the structural alterations associated with collagen degradation in the AF that occur during DDD.
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Affiliation(s)
- Manmeet S. Dhiman
- Department of Biomedical EngineeringUniversity of CalgaryCalgaryAlbertaCanada
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Taylor J. Bader
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Medical SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Dragana Ponjevic
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of Veterinary MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Paul T. Salo
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Surgery, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - David A. Hart
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Surgery, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Ganesh Swamy
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Surgery, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - John R. Matyas
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of Veterinary MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Neil A. Duncan
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Civil EngineeringUniversity of CalgaryCalgaryAlbertaCanada
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Ekram S, Khalid S, Ramzan F, Salim A, Bashir I, Durrieu MC, Khan I. Mesenchymal Stem Cell-Derived Extracellular Vesicles Protect Rat Nucleus Pulposus Cells from Oxidative Stress. Cartilage 2024; 15:328-344. [PMID: 37139781 PMCID: PMC11418459 DOI: 10.1177/19476035231172154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Oxidative stress (OS) is mainly associated with the pathogenesis of intervertebral disc (IVD) degeneration; it causes nucleus pulposus cells (NPCs) to undergo senescence and triggers autophagy and apoptosis. This study aims to evaluate the regeneration potential of extracellular vesicles (EVs) derived from human umbilical cord-mesenchymal stem cells (hUC-MSCs) in an in vitro rat NPC-induced OS model. DESIGN NPCs were isolated from rat coccygeal discs, propagated, and characterized. OS was induced by hydrogen peroxide (H2O2), which is confirmed by 2,7-dichlorofluorescein diacetate (H2DCFDA) assay. EVs were isolated from hUC-MSCs and characterized by analyzing the vesicles using fluorescence microscope, scanning electron microscope (SEM), atomic force microscope (AFM), dynamic light scattering (DLS), and Western blot (WB). The in vitro effects of EVs on migration, uptake, and survival of NPCs were determined. RESULTS SEM and AFM topographic images revealed the size distribution of EVs. The phenotypes of isolated EVs showed that the size of EVs was 403.3 ± 85.94 nm, and the zeta potential was -0.270 ± 4.02 mV. Protein expression analysis showed that EVs were positive for CD81 and annexin V. Treatment of NPCs with EVs reduced H2O2-induced OS as evidenced by a decrease in reactive oxygen species (ROS) levels. Co-culture of NPCs with DiI-labeled EVs showed the cellular internalization of EVs. In the scratch assay, EVs significantly increased NPC proliferation and migration toward the scratched area. Quantitative polymerase chain reaction analysis showed that EVs significantly reduced the expression of OS genes. CONCLUSION EVs protected NPCs from H2O2-induced OS by reducing intracellular ROS generation and improved NPC proliferation and migration.
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Affiliation(s)
- Sobia Ekram
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Shumaila Khalid
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Faiza Ramzan
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Asmat Salim
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Imtiaz Bashir
- University of Bordeaux, CNRS, Bordeaux INP, CBMN, UMR 5248, Pessac, France
| | | | - Irfan Khan
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
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Nakazato-Nakamine T, Romani F, Gutierrez C, Quezada P, Vera R, Artica K. Prevalence of Spinal Segmental Sensitization Syndrome in Outpatients Attending Physical Medicine and Rehabilitation Centers for Chronic Musculoskeletal Pain: A Multicenter Study. Arch Phys Med Rehabil 2024:S0003-9993(24)01189-4. [PMID: 39218242 DOI: 10.1016/j.apmr.2024.08.013] [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: 12/19/2023] [Revised: 08/22/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To determine the prevalence of spinal segmental sensitization (SSS) syndrome, a regional pain disorder, among patients visiting physical medicine and rehabilitation centers (PM&RCs) for chronic musculoskeletal pain (CMSP). DESIGN An observational, descriptive, cross-sectional study conducted from March to July 2023. SETTING Seven PM&RCs from 5 cities, representing 3 care systems: Social Security (SS), Ministry of Health (MH), and private practice (PP). PARTICIPANTS All patients, regardless of age, attending a physiatry consultation for CMSP for the first time and who provided informed consent to participate were included. Nonprobabilistic sampling was employed. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE We estimated the overall prevalence of SSS syndrome as a percentage among patients with CMSP, stratified by health care institution, sex, age, and occupation type. We also recorded the spinal segments involved and any concomitant painful disorders (CPDs). SSS syndrome was diagnosed using standardized criteria. RESULTS Of the eligible participants, 319 with CMSP were enrolled; 73.4% were women, and the median age of participants was 56.9 (range, 13-89y) years. The overall prevalence of SSS syndrome was 53.3%. Of these, 69.1%, 42.2%, and 13.8% were in the SS, MH, and PP systems, respectively. The most affected were female participants (56.4%), those aged 50-64 years (60.4%), and those with active jobs (58.8%). Most commonly, the lumbosacral and lumbar segments were affected, followed by the lower and middle cervical levels. Spine pathologies were the most common CPDs. CONCLUSION The prevalence of SSS syndrome was high among patients who visited PM&RCs for CMSP and varied according to the care system. Further research on SSS syndrome is warranted to relieve the burden it poses on patients with CMSP and ensure proper diagnosis in clinical practice.
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Affiliation(s)
| | | | | | | | - Ruth Vera
- Carlos Alberto Seguin National General Hospital, Arequipa, Peru
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10
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Tabarestani TQ, Drossopoulos PN, Huang CC, Bartlett AM, Paturu MR, Shaffrey CI, Chi JH, Ray WZ, Goodwin CR, Amrhein TJ, Abd-El-Barr MM. The Importance of Planning Ahead: A Three-Dimensional Analysis of the Novel Trans-Facet Corridor for Posterior Lumbar Interbody Fusion Using Segmentation Technology. World Neurosurg 2024; 188:e247-e258. [PMID: 38777315 DOI: 10.1016/j.wneu.2024.05.091] [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: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The rise of minimally invasive lumbar fusions and advanced imaging technologies has facilitated the introduction of novel surgical techniques with the trans-facet approach being one of the newest additions. We aimed to quantify any pathology-driven anatomic changes to the trans-facet corridor, which could thereby alter the ideal laterality of approach to the disc space. METHODS In this retrospective cohort study, we measured the areas and maximum permissible cannula diameters of the trans-facet corridor using commercially available software (BrainLab, Munich, Germany). Exiting and traversing nerve roots, thecal sacs, and lumbar vertebrae were manually segmented on T2-SPACE magnetic resonance imaging. Spondylolisthesis, disc protrusions, and disc space heights were recorded. RESULTS A total of 118 trans-facet corridors were segmented bilaterally in 16 patients (65.6 ± 12.1 years, 43.8% female, body mass index 29.2 ± 5.1 kg/m2). The mean areas at L1-L2, L2-L3, L3-L4, and L4-L5 were 89.4 ± 24.9 mm2, 124 ± 39.4 mm2, 123 ± 26.6 mm2, and 159 ± 42.7 mm2, respectively. The mean permissible cannula diameter at the same levels were 7.85 ± 1.43 mm, 8.98 ± 1.72 mm, 8.93 ± 1.26 mm, and 10.2 ± 1.94 mm, respectively. Both parameters increased caudally. Higher degrees for spondylolisthesis were associated with larger areas and maximum cannula diameters on regression analysis (P < 0.001). CONCLUSIONS Our results illustrate that pathology, like spondylolisthesis, can increase the area of the trans-facet corridor. By understanding this effect, surgeons can better decide on the optimal approach to the disc while taking into consideration a patient's unique anatomy.
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Affiliation(s)
- Troy Q Tabarestani
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Peter N Drossopoulos
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Chuan-Ching Huang
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | - Alyssa M Bartlett
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mounica R Paturu
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | | | - John H Chi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, North Carolina, USA
| | - Wilson Z Ray
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | - Timothy J Amrhein
- Department of Radiology, Duke University Hospital, Durham, North Carolina, USA
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11
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Wiersbicki DW, Osterhoff G, Heyde CE, Pieroh P. The relation of osteoporotic vertebral fractures and spine degeneration on the occurrence of complications: a systematic review. 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; 33:3213-3220. [PMID: 39014078 DOI: 10.1007/s00586-024-08403-6] [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: 02/01/2024] [Revised: 02/01/2024] [Accepted: 07/07/2024] [Indexed: 07/18/2024]
Abstract
STUDY DESIGN Systematic review. PURPOSE Osteoporotic vertebral fractures (OVFs) and degenerative spine conditions are age-related and associated with higher morbidity and mortality and greater health care costs. The relationship between OVFs and prevalent spine degeneration is rarely reported. The aim of this study was to systematically review current literature on the influence of preexisting degenerative spine conditions in patients with OVFs on the occurrence of complications during and after treatment. METHODS A systematic literature review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed using Web of Science and MEDLINE. We considered English and German articles published from January 1990 to December 2022. The inclusion criteria were patients with OVFs and preexisting spinal degeneration with complications such as subsequent fractures, deformity, implant failure and surgical and general complications. The included studies were controlled trials, cohort studies, and case series. RESULTS Ten articles met the inclusion criteria (two prospective studies, seven retrospective studies and one case series). These were divided into two groups: studies on OVFs in patients with coexisting degenerative spine conditions (n = 5) and studies on OVFs following surgical treatment for degenerative spine conditions (n = 5). Three studies reported more complications in patients with OVFs and severe degeneration. One study stated the opposite. One study did not find any correlation. The remaining studies described complications narratively. Subsequent fractures were the most frequent complications. CONCLUSION OVFs in patients with preexisting spinal degeneration seem to cause more complications. In addition to subsequent fractures, other complications have rarely been examined. The presence of degenerative changes or undergoing surgical correction may increase the risk of subsequent fractures.
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Affiliation(s)
- Dina W Wiersbicki
- Clinic for Orthopaedic, Trauma and Plastic Surgery, Department of Spine Surgery, University Hospital Leipzig, Liebigstr. 20, D-04103, Leipzig, Germany.
| | - Georg Osterhoff
- Clinic for Orthopaedic, Trauma and Plastic Surgery, Department of Spine Surgery, University Hospital Leipzig, Liebigstr. 20, D-04103, Leipzig, Germany
| | - Christoph-E Heyde
- Clinic for Orthopaedic, Trauma and Plastic Surgery, Department of Spine Surgery, University Hospital Leipzig, Liebigstr. 20, D-04103, Leipzig, Germany
| | - Philipp Pieroh
- Clinic for Orthopaedic, Trauma and Plastic Surgery, Department of Spine Surgery, University Hospital Leipzig, Liebigstr. 20, D-04103, Leipzig, Germany
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12
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Chen C, Deng Z, Yu Z, Chen Y, Yu T, Liang C, Ye Y, Huang Y, Lyu FJ, Liang G, Chang Y. The role of melatonergic system in intervertebral disc degeneration and its association with low back pain: a clinical study. PeerJ 2024; 12:e17464. [PMID: 39006038 PMCID: PMC11243980 DOI: 10.7717/peerj.17464] [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: 01/19/2024] [Accepted: 05/05/2024] [Indexed: 07/16/2024] Open
Abstract
Objective The mechanisms of intervertebral disc degeneration (IVDD) in low back pain (LBP) patients are multiples. In this study, we attempt to investigate whether melatonergic system plays a potential role in IVDD patients with LBP by analyzing their clinical specimens. The fucus will be given to the correlation between the melatonin receptor expression and intervertebral disc tissue apoptosis. Methods In this clinical study, 107 lumbar intervertebral disc nucleus pulposus (NP) specimens from patients with LBP were collected with patients' consents. The disc height (DH) discrepancy ratio, range of motion and sagittal parameters of the pathological plane were measured and Pfirrmann grade was used to classified the grades of IVDD level. Discs at grades 1-3 were served as normal control and grades 4-5 were considered as IVDD. The expression levels of melatonin receptor 1A (MT1) and 1B (MT2) were measured by immunohistochemistry. The apoptosis of NP was assessed using TUNEL staining. Their potential associations among MT1/2, DH, apoptosis, sagittal parameters with IVDD and LBP were evaluated with statistical analysis. Results The incidence of IVDD was positively associated with age and negatively related to VAS scores for LBP (p < 0.001). Patients with higher degree of IVDD also have higher DH discrepancy ratio (p < 0.001), higher prevalence of lumbar instability (p = 0.003) and higher cell apoptosis compared to the control. Nevertheless, no statistically significant correlation was identified between Pfirrmann grade and lumbar sagittal parameters. MT1 and MT2 both were highly expressed in the NP tissues. Importantly, MT1 expression but not MT2 was significantly increased in the intervertebral disc tissue of patients with IVDD and its level correlated well with cell apoptosis level and the severity of IVDD as well as lower VAS scores for LBP. Conclusion The highly elevated MT1 expression was found in NP tissues of patients with IVDD and LBP compared to the control. This phenomenon probably reflects the compensating response of the body to the pathological alteration of the IVDD and LBP. Therefore, these findings provide the novel information to use selective agonists of MT1 to target IVDD and LBP clinically.
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Affiliation(s)
- Chong Chen
- Department of Spine Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Zongyuan Deng
- Department of Spine Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Zhengran Yu
- Department of Spine Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yifan Chen
- Department of Spine Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Tao Yu
- Department of Spine Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Changxiang Liang
- Department of Spine Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yongyu Ye
- Department of Spine Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yongxiong Huang
- Department of Spine Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Feng-Juan Lyu
- Joint Center for Regenerative Medicine Research of South China University of Technology and The University of Western Australia, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Guoyan Liang
- Department of Spine Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yunbing Chang
- Department of Spine Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
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13
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Zhou C, Zhou N, Zheng Y, Si H, Wang Y, Yin J. The efficacy of 3D gait analysis to evaluate surgical (and rehabilitation) outcome after degenerative lumbar surgery. BMC Surg 2024; 24:197. [PMID: 38926745 PMCID: PMC11202385 DOI: 10.1186/s12893-024-02486-0] [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: 01/04/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Lumbar degenerative conditions are a major cause of back pain and disability in individuals aged 45 and above. Gait analysis utilizes sensor technology to collect movement data, aiding in the evaluation of various gait aspects like spatiotemporal parameters, joint angles, neuromuscular activity, and joint forces. It is widely used in conditions such as cerebral palsy and knee osteoarthritis. This research aims to assess the effectiveness of 3D gait analysis in evaluating surgical outcomes and postoperative rehabilitation for lumbar degenerative disorders. METHODS A prospective self-controlled before-after study (n = 85) carried out at our Hospital (Sep 2018 - Dec 2021) utilized a 3D motion analysis system to analyze gait in patients with lumbar degenerative diseases. The study focused on the multifidus muscle, a crucial spinal muscle, during a minimally invasive lumbar interbody fusion surgery conducted by Shandong Weigao Pharmaceutical Co., Ltd. Pre- and postoperative assessments included time-distance parameters (gait speed, stride frequency, stride length, stance phase), hip flexion angle, and stride angle. Changes in 3D gait parameters post-surgery and during rehabilitation were examined. Pearson correlation coefficient was employed to assess relationships with the visual analog pain scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) scores. Patient sagittal alignment was evaluated using "Surgimap" software from two types of lateral radiographs to obtain parameters like pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), intervertebral space height (DH), posterior height of the intervertebral space (PDH) at the operative segment, and anterior height of the intervertebral space (ADH). RESULTS By the 6th week post-operation, significant improvements were observed in the VAS score, JOA score, and ODI score of the patients compared to preoperative values (P < 0.05), along with notable enhancements in 3D gait quantification parameters (P < 0.05). Pearson correlation analysis revealed a significant positive correlation between improvements in 3D gait quantification parameters and VAS score, JOA score, and ODI value (all P < 0.001). CONCLUSION 3D gait analysis is a valuable tool for evaluating the efficacy of surgery and rehabilitation training in patients.
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Affiliation(s)
- Chao Zhou
- Department of Spine Surgery, Cheeloo College of Medicine, Qingdao Medical Engineering Interdisciplinary Key Laboratory, Qilu Hospital (Qingdao), Shandong University, No.758, Heifei Road, Qingdao, Shandong, 266000, China
| | - Ning Zhou
- Intensive Care Unit, Binzhou Central Hospital, No. 108, Huancheng South Road, Huimin, Binzhou, Shandong, 251700, China
| | - Yanping Zheng
- Department of Spine Surgery, Cheeloo College of Medicine, Qingdao Medical Engineering Interdisciplinary Key Laboratory, Qilu Hospital (Qingdao), Shandong University, No.758, Heifei Road, Qingdao, Shandong, 266000, China
| | - Haipeng Si
- Department of Spine Surgery, Cheeloo College of Medicine, Qingdao Medical Engineering Interdisciplinary Key Laboratory, Qilu Hospital (Qingdao), Shandong University, No.758, Heifei Road, Qingdao, Shandong, 266000, China
| | - Yanguo Wang
- Department of Spine Surgery, Cheeloo College of Medicine, Qingdao Medical Engineering Interdisciplinary Key Laboratory, Qilu Hospital (Qingdao), Shandong University, No.758, Heifei Road, Qingdao, Shandong, 266000, China
| | - Jun Yin
- Department of Spine Surgery, Cheeloo College of Medicine, Qingdao Medical Engineering Interdisciplinary Key Laboratory, Qilu Hospital (Qingdao), Shandong University, No.758, Heifei Road, Qingdao, Shandong, 266000, China.
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14
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Wang Z, Zhang D, Zhang Z, Miao J. The postoperative clinical effects of utilizing 3D printed (Ti6Al4V) interbody fusion cages in posterior lumbar fusion: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e38431. [PMID: 38905365 PMCID: PMC11191957 DOI: 10.1097/md.0000000000038431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/10/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND The research focused on the postoperative effect of using interbody fusion cage in lumbar posterior lamina decompression and interbody fusion with pedicle screw by comparing the postoperative effect of using 3D printing (Ti6Al4V) and PEEK material interbody fusion cage. METHODS Ninety-one patients with lumbar degenerative diseases from the Department of Spine Surgery of Tianjin Hospital were included in the study cohort. They were divided into 3D group (n = 39) and PEEK group (n = 52) according to the use of interbody fusion cage. The imaging data of the patients were collected and the postoperative data of the 2 groups were compared to evaluate patients' health status and the recovery of lumbar structure and function after operation. RESULTS Combined with the degree of fusion, the clinical effect of 3D printing titanium alloy interbody fusion cage was comprehensively judged. At the last follow-up, the JOA score, ODI index, VAS, prolo function score, and SF-36 scale of the 2 groups showed that the clinical symptoms were better than those before operation (P < .05). The height of intervertebral disc, the area of intervertebral foramen and the physiological curvature of lumbar vertebrae increased in varying degrees after operation (P < .05). At the last follow-up, the vertebral cage fusion rates were as high as 89.13% and 90.91% in the 3D and PEEK groups, with collapse rates of 6.5% and 4.5%, respectively. There were 10 cases of cage displacement in 3D group and 7 cases of cage displacement in PEEK group. There was no significant difference between the 2 groups (P > .05). CONCLUSIONS In conclusion, 3D printed (Ti6Al4V) interbody fusion cage can obtain good clinical effect in the surgical treatment of lumbar degenerative diseases. Posterior lumbar lamina decompression, bilateral pedicle screw fixation combined with 3D printed cage interbody fusion is excellent in rebuilding the stability of lumbar vertebrae. 3D printed interbody fusion cage can be an ideal substitute material for intervertebral bone grafting. The stable fusion time of interbody fusion cage after lumbar fusion is mostly from 3 months to half a year after operation.
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Affiliation(s)
- Zi Wang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Dongzhe Zhang
- Department of Spine Surgery, Cangzhou Hospital of Integrated TCM-WM, Cangzhou, China
| | - Zepei Zhang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Jun Miao
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
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15
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Gong Y, Zhuo H, Zhou Z, Cheng Z, Gan Y, He J, Song Z, Liu H, Liu Y, Liang D, Jiang X, Ren H. Zero-profile implant system versus novel plate systems after ACDF for comparison of sagittal balance parameters and clinical efficacy analysis. J Orthop Surg Res 2024; 19:363. [PMID: 38898467 PMCID: PMC11186272 DOI: 10.1186/s13018-024-04857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The zero-profile implant system (Zero-P) and conventional plates have been widely used in anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis. The purpose of this study was to compare the effects of the application of Zero-P and new conventional plates (ZEVO, Skyline) in ACDF on the sagittal imaging parameters of cervical spondylosis patients and to analyze their clinical efficacy. METHODS We conducted a retrospective study on 119 cervical spondylosis patients from January 2018 to December 2021, comparing outcomes between those receiving the Zero-P device (n = 63) and those receiving a novel conventional plate (n = 56, including 46 ZEVO and 10 Skyline plates) through ACDF. Cervical sagittal alignment was assessed pre- and postoperatively via lateral radiographs. The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were recorded at baseline, after surgery, and at the 2-year follow-up to evaluate patient recovery and intervention success. RESULTS There were significant differences in the postoperative C0-C2 Cobb angle and postoperative sagittal segmental angle (SSA) between patients in the novel conventional plate group and those in the Zero-P group (P < 0.05). Postoperatively, there were significant changes in the C2‒C7 Cobb angle, C0‒C2 Cobb angle, SSA, and average surgical disc height (ASDH) compared to the preoperative values in both patient groups (P < 0.05). Dysphagia in the immediate postoperative period was lower in the Zero-P group than in the new conventional plate group (0% in the Zero-P group, 7.14% in the novel conventional plate group, P = 0.046), and the symptoms disappeared within 2 years in both groups. There was no statistically significant difference between the two groups in terms of complications of adjacent spondylolisthesis (ASD) at 2 years postoperatively (3.17% in the Zero-P group, 8.93% in the novel conventional plate group; P = 0.252). According to the subgroup analysis, there were significant differences in the postoperative C2‒C7 Cobb angle, C0‒C2 Cobb angle, T1 slope, and ASDH between the ZEVO group and the Skyline group (P < 0.05). Compared with the preoperative scores, the JOA, NDI, and VAS scores of all groups significantly improved at the 2-year follow-up (P < 0.01). According to the subgroup analysis, the immediate postoperative NDI and VAS scores of the ZEVO group were significantly better than those of the Skyline group (P < 0.05). CONCLUSION In ACDF, both novel conventional plates and Zero-P can improve sagittal parameters and related scale scores. Compared to the Zero-P plate, the novel conventional plate has a greater advantage in correcting the curvature of the surgical segment, but the Zero-P plate is less likely to produce postoperative dysphagia.
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Affiliation(s)
- Yan Gong
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Hang Zhuo
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Zelin Zhou
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Zhaojun Cheng
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yanchi Gan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Jiahui He
- The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Zefeng Song
- Department of Medicine, Dalian University of Technology, Dalian, 116081, China
| | - Hao Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yu Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - De Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Xiaobing Jiang
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China
| | - Hui Ren
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China.
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Li Q, Long X, Wang R, Niu P, Cai L, Wang L, Song Y. Correlation between degeneration of cervical intervertebral disc and degeneration of paravertebral muscle. Front Endocrinol (Lausanne) 2024; 15:1391970. [PMID: 38962678 PMCID: PMC11220226 DOI: 10.3389/fendo.2024.1391970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/31/2024] [Indexed: 07/05/2024] Open
Abstract
Objective To investigate the relationship between degeneration of cervical intervertebral disc and degeneration of paravertebral muscles[multifidus (MF), cervical semispinalis (SCer), semispinalis capitis (SCap) and splenius capitis (SPL)]. Methods 82 patients with chronic neck pain were randomly selected, including 43 males and 39 females, with 50.73 0.7.51 years old. All patients were scanned by 3.0T MRI Philips Ingenia performed conventional MRI sequence scanning and fat measurement sequence mDIXON-Quant scanning of cervical. Fat infiltration (FI) and cross-sectional area (CSA) of cervical paravertebral muscle (MF, SCer, SCap and SPL) at central level of C5-6 disc were measured by Philips 3.0T MRI image post-processing workstation. According to Pfirrmann grading system, there was no grade I in the included cases. The number of grade IIr IV cases were n=16, 40, 19 and 7 respectively. CSA and FI of cervical paravertebral muscles were compared with t test or one-way ANOVA, Spearman correlation analysis was used to evaluate the correlation between age, disc degeneration, and CSA, FI of cervical paravertebral muscles, and multiple linear regression analysis was used to analyze the independent influencing factors of CSA and FI. Results CSA of cervical paravertebral muscles in male patients was significantly higher than that in female patients (all P<0.001), but there was no significant difference in FI (all P>0.05). Age was weakly correlated with CSA of MF+SCer, moderately correlated with CSA of SCap and SPL (r=-0.256, -0.355 and -0.361, P<0.05), weakly correlated with FI of SCap and SPL (r= 0.182 and 0.264, P<0.001), moderately correlated with FI of MF+SCer (r=0.408, P<0.001). There were significant differences in FI with disc degeneration (P<0.001, P=0.028 and P=0.005). Further correlation analysis showed that disc degeneration was strongly correlated with FI of MF+SCer (r=0.629, P<0.001), and moderately correlated with FI of SCap and SPL (r=0.363, P=0.001; r=0.345, P=0.002). Multiple linear regression analysis showed that sex and age were the influencing factors of CSA of SCap and SPL, sex was the independent influencing factor of CSA of MF+SCer, and disc degeneration was the independent influencing factor of FI. Conclusions Age is negatively correlated with CSA and positively correlated with FI. Disc degeneration was correlated with FI of paravertebral muscles, especially with FI of MF and SCer. Sex and age were the influencing factors of CSA, while disc degeneration was the independent influencing factor of FI.
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Affiliation(s)
- Qiujiang Li
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xingxia Long
- Department of Thoracic Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Rui Wang
- Medical Center, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Pengying Niu
- Medical Center, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Lijun Cai
- Department of Orthopedics, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Lei Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yueming Song
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Yang F, Duan Y, Li Y, Zhu D, Wang Z, Luo Z, Zhang Y, Zhang G, He X, Kang X. S100A6 Regulates nucleus pulposus cell apoptosis via Wnt/β-catenin signaling pathway: an in vitro and in vivo study. Mol Med 2024; 30:87. [PMID: 38877413 PMCID: PMC11179208 DOI: 10.1186/s10020-024-00853-4] [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: 04/02/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Intervertebral disc degeneration (IDD) is a common musculoskeletal degenerative disease, which often leads to low back pain and even disability, resulting in loss of labor ability and decreased quality of life. Although many progresses have been made in the current research, the underlying mechanism of IDD remains unclear. The apoptosis of nucleus pulposus (NP) cells (NPCs) is an important pathological mechanism in intervertebral disc degeneration (IDD). This study evaluated the relationship between S100A6 and NPCs and its underlying mechanism. METHODS Mass spectrometry, bioinformatics, and quantitative real-time polymerase chain reaction (qRT-PCR) analyses were used to screen and verify hub genes for IDD in human IVD specimens with different degeneration degrees. Western blotting, immunohistochemistry (IHC), and/or immunofluorescence (IF) were used to detect the expression level of S100A6 in human NP tissues and NPCs. The apoptotic phenotype of NPCs and Wnt/β-catenin signaling pathway were evaluated using flow cytometry, western blotting, and IF. S100A6 was overexpressed or knocked down in NPCs to determine its impact on apoptosis and Wnt/β-catenin signaling pathway activity. Moreover, we used the XAV-939 to inhibit and SKL2001 to activate the Wnt/β-catenin signaling pathway. The therapeutic effect of S100A6 inhibition on IDD was also evaluated. RESULTS S100A6 expression increased in IDD. In vitro, increased S100A6 expression promoted apoptosis in interleukin (IL)-1β-induced NPCs. In contrast, the inhibition of S100A6 expression partially alleviated the progression of annulus fibrosus (AF) puncture-induced IDD in rats. Mechanistic studies revealed that S100A6 regulates NPC apoptosis via Wnt/β-catenin signaling pathway. CONCLUSIONS This study showed that S100A6 expression increased during IDD and promoted NPCs apoptosis by regulating the Wnt/β-catenin signaling pathway, suggesting that S100A6 is a promising new therapeutic target for IDD.
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Affiliation(s)
- Fengguang Yang
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Yanni Duan
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Yanhu Li
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Daxue Zhu
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Zhaoheng Wang
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Zhangbin Luo
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Yizhi Zhang
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Guangzhi Zhang
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Xuegang He
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Xuewen Kang
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China.
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China.
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China.
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Wang J, Huang J, Cui B, Yang H, Tian D, Ma J, Duan W, Dong H, Chen Z, Lu J. Diffusion Tensor Imaging Identifies Cervical Spondylosis, Myelitis, and Spinal Cord Tumors. Diagnostics (Basel) 2024; 14:1225. [PMID: 38928642 PMCID: PMC11202471 DOI: 10.3390/diagnostics14121225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) has been increasingly recognized for its capability to study microstructural changes in the neuropathology of brain diseases. However, the optimal DTI metric and its diagnostic utility for a variety of spinal cord diseases are still under investigation. PURPOSE To evaluate the diagnostic efficacy of DTI metrics for differentiating between cervical spondylosis, myelitis, and spinal tumors. METHODS This retrospective study analyzed DTI scans from 68 patients (22 with cervical spondylosis, 23 with myelitis, and 23 with spinal tumors). DTI indicators, including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD), were calculated. The Kruskal-Wallis test was used to compare these indicators, followed by Receiver Operating Characteristic (ROC) curve analysis, to evaluate the diagnostic efficacy of each indicator across disease pairs. Additionally, we explored the correlations of DTI indicators with specific clinical measurements. RESULTS FA values were significantly lower in tumor patients compared to those with cervical spondylosis (p < 0.0001) and myelitis (p < 0.05). Additionally, tumor patients exhibited significantly elevated MD and RD values relative to the spondylosis and myelitis groups. ROC curve analysis underscored FA's superior discriminative performance, with an area under the curve (AUC) of 0.902 for differentiating tumors from cervical spondylosis, and an AUC of 0.748 for distinguishing cervical myelitis from spondylosis. Furthermore, a significant negative correlation was observed between FA values and Expanded Disability Status Scores (EDSSs) in myelitis patients (r = -0.62, p = 0.002), as well as between FA values and Ki-67 scores in tumor patients (r = -0.71, p = 0.0002). CONCLUSION DTI indicators, especially FA, have the potential in distinguishing spondylosis, myelitis, and spinal cord tumors. The significant correlation between FA values and clinical indicators highlights the value of FA in the clinical assessment and prognosis of spinal diseases and may be applied in diagnostic protocols in the future.
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Affiliation(s)
- Jiyuan Wang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Jing Huang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Bixiao Cui
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Hongwei Yang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Defeng Tian
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Jie Ma
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (W.D.); (Z.C.)
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (W.D.); (Z.C.)
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
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19
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Breen A, Nematimoez M, Branney J, Breen A. Passive intervertebral restraint is different in patients with treatment-resistant chronic nonspecific low back pain: a retrospective cohort study and control comparison. 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; 33:2405-2419. [PMID: 38730057 DOI: 10.1007/s00586-024-08249-y] [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: 11/21/2023] [Accepted: 03/31/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE In vivo studies of continuous lumbar sagittal plane motion have found passive intervertebral motion to be more uneven in patients with chronic nonspecific low back pain (CNSLBP) than healthy controls, but the mechanisms are unclear. This study aimed to compare patients with CNSLBP with a matched group of pain-free controls for intervertebral restraint during passive recumbent bending. METHODS Seventeen patients with CNSLBP and minimal disc degeneration who had quantitative fluoroscopy investigations were matched to 17 healthy controls from a database acquired using the same imaging protocol. The entire database (n = 136) was examined for clustering of peaking times, magnitudes and ROM of the first derivatives of the intervertebral angle/motion curves (PTFD, PMFD and ROM) during flexion and return that might introduce confounding. The groups were then compared for differences in these variables. RESULTS There were significant segmental ROM differences among clusters in the database when PMFD and ROM were used as clustering variables, indicating heterogeneity. However, in the patient-control study, it was PTFD (velocity) that differentiated the groups. At L5-S1, this was at 10.82% of the motion path compared with 25.06% in the controls (p = 0.0002). For L4-5, PTFD was at 23.42% of the motion path in patients and 16.33% in controls (p = 0.0694) suggesting a reduced initial bending moment there. There were no significant differences for PMFD or ROM. CONCLUSION Peaking time of passive intervertebral velocity occurs early at L5-S1 in patients with CNSLBP; however, these findings should be treated with caution pending their replication. Future studies should explore relationships with altered disc pressures and biochemistry. Usefulness for monitoring regenerative disc therapies should be considered.
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Affiliation(s)
- Alan Breen
- Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK
| | - Mehdi Nematimoez
- Department of Sport Biomechanics, University of Bojnord, Bojnurd, Iran
| | - Jonathan Branney
- Faculty of Health and Social Science, Bournemouth University, Poole, BH12 5BB, UK.
| | - Alexander Breen
- Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK
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Tolson JK, Menuet RL, Ly GH, Chanes BA, Bryan EA, Kataria S, Kim J, Ahmadzadeh S, Shekoohi S, Kaye AD. Evolving role of VIADISC for chronic low back and discogenic pain: a narrative review. Expert Opin Emerg Drugs 2024; 29:155-164. [PMID: 38602142 DOI: 10.1080/14728214.2024.2339912] [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: 10/16/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Chronic lower back pain is a leading cause of disability and healthcare spending worldwide. Discogenic pain, pain originating from the intervertebral disk, is a common etiology of chronic lower back pain. Currently, accepted treatments for chronic discogenic pain focus only on the management of symptoms, such as pain. There are no approved treatments that stop or reverse degenerating intervertebral discs. Biologic therapies promoting disc regeneration have been developed to expand treatment options. VIADISC™ NP, is a viable disc allograft supplementation that, in a recent trial, demonstrated a significant reduction in pain and increased function in patients suffering from symptomatic degenerative disc disease. AREAS COVERED This manuscript summarizes the epidemiology and etiology of low back pain, the pathophysiology of degenerative disc disease, current treatments, and a need for newer therapies. The rationale behind intradiscal biologics for the treatment of symptomatic degenerative disc disease is also discussed. EXPERT OPINION Characterization of the biology leading to disc degeneration has allowed for the development of intradiscal biologics. They may soon be capable of preventing and reversing disc degeneration. Clinical trials have shown promise, but further research into efficacy and safety is needed before these therapies are widely employed.
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Affiliation(s)
- Jack K Tolson
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Robert L Menuet
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Gianni H Ly
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Benjamin A Chanes
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Elizabeth A Bryan
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Saurabh Kataria
- Department of Neurology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Julian Kim
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 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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Tsai YC, Hsu WL, Kantha P, Chen PJ, Lai DM. Virtual reality skateboarding training for balance and functional performance in degenerative lumbar spine disease. J Neuroeng Rehabil 2024; 21:74. [PMID: 38724981 PMCID: PMC11080234 DOI: 10.1186/s12984-024-01357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Degenerative lumbar spine disease (DLD) is a prevalent condition in middle-aged and elderly individuals. DLD frequently results in pain, muscle weakness, and motor impairment, which affect postural stability and functional performance in daily activities. Simulated skateboarding training could enable patients with DLD to engage in exercise with less pain and focus on single-leg weight-bearing. The purpose of this study was to investigate the effects of virtual reality (VR) skateboarding training on balance and functional performance in patients with DLD. METHODS Fourteen patients with DLD and 21 age-matched healthy individuals completed a 6-week program of VR skateboarding training. The motion capture and force platform systems were synchronized to collect data during a single-leg stance test (SLST). Musculoskeletal simulation was utilized to calculate muscle force based on the data. Four functional performance tests were conducted to evaluate the improvement after the training. A Visual Analogue Scale (VAS) was also employed for pain assessment. RESULTS After the training, pain intensity significantly decreased in patients with DLD (p = 0.024). Before the training, patients with DLD took longer than healthy individuals on the five times sit-to-stand test (p = 0.024). After the training, no significant between-group differences were observed in any of the functional performance tests (p > 0.05). In balance, patients with DLD were similar to healthy individuals after the training, except that the mean frequency (p = 0.014) was higher. Patients with DLD initially had higher biceps femoris force demands (p = 0.028) but shifted to increased gluteus maximus demand after the training (p = 0.037). Gluteus medius strength significantly improved in patients with DLD (p = 0.039), while healthy individuals showed consistent muscle force (p > 0.05). CONCLUSION This is the first study to apply the novel VR skateboarding training to patients with DLD. VR skateboarding training enabled patients with DLD to achieve the training effects in a posture that relieves lumbar spine pressure. The results also emphasized the significant benefits to patients with DLD, such as reduced pain, enhanced balance, and improved muscle performance.
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Affiliation(s)
- Yi-Ching Tsai
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei, Taiwan.
- Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Phunsuk Kantha
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei, Taiwan
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Po-Jung Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei, Taiwan
| | - Dar-Ming Lai
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Tecce E, Sarikonda A, Leibold A, Mansoor Ali D, Thalheimer S, Sami A, Heller J, Prasad S, Sharan A, Harrop J, Vaccaro A, Sivaganesan A. Does Body Mass Index Influence Intraoperative Costs and Operative Times for Anterior Cervical Discectomy and Fusion? A Time-Driven Activity-Based Costing Analysis. World Neurosurg 2024; 185:e563-e571. [PMID: 38382758 DOI: 10.1016/j.wneu.2024.02.074] [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: 11/21/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Spine surgeons are often unaware of drivers of cost variation for anterior cervical discectomy and fusion (ACDF). We used time-driven activity-based costing to assess the relationship between body mass index (BMI), total cost, and operating room (OR) times for ACDFs. METHODS Total cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments. Timestamps for all involved personnel and material resources were documented. Total intraoperative costs were estimated for all ACDFs from 2017 to 2022. All patients were categorized into distinct BMI-based cohorts. Linear regression models were performed to assess the relationship between BMI, total cost, and OR times. RESULTS A total of 959 patients underwent ACDFs between 2017 and 2022. The average age and BMI were 58.1 ± 11.2 years and 30.2 ± 6.4 kg/m2, respectively. The average total intraoperative cost per case was $7120 ± $2963. Multivariable regression analysis revealed that BMI was not significantly associated with total cost (P = 0.36), supply cost (P = 0.39), or personnel cost (P = 0.20). Higher BMI was significantly associated with increased time spent in the OR (P = 0.018); however, it was not a significant factor for the duration of surgery itself (P = 0.755). Rather, higher BMI was significantly associated with nonoperative OR time (P < 0.001). CONCLUSIONS Time-driven activity-based costing is a feasible and scalable methodology for understanding the true intraoperative costs of ACDF. Although higher BMI was not associated with increased total cost, it was associated with increased preparatory time in the OR.
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Affiliation(s)
- Eric Tecce
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Advith Sarikonda
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
| | - Adam Leibold
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Daniyal Mansoor Ali
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Sara Thalheimer
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Ashmal Sami
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Joshua Heller
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Srinivas Prasad
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Alexander Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ahilan Sivaganesan
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
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Sakti YM, Samyudia ER, Emiri DM, Aryandono T, Magetsari R, Malueka RG, Dwianingsih EK. Balloon compression-induced spinal cord injury in canines: a large animal model for spinal cord injury research. J Med Life 2024; 17:508-522. [PMID: 39144692 PMCID: PMC11320615 DOI: 10.25122/jml-2023-0531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/08/2024] [Indexed: 08/16/2024] Open
Abstract
Spinal cord injury (SCI) is a life-altering condition that severely impacts an individual's functional capabilities and has significant implications for both the individual and society. Large animal models are crucial for understanding the pathology and biomechanics of SCI. Dogs (Canis lupus familiaris) are promising models for SCI research due to their anatomical and histopathological similarities to humans. Balloon compression is an established method for inducing controlled SCI in canines. In this study, we optimized a balloon compression procedure for inducing SCI in dogs, aiming to develop a reliable model for future in vivo studies. Our methodology successfully induced total motoric loss in canines, observed for seven days, a critical period for therapeutic interventions. Histopathological examinations using Luxol fast blue (LFB) staining revealed total demyelination in intralesional samples, confirming the structural damage caused by balloon compression. We concluded that a balloon compression model at the T10-T11 vertebral level, with an inflated balloon volume of 1.0 ml, induced SCI while minimizing the risk of balloon rupture. Longer duration of compression ensures total paralysis in this model, providing a platform for testing therapeutic interventions during the acute phase of SCI. The canine model generated consistent data and facilitated straightforward observational findings.
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Affiliation(s)
- Yudha Mathan Sakti
- Orthopedics and Traumatology Department, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Emir Riandika Samyudia
- Orthopedics and Traumatology Department, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Deas Makalingga Emiri
- Orthopedics and Traumatology Department, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Teguh Aryandono
- Department of Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rahadyan Magetsari
- Orthopedics and Traumatology Department, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rusdy Ghazali Malueka
- Neurology Department, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ery Kus Dwianingsih
- Anatomical Pathology Department, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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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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Yasaka K, Uehara S, Kato S, Watanabe Y, Tajima T, Akai H, Yoshioka N, Akahane M, Ohtomo K, Abe O, Kiryu S. Super-resolution Deep Learning Reconstruction Cervical Spine 1.5T MRI: Improved Interobserver Agreement in Evaluations of Neuroforaminal Stenosis Compared to Conventional Deep Learning Reconstruction. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01112-y. [PMID: 38671337 DOI: 10.1007/s10278-024-01112-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024]
Abstract
The aim of this study was to investigate whether super-resolution deep learning reconstruction (SR-DLR) is superior to conventional deep learning reconstruction (DLR) with respect to interobserver agreement in the evaluation of neuroforaminal stenosis using 1.5T cervical spine MRI. This retrospective study included 39 patients who underwent 1.5T cervical spine MRI. T2-weighted sagittal images were reconstructed with SR-DLR and DLR. Three blinded radiologists independently evaluated the images in terms of the degree of neuroforaminal stenosis, depictions of the vertebrae, spinal cord and neural foramina, sharpness, noise, artefacts and diagnostic acceptability. In quantitative image analyses, a fourth radiologist evaluated the signal-to-noise ratio (SNR) by placing a circular or ovoid region of interest on the spinal cord, and the edge slope based on a linear region of interest placed across the surface of the spinal cord. Interobserver agreement in the evaluations of neuroforaminal stenosis using SR-DLR and DLR was 0.422-0.571 and 0.410-0.542, respectively. The kappa values between reader 1 vs. reader 2 and reader 2 vs. reader 3 significantly differed. Two of the three readers rated depictions of the spinal cord, sharpness, and diagnostic acceptability as significantly better with SR-DLR than with DLR. Both SNR and edge slope (/mm) were also significantly better with SR-DLR (12.9 and 6031, respectively) than with DLR (11.5 and 3741, respectively) (p < 0.001 for both). In conclusion, compared to DLR, SR-DLR improved interobserver agreement in the evaluations of neuroforaminal stenosis using 1.5T cervical spine MRI.
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Affiliation(s)
- Koichiro Yasaka
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Shunichi Uehara
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shimpei Kato
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Yusuke Watanabe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Taku Tajima
- Department of Radiology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Hiroyuki Akai
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Naoki Yoshioka
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Kuni Ohtomo
- International University of Health and Welfare, 2600-1 Ktiakanemaru, Ohtawara, Tochigi, 324-8501, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigeru Kiryu
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan.
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Saeed A, Shao H, Hezam K, Liu C, Zhang Q, Tang X. Research trend of MRI application for lumbar disc degeneration with low back pain: a bibliometric analysis. Front Neurol 2024; 15:1360091. [PMID: 38694782 PMCID: PMC11061404 DOI: 10.3389/fneur.2024.1360091] [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: 12/22/2023] [Accepted: 04/02/2024] [Indexed: 05/04/2024] Open
Abstract
Background Low Back Pain (LBP) is a pervasive and complex musculoskeletal condition affecting over 80% of the global population. Lumbar Disc Degeneration (LDD) significantly contributes to LBP, and MRI is crucial for its diagnosis and understanding. This study aimes to provide a comprehensive bibliometric analysis of MRI research on LDD with LBP, shedding light on research patterns, collaborations, and potential knowledge gaps. Methods A comprehensive online search was conducted in the Scopus database to retrieve published literature on LDD with LBP. Bibliometric analysis was conducted to assess publication patterns, co-authorship networks, keyword co-occurrence, and co-citation analysis within the MRI applications for LDD research domain. Bibliometric analysis tools such as VOSviewer and the R package "bibliometrix" were utilized for quantitative assessments. Results A total of 1,619 publications related to MRI and LDD were analyzed. The analysis indicated a consistent annual growth rate of 4.62% in publications related to MRI and lumbar disc degeneration, reflecting a steady increase in research output over the past two decades. The USA, China, and Japan emerged as leading contributors. "SPINE", "European Spine Journal", and "Spine Journal" were the most productive journals in this domain. Key research themes identified included lumbar spine, low back pain, and magnetic resonance imaging. Network visualization shows that low back pain and magnetic resonance imaging were the most widely used keywords. Conclusion The comprehensive bibliometric analysis of MRI applications for Lumbar Disc Degeneration offers insights into prevailing research patterns, highlights key contributors and journals, and identifies significant research themes. This study provides a foundation for future research efforts and clinical practices in the field, ultimately contributing to the advancement of patient care for individuals suffering from LDD and associated Low Back Pain.
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Affiliation(s)
- Azzam Saeed
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haoyue Shao
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kamal Hezam
- Nankai University School of Medicine, Tianjin, China
| | - Chaoxu Liu
- Department of Orthopedics, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiya Zhang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangyu Tang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Liu Y, Zhang G, Wu J, Meng Y, Hu J, Fu H, Yang D. CARMA3 Drives NF-κB Activation and Promotes Intervertebral Disc Degeneration: Involvement of CARMA3-BCL10-MALT1 Signalosome. Inflammation 2024:10.1007/s10753-024-02016-3. [PMID: 38607566 DOI: 10.1007/s10753-024-02016-3] [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: 02/20/2024] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/13/2024]
Abstract
Intervertebral disc degeneration (IDD) diseases are common and frequent diseases in orthopedics. The caspase recruitment domain (CARD) and membrane-associated guanylate kinase-like protein 3 (CARMA3) is crucial in the activation of the NF-κB pathway. However, the biological function of CARMA3 in IDD remains unknown. Here, CARMA3 expression was elevated in nucleus pulposus (NP) tissues of IDD rats and nutrient deprivation (ND)-induced NP cells. The main pathological manifestations observed in IDD rats were shrinkage of the NP, reduction of NP cells, fibrosis of NP tissues, and massive reduction of proteoglycans. These changes were accompanied by a decrease in the expression of collagen II and aggrecan, an increase in the expression of the extracellular matrix (ECM) catabolic proteases MMP-3, MMP-13, and metalloprotease with ADAMTS-5, and an increase in the activity of the pro-apoptotic protease caspase-3. The expression of p-IκBαSer32/36 and p-p65Ser536 was also upregulated. However, these effects were reversed with the knockdown of CARMA3. Mechanistically, CARMA3 bound to BCL10 and MALT1 to form a signalosome. Knockdown of CARMA3 reduced the CARMA3-BCL10-MALT1 signalosome-mediated NF-κB activation. CARMA3 activated the NF-κB signaling pathway in a manner that bound to BCL10 and MALT1 to form a signalosome, which affects NP cell damage and is involved in the development of IDD. This supports CARMA3-BCL10-MALT1-NF-κB as a promising targeting axis for the treatment of IDD.
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Affiliation(s)
- Yadong Liu
- Department of Orthopedics, Central Hospital of Dalian University of Technology, No. 826 Xinan Road, Dalian, People's Republic of China
| | - Guiqi Zhang
- Department of Orthopedics, Central Hospital of Dalian University of Technology, No. 826 Xinan Road, Dalian, People's Republic of China
| | - Jiani Wu
- Department of Orthopedics, Central Hospital of Dalian University of Technology, No. 826 Xinan Road, Dalian, People's Republic of China
| | - Yi Meng
- Department of Orthopedics, Central Hospital of Dalian University of Technology, No. 826 Xinan Road, Dalian, People's Republic of China
| | - Jianyu Hu
- Department of Orthopedics, Central Hospital of Dalian University of Technology, No. 826 Xinan Road, Dalian, People's Republic of China
| | - Hao Fu
- Department of Orthopedics, Central Hospital of Dalian University of Technology, No. 826 Xinan Road, Dalian, People's Republic of China
| | - Dongfang Yang
- Department of Orthopedics, Central Hospital of Dalian University of Technology, No. 826 Xinan Road, Dalian, People's Republic of China.
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Menon RG, Monga A, Kijowski R, Regatte RR. Characterization of Age-Related and Sex-Related Differences of Relaxation Parameters in the Intervertebral Disc Using MR-Fingerprinting. J Magn Reson Imaging 2024; 59:1312-1324. [PMID: 37610269 PMCID: PMC10935608 DOI: 10.1002/jmri.28925] [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: 04/14/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Multiparameter characterization using MR fingerprinting (MRF) can quantify multiple relaxation parameters of intervertebral disc (IVD) simultaneously. These parameters may vary by age and sex. PURPOSE To investigate age- and sex-related differences in the relaxation parameters of the IVD of the lumbar spine using a multiparameter MRF technique. STUDY TYPE Prospective. SUBJECTS 17 healthy subjects (8 male; mean age = 34 ± 10 years, range 20-60 years). FIELD STRENGTH/SEQUENCE 3D-MRF sequence for simultaneous acquisition of proton density, T1 , T2 , and T1ρ maps at 3.0T. ASSESSMENT Global mean T1 , T2 , and T1ρ of all lumbar IVDs and mean T1 , T2 , and T1ρ of each individual IVD (L1-L5) were measured. Gray level co-occurrence matrix was used to quantify textural features (median, contrast, correlation, energy, and homogeneity) from T1 , T2 , and T1ρ maps. STATISTICAL TESTS Spearman rank correlations (R) evaluated the association between age and T1 , T2 , and T1ρ of IVD. Mann-Whitney U-tests evaluated differences between males and females in T1 , T2 , and T1ρ of IVD. Statistical significance was defined as P-value <0.05. RESULTS There was a significant negative correlation between age and global mean values of all IVDs for T1 (R = -0.637), T2 (R = -0.509), and T1ρ (R = -0.726). For individual IVDs, there was a significant negative correlation between age and mean T1 at all IVD segments (R range = -0.530 to -0.708), between age and mean T2 at L2-L3, L3-L4, and L4-L5 (R range = -0.493 to 0.640), and between age and mean T1ρ at all segments except L1-L2 (R range = -0.632 to -0.763). There were no significant differences between sexes in global mean T1 , T2, and T1ρ (P-value = 0.23-0.76) The texture features with the highest significant correlations with age for all IVDs were global T1ρ mean (R = -0.726), T1 energy (R = -0.681), and T1 contrast (R = 0.709). CONCLUSION This study showed that the 3D-MRF technique has potential to characterize age-related differences in T1 , T2, or T1ρ of IVD in healthy subjects. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Rajiv G. Menon
- Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine
| | - Anmol Monga
- Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine
| | - Richard Kijowski
- Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine
| | - Ravinder R. Regatte
- Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine
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Song C, Hu P, Peng R, Li F, Fang Z, Xu Y. Bioenergetic dysfunction in the pathogenesis of intervertebral disc degeneration. Pharmacol Res 2024; 202:107119. [PMID: 38417775 DOI: 10.1016/j.phrs.2024.107119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 03/01/2024]
Abstract
Intervertebral disc (IVD) degeneration is a frequent cause of low back pain and is the most common cause of disability. Treatments for symptomatic IVD degeneration, including conservative treatments such as analgesics, physical therapy, anti-inflammatories and surgeries, are aimed at alleviating neurological symptoms. However, there are no effective treatments to prevent or delay IVD degeneration. Previous studies have identified risk factors for IVD degeneration such as aging, inflammation, genetic factors, mechanical overload, nutrient deprivation and smoking, but metabolic dysfunction has not been highlighted. IVDs are the largest avascular structures in the human body and determine the hypoxic and glycolytic features of nucleus pulposus (NP) cells. Accumulating evidence has demonstrated that intracellular metabolic dysfunction is associated with IVD degeneration, but a comprehensive review is lacking. Here, by reviewing the physiological features of IVDs, pathological processes and metabolic changes associated with IVD degeneration and the functions of metabolic genes in IVDs, we highlight that glycolytic pathway and intact mitochondrial function are essential for IVD homeostasis. In degenerated NPs, glycolysis and mitochondrial function are downregulated. Boosting glycolysis such as HIF1α overexpression protects against IVD degeneration. Moreover, the correlations between metabolic diseases such as diabetes, obesity and IVD degeneration and their underlying molecular mechanisms are discussed. Hyperglycemia in diabetic diseases leads to cell senescence, the senescence-associated phenotype (SASP), apoptosis and catabolism of extracellualr matrix in IVDs. Correcting the global metabolic disorders such as insulin or GLP-1 receptor agonist administration is beneficial for diabetes associated IVD degeneration. Overall, we summarized the recent progress of investigations on metabolic contributions to IVD degeneration and provide a new perspective that correcting metabolic dysfunction may be beneficial for treating IVD degeneration.
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Affiliation(s)
- Chao Song
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Peixuan Hu
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Renpeng Peng
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Feng Li
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China.
| | - Zhong Fang
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China.
| | - Yong Xu
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China.
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Morimoto M, Tripathi S, Kodigudla M, Motohashi E, Fujitani J, Goel VK, Sairyo K. Biomechanical Effects of Thoracic Flexibility and Stiffness on Lumbar Spine Loading: A Finite Element Analysis Study. World Neurosurg 2024; 184:e282-e290. [PMID: 38280628 DOI: 10.1016/j.wneu.2024.01.112] [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: 10/10/2023] [Revised: 01/19/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE To determine the effects of thoracic stiffness on mechanical stress in the lumbar spine during motion. METHODS To evaluate the effect of preoperative thoracic flexibility, stiff and flexible spine models were created by changing the material properties of ligaments and discs in the thoracic spine. Total laminectomy was performed at L4/5 in stiff and flexible models. A biomechanical investigation and finite element analysis were performed preoperatively and postoperatively. A hybrid loading condition was applied, and the range of motion (ROM) at each segment and maximum stress in the discs and pars interarticularis were computed. RESULTS In the preoperative model with the stiff thoracic spine, lumbar disc stress, lumbar ROM, and pars interarticularis stress at L5 increased. In contrast, as the thoracic spine became more flexible, lumbar disc stress, lumbar ROM, and pars interarticularis stress at L5 decreased. All L4/5 laminectomy models had increased instability and ROM at L4/5. To evaluate the effect of thoracic flexibility on the lumbar spine, differences between the stiff and flexible thoracic spine were examined: Differences in ROM and intervertebral disc stress at L4/5 in flexion between the stiff and flexible thoracic spine were respectively 0.7° and 0.0179 MPa preoperatively and 1.5° and 0.0367 MPa in the L4/5 laminectomy model. CONCLUSIONS Biomechanically, disc stress and pars interarticularis stress decrease in the flexible thoracic spine. Flexibility of the thoracic spine reduces lumbar spine loading and could help to prevent stress-related disorders.
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Affiliation(s)
- Masatoshi Morimoto
- Department of Orthopedic Surgery, Tokushima University Graduate School of Medicine, Tokushima, Japan; Departments of Bioengineering and Orthopaedics, Engineering Center for Orthopaedic Research Excellence, University of Toledo, Toledo, Ohio, USA.
| | - Sudharshan Tripathi
- Departments of Bioengineering and Orthopaedics, Engineering Center for Orthopaedic Research Excellence, University of Toledo, Toledo, Ohio, USA
| | - Manoj Kodigudla
- Departments of Bioengineering and Orthopaedics, Engineering Center for Orthopaedic Research Excellence, University of Toledo, Toledo, Ohio, USA
| | - Emi Motohashi
- Department of Orthopedic Surgery, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Junzo Fujitani
- Department of Orthopedic Surgery, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Vijay K Goel
- Departments of Bioengineering and Orthopaedics, Engineering Center for Orthopaedic Research Excellence, University of Toledo, Toledo, Ohio, USA
| | - Koichi Sairyo
- Department of Orthopedic Surgery, Tokushima University Graduate School of Medicine, Tokushima, Japan
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Agustini D, Heimann MK, Co M, Walter BA, Purmessur D, Moore SA. Modic changes in the lumbar vertebral column of chondrodystrophic and non-chondrodystrophic dogs with intervertebral disc disease. Front Vet Sci 2024; 11:1359016. [PMID: 38566749 PMCID: PMC10985344 DOI: 10.3389/fvets.2024.1359016] [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: 12/27/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Modic changes (MC) are signs of vertebral pathology visible on magnetic resonance (MR) images that have been associated with low back pain (LBP) and disc degeneration in people. Multiple breeds of dogs also develop MCs and coincident back pain. However, the association between breed, MC, and spinal pathologies has yet to be fully elucidated. This study aimed to identify the prevalence of MC that occur spontaneously in the lumbar vertebral column of dogs diagnosed with intervertebral disc disease (IVDD) and examine their association with demographic criteria and the disc width index (DWI). Methods Medical records and lumbar vertebral column MR images were examined from 104 dogs (831 intervertebral disc spaces and adjacent vertebrae), which were divided into three groups: chondrodystrophic dogs (CD; n =54) and non-chondrodystrophic dogs (NCD; n =30) with IVDD as the primary diagnosis, and control dogs (n =20) with other spinal diseases as their primary diagnosis. Results Increasing age and a diagnosis of IVDD were significantly associated with MC in dogs (p < 0.001 and p = 0.0062, respectively). In CD dogs with IVDD, Type 2 MC were most prevalent, whereas, in NCD dogs, Type 3 MC were the most prevalent type. Type 2 MC were distributed nearly equally across the lumbar vertebral column, while Type 3 MC were primarily detected at the level of L7-S1. Discussion This study demonstrated that MC developed spontaneously in dogs, are common in dogs diagnosed with IVDD, and the type observed varies by breed. Further research is needed to understand the pathogenesis of MC; however, the increased presence of Type 2 MC in CD dogs, similar to what is found in people with disc degeneration, suggests that CD dogs could serve as models for MC in people.
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Affiliation(s)
- Dyah Agustini
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Mary K Heimann
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Megan Co
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Benjamin A Walter
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Devina Purmessur
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Sarah A Moore
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
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Clayton SW, Walk RE, Mpofu L, Easson GW, Tang SY. Analysis of Infiltrating Immune Cells Following Intervertebral Disc Injury Reveals Recruitment of Gamma-Delta ( γδ) T cells in Female Mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.01.582950. [PMID: 38464124 PMCID: PMC10925253 DOI: 10.1101/2024.03.01.582950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Inadequate repair of injured intervertebral discs (IVD) leads to degeneration and contributes to low back pain. Infiltrating immune cells into damaged musculoskeletal tissues are critical mediators of repair, yet little is known about their identities, roles, and temporal regulation following IVD injury. By analyzing longitudinal changes in gene expression, tissue morphology, and the dynamics of infiltrating immune cells following injury, we characterize sex-specific differences in immune cell populations and identify the involvement of previously unreported immune cell types, γδ and NKT cells. Cd3+Cd4-Cd8- T cells are the largest infiltrating lymphocyte population with injury, and we identified the presence of γδ T cells in this population in female mice specifically, and NKT cells in males. Injury-mediated IVD degeneration was prevalent in both sexes, but more severe in males. Sex-specific degeneration may be associated with the differential immune response since γδ T cells have potent anti-inflammatory roles and may mediate IVD repair.
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Affiliation(s)
| | - Remy E. Walk
- Washington University in St. Louis, St. Louis, MO
| | - Laura Mpofu
- Washington University in St. Louis, St. Louis, MO
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McKinley JP, O'Connell GD. Review of state-of-the-art micro and macro-bioreactors for the intervertebral disc. J Biomech 2024; 165:111964. [PMID: 38412621 DOI: 10.1016/j.jbiomech.2024.111964] [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: 08/08/2023] [Revised: 01/02/2024] [Accepted: 01/23/2024] [Indexed: 02/29/2024]
Abstract
Lower back pain continues to be a global epidemic, limiting quality of life and ability to work, due in large part to symptomatic disc degeneration. Development of more effective and less invasive biological strategies are needed to treat disc degeneration. In vitro models such as macro- or micro-bioreactors or mechanically active organ-chips hold great promise in reducing the need for animal studies that may have limited clinical translatability, due to harsher and more complex mechanical loading environments in human discs than in most animal models. This review highlights the complex loading conditions of the disc in situ, evaluates state-of-the-art designs for applying such complex loads across multiple length scales, from macro-bioreactors that load whole discs to organ-chips that aim to replicate cellular or engineered tissue loading. Emphasis was placed on the rapidly evolving more customizable organ-chips, given their greater potential for studying the progression and treatment of symptomatic disc degeneration. Lastly, this review identifies new trends and challenges for using organ-chips to assess therapeutic strategies.
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Affiliation(s)
- Jonathan P McKinley
- Berkeley BioMechanics Laboratory, Department of Mechanical Engineering, University of California, Berkeley 94720, CA, USA.
| | - Grace D O'Connell
- Berkeley BioMechanics Laboratory, Department of Mechanical Engineering, University of California, Berkeley 94720, CA, USA.
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Segar AH, Baroncini A, Urban JPG, Fairbank J, Judge A, McCall I. Obesity increases the odds of intervertebral disc herniation and spinal stenosis; an MRI study of 1634 low back pain patients. 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; 33:915-923. [PMID: 38363366 DOI: 10.1007/s00586-024-08154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/13/2023] [Accepted: 01/20/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE The objective of this study was to examine the relationships between BMI and intervertebral disc degeneration (DD), disc herniation (DH) and spinal stenosis (SS) using a large, prospectively recruited and heterogeneous patient population. METHODS Patients were recruited through the European Genodisc Study. An experienced radiologist scored MRI images for DD, DH and SS. Multivariate linear and logistic regression analyses were used to model the relationship between these variables and BMI with adjustment for patient and MRI confounders. RESULTS We analysed 1684 patients with a mean age of 51 years and BMI of 27.2 kg/m2.
The mean DD score was 2.6 (out of 5) with greater DD severity with increasing age (R2 = 0.44). In the fully adjusted model, a 10-year increase in age and a 5 kg/m2 increase in BMI were associated, respectively, with a 0.31-unit [95% CI 0.29,0.34] and 0.04-unit [CI 0.01,0.07] increase in degeneration. Age (OR 1.23 [CI 1.06,1.43]) and BMI (OR 2.60 [CI 2.28,2.96]) were positively associated with SS. For DH, age was a negative predictor (OR 0.70 [CI 0.64,0.76]) but for BMI (OR 1.19 [CI 1.07,1.33]), the association was positive. BMI was the strongest predictor of all three features in the upper lumbar spine. CONCLUSIONS While an increase in BMI was associated with only a slight increase in DD, it was a stronger predictor for DH and SS, particularly in the upper lumbar discs, suggesting weight loss could be a useful strategy for helping prevent disorders associated with these pathologies.
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Affiliation(s)
- Anand H Segar
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | | | - Jocelyn P G Urban
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Jeremy Fairbank
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Andrew Judge
- Centre for Statistics in Medicine, Nuffield, Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, UK
| | - Iain McCall
- Department of Radiology, Robert Jones and Agnes Hunt Hospital, Oswestry, UK
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Makineni PS, Lavu MS, Eghrari NB, Kim CH, Kaelber DC, Kelly ML. Incidence of Sacroiliac Joint Pain Following Lumbar Fractures: A Retrospective-Cohort Study. World Neurosurg 2024; 183:e936-e943. [PMID: 38246533 DOI: 10.1016/j.wneu.2024.01.068] [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: 08/21/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Sacroiliac joint (SIJ) pain commonly affects patients with low back pain and can arise from traumatic and degenerative causes. However, the incidence of SIJ pain following lumbar fractures is not well understood. METHODS TriNetX, a national network of deidentified patient records, was retrospectively queried. The lumbar fracture cohort included 239,199 adults, while the no lumbar fracture group included 6,975,046 adults. Following a propensity-score match based on demographics and risk factors for SIJ, there were 239,197 patients in each cohort. The incidence of SIJ pain and clinical outcomes were analyzed from 1 day to 1 year following the index event. Moreover, the location and type of single-level lumbar fractures were reported. The incidence of SIJ pain for single-level fractures was compared using a χ2 goodness-of-fit. RESULTS The lumbar fracture cohort was more likely to develop SIJ pain at 3 months (odds ratio [OR]: 5.3, 95% confidence interval [CI]: 4.8-5.9), 6 months (OR: 4.4, 95% CI: 4.1-4.8), and 1 year (OR: 3.9, 95% CI: 3.6-4.2) postfracture. Among single-level lumbar fractures, the incidence of SIJ pain at 1 month (P = 0.005), 6 months (P = 0.010), and 1 year (P = 0.003) varied significantly, with the highest incidence in the L5 cohort. CONCLUSIONS Our findings suggest that lumbar fractures are a risk factor for developing SIJ pain. Moreover, the incidence of SIJ pain is greater following an L5 fracture than an L1 fracture. Further investigation is warranted to determine how the type and treatment of lumbar fractures affects the incidence of SIJ pain.
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Affiliation(s)
- Pratheek S Makineni
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA
| | - Monish S Lavu
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA
| | - Nafis B Eghrari
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA
| | - Chong H Kim
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA; Department of Neurological Surgery, The MetroHealth System, Cleveland, Ohio, USA
| | - David C Kaelber
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA; Department of Neurological Surgery, The MetroHealth System, Cleveland, Ohio, USA
| | - Michael L Kelly
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA; Department of Neurological Surgery, The MetroHealth System, Cleveland, Ohio, USA.
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Cheung STY, Tsang HHL, Cheung PWH, Cheung JPY. Male spondyloarthritis patients and those with longer disease duration have less severe disc degeneration: propensity score-matched comparison. Rheumatol Adv Pract 2024; 8:rkae015. [PMID: 38405075 PMCID: PMC10884529 DOI: 10.1093/rap/rkae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/14/2024] [Indexed: 02/27/2024] Open
Abstract
Objective Using whole spine sagittal T2 MRI, we aimed to compare the severity and prevalence of disc degeneration (DD) in axial SpA patients vs the general population and to determine any association between spinal inflammation, structural changes, mobility and DD among SpA patients. Methods Two prospectively collected cohorts of SpA patients (n = 411) and the general population (n = 2007) were recruited. Eventually, 967 participants from the populational cohort and 304 participants from the SpA cohort were analysed. Two hundred and nineteen matched pairs were generated by propensity score matching. Imaging parameters, including Pfirrmann grading, disc herniation, high-intensity zone, Schmorl's node, Modic change and anterior marrow change were studied and compared from C2/3 to L5/S1. DD was defined as Pfirrmann grade 4 or 5. Demographic factors, including age, sex and BMI, were collected. Multivariable linear regression was used to determine the association between spinal inflammation [Spondyloarthritis Research Consortium of Canada (SPARCC) spine MRI index], structural changes [modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS)] and mobility (BASMI) with lumbar Pfirrmann score. Results SpA patients had lower prevalence of DD (P < 0.001). The disease stage-stratified regression model showed that SPARCC spinal MRI index was associated with higher lumbar Pfirrmann scores in early disease (β = 0.196, P = 0.044), whereas mSASSS was associated with lower lumbar Pfirrmann scores in later disease (β = -0.138, P = 0.038). Males had higher mSASSS (P < 0.001) and lower odds of whole spine DD (odds ratio = 0.622, P = 0.028). Conclusion SpA patients had lower DD severity than the general population. Males had higher mSASSSs, and increased mSASSS at later disease was associated with less severe DD.
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Affiliation(s)
- Samuel Tin Yan Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Helen Hoi Lun Tsang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | | | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Razak A, Corman B, Servider J, Mavarez-Martinez A, Jin Z, Mushlin H, Bergese SD. Postoperative analgesic options after spine surgery: finding the optimal treatment strategies. Expert Rev Neurother 2024; 24:191-200. [PMID: 38155560 DOI: 10.1080/14737175.2023.2298824] [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: 06/03/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Spine surgery is one of the most common types of surgeries performed in the United States; however, managing postoperative pain following spine surgery has proven to be challenging. Patients with spine pathologies have higher incidences of chronic pain and resultant opioid use and potential for tolerance. Implementing a multimodal plan for postoperative analgesia after spine surgery can lead to enhanced recovery and outcomes. AREAS COVERED This review presents several options for analgesia following spine surgery with an emphasis on multimodal techniques to best aid this specific patient population. In addition to traditional therapeutics, such as acetaminophen, non-steroidal anti-inflammatory medications, and opioids, we discuss intrathecal morphine administration and emerging regional anesthesia techniques. EXPERT OPINION Several adjuncts to improve analgesia following spine surgery are efficacious in the postoperative period. Intrathecal morphine provides sustained analgesia and can be instilled intraoperatively by the surgical team under direct visualization. Local anesthetics deposited under ultrasound guidance by an anesthesiologist trained in regional techniques also provide the opportunity for single injections or continuous analgesia via an indwelling catheter.
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Affiliation(s)
- Alina Razak
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Benjamin Corman
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - John Servider
- Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Ana Mavarez-Martinez
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Harry Mushlin
- Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Sergio D Bergese
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
- Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, NY, USA
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Omid-Fard N, Thornhill RE, Torres C, Almansoori TM, Rush CAE, Glikstein R. MRI Markers of Degenerative Disc Disease in Young Patients With Multiple Sclerosis. Can Assoc Radiol J 2024; 75:136-142. [PMID: 37339165 DOI: 10.1177/08465371231180815] [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: 06/22/2023] Open
Abstract
Background and Purpose: Evidence has emerged for an association between degenerative disc disease (DDD) and multiple sclerosis (MS). The purpose of the current study is to determine the presence and extent of cervical DDD in young patients (age <35) with MS, an age cohort that is less well studied for these changes. Methods: Retrospective chart review of consecutive patients aged <35 referred from the local MS clinic who were MRI scanned between May 2005 and November 2014. 80 patients (51 female and 29 male) with MS of any type ranging between 16 and 32 years of age (average 26) were included. Images were reviewed by 3 raters and assessed for presence and extent of DDD, as well as cord signal abnormalities. Interrater agreement was assessed using Kendall's W and Fleiss' Kappa statistics. Results: Substantial to very good interrater agreement was observed using our novel DDD grading scale. At least some degree of DDD was found in over 91% of patients. The majority scored mild (grade 1, 30-49%) to moderate (grade 2, 39-51%) degenerative changes. Cord signal abnormality was seen in 56-63%. Cord signal abnormality, when present, occurred exclusively at degenerative disc levels in only 10-15%, significantly lower than other distributions (P < .001 for all pairwise comparisons). Conclusions: MS patients demonstrate unexpected cervical DDD even at a young age. Future study is warranted to investigate the underlying etiology, such as altered biomechanics. Furthermore, cord lesions were found to occur independently of DDD.
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Affiliation(s)
- Nima Omid-Fard
- Department of Radiology, University of Ottawa, ON, Canada
| | | | - Carlos Torres
- Department of Radiology, University of Ottawa, ON, Canada
| | - Taleb M Almansoori
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, United Arab Emirates
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Curry KD, Yu FB, Vance SE, Segarra S, Bhaya D, Chikhi R, Rocha EP, Treangen TJ. Reference-free Structural Variant Detection in Microbiomes via Long-read Coassembly Graphs. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.25.577285. [PMID: 38352454 PMCID: PMC10862772 DOI: 10.1101/2024.01.25.577285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Bacterial genome dynamics are vital for understanding the mechanisms underlying microbial adaptation, growth, and their broader impact on host phenotype. Structural variants (SVs), genomic alterations of 10 base pairs or more, play a pivotal role in driving evolutionary processes and maintaining genomic heterogeneity within bacterial populations. While SV detection in isolate genomes is relatively straightforward, metagenomes present broader challenges due to absence of clear reference genomes and presence of mixed strains. In response, our proposed method rhea, forgoes reference genomes and metagenome-assembled genomes (MAGs) by encompassing a single metagenome coassembly graph constructed from all samples in a series. The log fold change in graph coverage between subsequent samples is then calculated to call SVs that are thriving or declining throughout the series. We show rhea to outperform existing methods for SV and horizontal gene transfer (HGT) detection in two simulated mock metagenomes, which is particularly noticeable as the simulated reads diverge from reference genomes and an increase in strain diversity is incorporated. We additionally demonstrate use cases for rhea on series metagenomic data of environmental and fermented food microbiomes to detect specific sequence alterations between subsequent time and temperature samples, suggesting host advantage. Our innovative approach leverages raw read patterns rather than references or MAGs to include all sequencing reads in analysis, and thus provide versatility in studying SVs across diverse and poorly characterized microbial communities for more comprehensive insights into microbial genome dynamics.
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Affiliation(s)
- Kristen D. Curry
- Rice University, Department of Computer Science, Houston, TX 77005, United States
- Institut Pasteur, Université Paris Cité, CNRS, UMR3525, Microbial Evolutionary Genomics, 75015 Paris, France
| | | | - Summer E. Vance
- University of California, Berkeley, Department of Environmental Science, Policy, and Management, Berkeley, CA 94720, United States
| | - Santiago Segarra
- Rice University, Department of Electrical and Computer Engineering, Houston, TX 77005, United States
| | - Devaki Bhaya
- Carnegie Institution for Science, Department of Plant Biology, Stanford, CA 94305, United States
| | - Rayan Chikhi
- Institut Pasteur, Université Paris Cité, Sequence Bioinformatics unit, 75015 Paris, France
| | - Eduardo P.C. Rocha
- Institut Pasteur, Université Paris Cité, CNRS, UMR3525, Microbial Evolutionary Genomics, 75015 Paris, France
| | - Todd J. Treangen
- Rice University, Department of Computer Science, Houston, TX 77005, United States
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Novais EJ, Narayanan R, Canseco JA, van de Wetering K, Kepler CK, Hilibrand AS, Vaccaro AR, Risbud MV. A new perspective on intervertebral disc calcification-from bench to bedside. Bone Res 2024; 12:3. [PMID: 38253615 PMCID: PMC10803356 DOI: 10.1038/s41413-023-00307-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024] Open
Abstract
Disc degeneration primarily contributes to chronic low back and neck pain. Consequently, there is an urgent need to understand the spectrum of disc degeneration phenotypes such as fibrosis, ectopic calcification, herniation, or mixed phenotypes. Amongst these phenotypes, disc calcification is the least studied. Ectopic calcification, by definition, is the pathological mineralization of soft tissues, widely studied in the context of conditions that afflict vasculature, skin, and cartilage. Clinically, disc calcification is associated with poor surgical outcomes and back pain refractory to conservative treatment. It is frequently seen as a consequence of disc aging and progressive degeneration but exhibits unique molecular and morphological characteristics: hypertrophic chondrocyte-like cell differentiation; TNAP, ENPP1, and ANK upregulation; cell death; altered Pi and PPi homeostasis; and local inflammation. Recent studies in mouse models have provided a better understanding of the mechanisms underlying this phenotype. It is essential to recognize that the presentation and nature of mineralization differ between AF, NP, and EP compartments. Moreover, the combination of anatomic location, genetics, and environmental stressors, such as aging or trauma, govern the predisposition to calcification. Lastly, the systemic regulation of calcium and Pi metabolism is less important than the local activity of PPi modulated by the ANK-ENPP1 axis, along with disc cell death and differentiation status. While there is limited understanding of this phenotype, understanding the molecular pathways governing local intervertebral disc calcification may lead to developing disease-modifying drugs and better clinical management of degeneration-related pathologies.
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Affiliation(s)
- Emanuel J Novais
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Unidade Local de Saúde do Litoral Alentejano, Orthopedic Department, Santiago do Cacém, Portugal
| | - Rajkishen Narayanan
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Koen van de Wetering
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Makarand V Risbud
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
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Liu C, Ran J, Hou B, Li Y, Morelli JN, Li X. Causal effects of body mass index, education, and lifestyle behaviors on intervertebral disc disorders: Mendelian randomization study. J Orthop Res 2024; 42:183-192. [PMID: 37408137 DOI: 10.1002/jor.25656] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/26/2023] [Accepted: 07/01/2023] [Indexed: 07/07/2023]
Abstract
This study aimed to investigate the causal risk factors for intervertebral disc disorders (IVDD) to help establish prevention strategies for IVDD-related diseases. We performed two-sample Mendelian randomization analyses to investigate the causal effects of body mass index (BMI), education, and lifestyle behaviors (sedentary behavior, smoking, and sleeping) on thoracic/thoracolumbar/lumbosacral IVDD (TTL-IVDD) and cervical IVDD. The inverse-variance weighted (IVW) method was conducted as the primary model to pool effect sizes using odds ratio and 95% confidence interval. The strength of causal evidence was evaluated from the effect size and different Mendelian randomization methods (MR-Egger/weighted median/weighted mode method, Cochran's Q test, leave-one-out analysis, MR Steiger, MR-PRESSO and radial IVW analyses). We found strong evidence for the causal associations between IVDD and BMI (TTL-IVDD, 1.27 [1.18, 1.37], p = 2.40 × 10-10 ; cervical IVDD, 1.24 [1.12, 1.37, p = 6.58 × 10-5 ), educational attainment (TTL-IVDD, 0.57 [0.51, 0.64], p = 9.64 × 10-21 ; cervical IVDD, 0.58 [0.49, 0.68], p = 1.78 × 10-10 ), leisure television watching (TTL-IVDD, 1.54 [1.29, 1.84], p = 7.80 × 10-6 ; cervical IVDD, 1.65 [1.29, 2.11], p = 0.0001), smoking initiation (TTL-IVDD, 1.37 [1.25, 1.50], p = 1.78 × 10-10 ; cervical IVDD, 1.32 [1.16, 1.51], p = 6.49 × 10-5 ), short sleep (TTL-IVDD, 1.28 [1.09, 1.49], p = 0.0027; cervical IVDD, 1.53 [1.21, 1.94], p = 0.0008), or frequent insomnia (TTL-IVDD, 1.20 [1.11, 1.30], p = 1.54 × 10-5 ; cervical IVDD, 1.37 [1.20, 1.57], p = 7.80 × 10-6 ). This study provided genetic evidence that increased BMI, low educational attainment, sedentary behavior by leisure television watching, smoking initiation, short sleep, and frequent insomnia were causal risk factors for IVDD. More efforts should be directed toward increasing public awareness of these modifiable risk factors and mobilizing individuals to adopt healthy lifestyles.
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Affiliation(s)
- Chanyuan Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jun Ran
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Bowen Hou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yitong Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - John N Morelli
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xiaoming Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Teraguchi M, Hashizume H, Oka H, Kagotani R, Nagata K, Ishimoto Y, Tanaka S, Yoshida M, Yoshimura N, Yamada H. Prevalence and distribution of Schmorl node and endplate signal change, and correlation with disc degeneration in a population-based cohort: the Wakayama Spine Study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:103-110. [PMID: 37907767 DOI: 10.1007/s00586-023-08009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE Degenerative spinal conditions, including disc degeneration (DD), Schmorl nodes (SN), and endplate signal changes (ESC), are pervasive age-associated phenomena that critically affect spinal health. Despite their prevalence, a comprehensive exploration of their distribution and correlations is lacking. This study examined the prevalence, distribution, and correlation of DD, SN, and ESC across the entire spine in a population-based cohort. METHODS The Wakayama Spine Study included 975 participants (324 men, mean age 67.2 years; 651 women, mean age 66.0 years). Magnetic resonance imaging (MRI) was used to evaluate the intervertebral space from C2/3 to L5/S1. DD was classified using Pfirrmann's system, ESC was identified by diffuse high-intensity signal changes on the endplates, and SN was defined as a herniation pit with a hypointense signal. We assessed the prevalence and distribution of SN, ESC, and DD across the entire spine. The correlations among these factors were examined. RESULTS Prevalence of ≥ 1 SN over the entire spine was 71% in men and 77% in women, while prevalence of ≥ 1 ESC was 57.9% in men and 56.3% in women. The prevalence of ESC and SN in the thoracic region was the highest among the three regions in both sexes. Positive linear correlations were observed between the number of SN and DD (r = 0.41, p < 0.001) and the number of ESC and DD (r = 0.40, p < 0.001), but weak correlations were found between the number of SN and ESC (r = 0.29, p < 0.001). CONCLUSION The prevalence and distribution of SN and ESC over the entire spine were observed, and correlations between SN, ESC, and DD were established. This population-based cohort study provides a comprehensive analysis of these factors.
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Affiliation(s)
- Masatoshi Teraguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan.
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ryohei Kagotani
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Yuyu Ishimoto
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyoku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
- Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
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Wegner M, Backhauß JC, Michalsky Y, Seesko H, Hensler J, Klueter T, Jansen O, Seekamp A, Lippross S. Prevalence of degenerative vertebral disc changes in elite female Crossfit athletes - a cross-sectional study. BMC Musculoskelet Disord 2023; 24:963. [PMID: 38082262 PMCID: PMC10712126 DOI: 10.1186/s12891-023-07071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Crossfit athletes consistently recruit or transfer high levels of repetitive forces through the spine, and MRI has documented a higher rate of intervertebral disc degeneration in athletes compared with matched controls. The aim of this study was to evaluate early degenerative spinal disc changes in elite female CrossFit athletes quantified by 3.0 Tesla magnetic resonance imaging (MRI) matched with female none-athletes. METHODS In a cross-sectional single-center study 19 asymptomatic adult participants, nine German female elite Crossfit athletes and ten female participants underwent spinal MRI (3.0T). Demographic data, spinal clinical examination results and sport-specific performance parameters were collected prior to the MRI. The primary outcome was the prevalence of degenerative spinal disc changes. The secondary outcome was the grade of degeneration using Pfirrmann grading. RESULTS A total of 437 discs underwent spinal MRI (3.0T). The prevalence of early degenerative disc disease was not increased. Pfirrmann degenerative grade did not show significant differences among groups. CONCLUSION Asymptomatic female elite Crossfit athletes do not show an increased prevalence of degenerative disc disease. Compared to a sex-matched control group, high training volume in Crossfit does not correlate to a higher incidence of degenerative disc changes in young females.
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Affiliation(s)
- Mathis Wegner
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany.
| | - Jan-Christoph Backhauß
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Yannik Michalsky
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Henrik Seesko
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Johannes Hensler
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Tim Klueter
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Andreas Seekamp
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Sebastian Lippross
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
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Ristaniemi A, Šećerović A, Grad S, Ferguson SJ. A Novel Fiber-Reinforced Poroviscoelastic Bovine Intervertebral Disc Finite Element Model for Organ Culture Experiment Simulations. J Biomech Eng 2023; 145:121006. [PMID: 37773639 DOI: 10.1115/1.4063557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/28/2023] [Indexed: 10/01/2023]
Abstract
Intervertebral disc (IVD) degeneration and methods for repair and regeneration have commonly been studied in organ cultures with animal IVDs under compressive loading. With the recent establishment of a novel multi-axial organ culture system, accurate predictions of the global and local mechanical response of the IVD are needed for control system development and to aid in experiment planning. This study aimed to establish a finite element model of bovine IVD capable of predicting IVD behavior at physiological and detrimental load levels. A finite element model was created based on the dimensions and shape of a typical bovine IVD used in the organ culture. The nucleus pulposus (NP) was modeled as a neo-Hookean poroelastic material and the annulus fibrosus (AF) as a fiber-reinforced poroviscoelastic material. The AF consisted of 10 lamella layers and the material properties were distributed in the radial direction. The model outcome was compared to a bovine IVD in a compressive stress-relaxation experiment. A parametric study was conducted to investigate the effect of different material parameters on the overall IVD response. The model was able to capture the equilibrium response and the relaxation response at physiological and higher strain levels. Permeability and elastic stiffness of the AF fiber network affected the overall response most prominently. The established model can be used to evaluate the response of the bovine IVD at strain levels typical for organ culture experiments, to define relevant boundaries for such studies, and to aid in the development and use of new multi-axial organ culture systems.
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Affiliation(s)
- Aapo Ristaniemi
- AO Research Institute Davos, Clavadelerstrasse 8, Davos 7270, Switzerland
| | - Amra Šećerović
- AO Research Institute Davos, Clavadelerstrasse 8, Davos 7270, Switzerland
| | - Sibylle Grad
- AO Research Institute Davos, Clavadelerstrasse 8, Davos 7270, Switzerland
| | - Stephen J Ferguson
- Institute for Biomechanics, ETH Zürich, Hönggerbergring 64, Zürich 8093, Switzerland
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Xiao F, van Dieën JH, Han J, Maas H. Stab lesion of the L4/L5 intervertebral disc in the rat causes acute changes in disc bending mechanics. J Biomech 2023; 161:111830. [PMID: 37821333 DOI: 10.1016/j.jbiomech.2023.111830] [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: 04/06/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
Low-back pain often coincides with altered neuromuscular control, possibly due to changes in spine stability resulting from injury or degeneration, or due to effects of nociception. The relative importance of these mechanisms, and their possible interaction, are unknown. In spine bending, the bulk of the load is borne by the IVD, yet the acute effects of intervertebral disc (IVD) injury on bending mechanics have not been investigated. In the present study, we aimed to quantify the acute effects of a stab lesion of the disc on its mechanical properties, because such changes can be expected to elicit compensatory changes in neuromuscular control. L4/L5 spinal segments were collected from 27 Wistar rats within two hours after sacrifice and stored at -20℃. Following thawing, bending tests were performed to assess the intersegmental angle-moment characteristics. Specimens were loaded in right bending, left bending and flexion, before and after a stab lesion of the IVD fully penetrating the nucleus pulposus. In the angle-moment curves, we found reduced moments at equal bending angles after IVD lesion in left bending, right bending and flexion. Peak stiffness, peak moment, and hysteresis were significantly decreased (by 7.8-27.7 %) after IVD lesion in all directions. In conclusion, L4/L5 IVD lesion in the rat caused small to moderate acute changes in IVD mechanical properties. Our next steps will be to evaluate the longer term effects of IVD lesion on spine mechanics and the neural control of trunk muscles.
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Affiliation(s)
- Fangxin Xiao
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China; Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
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Hanada S, Reinking B, Kim S, Ueda K. Transesophageal echocardiography for thoracic spinal cord imaging and confirmation of epidural catheter placement in pediatrics. J Clin Anesth 2023; 91:111231. [PMID: 37696242 DOI: 10.1016/j.jclinane.2023.111231] [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: 06/13/2023] [Revised: 07/19/2023] [Accepted: 08/15/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Transesophageal echocardiography (TEE) use continues to expand to include extracardiac applications. However, there is limited research investigating the use of TEE as a tool to confirm the position of the epidural catheter. This prospective observational study aimed to evaluate whether TEE could be used to visualize the anatomy of the thoracic spinal canal in pediatrics. A subsequent prospective case series was conducted to evaluate whether TEE could be used to assist in the placement of epidural catheters in pediatric surgical patients. METHODS Seventy-five patients (50 pediatric and 25 adult subjects) were enrolled. The operators attempted to identify four structures (spinal cord, cerebrospinal fluid, dura mater, epidural space) within the thoracic spinal canal with TEE. After demonstrating the feasibility of this technique for observing the spinal anatomy, 20 pediatric surgical patients were enrolled in a case series. These patients had epidural catheter placement, and the final catheter position was confirmed with TEE. RESULTS The total number of thoracic spinal segment visualized in pediatric patients was 542 out of 550 (99%) segments, and 191 out of 275 (70%) segments in adult subjects (difference, 29% [95% confidence interval, 23-34]; p < 0.001). Additionally, a case series of 20 pediatric surgical patients demonstrated successful caudal or epidural catheter placement at target spinal level in 17 cases. CONCLUSIONS This observational study demonstrated the successful visualization of the thoracic spinal cord at virtually every level in pediatric patients. A subsequent case series demonstrated that TEE could be used to successfully confirm the position of the epidural catheter in the targeted thoracic spinal segment for pediatric surgical patients.
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Affiliation(s)
- Satoshi Hanada
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Benjamin Reinking
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Sung Kim
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Kenichi Ueda
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Department of Anesthesiology, Kameda Medical Center, Kamogawa City, Chiba 296-0041, Japan.
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Chen L, Chen A, Zhang XD, Robles MST, Han HS, Xiao Y, Xiao G, Pipas JM, Weitz DA. High-sensitivity whole-genome recovery of single viral species in environmental samples. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.13.566948. [PMID: 38014300 PMCID: PMC10680796 DOI: 10.1101/2023.11.13.566948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Characterizing unknown viruses is essential for understanding viral ecology and preparing against viral outbreaks. Recovering complete genome sequences from environmental samples remains computationally challenging using metagenomics, especially for low-abundance species with uneven coverage. This work presents a method for reliably recovering complete viral genomes from complex environmental samples. Individual genomes are encapsulated into droplets and amplified using multiple displacement amplification. A novel gene detection assay, which employs an RNA-based probe and an exonuclease, selectively identifies droplets containing the target viral genome. Labeled droplets are sorted using a microfluidic sorter, and genomes are extracted for sequencing. Validation experiments using a sewage sample spiked with two known viruses demonstrate the method's efficacy. We achieve 100% recovery of the spiked-in SV40 (Simian virus 40, 5243bp) genome sequence with uniform coverage distribution, and approximately 99.4% for the larger HAd5 genome (Human Adenovirus 5, 35938bp). Notably, genome recovery is achieved with as few as one sorted droplet, which enables the recovery of any desired genomes in complex environmental samples, regardless of their abundance. This method enables targeted characterizations of rare viral species and whole-genome amplification of single genomes for accessing the mutational profile in single virus genomes, contributing to an improved understanding of viral ecology.
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Affiliation(s)
- Liyin Chen
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Anqi Chen
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Xinge Diana Zhang
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Maria Saenz T Robles
- Department of Biological Sciences, University of Pittsburgh, Pennsylvania 15260, USA
| | - Hee-Sun Han
- Department of Chemistry, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
| | - Yi Xiao
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Gao Xiao
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - James M Pipas
- Department of Biological Sciences, University of Pittsburgh, Pennsylvania 15260, USA
| | - David A Weitz
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Department of Physics, Harvard University, Cambridge, MA, 02138, USA
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Guan X, Zhang D, Zhang F, Zong Y, Wang H, Shen Z, Yin F. Causal association of physical activity with low back pain, intervertebral disc degeneration and sciatica: a two-sample mendelian randomization analysis study. Front Cell Dev Biol 2023; 11:1260001. [PMID: 38020887 PMCID: PMC10665496 DOI: 10.3389/fcell.2023.1260001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Objective: Previous studies are insufficient to confirm a causal association between physical activity (PA) and low back pain (LBP), intervertebral disc degeneration (IDD), and sciatica. The present study used a two-sample Mendelian randomization (MR) analysis method to demonstrate whether or not there was a causal connection. Methods: First, four PA phenotypes were selected [accelerometer-based PA (average acceleration), accelerometer-based PA (acceleration fraction >425 mg), self-reported moderate-to-vigorous PA, and self-reported vigorous PA], setting thresholds for single nucleotide polymorphisms (SNPs) significantly concerned with PA p < 5 × 10-8, linkage disequilibrium (LD) r 2 < 0.01, genetic distance >5,000 kb, and F-value >10. SNPs associated with the outcome and confounding factors were then excluded using the PhenoScanncer database. Finally, after coordinating the genetic instruments from genome-wide association studies (GWAS) effect alleles for exposure and outcomes, multiplicative random effects inverse variance weighting (IVW), MR-Egger, weighted median method (WMM), and weighted mode method were used to assess exposure-outcome causality and perform sensitivity analysis on the estimated results. Results: The current study's IVW findings revealed proof of a causal connection between PA and LBP. While there was a positive causal tie between accelerometer-based PA (acceleration fraction >425 mg) and LBP [OR: 1.818, 95% CI:1.129-2.926, p = 0.012], there was a negative causal link between accelerometer-based PA (average acceleration) and LBP [OR: 0.945, 95% CI: 0.909-0.984, p = 0.005]. However causal relationship between PA and IDD or sciatica was not found. Conclusion: Increasing average PA but needing to avoid high-intensity PA may be an effective means of preventing low back pain. Although PA is not directly causally related to disc degeneration and sciatica, it can act through indirect pathways.
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Affiliation(s)
| | | | | | | | | | | | - Fei Yin
- Departments of Orthopedics Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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Masuda K, Shigematsu H, Maeda M, Okuda A, Tanaka Y. Ultrasound-guided disc pain induction test for diagnosis of discogenic lumbar pain: a cross-sectional study. J Orthop Surg Res 2023; 18:847. [PMID: 37941032 PMCID: PMC10631160 DOI: 10.1186/s13018-023-04327-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Several methods can be used to diagnose discogenic pain, but only discoblock can diagnose discogenic pain definitively. This study aimed to examine the usefulness of an ultrasound-guided disc pain induction test for a simple and accurate diagnosis of the culprit lesion. METHODS We included 41 patients with lumbar pain in whom pain was induced by an ultrasound-guided disc pain induction test. All patients had confirmed pain at L1/2 to L5/S1 based on an ultrasound-guided disc pain induction test and underwent X-ray photography and magnetic resonance imaging. Seventeen patients who required injection due to severe pain underwent discoblock procedures for discs with the most intense pain, and visual analogue scale (VAS) scores were obtained before and after the procedure for these patients. We analysed the association between painful discs and radiological findings. RESULTS Pain induction was noted in a total of 65 discs, and the pain was induced in 23 patients in only one disc. All patients had disc degeneration of Pfirrmann classification grade 1 or higher, with more significant disc degeneration in painful discs than in painless discs. There was no significant relationship between the presence or absence of pain and Modic type. The average VAS measurements improved significantly from 9.5 (pre-procedure) to 2.5 (post-procedure). These results suggest that the most painful discs were the causes of discogenic lumbar pain. CONCLUSIONS Our ultrasound-guided disc pain induction test may help diagnose disc degeneration and identify culprit lesions, even when multiple discs exhibit findings of degeneration.
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Affiliation(s)
- Keisuke Masuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan.
| | - Manabu Maeda
- Department of Orthopedic Surgery, Maeda Orthopaedic Clinic, 864-1, Kideracho, Nara City, Nara, 6308306, Japan
| | - Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan
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