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Banno T, Hasegawa T, Yamato Y, Yoshida G, Arima H, Oe S, Ide K, Yamada T, Kurosu K, Matsuyama Y. Psychological Factors Can Affect the Clinical Outcome of Chemonucleolysis with Condoliase in Patients with Lumbar Disk Herniation. Spine Surg Relat Res 2024; 8:195-202. [PMID: 38618216 PMCID: PMC11007243 DOI: 10.22603/ssrr.2023-0117] [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: 05/27/2023] [Accepted: 09/18/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Condoliase-based chemonucleolysis is a minimally invasive intermediate treatment option between conservative approaches and surgical interventions for lumbar disk herniation (LDH). In this study, the effects of psychological factors on the clinical outcomes of condoliase therapy for LDH were assessed. Methods This study involved patients with LDH who received condoliase injections over a 1-year follow-up period. Data from the visual analog scale (VAS) scores for leg and back pain, Oswestry Disability Index, and Hospital Anxiety and Depression Scale (HADS), which was utilized for the psychological assessment, were collected. Using magnetic resonance imaging, changes in disk height and degeneration were evaluated. Data were assessed at baseline and 1-month, 3-month, and 1-year follow-ups. Condoliase therapy was considered effective in patients whose VAS score for leg pain improved by ≥50% at 1 year from baseline and who did not require surgery. The patients were divided into two groups: those who reported effective treatment (Group E) and those who did not (Group I). Between these two groups, comparative analyses were carried out. Results In this study, a total of 102 patients (70 men; mean age, 43.8±18.2 years) were included. Condoliase therapy was effective in 76 patients (74.5%). Thirty-five patients (34.3%) showed psychological factors (HADS-Anxiety [HADS-A]≥8 or HADS-Depression [HADS-D]≥8) preoperatively and had a significantly lower rate of effectiveness than did those without psychological factors. Group I demonstrated significantly higher baseline back pain VAS, HADS, and HADS-D scores when compared with Group E. Logistic regression analysis identified females and the baseline HADS-D score as independent factors that were related to the effectiveness of condoliase therapy. Conclusions The patients with psychological factors tended to experience residual pain resulting in adverse effects on the clinical outcomes of chemonucleolysis with condoliase.
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Affiliation(s)
- Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Division of Surgical Care, Mori-machi, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kenta Kurosu
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Tang C, Guo G, Fang S, Yao C, Zhu B, Kong L, Pan X, Li X, He W, Wu Z, Fang M. Abnormal brain activity in lumbar disc herniation patients with chronic pain is associated with their clinical symptoms. Front Neurosci 2023; 17:1206604. [PMID: 37575297 PMCID: PMC10416647 DOI: 10.3389/fnins.2023.1206604] [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: 04/16/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Lumbar disc herniation, a chronic degenerative disease, is one of the major contributors to chronic low back pain and disability. Although many studies have been conducted in the past on brain function in chronic low back pain, most of these studies did not classify chronic low back pain (cLBP) patients according to their etiology. The lack of etiologic classification may lead to inconsistencies between findings, and the correlation between differences in brain activation and clinical symptoms in patients with cLBP was less studied in the past. Methods In this study, 36 lumbar disc herniation patients with chronic low back pain (LDHCP) and 36 healthy controls (HCs) were included to study brain activity abnormalities in LDHCP. Visual analogue scale (VAS), oswestry disability index (ODI), self-rating anxiety scale (SAS), self-rating depression scale (SDS) were used to assess clinical symptoms. Results The results showed that LDHCP patients exhibited abnormally increased and diminished activation of brain regions compared to HCs. Correlation analysis showed that the amplitude of low frequency fluctuations (ALFF) in the left middle frontal gyrus is negatively correlated with SAS and VAS, while the right superior temporal gyrus is positively correlated with SAS and VAS, the dorsolateral left superior frontal gyrus and the right middle frontal gyrus are negatively correlated with VAS and SAS, respectively. Conclusion LDHCP patients have brain regions with abnormally increased and abnormally decreased activation compared to healthy controls. Furthermore, some of the abnormally activated brain regions were correlated with clinical pain or emotional symptoms.
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Affiliation(s)
- Cheng Tang
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guangxin Guo
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sitong Fang
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chongjie Yao
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bowen Zhu
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lingjun Kong
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuanjin Pan
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinrong Li
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weibin He
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhiwei Wu
- Research Institute of Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Fang
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
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Chen XW, Li QW, Wang H. Sequencing and bioinformatics analysis of miRNA from rat endplate chondrogenic exosomes. Exp Ther Med 2023; 25:267. [PMID: 37206570 PMCID: PMC10189748 DOI: 10.3892/etm.2023.11966] [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: 09/21/2022] [Accepted: 03/16/2023] [Indexed: 05/21/2023] Open
Abstract
Exosomes have a key role in various diseases, such as arthritis, heart disease and respiratory disease. Exosomes from various sources have also been indicated to improve intervertebral disc degeneration. However, the role of endplate chondrogenic exosomes in intervertebral disc degeneration has remained largely elusive. The aim of the present study was to compare exosomal microRNA (miRNA) expression patterns in endplate chondrocytes before and after degeneration, and their potential roles in the pathogenesis of intervertebral disc degeneration (IVDD). Endplate chondrocytes were extracted from rats and cultured to obtain pre- and post-degeneration chondrocytes. Exosomes were obtained from the chondrocytes by centrifugation. The two groups of exosomes were subjected to small RNA sequencing, miRNA identification, novel miRNA prediction, quantitative analysis of miRNA expression and differentially expressed (DE) miRNA screening, in addition to miRNA target gene (TG) prediction and TG functional annotation and enrichment analysis. The percentage of miRNAs isolated from the exosomes before and after degeneration was found to differ. A total of 58 DE miRNAs were analyzed, the expression levels of which were significantly different post-degeneration compared with pre-degeneration. Cell experiments were also performed, in which the exosomes were co-cultured with nucleus pulposus (NP) cells. The results indicated that the chondrocyte-derived exosomes were taken up by the NP cells and influenced the expression of aggrecan and collagen 1A and 2A, suggesting that they may inhibit IVDD via their action on NP cells. The specific miRNAs present in exosomes during IVDD may be used to develop new targets for the treatment and diagnosis of this condition. DE exosomal miRNAs derived from endplate cartilage pre- and post-degeneration may be associated with the risk of IVDD and could help to distinguish patients with IVDD. Furthermore, the expression of certain miRNAs may be associated with disease progression, which may contribute to understanding the pathophysiology of IVDD from an epigenetic perspective.
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Affiliation(s)
- Xue-Wu Chen
- Department of Spinal Orthopedics, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Qiu-Wei Li
- Department of Spinal Orthopedics, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Hong Wang
- Department of Spinal Orthopedics, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241000, P.R. China
- Correspondence to: Professor Hong Wang, Department of Spinal Orthopedics, Yijishan Hospital of Wannan Medical College, 2 Zheshan West Road, Jinghu, Wuhu, Anhui 241000, P.R. China
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Lambrechts MJ, Pitchford C, Hogan D, Li J, Fogarty C, Rawat S, Leary EV, Cook JL, Choma TJ. Lumbar spine intervertebral disc desiccation is associated with medical comorbidities linked to systemic inflammation. Arch Orthop Trauma Surg 2023; 143:1143-1153. [PMID: 34623492 DOI: 10.1007/s00402-021-04194-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/24/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Symptomatic disc degeneration is a common cause of low back pain. Recently, the prevalence of low back pain has swiftly risen leading to increased patient disability and loss of work. The increase in back pain also coincides with a rapid rise in patient medical comorbidities. However, a comprehensive study evaluating a link between patient's medical comorbidities and their influence on lumbar intervertebral disc morphology is lacking in the literature. METHODS Electronic medical records (EMR) were retrospectively reviewed to determine patient-specific medical characteristics. Magnetic resonance imaging (MRI) was evaluated for lumbar spine intervertebral disc desiccation and height loss according to the Griffith-modified Pfirrmann grading system. Bivariate and multivariable linear regression analyses assessed strength of associations between patient characteristics and lumbar spine Pfirrmann grade severity (Pfirrmann grade of the most affected lumbar spine intervertebral disc) and cumulative grades (summed Pfirrmann grades for all lumbar spine intervertebral discs). RESULTS In total, 605 patients (304 diabetics and 301 non-diabetics) met inclusion criteria. Bivariate analysis identified older age, diabetes, American Society of Anesthesiologists (ASA) class, hypertension, chronic obstructive pulmonary disease (COPD), peripheral vascular disease, and hypothyroidism as being strongly associated with an increasing cumulative Pfirrmann grades. Multivariable models similarly found an association linking increased cumulative Pfirrmann grades with diabetes, hypothyroidism, and hypertension, while additionally identifying non-white race, heart disease, and previous lumbar surgery. Chronic pain, depression, and obstructive sleep apnea (OSA) were associated with increased Pfirrmann grades at the most affected level without an increase in cumulative Pfirrmann scores. Glucose control was not associated with increasing severity or cumulative Pfirrmann scores. CONCLUSION These findings provide specific targets for future studies to elucidate key mechanisms by which patient-specific medical characteristics contribute to the development and progression of lumbar spine disc desiccation and height loss. LEVEL OF EVIDENCE III (retrospective cohort).
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.
| | - Chase Pitchford
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Daniel Hogan
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Jinpu Li
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Casey Fogarty
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,School of Medicine, University of Missouri, Columbia, MO, USA
| | - Sury Rawat
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,School of Medicine, University of Missouri, Columbia, MO, USA
| | - Emily V Leary
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - James L Cook
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Theodore J Choma
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA
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Kvasnitskyi MV. MANIFESTATIONS AND TREATMENT OF LOWER BACK PAIN SYNDROME IN WARTIME. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1185-1190. [PMID: 37364071 DOI: 10.36740/wlek202305208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The aim: To improve treatment of patients with lower back pain through identification of pathogenetic factors in its formation. PATIENTS AND METHODS Materials and methods: The early results of treatment of 84 patients with lower back pain (main group) were analysed. Patients of the main group were divided into two subgroups: one group involved patients with mental disorders, the other - patients not suffering from such disorders (the Spielberger-Hanin Anxiety Test used). The patients of the main group with mental disorders (49 patients) were administered with epidural steroid injections and antidepressants. The patients with no mental disorders (35 patients) were administered with epidural steroid injections only. The control group involved 36 patients with lower back pain who did not undergo any psychological testing and were administered with epidural steroid injections only. The Visual Analog Scale (VAS) and the Oswestry Disability Index questionnaire were used to assess pain syndrome. The assessment was carried out twice: in the pre-operative period and in three months after the treatment. RESULTS Results: A significant difference in the early treatment results between the main and control groups was established according to both the Visual Analog Scale and the Oswestry Disability Index in favour of the main group patients, who were differentiated by pathogenetic factors of the pain syndrome formation. CONCLUSION Conclusions: Lower back pain syndrome necessitates clarification of its components in order to develop pathogenically based treatment.
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Affiliation(s)
- Mykola V Kvasnitskyi
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
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