Degenerative inter-vertebral disc disease osteochondrosis intervertebralis in Europe: prevalence, geographic variation and radiological correlates in men and women aged 50 and over

The correlation between osteoporotic vertebrae fracture risk and bone mineral density measured by quantitative computed tomography and dual energy X-ray absorptiometry: a systematic review and meta-analysis

This paper presents a comparison of quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in osteoporosis with vertebral fracture and osteoporosis without fracture. It has been proved that the volumetric bone mineral density (vBMD) measured by QCT exhibits a stronger correlation with fracture risk than areal bone mineral density (aBMD) measured by DXA.

PURPOSE

This study aims to systematically evaluate the ability of QCT and DXA to distinguish between osteoporosis with vertebral fracture and osteoporosis without fracture according to vBMD and aBMD.

METHODS

We conducted a primary literature search of the online databases up to 3 July, 2022, in both English and Chinese publications, combining synonyms for "QCT", "DXA" and "osteoporosis". The Newcastle-Ottawa scale (NOS) was employed to evaluate the quality of the selected articles. vBMD obtained through QCT and aBMD obtained through DXA were extracted, and were analyzed by Review Manager 5.4 and RStudio.

RESULTS

Six studies with 610 individuals aged 45 to 90, of which 179 had vertebral fractures, were included in the final analysis. The weighted mean difference (WMD) between osteoporosis with vertebral fracture and osteoporosis without fracture for vBMD was - 27.08 (95% CI  - 31.24 to  - 22.92), while for aBMD was - 0.05 (95% CI - 0.08 to - 0.03).

CONCLUSIONS

Both vBMD detected by QCT and aBMD detected by DXA could discriminate fracture status in the spine, and vBMD performed a stronger correlation with fracture risk.

TRIAL REGISTRATION

PROSPERO 2022 CRD42022349185.

Kartogenin-enhanced dynamic hydrogel ameliorates intervertebral disc degeneration via restoration of local redox homeostasis

INTRODUCTION

Over-activation of oxidative stress due to impaired antioxidant functions in nucleus pulpous (NP) has been identified as a key factor contributing to intervertebral disc degeneration (IVDD). While Kartogenin (KGN) has previously demonstrated antioxidant properties on articular cartilage against osteoarthritis, its effects on NP degeneration have yet to be fully understood.

OBJECTIVES

This study aimed to investigate the protective effects of KGN on nucleus pulpous cells (NPCs) against an inflammatory environment induced by interleukin (IL)-1β, as well as to explore the therapeutic potential of KGN-enhanced dynamic hydrogel in preventing IVDD.

METHODS

NPCs were isolated from rat caudal IVDs and subjected to treatment with KGN at varying concentrations (ranging from 0.01 to 1 ​μM) in the presence of IL-1β. The expression of extracellular matrix (ECM) anabolism markers was quantitatively assessed at both the mRNA and protein levels. Additionally, intracellular reactive oxygen species and antioxidant enzyme expression were evaluated, along with the role of nuclear factor erythroid 2-related factor 2 (NRF2). Based on these findings, a dynamic self-healing hydrogel loaded with KGN was developed through interconnecting networks. Subsequently, KGN-enhanced dynamic hydrogel was administered into rat caudal IVDs that had undergone puncture injury, followed by radiographic analysis and immunohistochemical staining to evaluate the therapeutic efficacy.

RESULTS

In vitro treatments utilizing KGN were observed to maintain ECM synthesis and inhibit catabolic activities in IL-1β-stimulated NPCs. The mechanism behind this protective effect of KGN on NPCs was found to involve the asctivation of NRF2 and downstream antioxidant enzymes, including glutathione peroxidase 1 and heme oxygenase 1. This was further supported by the loss of both antioxidant and anabolic effects upon pharmacological inhibition of NRF2. Furthermore, a self-healing hydrogel was developed and loaded with KGN to achieve localized and sustained release of the compound. The injection of KGN-enhanced hydrogel effectively ameliorated the degradation of NP ECM and mitigated inflammation in a rat model of puncture-induced IVDD.

CONCLUSIONS

Our results indicate that KGN exhibits potential as a therapeutic agent for NP degeneration, and that KGN-enhanced dynamic hydrogel represents a novel approach for treating IVDD by restoring redox homeostasis in NP.The translational potential of this article: The dysregulation of oxidant and antioxidant balance has been shown to impede the repair and regeneration of NP, thereby hastening the progression of IVDD following injury. The present investigation has demonstrated that the sustained release of KGN promotes the synthesis of ECM in vitro and mitigates the progression of IVDD in vivo by restoring redox equilibrium, thereby presenting a novel therapeutic candidate based on the antioxidant properties of KGN for the treatment of IVDD.

Hip replacement improves lumbar flexibility and intervertebral disc height - a prospective observational investigation with standing and sitting assessment of patients undergoing total hip arthroplasty

PURPOSE

The pathogenic mechanism of the hip-spine syndrome is still poorly elucidated. Some studies have reported a reduction in low back pain after total hip arthroplasty (THA). However, the biomechanical mechanisms of THA acting on the lumbar spine are not well understood. The aim of the study is to evaluate the influence of THA on (1) the lumbar lordosis and the lumbar flexibility and (2) the lumbar intervertebral disc height.

METHODS

A total of 197 primary THA patients were prospectively enrolled. Pre- and post-operative biplanar stereoradiography was performed in standing and sitting positions. Spinopelvic parameters (lumbar lordosis (LL), pelvic tilt, sacral slope, pelvic incidence), sagittal spinal alignment (sagittal vertical axis, PI-LL mismatch (PI-LL)) and lumbar disc height index (DHI) for each segment (L1/2 to L5/S1) were evaluated. The difference between standing and sitting LL (∆LL = LL_standing - LL_sitting) was determined as lumbar flexibility. Osteochondrosis intervertebralis was graded according to Kellgren and Lawrence (0-4), and patients were assigned to subgroups (mild: 0-2; severe: 3-4).

RESULTS

Lumbar flexibility increased significantly after THA (pre: 22.04 ± 12.26°; post: 25.87 ± 12.26°; p < 0.001), due to significant alterations in LL in standing (pre: 51.3 ± 14.3°; post: 52.4 ± 13.8°; p < 0.001) and sitting (pre: 29.4 ± 15.4°; post: 26.7 ± 15.4°; p = 0.01). ∆LL increased significantly in both subgroups stratified by osteochondrosis (pre/post: ΔLL_mild: 25.4 (± 11.8)/29.4 ± 12.0°; p < 0.001; ΔLL_severe: 17.5 (± 11.4)/21.0 ± 10.9°; p = 0.003). The DHI increased significantly from pre-operatively to post-operatively in each lumbar segment. PI-LL mismatch decreased significantly after THA (pre: 3.5°; post: 1.4°; p < 0.001).

CONCLUSION

The impact of THA on the spinopelvic complex was demonstrated by significantly improved lumbar flexibility and a gain in post-operative disc height. These results illustrate the close interaction between the pelvis and the vertebral column. The investigation provides new insights into the biomechanical patterns influencing the hip-spine syndrome.

Physical Therapy of Elderly People with Lumbosacral Steochondrosis in the Conditions of Sanatorium-resort Institution

Aim: To improve the process of physical therapy of elderly people with lumbosacral osteochondrosis in the conditions of health complex of the sanatorium-resort establishment. Materials and Methods: The study was conducted on the basis of the health complex of the sanatorium-resort institution “Hopry” in Hola Prystan, Kherson region, Ukraine. The study involved 40 patients aged from 61-74 years with lumbosacral osteochondrosis. To implement the tasks, patients were divided into two groups: core and control. Results: As a result of our study, we obtained the following data: all patients in the control and main groups described the dynamics of their general condition as positive. This was manifested by the fact that after the proposed program of physical therapy in a sanatorium, patients had reduced pain, increased range of motion in the intervertebral joints, improved mobility of the patient’s spine, thereby increased motor abilities of patients, which gave a significant stimulating response. improving their psycho-emotional state. Conclusions: The developed set of physiotherapeutic measures in the sanatorium significantly promotes the development of motor skills and maintains the optimal level of functional capabilities of the elderly with osteochondrosis, increases their physical activity and significantly reduces pain by 80%. The efficiency of rehabilitation of elderly people with red and lumbar osteochondrosis has also increased by 30% in all indicators, under the influence of the traditional complex – by 21%. This gives grounds to recommend the proposed complex for practical use in the system of physical therapy of elderly people with lumbosacral spine in sanatoriums.

Alteration of Relative Rates of Biodegradation and Regeneration of Cervical Spine Cartilage through the Restoration of Arterial Blood Flow Access to Rhomboid Fossa: A Hypothesis

We found the logical way to prove the existence of the mechanism that maintains the rates of biodegradation and regeneration of cervical spine cartilage. We demonstrate, that after we restore access to arterial blood flow through cervical vertebral arteries to rhomboid fossa it causes the prevalence of regeneration over biodegradation. This is in the frames of consideration of the human body as a dissipative structure. Then the recovery of the body should be considered as a reduction of the relative rates of decay below the regeneration ones. Then the recovery of cervical spine cartilage through redirecting of inner dissipative flow depends on the information about oxygen availability that is provided from oxygen detectors in the rhomboid fossa to the cerebellum. Our proposed approach explains already collected data, which satisfies all the scientific requirements. This allows us to draw conclusions that permit reconsidering the way of dealing with multiple chronic diseases.

Effect of Robot-Assisted Surgery on Lumbar Pedicle Screw Internal Fixation in Patients with Osteoporosis

OBJECTIVE

We sought to compare clinical outcomes of robot-assisted versus conventional freehand fluoroscopy-assisted lumbar pedicle screw insertion in patients with osteoporosis.

METHODS

This study included 80 patients with osteoporosis and lumbar disease treated with pedicle screw internal fixation in the Department of Spine Surgery, Beijing Jishuitan Hospital between June 2016 and July 2018. Patients were randomly assigned to receive either robot-assisted pedicle screw insertion (experimental group) or freehand fluoroscopy-assisted pedicle screw insertion (control group). The accuracy of screw placement was assessed with postoperative computed tomography. Operative time, pedicle screw placement time, radiation exposure to the medical team, and intraoperative blood loss were recorded.

RESULTS

A total of 427 pedicle screws were inserted in 80 patients; 202 pedicle screws were placed in the experimental group, and 225 pedicle screws were placed in the control group. The accuracy of screw placement was significantly higher with robot-assisted pedicle screw insertion (98.5% [199/202]) compared with that achieved with the freehand technique (91.6% [206/225]) (P < 0.05). Robot-assisted pedicle screw insertion was associated with reductions in the mean total pedicle screw placement time (27.60 ± 8.58 vs. 32.26 ± 10.48 minutes), radiation exposure to the medical team (2.23 ± 0.62 vs. 3.35 ± 0.80 fluoroscopic images), and intraoperative blood loss (254.75 ± 115.34 vs. 356.25 ± 141.00 mL; P < 0.05). The mean operative time did not differ significantly between the groups.

CONCLUSIONS

Robot-assisted pedicle screw insertion is a more effective surgical option for patients with osteoporosis who present with various spine diseases compared with fluoroscopy-assisted freehand screw placement techniques.

Moderate Fluid Shear Stress Could Regulate the Cytoskeleton of Nucleus Pulposus and Surrounding Inflammatory Mediators by Activating the FAK-MEK5-ERK5-cFos-AP1 Signaling Pathway

We first applied moderate fluid shear stress to nucleus pulposus cells. The correlation of AP-1 with type II collagen, proteoglycan, Cytokeratin 8 protein, MAP-1, MAP-2, and MAP-4 and the correlation of AP-1 with IL-1β, TNF-α, IL-6, IL-8, MIP-1, MCP-1, and NO were detected. Our results document that moderate fluid shear stress could activate the FAK-MEK5-ERK5-cFos-AP1 signaling pathway. AP1 could downregulate the construct factors of cytoskeleton such as type II collagen, proteoglycan, Cytokeratin 8 protein, MAP-1, MAP-2, and MAP-4 in nucleus pulposus cell after the fluid shear stress was loaded. AP1 could upregulate the inflammatory factors such as IL-1β, TNF-α, IL-6, IL-8, MIP-1, MCP-1, and NO in nucleus pulposus cell after the fluid shear stress was loaded. Taken together, our data suggested that moderate fluid shear stress may play an important role in the cytoskeleton of nucleus pulposus and surrounding inflammatory mediators by activating the FAK-MEK5-ERK5-cFos-AP1 signaling pathway, thereby affecting cell degeneration.