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Dhiman MS, Bader TJ, Ponjevic D, Salo PT, Hart DA, Swamy G, Matyas JR, Duncan NA. Collagen integrity of the annulus fibrosus in degenerative disc disease individuals quantified with collagen hybridizing peptide. JOR Spine 2024; 7:e1359. [PMID: 39092166 PMCID: PMC11291301 DOI: 10.1002/jsp2.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/27/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction Degenerative disc disease (DDD) is accompanied by structural changes in the intervertebral discs (IVD). Extra-cellular matrix degradation of the annulus fibrosus (AF) has been linked with degeneration of the IVD. Collagen is a vital component of the IVD. Collagen hybridizing peptide (CHP) is an engineered protein that binds to degraded collagen, which we used to quantify collagen damage in AF. This method was used to compare AF samples obtained from donors with no DDD to AF samples from patients undergoing surgery for symptomatic DDD. Methods Fresh AF tissue was embedded in an optimal cutting temperature compound and cryosectioned at a thickness of 8 μm. Hematoxylin and Eosin staining was performed on sections for general histomorphological assessment. Serial sections were stained with Cy3-conjugated CHP and the mean fluorescence intensity and areal fraction of Cy3-positive staining were averaged for three regions of interest (ROI) on each CHP-stained section. Results Increases in mean fluorescence intensity (p = 0.0004) and percentage of positively stained area (p = 0.00008) with CHP were detected in DDD samples compared to the non-DDD samples. Significant correlations were observed between mean fluorescence intensity and percentage of positively stained area for both non-DDD (R = 0.98, p = 5E-8) and DDD (R = 0.79, p = 0.0012) samples. No significant differences were detected between sex and the lumbar disc level subgroups of the non-DDD and DDD groups. Only tissue pathology (non-DDD versus DDD) influenced the measured parameters. No three-way interactions between tissue pathology, sex, and lumbar disc level were observed. Discussion and Conclusions These findings suggest that AF collagen degradation is greater in DDD samples compared to non-DDD samples, as evidenced by the increased CHP staining. Strong positive correlations between the two measured parameters suggest that when collagen degradation occurs, it is detected by this technique and is widespread throughout the tissue. This study provides new insights into the structural alterations associated with collagen degradation in the AF that occur during DDD.
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Affiliation(s)
- Manmeet S. Dhiman
- Department of Biomedical EngineeringUniversity of CalgaryCalgaryAlbertaCanada
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Taylor J. Bader
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Medical SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Dragana Ponjevic
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of Veterinary MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Paul T. Salo
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Surgery, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - David A. Hart
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Surgery, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Ganesh Swamy
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Surgery, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - John R. Matyas
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of Veterinary MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Neil A. Duncan
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Civil EngineeringUniversity of CalgaryCalgaryAlbertaCanada
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Yang S, Zhu Y, Shi Y, Su S, Liang H, Li S, Wu Z, Miao J, Chen Y, Zhang X, Wang X. Screening of NSAIDs library identifies Tinoridine as a novel ferroptosis inhibitor for potential intervertebral disc degeneration therapy. Free Radic Biol Med 2024; 221:245-256. [PMID: 38806104 DOI: 10.1016/j.freeradbiomed.2024.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 05/30/2024]
Abstract
Low back pain (LBP) may profoundly impact the quality of life across the globe, and intervertebral disc degeneration (IVDD) is the major cause of LBP; however, targeted pharmaceutical interventions for IVDD are still lacking. Ferroptosis is a novel form of iron-dependent programmed cell death. Studies have showed that ferroptosis may closely associate with IVDD; thus, targeting ferroptosis may have great potential for IVDD therapy. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line medications for LBP, while nuclear factor-erythroid 2-related factor-2 (Nrf2) is a key inhibitory protein for ferroptosis. In the current study, we conducted a molecular docking screening between NSAIDs library and Nrf2 protein. Tinoridine was shown to have a high binding affinity to Nrf2. The in vitro study in nucleus pulposus (NP) cells showed that Tinoridine may promote the expression and activity of Nrf2, it may also rescue RSL3-induced ferroptosis in NP cells. Knockdown of Nrf2 reverses the protective effect of Tinoridine on RSL3-induced ferroptosis in NP cells, suggesting that the inhibitory effect of Tinoridine on ferroptosis is through Nrf2. In vivo study demonstrated that Tinoridine may attenuate the progression of IVDD in rats. As NSAIDs are already clinically used for LBP therapy, the current study supports Tinoridine's application from the view of ferroptosis inhibition.
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Affiliation(s)
- Shu Yang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yuxuan Zhu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yifeng Shi
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Shenkai Su
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Haibo Liang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Sunlong Li
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhouwei Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jiansen Miao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yuli Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiaolei Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
| | - Xiangyang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
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Tang J, Luo Y, Wang Q, Wu J, Wei Y. Stimuli-Responsive Delivery Systems for Intervertebral Disc Degeneration. Int J Nanomedicine 2024; 19:4735-4757. [PMID: 38813390 PMCID: PMC11135562 DOI: 10.2147/ijn.s463939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024] Open
Abstract
As a major cause of low back pain, intervertebral disc degeneration is an increasingly prevalent chronic disease worldwide that leads to huge annual financial losses. The intervertebral disc consists of the inner nucleus pulposus, outer annulus fibrosus, and sandwiched cartilage endplates. All these factors collectively participate in maintaining the structure and physiological functions of the disc. During the unavoidable degeneration stage, the degenerated discs are surrounded by a harsh microenvironment characterized by acidic, oxidative, inflammatory, and chaotic cytokine expression. Loss of stem cell markers, imbalance of the extracellular matrix, increase in inflammation, sensory hyperinnervation, and vascularization have been considered as the reasons for the progression of intervertebral disc degeneration. The current treatment approaches include conservative therapy and surgery, both of which have drawbacks. Novel stimuli-responsive delivery systems are more promising future therapeutic options than traditional treatments. By combining bioactive agents with specially designed hydrogels, scaffolds, microspheres, and nanoparticles, novel stimuli-responsive delivery systems can realize the targeted and sustained release of drugs, which can both reduce systematic adverse effects and maximize therapeutic efficacy. Trigger factors are categorized into internal (pH, reactive oxygen species, enzymes, etc.) and external stimuli (photo, ultrasound, magnetic, etc.) based on their intrinsic properties. This review systematically summarizes novel stimuli-responsive delivery systems for intervertebral disc degeneration, shedding new light on intervertebral disc therapy.
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Affiliation(s)
- Jianing Tang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- First Clinic School, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yuexin Luo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- First Clinic School, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Qirui Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- First Clinic School, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Juntao Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- First Clinic School, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yulong Wei
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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Xi Z, Xie Y, Sun S, Wang N, Chen S, Kang X, Li J. Stepwise reduction of bony density in patients induces a higher risk of annular tears by deteriorating the local biomechanical environment. Spine J 2024; 24:831-841. [PMID: 38232914 DOI: 10.1016/j.spinee.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/15/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND CONTEXT The relationship between osteoporosis and intervertebral disc degeneration (IDD) remains unclear. Considering that annular tear is the primary phenotype of IDD in the lumbar spine, the deteriorating local biomechanical environment may be the main trigger for annular tears. PURPOSE To investigate whether poor bone mineral density (BMD) in the vertebral bodies may increase the risk of annular tears via the degradation of the local biomechanical environment. STUDY DESIGN This study was a retrospective investigation with relevant numerical mechanical simulations. PATIENT SAMPLE A total of 64 patients with low back pain (LBP) and the most severe IDD in the L4-L5 motion segment were enrolled. OUTCOME MEASURES Annulus integration status was assessed using diffusion tensor fibre tractography (DTT). Hounsfield unit (HU) values of adjacent vertebral bodies were employed to determine BMD. Numerical simulations were conducted to compute stress values in the annulus of models with different BMDs and body positions. METHODS The clinical data of the 64 patients with low back pain were collected retrospectively. The BMD of the vertebral bodies was measured using the HU values, and the annulus integration status was determined according to DTT. The data of the patients with and without annular tears were compared, and regression analysis was used to identify the independent risk factors for annular tears. Furthermore, finite element models of the L4-L5 motion segment were constructed and validated, followed by estimating the maximum stress on the post and postlateral interfaces between the superior and inferior bony endplates (BEPs) and the annulus. RESULTS Patients with lower HU values in their vertebral bodies had significantly higher incidence rates of annular tears, with decreased HU values being an independent risk factor for annular tears. Moreover, increased stress on the BEP-annulus interfaces was associated with a stepwise reduction of bony density (ie, elastic modulus) in the numerical models. CONCLUSIONS The stepwise reduction of bony density in patients results in a higher risk of annular tears by deteriorating the local biomechanical environment. Thus, osteoporosis should be considered to be a potential risk factor for IDD biomechanically.
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Affiliation(s)
- Zhipeng Xi
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street , Nanjing, 210028, Jiangsu Province, P.R. China; Department of Orthopedics, Traditional Chinese Medicine Hospital of Ili Kazak Autonomous Prefecture, 2th. Jiankang Street, Yining, 835000, Xinjiang Uighur Autonomous Region, P.R. China
| | - Yimin Xie
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street , Nanjing, 210028, Jiangsu Province, P.R. China
| | - Shenglu Sun
- Department of Imaging, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street , Nanjing, 210028, Jiangsu Province, P.R. China
| | - Nan Wang
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street , Nanjing, 210028, Jiangsu Province, P.R. China
| | - Shuang Chen
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street , Nanjing, 210028, Jiangsu Province, P.R. China
| | - Xiong Kang
- Department of Orthopedics, Traditional Chinese Medicine Hospital of Ili Kazak Autonomous Prefecture, 2th. Jiankang Street, Yining, 835000, Xinjiang Uighur Autonomous Region, P.R. China
| | - Jingchi Li
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, No.182, Chunhui Rd, Longmatan District, Luzhou, 646000, Sichuan Province, P.R. China.
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Couasnay G, Garcia H, Elefteriou F. A comparative analysis of TonEBP conditional knockout mouse models reveals inter-dependency between compartments of the intervertebral disc. Development 2024; 151:dev202354. [PMID: 38421307 PMCID: PMC11006390 DOI: 10.1242/dev.202354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
Interactions between notochord and sclerotome are required for normal embryonic spine patterning, but whether the postnatal derivatives of these tissues also require interactions for postnatal intervertebral disc (IVD) growth and maintenance is less established. We report here the comparative analysis of four conditional knockout mice deficient for TonEBP, a transcription factor known to allow cells to adapt to changes in extracellular osmotic pressure, in specific compartments of the IVD. We show that TonEBP deletion in nucleus pulposus (NP) cells does not affect their survival or aggrecan expression, but promoted cell proliferation in the NP and in adjacent vertebral growth plates (GPs). In cartilage end plates/GPs, TonEBP deletion induced cell death, but also structural alterations in the adjacent NP cells and vertebral bodies. Embryonic or postnatal TonEBP loss generated similar IVD changes. In addition to demonstrating the requirement of TonEBP in the different compartments of the IVD, this comparative analysis uncovers the in vivo interdependency of the different IVD compartments during the growth of the postnatal IVD-vertebral units.
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Affiliation(s)
- Greig Couasnay
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Haley Garcia
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Florent Elefteriou
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
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Cherif H, Li L, Snuggs J, Li X, Sammon C, Li J, Beckman L, Haglund L, Le Maitre CL. Injectable hydrogel induces regeneration of naturally degenerate human intervertebral discs in a loaded organ culture model. Acta Biomater 2024; 176:201-220. [PMID: 38160855 DOI: 10.1016/j.actbio.2023.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
Low back pain resulting from disc degeneration is a leading cause of disability worldwide. However, to date few therapies target the cause and fail to repair the intervertebral disc (IVD). This study investigates the ability of an injectable hydrogel (NPgel), to inhibit catabolic protein expression and promote matrix expression in human nucleus pulposus (NP) cells within a tissue explant culture model isolated from degenerate discs. Furthermore, the injection capacity of NPgel into naturally degenerate whole human discs, effects on mechanical function, and resistance to extrusion during loading were investigated. Finally, the induction of potential regenerative effects in a physiologically loaded human organ culture system was investigated following injection of NPgel with or without bone marrow progenitor cells. Injection of NPgel into naturally degenerate human IVDs increased disc height and Young's modulus, and was retained during extrusion testing. Injection into cadaveric discs followed by culture under physiological loading increased MRI signal intensity, restored natural biomechanical properties and showed evidence of increased anabolism and decreased catabolism with tissue integration observed. These results provide essential proof of concept data supporting the use of NPgel as an injectable therapy for disc regeneration. STATEMENT OF SIGNIFICANCE: Low back pain resulting from disc degeneration is a leading cause of disability worldwide. However, to date few therapies target the cause and fail to repair the intervertebral disc. This study investigated the potential regenerative properties of an injectable hydrogel system (NPgel) within human tissue samples. To mimic the human in vivo conditions and the unique IVD niche, a dynamically loaded intact human disc culture system was utilised. NPgel improved the biomechanical properties, increased MRI intensity and decreased degree of degeneration. Furthermore, NPgel induced matrix production and decreased catabolic factors by the native cells of the disc. This manuscript provides evidence for the potential use of NPgel as a regenerative biomaterial for intervertebral disc degeneration.
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Affiliation(s)
- Hosni Cherif
- Department of Surgery, McGill University, Montreal, QC H3G 1A4, Canada
| | - Li Li
- Department of Surgery, McGill University, Montreal, QC H3G 1A4, Canada
| | - Joseph Snuggs
- Oncology and Metabolism Department, Medical School, & INSIGNEO Institute, University of Sheffield, Sheffield, UK; Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Xuan Li
- Department of Mechanical Engineering, McGill University, Montreal, QC H3A 0C3, Canada
| | - Christopher Sammon
- Materials and Engineering Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Jianyu Li
- Department of Surgery, McGill University, Montreal, QC H3G 1A4, Canada; Department of Mechanical Engineering, McGill University, Montreal, QC H3A 0C3, Canada; Department of Biomedical Engineering, McGill University, Montreal, QC H3A 2B4, Canada
| | - Lorne Beckman
- Department of Surgery, McGill University, Montreal, QC H3G 1A4, Canada
| | - Lisbet Haglund
- Department of Surgery, McGill University, Montreal, QC H3G 1A4, Canada; Shriners Hospital for Children, Montreal, QC H4A 0A9, Canada
| | - Christine L Le Maitre
- Oncology and Metabolism Department, Medical School, & INSIGNEO Institute, University of Sheffield, Sheffield, UK; Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK.
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Xi Z, Xie Y, Sun S, Wang N, Chen S, Wang G, Li J. IVD fibrosis and disc collapse comprehensively aggravate vertebral body disuse osteoporosis and zygapophyseal joint osteoarthritis by posteriorly shifting the load transmission pattern. Comput Biol Med 2024; 170:108019. [PMID: 38325217 DOI: 10.1016/j.compbiomed.2024.108019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/26/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Disuse is a typical phenotype of osteoporosis, but the underlying mechanism has yet to be identified in elderly patients. Disc collapse and intervertebral disc (IVD) fibrosis are two main pathological changes in IVD degeneration (IDD) progression, given that these changes affect load transmission patterns, which may lead to disuse osteoporosis of vertebral bodies and zygapophyseal joint (ZJ) osteoarthritis (ZJOA) biomechanically. METHODS Clinical data from 59 patients were collected retrospectively. Patient vertebral bony density, ZJOA grade, and disc collapse status were judged via CT. The IVD fibrosis grade was determined based on the FA measurements. Regression analyses identified potential independent risk factors for osteoporosis and ZJOA. L4-L5 numerical models with and without disc collapse and IVD fibrosis were constructed; stress distributions on the bony endplate (BEP) and zygapophyseal joint (ZJ) cartilages were computed in models with and without disc collapse and IVD fibrosis. RESULTS A significantly lower disc height ratio and significantly greater FA were recorded in patients with ZJOA. A significant correlation was observed between lower HU values and two parameters related to IDD progression. These factors were also proven to be independent risk factors for both osteoporosis and ZJOA. Correspondingly, compared to the intact model without IDD. Lower stress on vertebral bodies and greater stress on ZJOA can be simultaneously recorded in models of disc collapse and IVD fibrosis. CONCLUSIONS IVD fibrosis and disc collapse simultaneously aggravate vertebral body disuse osteoporosis and ZJOA by posteriorly shifting the load transmission pattern.
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Affiliation(s)
- Zhipeng Xi
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, PR China; Department of Orthopedics, Traditional Chinese Medicine Hospital of Ili Kazak Autonomous Prefecture, Yining, 835000, Xinjiang Uighur Autonomous Region, PR China
| | - Yimin Xie
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, PR China
| | - Shenglu Sun
- Department of Imaging, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, PR China
| | - Nan Wang
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, PR China
| | - Shuang Chen
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, PR China
| | - Guoyou Wang
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, NO.182, Chunhui Road, Longmatan District, Luzhou, Sichuan Province, 646000, PR China.
| | - Jingchi Li
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, NO.182, Chunhui Road, Longmatan District, Luzhou, Sichuan Province, 646000, PR China.
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Huang F, Huang G, Jia J, Lu S, Li J. Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically: an in silico study. J Orthop Surg Res 2024; 19:143. [PMID: 38365801 PMCID: PMC10870541 DOI: 10.1186/s13018-024-04550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/09/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The capsule of the zygapophyseal joint plays an important role in motion segmental stability maintenance. Iatrogenic capsule injury is a common phenomenon in posterior approach lumbar interbody fusion operations, but whether this procedure will cause a higher risk of adjacent segment degeneration acceleration biomechanically has yet to be identified. METHODS Posterior lumbar interbody fusion (PLIF) with different grades of iatrogenic capsule injury was simulated in our calibrated and validated numerical model. By adjusting the cross-sectional area of the capsule, different grades of capsule injury were simulated. The stress distribution on the cranial motion segment was computed under different loading conditions to judge the potential risk of adjacent segment degeneration acceleration. RESULTS Compared to the PLIF model with an intact capsule, a stepwise increase in the stress value on the cranial motion segment can be observed with a step decrease in capsule cross-sectional areas. Moreover, compared to the difference between models with intact and slightly injured capsules, the difference in stress values was more evident between models with slight and severe iatrogenic capsule injury. CONCLUSION Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically, and iatrogenic capsule damage on the cranial motion segment should be reduced to optimize patients' long-term prognosis.
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Affiliation(s)
- Fei Huang
- Department of Orthopedics, Meishan Hospital of Traditional Chinese Medicine, Meishan, China
| | - Gang Huang
- Luzhou Key Laboratory of Orthopedic Disorders, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Junpengli Jia
- Luzhou Key Laboratory of Orthopedic Disorders, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Shihao Lu
- Department of Orthopedics, Changzheng Hospital Affiliated to the Naval Medical University, Xiangyin Road, Shanghai, 200433, People's Republic of China.
| | - Jingchi Li
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182, Chunhui Road, Longmatan District, Luzhou, 646000, Sichuan Province, People's Republic of China.
- Luzhou Key Laboratory of Orthopedic Disorders, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China.
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Chen S, Croft AS, Bigdon S, Albers CE, Li Z, Gantenbein B. Conditioned Medium of Intervertebral Disc Cells Inhibits Osteo-Genesis on Autologous Bone-Marrow-Derived Mesenchymal Stromal Cells and Osteoblasts. Biomedicines 2024; 12:376. [PMID: 38397978 PMCID: PMC10886592 DOI: 10.3390/biomedicines12020376] [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: 12/13/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Low back pain (LBP) is associated with the degeneration of human intervertebral discs (IVDs). Despite progress in the treatment of LBP through spinal fusion, some cases still end in non-fusion after the removal of the affected IVD tissue. In this study, we investigated the hypothesis that the remaining IVD cells secrete BMP inhibitors that are sufficient to inhibit osteogenesis in autologous osteoblasts (OBs) and bone marrow mesenchymal stem cells (MSCs). A conditioned medium (CM) from primary human IVD cells in 3D alginate culture was co-cultured with seven donor-matched OB and MSCs. After ten days, osteogenesis was quantified at the transcript level using qPCR to measure the expression of bone-related genes and BMP antagonists, and at the protein level by alkaline phosphatase (ALP) activity. Additionally, cells were evaluated histologically using alizarin red (ALZR) staining on Day 21. For judging ALP activity and osteogenesis, the Noggin expression in samples was investigated to uncover the potential causes. The results after culture with the CM showed significantly decreased ALP activity and the inhibition of the calcium deposit formation in alizarin red staining. Interestingly, no significant changes were found among most bone-related genes and BMP antagonists in OBs and MSCs. Noteworthy, Noggin was relatively expressed higher in human IVD cells than in autologous OBs or MSCs (relative to autologous OB, the average fold change was in 6.9, 10.0, and 6.3 in AFC, CEPC, and NPC, respectively; and relative to autologous MSC, the average fold change was 2.3, 3.4, and 3.2, in AFC, CEPC, and NPC, respectively). The upregulation of Noggin in residual human IVDs could potentially inhibit the osteogenesis of autologous OB and MSC, thus inhibiting the postoperative spinal fusion after discectomy surgery.
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Affiliation(s)
- Shuimu Chen
- Tissue Engineering for Orthopedics & Mechanobiology (TOM), Bone & Joint Program, Department for BioMedical Research (DBMR), Faculty of Medicine, University of Bern, 3008 Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, 3012 Bern, Switzerland
| | - Andreas S Croft
- Tissue Engineering for Orthopedics & Mechanobiology (TOM), Bone & Joint Program, Department for BioMedical Research (DBMR), Faculty of Medicine, University of Bern, 3008 Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, 3012 Bern, Switzerland
| | - Sebastian Bigdon
- Department of Orthopedic Surgery & Traumatology, Inselspital, University of Bern, 3010 Bern, Switzerland
| | - Christoph E Albers
- Department of Orthopedic Surgery & Traumatology, Inselspital, University of Bern, 3010 Bern, Switzerland
| | - Zhen Li
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Benjamin Gantenbein
- Tissue Engineering for Orthopedics & Mechanobiology (TOM), Bone & Joint Program, Department for BioMedical Research (DBMR), Faculty of Medicine, University of Bern, 3008 Bern, Switzerland
- Department of Orthopedic Surgery & Traumatology, Inselspital, University of Bern, 3010 Bern, Switzerland
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10
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Lai A, Iliff D, Zaheer K, Gansau J, Laudier DM, Zachariou V, Iatridis JC. Annulus Fibrosus Injury Induces Acute Neuroinflammation and Chronic Glial Response in Dorsal Root Ganglion and Spinal Cord-An In Vivo Rat Discogenic Pain Model. Int J Mol Sci 2024; 25:1762. [PMID: 38339040 PMCID: PMC10855200 DOI: 10.3390/ijms25031762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic painful intervertebral disc (IVD) degeneration (i.e., discogenic pain) is a major source of global disability needing improved knowledge on multiple-tissue interactions and how they progress in order improve treatment strategies. This study used an in vivo rat annulus fibrosus (AF) injury-driven discogenic pain model to investigate the acute and chronic changes in IVD degeneration and spinal inflammation, as well as sensitization, inflammation, and remodeling in dorsal root ganglion (DRG) and spinal cord (SC) dorsal horn. AF injury induced moderate IVD degeneration with acute and broad spinal inflammation that progressed to DRG to SC changes within days and weeks, respectively. Specifically, AF injury elevated macrophages in the spine (CD68) and DRGs (Iba1) that peaked at 3 days post-injury, and increased microglia (Iba1) in SC that peaked at 2 weeks post-injury. AF injury also triggered glial responses with elevated GFAP in DRGs and SC at least 8 weeks post-injury. Spinal CD68 and SC neuropeptide Substance P both remained elevated at 8 weeks, suggesting that slow and incomplete IVD healing provides a chronic source of inflammation with continued SC sensitization. We conclude that AF injury-driven IVD degeneration induces acute spinal, DRG, and SC inflammatory crosstalk with sustained glial responses in both DRGs and SC, leading to chronic SC sensitization and neural plasticity. The known association of these markers with neuropathic pain suggests that therapeutic strategies for discogenic pain need to target both spinal and nervous systems, with early strategies managing acute inflammatory processes, and late strategies targeting chronic IVD inflammation, SC sensitization, and remodeling.
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Affiliation(s)
- Alon Lai
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.I.); (K.Z.); (J.G.); (D.M.L.); (J.C.I.)
| | - Denise Iliff
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.I.); (K.Z.); (J.G.); (D.M.L.); (J.C.I.)
| | - Kashaf Zaheer
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.I.); (K.Z.); (J.G.); (D.M.L.); (J.C.I.)
| | - Jennifer Gansau
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.I.); (K.Z.); (J.G.); (D.M.L.); (J.C.I.)
| | - Damien M. Laudier
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.I.); (K.Z.); (J.G.); (D.M.L.); (J.C.I.)
| | - Venetia Zachariou
- Department of Pharmacology, Physiology and Biophysics, Chobanian and Avedisian School of Medicine at Boston University, Boston, MA 02118, USA;
| | - James C. Iatridis
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.I.); (K.Z.); (J.G.); (D.M.L.); (J.C.I.)
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11
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Qiu Y, Wei X, Tao Y, Song B, Wang M, Yin Z, Xie M, Duan A, Chen Z, Wang Z. Causal association of leisure sedentary behavior and cervical spondylosis, sciatica, intervertebral disk disorders, and low back pain: a Mendelian randomization study. Front Public Health 2024; 12:1284594. [PMID: 38322127 PMCID: PMC10844448 DOI: 10.3389/fpubh.2024.1284594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
Background Some studies suggest sedentary behavior is a risk factor for musculoskeletal disorders. This study aimed to investigate the potential causal association between leisure sedentary behavior (LSB) (including television (TV) viewing, computer use, and driving) and the incidence of sciatica, intervertebral disk degeneration (IVDD), low back pain (LBP), and cervical spondylosis (CS). Methods We obtained the data of LSB, CS, IVDD, LBP, sciatica and proposed mediators from the gene-wide association studies (GWAS). The causal effects were examined by Inverse Variance Weighted (IVW) test, MR-Egger, weighted median, weighted mode and simple mode. And sensitivity analysis was performed using MR-Pleiotropy Residual Sum and Outlier (MR-PRESSO) and MR-Egger intercept test. Multivariable MR (MVMR) was conducted to investigate the independent factor of other LSB; while two-step MR analysis was used to explore the potential mediators including Body mass index (BMI), smoking initiation, type 2 diabetes mellitus (T2DM), major depressive disorder (MDD), schizophrenia, bipolar disorder between the causal association of LSB and these diseases based on previous studies. Results Genetically associated TV viewing was positively associated with the risk of CS (OR = 1.61, 95%CI = 1.25 to 2.07, p = 0.002), IVDD (OR = 2.10, 95%CI = 1.77 to 2.48, p = 3.79 × 10-18), LBP (OR = 1.84, 95%CI = 1.53 to 2.21, p = 1.04 × 10-10) and sciatica (OR = 1.82, 95% CI = 1.45 to 2.27, p = 1.42 × 10-7). While computer use was associated with a reduced risk of IVDD (OR = 0.66, 95%CI = 0.55 to 0.79, p = 8.06 × 10-6), LBP (OR = 0.49, 95%CI = 0.40 to 0.59, p = 2.68 × 10-13) and sciatica (OR = 0.58, 95%CI = 0.46 to 0.75, p = 1.98 × 10-5). Sensitivity analysis validated the robustness of MR outcomes. MVMR analysis showed that the causal effect of TV viewing on IVDD (OR = 1.59, 95%CI = 1.13 to 2.25, p = 0.008), LBP (OR = 2.15, 95%CI = 1.50 to 3.08, p = 3.38 × 10-5), and sciatica (OR = 1.61, 95%CI = 1.03 to 2.52, p = 0.037) was independent of other LSB. Furthermore, two-step MR analysis indicated that BMI, smoking initiation, T2DM may mediate the causal effect of TV viewing on these diseases. Conclusion This study provides empirical evidence supporting a positive causal association between TV viewing and sciatica, IVDD and LBP, which were potentially mediated by BMI, smoking initiation and T2DM.
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Affiliation(s)
- Youjia Qiu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xingzhou Wei
- Suzhou Medical School of Soochow University, Suzhou, Jiangsu, China
| | - Yuchen Tao
- Suzhou Medical School of Soochow University, Suzhou, Jiangsu, China
| | - Bingyi Song
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Menghan Wang
- Suzhou Medical School of Soochow University, Suzhou, Jiangsu, China
| | - Ziqian Yin
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Minjia Xie
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Aojie Duan
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhouqing Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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12
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Xie J, Yang Y, Jiang Z, Zhang K, Zhang X, Lin Y, Shen Y, Jia X, Liu H, Yang S, Jiang Y, Ma L. MRI radiomics-based decision support tool for a personalized classification of cervical disc degeneration: a two-center study. Front Physiol 2024; 14:1281506. [PMID: 38235385 PMCID: PMC10791783 DOI: 10.3389/fphys.2023.1281506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/24/2023] [Indexed: 01/19/2024] Open
Abstract
Objectives: To develop and validate an MRI radiomics-based decision support tool for the automated grading of cervical disc degeneration. Methods: The retrospective study included 2,610 cervical disc samples of 435 patients from two hospitals. The cervical magnetic resonance imaging (MRI) analysis of patients confirmed cervical disc degeneration grades using the Pfirrmann grading system. A training set (1,830 samples of 305 patients) and an independent test set (780 samples of 130 patients) were divided for the construction and validation of the machine learning model, respectively. We provided a fine-tuned MedSAM model for automated cervical disc segmentation. Then, we extracted 924 radiomic features from each segmented disc in T1 and T2 MRI modalities. All features were processed and selected using minimum redundancy maximum relevance (mRMR) and multiple machine learning algorithms. Meanwhile, the radiomics models of various machine learning algorithms and MRI images were constructed and compared. Finally, the combined radiomics model was constructed in the training set and validated in the test set. Radiomic feature mapping was provided for auxiliary diagnosis. Results: Of the 2,610 cervical disc samples, 794 (30.4%) were classified as low grade and 1,816 (69.6%) were classified as high grade. The fine-tuned MedSAM model achieved good segmentation performance, with the mean Dice coefficient of 0.93. Higher-order texture features contributed to the dominant force in the diagnostic task (80%). Among various machine learning models, random forest performed better than the other algorithms (p < 0.01), and the T2 MRI radiomics model showed better results than T1 MRI in the diagnostic performance (p < 0.05). The final combined radiomics model had an area under the receiver operating characteristic curve (AUC) of 0.95, an accuracy of 89.51%, a precision of 87.07%, a recall of 98.83%, and an F1 score of 0.93 in the test set, which were all better than those of other models (p < 0.05). Conclusion: The radiomics-based decision support tool using T1 and T2 MRI modalities can be used for cervical disc degeneration grading, facilitating individualized management.
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Affiliation(s)
- Jun Xie
- Information Technology Center, West China Hospital of Sichuan University, Chengdu, China
- Information Technology Center, Sanya People’s Hospital, Sanya, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zekun Jiang
- College of Computer Science, Sichuan University, Chengdu, Sichuan, China
- West China Biomedical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Kerui Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuheng Lin
- West China Biomedical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Yiwei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuehai Jia
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shaofen Yang
- Cadre Health Section, Hezhou People’s Hospital, Hezhou, Guangxi, China
| | - Yang Jiang
- Department of Orthopedic Spine, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, Sichuan, China
| | - Litai Ma
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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13
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Hutchinson JL, Veras MA, Serjeant ME, McCann MR, Kelly AL, Quinonez D, Beier F, Séguin CA. Comparative histopathological analysis of age-associated intervertebral disc degeneration in CD-1 and C57BL/6 mice: Anatomical and sex-based differences. JOR Spine 2023; 6:e1298. [PMID: 38156059 PMCID: PMC10751972 DOI: 10.1002/jsp2.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/28/2023] [Accepted: 10/19/2023] [Indexed: 12/30/2023] Open
Abstract
Background Intervertebral disc (IVD) degeneration is a major contributor to back pain and disability. The cause of IVD degeneration is multifactorial, with no disease-modifying treatments. Mouse models are commonly used to study IVD degeneration; however, the effects of anatomical location, strain, and sex on the progression of age-associated degeneration are poorly understood. Methods A longitudinal study was conducted to characterize age-, anatomical-, and sex-specific differences in IVD degeneration in two commonly used strains of mice, C57BL/6 and CD-1. Histopathological evaluation of the cervical, thoracic, lumbar, and caudal regions of mice at 6, 12, 20, and 24 months of age was conducted by two blinded observers at each IVD for the nucleus pulposus (NP), annulus fibrosus (AF), and the NP/AF boundary compartments, enabling analysis of scores by tissue compartment, summed scores for each IVD, or averaged scores for each anatomical region. Results C57BL/6 mice displayed mild IVD degeneration until 24 months of age; at this point, the lumbar spine demonstrated the most degeneration compared to other regions. Degeneration was detected earlier in the CD-1 mice (20 months of age) in both the thoracic and lumbar spine. In CD-1 mice, moderate to severe degeneration was noted in the cervical spine at all time points assessed. In both strains, age-associated IVD degeneration in the thoracic and lumbar spine was associated with increased histopathological scores in all IVD compartments. In both strains, minimal degeneration was detected in caudal IVDs out to 24 months of age. Both C57BL/6 and CD-1 mice displayed sex-specific differences in the presentation and progression of age-associated IVD degeneration. Conclusions These results showed that the progression and severity of age-associated degeneration in mouse models is associated with marked differences based on anatomical region, sex, and strain. This information provides a fundamental baseline characterization for users of mouse models to enable effective and appropriate experimental design, interpretation, and comparison between studies.
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Affiliation(s)
- Jeffrey L. Hutchinson
- Department of Physiology and Pharmacology, Schulich School of Medicine and DentistryThe Bone and Joint Institute, The University of Western OntarioLondonOntarioCanada
| | - Matthew A. Veras
- Department of Physiology and Pharmacology, Schulich School of Medicine and DentistryThe Bone and Joint Institute, The University of Western OntarioLondonOntarioCanada
| | - Meghan E. Serjeant
- Department of Physiology and Pharmacology, Schulich School of Medicine and DentistryThe Bone and Joint Institute, The University of Western OntarioLondonOntarioCanada
| | - Matthew R. McCann
- Department of Physiology and Pharmacology, Schulich School of Medicine and DentistryThe Bone and Joint Institute, The University of Western OntarioLondonOntarioCanada
| | - Ashley L. Kelly
- Department of Physiology and Pharmacology, Schulich School of Medicine and DentistryThe Bone and Joint Institute, The University of Western OntarioLondonOntarioCanada
| | - Diana Quinonez
- Department of Physiology and Pharmacology, Schulich School of Medicine and DentistryThe Bone and Joint Institute, The University of Western OntarioLondonOntarioCanada
| | - Frank Beier
- Department of Physiology and Pharmacology, Schulich School of Medicine and DentistryThe Bone and Joint Institute, The University of Western OntarioLondonOntarioCanada
| | - Cheryle A. Séguin
- Department of Physiology and Pharmacology, Schulich School of Medicine and DentistryThe Bone and Joint Institute, The University of Western OntarioLondonOntarioCanada
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14
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Hou Z, Wang W, Su S, Chen Y, Chen L, Lu Y, Zhou H. Bibliometric and Visualization Analysis of Biomechanical Research on Lumbar Intervertebral Disc. J Pain Res 2023; 16:3441-3462. [PMID: 37869478 PMCID: PMC10590139 DOI: 10.2147/jpr.s428991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023] Open
Abstract
Background Biomechanical research on the lumbar intervertebral disc (IVD) provides valuable information for the diagnosis, treatment, and prevention of related diseases, and has received increasing attention. Using bibliometric methods and visualization techniques, this study investigates for the first time the research status and development trends in this field, with the aim of providing guidance and support for subsequent research. Methods The Science Citation Index Expanded (SCI-Expanded) within the Web of Science Core Collection (WoSCC) database was used as the data source to select literature published from 2003 to 2022 related to biomechanical research on lumbar IVD. VOSviewer 1.6.19 and CiteSpace 6.2.R2 visualization software, as well as the online analysis platform of literature metrology, were utilized to generate scientific knowledge maps for visual display and data analysis. Results The United States is the most productive country in this field, with the Ulm University making the largest contribution. Wilke HJ is both the most prolific author and one of the highly cited authors, while Adams MA is the most cited author. Spine, J Biomech, Eur Spine J, Spine J, and Clin Biomech are not only the journals with the highest number of publications, but also highly cited journals. The main research topics in this field include constructing and validating three-dimensional (3D) finite element model (FEM) of lumbar spine, measuring intradiscal pressure, exploring the biomechanical effects and related risk factors of lumbar disc degeneration, studying the mechanical responses to different torque load combinations, and classifying lumbar disc degeneration based on magnetic resonance images (MRI), which are also the hot research themes in recent years. Conclusion This study systematically reviews the knowledge system and development trends in the field of biomechanics of lumbar IVD, providing valuable references for further research.
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Affiliation(s)
- Zhaomeng Hou
- Faculty of Orthopedics and Traumatology, Guangxi University of Chinese Medicine, Nanning, People’s Republic of China
- Department of Orthopedics and Traumatology, Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, People’s Republic of China
- Department of Orthopedics and Traumatology, Yancheng TCM Hospital, Yancheng, People’s Republic of China
| | - Wei Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, People’s Republic of China
| | - Shaoting Su
- Faculty of Orthopedics and Traumatology, Guangxi University of Chinese Medicine, Nanning, People’s Republic of China
| | - Yixin Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, People’s Republic of China
| | - Longhao Chen
- Faculty of Orthopedics and Traumatology, Guangxi University of Chinese Medicine, Nanning, People’s Republic of China
- Guangxi Key Laboratory of Biomechanics and Injury Repair in Traditional Chinese Medicine Orthopedics and Traumatology, Nanning, People’s Republic of China
| | - Yan Lu
- Faculty of Orthopedics and Traumatology, Guangxi University of Chinese Medicine, Nanning, People’s Republic of China
- Guangxi Key Laboratory of Biomechanics and Injury Repair in Traditional Chinese Medicine Orthopedics and Traumatology, Nanning, People’s Republic of China
- Department of Orthopedics and Traumatology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, People’s Republic of China
| | - Honghai Zhou
- Faculty of Orthopedics and Traumatology, Guangxi University of Chinese Medicine, Nanning, People’s Republic of China
- Guangxi Key Laboratory of Biomechanics and Injury Repair in Traditional Chinese Medicine Orthopedics and Traumatology, Nanning, People’s Republic of China
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15
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Rahman T, Tavana S, Baxan N, Raftery KA, Morgan G, Schaer TP, Smith N, Moore A, Bull J, Stevens MM, Newell N. Quantifying internal intervertebral disc strains to assess nucleus replacement device designs: a digital volume correlation and ultra-high-resolution MRI study. Front Bioeng Biotechnol 2023; 11:1229388. [PMID: 37849982 PMCID: PMC10577660 DOI: 10.3389/fbioe.2023.1229388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction: Nucleus replacement has been proposed as a treatment to restore biomechanics and relieve pain in degenerate intervertebral discs (IVDs). Multiple nucleus replacement devices (NRDs) have been developed, however, none are currently used routinely in clinic. A better understanding of the interactions between NRDs and surrounding tissues may provide insight into the causes of implant failure and provide target properties for future NRD designs. The aim of this study was to non-invasively quantify 3D strains within the IVD through three stages of nucleus replacement surgery: intact, post-nuclectomy, and post-treatment. Methods: Digital volume correlation (DVC) combined with 9.4T MRI was used to measure strains in seven human cadaveric specimens (42 ± 18 years) when axially compressed to 1 kN. Nucleus material was removed from each specimen creating a cavity that was filled with a hydrogel-based NRD. Results: Nucleus removal led to loss of disc height (12.6 ± 4.4%, p = 0.004) which was restored post-treatment (within 5.3 ± 3.1% of the intact state, p > 0.05). Nuclectomy led to increased circumferential strains in the lateral annulus region compared to the intact state (-4.0 ± 3.4% vs. 1.7 ± 6.0%, p = 0.013), and increased maximum shear strains in the posterior annulus region (14.6 ± 1.7% vs. 19.4 ± 2.6%, p = 0.021). In both cases, the NRD was able to restore these strain values to their intact levels (p ≥ 0.192). Discussion: The ability of the NRD to restore IVD biomechanics and some strain types to intact state levels supports nucleus replacement surgery as a viable treatment option. The DVC-MRI method used in the present study could serve as a useful tool to assess future NRD designs to help improve performance in future clinical trials.
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Affiliation(s)
- Tamanna Rahman
- Department of Bioengineering, Imperial College London, London, United Kingdom
- Department of Mechanical Engineering, Biomechanics Group, Imperial College London, London, United Kingdom
| | - Saman Tavana
- Department of Bioengineering, Imperial College London, London, United Kingdom
- Department of Mechanical Engineering, Biomechanics Group, Imperial College London, London, United Kingdom
| | - Nicoleta Baxan
- Biological Imaging Centre, Central Biomedical Services, Imperial College London, London, United Kingdom
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Kay A. Raftery
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - George Morgan
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Thomas P. Schaer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States
| | - Nigel Smith
- Division of Surgery and Interventional Science, University College London, Stanmore, United Kingdom
| | - Axel Moore
- Department of Bioengineering, Imperial College London, London, United Kingdom
- Department of Materials and Institute of Biomedical Engineering, Imperial College London, London, United Kingdom
| | - Jonathan Bull
- Neurosurgery, BARTS Health NHS Trust, London, United Kingdom
| | - Molly M. Stevens
- Department of Bioengineering, Imperial College London, London, United Kingdom
- Department of Materials and Institute of Biomedical Engineering, Imperial College London, London, United Kingdom
| | - Nicolas Newell
- Department of Bioengineering, Imperial College London, London, United Kingdom
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16
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Xu C, Xi Z, Fang Z, Zhang X, Wang N, Li J, Liu Y. Annulus Calibration Increases the Computational Accuracy of the Lumbar Finite Element Model. Global Spine J 2023; 13:2310-2318. [PMID: 35293827 PMCID: PMC10538312 DOI: 10.1177/21925682221081224] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Mechanical simulations. OBJECTIVE Inadequate calibration of annuli negatively affects the computational accuracy of finite element (FE) models. Specifically, the definition of annulus average radius (AR) does not have uniformity standards. Differences between the elastic moduli in the different layers and parts of the annulus were not fully calibrated when a linear elastic material is used to define its material properties. This study aims to optimize the computational accuracy of the FE model by calibrating the annulus. METHODS We calibrated the annulus AR and elastic modulus in our anterior-constructed lumbar model by eliminating the difference between the computed range of motion and that measured by in vitro studies under a flexion-extension loading condition. Multi-indicator validation was performed by comparing the computed indicators with those measured in in vitro studies. The computation time required for the different models has also been recorded to evaluate the computational efficiency. RESULTS The difference between computed and measured ROMs was less than 1% when the annulus AR and elastic modulus were calibrated. In the model validation process, all the indicators computed by the calibrated FE model were within ±1 standard deviation of the average values obtained from in vitro studies. The maximum difference between the computed and measured values was less than 10% under nearly all loading conditions. There is no apparent variation tendency for the computational time associated with different models. CONCLUSION The FE model with calibrated annulus AR and regional elastic modulus has higher computational accuracy and can be used in subsequent mechanical studies.
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Affiliation(s)
- Chen Xu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhipeng Xi
- Department of Orthopedics, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Zhongxin Fang
- Fluid and Power Machinery Key Laboratory of Ministry of Education, Xihua University, Chengdu, China
| | - Xiaoyu Zhang
- Department of Orthopedics, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Nan Wang
- Department of Orthopedics, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Jingchi Li
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Department of Orthopedics, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, China
| | - Yang Liu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
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Lama P, Tiwari J, Mutreja P, Chauhan S, Harding IJ, Dolan T, Adams MA, Maitre CL. Cell clusters in intervertebral disc degeneration: an attempted repair mechanism aborted via apoptosis. Anat Cell Biol 2023; 56:382-393. [PMID: 37503630 PMCID: PMC10520859 DOI: 10.5115/acb.23.067] [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: 03/08/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 07/29/2023] Open
Abstract
Cell clusters are a histological hallmark feature of intervertebral disc degeneration. Clusters arise from cell proliferation, are associated with replicative senescence, and remain metabolically, but their precise role in various stages of disc degeneration remain obscure. The aim of this study was therefore to investigate small, medium, and large size cell-clusters. For this purpose, human disc samples were collected from 55 subjects, aged 37-72 years, 21 patients had disc herniation, 10 had degenerated non-herniated discs, and 9 had degenerative scoliosis with spinal curvature <45°. 15 non-degenerated control discs were from cadavers. Clusters and matrix changes were investigated with histology, immunohistochemistry, and Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Data obtained were analyzed with spearman rank correlation and ANOVA. Results revealed, small and medium-sized clusters were positive for cell proliferation markers Ki-67 and proliferating cell nuclear antigen (PCNA) in control and slightly degenerated human discs, while large cell clusters were typically more abundant in severely degenerated and herniated discs. Large clusters associated with matrix fissures, proteoglycan loss, matrix metalloproteinase-1 (MMP-1), and Caspase-3. Spatial association findings were reconfirmed with SDS-PAGE that showed presence to these target markers based on its molecular weight. Controls, slightly degenerated discs showed smaller clusters, less proteoglycan loss, MMP-1, and Caspase-3. In conclusion, cell clusters in the early stages of degeneration could be indicative of repair, however sustained loading increases large cell clusters especially around microscopic fissures that accelerates inflammatory catabolism and alters cellular metabolism, thus attempted repair process initiated by cell clusters fails and is aborted at least in part via apoptosis.
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Affiliation(s)
- Polly Lama
- Department of Anatomy, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Sikkim, India
| | - Jerina Tiwari
- Department of Anatomy, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Sikkim, India
| | - Pulkit Mutreja
- Department of Anatomy, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Sikkim, India
| | - Sukirti Chauhan
- Department of Anatomy, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Sikkim, India
| | - Ian J Harding
- Centre for Clinical Anatomy, University of Bristol, Bristol, UK
| | - Trish Dolan
- Centre for Clinical Anatomy, University of Bristol, Bristol, UK
| | - Michael A Adams
- Centre for Clinical Anatomy, University of Bristol, Bristol, UK
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18
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Hoseinyazdi M, Asadollahi S, Luna R, Rafiee F, Gong G, Yousem DM. Longitudinal assessment of annular fissures of the cervical spine: overlooked and static. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 15:100238. [PMID: 37457394 PMCID: PMC10345478 DOI: 10.1016/j.xnsj.2023.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
Background Cervical annular fissures (AFs) have not been studied specifically as to their prevalence, imaging features, and persistence over time. We sought to determine the prevalence and natural history of cervical AFs. We hypothesized that these are static lesions that are not prevalent in the population. Methods This was a cross-sectional retrospective study of cervical MRI examinations performed between 2011-2021. We retrospectively reviewed the studies of 115 consecutive patients (63 female, 52 male) who had 2 or more MRI studies of the cervical spine to identify (1) imaging features of cervical AFs on various pulse sequences, (2) the concurrence of disc bulges/herniations, (3) changes in those imaging findings over time (mean follow-up 39.3 months) and (4) rate at which cervical AFs were mentioned in radiology reports. 620 initial and follow-up studies were reviewed. Results 50/115 (43.5%) patients had cervical AFs; 21 patients had a single AF and 29 patients had multi-level AFs (total 109 AFs). The most common levels affected were C4-C5 (28%, n = 31) and C5-C6 (27%, n = 30). All cervical AFs were hyperintense on T2WI and, over time, 95% (n = 104/109) of the AFs remained hyperintense; 22% (n = 25) showed less hyperintensity, 10% (n = 11) more hyperintensity, and 60% (n = 66) the same hyperintensity. 5 AFs (4%) resolved completely. Only 2 (8%) of 25 cervical AFs enhanced with gadolinium. The rate of concomitant disc bulges and herniations was 71% (n = 78) and 22% (n = 24) respectively. The presence of cervical AFs did not increase the risk of progression to bulges or herniations. None of the cervical AFs were mentioned in the radiology reports. Conclusions Cervical AFs occurred in 43.5% of patients but were rarely reported. They usually remained bright on T2W but their brightness could vary over time. Cervical AFs were often associated with disc bulges/herniations and enhanced less frequently (8%) than lumbar disk AFs.
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Affiliation(s)
- Meisam Hoseinyazdi
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD 21287
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Boston, Boston MA
| | - Shadi Asadollahi
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD 21287
| | - Rodrigo Luna
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD 21287
| | - Faranak Rafiee
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Boston, Boston MA
| | - Gary Gong
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD 21287
| | - David M. Yousem
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD 21287
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19
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Wang D, Lai A, Gansau J, Seifert AC, Munitz J, Zaheer K, Bhadouria N, Lee Y, Nasser P, Laudier DM, Holguin N, Hecht AC, Iatridis JC. Lumbar endplate microfracture injury induces Modic-like changes, intervertebral disc degeneration and spinal cord sensitization - an in vivo rat model. Spine J 2023; 23:1375-1388. [PMID: 37086976 PMCID: PMC10524828 DOI: 10.1016/j.spinee.2023.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/05/2023] [Accepted: 04/18/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND CONTEXT Endplate (EP) injury plays critical roles in painful IVD degeneration since Modic changes (MCs) are highly associated with pain. Models of EP microfracture that progress to painful conditions are needed to better understand pathophysiological mechanisms and screen therapeutics. PURPOSE Establish in vivo rat lumbar EP microfracture model and assess crosstalk between IVD, vertebra and spinal cord. STUDY DESIGN/SETTING In vivo rat EP microfracture injury model with characterization of IVD degeneration, vertebral remodeling, spinal cord substance P (SubP), and pain-related behaviors. METHODS EP-injury was induced in 5 month-old male Sprague-Dawley rats L4-5 and L5-6 IVDs by puncturing through the cephalad vertebral body and EP into the NP of the IVDs followed by intradiscal injections of TNFα (n=7) or PBS (n=6), compared with Sham (surgery without EP-injury, n=6). The EP-injury model was assessed for IVD height, histological degeneration, pain-like behaviors (hindpaw von Frey and forepaw grip test), lumbar spine MRI and μCT, and spinal cord SubP. RESULTS Surgically-induced EP microfracture with PBS and TNFα injection induced IVD degeneration with decreased IVD height and MRI T2 signal, vertebral remodeling, and secondary damage to cartilage EP adjacent to the injury. Both EP injury groups showed MC-like changes around defects with hypointensity on T1-weighted and hyperintensity on T2-weighted MRI, suggestive of MC type 1. EP injuries caused significantly decreased paw withdrawal threshold, reduced axial grip, and increased spinal cord SubP, suggesting axial spinal discomfort and mechanical hypersensitivity and with spinal cord sensitization. CONCLUSIONS Surgically-induced EP microfracture can cause crosstalk between IVD, vertebra, and spinal cord with chronic pain-like conditions. CLINICAL SIGNIFICANCE This rat EP microfracture model was validated to induce broad spinal degenerative changes that may be useful to improve understanding of MC-like changes and for therapeutic screening.
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Affiliation(s)
- Dalin Wang
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1188, New York, NY 10029 USA; Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu 210006, China; Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Alon Lai
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1188, New York, NY 10029 USA
| | - Jennifer Gansau
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1188, New York, NY 10029 USA
| | - Alan C Seifert
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Leon and Norma Hess Center for Science and Medicine, 1470 Madison Avenue, 1st Floor, New York, NY 10029, USA
| | - Jazz Munitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Leon and Norma Hess Center for Science and Medicine, 1470 Madison Avenue, 1st Floor, New York, NY 10029, USA
| | - Kashaf Zaheer
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1188, New York, NY 10029 USA
| | - Neharika Bhadouria
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1188, New York, NY 10029 USA; School of Mechanical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, IN 47907, USA
| | - Yunsoo Lee
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1188, New York, NY 10029 USA
| | - Philip Nasser
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1188, New York, NY 10029 USA
| | - Damien M Laudier
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1188, New York, NY 10029 USA
| | - Nilsson Holguin
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1188, New York, NY 10029 USA
| | - Andrew C Hecht
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1188, New York, NY 10029 USA
| | - James C Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1188, New York, NY 10029 USA.
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20
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Wan S, Zhang J, Wu C, Lin X, Li J, Wu F, Zhang Z, He L. Nucleus high intensity in the T2-weighted MRI is a potential predictor of annulus tear in cervical injured patients: a case comparative study. BMC Musculoskelet Disord 2023; 24:602. [PMID: 37488519 PMCID: PMC10364398 DOI: 10.1186/s12891-023-06615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/09/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Segmental fusion operations assume paramount significance for individuals afflicted by full layers of annulus tears as they avert the perils of rapid disc degeneration and segmental instability. Structures with high signal intensity in the T2-weighted MRI can predict potential damage to the injured segment. Since local structures are shortly related biomechanically, this may be an effective predictor for annulus tears. METHODS A retrospective analysis of the clinical data of 57 patients afflicted by cervical injuries and subjected to single-segment ACDF has been performed in this study. The surgeon performed intraoperative exploration to assess the integration status of the annulus. The signal intensity of the prevertebral space, nucleus, and injured vertebral bodies were judged in the T2-weighted imaging data. Regression analyses identified independent predictors for annulus tears, and the area under the receiver operating characteristic curve (AUC) was computed to evaluate the predictive performance of potential independent predictors. RESULTS The occurrence of nucleus high intensity was significantly higher among individuals with annulus tears, and the nucleus high intensity was deemed an independent predictor for determining the presence of intraoperative visible annulus tears in patients with cervical injuries. AUC for nucleus high intensity was calculated as 0.717, with a corresponding p-value less than 0.05. CONCLUSIONS In the realm of diagnosing annulus tears in injured cervical patients, nucleus high intensity in the T2-weighted MRI emerges as a promising predictive factor. Notably, this applies specifically to patients devoid of fracture and visible annulus tears in their MRI scans. Such positive outcomes should be regarded as prospective indications for ACDF.
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Affiliation(s)
- Shengyu Wan
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan Province, People's Republic of China
| | - Jian Zhang
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan Province, People's Republic of China
| | - Chao Wu
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan Province, People's Republic of China
| | - Xu Lin
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan Province, People's Republic of China
| | - Jingchi Li
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, No. 182, Chunhui Road, Luzhou, Sichuan Province, 646000, People's Republic of China
| | - Fan Wu
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan Province, People's Republic of China
| | - Zifan Zhang
- Department of Spine Surgery, Changzheng Hospital Affiliated to the Naval Medical University, 200003, Shanghai, People's Republic of China.
| | - Lipeng He
- Department of Orthopaedics, Wuxi Hospital of Traditional Chinese Medicine, Wuxi, 214000, Jiangsu Province, People's Republic of China.
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21
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Moser M, Adl Amini D, Albertini Sanchez L, Oezel L, Haffer H, Muellner M, Zhu J, Carrino JA, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The association between vertebral endplate defects, subchondral bone marrow changes, and lumbar intervertebral disc degeneration: a retrospective, 3-year longitudinal study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2350-2357. [PMID: 36773077 DOI: 10.1007/s00586-023-07544-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 10/22/2022] [Accepted: 01/13/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To investigate the influence of vertebral endplate defects and subchondral bone marrow changes on the development of lumbar intervertebral disc degeneration (DD). METHODS Patients > 18 y/o without any history of lumbar fusion who had repeat lumbar magnetic resonance imaging scans primarily for low back pain (LBP) performed at a minimum of 3 years apart at a single institution, and no spinal surgery in between scans were included. Total endplate score (TEPS), Modic changes (MC), and Pfirrmann grading (PFG) per lumbar disc level were assessed. DD was defined as PFG ≥ 4. RESULTS Three hundred and fifty-three patients (54.4% female) were included in the final analysis, comprising 1765 lumbar intervertebral discs. The patient population was 85.6% Caucasian with a median age of 60.1 years and a body mass index (BMI) of 25.8 kg/m2. A cutoff score of 5 was identified for the TEPS above which both the prevalence of DD and the odds of developing DD increased. The probability of developing DD did not differ significantly between lumbar disc levels (P = 0.419). In the multivariable analysis with adjustments for age, sex, race, body mass index (BMI), MC, TEPS cutoff > 5, and spinal level, only age (OR = 1.020; P = 0.002) was found to be an independent risk factor for developing intervertebral DD. CONCLUSION Our results suggest that TEPS does not unequivocally predict intervertebral DD in patients with LBP, since higher degrees of endplate defects might also develop secondarily to DD, and MC tend to occur late in the cascade of degeneration.
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Affiliation(s)
- Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Leonardo Albertini Sanchez
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jiaqi Zhu
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
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22
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Li X, Liu Y, Li L, Huo R, Ghezelbash F, Ma Z, Bao G, Liu S, Yang Z, Weber MH, Li-Jessen NYK, Haglund L, Li J. Tissue-mimetic hybrid bioadhesives for intervertebral disc repair. MATERIALS HORIZONS 2023; 10:1705-1718. [PMID: 36857679 DOI: 10.1039/d2mh01242a] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Intervertebral disc (IVD) degeneration and herniation often necessitate surgical interventions including a discectomy with or without a nucleotomy, which results in a loss of the normal nucleus pulposus (NP) and a defect in the annulus fibrosus (AF). Due to the limited regenerative capacity of the IVD tissue, the annular tear may remain a persistent defect and result in recurrent herniation post-surgery. Bioadhesives are promising alternatives but show limited adhesion performance, low regenerative capacity, and inability to prevent re-herniation. Here, we report hybrid bioadhesives that combine an injectable glue and a tough sealant to simultaneously repair and regenerate IVD post-nucleotomy. The glue fills the NP cavity while the sealant seals the AF defect. Strong adhesion occurs with the IVD tissues and survives extreme disc loading. Furthermore, the glue can match native NP mechanically, and support the viability and matrix deposition of encapsulated cells, serving as a suitable cell delivery vehicle to promote NP regeneration. Besides, biomechanical tests with bovine IVD motion segments demonstrate the capacity of the hybrid bioadhesives to restore the biomechanics of bovine discs under cyclic loading and to prevent permanent herniation under extreme loading. This work highlights the synergy of bioadhesive and tissue-engineering approaches. Future works are expected to further improve the tissue specificity of bioadhesives and prove their efficacy for tissue repair and regeneration.
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Affiliation(s)
- Xuan Li
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke St W, Montreal, QC H3A 0C3, Canada.
| | - Yin Liu
- Department of Biomedical Engineering, McGill University, 3775 rue University, Montreal, Quebec H3A 2B4, Canada
| | - Li Li
- Department of Surgery, McGill University, 1650 Cedar Avenue, Room C10.148.2, Montreal, QC, H3G 1A4, Canada.
| | - Ran Huo
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke St W, Montreal, QC H3A 0C3, Canada.
| | - Farshid Ghezelbash
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke St W, Montreal, QC H3A 0C3, Canada.
- Department of Mechanical Engineering, Polytechnique Montreal, Montreal, Quebec H3C 3A7, Canada
| | - Zhenwei Ma
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke St W, Montreal, QC H3A 0C3, Canada.
| | - Guangyu Bao
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke St W, Montreal, QC H3A 0C3, Canada.
| | - Shiyu Liu
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke St W, Montreal, QC H3A 0C3, Canada.
| | - Zhen Yang
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke St W, Montreal, QC H3A 0C3, Canada.
| | - Michael H Weber
- Department of Surgery, McGill University, 1650 Cedar Avenue, Room C10.148.2, Montreal, QC, H3G 1A4, Canada.
| | - Nicole Y K Li-Jessen
- Department of Biomedical Engineering, McGill University, 3775 rue University, Montreal, Quebec H3A 2B4, Canada
- School of Communication Sciences and Disorders, McGill University, Montreal, Quebec H3A 1G1, Canada
- Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Lisbet Haglund
- Department of Surgery, McGill University, 1650 Cedar Avenue, Room C10.148.2, Montreal, QC, H3G 1A4, Canada.
| | - Jianyu Li
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke St W, Montreal, QC H3A 0C3, Canada.
- Department of Biomedical Engineering, McGill University, 3775 rue University, Montreal, Quebec H3A 2B4, Canada
- Department of Surgery, McGill University, 1650 Cedar Avenue, Room C10.148.2, Montreal, QC, H3G 1A4, Canada.
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23
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Wang D, Lai A, Gansau J, Seifert AC, Munitz J, Zaheer K, Bhadouria N, Lee Y, Nasser P, Laudier DM, Holguin N, Hecht AC, Iatridis JC. Lumbar endplate microfracture injury induces Modic-like changes, intervertebral disc degeneration and spinal cord sensitization - An In Vivo Rat Model. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.27.525924. [PMID: 36778423 PMCID: PMC9915494 DOI: 10.1101/2023.01.27.525924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND CONTEXT : Endplate (EP) injury plays critical roles in painful IVD degeneration since Modic changes (MCs) are highly associated with pain. Models of EP microfracture that progress to painful conditions are needed to better understand pathophysiological mechanisms and screen therapeutics. PURPOSE : Establish in vivo rat lumbar EP microfracture model with painful phenotype. STUDY DESIGN/SETTING : In vivo rat study to characterize EP-injury model with characterization of IVD degeneration, vertebral bone marrow remodeling, spinal cord sensitization, and pain-related behaviors. METHODS : EP-driven degeneration was induced in 5-month-old male Sprague-Dawley rats L4-5 and L5-6 IVDs through the proximal vertebral body injury with intradiscal injections of TNFα (n=7) or PBS (n=6), compared to Sham (surgery without EP-injury, n=6). The EP-driven model was assessed for IVD height, histological degeneration, pain-like behaviors (hindpaw von Frey and forepaw grip test), lumbar spine MRI and μCT analyses, and spinal cord substance P (SubP). RESULTS : EP injuries induced IVD degeneration with decreased IVD height and MRI T2 values. EP injury with PBS and TNFα both showed MC type1-like changes on T1 and T2-weighted MRI, trabecular bone remodeling on μCT, and damage in cartilage EP adjacent to the injury. EP injuries caused significantly decreased paw withdrawal threshold and reduced grip forces, suggesting increased pain sensitivity and axial spinal discomfort. Spinal cord dorsal horn SubP was significantly increased, indicating spinal cord sensitization. CONCLUSIONS : EP microfracture can induce crosstalk between vertebral bone marrow, IVD and spinal cord with chronic pain-like conditions. CLINICAL SIGNIFICANCE : This rat EP microfracture model of IVD degeneration was validated to induce MC-like changes and pain-like behaviors that we hope will be useful to screen therapies and improve treatment for EP-drive pain.
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Affiliation(s)
- Dalin Wang
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, USA 66160
| | - Alon Lai
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer Gansau
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alan C. Seifert
- Biomedical Engineering and Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jazz Munitz
- Biomedical Engineering and Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kashaf Zaheer
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Neharika Bhadouria
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
- School of Mechanical Engineering, Purdue University, West Lafayette, IN
| | - Yunsoo Lee
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Philip Nasser
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Damien M. Laudier
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nilsson Holguin
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrew C. Hecht
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James C. Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
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Abourehab MAS, Baisakhiya S, Aggarwal A, Singh A, Abdelgawad MA, Deepak A, Ansari MJ, Pramanik S. Chondroitin sulfate-based composites: a tour d'horizon of their biomedical applications. J Mater Chem B 2022; 10:9125-9178. [PMID: 36342328 DOI: 10.1039/d2tb01514e] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chondroitin sulfate (CS), a natural anionic mucopolysaccharide, belonging to the glycosaminoglycan family, acts as the primary element of the extracellular matrix (ECM) of diverse organisms. It comprises repeating units of disaccharides possessing β-1,3-linked N-acetyl galactosamine (GalNAc), and β-1,4-linked D-glucuronic acid (GlcA), and exhibits antitumor, anti-inflammatory, anti-coagulant, anti-oxidant, and anti-thrombogenic activities. It is a naturally acquired bio-macromolecule with beneficial properties, such as biocompatibility, biodegradability, and immensely low toxicity, making it the center of attention in developing biomaterials for various biomedical applications. The authors have discussed the structure, unique properties, and extraction source of CS in the initial section of this review. Further, the current investigations on applications of CS-based composites in various biomedical fields, focusing on delivering active pharmaceutical compounds, tissue engineering, and wound healing, are discussed critically. In addition, the manuscript throws light on preclinical and clinical studies associated with CS composites. A short section on Chondroitinase ABC has also been canvassed. Finally, this review emphasizes the current challenges and prospects of CS in various biomedical fields.
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Affiliation(s)
- Mohammed A S Abourehab
- Department of Pharmaceutics, College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia. .,Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Minia University, Minia 11566, Egypt
| | - Shreya Baisakhiya
- Department of Biotechnology and Medical Engineering, National Institute of Technology Rourkela, Sector 1, Rourkela, Odisha 769008, India.,School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu 613401, India
| | - Akanksha Aggarwal
- Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, New Delhi, 110017, India
| | - Anshul Singh
- Department of Chemistry, Baba Mastnath University, Rohtak-124021, India
| | - Mohamed A Abdelgawad
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Sakaka, Al Jouf 72341, Saudi Arabia
| | - A Deepak
- Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai 600128, Tamil Nadu, India.
| | - Mohammad Javed Ansari
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Sheersha Pramanik
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai 600036, Tamil Nadu, India.
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Zhang C, Guo LX. Effect of whole-body vibration at different frequencies on the lumbar spine: A finite element study based on a whole human body model. Proc Inst Mech Eng H 2022; 236:1752-1761. [DOI: 10.1177/09544119221135688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many previous studies have found that occupational drivers commonly suffered from low back pain, and low back pain and degeneration of the intervertebral disc might be associated with vibration conditions. However, the biomechanical mechanisms of whole-body vibration that caused pain and injury were not clear. In this study, a validated whole human body finite element model was used, and vibration loads at frequencies of 3, 5, 7 and 9 Hz were loaded to evaluate the frequency effects on the spine. The results showed that the responses of the spine were strong at the 5 Hz vibration load. Vibration loads would produce alternating stresses and bulges in the annulus fibrosus and change the direction of the pressure in the nucleus pulposus. The posterior region of the intervertebral disc showed greater stress fluctuations than the anterior region. The Risk Factors showed that long-term exposure to whole-body vibrations at 5 and 7 Hz might have greater adverse effects on the spine. The findings of this study confirmed that vibrations near the resonance frequency of the human body would cause more injuries to the spine than other frequencies. Alternating stress and bulge might cause fatigue and the degeneration of the intervertebral disc, which might be the mechanisms of spinal injury caused by whole-body vibration, and the posterior regions of the intervertebral disc were more susceptible to degeneration. Some appropriate measures should be taken to reduce the adverse effects of whole-body vibration on spinal health.
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Affiliation(s)
- Chi Zhang
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
| | - Li-Xin Guo
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
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[Biomechanical evaluation of effects of percutaneous cement discoplasty and percutaneous cement interbody fusion on spinal stability]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1407-1412. [PMID: 36382460 PMCID: PMC9681586 DOI: 10.7507/1002-1892.202206052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate the effects of percutaneous cement discoplasty (PCD) and percutaneous cement interbody fusion (PCIF) on spinal stability by in vitro biomechanical tests. METHODS Biomechanical test was divided into intact (INT) group, percutaneous lumbar discectomy (PLD) group, PCD group, and PCIF group. Six specimens of L 4, 5 (including vertebral bodies and intervertebral discs) from fresh male cadavers were taken to prepare PLD, PCD, and PCIF specimens, respectively. Before treatment and after the above treatments, the MTS multi-degree-of-freedom simulation test system was used to conduct the biomechanical test. The intervertebral height of the specimen was measured before and after the axial loading of 300 N, and the difference was calculated. The range of motion (ROM) and stiffness of the spine in flexion, extension, left/right bending, and left/right rotation under a torque of 7.5 Nm were calculated. RESULTS After axial loading, the change of intervertebral height in PLD group was more significant than that in other three groups ( P<0.05). Compared with INT group, the ROM in all directions significantly increased and the stiffness significantly decreased in PLD group ( P<0.05). Compared with INT group, the ROM of flexion, extension, and left/right rotation in PCD group significantly increased and the stiffness significantly decreased ( P<0.05); compared with PLD group, the ROM of flexion, extension, and left/right bending in PCD group significantly decreased and the stiffness significantly increased ( P<0.05). Compared with INT group, ROM of left/right bending in PCIF group significantly decreased and stiffness significantly increased ( P<0.05); compared with PLD group, the ROM in all directions significantly decreased and the stiffness significantly increased ( P<0.05); compared with PCD group, the ROM of flexion, left/right bending, and left/right rotation significantly decreased and stiffness significantly increased ( P<0.05). CONCLUSION Both PCD and PCIF can provide good biomechanical stability. The former mainly affects the stiffness in flexion, extension, and bending, while the latter is more restrictive on lumbar ROM in all directions, especially in bending and rotation.
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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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Imrich R, Sedláková J, Úlehlová M, Gornall M, Jackson R, Olsson B, Rudebeck M, Gallagher J, Lukáčová O, Mlynáriková V, Stančík R, Vrtíková E, Záňová E, Zaťková A, Arnoux JB, Rovenský J, Luangrath E, Bygott H, Khedr M, Ranganath LR. Radiological evolution of spinal disease in alkaptonuria and the effect of nitisinone. RMD Open 2022; 8:rmdopen-2022-002422. [PMID: 36270742 PMCID: PMC9594597 DOI: 10.1136/rmdopen-2022-002422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives Ochronotic spondyloarthropathy represents one of the main clinical manifestations of alkaptonuria (AKU); however, prospective data and description of the effect of nitisinone treatment are lacking. Methods Patients with AKU aged 25 years or older were randomly assigned to receive either oral nitisinone 10 mg/day (N=69) or no treatment (N=69). Spine radiographs were recorded yearly at baseline, 12, 24, 36 and 48 months, and the images were scored for the presence of intervertebral space narrowing, soft tissue calcifications, vacuum phenomena, osteophytes/hyperostosis and spinal fusion in the cervical, thoracic and lumbosacral segment at each of the time points. Results At baseline, narrowing of the intervertebral spaces, the presence of osteophytes/hyperostosis and calcifications were the three most frequent radiographic features in AKU. The rate of progression of the five main features during the 4 years, ranked from the highest to lowest was as follows: intervertebral spaces narrowing, calcifications, vacuum phenomena, osteophytes/hyperostosis and fusions. The rate of progression did not differ between the treated and untreated groups in any of the five radiographic parameters except for a slower rate of progression (sum of all five features) in the treatment group compared with the control group (0.45 (1.11) nitisinone vs 0.74 (1.11) controls, p=0.049) in the thoracic segment. Conclusion The present study shows a relatively slow but significant worsening of radiographic features in patients with AKU over 4 years. Our results demonstrate a modest beneficial effect of 10 mg/day of nitisinone on the slowly progressing spondylosis in AKU during the relatively limited follow-up time. Trial registration number NCT01916382.
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Affiliation(s)
- Richard Imrich
- Institute of Clinical and Translational Research, Biomedical Research Center Slovak Academy of Sciences, Bratislava, Slovakia,National Institute of Rheumatic Diseases, Piešťany, Slovakia
| | - Jana Sedláková
- National Institute of Rheumatic Diseases, Piešťany, Slovakia
| | - Mária Úlehlová
- National Institute of Rheumatic Diseases, Piešťany, Slovakia
| | | | | | | | | | - James Gallagher
- Musculoskeletal Biology, University of Liverpool, Liverpool, UK
| | - Oľga Lukáčová
- National Institute of Rheumatic Diseases, Piešťany, Slovakia
| | | | - Roman Stančík
- National Institute of Rheumatic Diseases, Piešťany, Slovakia
| | - Eva Vrtíková
- National Institute of Rheumatic Diseases, Piešťany, Slovakia
| | | | - Andrea Zaťková
- Institute of Clinical and Translational Research, Biomedical Research Center Slovak Academy of Sciences, Bratislava, Slovakia
| | | | - Jozef Rovenský
- National Institute of Rheumatic Diseases, Piešťany, Slovakia
| | - Emily Luangrath
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Helen Bygott
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Milad Khedr
- Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Liverpool, UK
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Saraceni N, Campbell A, Kent P, Ng L, Straker L, O'Sullivan P. Does intra-lumbar flexion during lifting differ in manual workers with and without a history of low back pain? A cross-sectional laboratory study. ERGONOMICS 2022; 65:1380-1396. [PMID: 35098885 DOI: 10.1080/00140139.2022.2036819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Advice to limit or avoid a flexed lumbar curvature during lifting is widely promoted to reduce the risk of low back pain (LBP), yet there is very limited evidence to support this relationship. To provide higher quality evidence this study compared intra-lumbar flexion in manual workers with (n = 21) and without a history of LBP (n = 21) during a repeated lifting task. In contrast to common expectations, the LBP group demonstrated less peak absolute intra-lumbar flexion during lifting than the noLBP group [adjusted difference -3.7° (95%CI -6.9 to -0.6)]. The LBP group was also further from the end of range intra-lumbar flexion and did not use more intra-lumbar range of motion during any lift condition (both symmetrical and asymmetrical lifts and different box loads). Peak absolute intra-lumbar flexion was more variable in the LBP group during lifting and both groups increased their peak absolute intra-lumbar flexion over the lift repetitions. This high-quality capture of intra-lumbar spine flexion during repeated lifting in a clinically relevant cohort questions dominant safe lifting advice.Practitioner summary: Lifting remains a common trigger for low back pain (LBP). This study demonstrated that people with LBP, lift with less intra-lumbar flexion than those without LBP. Providing the best quality in-vivo laboratory evidence, that greater intra-lumbar flexion is not associated with LBP in manual workers, raising questions about lifting advice.
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Affiliation(s)
- Nic Saraceni
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Amity Campbell
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Peter Kent
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Leo Ng
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Leon Straker
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Peter O'Sullivan
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Body Logic Physiotherapy Clinic, Perth, Australia
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In-vitro models of disc degeneration - A review of methods and clinical relevance. J Biomech 2022; 142:111260. [PMID: 36027637 DOI: 10.1016/j.jbiomech.2022.111260] [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: 03/09/2022] [Revised: 07/22/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022]
Abstract
The intervertebral disc (IVD) provides flexibility, acts as a shock absorber, and transmits load. Degeneration of the IVD includes alterations in the biomechanics, extracellular matrix (ECM), and cellular activity. These changes are not always perceived, however, IVD degeneration can lead to severe health problems including long-term disability. To understand the pathogenesis of IVD degeneration and suitable testing methods for emerging treatments and therapies, this review documents in-vitro models of IVD degeneration including physical disruption, hyperphysiological loading, ECM degradation by enzyme digestion, or a combination of these methods. This paper reviews and critically analyses the models of degeneration published since the year 2000 in either in human or animal specimens. The results are categorised in terms of the IVD biomechanics, physical attributes, ECM composition, tissue damage and cellularity to evaluate the models with respect to natural human degeneration, and to provide recommendations for clinically relevant models for the various stages of degeneration. There is no one model that replicates the wide range of degenerative changes that occur as part of normal degeneration. However, cyclic overloading replicates many aspects of degeneration, with the advantage of a dose-response allowing the tuning of damage initiated. Models of severe degeneration are currently lacking, but there is potential that combining cyclic overloading and enzymatic digestion will provide model that closely resembles human IVD degeneration. This will provide an effective way to investigate the effects of severe degeneration, and the evaluation of treatments for the IVD, which would generally be indicated at this advanced stage of degeneration.
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Conger A, Smuck M, Truumees E, Lotz JC, DePalma MJ, McCormick ZL. Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain. PAIN MEDICINE 2022; 23:S63-S71. [PMID: 35856329 PMCID: PMC9297155 DOI: 10.1093/pm/pnac081] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/22/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Aaron Conger
- Correspondence to: Aaron Conger, DO, Department of Physical Medicine and Rehabilitation, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA. Tel: 801-587-5458; Fax: 801-587-7111; E-mail:
| | - Matthew Smuck
- Department of Orthopaedics, Stanford University, Redwood City, CA, USA
| | - Eeric Truumees
- The University of Texas Dell Medical School, Ascension Texas Spine and Scoliosis, Austin, TX, USA
| | - Jeffrey C Lotz
- Department of Orthopaedics, University of California San Francisco, San Francisco, CA, USA
| | | | - Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
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Ex vivo biomechanical evaluation of Acute lumbar endplate injury and comparison to annulus fibrosus injury in a rat model. J Mech Behav Biomed Mater 2022; 131:105234. [DOI: 10.1016/j.jmbbm.2022.105234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/14/2022] [Accepted: 04/09/2022] [Indexed: 11/20/2022]
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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Wáng YXJ, Martínez Barbero JP, García Espinosa J, Martínez Martínez A. The value of magnetic resonance imaging and computed tomography in the study of spinal disorders. Quant Imaging Med Surg 2022; 12:3947-3986. [PMID: 35782254 PMCID: PMC9246762 DOI: 10.21037/qims-2022-04] [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] [Received: 02/16/2022] [Accepted: 04/13/2022] [Indexed: 08/15/2023]
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders.
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Affiliation(s)
| | | | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - José Pablo Martínez Barbero
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Jade García Espinosa
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Alberto Martínez Martínez
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
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Jia H, Xu B, Qi X. Biomechanical evaluation of percutaneous cement discoplasty by finite element analysis. BMC Musculoskelet Disord 2022; 23:594. [PMID: 35725467 PMCID: PMC9208188 DOI: 10.1186/s12891-022-05508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background Percutaneous cement discoplasty (PCD) is a minimally invasive treatment for degenerative lumbar spine disease, but the relationship between decompression effect on the nerve root and different doses of bone cement is uncertain. Purpose To investigate the indirect decompression effect of cement with different doses on nerve roots and the biomechanical changes on the spine during PCD using finite element analysis (FEA). Methods FEA was adapted to analyze the mechanical changes in the lumbar vertebrae before and after the application of PCD.CT scan images of adult males were utilized to establish a finite element model of the lumbar vertebral body using mimics and Pro/E software. The images were divided into four models: the normal model (normal, model N), the disc degeneration model (high, model H), the intervertebral disc injected with 3 mL of bone cement (model H1), and the intervertebral disc injected with 5 mL of bone cement (model H2). All models were analyzed using the ABAQUS6.14.2 software. The normal physiological movements were simulated, and the mechanical changes in the lumbar vertebrae were observed prior to and after the cement filling application. Results The stress of the nerve root in model H was the largest. The nerve root stress in the model H2 was the smallest during flexion, extension, left bending, right bending, left rotation, and right rotation at 90%, 44%, 25%, 56%, 56%, and 51% of the normal benchmark, respectively. After the injection of bone cement, the nerve root stress is reduced. The greater the amount of cement, the lesser the nerve root stress. The motion was reduced in models H, H1, and H2, and there were differences between models H1 and H2. Cartilage endplate stress was less in model H2 than in model H1. Conclusions The nerve root stress increased after degeneration and decreased after intervertebral height recovery through cement injection, resulting in a significant indirect decompression effect.The stress of the nerve root decreased with the increase in the amount of cement injection.
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Affiliation(s)
- Hongwei Jia
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei province, Shijiazhuang, China
| | - Bin Xu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei province, Shijiazhuang, China
| | - Xiangbei Qi
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei province, Shijiazhuang, China.
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Wang Y, Wang H, Sun Z, Sun H, Ur-Rehman U, Tian J. Response of Heme Oxygenase-1 in Intervertebral Disc Degeneration by Promoting Autophagy and Apoptosis. INT J PHARMACOL 2022. [DOI: 10.3923/ijp.2022.1278.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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How annulus defects can act as initiation sites for 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; 31:1487-1500. [PMID: 35174401 DOI: 10.1007/s00586-022-07132-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/13/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Both posture and loading rate are key factors in the herniation process and can determine the mechanism of disc failure. The aim of this study was to test the hypothesis that disruption visible with HR-MRI post-testing corresponds with microstructural features and further elucidate the mechanism by which this disruption weakens the disc. This will enable us to gain new insights into the herniation process. METHODS Thirty ovine lumbar spinal segments were subjected to combinations of four loading conditions (0-12° flexion, 0-9° lateral bending, 0-4° axial rotation, 0-1500 N axial compression) for 1000 loading cycles at 2 Hz in a dynamic disc loading simulator. The discs were scanned in an ultra-high field MRI (11.7 T) then examined using brightfield microscopy to examine their microstructure. RESULTS Four discs herniated and seven discs suffered nucleus displacement. These discs contained pre-existing defects in the central posterior annulus. Generally, following testing discs contained more posterior annulus disruption, Microstructural investigation revealed there was clear correspondence between HR-MRI and microstructural observations, and that the mid-outer annular-endplate junction had failed in all discs examined in this study. CONCLUSIONS While all discs suffered outer annulus damage, only the discs containing pre-existing defects herniated. These pre-existing defects weakened the inner and mid annulus, allowing herniation to occur once the mid and outer annular wall was compromised. We propose this can occur during the degenerative cascade.
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Medeiros Borsagli FGL, Rodrigues JS, Aguiar RA, Paiva AE, Vasquez JFB, Ramos WTDS, Allibrandini P, Rocha EPA, Gonçalves MP, de Souza FE. Low-cost luminescent scaffolds-based on thiol chitosans by microwave radiation for vertebral disc repair/theragnostic. Int J Biol Macromol 2022; 209:2109-2118. [PMID: 35513089 DOI: 10.1016/j.ijbiomac.2022.04.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 12/18/2022]
Abstract
This study introduces a new 3D scaffold based on thiolated chitosans with luminescence by microwave radiation using cysteine (Chi_CT_Cys) and 11-mercaptoundecanoic acid (Chi_CT_MUA) for vertebral disc regeneration/theragnostic. These scaffolds were characterized by Raman, PL spectroscopy, swelling, gel-fraction, and morphologies. Cytocompatibility and mechanical behavior were evaluated. Raman showed that disulfide bonds improved the grafting degree (Chi_CT_Cys (1072 ± 136) μmol·g-1 and Chi_CT_MUA (3245 ± 105) μmol·g-1). Morphologies showed interesting characteristics. Swelling behavior showed that Chi_CT_MUA presented a slight minor swelling (2101 ± 251) % compared to Chi_CT_Cys (2589 ± 188) %. Differently, gel-fraction showed that the chemical stability of Chi_CT_Cys was worse (29 ± 4) % than Chi_CT_MUA (15 ± 3) %. PL showed a possibility to use theragnostic evaluation of points of greater compression in a vertebral disc. The mechanical behavior of Chi_CT_MUA presented better results ((70 ± 3) MPa) than Chi_CT_Cys ((37 ± 3) MPa). Cytocompatible showed that the scaffolds presented cell viability >90%. Thusly, these 3D scaffolds presented an incredible potential for tissue engineering applications.
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Affiliation(s)
- Fernanda G L Medeiros Borsagli
- Institute of Engineering, Science and Technology, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Av. 01, 4050 Cidade Universitária, 39440-039, Janaúba, MG, Brazil.
| | - Jordane S Rodrigues
- Institute of Engineering, Science and Technology, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Av. 01, 4050 Cidade Universitária, 39440-039, Janaúba, MG, Brazil
| | - Rafaella A Aguiar
- Institute of Engineering, Science and Technology, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Av. 01, 4050 Cidade Universitária, 39440-039, Janaúba, MG, Brazil
| | | | | | - Welyson Tiano do Santos Ramos
- Institute of Engineering, Science and Technology, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Av. 01, 4050 Cidade Universitária, 39440-039, Janaúba, MG, Brazil
| | - Paulo Allibrandini
- Institute of Engineering, Science and Technology, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Av. 01, 4050 Cidade Universitária, 39440-039, Janaúba, MG, Brazil
| | - Elém Patrícia Alves Rocha
- Institute of Engineering, Science and Technology, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Av. 01, 4050 Cidade Universitária, 39440-039, Janaúba, MG, Brazil
| | - Max P Gonçalves
- Institute of Engineering, Science and Technology, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Av. 01, 4050 Cidade Universitária, 39440-039, Janaúba, MG, Brazil
| | - Fidel Edson de Souza
- Institute of Engineering, Science and Technology, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Av. 01, 4050 Cidade Universitária, 39440-039, Janaúba, MG, Brazil
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Zehra U, Tryfonidou M, Iatridis JC, Illien-Jünger S, Mwale F, Samartzis D. Mechanisms and clinical implications of intervertebral disc calcification. Nat Rev Rheumatol 2022; 18:352-362. [DOI: 10.1038/s41584-022-00783-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 12/19/2022]
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Sex-Based Differences in Age-Related Changes of the Vertebral Column from a Bronze Age Urban Population in Ancient China. ANTHROPOLOGICAL REVIEW 2022. [DOI: 10.18778/1898-6773.85.1.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The health disparities between males and females in bioarchaeological settings are important indicators of gender-based differences in socioeconomic roles. In this study, sex-based differences of the vertebral column in spine pathology were investigated in human skeletons excavated from a Bronze Age cemetery of the Western Zhou Dynasty at the Dahekou site in Shanxi, China. Results demonstrated that females had a higher prevalence of vertebral compressive fractures, with the majority found in those between twenty-five and thirty years old, suggesting that the fractures were a consequence of osteoporosis and its early onset in females. In contrast, males expressed overall more severe ageing in all vertebral divisions compared to females. Males also had a higher prevalence of vertebral facet joint osteoarthritis in cervical and thoracic divisions than females. Likewise, the incidence of facet joint osteoarthritis was more asymmetric between the left and right joints in males than in females. These findings reflect disparities of vertebral health between the two sexes in an urban setting, in which ageing and injuries of the vertebral column might be driven by different mechanisms. Age-related changes in female vertebral columns may have been more influenced by conditions of hormone deficiency such as menopause, while male vertebral columns might have been more prone to age-related changes due to heavy labor-induced physical stressors. Further studies on the differentiation of ageing mechanisms between the two sexes based on physiology, socioeconomic roles, and living conditions are warranted. The studies are necessary in understanding how multiple sociocultural and physiological factors contribute to health disparities in historic and contemporary environments.
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DiStefano TJ, Vaso K, Danias G, Chionuma HN, Weiser JR, Iatridis JC. Extracellular Vesicles as an Emerging Treatment Option for Intervertebral Disc Degeneration: Therapeutic Potential, Translational Pathways, and Regulatory Considerations. Adv Healthc Mater 2022; 11:e2100596. [PMID: 34297485 PMCID: PMC8783929 DOI: 10.1002/adhm.202100596] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/08/2021] [Indexed: 12/14/2022]
Abstract
Emergent approaches in regenerative medicine look toward the use of extracellular vesicles (EVs) as a next-generation treatment strategy for intervertebral disc (IVD) degeneration (IVDD) because of their ability to attenuate chronic inflammation, reduce apoptosis, and stimulate proliferation in a number of tissue systems. Yet, there are no Food and Drug Administration (FDA)-approved EV therapeutics in the market with an indication for IVDD, which motivates this article to review the current state of the field and provide an IVD-specific framework to assess its efficacy. In this systematic review, 29 preclinical studies that investigate EVs in relation to the IVD are identified, and additionally, the regulatory approval process is reviewed in an effort to accelerate emerging EV-based therapeutics toward FDA submission and timeline-to-market. The majority of studies focus on nucleus pulposus responses to EV treatment, where the main findings show that stem cell-derived EVs can decelerate the progression of IVDD on the molecular, cellular, and organ level. The findings also highlight the importance of the EV parent cell's pathophysiological and differentiation state, which affects downstream treatment responses and therapeutic outcomes. This systematic review substantiates the use of EVs as a promising cell-free strategy to treat IVDD and enhance endogenous repair.
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Affiliation(s)
- Tyler J. DiStefano
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Keti Vaso
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, New York NY, USA
| | - George Danias
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Henry N. Chionuma
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Jennifer R. Weiser
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, New York NY, USA
| | - James C. Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York NY, USA
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41
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Wang D, He X, Zheng C, Wang C, Peng P, Gao C, Xu X, Ma Y, Liu M, Yang L, Luo Z. Endoplasmic Reticulum Stress: An Emerging Therapeutic Target for Intervertebral Disc Degeneration. Front Cell Dev Biol 2022; 9:819139. [PMID: 35178406 PMCID: PMC8843852 DOI: 10.3389/fcell.2021.819139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/24/2021] [Indexed: 12/22/2022] Open
Abstract
Low back pain (LBP) is a global health issue. Intervertebral disc degeneration (IDD) is a major cause of LBP. Although the explicit mechanisms underpinning IDD are unclear, endoplasmic reticulum (ER) stress caused by aberrant unfolded or misfolded proteins may be involved. The accumulation of unfolded/misfolded proteins may result in reduced protein synthesis and promote aberrant protein degradation to recover ER function, a response termed the unfolded protein response. A growing body of literature has demonstrated the potential relationships between ER stress and the pathogenesis of IDD, indicating some promising therapeutic targets. In this review, we summarize the current knowledge regarding the impact of ER stress on the process of IDD, as well as some potential therapeutic strategies for alleviating disc degeneration by targeting different pathways to inhibit ER stress. This review will facilitate understanding the pathogenesis and progress of IDD and highlights potential therapeutic targets for treating this condition.
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Affiliation(s)
- Dong Wang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xin He
- Pharmacy Department, Air Force Hospital of Eastern Theater Command, Nanjing, China
| | - Chao Zheng
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chengzhe Wang
- Rehabilitation Department, Dongchangfu Traditional Chinese Medicine Hospital, Liaocheng, China
| | - Pandi Peng
- Institute of Flexible Electronics, Northwestern Polytechnical University, Xi'an, China
| | - Chu Gao
- Medical Research Institute, Northwestern Polytechnical University, Xi'an, China
| | - Xiaolong Xu
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yachao Ma
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Mei Liu
- Pharmacy Department, Air Force Hospital of Eastern Theater Command, Nanjing, China
| | - Liu Yang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Medical Research Institute, Northwestern Polytechnical University, Xi'an, China
| | - Zhuojing Luo
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Medical Research Institute, Northwestern Polytechnical University, Xi'an, China
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42
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Skripkina NA, Levin OS. [Diagnosis and treatment of low back pain in old patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:52-57. [PMID: 34870914 DOI: 10.17116/jnevro202112110252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The back pain is one of the most common and socially significant neurological syndromes, leading to limited mobility and household independence of elderly patients. Specific «serious» causes of back pain account for 1-2% of all cases of back pain, approximately 10% of cases of pain correspond to radiculopathy, while the rest of the most common variants is related to nonspecific axial back pain. In the most cases of back pain, a clear connection between degenerative-dystrophic changes in the spine and the clinical manifestations and intensity of back pain is absent. On the other hand, dystrophic changes in the spine, which under certain conditions can be a source of chronic pain, cannot be completely ignored. Therefore, «osteochondrosis» is currently considered as a heterogeneous cascade process with the different course variations. In practice, it is not always possible to draw a line between nociceptive, neuropathic, nociplastic and psychogenic pain, more often in this case we can talk about a mixed nature of pain. Unreasonable neuroimaging with the identification of «accidental» findings can complicate the interpretation of the causes of pain, however, it is absolutely indicated to exclude serious specific diseases, spinal stenosis, when determining the indications for surgery. The presence of comorbid affective disorders, certain personality characteristics of patients contributes to the persistent nature of low back pain, therefore it is important to take these factors into account when diagnosing the causes and treatment of pain. Along with conventional anti-inflammatory drugs and other analgesics with a proven effect in the complex treatment of patients with degenerative-dystrophic changes in the spine with radicular and non-root pain syndromes, Symptomatic Slow-Acting Drugs in Osteoarthritis can be recommended.
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Affiliation(s)
- N A Skripkina
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - O S Levin
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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43
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Oppici L, Grütters K, Garofolini A, Rosenkranz R, Narciss S. Deliberate Practice and Motor Learning Principles to Underpin the Design of Training Interventions for Improving Lifting Movement in the Occupational Sector: A Perspective and a Pilot Study on the Role of Augmented Feedback. Front Sports Act Living 2021; 3:746142. [PMID: 34796319 PMCID: PMC8593185 DOI: 10.3389/fspor.2021.746142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
Spine posture during repetitive lifting is one of the main risk factors for low-back injuries in the occupational sector. It is thus critical to design appropriate intervention strategies for training workers to improve their posture, reducing load on the spine during lifting. The main approach to train safe lifting to workers has been educational; however, systematic reviews and meta-analyses have shown that this approach does not improve lifting movement nor reduces the risk of low back injury. One of the main limitations of this approach lies in the amount, quality and context of practice of the lifting movement. In this article, first we argue for integrating psychologically-grounded perspectives of practice design in the development of training interventions for safe lifting. Principles from deliberate practice and motor learning are combined and integrated. Given the complexity of lifting, a training intervention should occur in the workplace and invite workers to repeatedly practice/perform the lifting movement with the clear goal of improving their lifting-related body posture. Augmented feedback has a central role in creating the suitable condition for achieving such intervention. Second, we focus on spine bending as risk factor and present a pilot study examining the benefits and boundary conditions of different feedback modalities for reducing bending during lifting. The results showed how feedback modalities meet differently key requirements of deliberate practice conditions, i.e., feedback has to be informative, individualized and actionable. Following the proposed approach, psychology will gain an active role in the development of training interventions, contributing to finding solutions for a reduction of risk factors for workers.
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Affiliation(s)
- Luca Oppici
- Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany.,Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Kim Grütters
- Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
| | - Alessandro Garofolini
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia
| | - Robert Rosenkranz
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany.,Acoustic and Haptic Engineering, Faculty of Electrical and Computer Engineering, Technische Universität Dresden, Dresden, Germany
| | - Susanne Narciss
- Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany.,Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
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44
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Ketola JHJ, Inkinen SI, Karppinen J, Niinimäki J, Tervonen O, Nieminen MT. T 2 -weighted magnetic resonance imaging texture as predictor of low back pain: A texture analysis-based classification pipeline to symptomatic and asymptomatic cases. J Orthop Res 2021; 39:2428-2438. [PMID: 33368707 DOI: 10.1002/jor.24973] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/20/2020] [Accepted: 12/21/2020] [Indexed: 02/04/2023]
Abstract
Low back pain is a very common symptom and the leading cause of disability throughout the world. Several degenerative imaging findings seen on magnetic resonance imaging are associated with low back pain but none of them is specific for the presence of low back pain as abnormal findings are prevalent among asymptomatic subjects as well. The purpose of this population-based study was to investigate if more specific magnetic resonance imaging predictors of low back pain could be found via texture analysis and machine learning. We used this methodology to classify T2 -weighted magnetic resonance images from the Northern Finland Birth Cohort 1966 data to symptomatic and asymptomatic groups. Lumbar spine magnetic resonance imaging was performed using a fast spin-echo sequence at 1.5 T. Texture analysis pipeline consisting of textural feature extraction, principal component analysis, and logistic regression classifier was applied to the data to classify them into symptomatic (clinically relevant pain with frequency ≥30 days and intensity ≥6/10) and asymptomatic (frequency ≤7 days, intensity ≤3/10, and no previous pain episodes in the follow-up period) groups. Best classification results were observed applying texture analysis to the two lowest intervertebral discs (L4-L5 and L5-S1), with accuracy of 83%, specificity of 83%, sensitivity of 82%, negative predictive value of 94%, precision of 56%, and receiver operating characteristic area-under-curve of 0.91. To conclude, textural features from T2 -weighted magnetic resonance images can be applied in low back pain classification.
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Affiliation(s)
- Juuso H J Ketola
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Satu I Inkinen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Physical and Rehabilitation Medicine, Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland.,Department of Occupational Health, Finnish Institute of Occupational Health, Oulu, Finland
| | - Jaakko Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Osmo Tervonen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Miika T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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45
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Negative biomechanical effects of large grade nuclectomy in the transforaminal endoscopic discectomy increased the risk of adjacent segment diseases: A finite element study. J Clin Neurosci 2021; 93:141-146. [PMID: 34656238 DOI: 10.1016/j.jocn.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The protection of articular processes (AP) in the transforaminal endoscopic discectomy (TED) was proven to optimise post-operative biomechanical environments. Published studies reported a large grade of nuclectomy leading to poor prognosis, but the underlying biomechanical mechanism was unclearly illustrated. This study aimed to investigate the changes of biomechanical environments after an in-out TED with intact AP and a large grade of nuclectomy and an out-in TED with limited foraminoplasty and a smaller grade of nuclectomy. METHODS A previously constructed and validated lumbo-sacral model was used in this study, and in-out TED with intact AP and out-in TED with limited foraminoplasty, a smaller grade of nuclectomy was simulated. Biomechanical changes in the L5-S1 segment related to the degeneration acceleration were computed under different directional loading conditions. RESULTS Post-operative biomechanical changes after the out-in TED with limited foraminoplasty were slight, except for the facet contact pressure under the extension position. By contrast, significant biomechanical deterioration, both in the adjacent disc and zygapophyseal joints, is observed under extension in the model after the in-out TED with large nuclectomy. CONCLUSION A large grade of nuclectomy is regarded as an independent risk factor of adjacent segment disease in the caudal functional spinal unit after the in-out TED.
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Christiani T, Mys K, Dyer K, Kadlowec J, Iftode C, Vernengo AJ. Using embedded alginate microparticles to tune the properties of in situ forming poly( N-isopropylacrylamide)-graft-chondroitin sulfate bioadhesive hydrogels for replacement and repair of the nucleus pulposus of the intervertebral disc. JOR Spine 2021; 4:e1161. [PMID: 34611588 PMCID: PMC8479524 DOI: 10.1002/jsp2.1161] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/16/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
Low back pain is a major public health issue associated with degeneration of the intervertebral disc (IVD). The early stages of degeneration are characterized by the dehydration of the central, gelatinous portion of the IVD, the nucleus pulposus (NP). One possible treatment approach is to replace the NP in the early stages of IVD degeneration with a hydrogel that restores healthy biomechanics while supporting tissue regeneration. The present study evaluates a novel thermosensitive hydrogel based on poly(N-isopropylacrylamide-graft-chondroitin sulfate) (PNIPAAM-g-CS) for NP replacement. The hypothesis was tested that the addition of freeze-dried, calcium crosslinked alginate microparticles (MPs) to aqueous solutions of PNIPAAm-g-CS would enable tuning of the rheological properties of the injectable solution, as well as the bioadhesive and mechanical properties of the thermally precipitated composite gel. Further, we hypothesized that the composite would support encapsulated cell viability and differentiation. Structure-material property relationships were evaluated by varying MP concentration and diameter. The addition of high concentrations (50 mg/mL) of small MPs (20 ± 6 μm) resulted in the greatest improvement in injectability, compressive mechanical properties, and bioadhesive strength of PNIPAAm-g-CS. This combination of PNIPAAM-g-CS and alginate MPs supported the survival, proliferation, and differentiation of adipose derived mesenchymal stem cells toward an NP-like phenotype in the presence of soluble GDF-6. When implanted ex vivo into the intradiscal cavity of degenerated porcine IVDs, the formulation restored the compressive and neutral zone stiffnesses to intact values and resisted expulsion under lateral bending. Overall, results indicate the potential of the hydrogel composite to serve as a scaffold for supporting NP regeneration. This work uniquely demonstrates that encapsulation of re-hydrating polysaccharide-based MPs may be an effective method for improving key functional properties of in situ forming hydrogels for orthopedic tissue engineering applications.
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Affiliation(s)
- Thomas Christiani
- Department of Biomedical Engineering, Rowan UniversityGlassboroNew JerseyUSA
| | - Karen Mys
- AO Research Institute DavosDavosSwitzerland
| | - Karl Dyer
- Department of Mechanical Engineering, Rowan UniversityGlassboroNew JerseyUSA
| | - Jennifer Kadlowec
- Department of Computer Science and Engineering, Baldwin Wallace UniversityBereaOhioUSA
| | - Cristina Iftode
- Department of Molecular and Cellular Biosciences, Rowan UniversityGlassboroNew JerseyUSA
| | - Andrea Jennifer Vernengo
- Department of Biomedical Engineering, Rowan UniversityGlassboroNew JerseyUSA
- AO Research Institute DavosDavosSwitzerland
- Department of Chemical Engineering, Rowan UniversityGlassboroNew JerseyUSA
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Brendler J, Winter K, Lochhead P, Schulz A, Ricken AM. Histological differences between lumbar and tail intervertebral discs in mice. J Anat 2021; 240:84-93. [PMID: 34427936 PMCID: PMC8655214 DOI: 10.1111/joa.13540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 08/08/2021] [Accepted: 08/12/2021] [Indexed: 01/05/2023] Open
Abstract
Both the lumbar and tail intervertebral discs (IVD) of mice serve as models for the pathogenesis and histologic progression of degenerative disc disease. Recent studies in mature mice, however, demonstrate that the mechanics and physical attributes of lumbar and tail IVD‐endplate (EP)‐interfaces are strikingly different. We hypothesized that these structural disparities are associated with differences in the composition and organization of soft tissue elements that influence the biomechanical properties of the spine. Lumbar and tail vertebral segments and discs were collected from the same C57BL/6N and C57BL/6JRj mice, respectively for histological comparison of coronal sections at the ages of 4 weeks (weaned, both strains, C57BL/6N: n = 7; C57BL/6JRj: n = 4), three (mature, C57BL/6N: n = 7; C57BL/6JRj: n = 4), twelve (middle aged, C57BL/6JRj only: n = 3) and eighteen (old, C57BL/6JRj only: n = 3) months old. The histology of lumbar and tail IVD‐EP‐interfaces of mature mice differed markedly. The lumbar IVD‐EP‐interphase was characterized by a broad cartilaginous EP, while the tail IVD‐EP‐interphase comprised a thin layer of cartilage cells adjacent to a broad bony layer abutting the vertebral growth plate. Furthermore, the composition of the nuclei pulposi (NP) of lumbar and tail IVD in mature mice differed greatly. Lumbar NP consisted of a compact cluster of mainly large, uni‐vacuolated cells centered in an amorphous matrix, while tail NP were composed of a loose aggregate of vacuolated and non‐vacuolated cells. The anuli fibrosi also differed, with more abundant and sharply defined lamellae in tail compared to lumbar discs. The observed histological differences in the EP were even most prominent in weaned mice but were still discernible in middle‐aged and old mice. An appreciation of the histological differences between lumbar and tail IVD components in mice, including nucleus pulposus, annulus fibrosus, and endplates, is essential to our understanding of spinal biomechanics in these animals and should inform the design and interpretation of future IVD‐studies.
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Affiliation(s)
| | | | - Paul Lochhead
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Angela Schulz
- Rudolf-Schönheimer-Institute of Biochemistry, Faculty of Medicine, University of Leipzig, Leipzig, Germany
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48
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Żak M, Pezowicz C. Effect of overload on changes in mechanical and structural properties of the annulus fibrosus of the intervertebral disc. Biomech Model Mechanobiol 2021; 20:2259-2267. [PMID: 34431033 PMCID: PMC8595169 DOI: 10.1007/s10237-021-01505-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/12/2021] [Indexed: 11/02/2022]
Abstract
The research focussed on analysing structural and mechanical properties in the intervertebral disc (IVD), caused by long-term cyclic loading. Spinal motion segments were divided into two groups: the control (C), and the group in which it was analysed the impact of posterior column in the load-bearing system of the spine-specimens with intact posterior column (IPC) and without posterior column (WPC). To evaluate the structural and mechanical changes, the specimens were tested with simulation of 100,000 compression-flexion load cycles after which it was performed macroscopic analysis. Mechanical properties of the annulus fibrosis (AF) from the anterior and posterior regions of the IVD were tested at the uniaxial tension test. The stiffness coefficient values were statistically 32% higher in the WPC group (110 N/mm) than in the IPC (79 N/mm). The dynamics of increase in this parameter does not correspond with the course of decrease in height loss. WPC segments revealed clear structural changes that mainly involve the posterior regions of the IVD (bulging and delamination with the effect of separation of collagen fibre bundles). Pathological changes also caused decreases in the value of stress in the AF. The greatest changes in the stress value about group C (7.43 ± 4.49 MPa) were observed in the front part of the fibrous ring, where this value was for IPC 4.49 ± 4.78 MPa and WPC 2.56 ± 1.01 MPa. The research indicates that the applied load model allows simulating damage that occurs in pathological IVD. And the posterior column's presence affects this change's dynamics, structural and mechanical properties of AF.
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Affiliation(s)
- Małgorzata Żak
- Department of Mechanics, Materials and Biomedical Engineering, Faculty of Mechanical Engineering, Wrocław University of Science and Technology, Łukasiewicza 7/9, 50-371, Wrocław, Poland.
| | - Celina Pezowicz
- Department of Mechanics, Materials and Biomedical Engineering, Faculty of Mechanical Engineering, Wrocław University of Science and Technology, Łukasiewicza 7/9, 50-371, Wrocław, Poland
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Li J, Xu C, Zhang X, Xi Z, Sun S, Zhang K, Fang X, Xie L, Liu Y, Song Y. Disc measurement and nucleus calibration in a smoothened lumbar model increases the accuracy and efficiency of in-silico study. J Orthop Surg Res 2021; 16:498. [PMID: 34389025 PMCID: PMC8362282 DOI: 10.1186/s13018-021-02655-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/05/2021] [Indexed: 02/08/2023] Open
Abstract
Backgrounds Finite element analysis (FEA) is an important tool during the spinal biomechanical study. Irregular surfaces in FEA models directly reconstructed based on imaging data may increase the computational burden and decrease the computational credibility. Definitions of the relative nucleus position and its cross-sectional area ratio do not conform to a uniform standard in FEA. Methods To increase the accuracy and efficiency of FEA, nucleus position and cross-sectional area ratio were measured from imaging data. A FEA model with smoothened surfaces was constructed using measured values. Nucleus position was calibrated by estimating the differences in the range of motion (RoM) between the FEA model and that of an in-vitro study. Then, the differences were re-estimated by comparing the RoM, the intradiscal pressure, the facet contact force, and the disc compression to validate the measured and calibrated indicators. The computational time in different models was also recorded to evaluate the efficiency. Results Computational results indicated that 99% of accuracy was attained when measured and calibrated indicators were set in the FEA model, with a model validation of greater than 90% attained under almost all of the loading conditions. Computational time decreased by around 70% in the fitted model with smoothened surfaces compared with that of the reconstructed model. Conclusions The computational accuracy and efficiency of in-silico study can be improved in the lumbar FEA model constructed using smoothened surfaces with measured and calibrated relative nucleus position and its cross-sectional area ratio.
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Affiliation(s)
- Jingchi Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital/West China School of Medicine for Sichuan University, Chengdu, 610041, China
| | - Chen Xu
- Department of Spine Surgery, Changzheng Hospital Affiliated to the Naval Medical University, Shanghai, 200041, China
| | - Xiaoyu Zhang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, 210028, China
| | - Zhipeng Xi
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, 210028, China
| | - Shenglu Sun
- Department of Imaging, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu, China
| | - Ke Zhang
- Department of Spine Surgery, Changzheng Hospital Affiliated to the Naval Medical University, Shanghai, 200041, China
| | - Xiaoyang Fang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, 210028, China
| | - Lin Xie
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, 210028, China.
| | - Yang Liu
- Department of Spine Surgery, Changzheng Hospital Affiliated to the Naval Medical University, Shanghai, 200041, China.
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital/West China School of Medicine for Sichuan University, Chengdu, 610041, China.
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50
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Din RU, Cheng X, Yang H. Diagnostic Role of Magnetic Resonance Imaging in Low Back Pain Caused by Vertebral Endplate Degeneration. J Magn Reson Imaging 2021; 55:755-771. [PMID: 34309129 DOI: 10.1002/jmri.27858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/25/2022] Open
Abstract
Low back pain (LBP) is a common health issue worldwide with a huge economic burden on healthcare systems. In the United States alone, the cost is estimated to be $100 billion each year. Intervertebral disc degeneration is considered one of the primary causes of LBP. Moreover, the critical role of the vertebral endplates in disc degeneration and LBP is becoming apparent. Endplate abnormalities are closely correlated with disc degeneration and pain in the lumbar spine. Imaging modalities such as plain film radiography, computed tomography, and fluoroscopy are helpful but not very effective in detecting the causes behind LBP. Magnetic resonance imaging (MRI) can be used to acquire high-quality three-dimensional images of the lumbar spine without using ionizing radiation. Therefore, it is increasingly being used to diagnose spinal disorders. However, according to the American College of Radiology, current referral and justification guidelines for MRI are not sufficiently clear to guide clinical practice. This review aimed to evaluate the role of MRI in diagnosing LBP by considering the correlative contributions of vertebral endplates. The findings of the review indicate that MRI allows for fine evaluations of endplate morphology, endplate defects, diffusion and perfusion properties of the endplate, and Modic changes. Changes in these characteristics of the endplate were found to be closely correlated with disc degeneration and LBP. The collective evidence from the literature suggests that MRI may be the imaging modality of choice for patients suffering from LBP. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Rahman Ud Din
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | | | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
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