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Ottone OK, Mundo JJ, Kwakye BN, Slaweski A, Collins JA, Wu Q, Connelly MA, Niaziorimi F, van de Wetering K, Risbud MV. Oral citrate supplementation mitigates age-associated pathological intervertebral disc calcification in LG/J mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.17.604008. [PMID: 39071393 PMCID: PMC11275755 DOI: 10.1101/2024.07.17.604008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Despite the high prevalence of age-dependent intervertebral disc calcification, there is a glaring lack of treatment options for this debilitating pathology. Here, we investigate the efficacy of long-term oral K3Citrate supplementation in ameliorating disc calcification in LG/J mice, a model of spontaneous age-associated disc calcification. K3Citrate successfully reduced the incidence of disc calcification in LG/J mice without deleterious effects on vertebral bone structure, plasma chemistry, and locomotion. Notably, a positive effect on grip strength was evident in treated mice. Spectroscopic investigation of the persisting calcified nodules indicated K3Citrate did not alter the mineral composition and revealed that reactivation of an endochondral differentiation program in endplates may drive LG/J disc calcification. Importantly, K3Citrate reduced calcification incidence without altering the pathological endplate chondrocyte hypertrophy, suggesting mitigation of disc calcification primarily occurred through Ca2+ chelation, a conclusion supported by chondrogenic differentiation and Seahorse metabolic assays. Overall, this study underscores the therapeutic potential of K3Citrate as a systemic intervention strategy for disc calcification.
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Affiliation(s)
- Olivia K. Ottone
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Graduate Program in Cell Biology and Regenerative Medicine, Jefferson College of Life Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jorge J. Mundo
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Boahen N. Kwakye
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amber Slaweski
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - John A. Collins
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Fatemeh Niaziorimi
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- PXE International Center of Excellence for Research and Clinical Care
| | - Koen van de Wetering
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- PXE International Center of Excellence for Research and Clinical Care
| | - Makarand V. Risbud
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Graduate Program in Cell Biology and Regenerative Medicine, Jefferson College of Life Sciences, Thomas Jefferson University, Philadelphia, PA, USA
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He Y, Liu S, Lin H, Ding F, Shao Z, Xiong L. Roles of organokines in intervertebral disc homeostasis and degeneration. Front Endocrinol (Lausanne) 2024; 15:1340625. [PMID: 38532900 PMCID: PMC10963452 DOI: 10.3389/fendo.2024.1340625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Abstract
The intervertebral disc is not isolated from other tissues. Recently, abundant research has linked intervertebral disc homeostasis and degeneration to various systemic diseases, including obesity, metabolic syndrome, and diabetes. Organokines are a group of diverse factors named for the tissue of origin, including adipokines, osteokines, myokines, cardiokines, gastrointestinal hormones, and hepatokines. Through endocrine, paracrine, and autocrine mechanisms, organokines modulate energy homeostasis, oxidative stress, and metabolic balance in various tissues to mediate cross-organ communication. These molecules are involved in the regulation of cellular behavior, inflammation, and matrix metabolism under physiological and pathological conditions. In this review, we aimed to summarize the impact of organokines on disc homeostasis and degeneration and the underlying signaling mechanism. We focused on the regulatory mechanisms of organokines to provide a basis for the development of early diagnostic and therapeutic strategies for disc degeneration.
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Affiliation(s)
- Yuxin He
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Lin
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Ding
- Department of Orthopaedics, JingMen Central Hospital, Jingmen, China
- Hubei Minzu University, Enshi, China
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Xiong
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Novais EJ, Narayanan R, Canseco JA, van de Wetering K, Kepler CK, Hilibrand AS, Vaccaro AR, Risbud MV. A new perspective on intervertebral disc calcification-from bench to bedside. Bone Res 2024; 12:3. [PMID: 38253615 PMCID: PMC10803356 DOI: 10.1038/s41413-023-00307-3] [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: 10/15/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024] Open
Abstract
Disc degeneration primarily contributes to chronic low back and neck pain. Consequently, there is an urgent need to understand the spectrum of disc degeneration phenotypes such as fibrosis, ectopic calcification, herniation, or mixed phenotypes. Amongst these phenotypes, disc calcification is the least studied. Ectopic calcification, by definition, is the pathological mineralization of soft tissues, widely studied in the context of conditions that afflict vasculature, skin, and cartilage. Clinically, disc calcification is associated with poor surgical outcomes and back pain refractory to conservative treatment. It is frequently seen as a consequence of disc aging and progressive degeneration but exhibits unique molecular and morphological characteristics: hypertrophic chondrocyte-like cell differentiation; TNAP, ENPP1, and ANK upregulation; cell death; altered Pi and PPi homeostasis; and local inflammation. Recent studies in mouse models have provided a better understanding of the mechanisms underlying this phenotype. It is essential to recognize that the presentation and nature of mineralization differ between AF, NP, and EP compartments. Moreover, the combination of anatomic location, genetics, and environmental stressors, such as aging or trauma, govern the predisposition to calcification. Lastly, the systemic regulation of calcium and Pi metabolism is less important than the local activity of PPi modulated by the ANK-ENPP1 axis, along with disc cell death and differentiation status. While there is limited understanding of this phenotype, understanding the molecular pathways governing local intervertebral disc calcification may lead to developing disease-modifying drugs and better clinical management of degeneration-related pathologies.
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Affiliation(s)
- Emanuel J Novais
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Unidade Local de Saúde do Litoral Alentejano, Orthopedic Department, Santiago do Cacém, Portugal
| | - Rajkishen Narayanan
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Koen van de Wetering
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Makarand V Risbud
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
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Tanoren B, Dipcin B, Birdogan S, Unlu MB, Ozdol C, Aghayev K. Examination of annulus fibrosus and nucleus pulposus in cervical and lumbar intervertebral disc herniation patients by scanning acoustic microscopy, scanning electron microscopy and energy dispersive spectroscopy. RSC Adv 2024; 14:2603-2609. [PMID: 38226141 PMCID: PMC10788776 DOI: 10.1039/d3ra07195b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/18/2023] [Indexed: 01/17/2024] Open
Abstract
Intervertebral disc herniation (IVDH) is observed in humans as a result of the alteration of annulus fibrous (AF) and nucleus pulposus (NP) tissue compositions in intervertebral discs. In this study, we studied the feasibility of scanning acoustic microscopy (SAM), scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) in characterizing the herniated segments of AF and NP tissues from male and female patients. SAM determined the acoustic property variations in AF and NP tissues by calculating the acoustic impedance values of samples of 15 patients. SEM obtained higher resolution images and EDS made elemental analysis of the specimen. Consequently, we suggest that these techniques have the potential to be combined for the investigation and removal of the disrupted AF and NP tissues with micrometer resolution in clinics.
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Affiliation(s)
- Bukem Tanoren
- Acibadem University, Faculty of Engineering and Natural Sciences, Department of Natural Sciences Istanbul Turkey +90 216 500 4156 +90 216 576 5076
| | - Beste Dipcin
- Acibadem University, Faculty of Engineering and Natural Sciences, Department of Molecular Biology and Genetics Istanbul Turkey
| | - Selcuk Birdogan
- Sabanci University SUNUM Nanotechnology Research and Application Center Istanbul Turkey
| | | | - Cagatay Ozdol
- Antalya Education and Research Hospital Istanbul Turkey
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Kumar V, Bansal P, Dhillon M, Dhatt SS, Vatkar AJ. Surgical techniques and perioperative surgical outcomes after discectomy for calcified lumbar disc herniation: a review and meta-analysis. 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 2024; 33:47-60. [PMID: 37659048 DOI: 10.1007/s00586-023-07914-y] [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: 02/17/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Calcified lumbar disc herniation (CLDH) poses surgical challenges due to longstanding disease and adherence of herniated disc to the surrounding neural structures. The data regarding outcomes after surgery for CLDH are limited. This review was conducted to analyse the surgical techniques, perioperative findings and the postoperative clinical outcomes after surgery for CLDH. METHODS PRISMA guidelines were followed whilst conducting this systematic review and meta-analysis. The literature review was conducted on 3 databases (PubMed, EMBASE, and CINAHL). After thorough screening of all search results, 9 studies were shortlisted from which data were extracted and statistical analysis was done. Pooled analysis was done to ascertain the perioperative and postoperative outcomes after surgery for CLDH. Additional comparative analysis was done compared to CLDH with non-calcified lumbar disc herniation (NCLDH) cases. RESULTS We included 9 studies published between 2016 and 2022 in our review, 8 of these were retrospective. A total of 356 cases of CLDH were evaluated in these studies with a male preponderance (56.4%). Mean operative time was significantly lower in NCLDH cases compared to CLDH cases. The mean estimated blood loss showed a negative correlation with the percentage of males. Satisfactory clinical outcomes were observed in majority of patients. The risk of bias of the included studies was moderate to high. CONCLUSION Surgical difficulties in CLDH cases leads to increase in operative time compared to NCLDH. Good clinical outcomes can be obtained with careful planning; the focus of surgery should be on decompression of the neural structures rather than disc removal.
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Affiliation(s)
- Vishal Kumar
- Department of Orthopaedics, AIIMS, Deoghar, India
| | - Parth Bansal
- Department of Orthopaedics, PGIMER, Chandigarh, India.
| | - Mehar Dhillon
- Department of Orthopaedics, PGIMER, Chandigarh, India
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Jiang X, Gu L, Xu G, Cao X, Jiang J, Zhang D, Xu M, Yan Y. Nomogram for predicting the unfavourable outcomes of percutaneous endoscopic transforaminal discectomy for lumbar disc herniation: a retrospective study. Front Surg 2023; 10:1188517. [PMID: 37334203 PMCID: PMC10272560 DOI: 10.3389/fsurg.2023.1188517] [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: 03/17/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Objective To investigate and integrate multiple independent risk factors to establish a nomogram for predicting the unfavourable outcomes of percutaneous endoscopic transforaminal discectomy (PETD) for lumbar disc herniation (LDH). Methods From January 2018 to December 2019, a total of 425 patients with LDH undergoing PETD were included in this retrospective study. All patients were divided into the development and validation cohort at a ratio of 4:1. Univariate and multivariate logistic regression analyses were used to investigate the independent risk factors associated with the clinical outcomes of PETD for LDH in the development cohort, and a prediction model (nomogram) was established to predict the unfavourable outcomes of PETD for LDH. In the validation cohort, the nomogram was validated by the concordance index (C-index), calibration curve, and decision curve analysis (DCA). Results 29 of 340 patients showed unfavourable outcomes in the development cohort, and 7 of 85 patients showed unfavourable outcomes in the validation cohort. Body mass index (BMI), course of disease (COD), protrusion calcification (PC), and preoperative lumbar epidural steroid injection (LI) were independent risk factors associated with the unfavourable outcomes of PETD for LDH and were identified as predictors for the nomogram. The nomogram was validated by the validation cohort and showed high consistency (C-index = 0.674), good calibration and high clinical value. Conclusions The nomogram based on patients' preoperative clinical characteristics, including BMI, COD, LI and PC, can be used to accurately predict the unfavourable outcomes of PETD for LDH.
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Affiliation(s)
- Xiaofeng Jiang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Pain Medicine, Jiangxi Academy of Clinical and Medical Sciences, Nanchang, China
| | - Lili Gu
- Institute of Pain Medicine, Jiangxi Academy of Clinical and Medical Sciences, Nanchang, China
- Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Gang Xu
- Institute of Pain Medicine, Jiangxi Academy of Clinical and Medical Sciences, Nanchang, China
- Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xuezhong Cao
- Institute of Pain Medicine, Jiangxi Academy of Clinical and Medical Sciences, Nanchang, China
- Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jian Jiang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Pain Medicine, Jiangxi Academy of Clinical and Medical Sciences, Nanchang, China
| | - Daying Zhang
- Institute of Pain Medicine, Jiangxi Academy of Clinical and Medical Sciences, Nanchang, China
- Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Mu Xu
- Institute of Pain Medicine, Jiangxi Academy of Clinical and Medical Sciences, Nanchang, China
- Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Yan
- Institute of Pain Medicine, Jiangxi Academy of Clinical and Medical Sciences, Nanchang, China
- Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Ding Y, Chen JY, Yang JC, Li RY, Yin YJ, Chen JT, Zhu QA. Disc degeneration contributes to the denser bone in the subendplate but not in the vertebral body in patients with lumbar spinal stenosis or disc herniation. Spine J 2023; 23:64-71. [PMID: 36202206 DOI: 10.1016/j.spinee.2022.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND CONTEXT It is commonly believed that decreased bone quality would lead to endplate degeneration and arthritic changes in the facet joints, and thus accelerated disc degeneration (DD). However, some more detailed studies of vertebral bone structure have found that bone mineral density (BMD) in the vertebral body is increased rather than decreased in moderate or greater disc degeneration. The relationship between BMD and DD still needs further study. MRI-based vertebral bone quality scores have been shown to be effective in reflecting BMD, rendering a new way to evaluate the changes of vertebral body bone with DD using MRI alone. PURPOSE To evaluate MRI-based vertebral bone quality and Pfirrmann grades in patients with lumbar spinal stenosis or disc herniation, and to identify if DD is associated with denser bone around the endplate. STUDY DESIGN/SETTING A single-center, retrospective cohort study. PATIENT SAMPLE A total of 130 patients with lumbar disc herniation and lumbar spinal stenosis from January 2019 to November 2020 who had a complete dual-energy X-ray absorptiometry scan and noncontrast lumbosacral spine MRI data. OUTCOME MEASURES The vertebral bone quality score (VBQ) and sub-endplate bone quality score (EBQ) was calculated as a ratio of the signal intensity of the vertebral bodies and sub-endplate regions to the signal intensity of the cerebrospinal fluid at L3 on the mid-sagittal T1-weighted MRI images, respectively. The Pfirrmann grades of the lumbar discs were assessed as well. METHODS The age, gender, body mass index, and T-score of the lumbar spine of the patients were collected. The degeneration grades of the lumbar discs were evaluated according to the Pfirrmann classification. VBQ and EBQ were measured through T1-weighted lumbar MRI. The VBQ and EBQ scores were compared between cranial and caudal sides. The correlation between MRI-based bone quality and DD was calculated. A linear regression model was used to examine the association between DD and adjacent EBQ and VBQ. RESULTS This study included 569 lumbar segments from 130 inpatients. Cranial and caudal EBQ decreased with the increase of the Pfirrmann grade. The discs with Pfirrmann grade 5 had significantly lower caudal EBQ than the discs with Pfirrmann grades 2, 3, and 4. In the osteoporosis patients, the Pfirrmann grades negatively correlated both with the cranial EBQ and caudal EBQ. Pfirrmann grade greater than 4 was an independent contributor to the cranial EBQ, whereas greater than 3 was an independent contributor to the caudal EBQ. CONCLUSIONS Disc degeneration grades correlated with the EBQ but not with the VBQ. In patients with lumbar spinal stenosis or disc herniation, DD contributes to the denser bone in the sub-endplate, but not in the whole vertebral body.
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Affiliation(s)
- Yin Ding
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China; Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou, China
| | - Jia-Yu Chen
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
| | - Jia-Chen Yang
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
| | - Ruo-Yao Li
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
| | - Yong-Jie Yin
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
| | - Jian-Ting Chen
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
| | - Qing-An Zhu
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China.
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Sharma S, Neelavalli J, Shah T, Gupta RK. Susceptibility-weighted imaging: an emerging technique for evaluation of the spine and spinal cord. Br J Radiol 2022; 95:20211294. [PMID: 35830235 PMCID: PMC9815740 DOI: 10.1259/bjr.20211294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/13/2022] [Accepted: 06/28/2022] [Indexed: 01/13/2023] Open
Abstract
We present the application of three-dimensional susceptibility-weighted imaging technique for evaluation of pathologies of the spine and spinal cord. This work focuses on the advantage of this imaging technique as an adjunct to the conventional imaging to evaluate various disorders of the spine and spinal cord like trauma, degenerative diseases, vascular malformations, and tumours, where susceptibility-weighted imaging may offer valuable harmonising evidence that may be helpful in the diagnosis and management of the patients with these pathologies.
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Affiliation(s)
- Shalini Sharma
- Department of Radiology, Fortis Memorial Research Institute, Gurgaon, India
| | | | | | - Rakesh Kumar Gupta
- Department of Radiology, Fortis Memorial Research Institute, Gurgaon, India
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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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Zhu G, Xu Y, Cui J, Tang J, Ren H, De L, Jiang X. Cave-in Decompression Technique in Percutaneous Endoscopic Transforaminal Discectomy for Ossification Occupation in Lumbar Spinal Canal: A retrospective analysis of 23 cases. Neurochirurgie 2022; 68:498-503. [PMID: 35477015 DOI: 10.1016/j.neuchi.2022.03.006] [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: 01/13/2022] [Revised: 03/01/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECT Percutaneous endoscopic transforaminal discectomy (PETD) for the treatment of ossification occupation of the lumbar spinal canal is technically demanding. The purpose of this study was to describe an endoscopic cave-in decompression technique in PETD for ossification occupation of the lumbar spinal canal and to report the clinical results. METHODS From May 2018 to June 2020, 23 consecutive cases, diagnosed in our institution as ventral ossification in the lumbar spinal canal and treated with PETD, were evaluated. The endoscopic cave-in decompression technique was performed. We analyzed the clinical outcomes on a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Perioperative data and complications rate were also recorded. RESULTS Mean follow-up was 15.7 ± 2.8 months. Mean preoperative VAS score for low-back pain was 5.65 ± 1.43, and decreased to 0.57 ± 0.5 at final follow-up. Mean preoperative VAS score for leg pain was 5.48 ± 1.38, and decreased to 0.56 ± 0.5 at final follow-up. Mean preoperative ODI score decreased from 33.04 ± 5.28 preoperatively to 8.7 ± 2.54 at last follow-up. One patient experienced transient postoperative hypoesthesia, and 1 developed a mild transient decline in muscle strength; both recovered progressively. Postoperative CT and MRI showed that the ossification was effectively removed and the nerve root and dural mater was completely decompressed in all cases. CONCLUSION The endoscopic cave-in decompression technique in PETD is a safe and effective treatment method for selected patients with ossification occupation of the lumbar spinal canal.
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Affiliation(s)
- Guangye Zhu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Yuerong Xu
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Jianchao Cui
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Jingjing Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Hui Ren
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Liang De
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China.
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Du L, Li X, Gao Q, Yuan P, Sun Y, Chen Y, Huang B, Deng Y, Wang B. LncRNA nuclear receptor subfamily 2 group F member 1 antisense RNA 1 (NR2F1-AS1) aggravates nucleus pulposus cell apoptosis and extracellular matrix degradation. Bioengineered 2022; 13:2746-2762. [PMID: 35094651 PMCID: PMC8973659 DOI: 10.1080/21655979.2021.2016087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Emerging reports uncover that long noncoding RNAs (lncRNAs) help regulate intervertebral disc degeneration (IVDD). Here, we probe the function of lncRNA nuclear receptor subfamily 2 group F member 1 antisense RNA 1 (NR2F1-AS1) in IVDD. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was applied to verify the expression of NR2F1-AS1 and miR-145-5p in nucleus pulposus (NP) tissues from IVDD patients or NP cells dealt with IL-1β or TNF-α. Flow cytometry or the TdT-mediated dUTP nick end labeling (TUNEL) assay was performed to validate the apoptosis of NP cells with selective regulation of NR2F1-AS1 and miR-145-5p. ECM-related genes, FOXO1, Bax, and Bcl2 were evaluated by qRT-PCR or Western blot (WB). The targeted relationships between NR2F1-AS1 and miR-145-5p, miR-145-5p and FOXO1 were testified by the dual-luciferase reporter assay and the RNA immunoprecipitation (RIP) assay. Our outcomes substantiated that NR2F1-AS1 was up-regulated, while miR-145-5p was down-regulated in intervertebral disc tissues of IVDD patients or NP cells treated with IL-1β or TNF-α. Besides, overexpressing NR2F1-AS1 intensified ECM degradation and NP cell apoptosis induced by IL-1β, while knocking down NR2F1-AS1 or up-regulating miR-145-5p reversed IL-1β-mediated effects in NP cells. Meanwhile, NR2F1-AS1 choked miR-145-5p and abated its effects in NP cells. This study confirms that NR2F1-AS1 modulates IVDD progression by up-regulating the FOXO1 pathway through the sponge of miR-145-5p as a competitive endogenous RNA (ceRNA).
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Affiliation(s)
- Longlong Du
- Pain Area of Orthopedics of Traditional Chinese Medicine, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xuefeng Li
- Department of Traditional Chinese and Western Medicine, Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi, China
| | - Qimeng Gao
- Department of Traditional Chinese and Western Medicine, Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi, China
| | - Puwei Yuan
- Department of Traditional Chinese and Western Medicine, Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi, China
| | - Yindi Sun
- Pain Area of Orthopedics of Traditional Chinese Medicine, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yingpu Chen
- Pain Area of Orthopedics of Traditional Chinese Medicine, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Bo Huang
- Department of Orthopaedic, Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi, China
| | - Yu Deng
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Baohui Wang
- Pain Area of Orthopedics of Traditional Chinese Medicine, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Calcified lumbar disc prolapse technical note and management algorithm: a prospective study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ultra-high resolution 3D MRI for chondrocalcinosis detection in the knee-a prospective diagnostic accuracy study comparing 7-tesla and 3-tesla MRI with CT. Eur Radiol 2021; 31:9436-9445. [PMID: 34047850 PMCID: PMC8589732 DOI: 10.1007/s00330-021-08062-x] [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: 02/03/2021] [Revised: 03/10/2021] [Accepted: 05/07/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To test the diagnostic accuracy of a 3D dual-echo steady-state (DESS) sequence at 7-T MRI regarding the detection of chondral calcific deposits of the knee in comparison to 3-T MRI, using CT as cross-sectional imaging reference standard. METHODS CT and 7-T MRI (DESS) of knee joints in 42 patients with radiographically known chondrocalcinosis (13 of 42 bilateral) were prospectively acquired for all included patients (n = 55 knee joints). Additionally, 3-T MRI (DESS) was performed for 20 of these 55 knee joints. Two fellowship-trained musculoskeletal radiologists scored eight cartilage regions of each knee joint separately regarding presence of cartilage calcification, diagnostic confidence level, and sharpness of calcific deposits. In an explorative subanalysis, micro-CT of the menisci was evaluated after knee arthroplasty in one patient. Diagnostic performance metrics and nonparametric tests were used to compare between modalities. p values < 0.05 were considered to represent statistical significance. RESULTS Sensitivity for chondrocalcinosis detection was significantly higher for 7-T MRI (100%) compared to 3-T MRI (reader 1: 95.9%, p = 0.03; reader 2: 93.2%, p = 0.002). The diagnostic confidence was significantly higher for both readers at 7 T compared to both 3-T MRI (p < 0.001) and to CT (p = 0.03). The delineation of chondral calcifications was significantly sharper for 7-T compared to both 3-T MRI and CT (p < 0.001, both readers). Micro-CT in one patient suggested that 7-T MRI may potentially outperform standard CT in diagnosing chondral calcifications. CONCLUSION 3D-DESS imaging at 7-T MRI offers a significantly higher sensitivity in detection of chondral calcific deposits compared to 3-T MRI. KEY POINTS • 3D dual-echo steady-state (DESS) MRI at 7 T has a higher sensitivity in detection of chondral calcific deposits compared to 3-T MRI (p ≤ 0.03). • 3D DESS MRI at 7 T yields no false-negative cases regarding presence of chondral calcific deposits. • 3D DESS MRI at 7 T offers better delineation and higher diagnostic confidence in detection of chondral calcific deposits compared to 3-T MRI (p < 0.001).
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Kim JW, Jeon N, Shin DE, Lee SY, Kim M, Han DH, Shin JY, Lee S. Regeneration in Spinal Disease: Therapeutic Role of Hypoxia-Inducible Factor-1 Alpha in Regeneration of Degenerative Intervertebral Disc. Int J Mol Sci 2021; 22:ijms22105281. [PMID: 34067899 PMCID: PMC8155933 DOI: 10.3390/ijms22105281] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 01/05/2023] Open
Abstract
The intervertebral disc (IVD) is a complex joint structure comprising three primary components—namely, nucleus pulposus (NP), annulus fibrosus (AF), and cartilaginous endplate (CEP). The IVD retrieves oxygen from the surrounding vertebral body through CEP by diffusion and likely generates ATP via anaerobic glycolysis. IVD degeneration is characterized by a cascade of cellular, compositional, structural changes. With advanced age, pronounced changes occur in the composition of the disc extracellular matrix (ECM). NP and AF cells in the IVD possess poor regenerative capacity compared with that of other tissues. Hypoxia-inducible factor (HIF) is a master transcription factor that initiates a coordinated cellular cascade in response to a low oxygen tension environment, including the regulation of numerous enzymes in response to hypoxia. HIF-1α is essential for NP development and homeostasis and is involved in various processes of IVD degeneration process, promotes ECM in NP, maintains the metabolic activities of NP, and regulates dystrophic mineralization of NP, as well as angiogenesis, autophagy, and apoptosis during IVD degeneration. HIF-1α may, therefore, represent a diagnostic tool for early IVD degeneration and a therapeutic target for inhibiting IVD degeneration
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Affiliation(s)
- Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea; (J.-W.K.); (N.J.); (M.K.)
| | - Neunghan Jeon
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea; (J.-W.K.); (N.J.); (M.K.)
| | - Dong-Eun Shin
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13488, Korea; (D.-E.S.); (D.H.H.)
| | - So-Young Lee
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si 13488, Korea;
| | - Myongwhan Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea; (J.-W.K.); (N.J.); (M.K.)
| | - Dong Hun Han
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13488, Korea; (D.-E.S.); (D.H.H.)
| | - Jae Yeon Shin
- Department of Computer Science, College of IT Engineering, SeMyung University, Jechun 27136, Korea;
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13488, Korea; (D.-E.S.); (D.H.H.)
- Correspondence: ; Tel.: +82-31-780-5289; Fax: +82-31-708-3578
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Li Y, Liu S, Pan D, Xu B, Xing X, Zhou H, Zhang B, Zhou S, Ning G, Feng S. The potential role and trend of HIF‑1α in intervertebral disc degeneration: Friend or foe? (Review). Mol Med Rep 2021; 23:239. [PMID: 33537810 PMCID: PMC7893690 DOI: 10.3892/mmr.2021.11878] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/08/2019] [Indexed: 12/11/2022] Open
Abstract
Lower back pain (LBP) is one of the most common reasons for seeking medical advice in orthopedic clinics. Increasingly, research has shown that symptomatic intervertebral disc degeneration (IDD) is mostly related to LBP. This review first outlines the research and findings of studies into IDD, from the physiological structure of the intervertebral disc (IVD) to various pathological cascades. The vicious cycles of IDD are re-described in relation to the analysis of the relationship among the pathological mechanisms involved in IDD. Interestingly, a ‘chief molecule’ was found, hypoxia-inducible factor-1α (HIF-1α), that may regulate all other mechanisms involved in IDD. When the vicious cycle is established, the low oxygen tension activates the expression of HIF-1α, which subsequently enters into the hypoxia-induced HIF pathways. The HIF pathways are dichotomized as friend and foe pathways according to the oxygen tension of the IVD microenvironment. Combined with clinical outcomes and previous research, the trend of IDD development has been predicted in this paper. Lastly, an early precautionary diagnosis and treatment method is proposed whereby nucleus pulposus tissue for biopsy can be obtained through IVD puncture guided by B-ultrasound when the patient is showing symptoms but MRI imaging shows negative results. The assessment criteria for biopsy and the feasibility, superiority and challenges of this approach have been discussed. Overall, it is clear that HIF-1α is an indispensable reference indicator for the accurate diagnosis and treatment of IDD.
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Affiliation(s)
- Yongjin Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Shen Liu
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Dayu Pan
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Baoshan Xu
- Department of Spine Surgery, Tianjin Hospital, Tianjin 300000, P.R. China
| | - Xuewu Xing
- Department of Orthopedic Surgery, First Central Clinical of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Hengxing Zhou
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Bin Zhang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Suzhe Zhou
- Department of Orthopedics, The Affiliated Zhongshan Hospital of Fudan University, Shanghai 200034, P.R. China
| | - Guangzhi Ning
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Shiqing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
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Ammar A, Alwadei A, Al Hayek A, Alabbas FM, Almatrafi FR, Elshawarby M. The Correlation between Histopathology of Herniated Lumbar Intervertebral Disc and Clinical Findings. Asian J Neurosurg 2020; 15:545-553. [PMID: 33145205 PMCID: PMC7591170 DOI: 10.4103/ajns.ajns_193_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/26/2020] [Accepted: 06/11/2020] [Indexed: 11/04/2022] Open
Abstract
Objective Prolapsed lumbar disc is one of the most frequent diseases, which is usually presented by motor and sensory deficits. Consistency of herniated disc may play a significant role in surgical treatment and postoperative improvement. The objective of this study is to assess whether the histopathological degeneration in the sample of lumbar discs operated on is correlated to clinical variables and surgical outcomes. Materials and Methods A randomized double-blind prospective study of lumbar disc prolapse cases over a period of 24 months was done. Forty cases were initially included in the study. All the included cases with a scheduled lumbar discectomy in the Department of Neurosurgery, King Fahd University Hospital, Al-Khobar, Saudi Arabia, during this period were examined histologically. Results Finally, 21 patients were only considered in this study due to loss of follow-up of the other 19 patients; of these 21 patients, 18 were male and 3 were female. The youngest patient was 32 years old, and the oldest was 72 years old. There is no significant correlation between the major histopathological changes of the prolapsed discs and the clinical findings of low back pain (correlation coefficient = 0.058, P < 0.8), duration of sciatica (correlation coefficient = -0.337, P < 0.1), paresthesia (correlation coefficient = 0.111, P < 0.6), motor weakness (correlation coefficient = 0.274, P < 0.2), and reflex (correlation coefficient = 0.081, P < 0.7). Meanwhile, the correlation coefficient between numbness and histopathological degeneration score (HPDS) is not defined because all reported cases were presented with numbness. Conclusions There is no significant correlation between the histopathological changes of the prolapsed discs and some clinical findings. Moreover, the different types of prolapsed discs' histopathological changes have no impact on the outcome of the surgery. We also concluded that the disc material undergoes certain degenerative processes with age.
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Affiliation(s)
- Ahmed Ammar
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ali Alwadei
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ali Al Hayek
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal M Alabbas
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal Rashed Almatrafi
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Elshawarby
- Department of Pathology, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Wang D, Xing J, Shao B, Su H, Zhang X, Zhao W, Fang Q, Sun J, Zhang Z, Zhang D, Zhang T. A surgical decompression procedure for effective treatment of calcified lumbar disc herniation. J Int Med Res 2020; 48:300060520938966. [PMID: 32668175 PMCID: PMC7364838 DOI: 10.1177/0300060520938966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 06/09/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To present our experience in managing calcified lumbar disc herniation (cLDH) using a surgical decompression procedure. METHODS Patients who had low back pain radiating to the leg, were preoperatively diagnosed with cLDH by computed tomography and/or magnetic resonance imaging, and were treated with a surgical decompression procedure were studied. Those without cLDH or who were treated with a method other than decompression were excluded. The treatment outcome was analyzed using the visual analog scale (VAS) score, Oswestry Disability Index, and modified Macnab criteria. RESULTS Thirty-seven patients aged 60.5 ± 9.6 years were evaluated. The VAS scores were significantly decreased 1 day after surgery and remained low at the 3-month and 1-year follow-ups. The Oswestry Disability Index was also significantly lower at the 3-month and 1-year follow-ups. Ninety-four percent of patients rated the results as "excellent" or "good" according to the modified Macnab criteria at the 3-month follow-up. The patients developed few postoperative complications and no recurrence during 1 year of follow-up. CONCLUSION Our data suggest that the decompression approach is effective for management of cLDH at least in the short term (1 year) with respect to reducing pain and improving patient satisfaction with few complications.
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Affiliation(s)
- Dawei Wang
- Department of Spine Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Jianqiang Xing
- Department of Spine Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Bin Shao
- Department of Spine Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Hongmin Su
- Department of Spine Surgery, Heze Municipal Hospital, Heze, Shandong Province, China
| | - Xiaomei Zhang
- Department of Spine Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Wei Zhao
- Department of Spine Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Qingmin Fang
- Department of Spine Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Jinchuan Sun
- Department of Hand and Foot Surgery, Binzhou People’s Hospital, Binzhou, Shandong Province, China
| | - Zheng Zhang
- Department of Spine Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Daijie Zhang
- Department of Spine Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Tianqi Zhang
- Department of Spine Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
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Silva MJ, Holguin N. Aging aggravates intervertebral disc degeneration by regulating transcription factors toward chondrogenesis. FASEB J 2019; 34:1970-1982. [PMID: 31909538 DOI: 10.1096/fj.201902109r] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 12/17/2022]
Abstract
Osterix is a critical transcription factor of mesenchymal stem cell fate, where its loss or loss of Wnt signaling diverts differentiation to a chondrocytic lineage. Intervertebral disc (IVD) degeneration activates the differentiation of prehypertrophic chondrocyte-like cells and inactivates Wnt signaling, but its interactive role with osterix is unclear. First, compared to young-adult (5 mo), mechanical compression of old (18 mo) IVD induced greater IVD degeneration. Aging (5 vs 12 mo) and/or compression reduced the transcription of osterix and notochordal marker T by 40-75%. Compression elevated the transcription of hypertrophic chondrocyte marker MMP13 and pre-osterix transcription factor RUNX2, but less so in 12 mo IVD. Next, using an Ai9/td reporter and immunohistochemical staining, annulus fibrosus and nucleus pulposus cells of young-adult IVD expressed osterix, but aging and compression reduced its expression. Lastly, in vivo LRP5-deficiency in osterix-expressing cells inactivated Wnt signaling in the nucleus pulposus by 95%, degenerated the IVD to levels similar to aging and compression, reduced the biomechanical properties by 45-70%, and reduced the transcription of osterix, notochordal markers and chondrocytic markers by 60-80%. Overall, these data indicate that age-related inactivation of Wnt signaling in osterix-expressing cells may limit regeneration by depleting the progenitors and attenuating the expansion of chondrocyte-like cells.
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Affiliation(s)
- Matthew J Silva
- Department of Biomedical Engineering, Orthopaedic Surgery, Musculoskeletal Research Center, Washington University, St. Louis, MO, USA
| | - Nilsson Holguin
- Department of Mechanical and Energy Engineering, Indiana Center for Musculoskeletal Health, IUPUI, Indianapolis, IN, USA.,Department of Anatomy and Cell Biology, Indiana Center for Musculoskeletal Health, IUPUI, Indianapolis, IN, USA
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Abstract
Starting with the smallest functional unit, the spinal segment including the centrally located intervertebral disc, the spine and pelvis including the sacroiliac and hip joints form a functional unit. The discs play an important role in the complex interaction between disc, osseous and ligamentous structures and the adjacent muscles. Disc pathologies are very frequently associated with changes of the adjacent endplates of the vertebral bodies and can be depicted at an early stage using magnetic resonance imaging (MRI). The focus of the diagnostics and assessment of degenerative disc pathologies should be centered on the clinical problem. The basis for this is the use of a uniform terminology between the disciplines involved.
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20
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Ma J, He Y, Wang A, Wang W, Xi Y, Yu J, Ye X. Risk Factors Analysis for Foot Drop Associated with Lumbar Disc Herniation: An Analysis of 236 Patients. World Neurosurg 2017; 110:e1017-e1024. [PMID: 29223521 DOI: 10.1016/j.wneu.2017.11.154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To identify the risk factors for foot drop in patients with lumbar disc herniation (LDH). METHODS Two hundred thirty-six patients who underwent surgery for LDH were retrospectively reviewed. Foot drop was defined as tibialis anterior muscle strength of lower than grade 4 by the manual muscle test. Possible risk factors, including demographic and radiographic parameters, were evaluated by multivariate logistic regression analysis. RESULTS Fifty-two patients (22.9%) suffered from foot drop. Multivariate logistic regression analysis revealed that diabetes mellitus, disc calcification, patients who had an acute episode or acute-on-chronic episode, and patients who presented with lateral recess or extraforaminal type of disc herniation were at greater risk of foot drop. Notably, patients who had a canal occupancy rate of more than 50% were at greater risk of foot drop compared with patients who had a canal occupy rate of less than 25%. With a 1.0-mm increase in anteroposterior diameter of the index spinal canal, the risk of developing foot drop decreased to 51.8% in these patients (P < 0.05). CONCLUSIONS The following factors may affect the development of foot drop in patients with LDH: 1) diabetes mellitus; 2) patients with an acute episode or acute-on-chronic episode; 3) patients with lateral recess or foraminal type of herniation; 4) disc calcification; 5) canal occupancy rate greater than 50%; and 6) the anteroposterior diameter of canal. Surgical treatments for patients with those risk factors should be implemented positively during the follow-up period to reduce possible adverse outcomes.
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Affiliation(s)
- Jun Ma
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
| | - Yunfei He
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China; Department of Spinal Surgery, Lanzhou General Hospital of Lanzhou Military Command Region, Lanzhou, PR China
| | - An Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China; Department of Orthopaedics, Shanghai Armed Police Force Hospital, Shanghai, PR China
| | - Weiheng Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
| | - Yanhai Xi
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
| | - Jiangming Yu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China.
| | - Xiaojian Ye
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China.
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Zehra U, Bow C, Cheung JPY, Pang H, Lu W, Samartzis D. The association of lumbar intervertebral disc calcification on plain radiographs with the UTE Disc Sign on MRI. 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; 27:1049-1057. [PMID: 28993894 DOI: 10.1007/s00586-017-5312-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/10/2017] [Accepted: 09/24/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE The pathogenesis and the clinical impact of disc calcification are not well known. Utilizing ultra-short time-to-echo (UTE) magnetic resonance imaging, the UTE Disc Sign (UDS) (i.e., hypo/hyper-intense disc band) was developed and found to be more significantly related to pain and disability than the conventional T2-weighted (T2W) MRI. It has been hypothesized that the UDS may represent mineralized deposits in the disc. The following study addressed the relationship between disc calcification on plain radiographs to that of the UDS on MRI. METHODS A cross-sectional study was performed on 106 Southern Chinese subjects (50% male; mean age 52.3 years). Standing lateral plain radiographs as well as T2W and UTE MRI of L1-S1 (n = 530 discs) were performed of all subjects. Lateral radiographs were used to localize disc calcification of the lumbar spine, T2W MRI was utilized to assess disc degeneration based on a defined grading scheme, and the UTE MRI was implemented to detect the UDS (hyper- or hypo-intense band across a disc). Disc degeneration and UDS scores were summed to represent cumulative scores. Subject demographics and disability profiles (Oswestry Disability Index: ODI) were obtained. RESULTS Disc calcification on plain radiographs was observed in 33.9% of subjects (55.5% males; mean age 54.3 years), whereas UDS was noted in 40.5% of subjects (51.1% males; mean age 55.0 years). Of these subjects, 66.6% calcification and 74.4% UDS occurred at the three lowest lumbar levels, while multilevel calcification and UDS involved 19.4 and 39.5%, respectively. 72.2% of subjects with plain radiographic disc calcification had corresponding UDS on UTE MRI (p < 0.001). Multilevel disc calcification on plain radiographs was associated with multilevel UDS (71.4%, p < 0.001). Both the number of calcified disc levels on plain radiographs and the number of UDS levels were also significantly and positively correlated with each other (r = 0.58, p < 0.001). Subjects with disc calcification and positive UDS as well as individuals with increased disc degeneration scores on T2 W MRI were significantly older (p < 0.05). The cumulative UDS score on UTE MRI significantly correlated with worse ODI scores (r = 0.31; p = 0.001), whereas cumulative disc calcification scores on plain radiographs did not (r = 0.15; p = 0.19). CONCLUSIONS This is the first study to compare the UDS on UTE MRI with disc calcification on plain radiographs. Disc calcification was correlated with the UDS on UTE, suggesting that the UDS may represent disc calcification. However, UTE MRI appears to be a more sensitive imaging modality in identifying subtle and unique disc changes that may not be revealed on plain radiographs or conventional MRI. This disconnect may rationalize the significant correlation of UTE with disability in comparison with the conventional imaging, further stressing its potential clinical importance.
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Affiliation(s)
- Uruj Zehra
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Cora Bow
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Henry Pang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - William Lu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China.
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Zhang H, Li J, Duan D, She W, Wang L, Zhang F. The role of lncRNA MALAT1 in intervertebral degenerative disc disease. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:10611-10617. [PMID: 31966403 PMCID: PMC6965762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/17/2017] [Indexed: 06/10/2023]
Abstract
Intervertebral degenerative disc disease (IDDD) is a common disease in clinic that causes pain and heavy financial burden on patients with poor prognosis. However, the pathogenesis of IDDD is not clear. Long non-coding RNA (LncRNA) is involved in regulating various body growth and pathological processes by affecting cell proliferation, differentiation, and apoptosis. However, the role of lncRNAs in IDDD is rarely reported. This study aims to investigate the role and mechanism of lncRNA MALAT1 in the development of IDDD. The nucleus pulposus of the intervertebral disc were collected and the primary nucleus pulposus cells were isolated and cultured. The cells were divided into three groups, including IDDD group, empty plasmid group transfected by pcDNA3.1, or MALAT1 group transfected by pcDNA3.1-MALAT1. MALAT1 expression was detected by real-time PCR. Cell proliferation was assessed by MTT assay. Caspase 3 activity was tested by the activity detection kit. IL-1 and IL-6 levels were analyzed by ELISA. The expression of MALAT1 in IDDD nucleus pulposus cells was significantly lower than that in control group (P < 0.05). The expression of MALAT1 was significantly increased after transfection with pcDNA3.1-MALAT1 plasmid in IDDD nucleus pulposus cells, which obviously inhibited cell proliferation, enhanced Caspase 3 activity, and promoted the secretion of IL-1 and IL-6 compared with IDDD group (P < 0.05). MALAT1 level decreased in IDDD nucleus pulposus cells. Upregulation of MALAT1 expression restrained IDDD through suppressing inflammation; inhibiting nucleus pulposus cell apoptosis, and promoting cell proliferation.
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Affiliation(s)
- Hui Zhang
- Department of Orthopedics, Gansu Provincial People’s HospitalLanzhou, Gansu, China
| | - Jinde Li
- Department of Orthopedics, The Second People’s Hospital of Lanzhou CityLanzhou, Gansu, China
| | - Dapeng Duan
- Department of Orthopedics, Shaanxi Provincial People’s HospitalXi’an, Shaanxi, China
| | - Wei She
- Department of Orthopedics, Gansu Provincial People’s HospitalLanzhou, Gansu, China
| | - Liguo Wang
- Department of Orthopedics, Gansu Provincial People’s HospitalLanzhou, Gansu, China
| | - Fuqiang Zhang
- Department of Orthopedics, Gansu Provincial People’s HospitalLanzhou, Gansu, China
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Shao J, Yu M, Jiang L, Wu F, Liu X. Sequencing and bioinformatics analysis of the differentially expressed genes in herniated discs with or without calcification. Int J Mol Med 2017; 39:81-90. [PMID: 27959380 PMCID: PMC5179188 DOI: 10.3892/ijmm.2016.2821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/01/2016] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study was to detect the differentially expressed genes between ossified herniated discs and herniated discs without ossification. In addition, we sought to identify a few candidate genes and pathways by using bioinformatics analysis. We analyzed 6 samples each of ossified herniated discs (experimental group) and herniated discs without ossification (control group). Purified mRNA and cDNA extracted from the samples were subjected to sequencing. The NOISeq method was used to statistically identify the differentially expressed genes (DEGs) between the 2 groups. An in-depth analysis using bioinformatics tools based on the DEGs was performed using Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment, and protein-protein interaction network analysis. The top 6 DEGs were verified using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). A total of 132 DEGs was detected. A total of 129 genes in the ossified group were upregulated and 3 genes were found to be downregulated as compared to the control group. The top 3 cellular components in GO ontologies analysis were extracellular matrix components. GO functions were mainly related to the glycoprotein in the cell membrane and extracellular matrix. The GO process was related to completing response to stimulus, immune reflex and defense. The top 5 KEGG enrichment pathways were associated with infection and inflammation. Three of the top 20 DEGs [sclerostin (SOST), WNT inhibitory factor 1 (WIF1) and secreted frizzled related protein 4 (SFRP4)] were related to the inhibition of the Wnt pathway. The ossified discs exhibited a higher expression of the top 6 DEGs [SOST, joining chain of multimeric IgA and IgM (IGJ; also known as JCHAIN), defensin alpha 4 (DEFA4), SFRP4, proteinase 3 (PRTN3) and cathepsin G (CTSG)], with the associated P-values of 0.045, 0.000, 0.008, 0.010, 0.015 and 0.002, respectively, as calculated by the independent sample t-test. The gene expression profiling of the 2 groups revealed differential gene expression. Thus, our data suggest that Wnt pathway abnormality and local inflammation may be related to disc ossification.
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Affiliation(s)
- Jia Shao
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Miao Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Fengliang Wu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
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