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Zhu F, Jia D, Zhang Y, Feng C, Peng Y, Ning Y, Leng X, Li J, Zhou Y, Li C, Huang B. Development and validation of a nomogram to predict the risk of residual low back pain after tubular microdiskectomy of lumbar disk herniation. 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; 33:2179-2189. [PMID: 38647605 DOI: 10.1007/s00586-024-08255-0] [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: 11/24/2023] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Tubular microdiskectomy (tMD) is one of the most commonly used for treating lumbar disk herniation. However, there still patients still complain of persistent postoperative residual low back pain (rLBP) postoperatively. This study attempts to develop a nomogram to predict the risk of rLBP after tMD. METHODS The patients were divided into non-rLBP (LBP VAS score < 2) and rLBP (LBP VAS score ≥ 2) group. The correlation between rLBP and these factors were analyzed by multivariate logistic analysis. Then, a nomogram prediction model of rLBP was developed based on the risk factors screened by multivariate analysis. The samples in the model are randomly divided into training and validation sets in a 7:3 ratio. The Receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the diskrimination, calibration and clinical value of the model, respectively. RESULTS A total of 14.3% (47/329) of patients have persistent rLBP. The multivariate analysis suggests that higher preoperative LBP visual analog scale (VAS) score, lower facet orientation (FO), grade 2-3 facet joint degeneration (FJD) and moderate-severe multifidus fat atrophy (MFA) are risk factors for postoperative rLBP. In the training and validation sets, the ROC curves, calibration curves, and DCAs suggested the good diskrimination, predictive accuracy between the predicted probability and actual probability, and clinical value of the model, respectively. CONCLUSION This nomogram including preoperative LBP VAS score, FO, FJD and MFA can serve a promising prediction model, which will provide a reference for clinicians to predict the rLBP after tMD.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Dongqing Jia
- Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Yan Peng
- Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Jianmin Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China.
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Lee DH, Park KS, Shin HE, Kim SB, Choi H, An SB, Choi H, Kim JP, Han I. Safety and Feasibility of Intradiscal Administration of Matrilin-3-Primed Adipose-Derived Mesenchymal Stromal Cell Spheroids for Chronic Discogenic Low Back Pain: Phase 1 Clinical Trial. Int J Mol Sci 2023; 24:16827. [PMID: 38069151 PMCID: PMC10706656 DOI: 10.3390/ijms242316827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
Functionally enhanced mesenchymal stromal cells participate in the repair of intervertebral disc. This study aimed to assess the safety and tolerability of intradiscal administration of matrilin-3-primed adipose-derived stromal cell (ASC) spheroids with hyaluronic acid (HA) in patients with chronic discogenic low back pain (LBP). In this single-arm, open-label phase I clinical trial, eight patients with chronic discogenic LBP were observed over 6 months. Each patient underwent a one-time intradiscal injection of 1 mL of 6.0 × 106 cells/disc combined with HA under real-time fluoroscopic guidance. Safety and feasibility were gauged using Visual Analogue Scale (VAS) pain and Oswestry Disability Index (ODI) scores and magnetic resonance imaging. All participants remained in the trial, with no reported adverse events linked to the procedure or stem cells. A successful outcome-marked by a minimum 2-point improvement in the VAS pain score and a 10-point improvement in ODI score from the start were observed in six participants. Although the modified Pfirrmann grade remained consistent across all participants, radiological improvements were evident in four patients. Specifically, two patients exhibited reduced high-intensity zones while another two demonstrated decreased disc protrusion. In conclusion, the intradiscal application of matrilin-3-primed ASC spheroids with HA is a safe and feasible treatment option for chronic discogenic LBP.
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Affiliation(s)
- Dong Hyun Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon 16480, Republic of Korea;
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Republic of Korea
| | - Kwang-Sook Park
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Republic of Korea
| | - Hae Eun Shin
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Republic of Korea
| | - Sung Bum Kim
- Department of Neurosurgery, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hyejeong Choi
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Republic of Korea
| | - Seong Bae An
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Republic of Korea
| | - Hyemin Choi
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Republic of Korea
| | - Joo Pyung Kim
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Republic of Korea
| | - Inbo Han
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Republic of Korea
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Kim Y, An SB, Lee SH, Lee JJ, Kim SB, Ahn JC, Hwang DY, Han I. Enhanced Intervertebral Disc Repair via Genetically Engineered Mesenchymal Stem Cells with Tetracycline Regulatory System. Int J Mol Sci 2023; 24:16024. [PMID: 38003216 PMCID: PMC10671788 DOI: 10.3390/ijms242216024] [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: 09/30/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
The therapeutic potential of Mesenchymal stem cells (MSCs) for the treatment of Intervertebral disc (IVD) degeneration can be enhanced by amplifying specific cytokines and proteins. This study aimed to investigate the therapeutic potential of tetracycline-off system-engineered tonsil-derived mesenchymal stem cells (ToMSC-Tetoff-TGFβ1-IGF1-BMP7) for treating intervertebral disc (IVD) degeneration. ToMSCs were isolated from a tonsillectomy patient and genetically modified with four distinct plasmids via CRISPR/Cas9-mediated knock-in gene editing. Transgene expression was confirmed through immunofluorescence, western blots, and an enzyme-linked immunosorbent assay for transforming growth factor beta 1 (TGFβ1) protein secretion, and the effect of MSC-TetOff-TGFβ1-IGF1-BMP7 on disc injury was assessed in a rat model. The ToMSC-Tetoff-TGFβ1-IGF1-BMP7 treatment exhibited superior therapeutic effects compared to ToMSC-TGFβ1, and ToMSC-SDF1α implantation groups, stimulating the regeneration of nucleus pulposus (NP) cells crucial for IVD. The treatment showed potential to restore the structural integrity of the extracellular matrix (ECM) by upregulating key molecules such as aggrecan and type II collagen. It also exhibited anti-inflammatory properties and reduced pain-inducing neuropeptides. ToMSC-Tetoff-TGFβ1-IGF1-BMP7 holds promise as a novel treatment for IVD degeneration. It appears to promote NP cell regeneration, restore ECM structure, suppress inflammation, and reduce pain. However, more research and clinical trials are required to confirm its therapeutic potential.
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Affiliation(s)
- Yeji Kim
- Research Competency Milestones Program of School of Medicine, CHA University School of Medicine, Seongnam-si 13496, Republic of Korea;
| | - Seong Bae An
- Department of Biomedical Science, Graduate School of CHA University, Seongnam-si 13496, Republic of Korea;
| | - Sang-Hyuk Lee
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-si 13496, Republic of Korea;
| | - Jong Joo Lee
- Department of Medicine, Graduate School, Kyung Hee University, Seoul 02453, Republic of Korea;
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul 03181, Republic of Korea
| | - Sung Bum Kim
- Department of Neurosurgery, Kyung Hee University, Seoul 02453, Republic of Korea;
| | - Jae-Cheul Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-si 13496, Republic of Korea
| | - Dong-Youn Hwang
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-si 13496, Republic of Korea;
- Department of Microbiology, School of Medicine, CHA University, Seongnam-si 13496, Republic of Korea
| | - Inbo Han
- Department of Biomedical Science, Graduate School of CHA University, Seongnam-si 13496, Republic of Korea;
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Zhu F, Chen Y, Jia D, Zhang Y, Peng Y, Ning Y, Leng X, Feng C, Zhou Y, Li C, Huang B. Risk Factors of Low Back Pain Aggravation After Tubular Microdiscectomy of Lumbar Disc Herniation. World Neurosurg 2023; 178:e673-e681. [PMID: 37543197 DOI: 10.1016/j.wneu.2023.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Although lumbar disc herniation (LDH) patients' sciatic symptoms such as leg pain can be improved by decompressive surgery, some patients report postoperative aggravated low back pain (LBP). However, the exact reason for this phenomenon remained unknown. METHODS We retrospectively analyzed the prospectively collected LDH data of patients who underwent tubular microdiscectomy between December 2015 and December 2020. The patients were divided into aggravated and non-aggravated group according to whether the postoperative LBP visual analogue scale (VAS) score was higher than the preoperative score. We analyzed the relationship of the clinical and radiologic parameters with aggravated LBP. RESULTS Postoperative aggravated LBP cases accounted for 14.1% (57 of 404) of this series. Of the 57 patients, 88% (50 of 57) had mild postoperative LBP aggravation (1-2), and 12% (7 of 57) had severe LBP aggravation (>2). The preoperative LBP VAS score of the aggravated group was significantly lower than that of the non-aggravated group (P < 0.001), while the LBP VAS score and Oswestry Disability Index at final follow-up was significantly higher in the aggravated group (P < 0.05). Additionally, the proportion of preoperative moderate-to-severe multifidus fatty atrophy (MFA) and lumbar facet joint degeneration (LFJD) was significantly higher in the aggravated group. A multiple stepwise logistic regression analysis indicated that the preoperative LBP VAS score (P < 0.001, odds ratio 0.266, 95% CI 0.161-0.439) and MFA (P < 0.001, odds ratio 4.491, 95% CI 2.092-9.640) were the risk factors for postoperative aggravated LBP. CONCLUSIONS A preoperative lower LBP VAS score and moderate-to-severe MFA were associated with postoperative aggravated LBP. This will provide important guidance for patient's preoperative assessment and education.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yu Chen
- Department of Urology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dongqing Jia
- Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yan Peng
- Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China.
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Kim CH, Choi Y, Chung CK, Yang SH, Lee CH, Park SB, Kim K, Chung SG. Cost-utility analysis of endoscopic lumbar discectomy following a uniform clinical pathway in the Korean national health insurance system. PLoS One 2023; 18:e0287092. [PMID: 37319283 PMCID: PMC10270587 DOI: 10.1371/journal.pone.0287092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 05/25/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Full-endoscopic lumbar discectomy (FELD) is a type of minimally invasive spinal surgery for lumbar disc herniation (LDH). Sufficient evidence exists to recommend FELD as an alternative to standard open microdiscectomy, and some patients prefer FELD due to its minimally invasive nature. However, in the Republic of Korea, the National Health Insurance System (NHIS) controls the reimbursement and use of supplies for FELD, but FELD is not currently reimbursed by the NHIS. Nonetheless, FELD has been performed upon patients' request, but providing FELD for patients' sake is inherently an unstable arrangement in the absence of a practical reimbursement system. The purpose of this study was to conduct a cost-utility analysis of FELD to suggest appropriate reimbursements. METHOD This study was a subgroup analysis of prospectively collected data including 28 patients who underwent FELD. All patients were NHIS beneficiaries and followed a uniform clinical pathway. Quality-adjusted life years (QALYs) were assessed with a utility score using the EuroQol 5-Dimension (EQ-5D) instrument. The costs included direct medical costs incurred at the hospital for 2 years and the price of the electrode ($700), although it was not reimbursed. The costs and QALYs gained were used to calculate the cost per QALY gained. RESULT Patients' mean age was 43 years and one-third (32%) were women. L4-5 was the most common surgical level (20/28, 71%) and extrusion was the most common type of LDH (14, 50%). Half of the patients (15, 54%) had jobs with an intermediate level of activity. The preoperative EQ-5D utility score was 0.48±0.19. Pain, disability, and the utility score significantly improved starting 1 month postoperatively. The average EQ-5D utility score during 2 years after FELD was estimated as 0.81 (95% CI: 0.78-0.85). For 2 years, the mean direct costs were $3,459 and the cost per QALY gained was $5,241. CONCLUSION The cost-utility analysis showed a quite reasonable cost per QALY gained for FELD. A comprehensive range of surgical options should be provided to patients, for which a practical reimbursement system is a prerequisite.
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Affiliation(s)
- Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, South Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Borame Medical Center, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sun Gun Chung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
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Adindu EK, Singh D, Geck M, Stokes J, Truumees E. Minimal Clinically Important Difference and Patient-Acceptable Symptom State in Orthopaedic Spine Surgery: A Review. JBJS Rev 2023; 11:01874474-202304000-00005. [PMID: 37071742 DOI: 10.2106/jbjs.rvw.22.00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
» Minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) are both metrics at interpreting patient-reported outcome measures (PROMs). » MCID values tend to vary significantly depending on the baseline pain and function in both acute and chronic symptom states while PASS thresholds are more stable. » MCID values are more easily attainable than PASS thresholds. » Although PASS is more relevant to the patient, it should continue to be used in tandem with MCID when interpreting PROM data.
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Affiliation(s)
| | | | - Matthew Geck
- Department of Orthopaedic Surgery, Ascension Texas Spine and Scoliosis, The University of Texas Dell Medical School, Austin, Texas
| | - John Stokes
- Ascension Texas Spine and Scoliosis, Austin, Texas
| | - Eeric Truumees
- Department of Orthopaedic and Neurological Surgery, Ascension Texas Spine and Scoliosis, The University of Texas Dell Medical School, Austin, Texas
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Jitpakdee K, Liu Y, Kim YJ, Kotheeranurak V, Kim JS. Factors associated with incomplete clinical improvement in patients undergoing transforaminal endoscopic lumbar discectomy for lumbar disc herniation. 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 2023:10.1007/s00586-023-07636-1. [PMID: 36917301 DOI: 10.1007/s00586-023-07636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 11/22/2022] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
PURPOSES To analyze the clinical and radiographic risk factors that might predict incomplete clinical improvement after transforaminal endoscopic lumbar discectomy (TELD). METHODS A retrospective analysis was conducted from 194 consecutive patients who underwent TELD due to lumbar disc herniation (LDH). Patients with incomplete clinical improvement were defined from patient-reported outcomes of poor improvement in pain or disability after surgery and patient dissatisfaction. Clinical and radiographic characteristics were evaluated to identify predicting factors of poor outcomes. RESULTS Of 194 patients who underwent TELD procedures, 32 patients (16.5%) had incomplete clinical improvement and 12 patients (6.1%) required revision surgery. The mean ages were 46.4 years and most of the patients suffered from predominant leg pain (48.9%). The most common surgical level was L4-5 (63.9%). Overall, the Oswestry Disability Index (44.3-15), visual analog scores of back pain (4.9-1.8) and leg pain (7.3-1.6) were significantly improved after surgery. Multivariate logistic regression analysis demonstrated that high body mass index, history of previous surgery, preoperative disability, weakness, and disc degeneration were related to incomplete clinical improvement. There were 15 recurrent LDH (7.7%) with a total of 12 revision surgeries (6.2%). CONCLUSIONS We identified independent risk factors associated with incomplete clinical improvement following TELD, including overweight, significant preoperative disability or weakness and history of previous surgery. Advanced age, disc degeneration, vacuum phenomenon, and spondylolisthesis were also possible risk factors. Recognizing these risk factors would help decide whether patients are good candidates for TELD, and optimize the surgical planning preoperatively to achieve good surgical results.
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Affiliation(s)
- Khanathip Jitpakdee
- Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, Chonburi, Thailand
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yanting Liu
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Jin Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Nie JW, Hartman TJ, Oyetayo OO, Zheng E, MacGregor KR, Massel DH, Sayari AJ, Singh K. Influence of Preoperative Disability on Clinical Outcomes in Patients Undergoing Anterior Lumbar Interbody Fusion. World Neurosurg 2023; 171:e412-e421. [PMID: 36509327 DOI: 10.1016/j.wneu.2022.12.024] [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: 10/28/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few studies have examined the influence of preoperative disability through the Oswestry Disability Index (ODI) on clinical outcomes in patients undergoing anterior lumbar interbody fusion (ALIF). METHODS Patients undergoing ALIF were separated into 2 groups based on ODI<41 (lower disability) versus ODI≥41% (higher disability). Patient-reported outcomes (PROs) were collected at preoperative and postoperative 6-week/12-week/6-month/1-year/2-year time points. Physical function PROs were Patient-Reported Outcomes Measurement Information System Physical Function and 12-item Short Form Physical Component Score. Mental function PROs were 12-item Short Form Mental Component Score and Patient Health Questionnaire-9. Pain PROs were visual analog scale back and visual analog scale leg. ODI was the disability PRO. RESULTS A total of 148 patients were identified, with 52 patients with lower disability. Higher disability patients demonstrated significant improvement in mental function (P ≤ 0.010, all). Lower disability patients demonstrated superior postoperative PROs in physical function, mental function, back pain, and disability outcomes (P ≤ 0.034, all). Minimum clinically important difference achievement rates for lower disability patients were higher for back pain and lower for mental function and disability outcomes (P ≤ 0.041, all). CONCLUSIONS Independent of preoperative disability, patients undergoing ALIF reported significant postoperative improvement in physical function, pain, and disability outcomes. Patients with lower preoperative disability continued to report superior PROs in mental function, back pain, and disability postoperatively. Minimum clinically important difference achievement rates for lower disability patients were higher for back pain and lower in mental function and disability outcomes. Patients undergoing ALIF with higher preoperative disability may experience greater clinically meaningful improvement in mental function and disability.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Bhujel B, Yang SS, Kim HR, Kim SB, Min BH, Choi BH, Han I. An Injectable Engineered Cartilage Gel Improves Intervertebral Disc Repair in a Rat Nucleotomy Model. Int J Mol Sci 2023; 24:3146. [PMID: 36834559 PMCID: PMC9966384 DOI: 10.3390/ijms24043146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Lower back pain is a major problem caused by intervertebral disc degeneration. A common surgical procedure is lumbar partial discectomy (excision of the herniated disc causing nerve root compression), which results in further disc degeneration, severe lower back pain, and disability after discectomy. Thus, the development of disc regenerative therapies for patients who require lumbar partial discectomy is crucial. Here, we investigated the effectiveness of an engineered cartilage gel utilizing human fetal cartilage-derived progenitor cells (hFCPCs) on intervertebral disc repair in a rat tail nucleotomy model. Eight-week-old female Sprague-Dawley rats were randomized into three groups to undergo intradiscal injection of (1) cartilage gel, (2) hFCPCs, or (3) decellularized extracellular matrix (ECM) (n = 10/each group). The treatment materials were injected immediately after nucleotomy of the coccygeal discs. The coccygeal discs were removed six weeks after implantation for radiologic and histological analysis. Implantation of the cartilage gel promoted degenerative disc repair compared to hFCPCs or hFCPC-derived ECM by increasing the cellularity and matrix integrity, promoting reconstruction of nucleus pulposus, restoring disc hydration, and downregulating inflammatory cytokines and pain. Our results demonstrate that cartilage gel has higher therapeutic potential than its cellular or ECM component alone, and support further translation to large animal models and human subjects.
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Affiliation(s)
- Basanta Bhujel
- Department of Biomedical Science, College of Life Sciences, CHA University, Seongnam 13496, Republic of Korea
| | | | | | - Sung Bum Kim
- Department of Neurosurgery, Kyung Hee University, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Byoung-Hyun Min
- ATEMs Inc., Seoul 02447, Republic of Korea
- Wake Forest Institute of Regenerative Medicine, School of Medicine, Wake Forest University, Winston Salem, NC 27101, USA
| | - Byung Hyune Choi
- ATEMs Inc., Seoul 02447, Republic of Korea
- Department of Biomedical Sciences, Inha University College of Medicine, Incheon 22212, Republic of Korea
| | - Inbo Han
- Department of Neurosurgery, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam 13496, Republic of Korea
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