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Guo Z, Wang P, Ye S, Li H, Bao J, Shi R, Yang S, Yin R, Wu X. Interpretable Machine Learning Models Based on Shapley Additive Explanations for Predicting the Risk of Cerebrospinal Fluid Leakage in Lumbar Fusion Surgery. Spine (Phila Pa 1976) 2024; 49:1281-1293. [PMID: 38963261 DOI: 10.1097/brs.0000000000005087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES The objective of this investigation was to formulate and internally verify a customized machine learning (ML) framework for forecasting cerebrospinal fluid leakage (CSFL) in lumbar fusion surgery. This was accomplished by integrating imaging parameters and using the SHapley Additive exPlanation (SHAP) technique to elucidate the interpretability of the model. SUMMARY OF BACKGROUND DATA Given the increasing incidence and surgical volume of spinal degeneration worldwide, accurate predictions of postoperative complications are urgently needed. SHAP-based interpretable ML models have not been used for CSFL risk factor analysis in lumbar fusion surgery. METHODS Clinical and imaging data were retrospectively collected from 3505 patients who underwent lumbar fusion surgery. Six distinct machine learning models were formulated: extreme gradient boosting (XGBoost), decision tree (DT), random forest (RF), support vector machine (SVM), Gaussian naive Bayes (GaussianNB), and K-nearest neighbors (KNN) models. Evaluation of model performance on the test dataset was performed using performance metrics, and the analysis was executed through the SHAP framework. RESULTS CSFL was detected in 95 (2.71%) of 3505 patients. Notably, the XGBoost model exhibited outstanding accuracy in forecasting CSFLs, with high precision (0.9815), recall (0.6667), accuracy (0.8182), F1 score (0.7347), and AUC (0.7343). In addition, through SHAP analysis, significant predictors of CSFL were identified, including ligamentum flavum thickness, zygapophysial joint degeneration grade, central spinal stenosis grade, decompression segment count, decompression mode, intervertebral height difference, Cobb angle, intervertebral height index difference, operation mode, lumbar segment lordosis angle difference, Meyerding grade of lumbar spondylolisthesis, and revision surgery. CONCLUSIONS The combination of the XGBoost model with the SHAP is an effective tool for predicting the risk of CSFL during lumbar fusion surgery. Its implementation could aid clinicians in making informed decisions, potentially enhancing patient outcomes and lowering healthcare expenses. This study advocates for the adoption of this approach in clinical settings to enhance the evaluation of CSFL risk among patients undergoing lumbar fusion.
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Affiliation(s)
- ZongJie Guo
- Spine Surgery Center, Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - PeiYang Wang
- Spine Surgery Center, Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - SuHui Ye
- Department of Orthopedics, Yancheng Third People's Hospital, Yancheng, Jiangsu, People's Republic of China
| | - HaoYu Li
- Spine Surgery Center, Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - JunPing Bao
- Spine Surgery Center, Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Rui Shi
- Spine Surgery Center, Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Shu Yang
- Spine Surgery Center, Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Rui Yin
- Department of immunology, Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, Jiangsu, People's Republic of China
| | - XiaoTao Wu
- Spine Surgery Center, Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, People's Republic of China
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Otani Y, Schol J, Sakai D, Nakamura Y, Sako K, Warita T, Tamagawa S, Ambrosio L, Munesada D, Ogasawara S, Matsushita E, Kawachi A, Naiki M, Sato M, Watanabe M. Assessment of Tie2-Rejuvenated Nucleus Pulposus Cell Transplants from Young and Old Patient Sources Demonstrates That Age Still Matters. Int J Mol Sci 2024; 25:8335. [PMID: 39125917 PMCID: PMC11312270 DOI: 10.3390/ijms25158335] [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: 05/13/2024] [Revised: 07/23/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Cell transplantation is being actively explored as a regenerative therapy for discogenic back pain. This study explored the regenerative potential of Tie2+ nucleus pulposus progenitor cells (NPPCs) from intervertebral disc (IVD) tissues derived from young (<25 years of age) and old (>60 years of age) patient donors. We employed an optimized culture method to maintain Tie2 expression in NP cells from both donor categories. Our study revealed similar Tie2 positivity rates regardless of donor types following cell culture. Nevertheless, clear differences were also found, such as the emergence of significantly higher (3.6-fold) GD2 positivity and reduced (2.7-fold) proliferation potential for older donors compared to young sources. Our results suggest that, despite obtaining a high fraction of Tie2+ NP cells, cells from older donors were already committed to a more mature phenotype. These disparities translated into functional differences, influencing colony formation, extracellular matrix production, and in vivo regenerative potential. This study underscores the importance of considering age-related factors in NPPC-based therapies for disc degeneration. Further investigation into the genetic and epigenetic alterations of Tie2+ NP cells from older donors is crucial for refining regenerative strategies. These findings shed light on Tie2+ NPPCs as a promising cell source for IVD regeneration while emphasizing the need for comprehensive understanding and scalability considerations in culture methods for broader clinical applicability.
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Affiliation(s)
- Yuto Otani
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
| | - Jordy Schol
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Daisuke Sakai
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Yoshihiko Nakamura
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
| | - Kosuke Sako
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
| | - Takayuki Warita
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
- TUNZ Pharma Corporation, Osaka 541-0046, Japan;
| | - Shota Tamagawa
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Luca Ambrosio
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 01128 Rome, Italy
| | - Daiki Munesada
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
| | - Shota Ogasawara
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
| | - Erika Matsushita
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Asami Kawachi
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
- TUNZ Pharma Corporation, Osaka 541-0046, Japan;
| | | | - Masato Sato
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Masahiko Watanabe
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.O.); (J.S.); (Y.N.); (K.S.); (T.W.); (S.T.); (L.A.); (D.M.); (S.O.); (A.K.); (M.S.); (M.W.)
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara 259-1193, Japan
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Worthoff WA, Shah NJ, Choi CH. Editorial for "Sodium MRI of the Lumbar Intervertebral Disks of the Human Spine: An Ex Vivo Study". J Magn Reson Imaging 2024. [PMID: 38970389 DOI: 10.1002/jmri.29530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 07/08/2024] Open
Affiliation(s)
- Wieland A Worthoff
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Juelich, Juelich, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Juelich, Juelich, Germany
- Institute of Neuroscience and Medicine - 11, Forschungszentrum Juelich, Juelich, Germany
- JARA - BRAIN - Translational Medicine, Aachen, Germany
- Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - Chang-Hoon Choi
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Juelich, Juelich, Germany
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Nie MD, Li N, Huang ZB, Cheng RS, Zhang Q, Fu LJ, Cheng CK. Innovative hydrogel-patch combination for large annulus fibrosus defects: a prospective approach to address herniation recurrence. Spine J 2024:S1529-9430(24)00300-0. [PMID: 38914373 DOI: 10.1016/j.spinee.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND CONTEXT Large annulus fibrosus (AF) defects often lead to a high rate of reherniation, particularly in the medial AF region, which has limited self-healing capabilities. The increasing prevalence of herniated discs underscores the need for effective repair strategies. PURPOSE The objectives of this study were to design an AF repair technique to reduce solve the current problems of insufficient mechanical properties and poor sealing capacity. STUDY DESIGN In vitro biomechanical experiments and finite element analysis. METHODS The materials used in this study were patches and hydrogels with good biocompatibility and sufficient mechanical properties to withstand loading in the lumbar spine. Five repair techniques were assessed in this study: hydrogel filler (HF), AF patch medial barrier (MB), AF patch medial barrier and hydrogel filler (MB&HF), AF patch medial-lateral barrier (MLB), and AF patch medial-lateral barrier and hydrogel filler (MLB&HF). The repair techniques were subjected to in vitro testing (400 N axial compression and 0-500 N fatigue loading at 5Hz) and finite element analysis (400 N axial compression) to evaluate the effectiveness at repairing large AF defects. The evaluation included repair tightness, spinal stability, and fatigue resistance. RESULTS From the in vitro testing, the failure load of the repair techniques was in the following order HF MLB >MB&HF >MLB&HF. CONCLUSIONS The combined use of patches and hydrogels exhibited promising mechanical properties postdiscectomy, providing a promising solution for addressing large AF defects and improving disc stability. CLINICAL SIGNIFICANCE This study introduces a promising method for repairing large annular fissure (AF) defects after disc herniation, combining patch repair with a hydrogel filler. These techniques hold potential for developing clinical AF repair products to address this challenging issue.
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Affiliation(s)
- Mao-Dan Nie
- School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Huashan Road, Xuhui District, Shanghai, 200030, China
| | - Na Li
- Department of Absorbable Materials Research and Development, Beijing Naton Medical Institute, No.9 Chengwan Street, Haidian District, Beijing, 100143, China
| | - Ze-Bin Huang
- Department of Spine Surgery, First Affiliated Hospital of Second Military Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Rong-Shan Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Huashan Road, Xuhui District, Shanghai, 200030, China
| | - Qiang Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Huashan Road, Xuhui District, Shanghai, 200030, China
| | - Ling-Jie Fu
- Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Huashan Road, Xuhui District, Shanghai, 200030, China.
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Eremina GM, Smolin AY. Effect of patient-specific factors on regeneration in lumbar spine at healthy disc and total disc replacement. Computer simulation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108172. [PMID: 38669718 DOI: 10.1016/j.cmpb.2024.108172] [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: 01/22/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Degenerative diseases of the spine have a negative impact on the quality of life of patients. This study presents the results of numerical modelling of the mechanical behaviour of the lumbar spine with patient-specific conditions at physiological loads. This paper aims to numerically study the influence of degenerative changes in the spine and the presence of an endoprosthesis on the creation of conditions for tissue regeneration. METHODS A numerical model of the mechanical behaviour of lumbar spine at healthy and after total disc replacement under low-energy impacts equivalent to physiological loads is presented. The model is based on the movable cellular automaton method (discrete elements), where the mechanical behaviour of bone tissue is described using the Biot poroelasticity accounting for the presence and transfer of interstitial biological fluid. The nutritional pathways of the intervertebral disc in cases of healthy and osteoporotic bone tissues were predicted based on the analysis of the simulation results according to the mechanobiological principles. RESULTS Simulation of total disc replacement showed that osseointegration of the artificial disc plates occurs only in healthy bone tissue. With total disc replacement in a patient with osteoporosis, there is an area of increased risk of bone resorption in the near-contact area, approximately 1 mm wide, around the fixators. Dynamic loads may improve the osseointegration of the implant in pathological conditions of the bone tissue. CONCLUSIONS The results obtained in the case of healthy spine and osteoporotic bone tissues correspond to the experimental data on biomechanics and possible methods of IVD regeneration from the position of mechanobiological principles. The results obtained with an artificial disc (with keel-type fixation) showed that the use of this type of endoprosthesis in healthy bone tissues allows to reproduce the function of the natural intervertebral disc and does not contribute to the development of neoplastic processes. In the case of an artificial disc with osteoporosis of bone tissues, there is a zone with increased risk of tissue resorption and development of neoplastic processes in the area near the contact of the implant attachment. This circumstance can be compensated by increasing the loading level.
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Affiliation(s)
- Galina M Eremina
- Institute of Strength Physics and Materials Science of SB RAS, 2/4, pr. Akademicheskii, Tomsk, 634055, Russia.
| | - Alexey Yu Smolin
- Institute of Strength Physics and Materials Science of SB RAS, 2/4, pr. Akademicheskii, Tomsk, 634055, Russia
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Nikkhoo M, Wang JL, Cheng CH, Parnianpour M, Khalaf K. Enzymatic denaturation versus excessive fatigue loading degeneration: Effects on the time-dependent response of the intervertebral disc. J Biomech 2024; 171:112159. [PMID: 38852480 DOI: 10.1016/j.jbiomech.2024.112159] [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: 08/30/2023] [Revised: 03/23/2024] [Accepted: 05/16/2024] [Indexed: 06/11/2024]
Abstract
Degenerative disc disease (DDD), regardless of its phenotype and clinical grade, is widely associated with low back pain (LBP), which remains the single leading cause of disability worldwide. This work provides a quantitative methodology for comparatively investigating artificial IVD degeneration via two popular approaches: enzymatic denaturation and fatigue loading. An in-vitro animal study was used to study the time-dependent responses of forty fresh juvenile porcine thoracic IVDs in conjunction with inverse and forward finite element (FE) simulations. The IVDs were dissected from 6-month-old-juvenile pigs and equally assigned to 5 groups (intact, denatured, low-level, medium-level, high-level fatigue loading). Upon preloading, a sinusoid cyclic load (Peak-to-peak/0.1-to-0.8 MPa) was applied (0.01-10 Hz), and dynamic-mechanical-analyses (DMA) was performed. The DMA outcomes were integrated with a robust meta-model analysis to quantify the poroelastic IVD characteristics, while specimen-specific FE models were developed to study the detailed responses. The results demonstrated that enzymatic denaturation had a more significantly pronounced effect on the resistive strength and shock attenuation capabilities of the intervertebral discs. This can be attributed to the simultaneous disruption of the collagen fibers and water-proteoglycan bonds induced by trypsin digestion. Fatigue loading, on the other hand, primarily influenced the disc's resistance to deformation in a frequency-dependent pattern, where alterations were most noticeable at low loading frequencies. This study confirms the intricate interplay between the biochemical changes induced by enzymatic processes and the mechanical behavior stemming from fatigue loading, suggesting the need for a comprehensive approach to closely mimic the interrelated multifaceted processes of human disc degeneration.
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Affiliation(s)
- Mohammad Nikkhoo
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Jaw-Lin Wang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; Center of Medical Devices, National Taiwan University, Taipei, Taiwan.
| | - Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Kinda Khalaf
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, and Health Engineering Innovation Center, Abu Dhabi, United Arab Emirates.
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Zehra U, Ilyas MS, Latif R, Imran S, Ahmad I, Aziz A. MRI phenotypes of herniated discs associated with adjacent disc degeneration. J Orthop Res 2024; 42:1104-1110. [PMID: 37975261 DOI: 10.1002/jor.25739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/17/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Adjacent segment degeneration is commonly observed in patients after fusion surgery. Among the associated risk factors is the preoperative presence of adjacent disc degeneration (ADD). The risk factors and other spine phenotypes associated with preoperative ADD is critical to understand the pathological process and better prognosis postsurgery. Current study aims to assess and compare the magnetic resonance imaging (MRI) spinal phenotype of herniated level with and without ADD. Preoperative T2W sagittal lumbar MRI images of 155 lumbar disc herniated patients were analyzed for the presence of ADD (Pfirrmann grade III and above). The herniated disc level was assessed for the presence and absence of vertebral endplate (VEP) defects, Modic changes, and high intensity zone (HIZ). Mean age of patients was 38 ± 2 years, almost 62% were males. ADD was found in 57%, VEP defects were seen in 62% of the herniated level, 24.5% showed Modic changes, 3.8% showed spondylolishthesis, and 15.5% revealed HIZ. Age and other demographic factors did not have any significant effect on the presence of ADD, the patients with extruded and sequestered discs had more ADD (p = 0.02). VEP defects were significantly higher in levels with ADD (p = 0.02). Patients with ADD had significantly VEP defect scores (p = 0.01), Modic score (p = 0.002), HIZ score (0.02), and posterior bulge score (p < 0.001). Findings suggest that affected levels with VEP defects and severe grade of disc herniation have the greater likelihood of having ADD. Once developed this ADD may also affect the other spinal levels, and also can affect postoperative prognosis.
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Affiliation(s)
- Uruj Zehra
- Department of Anatomy, University of Health Sciences, Lahore, Pakistan
| | - Muhammad Saad Ilyas
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Rabia Latif
- Department of Anatomy, University of Health Sciences, Lahore, Pakistan
- Department of Anatomy, CMH Lahore Medical College and Institute of Dentistry (NUMS), Lahore, Pakistan
| | - Sumera Imran
- Department of Anatomy, University of Health Sciences, Lahore, Pakistan
| | - Ijaz Ahmad
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Amer Aziz
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
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Xue P, Wang Y, Lv L, Wang D, Wang Y. Roles of Chemokines in Intervertebral Disk Degeneration. Curr Pain Headache Rep 2024; 28:95-108. [PMID: 37976014 DOI: 10.1007/s11916-023-01188-1] [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] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW Intervertebral disc degeneration is the primary etiology of low back pain and radicular pain. This review examines the roles of crucial chemokines in different stages of degenerative disc disease, along with interventions targeting chemokine function to mitigate disc degeneration. RECENT FINDINGS The release of chemokines from degenerated discs facilitates the infiltration and activation of immune cells, thereby intensifying the inflammatory cascade response. The migration of immune cells into the venous lumen is concomitant with the emergence of microvascular tissue and nerve fibers. Furthermore, the presence of neurogenic factors secreted by disc cells and immune cells stimulates the activation of pain-related cation channels in the dorsal root ganglion, potentially exacerbating discogenic and neurogenic pain and intensifying the degenerative cascade response mediated by chemokines. Gaining a deeper comprehension of the functions of chemokines and immune cells in these processes involving catabolism, angiogenesis, and injury detection could offer novel therapeutic avenues for managing symptomatic disc disease.
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Affiliation(s)
- Pengfei Xue
- Medical School of Southeast University, Nanjing, Jiangsu, 210009, China
- Central Laboratory, Gaochun Hospital Affiliated to Jiangsu University, Nanjing, Jiangsu, 211300, China
| | - Yi Wang
- Department of Orthopaedics, Jiujiang Traditional Chinese Medicine Hospital, Jiujiang, Jiangxi, 332000, China
| | - Long Lv
- Central Laboratory, Gaochun Hospital Affiliated to Jiangsu University, Nanjing, Jiangsu, 211300, China
| | - Dongming Wang
- Central Laboratory, Gaochun Hospital Affiliated to Jiangsu University, Nanjing, Jiangsu, 211300, China.
| | - Yuntao Wang
- Medical School of Southeast University, Nanjing, Jiangsu, 210009, China.
- Department of Spine Center, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, 210009, China.
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Ma S, Liu K, Yang JY, Huang RJ, Yu D. Therapeutic effect and mechanism of Yougui Wan in rats with intervertebral disk degeneration. J Orthop Surg Res 2024; 19:89. [PMID: 38267956 PMCID: PMC10809622 DOI: 10.1186/s13018-024-04554-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE To explore the potential mechanism of Yougui Wan on deformed lumbar intervertebral disk structure in rats. METHODS Thirty male Sprague-Dawley rats were randomly divided into 3 groups, with 10 rats in each group. The animals in the blank control group were healthy rats without specific treatment, and those in the model group and traditional Chinese medicine (TCM) group were used to establish the intervertebral disk degeneration (IDD) model by puncturing the annulus. Four weeks after modeling, rats in the TCM group were administered Yougui Wan by gavage for 2 consecutive weeks. Serum interleukin-6 (IL-10), macrophage migration inhibitory factor (MIF) and tumor necrosis factor alpha (TNF-α) levels were measured by ELISA, and the protein expression levels of collagen II and Notch1 in intervertebral disk tissues were examined by Western blotting. Apoptosis was detected by the TUNEL method. RESULTS Compared with those in the blank group, IL-10, MIF and TNF-α levels in the model group and TCM group were increased (P < 0.05), the protein expression levels of collagen II were decreased, and the protein expression levels of Notch1 were increased. Compared with those in the model group, the levels of IL-10 in the TCM group were increased (P < 0.05), the levels of MIF and TNF-α were decreased (P < 0.05), the protein expression levels of collagen II were increased, and the protein expression levels of Notch1 were decreased. CONCLUSION Yougui Wan can inhibit the inflammatory response in IDD rats, reduce the degradation of extracellular matrix, reduce apoptosis in nucleus pulposus cells, and alleviate intervertebral disk degeneration. The mechanism may be related to the regulation of the Notch signaling pathway.
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Affiliation(s)
- She Ma
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Kan Liu
- Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Jing-Yan Yang
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Ren-Jun Huang
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Dong Yu
- Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China.
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10
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Peredo AP, Gullbrand SE, Friday CS, Orozco BS, Dehghani B, Jenk AC, Bonnevie ED, Hilliard RL, Zlotnick HM, Dodge GR, Lee D, Engiles JB, Hast MW, Schaer TP, Smith HE, Mauck RL. Tension-activated nanofiber patches delivering an anti-inflammatory drug improve repair in a goat intervertebral disc herniation model. Sci Transl Med 2023; 15:eadf1690. [PMID: 37967202 PMCID: PMC10812087 DOI: 10.1126/scitranslmed.adf1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
Conventional microdiscectomy treatment for intervertebral disc herniation alleviates pain but does not repair the annulus fibrosus, resulting in a high incidence of recurrent herniation and persistent dysfunction. The lack of repair and the acute inflammation that arise after injury can further compromise the disc and result in disc-wide degeneration in the long term. To address this clinical need, we developed tension-activated repair patches (TARPs) for annulus fibrosus repair and local delivery of the anti-inflammatory factor anakinra (a recombinant interleukin-1 receptor antagonist). TARPs transmit physiologic strain to mechanically activated microcapsules embedded within the patch, which release encapsulated bioactive molecules in direct response to spinal loading. Mechanically activated microcapsules carrying anakinra were loaded into TARPs, and the effects of TARP-mediated annular repair and anakinra delivery were evaluated in a goat model of annular injury in the cervical spine. TARPs integrated with native tissue and provided structural reinforcement at the injury site that prevented aberrant disc-wide remodeling resulting from detensioning of the annular fibrosus. The delivery of anakinra by TARP implantation increased matrix deposition and retention at the injury site and improved maintenance of disc extracellular matrix. Anakinra delivery additionally attenuated the inflammatory response associated with TARP implantation, decreasing osteolysis in adjacent vertebrae and preserving disc cellularity and matrix organization throughout the annulus fibrosus. These results demonstrate the therapeutic potential of TARPs for the treatment of intervertebral disc herniation.
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Affiliation(s)
- Ana P. Peredo
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Sarah E. Gullbrand
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Chet S. Friday
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
| | - Briana S. Orozco
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Bijan Dehghani
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Austin C. Jenk
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Edward D. Bonnevie
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Rachel L. Hilliard
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania; Philadelphia, PA 19348, USA
| | - Hannah M. Zlotnick
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - George R. Dodge
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Daeyeon Lee
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania; Philadelphia, 19104, USA
| | - Julie B. Engiles
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania; Philadelphia, PA 19348, USA
- Department of Pathobiology, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania; Philadelphia, PA 19348, USA
| | - Michael W. Hast
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Thomas P. Schaer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania; Philadelphia, PA 19348, USA
| | - Harvey E. Smith
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Robert L. Mauck
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
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11
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Sun R, Zhu J, Sun K, Gao L, Zheng B, Shi J. Strontium Ranelate Ameliorates Intervertebral Disc Degeneration via Regulating TGF-β1/NF-κB Axis. Int J Med Sci 2023; 20:1679-1697. [PMID: 37928874 PMCID: PMC10620869 DOI: 10.7150/ijms.86665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/15/2023] [Indexed: 11/07/2023] Open
Abstract
Intervertebral disc degeneration (IVDD) is a prevalent and debilitating condition characterized by chronic back pain and reduced quality of life. Strontium ranelate (SRR) is a compound traditionally used for treating osteoporosis via activating TGF-β1 signaling pathway. Recent studies have proved the anti-inflammatory effect of SRR on chondrocytes. Although the exact mechanism of IVDD remains unclear, accumulating evidences have emphasized the involvement of multifactorial pathogenesis including inflammation, oxidative stress damage, and etc. However, the biological effect of SRR on IVDD and its molecular mechanism has not been investigated. Firstly, this study proved the decreased expression of Transforming Growth Factor-beta 1(TGF-β1) in degenerated human intervertebral disc tissues. Subsequently, we confirmed for the first time that SRR could promote cell proliferation, mitigate inflammation and oxidative stress in human nucleus pulposus cells in vitro via increasing the expression of TGF-β1 and suppressing the Nuclear Factor Kappa-Light-Chain-Enhancer of Activated B Cells (NF-κB) pathway. The molecular docking result proved the interaction between SRR and TGF-β1 protein. To further verify this interaction, gain- and loss- of function experiments were conducted. We discovered that both TGF-β1 knockdown and overexpression influenced the activation of the NF-κB pathway. Taken together, SRR could mitigate IL-1β induced-cell dysfunction in human nucleus pulposus cells by regulating TGF-β1/NF-κB axis in vitro. Finally, the in vivo therapeutic effect of SRR on IVDD was confirmed. Our findings may contribute to the understanding of the complex interplay between inflammation and degenerative processes in the intervertebral disc and provide valuable insights into the development of targeted treatment-based therapeutics for IVDD.
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Affiliation(s)
- Ruping Sun
- School of Health Science and Engineering, University of Shanghai for Science and Technology, No. 516 Jungong Road, Shanghai 200093, China
| | - Jian Zhu
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Kaiqiang Sun
- Department of Orthopaedic Surgery, Naval Medical Center, Naval Medical University, Shanghai 200433, China
| | - Lu Gao
- Department of Department of Physiology, Naval Medical University, Shanghai 200433, China
| | - Bing Zheng
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Jiangang Shi
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, No.415 Fengyang Road, Shanghai 200003, China
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12
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Zhang J, Ruan D, Xuan A, He Q, Zhang C, Xu C, Zhu C, Zhou Q. Comparative study of outcomes between allograft intervertebral disc transplantation and anterior cervical discectomy and fusion: a retrospective cohort study at least 5 years of follow-up. 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; 32:3561-3574. [PMID: 37330937 DOI: 10.1007/s00586-023-07799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/24/2023] [Accepted: 05/26/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE Adjacent segment degeneration (ASDeg) after anterior cervical discectomy and fusion (ACDF) seriously affects the long-term efficacy of the operation. Therefore, our team has done a lot of research on allograft intervertebral disc transplantation (AIDT) to prove its feasibility and safety. This study will compare the efficacy between AIDT and ACDF in the treatment of cervical spondylosis. METHODS All patients who received ACDF or AIDT in our hospital from 2000 to 2016 and followed up for at least 5 years were recruited and divided into ACDF and AIDT groups. The clinical outcomes including functional scores and radiological data of both groups were collected and compared preoperatively and postoperatively at 1 week, 3 months, 6 months, 12 months, 24 months, 60 months and last follow-up. Functional scores included Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), Visual Analog Scale of Neck (N-VAS) and Arms (A-VAS) pain, the Short Form Health Survey-36 (SF-36) and imaging dates including digital radiographs in the lateral, hyperextension and flexion positions to assess the stability, sagittal balance and mobility of the cervical spine and magnetic resonance imaging (MRI) scans to assess the degeneration of adjacent segment. RESULTS There were 68 patients with 25 in AIDT group and 43 in ACDF group. Satisfactory clinical results were obtained in both groups, but the long-term NDI score and N-VAS score in the AIDT group were better. The AIDT obtained the same stability and sagittal balance of the cervical spine as fusion surgery. The range of motion of adjacent segments can be restored to the preoperative level after transplantation, but this increases significantly after ACDF. There were significant differences in the superior adjacent segment range of motion (SROM) between two groups at 12 months (P = 0.039), 24 months (P = 0.035), 60 months (P = 0.039) and the last follow-up (P = 0.011). The inferior adjacent segment range of motion (IROM) and SROM had a similar trend in the two groups. The ratio value of the greyscale (RVG) of adjacent segments showed a downward trend. At the last follow-up, the RVG decreased more significantly in the ACDF group. At the last follow-up, there was a significant difference in the incidence of ASDeg between the two groups (P = 0.000). And the incidence of adjacent segment disease (ASDis) is 22.86% in the ACDF group. CONCLUSION The allograft intervertebral disc transplantation may be as an alternative technique to traditional anterior cervical discectomy and fusion for the management of cervical degenerative diseases. For the more, the results showed it would improve cervical kinematics and reduce the incidence of adjacent segment degeneration.
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Affiliation(s)
- Junyou Zhang
- The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, People's Republic of China
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Dike Ruan
- The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, People's Republic of China.
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China.
| | - Anwu Xuan
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Qing He
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Chao Zhang
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Cheng Xu
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Chao Zhu
- The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, People's Republic of China
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Qing Zhou
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, 230032, Anhui Province, China
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13
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Jiang Y, Wang J, Wu R, Qi L, Huang L, Wang J, Du M, Liu Z, Li Y, Liu L, Feng G, Zhang L. Bioinspired Construction of Annulus Fibrosus Implants with a Negative Poisson's Ratio for Intervertebral Disc Repair and Restraining Disc Herniation. Bioconjug Chem 2023. [PMID: 36961940 DOI: 10.1021/acs.bioconjchem.3c00105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Inspired by the negative Poisson's ratio (NPR) effects of the annulus fibrosus (AF) in intervertebral discs (IVDs), we designed a re-entrant honeycomb model and then 3D printed it into a poly(ε-caprolactone) (PCL) scaffold with NPR effects, which was followed by in situ polymerization of polypyrrole (PPy), thus constructing a PPy-coated NPR-structured PCL scaffold (-vPCL-PPy) to be used as the AF implant for the treatment of lumbar herniated discs. Mechanical testing and finite element (FE) simulation indicated that the NPR composite implant could sustain axial spine loading and resist nucleus pulposus (NP) swelling while displaying uniform stress diffusion under NP swelling and contraction. More interestingly, the NPR-structured composite scaffold could also apply a reacting force to restrain NP herniation owing to the NPR effect. In addition, the in vitro biological assessment and in vivo implantation demonstrated that the NPR composite scaffold exhibited good biocompatibility and exerted the ability to restore the physiological function of the disc segments.
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Affiliation(s)
- Yulin Jiang
- Analytical and Testing Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Juehan Wang
- Analytical and Testing Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Ruibang Wu
- Analytical and Testing Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Lin Qi
- Analytical and Testing Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Leizheng Huang
- Analytical and Testing Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Jing Wang
- Analytical and Testing Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Meixuan Du
- Analytical and Testing Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Zheng Liu
- Analytical and Testing Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Yubao Li
- Analytical and Testing Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Limin Liu
- Analytical and Testing Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Ganjun Feng
- Analytical and Testing Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Li Zhang
- Analytical and Testing Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610065, China
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14
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Fine N, Lively S, Séguin CA, Perruccio AV, Kapoor M, Rampersaud R. Intervertebral disc degeneration and osteoarthritis: a common molecular disease spectrum. Nat Rev Rheumatol 2023; 19:136-152. [PMID: 36702892 DOI: 10.1038/s41584-022-00888-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/27/2023]
Abstract
Intervertebral disc degeneration (IDD) and osteoarthritis (OA) affecting the facet joint of the spine are biomechanically interdependent, typically occur in tandem, and have considerable epidemiological and pathophysiological overlap. Historically, the distinctions between these degenerative diseases have been emphasized. Therefore, research in the two fields often occurs independently without adequate consideration of the co-dependence of the two sites, which reside within the same functional spinal unit. Emerging evidence from animal models of spine degeneration highlight the interdependence of IDD and facet joint OA, warranting a review of the parallels between these two degenerative phenomena for the benefit of both clinicians and research scientists. This Review discusses the pathophysiological aspects of IDD and OA, with an emphasis on tissue, cellular and molecular pathways of degeneration. Although the intervertebral disc and synovial facet joint are biologically distinct structures that are amenable to reductive scientific consideration, substantial overlap exists between the molecular pathways and processes of degeneration (including cartilage destruction, extracellular matrix degeneration and osteophyte formation) that occur at these sites. Thus, researchers, clinicians, advocates and policy-makers should consider viewing the burden and management of spinal degeneration holistically as part of the OA disease continuum.
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Affiliation(s)
- Noah Fine
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Starlee Lively
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Cheryle Ann Séguin
- Department of Physiology & Pharmacology, Schulich School of Medicine & Dentistry, Bone and Joint Institute, University of Western Ontario London, London, Ontario, Canada
| | - Anthony V Perruccio
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohit Kapoor
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Raja Rampersaud
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada. .,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. .,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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15
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Degenerative Disc Disease of the Spine: From Anatomy to Pathophysiology and Radiological Appearance, with Morphological and Functional Considerations. J Pers Med 2022; 12:jpm12111810. [PMID: 36579533 PMCID: PMC9698646 DOI: 10.3390/jpm12111810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
Degenerative disc disease is a common manifestation in routine imaging of the spine; this finding is partly attributable to physiological aging and partly to a pathological condition, and sometimes this distinction is simply not clear. In this review, we start focusing on disc anatomy and pathophysiology and try to correlate them with radiological aspects. Furthermore, there is a special focus on degenerative disc disease terminology, and, finally, some considerations regarding disc morphology and its specific function, as well as the way in which these aspects change in degenerative disease. Radiologists, clinicians and spine surgeons should be familiar with these aspects since they have an impact on everyday clinical practice.
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16
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Sun K, Jiang J, Wang Y, Sun X, Zhu J, Xu X, Sun J, Shi J. The role of nerve fibers and their neurotransmitters in regulating intervertebral disc degeneration. Ageing Res Rev 2022; 81:101733. [PMID: 36113765 DOI: 10.1016/j.arr.2022.101733] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/11/2022] [Accepted: 09/11/2022] [Indexed: 01/31/2023]
Abstract
Intervertebral disc degeneration (IVDD) has been the major contributor to chronic lower back pain (LBP). Abnormal apoptosis, senescence, and pyroptosis of IVD cells, extracellular matrix (ECM) degradation, and infiltration of immune cells are the major molecular alternations during IVDD. Changes at tissue level frequently occur at advanced IVD tissue. Ectopic ingrowth of nerves within inner annulus fibrosus (AF) and nucleus pulposus (NP) tissue has been considered as the primary cause for LBP. Innervation at IVD tissue mainly included sensory and sympathetic nerves, and many markers for these two types of nerves have been detected since 1940. In fact, in osteoarthritis (OA), beyond pain transmission, the direct regulation of neuropeptides on functions of chondrocytes have attracted researchers' great attention recently. Many physical and pathological similarities between joint and IVD have shed us the light on the neurogenic mechanism involved in IVDD. Here, an overview of the advances in the nervous system within IVD tissue will be performed, with a discussion on in the role of nerve fibers and their neurotransmitters in regulating IVDD. We hope this review can attract more research interest to address neuromodulation and IVDD itself, which will enhance our understanding of the contribution of neuromodulation to the structural changes within IVD tissue and inflammatory responses and will help identify novel therapeutic targets and enable the effective treatment of IVDD disease.
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Affiliation(s)
- Kaiqiang Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China; Department of Orthopedics, Naval Medical Center of PLA, China
| | - Jialin Jiang
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Yuan Wang
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Xiaofei Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Jian Zhu
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Ximing Xu
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China.
| | - Jiangang Shi
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China.
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17
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Che YJ, Guo JB, Hao YF, Luo ZP. Regenerating and repairing degenerative intervertebral discs by regulating the micro/nano environment of degenerative bony endplates based on low-tension mechanics. BMC Musculoskelet Disord 2022; 23:462. [PMID: 35578221 PMCID: PMC9112526 DOI: 10.1186/s12891-022-05422-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Conservative treatment is the recommended first-line treatment for degenerative disc diseases. Traction therapy has historically been one of the most common clinical methods to address this, but the clinical effect remains controversial. Methods Forty-two six-month-old male Sprague-Dawley rats were randomly divided into six groups: the model group (Group A, four coccyx vertebrae (Co7-Co10) were fixed with customized external fixators, and the vertebral disc degeneration model was constructed by axial compression of the target segment Co8 - Co9 for 4 weeks), the experimental control group (Group B, after successful modeling, the external fixation device was removed and self-rehabilitation was performed) and four intervention groups (Groups C to F): Groups C and E: Co8 - Co9 vertebrae compressed for 4 weeks followed by two or 4 weeks of high tension traction (HTT), respectively, and Groups D and F: vertebrae compressed for 4 weeks followed by two or 4 weeks of low-tension traction (LTT), respectively. Imaging tests (X-ray and MRI) were performed to assess disc height and T2 signal intensity at each time point. After the experiment, the animals were euthanized, and the caudal vertebrae were collected for analysis of intervertebral disc histopathology, proteoglycan content, and micronanostructure of the annulus fibrosus, nucleus pulposus and bony endplate. Results Signs of tissue regeneration were apparent in all four intervention groups. After two to 4 weeks of intervention (HTT and LTT), the morphology of pores in the bony endplate, their number, and diameter had recovered significantly compared with those in Group A. The LTT group was superior to the HTT group, and the 4w in situ group was significantly superior to the 2w group. Meanwhile, the histological scores of discs, the mean fibril diameter and modulus of annulus fibrosus were significantly improved compared with the control groups, and the LTT group was superior to HTT group. Conclusions Low-tension traction better promotes active reconstruction of bony endplates and improves the elastic modulus and micro/nanostructure of the disc. Thus, it further promotes the regeneration and repair of intervertebral discs.
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Affiliation(s)
- Yan-Jun Che
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215008, Jiangsu Province, China.
| | - Jiang-Bo Guo
- Department of Orthopaedics, Orthopaedic Institute, The First Affiliated Hospital of SooChow University, 708 Renmin Rd, SuZhou, Jiangsu, 215007, People's Republic of China
| | - Yue Feng Hao
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215008, Jiangsu Province, China
| | - Zong-Ping Luo
- Department of Orthopaedics, Orthopaedic Institute, The First Affiliated Hospital of SooChow University, 708 Renmin Rd, SuZhou, Jiangsu, 215007, People's Republic of China
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胡 华, 李 连, 刘 艳, 王 书, 谢 双, 孙 建. [Effect of resveratrol on high mobility group box-1 protein signaling pathway in cartilage endplate degeneration caused by inflammation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:461-469. [PMID: 35426287 PMCID: PMC9011066 DOI: 10.7507/1002-1892.202110084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/23/2022] [Indexed: 01/24/2023]
Abstract
Objective To investigate the effect of resveratrol (RES) on inflammation-induced cartilage endplate (CEP) degeneration, and its regulatory mechanism on high mobility group box-1 protein (HMGB1) signaling pathway. Methods The intervertebral CEP cells of Sprague Dawley (SD) rats aged 3 weeks were extracted and identified by toluidine blue staining and immunofluorescence staining of rabbit anti-rat collagen type Ⅱ. The cell counting kit 8 (CCK-8) method was used to screen the optimal concentration of RES on intervertebral CEP cells. Gene chip analysis was used to determine the target of RES on intervertebral CEP cells. Interleukin 1β (IL-1β) was used to construct the intervertebral CEP cell degeneration model caused by inflammation and the 7-8-week-old SD rat intervertebral disc degeneration model, and pcDNA3.1-HMGB1 (pcDNA3.1) was used as the control of RES effect. Flow cytometry and TUNEL staining were used to detect the apoptotic rate of intervertebral CEP cells and rat intervertebral disc tissue cells, respectively. ELISA kit was used to detect the content of interleukin 10 (IL-10) and tumor necrosis factor α (TNF-α) in the cell supernatant and rat serum. Western blot was used to detect the expressions of HMGB1, extracellular signal-regulated protein kinase (ERK), phosphorylated ERK (p-ERK), B cell lymphoma/leukemia 2 gene (Bcl-2), and Bcl-2-associated X protein (Bax). Results The extracted cells were identified as rat intervertebral CEP cells. CCK-8 method screened out the highest activity of intervertebral CEP cells treated with 30 μmol/L RES. The gene chip analysis confirmed that the HMGB1-ERK signal was the target of RES. Both cell experiments and animal experiments showed that RES treatment can significantly down-regulate the apoptosis rate of intervertebral CEP cells, inhibit the release of TNF-α, and increase the content of IL-10; and down-regulate the expressions of HMGB1, p-ERK, and Bax, and increase Bcl-2; and pcDNA3.1 could partially reverse these effects of RES, and the differences were all significant (P<0.05). Conclusion RES can significantly inhibit the apoptosis of intervertebral CEP cells induced by inflammation, which is related to inhibiting the expression of HMGB1.
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Affiliation(s)
- 华 胡
- 承德医学院附属医院骨伤科(河北承德 067000)Department of Orthopedics, Affiliated Hospital of Chengde Medical College, Chengde Hebei, 067000, P. R. China
| | - 连泰 李
- 承德医学院附属医院骨伤科(河北承德 067000)Department of Orthopedics, Affiliated Hospital of Chengde Medical College, Chengde Hebei, 067000, P. R. China
| | - 艳伟 刘
- 承德医学院附属医院骨伤科(河北承德 067000)Department of Orthopedics, Affiliated Hospital of Chengde Medical College, Chengde Hebei, 067000, P. R. China
| | - 书君 王
- 承德医学院附属医院骨伤科(河北承德 067000)Department of Orthopedics, Affiliated Hospital of Chengde Medical College, Chengde Hebei, 067000, P. R. China
| | - 双喜 谢
- 承德医学院附属医院骨伤科(河北承德 067000)Department of Orthopedics, Affiliated Hospital of Chengde Medical College, Chengde Hebei, 067000, P. R. China
| | - 建君 孙
- 承德医学院附属医院骨伤科(河北承德 067000)Department of Orthopedics, Affiliated Hospital of Chengde Medical College, Chengde Hebei, 067000, P. R. China
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Cheng F, Yang H, Cheng Y, Liu Y, Hai Y, Zhang Y. The role of oxidative stress in intervertebral disc cellular senescence. Front Endocrinol (Lausanne) 2022; 13:1038171. [PMID: 36561567 PMCID: PMC9763277 DOI: 10.3389/fendo.2022.1038171] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
With the aggravation of social aging and the increase in work intensity, the prevalence of spinal degenerative diseases caused by intervertebral disc degeneration(IDD)has increased yearly, which has driven a heavy economic burden on patients and society. It is well known that IDD is associated with cell damage and degradation of the extracellular matrix. In recent years, it has been found that IDD is induced by various mechanisms (e.g., genetic, mechanical, and exposure). Increasing evidence shows that oxidative stress is a vital activation mechanism of IDD. Reactive oxygen species (ROS) and reactive nitrogen species (RNS) could regulate matrix metabolism, proinflammatory phenotype, apoptosis, autophagy, and aging of intervertebral disc cells. However, up to now, our understanding of a series of pathophysiological mechanisms of oxidative stress involved in the occurrence, development, and treatment of IDD is still limited. In this review, we discussed the oxidative stress through its mechanisms in accelerating IDD and some antioxidant treatment measures for IDD.
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Affiliation(s)
| | | | | | - Yuzeng Liu
- *Correspondence: Yuzeng Liu, ; Yong Hai, ; ; Yangpu Zhang,
| | - Yong Hai
- *Correspondence: Yuzeng Liu, ; Yong Hai, ; ; Yangpu Zhang,
| | - Yangpu Zhang
- *Correspondence: Yuzeng Liu, ; Yong Hai, ; ; Yangpu Zhang,
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