Short-Term Effect of Lumbar Traction on Intervertebral Discs in Patients with Low Back Pain: Correlation between the T2 Value and ODI/VAS Score

Influence of rapid recovery nutritional support on functional recovery and hospitalization duration in patients undergoing minimally invasive lumbar surgery

OBJECTIVE

To examine the impact of a nutrition support model, specifically focused on rapid recovery, on postoperative recovery in patients with degenerative lumbar spinal stenosis who underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

METHODS

A retrospective analysis was conducted, utilizing the medical records of 114 patients with degenerative lumbar spinal stenosis who underwent MIS-TLIF at the Affiliated Hospital of Gansu University of Chinese Medicine from February 2020 to October 2022. Among these patients, 63 individuals received a nutrition support model based on the concept of rapid recovery, comprising the observation group, while the remaining 51 patients received conventional postoperative support, forming the control group. The study compared the post-intervention lumbar function recovery, postoperative pain score, perioperative hospital stay, and patient satisfaction with nursing work between the two groups.

RESULTS

There was no statistically significant difference in the Japanese Orthopaedic Association (JOA) score and Oswestry Disability Index (ODI) at 6 months after the intervention between the two groups (P>0.05). Similarly, there was no statistically significant difference in the modified Barthel index and visual analog scale scores at 6 months after the intervention between the two groups (P>0.05). In terms of operation time and intraoperative blood loss, there was no statistically significant difference observed between the observation group and the control group (P>0.05). However, when compared to the control group, the observation group showed significant shorter hospital stay and time to ambulation after the intervention, leading to a decrease in treatment cost (P<0.01). Multivariate logistic regression analysis revealed that age, history of diabetes, nursing plan, operation time, and preoperative JOA score were identified as independent risk factors for prolonged hospital stay (P<0.05).

CONCLUSION

The nutrition support model, which is based on the concept of rapid recovery, has been found to have several benefits for patients with degenerative lumbar spinal stenosis undergoing MIS-TLIF. These benefits include reducing the hospital stay, treatment cost, and the time to ambulation. Additionally, logistic regression analysis has identified several independent risk factors that can affect the length of hospital stay. These risk factors include age, history of diabetes, nursing plan, operation time, and preoperative JOA score.

In search of biomarkers for low back pain: can traction therapy effectiveness be prognosed by surface electromyography or blood parameters?

Background: Lumbar traction therapy is a common method to reduce low back pain (LBP) but is not always effective. The search for biomarkers that would prognose the effectiveness of LBP management is one priority for improving patients' quality of life. Objectives: 1) To determine the phenotype of patients benefiting most from lumbar traction therapy. 2) To correlate systemic and electromyographic biomarkers with pain and pain-related disability. Methods: Data on muscle bioelectrical activity (surface electromyography [SEMG]) in the flexion-extension task, the concentrations of twelve systemic biochemical factors, LBP intensity (Visual Analog Scale), the Oswestry Disability Index, and the Roland-Morris Disability Questionnaire (RMDQ) were collected before and 72 h after 20 sessions of lumbar traction therapy. Patients were divided into responders and nonresponders based on the criterion of a 50% reduction in maximal pain. Results: The responders had lower maximal muscle bioactivity in the extension phase on the left side (p < 0.01) and higher flexion-extension ratios on both sides of the body in the SEMG (left: p < 0.05; right: p < 0.01), and higher adipsin, interleukin-2, interleukin-4, and interleukin-10 concentrations (p < 0.05) than nonresponders. Patients with higher interleukin-4 concentrations before therapy achieved greater reductions in maximal pain in the sitting position, bioelectrical muscle activity in flexion, and flexion-relaxation ratio on the left side of the body. Changes in adipsin and interleukin-4 concentrations correlated with changes in LBP intensity (r = 0.68; r = -0.77). Changes in stem cell growth factor and interleukin-17A correlated with changes in RMDQ (R = 0.53) and bioelectrical muscle activity in extension (left: R = -0.67; right: R = -0.76), respectively. Conclusion: Responders to traction therapy had SEMG indices of less favorable muscle activity in the flexion-extension task and elevated indices of inflammation before the study. For the first time, interleukin-4 was indicated as a potential biomarker for prognosing post-therapy changes in pain intensity and muscle activity.

Subjective assessment and biochemical evaluation of traction therapy in women with chronic low back pain: does body mass index matter? A clinical study

BACKGROUND

Apart from the positive effect of lumbar traction on structural changes within the spine in patients with low back pain, it is likely that therapeutic effects are correlated with pain biomarkers in the blood. Among them, systemic metabolic factors related to obesity may play an important role. This is the first study designed to examine the effectiveness of traction therapy in two experimental groups with considerably different BMI and to assess relationships between blood biomarkers and low back pain intensity.

METHODS

In the prospective clinical trial, women suffering from chronic low back pain were allocated into the normal-weight or obesity groups. Patients in both groups underwent twenty sessions of lumbar traction therapy (30 min a day, continuous mode with a force level of 25-30% of body weight). Before and after therapy subjective assessments of pain (VAS and PPT) were performed, and serum concentrations of aggrecan chondroitin sulfate 846 epitope (CS-846), neuropeptide Y, leptin, adipsin and growth and differentiation factor 15 (GDF-15) were determined. The data were statistically evaluated for 28 women.

RESULTS

After therapy, the maximal low back pain decreased in both groups, GDF-15 concentration was reduced in the normal-weight group and increased in the obesity group, and CS-846 concentration decreased in the obesity group. The sensation of PPT in the lumbar spine and mean concentrations of neuropeptide Y, leptin and adipsin did not change in both groups. However, the relationships of GDF-15, leptin, and adipsin concentrations with the perception of pain were revealed.

CONCLUSION

Distinct differences between the normal-weight and obesity groups pointed on the role of excessive adipose tissue in aggravating the inflammatory processes and in the development of low back pain. Adipsin, CS-846 and GDF-15 aspire to be the low back pain biomarkers in women with obesity, but there is a need for further research to answer whether they might be considered reliable biomarkers for the prognosis and monitoring of chronic low back treatment.

TRIAL REGISTRATION

NCT04507074, registered prospectively on July 6, 2020.

Applicative value of T2 mapping in evaluating lumbosacral nerve root injury induced by lumbosacral disc herniation

BACKGROUND

To alleviate the damage caused by nerve root entrapment mediated by lumbosacral disc herniation (LDH), an imaging method that allows quantitative evaluation of the lumbosacral nerve injury is necessary.

PURPOSE

To investigate the diagnostic value of magnetic resonance (MR) T2 mapping in nerve root injury caused by LDH.

MATERIAL AND METHODS

A total of 70 patients with unilateral sciatic nerve pain and 35 healthy volunteers were divided into three groups: LDH with nerve root entrapment; LDH without nerve root entrapment; and 35 healthy volunteers. All participants underwent 3.0-T MR with T1-weighted (T1W) imaging, T2-weighted (T2W) imaging, and T2-mapping images. T2 was measured and observed with the left and right nerve roots of the L4-S1 segments in healthy volunteers; the differences between the three groups were compared. T2 and the relaxation rate of nerve root injury were analyzed.

RESULTS

T2 showed significant differences among the three groups (F = 89.494; P = 0.000), receiver operating characteristic curve revealed that the T2 relaxation threshold was 79 ms, the area under curve (AUC) area was 0.86, sensitivity was 0.77, and specificity was 0.74; the T2 relaxation rate was 1.06, the AUC area was 0.88, sensitivity was 0.74, and specificity was 0.85.

CONCLUSION

T2 mapping could quantitatively evaluate the nerve root injury with lumbar disc degeneration. Hence, it can be used for the clinical evaluation of nerve root entrapment caused by LDH.

Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis

Objective

This study is aimed at exploring the clinical effect of mechanical traction on lumbar disc herniation (LDH).

Methods

Related literatures were retrieved from PubMed, Medline, Embase, CENTRAL, and CNKI databases. Inclusion of literature topic was comparison of mechanical traction and conventional physical therapy for lumbar disc herniation. Jadad scale was used to evaluate the quality of the included RCT studies. The Chi-square test was used for the heterogeneity test, and a random effect model was used with heterogeneity. Subgroup analysis and sensitivity analysis were used to explore the causes of heterogeneity. If there was no heterogeneity, the fixed effect model was used, and funnel plots were used to test publication bias.

Results

Visual analog scale (VAS) in the mechanical traction group was lower than that in the conventional physical therapy group (MD = −1.39 (95% CI (-1.81, -0.98)), Z = 6.56, and P < 0.00001). There was no heterogeneity among studies (Chi² = 6.62, P = 0.25, and I² = 24%) and no publication bias. Oswestry disability index (ODI) in the mechanical traction group was lower than that in the conventional physical therapy group (MD = −6.34 (95% CI (-10.28, -2.39)), Z = 3.15, and P = 0.002). There was no heterogeneity between studies (Chi² = 6.27, P = 0.18, and I² = 36%) and no publication bias. There was no significant difference in Schober test scores between the mechanical traction group and the conventional physical therapy group (MD = −0.40 (95% CI (-1.07, 0.28)), Z = 1.16, and P = 0.25). There was no heterogeneity among studies (Chi² = 1.61, P = 0.66, and I² = 0%) and no publication bias.

Conclusion

Mechanical traction can effectively relieve lumbar and leg pain and improve ODI in patients with lumbar disc herniation but has no significant effect on spinal motion. The therapeutic effect of mechanical traction was significantly better than that of conventional physical therapy. Lumbar traction can be used in conjunction with other traditional physical therapy.

Diurnal Variation in Hydration of the Cervical Intervertebral Disc Assessed Using T2 Mapping of Magnetic Resonance Imaging

Objective

The study aimed to investigate the diurnal variation in cervical disc hydration and its relationship with cervical degeneration.

Materials and Methods

C3–C7 discs of 86 prospectively enrolled participants (37 males, 49 females; mean age ± standard deviation, 23.5 ± 2.5 years) were assessed using T2 mapping in the morning and evening. All discs were stratified by Miyazaki grade or C2–C7 Cobb angle and T2 values (T2). The degree of diurnal T2 variation (T2-DDV), defined as (morning T2 – evening T2)/morning T2 × 100%, was measured for the entire disc, annulus fibrosus (AF), nucleus pulposus (NP), and endplate zones.

Results

T2 of the entire disc decreased significantly after the daytime load (p < 0.001), with a T2-DDV of 13.3% for all discs and 16.0%, 12.2%, and 13.0% for healthy (grade I), mild degenerative (grade II), and advanced degenerative (grade III/IV) discs, respectively. T2 of regional NPs and AFs decreased significantly from morning to evening (p ≤ 0.049) except in the healthy anterior inner AF (p = 0.092). Compared with healthy discs, mild degenerative discs displayed lower T2 and T2-DDV in regional NPs (p < 0.001). Advanced degenerative discs showed higher T2-DDV in the anterior inner AF compared with healthy discs (p = 0.050). Significant diurnal T2 changes in the endplate zones were observed only in healthy discs (p = 0.013). Cervical discs in the low Cobb angle group showed higher T2-DDV in the anterior AFs and anterior NP and lower T2-DDV in the posterior AF than those in the high Cobb angle group (p ≤ 0.041).

Conclusion

This study characterized the diurnal variation in hydration of the cervical discs as assessed using T2 mapping and revealed early chemo-mechanical coupling dysfunction in degenerating discs. Cervical sagittal alignment on MRI can affect the diurnal stress patterns of the cervical discs. T2 mapping is sensitive to disc biomechanical dysfunction and offers translational potential from biomechanical research to clinical application.

Association of Paraspinal Muscle CSA and PDFF Measurements With Lumbar Intervertebral Disk Degeneration in Patients With Chronic Low Back Pain

There is an interaction between the lumbar spine and paraspinal muscles, which may play a role in the development of intervertebral disc (IVD) degeneration and may affect CLBP. The study aims to assess the relationship between IVD degeneration and paraspinal muscle fat infiltration in CLBP patients by quantitative MR imaging, and to evaluate the influence of sex and age on CLBP muscle fat infiltration. Sixty CLBP patients (46.3 years ±17.0) and thirty-two healthy subjects (44.9 years ±17.6) were recruited for this study. 3.0 T MRI was used to perform the sagittal and axial T1, T2 of the lumbar spine, and axial paraspinal muscle IDEAL imaging at the L4/5 and L5/S1 levels. Proton density fat fraction (PDFF) of the multifidus and erector spinae at two IVD levels were measured. The Pfirrmann grades of IVD degeneration, Oswestry Disability Index (ODI), and Visual Analog Scale (VAS) were also evaluated. Compare the cross-sectional area (CSA) and PDFF of the paraspinal muscles between CLBP patients and healthy subjects, and analyze the relationship between the muscle PDFF and Pfirrmann grades, gender, and age of CLBP patients. Compared with healthy subjects, the CSA of the multifidus muscle in CLBP patients decreased (1320.2±188.1mm²vs. 1228.7±191.0 mm², p<0.05) at the L4/5 level, the average PDFF increased, (7.7±2.6% vs. 14.79±5.3%, 8.8±4.2% vs. 16.03±5.3%, all p<0.05) at both L4/5 and L5/S1 levels. The PDFF of paraspinal muscles were correlated with adjacent IVD degeneration, ODI and VSA in CLBP patients (all p<0.05). After using age and body mass index (BMI) as control variables, significance was retained (all p<0.05). Multiple regression analysis revealed sex and age also were significantly associated with multifidus PDFF (all p < 0.05). This study confirmed that the CSA decreased and the PDFF increased of the paraspinal muscles in CLBP patients. It reveals a significant correlation between the PDFF of CLBP paraspinal muscles and the grade of IVD degeneration. Sex and age are also important factors influencing CLBP paraspinal muscle infiltration.

Effect of Nonsurgical Spinal Decompression on Intensity of Pain and Herniated Disc Volume in Subacute Lumbar Herniated Disc

OBJECTIVE

Nonsurgical spinal decompression therapy (NSDT) is a conservative treatment for the lumbosacral herniated intervertebral disc (L-HIVD). This study aimed to evaluate the clinical effectiveness of the NSDT and change in disc volume through magnetic resonance imaging (MRI) in subacute L-HIVD.

METHODS

Sixty patients with subacute L-HIVD were randomized into either the decompression group (group D, n = 30) or the nondecompression group (group N, n = 30). In group D, NSDT was performed ten times in eight weeks. In group N, pseudodecompression therapy (no force) was performed with the same protocol. Lower back and lower leg pain intensities and functional improvements were measured by the visual analog scale and the Korean Oswestry Disability Index (K-ODI). The change in the lumbosacral disc herniation index (HI) was evaluated through a follow-up MRI three months after the therapy.

RESULTS

The lower leg pain intensity in group D was lower than that in group N at two months (p=0.028). Additionally, there were significantly lower K-ODI scores in group D at two and three months (p=0.023, 0.019) than in group N. The change in HI after the therapy was -27.6 ± 27.5 (%) in group D and -7.1 ± 24.9 (%) in group N, with a significant difference (p=0.017). Approximately 26.9% of patients in group D and no patients in group N showed over 50% reduction in HI (p=0.031).

CONCLUSION

NSDT may be a suitable treatment option for conservative treatment of subacute L-HIVD.