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Deguchi T, Hashizume H, Terao C, Nakajima M, Teraguchi M, Yamada H, Tanaka S, Yoshimura N, Yoshida M, Ikegawa S. A longitudinal population-based study identifies THBS2 as a susceptibility gene for intervertebral disc degeneration. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08152-6. [PMID: 38918228 DOI: 10.1007/s00586-024-08152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Intervertebral disc degeneration (IDD) is a common degenerative disease associated with ageing. Additionally, IDD is recognized as one of the leading causes of low back pain and disability in the working-age population and is the first step in the process leading to degenerative spinal changes. However, the genetic factors and regulatory mechanisms of IDD remain unknown. Therefore, we selected eight single nucleotide polymorphisms of genes to reveal the progression of IDD in a 7-year longitudinal study of the general population in Japan. METHODS IDD was evaluated in the Wakayama Spine Study (WSS), which is a population-based cohort study. Overall, 574 participants from the general population cohort who underwent whole spine magnetic resonance imaging and provided clinical information were included in this longitudinal survey. RESULTS The progression of IDD was affected only by THBS2 at the lumbar region, T12-L1 (p = 0.0044) and L3-4 (p = 0.0045). The significant interaction between THBS2 and age with IDD negatively affected the thoracic spines and passively influenced both the thoracolumbar junction and thoracic spines. The higher progression per year of Pfirrmann's score was rapid in young people with age; however, this decelerated the IDD progression per year in different ages. CONCLUSION Our longitudinal study found the genes associated with IDD progression and that genetic factors' impact on IDD differs depending on disc level and age.
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Affiliation(s)
- Tsuyoshi Deguchi
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, 1-1 Yamadaoka, Suita-City, Japan
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan.
- School of Health and Nursing Science, Wakayama Medical University, 590 Mikazura, Wakayama City, Wakayama, 641-0011, Japan.
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, RIKEN, Suehiro-cho 1-7-22, Tsurumi-ku, Yokohama City, Japan
| | - Masahiro Nakajima
- Laboratory of Bone and Joint Diseases, Center for Integrative Medical Sciences, RIKEN, 4-6-1 Shirokane, Minato-ku, Tokyo, 108-8639, Japan
| | - Masatoshi Teraguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Shiro Ikegawa
- Laboratory of Bone and Joint Diseases, Center for Integrative Medical Sciences, RIKEN, 4-6-1 Shirokane, Minato-ku, Tokyo, 108-8639, Japan.
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O'Connor B, Bansal A, Leveque JC, Drolet CE, Shen J, Nemani V, Canlas G, Louie PK. Early Compensatory Segmental Angle Changes at L3-L4 and L4-L5 After a L5-S1 Interbody Fusion for a Grade 1 Spondylolisthesis. Spine (Phila Pa 1976) 2024; 49:865-872. [PMID: 37798836 DOI: 10.1097/brs.0000000000004845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
STUDY DESIGN The retrospective study included patients who underwent an L5-S1 anterior (ALIF) or transforaminal (TLIF) lumbar interbody fusion with posterior pedicle screw instrumentation for grade 1 spondylolisthesis from 2018 to 2022. OBJECTIVE To compare early reciprocal changes at the L3-L4 and L4-L5 adjacent levels 6 months after ALIF or TLIF at L5-S1. BACKGROUND Degenerative and chronic isthmic spondylolistheses often result in decreased segmental lordosis (SL) at L5-S1. This can lead to lordotic overcompensation at adjacent levels to maintain spinopelvic balance. However, the fate of adjacent angles after interbody fusion is not well understood. PATIENTS AND METHODS Preoperative and 6-month postoperative measurements of SL (L3-L4, L4-L5, and L5-S1), lumbar lordosis, and pelvic incidence (PI) were obtained from sagittal standing radiographs. Preliminary t tests were performed for descriptive purposes, and multiple regression was used for hypothesis testing. RESULTS Ninety-eight patients met the inclusion criteria (50 ALIF and 48 TLIF). A greater amount of lordosis achieved at L5-S1 was significantly associated with a greater reduction of SL at L4-L5 ( r = -0.65, P < 0.001) or L3-L4 ( r = -0.46, P < 0.001). A greater preoperative PI was associated with a greater reduction of SL at L4-L5 ( r = -0.42, P < 0.001) and at L3-L4 ( r = -0.44, P < 0.001). CONCLUSION At 6 months after a lumbar interbody fusion at L5-S1, greater compensatory changes with lordosis reduction are observed at the supra-adjacent L4-L5 and L3-L4 levels in patients achieving greater L5-S1 SL. In addition, preoperative PI played a role in influencing lordotic correction.
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Affiliation(s)
- Bailey O'Connor
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA
- School of Medicine, University of Washington, Seattle, WA
| | - Aiyush Bansal
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA
| | - Jean-Christophe Leveque
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA
| | - Caroline E Drolet
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA
| | - Jesse Shen
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA
- Department of Surgery, University of Montreal, Quebec, Canada
| | - Venu Nemani
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA
| | - Gina Canlas
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA
- School of Medicine, University of Washington, Seattle, WA
| | - Philip K Louie
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA
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Tolson JK, Menuet RL, Ly GH, Chanes BA, Bryan EA, Kataria S, Kim J, Ahmadzadeh S, Shekoohi S, Kaye AD. Evolving role of VIADISC for chronic low back and discogenic pain: a narrative review. Expert Opin Emerg Drugs 2024; 29:155-164. [PMID: 38602142 DOI: 10.1080/14728214.2024.2339912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Chronic lower back pain is a leading cause of disability and healthcare spending worldwide. Discogenic pain, pain originating from the intervertebral disk, is a common etiology of chronic lower back pain. Currently, accepted treatments for chronic discogenic pain focus only on the management of symptoms, such as pain. There are no approved treatments that stop or reverse degenerating intervertebral discs. Biologic therapies promoting disc regeneration have been developed to expand treatment options. VIADISC™ NP, is a viable disc allograft supplementation that, in a recent trial, demonstrated a significant reduction in pain and increased function in patients suffering from symptomatic degenerative disc disease. AREAS COVERED This manuscript summarizes the epidemiology and etiology of low back pain, the pathophysiology of degenerative disc disease, current treatments, and a need for newer therapies. The rationale behind intradiscal biologics for the treatment of symptomatic degenerative disc disease is also discussed. EXPERT OPINION Characterization of the biology leading to disc degeneration has allowed for the development of intradiscal biologics. They may soon be capable of preventing and reversing disc degeneration. Clinical trials have shown promise, but further research into efficacy and safety is needed before these therapies are widely employed.
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Affiliation(s)
- Jack K Tolson
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Robert L Menuet
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Gianni H Ly
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Benjamin A Chanes
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Elizabeth A Bryan
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Saurabh Kataria
- Department of Neurology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Julian Kim
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
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Cetintas SC, Akyol S, Alizada O, Akgun MY, Tahmazoglu B, Hanci M, Isler C. The Relationship Between Inflammatory Processes and Apoptosis in Lumbar Disc Degeneration. World Neurosurg 2024; 186:e261-e272. [PMID: 38548052 DOI: 10.1016/j.wneu.2024.03.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Degenerative Disc Disease (DDD) is a common health problem in the population. There are recent studies focusing on relationship between DDD and immunological factors. However, there is still a lack of data on the role of apoptosis in DDD pathophysiology. Therefore, we aimed to investigate the relationship between Modic-type changes and the apoptosis in DDD. MATERIALS AND METHODS Ninety adult male patients who presented with low back and/or radicular pain and were operated on due to lumbar disc herniation were included. Three groups were formed based on Modic type degeneration observed on magnetic resonance imaging. Specific parameters involved in the intrinsic and extrinsic pathways of apoptosis were assessed in excised disc materials using the enzyme-linked immunosorbent assay method. RESULTS All three groups formed according to Modic degeneration types were homogenous in all variances. Cytochrome-C was significantly decreased only in the Modic type-3 group, whereas Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand Receptor-1, B-Cell Lymphoma-2 (Bcl-2) Homologous Antagonist Killer-1, Direct Inhibitor of Apoptosis-Binding Protein with Low Pi, and Bcl-2 Associated X Apoptosis Regulator levels were significantly different in both Modic type-2 and -3 groups. However, BH3 interacting domain death agonist and Bcl-2 levels were similar across all groups. CONCLUSIONS In conclusion, this study suggests that Direct Inhibitor of Apoptosis-Binding Protein with Low Pi, cytochrome - c, Bcl-2 Associated X Apoptosis Regulator, Bcl-2 Homologous Antagonist Killer-1, and Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand Receptor-1proteins play important roles in the development and progression of DDD and are correlated with Modic types. Further studies are needed to explore the potential therapeutic role of inhibiting these apoptotic proteins in DDD.
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Affiliation(s)
- Semih Can Cetintas
- Department of Neurosurgery, Turkish Ministry of Health, Bitlis State Hospital, Bitlis, Turkey
| | - Sibel Akyol
- Department of Physiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Orkhan Alizada
- Department of Neurosurgery, Baskent University, School of Medicine, Istanbul, Turkey
| | | | - Burak Tahmazoglu
- Department of Neurosurgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Murat Hanci
- Department of Neurosurgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Cihan Isler
- Department of Neurosurgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey.
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Hedman T, Rogers A, Beall D. A Self-Polymerizing Mesh of Nano-Tethers for the Mechanical Constraint of Degraded Intervertebral Discs-A Review of 25 Years of Pre-Clinical and Early Clinical Research. Bioengineering (Basel) 2024; 11:535. [PMID: 38927771 PMCID: PMC11200395 DOI: 10.3390/bioengineering11060535] [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: 04/19/2024] [Revised: 05/08/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
Genipin polymers are self-forming tensile-load-carrying oligomers, derived from the gardenia fruit, that covalently bond to amines on collagen. The potential therapeutic mechanical benefits of a non-discrete in situ forming mesh of genipin oligomers for degraded spinal discs were first conceived in 1998. Over more than two decades, numerous studies have demonstrated the immediate mechanical effects of this injectable, intra-annular polymeric mesh including an early demonstration of an effect on clinical outcomes for chronic or recurrent discogenic low back pain. This literature review focused on articles investigating mechanical effects in cadaveric animal and human spinal discs, biochemical mechanism of action studies, articles describing the role of mechanical degradation in the pathogenesis of degenerative disc disease, initial clinical outcomes and articles describing current discogenic low back pain treatment algorithms. On the basis of these results, clinical indications that align with the capabilities of this novel injectable polymer-based treatment strategy are discussed. It is intended that this review of a novel nano-scale material-based solution for mechanical deficiencies in biologically limited tissues may provide a helpful example for other innovations in spinal diseases and similarly challenging musculoskeletal disorders.
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Affiliation(s)
- Thomas Hedman
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY 40513, USA
- Spinal Simplicity LLC, Overland Park, KS 66211, USA
| | - Adam Rogers
- Spinal Simplicity LLC, Overland Park, KS 66211, USA
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Szigethy L, Sigmundsson FG, Joelson A. Surgically Treated Degenerative Lumbar Spine Diseases in Twins. J Bone Joint Surg Am 2024; 106:891-895. [PMID: 38386722 DOI: 10.2106/jbjs.23.00902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND There is growing evidence to suggest a potential genetic component underlying the development and progression of lumbar spine diseases. However, the heritability and the concordance rates for the phenotypes requiring surgery for the common spine diseases lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH) are unknown. The aim of this study was to determine the heritability and the concordance rates for LSS and LDH requiring surgery by studying monozygotic (MZ) and dizygotic (DZ) twin pairs. METHODS Patients between 18 and 85 years of age who underwent surgery for LSS or LDH between 1996 and 2022 were identified in the national Swedish spine registry (LSS: 45,110 patients; LDH: 39,272 patients), and matched with the Swedish Twin Registry to identify MZ and DZ twins. Pairwise and probandwise concordance rates, heritability estimates, and MZ/DZ concordance ratios were calculated. RESULTS We identified 414 twin pairs (92 MZ and 322 DZ pairs) of whom 1 or both twins underwent surgery for LSS. The corresponding number for LDH was 387 twin pairs (118 MZ and 269 DZ pairs). The probandwise concordance rate for LSS requiring surgery was 0.25 (26 of 105) (95% confidence interval [CI], 0.14 to 0.34) for MZ twins and 0.04 (12 of 328) (95% CI, 0.01 to 0.07) for DZ twins. The corresponding values for LDH requiring surgery were 0.03 (4 of 120) (95% CI, 0 to 0.08) and 0.01 (4 of 271) (95% CI, 0 to 0.04), respectively. The probandwise MZ/DZ concordance ratio was 6.8 (95% CI, 2.9 to 21.5) for LSS and 2.3 (95% CI, 0 to 8.9) for LDH. The heritability was significantly higher in LSS compared with LDH (0.64 [95% CI, 0.50 to 0.74] versus 0.19 [95% CI, 0.08 to 0.35]). CONCLUSIONS Our findings suggest that genetic factors may play an important role in the risk of developing LSS requiring surgery, whereas heredity seems to be of less importance in LDH requiring surgery. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lilla Szigethy
- Department of Orthopedics, Orebro University Hospital, Orebro, Sweden
| | - Freyr G Sigmundsson
- Department of Orthopedics, Orebro University Hospital, Orebro, Sweden
- Orebro University School of Medical Sciences, Orebro, Sweden
| | - Anders Joelson
- Department of Orthopedics, Orebro University Hospital, Orebro, Sweden
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Saeed A, Shao H, Hezam K, Liu C, Zhang Q, Tang X. Research trend of MRI application for lumbar disc degeneration with low back pain: a bibliometric analysis. Front Neurol 2024; 15:1360091. [PMID: 38694782 PMCID: PMC11061404 DOI: 10.3389/fneur.2024.1360091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/02/2024] [Indexed: 05/04/2024] Open
Abstract
Background Low Back Pain (LBP) is a pervasive and complex musculoskeletal condition affecting over 80% of the global population. Lumbar Disc Degeneration (LDD) significantly contributes to LBP, and MRI is crucial for its diagnosis and understanding. This study aimes to provide a comprehensive bibliometric analysis of MRI research on LDD with LBP, shedding light on research patterns, collaborations, and potential knowledge gaps. Methods A comprehensive online search was conducted in the Scopus database to retrieve published literature on LDD with LBP. Bibliometric analysis was conducted to assess publication patterns, co-authorship networks, keyword co-occurrence, and co-citation analysis within the MRI applications for LDD research domain. Bibliometric analysis tools such as VOSviewer and the R package "bibliometrix" were utilized for quantitative assessments. Results A total of 1,619 publications related to MRI and LDD were analyzed. The analysis indicated a consistent annual growth rate of 4.62% in publications related to MRI and lumbar disc degeneration, reflecting a steady increase in research output over the past two decades. The USA, China, and Japan emerged as leading contributors. "SPINE", "European Spine Journal", and "Spine Journal" were the most productive journals in this domain. Key research themes identified included lumbar spine, low back pain, and magnetic resonance imaging. Network visualization shows that low back pain and magnetic resonance imaging were the most widely used keywords. Conclusion The comprehensive bibliometric analysis of MRI applications for Lumbar Disc Degeneration offers insights into prevailing research patterns, highlights key contributors and journals, and identifies significant research themes. This study provides a foundation for future research efforts and clinical practices in the field, ultimately contributing to the advancement of patient care for individuals suffering from LDD and associated Low Back Pain.
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Affiliation(s)
- Azzam Saeed
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haoyue Shao
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kamal Hezam
- Nankai University School of Medicine, Tianjin, China
| | - Chaoxu Liu
- Department of Orthopedics, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiya Zhang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangyu Tang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Li W, Djuric N, Cobbaert C, Vleggeert-Lankamp CLA. Modic Changes in the Lumbar Spine: Exploring Their Association with Abdominal Aortic Calcification as a Potential Indicator of Systemic Atherosclerosis. World Neurosurg 2024; 184:e503-e510. [PMID: 38310947 DOI: 10.1016/j.wneu.2024.01.157] [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: 09/07/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND This was a cross-sectional study on the correlation between abdominal aortic calcification (AAC) and Modic changes (MC). Little is known regarding the etiology of MC in the lumbar spine. Currently, insufficient vascularization of the endplate has been proposed to contribute to the appearance of MC. Our objective was to investigate whether AAC, a marker for a poor vascular status, is associated with MC in patients suffering from degenerative disc disease. METHODS Radiologic images of patients (n = 130) suffering from degenerative lumbar disc disease were reviewed. Type and severity of MC were assessed using magnetic resonance images, and severity of AAC was evaluated using computed tomography images or fluoroscopy. Both items were dichotomized into minimal and relevant grades. The correlation between them was studied using Spearman's correlation test, with age as a covariate. RESULTS Of the patients, 113 (87%) demonstrated MC (31% type I, 63% type II, and 6% type III) (55% relevant grade), and 68% had AAC (44% relevant grade). Spearman statistical analysis revealed that AAC was correlated with age (P < 0.001), whereas MC were not (P = 0.142). AAC severity was significantly correlated with MC, remaining so after age adjustment (P < 0.05). While MC type I lacked correlation with AAC, MC type II were significantly correlated with AAC (0.288, P = 0.015); however, this association lost significance after adjusting for age (P = 0.057). CONCLUSIONS AAC and MC (mainly MC type II) are associated, indicating that reduced blood supply or even a poor systemic vascularization status due to atherosclerotic disease may play a role in the formation of MC. Future studies focusing on the etiology of MC should pay more attention to patients' vascular status and determinants of abdominal aorta calcification.
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Affiliation(s)
- Wensen Li
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden, Netherlands.
| | - Niek Djuric
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden, Netherlands
| | - Christa Cobbaert
- Department of Clinical Chemistry, Leiden University Medical Center, Leiden, Netherlands
| | - Carmen L A Vleggeert-Lankamp
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden, Netherlands; Spaarne Gasthuis, Haarlem/Hoofddorp, Leiden, Netherlands
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Szigethy L, Sigmundsson FG, Joelson A. Surgically treated degenerative disk disease in twins. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1381-1384. [PMID: 38416191 DOI: 10.1007/s00586-024-08161-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/08/2023] [Accepted: 01/24/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Previous studies have suggested that genetic factors are important in the development of degenerative disk disease (DDD). However, the concordance rates for the phenotypes requiring surgery are unknown. The purpose of this study was to determine the concordance rates for DDD requiring surgery by studying monozygotic (MZ) and dizygotic (DZ) twin pairs. METHODS Patients, aged between 18 and 85 years, operated for DDD between 1996 and 2022 were identified in the national Swedish spine register (Swespine) and matched with the Swedish twin registry (STR) to identify MZ and DZ twins. Pairwise and probandwise concordance rates were calculated. RESULTS We identified 11,207 patients, 53% women, operated for DDD. By matching the Swespine patients with the STR, we identified 121 twin pairs (37 MZ and 84 DZ) where one or both twins were surgically treated for DDD. The total twin incidence for operated DDD was 1.1%. For DDD requiring surgery, we found no concordant MZ pair and no concordant DZ pair where both twins were operated for DDD. When we evaluated pairs where at least one twin was operated for DDD, we found two concordant MZ pairs (the co-twins were operated for spinal stenosis) and two concordant DZ pairs (one co-twin operated for spinal stenosis and one (co-twin operated for disk herniation). CONCLUSIONS Our findings suggest that genetic factors are probably not a major etiologic component in most cases of DDD requiring surgery. The findings of this study can be used for counseling patients about the risk for requiring DDD surgery.
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Affiliation(s)
- Lilla Szigethy
- Department of Orthopedics, Orebro University Hospital, 70185, Orebro, Sweden
| | - Freyr Gauti Sigmundsson
- Department of Orthopedics, Orebro University Hospital, 70185, Orebro, Sweden
- School of Medical Sciences, Orebro University, 70182, Orebro, Sweden
| | - Anders Joelson
- Department of Orthopedics, Orebro University Hospital, 70185, Orebro, Sweden.
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Ollila L, Oura P, Karppinen J, Niinimäki J, Junno JA. Association between vertebral cross-sectional area and lumbar disc displacement - a population-based study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:900-905. [PMID: 37452838 DOI: 10.1007/s00586-023-07853-8] [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: 05/30/2023] [Revised: 05/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Vertebral dimensions may constitute a potential risk factor for degenerative changes in the spine. Previous studies have found a positive association between vertebral height and both type 2 Modic changes and intervertebral disc height loss. Also, vertebral endplate size has been associated with disc degeneration. However, only a few studies have investigated the association between vertebral dimensions and lumbar disc displacement (LDD). This study aimed to investigate the association between vertebral cross-sectional area (CSA) and LDD among the general middle-aged Finnish population. We hypothesized that larger vertebral CSA is associated with LDD. MATERIALS AND METHODS The study was conducted by using data from the Northern Finland Birth Cohort 1966 (NFBC1966). At the age of 46, a subpopulation of NFBC1966 underwent clinical examinations including magnetic resonance imaging (MRI) (n = 1249). MRI scans were used to measure L4 CSA and evaluate the presence of LDD (bulge, protrusion, and extrusion/sequestration) in the adjacent discs. The association between L4 CSA and LDD was analysed using logistic regression, with adjustment for sex, education, body mass index, leisure-time physical activity, smoking, diet, and L4 height. RESULTS Larger L4 CSA was associated with LDD; an increase of 1 cm2 in vertebral CSA elevated the odds of LDD relative to no LDD by 10% (adjusted odds ratio 1.10, 95% CI 1.01-1.19). The association was similar among either sex. CONCLUSIONS Larger L4 vertebral CSA was associated with LDD in our study sample. Even though smaller vertebral size exposes our vertebrae to osteoporotic fractures, it simultaneously seems to protect us from LDD.
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Affiliation(s)
- Laura Ollila
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.
| | - Petteri Oura
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Rehabilitation Services of South Karelia Social and Health Care District, Valto Käkelän Katu 3, 53130, Lappeenranta, Finland
- Finnish Institute of Occupational Health, Aapistie 1, 90220, Oulu, Finland
| | - Jaakko Niinimäki
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Juho-Antti Junno
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Department of Archaeology, Faculty of Humanities, University of Oulu, Oulu, Finland
- Faculty of Medicine, Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland
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11
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Zhang T, Gao G, Gao F, Guo N, Wang Y. Percutaneous microchannel unilateral approach bilateral micro decompression for adjacent segmental degeneration after lumbar fusion at 10 years: a case report and review of literature. Front Surg 2024; 11:1284967. [PMID: 38327546 PMCID: PMC10847338 DOI: 10.3389/fsurg.2024.1284967] [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: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Background Adjacent segmental degeneration after lumbar fusion is one of the common long-term complications after lumbar fusion. With the continuous development of adjacent segmental degeneration, patients who fail conservative treatment often need reoperation to relieve symptoms. In recent years, the technique of bilateral microdecompression through unilateral approach under microchannel has been widely used in the treatment of lumbar degenerative diseases. However, the efficacy of this procedure for adjacent-segment degeneration after lumbar fusion has not been established. Here, we report a case of bilateral microscopic decompression via a unilateral approach through a microchannel in a patient with adjacent segmental degeneration after lumbar fusion. Case report A 70-year-old male patient was admitted to hospital because of lumbago accompanied by left lower extremity pain, numbness and weakness for 2 years, which aggravated for 2 months. Ten years ago, he underwent PLIF for lumbar spinal stenosis, and recovered well after the operation. According to imaging data and physical examination, the diagnosis was adjacent segmental degeneration after lumbar fusion. Bilateral microdecompression was performed through a unilateral approach under a microchannel. Good clinical outcomes was observed through 1-year postoperative follow-up. Conclusions This report reports the successful treatment of a patient with ASD 10 years after lumbar fusion. Bilateral microdecompression via a unilateral approach under a microchannel is a safe and effective method for the treatment of ASD after lumbar fusion with good surgical outcomes.
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Affiliation(s)
- Tingxin Zhang
- Department of Orthopedics, Ordos Central Hospital, Ordos, China
| | - Gang Gao
- Department of Orthopedics, Ordos Central Hospital, Ordos, China
| | - Feng Gao
- Department of Orthopedics, Ordos Central Hospital, Ordos, China
| | - Nana Guo
- Critical Care Medicine, Ordos Central Hospital, Ordos, China
| | - Yongjiang Wang
- Department of Orthopedics, Ordos Central Hospital, Ordos, China
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12
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Pennisi G, D'Ercole M, Izzo A, Polli FM, Rapisarda A, Papacci F, Olivi A, Montano N. Change of Clinical and Radiologic Parameters after Minimally Invasive Decompression in Patients with Lumbar Spinal Stenosis: A Prospective Study with Long-term Follow-up. J Neurol Surg A Cent Eur Neurosurg 2024; 85:14-20. [PMID: 35901813 DOI: 10.1055/a-1911-8864] [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: 10/16/2022]
Abstract
BACKGROUND The impact of minimally invasive decompression (MID) techniques on spinopelvic parameters and on the sagittal alignment remains a controversial topic. Here we studied the changes in clinical and radiologic parameters and their relationships in a series of lumbar spinal stenosis (LSS) submitted to MID with a minimum follow-up (FU) of 24 months. METHODS We prospectively collected clinical and radiologic data of 20 consecutive patients who were evaluated preoperatively, at the 6-month FU, and at the 24-month FU. Visual analog scale (VAS) for back and leg pain, Oswestry disability index (ODI), neck disability index (NDI), sagittal vertical axis (SVA), C7 slope (C7S), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were assessed for each patient. Moreover, the percentage variation of clinical and radiologic factors at the 24-month FU compared with the preoperative factors was calculated to perform correlation studies among these variables. RESULTS We reported a significant improvement of all clinical parameters. A significant increase of LL and SS and a significant decrease of PT and SVA were observed. The preoperative values of ODI, LL, SS, PT, and SVA significantly affect the 24-month FU values, and the percentage improvement of SVA at the 24-month FU compared with the preoperative values was significantly related to the percentage improvement of LL. CONCLUSIONS MID is clinically effective in patients with LSS and improves the spinopelvic parameters and the global sagittal balance of the spine. The preoperative spinal alignment affects the spinal alignment at FU. The improvement of SVA was strictly related to the improvement of LL.
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Affiliation(s)
- Giovanni Pennisi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Papacci
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Leite Pereira C, Grad S, Gonçalves RM. Biomarkers for intervertebral disc and associated back pain: From diagnosis to disease prognosis and personalized treatment. JOR Spine 2023; 6:e1280. [PMID: 38156062 PMCID: PMC10751979 DOI: 10.1002/jsp2.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 12/30/2023] Open
Abstract
Biomarkers are commonly recognized as objective indicators of a medical state or clinical outcome and have been widely used as clinical and diagnostic tools and surrogate endpoints in many pathological conditions. In the context of intervertebral disc (IVD) and associated back pain, also known as degenerative disc disease (DDD), the use of biomarkers has been poorly explored. DDD is currently diagnosed using imaging techniques and subjective pain scales, limiting an objective association between DDD and pain levels, as well as an evaluation of disease progression. There is a need for objective and reliable measurements for DDD, pain and pathology progression. DDD predictors could also help clinicians in deciding on the optimal treatment for distinct patient groups. This review addresses the current candidate biomarkers in DDD, including imaging, genetic, metabolite and protein-based parameters, both at the tissue and systemic levels, that may become a major advance in the diagnosis and prognosis of the disease, as well as in the management of therapeutic approaches to DDD.
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Affiliation(s)
- Catarina Leite Pereira
- I3S, Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
- INEB, Instituto de Engenharia BiomédicaUniversidade do PortoPortoPortugal
| | | | - Raquel M. Gonçalves
- I3S, Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
- INEB, Instituto de Engenharia BiomédicaUniversidade do PortoPortoPortugal
- ICBAS, Instituto de Ciências Biomédicas Abel SalazarUniversidade do PortoPortoPortugal
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14
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Khan N, Drolet CE, Farrokhi F, Nemani V, Leveque JCA, Krause K, Friedman AS, Bansal A, Louie PK. Clinical Guidelines for the Evaluation and Treatment of Lumbar Disc Herniations: How Accurate is the Internet? World Neurosurg 2023; 178:e682-e691. [PMID: 37544595 DOI: 10.1016/j.wneu.2023.07.144] [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: 05/15/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To compare information online regarding lumbar disc herniation (LDH) on commonly searched websites and compare those findings with the evidence-based recommendations listed in the North American Spine Society (NASS) clinical practice guidelines. METHODS NASS Clinical Practice Guidelines, Internet searches were performed utilizing three common search engines (Google, Bing, Yahoo) and keywords associated with LDH. The top 20 websites from each search were selected. The content regarding diagnosis and treatment of LDH was compared to the NASS clinical practice guidelines. RESULTS On average, websites mentioned only 59% of recommendations supported by Level I evidence. Websites included an average of 3 recommendations not discussed in the NASS guidelines out of an average of 12 total recommendations. Muscle and sensory testing and physical therapy were the most frequent recommendations, appearing on over 80% of websites. Websites were equally likely to contain recommendations backed by high-quality evidence as recommendations not included in NASS guidelines. CONCLUSIONS This study demonstrates that websites regarding LDH contain a mix of information, with only a fraction of recommendations aligning with NASS clinical guidelines. Patients who use these websites are presented with unsubstantiated information, conceivably impacting their understanding, expectations and decision-making in physician offices.
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Affiliation(s)
- Nadia Khan
- Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, Washington, USA; School of Medicine, University of Washington, Seattle, Washington, USA
| | - Caroline E Drolet
- Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Farrokh Farrokhi
- Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Venu Nemani
- Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | | | - Katie Krause
- Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Andrew S Friedman
- Physcial Medicine and Rehabilitation, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Aiyush Bansal
- Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Philip K Louie
- Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, Washington, USA.
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15
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Nematimoez M, Breen A, Breen A. Spatio-temporal clustering of lumbar intervertebral flexion interactions in 127 asymptomatic individuals. J Biomech 2023; 154:111634. [PMID: 37209467 DOI: 10.1016/j.jbiomech.2023.111634] [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: 01/18/2023] [Revised: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 05/22/2023]
Abstract
The purpose of this study was to categorize asymptomatic participants based on the clustering of spatial and temporal intervertebral kinematic variables during lumbar flexion. Lumbar segmental interactions (L2-S1) were evaluated in 127 asymptomatic participants during flexion using fluoroscopy. First, four variables were identified consisting of: 1. Range of motion (ROMC), 2. Peaking time of the first derivative for separate segmentation (PTFDs), 3. Peaking magnitude of the first derivative (PMFD), and 4. Peaking time of the first derivative for stepwise (grouped) segmentation (PTFDss). These variables were used to cluster and order the lumbar levels. The number of participants required to constitute a cluster was chosen as 7. Participants formed eight (ROMC), four (PTFDs), eight (PMFD), and four (PTFDss) clusters, which included 85%, 80%, 77%, and 60% of them, respectively, according to the above features. For all clustering variables, angle time series of some lumbar levels showed significant differences between clusters. However, in general, all clusters could be categorized based on the segmental mobility contexts into three main groups as incidental macro clusters: the upper (L2-L4 > L4-S1), middle (L2-L3 < L3-L5 > L5-S1) and lower (L2-L4 < L4-S1) domains. There are spatial and temporal segmental interactions and between-subject variability in asymptomatic participants. In addition, the differences in angle time series among the clusters have provided evidence of feedback control strategies, while the stepwise segmentation facilitates consideration of the lumbar spine as a system and provides supplementary information about segmental interactions. Clinically, these facts could be taken into account when considering any intervention, but especially fusion surgery.
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Affiliation(s)
| | - Alexander Breen
- Faculty of Science and Technology, Bournemouth University, Poole BH12 5BB, UK
| | - Alan Breen
- Faculty of Science and Technology, Bournemouth University, Poole BH12 5BB, UK
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16
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Hu B, Lin S, Lin S, Rui G. Ginkgetin Alleviates Intervertebral Disc Degeneration by Inhibiting Apoptosis, Inflammation, and Disturbance of Extracellular Matrix Synthesis and Catabolism via Inactivation of NLRP3 Inflammasome. Immunol Invest 2023:1-15. [PMID: 37154418 DOI: 10.1080/08820139.2023.2205884] [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: 05/10/2023]
Abstract
BACKGROUND Apoptosis, inflammation, and the extracellular matrix (ECM) synthesis and catabolism are compromised with intervertebral disc degeneration (IDD). Ginkgetin (GK) has been demonstrated to alleviate several diseases; however, its effect on IDD remains unknown. METHODS The nucleus pulposus cells (NPCs) were stimulated with interleukin (IL)-1β to construct the IDD models in vitro. Rats were used for the construction of the IDD models in vivo via the fibrous ring puncture method. The effect and mechanism of GK on IDD were determined by cell counting kit-8 (CCK-8), flow cytometry, western blot, real-time quantitative polymerase chain reaction (RT-qPCR), enzyme‑linked immunosorbent assay (ELISA), hematoxylin and eosin (HE) and safranine O staining, and immunohistochemistry (IHC) assays, respectively. RESULTS GK increased the cell viability and upregulated the expressions of anti-apoptosis and ECM synthesis markers in NPCs treated with IL-1β. GK also decreased apoptosis rate, and downregulated the expressions of proteins related to pro-apoptosis, ECM catabolism, and inflammation in vitro. Mechanically, GK reduced the expression of nucleotide binding oligomeric domain like receptor protein 3 (NLRP3) inflammasome-related proteins. Overexpression of NLRP3 reversed the effect of GK on the proliferation, apoptosis, inflammation, and ECM degradation in IL-1β-induced NPCs. Moreover, GK attenuated the pathological manifestations, inflammation, ECM degradation, and NLRP3 inflammasome expression in IDD rats. CONCLUSION GK suppressed apoptosis, inflammation, and ECM degradation to alleviate IDD via the inactivation of NLRP3 inflammasome.
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Affiliation(s)
| | | | - Shengrong Lin
- Department of Orthopaedics, The Third Clinical Medical College, Fujian Medical University, Xiamen, China
| | - Gang Rui
- Department of Orthopaedics, The Third Clinical Medical College, Fujian Medical University, Xiamen, China
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17
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Lee HJ, Lee SJ, Jung JM, Lee TH, Jeong C, Lee TJ, Jang JE, Lee JW. Biomechanical Evaluation of Lateral Lumbar Interbody Fusion with Various Fixation Options for Adjacent Segment Degeneration: A Finite Element Analysis. World Neurosurg 2023; 173:e156-e167. [PMID: 36775239 DOI: 10.1016/j.wneu.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Adjacent segment degeneration (ASD) is a common phenomenon after lumbar fusion. Lateral lumbar interbody fusion (LLIF) may provide an alternative treatment method for ASD. This study used finite element analysis to evaluate the biomechanical effects of LLIF with various fixation options and identify an optimal surgical strategy for ASD. METHODS A validated L1-S1 finite element model was modified for simulation. Six finite element models of the lumbar spine were created and were divided into group 1 (L4-5 posterior lumbar interbody fusion [PLIF] + L3-4 LLIF) and group 2 (L5-S1 PLIF + L4-5 LLIF). Each group consisted of 1) cage-alone, 2) cage + lateral screw fixation (LSF), and 3) cage + bilateral pedicle screw fixation (BPSF) models. The range of motion, intradiscal pressure, and facet loads of adjacent segments as well as interbody cage stress were analyzed. RESULTS The stress on the LLIF cage-superior endplate interface was highest in the cage-alone model followed by the cage + LSF model and cage + BPSF model. The increase in range of motion, intradiscal pressure, and facet loads at the adjacent segment was highest in the cage + BPSF model followed by the cage + LSF model and cage-alone model. However, the biomechanical effect on the adjacent segment seemed similar in the cage-alone and cage + LSF models. CONCLUSIONS LLIF with BPSF is recommended when performing LLIF surgery for ASD after L4-5 and L5-S1 PLIF. Considering cage subsidence and biomechanical effects on the adjacent segment, LLIF with LSF may be a suboptimal option for ASD surgery.
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Affiliation(s)
- Hyun Ji Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea
| | - Jong-Myung Jung
- Department of Neurosurgery, 9988 Joint & Spine Hospital, Seoul, Republic of Korea.
| | - Tae Hoon Lee
- Department of Orthopedic Surgery, 9988 Joint & Spine Hospital, Seoul, Republic of Korea
| | - Chandong Jeong
- Department of Orthopedic Surgery, 9988 Joint & Spine Hospital, Seoul, Republic of Korea
| | - Tae Jin Lee
- Department of Orthopedic Surgery, 9988 Joint & Spine Hospital, Seoul, Republic of Korea
| | - Ji-Eun Jang
- R&D Center, GS Medical Co., Ltd., Cheongju, Republic of Korea
| | - Jae-Won Lee
- R&D Center, GS Medical Co., Ltd., Cheongju, Republic of Korea
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18
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Mertimo T, Heikkala E, Niinimäki J, Blanco Sequeiros R, Määttä J, Kankaanpää M, Oura P, Karppinen J. The role of co-occurring insomnia and mental distress in the association between lumbar disc degeneration and low back pain related disability. BMC Musculoskelet Disord 2023; 24:293. [PMID: 37060071 PMCID: PMC10103434 DOI: 10.1186/s12891-023-06365-2] [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: 10/01/2022] [Accepted: 03/24/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Lumbar disc degeneration (LDD) is associated with low back pain (LBP). Although both insomnia and mental distress appear to influence the pain experience, their role in the association between LDD and LBP is uncertain. Our objective was to investigate the role of co-occurring insomnia and mental distress in the association between LDD and LBP-related disability. METHODS A total of 1080 individuals who had experienced LBP during the previous year underwent 1.5-T lumbar magnetic resonance imaging, responded to questionnaires, and participated in a clinical examination at the age of 47. Full data was available for 843 individuals. The presence of LBP and LBP-related disability (numerical rating scale, range 0-10) were assessed using a questionnaire. LDD was assessed by a Pfirrmann-based sum score (range 0-15, higher values indicating higher LDD). The role of insomnia (according to the five-item Athens Insomnia Scale) and mental distress (according to the Hopkins Symptom Check List-25) in the association between the LDD sum score and LBP-related disability was analyzed using linear regression with adjustments for sex, smoking, body mass index, education, leisure-time physical activity, occupational physical exposure, Modic changes, and disc herniations. RESULTS A positive association between LDD and LBP-related disability was observed among those with absence of both mental distress and insomnia (adjusted B = 0.132, 95% CI = 0.028-0.236, p = 0.013), and among those with either isolated mental distress (B = 0.345 CI = 0.039-0.650, p = 0.028) or isolated insomnia (B = 0.207, CI = 0.040-0.373, p = 0.015). However, among individuals with co-occurring insomnia and mental distress, the association was not significant (B = -0.093, CI = -0.346-0.161, p = 0.470). CONCLUSIONS LDD does not associate with LBP-related disability when insomnia and mental distress co-occur. This finding may be useful when planning treatment and rehabilitation that aim to reduce disability among individuals with LDD and LBP. Future prospective research is warranted.
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Affiliation(s)
- Teija Mertimo
- Faculty of Medicine and Health Technology, Tampere University Hospital and University of Tampere, P.O. Box 607, Tampere, FI-33014, Finland.
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, P.O. Box 5000, Oulu, FI- 90014, Finland.
| | - Eveliina Heikkala
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, P.O. Box 5000, Oulu, FI- 90014, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland
| | - Jaakko Niinimäki
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland
| | - Roberto Blanco Sequeiros
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland
- Department of Radiology, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20520, Finland
| | - Juhani Määttä
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland
| | - Markku Kankaanpää
- Department of Rehabilitation and Psychosocial Support, Tampere University Hospital, P.O. Box 2000, Tampere, FI-33521, Finland
| | - Petteri Oura
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland
- Rehabilitation Services of South Karelia Social and Health Care District, Valto Käkelän katu 3, Lappeenranta, FI- 53130, Finland
- Finnish Institute of Occupational Health, Aapistie 1, Oulu, FI-90220, Finland
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19
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Yao B, Cai Y, Wang W, Deng J, Zhao L, Han Z, Wan L. The Effect of Gut Microbiota on the Progression of Intervertebral Disc Degeneration. Orthop Surg 2023; 15:858-867. [PMID: 36600636 PMCID: PMC9977585 DOI: 10.1111/os.13626] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Intervertebral disc degeneration (IDD) is the main cause of back pain, and its treatment is a serious socio-economic burden. The safety and treatment of fecal microbiota transplantation (FMT) has been established. However, the relationship between FMT and IDD still unclear. We aimed to explore whether FMT plays a role in IDD to provide a reference for the treatment of IDD. METHODS An experimental model of IDD was established using 2-month-old male Sprague-Dawley rats. FMT was performed by intragastric gavage of IDD rats with a fecal bacterial solution. Rat serum, feces, and vertebral disc tissue were collected after surgery for 2 months. The levels of TNF-α, IL-1β, IL-6, matrix metalloproteinase (MMP)-3, MMP-13, Collagen II, and aggrecan in the serum or vertebral disc tissue were measured by an enzyme-linked immunosorbent assay, immunohistochemistry, quantitative real-time polymerase chain reaction, or western blotting. We also examined the pathology of the vertebral disc tissue using hematoxylin and eosin (HE) and safranin O-fast green staining. Finally, we examined the gut microbiota in rat feces using 16 S rRNA gene sequencing. RESULTS We found that the expression of TNF-α, IL-1β, IL-6, MMP-3, MMP-13, NLRP3 and Caspase-1 increased in the IDD group rats. In contrast, Collagen II and aggrecan levels were downregulated. Additionally, vertebral disc tissue was severely damaged in the IDD group, with disordered cell arrangement and uneven safranin coloration. FMT reversed the effects of IDD modeling on these factors and alleviated cartilage tissue damage. In addition, FMT increased the gut microbiota diversity and microbial abundance in rats treated with IDD. CONCLUSION Our findings suggest that FMT has a positive effect in maintaining cellular stability in the vertebral disc and alleviating histopathological damage. It affects the diversity and abundance of gut microbiota in rats with IDD. Therefore, FMT may serve as a promising target for amelioration of IDD.
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Affiliation(s)
- Bo Yao
- Department of Spine SurgeryWant want hospitalChangshaHunanChina
| | - Youquan Cai
- Department of Spine SurgeryWant want hospitalChangshaHunanChina
| | - Weiguo Wang
- Department of Spine Surgery, the Third Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Jia Deng
- Department of Spine SurgeryWant want hospitalChangshaHunanChina
| | - Lei Zhao
- Department of Spine SurgeryWant want hospitalChangshaHunanChina
| | - Ziwei Han
- Department of Spine SurgeryWant want hospitalChangshaHunanChina
| | - Li Wan
- Department of Spine SurgeryWant want hospitalChangshaHunanChina
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20
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Clinicians' perceptions around discectomy surgery for lumbar disc herniation: a survey of orthopaedic and neuro-surgeons in Australia and New Zealand. Arch Orthop Trauma Surg 2023; 143:189-201. [PMID: 34216261 DOI: 10.1007/s00402-021-04019-3] [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: 01/14/2021] [Accepted: 06/24/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Understanding practice-based differences in treatment of lumbar disc herniations (LDHs) is vital for reducing unwarranted variation in the delivery of spine surgical health care. Identifying factors that influence surgeons' decision-making will offer useful insights for developing the most cost-effective and safest surgical strategy as well as developing surgeon education materials for common lumbar pathologies. This study was to capture any variation in techniques used by surgeons in Australia and New Zealand (ANZ) region, and perceived complications of different surgical procedures for primary and recurrent LDH (rLDH). MATERIALS AND METHODS Web-based survey study was emailed to orthopaedic and neurosurgeons who routinely performed spinal surgery in ANZ from Decmber 20, 2018 to February 20, 2020. The response data were analyzed to assess for differences based on geography, practice setting, speciality, practice experience, practice length, and operative volume. RESULTS Invitations were sent to 150 surgeons; 96 (64%) responded. Most surgeons reported microdiscectomy as their surgical technique of choice for primary LDH (73%) and the first rLDH (72%). For the second rLDH, the preferred choice for most surgeons was fusion surgery (82%). A surgeon's practice setting (academic/private/hybrid) was a statistically significant factor in what surgical procedure was chosen for the first rLDH (P = 0.014). When stratifying based on surgeon experience, there were statisfically significant differences based on the annual volume of spine surgeries performed (perceived reherniation rates following primary discectomy, P = 0.013; perceived reherniation rates following revision surgeries, P = 0.017; perceived intraoperative complications rates following revision surgeries, P = 0.016) and based on the annual volume of lumbar discectomies performed (perceived reherniation rates following revision surgeries, P = 0.022; perceived intraoperative complications rates following revision surgeries, P = 0.036; perceived durotomy rates following primary discectomy, P = 0.023). CONCLUSIONS Surgeons' annual practice volume and practice setting have significant influences in the selection of surgical procedures and the perception of surgical complications when treating LDHs.
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21
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Chen H, Zhou J, Zhang G, Luo Z, Li L, Kang X. Emerging role and therapeutic implication of mTOR signalling in intervertebral disc degeneration. Cell Prolif 2022; 56:e13338. [PMID: 36193577 PMCID: PMC9816935 DOI: 10.1111/cpr.13338] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/16/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023] Open
Abstract
Intervertebral disc degeneration (IDD), an important cause of chronic low back pain (LBP), is considered the pathological basis for various spinal degenerative diseases. A series of factors, including inflammatory response, oxidative stress, autophagy, abnormal mechanical stress, nutritional deficiency, and genetics, lead to reduced extracellular matrix (ECM) synthesis by intervertebral disc (IVD) cells and accelerate IDD progression. Mammalian target of rapamycin (mTOR) is an evolutionarily conserved serine/threonine kinase that plays a vital role in diverse degenerative diseases. Recent studies have shown that mTOR signalling is involved in the regulation of autophagy, oxidative stress, inflammatory responses, ECM homeostasis, cellular senescence, and apoptosis in IVD cells. Accordingly, we reviewed the mechanism of mTOR signalling in the pathogenesis of IDD to provide innovative ideas for future research and IDD treatment.
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Affiliation(s)
- Hai‐Wei Chen
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouGansuPeople's Republic of China,The Second Clinical Medical CollegeLanzhou UniversityLanzhouGansuPeople's Republic of China
| | - Jian‐Wei Zhou
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouGansuPeople's Republic of China,Key Laboratory of Orthopaedics Disease of Gansu ProvinceLanzhou University Second HospitalLanzhouGansu ProvincePeople's Republic of China
| | - Guang‐Zhi Zhang
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouGansuPeople's Republic of China,The Second Clinical Medical CollegeLanzhou UniversityLanzhouGansuPeople's Republic of China
| | - Zhang‐Bin Luo
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouGansuPeople's Republic of China,The Second Clinical Medical CollegeLanzhou UniversityLanzhouGansuPeople's Republic of China
| | - Lei Li
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouGansuPeople's Republic of China,The Second Clinical Medical CollegeLanzhou UniversityLanzhouGansuPeople's Republic of China
| | - Xue‐Wen Kang
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouGansuPeople's Republic of China,The Second Clinical Medical CollegeLanzhou UniversityLanzhouGansuPeople's Republic of China,Key Laboratory of Orthopaedics Disease of Gansu ProvinceLanzhou University Second HospitalLanzhouGansu ProvincePeople's Republic of China
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22
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Watanabe T, Otani K, Sekiguchi M, Konno SI. Relationship between lumbar disc degeneration on MRI and low back pain: A cross-sectional community study. Fukushima J Med Sci 2022; 68:97-107. [PMID: 35922918 PMCID: PMC9493335 DOI: 10.5387/fms.2022-17] [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] [Indexed: 11/17/2022] Open
Abstract
Purpose: Although an association has been suggested between disc degeneration (DD) and low back pain (LBP), some DD is thought to be an age-related change unrelated to symptoms. Age-inappropriate DD, however, may be associated with LBP. The purpose of this study was to investigate whether there is a difference in LBP and LBP-related quality of life between age-appropriate and age-inappropriate DD, as assessed by magnetic resonance imaging (MRI). Participants and methods: In this cross-sectional study, degenerative change in the lumbar intervertebral discs of 382 subjects (age range, 27-82 years) was evaluated by MRI. Degenerative Disc Disease (DDD) scores were assigned using the Schneiderman classification, as the sum of grades for all intervertebral levels (0-15). We classified subjects into three groups according to age and DDD score: Low DD (mild DD relative to age), Appropriate (age-appropriate DD), and High DD (severe DD relative to age). We compared the three groups in terms of LBP prevalence, LBP intensity, LBP-specific quality of life (QOL) according to the Roland-Morris Disability Questionnaire (RDQ), and the Short Form-36 Item Health Survey (SF-36). Results: Of 382 subjects, there were 35% in the Low DD group, 54% in the Appropriate group, and 11% in the High DD group. There were no significant differences among the groups in terms of prevalence of LBP, LBP intensity, RDQ score, or SF-36 score. Conclusion: No association was found between age-inappropriate DD (Low or High DD group) and age-appropriate DD (Appropriate group) in terms of prevalence of LBP, LBP intensity, RDQ, or SF-36.
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Affiliation(s)
- Takehiro Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Shin-Ichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
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23
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El Rachkidi R, Massaad A, Saad E, Kawkabani G, Semaan K, Abi Nahed J, Ghanem I, Lafage V, Skalli W, Assi A. Spinopelvic Adaptations in Standing and Sitting Positions in Patients With Adult Spinal Deformity. Cureus 2022; 14:e28113. [PMID: 36134075 PMCID: PMC9481204 DOI: 10.7759/cureus.28113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To describe spinopelvic adaptations in the standing and sitting positions in patients with adult spinal deformity (ASD). Methods Ninety-five patients with ASD and 32 controls completed health-related quality of life (HRQOL) questionnaires: short form 36 (SF36), Oswestry Disability Index (ODI), and visual analog scale (VAS) for pain. They underwent biplanar radiography in both standing and sitting positions. Patients with ASD were divided into ASD-front (frontal deformity Cobb > 20°, n = 24), ASD-sag (sagittal vertical axis (SVA) > 50 mm, pelvic tilt (PT) > 25°, or pelvic incidence (PI)-lumbar lordosis (LL) > 10°, n = 40), and ASD-hyper thoracic kyphosis (TK >60°, n = 31) groups. Flexibility was defined as the difference (Δ) in radiographic parameters between the standing and sitting positions. The radiographic parameters were compared between the groups. Correlations between HRQOL scores were evaluated. Results All participants increased their SVA from standing to sitting (ΔSVA<0), except for patients with ASD-sag, who tended to decrease their SVA (78-62 mm) and maximize their pelvic retroversion (27-40° vs 10-34° in controls, p<0.001). They also showed reduced thoracic and lumbar flexibility (ΔLL = 3.4 vs 37.1°; ΔTK = −1.7 vs 9.4° in controls, p<0.001). ASD-hyperTK showed a decreased PT while sitting (28.9 vs 34.4° in controls, p<0.001); they tended to decrease their LL and TK but could not reach values for controls (ΔLL = 22.8 vs 37.1° and ΔTK = 5.2 vs 9.4°, p<0.001). The ASD-front had normal standing and sitting postures. ΔSVA and ΔLL were negatively correlated with the physical component scale (PCS of SF36) and ODI (r = −0.39 and r = −0.46, respectively). Conclusion Patients with ASD present with different spinopelvic postures and adaptations from standing to sitting positions, with those having sagittal malalignment most affected. In addition, changes in standing and sitting postures were related to HRQOL outcomes. Therefore, surgeons should consider patient sitting adaptations in surgical planning and spinal fusion. Future studies on ASD should evaluate whether physical therapy or spinal surgery can improve sitting posture and QOL, especially for those with high SVA or PT.
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24
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Rudisill SS, Hornung AL, Barajas JN, Bridge JJ, Mallow GM, Lopez W, Sayari AJ, Louie PK, Harada GK, Tao Y, Wilke HJ, Colman MW, Phillips FM, An HS, Samartzis D. Artificial intelligence in predicting early-onset adjacent segment degeneration following anterior cervical discectomy and fusion. 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 2022; 31:2104-2114. [PMID: 35543762 DOI: 10.1007/s00586-022-07238-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/12/2022] [Accepted: 04/17/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Anterior cervical discectomy and fusion (ACDF) is a common surgical treatment for degenerative disease in the cervical spine. However, resultant biomechanical alterations may predispose to early-onset adjacent segment degeneration (EO-ASD), which may become symptomatic and require reoperation. This study aimed to develop and validate a machine learning (ML) model to predict EO-ASD following ACDF. METHODS Retrospective review of prospectively collected data of patients undergoing ACDF at a quaternary referral medical center was performed. Patients > 18 years of age with > 6 months of follow-up and complete pre- and postoperative X-ray and MRI imaging were included. An ML-based algorithm was developed to predict EO-ASD based on preoperative demographic, clinical, and radiographic parameters, and model performance was evaluated according to discrimination and overall performance. RESULTS In total, 366 ACDF patients were included (50.8% male, mean age 51.4 ± 11.1 years). Over 18.7 ± 20.9 months of follow-up, 97 (26.5%) patients developed EO-ASD. The model demonstrated good discrimination and overall performance according to precision (EO-ASD: 0.70, non-ASD: 0.88), recall (EO-ASD: 0.73, non-ASD: 0.87), accuracy (0.82), F1-score (0.79), Brier score (0.203), and AUC (0.794), with C4/C5 posterior disc bulge, C4/C5 anterior disc bulge, C6 posterior superior osteophyte, presence of osteophytes, and C6/C7 anterior disc bulge identified as the most important predictive features. CONCLUSIONS Through an ML approach, the model identified risk factors and predicted development of EO-ASD following ACDF with good discrimination and overall performance. By addressing the shortcomings of traditional statistics, ML techniques can support discovery, clinical decision-making, and precision-based spine care.
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Affiliation(s)
- Samuel S Rudisill
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Alexander L Hornung
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - J Nicolás Barajas
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Jack J Bridge
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,Department of Data Science and Analytics, University of Missouri, Colombia, MO, USA
| | - G Michael Mallow
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Wylie Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Philip K Louie
- Virginia Mason Medical Center, Neuroscience Institute, Seattle, WA, USA
| | - Garrett K Harada
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Ulm, Germany
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Frank M Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA. .,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA.
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25
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Saini R, Sharma A, Dave MB. Clinical Reporting of Magnetic Resonance Imaging, the Way Forward for Patients With Lumbar Disc Herniation: A Prospective Correlational Study. Cureus 2022; 14:e27232. [PMID: 36039233 PMCID: PMC9400709 DOI: 10.7759/cureus.27232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Lower back pain (LBP) is a major cause of increasing years lived with disability. Many adults suffer from LBP once in their lifetime. Multiple environmental, genetic, and acquired factors lead to disc degeneration. Spinal stenosis can be caused due to bony, ligamentous, or discogenic origin. The majority of cases have a combined etiology of bony, ligamentous, and disc disease. Lumbar disc disease (LDD) has been mentioned by various terminologies in the literature. A standardized nomenclature is needed for better research and communication. Our study is based on the correlation between lumbar disc herniation (LDH) and magnetic resonance imaging (MRI) findings. Methodology A prospective observational study was undertaken on patients presenting with signs and symptoms suggestive of LDD to the Department of Orthopaedics at a tertiary care hospital in southern Rajasthan. The purposive sampling technique with a consecutive scheme was used. MRI is a valuable tool for diagnosing LDH. Results Many studies have concluded false-positive results for MRI in cases of LDH. Hence, interpretation with grading systems (Pfirrmann’s and Scizas grading) and correlation with clinical findings are mandatory for accurate diagnosis and management of patients. Conclusions We suggest clinicians adopt clinical reporting of MRI to improve the diagnostic accuracy with clinical and radiological correlation. Reporting can guide professionals in deciding the course of treatment in the form of conservative or surgical management.
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26
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Bermudez-Lekerika P, Crump KB, Tseranidou S, Nüesch A, Kanelis E, Alminnawi A, Baumgartner L, Muñoz-Moya E, Compte R, Gualdi F, Alexopoulos LG, Geris L, Wuertz-Kozak K, Le Maitre CL, Noailly J, Gantenbein B. Immuno-Modulatory Effects of Intervertebral Disc Cells. Front Cell Dev Biol 2022; 10:924692. [PMID: 35846355 PMCID: PMC9277224 DOI: 10.3389/fcell.2022.924692] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Low back pain is a highly prevalent, chronic, and costly medical condition predominantly triggered by intervertebral disc degeneration (IDD). IDD is often caused by structural and biochemical changes in intervertebral discs (IVD) that prompt a pathologic shift from an anabolic to catabolic state, affecting extracellular matrix (ECM) production, enzyme generation, cytokine and chemokine production, neurotrophic and angiogenic factor production. The IVD is an immune-privileged organ. However, during degeneration immune cells and inflammatory factors can infiltrate through defects in the cartilage endplate and annulus fibrosus fissures, further accelerating the catabolic environment. Remarkably, though, catabolic ECM disruption also occurs in the absence of immune cell infiltration, largely due to native disc cell production of catabolic enzymes and cytokines. An unbalanced metabolism could be induced by many different factors, including a harsh microenvironment, biomechanical cues, genetics, and infection. The complex, multifactorial nature of IDD brings the challenge of identifying key factors which initiate the degenerative cascade, eventually leading to back pain. These factors are often investigated through methods including animal models, 3D cell culture, bioreactors, and computational models. However, the crosstalk between the IVD, immune system, and shifted metabolism is frequently misconstrued, often with the assumption that the presence of cytokines and chemokines is synonymous to inflammation or an immune response, which is not true for the intact disc. Therefore, this review will tackle immunomodulatory and IVD cell roles in IDD, clarifying the differences between cellular involvements and implications for therapeutic development and assessing models used to explore inflammatory or catabolic IVD environments.
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Affiliation(s)
- Paola Bermudez-Lekerika
- Tissue Engineering for Orthopaedics and Mechanobiology, Bone and Joint Program, Department for BioMedical Research (DBMR), Faculty of Medicine, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Medical Faculty, University of Bern, Bern, Switzerland
| | - Katherine B Crump
- Tissue Engineering for Orthopaedics and Mechanobiology, Bone and Joint Program, Department for BioMedical Research (DBMR), Faculty of Medicine, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Medical Faculty, University of Bern, Bern, Switzerland
| | | | - Andrea Nüesch
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Exarchos Kanelis
- ProtATonce Ltd., Athens, Greece.,School of Mechanical Engineering, National Technical University of Athens, Zografou, Greece
| | - Ahmad Alminnawi
- GIGA In Silico Medicine, University of Liège, Liège, Belgium.,Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | | | | | - Roger Compte
- Twin Research and Genetic Epidemiology, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Francesco Gualdi
- Institut Hospital Del Mar D'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Leonidas G Alexopoulos
- ProtATonce Ltd., Athens, Greece.,School of Mechanical Engineering, National Technical University of Athens, Zografou, Greece
| | - Liesbet Geris
- GIGA In Silico Medicine, University of Liège, Liège, Belgium.,Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium.,Biomechanics Research Unit, KU Leuven, Leuven, Belgium
| | - Karin Wuertz-Kozak
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, United States.,Spine Center, Schön Klinik München Harlaching Academic Teaching Hospital and Spine Research Institute of the Paracelsus Private Medical University Salzburg (Austria), Munich, Germany
| | - Christine L Le Maitre
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | | | - Benjamin Gantenbein
- Tissue Engineering for Orthopaedics and Mechanobiology, Bone and Joint Program, Department for BioMedical Research (DBMR), Faculty of Medicine, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Medical Faculty, University of Bern, Bern, Switzerland
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Huang X, Chen C, Chen Y, Xu J, Liu L. Omentin-1 alleviate interleukin-1β(IL-1β)-induced nucleus pulposus cells senescence. Bioengineered 2022; 13:13849-13859. [PMID: 35707832 PMCID: PMC9275897 DOI: 10.1080/21655979.2022.2084495] [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] [Indexed: 11/25/2022] Open
Abstract
One of the main causes of low back pain (LBP) and degenerative musculoskeletal disorders is intervertebral disc degeneration (IVDD). Inflammation-associated senescence of Human nucleus pulposus cells (HNPCs) plays an essential function in the disease progression of IVDD. Omentin-1 is an adipokine that has been recently reported to have anti-inflammatory potential. In our research, IL-1β was used to simulate the inflammatory environment in the IVDD. We investigated in vitro the effects of Omentin-1 on HNPCs, including the components of senescence, cell cycle and extracellular matrix (ECM) synthesis. The results showed that the addition of Omentin-1 improved IL-1β-induced senescence in HNPCs. G1 phase cell cycle arrest and reduced ECM synthesis in HNPCs. Furthermore, we demonstrated that the effect of Omentin-1 in reducing senescence of HNPCs is dependent on SIRT1. These findings suggest that Omentin-1 plays an important function in protecting HNPCs against senescence and has the potential for IVDD gene target therapy.
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Affiliation(s)
- Xin Huang
- Department of Orthopaedic Surgery, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Changhong Chen
- Department of Orthopaedic Surgery, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Yaofei Chen
- Department of Orthopaedic Surgery, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Jun Xu
- Department of Orthopaedic Surgery, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Lin Liu
- Department of Orthopaedic Surgery, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
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28
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Wu T, Jia X, Zhu Z, Guo K, Wang Q, Gao Z, Li X, Huang Y, Wu D. Inhibition of miR-130b-3p restores autophagy and attenuates intervertebral disc degeneration through mediating ATG14 and PRKAA1. Apoptosis 2022; 27:409-425. [PMID: 35435532 DOI: 10.1007/s10495-022-01725-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
Oxidative stress-induced autophagy dysfunction is involved in the pathogenesis of intervertebral disc degeneration (IVDD). MicroRNAs (miRNAs) not only have been regarded as important regulators of IVDD but also reported to be related to autophagy. This research was aimed to explore the role of miR-130b-3p in IVDD and its regulation on autophagy mechanism. The miR-130b-3p expression in the patient's degenerative nucleus pulposus (NP) samples and rat NP tissues was detected by qRT-PCR and FISH assay. The miR-130b-3p was knocked down or overexpressed in the human NP cells by lentivirus transfection. TBHP was used to induce oxidative stress in the human NP cells. Apoptosis, senescence, and autophagy were evaluated by flow cytometry, β-gal staining, immunofluorescence, electron microscopy, and Western blot in the miR-130b-3p knocked down human NP cells under TBHP treatment. The relationship between the miR-130b-3p and ATG14 or PRKAA1 was confirmed by luciferase assay. The siRNA transfection was used to knock down the ATG14 and PRKAA1 expression, and then the human NP cells functions were further determined. In the in vivo experiment, the IVDD rat model was constructed and an adeno-associated virus (AAV)-miR-130b-3p inhibitor was intradiscally injected. After that, MRI and histological staining were conducted to evaluate the role of miR-130b-3p inhibition in the IVDD rat model. We found that the miR-130b-3p was upregulated in the degenerative NP samples from humans and rats. Interestingly, the inhibition of miR-130b-3p rescued oxidative stress-induced dysfunction of the human NP cells, and miR-130b-3p inhibition upregulated autophagy. Mechanistically, we confirmed that the miR-130b-3p regulated the ATG14 and PRKAA1 directly and the knockdown of the ATG14 or PRKAA1 as well as the treatment of autophagy inhibitor blockaded the autophagic flux and reversed the protective effects of miR-130b-3p inhibition in the TBHP-induced human NP cells. Furthermore, the inhibition of the miR-130b-3p via AAV- miR-130b-3p injection ameliorated the IVDD in a rat model. These data demonstrated that the miR-130b-3p inhibition could upregulate the autophagic flux and alleviate the IVDD via targeting ATG14 and PRKAA1.The translational potential of this article: The suppression of miR-130b-3p may become an effective therapeutic strategy for IVDD.
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Affiliation(s)
- Tongde Wu
- Department of Spine Surgery, Shanghai East Hospital, Pudong District, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China
| | - Xuebing Jia
- Cancer Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Ziqi Zhu
- Department of Spine Surgery, Shanghai East Hospital, Pudong District, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China
| | - Kai Guo
- Department of Spine Surgery, Shanghai East Hospital, Pudong District, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China
| | - Qiang Wang
- Department of Spine Surgery, Shanghai East Hospital, Pudong District, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China
| | - Zhiqiang Gao
- Department of Spine Surgery, Shanghai East Hospital, Pudong District, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China
| | - Xinhua Li
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yufeng Huang
- Department of Spine Surgery, Shanghai East Hospital, Pudong District, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China.
| | - Desheng Wu
- Department of Spine Surgery, Shanghai East Hospital, Pudong District, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China.
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Kim SK, Kwak SG, Choe JY. Decline of Lung Function in Knee and Spine Osteoarthritis in the Korean Population: Cross-Sectional Analysis of Data from the Korea National Health and Nutrition Examination Survey. Healthcare (Basel) 2022; 10:healthcare10040736. [PMID: 35455913 PMCID: PMC9027391 DOI: 10.3390/healthcare10040736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/01/2022] [Accepted: 04/13/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Evidence on the close association between osteoarthritis (OA) and lung diseases is supported by the shared pathogenesis of the two diseases. We assessed the association between knee and spine OA and chronic obstructive pulmonary disease (COPD) in the Korean population. Methods: Using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2012, a total of 2006 subjects who underwent both plain radiography for assessment of knee and lumbar spine and spirometry analysis for lung function were analyzed. Radiographic severity grade for OA was assessed using the Kellgren−Lawrence (K-L) grading scale. COPD was defined as a ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) less than 0.7. Results: Subjects with spine OA had higher prevalence of COPD than controls (p < 0.001), but not knee OA (p = 0.990). FVC (L), FEV1 (L), and FVC/FEV1 (%) were significantly decreased in spine OA compared to in controls (p = 0.003, p < 0.001, and p < 0.001, respectively). FVC (L), FVC (%), FEV1 (L), and FEV1 (%) were significantly different between knee OA and controls. Univariate regression analysis showed that spine OA was significantly associated with COPD (OR 1.581, 95% CI 1.204−2.076, p = 0.001), but not knee OA. Multivariate analysis revealed that spine OA lost statistical significance for COPD. Conclusion: This study found that subjects with knee OA and spine OA had a decline of lung function compared to subjects without OA, although OA was not associated with COPD.
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Affiliation(s)
- Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu 42472, Korea;
- Correspondence: ; Tel.: +82-53-6503465; Fax: +82-53-6298248
| | - Sang Gyu Kwak
- Department of Medical Statistics, Catholic University of Daegu School of Medicine, Daegu 42472, Korea;
| | - Jung-Yoon Choe
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu 42472, Korea;
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Mertimo T, Karppinen J, Niinimäki J, Blanco R, Määttä J, Kankaanpää M, Oura P. Association of lumbar disc degeneration with low back pain in middle age in the Northern Finland Birth Cohort 1966. BMC Musculoskelet Disord 2022; 23:359. [PMID: 35428226 PMCID: PMC9011971 DOI: 10.1186/s12891-022-05302-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although it has been suggested that lumbar disc degeneration (LDD) is a significant risk factor for low back pain (LBP), its role remains uncertain. Our objective was to clarify the association between LDD and LBP and whether mental distress modifies the association.
Methods
Participants of a birth cohort underwent 1.5-T lumbar magnetic resonance imaging at the age of 47. The association between the sum score of LDD (Pfirrmann classification, range 0–15) and LBP (categorized into “no pain”, “mild-to-moderate pain”, “bothersome-and-frequent pain”) was assessed using logistic regression analysis, with sex, smoking, body mass index, physical activity, occupational exposure, education, and presence of Modic changes and disc herniations as confounders. The modifying role of mental distress (according to the Hopkins Symptom Check List-25 [HSCL-25], the Beck Depression Inventory and the Generalized Anxiety Disorder Scale) in the association was analyzed using linear regression.
Results
Of the study population (n = 1505), 15.2% had bothersome and frequent LBP, and 29.0% had no LBP. A higher LDD sum score increased the odds of belonging to the “mild-to-moderate pain” category (adjusted OR corresponding to an increase of one point in the LDD sum score 1.11, 95% CI 1.04–1.18, P = 0.003) and the “bothersome-and-frequent pain” category (adjusted OR 1.20, 95% CI 1.10–1.31, P < 0.001), relative to the “no pain” category. Mental distress significantly modified the association between LDD and LBP, as a linear positive association was consistently observed among individuals without mental distress according to HSCL-25 (adjusted B 0.16, 95% CI 0.07–0.26, P < 0.001), but not among individuals with higher mental distress.
Conclusions
LDD was significantly associated with both mild-to-moderate and bothersome-and-frequent LBP. However, the co-occurrence of mental distress diminished the association between LDD and LBP bothersomeness. Our results strongly suggest that mental symptoms affect the pain experience.
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Zhu M, Yan X, Zhao Y, Xue H, Wang Z, Wu B, Li X, Shen Y. lncRNA LINC00284 promotes nucleus pulposus cell proliferation and ECM synthesis via regulation of the miR‑205‑3p/Wnt/β‑catenin axis. Mol Med Rep 2022; 25:179. [PMID: 35322864 PMCID: PMC8972274 DOI: 10.3892/mmr.2022.12695] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/23/2022] [Indexed: 11/08/2022] Open
Abstract
Intervertebral disc degeneration (IDD) is a leading cause of degenerative spinal disease. Long non-coding RNA (lncRNA) LINC00284 is overexpressed in multiple types of cancer and promotes cancer cell proliferation and inhibits apoptosis; however, its role in human IDD and nucleus pulposus (NP) remain unclear. In the present study, intervertebral disc (IVD) tissues were collected from IDD patients for detection of LINC00284 expression using reverse transcription-quantitative PCR, the binding effect between miR-205-3p and LINC00284 was validated by dual-luciferase reporter assay. miR-205-3p and small interfering RNA (siRNA) was used for LINC00240 knockdown to investigate the proliferation, apoptosis of cells in the NP cells measured by Cell Counting Kit (CCK)-8 assay and Annexin V-FITC/Propidium Iodide (PI) staining with flow cytometry receptivity. IDD animal models were constructed for in vivo study of the role LINC00284 in IDD improvement. The results showed that LINC00284 expression was upregulated in IDD tissue and IL-1β-induced NP cells. LINC00284 knockdown resulted in an increase in IL-1β-induced NP cell proliferation, a decrease in apoptosis and matrix metalloproteinase-3 expression and an increase in expression of extracellular matrix (ECM) markers aggrecan and collagen II. In vivo experiments and histomorphometric analysis confirmed the protective effect of LINC00284 knockdown in IDD. LINC00284 was also shown to be a target of microRNA (miR)-205-3p, and there was a negative correlation between LINC00284 and miR-205-3p levels in IDD tissue. Additionally, LINC00284 knockdown or miR-205-3p upregulation resulted in inhibition of Wnt/β-catenin signaling and subsequent degradation of the ECM. The present study demonstrated that LINC00284 activated the Wnt/β-catenin signaling via sponging miR-205-3p, resulting in inhibition of NP cell proliferation and ECM synthesis. These results suggested that targeting LINC00284 to rescue miR-205-3p expression may be a potential method for IDD management.
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Affiliation(s)
- Min Zhu
- Department of Spine Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Xiaoling Yan
- Chemotherapy Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Yin Zhao
- Department of Spine Surgery, Shanghai Changzheng Hospital, The Second Military Medical University, Shanghai 200003, P.R. China
| | - Huawei Xue
- Department of Spine Surgery, Nantong Third People's Hospital, Nantong, Jiangsu 226006, P.R. China
| | - Zhen Wang
- Department of Spine Surgery, Nantong Third People's Hospital, Nantong, Jiangsu 226006, P.R. China
| | - Bo Wu
- Department of Spine Surgery, Nantong Third People's Hospital, Nantong, Jiangsu 226006, P.R. China
| | - Xiangyang Li
- Department of Spine Surgery, Nantong Third People's Hospital, Nantong, Jiangsu 226006, P.R. China
| | - Yixin Shen
- Department of Spine Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
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Distribution Patterns of Degeneration of the Lumbar Spine in a Cohort of 200 Patients with an Indication for Lumbar MRI. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063721. [PMID: 35329406 PMCID: PMC8951543 DOI: 10.3390/ijerph19063721] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
Lower back pain is one of the most common causes of a reduced quality of life. Magnetic resonance imaging (MRI) is the best suited imaging technique to detect causes of that pain. We retrospectively evaluated the MRIs of the lumbar spine for 200 patients in order to describe the distribution of signs of degeneration with regard to age, sex, and position of the disc affected. The number of spinal segments affected by degeneration increased with age, as did the number of signs of degeneration per segment. In patients aged between 21 and 30, 38.8% of discs were affected, while for patients aged between 51 and 60, 91.6% of discs were affected. There was no statistically significant gender difference. The lower two segments were most commonly affected by degeneration. The most common were structural changes to the discs, which affected 88.4% of patients over 50. Spondylosis was the most common bone-related change, found in 60.4% of patients over the age of 50. A reduction in disc height increases the likelihood of structural changes to the disc and bone-related changes. When investigating risk factors for developing disc-related diseases, the complex disc degeneration patterns described here should be taken into account.
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Sneath RJS, Khan A, Hutchinson C. An Objective Assessment of Lumbar Spine Degeneration/Ageing Seen on MRI Using An Ensemble Method-A Novel Approach to Lumbar MRI Reporting. Spine (Phila Pa 1976) 2022; 47:E187-E195. [PMID: 34224512 DOI: 10.1097/brs.0000000000004159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective, randomized, radiographic study assessing age-related changes (ARCs) on lumbar magnetic resonance imaging (MRI) using an ensemble method. OBJECTIVES This study proposed to develop a novel reporting method to calculate a predicted "age estimate" for the ARC seen on lumbar MRI. SUMMARY OF BACKGROUND DATA Lumbar MRI reports include pathological findings but usually not the prevalence data of common findings which has been shown to decrease the need for narcotics in the management of non-specific lower back pain (NSLBP). Comparing the normal age estimation for lumbar spine degenerative changes/ARC on MRI and comparing this to the patient's real age may improve patient outcome in the management of NSLBP. METHODS A total of 60 lumbar MRI were taken from patients aged between 0 and 100 years. Lumbar MRI features reported as associated with age on review of the literature were measured on each MRI and statistically evaluated for correlation with age. Factors found to be associated were then entered into an ensemble model consisting of several machine learning techniques. The resulting ensemble model was then tested to predict age for a further 10 random lumbar MRI scans. One further lumbar MRI was then assessed for observer variability. RESULTS Features that correlated with age were disc signal intensity, the appearance of paravertebral and psoas muscle, disc height, facet joint size, ligamentum flavum thickness, Schmorl nodes, Modic changes, vertebral osteophytes, and high-intensity zones. With the ensemble model, 80% of estimated spinal age were within 11 years of the subjects' physical age. CONCLUSION It would appear that the intervertebral discs, and many other structures that are subjected to loading in and around the lumbar spine change their lumbar MRI appearance in a predictable way with increasing age. ARC on lumbar MRI can be assessed to predict an "expected age" for the subject.Level of Evidence: 2.
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Raak CK, Scharbrodt W, Berger B, Büssing A, Schönenberg-Tu A, Martin DD, Robens S, Ostermann T. Hypericum perforatum to Improve Postoperative Pain Outcome After Monosegmental Spinal Sequestrectomy (HYPOS): Results of a Randomized, Double-Blind, Placebo-Controlled Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:407-417. [PMID: 35171041 DOI: 10.1089/jicm.2021.0389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Patients undergoing lumbar spine surgery often suffer from severe radicular postoperative pain leading to the prescription of high-dose opioids. In Integrative Medicine, Hypericum perforatum is known as a remedy to relieve pain caused by nerve damage. Objectives: This trial investigated whether homeopathic Hypericum leads to a reduction in postoperative pain and a decrease in pain medication compared with placebo. Design: Randomized double blind, monocentric, placebo controlled clinical trial. Settings/Location: Department of Neurosurgery, Community Hospital Herdecke. Subjects: Inpatients undergoing lumbar sequestrectomy surgery. Interventions: Homeopathic treatment versus placebo in addition to usual pain management. Outcomes Measures: Primary endpoint was pain relief measured with a visual analog scale. Secondary endpoints were the reduction of inpatient postoperative analgesic medication and change in sensory and affective pain perception. Results: Baseline characteristics were comparable between the groups. Pain perception between baseline and day 3 did not significantly differ between the study arms. With respect to pain medication, total morphine equivalent doses did not differ significantly. However, a statistical trend and a moderate effect (d = 0.432) in the decrease of pain medication consumption in favor of the Hypericum group was observed. Conclusion: This is the first trial of homeopathy that evaluated the efficacy of Hypericum C200 after lumbar monosegmental spinal sequestrectomy. Although no significant differences between the groups could be shown, we found that patients who took potentiated Hypericum in addition to usual pain management showed lower consumption of analgesics. Further investigations, especially with regard to pain medication, should follow to better classify the described analgesic reduction. Clinical Trial Registration Number: German Clinical Trials Register No: DRKS00007913.
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Affiliation(s)
- Christa K Raak
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany.,Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, Herdecke, Germany
| | - Wolfram Scharbrodt
- Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, Herdecke, Germany
| | - Bettina Berger
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Arndt Büssing
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Anna Schönenberg-Tu
- Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, Herdecke, Germany
| | - David D Martin
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Sibylle Robens
- Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Witten, Germany
| | - Thomas Ostermann
- Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Witten, Germany
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The Roles of circRNAs in Intervertebral Disc Degeneration: Inflammation, Extracellular Matrix Metabolism, and Apoptosis. Anal Cell Pathol (Amst) 2022; 2022:9550499. [PMID: 35186669 PMCID: PMC8856834 DOI: 10.1155/2022/9550499] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/19/2022] [Indexed: 12/15/2022] Open
Abstract
Low back pain (LBP) is seriously harmful to human health and produces heavy economic burden. And most scholars hold that intervertebral disc degeneration (IDD) is the primary cause of LBP. With the study of IDD, aberrant expression of gene has become an important pathogenic factor of IDD. Circular RNAs (circRNAs), as a kind of noncoding RNA (ncRNA), participate in the regulation of genetic transcription and translation and further affect the expression of inflammatory cytokine, metabolism of extracellular matrix (ECM), the proliferation and apoptosis of cells, etc. Therefore, maybe it will become a new therapeutic target for IDD. At present, our understanding of the mechanism of circRNAs in IDD is limited. The purpose of this review is to summarize the mechanism and related signaling pathways of circRNAs in IDD reported in the past. Particularly, the roles of circRNAs in inflammation, ECM metabolism, and apoptosis are emphasized.
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Kim S, Choe J. Association between metabolic syndrome and radiographic spine osteoarthritis: Cross‐sectional analysis using data from the Korea National Health and Nutrition Examination Survey. Int J Rheum Dis 2022; 25:466-473. [DOI: 10.1111/1756-185x.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Seong‐Kyu Kim
- Division of Rheumatology Department of Internal Medicine Catholic University of Daegu School of Medicine Daegu Korea
| | - Jung‐Yoon Choe
- Division of Rheumatology Department of Internal Medicine Catholic University of Daegu School of Medicine Daegu Korea
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Salo S, Hurri H, Rikkonen T, Sund R, Kröger H, Sirola J. Association between severe lumbar disc degeneration and self-reported occupational physical loading. J Occup Health 2022; 64:e12316. [PMID: 35084078 PMCID: PMC8793002 DOI: 10.1002/1348-9585.12316] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Occupational physical loading has been reported to be associated with intervertebral disc degeneration. However, previous literature reports inconsistent results for different vertebral levels. The aim of our study was to investigate the association between lumbar disc degeneration (LDD) at different vertebral levels and the self‐reported physical loading of occupation. Methods The study population consisted of 1,022 postmenopausal women and was based on the prospective Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort. The severity of LDD was graded from T2‐weighted MRI images using the five‐grade Pfirrmann classification. Five intervertebral levels (L1–L2 to L5–S1) were studied (total 5110 discs). The self‐rated occupational physical loading contained four groups: sedentary, light, moderate, and heavy. Results The heavy occupational physical loading group had higher odds for severe LDD at the L5–S1 vertebral level (OR 1.86, 95% CI: 1.19–2.92, p = .006) in comparison with the sedentary work group. A clear trend of increasing disc degeneration with heavier occupational loading was also observed at the L5–S1 level. Age, smoking, and higher body mass index (BMI) were associated with more severe LDD. Leisure‐time physical activity at the age of 11–17 years was associated with less severe LDD. Controlling for confounding factors did not alter the results. Conclusions There appears to be an association between occupational physical loading and severe disc degeneration at the lower lumbar spine in postmenopausal women. Individuals in occupations with heavy physical loading may have an increased risk for work‐related disability due to more severe disc degeneration.
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Affiliation(s)
- Sami Salo
- Kuopio musculoskeletal research unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Heidi Hurri
- Kuopio musculoskeletal research unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Toni Rikkonen
- Kuopio musculoskeletal research unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Reijo Sund
- Kuopio musculoskeletal research unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Heikki Kröger
- Kuopio musculoskeletal research unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Joonas Sirola
- Kuopio musculoskeletal research unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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Tan J, Li Z, Liu L, Liu H, Xue J. IL‐17 in intervertebral disc degeneration: mechanistic insights and therapeutic implications. Cell Biol Int 2022; 46:535-547. [PMID: 35066966 DOI: 10.1002/cbin.11767] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Jing‐Hua Tan
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South ChinaHengyangHunan421001China
| | - Ze‐Peng Li
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South ChinaHengyangHunan421001China
| | - Lu‐Lu Liu
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South ChinaHengyangHunan421001China
| | - Hao Liu
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South ChinaHengyangHunan421001China
| | - Jing‐Bo Xue
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South ChinaHengyangHunan421001China
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Comorbidities and Health-Related Quality of Life in Subjects with Spine Osteoarthritis at 50 Years of Age or Older: Data from the Korea National Health and Nutrition Examination Survey. Medicina (B Aires) 2022; 58:medicina58010126. [PMID: 35056434 PMCID: PMC8777974 DOI: 10.3390/medicina58010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/21/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objective: This study assessed comorbidities and health-related quality of life (HRQOL) in subjects with lumbar spine osteoarthritis (OA) in the Korean population. Materials and Methods: We analyzed 3256 subjects who were 50 years or older and underwent plain radiography of the lumbar spine as part of the Korea National Health and Nutrition Examination Survey (KNHANES) 2012. Radiographic assessment was based on Kellgren–Lawrence (K-L) grade ranging from 0 to 2, with K-L grade 2 defined as lumbar spine OA. HRQOL was assessed by EuroQol-5 dimensions (EQ-5D), which include the EQ-5D index and visual analogue scale (EQ-VAS) measurements. Results: Comorbidities such as hypertension, myocardial infarction, angina, cerebral infarction, and diabetes mellitus were more frequent in spine OA than in controls, while dyslipidemia was less common. Subjects with spine OA had higher mean number of comorbid conditions than controls (1.40 (SE 0.05) vs. 1.20 (SE 0.03), p = 0.001). Subjects with spine OA had much lower EQ-5D index than controls (p < 0.001) but not lower EQ-VAS score. Multivariate binary logistic analysis showed that hypertension and colon cancer were associated with spine OA compared to controls (OR 1.219, 95% CI 1.020–1.456, p = 0.030 and OR 0.200, 95% CI 0.079–0.505, p = 0.001, respectively) after adjustment for confounding factors. Lower EQ-5D index was related to spine OA (95% CI 0.256, 95% CI 0.110–0.595, p = 0.002) but not EQ-VAS score. Conclusion: In this study, we found that comorbidities such as hypertension and colon cancer as well as lower HRQOL were associated with spine OA.
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Falowski SM, Koga SF, Northcutt T, Garamszegi L, Leasure J, Block JE. Improving the Management of Patients with Osteoporosis Undergoing Spinal Fusion: The Need for a Bone Mineral Density-Matched Interbody Cage. Orthop Res Rev 2021; 13:281-288. [PMID: 34934366 PMCID: PMC8684416 DOI: 10.2147/orr.s339222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
With an increasingly aging population globally, a confluence has emerged between the rising prevalence of degenerative spinal disease and osteoporosis. Fusion of the anterior spinal column remains the mainstay surgical intervention for many spinal degenerative disorders. However, decreased vertebral bone mineral density (BMD), quantitatively measured by dual x-ray absorptiometry (DXA), complicates treatment with surgical interbody fusion as weak underlying bone stock increases the risk of post-operative implant-related adverse events, including cage subsidence. There is a necessity for developing cages with advanced structural designs that incorporate bioengineering and architectural principles to tailor the interbody fusion device directly to the patient’s BMD status. Specifically, lattice-designed cages that mimic the web-like structure of native cancellous bone have demonstrated excellent resistance to post-operative subsidence. This article provides an introductory profile of a spinal interbody implant designed intentionally to simulate the lattice structure of human cancellous bone, with a similar modulus of elasticity, and specialized to match a patient’s bone status across the BMD continuum. The implant incorporates an open pore design where the degree of pore compactness directly corresponds to the patient’s DXA-defined BMD status, including patients with osteoporosis.
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Affiliation(s)
- Steven M Falowski
- Argires-Marotti Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | | | | | | | | | - Jon E Block
- Independent Clinical Consultant, San Francisco, CA, USA
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Yang JE, Zhao KH, Qu Y, Zou YC. Increased serum CXCL10 levels are associated with clinical severity and radiographic progression in patients with lumbar disc degeneration. Clin Chim Acta 2021; 525:15-22. [PMID: 34902344 DOI: 10.1016/j.cca.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/16/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lumbar intervertebral degenerative disc disease (IDD) is a multifaceted progressive condition that commonly occurs in conjunction with lumbar disc herniation (LDH). CXCL10 mRNA appears to be increased in both IDD and LHD. OBJECTIVE This study was performed to identify the relationship between serum CXCL10 levels and disease severity in patients with IDD. METHODS 136 IDD patients with low back pain, 127 asymptomatic volunteers and 120 healthy controls were enrolled. Serum CXCL10 protein concentrations were detected using commercial human CXCL10 ELISA Kits. Serum CXCL10 mRNA were examined using qRT-PCR. Clinical severity was assessed using the visual analog scale (VAS) and Oswestry Disability Index(ODI) scores. Radiographic severity was defined using the MRI-based Pfirrmann classification of disc degeneration. Receiver operating characteristic (ROC) curve analysis was used in estimating the correlation between CXCL10 and Pfirrmann grade. The cross-sectional area (CSA) of the lumbar multifidus muscle (LMM) and psoas major (PM) were calculated, and fat infiltration was evaluated by Ropponen-Kjaer criteria. RESULTS Serum CXCL10 concentrations were markedly raised in IDD patients with low back pain in contrast to asymptomatic individuals and healthy controls. Serum CXCL10 levels were positively associated with Pfirrmann grade. ROC curve analysis indicated that serum CXCL10 correlated well with Pfirrmann grade. In addition, serum CXCL10 concentrations were significantly higher in IDD patients with LMM and PM degeneration compared with IDD patients without degeneration. Increased CXCL10 levels positively correlated with VAS and ODI scores, as well as decreased CSA and fat filtration of the LMM and PM. CONCLUSION Increased serum CXCL10 levels correspond to clinical severity and radiographic progression in IDD patients.
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Affiliation(s)
- Jia-En Yang
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu 610041, Sichuan, China; Department of Rehabilitation Medicine, Affiliated Foshan Gaoming Hospital of Guangdong Medical University, Foshan 528000, Guangdong, China
| | - Ke-Hong Zhao
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yun Qu
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Yu-Cong Zou
- Department of Rehabilitation,The third Affiliated Hospital,Southern Medical University ,Guangzhou 510630, GuangDong, China.
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Cirillo Totera JI, Fleiderman Valenzuela JG, Garrido Arancibia JA, Pantoja Contreras ST, Beaulieu Lalanne L, Alvarez-Lemos FL. Sagittal balance: from theory to clinical practice. EFORT Open Rev 2021; 6:1193-1202. [PMID: 35839102 PMCID: PMC8693232 DOI: 10.1302/2058-5241.6.210062] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Adequate sagittal balance (SB) is essential to maintain an upright, efficient, and painless posture. It has been shown that sagittal profile alterations affect quality of life of patients with a similar or even greater impact than chronic disease. Evaluation of the SB has gained much relevance in recent years, with recognition of its importance in the evaluation of spinal pathology. This review summarizes the basic principles of SB, aiming to obtain a practical, simple and understandable evaluation of the sagittal profile of a patient. SB is a dynamic process that involves a varying degree of energy expenditure. Distinguishing between a balanced, compensated imbalance or decompensated imbalanced patient, is relevant to diagnosis and therapeutic decision-making.
Cite this article: EFORT Open Rev 2021;6:1193-1202. DOI: 10.1302/2058-5241.6.210062
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Affiliation(s)
- Juan I. Cirillo Totera
- Clínica Universidad de los Andes, Santiago, Chile
- Hospital del Trabajador, Santiago, Chile
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Yan Q, Xiao Q, Ge J, Wu C, Wang Y, Yu H, Yang H, Zou J. Bioinformatics-Based Research on Key Genes and Pathways of Intervertebral Disc Degeneration. Cartilage 2021; 13:582S-591S. [PMID: 33233925 PMCID: PMC8804785 DOI: 10.1177/1947603520973247] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To find out the pathways and key genes and to reveal disc degeneration pathogenesis based on bioinformatic analyses. DESIGN The GSE70362 dataset was downloaded from the GEO (Gene Expression Omnibus) database. Differentially expressed genes (DEGs) between the patients having disc degeneration and healthy controls were screened by Limma package in R language. Critical genes were identified by adopting gene ontologies (GOs), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, and protein-protein interaction (PPI) networks. RESULTS We identified 112 DEGs, including 60 genes which were upregulated and 52 that were downregulated. Analyses, such as GO and KEGG demonstrated that the DEGs got enriched in 4 biological processes and 2 signaling pathways, mainly related to disc degeneration. The PPI network analyses identified 5 key proteins, CCND1 (cyclin D1), GATA3, TNFSF11, LEF1, and DKK1 (Dickkopf related protein 1). CONCLUSION In this study, the DEGs and pathways determined promoted us understand the disc degeneration mechanisms. Also, the study may contribute novel biomarkers for the diagnosis and prevention of disc degeneration, and seek new treatment methods to repair and even regenerate degenerative intervertebral disc.
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Affiliation(s)
- Qi Yan
- Department of Orthopaedic Surgery, The
First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Quan Xiao
- Department of Orthopaedic Surgery, The
First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Department of Orthopaedic Surgery, The
Affiliated Lianshui People’s Hospital of Kangda College of Nan Jing Medical
Universty, Lianshui, Jiangsu, China
| | - Jun Ge
- Department of Orthopaedic Surgery, The
First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Cenhao Wu
- Department of Orthopaedic Surgery, The
First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yingjie Wang
- Department of Orthopaedic Surgery, The
First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hao Yu
- Department of Orthopaedic Surgery, The
First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The
First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jun Zou
- Department of Orthopaedic Surgery, The
First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Jun Zou, Department of Orthopaedic Surgery,
The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou,
Jiangsu 215006, China.
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Pinto EM, Teixeira A, Frada R, Atilano P, Miranda A. Surgical risk factors associated with the development of adjacent segment pathology in the lumbar spine. EFORT Open Rev 2021; 6:966-972. [PMID: 34760295 PMCID: PMC8559561 DOI: 10.1302/2058-5241.6.210050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Adjacent segment pathology (ASP) is a major cause of disability, and the recognition of the surgical risk factors associated with the development of this condition is essential for its prevention. Different surgical approaches, from decompression without fusion to non-instrumented and instrumented fusion, have distinct contributions to the development of ASP. Although motion-preservation procedures could reduce the prevalence of ASP, these are also associated with a higher percentage of complications. Several risk factors associated with previous surgery, namely the chosen surgical approach and anatomical dissection, the choice of interbody fusion, the increment and length of the fusion, and the restoration of sagittal alignment, may influence the development of ASP.
Cite this article: EFORT Open Rev 2021;6:966-972. DOI: 10.1302/2058-5241.6.210050
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Affiliation(s)
- Eduardo Moreira Pinto
- Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal
| | - Artur Teixeira
- Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal
| | - Ricardo Frada
- Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal
| | - Pedro Atilano
- Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal
| | - António Miranda
- Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal
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Liu X, Liu H, Yang X, Liu Z, Liu X, Yu M. Can formetric 4D measurements predict the development of adjacent segment degeneration after single-segment PLIF?: Relative rotation angle as a sensitive predictor. J Orthop Sci 2021; 26:941-947. [PMID: 33148477 DOI: 10.1016/j.jos.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/24/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adjacent segment degeneration (ASD) is a major issue after posterior lumbar interbody fusion (PLIF). The postoperative dynamic change of adjacent segments remains unknown. Hence, this study using the formetric 4D system (DIERS, International GmbH of Schlangenbad, Germany) to determine the impact of PLIF on ASD, and to compare the effectiveness with traditional radiography for the predication of ASD. METHODS Eighty-five consecutive patients who underwent PLIF of a single-segment were included. The formetric 4D system was used to calculate the relative rotation angle between the fusion segment and the upper and lower adjacent vertebrae before and at 6, 12 and 24 months after surgery. The range of motion (ROM) and disc height (DH) of adjacent segments were measured using radiography before surgery and 24 months postoperatively. At the final follow-up, the visual analogue scale (VAS) and Oswestry disability index were used to evaluate the surgical outcome. The patients were divided into two groups according to the occurrence of radiographic ASD: the ASD group with progression of degeneration and the N-ASD group without progression of degeneration. RESULTS The index fusion segments included L2-3 to L5-S1. Preoperatively, the relative rotation angles formed by the fusion segment with the upper and lower adjacent vertebrae were 5.1° ± 2.2° and 3.3° ± 2.0°, respectively, and both angles increased significantly at all time points after surgery (p < 0.05). The angles changed most significantly during L2-3 fusion. Radiographic ASD developed in 13 of 85 patients (15.3%) at 24 months. And the relative rotation angle with the upper adjacent vertebra was larger in the ASD group than in the N-ASD group (p < 0.05). CONCLUSION The relative rotation angle with adjacent vertebra increased significantly after lumbar fusion surgery. It may be a more sensitive predictor than the flexion-extension ROM and DH for the development of radiographic ASD.
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Affiliation(s)
- Xiao Liu
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Haonan Liu
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 South Lishi Road, Xicheng District, Beijing, 100045, China
| | - Xiaosong Yang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Miao Yu
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Džubera A, Chochol J, Illéš R, Chocholová A, Zemková E. Vertebral Algic Syndrome Treatment in Long COVID-Cases Reports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11457. [PMID: 34769973 PMCID: PMC8582844 DOI: 10.3390/ijerph182111457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/08/2023]
Abstract
Though pain is a frequent symptom of long COVID-19, little attention has been paid to vertebral algic syndrome. Therefore, we present the cases reports of two precisely selected physically active patients where vertebral algic syndrome and radiculopathy dramatically worsened in acute SARS-CoV-2 infections. The vertebral pain with radicular irritation was resistant to conservative treatment in chronic post-COVID syndrome. The neurological difficulties corresponded to the radiologic imaging presented on MRI scans. Due to the absence of standard therapeutic guidelines in literature sources, it was decided to provide routine therapeutic procedures. Spinal surgery with radicular decompression was performed within 6 months after acute SARS-CoV-2 infection. This led to the improvement of their neurological status and was in corroboration with decreases of VAS (from 9 to 0 in Patient 1 and from 7 to 1 in Patient 2). Our experience indicates that these patients benefited from the standard neurosurgical radicular decompression, and sufficient pain relief was achieved; nevertheless, the initial trigger of neurological worsening was acute SARS-CoV-2 infection.
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Affiliation(s)
- Andrej Džubera
- Department of Neurosurgery, Faculty of Medicine of Slovak Medical University, University Hospital—St. Michal’s Hospital, Satinského 1, 811 08 Bratislava, Slovakia; (A.D.); (R.I.)
| | - Juraj Chochol
- Department of Neurosurgery, Faculty of Medicine of Slovak Medical University, University Hospital—St. Michal’s Hospital, Satinského 1, 811 08 Bratislava, Slovakia; (A.D.); (R.I.)
| | - Róbert Illéš
- Department of Neurosurgery, Faculty of Medicine of Slovak Medical University, University Hospital—St. Michal’s Hospital, Satinského 1, 811 08 Bratislava, Slovakia; (A.D.); (R.I.)
| | - Alica Chocholová
- Department of Pediatric Hematology and Oncology, National Institute of Children’s Diseases, Comenius University, Limbova 1, 833 40 Bratislava, Slovakia;
| | - Erika Zemková
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Nábrežie Armádneho Generála Ludvíka Svobodu 9, 814 69 Bratislava, Slovakia;
- Faculty of Electrical Engineering and Information Technology, Sports Technology Institute, Slovak University of Technology, Ilkovičova 3, 812 19 Bratislava, Slovakia
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Valenzuela F, Rana M, Sitaram R, Uribe S, Eblen-Zajjur A. Non-Invasive Functional Evaluation of the Human Spinal Cord by Assessing the Peri-Spinal Neurovascular Network With Near Infrared Spectroscopy. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2312-2321. [PMID: 34705650 DOI: 10.1109/tnsre.2021.3123587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Current medical care lacks an effective functional evaluation for the spinal cord. Magnetic resonance imaging and computed tomography mainly provide structural information of the spinal cord, while spinal somatosensory evoked potentials are limited by a low signal to noise ratio. We developed a non-invasive approach based on near-infrared spectroscopy in dual-wavelength (760 and 850 nm for deoxy- or oxyhemoglobin respectively) to record the neurovascular response (NVR) of the peri-spinal vascular network at the 7th cervical and 10th thoracic vertebral levels of the spinal cord, triggered by unilateral median nerve electrical stimulation (square pulse, 5-10 mA, 5 ms, 1 pulse every 4 minutes) at the wrist. Amplitude, rise-time, and duration of NVR were characterized in 20 healthy participants. A single, painless stimulus was able to elicit a high signal-to-noise ratio and multi-segmental NVR (mainly from Oxyhemoglobin) with a fast rise time of 6.18 [4.4-10.4] seconds (median [Percentile 25-75]) followed by a slow decay phase for about 30 seconds toward the baseline. Cervical NVR was earlier and larger than thoracic and no left/right asymmetry was detected. Stimulus intensity/NVR amplitude fitted to a 2nd order function. The characterization and feasibility of the peri-spinal NVR strongly support the potential clinical applications for a functional assessment of spinal cord lesions.
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Impairment of Proprioception in Young Adult Nonradicular Patients with Lumbar Derangement Syndrome. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5550257. [PMID: 34660792 PMCID: PMC8516538 DOI: 10.1155/2021/5550257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/17/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022]
Abstract
Maintaining body balance is a complex function based on the information deriving from the vestibular, visual, and proprioceptive systems. The aim of the study was to evaluate quiet single stance stability in young adults with lumbar derangement syndrome (LDS) and in the control group of the healthy subjects. The second aim of this study was to determine whether pain intensity, degree of disability, and the level of physical activity can influence postural control in patients with LDS. It is important to underline that selecting a homogeneous group of LBP patients using, for example, mechanical diagnosis and therapy method and Quebec Task Force Classification, can result in an increased sensitivity of the study. The study included 126 subjects: 70 patients with LDS (37 women, 33 men) and the control group 56 healthy volunteers (36 women, 20 men). In case of multiple group comparisons for variables with normal distribution, ANOVA post hoc test was used or, as the nonparametric equivalent, Kruskal-Wallis test. In all these calculations, the statistical significance level was set to p < 0.05. The stability index eyes open for the study group was 88.34 and for the control group 89.86. There was no significant difference in the level of postural control between the study and control groups (p > 0.05). The level of stability index eyes closed (SI EC) for the study group was 71.44 and for the control group 77.1. SI EC results showed significant differences in proprioceptive control during single leg stance between the study and control groups (p < 0.05). The level of pain intensity, the degree of disability, and physical activity level did not influence postural control in the study group with LDS. In summary, patients with LDS showed significantly worse proprioceptive control.
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Zhang HJ, Liao HY, Bai DY, Wang ZQ, Xie XW. MAPK /ERK signaling pathway: A potential target for the treatment of intervertebral disc degeneration. Biomed Pharmacother 2021; 143:112170. [PMID: 34536759 DOI: 10.1016/j.biopha.2021.112170] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 12/17/2022] Open
Abstract
Intervertebral disc degeneration (IDD) is a chronic skeletal muscle degenerative disease, which is considered the main cause of low back pain. It seriously affects the quality of life of patients and consequently brings a heavy economic burden to their families and the society. Although IDD is considered a natural process in degenerative lesions, it is mainly caused by aging, trauma, genetic susceptibility and other factors. It is closely related to changes in the tissue structure and function, including the progressive destruction of extracellular matrix, cell aging, cell death of the intervertebral disc (IVD), inflammation, and impairment of tissue biomechanical function. Currently, the treatment of IDD is aimed at alleviating symptoms rather than at targeting pathological changes in the IVD. Furthermore, the mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) signaling pathway is closely related to various pathological processes in IDD, and the activation of the MAPK/ERK pathway promotes the degradation of the IVD extracellular matrix, cell aging, apoptosis, and inflammatory responses. It also induces autophagy and oxidative stress that accelerate the IVD process. In our current review, we summarize the latest developments in the negative regulation of IDD after activation of the MAPK/ERK signaling pathway and emphasize on its influence on IDD. Targeting this pathway may become an attractive treatment strategy for IDD in the near future.
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Affiliation(s)
- Hai-Jun Zhang
- Second Provincial People's Hospital of Gansu, 1 Hezheng West Street, Lanzhou 730000, PR China; Affiliated Hospital of Northwest Minzu Univsity, Lanzhou 730000, PR China
| | - Hai-Yang Liao
- Fist Affiliated Hospital of Ganan Medical University, 23 Qingnian Road, Ganzhou 342800, PR China
| | - Deng-Yan Bai
- Second Provincial People's Hospital of Gansu, 1 Hezheng West Street, Lanzhou 730000, PR China; Affiliated Hospital of Northwest Minzu Univsity, Lanzhou 730000, PR China
| | - Zhi-Qiang Wang
- Fist Affiliated Hospital of Ganan Medical University, 23 Qingnian Road, Ganzhou 342800, PR China
| | - Xing-Wen Xie
- Second Provincial People's Hospital of Gansu, 1 Hezheng West Street, Lanzhou 730000, PR China; Affiliated Hospital of Northwest Minzu Univsity, Lanzhou 730000, PR China.
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Kang KW, Song JE, Lee BH, Jeon MJ, Yu ES, Kim DS, Lee SR, Sung HJ, Choi CW, Park Y, Kim BS. A nationwide study of patients with monoclonal gammopathy of undetermined significance with a 10-year follow-up in South Korea. Sci Rep 2021; 11:18449. [PMID: 34531426 PMCID: PMC8445957 DOI: 10.1038/s41598-021-97664-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/27/2021] [Indexed: 11/08/2022] Open
Abstract
In clinical practice, most patients with monoclonal gammopathy of undetermined significance (MGUS) undergo long-term follow-up without disease progression. There is insufficient real-world data about how closely and whether anything other than disease progression should be monitored. Herein, we performed a nationwide study of 470 patients with MGUS with a 10-year follow-up to determine the patterns of disease progression and other comorbidities. During the follow-up period, 158 of 470 patients with MGUS (33.62%) progressed to symptomatic monoclonal gammopathies. Most of these were multiple myeloma (134/470 patients, 28.51%), and those diagnosed within 2 years after diagnosis of MGUS was high. Approximately 30-50% of patients with MGUS had hypertension, diabetes, hyperlipidemia, and osteoarthritis at the time of diagnosis, and these comorbidities were newly developed during the follow-up period in approximately 50% of the remaining patients with MGUS. Approximately 20-40% of patients with MGUS have acute or chronic kidney failure, thyroid disorders, disc disorders, peripheral neuropathy, myocardial infarction, stroke, and heart failure during the follow-up period. Altogether, when MGUS is diagnosed, close follow-up of the possibility of progression to multiple myeloma is required, especially within 2 years after diagnosis; simultaneously, various comorbidities should be considered and monitored during the follow-up of patients with MGUS. Continuous research is needed to establish appropriate follow-up guidelines.
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Affiliation(s)
- Ka-Won Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Ji Eun Song
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Byung-Hyun Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Min Ji Jeon
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Eun Sang Yu
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Dae Sik Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Se Ryeon Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Hwa Jung Sung
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Chul Won Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Yong Park
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Byung Soo Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
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