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Wing-Yuk Chan R, Chiang YH, Yang YA, Chen YY, Tsou YS. One-Year Follow-Up Study on Assessing the Range of Segmental Motion and Clinical Outcomes Following Cervical Disc Arthroplasty for Treatment of Severe Cervical Disc Degeneration. World Neurosurg 2024; 183:e276-e281. [PMID: 38128758 DOI: 10.1016/j.wneu.2023.12.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Though previous studies have documented various clinical outcomes after cervical arthroplasty for degenerative cervical disc disease, none of them reported the impact of cervical arthroplasty on severe cervical disc degeneration (CDD). METHODS This retrospective cohort study included severe 40 CDD (C3-C7) patients who underwent single-level cervical arthroplasty using ProDisc-C between January 2017 and December 2019. After surgical intervention, the range of motion (ROM) was determined, whereas clinical outcomes were measured in terms of the Visual Analogue Scale (VAS) and Neck Disability Index (NDI) to evaluate neck pain and disability, respectively. RESULTS Compared to the mean preoperative ROM (6.57 ± 4.85°), the cervical dynamic ROM was increased 3 months after cervical arthroplasty, and the increment was maintained for at least 1 year. The increased ROM is attributed to the extension and not flexion components. The mean preoperative ROM of 6.57 ± 4.85° significantly increased to 11.67 ± 4.98° (P = 0.0005), 10.05 ± 5.18° (P = 0.0426) and 10.46 ± 4.73° (P = 0.0247) after 3 months, 6 months and 1 year, respectively. The extension ROM also revealed a similar trend. VAS for neck and arm decreased from 7.4 and 6.6 to 1.4 and 1.2, respectively. Consistently, the preoperative mean Neck Disability Index (NDI) score of 27.6 decreased to 14.6. We recorded a case of device subsidence, but without extrusion. CONCLUSIONS Cervical arthroplasty can improve clinical outcomes and restore ROM in severe CDD patients.
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Affiliation(s)
- Ryan Wing-Yuk Chan
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Yung-Hsiao Chiang
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-An Yang
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Yu Chen
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Syue Tsou
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
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Cheung STY, Tsang HHL, Cheung PWH, Cheung JPY. Male spondyloarthritis patients and those with longer disease duration have less severe disc degeneration: propensity score-matched comparison. Rheumatol Adv Pract 2024; 8:rkae015. [PMID: 38405075 PMCID: PMC10884529 DOI: 10.1093/rap/rkae015] [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: 11/20/2023] [Accepted: 01/14/2024] [Indexed: 02/27/2024] Open
Abstract
Objective Using whole spine sagittal T2 MRI, we aimed to compare the severity and prevalence of disc degeneration (DD) in axial SpA patients vs the general population and to determine any association between spinal inflammation, structural changes, mobility and DD among SpA patients. Methods Two prospectively collected cohorts of SpA patients (n = 411) and the general population (n = 2007) were recruited. Eventually, 967 participants from the populational cohort and 304 participants from the SpA cohort were analysed. Two hundred and nineteen matched pairs were generated by propensity score matching. Imaging parameters, including Pfirrmann grading, disc herniation, high-intensity zone, Schmorl's node, Modic change and anterior marrow change were studied and compared from C2/3 to L5/S1. DD was defined as Pfirrmann grade 4 or 5. Demographic factors, including age, sex and BMI, were collected. Multivariable linear regression was used to determine the association between spinal inflammation [Spondyloarthritis Research Consortium of Canada (SPARCC) spine MRI index], structural changes [modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS)] and mobility (BASMI) with lumbar Pfirrmann score. Results SpA patients had lower prevalence of DD (P < 0.001). The disease stage-stratified regression model showed that SPARCC spinal MRI index was associated with higher lumbar Pfirrmann scores in early disease (β = 0.196, P = 0.044), whereas mSASSS was associated with lower lumbar Pfirrmann scores in later disease (β = -0.138, P = 0.038). Males had higher mSASSS (P < 0.001) and lower odds of whole spine DD (odds ratio = 0.622, P = 0.028). Conclusion SpA patients had lower DD severity than the general population. Males had higher mSASSSs, and increased mSASSS at later disease was associated with less severe DD.
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Affiliation(s)
- Samuel Tin Yan Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Helen Hoi Lun Tsang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | | | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Keskimölö T, Pernu J, Karppinen J, Niinimäki J, Oura P, Leino T, Honkanen T. Degenerative cervical spine changes among early career fighter pilots: a 5-year follow-up. BMJ Mil Health 2023; 169:291-296. [PMID: 34131064 PMCID: PMC10423485 DOI: 10.1136/bmjmilitary-2021-001848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/29/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Degenerative changes of the cervical spine often cause disability and flight duty limitations among Finnish Air Force (FINAF) fighter pilots. We aimed to study the effect of +Gz exposure on degenerative changes in the cervical spine by comparing cervical MRIs of FINAF fighter pilots and controls. METHODS At baseline, the volunteer study population consisted of 56 20-year-old FINAF male fighter pilots (exposure group) and 56 21-year-old Army and Navy cadets (control group). Both groups underwent MRI of the cervical spine at the baseline and after 5 years. Degenerative changes evaluated using MRI included intervertebral disc (IVD) degeneration (Pfirrmann classification), disc herniations, uncovertebral arthrosis, Schmorl's nodes, Modic changes, spinal canal stenosis, kyphosis and scoliosis. RESULTS The degree of IVD degeneration in the whole cervical spine increased significantly in both populations with no between-group differences. The prevalence of disc herniations also tended to increase in both populations with no difference in the incidence over the follow-up. However, pilots proved to have more disc herniations at the baseline and at the follow-up. There were virtually no between-group differences in other assessed degenerative changes. DISCUSSION We found that IVD degeneration and the prevalence of disc herniations increased at a similar rate for fighter pilots and non-flying military students when all cervical levels were summed up. The lack of difference may be explained by the relatively low cumulative +Gz exposure during the first 5 years of a pilots' career.
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Affiliation(s)
| | - J Pernu
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - J Karppinen
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
- Finnish Institute of Occupational Health Oulu Regional Office, Oulu, Finland
| | - J Niinimäki
- Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - P Oura
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - T Leino
- Air Force Command Finland, Tikkakoski, Finland
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - T Honkanen
- Aeromedical Centre, Centre for Military Medicine, Finnish Defence Forces, Helsinki, Uusimaa, Finland
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Wan ZY, Zhang J, Shan H, Liu TF, Song F, Samartzis D, Wang HQ. Epidemiology of Lumbar Degenerative Phenotypes of Children and Adolescents: A Large-Scale Imaging Study. Global Spine J 2023; 13:599-608. [PMID: 33843321 DOI: 10.1177/21925682211000707] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE Recently, there has been a rise in children and adolescents developing low back pain and/or sciatica. Degenerative lumbar spine MRI phenotypes can occur in this population but reports have been sporadic and the true incidence of such spine changes remains debatable. As such, the study aimed to address the epidemiology of MRI phenotypes of the lumbar spine in this young population. METHODS 597 children and adolescents with lumbar MRIs were included in the study. T1- and T2-weighted lumbar images from L1/2 to L5/S1 were analyzed in axial and sagittal planes. Global phenotype assessment was performed of each level and based on established nomenclature protocols. RESULTS The cohort consisted of 57.3% (342) boys and 42.7% (255) girls, with a mean age of 10.75 ± 5.25 years (range: 0 to 18 years). The prevalence of imaging findings of lumbar disc degeneration (LDD) and lumbar disc herniation (LDH) were 2.2% (95% CI: 0.93-3.43) and 5.8% (95%CI: 2.58-8.99), respectively. There was significant difference between each disc segment from L1/2 to L5/S1 for both LDD and LDH. Schmorl's nodes were noted in 16 cases (2.7%, youngest case as 15 years), with 11 boys (68.8%) and most frequent segment as L3/4. Modic changes and high-intensity zones were absent in this cohort. CONCLUSIONS LDD can emerge as early as the first decade of life with Schmorl's nodes, without additional specific phenotypes, including Modic changes and high-intensity zones. The study provides valuable information of a unique age group that is often under-represented but equally important as adults.
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Affiliation(s)
- Zhong-Yuan Wan
- Department of Orthopedics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jun Zhang
- Department of Orthopedics, Baoji Central Hospital, Baoji, Shaanxi Province, People's Republic of China
| | - Hua Shan
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
| | - Tang-Fen Liu
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
| | - Fang Song
- Department of Stomatology, PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China
| | - Dino Samartzis
- Department of Orthopaedic Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Hai-Qiang Wang
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
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Sharma A, Martin PR, Rodriguez FR. Lumbar osteoporotic fractures develop in segments with less degenerated discs which then become more degenerated. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1437-1445. [PMID: 36795180 DOI: 10.1007/s00586-023-07573-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/16/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Our aim was to study the influence of segmental variations in intervertebral disc degeneration on the location of acute osteoporotic compression fractures and to investigate chronic effect of such fractures on adjacent discs. METHODS This retrospective study included 83 patients (69 females; mean ± SD age: 72.3 ± 14.0 years) with osteoporotic vertebral fractures. Using lumbar MRI, two neuroradiologists evaluated 498 lumbar vertebral segments for the presence and acuity of fractures and graded adjacent intervertebral disc degeneration on Pfirrmann's scale. Absolute and relative (to average patient-specific degeneration grade) segmental degeneration grades were compared against the presence and chronicity of vertebral fractures for all segments and for upper (T12-L2) and lower (L3-L5) subgroups. Intergroup analysis was conducted using Mann-Whitney U tests, with p value of < .05 considered significant. RESULTS Fractures involved 149/498 (29.9%; 15.1% acute) vertebral segments, majority (61.1%) involving T12-L2 segments. Segments with acute fractures had significantly lower degeneration grades (mean ± SD: absolute: 2.72 ± 0.62; relative: 0.91 ± 0.17) than those with no (absolute: 3.03 ± 0.79, p = 0.003; relative: 0.99 ± 0.16, p < 0.001) or chronic fractures (absolute: 3.03 ± 0.62, p = 0.003; relative: 1.02 ± 0.16, p < 0.001). Degeneration grades were higher in the lower lumbar spine (p < 0.001) in the absence of fractures, but comparable to upper spine for segments with acute or chronic fractures (p = 0.28 and 0.56, respectively). CONCLUSIONS Osteoporotic vertebral fractures favour segments with lower burden of disc degeneration, but likely contribute to subsequent worsening of adjacent disc degeneration.
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Affiliation(s)
- Aseem Sharma
- Department of Radiology, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Parker R Martin
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Francisco Rivas Rodriguez
- Department of Radiology, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
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Meadows KD, Peloquin JM, Newman HR, Cauchy PJK, Vresilovic EJ, Elliott DM. MRI
‐based measurement of in vivo disc mechanics in a young population due to flexion, extension, and diurnal loading. JOR Spine 2023; 6:e1243. [PMID: 36994458 PMCID: PMC10041375 DOI: 10.1002/jsp2.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Background Intervertebral disc degeneration is often implicated in low back pain; however, discs with structural degeneration often do not cause pain. It may be that disc mechanics can provide better diagnosis and identification of the pain source. In cadaveric testing, the degenerated disc has altered mechanics, but in vivo, disc mechanics remain unknown. To measure in vivo disc mechanics, noninvasive methods must be developed to apply and measure physiological deformations. Aim Thus, this study aimed to develop methods to measure disc mechanical function via noninvasive MRI during flexion and extension and after diurnal loading in a young population. This data will serve as baseline disc mechanics to later compare across ages and in patients. Materials & Methods To accomplish this, subjects were imaged in the morning in a reference supine position, in flexion, in extension, and at the end of the day in a supine position. Disc deformations and vertebral motions were used to quantify disc axial strain, changes in wedge angle, and anterior-posterior (A-P) shear displacement. T2 weighted MRI was also used to evaluate disc degeneration via Pfirrmann grading and T2 time. All measures were then tested for effect of sex and disc level. Results We found that flexion and extension caused level-dependent strains in the anterior and posterior of the disc, changes in wedge angle, and A-P shear displacements. Flexion had higher magnitude changes overall. Diurnal loading did not cause level-dependent strains but did cause small level-dependent changes in wedge angle and A-P shear displacements. Discussion Correlations between disc degeneration and mechanics were largest in flexion, likely due to the smaller contribution of the facet joints in this condition. Conclusion In summary, this study established methods to measure in vivo disc mechanical function via noninvasive MRI and established a baseline in a young population that may be compared to older subjects and clinical disorders in the future.
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Affiliation(s)
- Kyle D. Meadows
- Department of Biomedical Engineering University of Delaware Newark Delaware USA
| | - John M. Peloquin
- Department of Biomedical Engineering University of Delaware Newark Delaware USA
| | - Harrah R. Newman
- Department of Biomedical Engineering University of Delaware Newark Delaware USA
| | - Peter J. K. Cauchy
- Department of Biomedical Engineering University of Delaware Newark Delaware USA
| | | | - Dawn M. Elliott
- Department of Biomedical Engineering University of Delaware Newark Delaware USA
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Paik S, Choi Y, Chung CK, Won YI, Park SB, Yang SH, Lee CH, Rhee JM, Kim KT, Kim CH. Cervical kinematic change after posterior full-endoscopic cervical foraminotomy for disc herniation or foraminal stenosis. PLoS One 2023; 18:e0281926. [PMID: 36809260 PMCID: PMC9942978 DOI: 10.1371/journal.pone.0281926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/04/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE Posterior full-endoscopic cervical foraminotomy (PECF) is one of minimally invasive surgical techniques for cervical radiculopathy. Because of minimal disruption of posterior cervical structures, such as facet joint, cervical kinematics was minimally changed. However, a larger resection of facet joint is required for cervical foraminal stenosis (FS) than disc herniation (DH). The objective was to compare the cervical kinematics between patients with FS and DH after PECF. METHODS Consecutive 52 patients (DH, 34 vs. FS, 18) who underwent PECF for single-level radiculopathy were retrospectively reviewed. Clinical parameters (neck disability index, neck pain and arm pain), and segmental, cervical and global radiological parameters were compared at postoperative 3, 6, and 12 months, and yearly thereafter. A linear mixed-effect model was used to assess interactions between groups and time. Any occurrence of significant pain during follow-up was recorded during a mean follow-up period of 45.5 months (range 24-113 months). RESULTS Clinical parameters improved after PECF, with no significant differences between groups. Recurrent pain occurred in 6 patients and surgery (PECF, anterior discectomy and fusion) was performed in 2 patients. Pain-free survival rate was 91% for DH and 83% for FS, with no significant difference between the groups (P = 0.29). Radiological changes were not different between groups (P > 0.05). Segmental neutral and extension curvature became more lordotic. Cervical curvature became more lordotic on neutral and extension X-rays, and the range of cervical motion increased. The mismatch between T1-slope and cervical curvature decreased. Disc height did not change, but the index level showed degeneration at postoperative 2 years. CONCLUSION Clinical and radiological outcomes after PECF were not different between DH and FS patients and kinematics were significantly improved. These findings may be informative in a shared decision-making process.
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Affiliation(s)
- Seungyoon Paik
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chun Kee Chung
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
| | - Young Il Won
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Republic of Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - John Min Rhee
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Republic of Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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An ambiguity-aware classifier of lumbar disc degeneration. Knowl Based Syst 2022. [DOI: 10.1016/j.knosys.2022.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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A protocol for recruiting and analyzing the disease-oriented Russian disc degeneration study (RuDDS) biobank for functional omics studies of lumbar disc degeneration. PLoS One 2022; 17:e0267384. [PMID: 35560143 PMCID: PMC9106166 DOI: 10.1371/journal.pone.0267384] [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] [Received: 05/26/2021] [Accepted: 04/07/2022] [Indexed: 11/30/2022] Open
Abstract
Lumbar intervertebral disc degeneration (DD) disease is one of the main risk factors for low back pain and a leading cause of population absenteeism and disability worldwide. Despite a variety of biological studies, lumbar DD is not yet fully understood, partially because there are only few studies that use systematic and integrative approaches. This urges the need for studies that integrate different omics (including genomics and transcriptomics) measured on samples within a single cohort. This protocol describes a disease-oriented Russian disc degeneration study (RuDDS) biobank recruitment and analyses aimed to facilitate further omics studies of lumbar DD integrating genomic, transcriptomic and glycomic data. A total of 1,100 participants aged over 18 with available lumbar MRI scans, medical histories and biological material (whole blood, plasma and intervertebral disc tissue samples from surgically treated patients) will be enrolled during the three-year period from two Russian clinical centers. Whole blood, plasma and disc tissue specimens will be used for genotyping with genome-wide SNP-arrays, glycome profiling and RNA sequencing, respectively. Omics data will be further used for a genome-wide association study of lumbar DD with in silico functional annotation, analysis of plasma glycome and lumbar DD disease interactions and transcriptomic data analysis including an investigation of differential expression patterns associated with lumbar DD disease. Statistical tests applied in each of the analyses will meet the standard criteria specific to the attributed study field. In a long term, the results of the study will expand fundamental knowledge about lumbar DD development and contribute to the elaboration of novel personalized approaches for disease prediction and therapy. Additionally to the lumbar disc degeneration study, a RuDDS cohort could be used for other genetic studies, as it will have unique omics data. Trial registration numberNCT04600544.
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Foizer GA, Paiva VCD, Nascimento RDD, Gorios C, Cliquet Júnior A, Miranda JBD. Is There Any Association between the Severity of Disc Degeneration and Low Back Pain? Rev Bras Ortop 2022; 57:334-340. [PMID: 35652022 PMCID: PMC9142238 DOI: 10.1055/s-0041-1735831] [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: 11/06/2020] [Accepted: 04/07/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To access the possibility that higher degrees of disc degeneration lead to higher levels of pain and dysfunction. Methods Magnetic resonance imaging (MRI) scans of 85 patients with low back pain lasting for more than 12 weeks were evaluated, and the degree of disc degeneration was quantified according to the Pfirrmann grading system. The Pfirrmann degree in each disc space from L1-L2 to L5-S1, the maximum degree of Pfirrmann (Pfirrmann-max) between the lumbar discs, and the sum of Pfirrmann (Pfirrmann-sum) degrees were correlated (through the Spearman test) with the Oswestry Disability Index (ODI) and the Visual Analogical Scale (VAS) for pain. Results In total, 87% of the patients had moderate to severe lumbar disc degeneration measured by Pfirrmann-max, and the most degenerated discs were L4-L5 and L5-S1. There was a week to moderate correlation regarding the Pfirrmann-max (r = 0,330; p = 0.002) and the Pfirrmann-sum (r = 0,266; p = 0,037) and the ODI, and the Pfirrmann scores in L1-L2 were correlated with the ODI and the VAS. Conclusion Patients with chronic idiopathic low back pain frequently have moderate to severe lumbar disc degeneration, which has a negative impact on the quality of life of the patients. Low degrees of degeneration in L1-L2 might be related with higher degrees of pain and of functional disability.
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Affiliation(s)
- Guilherme Augusto Foizer
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
- Ambulatório de Coluna Vertebral, Hospital Geral de Carapicuíba, São Paulo, SP, Brazil
| | | | | | - Carlos Gorios
- Ambulatório de Coluna Vertebral, Hospital Geral de Carapicuíba, São Paulo, SP, Brazil
| | - Alberto Cliquet Júnior
- Departamento de Ortopedia, Reumatologia e Traumatologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - João Batista de Miranda
- Departamento de Ortopedia, Reumatologia e Traumatologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
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Sun S, Tan ET, Mintz DN, Sahr M, Endo Y, Nguyen J, Lebel RM, Carrino JA, Sneag DB. Evaluation of deep learning reconstructed high-resolution 3D lumbar spine MRI. Eur Radiol 2022; 32:6167-6177. [PMID: 35322280 DOI: 10.1007/s00330-022-08708-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/24/2022] [Accepted: 03/05/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To compare interobserver agreement and image quality of 3D T2-weighted fast spin echo (T2w-FSE) L-spine MRI images processed with a deep learning reconstruction (DLRecon) against standard-of-care (SOC) reconstruction, as well as against 2D T2w-FSE images. The hypothesis was that DLRecon 3D T2w-FSE would afford improved image quality and similar interobserver agreement compared to both SOC 3D and 2D T2w-FSE. METHODS Under IRB approval, patients who underwent routine 3-T lumbar spine (L-spine) MRI from August 17 to September 17, 2020, with both isotropic 3D and 2D T2w-FSE sequences, were retrospectively included. A DLRecon algorithm, with denoising and sharpening properties was applied to SOC 3D k-space to generate 3D DLRecon images. Four musculoskeletal radiologists blinded to reconstruction status evaluated randomized images for motion artifact, image quality, central/foraminal stenosis, disc degeneration, annular fissure, disc herniation, and presence of facet joint cysts. Inter-rater agreement for each graded variable was evaluated using Conger's kappa (κ). RESULTS Thirty-five patients (mean age 58 ± 19, 26 female) were evaluated. 3D DLRecon demonstrated statistically significant higher median image quality score (2.0/2) when compared to SOC 3D (1.0/2, p < 0.001), 2D axial (1.0/2, p < 0.001), and 2D sagittal sequences (1.0/2, p value < 0.001). κ ranges (and 95% CI) for foraminal stenosis were 0.55-0.76 (0.32-0.86) for 3D DLRecon, 0.56-0.73 (0.35-0.84) for SOC 3D, and 0.58-0.71 (0.33-0.84) for 2D. Mean κ (and 95% CI) for central stenosis at L4-5 were 0.98 (0.96-0.99), 0.97 (0.95-0.99), and 0.98 (0.96-0.99) for 3D DLRecon, 3D SOC and 2D, respectively. CONCLUSIONS DLRecon 3D T2w-FSE L-spine MRI demonstrated higher image quality and similar interobserver agreement for graded variables of interest when compared to 3D SOC and 2D imaging. KEY POINTS • 3D DLRecon T2w-FSE isotropic lumbar spine MRI provides improved image quality when compared to 2D MRI, with similar interobserver agreement for clinical evaluation of pathology. • 3D DLRecon images demonstrated better image quality score (2.0/2) when compared to standard-of-care (SOC) 3D (1.0/2), p value < 0.001; 2D axial (1.0/2), p value < 0.001; and 2D sagittal sequences (1.0/2), p value < 0.001. • Interobserver agreement for major variables of interest was similar among all sequences and reconstruction types. For foraminal stenosis, κ ranged from 0.55 to 0.76 (95% CI 0.32-0.86) for 3D DLRecon, 0.56-0.73 (95% CI 0.35-0.84) for standard-of-care (SOC) 3D, and 0.58-0.71 (95% CI 0.33-0.84) for 2D.
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Affiliation(s)
- Simon Sun
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Douglas N Mintz
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Meghan Sahr
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Joseph Nguyen
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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Yao C, Guo G, Huang R, Tang C, Zhu Q, Cheng Y, Kong L, Ren J, Fang M. Manual therapy regulates oxidative stress in aging rat lumbar intervertebral discs through the SIRT1/FOXO1 pathway. Aging (Albany NY) 2022; 14:2400-2417. [PMID: 35289767 PMCID: PMC8954973 DOI: 10.18632/aging.203949] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
Abstract
With the increasing burden of a globally aging population, low back pain has become one of the most common musculoskeletal disorders, caused mainly by intervertebral disc (IVD) degeneration. There are currently several clinical methods to alleviate back pain, but there is scarce attention paid as to whether they can improve age-related IVD degeneration. It is therefore difficult to conduct an in-depth evaluation of these methods. A large number of clinical studies have shown that manual therapy (MT), a widely used comprehensive alternative method, has effects on pain, the mechanisms of which require further study. In this study, MT was performed on aging rats for 6 months, and their behaviors were compared with those of a non-intervention group of aging and young rats. After the intervention, all rats were examined by X-ray to observe lumbar spine degeneration, and the IVD tissues were dissected for detection, including pathological staining, immunofluorescence, Western bolt, etc. This study demonstrated the possibility that MT intervention delay the lumbar IVD degeneration in aging rats, specifically improving the motor function and regulating senescence-associated β-galactosidase, p53, p21, p16, and telomerase activity to retard the senescence of cells in IVDs. Moreover, MT intervention can modify oxidative stress, increase the expression of SIRT1 and FOXO1 in IVDs and decrease ac-FOXO1 expression, suggesting that MT can reduce oxidative stress through the SIRT1/FOXO1 pathway, thereby playing a role in delaying the aging of IVDs. This study shows that drug-free, non-invasive mechanical interventions could be of major significance in improving the physical function of the elderly.
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Affiliation(s)
- Chongjie Yao
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China.,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, P.R. China
| | - Guangxin Guo
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China.,Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Ruixin Huang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, P.R. China
| | - Cheng Tang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, P.R. China
| | - Qingguang Zhu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, P.R. China.,Research Institute of Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai 200437, P.R. China
| | - Yanbin Cheng
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, P.R. China.,Research Institute of Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai 200437, P.R. China
| | - Lingjun Kong
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, P.R. China.,Research Institute of Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai 200437, P.R. China
| | - Jun Ren
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, P.R. China
| | - Min Fang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China.,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, P.R. China.,Research Institute of Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai 200437, P.R. China
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Novikova AV, Pravdyuk NG, Saklakova VS, Lolomadze EA, Feniksov VM, Nikolaev DA, Davygora KS, Timofeev VT, Shostak NA. Degenerative disc disease in young adults: cytokine profile and angiogenic factors. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2021. [DOI: 10.24075/brsmu.2021.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Back pain (BP), associated with the degenerative disc disease (DDD), poses a heavy social and economic burden due to early disability and indications to surgery, emerging in young adults. Pathophysiological basis of premature intervertebral disc (IVD) degeneration is being actively studied. The study was aimed to define the profiles of inflammatory cytokines in DDD, as well as their relationship to the structural spine diseases. The molecular genetic analysis of the mRNA gene abundance in patients with BP and herniated IVD after discectomy and healthy individuals was performed by the quantitative polymerase chain reaction method. High expression of TNFα, IL17 was revealed in the IVD tissues of the affected patients (p < 0.01); the levels of TNFα and IL1β correlated with the DDD severity (r = 0.301 and 0.37; p < 0.05). Elevated expression of IL1β, IL6 was found in peripheral white blood cells (p < 0.01); the levels of IL6 negatively correlated with Modic type 1 and 2 changes (r = –0.31; p < 0.05), and the levels of IL17 positively correlated with the IVD herniation in combination with erosions of the adjacent vertebral body endplates and Modic changes (r = 0.401; p < 0.05). The expression of VEGF-А in the IVD tissues and white blood cells negatively correlated with the DDD grades (r = –0.85; p < 0.001), indicating reduced vascularization in the terminal phase of the disease. The findings on DDD demonstrate the contribution of the local low-immune inflammation, coupled with the intense disc vascularization at the earlier stages, and associated with the reactive inflammation in vertebral bodies. The results are prerequisites for developing the anti-inflammatory and reparative therapy based on the DDD grade and the presence of Modic changes in young adults with BP.
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Affiliation(s)
- AV Novikova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - NG Pravdyuk
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - VS Saklakova
- Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - EA Lolomadze
- Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - VM Feniksov
- Pirogov City Clinical Hospital № 1, Moscow, Russia
| | - DA Nikolaev
- Pirogov City Clinical Hospital № 1, Moscow, Russia
| | - KS Davygora
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - VT Timofeev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - NA Shostak
- Pirogov Russian National Research Medical University, Moscow, Russia
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Expression of ANGPTL4 in Nucleus Pulposus Tissues Is Associated with Intervertebral Disc Degeneration. DISEASE MARKERS 2021; 2021:3532716. [PMID: 34876931 PMCID: PMC8645404 DOI: 10.1155/2021/3532716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
Objective Angiopoietin-like protein 4 (ANGPTL4), encoding a glycosylated secreted protein, has been reported to be closely related to many kinds of diseases, including diabetes, tumor, and some musculoskeletal pathologies, such as rheumatoid arthritis, osteoarthritis, and osteoporosis. The aim of the current study is to investigate the role of ANGPTL4 in intervertebral disc degeneration and analyze the association of ANGPTL4 expression with Pfirrmann grades. Methods A total of 162 nucleus pulposus tissues were collected from lumbar intervertebral disc herniation patients undergoing interforaminal endoscopic surgery. Real-time quantitative PCR and western blot were performed to determine the mRNA and protein expression of ANGPTL4 in nucleus pulposus samples. Statistical analysis was performed to analyze the association of ANGPTL4 expression with Pfirrmann grades. Results Based on the clinical data of 162 patients, results showed that Pfirrmann grades were significantly associated with patients' age (r = 0.162, P = 0.047) and were not significantly associated with patients' gender (P > 0.05). RT-qPCR and western blot results showed that the mRNA (r = 0.287, P < 0.05) and protein (r = 0.356, P < 0.05) expressions of ANGPTL4 were both closely associated with Pfirrmann grades. The expression of ANGPTL4 was remarkably increased in the groups of high IVDD Pfirrmann grades. Conclusion The results demonstrated that ANGPTL4 expression was positively associated with the Pfirrmann grades and the severity of intervertebral disc degeneration. ANGPTL4 may be served as a candidate biomarker for intervertebral disc degeneration.
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15
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Kaliya-Perumal AK, Soh TLT, Tan M, Oh JYL. Early Postoperative Loss of Disc Height Following Transforaminal and Lateral Lumbar Interbody Fusion: A Radiographic Analysis. Asian Spine J 2021; 16:471-477. [PMID: 34784700 PMCID: PMC9441439 DOI: 10.31616/asj.2021.0109] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective comparative radiological study. Purpose To analyze the difference in early disc height loss following transforaminal and lateral lumbar interbody fusion (TLIF and LLIF). Overview of Literature Minimal disc height loss facilitated by the polyaxial screw heads can occur naturally due to mechanical loading following lumbar fusion procedures. This loss does not usually cause any significant foraminal narrowing. However, when there is concomitant cage subsidence, symptomatic foraminal compromise could occur, especially when posterior decompression is not performed. It is not known whether the type of procedure, TLIF or LLIF, could influence this phenomenon. Methods Retrospectively, patients who underwent TLIF and LLIF for various degenerative conditions were shortlisted. Each of their fused levels with the cage in situ was analyzed independently, and the preoperative, postoperative, and follow-up disc height measurements were compared between the groups. In addition, the total disc height loss since surgery was calculated at final follow-up and was compared between the groups. Results Forty-six patients (age, 64.1±8.9 years) with 70 cage levels, 35 in each group, were selected. Age, sex, construct length, preoperative disc height, cage height, and immediate postoperative disc height were similar between the groups. By 3 months, disc height of the TLIF group was significantly less and continued to decrease over time, unlike in the LLIF group. By 1 year, the TLIF group demonstrated greater disc height loss (2.30±1.3 mm) than the LLIF group (0.89±1.1 mm). However, none of the patients in either group had any symptomatic complications throughout follow-up. Conclusions Although our study highlights the biomechanical advantage of LLIF over TLIF in maintaining disc height, none of the patients in our cohort had symptomatic complications or implant-related failures. Hence, TLIF, as it incorporates posterior decompression, remains a safe and reliable technique despite the potential for greater disc height loss.
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Affiliation(s)
- Arun-Kumar Kaliya-Perumal
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Tamara Lee Ting Soh
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Mark Tan
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Jacob Yoong-Leong Oh
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Characteristics of lumbar disc degeneration and risk factors for collapsed lumbar disc in Korean farmers and fishers. Ann Occup Environ Med 2021; 33:e16. [PMID: 34754477 PMCID: PMC8203835 DOI: 10.35371/aoem.2021.33.e16] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/07/2021] [Indexed: 11/20/2022] Open
Abstract
Background Few studies have investigated the risk factors for lumbar intervertebral disc degeneration among hard physical workers involved in heavy lifting. In this study, we aimed to identify the characteristics of lumbar intervertebral disc degeneration and evaluate the relationship between collapsed lumbar disc and potential risk factors in farmers and fishers. Methods This study included 203 farmers (103 men and 100 women) and 166 fishers (95 men and 71 women) aged 40–69 years who had undergone lumbar magnetic resonance imaging and were enrolled in the Korea Farmer's Knee Cohort and the Jeonnam Fishers' Cohort. We evaluated each of the 5 lumbar discs using the Pfirrmann grading system and classified collapsed lumbar intervertebral disc (cLD) as a case with ≥ 1 grade 5 at any disc level. We investigated potential risk factors, such as gender, age, body mass index (BMI), working hours per day, working months per year, and cumulative heavy lifting working time (CLWT). The odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated. Results The prevalence of cLD was 19.8% (23.7% among fishers, 21.2% among fishers with farming, and 17.2% among farmers). cLD correlated with factors such as age and occupation. Gender, CLWT and the working time matrix were not significantly associated with cLD. The OR of cLD adjusted by gender, age, BMI, and working time matrix was 1.26 (95% CI: 0.69–2.30) for ≥ 5,000 hours CLWT compared to that for < 2,000 hours CLWT. The OR of cLD adjusted by gender, age, BMI, CLWT, and working time matrix was 2.08 (95% CI: 1.06–4.06) for fishers compared to that for farmers. Conclusions Heavy lifting did not show a significant association with cLD in farmers and fishers. However, there is possibility that fishers are at a higher risk of lumbar disc collapse than farmers.
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Abstract
STUDY DESIGN Longitudinal study of cervical MR in patients with degenerative disc disease (DDD). OBJECTIVE To evaluate the evolution of the degenerative changes in the C2-D1 cervical segments and to assess the association magnetic resonance imaging (MRI) parameters with clinical symptoms after surgical treatment in patients with DDD. SUMMARY OF BACKGROUND DATA The evolution of degenerative changes in the cervical spine is poorly understood. Endplate defects can be of great importance in progressive disc degeneration (DD). Clarification of this predictor may be important in determining the treatment tactics in patients with DDD. METHODS The study included patients who had 2-years' follow-up after cervical fusion for spondylotic radiculo- with/without myelopathy. Demographic data (age, sex, surgical data) were assessed; clinical data (visual analogue scale [VAS] neck, VAS arm, Neck Disability Index [NDI]) and cervical MRI (DD grades by Pfirrmann, Modic changes (MC), total endplate scores (TEPS) were compared to preoperative data. RESULTS The median follow-up term was 26.5 (18.9-33.1) months. All patients reported a decrease neck pain and arm pain at follow-up (P < 0.001). There was observed the change in MC types (P < 0.001) and an increase of TEPS (P < 0.05). 71.7% discs remained unchanged during the follow-up, but a significant number of discs went from Grade 2 to Grade 3 and from Grade 3 to Grade 4 by Pfirrmann (P < 0.001). Clinical scores (VAS neck, VAS arm, NDI) had no correlation with MRI changes (P > 0.05). DD was associated with TEPS (odds ratio [OR] 2.05-5.47, P < 0.05) and patients' age (OR 1.11-2.33, P < 0.05) at all cervical levels; with MC types, but only at C4-C5 and C6-C7 levels (OR = 2.91 and 2.79, respectively, P < 0.05). Receiver-operating characteristic analysis showed a TEPS threshold value of 7, above which the probability of DD significantly higher. CONCLUSION During 2 years' follow-up the significant increase of DD grades by Pfirrmann was observed at C4-C6 levels (P < 0.001). A significant association DD with TEPS and age at all cervical levels was determined.Level of Evidence: 3.
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Description of spine motion during gait in normal adolescents and young adults. 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 2021; 30:2520-2530. [PMID: 34247292 DOI: 10.1007/s00586-021-06918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/01/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Standing radiographs allow analysis of spinal segments and their relative positioning. However, it requires a specific positioning influencing spinal alignment. Knowledge of trunk movements when walking is therefore an essential step to evaluate dynamic sagittal balance. Our objective was to define spinal junction kinematics and their correlations during gait in a healthy population. METHOD This is a prospective, single-center study. Between 2015 and 2017, 25 healthy volunteers were included. The measurements were taken in a motion analysis laboratory. Several kinematic parameters were studied, including spinal junction movements in the three planes and dynamic sagittal vertical axis (Dyn-SVA). Pearson correlation coefficients were calculated to determine the interactions between the spinal junctions. RESULTS In the sagittal plane, the average amplitude of variation of the dyn-SVA was 25.5 cm (SD = 8.9). The average range of motion of the lumbosacral and thoracolumbar junction was approximately 3°, they operated in anti-phase during the gait cycle and were strongly correlated (r = -0.5069, p = 0.01). In the transverse plane, the anti-rotation of the upper body relative to the pelvis was mainly ensured by the opposite movements of the lumbosacral and thoracolumbar junction (r = 0.5689, p = 0.003). In the frontal plane, the lateral inclination in the lumbar region was made in the opposite direction from the pelvis toward the carrying member. CONCLUSION Although there is substantial inter-subject variability, our study characterized the angular movements in the three planes of the different spinal junctions, of the pelvis and the lower limbs during a gait cycle in a healthy population.
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Chuang HC, Tseng YH, Chen Y, Chou PH, Chang WL, Su PF, Lin CL. Assessment of sagittal spinopelvic parameters in a Taiwanese population with spondylolysis by the EOS imaging system: a retrospective radiological analysis. BMC Musculoskelet Disord 2021; 22:553. [PMID: 34144702 PMCID: PMC8214289 DOI: 10.1186/s12891-021-04440-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background The impact of sagittal spinopelvic alignment on spondylolysis is well established in Caucasian populations. However, prior studies suggest that people from different ethnological backgrounds showed divergence, and a few studies that focused on Asian populations reported conflicting results. The aim of this study is to use the EOS imaging system to evaluate the spinopelvic parameters of spondylolysis patients, and their relationship with spondylolisthesis, disc degeneration, and age in a Taiwanese population. Methods Radiographic sagittal spinopelvic parameters for 45 spondylolysis patients and 32 healthy people were evaluated, including pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), and lumbar lordosis (LL). The spinopelvic parameters were compared between spondylolytic and control groups. These parameters were further compared between spondylolytic subjects with and without spondylolisthesis, with and without high-grade disc degeneration, and young (< 30 years old) and middle-aged. Results The PI and LL of the spondylolytic group (52.6°±12.0° and 41.3°±15.2°) were significantly higher than those of the healthy control group (47.16°±7.95° and 28.22°±10.65°). Further analysis of the spondylolytic patients revealed that those with high-grade disc degeneration were more prone to spondylolisthesis (92.3 %) compared to those without (50 %; p = 0.001). The middle-aged group had significantly higher rates of spondylolisthesis (80 %) and high-grade disc degeneration (52.4 %) compared with those for the young group (45 and 16.7 %, respectively; p = 0.017 and 0.047, respectively). No statistically significant difference in the sagittal spinopelvic parameters was found when spondylolytic patients were divided according to the occurrence of spondylolisthesis or high-grade disc degeneration. Conclusions In a Taiwanese population, PI and LL were significantly larger in spondylolytic patients. Disc degeneration and age were associated with the occurrence of spondylolisthesis. Ethnological differences should thus be taken into account when making clinical decisions regarding spondylolysis in a Taiwanese population.
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Affiliation(s)
- Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, 70428, Tainan, Taiwan
| | - Yu-Hsiang Tseng
- Department of Plastic Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Christian Hospital, Tainan, Taiwan
| | - Po-Hsin Chou
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Lun Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, 70428, Tainan, Taiwan.,Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan
| | - Pei-Fang Su
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Li Lin
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, 70428, Tainan, Taiwan. .,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan. .,Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan, Taiwan. .,Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan.
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A New Hope in Spinal Degenerative Diseases: Piezo1. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6645193. [PMID: 33575334 PMCID: PMC7857891 DOI: 10.1155/2021/6645193] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/09/2021] [Indexed: 12/19/2022]
Abstract
As a newly discovered mechanosensitive ion channel protein, the piezo1 protein participates in the transmission of mechanical signals on the cell membrane and plays a vital role in mammalian biomechanics. Piezo1 has attracted widespread attention since it was discovered in 2010. In recent years, studies on piezo1 have gradually increased and deepened. In addition to the discovery that piezo1 is expressed in the respiratory, cardiovascular, gastrointestinal, and urinary systems, it is also stably expressed in cells such as mesenchymal stem cells (MSCs), osteoblasts, osteoclasts, chondrocytes, and nucleus pulposus cells that constitute vertebral bodies and intervertebral discs. They can all receive external mechanical stimulation through the piezo1 protein channel to affect cell proliferation, differentiation, migration, and apoptosis to promote the occurrence and development of lumbar degenerative diseases. Through reviewing the relevant literature of piezo1 in the abovementioned cells, this paper discusses the effect of piezo1 protein expression under mechanical stress stimuli on spinal degenerative disease, providing the molecular basis for the pathological mechanism of spinal degenerative disease and also a new basis, ideas, and methods for the prevention and treatment of this degenerative disease.
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Aono H, Takenaka S, Tobimatsu H, Nagamoto Y, Furuya M, Yamashita T, Ishiguro H, Iwasaki M. Adjacent-segment disease after L3-4 posterior lumbar interbody fusion: does L3-4 fusion have cranial adjacent-segment degeneration similar to that after L4-5 fusion? J Neurosurg Spine 2020; 33:455-460. [PMID: 32470931 DOI: 10.3171/2020.3.spine20122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Posterior lumbar interbody fusion (PLIF) is a widely accepted procedure for degenerative lumbar diseases, and there have been many reports concerning adjacent-segment disease (ASD) after PLIF. In the reports of ASD in which the fusion level was limited to 1 segment, all reports describe ASD of the L3-4 segment after L4-5 PLIF. On the basis of these reports, it is thought that ASD mainly occurs at the cranial segment. However, no report has covered ASD after L3-4 PLIF. Therefore, the authors investigated ASD after L3-4 PLIF. METHODS In conducting a retrospective case series analysis, the authors reviewed a surgical database providing details of all spine operations performed between 2006 and 2017 at a single institution. During that period, PLIF was performed to treat 632 consecutive patients with degenerative lumbar diseases. Of these patients, 71 were treated with L3-4 PLIF alone, and 67 who were monitored for at least 2 years (mean 5.8 years; follow-up rate 94%) after surgery were enrolled in this study. Radiological ASD (R-ASD), symptomatic ASD (S-ASD), and operative ASD (O-ASD) were evaluated. These types of ASD were defined as follows: R-ASD refers to radiological degeneration adjacent to the fusion segment as shown on plain radiographs; S-ASD is a symptomatic condition due to neurological deterioration at the adjacent-segment degeneration; and O-ASD refers to S-ASD requiring revision surgery. RESULTS All patients had initial improvement of neurological symptoms after primary PLIF. R-ASD was observed in 32 (48%) of 67 patients. It occurred at the cranial segment in 12 patients and at the caudal segment in 24; R-ASD at both adjacent segments was observed in 4 patients. Thus, the occurrence of R-ASD was more significant in the caudal segment than in the cranial segment. S-ASD was observed in 10 patients (15%), occurring at the cranial segment in 3 patients and at the caudal segment in 7. O-ASD was observed in 6 patients (9%): at the cranial segment in 1 patient and at the caudal segment in 5. Thus, the rate of involvement of the caudal segment was 67% in R-ASD, 70% in S-ASD, and 83% in O-ASD. CONCLUSIONS The incidences of R-ASD, S-ASD, and O-ASD were 48%, 15%, and 9%, respectively, after L3-4 PLIF for degenerative lumbar diseases. In contrast to ASD after L4-5 PLIF, ASD after L3-4 PLIF was more frequently observed at the caudal segment than at the cranial segment. In follow-up for patients with L3-4 PLIF, surgeons should pay attention to ASD in the caudal segment.
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Affiliation(s)
- Hiroyuki Aono
- 1National Hospital Organization, Osaka National Hospital
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Mitchell UH, Bowden JA, Larson RE, Belavy DL, Owen PJ. Long-term running in middle-aged men and intervertebral disc health, a cross-sectional pilot study. PLoS One 2020; 15:e0229457. [PMID: 32084224 PMCID: PMC7034897 DOI: 10.1371/journal.pone.0229457] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To measure intervertebral disc (IVD) health parameters in middle-aged long-term runners compared to matched non-physically active controls. Methods Seventeen males aged 44-62yr were included in the study: 9 runners with a running history of >10yr, averaging >50km/week, and eight matched non-physically active controls, the data from one participant had to be excluded. T2-relaxometry, diffusion weighted imaging, T1- and T2-weighted MR scanning, as well as T2 time mapping were performed. Morphological data relating to IVD were extrapolated. Results Compared to controls on average, runners had 20% greater IVD height (p = 0.002) and seven percentage points greater IVD-vertebral body height ratio (p = 0.001). No significant differences were observed between groups for mean(SD) IVD hydration status, as indicated by similar T2-times (runners: 94.4(11.1)ms, controls: 88.6(23.6)ms), or apparent diffusion coefficients (runners: 249.0(175.2)mm2/s, controls: 202.3(149.5)mm2/s). Average Pfirrmann score for the L5-S1 IVD was 2.2(0.7) for runners and 3.3(1.0) for controls (p = 0.026), average scores for all lumbar levels (L2-S1) were 1.9(0.2) and 2.5(0.7), respectively (p = 0.036). Anterior annulus T2-time and overall average lumbar level Pfirrmann grades were strongly correlated (r = 0.787, p = 0.021 and r = -0.704, p = 0.034, respectively) with greater distances run per week. Average lumbar level Pfirrmann grades were also strongly correlated (r = -0.823, p = 0.006) to total years of running. Conclusion Middle-aged long-term endurance runners exhibit less age-related decline in their lumbar IVDs. In addition, the measures of IVD morphology appeared to be better in those who had been running for a greater number of years, as well as in those who ran a greater distance per week.
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Affiliation(s)
- Ulrike H. Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, United States of America
- * E-mail:
| | - Jennifer A. Bowden
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, United States of America
| | - Robert E. Larson
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, United States of America
| | - Daniel L. Belavy
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Patrick J. Owen
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
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Prospective Observational Cohort Study of Health-related Quality of Life: Marked Adult Sagittal Deformity (ASD) in Comparison With Mild to Moderate ASD. Spine (Phila Pa 1976) 2019; 44:1723-1730. [PMID: 31348181 DOI: 10.1097/brs.0000000000003170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis of prospective observational cohort OBJECTIVE.: This study assessed the difference in health-related quality of life (HRQOL) between participants with a mild to moderate adult sagittal deformity (ASD) (sagittal vertical axis [SVA] ≤9.5 cm) and those with a marked deformity (SVA >9.5 cm). We also evaluated predisposing factors for a marked deformity. SUMMARY OF BACKGROUND DATA Sagittal imbalance is closely associated with HRQOL for the patient. However, how the effect changes depending on the degree of imbalance has not been fully evaluated. The understanding of the predisposing factor associated with marked deformity also lacks. METHODS A total of 124 elderly persons with a stooping posture were enrolled. Questionnaires related to HRQOL were administered. Sagittal alignment parameters and pelvic parameters were measured with a whole spine x-ray. Lumbar spine magnetic resonance imaging was used to assess the presence of pathologic conditions, muscle quality and quantity. Multivariate logistic regression analysis was conducted to analyze potential risk factors. RESULTS Marked ASD was associated with female sex, lower height and weight, and osteoporosis (P < 0.05). Back pain (assessed by a visual analogue scale) and the Oswestry Disability Index were significantly higher in the marked deformity group (P = 0.012, 0.002, respectively). Multivariate logistic regression analysis showed significant relationships between the following parameters and marked deformity: preexisting compression fracture (odds ratio [OR] = 7.793; 95% confidence interval [CI], 1.527-39.768), severe L5/S1 Pfirrmann disc degeneration grade (OR = 1.916; 95% CI, 1.086-3.382), and lower quantities of multifidus and psoas muscles (OR = 0.994, 0.997; 95% CI, 0.991-0.998, 0.994-0.999, respectively). CONCLUSION Participants with a marked ASD showed different features from those with a mild to moderate ASD. This study also implies that anatomical factors, including the vertebrae, intervertebral discs, and paraspinal muscles, synergistically contribute to progression into marked deformity. LEVEL OF EVIDENCE 3.
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Choi HY, Lee CH. Can Beta-Endorphin Be Used as a Biomarker for Chronic Low Back Pain? A Meta-analysis of Randomized Controlled Trials. PAIN MEDICINE 2019; 20:28-36. [PMID: 30256990 DOI: 10.1093/pm/pny186] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Chronic low back pain (CLBP) is usually quantified using the visual analog scale (VAS). However, the VAS is a subjective measure and prone to reporting bias, therefore making it difficult to differentiate patients with true pain from those seeking to obtain secondary gain. This study aimed to evaluate the feasibility of using plasma β-endorphin as an objective biomarker for CLBP. Methods We searched PubMed, Embase, and the Cochrane Library for randomized trials that compared treatment vs sham procedures for patients with CLBP. Changes in VAS and β-endorphin levels between baseline and final evaluations were assessed for the treatment and control groups. A meta-regression model was developed to evaluate the association between the β-endorphin level and VAS. Results We included data from seven trials involving 375 patients. There was no significant difference in VAS scores and β-endorphin levels between both groups at baseline. At final evaluation, the treatment group demonstrated significantly greater improvements in VAS scores and an increased β-endorphin level compared with the control group. The change in the plasma β-endorphin level may be a surrogate marker of treatment response for patients with CLBP (explanatory power: 80%). The plasma β-endorphin level might be rarely affected by sham procedures. For patients with CLBP, the baseline β-endorphin level may reflect the intensity of CLBP (explanatory power: 66%). Conclusions A change in plasma β-endorphin level may be a surrogate marker of the treatment response for patients with CLBP. Advancements in β-endorphin measurements may help us better quantify pain intensity.
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Affiliation(s)
- Ho Yong Choi
- Department of Neurosurgery, Spine Center, Kyung Hee University Hospital at Gangdong, Kyung-Hee University School of Medicine, Seoul, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
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Novel Application of the Pfirrmann Disc Degeneration Grading System to 9.4T MRI: Higher Reliability Compared to 3T MRI. Spine (Phila Pa 1976) 2019; 44:E766-E773. [PMID: 31205169 DOI: 10.1097/brs.0000000000002967] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Reliability study. OBJECTIVE To evaluate the applicability and reliability of 9.4T magnetic resonance imaging (MRI) in the assessment of degenerative disc disease compared with 3T MRI. SUMMARY OF BACKGROUND DATA MRI is a reliable indicator of biochemical changes in the intervertebral disc (IVD) including hydration status, proteoglycan content, and disc degeneration compared with anatomical and histological studies. High-field 9.4T MRI has been shown to provide superior resolution and anatomical detail. However, it has not been tested against current standard MRI techniques. METHODS Disc degeneration was initiated in 36 skeletally mature ewes 6 months prior to necropsy via validated surgical IVD injury models using either scalpel injury or drill-bit injury techniques at lumbar spine levels L2/3 and L3/4 with L1/2, L4/5, and L5/6 serving as control discs. All ex vivo IVDs were examined with 9.4T MRI and 3T MRI. All scans were analyzed using the Pfirrmann grading system by four independent observers. Intra- and interobserver reliability was assessed using kappa statistics and Spearman correlation. RESULTS Inter- and intraobserver agreement for 9.4T MRI was excellent, both at κ 0.91 (P < 0.001). Comparatively, 3T interobserver reliability demonstrated substantial agreement at κ 0.61 (P < 0.001). Complete agreement was obtained in 92.7% to 100% of discs at 9.4T compared with 69.7% to 83.1% at 3T. A difference of one grade or more occurred in 6.7% at 9.4T and 39.3% at 3T. 9.4T MRI scored 97.3% of discs as grade 1 to 2 compared with 71.3% at 3T. 3T MRI tended to over-score the extent of disc degeneration with 28.6% of discs scored as grade 3 or higher compared with 2.7% at 9.4T MRI. CONCLUSION 9.4T MRI study of IVD degeneration using the Pfirrmann grading system demonstrated excellent inter- and intraobserver reliability. Comparatively, 3T MRI demonstrated a tendency to over score the extent of disc degeneration. This improved reliability of 9.4T MRI holds great potential for its clinical applications. LEVEL OF EVIDENCE 3.
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Vincent K, Mohanty S, Pinelli R, Bonavita R, Pricop P, Albert TJ, Dahia CL. Aging of mouse intervertebral disc and association with back pain. Bone 2019; 123:246-259. [PMID: 30936040 PMCID: PMC6549718 DOI: 10.1016/j.bone.2019.03.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/26/2019] [Accepted: 03/26/2019] [Indexed: 12/11/2022]
Abstract
With the increased burden of low back pain (LBP) in our globally aging population there is a need to develop preclinical models of LBP that capture clinically relevant features of physiological aging, degeneration, and disability. Here we assess the validity of using a mouse model system for age-related LBP by characterizing aging mice for features of intervertebral disc (IVD) degeneration, molecular markers of peripheral sensitization, and behavioral signs of pain. Compared to three-month-old and one-year-old mice, two-year-old mice show features typical of IVD degeneration including loss of disc height, bulging, innervation and vascularization in the caudal lumbar IVDs. Aging is also associated with the loss of whole-body bone mineral density in both male and female mice, but not associated with percent lean mass or body fat. Additionally, two-year-old mice have an accumulation of TRPA1 channels and sodium channels NaV1.8 and NaV1.9 in the L4 and L5 lumbar dorsal root ganglia consistent with changes in nociceptive signaling. Lastly, the effect of age, sex, and weight on mobility, axial stretching and radiating pain measures was assessed in male and female mice ranging from two months to two years in a general linear model. The model revealed that regardless of sex or weight, increased age was a predictor of greater reluctance to perform axial stretching and sensitivity to cold, but not heat in mice.
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Affiliation(s)
| | | | | | | | - Paul Pricop
- Hospital for Special Surgery, New York, NY 10021, USA
| | - Todd J Albert
- Hospital for Special Surgery, New York, NY 10021, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Chitra Lekha Dahia
- Hospital for Special Surgery, New York, NY 10021, USA; Department of Cell and Developmental Biology, Weill Cornell Medicine, Graduate School of Medical Science, New York, NY 10065, USA.
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A comparative study of diffusion kurtosis imaging and T2* mapping in quantitative detection of lumbar intervertebral disk degeneration. 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 2019; 28:2169-2178. [PMID: 31093750 DOI: 10.1007/s00586-019-06007-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/06/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the feasibility of diffusion kurtosis imaging (DKI) for diagnosing lumbar intervertebral disk degeneration (IDD) and to compare the potential of DKI and T2* mapping in the diagnosis of early IDD. METHODS Sagittal T2WI, DKI, and T2* mapping were performed in 75 subjects with 375 lumbar intervertebral disks at a 3.0-T MRI. DKI-related parameters including mean kurtosis (MK), mean diffusivity (MD), fractional anisotropy (FA), and T2* values were calculated for each disk which was segmented into three regions: nucleus pulposus (NP), anterior annulus fibrosus (AAF), and posterior annulus fibrosus (PAF). RESULTS MK and FA were positively correlated with Pfirrmann grade (all P < 0.001). MD and T2* were negatively correlated with Pfirrmann grade (all P < 0.001) except for T2* value of AAF (r = 0.087, P > 0.05). MK and FA values increased, while MD and T2* values decreased with age. No statistical significance was found between men and women (P > 0.05). Cephalic lumbar disks (L1/L2 and L2/L3) got lower MK and FA values than caudal lumbar disks (L4/L5 and L5/S1) (all P < 0.05), while cephalic lumbar disks got higher MD value than caudal lumbar disks (all P < 0.05). ROC analysis demonstrated that MK, MD, and FA showed significantly higher diagnostic accuracies than T2*, especially in NP and PAF. CONCLUSIONS DKI can be used to assess human lumbar IDD. And DKI was more sensitive to the quantitative detection of early lumbar IDD than T2* mapping. These slides can be retrieved under Electronic Supplementary Material.
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TO THE EDITOR. Spine (Phila Pa 1976) 2019; 44:E630-E631. [PMID: 31046002 DOI: 10.1097/brs.0000000000003026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Li Y, Zheng S, Wu Y, Liu X, Dang G, Sun Y, Chen Z, Wang J, Li J, Liu Z. Trends of surgical treatment for spinal degenerative disease in China: a cohort of 37,897 inpatients from 2003 to 2016. Clin Interv Aging 2019; 14:361-366. [PMID: 30863029 PMCID: PMC6388778 DOI: 10.2147/cia.s191449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose Given the aging Chinese population and the inevitable degenerative process of the spine, more elderly patients with spinal degenerative disease (SDD) are surgical candidates, placing a significant burden on health care resources. Few studies have investigated recent trends in hospital admissions and procedures for SDD in China. This study aimed to identify the trends, if any, in the number of surgical procedures undertaken for SDD in a large patient cohort. Materials and methods This retrospective cohort analysis used data from inpatient medical records at Peking University Third Hospital between 2003 and 2016. Descriptive statistical analysis, regression models, and a Holt–Winters seasonal model were used to analyze trends. Results Altogether, 38,676 surgery records from 37,897 SDD patients who had undergone surgical treatment were included in our study, among whom 49.60%, 47.81%, and 2.59% were treated because of cervical, lumbar, and thoracic degenerative disease, respectively. There was an increasing trend for spinal surgery performance with an increasing mean age at surgery, from 50.65 years of age in 2003 to 55.29 years in 2016. We also revealed interesting seasonal variation in our study – that is, most of the spinal procedures were performed during the winter and spring months. Conclusion Our study showed a significantly increasing surgical workload for addressing SDD in China. Both the public and the health care system should be aware of this increase in chronic degenerative disease in the aging population.
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Affiliation(s)
- Yan Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,
| | - Si Zheng
- Institute of Medical Information, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yunxia Wu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,
| | - Xiaoguang Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,
| | - Gengding Dang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,
| | - Yu Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,
| | - Jiayang Wang
- Institute of Medical Information, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jiao Li
- Institute of Medical Information, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhongjun Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,
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Hashimoto K, Aizawa T, Kanno H, Itoi E. Adjacent segment degeneration after fusion spinal surgery—a systematic review. INTERNATIONAL ORTHOPAEDICS 2018; 43:987-993. [DOI: 10.1007/s00264-018-4241-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
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