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Fang X, Cui M, Wang Y, Liu L, Lv W, Ye H, Liu G. Effects of axial loading and positions on lumbar spinal stenosis: an MRI study using a new axial loading device. Skeletal Radiol 2024:10.1007/s00256-024-04720-5. [PMID: 38849534 DOI: 10.1007/s00256-024-04720-5] [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: 04/17/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE A new axial loading device was used to investigate the effects of axial loading and positions on lumbar structure and lumbar spinal stenosis. METHODS A total of 40 patients sequentially underwent 4 examinations: (1) the psoas-relaxed position MRI, (2) the extended position MRI, (3) the psoas-relaxed position axial loading MRI, (4) the extended position axial loading MRI. The dural sac cross-sectional area, sagittal vertebral canal diameter, disc height and ligamentum flavum thickness of L3-4, L4-5, L5-S1 and lumbar lordosis angle were measured and compared. A new device with pneumatic shoulder-hip compression mode was used for axial loading. RESULTS In the absence of axial loading, there was a significant reduction in dural sac cross-sectional area with extension only seen at the L3-4 (p = 0.033) relative to the dural sac area in the psoas-relaxed position. However, with axial loading, there was a significant reduction in dural sac cross-sectional area at all levels in both psoas-relaxed (L3-4, p = 0.041; L5-S1, p = 0.005; L4-5, p = 0.002) and extension (p < 0.001) positions. The sagittal vertebral canal diameter and disc height were significantly reduced at all lumbar levels with axial loading and extension (p < 0.001); however, in psoas-relaxed position, the sagittal vertebral canal diameter was only reduced with axial loading at L3-4 (p = 0.018) and L4-5 (p = 0.011), and the disc height was reduced with axial-loading at all levels (L3-4, p = 0.027; L5-S1, p = 0.001; L4-5, p < 0.001). The ligamentum flavum thickness and lumbar lordosis in extension position had a statistically significant increase compared to psoas-relaxed position with or without axial loading (p < 0.001). CONCLUSION Both axial loading and extension of lumbar may exacerbate lumbar spinal stenosis. Axial loading in extension position could maximally aggravate lumbar spinal stenosis, but may cause some patients intolerable. For those patients, axial loading MRI in psoas-relaxed position may be a good choice.
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Affiliation(s)
- Xingyu Fang
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Department of Radiology, the 305 Hospital of PLA, Beijing, 100017, China
| | - Mengqiu Cui
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yingwei Wang
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lin Liu
- Department of Radiology, the 305 Hospital of PLA, Beijing, 100017, China
| | - Wei Lv
- Department of Radiology, the 305 Hospital of PLA, Beijing, 100017, China
| | - Huiyi Ye
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Gang Liu
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
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Saremi A, Goyal KK, Benzel EC, Orr RD. Evolution of lumbar degenerative spondylolisthesis with key radiographic features. Spine J 2024; 24:989-1000. [PMID: 38199449 DOI: 10.1016/j.spinee.2024.01.001] [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: 04/30/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Spondylolisthesis is a common finding in middle-aged and older adults with back pain. The pathophysiology of degenerative spondylolisthesis is a subject of controversy regarding not only its etiology but also the mechanisms of its progression. It is theorized that degeneration of the facets and discs can lead to segmental instability, leading to displacement over time. Kirkaldy-Willis divided degenerative spondylolisthesis into three phases: dysfunction, instability, and finally, restabilization. There is a paucity of literature on the unification of the radiological hallmarks seen in spondylolisthesis within these phases. The radiographic features include (1) facet morphology/arthropathy, (2) facet effusion, (3) facet vacuum, (4) synovial cyst, (5) interspinous ligament bursitis, and (6) vacuum disc as markers of dysfunction, instability, and/or restabilization. We discuss these features, which can be seen on X-ray, CT, and MRI, with the intention of establishing a timeline upon which they present clinically. Spondylolisthesis is initiated as either degeneration of the intervertebral disc or facet joints. Early degeneration can be seen as facet vacuum without considerable arthropathy. As the vertebral segment becomes increasingly dynamic, fluid accumulates within the facet joint space. Further degeneration will lead to the advancement of facet arthropathy, degenerative disc disease, and posterior ligamentous complex pathology. Facet effusion can eventually be replaced with a vacuum in severe facet osteoarthritis. Intervertebral disc vacuum continues to accumulate with further cleft formation and degeneration. Ultimately, autofusion of the vertebra at the facets and endplates can be observed. With this review, we hope to increase awareness of these radiographical markers and their timeline, thus placing them within the framework of the currently accepted model of degenerative spondylolisthesis, to help guide future research and to help refine management guidelines.
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Affiliation(s)
- Arvin Saremi
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH 44106, USA.
| | - Kush K Goyal
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Edward C Benzel
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - R Douglas Orr
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Qiu C, Cheng L, Liu J, Ding Z, Sun M, Yu Y, An D, Wang L, Gao X, Pan X, Liu X, Wang S. The Comparison between Spinal Facet Joint Toothed Plate and Traditional Pedicle Screw-rod on Reduction of Thoracolumbar Fracture. Orthop Surg 2024. [PMID: 38766812 DOI: 10.1111/os.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE Thoracolumbar fractures are one of the most common fractures in clinical practice. Surgical intervention is recommended to restore spinal alignment or decompress the nerves when there are unstable fractures or neurological injuries. However, after excessive forward thrust force restoration, facet joint dislocation often occurs between the upper vertebra and the fractured vertebra, which usually leads to unsatisfactory reduction outcomes. Herein, we propose a novel spinal facet joint toothed plate to assist in fracture reduction. The purpose of this study is to evaluate the effectiveness of the new spinal facet joint toothed plate in preventing facet joint dislocation, and its advantages compared to traditional pedicle screw-rod decompression. METHODS A total of 26 patients in the toothed plate group and 93 patients in the traditional group who experienced thoracolumbar fracture with reduction were retrospectively included. Relevant patients' information and clinical parameters were collected. Furthermore, visual analogue scores (VAS) scores and Oswestry disability index (ODI) scores were also collected. Moreover, imaging parameters were calculated based on radiographs. Correlated data were analyzed by χ2 test and t test. RESULTS All patients in this study had no postoperative complications. Postoperative VAS scores and ODI scores (p < 0.001) were statistically significant (p < 0.001) in both groups compared with preoperative scores and further decreased (p < 0.001) at final follow-up. In addition, the postoperative vertebral margin ratio (VMR) (p < 0.001) and vertebral angle of the injured vertebrae (p < 0.001) were significantly improved compared with the preoperative period. There were no significant differences in postoperative VAS scores and ODI scores between the two groups. However, toothed plate reduction significantly improved the VMR (p < 0.05) and vertebral angle (p < 0.05) compared with conventional reduction. Ultimately, the total screw accuracy was 98.72% (sum of levels 0 and I), with 100% screw accuracy in the segment related to the tooth plate in the tooth plate group. The dislocation rate was higher in the conventional group (6.45%) than in the new serrated plate repositioning group (0.00%). CONCLUSION The facet toothed plate assisted reduction method prevents facet joint dislocation and improves fracture reduction compared to traditional reduction technique, hence it could be considered as a novel surgical strategy for thoracolumbar fracture reduction.
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Affiliation(s)
- Cheng Qiu
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lin Cheng
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Jingwei Liu
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zhiguo Ding
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China
- Department of Orthopedics, Shouguang People's Hospital, Weifang, China
| | - Musen Sun
- Department of Orthopaedic Surgery, Huimin County People's Hospital, Binzhou, China
| | - Yanyong Yu
- Department of Orthopaedic Surgery, Yucheng People's Hospital, Dezhou, China
| | - Dingling An
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Lianlei Wang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xianlei Gao
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xin Pan
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xinyu Liu
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Songgang Wang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China
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Wu Y, Sun B, Huang Z, Han W, Zheng W, Zhang C, Han S, Li S, Gao B, Ye W. Novel Risk Factors for Cervical Facet Joint Degeneration in the Subaxial Cervical Spine: Correlation with Cervical Sagittal Alignment and Bone Mineral Density. World Neurosurg 2024; 185:e850-e859. [PMID: 38432510 DOI: 10.1016/j.wneu.2024.02.138] [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: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE The impact of cervical sagittal alignment on cervical facet joint degeneration (CFD) and the risk factors for CFD in patients with degenerative cervical myelopathy (DCM) were investigated in the current study. METHODS A total of 250 surgical patients with DCM were recruited. The clinical data and radiographical characteristics, including CFD, cervical sagittal balance parameters, Hounsfield unit (HU) values, disc degeneration (DD), and modic change, were collected. The detailed correlation between these characteristics and CFD was analyzed. Characteristics, including CFD, were compared among the various cervical alignment types and different CFD groups. Finally, the risk factors for CFD were revealed via logistic regression. RESULTS CFD was prevalent in DCM patients. Age, cervical sagittal vertical axis (cSVA), range of motion, T1 slope, thoracic inlet angle, DD, HU value, and modic change correlated with CFD segmentally and globally (P < 0.05). The lordosis and sigmoid types had a significantly higher CFD prevalence (P < 0.05). Furthermore, the average CFD threshold for the severe CFD group was 1.625 (area under the curve, 0.958). Additionally, 167 patients with average CFD <1.625 and 83 patients with CFD of ≥1.625 were classified into the mild CFD group and severe CFD group, respectively. Finally, multivariate analysis was performed, and age, cSVA, HU value, modic change, and DD were determined to be independent risk factors for CFD. CONCLUSIONS The load distribution tends to shift to a more shear-like pattern in the sigmoid and kyphosis types and in those with a higher cSVA, thereby promoting CFD. Aging, cervical malalignment, low bone mineral density, DD, and modic change were revealed to result in high risks of CFD.
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Affiliation(s)
- Yuliang Wu
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bo Sun
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhengqi Huang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weitao Han
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wanli Zheng
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Department of Orthopedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Chao Zhang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shun Han
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuangxing Li
- Department of Orthopedics, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, China
| | - Bo Gao
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Ye
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Taçyıldız AE, İnceoğlu F. Classification of Osteophytes Occurring in the Lumbar Intervertebral Foramen. Tomography 2024; 10:618-631. [PMID: 38668404 PMCID: PMC11053472 DOI: 10.3390/tomography10040047] [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: 03/24/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Surgeons have limited knowledge of the lumbar intervertebral foramina. This study aimed to classify osteophytes in the lumbar intervertebral foramen and to determine their pathoanatomical characteristics, discuss their potential biomechanical effects, and contribute to developing surgical methods. METHODS We conducted a retrospective, non-randomized, single-center study involving 1224 patients. The gender, age, and anatomical location of the osteophytes in the lumbar intervertebral foramina of the patients were recorded. RESULTS Two hundred and forty-nine (20.34%) patients had one or more osteophytes in their lumbar 4 and 5 foramina. Of the 4896 foramina, 337 (6.88%) contained different types of osteophytes. Moreover, four anatomical types of osteophytes were found: mixed osteophytes in 181 (3.69%) foramina, osteophytes from the lower endplate of the superior vertebrae in 91 (1.85%) foramina, osteophytes from the junction of the pedicle and lamina of the upper vertebrae in 39 foramina (0.79%), and osteophytes from the upper endplate of the lower vertebrae in 26 (0.53%) foramina. The L4 foramen contained a significantly higher number of osteophytes than the L5 foramen. Osteophyte development increased significantly with age, with no difference between males and females. CONCLUSIONS The findings show that osteophytic extrusions, which alter the natural anatomical structure of the lumbar intervertebral foramina, are common and can narrow the foramen.
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Affiliation(s)
- Abdullah Emre Taçyıldız
- Department of Neurosurgery, Faculty of Medicine, Turgut Özal University, Malatya 44090, Turkey
- Department of Neurosurgery, Faculty of Medicine, Karabuk University, Karabuk 78200, Turkey
| | - Feyza İnceoğlu
- Department of Biostatistics, Faculty of Medicine, Turgut Özal University, Malatya 44090, Turkey;
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6
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Grimaldi A, Mellor R, Nasser A, Vicenzino B, Hunter DJ. Current and future advances in practice: tendinopathies of the hip. Rheumatol Adv Pract 2024; 8:rkae022. [PMID: 38601140 PMCID: PMC11003818 DOI: 10.1093/rap/rkae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/25/2024] [Indexed: 04/12/2024] Open
Abstract
Tendinopathy describes persistent tendon pain and loss of function related to mechanical loading. Two common hip tendinopathies seen in practice are gluteal tendinopathy and proximal hamstring tendinopathy. Both conditions can be frustrating for patients and clinicians due to the delay in diagnosis, significant disability caused and lack of response to common treatments. Tendinopathy is a clinical diagnosis and can most often be made using findings from the patient interview and pain provocation tests, without the need for imaging. Specific education and progressive exercise offer a low-risk and effective option for gluteal tendinopathy and result in greater rates of treatment success than corticosteroid injection, both in the short term (8 weeks) and at 1 year. Proximal hamstring tendinopathy is a common, but less researched, and under-recognized cause of persistent ischial pain. As research on proximal hamstring tendinopathy is limited, this review summarizes the available evidence on diagnosis and treatment following similar principles to other well-researched tendinopathies.
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Affiliation(s)
- Alison Grimaldi
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- PhysioTec, Tarragindi, Queensland, Australia
| | - Rebecca Mellor
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Gallipoli Medical Research, Greenslopes, Queensland, Australia
| | - Anthony Nasser
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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Guven AE, Chiapparelli E, Camino-Willhuber G, Zhu J, Schönnagel L, Amoroso K, Caffard T, Erduran A, Shue J, Sama AA, Girardi FP, Cammisa FP, Hughes AP. Assessing paraspinal muscle atrophy with electrical impedance myography: Limitations and insights. J Orthop Res 2024. [PMID: 38594874 DOI: 10.1002/jor.25848] [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: 10/11/2023] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
Paraspinal muscle atrophy is gaining attention in spine surgery due to its link to back pain, spinal degeneration and worse postoperative outcomes. Electrical impedance myography (EIM) is a noninvasive diagnostic tool for muscle quality assessment, primarily utilized for patients with neuromuscular diseases. However, EIM's accuracy for paraspinal muscle assessment remains understudied. In this study, we investigated the correlation between EIM readings and MRI-derived muscle parameters, as well as the influence of dermal and subcutaneous parameters on these readings. We retrospectively analyzed patients with lumbar spinal degeneration who underwent paraspinal EIM assessment between May 2023 to July 2023. Paraspinal muscle fatty infiltration (FI) and functional cross-sectional area (fCSA), as well as the subcutaneous thickness were assessed on MRI scans. Skin ultrasound imaging was assessed for dermal thickness and the echogenicities of the dermal and subcutaneous layers. All measurements were performed on the bilaterally. The correlation between EIM readings were compared with ultrasound and MRI parameters using Spearman's correlation analyses. A total of 20 patients (65.0% female) with a median age of 69.5 years (IQR, 61.3-73.8) were analyzed. The fCSA and FI did not significantly correlate with the EIM readings, regardless of frequency. All EIM readings across frequencies correlated with subcutaneous thickness, echogenicity, or dermal thickness. With the current methodology, paraspinal EIM is not a valid alternative to MRI assessment of muscle quality, as it is strongly influenced by the dermal and subcutaneous layers. Further studies are required for refining the methodology and confirming our results.
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Affiliation(s)
- Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York, USA
| | - Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
- Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany
| | - Ada Erduran
- Department of Electrical Engineering, Technical University Berlin, Berlin, Germany
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
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Wang Z, Liang W, Wang G, Wu H, Dang W, Zhen Y, An Y. Construction Form and Application of Three-Dimensional Bioprinting Ink Containing Hydroxyapatite. TISSUE ENGINEERING. PART B, REVIEWS 2024. [PMID: 38569169 DOI: 10.1089/ten.teb.2023.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
With the increasing prevalence of bone tissue diseases, three-dimensional (3D) bioprinting applied to bone tissue engineering for treatment has received a lot of interests in recent years. The research and popularization of 3D bioprinting in bone tissue engineering require bioinks with good performance, which is closely related to ideal material and appropriate construction form. Hydroxyapatite (HAp) is the inorganic component of natural bone and has been widely used in bone tissue engineering and other fields due to its good biological and physicochemical properties. Previous studies have prepared different bioinks containing HAp and evaluated their properties in various aspects. Most bioinks showed significant improvement in terms of rheology and biocompatibility; however, not all of them had sufficiently favorable mechanical properties and antimicrobial activity. The deficiencies in properties of bioink and 3D bioprinting technology limited the applications of bioinks containing HAp in clinical trials. This review article summarizes the construction forms of bioinks containing HAp and its modifications in previous studies, as well as the 3D bioprinting techniques adopted to print bioink containing HAp. In addition, this article summarizes the advantages and underlying mechanisms of bioink containing HAp, as well as its limitations, and suggests possible improvement to facilitate the development of bone tissue engineering bioinks containing HAp in the future.
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Affiliation(s)
- Zimo Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Wei Liang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Guanhuier Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Huiting Wu
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Wanwen Dang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Yonghuan Zhen
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Yang An
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
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Park JS, Goh TS, Lee JS, Lee C. Analyzing isolated degeneration of lumbar facet joints: implications for degenerative instability and lumbar biomechanics using finite element analysis. Front Bioeng Biotechnol 2024; 12:1294658. [PMID: 38600941 PMCID: PMC11005061 DOI: 10.3389/fbioe.2024.1294658] [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: 09/15/2023] [Accepted: 02/26/2024] [Indexed: 04/12/2024] Open
Abstract
The facet joint contributes to lumbar spine stability as it supports the weight of body along with the intervertebral discs. However, most studies on the causes of degenerative lumbar diseases focus on the intervertebral discs and often overlook the facet joints. This study aimed to investigate the impact of facet joint degeneration on the degenerative changes and diseases of the lumbar spine. A finite element model of the lumbar spine (L1-S1) was fabricated and validated to study the biomechanical characteristics of the facet joints. To simulate degeneration of the facet joint, the model was divided into four grades based on the number of degenerative segments (L4-L5 or L4-S1) and the contact condition between the facet joint surfaces. Finite element analysis was performed on four spine motions: flexion, extension, lateral bending, and axial torsion, by applying a pure moment to the upper surface of L1. Important parameters that could be used to confirm the effect of facet joint degeneration on the lumbar spine were calculated, including the range of motion (ROM) of the lumbar segments, maximum von Mises stress on the intervertebral discs, and reaction force at the facet joint. Facet joint degeneration affected the biomechanical characteristics of the lumbar spine depending on the movements of the spine. When analyzed by dividing it into degenerative onset and onset-adjacent segments, lumbar ROM and the maximum von Mises stress of the intervertebral discs decreased as the degree of degeneration increased in the degenerative onset segments. The reaction force at the facet joint decreased with flexion and increased with lateral bending and axial torsion. In contrast, lumbar ROM of the onset-adjacent segments remained almost unchanged despite severe degeneration of the facet joint, and the maximum von Mises stress of the intervertebral discs increased with flexion and extension but decreased with lateral bending and axial torsion. Additionally, the facet joint reaction force increased with extension, lateral bending, and axial rotation. This analysis, which combined the ROM of the lumbar segment, maximum von Mises stress on the intervertebral disc, and facet joint reaction force, confirmed the biomechanical changes in the lumbar spine due to the degeneration of isolated facet joints under the load of spinal motion. In the degenerative onset segment, spinal instability decreased, whereas in the onset-adjacent segment, a greater load was applied than in the intact state. When conducting biomechanical studies on the lumbar spine, considering facet joint degeneration is important since it can lead to degenerative spinal diseases, including adjacent segment diseases.
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Affiliation(s)
- Jun Sung Park
- Department of Biomedical Engineering, Graduate School, Pusan National University, Busan, Republic of Korea
| | - Tae Sik Goh
- Department of Orthopaedic Surgery, School of Medicine, Pusan National University, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, School of Medicine, Pusan National University, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Chiseung Lee
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Biomedical Engineering, School of Medicine, Pusan National University, Busan, Republic of Korea
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10
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Guven AE, Evangelisti G, Burkhard MD, Köhli P, Hambrecht J, Zhu J, Chiapparelli E, Kelly M, Tsuchiya K, Amoroso K, Zadeh A, Shue J, Tan ET, Sama AA, Girardi FP, Cammisa FP, Hughes AP. Asymmetrical atrophy of the paraspinal muscles in patients undergoing unilateral lumbar medial branch radiofrequency neurotomy. Pain 2024:00006396-990000000-00557. [PMID: 38635483 DOI: 10.1097/j.pain.0000000000003223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/31/2024] [Indexed: 04/20/2024]
Abstract
ABSTRACT Lumbar medial branch radiofrequency neurotomy (RFN), a common treatment for chronic low back pain due to facet joint osteoarthritis (FJOA), may amplify paraspinal muscle atrophy due to denervation. This study aimed to investigate the asymmetry of paraspinal muscle morphology change in patients undergoing unilateral lumbar medial branch RFN. Data from patients who underwent RFN between March 2016 and October 2021 were retrospectively analyzed. Lumbar foramina stenosis (LFS), FJOA, and fatty infiltration (FI) functional cross-sectional area (fCSA) of the paraspinal muscles were assessed on preinterventional and minimum 2-year postinterventional MRI. Wilcoxon signed-rank tests compared measurements between sides. A total of 51 levels of 24 patients were included in the analysis, with 102 sides compared. Baseline MRI measurements did not differ significantly between the RFN side and the contralateral side. The RFN side had a higher increase in multifidus FI (+4.2% [0.3-7.8] vs +2.0% [-2.2 to 6.2], P = 0.005) and a higher decrease in multifidus fCSA (-60.9 mm2 [-116.0 to 10.8] vs -19.6 mm2 [-80.3 to 44.8], P = 0.003) compared with the contralateral side. The change in erector spinae FI and fCSA did not differ between sides. The RFN side had a higher increase in multifidus muscle atrophy compared with the contralateral side. The absence of significant preinterventional degenerative asymmetry and the specificity of the effect to the multifidus muscle suggest a link to RFN. These findings highlight the importance of considering the long-term effects of lumbar medial branch RFN on paraspinal muscle health.
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Affiliation(s)
- Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Gisberto Evangelisti
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco D Burkhard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Paul Köhli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Hambrecht
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, United States
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Michael Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Koki Tsuchiya
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Arman Zadeh
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
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11
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Ding Y, Liu L, Shi J, Zhang X, Chen R, Xu S. Biochemical changes in lumbar facet joint and disc degeneration by T2* mapping. BMC Musculoskelet Disord 2024; 25:224. [PMID: 38504210 PMCID: PMC10953206 DOI: 10.1186/s12891-024-07265-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/07/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND To investigate the biochemical changes in lumbar facet joint (LFJ) and intervertebral disc (IVD) with different degenerative grade by T2* mapping. METHODS Sixty-eight patients with low back pain (study group) and 20 volunteers (control group) underwent standard MRI protocols and axial T2* mapping. Morphological evaluation of LFJ and IVD were performed on T2-weighted imaging according to Weishaupt and Pfirrmann grading system, respectively. T2* values of LFJ and of AF (anterior annulus fibrosus), NP (nucleus pulposus), and PF (posterior annulus fibrosus) in IVD were measured. Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare T2* values of subjects with different degenerative grade. RESULTS The mean T2* value of grade 0 LFJ (21.68[17.77,26.13]) was higher than those of grade I (18.42[15.68,21.8], p < 0.001), grade II (18.98[15.56,22.76], p = 0.011) and grade III (18.38[16.05,25.07], p = 0.575) LFJ in study group, and a moderate correlation was observed between T2* value and LFJ grade (rho=-0.304, p < 0.001) in control group. In the analysis of IVD, a moderate correlation was observed between AF T2* value and IVD grade (rho=-0.323, p < 0.001), and between NP T2* value and IVD grade (rho=-0.328, p < 0.001), while no significant difference was observed between the T2* values of PF in IVD of different grade in study group. CONCLUSIONS Downward trend of T2* values can be found in LFJ, AF and NP as the degenerative grade rised. But in elderly patients with low back pain, no change trend was found in LFJ due to increased fluid accumulation in the joint space.
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Affiliation(s)
- Yi Ding
- Department of Spine Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, 341000, China
- Department of Spine Surgery, Ganzhou Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, 341000, China
| | - Liping Liu
- Department of Spine Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, 341000, China
- Department of Spine Surgery, Ganzhou Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, 341000, China
| | - Jiangyou Shi
- Department of Spine Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, 341000, China
| | - Xiaodong Zhang
- Department of Medical Imaging, Ganzhou People's Hospital, Ganzhou, Jiangxi, 341000, China
| | - Rongchun Chen
- Department of Spine Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, 341000, China.
- Department of Spine Surgery, Ganzhou Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Shuaishuai Xu
- Department of Nuclear Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324 Jingwu Road, Jinan, Shandong, 250021, China.
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12
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McGill KC, Baal JD, Bucknor MD. Update on musculoskeletal applications of magnetic resonance-guided focused ultrasound. Skeletal Radiol 2024:10.1007/s00256-024-04620-8. [PMID: 38363419 DOI: 10.1007/s00256-024-04620-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive, incisionless, radiation-free technology used to ablate tissue deep within the body. This technique has gained increased popularity following FDA approval for treatment of pain related to bone metastases and limited approval for treatment of osteoid osteoma. MRgFUS delivers superior visualization of soft tissue targets in unlimited imaging planes and precision in targeting and delivery of thermal dose which is all provided during real-time monitoring using MR thermometry. This paper provides an overview of the common musculoskeletal applications of MRgFUS along with updates on clinical outcomes and discussion of future applications.
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Affiliation(s)
- Kevin C McGill
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite M391, San Francisco, CA, 94143, USA.
| | - Joe D Baal
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite M391, San Francisco, CA, 94143, USA
| | - Matthew D Bucknor
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite M391, San Francisco, CA, 94143, USA
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Kuroda T, Shiraki M, Saito M, Urano T. Spinal osteoarthritis is a risk of vertebral fractures in postmenopausal women. Sci Rep 2024; 14:3528. [PMID: 38347047 PMCID: PMC10861596 DOI: 10.1038/s41598-024-53994-1] [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: 07/23/2023] [Accepted: 02/07/2024] [Indexed: 02/15/2024] Open
Abstract
Recent studies have revealed that despite high bone mineral density (BMD), osteoarthritis (OA) is a risk factor for osteoporotic fractures. However, the relationship between spinal OA and vertebral fractures has not yet been fully investigated. This longitudinal analysis used a subset of ongoing cohort study consist with Japanese postmenopausal women. The prevalence of spinal OA was determined using Kellgren-Lawrence grading method. The incidence of vertebral fractures were determined by semiquantitative analysis of spinal X-ray films. The relationship between the presence of spinal OA and incidence of vertebral fractures was evaluated using the Cox regression analysis. In total, 1480 women were followed up for 8.1 ± 6.4 years. Among them, 923 were diagnosed with spinal OA, and incident vertebral fractures were observed in 473 participants. After adjusting for confounding variables, the spinal OA (≥ grade 2) was a significant predictor of incident vertebral fractures (hazard ratio, 1.52; 95% confidence interval: 1.19-1.93, p = 0.001). Using ROC analysis, the thresholds of lumbar BMD for incident vertebral fractures were 0.952 g/cm2 for patients with spinal OA and 0.753 g/cm2 for patients without spinal OA. The presence of spinal OA is a risk factor for incident vertebral fractures despite high lumbar BMD.
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Affiliation(s)
| | - Masataka Shiraki
- Research Institute and Practice for Involutional Diseases, Azumino City, Nagano, Japan
| | - Mitsuru Saito
- Department of Orthopedic Surgery, Tokyo Jikei University, School of Medicine, Minato-ku, Tokyo, Japan
| | - Tomohiko Urano
- Department of Geriatric Medicine, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita City, Chiba, 286-8686, Japan.
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14
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Shi H, Li S, Liu S, Hu W, Chen J, Chen Y, Lin Y, Zhou H, Liao N, Huang D, Gao W, Liang A. Facet joint tropism, pelvic incidence and intervertebral height index: associations with facet joint osteoarthritis in lumbar spinal stenosis. Spine J 2024; 24:317-324. [PMID: 37844628 DOI: 10.1016/j.spinee.2023.10.001] [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: 05/10/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND CONTEXT Facet joint osteoarthritis (FJOA) is associated with lumbar disc degeneration and has a significant role in the development of lumbar spinal stenosis (LSS). The relationship between various radiographic parameters and the grade of FJOA is not well understood. PURPOSE To explore radiographical parameters associated with FJOA in LSS without lumbar dynamic instability. STUDY DESIGN Retrospective study analysis. PATIENT SAMPLE A total of 122 patients diagnosed with LSS who visited our hospital between January 2015 and July 2022. OUTCOME MEASURES We evaluated radiographic parameters of patients at L4-5 including lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), grades of FJOA, facet joint orientation (FO), facet joint tropism (FT), intervertebral height index (IHI) and the relative cross-sectional area (RCSA) of paraspinal muscles. METHODS Patients diagnosed with LSS between January 2015 and July 2022 were enrolled. Demographic characteristics and radiographic parameters were collected. Spinopelvic parameters were measured through the preoperative lateral image of the whole spine, including LL, PI, pelvic tilt, and sacral slope. Lumbar computed tomography scan and magnetic resonance imaging were collected to measure the FO, FT, IHI, and the RCSA of paraspinal muscles respectively. Patients were divided into three groups according to the severity of FJOA graded by the Weishaupt classification: grade 0 and grade 1 were group A, grade 2 were group B, and grade 3 were group C. All variables were compared among the three groups, while the relationship between parameters and grades of FJOA were also analyzed. RESULTS A total of 122 patients were included. PI was significantly greater in group C compared to group A (p = 0.025) and group B (p=0.022). FT was significantly greater in group C compared to group A (p<.001) and group B (p<.001). The RCSA of multifidus in group A were significantly greater than that in group B (p=0.02) and C (p=0.002). Additionally, FO in group C were significantly lower than group A (p<.001) and group B (p=0.028). The IHI in group C was significantly lower than group A (p=0.017). The correlation analysis indicated that grades of FJOA was positively related to Age, BMI (body mass index), PI, LL and FT, while negatively related to IHI, FO, RCSA of multifidus and RCSA of psoas major. Furthermore, the logistics regression showed that FT, PI, and IHI were important influence factors for FJOA. CONCLUSIONS The current study confirmed that FT, PI and IHI were significantly associated with grades of FJOA at L4-5. Additionally, longitudinal studies are needed to understand the causal relationship between these parameters and FJOA.
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Affiliation(s)
- Huihong Shi
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Shaoguang Li
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Song Liu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Wenjun Hu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Jianan Chen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Yanbo Chen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Youxi Lin
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Hang Zhou
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Nianchun Liao
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Dongsheng Huang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China.
| | - Wenjie Gao
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China.
| | - Anjing Liang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China.
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15
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Tan L, Du X, Tang R, Rong L, Zhang L. Preoperative Adjacent Facet Joint Osteoarthritis Is Associated with the Incidence of Adjacent Segment Degeneration and Low Back Pain after Lumbar Interbody Fusion. Asian Spine J 2024; 18:21-31. [PMID: 38379146 PMCID: PMC10910148 DOI: 10.31616/asj.2023.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 02/22/2024] Open
Abstract
STUDY DESIGN A retrospective cohort study. PURPOSE To analyze the association between preoperative adjacent facet joint osteoarthritis (FJOA) and outcomes of lumbar interbody fusion (LIF). OVERVIEW OF LITERATURE Whether preoperative adjacent FJOA is associated with the incidence of radiological adjacent segment degeneration (RASD) and low back pain (LBP) relief after lumbar fusion remains unknown. METHODS The study included patients who underwent LIF. The demographic characteristics and radiographic and surgical data were collected and evaluated. The included patients were divided into control group and FJOA group based on the preoperative adjacent facet joint Pathria grade. Preoperative and last follow-up LBP Visual Analog Scale (VAS) score, leg pain (LP) VAS, Oswestry Disability Index (ODI) and RASD were evaluated and compared. The improvement rates in VAS and ODI were calculated and compared between the two groups. Logistic regression was used to analyze the risk factors of LBP relief and incidence of RASD. RESULTS In total, 197 patients (control group, 86; FJOA group, 111) were included, and the median follow-up was 46 months. The VAS and ODI in both groups significantly improved after surgery. At the last follow-up, the FJOA group had higher VAS and lower VAS improvement rates of LBP than the control group (p<0.05). However, no significant difference in the LP VAS and ODI was found between the two groups. The incidence of RASD in the FJOA group was significantly higher than that in the control group (48.6% vs. 30.2%, p=0.034). Multivariate logistic regression analysis showed that preoperative adjacent FJOA was significantly associated with LBP relief (odds ratio [OR], 0.691; 95% confidence interval [CI], 0.498-0.958) and the postoperative incidence of RASD (OR, 1.406; 95% CI, 1.020-1.939). CONCLUSIONS The preoperative FJOA in the adjacent segments was significantly associated with LBP following LIF. Patients with preoperative FJOA were more likely to have RASD following lumbar fusion surgery.
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Affiliation(s)
- Lixian Tan
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Xiaokang Du
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Runmin Tang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Limin Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou,
China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou,
China
| | - Liangming Zhang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou,
China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou,
China
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16
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Han Y, Yuan W, Sun S, Ren B, Zhang X, Li Z, Miao J, Wang X. Effect of different loads on facet joint motion during lumbar lateral bending in sitting position. J Orthop Surg Res 2024; 19:61. [PMID: 38218824 PMCID: PMC10787429 DOI: 10.1186/s13018-024-04533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE To study the effect of weight-bearing on lumbar facet joint during lateral bending in sitting position. METHODS Ten normal healthy people (5 males and 5 females) aged 25-39 years (mean 32 ± 4.29 years) were recruited. CT scanning was used to reconstruct the lumbar spine model, and then dual fluoroscopic image system (DFIS) was used to restore the lumbar facet joint movement in sitting position. Finally, the lumbar facet joint translation distance and rotation angle were measured. RESULTS In L3-4 level, the displacement of right facet joint in Y-axis was the smallest at 0.05 ± 0.40 mm, the displacement of 0 kg left facet joint in X-axis was the largest at 1.68 ± 0.85 mm, and the rotation angle was - 0.57 ± 1.43° to 5.66 ± 2.70° at 10 kg; in L4-5 level, the displacement of right facet joint in Y-axis was the smallest at 10 kg, - 0.13 ± 0.91 mm, and the displacement of left facet joint in Z-axis was the largest at - 2.11 ± 0.88 mm, and the rotation angle was 0.21 ± 2.14° to 7.89 ± 2.59° at 10 kg; in L5-S1 level, the displacement of right facet joint in Y-axis was the smallest at 10 kg, - 0.17 ± 1.10 mm, and the displacement of 0 kg left facet joint in X-axis was the largest at 2.19 ± 2.28 mm, and the rotation angle was 0.03 ± 2.02° to 3.98 ± 0.37°. CONCLUSION In sitting position, weight-bearing has certain influence on the displacement of facet joints during lumbar lateral bending movement, and this influence occurs simultaneously in translation and rotation; the left and right facet joints are not symmetrical during lumbar lateral bending movement.
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Affiliation(s)
- Ye Han
- Department of Orthopaedics, Affiliated Hospital of Hebei University, No.212, Yuhua Road, Baoding City, 071000, Hebei, China
| | - Wei Yuan
- Department of Tuberculosis, Affiliated Hospital of Hebei University, Hebei, China
| | - Shaosong Sun
- Department of Orthopaedics, Affiliated Hospital of Hebei University, No.212, Yuhua Road, Baoding City, 071000, Hebei, China
| | - Bao Ren
- Department of Orthopaedics, Affiliated Hospital of Hebei University, No.212, Yuhua Road, Baoding City, 071000, Hebei, China
| | - Xiong Zhang
- Department of Orthopaedics, Affiliated Hospital of Hebei University, No.212, Yuhua Road, Baoding City, 071000, Hebei, China
| | - Zheng Li
- Department of Rehabilitation, Baoding Third Central Hospital, Tianjin Hospital, No.406, Jiefang Road, Tianjin, 300000, Hebei, China
| | - Jun Miao
- Tianjin Hospital, Tianjin, China.
| | - Xiaodong Wang
- Department of Orthopaedics, Affiliated Hospital of Hebei University, No.212, Yuhua Road, Baoding City, 071000, Hebei, China.
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17
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Yoo YM, Kim KH. Facet joint disorders: from diagnosis to treatment. Korean J Pain 2024; 37:3-12. [PMID: 38072795 PMCID: PMC10764212 DOI: 10.3344/kjp.23228] [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: 07/31/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 12/30/2023] Open
Abstract
One of the most common sources of spinal pain syndromes is the facet joints. Cervical, thoracic, and lumbar facet joint pain syndromes comprise 55%, 42%, and 31% of chronic spinal pain syndromes, respectively. Common facet joint disorders are degenerative disorders, such as osteoarthritis, hypertrophied superior articular process, and facet joint cysts; septic arthritis; systemic and metabolic disorders, such as ankylosing spondylitis or gout; and traumatic dislocations. The facet pain syndrome from osteoarthritis is suspected from a patient's history (referred pain pattern) and physical examination (tenderness). Other facet joint disorders may cause radicular pain if mass effect from a facet joint cyst, hypertrophied superior articular process, or tumors compress the dorsal root ganglion. However, a high degree of morphological change does not always provoke pain. The superiority of innervating nerve block or direct joint injection for diagnosis and treatment is still a controversy. Treatment includes facet joint injection in facet joint osteoarthritis or whiplash injury provoking referred pain or decompression in mass effect in cases of hypertrophied superior articular process or facet joint cyst eliciting radicular pain. In addition, septic arthritis is treated using a proper antibiotic, based on infected tissue or blood culture. This review describes the diagnosis and treatment of common facet joint disorders.
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Affiliation(s)
- Yeong-Min Yoo
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Kyung-Hoon Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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18
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Okuzu Y, Goto K, Kuroda Y, Kawai T, Matsuda S. How Do Spinal Parameters Change in Patients Who Have Improvement of Low Back Pain After Total Hip Arthroplasty? A Propensity Score-Matched Cohort Study. J Arthroplasty 2024; 39:132-137. [PMID: 37331437 DOI: 10.1016/j.arth.2023.06.021] [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: 01/10/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Many studies have demonstrated that low back pain (LBP) improves after total hip arthroplasty (THA). However, the mechanism underlying this improvement remains unclear. We aimed to investigate changes in the spinal parameters of patients who had LBP improvement after THA to elucidate the mechanism of LBP improvement. METHODS We included 261 patients who underwent primary THA between December 2015 and June 2021 and had a preoperative visual analog scale score of ≥ 2 for LBP. The patients were classified into the LBP-improved or LBP-continued groups based on the visual analog scale for LBP at 1 year after THA. Preoperative and postoperative changes in the coronal and sagittal spinal parameters were compared between the 2 groups after propensity score matching for age, sex, body mass index, and preoperative spinal parameters. RESULTS A total of 161 patients (61.7%) were classified into the LBP-improved group. After 85 patients in both groups were matched, the LBP-improved group showed significant differences in spinal parameter changes, which were a higher lumbar lordosis (LL) (P = .04) and lower sagittal vertical axis (SVA) (P = .02) and pelvic incidence (PI) minus LL (PI-LL) (P = .01) postoperatively, whereas the LBP-continued group showed worsened changes in LL and SVA and PI-LL mismatch. CONCLUSION Patients who had LBP improvement after THA had significant differences in spinal parameter changes in LL, SVA, and PI-LL. These spinal parameters may be the key factors in the mechanism of LBP improvement after THA.
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Affiliation(s)
- Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
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Shen YW, Yang Y, Liu H, Wang BY, Ding C, Meng Y, Rong X, Hong Y. The Effect of Preoperative Cervical Spondylosis on Heterotopic Ossification After Cervical Disc Replacement. Global Spine J 2024; 14:56-66. [PMID: 35403474 PMCID: PMC10676169 DOI: 10.1177/21925682221094265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study aimed to explore the effect of preoperative cervical spondylosis on the heterotopic ossification (HO) formation in different locations after cervical disc replacement (CDR). METHODS The degree of preoperative cervical spondylosis was evaluated radiologically, including the intervertebral disc, uncovertebral joints, facet joints and ligaments. The effects of cervical spondylosis on the HO formation after CDR were analyzed according to the location of HO. Multivariate logistic regression was performed to identify the independent factors. RESULTS 149 patients with a total of 196 arthroplasty segments were involved in this study. HO, anterior HO (AHO), and posterior HO (PHO) developed in 59.69%, 22.96%, and 41.84% levels, respectively. The significant factors in univariate analysis for PHO after CDR included the disc height loss, anterior osteophytes, preoperative uncovertebral joint osteophytes and facet joint degeneration. The incidence of adjacent segment degeneration (ASD) was significantly higher in the PHO group compared to that without PHO at the last follow-up (P = .003). The disc height loss in high-grade HO was significantly more than that in low-grade group (P = .039). Multivariate analysis identified disc height loss was the only independent factor for PHO (P = .009). No significant degenerative factors related to the formation of AHO were found. CONCLUSIONS Preoperative cervical spondylosis predominantly affected the HO formation in the posterior disc space after CDR. The disc height loss was an independent risk factor for PHO formation. Rigorous criteria for the extent of preoperative disc height loss should be used when selecting appropriate candidates for CDR.
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Affiliation(s)
- Yi-Wei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bei-Yu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Rong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Operation Room and Anesthesia Center, West China Hospital, Sichuan University, Chengdu, China
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Soares D, Abbady K, Kasap S, Shabanliyski D. Simulation analysis of low back forces in Snatch and Clean & Jerk movements via digital human modelling. J Back Musculoskelet Rehabil 2024; 37:697-706. [PMID: 38160337 DOI: 10.3233/bmr-230181] [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] [Indexed: 01/03/2024]
Abstract
BACKGROUND Weightlifting is an Olympic sport for dynamic strength and power, and requires the execution of different lifting techniques It is important to analyze the forces subjected to the lower back during weightlifting movements to prevent injuries. Digital Human Modeling (DHM) is a powerful tool that can be used to analyze and optimize the performance of humans while doing their work or activities. OBJECTIVE The purpose of this study is to present a simulation analysis of the lower back forces during the execution of two weightlifting techniques: Snatch (SN) and Clean & Jerk (CJ), with different loads and for both genders. METHODS Digital Human modelling through JACK simulation package was used analyze the forces exerted on the lumbosacral area (L5-S1) of the lower back in order to determine the risk for low back injuries. The level of compression and shear forces recommended by the literature have been set as thresholds. The simulaitons were performed in male and female models, with loads from 20-100 kg. RESULTS The results show that any weight higher than 60 kg in both movements poses risk for the weightlifters in terms of compression and shear forces. It has been observed that weightlifters can lift greater loads in the CJ technique compared to the SN technique. Furthermore, females are able to lift higher loads with lower risk of injuries. CONCLUSION Weightlifting is a high-risk activity due to the high levels of shear and compression forces that the body is exposed to during the lifting techniques. Digital Human Modeling holds significant value due to their ability to facilitate the exploration of diverse conditions within a safe environment, devoid of any potential harm to human subjects.
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Affiliation(s)
- Denise Soares
- Liberal Arts Department, American University of the Middle East, Kuwait
| | - Karim Abbady
- College of Engineering and Technology, American University of the Middle East, Kuwait
| | - Suat Kasap
- College of Engineering and Technology, American University of the Middle East, Kuwait
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21
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Raman R, Bahri MA, Degueldre C, Caetano da Silva C, Sanchez C, Ostertag A, Collet C, Cohen-Solal M, Plenevaux A, Henrotin Y, Muller M. A Zebrafish Mutant in the Extracellular Matrix Protein Gene efemp1 as a Model for Spinal Osteoarthritis. Animals (Basel) 2023; 14:74. [PMID: 38200805 PMCID: PMC10778253 DOI: 10.3390/ani14010074] [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: 10/26/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Osteoarthritis is a degenerative articular disease affecting mainly aging animals and people. The extracellular matrix protein Efemp1 was previously shown to have higher turn-over and increased secretion in the blood serum, urine, and subchondral bone of knee joints in osteoarthritic patients. Here, we use the zebrafish as a model system to investigate the function of Efemp1 in vertebrate skeletal development and homeostasis. Using in situ hybridization, we show that the efemp1 gene is expressed in the brain, the pharyngeal arches, and in the chordoblasts surrounding the notochord at 48 hours post-fertilization. We generated an efemp1 mutant line, using the CRISPR/Cas9 method, that produces a severely truncated Efemp1 protein. These mutant larvae presented a medially narrower chondrocranium at 5 days, which normalized later at day 10. At age 1.5 years, µCT analysis revealed an increased tissue mineral density and thickness of the vertebral bodies, as well as a decreased distance between individual vertebrae and ruffled borders of the vertebral centra. This novel defect, which has, to our knowledge, never been described before, suggests that the efemp1 mutant represents the first zebrafish model for spinal osteoarthritis.
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Affiliation(s)
- Ratish Raman
- Laboratory for Organogenesis and Regeneration (LOR), GIGA Institute, University of Liège, 4000 Liège, Belgium;
| | - Mohamed Ali Bahri
- GIGA CRC In Vivo Imaging, University of Liege, Sart Tilman, 4000 Liège, Belgium; (M.A.B.); (C.D.); (A.P.)
| | - Christian Degueldre
- GIGA CRC In Vivo Imaging, University of Liege, Sart Tilman, 4000 Liège, Belgium; (M.A.B.); (C.D.); (A.P.)
| | - Caroline Caetano da Silva
- Hospital Lariboisière, Reference Centre for Rare Bone Diseases, INSERM U1132, Université de Paris-Cité, F-75010 Paris, France; (C.C.d.S.); (A.O.); (C.C.); (M.C.-S.)
| | - Christelle Sanchez
- MusculoSKeletal Innovative Research Lab, Center for Interdisciplinary Research on Medicines, University of Liège, 4000 Liège, Belgium; (C.S.); (Y.H.)
| | - Agnes Ostertag
- Hospital Lariboisière, Reference Centre for Rare Bone Diseases, INSERM U1132, Université de Paris-Cité, F-75010 Paris, France; (C.C.d.S.); (A.O.); (C.C.); (M.C.-S.)
| | - Corinne Collet
- Hospital Lariboisière, Reference Centre for Rare Bone Diseases, INSERM U1132, Université de Paris-Cité, F-75010 Paris, France; (C.C.d.S.); (A.O.); (C.C.); (M.C.-S.)
- UF de Génétique Moléculaire, Hôpital Robert Debré, APHP, F-75019 Paris, France
| | - Martine Cohen-Solal
- Hospital Lariboisière, Reference Centre for Rare Bone Diseases, INSERM U1132, Université de Paris-Cité, F-75010 Paris, France; (C.C.d.S.); (A.O.); (C.C.); (M.C.-S.)
| | - Alain Plenevaux
- GIGA CRC In Vivo Imaging, University of Liege, Sart Tilman, 4000 Liège, Belgium; (M.A.B.); (C.D.); (A.P.)
| | - Yves Henrotin
- MusculoSKeletal Innovative Research Lab, Center for Interdisciplinary Research on Medicines, University of Liège, 4000 Liège, Belgium; (C.S.); (Y.H.)
| | - Marc Muller
- Laboratory for Organogenesis and Regeneration (LOR), GIGA Institute, University of Liège, 4000 Liège, Belgium;
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22
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Mardini M, Badawi A, Zaven T, Gergian R, Nikita E. Mechanical stress in the urbanized Roman Phoenician coast. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 43:58-67. [PMID: 37804603 DOI: 10.1016/j.ijpp.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE Skeletal populations from Byblos, Beirut, and Tyre were studied to assess mechanical stress along the Roman Phoenician coast. MATERIALS The sample included 153 adult skeletons. METHODS Skeletal remains were macroscopically assessed for osteoarthritis, intervertebral disc disease (IDD), and Schmorl's nodes. RESULTS The Byblos population experienced higher levels of mechanical stress than the Beirut and Tyre ones. Sex-based differences were also found in all skeletal assemblages with males likely engaging in physically more demanding tasks. CONCLUSIONS The variation in mechanical stress, and associated physically demanding tasks, between these populations can be attributed to their differing political and economic status during the Roman period; textual sources highlight the economic and political dominance of Beirut and Tyre, emanating from their status as coloniae. SIGNIFICANCE This study represents one of the first attempts to investigate mechanical stress in coastal Phoenicia during the Roman period. It provides valuable insights into the biocultural structure of understudied communities at the periphery of the Roman world, and can serve as a basis for further future research into the occupational patterns of Phoenician communities. LIMITATIONS The contextual information for these skeletal populations is very limited and does not allow secure conclusions regarding their representativeness. The sample sizes are also rather small, especially when divided per sex and age. SUGGESTIONS FOR FURTHER RESEARCH Further investigation employing complementary methods such as cross-sectional geometric properties and entheseal changes is needed to reconstruct the occupational patterns of these communities, taking into account cultural, environmental, and temporal factors.
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Affiliation(s)
- Mahmoud Mardini
- Science and Technology in Archaeology and Culture Research Center, The Cyprus Institute, 2121 Aglantzia, Nicosia, Cyprus.
| | - Ali Badawi
- Lebanese Directorate General of Antiquities, Damascus Road, Beirut, Lebanon; Lebanese University, 5th Branch, Faculty of Letters and Human Sciences, Sidon, Lebanon
| | - Tania Zaven
- Lebanese Directorate General of Antiquities, Damascus Road, Beirut, Lebanon
| | - Raffi Gergian
- Lebanese Directorate General of Antiquities, Damascus Road, Beirut, Lebanon
| | - Efthymia Nikita
- Science and Technology in Archaeology and Culture Research Center, The Cyprus Institute, 2121 Aglantzia, Nicosia, Cyprus
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23
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Fainor M, Orozco BS, Muir VG, Mahindroo S, Gupta S, Mauck RL, Burdick JA, Smith HE, Gullbrand SE. Mechanical crosstalk between the intervertebral disc, facet joints, and vertebral endplate following acute disc injury in a rabbit model. JOR Spine 2023; 6:e1287. [PMID: 38156057 PMCID: PMC10751980 DOI: 10.1002/jsp2.1287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/21/2023] [Accepted: 09/06/2023] [Indexed: 12/30/2023] Open
Abstract
Background Vertebral endplate sclerosis and facet osteoarthritis have been documented in animals and humans. However, it is unclear how these adjacent pathologies engage in crosstalk with the intervertebral disc. This study sought to elucidate this crosstalk by assessing each compartment individually in response to acute disc injury. Methods Eleven New Zealand White rabbits underwent annular disc puncture using a 16G or 21G needle. At 4 and 10 weeks, individual compartments of the motion segment were analyzed. Discs underwent T 1 relaxation mapping with MRI contrast agent gadodiamide as well T 2 mapping. Both discs and facets underwent mechanical testing via vertebra-disc-vertebra tension-compression creep testing and indentation testing, respectively. Endplate bone density was quantified via μCT. Discs and facets were sectioned and stained for histology scoring. Results Intervertebral discs became more degenerative with increasing needle diameter and time post-puncture. Bone density also increased in endplates adjacent to both 21G and 16G punctured discs leading to reduced gadodiamide transport at 10 weeks. The facet joints, however, did not follow this same trend. Facets adjacent to 16G punctured discs were less degenerative than facets adjacent to 21G punctured discs at 10 weeks. 16G facets were more degenerative at 4 weeks than at 10, suggesting the cartilage had recovered. The formation of severe disc osteophytes in 16G punctured discs between 4 and 10 weeks likely offloaded the facet cartilage, leading to the recovery observed. Conclusions Overall, this study supports that degeneration spans the whole spinal motion segment following disc injury. Vertebral endplate thickening occurred in response to disc injury, which limited the diffusion of small molecules into the disc. This work also suggests that altered disc mechanics can induce facet degeneration, and that extreme bony remodeling adjacent to the disc may promote facet cartilage recovery through offloading of the articular cartilage.
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Affiliation(s)
- Matthew Fainor
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Brianna S. Orozco
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Victoria G. Muir
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sonal Mahindroo
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- Department of BiologySt. Bonaventure UniversitySt. BonaventureNew YorkUSA
| | - Sachin Gupta
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Robert L. Mauck
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jason A. Burdick
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- BioFrontiers Institute and Department of Chemical and Biological EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Harvey E. Smith
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Sarah E. Gullbrand
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
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24
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Yahara Y, Seki S, Makino H, Futakawa H, Kamei K, Kawaguchi Y. Asymmetric Load Transmission Induces Facet Joint Subchondral Sclerosis and Hypertrophy in Patients with Idiopathic Adolescent Scoliosis: Evaluation Using Finite Element Model and Surgical Specimen. JBMR Plus 2023; 7:e10812. [PMID: 38130755 PMCID: PMC10731138 DOI: 10.1002/jbm4.10812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 12/23/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) with thoracic curvature primarily progresses from the thoracolumbar region, causing abnormal twisting and rotation of the spinal column. This results in unbalanced, asymmetric loads on each vertebrae and increased demands on the thoracic facet joints to withstand rotational stress from adjacent vertebrae. However, no studies have focused on the stress distribution on the facet joints of the thoracic spine in patients with AIS. This study aimed to investigate the mechanical loading and its distribution on the thoracic facet joints of AIS patients using finite element (FE) analysis and surgical specimens. FE models of the thoracic spine were created from a total of 13 female AIS patients (Lenke type 1, n = 4; Lenke type 2, n = 4; Lenke type 3, n = 5). A load of 200 N on the T3 vertebrae and 30 N each on the bilateral superior articular processes were applied vertically to quantify the contact force on the facet joints from T3 to T11. In addition, morphological and histological analyses were performed on the inferior articular processes obtained during surgery. FE analysis demonstrated that contact forces of the facet joint progressively increased from the mid to lower thoracic spine of the concave side, reaching a maximum around the apex. More than 91% of the load was transmitted by the facet joints at the concave side, resulting in facet joint subchondral sclerosis and hypertrophy. The apical facet joint in AIS helps counteract rotational stress between vertebrae and transfers most stress through the concave side. In conclusion, this study found that asymmetric load transfer in the facet joints leads to subchondral sclerosis and hypertrophy. These findings can enhance our understanding of the stress loading on facet joints and the resulting biological changes and help clarify the mechanisms involved in scoliosis progression. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Yasuhito Yahara
- WPI‐Immunology Frontier Research CenterOsaka UniversitySuitaJapan
- Department of Orthopaedic Surgery, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Hayato Futakawa
- Department of Orthopaedic Surgery, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of MedicineUniversity of ToyamaToyamaJapan
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25
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Haddas R, Botros M, D'Agostino CR, Jablonski J, Ramirez G, Vasalos K, Thirukumaran C, Rubery PT. The effect of a workplace wellness program on disability, function and pain in healthcare providers workers with low back pain-outcomes of 3040 academic health center employees. 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 2023; 32:4405-4419. [PMID: 37875680 DOI: 10.1007/s00586-023-07971-3] [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: 06/28/2023] [Revised: 08/16/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE (1) Identification of musculoskeletal risk factors for healthcare providers suffering low back pain (LBP) and the creation of risk profiles for those individuals and (2) analyze the impact of a workplace wellness program on healthcare providers who suffer from low back pain. METHODS A total of 3040 employees at an academic healthcare center underwent a computer-adaptive survey of health-related quality of life (HRQOL), biometric tests, and a disability and functional movement assessment as part of the workplace wellness program (WWP). Clinical interventions with a rehabilitation specialist were offered to employees identified as at risk for low back pain. Data collected were analyzed using descriptive methods and multivariable regressions to address the study objectives. RESULTS Of the 3040 healthcare providers enrolled in this study, 77% identified with non-specific LBP with greater weakness, numbness, reduced flexibility, and physical activity. The major predictive risk factors for LBP were Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference score, PROMIS fatigue, previous work injury, flexibility, numbness, PROMIS social function, level of education, and BMI. Healthcare providers with LBP who completed the WWP improved in most dimensions of HRQOL and disability and functional outcomes. CONCLUSIONS A high proportion of healthcare providers suffer from LBP as a result of the nature of their work. Disability and functional outcomes measurements and PROMIS results quantitatively assess healthcare providers with LBP. Organizations can develop injury mitigation programs to target employees at high risk of LBP using the risk factors we identify. Completion of the WWP was associated with improvements in disability, HRQOL and functional measures.
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Affiliation(s)
- Ram Haddas
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA.
| | - Mina Botros
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Charles R D'Agostino
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Justin Jablonski
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Gabriel Ramirez
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Kostantinos Vasalos
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Caroline Thirukumaran
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Paul T Rubery
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
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Tiegs-Heiden CA, Hesley GK, Long Z, Lu A, Lamer TJ, Gorny KR, Hangiandreou NJ, Lehman VT. MRI-guided focused ultrasound ablation of painful lumbar facet joints: a retrospective assessment of safety and tolerability in human subjects. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1219-1223. [PMID: 37478345 DOI: 10.1093/pm/pnad100] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To evaluate the safety and tolerability of MRI-guided focused ultrasound (MRgFUS) for the treatment of facet joint-mediated pain in human subjects for whom conventional treatment had failed. Secondarily, to evaluate effectiveness of the procedure. METHODS Consecutive patients who underwent MRgFUS at our institution were retrospectively identified. Chart review was performed to obtain relevant clinical and technical data. All patients had chronic low back pain and positive comparative medial branch blocks. RESULTS Twenty-six MRgFUS treatments in 20 patients were included. Mean sonication energy was 1436.6 Joules. The procedure was technically successful in all patients. Of the treated patients, 29.6% experienced short-term worsening of low back pain immediately after the procedure, all by 1-4 points on a 0-10 scale. One patient (3.8%) reported temporary worsening of preexisting radicular symptoms after the procedure. Of 21 treatments with clinical follow-up of at least 3 months available, 12 (57.1%) had >3 months' pain relief, 2 (10%) had <3 months' benefit, 6 (30%) reported no benefit, and 1 (5%) patient was lost to follow-up. In patients who reported at least some benefit with prior conventional radiofrequency ablation, 8/10 (80%) benefited from the MRgFUS procedure. CONCLUSION The present study demonstrates that MRgFUS ablation of the lumbar facet joints is a safe and tolerable procedure in human subjects and could provide another option for patients for whom radiofrequency ablation had failed. More than half of all patients received significant durable pain relief, which jumped to 80% for patients who had experienced at least some benefit from prior radiofrequency ablations.
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Affiliation(s)
| | - Gina K Hesley
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States
| | - Zaiyang Long
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States
| | - Aiming Lu
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States
| | - Tim J Lamer
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
| | - Krzysztof R Gorny
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States
| | | | - Vance T Lehman
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States
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27
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Ahangar-Sirous R, Alizadeh M, Nejadghaderi SA, Noori M, Khabbazi A, Sullman MJ, Kolahi AA, Collins GS, Safiri S. The burden of neck pain in the Middle East and North Africa region, 1990-2019. Heliyon 2023; 9:e21296. [PMID: 38027849 PMCID: PMC10643100 DOI: 10.1016/j.heliyon.2023.e21296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Neck pain is a common cause of disability across the world. The objective of the present study was to present a thorough investigation of the burden caused by neck pain in the Middle East and North Africa (MENA) region, by country, sex, age group and socio-demographic index (SDI). Methods The data on the burden of neck pain, encompassing its prevalence, incidence and years lived with disability (YLDs), were extracted from the Global Burden of Disease (GBD) 2019 study. These findings are reported as age-standardised numbers and rates (per 100,000), accompanied by 95 % uncertainty intervals (UIs). Results The age-standardised point prevalence of neck pain in 2019 was 3066.7 (95 % UI: 2407.8 to 3894.3) per 100,000, with an age-standardised incidence rate of 649.2 (509.2-829.2) in the MENA region, neither of which have changed since 1990. The age-standardised YLD rate of neck pain was 303.0 (201.5-438.8) per 100,000 population in 2019. The highest YLD rate of neck pain was found in Iran [423.5 (280.3-609.8)] and the lowest in Kuwait [215.0 (141.0-314.1)]. The highest number of prevalent cases were seen in the 45-49 age-group for both sexes in 2019, but overall females had a higher point prevalence than males. Furthermore, over the study period (1990-2019) there was no clear and consistent relationship between the SDI and the burden of neck pain. Conclusion Although the burden of neck pain has largely remained stable over the past three decades, the prevalence and morbidity in the MENA region remains high. Preventive and rehabilitative programs should be implemented that firstly target middle-aged females and males.
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Affiliation(s)
- Ramin Ahangar-Sirous
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahasti Alizadeh
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Aria Nejadghaderi
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Khabbazi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mark J.M. Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gary S. Collins
- Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Saeid Safiri
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Morgan RE, Fiske-Jackson A, Chang YM. Comparison of ultrasonographic and computed tomographic imaging of equine thoracolumbar articular process joints. Equine Vet J 2023. [PMID: 37904723 DOI: 10.1111/evj.14017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/08/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Osteoarthritis of the equine thoracolumbar articular process joints (APJs) has been linked to back pain. Changes are commonly diagnosed through nuclear scintigraphy, radiography and ultrasonography (US). OBJECTIVES (1) To assess the agreement of APJ grades between US and computed tomography (CT) images; (2) to assess the effect of location on the agreement of APJ grades between US and CT images. It was hypothesised that: (1) Periarticular modelling and modification of the joint space would have the highest and lowest agreement between US and CT images, respectively; (2) Caudal thoracolumbar APJ grades would have higher agreement between US and CT images than mid thoracic APJs. STUDY DESIGN Comparative diagnostic imaging study using cadaveric specimens. METHODS Disarticulated thoracolumbar spines of six equids euthanised for reasons unrelated to back pain, underwent US and CT examination of the APJs. Images were assessed for periarticular modelling, modification of the joint space and enlargement of the APJ. Intra-observer, inter-modality and inter-observer agreement using multilevel weighted kappa statistics to evaluate the effects of location, US/CT characteristic and their interaction. RESULTS Intra-observer agreement of US and CT grades ranged from moderate to perfect. Between T15 and L1, inter-modality agreement (CT vs. US) for periarticular modelling was moderate, and fair for enlargement and modification of the joint space. Inter-observer agreement (US vs. US) of periarticular modelling was substantial between T15 and L1, moderate between L1 and L5 and fair between T10 and T15. Wide confidence intervals (CIs) seen for most grades apart from inter-observer grades of periarticular modelling at T15-L5, introducing a degree of uncertainty into the results. MAIN LIMITATIONS Large prevalence index influenced kappa values, small sample size. CONCLUSIONS Good inter-observer (US vs. US) and inter-modality (CT vs. US) agreement of caudal thoracolumbar APJ periarticular modelling. This US characteristic provides a measure of bone change, therefore supporting the use of diagnostic ultrasound. Inter-modality CIs were wide, highlighting the study and imaging modality limitations.
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Affiliation(s)
- Rhiannon E Morgan
- Equine Referral Hospital, The Royal Veterinary College, Hertfordshire, UK
| | | | - Yu-Mei Chang
- Comparative Biomedical Sciences, The Royal Veterinary College, Hertfordshire, UK
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Haider N, Gargya A. Management of Osteoarthritic Axial Neck Pain With Cervical Neuromodulation. Cureus 2023; 15:e46890. [PMID: 37841979 PMCID: PMC10569083 DOI: 10.7759/cureus.46890] [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] [Accepted: 10/12/2023] [Indexed: 10/17/2023] Open
Abstract
Chronic refractory facetogenic axial neck pain is a challenging diagnosis to manage long-term. With limited options available for patients who have failed cervical medial branch blocks, patients often have to endure a poor quality of life. Although neuromodulation devices such as peripheral nerve stimulators are currently available for the management of various chronic conditions, their role in the treatment of axial neck pain has not been studied. We present a case of successful management of facetogenic axial neck pain with cervical medial branch peripheral nerve stimulation.
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Affiliation(s)
- Naeem Haider
- Anesthesiology, University of Vermont Health Network, Burlington, USA
| | - Akshat Gargya
- Anesthesiology, University of Vermont Health Network, Burlington, USA
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30
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Eede NVD, Friedrich KM, Hauwe LVD. Imaging the Posterior Elements of the Spine. Semin Musculoskelet Radiol 2023; 27:553-560. [PMID: 37816363 DOI: 10.1055/s-0043-1770996] [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: 10/12/2023]
Abstract
The posterior elements of the spine consist of the pedicles, laminae, facets (articular processes), transverse processes, and the spinous process. They are essential for spinal stability, protecting the spinal cord and nerve roots, and enabling movement of the spine. Pathologies affecting the posterior elements can cause significant pain and disability. Imaging techniques, such as conventional radiography, computed tomography, and magnetic resonance imaging, are crucial for the diagnosis and evaluation of pathology, enabling accurate localization, characterization, and staging of the disease.
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Affiliation(s)
- Nick Van den Eede
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Radiology, AZ KLINA, Brasschaat, Belgium
| | - Klaus M Friedrich
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Luc van den Hauwe
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Radiology, AZ KLINA, Brasschaat, Belgium
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31
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Lorio M, Lewandrowski KU, Coric D, Phillips F, Shaffrey CI. International Society for the Advancement of Spine Surgery Statement: Restorative Neurostimulation for Chronic Mechanical Low Back Pain Resulting From Neuromuscular Instability. Int J Spine Surg 2023; 17:728-750. [PMID: 37562978 PMCID: PMC10623686 DOI: 10.14444/8525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
This International Society for the Advancement of Spine Surgery statement has been generated to respond to growing requests for background, supporting literature and evidence, and proper coding for restorative neurostimulation for chronic low back pain. Chronic low back pain describes the diverse experience of a significant proportion of the population. Conservative management of these patients remains the predominant care pathway, but for many patients, symptom relief is poor. The application of new techniques in patients who have exhausted traditional care paradigms should be undertaken with a detailed understanding of the pathology being treated, the mechanisms involved, and the data supporting efficacy. This statement on restorative neurostimulation places this technology in the context of the current understanding of the etiology of mechanical low back pain and the currently available evidence for this technique. In an appropriately selected cohort with a specific subset of chronic low back pain symptoms, this technique may provide benefit to payers and patients.
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Affiliation(s)
- Morgan Lorio
- Advanced Orthopedics, Altamonte Springs, FL, USA
| | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona, The Surgical Institute of Tucson, Tucson, AZ, USA
- Department of Orthopedics, Fundación Universitaria Sanitas, Bogotá, DC, Colombia
- Department of Orthopedics Hospital Universitário Gaffre e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Domagoj Coric
- Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA
| | - Frank Phillips
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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32
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Said N, Amrhein TJ, Joshi AB, N NCN, Kranz PG. Facets of facet joint interventions. Skeletal Radiol 2023; 52:1873-1886. [PMID: 36245007 DOI: 10.1007/s00256-022-04184-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 02/02/2023]
Abstract
Facet joint (FJ) disease is a common cause of axial low back pain with many minimally invasive image-guided treatment options. This article discusses fluoroscopic and CT-guided intraarticular FJ injections, medial branch (MB) radiofrequency ablation (RFA), and lumbar facet synovial cyst (LFSC) aspiration, rupture, or fenestration. Additionally, the article will highlight medial branch blocks (MBBs) utilized to diagnose facet-mediated pain and to predict outcomes to RFA.
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Affiliation(s)
- Nicholas Said
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA.
| | - Timothy J Amrhein
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | - Anand B Joshi
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Nicholas C Nacey N
- Department of Radiology and Medical Imaging, University of Virginia, 1215 Lee St, PO Box 800170, Charlottesville, VA, 22908, USA
| | - Peter G Kranz
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
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Dzefi-Tettey K, Edzie EKM, Mensah SK, Osei S, Piersson AD, Amedi MK, Asemah AR, Kusodzi H. Lumbar facet joint arthrosis on magnetic resonance imaging and its association with low back pain in a selected Ghanaian population. J Neurosci Rural Pract 2023; 14:681-685. [PMID: 38059220 PMCID: PMC10696332 DOI: 10.25259/jnrp_94_2023] [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: 02/23/2023] [Accepted: 06/27/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Facet joint arthrosis is a common radiologic finding but remains controversial as a source of low back pain. We conducted a study to evaluate some of the potential risk factors contributing to the development of facet joint arthrosis, such as age, gender, and body mass index (BMI). The study aimed at establishing an association between these factors and facet joint arthrosis in the Ghanaian population, as a foundation for further research on low back pain. Materials and Methods This was a retrospective study done at the Department of Radiology, Korle Bu Teaching Hospital from January 2019 to December 2021. The study population included all cases referred to our department with complaints of low back pain. Patients below 18 years and those with a history of congenital lesions, trauma, infection, and malignancies were excluded. A total of 1017 cases were identified with facet joint arthrosis. The mean difference in age and BMI between males and females was compared using an independent sample t-test. Statistical association was done using Pearson's Chi-square test. P ≤ 0.05 was used as statistical significance. Results Majority of the study subjects were overweight with a mean BMI of 27.31 ± 5.37 kg/m2. The mean age was 53.61 ± 16.22 years, and majority were within the age of 51-60 years. Age was significantly associated with the prevalence of facet joint arthrosis. Conclusion The prevalence of facet joint arthrosis is significantly associated with increasing age but not with the BMI. Lumbar facet joint arthrosis is more prevalent in women than in men, which may be due to the sensitivity of cartilage to female sex hormones.
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Affiliation(s)
| | - Emmanuel Kobina Mesi Edzie
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, Cape Coast, Ghana
| | | | - Samson Osei
- Department of Radiology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Albert Dayor Piersson
- Department of Imaging Technology and Sonography, University of Cape Coast, Cape Coast, Ghana
| | | | - Abdul Raman Asemah
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, Cape Coast, Ghana
| | - Henry Kusodzi
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, Cape Coast, Ghana
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Zhao J, Sun Y, Sheng X, Xu J, Dai G, He R, Jin Y, Liu Z, Xie Y, Wu T, Cao Y, Hu J, Duan C. Hypoxia-treated adipose mesenchymal stem cell-derived exosomes attenuate lumbar facet joint osteoarthritis. Mol Med 2023; 29:120. [PMID: 37670256 PMCID: PMC10478461 DOI: 10.1186/s10020-023-00709-3] [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] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Lumbar facet joint osteoarthritis (LFJ OA) is a common disease, and there is still a lack of effective disease-modifying therapies. Our aim was to determine the therapeutic effect of hypoxia-treated adipose mesenchymal stem cell (ADSC)-derived exosomes (Hypo-ADSC-Exos) on the protective effect against LFJ OA. METHODS The protective effect of Hypo-ADSC-Exos against LFJ OA was examined in lumbar spinal instability (LSI)-induced LFJ OA models. Spinal pain behavioural assessments and CGRP (Calcitonin Gene-Related Peptide positive) immunofluorescence were evaluated. Cartilage degradation and subchondral bone remodelling were assessed by histological methods, immunohistochemistry, synchrotron radiation-Fourier transform infrared spectroscopy (SR-FTIR), and 3D X-ray microscope scanning. RESULTS Hypoxia enhanced the protective effect of ADSC-Exos on LFJ OA. Specifically, tail vein injection of Hypo-ADSC-Exos protected articular cartilage from degradation, as demonstrated by lower FJ OA scores of articular cartilage and less proteoglycan loss in lumbar facet joint (LFJ) cartilage than in the ADSC-Exo group, and these parameters were significantly improved compared to those in the PBS group. In addition, the levels and distribution of collagen and proteoglycan in LFJ cartilage were increased in the Hypo-ADSC-Exo group compared to the ADSC-Exo or PBS group by SR-FTIR. Furthermore, Hypo-ADSC-Exos normalized uncoupled bone remodelling and aberrant H-type vessel formation in subchondral bone and effectively reduced symptomatic spinal pain caused by LFJ OA in mice compared with those in the ADSC-Exo or PBS group. CONCLUSIONS Our results show that hypoxia is an effective method to improve the therapeutic effect of ADSC-Exos on ameliorating spinal pain and LFJ OA progression.
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Affiliation(s)
- Jinyun Zhao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yi Sun
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xiaolong Sheng
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jiaqi Xu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Guoyu Dai
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Rundong He
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yuxin Jin
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Zhide Liu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yong Xie
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Tianding Wu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yong Cao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China.
- Hunan Engineering Research Center of Sports and Health, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
| | - Jianzhong Hu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China.
- Hunan Engineering Research Center of Sports and Health, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
| | - Chunyue Duan
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China.
- Hunan Engineering Research Center of Sports and Health, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
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Moka E, Allam AES, Rekatsina M, Abed L, Paladini A, AlKharabsheh A, Vadalouca A, Varrassi G. Current Approaches to Four Challenging Pain Syndromes. Cureus 2023; 15:e45573. [PMID: 37868397 PMCID: PMC10586888 DOI: 10.7759/cureus.45573] [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: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
During a conference of pain specialists, some of the experts addressed the potential management of four prevalent but difficult painful conditions, namely, chronic postsurgical pain (CPSP), knee osteoarthritis, chest trauma, and facet joint arthropathy. In all cases, the conditions posed challenges in accurate diagnoses as well as safe, effective treatments, especially using locoregional blocks. It is not clear why some surgical patients develop CPSP and others do not, although some risk factors have been identified. More importantly, the transitional phase of pain from acute to chronic deserves greater scrutiny. It appears as if more aggressive and more effective perioperative and postoperative analgesia could help mitigate or possibly prevent CPSP. Knee osteoarthritis is prevalent but is often managed pharmacologically and then with joint replacement; many patients simply live with the condition which can be viewed as a disease of the entire joint. New approaches with intra-articular injections of hyaluronic acid, platelet-rich plasma, and botulinum toxin may provide safe, effective, and durable pain control. Chest trauma can be extremely painful and a source of morbidity, but its management tends to rely on watchful waiting and drug therapy. New approaches to regional nerve blocks can be beneficial and may reduce troublesome symptoms such as the inability to cough or clear the lungs. Facet joint arthropathy is very prevalent among older people but is not completely clarified. It may be the source of intense pain with limited management strategies. The role of nerve blocks in facet joint arthropathy is an important new addition to the armamentarium of pain management, particularly for geriatric patients.
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Affiliation(s)
- Eleni Moka
- Department of Anesthesiology, Creta InterClinic Hospital, Herakleion, GRC
| | - Abdallah El-Sayed Allam
- Morphological Madrid Research Center (MoMaRC), UltraDissection Spain EchoTraining School, Madrid, ESP
- Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals & Faculty of Medicine, Tanta University, Tanta, EGY
| | | | - Lynda Abed
- Anesthesia and Intensive Care, Djilali Bounaama Douera Hospital University, Algiers, DZA
| | - Antonella Paladini
- Department of Life, Health and Environmental Sciences (MESVA, University of L'Aquila, L'Aquila, ITA
| | - Abdullah AlKharabsheh
- King Abdullah University Hospital, Jordan University of Science and Technology, Amman, JOR
| | - Athina Vadalouca
- Pain and Palliative Care Center, Athens Medical Hospital, Athens, GRC
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Nikpasand M, Abbott RE, Kage CC, Singh S, Winkelstein BA, Barocas VH, Ellingson AM. Cervical facet capsular ligament mechanics: Estimations based on subject-specific anatomy and kinematics. JOR Spine 2023; 6:e1269. [PMID: 37780821 PMCID: PMC10540825 DOI: 10.1002/jsp2.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 10/03/2023] Open
Abstract
Background To understand the facet capsular ligament's (FCL) role in cervical spine mechanics, the interactions between the FCL and other spinal components must be examined. One approach is to develop a subject-specific finite element (FE) model of the lower cervical spine, simulating the motion segments and their components' behaviors under physiological loading conditions. This approach can be particularly attractive when a patient's anatomical and kinematic data are available. Methods We developed and demonstrated methodology to create 3D subject-specific models of the lower cervical spine, with a focus on facet capsular ligament biomechanics. Displacement-controlled boundary conditions were applied to the vertebrae using kinematics extracted from biplane videoradiography during planar head motions, including axial rotation, lateral bending, and flexion-extension. The FCL geometries were generated by fitting a surface over the estimated ligament-bone attachment regions. The fiber structure and material characteristics of the ligament tissue were extracted from available human cervical FCL data. The method was demonstrated by application to the cervical geometry and kinematics of a healthy 23-year-old female subject. Results FCL strain within the resulting subject-specific model were subsequently compared to models with generic: (1) geometry, (2) kinematics, and (3) material properties to assess the effect of model specificity. Asymmetry in both the kinematics and the anatomy led to asymmetry in strain fields, highlighting the importance of patient-specific models. We also found that the calculated strain field was largely independent of constitutive model and driven by vertebrae morphology and motion, but the stress field showed more constitutive-equation-dependence, as would be expected given the highly constrained motion of cervical FCLs. Conclusions The current study provides a methodology to create a subject-specific model of the cervical spine that can be used to investigate various clinical questions by coupling experimental kinematics with multiscale computational models.
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Affiliation(s)
- Maryam Nikpasand
- Department of Mechanical EngineeringUniversity of Minnesota—Twin CitiesMinneapolisMinnesotaUSA
| | - Rebecca E. Abbott
- Department of Rehabilitation MedicineUniversity of Minnesota—Twin CitiesMinneapolisMinnesotaUSA
| | - Craig C. Kage
- Department of Rehabilitation MedicineUniversity of Minnesota—Twin CitiesMinneapolisMinnesotaUSA
| | - Sagar Singh
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Beth A. Winkelstein
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Victor H. Barocas
- Department of Mechanical EngineeringUniversity of Minnesota—Twin CitiesMinneapolisMinnesotaUSA
- Department of Biomedical EngineeringUniversity of Minnesota—Twin CitiesMinneapolisMinnesotaUSA
| | - Arin M. Ellingson
- Department of Rehabilitation MedicineUniversity of Minnesota—Twin CitiesMinneapolisMinnesotaUSA
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Pang H, Chen S, Klyne DM, Harrich D, Ding W, Yang S, Han FY. Low back pain and osteoarthritis pain: a perspective of estrogen. Bone Res 2023; 11:42. [PMID: 37542028 PMCID: PMC10403578 DOI: 10.1038/s41413-023-00280-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 08/06/2023] Open
Abstract
Low back pain (LBP) is the world's leading cause of disability and is increasing in prevalence more rapidly than any other pain condition. Intervertebral disc (IVD) degeneration and facet joint osteoarthritis (FJOA) are two common causes of LBP, and both occur more frequently in elderly women than in other populations. Moreover, osteoarthritis (OA) and OA pain, regardless of the joint, are experienced by up to twice as many women as men, and this difference is amplified during menopause. Changes in estrogen may be an important contributor to these pain states. Receptors for estrogen have been found within IVD tissue and nearby joints, highlighting the potential roles of estrogen within and surrounding the IVDs and joints. In addition, estrogen supplementation has been shown to be effective at ameliorating IVD degeneration and OA progression, indicating its potential use as a therapeutic agent for people with LBP and OA pain. This review comprehensively examines the relationship between estrogen and these pain conditions by summarizing recent preclinical and clinical findings. The potential molecular mechanisms by which estrogen may relieve LBP associated with IVD degeneration and FJOA and OA pain are discussed.
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Affiliation(s)
- Huiwen Pang
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia
| | - Shihui Chen
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia
| | - David M Klyne
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia
| | - David Harrich
- Department of Cell and Molecular Biology, QIMR Berghofer Medical Research Institute, Herston, QLD, 4006, Australia
| | - Wenyuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Hebei Joint International Research Center for Spinal Diseases, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Sidong Yang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China.
- Hebei Joint International Research Center for Spinal Diseases, 139 Ziqiang Road, Shijiazhuang, 050051, China.
| | - Felicity Y Han
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia.
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Wang S, Aikeremu D, Kahaer A, Maimaiti A, Xiao Y, Tuoheti A, Zhang R, Maimaiti X, Guo H, Rexiti P. Anatomical and imaging measurements of the angle between the axis of the lumbar pedicle and lateral isthmus margin and its clinical significance. J Orthop Surg Res 2023; 18:509. [PMID: 37464385 DOI: 10.1186/s13018-023-03983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND This study aims to explore the measurement of the angle between the axis of the pedicle and the lateral margin of the isthmus on the lumbar spine, and investigate its clinical significance. METHODS The angle was measured on 120 normal adults' X-ray and 25 dry anatomical specimens. 60 screws were placed by junior residents on 6 wet specimens through the freehand technique. 30 screws were placed on one side with their original experience. After learning the techniques mentioned in the study, 30 screws were placed on the other side. The specimens were examined by X-ray and CT, and the angles of the screw paths and the integrity of the pedicle were evaluated. RESULTS The angles of 120 subjects and 25 anatomical specimens show a gradually increasing trend. The differences among each segment were statistically significant (P < 0.05), but the difference in the same segment between the X-ray and the anatomical specimens was not statistically significant (P > 0.05). Furthermore, the differences in L1, L2, and L3 between the two genders were not statistically significant (P > 0.05). However, the angles were larger in female group than in male group in L4 and L5, and the differences were statistically significant (P < 0.05). The difference in the deviation rate of screw placement before and after the learning was statistically significant only in the L5 segment (P < 0.05). The difference in overall excellence rate was statistically significant (P < 0.05). CONCLUSIONS The measurement of the angle between the axis of the pedicle and the lateral margin of the isthmus on the lumbar can improve the accuracy of the lumbar sagittal screw angle.
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Affiliation(s)
- Shuiquan Wang
- Department of Anatomy, College of Basic Medicine, Xinjiang Medical University, Urumqi, China
| | - Dilimulati Aikeremu
- Department of 2nd Spine Surgery, People's Hospital of Xinjiang, Urumqi, China
| | - Alafate Kahaer
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Xiao
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudusalamu Tuoheti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xieraili Maimaiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Paerhati Rexiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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Tanus AD, Nishio I, Williams R, Friedly J, Soares B, Anderson D, Bambara J, Dawson T, Hsu A, Kim PY, Krashin D, Piero LD, Korpak A, Timmons A, Suri P. Combining Procedural and Behavioral Treatments for Chronic Low Back Pain: A Pilot Feasibility Randomized Controlled Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.02.23290392. [PMID: 37333215 PMCID: PMC10274974 DOI: 10.1101/2023.06.02.23290392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Individual treatments for chronic low back pain (CLBP) have small magnitude effects. Combining different types of treatments may produce larger effects. This study used a 2×2 factorial randomized controlled trial (RCT) design to combine procedural and behavioral treatments for CLBP. The study aims were to: (1) assess feasibility of conducting a factorial RCT of these treatments; and (2) estimate individual and combined treatment effects of (a) lumbar radiofrequency ablation (LRFA) of the dorsal ramus medial branch nerves (vs. a simulated LRFA control procedure) and (b) Activity Tracker-Informed Video-Enabled Cognitive Behavioral Therapy program for CLBP (AcTIVE-CBT) (vs. an educational control treatment) on back-related disability at 3 months post-randomization. Participants (n=13) were randomized in a 1:1:1:1 ratio. Feasibility goals included an enrollment proportion ≥30%, a randomization proportion ≥80%, and a ≥80% proportion of randomized participants completing the 3-month Roland-Morris Disability Questionnaire (RMDQ) primary outcome endpoint. An intent-to-treat analysis was used. The enrollment proportion was 62%, the randomization proportion was 81%, and all randomized participants completed the primary outcome. Though not statistically significant, there was a beneficial, moderate-magnitude effect of LRFA vs. control on 3-month RMDQ (-3.25 RMDQ points; 95% CI: -10.18, 3.67). There was a significant, beneficial, large-magnitude effect of AcTIVECBT vs. control (-6.29, 95% CI: -10.97, -1.60). Though not statistically significant, there was a beneficial, large effect of LRFA+AcTIVE-CBT vs. control (-8.37; 95% CI: -21.47, 4.74). We conclude that it is feasible to conduct an RCT combining procedural and behavioral treatments for CLBP.
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Affiliation(s)
- Adrienne D. Tanus
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, USA
| | - Isuta Nishio
- Anesthesia and Pain Medicine Service Line, VA Puget Sound Health Care System, Seattle, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - Rhonda Williams
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, USA
| | - Janna Friedly
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, USA
| | - Bosco Soares
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, USA
| | - Derek Anderson
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, USA
| | - Jennifer Bambara
- Anesthesia and Pain Medicine Service Line, VA Puget Sound Health Care System, Seattle, USA
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, USA
| | - Timothy Dawson
- Anesthesia and Pain Medicine Service Line, VA Puget Sound Health Care System, Seattle, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - Amy Hsu
- Anesthesia and Pain Medicine Service Line, VA Puget Sound Health Care System, Seattle, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - Peggy Y. Kim
- Anesthesia and Pain Medicine Service Line, VA Puget Sound Health Care System, Seattle, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - Daniel Krashin
- Anesthesia and Pain Medicine Service Line, VA Puget Sound Health Care System, Seattle, USA
| | - Larissa Del Piero
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, USA
| | - Anna Korpak
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, USA
| | - Andrew Timmons
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, USA
| | - Pradeep Suri
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, USA
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, USA
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Jian S, Luo D, Wang Y, Xu W, Zhang H, Zhang L, Zhou X. MiR-337-3p confers protective effect on facet joint osteoarthritis by targeting SKP2 to inhibit DUSP1 ubiquitination and inactivate MAPK pathway. Cell Biol Toxicol 2023; 39:1099-1118. [PMID: 34697729 DOI: 10.1007/s10565-021-09665-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To probe the performance of miR-337-3p on the facet joint osteoarthritis (FJOA) and its underlying mechanism. METHODS qRT-PCR and Western blot were utilized to analyze the levels of miR-337-3p and DUSP1 in the synovial tissues from 36 FJOA patients and 10 healthy controls. The human synovial fibroblasts of FJOA were isolated and cultured followed by cell transfection. Then, cells were exposed to 10 ng/mL of IL-1β to induce inflammatory response of synovial fibroblasts. The alternation on cell biological function in cell models was determined. The binding of miR-337-3p and SKP2 was predicted by StarBase, TargetScan, DIANA-microT and miRmap, and further verified by RIP assay and dual-luciferase reporter assay. Co-IP experiment and ubiquitination assay were used to display the binding of SKP2 and DUSP1 as well as the ubiquitination and degradation of DUSP1. After that, the FJOA rat model was established and miR-337-3p mimic or negative control was given to rats by tail vein injection. The pathological changes of synovial tissues, synovitis score, and inflammation level in rats were assessed. RESULTS The low expressions of miR-337-3p and DUSP1 were noticed in the synovial tissues of FJOA patients and in IL-1β-induced synovial fibroblasts, and highly expressed p-p38 MAPK was noticed. Upregulation of miR-337-3p/DUSP1 or downregulation of SKP2 inhibited IL-1β-induced proliferation and inflammatory response of synovial fibroblasts. SKP2 was the target gene of miR-337-3p, and SKP2 induced the ubiquitination and degradation of DUSP1. MiR-337-3p exerted a protective effect on FJOA rats by alleviating damage of rat synovial tissues, promoting cell apoptosis and repressing inflammatory response. CONCLUSION MiR-337-3p plays a protective role in FJOA by negatively targeting SKP2 to suppress DUSP1 ubiquitination and inactivate the p38 MAPK pathway.
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Affiliation(s)
- Shengsheng Jian
- Department of Orthopedics, the Third Affiliated Hospital (the Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, Guangdong, 518001, People's Republic of China
| | - Dixin Luo
- The Spine Department, Orthopaedic Center, Guangdong Second Provincial General Hospital, No. 466, Mid Xingang Road, Haizhu District, Guangzhou, Guangdong, 510317, People's Republic of China
| | - Yeyang Wang
- The Spine Department, Orthopaedic Center, Guangdong Second Provincial General Hospital, No. 466, Mid Xingang Road, Haizhu District, Guangzhou, Guangdong, 510317, People's Republic of China
| | - Wangyang Xu
- The Spine Department, Orthopaedic Center, Guangdong Second Provincial General Hospital, No. 466, Mid Xingang Road, Haizhu District, Guangzhou, Guangdong, 510317, People's Republic of China
| | - Hui Zhang
- The Spine Department, Orthopaedic Center, Guangdong Second Provincial General Hospital, No. 466, Mid Xingang Road, Haizhu District, Guangzhou, Guangdong, 510317, People's Republic of China
| | - Li Zhang
- The Spine Department, Orthopaedic Center, Guangdong Second Provincial General Hospital, No. 466, Mid Xingang Road, Haizhu District, Guangzhou, Guangdong, 510317, People's Republic of China
| | - Xiaozhong Zhou
- The Spine Department, Orthopaedic Center, Guangdong Second Provincial General Hospital, No. 466, Mid Xingang Road, Haizhu District, Guangzhou, Guangdong, 510317, People's Republic of China.
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Zhang R, Kahaer A, Niu H, Wang J, Jumahan A, Qiu Y, Guo H, Rexiti P. Biomechanical evaluation of the hybrid pedicle screw-cortical bone trajectory technique in transforaminal lumbar interbody fusion to adjacent segment degeneration-finite element analysis. BMC Musculoskelet Disord 2023; 24:409. [PMID: 37221546 DOI: 10.1186/s12891-023-06411-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/07/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Transforaminal lumbar interbody fusion is an effective surgical treatment of intervertebral disk herniation. However, its clinical efficacy for adjacent segment disk degeneration (ASDD) after hybrid bilateral pedicle screw - bilateral cortical screw (pedicle screw at L4 and cortical bone trajectory screw at L5) and hybrid bilateral cortical screw - bilateral pedicle screw (bilateral cortical screw at L4 and bilateral pedicle screw at L5) remains undiscovered. Therefore, the aim of this study is to evaluate the effect of the hybrid bilateral pedicle screw - bilateral cortical screw and hybrid bilateral cortical screw - bilateral pedicle screw on the adjacent segment via a 3-dimensional (3D) finite element (FE) analysis. METHODS Four human cadaveric lumbar spine specimens were provided by the anatomy teaching and research department of Xinjiang Medical University. Four finite element models of L1-S1 lumbar spine segment were generated. For each of these, four lumbar transforaminal lumbar interbody fusion models at L4-L5 segment with the following instruments were created: hybrid bilateral pedicle screw - bilateral cortical screw, bilateral cortical screw - bilateral cortical screw (bilateral cortical screw at both L4 and L5 segments), bilateral pedicle screw - bilateral pedicle screw (bilateral pedicle screw at both L4 and L5 segments), and hybrid bilateral cortical screw - bilateral pedicle screw. A 400-N compressive load with 7.5 Nm moments was applied for the simulation of flexion, extension, lateral bending, and rotation. The range of motion of L3-L4 and L5-S1 segments and von Mises stress of the intervertebral disc at the adjacent segment were compared. RESULTS Hybrid bilateral pedicle screw - bilateral cortical screw has the lowest range of motion at L3-L4 segment in flexion, extension, and lateral bending, and the highest disc stress in all motions, while the range of motion at L5-S1 segment and disc stress was lower than bilateral pedicle screw - bilateral pedicle screw in flexion, extension, and lateral bending, and higher than bilateral cortical screw - bilateral cortical screw in all motions. The range of motion of hybrid bilateral cortical screw - bilateral pedicle screw at L3-L4 segment was lower than bilateral pedicle screw - bilateral pedicle screw and higher than bilateral cortical screw - bilateral cortical screw in flexion, extension, and lateral bending, and the range of motion at L5-S1 segment was higher than bilateral pedicle screw - bilateral pedicle screw in flexion, lateral bending, and axial rotation. The disc stress at L3-L4 segment was lowest and more dispersed in all motions, and the disc stress at L5-S1 segment was higher than bilateral pedicle screw - bilateral pedicle screw in lateral bending and axial rotation, but more dispersed. CONCLUSION Hybrid bilateral cortical screw - bilateral pedicle screw decreases the impact on adjacent segments after spinal fusion, reduces the iatrogenic injury to the paravertebral tissues, and provides throughout decompression of the lateral recess.
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Affiliation(s)
- Rui Zhang
- Second Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, China
| | - Hanqian Niu
- Fifth Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Jingwen Wang
- Second Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Ayididaer Jumahan
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Yanning Qiu
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, China.
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, China.
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Sun T, Wang J, Suo M, Liu X, Huang H, Zhang J, Zhang W, Li Z. The Digital Twin: A Potential Solution for the Personalized Diagnosis and Treatment of Musculoskeletal System Diseases. Bioengineering (Basel) 2023; 10:627. [PMID: 37370558 DOI: 10.3390/bioengineering10060627] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023] Open
Abstract
Due to the high prevalence and rates of disability associated with musculoskeletal system diseases, more thorough research into diagnosis, pathogenesis, and treatments is required. One of the key contributors to the emergence of diseases of the musculoskeletal system is thought to be changes in the biomechanics of the human musculoskeletal system. However, there are some defects concerning personal analysis or dynamic responses in current biomechanical research methodologies. Digital twin (DT) was initially an engineering concept that reflected the mirror image of a physical entity. With the application of medical image analysis and artificial intelligence (AI), it entered our lives and showed its potential to be further applied in the medical field. Consequently, we believe that DT can take a step towards personalized healthcare by guiding the design of industrial personalized healthcare systems. In this perspective article, we discuss the limitations of traditional biomechanical methods and the initial exploration of DT in musculoskeletal system diseases. We provide a new opinion that DT could be an effective solution for musculoskeletal system diseases in the future, which will help us analyze the real-time biomechanical properties of the musculoskeletal system and achieve personalized medicine.
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Affiliation(s)
- Tianze Sun
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Moran Suo
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Wentao Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
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Wong MJ, Rajarathinam M. Ultrasound-guided axial facet joint interventions for chronic spinal pain: A narrative review. Can J Pain 2023; 7:2193617. [PMID: 37214187 PMCID: PMC10193888 DOI: 10.1080/24740527.2023.2193617] [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: 11/27/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 05/24/2023]
Abstract
Background Axial facet joint interventions (e.g., medial branch block and radiofrequency ablation, facet joint intra-articular injection) are commonly performed for managing chronic spinal pain. Although traditionally performed with fluoroscopy or computed tomography (CT) guidance, ultrasound-guided techniques have also been developed for these interventions. Aims The aim of this study is to present contemporary ultrasound-guided techniques for facet joint interventions and synthesize data addressing their accuracy, safety, and efficacy. Methods The PubMed, MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials databases were systematically searched for studies of ultrasound-guided facet joint interventions with human subjects from November 1, 1992, to November 1, 2022. Additional sources were drawn from reference lists and citations of relevant studies. Results We found 48 studies assessing ultrasound-guided facet joint interventions. Ultrasound guidance for injection of the cervical facet joints and their innervating nerves had favorable accuracy (78%-100%), with lower procedural time compared to fluoroscopy or CT guidance and comparable pain relief. Accuracy with ultrasound-guided lumbar facet joint intra-articular injection (86%-100%) was more reliable than medial branch block (72%-97%); analgesia was comparable to fluoroscopy and CT guidance. In general, these procedures were more challenging for patients with obesity, and deeper structures were more difficult to accurately target (e.g., lower cervical levels, L5 dorsal ramus). Conclusions Ultrasound-guided facet joint interventions continue to evolve. Some technically challenging interventions may be impractical for widespread usage or require further technical refinement. The utility of ultrasound guidance with obesity and abnormal anatomy may be reduced.
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Affiliation(s)
- Michael J. Wong
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Manikandan Rajarathinam
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Wang Y, Zhang P, Yan X, Wang J, Zhu M, Teng H. The correlation between lumbar interlaminar space size on plain radiograph and spinal stenosis. 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 2023; 32:1721-1728. [PMID: 36941496 DOI: 10.1007/s00586-023-07646-z] [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: 11/08/2022] [Revised: 02/04/2023] [Accepted: 03/06/2023] [Indexed: 03/22/2023]
Abstract
PURPOSE Investigating the correlation between the interlaminar space size on plain radiograph and lumbar spinal stenosis (LSS). METHODS 100 Patients with LSS and 100 normal participants without LSS were included in this study. Lumbar interlaminar parameters were measured on plain radiographs. Spinal canal parameters were measure on CT and MRI. These image parameters were compared between LSS and control group. The linear correlation among interlaminar parameters, spinal canal parameters and Oswestry Disability Index (ODI) were analyzed. The cut-off values of interlaminar parameters for diagnosing L3/4 and L4/5 symptomatic LSS were analyzed. RESULTS Excepting for L1/2 interlaminar width, all interlaminar and spinal canal related parameters in LSS group were significantly smaller than those in control group. Excepting for L1/2 interlaminar width and L5/S1 interlaminar height, all interlaminar parameters had significantly positive linear correlation with spinal canal parameters accordingly in each lumbar level. For diagnosis of symptomatic LSS, The cut off values of L4/5 interlaminar width, height and area were 18.46 mm, 11.37 mm and 134.05 mm2 while 15.78 mm, 13.59 mm and 157.98 mm2 in L3/4. Both spinal canal size and interlaminar size had no linear correlation with ODI in cases of L4/5 LSS. CONCLUSIONS Lumbar interlaminar space size on plain radiograph has positive linear correlation with developmental and degenerative LSS, excepting for L1/2 interlaminar width and L5/S1 interlaminar height. Lumbar plain radiograph can be a feasible way for predicting and helping to diagnose LSS through evaluating the interlaminar space size. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yu Wang
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.
| | - Peng Zhang
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Xin Yan
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Jing Wang
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Minyu Zhu
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Honglin Teng
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.
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Duarte FCK, Chien R, Ghazinour G, Murnaghan K, West DWD, Kumbhare DA. Myofascial Pain as an Unseen Comorbidity in Osteoarthritis: A Scoping Review. Clin J Pain 2023; 39:188-201. [PMID: 36943163 DOI: 10.1097/ajp.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/25/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This review aimed to identify, summarize, and appraise the evidence supporting the coexistence of myofascial pain (MPS) and trigger points (MTrP) in osteoarthritis (OA), and the effectiveness of MTrPs treatments in OA-related pain and physical function outcomes. METHODS Three databases were searched from inception to June 2022. We included observational and experimental studies to fulfill our 2 study aims. Two independent reviewers conducted 2-phase screening procedures and risk of bias using checklist tools for cross-sectional, quasi-experimental, and randomized control trials. Patient characteristics, findings of active and latent MTrPs in relevant muscles, treatments, and pain and physical function outcomes were extracted from low-risk bias studies. RESULTS The literature search yielded 2898 articles, of which 6 observational and 7 experimental studies had a low bias risk and the data extracted. Active MTrPs in knee OA patients was more evident in the quadriceps and hamstring muscles than in healthy individuals. Dry needling on active MTrPs improved pain and physical function in the short term compared with sham treatment in hip OA patients. In knee OA, dry needling on latent or active MTrPs improved pain and functional outcomes compared with sham needling but did not result in better pain and physical outcomes when combined with a physical exercise program. DISCUSSION The presence of active versus latent MTrPs seems to be a more sensitive discriminating feature of OA given that latent is often present in OA and healthy individuals. Dry needling on active MTrPs improved pain and physical function in the short term compared with sham treatment in hip OA patients. However, the small sample size and the few number of studies limit any firm recommendation on the treatment. REGISTRY The study protocol was prospectively registered in Open Science Framework (https://doi.org/10.17605/OSF.IO/8DVU3).
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Affiliation(s)
- Felipe C K Duarte
- Canadian Memorial Chiropractic College
- KITE Research, Toronto Rehabilitation Institute, University Health Network
- Discipline of Chiropractic, School of Health, Medical and Applied Sciences, CQUniversity, Brisbane, Australia
| | | | - Golnaz Ghazinour
- Faculty of Kinesiology and Physical Education, University of Toronto
| | | | - Daniel W D West
- Faculty of Kinesiology and Physical Education, University of Toronto
- Discipline of Chiropractic, School of Health, Medical and Applied Sciences, CQUniversity, Brisbane, Australia
| | - Dinesh A Kumbhare
- Faculty of Kinesiology and Physical Education, University of Toronto
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Discipline of Chiropractic, School of Health, Medical and Applied Sciences, CQUniversity, Brisbane, Australia
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Chen Z, Lei F, Ye F, Yuan H, Li S, Feng D. MRI-based vertebral bone quality score for the assessment of osteoporosis in patients undergoing surgery for lumbar degenerative diseases. J Orthop Surg Res 2023; 18:257. [PMID: 36991471 DOI: 10.1186/s13018-023-03746-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE To explore the value of vertebral bone quality (VBQ) scores in diagnosing osteoporosis in patients with lumbar degeneration. METHODS A retrospective analysis was conducted of 235 patients treated with lumbar fusion surgery at the age of ≥ 50; they were divided into a degenerative group and a control group according to the severity of degenerative changes on three-dimensional computed tomography. The L1-4 vertebral body and L3 cerebrospinal fluid signal intensities in the T1-weighted lumbar magnetic resonance imaging (MRI) image were recorded, and the VBQ score was calculated. Demographics, clinical data, and dual-energy X-ray absorptiometry (DXA) indicators were recorded, and the VBQ value was compared with bone density and T-score using the Pearson correlation coefficient. The VBQ threshold was obtained according to the control group and compared with the efficacy of osteoporosis diagnosis based on DXA. RESULTS A total of 235 patients were included in the study, and the age of the degenerative group was older than that of the control group (61.8 vs. 59.4, P = 0.026). The VBQ score of the control group suggested a higher correlation with the bone mineral density (BMD) value and T-score (r = - 0.611 and - 0.62, respectively). The BMD value and T-score in the degenerative group were higher than those in the control group (P < 0.05). Receiver-operating characteristic curve analysis showed that the VBQ score had a good predictive ability for osteoporosis (AUC = 0.818), with a sensitivity of 93% and a specificity of 65.4%. Among the undiagnosed osteoporosis patients with T-score, the VBQ score after adjusting the threshold was higher in the degenerative group (46.9% vs. 30.8%). CONCLUSIONS Emerging VBQ scores can reduce the interference caused by degenerative changes compared to traditional DXA measures. Screening for osteoporosis in patients undergoing lumbar spine surgery provides new ideas.
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Affiliation(s)
- Zan Chen
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Fei Lei
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Fei Ye
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Hao Yuan
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Songke Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Daxiong Feng
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.
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Giglio M, Farì G, Preziosa A, Corriero A, Grasso S, Varrassi G, Puntillo F. Low Back Pain and Radiofrequency Denervation of Facet Joint: Beyond Pain Control-A Video Recording. Pain Ther 2023; 12:879-884. [PMID: 36928501 PMCID: PMC10199989 DOI: 10.1007/s40122-023-00489-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
Chronic low back pain is often due to L5S1 instability resulting in facet joint syndrome. Patients suffering from low back pain may also have a gait pattern characterized by a reduced speed and a shorter, asymmetrical step in order to reduce pain. This case is of a patient with L5S1 instability that occurred after L1 to L5 lumbar stabilization who was treated with radiofrequency (RF) denervation of the medial branch of L5S1 bilaterally. RF ablation outcome was tested by comparing its impact on pain, function, quality of life, and on gait pattern, before and 1 month after the procedure. To objectify the impact of a good pain control on gait, a video recording was performed (see Video 1).
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Affiliation(s)
- Mariateresa Giglio
- Anaesthesia, Intensive Care and Pain Unit, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Giacomo Farì
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121, Bari, Italy
| | - Angela Preziosa
- Anaesthesia and Intensive Care Unit, Policlinico Hospital, Bari, Italy
| | - Alberto Corriero
- Anaesthesia, Intensive Care and Pain Unit, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Salvatore Grasso
- Department of Precision and Regeneration Medicine and Jonian Area, University of Bari "Aldo Moro", Bari, Italy
| | | | - Filomena Puntillo
- Anaesthesia, Intensive Care and Pain Unit, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
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Differentiating Lumbar Spinal Etiology from Peripheral Plexopathies. Biomedicines 2023; 11:biomedicines11030756. [PMID: 36979737 PMCID: PMC10044821 DOI: 10.3390/biomedicines11030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Clinicians have managed and treated lower back pain since the earliest days of practice. Historically, lower back pain and its accompanying symptoms of radiating leg pain and muscle weakness have been recognized to be due to any of the various lumbar spine pathologies that lead to the compression of the lumbar nerves at the root, the most common of which is the radiculopathy known as sciatica. More recently, however, with the increased rise in chronic diseases, the importance of differentially diagnosing a similarly presenting pathology, known as lumbosacral plexopathy, cannot be understated. Given the similar clinical presentation of lumbar spine pathologies and lumbosacral plexopathies, it can be difficult to differentiate these two diagnoses in the clinical setting. Resultingly, the inappropriate diagnosis of either pathology can result in ineffective clinical management. Thus, this review aims to aid in the clinical differentiation between lumbar spine pathology and lumbosacral plexopathy. Specifically, this paper delves into spine and plexus anatomy, delineates the clinical assessment of both pathologies, and highlights powerful diagnostic tools in the hopes of bolstering appropriate diagnosis and treatment. Lastly, this review will describe emerging treatment options for both pathologies in the preclinical and clinical realms, with a special emphasis on regenerative nerve therapies.
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49
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Fine N, Lively S, Séguin CA, Perruccio AV, Kapoor M, Rampersaud R. Intervertebral disc degeneration and osteoarthritis: a common molecular disease spectrum. Nat Rev Rheumatol 2023; 19:136-152. [PMID: 36702892 DOI: 10.1038/s41584-022-00888-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/27/2023]
Abstract
Intervertebral disc degeneration (IDD) and osteoarthritis (OA) affecting the facet joint of the spine are biomechanically interdependent, typically occur in tandem, and have considerable epidemiological and pathophysiological overlap. Historically, the distinctions between these degenerative diseases have been emphasized. Therefore, research in the two fields often occurs independently without adequate consideration of the co-dependence of the two sites, which reside within the same functional spinal unit. Emerging evidence from animal models of spine degeneration highlight the interdependence of IDD and facet joint OA, warranting a review of the parallels between these two degenerative phenomena for the benefit of both clinicians and research scientists. This Review discusses the pathophysiological aspects of IDD and OA, with an emphasis on tissue, cellular and molecular pathways of degeneration. Although the intervertebral disc and synovial facet joint are biologically distinct structures that are amenable to reductive scientific consideration, substantial overlap exists between the molecular pathways and processes of degeneration (including cartilage destruction, extracellular matrix degeneration and osteophyte formation) that occur at these sites. Thus, researchers, clinicians, advocates and policy-makers should consider viewing the burden and management of spinal degeneration holistically as part of the OA disease continuum.
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Affiliation(s)
- Noah Fine
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Starlee Lively
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Cheryle Ann Séguin
- Department of Physiology & Pharmacology, Schulich School of Medicine & Dentistry, Bone and Joint Institute, University of Western Ontario London, London, Ontario, Canada
| | - Anthony V Perruccio
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohit Kapoor
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Raja Rampersaud
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada. .,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. .,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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50
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Gupta S, Xiao R, Fainor M, Mauck RL, Smith HE, Gullbrand SE. Level dependent alterations in human facet cartilage mechanics and bone morphometry with spine degeneration. J Orthop Res 2023; 41:674-683. [PMID: 35770853 PMCID: PMC9800647 DOI: 10.1002/jor.25407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/10/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023]
Abstract
The zygapophyseal joints of the spine, also known as the facet joints, are paired diarthrodial joints posterior to the intervertebral disc and neural elements. The pathophysiology of facet osteoarthritis (OA), as well as crosstalk between the disc and facets, remains largely understudied compared to disc degeneration. The purpose of this study was to characterize alterations to human facet cartilage and subchondral bone across a spectrum of degeneration and to investigate correlations between disc and facet degeneration. Human lumbar facet articular surfaces from six independent donors were subject to creep indentation mechanical testing to quantify cartilage mechanical properties, followed by microcomputed tomography (µCT) analyses for subchondral bone morphometry. The degenerative state of each articular surface was assessed via macroscopic scoring and via Osteoarthritis Research Society International histopathology scoring. Our data suggest reduced facet cartilage compressive and tensile moduli and increased permeability with increasing degenerative grade, particularly at the lower levels of the spine. µCT analyses revealed spinal level-dependent alterations to the subchondral bone, with an increase in trabecular bone at the L4-L5 level, but a decrease at the upper levels of the lumbar spine with increasing degenerative grade. Cortical bone volume fraction was generally decreased with increasing degenerative grade across spinal levels. Correlation analysis revealed several associations between quantitative measures of disc degeneration and facet OA. This study showed that alterations in the mechanical properties of facet cartilage and in the structural properties of facet subchondral bone correlated with aspects of disc degeneration and were highly dependent on spinal level.
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Affiliation(s)
- Sachin Gupta
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rui Xiao
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthew Fainor
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert L. Mauck
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - Harvey E. Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sarah E. Gullbrand
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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