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Kandil K, Zaïri F, Zaïri F. Comprehensive analysis of damage evolution in human annulus fibrosus: Numerical exploration of mechanical sensitivity to biological age-dependent alteration. Comput Biol Med 2024; 182:109108. [PMID: 39276612 DOI: 10.1016/j.compbiomed.2024.109108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 08/12/2024] [Accepted: 09/02/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND AND OBJECTIVE The annulus fibrosus is an essential part of the intervertebral disc, critical for its structural integrity. Mechanical deterioration in this component can lead to complete disc failure, particularly through tears development, with radial tears being the most common. These tears are often the result of both mechanical and biological factors. This study aims to numerically investigate the mechanisms of radial failure in the annulus tissue, taking into account the mechanical and age-dependent biological damage origins. A newly developed microstructure-based model was upgraded to predict damage evolution in the different annulus regions. METHODS The study employs a computational model to predict mechanical failures in various annulus regions, using experimental data for comparison. The model incorporates age-dependent microstructural changes to evaluate the effects of biological aging on the mechanical behavior. It specifically includes a detailed analysis of the temporal changes in circumferential rigidity and failure strain of the annulus. RESULTS The model demonstrated a strong ability to replicate the experimental responses of the different annulus regions to failure. It revealed that age-related microstructural changes significantly impact the rigidity and failure response of the annulus, particularly in the posterior regions and as well the anterior inner side. These changes increase susceptibility to rupture with aging. A correlation was also observed between the composition of collagen fibers, water content, and the annulus transversal response in both radial and axial directions. CONCLUSION The findings challenge previous assumptions, showing that age-dependent microstructural changes have a notable effect on the annulus mechanical properties. The computational model closely aligns with experimental observations, underscoring the determinant role of oriented collagen fibers in radial failure. This study enhances the understanding of annulus failure and provides a foundation for further research on the impact of aging on disc mechanical integrity and failure.
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Affiliation(s)
- Karim Kandil
- Icam School of Engineering, Lille campus, 6 rue Auber, B.P. 10079, 59016, Lille, France; Univ. Lille, IMT Nord Europe, Univ. Artois, JUNIA, ULR 4515 - LGCgE, Laboratoire de Génie Civil et géo-Environnement, F-59000, Lille, France
| | - Fahmi Zaïri
- Univ. Lille, IMT Nord Europe, Univ. Artois, JUNIA, ULR 4515 - LGCgE, Laboratoire de Génie Civil et géo-Environnement, F-59000, Lille, France.
| | - Fahed Zaïri
- Ramsay Générale de Santé, Hôpital Privé Le Bois, 59000, Lille, France
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Wang K, Wu Z, Gong C, Zhao G, Zhang H. TGF-β1 Inhibits Osteoclast Differentiation and Abnormal Angiogenesis in Intervertebral Disc Degeneration: Evidence from RNA Sequencing and Animal Studies. Orthop Surg 2024; 16:167-182. [PMID: 38014468 PMCID: PMC10782258 DOI: 10.1111/os.13912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE Mechanisms involved in developing intervertebral disc degeneration (IDD) are poorly understood, thus making developing effective therapies difficult. This study aimed to suggest a possible molecular mechanism, based on transcriptome sequencing-identified transforming growth factor (TGF-β), underlying the effects on bone homeostasis in IDD. METHODS A mouse model for IDD was established. Transcriptome sequencing of nucleus pulposus tissue from mice (n = 3) identified differentially expressed mRNAs and key genes impacting bone homeostasis. A protein-protein interaction network pinpointed core genes. GO and KEGG analysis revealed gene functions. Expression levels of TGF-β1, tartrate-resistant acid phosphatase (TRAP), and cathepsin K (CTSK) were measured. Micro-CT evaluated vertebral structures and vascular imaging. Western Blot measured expression levels of Vegf, Opn, MMP3, and MMP13. Safranin O-Fast Green and TRAP staining were performed on intervertebral discs and endplates. RESULTS Transcriptomic analysis found 1790 differentially expressed mRNAs in IDD mice. Twenty-eight genes related to bone homeostasis in IDD were identified. TGF-β1 was confirmed as the core gene. GO and KEGG showed TGF-β1 regulates osteoclast markers like CTSK and TRAP through pathways including NF-κB and MAPK. Experimental validation revealed lower TGF-β1 expression in IDD mice than controls, and increased TRAP and CTSK expression. Micro-CT showed decreased bone mass and intervertebral disc space in IDD mice. Vascular imaging showed increased vascular volume in IDD cartilaginous endplates. Western blot displayed increased VEGF and OPN levels, but decreased MMP3 and MMP13 in IDD mice. Safranin O-fast green staining revealed severe IDD degeneration. However, TGF-β1 injection improved bone parameters in IDD mice. In vitro experiments confirmed TGF-β1 inhibits bone marrow macrophages differentiation into osteoclasts. CONCLUSION From our data, we conclude that TGF-β1 repressed osteoclast differentiation and aberrant bone-associated angiogenesis in cartilage endplates (EPs) to alleviate IDD, which may be instrumental for the therapeutic targeting of IDD.
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Affiliation(s)
- Keping Wang
- Department of OrthopedicsSecond Hospital of Lanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhouChina
- Lanzhou UniversityLanzhouChina
| | - Zuolong Wu
- Department of OrthopedicsSecond Hospital of Lanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhouChina
- Lanzhou UniversityLanzhouChina
| | - Chaoyang Gong
- Department of OrthopedicsSecond Hospital of Lanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhouChina
- Lanzhou UniversityLanzhouChina
| | - Guanghai Zhao
- Department of OrthopedicsSecond Hospital of Lanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhouChina
- Lanzhou UniversityLanzhouChina
| | - Haihong Zhang
- Department of OrthopedicsSecond Hospital of Lanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhouChina
- Lanzhou UniversityLanzhouChina
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Azzouzi H, Ichchou L. Schmorl's nodes: demystification road of endplate defects-a critical review. Spine Deform 2022; 10:489-499. [PMID: 34825353 DOI: 10.1007/s43390-021-00445-w] [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: 09/13/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Schmorl's nodes (SN) were the first vertebral endplate defects described. Debate continues about their epidemiology, physiopathology, and clinical significance. The purpose of this work was to summarize and discuss available literature about SN. METHODS We have searched for relevant papers about SN until April 2020, with 104 articles have been reviewed. RESULTS More than half of the available literature described the epidemiological aspects of SN or reported rare clinical presentations and treatment options. The lack of a consensual definition of SN, among other endplate defects, contributed to difficulties in literature results' interpretation. Summing up, SN is a frequent vertebral defect at the thoracolumbar juncture, with ethnic and gender influence. Lumbar Schmorl's nodes were frequently associated with disc degenerative disease and back pain. Their physiopathology remains unknown. However, strain energy changes in the spine along with morphological aspects of the vertebra, the genetic background, and the osteoimmunology may constitute possible clues. New SN could be confused in malignancy context with bone metastasis. The literature describes some imaging techniques to differentiate them, avoiding invasive approaches. Treatment options for rare painful presentations remain few with low evidence. Further studies are needed to establish a consensual definition for SN, understand clinical aspects, and provide adequate therapeutic strategies.
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Affiliation(s)
- Hamida Azzouzi
- Department of Rheumatology, Faculty of Medicine, Mohammed VI University Hospital of Oujda, Université Mohammed Premier, Oujda, Morocco.
| | - Linda Ichchou
- Department of Rheumatology, Faculty of Medicine, Mohammed VI University Hospital of Oujda, Université Mohammed Premier, Oujda, Morocco
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Xu C, Huang C, Cai P, Fang Z, Wei Z, Liu F, Li J, Liu Y. Biomechanical Effects of Pedicle Screw Positioning on the Surgical Segment in Models After Oblique Lumbar Interbody Fusion: An in-silico Study. Int J Gen Med 2022; 15:1047-1056. [PMID: 35140507 PMCID: PMC8818966 DOI: 10.2147/ijgm.s352304] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Bilateral pedicle screw (BPS) is the “gold standard” of fixation methods for patients with lumbar interbody fusion. Biomechanical deterioration initially triggers complications in the surgical segment. Studies proved that BPS positions and trajectory changes affect the local biomechanical environment. However, no study illustrates the biomechanical effect of insertional screw positions’ change on the surgical segment. Methods Oblique lumbar interbody fusion (OLIF) with different BPS insertional positions has been simulated in a well-validated lumbo-sacral model. Fixation stability and stress responses on the surgical segment were evaluated under identical loading conditions. Results There is no clear variation tendency for the risk of BPS failure and the change of strain energy density of the grafted bone. However, shifting the insertional screw position close to the surgical segment will increase the range of motions (ROM) in the surgical segment and lead to stress concentration of bony structures, especially in the caudal side of the surgical segment. Conclusion Adjusting the insertional position of BPS close to the surgical segment in OLIF models will lead to stress concentration of bony structures and surgical segmental instability. Therefore, reducing BPS’s fixation length was not recommended, which may increase the risk of segmental instability, non-union, and cage subsidence.
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Affiliation(s)
- Chen Xu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Chenyi Huang
- Department of Orthopedics, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, People’s Republic of China
| | - Ping Cai
- Department of Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of China
| | - Zhongxin Fang
- Fluid and Power Machinery Key Laboratory of Ministry of Education, Xihua University, Chengdu, People’s Republic of China
| | - Zhangchao Wei
- Department of Orthopedics, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, People’s Republic of China
| | - Fei Liu
- Department of Orthopedics, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, People’s Republic of China
| | - Jingchi Li
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, People’s Republic of China
- Department of Orthopedics, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, People’s Republic of China
- Jingchi Li, Department of Orthopedics, Hospital (T.C.M) Affiliated to Southwest Medical University, No. 182, Chunhui Road, Luzhou, Sichuan Province, 646000, People’s Republic of China, Email
| | - Yang Liu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, People’s Republic of China
- Correspondence: Yang Liu, Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People’s Republic of China, Email
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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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Li J, Xu C, Zhang X, Xi Z, Liu M, Fang Z, Wang N, Xie L, Song Y. TELD with limited foraminoplasty has potential biomechanical advantages over TELD with large annuloplasty: an in-silico study. BMC Musculoskelet Disord 2021; 22:616. [PMID: 34246272 PMCID: PMC8272903 DOI: 10.1186/s12891-021-04504-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background Facetectomy, an important procedure in the in–out and out–in techniques of transforaminal endoscopic lumbar discectomy (TELD), is related to the deterioration of the postoperative biomechanical environment and poor prognosis. Facetectomy may be avoided in TELD with large annuloplasty, but iatrogenic injury of the annulus and a high grade of nucleotomy have been reported as risk factors influencing poor prognosis. These risk factors may be alleviated in TELD with limited foraminoplasty, and the grade of facetectomy in this surgery can be reduced by using an endoscopic dynamic drill. Methods An intact lumbo-sacral finite element (FE) model and the corresponding model with adjacent segment degeneration were constructed and validated to evaluate the risk of biomechanical deterioration and related postoperative complications of TELD with large annuloplasty and TELD with limited foraminoplasty. Changes in various biomechanical indicators were then computed to evaluate the risk of postoperative complications in the surgical segment. Results Compared with the intact FE models, the model of TELD with limited foraminoplasty demonstrated slight biomechanical deterioration, whereas the model of TELD with large annuloplasty revealed obvious biomechanical deterioration. Degenerative changes in adjacent segments magnified, rather than altered, the overall trends of biomechanical change. Conclusions TELD with limited foraminoplasty presents potential biomechanical advantages over TELD with large annuloplasty. Iatrogenic injury of the annulus and a high grade of nucleotomy are risk factors for postoperative biomechanical deterioration and complications of the surgical segment.
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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, 37# Wuhou Guoxue road, Chengdu, Sichuan Province, 610041, P.R. 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, Jiangsu Province, 210028, P.R. China
| | - Zhipeng Xi
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Mengnan Liu
- Macau University of Science and Technology, Macau, 999078, China
| | - Zhongxin Fang
- Fluid and Power Machinery Key Laboratory of Ministry of Education, Xihua University, Chengdu, 610039, China
| | - Nan Wang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Lin Xie
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China.
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital/West China School of Medicine for Sichuan University, 37# Wuhou Guoxue road, Chengdu, Sichuan Province, 610041, P.R. China.
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Hu BW, Lv X, Chen SF, Shao ZW. Application of Finite Element Analysis for Investigation of Intervertebral Disc Degeneration: from Laboratory to Clinic. Curr Med Sci 2019; 39:7-15. [PMID: 30868485 DOI: 10.1007/s11596-019-1993-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 09/06/2018] [Indexed: 01/06/2023]
Abstract
Due to the ethical concern and inability to detect inner stress distributions of intervertebral disc (IVD), traditional methods for investigation of intervertebral disc degeneration (IVDD) have significant limitations. Many researchers have demonstrated that finite element analysis (FEA) is an effective tool for the research of IVDD. However, the specific application of FEA for investigation of IVDD has not been systematically elucidated before. In the present review, we summarize the current finite element models (FEM) used for the investigation of IVDD, including the poroelastic nonlinear FEM, diffusive-reactive theory model and cell-activity coupled mechano-electrochemical theory model. We further elaborate the use of FEA for the research of IVDD pathogenesis especially for nutrition and biomechanics associated etiology, and the biological, biomechanical and clinical influences of IVDD. In addition, the application of FEA for evaluation and exploration of various treatments for IVDD is also elucidated. We conclude that FEA is an excellent technique for research of IVDD, which could be used to explore the etiology, biology and biomechanics of IVDD. In the future, FEA may help us to achieve the goal of individualized precision therapy.
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Affiliation(s)
- Bin-Wu Hu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiao Lv
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Song-Feng Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Zeng-Wu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Xiao ZF, He JB, Su GY, Chen MH, Hou Y, Chen SD, Lin DK. Osteoporosis of the vertebra and osteochondral remodeling of the endplate causes intervertebral disc degeneration in ovariectomized mice. Arthritis Res Ther 2018; 20:207. [PMID: 30201052 PMCID: PMC6131954 DOI: 10.1186/s13075-018-1701-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/15/2018] [Indexed: 12/21/2022] Open
Abstract
Background Studies on the relationship between osteoporosis and intervertebral disc degeneration (IVDD) are inconsistent. Therefore, we assessed whether IVDD is affected by vertebral osteoporosis in ovariectomized mice and investigated the underlying pathogenesis of IVDD related to osteoporosis. Methods Thirty healthy female C57BL/6 J mice aged 8 weeks were randomly divided into two groups: a control group (sham operation, n = 15) and an ovariectomy group (OVX; bilateral ovariectomy, n = 15). At 12 weeks after surgery, the bone quantity and microstructure in the lumbar vertebra and endplate as well as the volume of the L4/5 disc space were evaluated by microcomputed tomography (micro-CT). The occurrence and characteristic alterations of IVDD were identified via histopathological staining. The osteoclasts were detected using tartrate-resistant acid phosphatase (TRAP) staining. Type II collagen (Col II), osterix (OSX), osteopontin (OPN), and vascular endothelial growth factor (VEGF) expression in the intervertebral disc were detected by immunohistochemical analysis. Results OVX significantly increased the body weight and decreased the uterus weight. Micro-CT analysis showed that osteoporosis of the vertebra and osteochondral remodeling of the endplate were accompanied by an increase in the endplate porosity and a decrease in the disc volume in the OVX group. Likewise, histological evaluation revealed that IVDD occurred at 12 weeks after ovariectomy, with features of endochondral ossification of the endplate, loose and broken annulus fibrosus, and degeneration of nucleus pulposus. TRAP staining showed that numerous active osteoclasts appeared in the subchondral bone and cartilaginous endplate of OVX mice, whereas osteoclasts were rarely detected in control mice. Immunohistochemical analysis demonstrated that the expression of osterix was significantly increased, notably in the endplate of OVX mice. In addition, Col II was decreased in the ossification endplate and the degenerative annulus fibrosus, where OPN and VEGF expressions were elevated in OVX mice. Conclusions OVX induced vertebral osteoporosis and osteochondral remodeling of the cartilaginous endplate contributing to the angiogenesis and an increase in porosity of the bone-cartilage surface, and also affected the matrix metabolism which consequently had detrimental effects on the intervertebral disc. Our study suggests that preserving the structural integrity and the function of the adjacent structures, including the vertebrae and endplates, may protect the disc against degeneration. Electronic supplementary material The online version of this article (10.1186/s13075-018-1701-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhi-Feng Xiao
- The Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120, China.,The Laboratory Affiliated to Orthopaedics and Traumatology of Chinese Medicine of Linnan Medical Research Center of Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510405, China.,Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510405, China
| | - Jian-Bo He
- The Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120, China.,The Laboratory Affiliated to Orthopaedics and Traumatology of Chinese Medicine of Linnan Medical Research Center of Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510405, China.,Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510405, China
| | - Guo-Yi Su
- The Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120, China.,Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510405, China
| | - Mei-Hui Chen
- The Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120, China.,The Laboratory Affiliated to Orthopaedics and Traumatology of Chinese Medicine of Linnan Medical Research Center of Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510405, China.,Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510405, China
| | - Yu Hou
- The Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120, China.,Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510405, China
| | - Shu-Dong Chen
- The Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120, China.,Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510405, China
| | - Ding-Kun Lin
- The Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120, China. .,The Laboratory Affiliated to Orthopaedics and Traumatology of Chinese Medicine of Linnan Medical Research Center of Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510405, China. .,Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510405, China.
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Zehra U, Bow C, Lotz JC, Williams FMK, Rajasekaran S, Karppinen J, Luk KDK, C Battiê M, Samartzis D. Structural vertebral endplate nomenclature and etiology: a study by the ISSLS Spinal Phenotype Focus Group. 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 2017; 27:2-12. [PMID: 28900744 DOI: 10.1007/s00586-017-5292-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/23/2017] [Accepted: 09/03/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE Vertebral endplate abnormalities may be associated with disc degeneration and, perhaps, pain generation. However, consensus definitions for endplate findings on spine MRI do not exist, posing a challenge to compare findings between studies and ethnic groups. The following survey was created to characterize the variability among the global spine community regarding endplate structural findings with respect to nomenclature and etiology. METHODS A working group within the International Society for the Study of the Lumbar Spine (ISSLS) Spinal Phenotype Focus Group was established to assess the endplate phenotype. A survey which consisted of 13 T2-weighted sagittal MRIs of the human lumbar spine illustrating the superior and inferior endplates was constructed based on discussion and agreement by the working group. A list of nomenclature and etiological terms with historical precedence was generated. Participants were asked to describe the endplates of each image and select from 14 possible nomenclatures and 10 etiological terms along with the option of free text response. The survey was entered into RedCap and was circulated throughout the ISSLS membership for data capture. Participants' demographics were also noted. RESULTS The survey was completed by 55 participants (87% males; 85% above 45 years of age, 39 clinicians, and 16 researchers). Sixty-eight percent of researchers and seventy-four percent of clinicians reported more than 16 and 20 years of research and clinical experience. Considerable variation existed in selection of nomenclature, etiology, and degree of severity of the endplate structural findings (reliability coefficients for single measures in each case were 0.3, 0.08, and 0.2, respectively). Sixty-seven percent regarded Modic changes as being a structural endplate finding. Approximately 84 and 80% of clinicians and researchers, respectively, agreed that a standardized endplate nomenclature and understanding the etiology is clinically important and needed. CONCLUSIONS This study found that variations exist with respect to endplate nomenclature and etiology between clinicians and basic scientists, and paves the way for a consensus process to formalize the definitions.
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Affiliation(s)
- Uruj Zehra
- Department of Orthopedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Cora Bow
- Department of Orthopedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA, USA
| | | | - S Rajasekaran
- Department of Orthopedics and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Keith D K Luk
- Department of Orthopedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Michele C Battiê
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Dino Samartzis
- Department of Orthopedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China.
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Plomp K, Roberts C, Strand Vidarsdottir U. Does the correlation between Schmorl's nodes and vertebral morphology extend into the lumbar spine? AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2015; 157:526-34. [PMID: 25752504 DOI: 10.1002/ajpa.22730] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 11/07/2022]
Abstract
Schmorl's nodes are depressions on vertebrae due to herniation of the nucleus pulposus of the intervertebral disc into the vertebral body. This study provides an extension of our previous study which analyzed the shape of the lower thoracic spine and found that vertebral morphology was associated with the presence of Schmorl's nodes. Ninety adult individuals from the late Medieval site of Fishergate House, York, and the Post-Medieval site of Coach Lane, North Shields, Tyne and Wear, England, were analysed using 2D geometric morphometrics to identify possible relationships between vertebral morphology and Schmorl's nodes at the thoraco-lumbar junction and in the lumbar spine. A significant correlation was found between vertebral shape and the presence of Schmorl's nodes in the twelfth thoracic vertebrae and the first to third lumbar vertebrae. The findings corroborate previous studies and suggest that vertebral shape may be an important factor in spinal health. It is hypothesized that the pedicle shape of affected vertebrae may not provide adequate structural support for the vertebral bodies, resulting in vertical disc herniation.
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Affiliation(s)
- Kimberly Plomp
- Human Evolutionary Studies Program, Department of Archaeology, Simon Fraser University, Vancouver, BC, Canada
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