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Wáng YXJ, Diacinti D, Iannacone A, Kripa E, Leung JCS, Kwok TCY, Diacinti D. A comparison of radiographic degeneration features of older Chinese women and older Italian Caucasian women with a focus on thoracic spine. Aging Clin Exp Res 2023; 35:2583-2591. [PMID: 37646923 DOI: 10.1007/s40520-023-02537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Compared with Caucasians, East Asians have a lower incident of back pain, lower prevalence and severity of osteoporotic vertebral fracture and lumbar spine degeneration. AIM This study compares radiographic spine degeneration features of older Chinese women (as an example of East Asians) and older Italian women (as an example of Caucasians) with a focus on the thoracic spine. METHODS From two population-based epidemiological studies conducted in Hong Kong, China and Rome, Italy, 297 pairs (mean age: 73.6 years) age-matched older community women's lateral spine radiographs were sampled. Existence (or absence) of seven degeneration features were assessed including: (1) hyper-kyphosis, (2) disc space narrowing (T3/T4 ~ T11/T12), (3) osteoarthritic (OA) wedging (T4 ~ T12), (4) generalised osteophyte formation (T4 ~ T12); (5) acquired short vertebrae (T4 ~ T12), (6) Schmorl node (T4 - L5), (7) disc calcification (T4-L5). RESULTS Italian women were more likely to have hyper-kyphosis (53.4% vs 25.6%), disc space narrowing (34.4% vs. 17.2%), OA wedging (6.4% vs. 0.67%), Schmorl node (19.5% vs. 4.4%, all P < 0.001). However, there was no statistically significant difference in osteophyte formation (7.7% vs. 9.4%, P > 0.1) and acquired short vertebrae (8.0% vs. 10.4%, P > 0.1). Disc calcification was uncommon among both Chinese and Italians. DISCUSSION AND CONCLUSION For the first time, this study documented a lower prevalence of a number of thoracic spine degeneration features among Chinese. This study further affirms the concept of a generally healthier spine in older Chinese relative to older Caucasians. The observed differences may reflect a foundational background influence of genetic predisposition that represents an important line of future research.
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Affiliation(s)
- Yi Xiang Jshiang Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
| | - Davide Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
- Department of Diagnostic and Molecular Imaging, Radiology and Radiotherapy, University Foundation Hospital Tor Vergata, Rome, Italy
| | - Antonio Iannacone
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Endi Kripa
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Jason Chi Shun Leung
- Faculty of Medicine, JC Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Timothy Chi Yui Kwok
- Faculty of Medicine, JC Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
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Huang H, Liu X, Wang J, Suo M, Zhang J, Sun T, Zhang W, Li Z. Umbilical cord mesenchymal stem cells for regenerative treatment of intervertebral disc degeneration. Front Cell Dev Biol 2023; 11:1215698. [PMID: 37601097 PMCID: PMC10439242 DOI: 10.3389/fcell.2023.1215698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/27/2023] [Indexed: 08/22/2023] Open
Abstract
Intervertebral disc degeneration is thought to be a major contributor to low back pain, the etiology of which is complex and not yet fully understood. To compensate for the lack of drug and surgical treatment, mesenchymal stem cells have been proposed for regenerative treatment of intervertebral discs in recent years, and encouraging results have been achieved in related trials. Mesenchymal stem cells can be derived from different parts of the body, among which mesenchymal stem cells isolated from the fetal umbilical cord have excellent performance in terms of difficulty of acquisition, differentiation potential, immunogenicity and ethical risk. This makes it possible for umbilical cord derived mesenchymal stem cells to replace the most widely used bone marrow-derived and adipose tissue derived mesenchymal stem cells as the first choice for regenerating intervertebral discs. However, the survival of umbilical cord mesenchymal stem cells within the intervertebral disc is a major factor affecting their regenerative capacity. In recent years biomaterial scaffolds in tissue engineering have aided the survival of umbilical cord mesenchymal stem cells by mimicking the natural extracellular matrix. This seems to provide a new idea for the application of umbilical cord mesenchymal stem cells. This article reviews the structure of the intervertebral disc, disc degeneration, and the strengths and weaknesses of common treatment methods. We focus on the cell source, cell characteristics, mechanism of action and related experiments to summarize the umbilical cord mesenchymal stem cells and explore the feasibility of tissue engineering technology of umbilical cord mesenchymal stem cells. Hoping to provide new ideas for the treatment of disc degeneration.
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Affiliation(s)
- Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Moran Suo
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tianze Sun
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wentao Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian, Liaoning, China
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Cheung STY, Cheung PWH, Cheung JPY. Why Are Some Intervertebral Discs More Prone to Degeneration?: Insights Into Isolated Thoracic "Dysgeneration". Spine (Phila Pa 1976) 2023; 48:E177-E187. [PMID: 37262423 PMCID: PMC10212581 DOI: 10.1097/brs.0000000000004632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/01/2023] [Indexed: 06/03/2023]
Abstract
STUDY DESIGN Prospective observational study. OBJECTIVE To determine the prevalence of isolated thoracic degeneration on magnetic resonance imaging (MRI), demographic factors and imaging features, as well as the patient-reported quality of life outcomes associated with this condition. SUMMARY OF BACKGROUND DATA Thoracic intervertebral discs are least susceptible to disc degeneration (DD) and may represent a manifestation of "dysgeneration." These discs may never be hydrated from the beginning and seem hypointense on MRI. PATIENTS AND METHODS A population-based MRI study of 2007 volunteers was conducted. Each disc from C2/3 to L5/S1 was measured by Pfirrmann and Schneiderman grading. Disc herniation, Schmorl node (SN), high-intensity zones (HIZ), and Modic changes were studied. DD was defined by Pfirrmann 4 or 5. patient-reported quality of life scores, including a 36-item short-form questionnaire and visual analog scale for low back pain, were recorded. Subjects were divided into "isolated thoracic degeneration" (only thoracic segment) and "tandem thoracic degeneration" (thoracic with other segments). The association between imaging findings and isolated thoracic degeneration was determined using multivariate logistic regression. RESULTS The mean age of the subjects was 50.0 ± 0.5 and 61.4% were females (n = 1232). Isolated thoracic degeneration was identified in 2.3% of the cohort. Factors associated with isolated thoracic degeneration included lower age, C6/7 HIZ, T8/9 HIZ, and T8/9 SN. Factors associated with tandem thoracic degeneration included L4/5 posterior bulging. The thoracic and lumbar tandem degeneration group demonstrated higher bodily pain, despite a lower visual analog scale, and a higher physical component score of the 36-item short form. CONCLUSIONS Isolated thoracic degeneration demonstrated an earlier age of onset, mostly involving the mid-thoracic region (T5/6-T8/9), and in association with findings such as SN. Subjects with tandem thoracolumbar degeneration had less severe lumbar DD and low back pain as compared with those with isolated lumbar degeneration. This paints the picture of "dysgeneration" occurring in the thoracic and lumbar spine. LEVEL OF EVIDENCE 1.
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Shnayder NA, Ashkhotov AV, Trefilova VV, Nurgaliev ZA, Novitsky MA, Petrova MM, Narodova EA, Al-Zamil M, Chumakova GA, Garganeeva NP, Nasyrova RF. Molecular Basic of Pharmacotherapy of Cytokine Imbalance as a Component of Intervertebral Disc Degeneration Treatment. Int J Mol Sci 2023; 24:ijms24097692. [PMID: 37175399 PMCID: PMC10178334 DOI: 10.3390/ijms24097692] [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: 04/04/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Intervertebral disc degeneration (IDD) and associated conditions are an important problem in modern medicine. The onset of IDD may be in childhood and adolescence in patients with a genetic predisposition. With age, IDD progresses, leading to spondylosis, spondylarthrosis, herniated disc, spinal canal stenosis. One of the leading mechanisms in the development of IDD and chronic back pain is an imbalance between pro-inflammatory and anti-inflammatory cytokines. However, classical therapeutic strategies for correcting cytokine imbalance in IDD do not give the expected response in more than half of the cases. The purpose of this review is to update knowledge about new and promising therapeutic strategies based on the correction of the molecular mechanisms of cytokine imbalance in patients with IDD. This review demonstrates that knowledge of the molecular mechanisms of the imbalance between pro-inflammatory and anti-inflammatory cytokines may be a new key to finding more effective drugs for the treatment of IDD in the setting of acute and chronic inflammation.
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Affiliation(s)
- Natalia A Shnayder
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
- Shared Core Facilities "Molecular and Cell Technologies", V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Azamat V Ashkhotov
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
| | - Vera V Trefilova
- Department of Neurology, Hospital for War Veterans, 193079 Saint Petersburg, Russia
| | - Zaitun A Nurgaliev
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
- Department of Neurology, Hospital for War Veterans, 193079 Saint Petersburg, Russia
| | - Maxim A Novitsky
- Department of Neurology, Hospital for War Veterans, 193079 Saint Petersburg, Russia
| | - Marina M Petrova
- Shared Core Facilities "Molecular and Cell Technologies", V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Ekaterina A Narodova
- Shared Core Facilities "Molecular and Cell Technologies", V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Mustafa Al-Zamil
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples' Friendship University of Russia, 117198 Moscow, Russia
| | - Galina A Chumakova
- Department of Therapy and General Medical Practice with a Course of Postgraduate Professional Education, Altai State Medical University, 656038 Barnaul, Russia
| | - Natalia P Garganeeva
- Department of General Medical Practice and Outpatient Therapy, Siberian State Medical University, 634050 Tomsk, Russia
| | - Regina F Nasyrova
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
- International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, 443016 Samara, Russia
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Shnayder NA, Ashhotov AV, Trefilova VV, Nurgaliev ZA, Novitsky MA, Vaiman EE, Petrova MM, Nasyrova RF. Cytokine Imbalance as a Biomarker of Intervertebral Disk Degeneration. Int J Mol Sci 2023; 24:ijms24032360. [PMID: 36768679 PMCID: PMC9917299 DOI: 10.3390/ijms24032360] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
The intervertebral disk degeneration (IDD) and its associated conditions are an important problem in modern medicine. The onset of IDD may be in childhood and adolescence in patients with a genetic predisposition. IDD progresses with age, leading to spondylosis, spondylarthrosis, intervertebral disk herniation, and spinal stenosis. The purpose of this review is an attempt to summarize the data characterizing the patterns of production of pro-inflammatory and anti-inflammatory cytokines in IDD and to appreciate the prognostic value of cytokine imbalance as its biomarker. This narrative review demonstrates that the problem of evaluating the contribution of pro-inflammatory and anti-inflammatory cytokines to the maintenance or alteration of cytokine balance may be a new key to unlocking the mystery of IDD development and new therapeutic strategies for the treatment of IDD in the setting of acute and chronic inflammation. The presented data support the hypothesis that cytokine imbalance is one of the most important biomarkers of IDD.
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Affiliation(s)
- Natalia A. Shnayder
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
- Shared Core Facilities “Molecular and Cell Technologies”, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
- Correspondence: (N.A.S.); (R.F.N.); Tel.: +7-(812)-620-0220-7813 (N.A.S. & R.F.N.)
| | - Azamat V. Ashhotov
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
| | | | - Zaitun A. Nurgaliev
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
| | | | - Elena E. Vaiman
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
| | - Marina M. Petrova
- Shared Core Facilities “Molecular and Cell Technologies”, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Regina F. Nasyrova
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
- Correspondence: (N.A.S.); (R.F.N.); Tel.: +7-(812)-620-0220-7813 (N.A.S. & R.F.N.)
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Liebsch C, Wilke HJ. Even mild intervertebral disc degeneration reduces the flexibility of the thoracic spine: an experimental study on 95 human specimens. Spine J 2022; 22:1913-1921. [PMID: 35779838 DOI: 10.1016/j.spinee.2022.06.010] [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: 03/29/2022] [Revised: 05/31/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intervertebral disc degeneration represents one of multiple potential trigger factors for reduced passive spinal mobility and back pain. The effects of age-related degenerative intervertebral disc changes on spinal flexibility were however mainly investigated for the lumbar spine in the past, while intervertebral disc degeneration is also highly prevalent in the thoracic spine. PURPOSE To evaluate the effect of the degeneration grade on the range of motion and neutral zone of the thoracic spine. STUDY DESIGN Experimental study including combined radiological grading of intervertebral disc degeneration and biomechanical testing of 95 human thoracic functional spinal units (min. n=4 per level from T1-T2 to T11-T12) from 33 donors (15 female / 18 male, mean age 56 years, age range 37-80 years). METHODS Degeneration grades of the intervertebral discs were assessed using the validated x-ray grading scheme of Liebsch et al. (0=no, 1=mild, 2=moderate, 3=severe degeneration). Motion segments were loaded with pure moments in flexion/extension, lateral bending, and axial rotation to determine range of motion and neutral zone at 5 Nm. RESULTS All tested specimens exhibited degeneration grades between zero and two. Range of motion significantly decreased for grades one and two compared with grade zero in any motion direction (p<.05), showing the strongest decrease in extension comparing grade two with grade zero (-42%), while no significant differences were detected between grades one and two. Similar trends were found for the neutral zone with the strongest decrease in extension also comparing grade two with grade zero (-47%). Donor age did not significantly affect the range of motion, whereas the range of motion was significantly reduced in specimens from male donors due to the significantly higher degeneration grade in this study. CONCLUSIONS Even mild intervertebral disc degeneration reduces the range of motion and neutral zone of the thoracic spine in any motion plane, whereas progressing degeneration does not further affect its flexibility. This is in contrast to the lumbar spine, where a more gradual decrease of flexibility was found in prior studies, which might be explained by differences between thoracic and lumbar intervertebral disc morphologies. CLINICAL SIGNIFICANCE Thoracic intervertebral disc degeneration should be considered as one of multiple potential causal factors in patients showing reduced passive mobility and middle back pain.
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Affiliation(s)
- Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Helmholtzstr. 14, 89081 Ulm, Baden-Wuerttemberg, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Helmholtzstr. 14, 89081 Ulm, Baden-Wuerttemberg, Germany.
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Machino M, Nakashima H, Ito K, Tsushima M, Ando K, Kobayashi K, Imagama S. Influence of Age and Gender on Intervertebral Disk Degeneration and Height in the Thoracolumbar Spine. Spine Surg Relat Res 2022; 6:379-387. [PMID: 36051683 PMCID: PMC9381080 DOI: 10.22603/ssrr.2021-0187] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/02/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Intervertebral disk degeneration is a universal and natural process. However, no reports have summarized anatomical age-related intervertebral disk height and disk degenerative changes in the thoracolumbar spine or examined sex-specific differences. This study aimed to establish age-related changes and gender-specific differences of intervertebral disk height and disk degeneration of the thoracolumbar spine in a large cohort of relatively healthy subjects and also to evaluate the relationship between the degree of thoracolumbar disk height and disk degeneration. Methods Six hundred and twenty-seven relatively healthy subjects (307 males and 320 females; average age, 49.6±16.5 years) were enrolled. We included at least 50 males and 50 females in each decade of life between the 20s and the 70s. We measured intervertebral disk height from T10/T11 to L5/S1, vertebral body height from T10 to S1 on lateral neutral radiographs. Lumbar disk degeneration was defined according to the Pfirrmann classification in sagittal plane magnetic resonance imaging. Results Age-related decreases in intervertebral disk height were most prominent at L4/L5 in middle-aged and elderly individuals of both sexes. The grade of disk degeneration significantly increased with age in both genders at every level. Mild disk degeneration was observed even in the 20s. The disk degeneration occurred around the L4/L5 level. Although grade V disk degeneration was not identified for males in the 20s and the 30s, it appeared after the 40s and then increased further with age. The intervertebral disk height at the lower lumbar disks decreased with a progression in the disk degeneration grade in both genders. Conclusions This large-scale cross-sectional analysis of the thoracolumbar spine in relatively healthy subjects demonstrated that lumbar disk height narrowing progresses with age and is correlated with the progression of disk degeneration.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
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Maurer E, Klinger C, Lorbeer R, Hefferman G, Schlett CL, Peters A, Nikolaou K, Bamberg F, Notohamiprodjo M, Walter SS. Association between cardiovascular risk factors and degenerative disc disease of the thoracolumbar spine in the general population: results from the KORA MRI Study. Acta Radiol 2022; 63:750-759. [PMID: 33878932 DOI: 10.1177/02841851211010391] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about the associations between cardiovascular risk factors (CRF) and disc degeneration (DD). PURPOSE To evaluate the potential association between CRFs and intervertebral DD in a population-based sample. METHODS A total of 400 participants from the community-based KORA-study were assessed in terms of CRFs, specifically obesity, hypertension, diabetes, elevated LDL-c, low HDL-c, elevated triglycerides, smoking status, and alcohol consumption. The patients additionally underwent whole-body magnetic resonance imaging (MRI) using T2-weighted single-shot fast-spin-echo and T1 dual-echo gradient-echo Dixon pulse sequences. Thoracic and lumbar DD were assessed using the Pfirrmann score and for the presence of disc bulging/protrusion. Cross-sectional associations between CRFs and MR-based Pfirrmann score were then analyzed. RESULTS A total of 385 individuals (58.2% men; mean age 56.3 ± 9.2 years) were included. Prevalence of DD was 76.4%. Older age (β = 0.18; 95% CI 0.12-0.25; P < 0.001) and higher body mass index (BMI) (β = 0.19; 95% CI 0.06-0.30; P = 0.003) were significantly associated with DD of the thoracolumbar spine. Diabetes was significantly associated with DD at T7/8 (P = 0.029) and L3/4 (P = 0.017). Hypertension correlated significantly with DD in univariate analysis, but the association did not persist using multivariate analysis (β = 0.53; 95% CI -0.74 to 1.81; P = 0.41). None of the other CRFs (P ≥ 0.11) were associated with advanced DD. Disc bulging was independently associated with hypertension (β = 0.47; 95% CI 0.27-0.81; P = 0.01). CONCLUSION A significant independent association exists between age, BMI, and intervertebral DD. In contrast, there is no significant association between cardiovascular risk factors and DD. Providing strong evidence that the pathologic process undergirding DD is mechanical, rather than microvascular, in nature.
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Affiliation(s)
- Elke Maurer
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Christian Klinger
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Gerald Hefferman
- Brigham and Women’s Hospital, Department of Radiology and Harvard Medical School, Boston, MA, USA
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center ‐ University of Freiburg, Freiburg, Germany
| | - Annette Peters
- German Center for Cardiovascular Disease Research, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Cardiovascular Prevention, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Konstantin Nikolaou
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center ‐ University of Freiburg, Freiburg, Germany
| | - Mike Notohamiprodjo
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
- Die Radiologie, Munich, Germany
| | - Sven S Walter
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
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Cong M, Si M, Hou Y, Ma H, Nie L. Foot drop as the initial symptom caused by thoracic disc herniation. 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; 31:1795-1801. [PMID: 35598203 DOI: 10.1007/s00586-022-07254-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/14/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Foot drop is a syndrome resulting from weakness or paralysis of the tibialis anterior muscle. Some patients with thoracic disc herniation seek medical help complain of foot drop as the initial symptom. The study investigated the clinical characteristics of these patients and clarified the clinical efficacy after treatment. METHODS A total of 13 patients with foot drop as the initial symptom arising from thoracic disc herniation were collected from January 2015 to December 2020. The average follow-up period was 20.5 months. We recorded neurological functions, the tibialis anterior muscle strength, Japanese Orthopedic Association score (JOA), location of the lesion, and occupation rate of herniation in the spinal canal preoperatively and at the final follow-up. RESULTS None pathological reflex was found in the patients. Surgical treatment was performed in 12 of the 13 patients, and tibialis anterior functional recovery was observed in 83.4% (10/12) of the cases, with an average recovery rate of 52.8 ± 18.5%. The mean JOA score increased from 6.8 ± 1.9 points preoperatively to 8.9 ± 1.3 points postoperatively (p < 0.05), achieving a mean recovery rate of 52.3 ± 13.1%. The MRI showed the conus medullaris was obviously compressed at the level of T11-L1, and the occupation rate of herniation was more than 40% in all patients, with an average of 65.4 ± 16.3%. CT indicated that 84.6% of the cases had calcification in intervertebral discs. CONCLUSION Foot drop can be the initial symptom caused by thoracic disc herniation at the T11-L1 level, especially for the calcified disc herniation. A satisfactory recovery rate can be achieved by surgical decompression with fixation.
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Affiliation(s)
- Menglin Cong
- Department of Spine Surgery, Qilu Hospital of Shandong University, Shandong University, Jinan, 250012, China
| | - Meng Si
- Department of Spine Surgery, Qilu Hospital of Shandong University, Shandong University, Jinan, 250012, China
| | - Yong Hou
- Department of Spine Surgery, Qilu Hospital of Shandong University, Shandong University, Jinan, 250012, China
| | - Hecheng Ma
- Department of Spine Surgery, Qilu Hospital of Shandong University, Shandong University, Jinan, 250012, China.
| | - Lin Nie
- Department of Spine Surgery, Qilu Hospital of Shandong University, Shandong University, Jinan, 250012, China
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Xin J, Wang Y, Zheng Z, Wang S, Na S, Zhang S. Treatment of Intervertebral Disc Degeneration. Orthop Surg 2022; 14:1271-1280. [PMID: 35486489 PMCID: PMC9251272 DOI: 10.1111/os.13254] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 12/25/2022] Open
Abstract
Intervertebral disc degeneration (IDD) causes a variety of signs and symptoms, such as low back pain (LBP), intervertebral disc herniation, and spinal stenosis, which contribute to high social and economic costs. IDD results from many factors, including genetic factors, aging, mechanical injury, malnutrition, and so on. The pathological changes of IDD are mainly composed of the senescence and apoptosis of nucleus pulposus cells (NPCs), the progressive degeneration of extracellular matrix (ECM), the fibrosis of annulus fibrosus (AF), and the inflammatory response. At present, IDD can be treated by conservative treatment and surgical treatment based on patients' symptoms. However, all of these can only release the pain but cannot reverse IDD and reconstruct the mechanical function of the spine. The latest research is moving towards the field of biotherapy. Mesenchymal stem cells (MSCs) are regard as the potential therapy of IDD because of their ability to self-renew and differentiate into a variety of tissues. Moreover, the non-coding RNAs (ncRNAs) are found to regulate many vital processes in IDD. There have been many successes in the in vitro and animal studies of using biotherapy to treat IDD, but how to transform the experimental data to real therapy which can apply to humans is still a challenge. This article mainly reviews the treatment strategies and research progress of IDD and indicates that there are many problems that need to be solved if the new biotherapy is to be applied to clinical treatment of IDD. This will provide reference and guidance for clinical treatment and research direction of IDD.
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Affiliation(s)
- Jingguo Xin
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China.,Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Yongjie Wang
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China.,Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Zhi Zheng
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China.,Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Shuo Wang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Shibo Na
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China.,Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Shaokun Zhang
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China.,Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
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11
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Li S, Huang C, Xiao J, Wu Y, Zhang Z, Zhou Y, Tian N, Wu Y, Wang X, Zhang X. The Potential Role of Cytokines in Diabetic Intervertebral Disc Degeneration. Aging Dis 2022; 13:1323-1335. [PMID: 36186138 PMCID: PMC9466964 DOI: 10.14336/ad.2022.0129] [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: 11/23/2021] [Accepted: 01/29/2022] [Indexed: 12/02/2022] Open
Abstract
Intervertebral disc degeneration (IVDD) is a major cause of low back pain. Diabetes mellitus is a chronic inflammatory disease that may cause or aggravate IVDD; however, the mechanism by which diabetes induce IVDD is currently unclear. Compared to non-diabetic individuals, diabetic patients have higher levels of plasma cytokines, especially TNF-α, IL-1β, IL-5, IL-6, IL-7, IL-10, and IL-18. Due to the crucial role of cytokines in the process of intervertebral disc degeneration, we hypothesized that elevation of these cytokines in plasma of diabetic patients may be involved in the process of diabetes-induced IVDD. In this review, changes in plasma cytokine levels in diabetic patients were summarized and the potential role of elevated cytokines in diabetes-induced IVDD was discussed. Results showed that some cytokines such as TNF-α and IL-1β may accelerate the development of IVDD, while others such as IL-10 is supposed to prevent its development. Apoptosis, senescence, and extracellular matrix metabolism were found to be regulated by these cytokines in IVDD. Further studies are required to validate the cytokines targeted strategy for diabetic IVDD therapy.
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Affiliation(s)
- Sunlong Li
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang, China.
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Chongan Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang, China.
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Jian Xiao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang, China.
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Yuhao Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang, China.
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Zengjie Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, China.
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yifei Zhou
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang, China.
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Naifeng Tian
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang, China.
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Yaosen Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang, China.
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Xiangyang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang, China.
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Correspondence should be addressed to: Dr. Xiaolei Zhang () or Dr. Xiangyang Wang (), Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, West Xueyuan Road, Wenzhou, Zhejiang, China
| | - Xiaolei Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang, China.
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Chinese Orthopaedic Regenerative Medicine Society, Hangzhou, Zhejiang, China.
- Correspondence should be addressed to: Dr. Xiaolei Zhang () or Dr. Xiangyang Wang (), Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, West Xueyuan Road, Wenzhou, Zhejiang, China
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12
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Funabashi M, Son J, Pecora CG, Tran S, Lee J, Howarth SJ, Kawchuk G, de Luca K. Characterization of thoracic spinal manipulation and mobilization forces in older adults. Clin Biomech (Bristol, Avon) 2021; 89:105450. [PMID: 34450432 DOI: 10.1016/j.clinbiomech.2021.105450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/13/2021] [Accepted: 08/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spinal mobilization and spinal manipulation are common interventions used by manual therapists to treat musculoskeletal conditions in older adults. Their force-time characteristics applied to older adults' thoracic spine are important considerations for effectiveness and safety but remain unknown. This study aimed to describe the force-time characteristics of posterior-to-anterior spinal mobilization and manipulation delivered to older adults' thoracic spine. METHODS Twenty-one older adults (≥65 years) with no thoracic pain received posterior-to-anterior thoracic spinal mobilization and/or manipulation with the force characteristics a chiropractor deemed appropriate. Six-degree-of-freedom load cells and an instrumented treatment table recorded the force characteristics of both interventions at the clinician-participant and participant-table interfaces, respectively. Preload force, total peak force, time to peak and loading rate were analyzed descriptively. FINDINGS Based on data from 18 adults (56% female; average: 70 years old), mean resultant spinal mobilization forces at the clinician-participant interface were: 220 ± 51 N during preload, 323 ± 67 N total peak force, and 312 ± 38 ms time to peak. At the participant-table interface, mobilization forces were 201 ± 50 N during preload, 296 ± 63 N total peak force, and 308 ± 44 ms time to peak. Mean resultant spinal manipulation forces at the clinician-participant interface were: 260 ± 41 N during preload, 470 ± 46 N total peak force, and 165 ± 28 ms time to peak. At the participant table interface, spinal manipulation forces were 236 ± 47 N during preload, 463 ± 57 N total peak force, and 169 ± 28 ms time to peak. INTERPRETATION Results suggest older adults experience unique, but comparable force-time characteristics during spinal mobilization and manipulation delivered to their thoracic spine compared to the ones delivered to younger adults described in the literature.
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Affiliation(s)
- Martha Funabashi
- Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON M2H 3J1, Canada; Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 boulevard des Forges, Trois-Rivières, QC G9A 5H7, Canada.
| | - James Son
- Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON M2H 3J1, Canada.
| | - Cosma Gary Pecora
- Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON M2H 3J1, Canada.
| | - Steve Tran
- Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON M2H 3J1, Canada.
| | - Joyce Lee
- Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON M2H 3J1, Canada.
| | - Samuel J Howarth
- Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON M2H 3J1, Canada.
| | - Gregory Kawchuk
- Department of Physical Therapy, University of Alberta, 8205 114 St, 3-48 Corbett Hall, Edmonton, AB T6G 2G4, Canada.
| | - Katie de Luca
- Department of Chiropractic, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW 2109, Australia.
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Mesregah MK, Repajic M, Patel K, Gardner C, Roberts S, Buser Z, Wang J. Trends and patterns of thoracic intervertebral disc degeneration in symptomatic subjects: a magnetic resonance imaging analysis. 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 2021; 30:2221-2230. [PMID: 34114105 DOI: 10.1007/s00586-021-06895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/26/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to analyse the trends and patterns of IVD degeneration in different age groups at each level of the thoracic spine. METHODS This cross-sectional MRI study included 1000 symptomatic patients who had undergone upright thoracic spine MRI. A total of 13,000 thoracic IVDs from C7/T1 to T12/L1 were classified into five grades using Pfirrmann classification. Patients were divided according to their ages into five groups (n = 200/group). The severity and pattern of IVD degeneration were analysed in each age group. A predictive model of the severity and pattern of IVD degeneration in each age group was proposed. RESULTS The total grade of IVD degeneration and the number of degenerated levels increased with increasing age (P < 0.001). The most common degenerated level was T6/7 (13.3%), while the least common degenerated level was T12/L1 (1.8%). The most common grades were grade I in group 1 (60.5%), grade II in groups 2 (39%) and 3 (37.3%), and grade III in groups 4 (42.5%) and 5 (44.6%). Adjacent-level degenerations were more common than skip-level degenerations. Severe disc degeneration (Pfirrmann grades IV or V) could be predicted to occur more in group 5 (patients with 60 years and above) (margin = 0.79, 95% CI = 0.73-0.84, P < 0.001). CONCLUSIONS The severity of thoracic IVD degeneration and the number of degenerated levels increased with age. Disc degeneration was more accelerated in the mid-thoracic spine. Adjacent-level degeneration was more common than skip-level degenerations.
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Affiliation(s)
- Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA.,Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Michael Repajic
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Kishan Patel
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Carson Gardner
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Sidney Roberts
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA.
| | - Jeffrey Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
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14
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Differences in clinical and radiological features of thoracic disc herniation presenting with acute progressive myelopathy. 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 2020; 30:829-836. [PMID: 32507919 DOI: 10.1007/s00586-020-06485-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/31/2020] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Symptomatic thoracic disc herniation (TDH) is relatively rare, but patients with progressive myelopathy require surgical treatment without delay in diagnosis. The aim of this study was to review clinical and radiological features in patients with TDH presenting with myelopathy. METHODS A total of 28 consecutive patients with thoracic myelopathy (Frankel grade C or worse) due to TDH who underwent surgery were divided into 3 groups based on the time for development of myelopathy (acute (< 72 h), subacute (within a few weeks), and chronic [gradually over > 1 month)] and their data were analyzed. RESULTS The patients in the acute group were significantly younger and had a higher body mass index (BMI) compared to those in the subacute and chronic groups. Most cases of acute myelopathy were affected in the upper thoracic level, whereas all patients with subacute and chronic myelopathy had lesions in the lower thoracic level below T8-9. Interestingly, the affected thoracic level in patients with acute myelopathy matched the upper line of the sternum. The rate of acquired walking ability without assistance was only 50.0% in the acute group. CONCLUSIONS This study suggests that TDH presenting with acute myelopathy may have different clinical and radiological features compared to those of TDH with subacute and chronic myelopathy. Upper TDH should be suspected in cases of acute myelopathy that develops with sudden-onset back pain after certain triggers in younger and higher BMI people. These affected thoracic level matched with the upper line of the sternum in each case.
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