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Peng B, Li Q, Chen J, Wang Z. Research on the role and mechanism of IL-17 in intervertebral disc degeneration. Int Immunopharmacol 2024; 132:111992. [PMID: 38569428 DOI: 10.1016/j.intimp.2024.111992] [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: 01/15/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/05/2024]
Abstract
Intervertebral disc degeneration (IDD) is one of the primary causes of low back pain (LBP), which seriously affects patients' quality of life. In recent years, interleukin (IL)-17 has been shown to be highly expressed in the intervertebral disc (IVD) tissues and serum of patients with IDD, and IL-17A has been shown to promote IDD through multiple pathways. We first searched databases such as PubMed, Cochrane, Embase, and Web of Science using the search terms "IL-17 or interleukin 17″ and "intervertebral discs". The search period ranged from the inception of the databases to December 2023. A total of 24 articles were selected after full-text screening. The main conclusion of the clinical studies was that IL-17A levels are significantly increased in the IVD tissues and serum of IDD patients. The results from the in vitro studies indicated that IL-17A can activate signaling pathways such as the NF-κB and MAPK pathways; promote inflammatory responses, extracellular matrix degradation, and angiogenesis; and inhibit autophagy in nucleus pulposus cells. The main finding of the in vivo experiments was that puncture of animal IVDs resulted in elevated levels of IL-17A within the IVD, thereby inducing IDD. Clinical studies, in vitro experiments, and in vivo experiments confirmed that IL-17A is closely related to IDD. Therefore, drugs that target IL-17A may be novel treatments for IDD, providing a new theoretical basis for IDD therapy.
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Affiliation(s)
- Bing Peng
- Liuyang Hospital of Traditional Chinese Medicine, Liuyang City, Hunan Province, China; Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qian Li
- Liuyang Hospital of Traditional Chinese Medicine, Liuyang City, Hunan Province, China
| | - Jiangping Chen
- Liuyang Hospital of Traditional Chinese Medicine, Liuyang City, Hunan Province, China
| | - Zhexiang Wang
- Hunan Provincial Hospital of Integrative Traditional Chinese and Western Medicine, Changsha City, Hunan Province, China.
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Cardoso L, Khadka N, Dmochowski JP, Meneses E, Lee K, Kim S, Jin Y, Bikson M. Computational modeling of posteroanterior lumbar traction by an automated massage bed: predicting intervertebral disc stresses and deformation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:931274. [PMID: 36189059 PMCID: PMC9397988 DOI: 10.3389/fresc.2022.931274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022]
Abstract
Spinal traction is a physical intervention that provides constant or intermittent stretching axial force to the lumbar vertebrae to gradually distract spinal tissues into better alignment, reduce intervertebral disc (IVD) pressure, and manage lower back pain (LBP). However, such axial traction may change the normal lordotic curvature, and result in unwanted side effects and/or inefficient reduction of the IVD pressure. An alternative to axial traction has been recently tested, consisting of posteroanterior (PA) traction in supine posture, which was recently shown effective to increase the intervertebral space and lordotic angle using MRI. PA traction aims to maintain the lumbar lordosis curvature throughout the spinal traction therapy while reducing the intradiscal pressure. In this study, we developed finite element simulations of mechanical therapy produced by a commercial thermo-mechanical massage bed capable of spinal PA traction. The stress relief produced on the lumbar discs by the posteroanterior traction system was investigated on human subject models with different BMI (normal, overweight, moderate obese and extreme obese BMI cases). We predict typical traction levels lead to significant distraction stresses in the lumbar discs, thus producing a stress relief by reducing the compression stresses normally experienced by these tissues. Also, the stress relief experienced by the lumbar discs was effective in all BMI models, and it was found maximal in the normal BMI model. These results are consistent with prior observations of therapeutic benefits derived from spinal AP traction.
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Affiliation(s)
- Luis Cardoso
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
- *Correspondence: Luis Cardoso
| | - Niranjan Khadka
- Division of Neuropsychiatry and Neuromodulation, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Jacek P. Dmochowski
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
| | - Edson Meneses
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
| | - Kiwon Lee
- Clinical Research Institute, Ceragem Clinical Inc., Seoul, South Korea
| | - Sungjin Kim
- Clinical Research Institute, Ceragem Clinical Inc., Seoul, South Korea
| | - Youngsoo Jin
- Clinical Research Institute, Ceragem Clinical Inc., Seoul, South Korea
- Asan Medical Center, Seoul, South Korea
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
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Yoon YS, Lee JH, Lee M, Kim KE, Jang HY, Lee KJ, Bajgai J, Kim CS, Cho IY. Mechanical Changes of the Lumbar Intervertebral Space and Lordotic Angle Caused by Posterior-to-Anterior Traction Using a Spinal Thermal Massage Device in Healthy People. Healthcare (Basel) 2021; 9:healthcare9070900. [PMID: 34356278 PMCID: PMC8307674 DOI: 10.3390/healthcare9070900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022] Open
Abstract
Background: The axial (horizontal) traction approach has been traditionally used for treatment of low back pain-related spinal disorders such as nuclear protrusion, primary posterolateral root pain, and lower thoracic disc herniation; however, it is known to have some technical limitations due to reductions of the spinal curve. Lumbar lordosis plays a pivotal function in maintaining sagittal balance. Recently, vertical traction and combination traction have been attracting attention due to improving therapeutic outcomes, although evidence of their clinical application is rare; therefore, this study was conducted to investigate the mechanical changes of lumbar intervertebral space, lordotic angle, and the central spinal canal area through vertical traction treatment using a spinal massage device in healthy participants. Methods: In total, 10 healthy subjects with no musculoskeletal disorders and no physical activity restrictions participated. The participants lay on the experimental device (CGM MB-1901) in supine extended posture and vertical traction force was applied in a posterior-to-anterior direction on the L3–4 and L4–5 lumbar sections at level 1 (baseline) and level 9 (traction mode). Magnetic resonance (MR) images were recorded directly under traction mode using the MRI scanner. The height values of the intervertebral space (anterior, center, and posterior parts) and lordosis angle of the L3–4 and L4–5 sections were measured using Image J software and the central spinal canal area (L4–5) was observed through superimposition method using the MR images. All measurement and image analyses were conducted by 2 experienced radiologists under a single-blinded method. Results: The average height values of the intervertebral space under traction mode were significantly increased in both L3–4 and L4–5 sections compared to baseline, particularly in the anterior and central parts but not in the posterior part. Cobb’s angle also showed significant increases in both L3–4 and L4–5 sections compared to baseline (p < 0.001). The central spinal canal area showed a slightly expanded feature in traction mode. Conclusions: In this pilot experiment, posterior-to-anterior vertical traction on L3–4 and L4–5 sections using a spinal massage device caused positive and significant changes based on increases of the intervertebral space height, lumbar lordosis angle, and central spinal canal area compared to the baseline condition. Our results are expected to be useful as underlying data for the clinical application of vertical traction.
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Affiliation(s)
- Yong-Soon Yoon
- Presbyterian Medical Center, Department of Physical Medicine & Rehabilitation, 365, Seowon-ro, Wansan-gu, Jeonju-si 54987, Korea; (Y.-S.Y.); (J.-H.L.)
| | - Jong-Hoo Lee
- Presbyterian Medical Center, Department of Physical Medicine & Rehabilitation, 365, Seowon-ro, Wansan-gu, Jeonju-si 54987, Korea; (Y.-S.Y.); (J.-H.L.)
| | - Mihyun Lee
- Department of Physical Education, Sungkyul University, 53, Seonggyeoldaehak-ro, Manan-gu, Anyang-si 14097, Korea;
| | - Ka-Eun Kim
- College of Medical Sciences, Jeonju University, 303, Cheonjam-ro, Wansan-gu, Jeonju-si 55069, Korea;
| | - Hong-Young Jang
- Department of Medical Sciences Convergence Research Center for Medical Sciences, Jeonju University, 303, Cheonjam-ro, Wansan-gu, Jeonju-si 55069, Korea;
| | - Kyu-Jae Lee
- Department of Environmental Medical Biology, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea; (K.-J.L.); (J.B.); (C.-S.K.)
| | - Johny Bajgai
- Department of Environmental Medical Biology, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea; (K.-J.L.); (J.B.); (C.-S.K.)
| | - Cheol-Su Kim
- Department of Environmental Medical Biology, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea; (K.-J.L.); (J.B.); (C.-S.K.)
| | - Il-Young Cho
- Department of Medical Sciences Convergence Research Center for Medical Sciences, Jeonju University, 303, Cheonjam-ro, Wansan-gu, Jeonju-si 55069, Korea;
- Correspondence: ; Tel.: +82-63-220-3125
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Lai A, Gansau J, Gullbrand SE, Crowley J, Cunha C, Dudli S, Engiles JB, Fusellier M, Goncalves RM, Nakashima D, Okewunmi J, Pelletier M, Presciutti SM, Schol J, Takeoka Y, Yang S, Yurube T, Zhang Y, Iatridis JC. Development of a standardized histopathology scoring system for intervertebral disc degeneration in rat models: An initiative of the ORS spine section. JOR Spine 2021; 4:e1150. [PMID: 34337335 PMCID: PMC8313153 DOI: 10.1002/jsp2.1150] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/09/2021] [Accepted: 04/18/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Rats are a widely accepted preclinical model for evaluating intervertebral disc (IVD) degeneration and regeneration. IVD morphology is commonly assessed using histology, which forms the foundation for quantifying the state of IVD degeneration. IVD degeneration severity is evaluated using different grading systems that focus on distinct degenerative features. A standard grading system would facilitate more accurate comparison across laboratories and more robust comparisons of different models and interventions. AIMS This study aimed to develop a histology grading system to quantify IVD degeneration for different rat models. MATERIALS & METHODS This study involved a literature review, a survey of experts in the field, and a validation study using 25 slides that were scored by 15 graders from different international institutes to determine inter- and intra-rater reliability. RESULTS A new IVD degeneration grading system was established and it consists of eight significant degenerative features, including nucleus pulposus (NP) shape, NP area, NP cell number, NP cell morphology, annulus fibrosus (AF) lamellar organization, AF tears/fissures/disruptions, NP-AF border appearance, as well as endplate disruptions/microfractures and osteophyte/ossification. The validation study indicated this system was easily adopted, and able to discern different severities of degenerative changes from different rat IVD degeneration models with high reproducibility for both experienced and inexperienced graders. In addition, a widely-accepted protocol for histological preparation of rat IVD samples based on the survey findings include paraffin embedding, sagittal orientation, section thickness < 10 μm, and staining using H&E and/or SO/FG to facilitate comparison across laboratories. CONCLUSION The proposed histological preparation protocol and grading system provide a platform for more precise comparisons and more robust evaluation of rat IVD degeneration models and interventions across laboratories.
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Affiliation(s)
- Alon Lai
- Leni and Peter W. May Department of OrthopaedicsIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Jennifer Gansau
- Leni and Peter W. May Department of OrthopaedicsIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sarah E. Gullbrand
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - James Crowley
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical SchoolUniversity of New South WalesSydneyAustralia
| | - Carla Cunha
- i3S‐Instituto de Investigação e InovaçãoemSaúdeUniversidade do PortoPortoPortugal
| | - Stefan Dudli
- University Clinic of Rheumatology, Center of Experimental RheumatologyBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Julie B. Engiles
- Department of Pathobiology, New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Marion Fusellier
- Regenerative Medicine and Skeleton, Inserm, UMR 1229, RMeSUniversité de Nantes, ONIRISNantes CedexFrance
| | - Raquel M. Goncalves
- i3S‐Instituto de Investigação e InovaçãoemSaúdeUniversidade do PortoPortoPortugal
- Instituto de CiênciasBiomédicas Abel SalazarUniversidade do PortoPortoPortugal
| | - Daisuke Nakashima
- Department of Orthopaedic SurgeryKeio University School of MedicineTokyoJapan
| | - Jeffrey Okewunmi
- Leni and Peter W. May Department of OrthopaedicsIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Matthew Pelletier
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical SchoolUniversity of New South WalesSydneyAustralia
| | | | - Jordy Schol
- Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan
| | - Yoshiki Takeoka
- Department of Orthopaedic SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Sidong Yang
- Department of Spinal SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Takashi Yurube
- Department of Orthopaedic SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Yejia Zhang
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - James C. Iatridis
- Leni and Peter W. May Department of OrthopaedicsIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Lumbar mechanical traction: a biomechanical assessment of change at the lumbar spine. BMC Musculoskelet Disord 2019; 20:155. [PMID: 30961554 PMCID: PMC6454715 DOI: 10.1186/s12891-019-2545-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 03/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lumbar traction is a traditional treatment modality for chronic low back pain (CLBP) in many countries. However, its effectiveness has not been demonstrated in clinical practice because of the following: (1) the lack of in vivo biomechanical confirmation of the mechanism of lumbar traction that occurs at the lumbar spine; (2) the lack of a precise delivery system for traction force and, subsequently, the lack of reproducibility; and (3) few randomized controlled trials proving its effectiveness and utility. METHODS This study was planned as a preparatory experiment for a randomized clinical trial, and it aimed (1) to examine the biomechanical change at the lumbar area under lumbar traction and confirm its reproducibility and accuracy as a mechanical intervention, and (2) to reconfirm our clinical impression of the immediate effect of lumbar traction. One hundred thirty-three patients with non-specific CLBP were recruited from 28 orthopaedic clinics to undergo a biomechanical experiment and to assess and determine traction conditions for the next clinical trial. We used two types of traction devices, which are commercially available, and incorporated other measuring tools, such as an infrared range-finder and large extension strain gauge. The finite element method was used to analyze the real data of pelvic girdle movement at the lumbar spine level. Self-report assessments with representative two conditions were analyzed according to the qualitative coding method. RESULTS Thirty-eight participants provided available biomechanical data. We could not measure directly what happened in the body, but we confirmed that the distraction force lineally correlated with the movement of traction unit at the pelvic girdle. After applying vibration force to preloading, the strain gauge showed proportional vibration of the shifting distance without a phase lag qualitatively. FEM simulation provided at least 3.0-mm shifting distance at the lumbar spine under 100 mm of body traction. Ninety-five participants provided a treatment diary and were classified as no pain, improved, unchanged, and worsened. Approximately 83.2% of participants reported a positive response. CONCLUSION Lumbar traction can provide a distractive force at the lumbar spine, and patients who experience the application of such force show an immediate response after traction. TRIAL REGISTRATION University Hospital Medical Information Network - Clinical Trial Registration: UMIN-CTR000024329 (October 13, 2016).
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Fujii K, Yamazaki M, Kang JD, Risbud MV, Cho SK, Qureshi SA, Hecht AC, Iatridis JC. Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment. JBMR Plus 2019; 3:e10180. [PMID: 31131347 PMCID: PMC6524679 DOI: 10.1002/jbm4.10180] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/21/2018] [Accepted: 01/30/2019] [Indexed: 12/11/2022] Open
Abstract
Discogenic back pain is multifactorial; hence, physicians often struggle to identify the underlying source of the pain. As a result, discogenic back pain is often hard to treat—even more so when clinical treatment strategies are of questionable efficacy. Based on a broad literature review, our aim was to define discogenic back pain into a series of more specific and interacting pathologies, and to highlight the need to develop novel approaches and treatment strategies for this challenging and unmet clinical need. Discogenic pain involves degenerative changes of the intervertebral disc, including structural defects that result in biomechanical instability and inflammation. These degenerative changes in intervertebral discs closely intersect with the peripheral and central nervous systems to cause nerve sensitization and ingrowth; eventually central sensitization results in a chronic pain condition. Existing imaging modalities are nonspecific to pain symptoms, whereas discography methods that are more specific have known comorbidities based on intervertebral disc puncture and injection. As a result, alternative noninvasive and specific diagnostic methods are needed to better diagnose and identify specific conditions and sources of pain that can be more directly treated. Currently, there are many treatments/interventions for discogenic back pain. Nevertheless, many surgical approaches for discogenic pain have limited efficacy, thus accentuating the need for the development of novel treatments. Regenerative therapies, such as biologics, cell‐based therapy, intervertebral disc repair, and gene‐based therapy, offer the most promise and have many advantages over current therapies. © 2019 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research
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Affiliation(s)
- Kengo Fujii
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA.,Department of Orthopaedic Surgery University of Tsukuba Tsukuba Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery University of Tsukuba Tsukuba Japan
| | - James D Kang
- Department of Orthopaedic Surgery Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Makarand V Risbud
- Department of Orthopaedic Surgery Sidney Kimmel Medical College Thomas Jefferson University Philadelphia PA USA
| | - Samuel K Cho
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery Hospital for Special Surgery New York NY USA
| | - Andrew C Hecht
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA
| | - James C Iatridis
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA
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Mitchell UH, Beattie PF, Bowden J, Larson R, Wang H. Age-related differences in the response of the L5-S1 intervertebral disc to spinal traction. Musculoskelet Sci Pract 2017. [PMID: 28624722 DOI: 10.1016/j.msksp.2017.06.004] [Citation(s) in RCA: 7] [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] [Indexed: 01/07/2023]
Abstract
BACKGROUND Lumbar traction is a common treatment for low back pain; however its mechanisms of action are poorly understood. It has been hypothesized that a key effect of lumbar traction is its capacity to influence fluid movement within the intervertebral disc (IVD). OBJECTIVES To determine differences in the apparent diffusion coefficient (ADC) obtained with lumbar diffusion-weighted imaging (DWI) of the L5-S1 IVD before, and during, the application of lumbar traction. DESIGN Case series, repeated measures. METHODS A static traction load of ∼50% of body-weight was applied to the low back using a novel "MRI-safe" apparatus. DWI of the lumbar spine was performed prior to, and during the application of the traction load. RESULTS Participants were currently asymptomatic and included a young adult group (n = 18) and a middle-aged group (n = 15). The young adult group had a non-significant 2.2% increase in ADC (mean change = 0.03 × 10-3 mm2/s, SD = 0.24, 95% CI = -0.09, 0.15). The ADC for the middle-aged group significantly increased by 20% (mean change of 0.18 × 10-3 mm2/s, SD = 0.19; 95% CI = 0.07, 0.28; p = 0.003; effect size = 0.95). There was an inverse relationship between the ADC obtained before traction and the percent increase in ADC that was measured during traction. CONCLUSION Static traction was associated with an increase in diffusion of water within the L5-S1 IVDs of middle-age individuals, but not in young adults, suggesting age-related differences in the diffusion response. Further study is needed to assess the relationship between these findings and the symptoms of back pain. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, 106 Smith Fieldhouse, Provo, UT, 84602, USA.
| | - Paul F Beattie
- Doctoral Program in Physical Therapy, Department of Exercise Science, Arnold School of Public Health, 1300 Wheat St., University of South Carolina, Columbia, SC, 29208, USA
| | - Jennifer Bowden
- Department of Exercise Sciences, Brigham Young University, 106 Smith Fieldhouse, Provo, UT, 84602, USA
| | - Robert Larson
- Department of Exercise Sciences, Brigham Young University, 106 Smith Fieldhouse, Provo, UT, 84602, USA
| | - Haonan Wang
- Department of Electrical & Computer Engineering, Brigham Young University, 459 Clyde Building, Provo, UT, 84602, USA
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Mitchell UH, Helgeson K, Mintken P. Physiological effects of physical therapy interventions on lumbar intervertebral discs: A systematic review. Physiother Theory Pract 2017; 33:695-705. [PMID: 28715273 DOI: 10.1080/09593985.2017.1345026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND CONTEXT The use of physical therapy has been recommended in the treatment of low back pain based on primarily mechanical and neurophysiological effects. Recent studies have measured the physiological effects of physical therapy interventions, including manual therapy and traction, on the intervertebral discs (IVD), and these findings may have implications for the long-term management or even prevention of low back pain. PURPOSE The objective of this systematic review is to investigate the literature regarding possible physiological effects of physical therapy interventions on the intervertebral disc (IVD). STUDY DESIGN Systematic Review. METHODS A literature search of published articles through December 2014 resulted in the retrieval of 8 clinical studies assessing the influence of physical therapy interventions on the physiology of the IVD. RESULTS Three studies, including two using animal models, investigated the effects of 30-minute intermittent traction on disc height. One in vivo animal study and two studies using human subjects assessed changes of disc height associated with static traction. Three studies investigated the effects of lumbar spine manipulation and mobilization on changes in water diffusion within the IVD. All studies confirmed, either directly or indirectly, that their respective intervention influenced disc physiology primarily through water flow. CONCLUSION Physical therapy interventions may have an effect on the physiology of the IVD, primarily through water diffusion and molecular transport, which are important for the health of the IVD.
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Affiliation(s)
- Ulrike H Mitchell
- a Department of Exercise Sciences , Brigham Young University , Provo , UT , USA
| | - Kevin Helgeson
- b Department of Physical Therapy, Rocky Mountain University of Health Professions , Provo , UT , USA
| | - Paul Mintken
- c Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine , Aurora , CO , USA
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Mechanical effects of traction on lumbar intervertebral discs: A magnetic resonance imaging study. Musculoskelet Sci Pract 2017; 29:78-83. [PMID: 28347933 DOI: 10.1016/j.msksp.2017.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 03/08/2017] [Accepted: 03/18/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although traction has long been used for treating patients with low back pain (LBP), its effects are still inconclusive mainly because of limited high-quality evidence. OBJECTIVE To provide evidence of the mechanism of traction on lumbar intervertebral discs. DESIGN A quantitative approach with a repeated measurement protocol. METHOD Nine participants (mean age = 22.1 ± 0.8 years) without any LBP history were recruited. Magnetic Resonance Images of the lumbar spine of each participant were recorded before and after 30 min of horizontal lying and directly after 30 min of horizontal traction of 42% body weight. The average, anterior, central, and posterior disc height and tilt angle of each lumbar disc and lumbar lordosis were measured. RESULTS A significant increase in the average disc height for all lumbar discs, a significant reduction of lumbar lordosis and changes in tilt angle were observed after the application of 30 min of resting followed by 30 min of traction. A significant increase in the average disc height was observed only in lower lumbar discs after 30 min of traction. The increase in the posterior disc height was more apparent than that in the anterior disc height. CONCLUSIONS Horizontal traction was evidently effective in increasing the disc height of lower lumbar levels, particularly in the posterior regions of the discs. Further evidence of the effects of traction of different modes, magnitudes, and durations on the change in disc height is required for proper control of traction applied to specific disc levels.
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Manchikanti L, Hirsch JA. An update on the management of chronic lumbar discogenic pain. Pain Manag 2015; 5:373-86. [PMID: 26255722 DOI: 10.2217/pmt.15.33] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Lumbar degenerative disc disease without disc herniation, also known as discogenic pain, is an elusive diagnosis of chronic low back pain. Lumbar provocation discography and fusion surgery have been frequently utilized for several decades as the gold standards for the diagnosis and treatment of symptomatic lumbar discogenic pain, though controversial, based on conjecture, rather than evidence. In addition to lumbar fusion, various other operative and nonoperative modalities of treatments are available in managing chronic lumbar discogenic pain. This review provides an updated assessment of the management of chronic lumbar discogenic pain with a critical look at the many modalities of treatments that are currently available.
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Affiliation(s)
- Laxmaiah Manchikanti
- Pain Management Center of Paducah, Paducah, KY 42003, USA.,Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY 40292, USA
| | - Joshua A Hirsch
- NeuroInterventional Services & Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Han C, Ma XL, Wang T, Ma JX, Tian P, Zang JC, Kong JB, Li XD. Low magnitude of tensile stress represses the inflammatory response at intervertebral disc in rats. J Orthop Surg Res 2015; 10:26. [PMID: 25886263 PMCID: PMC4333165 DOI: 10.1186/s13018-015-0159-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/07/2015] [Indexed: 01/08/2023] Open
Abstract
Objective This study aims to determine if the involvement of tensile stress affects the expressions of inflammatory cytokines interleukin-17(IL-17), interleukin-1β (IL-1β), and inducible nitric oxide synthase (iNOS) at intervertebral discs in vivo. Material and method Sixty-four female Sprague–Dawley rats were randomly divided into four groups: sham, tail-suspended (TS), tail-suspended with needle puncture (TSNP), and single-needle puncture (SNP) groups. A tail-suspension device provides low magnitude of tensile stress (2.45 Newton (N)), and aseptic needle puncture on the tail disc induces inflammatory response. After 4 weeks, the treated discs were harvested for histologic analysis, quantitative real-time reverse transcription-polymerase chain reaction (RT-qPCR), and enzyme-linked immunosorbent assay (ELISA). Result Pathological examination demonstrated that compared to the sham group, the morphologies of nucleus pulposus (NP) and anulus fibrosus (AF) in TS, SNP, and TSNP groups displayed degenerative changes in varying degrees. Results from RT-qPCR showed that IL-17 and iNOS mRNA expression levels were significantly higher in both TSNP and SNP groups than those in the sham groups. Expression of IL-17 and iNOS are not significantly different between the sham and TS groups (P > 0.05). Compared with the SNP group, the mRNA expression of IL-17 and iNOS in the TSNP groups were markedly decreased (P < 0.05). The regulation of IL-1β and IL-17 detected by ELISA was coincident with the qRT-PCR results. Conclusion The results from this study suggested that relatively low magnitude tensile stress might play an essential role in the anti-inflammatory process and the relief of low-back pain (LBP).
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Affiliation(s)
- Chao Han
- Department of Orthopaedics, Tianjin Medical University General Hospital, No.154 Anshan Road, Heping District, Tianjin City, 300052, PR China. .,Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Xin-Long Ma
- Department of Orthopaedics, Tianjin Medical University General Hospital, No.154 Anshan Road, Heping District, Tianjin City, 300052, PR China. .,Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Tao Wang
- Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Jian-Xiong Ma
- Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Peng Tian
- Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Jia-Cheng Zang
- Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Jing-Bo Kong
- Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Xiao-Dan Li
- Department of Anesthesiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin City, 300192, PR China.
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Abstract
STUDY DESIGN Systematic review of the literature. OBJECTIVE A systematic evaluation of the literature was performed to investigate current nonoperative management of the treatment of discogenic low back pain. SUMMARY OF BACKGROUND DATA Back pain is a major health care concern with up to 39% being discogenic in origin according to one study. Nonoperative therapy is likely to be the initial treatment strategy for discogenic low back pain. METHODS PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for clinical studies evaluating nonoperative methods of treating discogenic back pain that were published between 2000 and 2012. Only prospective randomized controlled studies that compared a nonsurgical intervention with sham or placebo therapy were included. After removal of duplicate citations, a total of 226 articles were initially identified from the search terms. From these, we identified 11 randomized controlled trials (RCTs) from which data analysis was performed. RESULTS The 11 RCTs investigated traction therapy, injections, and ablative techniques. Results from 5 RCTs investigating methylene blue injection, steroid injection, ramus communicans ablation, intradiscal electrothermal therapy, and biacuplasty favored intervention over sham therapy. However, results from the study on methylene blue injections have not been replicated in other RCTs. Evaluation of the selection criteria used in the studies on ramus communicans ablation and intradiscal biacuplasty and a stratified analysis of results from the RCTs on intradiscal electrothermal therapy casts doubt on whether the conclusions from these RCTs can be applied to the general patient population with discogenic pain. CONCLUSION There are few high-quality studies evaluating nonoperative treatments for reducing discogenic low back pain. Although conclusions from several studies favor intervention over sham, it is unclear whether these interventions confer stable long-term benefit. There is some promise in newer modalities such as biacuplasty; however, more inclusive studies need to be performed.
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BRANDOLINI NICOLA, CRISTOFOLINI LUCA, VICECONTI MARCO. EXPERIMENTAL METHODS FOR THE BIOMECHANICAL INVESTIGATION OF THE HUMAN SPINE: A REVIEW. J MECH MED BIOL 2014. [DOI: 10.1142/s0219519414300026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In vitro mechanical testing of spinal specimens is extremely important to better understand the biomechanics of the healthy and diseased spine, fracture, and to test/optimize surgical treatment. While spinal testing has extensively been carried out in the past four decades, testing methods are quite diverse. This paper aims to provide a critical overview of the in vitro methods for mechanical testing the human spine at different scales. Specimens of different type are used, according to the aim of the study: spine segments (two or more adjacent vertebrae) are used both to investigate the spine kinematics, and the mechanical properties of the spine components (vertebrae, ligaments, discs); single vertebrae (whole vertebra, isolated vertebral body, or vertebral body without endplates) are used to investigate the structural properties of the vertebra itself; core specimens are extracted to test the mechanical properties of the trabecular bone at the tissue-level; mechanical properties of spine soft tissue (discs, ligaments, spinal cord) are measured on isolated elements, or on tissue specimens. Identification of consistent reference frames is still a debated issue. Testing conditions feature different pre-conditioning and loading rates, depending on the simulated action. Tissue specimen preservation is a very critical issue, affecting test results. Animal models are often used as a surrogate. However, because of different structure and anatomy, extreme caution is required when extrapolating to the human spine. In vitro loading conditions should be based on reliable in vivo data. Because of the high complexity of the spine, such information (either through instrumented implants or through numerical modeling) is currently unsatisfactory. Because of the increasing ability of computational models in predicting biomechanical properties of musculoskeletal structures, a synergy is possible (and desirable) between in vitro experiments and numerical modeling. Future perspectives in spine testing include integration of mechanical and structural properties at different dimensional scales (from the whole-body-level down to the tissue-level) so that organ-level models (which are used to predict the most relevant phenomena such as fracture) include information from all dimensional scales.
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Affiliation(s)
- NICOLA BRANDOLINI
- Laboratory for Medical Technology, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
- School of Mechanical Engineering, University of Leeds, Woodhouse Lane, LS2 9JT Leeds, UK
| | - LUCA CRISTOFOLINI
- Department of Industrial Engineering, School of Engineering and Architecture, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - MARCO VICECONTI
- Laboratory for Medical Technology, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
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Key S, Adams MA, Stefanakis M. Healing of painful intervertebral discs: implications for physiotherapy Part 2 — pressure change therapy: a proposed clinical model to stimulate disc healing. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Histomorphometric and radiographical changes after lumbar implantation of the PEEK nonfusion interspinous device in the BB.4S rat model. Spine (Phila Pa 1976) 2013; 38:E263-9. [PMID: 23222648 DOI: 10.1097/brs.0b013e318280c710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN An experimental animal study. OBJECTIVE To investigate histomorphometric and radiographical changes in the BB.4S rat model after PEEK (polyetheretherketone) nonfusion interspinous device implantation. SUMMARY OF BACKGROUND DATA Clinical effectiveness of the PEEK nonfusion spine implant Wallis (Abbott, Bordeaux, France; now Zimmer, Warsaw, IN) is well documented. However, there is a lack of evidence on the long-term effects of this implant on bone, in particular its influence on structural changes of bone elements of the lumbar spine. METHODS Twenty-four male BB.4S rats aged 11 weeks underwent surgery for implantation of a PEEK nonfusion interspinous device or for a sham procedure in 3 groups of 8 animals each: (1) implantation at level L4-L5; (2) implantation at level L5-L6; and (3) sham surgery. Eleven weeks postoperatively osteolyses at the implant-bone interface were measured via radiograph, bone mineral density of vertebral bodies was analyzed using osteodensitometry, and bone mineral content as well as resorption of the spinous processes were examined by histomorphometry. RESULTS.: Resorption of the spinous processes at the site of the interspinous implant was found in all treated segments. There was no significant difference in either bone density of vertebral bodies or histomorphometric structure of the spinous processes between adjacent vertebral bodies, between treated and untreated segments and between groups. CONCLUSION These findings indicate that resorption of spinous processes because of a result of implant loosening, inhibit the targeted load redistribution through the PEEK nonfusion interspinous device in the lumbar spinal segment of the rat. This leads to reduced long-term stability of the implant in the animal model. These results suggest that PEEK nonfusion interspinous devices like the Wallis implants may have time-limited effects and should only be used for specified indications.
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Chow DHK, Lai A, Tang FH, Leung MCP. Effects of Panax ginseng-containing herbal plasters on compressed intervertebral discs in an in vivo rat tail model. Chin Med 2013; 8:4. [PMID: 23419188 PMCID: PMC3585783 DOI: 10.1186/1749-8546-8-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 02/14/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Tienchi (Panax notoginseng) has been used in conservative treatments for back pain as a major ingredient of many herbal medicines. This study aims to investigate the effects of a herbal medicine containing tienchi on compressed intervertebral discs in rats. METHODS Using an in vivo rat tail model, intervertebral disc compression was simulated in the caudal 8-9 discs of 25 rats by continuous static compression (11 N) for 2 weeks. An herbal medicine plaster (in which the major ingredient was tienchi) was externally applied to the compressed disc (n=9) for three weeks, and held in place by an adhesive bandage, in animals in the Chinese Medicine (CM) group. The effect of the bandage was evaluated in a separate placebo group (n=9), while no intervention with unrestricted motion was provided to rats in an additional control group (n=7). Disc structural properties were quantified by in vivo disc height measurement and in vitro morphological analysis. RESULTS Disc height decreased after the application of compression (P < 0.001). The disc height decreased continuously in the control (P = 0.006) and placebo (P = 0.003) groups, but was maintained in the CM group (P = 0.494). No obvious differences in disc morphology were observed among the three groups (P = 0.896). CONCLUSION The tienchi-containing herbal plaster had no significant effect on the morphology of compressed discs, but maintained disc height in rats.
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Affiliation(s)
- Daniel H K Chow
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, PR China.
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Kim JS, Kroin JS, Li X, An HS, Buvanendran A, Yan D, Tuman KJ, van Wijnen AJ, Chen D, Im HJ. The rat intervertebral disk degeneration pain model: relationships between biological and structural alterations and pain. Arthritis Res Ther 2011; 13:R165. [PMID: 21996269 PMCID: PMC3308099 DOI: 10.1186/ar3485] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 06/09/2011] [Accepted: 10/13/2011] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Degeneration of the interverterbral disk is as a cause of low-back pain is increasing. To gain insight into relationships between biological processes, structural alterations and behavioral pain, we created an animal model in rats. METHODS Disk degeneration was induced by removal of the nucleus pulposus (NP) from the lumbar disks (L4/L5 and L5/L6) of Sprague Dawley rats using a 0.5-mm-diameter microsurgical drill. The degree of primary hyperalgesia was assessed by using an algometer to measure pain upon external pressure on injured lumbar disks. Biochemical and histological assessments and radiographs of injured disks were used for evaluation. We investigated therapeutic modulation of chronic pain by administering pharmaceutical drugs in this animal model. RESULTS After removal of the NP, pressure hyperalgesia developed over the lower back. Nine weeks after surgery we observed damaged or degenerated disks with proteoglycan loss and narrowing of disk height. These biological and structural changes in disks were closely related to the sustained pain hyperalgesia. A high dose of morphine (6.7 mg/kg) resulted in effective pain relief. However, high doses of pregabalin (20 mg/kg), a drug that has been used for treatment of chronic neuropathic pain, as well as the anti-inflammatory drugs celecoxib (50 mg/kg; a selective inhibitor of cyclooxygenase 2 (COX-2)) and ketorolac (20 mg/kg; an inhibitor of COX-1 and COX-2), did not have significant antihyperalgesic effects in our disk injury animal model. CONCLUSIONS Although similarities in gene expression profiles suggest potential overlap in chronic pain pathways linked to disk injury or neuropathy, drug-testing results suggest that pain pathways linked to these two chronic pain conditions are mechanistically distinct. Our findings provide a foundation for future research on new therapeutic interventions that can lead to improvements in the treatment of patients with back pain due to disk degeneration.
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Affiliation(s)
- Jae-Sung Kim
- Department of Biochemistry, Rush University Medical Center, Cohn Research BD 516, 1735 West Harrison Street, Chicago, IL 60612, USA
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