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Morino C, Kait J, Bass CR. Hydration State Throughout Porcine Lumbar Intervertebral Discs: Comparing Fresh and Frozen-Thawed Specimens. Ann Biomed Eng 2024:10.1007/s10439-024-03577-y. [PMID: 39012562 DOI: 10.1007/s10439-024-03577-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/29/2024] [Indexed: 07/17/2024]
Abstract
Water content in intervertebral discs (IVDs) is essential for physiological and mechanical function. Freezing post-mortem tissue prior to biomechanical testing is a common practice to prevent tissue degradation, but this process has been theorized to alter hydration within IVDs. The hydration state throughout porcine lumbar IVDs, a common lumbar surrogate, is unknown as are the effects of freezing on porcine IVD hydration. Nineteen porcine lumbar spines were stored in one of the three conditions: frozen (- 20 °C) wrapped in saline-soaked gauze, frozen (- 20 °C) without saline, or fresh. Water content was measured in four disc regions within each of 89 discs: nucleus pulposus (NP), inner (AF-A), intermediate (AF-B), and outer (AF-C) annulus fibrosus. A three-factor, repeated measure analysis of variance was conducted for storage condition, spinal level, and repeated measure disc region. No significant differences were observed in spinal level or storage condition as a main effect. Mean hydration was significantly different in each disc region with mass percentage of water found to be 88.8 ± 1.7% in NP, 79.6 ± 3.8% in AF-A, 71.9 ± 3.7% in AF-B, and 62.3 ± 3.3% in AF-C. No significant differences were shown in NP and AF-C regions between storage conditions. Two significant differences in storage condition were observed in AF-A and AF-B regions, but there is likely no biological difference in these populations. Water content throughout porcine lumbar IVD was determined and results suggest one freeze-thaw cycle at - 20 °C does not alter the overall hydration within the porcine lumbar IVD.
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Affiliation(s)
- Concetta Morino
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
- Engineering Systems Inc., Charlotte, NC, USA.
| | - Jason Kait
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Cameron R Bass
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
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Morino C, Middleton S, Op't Eynde J, Dimbath E, Kait J, Luck J, Bass C. Primary Creep Characterization in Porcine Lumbar Spine Subject to Repeated Loading. Ann Biomed Eng 2024:10.1007/s10439-024-03557-2. [PMID: 38951421 DOI: 10.1007/s10439-024-03557-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/29/2024] [Indexed: 07/03/2024]
Abstract
Low back pain (LBP) is a common medical condition worldwide, though the etiology of injuries causing most LBP is unknown. Flexion and repeated compression increase lumbar injury risk, yet the complex viscoelastic behavior of the lumbar spine has not been characterized under this loading scheme. Characterizing the non-injurious primary creep behavior in the lumbar spine is necessary for understanding the biomechanical response preceding injury. Fifteen porcine lumbar spinal units were loaded in repeated flexion-compression with peak compressive stresses ranging from 1.41 to 4.68 MPa. Applied loading simulated real loading exposures experienced by high-speed watercraft occupants. The strain response in the primary creep region was modeled for all tests using a generalized Kelvin-Voigt model. A quasilinear viscoelastic (QLV) approach was used to separate time-dependent (creep) and stress-dependent (elastic) responses. Optimizations between the models and experimental data determined creep time constants, creep coefficients, and elastic constants associated with this tissue under repeated flexion-compression loading. Average R2 for all fifteen models was 0.997. Creep time constants optimized across all fifteen models were 24 s and 580 s and contributed to 20 ± 3% and 30 ± 3% of the overall strain response, respectively. The non-transient behavior contributed to 50 ± 0% of the overall response. Elastic behavior for this porcine population had an average standard deviation of 24.5% strain across the applied stress range. The presented primary creep characterization provides the response precursor to injurious behavior in the lumbar spine. Results from this study can further inform lumbar injury prediction and kinematic models.
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Affiliation(s)
- Concetta Morino
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
- Engineering Systems Inc., Charlotte, North Carolina, USA.
| | - Shea Middleton
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Joost Op't Eynde
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Elizabeth Dimbath
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Jason Kait
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Jason Luck
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Cameron Bass
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
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Tolson JK, Menuet RL, Ly GH, Chanes BA, Bryan EA, Kataria S, Kim J, Ahmadzadeh S, Shekoohi S, Kaye AD. Evolving role of VIADISC for chronic low back and discogenic pain: a narrative review. Expert Opin Emerg Drugs 2024; 29:155-164. [PMID: 38602142 DOI: 10.1080/14728214.2024.2339912] [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: 10/16/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Chronic lower back pain is a leading cause of disability and healthcare spending worldwide. Discogenic pain, pain originating from the intervertebral disk, is a common etiology of chronic lower back pain. Currently, accepted treatments for chronic discogenic pain focus only on the management of symptoms, such as pain. There are no approved treatments that stop or reverse degenerating intervertebral discs. Biologic therapies promoting disc regeneration have been developed to expand treatment options. VIADISC™ NP, is a viable disc allograft supplementation that, in a recent trial, demonstrated a significant reduction in pain and increased function in patients suffering from symptomatic degenerative disc disease. AREAS COVERED This manuscript summarizes the epidemiology and etiology of low back pain, the pathophysiology of degenerative disc disease, current treatments, and a need for newer therapies. The rationale behind intradiscal biologics for the treatment of symptomatic degenerative disc disease is also discussed. EXPERT OPINION Characterization of the biology leading to disc degeneration has allowed for the development of intradiscal biologics. They may soon be capable of preventing and reversing disc degeneration. Clinical trials have shown promise, but further research into efficacy and safety is needed before these therapies are widely employed.
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Affiliation(s)
- Jack K Tolson
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Robert L Menuet
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Gianni H Ly
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Benjamin A Chanes
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Elizabeth A Bryan
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Saurabh Kataria
- Department of Neurology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Julian Kim
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
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Ma M, Zhang C, Zhong Z, Wang Y, He X, Zhu D, Qian Z, Yu B, Kang X. siRNA incorporated in slow-release injectable hydrogel continuously silences DDIT4 and regulates nucleus pulposus cell pyroptosis through the ROS/TXNIP/NLRP3 axis to alleviate intervertebral disc degeneration. Bone Joint Res 2024; 13:247-260. [PMID: 38771134 PMCID: PMC11107476 DOI: 10.1302/2046-3758.135.bjr-2023-0320.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Aims In this investigation, we administered oxidative stress to nucleus pulposus cells (NPCs), recognized DNA-damage-inducible transcript 4 (DDIT4) as a component in intervertebral disc degeneration (IVDD), and devised a hydrogel capable of conveying small interfering RNA (siRNA) to IVDD. Methods An in vitro model for oxidative stress-induced injury in NPCs was developed to elucidate the mechanisms underlying the upregulation of DDIT4 expression, activation of the reactive oxygen species (ROS)-thioredoxin-interacting protein (TXNIP)-NLRP3 signalling pathway, and nucleus pulposus pyroptosis. Furthermore, the mechanism of action of small interfering DDIT4 (siDDIT4) on NPCs in vitro was validated. A triplex hydrogel named siDDIT4@G5-P-HA was created by adsorbing siDDIT4 onto fifth-generation polyamidoamine (PAMAM) dendrimer using van der Waals interactions, and then coating it with hyaluronic acid (HA). In addition, we established a rat puncture IVDD model to decipher the hydrogel's mechanism in IVDD. Results A correlation between DDIT4 expression levels and disc degeneration was shown with human nucleus pulposus and needle-punctured rat disc specimens. We confirmed that DDIT4 was responsible for activating the ROS-TXNIP-NLRP3 axis during oxidative stress-induced pyroptosis in rat nucleus pulposus in vitro. Mitochondria were damaged during oxidative stress, and DDIT4 contributed to mitochondrial damage and ROS production. In addition, siDDIT4@G5-P-HA hydrogels showed good delivery activity of siDDIT4 to NPCs. In vitro studies illustrated the potential of the siDDIT4@G5-P-HA hydrogel for alleviating IVDD in rats. Conclusion DDIT4 is a key player in mediating pyroptosis and IVDD in NPCs through the ROS-TXNIP-NLRP3 axis. Additionally, siDDIT4@G5-P-HA hydrogel has been found to relieve IVDD in rats. Our research offers an innovative treatment option for IVDD.
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Affiliation(s)
- Miao Ma
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Chongjing Zhang
- Department of Sports Medicine, The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, China
| | - Zeyuan Zhong
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yajun Wang
- Department of Oncology, Zhangye People’s Hospital Affiliated to Hexi University, Zhangye, China
| | - Xuegang He
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Daxue Zhu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhi Qian
- Department of Joint and Sports Medicine, Institute of Orthopaedic Diseases, Zhangye People's Hospital Affiliated to Hexi University, Zhangye, China
| | - Baoqing Yu
- Shanghai Seventh People’s Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuewen Kang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
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Foreman M, Foster D, Gillam W, Ciesla C, Lamprecht C, Lucke-Wold B. Management Considerations for Cervical Corpectomy: Updated Indications and Future Directions. Life (Basel) 2024; 14:651. [PMID: 38929635 PMCID: PMC11205077 DOI: 10.3390/life14060651] [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: 03/29/2024] [Revised: 05/01/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024] Open
Abstract
Together, lower back and neck pain are among the leading causes of acquired disability worldwide and have experienced a marked increase over the past 25 years. Paralleled with the increasing aging population and the rise in chronic disease, this trend is only predicted to contribute to the growing global burden. In the context of cervical neck pain, this symptom is most often a manifestation of cervical degenerative disc disease (DDD). Traditionally, multilevel neck pain related to DDD that is recalcitrant to both physical and medical therapy can be treated with a procedure known as cervical corpectomy. Presently, there are many flavors of cervical corpectomy; however, the overarching goal is the removal of the pain-generating disc via the employment of the modern anterior approach. In this review, we will briefly detail the pathophysiological mechanism behind DDD, overview the development of the anterior approach, and discuss the current state of treatment options for said pathology. Furthermore, this review will also add to the current body of literature surrounding updated indications, surgical techniques, and patient outcomes related to cervical corpectomy. Finally, our discussion ends with highlighting the future direction of cervical corpectomy through the introduction of the "skip corpectomy" and distractable mesh cages.
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Affiliation(s)
- Marco Foreman
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA; (M.F.); (W.G.); (C.L.)
| | - Devon Foster
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (D.F.); (C.C.)
| | - Wiley Gillam
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA; (M.F.); (W.G.); (C.L.)
| | - Christopher Ciesla
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (D.F.); (C.C.)
| | - Chris Lamprecht
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA; (M.F.); (W.G.); (C.L.)
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA; (M.F.); (W.G.); (C.L.)
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Xu X, Shen L, Qu Y, Li D, Zhao X, Wei H, Yue S. Experimental validation and comprehensive analysis of m6A methylation regulators in intervertebral disc degeneration subpopulation classification. Sci Rep 2024; 14:8417. [PMID: 38600232 PMCID: PMC11006851 DOI: 10.1038/s41598-024-58888-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] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
Intervertebral disc degeneration (IVDD) is one of the most prevalent causes of chronic low back pain. The role of m6A methylation modification in disc degeneration (IVDD) remains unclear. We investigated immune-related m6A methylation regulators as IVDD biomarkers through comprehensive analysis and experimental validation of m6A methylation regulators in disc degeneration. The training dataset was downloaded from the GEO database and analysed for differentially expressed m6A methylation regulators and immunological features, the differentially regulators were subsequently validated by a rat IVDD model and RT-qPCR. Further screening of key m6A methylation regulators based on machine learning and LASSO regression analysis. Thereafter, a predictive model based on key m6A methylation regulators was constructed for training sets, which was validated by validation set. IVDD patients were then clustered based on the expression of key m6A regulators, and the expression of key m6A regulators and immune infiltrates between clusters was investigated to determine immune markers in IVDD. Finally, we investigated the potential role of the immune marker in IVDD through enrichment analysis, protein-to-protein network analysis, and molecular prediction. By analysising of the training set, we revealed significant differences in gene expression of five methylation regulators including RBM15, YTHDC1, YTHDF3, HNRNPA2B1 and ALKBH5, while finding characteristic immune infiltration of differentially expressed genes, the result was validated by PCR. We then screen the differential m6A regulators in the training set and identified RBM15 and YTHDC1 as key m6A regulators. We then used RBM15 and YTHDC1 to construct a predictive model for IVDD and successfully validated it in the training set. Next, we clustered IVDD patients based on the expression of RBM15 and YTHDC1 and explored the immune infiltration characteristics between clusters as well as the expression of RBM15 and YTHDC1 in the clusters. YTHDC1 was finally identified as an immune biomarker for IVDD. We finally found that YTHDC1 may influence the immune microenvironment of IVDD through ABL1 and TXK. In summary, our results suggest that YTHDC1 is a potential biomarker for the development of IVDD and may provide new insights for the precise prevention and treatment of IVDD.
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Affiliation(s)
- Xiaoqian Xu
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, China
| | - Lianwei Shen
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, China
| | - Yujuan Qu
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, China
| | - Danyang Li
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaojing Zhao
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, China
| | - Hui Wei
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, China
| | - Shouwei Yue
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, China.
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Qiu R, Cai K, Zhang K, Ying Y, Hu H, Jiang G, Luo K. The current status and development trend of hydrogel application in spinal surgery. J Mater Chem B 2024; 12:1730-1747. [PMID: 38294330 DOI: 10.1039/d3tb02613b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Spinal diseases often result in compromised mobility and diminished quality of life due to the intricate anatomy surrounding the nervous system. Medication and surgical interventions remain the primary treatment methods for spinal conditions. However, currently available medications have limited efficacy in treating spinal surgical diseases and cannot achieve a complete cure. Furthermore, surgical intervention frequently results in inevitable alterations and impairments to the initial anatomical integrity of the spinal structure, accompanied by the consequential loss of certain physiological functionalities. Changes in spine surgery treatment concepts and modalities in the last decade have led to a deepening of minimally invasive treatment, with treatment strategies focusing more on repairing and reconstructing the patient's spine and preserving physiological functions. Therefore, developing novel and more efficient treatment strategies to reduce spinal lesions and iatrogenic injuries is essential. In recent years, significant advancements in biomedical research have led to the discovery that hydrogels possess excellent biocompatibility, biodegradability, and adjustable mechanical properties. The application of hydrogel-based biotechnology in spinal surgery has demonstrated remarkable therapeutic potential. This review presents the therapeutic strategies for spinal diseases based on hydrogel tissue engineering technology.
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Affiliation(s)
- Rongzhang Qiu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Kaiwen Cai
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Kai Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Yijian Ying
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Hangtian Hu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Guoqiang Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Kefeng Luo
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
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Foreman M, Patel A, Nguyen A, Foster D, Orriols A, Lucke-Wold B. Management Considerations for Total Intervertebral Disc Replacement. World Neurosurg 2024; 181:125-136. [PMID: 37777178 DOI: 10.1016/j.wneu.2023.09.100] [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: 08/10/2023] [Accepted: 09/24/2023] [Indexed: 10/02/2023]
Abstract
The burden of disease regarding lumbar and cervical spine pain is a long-standing, pervasive problem within medicine that has yet to be resolved. Specifically, neck and back pain are associated with chronic pain, disability, and exorbitant health care use worldwide, which have only been exacerbated by the increase in overall life years and chronic disease. Traditionally, patients with significant pain and disability secondary to disease of either the cervical or lumbar spine are treated via fusion or discectomy. Although these interventions have proved curative in the short-term, numerous longitudinal studies evaluating the efficacy of traditional management have reported severe impairment of normal spinal range of motion, as well as postoperative complications, including neurologic injury, radiculopathy, osteolysis, subsidence, and infection, paired with less than desirable reoperation rates. Consequently, there is a call for innovation and improvement in the treatment of lumbar and cervical spine pain, which may be answered by a modern technique known as intervertebral disc arthroplasty, or total disc replacement (TDR). Thus, this review aims to describe the management strategy of TDR and to explore updated considerations for its use in practice, both to help guide clinical decision making.
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Affiliation(s)
- Marco Foreman
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
| | - Aashay Patel
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Andrew Nguyen
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Devon Foster
- Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Adrienne Orriols
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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Noor MA, Al-Ashqar M, Abul A, Grayston J, Nisar S, Loughenbury PR, Radcliffe G. The Clinical Utility of Repeating Magnetic Resonance Imaging (MRI) Scans Within 12 Months in the Management of Lumbosacral Degenerative Disc Disease. Cureus 2024; 16:e53100. [PMID: 38414690 PMCID: PMC10897750 DOI: 10.7759/cureus.53100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 02/29/2024] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI) is the gold standard investigation for lumbosacral degenerative disc disease. However, there is controversy regarding the clinical value of repeating an MRI scan within 12 months when a patient presents with recurring or changing symptoms. This study measures rates of radiological change in a real-world cohort to guide clinicians when deciding to repeat a scan. METHODS All patients over a 10-year window in one general hospital who underwent two lumbosacral MRI scans for degenerative disc disease within 12 months of each other were included in the study. All MRI reports were manually reviewed. The level of main vertebral pathology was recorded, along with the location of a disc prolapse. Time intervals between the two scans were calculated, and these were collated into 30-day intervals for analysis. The repeat scans were categorized into three groups: no change, radiological improvement, and radiological deterioration. Patients who had clinically significant deterioration in the form of cauda equina compression on MRI scans were recorded. FINDINGS Four hundred and eighty-one patients were included for analysis. Three hundred and ninety (81%) showed no change in MRI findings, 18 (3.7%) had improvements in their repeat scans, and 73 (15.3%) demonstrated deterioration in their repeat scans. Of the 73 patients with radiological deterioration, three patients (0.62% of the total) required urgent surgical intervention for cauda equina syndrome (CES). CONCLUSIONS Though there is no alternative to detailed clinical assessment in determining whether a repeat MRI scan is indicated, the findings demonstrate that repeating MRI within 12 months for patients with lumbosacral degenerative disc disease has a low chance of altering the management plan. Over the 10-year period, only three patients required an urgent change to their clinical management. We believe this data can help guide clinical decision-making when considering a repeat scan.
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Affiliation(s)
- Muhammad Ashhad Noor
- Department of Medicine and Surgery, Manchester University National Health Service (NHS) Foundation Trust, Manchester, GBR
| | - Mohammad Al-Ashqar
- Department of Trauma and Orthopaedics, Yorkshire and Humber Deanery, Leeds, GBR
| | - Ahmad Abul
- College of Medicine, University of Leeds, Leeds, GBR
| | - James Grayston
- Department of Trauma and Orthopaedics, University Hospital Crosshouse, Kilmarnock, GBR
| | - Sohail Nisar
- Department of Trauma and Orthopaedics, Bradford Royal Infirmary, Bradford, GBR
| | - Peter R Loughenbury
- Department of Spinal Surgery, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, GBR
| | - Graham Radcliffe
- Department of Trauma and Orthopaedics, Bradford Royal Infirmary, Bradford, GBR
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10
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Saunders LM, Sandhu HS, McBride L, Maniarasu VS, Taylor S, Dhokia R. Degenerative Cervical Myelopathy: An Overview. Cureus 2023; 15:e50387. [PMID: 38213348 PMCID: PMC10783125 DOI: 10.7759/cureus.50387] [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] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
Degenerative cervical myelopathy (DCM) is a spinal condition of growing importance due to its increasing prevalence within the ageing population. DCM involves the degeneration of the cervical spine due to various processes such as disc ageing, osteophyte formation, ligament hypertrophy or ossification, as well as coexisting congenital anomalies. This article provides an overview of the literature on DCM and considers areas of focus for future research. A patient with DCM can present with a variety of symptoms ranging from mild hand paraesthesia and loss of dexterity to a more severe presentation of gait disturbance and loss of bowel/bladder control. Hoffman's sign and the inverted brachioradialis reflex are also important signs of this disease. The gold standard imaging modality is MRI which can identify signs of degeneration of the cervical spine. Other modalities include dynamic MRI, myelography, and diffusion tensor imaging. One important scoring system to aid with the diagnosis and categorisation of the severity of DCM is the modified Japanese Orthopaedic Association score. This considers motor, sensory, and bowel/bladder dysfunction, and categorises patients into mild, moderate, or severe DCM. DCM is primarily treated with surgery as this can halt disease progression and may even allow for neurological recovery. The surgical approach will depend on the location of degeneration, the number of cervical levels involved and the pathophysiological process. Surgical approach options include anterior cervical discectomy and fusion, corpectomy, or posterior approach (laminectomy ± fusion). Conservative management is also considered for some patients with mild or non-progressive DCM or for patients where surgery is not an option. Conservative treatment may include physical therapy, traction, or neck immobilisation. Future recommendations include research into the prevalence rate of DCM and if there is a difference between populations. Further research on the benefit of conservative management for patients with mild or non-progressive DCM would be recommended.
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Affiliation(s)
- Laura M Saunders
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Hushil S Sandhu
- Department of Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, GBR
| | - Lorcán McBride
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | | | - Samantha Taylor
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Rakesh Dhokia
- Department of Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, GBR
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Jha R, Bernstock JD, Chalif JI, Hoffman SE, Gupta S, Guo H, Lu Y. Updates on Pathophysiology of Discogenic Back Pain. J Clin Med 2023; 12:6907. [PMID: 37959372 PMCID: PMC10647359 DOI: 10.3390/jcm12216907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Discogenic back pain, a subset of chronic back pain, is caused by intervertebral disc (IVD) degeneration, and imparts a notable socioeconomic health burden on the population. However, degeneration by itself does not necessarily imply discogenic pain. In this review, we highlight the existing literature on the pathophysiology of discogenic back pain, focusing on the biomechanical and biochemical steps that lead to pain in the setting of IVD degeneration. Though the pathophysiology is incompletely characterized, the current evidence favors a framework where degeneration leads to IVD inflammation, and subsequent immune milieu recruitment. Chronic inflammation serves as a basis of penetrating neovascularization and neoinnervation into the IVD. Hence, nociceptive sensitization emerges, which manifests as discogenic back pain. Recent studies also highlight the complimentary roles of low virulence infections and central nervous system (CNS) metabolic state alteration. Targeted therapies that seek to disrupt inflammation, angiogenesis, and neurogenic pathways are being investigated. Regenerative therapy in the form of gene therapy and cell-based therapy are also being explored.
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Affiliation(s)
- Rohan Jha
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Joshua I. Chalif
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Samantha E. Hoffman
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Hong Guo
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Yi Lu
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
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12
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Hoffeld K, Lenz M, Egenolf P, Weber M, Heck V, Eysel P, Scheyerer MJ. Patient-related risk factors and lifestyle factors for lumbar degenerative disc disease: a systematic review. Neurochirurgie 2023; 69:101482. [PMID: 37586480 DOI: 10.1016/j.neuchi.2023.101482] [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: 04/20/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Back pain is a very widespread disease pattern and is one of the most frequent causes for consultation of a physician in general. In most cases, discogenic changes are the pathomorphological correlate of back pain. Numerous risk factors have been identified for these degenerative changes, but the influence and significance of the risk factors remain unclear, which was the aim of this systematic review. METHODS A systematic literature search of the commonly used Pubmed database was performed using specific MESH terms. Further selection of the included studies was performed according to the PRISMA scheme, taking into account scientific merit as well as the relation to the research question. RESULTS A total of 111 studies out of 1035 found were finally included in the literature search. 134 risk factors for disc degeneration and disc herniation were identified. These were divided into (1) patient-specific risk factors (n░=░34), (2) radiological risk factors (n░=░31), (3) lifestyle risk factors (n░=░6), (4) workplace-related risk factors (n░=░12), (5) genetic risk factors (n░=░50), and (6) other risk factors (n░=░1). Non-adjustable risk factors were age >50 years (OR 1.7/year), female gender (OR 1.41), family disposition (OR 4.0), comorbidities like atherosclerosis (OR 2.24), arthritic changes in other joints (OR 3.1) and history of injuries of the back (OR 3.1). Adjustable factors were elevated BMI (OR 2.77), comorbidities like hypertension (OR 1.25), dyslipidemia (OR 1.26) and diabetes mellitus (OR 6.8), as well as lifestyle habits like smoking (OR 3.8). DISCUSSION In summary, intervertebral disc degenerations and herniations represent multifactorial events whose risk factors can be partly influenced and partly not influenced. This systematic review highlights the current state of knowledge as a basis for creating patient-specific algorithms to calculate risk for the development or progression of degenerative disc changes and disc herniations.
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Affiliation(s)
- Kai Hoffeld
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany.
| | - Maximilian Lenz
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Philipp Egenolf
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Maximilian Weber
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Vincent Heck
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Peer Eysel
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Max J Scheyerer
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany; University of Düsseldorf, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Moorenstraße 5, 40225 Düsseldorf, Germany
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13
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Çetin E, Şah V, Zengin I, Arabacı Ö, Akyol ME, Yücel M. Comparative Effectiveness of Epidural Steroid İnjections in Patients With Disc Bulging and Disc Protrusion. Cureus 2023; 15:e45994. [PMID: 37900516 PMCID: PMC10601978 DOI: 10.7759/cureus.45994] [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] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose Discogenic low back pain is a widespread disorder in the world. Many methods have been developed and continue to be developed in the treatment of discogenic low back pain. We aimed to examine the effect of epidural steroid administration on disc bulging and disc protrusion in patients with discogenic low back pain. Design The clinical effects of interlaminar epidural steroids administered to 71 patients who were admitted to our clinic and whose treatment did not require surgery were radiologically divided into two groups disc bulging and disc protrusion. Patients were followed up for six months and clinical results were recorded. Methods The scores of the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were measured before the procedure, one week after the procedure, one month after the procedure, and six months after the procedure. The normal distribution of continuous variables was evaluated using the Kolmogorov-Smirnov test. Continuous variables were compared with the Mann-Whitney U test and categorical variables were compared using the Chi-square test or Fisher's exact test. Results There was no significant difference in demographic data in patients with disc bulging and disc protrusion. In the disc protrusion group, the VAS scores in the first week after, the first month after and the sixth month after the procedure showed a significant decrease compared to the pre-procedure. There was no significant difference between the disc bulging and protrusion groups in the first week of post-procedure VAS score reduction. In the Disc Bulging group, the ODI score one week after, one month after, and six months after the procedure showed a significant decrease compared to the pre-procedure. In the Disc Protrusion group, the ODI score one week after, one month after, and six months after the procedure showed a significant decrease compared to the pre-procedure. Conclusion There was strong evidence that lumbar interlaminar steroid injection is an effective treatment for disc bulging and discogenic pain due to protrusion. When the ODI and VAS scores of patients with both disc bulging and disc protrusion were evaluated, it was seen that they benefited from epidural steroid injection. In the disc protrusion group, except for the first week of injection, relief due to the use of epidural steroids was observed to be greater compared to disc bulging.
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Affiliation(s)
- Eyup Çetin
- Department of Neurosurgery, Haydarpaşa Numune Education and Research Hospital, Istanbul, TUR
| | - Volkan Şah
- Department of Sports Medicine, Van Yuzuncu Yıl University, Van, TUR
| | - Irfan Zengin
- Department of Neurosurgery, Faculty of Medicine, Yuzuncu Yil University, Van, TUR
| | - Özkan Arabacı
- Department of Neurosurgery, Van Yuzuncu Yıl University, Van, TUR
| | - Mehmet E Akyol
- Department of Neurosurgery, Faculty of Medicine, Yuzuncu Yil University, Van, TUR
| | - Murat Yücel
- Department of Neurosurgery, Yalova University, Yalova, TUR
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14
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Lin SS, Ueng SWN, Chong KY, Chan YS, Tsai TT, Yuan LJ, Liu SJ, Yang CY, Hsiao HY, Hsueh YJ, Chen CA, Niu CC. Effects of Hyperbaric Oxygen Intervention on the Degenerated Intervertebral Disc: From Molecular Mechanisms to Animal Models. Cells 2023; 12:2111. [PMID: 37626921 PMCID: PMC10453512 DOI: 10.3390/cells12162111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
MicroRNA (miRNA) 107 expression is downregulated but Wnt3a protein and β-catenin are upregulated in degenerated intervertebral disc (IVD). We investigated mir-107/Wnt3a-β-catenin signaling in vitro and in vivo following hyperbaric oxygen (HBO) intervention. Our results showed 96 miRNAs were upregulated and 66 downregulated in degenerated nucleus pulposus cells (NPCs) following HBO treatment. The 3' untranslated region (UTR) of the Wnt3a mRNA contained the "seed-matched-sequence" for miR-107. MiR-107 was upregulated and a marked suppression of Wnt3a was observed simultaneously in degenerated NPCs following HBO intervention. Knockdown of miR-107 upregulated Wnt3a expression in hyperoxic cells. HBO downregulated the protein expression of Wnt3a, phosphorylated LRP6, and cyclin D1. There was decreased TOP flash activity following HBO intervention, whereas the FOP flash activity was not affected. HBO decreased the nuclear translocation of β-catenin and decreased the secretion of MMP-3 and -9 in degenerated NPCs. Moreover, rabbit serum KS levels and the stained area for Wnt3a and β-catenin in repaired cartilage tended to be lower in the HBO group. We observed that HBO inhibits Wnt3a/β-catenin signaling-related pathways by upregulating miR-107 expression in degenerated NPCs. HBO may play a protective role against IVD degeneration and could be used as a future therapeutic treatment.
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Affiliation(s)
- Song-Shu Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-S.L.); (Y.-S.C.); (T.-T.T.); (C.-Y.Y.); (C.-A.C.)
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 33302, Taiwan
- Hyperbaric Oxygen Medical Research Laboratory, Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
| | - Steve W. N. Ueng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-S.L.); (Y.-S.C.); (T.-T.T.); (C.-Y.Y.); (C.-A.C.)
- Hyperbaric Oxygen Medical Research Laboratory, Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Kowit-Yu Chong
- Hyperbaric Oxygen Medical Research Laboratory, Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yi-Sheng Chan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-S.L.); (Y.-S.C.); (T.-T.T.); (C.-Y.Y.); (C.-A.C.)
- Hyperbaric Oxygen Medical Research Laboratory, Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-S.L.); (Y.-S.C.); (T.-T.T.); (C.-Y.Y.); (C.-A.C.)
- Hyperbaric Oxygen Medical Research Laboratory, Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
| | - Li-Jen Yuan
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chuen-Yung Yang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-S.L.); (Y.-S.C.); (T.-T.T.); (C.-Y.Y.); (C.-A.C.)
- Hyperbaric Oxygen Medical Research Laboratory, Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
| | - Hui-Yi Hsiao
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.-Y.H.); (Y.-J.H.)
- Department of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yi-Jen Hsueh
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.-Y.H.); (Y.-J.H.)
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chung-An Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-S.L.); (Y.-S.C.); (T.-T.T.); (C.-Y.Y.); (C.-A.C.)
- Hyperbaric Oxygen Medical Research Laboratory, Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
| | - Chi-Chien Niu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-S.L.); (Y.-S.C.); (T.-T.T.); (C.-Y.Y.); (C.-A.C.)
- Hyperbaric Oxygen Medical Research Laboratory, Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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15
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Diallo TD, Rospleszcz S, Fabian J, Walter SS, Maurer E, Storz C, Roemer F, Rathmann W, Peters A, Jungmann PM, Jung M, Bamberg F, Kiefer LS. Associations of myosteatosis with disc degeneration: A 3T magnetic resonance imaging study in individuals with impaired glycaemia. J Cachexia Sarcopenia Muscle 2023. [PMID: 36892104 DOI: 10.1002/jcsm.13192] [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: 04/01/2022] [Revised: 11/11/2022] [Accepted: 01/22/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Intervertebral disc degeneration (IVDD) may be linked to dysregulations of skeletal muscle glucose metabolism and fatty alterations of muscle composition (Myosteatosis). Our aim was to evaluate the different associations of magnetic resonance imaging (MRI)-based paravertebral myosteatosis with lumbar disc degeneration in individuals with impaired glucose metabolism and normoglycaemic controls. METHODS In total, 304 individuals (mean age: 56.3 ± 9.1 years, 53.6% male sex, mean body mass index [BMI]: 27.6 ± 4.7 kg/m2 ) from a population-based cohort study who underwent 3-Tesla whole-body chemical-shift-encoded (six echo times) and T2-weighted single-shot-fast-spin-echo MRI were included. Lumbar disc degeneration was assessed at motion segments L1 to L5, categorized according to the Pfirrmann score and defined as Pfirrmann grade > 2 and/or disc bulging/herniation on at least one segment. Fat content of the autochthonous back muscles and the quadratus lumborum muscle was quantified as proton density fat fraction (PDFFmuscle ). Logistic regression models adjusted for age, sex, BMI and regular physical activity were calculated to evaluate the association between PDFFmuscle and outcome IVDD. RESULTS The overall prevalence of IVDD was 79.6%. There was no significant difference in the prevalence or severity distribution of IVDD between participants with or without impaired glucose metabolism (77.7% vs. 80.7%, P = 0.63 and P = 0.71, respectively). PDFFmuscle was significantly and positively associated with an increased risk for the presence of IVDD in participants with impaired glycaemia when adjusted for age, sex and BMI (PDFFautochthonous back muscles : odds ratio [OR] 2.16, 95% confidence interval [CI] [1.09, 4.3], P = 0.03; PDFFquadratus lumborum : OR 2.01, 95% CI [1.04, 3.85], P = 0.04). After further adjustment for regular physical activity, the results attenuated, albeit approaching statistical significance (PDFFautochthonous back muscles : OR 1.97, 95% CI [0.97, 3.99], P = 0.06; PDFFquadratus lumborum : OR 1.86, 95% CI [0.92, 3.76], P = 0.09). No significant associations were shown in healthy controls (PDFFautochthonous back muscles : OR 0.62, 95% CI [0.34, 1.14], P = 0.13; PDFFquadratus lumborum : OR 1.06, 95% CI [0.6, 1.89], P = 0.83). CONCLUSIONS Paravertebral myosteatosis is positively associated with intervertebral disc disease in individuals with impaired glucose metabolism, independent of age, sex and BMI. Regular physical activity may confound these associations. Longitudinal studies will help to better understand the pathophysiological role of skeletal muscle in those with concomitant disturbed glucose haemostasis and intervertebral disc disease, as well as possible underlying causal relationships.
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Affiliation(s)
- Thierno D Diallo
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Rospleszcz
- Department of Epidemiology, Ludwig-Maximilians-University München, Munich, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Centre for Cardiovascular Research (DZHK e.V.), Munich, Germany
| | - Jana Fabian
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Sven S Walter
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Department of Radiology, Division of Musculoskeletal Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Elke Maurer
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Corinna Storz
- Department of Neuroradiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frank Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany
| | - Annette Peters
- Department of Epidemiology, Ludwig-Maximilians-University München, Munich, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Centre for Cardiovascular Research (DZHK e.V.), Munich, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lena S Kiefer
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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16
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Jung M, Rospleszcz S, Löffler MT, Walter SS, Maurer E, Jungmann PM, Peters A, Nattenmüller J, Schlett CL, Bamberg F, Kiefer LS, Diallo TD. Association of lumbar vertebral bone marrow and paraspinal muscle fat composition with intervertebral disc degeneration: 3T quantitative MRI findings from the population-based KORA study. Eur Radiol 2023; 33:1501-1512. [PMID: 36241920 PMCID: PMC9935727 DOI: 10.1007/s00330-022-09140-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the association of lumbar bone marrow adipose tissue fat fraction (BMAT-FF) and paraspinal muscle proton density fat fraction (PDFF) and their interplay with intervertebral disc degeneration (IVDD). METHODS In this retrospective cross-sectional study based on a prospective population-based cohort, BMAT-FF and PDFF of asymptomatic individuals were calculated based on 3T-MRI dual-echo and multi-echo Dixon VIBE sequences. IVDD was assessed at motion segments L1 to L5 and dichotomized based on Pfirrmann grade ≥ 4 and/or presence of other severe degenerative changes or spinal abnormalities at least at one segment. Pearson's correlation coefficients were calculated for BMAT-FF and PDFF. Univariable and multivariable logistic regression models for IVDD were calculated. RESULTS Among 335 participants (mean age: 56.2 ± 9.0 years, 43.3% female), the average BMI was 27.7 ± 4.5 kg/m2 and the prevalence of IVDD was high (69.9%). BMAT-FF and PDFF were significantly correlated (r = 0.31-0.34; p < 0.001). The risk for IVDD increased with higher PDFF (OR = 1.45; CI 1.03, 2.04) and BMAT-FF (OR = 1.56; CI 1.16, 2.11). Pairwise combinations of PDFF and BMAT-FF quartiles revealed a lower risk for IVDD in individuals in the lowest BMAT-FF and PDFF quartile (OR = 0.21; CI 0.1, 0.48). Individuals in the highest BMAT-FF and PDFF quartile showed an increased risk for IVDD (OR = 5.12; CI 1.17, 22.34) CONCLUSION: Lumbar BMAT-FF and paraspinal muscle PDFF are correlated and represent both independent and additive risk factors for IVDD. Quantitative MRI measurements of paraspinal myosteatosis and vertebral bone marrow fatty infiltration may serve as imaging biomarkers to assess the individual risk for IVDD. KEY POINTS • Fat composition of the lumbar vertebral bone marrow is positively correlated with paraspinal skeletal muscle fat. • Higher fat-fractions of lumbar vertebral bone marrow and paraspinal muscle are both independent as well as additive risk factors for intervertebral disc degeneration. • Quantitative magnetic resonance imaging measurements of bone marrow and paraspinal muscle may serve as imaging biomarkers for intervertebral disc degeneration.
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Affiliation(s)
- Matthias Jung
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - Susanne Rospleszcz
- grid.4567.00000 0004 0483 2525Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Oberschleißheim, Germany ,grid.5252.00000 0004 1936 973XDepartment of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University München, Munich, Germany
| | - Maximilian T. Löffler
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany ,grid.6936.a0000000123222966Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Sven S. Walter
- grid.10392.390000 0001 2190 1447Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany ,grid.137628.90000 0004 1936 8753Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, New York, NY 10016 USA
| | - Elke Maurer
- grid.482867.70000 0001 0211 6259Department of Trauma and Reconstructive Surgery, BG Unfallklinik, Schnarrenbergstraße 95, 72070 Tuebingen, Germany
| | - Pia M. Jungmann
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Annette Peters
- grid.4567.00000 0004 0483 2525Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Oberschleißheim, Germany ,grid.5252.00000 0004 1936 973XDepartment of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University München, Munich, Germany
| | - Johanna Nattenmüller
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Christopher L. Schlett
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Fabian Bamberg
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Lena S. Kiefer
- grid.10392.390000 0001 2190 1447Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Thierno D. Diallo
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
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Hypoxia-Inducible Factor-1α Protects Against Intervertebral Disc Degeneration Through Antagonizing Mitochondrial Oxidative Stress. Inflammation 2023; 46:270-284. [PMID: 36064808 PMCID: PMC9971142 DOI: 10.1007/s10753-022-01732-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/07/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Abstract
Intervertebral disc degeneration (IVDD) demonstrates a gradually increased incidence and has developed into a major health problem worldwide. The nucleus pulposus is characterized by the hypoxic and avascular environment, in which hypoxia-inducible factor-1α (HIF-1α) has an important role through its participation in extracellular matrix synthesis, energy metabolism, cellular adaptation to stresses and genesis. In this study, the effects of HIF-1α on mouse primary nucleus pulposus cells (MNPCs) exposed to TNF-α were observed, the potential mechanism was explored and a rabbit IVDD model was established to verify the protective role of HIF-1α on IVDD. In vitro results demonstrated that HIF-1α could attenuate the inflammation, apoptosis and mitochondrial dysfunction induced by TNF-α in MNPCs; promote cellular anabolism; and inhibit cellular catabolism. In vivo results demonstrated that after establishment of IVDD model in rabbit, disc height and IVD extracellular matrix were decreased in a time-dependent manner, MRI analysis showed a tendency for decreased T2 values in a time-dependent manner and supplementation of HIF-1α improved histological and imaginative IVDD while downregulation of HIF-1α exacerbated this degeneration. In summary, HIF-1α protected against IVDD, possibly through reducing ROS production in the mitochondria and consequent inhibition of inflammation, metabolism disorders and apoptosis of MNPCs, which provided a potential therapeutic instrument for the treatment of IVDD diseases.
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Gao M, Guo P, Liu X, Zhang P, He Z, Wen L, Liu S, Zhou Z, Zhu W. Systematic study of single-cell isolation from musculoskeletal tissues for single-sell sequencing. BMC Mol Cell Biol 2022; 23:32. [PMID: 35883033 PMCID: PMC9327421 DOI: 10.1186/s12860-022-00429-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The single-cell platform provided revolutionary way to study cellular biology. Technologically, a sophistic protocol of isolating qualified single cells would be key to deliver to single-cell platform, which requires high cell viability, high cell yield and low content of cell aggregates or doublets. For musculoskeletal tissues, like bone, cartilage, nucleus pulposus and tendons, as well as their pathological state, which are tense and dense, it’s full of challenge to efficiently and rapidly prepare qualified single-cell suspension. Conventionally, enzymatic dissociation methods were wildly used but lack of quality control. In the present study, we designed the rapid cycling enzymatic processing method using tissue-specific enzyme cocktail to treat different human pathological musculoskeletal tissues, including degenerated nucleus pulposus (NP), ossifying posterior longitudinal ligament (OPLL) and knee articular cartilage (AC) with osteoarthritis aiming to rapidly and efficiently harvest qualified single-cell suspensions for single-cell RNA-sequencing (scRNA-seq).
Results
We harvested highly qualified single-cell suspensions from NP and OPLL with sufficient cell numbers and high cell viability using the rapid cycling enzymatic processing method, which significantly increased the cell viability compared with the conventional long-time continuous digestion group (P < 0.05). Bioanalyzer trace showed expected cDNA size distribution of the scRNA-seq library and a clear separation of cellular barcodes from background partitions were verified by the barcode-rank plot after sequencing. T-SNE visualization revealed highly heterogeneous cell subsets in NP and OPLL. Unfortunately, we failed to obtain eligible samples from articular cartilage due to low cell viability and excessive cell aggregates and doublets.
Conclusions
In conclusion, using the rapid cycling enzymatic processing method, we provided thorough protocols for preparing single-cell suspensions from human musculoskeletal tissues, which was timesaving, efficient and protective to cell viability. The strategy would greatly guarantee the cell heterogeneity, which is critical for scRNA-seq data analysis. The protocol to treat human OA articular cartilage should be further improved.
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Hu MH, Yang KC, Chen CW, Chu PH, Chang YL, Sun YH, Lin FH, Yang SH. Multilayer Electrospun-Aligned Fibroin/Gelatin Implant for Annulus Fibrosus Repair: An In Vitro and In Vivo Evaluation. Biomedicines 2022; 10:biomedicines10092107. [PMID: 36140208 PMCID: PMC9495938 DOI: 10.3390/biomedicines10092107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Annulus fibrosus (AF) damage is proven to prompt intervertebral disc (IVD) degeneration, and unrepaired AF lesions after surgical discectomy may boost herniation of the nucleus pulposus (NP) which may lead to further compression of neural structures. Moreover, vascular and neural ingrowth may occur within the defect which is known as a possible reason for discogenic pain. Due to a limited healing capacity, an effective strategy to repair and close the AF defect is necessary. In this study, using electrospinning technology, two nature polymers, silk fibroin and gelatin, were linked to imitate the unique lamellae structure of native AF. Our findings revealed that a multilayer electrospun-aligned fibroin/gelatin scaffold with mechanical and morphological properties mimicking those of native AF lamellae have been developed. The average diameter of the nanofiber is 162.9 ± 38.8 nm. The young’s modulus is around 6.70 MPa with an ultimate tensile strength of around 1.81 MP along preferred orientation. The in vitro test confirmed its biocompatibility and ability to maintain cell viability and colonization. Using a porcine model, we demonstrated that the multilayer-aligned scaffold offered a crucial microenvironment to induce collagen fibrous tissue production within native AF defect. In the implant-repaired AF, H&E staining showed homogeneous fibroblast-like cell infiltration at the repaired defect with very little vascular ingrowth, which was confirmed by magnetic resonance imaging findings. Picrosirius red staining and immunohistochemical staining against type I collagen revealed positively stained fibrous tissue in an aligned pattern within the implant-integrated site. Relative to the intact control group, the disc height index of the serial X-ray decreased significantly in both the injury control and implant group at 4 weeks and 8 weeks (p < 0.05) which indicated this scaffold may not reverse the degenerative process. However, the results of the discography showed that the effectiveness of annulus repair of the implant group is much superior to that of the untreated group. The scaffold, composed with nature fibroin/gelatin polymers, could potentially enhance AF healing that could prevent IVD recurrent herniation, as well as neural and neovascular ingrowth after discectomy surgeries.
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Affiliation(s)
- Ming-Hsiao Hu
- Department of Orthopedics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan
| | - Kai-Chiang Yang
- Department of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chih-Wei Chen
- Department of Orthopedics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan
- Department of Biomedical Engineering, National Taiwan University, Taipei 106216, Taiwan
| | - Po-Han Chu
- Department of Biomedical Engineering, National Taiwan University, Taipei 106216, Taiwan
| | - Yun-Liang Chang
- Department of Orthopedics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan
| | - Yuan-Hui Sun
- Department of Orthopedics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan
| | - Feng-Huei Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei 106216, Taiwan
| | - Shu-Hua Yang
- Department of Orthopedics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456 (ext. 63981)
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Chen CN, Chang HI, Yen CK, Liu WL, Huang KY. Mechanical Stretch Induced Osteogenesis on Human Annulus Fibrosus Cells through Upregulation of BMP-2/6 Heterodimer and Activation of P38 and SMAD1/5/8 Signaling Pathways. Cells 2022; 11:cells11162600. [PMID: 36010676 PMCID: PMC9406707 DOI: 10.3390/cells11162600] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 12/04/2022] Open
Abstract
Degenerative disc disease (DDD) is an important cause of low back pain. Repetitive tensile stress from the daily motion of the spine predisposes it to injury of the annulus fibrosus (AF) which causes IVD degeneration. This study aims to determine the causal relationship between mechanical stretch and osteogenesis in the AF cells of IVD as affected by bone morphogenic proteins (BMPs), specifically BMP-2/6 heterodimers. Our results found that 15% tensile stress (high cyclic stretching, HCS) may induce the expression of osteogenesis-related markers (Runx2, osterix) by upregulating BMP-2/6 heterodimeric ligands and their receptors on the human AF cell line. HCS also induced transient phosphorylation of p38 mitogen-activated protein (MAP) kinase and SMAD1/5/8. Neutralizing antibodies to the BMP-2/6 receptor (ALK3) blocked the expression of Runx2 and osterix, as well as the phosphorylation of p38 and SMAD1/5/8. In addition, treatment with a p38 MAPK inhibitor (SB203580) or siRNA to neutralize the effects of SMAD1/5/8 suppressed tensile stress-induced Runx2 and osterix expression. Mechanical stretching induces activation of p38 MAP kinase and SMAD1/5/8 signaling pathways, followed by the upregulation of BMP-2/6 heterodimer expression, thereby stimulating osteogenic Runx2 and osterix expression on AF cells. HCS may accelerate the progression of IVD degeneration by promoting an osteogenic response.
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Affiliation(s)
- Cheng-Nan Chen
- Department of Biochemical Science and Technology, National Chiayi University, Chiayi City 60004, Taiwan
| | - Hsin-I Chang
- Department of Biochemical Science and Technology, National Chiayi University, Chiayi City 60004, Taiwan
| | - Chia-Kung Yen
- Department of Food Science, National Chiayi University, Chiayi City 60004, Taiwan
| | - Wen-Lung Liu
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Kuo-Yuan Huang
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Correspondence: ; Tel.: +886-6-235-3535 (ext. 5237); Fax: +886-6-2766189
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21
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Forward Bending in Supine Test: Diagnostic Accuracy for Acute Vertebral Fragility Fracture. Healthcare (Basel) 2022; 10:healthcare10071215. [PMID: 35885742 PMCID: PMC9318760 DOI: 10.3390/healthcare10071215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/12/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Despite its high incidence rate, vertebral fragility fracture (VFF) is frequently underdiagnosed due to the absence of marked symptoms. This study evaluated the diagnostic accuracy of our suggested physical examinations and compared them with that of plain radiographs. Patients over 65 years of age with sudden back pain within the preceding 3 weeks were enrolled. Physical examinations in three different positions and a closed-fist percussion test were performed, and the presence of VFF was evaluated through confirmatory radiographic tools. We assessed the diagnostic accuracy of each physical examination and compared them with the interpretation of plain radiographs and examined the patient-reported pain locations based on the VFF level. A total of 179 patients were enrolled. The forward bending in supine (FB-SU) test demonstrated superior diagnostic values (sensitivity: 90.6%, specificity: 71.2%), which outperformed those of plain radiographs (sensitivity: 68.9%, specificity: 71.9%). The location of patient-reported pain was generally close to or lower than the index fracture level. FB-SU showed the highest diagnostic accuracy and was more valuable than plain radiographs in diagnosing acute VFF. FB-SU is a simple and affordable screening test. If positive, physicians should highly suspect VFF even when based on vague evidence of acute fracture provided by plain radiographs.
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22
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The Impact of Osteoporosis on Adverse Outcomes After Short Fusion for Degenerative Lumbar Disease. J Am Acad Orthop Surg 2022; 30:573-579. [PMID: 35297812 DOI: 10.5435/jaaos-d-21-01258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/30/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Osteoporosis affects nearly 200 million individuals worldwide. There are little available data regarding outcomes in patients with osteoporosis who undergo short-segment lumbar fusion for degenerative disk disease (DDD). We sought to identify a relationship between osteoporosis and risk of adverse outcomes in patients with DDD undergoing short-segment lumbar fusion. METHODS Using the New York State Statewide Planning and Research Cooperative System, all patients with DDD who underwent 2- to 3-level lumbar fusion from 2009 through 2011 were identified. Patients with bone mineralization disorders and other systemic and endocrine disorders and surgical indications of trauma, systemic disease(s), and infection were excluded. Patients were stratified by the presence or absence of osteoporosis and compared for demographics, hospital-related parameters, and 2-year complications and revision surgeries. Multivariate binary logistic regression models were used to identify notable predictors of complications. RESULTS A total of 29,028 patients (osteoporosis = 1,353 [4.7%], nonosteoporosis = 27,675 [95.3%]) were included. Patients with osteoporosis were older (66.9 vs 52.6 years), more often female (85.1% vs 48.4%), and White (82.8% vs 73.5%) (all P < 0.001). The Charlson/Deyo comorbidity index did not significantly differ between groups. Hospital lengths of stay and total charges were higher for patients with osteoporosis (4.9 vs 4.1 days; $74,484 vs $73,724; both P < 0.001). Medical complication rates were higher in patients with osteoporosis, including acute renal failure and deep-vein thrombosis (both P < 0.01). This cohort also had higher rates of implant-related (3.4% vs 1.9%) and wound (9.8% vs 5.9%) complications (both P < 0.01). Preoperative osteoporosis was strongly associated with 2-year medical and surgical complications (odds ratios, 1.6 and 1.7) as well as greater odds of revision surgeries (odds ratio, 1.3) (all P < 0.001). CONCLUSION Patients with osteoporosis undergoing 2- to 3-level lumbar fusion for DDD were at higher risk of 2-year medical and surgical complications, especially implant-related and wound complications. These findings highlight the importance of rigorous preoperative metabolic workup and patients' optimization before spinal surgery.
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Chepurin D, Chamoli U, Diwan AD. Bony Stress and Its Association With Intervertebral Disc Degeneration in the Lumbar Spine: A Systematic Review of Clinical and Basic Science Studies. Global Spine J 2022; 12:964-979. [PMID: 34018442 PMCID: PMC9344512 DOI: 10.1177/21925682211008837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Translational review encompassing basic science and clinical evidence. OBJECTIVES Multiple components of the lumbar spine interact during its normal and pathological function. Bony stress in the lumbar spine is recognized as a factor in the development of pars interarticularis defect and stress fractures, but its relationship with intervertebral disc (IVD) degeneration is not well understood. Therefore, we conducted a systematic review to examine the relationship between bony stress and IVD degeneration. METHODS Online databases Scopus, PubMed and MEDLINE via OVID were searched for relevant studies published between January 1980-February 2020, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two authors independently analyzed the data, noting characteristics and biases in various studies. RESULTS Thirty-two articles were included in the review: 8 clinical studies, 9 finite element modeling studies, 3 in-vivo biomechanical testing studies, and 12 in-vitro biomechanical testing studies. Of the 32 articles, 19 supported, 4 rejected and 9 made no conclusion on the hypothesis that there is a positive associative relationship between IVD degeneration and bony stress. However, sufficient evidence was not available to confirm or reject a causal relationship. CONCLUSIONS Most studies suggest that the prevalence of IVD degeneration increases in the presence of bony stress; whether a causal relationship exists is unclear. The literature recommends early diagnosis and clinical suspicion of IVD degeneration and bony stress. Longitudinal studies are required to explore causal relationships between IVD degeneration and bony stress.
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Affiliation(s)
- Daniel Chepurin
- Department of Orthopaedic Surgery,
Spine Service, St. George & Sutherland Clinical School, University of New South
Wales Australia, Kogarah, Sydney, New South Wales, Australia,Department of Medicine, Faculty of Medicine Nursing & Health
Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Uphar Chamoli
- Department of Orthopaedic Surgery,
Spine Service, St. George & Sutherland Clinical School, University of New South
Wales Australia, Kogarah, Sydney, New South Wales, Australia,School of Biomedical Engineering,
Faculty of Engineering & Information Technology, University of Technology
Sydney, Ultimo, Sydney, New South Wales, Australia,Uphar Chamoli, Spine Service, L5, Suite 16,
St. George Private Hospital, Kogarah, NSW 2217, Australia.
| | - Ashish D. Diwan
- Department of Orthopaedic Surgery,
Spine Service, St. George & Sutherland Clinical School, University of New South
Wales Australia, Kogarah, Sydney, New South Wales, Australia
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24
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DiStefano TJ, Vaso K, Danias G, Chionuma HN, Weiser JR, Iatridis JC. Extracellular Vesicles as an Emerging Treatment Option for Intervertebral Disc Degeneration: Therapeutic Potential, Translational Pathways, and Regulatory Considerations. Adv Healthc Mater 2022; 11:e2100596. [PMID: 34297485 PMCID: PMC8783929 DOI: 10.1002/adhm.202100596] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/08/2021] [Indexed: 12/14/2022]
Abstract
Emergent approaches in regenerative medicine look toward the use of extracellular vesicles (EVs) as a next-generation treatment strategy for intervertebral disc (IVD) degeneration (IVDD) because of their ability to attenuate chronic inflammation, reduce apoptosis, and stimulate proliferation in a number of tissue systems. Yet, there are no Food and Drug Administration (FDA)-approved EV therapeutics in the market with an indication for IVDD, which motivates this article to review the current state of the field and provide an IVD-specific framework to assess its efficacy. In this systematic review, 29 preclinical studies that investigate EVs in relation to the IVD are identified, and additionally, the regulatory approval process is reviewed in an effort to accelerate emerging EV-based therapeutics toward FDA submission and timeline-to-market. The majority of studies focus on nucleus pulposus responses to EV treatment, where the main findings show that stem cell-derived EVs can decelerate the progression of IVDD on the molecular, cellular, and organ level. The findings also highlight the importance of the EV parent cell's pathophysiological and differentiation state, which affects downstream treatment responses and therapeutic outcomes. This systematic review substantiates the use of EVs as a promising cell-free strategy to treat IVDD and enhance endogenous repair.
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Affiliation(s)
- Tyler J. DiStefano
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Keti Vaso
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, New York NY, USA
| | - George Danias
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Henry N. Chionuma
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Jennifer R. Weiser
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, New York NY, USA
| | - James C. Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York NY, USA
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Palmisciano P, Balasubramanian K, Scalia G, Sagoo NS, Haider AS, Bin Alamer O, Chavda V, Chaurasia B, Deora H, Passanisi M, Da Ros V, Giammalva GR, Maugeri R, Iacopino DG, Cicero S, Aoun SG, Umana GE. Posterior epidural intervertebral disc migration and sequestration: A systematic review. J Clin Neurosci 2022; 98:115-126. [PMID: 35152147 DOI: 10.1016/j.jocn.2022.01.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
Posterior epidural intervertebral disc migration and sequestration (PEIMS) is a rare and debilitating complication of degenerative disc disease. Radiological differential diagnosis is often challenging, complicating the accurate planning of appropriate treatment strategies. We systematically reviewed the literature on PEIMS, focusing on clinical-radiological features and available treatments. PubMed, Scopus, Web of Science, and Cochrane were searched to include studies reporting clinical data of patients with PEIMS. Clinical characteristics, treatment strategies, and functional outcomes were analyzed. We included 82 studies comprising 157 patients. Median age was 54 years (range, 19-91). PEIMSs occurred spontaneously (49.7%) or acutely in patients with underlying progressive degenerative disc disease (50.3%). The most common symptoms were lower-back pain (77.1%) and radiculopathy (66.2%), mainly involving the L5 nerve root (43.8%). PEIMSs were mostly detected at MRI (93%) and/or CT (7%), frequently located in the lumbar spine (81.5%). Median maximum PEIMS diameter was 2.4 cm (range, 1.2-5.0). Surgical debulking was completed in 150 patients (95.5%), sometimes coupled with decompressive laminectomy (65%) or hemilaminectomy (19.1%). Median follow-up time was 3 months (range, 0.5-36.0). Post-treatment symptomatic improvement was reported in 153 patients (97.5%), with total recovery in 118 (75.2%). All 7 patients (4.5%) who received conservative non-surgical management had total clinical recovery at ≤ 3 months follow-ups. PEIMS is a challenging entity that may severely quality-of-life in patients with degenerative disc disease. Surgical removal represents the gold standard to improve patient's functional status. Spine fusion and conservative strategies proved to be effective in some cases.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | | | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Navraj S Sagoo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ali S Haider
- Texas A&M University College of Medicine, Houston, TX, USA
| | - Othman Bin Alamer
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Vishal Chavda
- Division of Anaesthesia, Sardar Women's Hospital, Ahmedabad, Gujarat, India
| | - Bipin Chaurasia
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Maurizio Passanisi
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Valerio Da Ros
- Department of Biomedicine and Prevention, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe R Giammalva
- Unit of Neurosurgery, Department of Biomedical Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Unit of Neurosurgery, Department of Biomedical Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Domenico G Iacopino
- Unit of Neurosurgery, Department of Biomedical Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Salvatore Cicero
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy.
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26
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Li W, Zhang S, Wang D, Zhang H, Shi Q, Zhang Y, Wang M, Ding Z, Xu S, Gao B, Yan M. Exosomes Immunity Strategy: A Novel Approach for Ameliorating Intervertebral Disc Degeneration. Front Cell Dev Biol 2022; 9:822149. [PMID: 35223870 PMCID: PMC8870130 DOI: 10.3389/fcell.2021.822149] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022] Open
Abstract
Low back pain (LBP), which is one of the most severe medical and social problems globally, has affected nearly 80% of the population worldwide, and intervertebral disc degeneration (IDD) is a common musculoskeletal disorder that happens to be the primary trigger of LBP. The pathology of IDD is based on the impaired homeostasis of catabolism and anabolism in the extracellular matrix (ECM), uncontrolled activation of immunologic cascades, dysfunction, and loss of nucleus pulposus (NP) cells in addition to dynamic cellular and biochemical alterations in the microenvironment of intervertebral disc (IVD). Currently, the main therapeutic approach regarding IDD is surgical intervention, but it could not considerably cure IDD. Exosomes, extracellular vesicles with a diameter of 30–150 nm, are secreted by various kinds of cell types like stem cells, tumor cells, immune cells, and endothelial cells; the lipid bilayer of the exosomes protects them from ribonuclease degradation and helps improve their biological efficiency in recipient cells. Increasing lines of evidence have reported the promising applications of exosomes in immunological diseases, and regarded exosomes as a potential therapeutic source for IDD. This review focuses on clarifying novel therapies based on exosomes derived from different cell sources and the essential roles of exosomes in regulating IDD, especially the immunologic strategy.
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Affiliation(s)
- Weihang Li
- Department of Orthopedic Surgery, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Shilei Zhang
- Department of Orthopedic Surgery, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Dong Wang
- Department of Orthopedic Surgery, Xijing Hospital, Air Force Medical University, Xi’an, China
- Department of Orthopaedics, Affiliated Hospital of Yanan University, Yanan, China
| | - Huan Zhang
- Department of Orthopedic Surgery, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Quan Shi
- Department of Orthopedic Surgery, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Yuyuan Zhang
- Department of Critical Care Medicine, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Mo Wang
- The First Brigade of Basic Medical College, Air Force Military Medical University, Xi’an, China
| | - Ziyi Ding
- Department of Orthopedic Surgery, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Songjie Xu
- Beijing Luhe Hospital, Capital Medical University, Beijing, China
- *Correspondence: Songjie Xu, ; Bo Gao, ; Ming Yan,
| | - Bo Gao
- Department of Orthopedic Surgery, Xijing Hospital, Air Force Medical University, Xi’an, China
- *Correspondence: Songjie Xu, ; Bo Gao, ; Ming Yan,
| | - Ming Yan
- Department of Orthopedic Surgery, Xijing Hospital, Air Force Medical University, Xi’an, China
- *Correspondence: Songjie Xu, ; Bo Gao, ; Ming Yan,
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27
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Lan X, Wang Z, Huang Y, Ni Y, He Y, Wang X, Wu C, Hu R, Han R, Guo G, Li Z, Zhang X, Zhang J, Liao Q, Huang D, Zhou H. Clinical and Radiological Comparisons of Percutaneous Low-Power Laser Discectomy and Low-Temperature Plasma Radiofrequency Ablation for Cervical Radiculopathy: A Prospective, Multicenter, Cohort Study. Front Surg 2022; 8:779480. [PMID: 35223967 PMCID: PMC8863912 DOI: 10.3389/fsurg.2021.779480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background Minimally invasive techniques, such as percutaneous low-power laser discectomy (PLLD) and low-temperature plasma radiofrequency ablation (coblation) can be applied to treat degenerative cervical radiculopathy. However, less evidence supports the superiority of distinct minimally-invasive therapy. Our study aimed to evaluate the clinical and radiological characteristics of the PLLD and coblation for cervical radiculopathy. Methods This was a prospective, multicenter, cohort study (ChiCTR-ONC-17010356). The modified Macnab criteria was performed to assess the clinical improvement pre- and post-surgery. To evaluate the radiological effect, the Pfirrmann grading system and disk herniation index were applied with MRI. Results In this study, 28 patients were enrolled in the coblation group and 30 patients in the PLLD group. The mean good-excellent rate at 3-month follow-up was 82.1% for PLLD group, and 66.7% for coblation group, respectively (p = 0.179). The PLLD group achieved higher good-excellent rate 6 and 12 months after discharge (92.9 vs. 70.0%, p = 0.026). Radiological data revealed that PLLD but not coblation treatment achieved significant reduction of disk herniation index (p < 0.0001). Coblation treatment did not change the Pfirrmann grades of cervical radiculopathy patients (n = 18), and 7 out of 17 (41.2%) patients achieved improvement after PLLD therapy. None obvious adverse event was observed in this study. Conclusion Both PLLD and coblation are effective and safe option for patients with cervical radiculopathy. Better long-term clinical outcomes may be potentially associated with the improvement of disk degeneration after PLLD treatment.
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Affiliation(s)
- Xueqin Lan
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Department of Anesthesiology, The Affiliated Changsha Central Hospital, University of South China, Changsha, China
| | - Ziyang Wang
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuzhao Huang
- Department of Orthopedics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuncheng Ni
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yunwu He
- Department of Pain, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Xiaofeng Wang
- Department of Pain, Hunan Aerospace Hospital, Changsha, China
| | - Chunsheng Wu
- Department of Pain, People's Hospital of Xiangxi Prefecture, Jishou University, Jishou, China
| | - Rong Hu
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Rui Han
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Gangwen Guo
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhenxing Li
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xuan Zhang
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jianping Zhang
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qin Liao
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Dong Huang
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
- *Correspondence: Dong Huang
| | - Haocheng Zhou
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
- Haocheng Zhou
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Characteristics of lumbar disc degeneration and risk factors for collapsed lumbar disc in Korean farmers and fishers. Ann Occup Environ Med 2021; 33:e16. [PMID: 34754477 PMCID: PMC8203835 DOI: 10.35371/aoem.2021.33.e16] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/07/2021] [Indexed: 11/20/2022] Open
Abstract
Background Few studies have investigated the risk factors for lumbar intervertebral disc degeneration among hard physical workers involved in heavy lifting. In this study, we aimed to identify the characteristics of lumbar intervertebral disc degeneration and evaluate the relationship between collapsed lumbar disc and potential risk factors in farmers and fishers. Methods This study included 203 farmers (103 men and 100 women) and 166 fishers (95 men and 71 women) aged 40–69 years who had undergone lumbar magnetic resonance imaging and were enrolled in the Korea Farmer's Knee Cohort and the Jeonnam Fishers' Cohort. We evaluated each of the 5 lumbar discs using the Pfirrmann grading system and classified collapsed lumbar intervertebral disc (cLD) as a case with ≥ 1 grade 5 at any disc level. We investigated potential risk factors, such as gender, age, body mass index (BMI), working hours per day, working months per year, and cumulative heavy lifting working time (CLWT). The odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated. Results The prevalence of cLD was 19.8% (23.7% among fishers, 21.2% among fishers with farming, and 17.2% among farmers). cLD correlated with factors such as age and occupation. Gender, CLWT and the working time matrix were not significantly associated with cLD. The OR of cLD adjusted by gender, age, BMI, and working time matrix was 1.26 (95% CI: 0.69–2.30) for ≥ 5,000 hours CLWT compared to that for < 2,000 hours CLWT. The OR of cLD adjusted by gender, age, BMI, CLWT, and working time matrix was 2.08 (95% CI: 1.06–4.06) for fishers compared to that for farmers. Conclusions Heavy lifting did not show a significant association with cLD in farmers and fishers. However, there is possibility that fishers are at a higher risk of lumbar disc collapse than farmers.
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Lo WC, Chen YT, Chen CC. The Effects of Elgucare on Degenerated Intervertebral Disc-Induced Low Back Pain and Disc Regeneration: A Clinical Trial. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5824956. [PMID: 34790253 PMCID: PMC8592736 DOI: 10.1155/2021/5824956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Chronic low back pain (LBP) has a wide range of causes. However, most cases are induced by degeneration of the lumbar intervertebral discs (IVDs), and the aching caused by local compression of the affected region has considerable impacts on quality of life. This clinical trial investigated the use of Elgucare, a Chinese herbal formula, as a food supplement to reduce the pain of patients with LBP induced by degeneration of the lumbar IVDs. METHODS The study assessed patient subjective quality of life, functional limitations caused by LBP, and variations in pain. The assessment was done through the visual analogue scale (VAS) and effects on lumbar IVD thickness, water content, and bone mineral density (BMD). These parameters were evaluated before and after the administration of Elgucare or a placebo, one of which was taken by each participant for a 12-month period. RESULTS Elgucare reduced the patients' mean VAS pain score by 2.25 points and improved their mean LBP-hampered mobility as assessed by the Roland-Morris Questionnaire by 5.17 points. The results of another questionnaire indicated that Elgucare slowed the LBP-induced deterioration of patients' quality of life, while objective assessment indices obtained through X-ray and magnetic resonance imaging showed that the height and water retention of their IVDs were increased. However, the BMD results showed no improvements. CONCLUSIONS Elgucare can increase the water retention and height of IVDs and reduce LBP, thereby enhancing quality of life. Therefore, Elgucare can potentially be used as a clinical supplement.
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Affiliation(s)
- Wen-Cheng Lo
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu Ting Chen
- Research and Development of DC Botanical Biotechnology CO., LTD, LDY Chinese Medicine Hospital, New Taipei City, Taiwan
| | - Chen Ching Chen
- DC Botanical Biotechnology CO., LTD, LDY Chinese Medicine Hospital, New Taipei City, Taiwan
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Hashmi MR, Riaz M. Diagnosis of lumbar degenerative disc disease by using Lp-spaces related to generalized interval-valued m-polar neutrosophic choquet integral Operator. INT J BIOMATH 2021. [DOI: 10.1142/s1793524521500637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Innovative and astonishing developments in the field of spine analysis can commence with this manuscript. The lumbar disks ([Formula: see text] to [Formula: see text]) are most commonly impaired by degeneration due to their long-standing degeneration and associated strain. We investigate the indications, purposes, risk factors, and therapies of lumbar degenerated disc disease (L-DDD). We assume that the degeneration of five discs creates many effects, making it difficult to differentiate between the different types of degenerated discs and their seriousness. Since the indeterminacy and falsity portions of science or clinical diagnosis are often ignored. Due to this complexity, the reliability of the patient’s progress report cannot be calculated, nor can the period of therapy be measured. The revolutionary concept of interval-valued m-polar neutrosophic Choquet integral aggregation operator (IVmPNCIAO) is proposed to eliminate these problems. We associate generalized interval-valued m-polar neutrosophic Choquet integral aggregation operator (GIVmPNCIAO) with the statistical formulation of [Formula: see text]-spaces and use it to identify the actual kind of degenerative disc in the lumbar spine. For the classification of interval-valued m-polar neutrosophic numbers (IVMPNNs), we set the ranking index and score function. These concepts are appropriate and necessary in order to better diagnose degeneration by associating it with mathematical modeling. We construct a pre-diagnosis map based on the fuzzy interval [Formula: see text] to classify the types of degenerative discs. We develop an algorithm by using GIVmPNCIAO based on interval-valued m-polar neutrosophic sets (IVMPNNs) to identify the degenerative disc appropriately and to choose the most exquisite treatment for the corresponding degeneration of every patient. Furthermore, we discuss the sensitivity analysis with parameter [Formula: see text] in GIVmPNCIAO to investigate the patient’s improvement record.
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Affiliation(s)
| | - Muhammad Riaz
- Department of Mathematics, University of the Punjab, Lahore, Pakistan
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Krut Z, Pelled G, Gazit D, Gazit Z. Stem Cells and Exosomes: New Therapies for Intervertebral Disc Degeneration. Cells 2021; 10:cells10092241. [PMID: 34571890 PMCID: PMC8471333 DOI: 10.3390/cells10092241] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 12/12/2022] Open
Abstract
Intervertebral disc degeneration (IVDD) occurs as a result of an imbalance of the anabolic and catabolic processes in the intervertebral disc, leading to an alteration in the composition of the extracellular matrix (ECM), loss of nucleus pulposus (NP) cells, excessive oxidative stress and inflammation. Degeneration of the IVD occurs naturally with age, but mechanical trauma, lifestyle factors and certain genetic abnormalities can increase the likelihood of symptomatic disease progression. IVDD, often referred to as degenerative disc disease (DDD), poses an increasingly substantial financial burden due to the aging population and increasing incidence of obesity in the United States. Current treatments for IVDD include pharmacological and surgical interventions, but these lack the ability to stop the progression of disease and restore the functionality of the IVD. Biological therapies have been evaluated but show varying degrees of efficacy in reversing disc degeneration long-term. Stem cell-based therapies have shown promising results in the regeneration of the IVD, but face both biological and ethical limitations. Exosomes play an important role in intercellular communication, and stem cell-derived exosomes have been shown to maintain the therapeutic benefit of their origin cells without the associated risks. This review highlights the current state of research on the use of stem-cell derived exosomes in the treatment of IVDD.
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Affiliation(s)
- Zoe Krut
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (Z.K.); (G.P.); (D.G.)
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Gadi Pelled
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (Z.K.); (G.P.); (D.G.)
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Dan Gazit
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (Z.K.); (G.P.); (D.G.)
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Zulma Gazit
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (Z.K.); (G.P.); (D.G.)
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Correspondence:
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Akinola BK, Abiodun AA. Intervertebral Disk Degeneration in Rabbits: Histomorphometric and Histomorphological Effects of Aloe Vera Gel. Global Spine J 2021; 11:852-858. [PMID: 32677517 PMCID: PMC8258827 DOI: 10.1177/2192568220927712] [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] [Indexed: 12/02/2022] Open
Abstract
STUDY DESIGN This is an experimental study using an animal model. OBJECTIVES Disk degeneration is a common cause of low back pain. However, few attempts have been made to proffer a medical solution. The aim of this study was to investigate the effect of aloe vera gel (AVG) on the histomorphometric changes in the intervertebral disk of annular-punctured rabbits. METHODS A total of 25 rabbits weighing 1.0 to 3.5 kg were used for this study; 20 rabbits were subjected to annular puncture of the L3/L4, L4/L5, and L5/L6 disks using an 18G needle. Five rabbits were randomly assigned to 5 groups (A, B, C, D, and E) of 5 animals per group. Group A was not punctured. Group B was punctured. Groups C, D, and E were punctured and given 600 400, and 200 (mg/kg) of AVG orally, respectively. The disk histology and nucleus pulposus cell count were done 6 weeks after the puncture procedure. RESULTS The results revealed a gradual reversal of degenerative changes in the treated groups compared with the nontreated groups (P < .05). The observed changes in the organization of the elastic and collagen content, increase in fibrochondrocyte-like cells of the nucleus pulposus and annulus fibrosus (P = .0027), and the degree of degeneration of the disk (P = .0001) in the treated groups compared with the nontreated groups were statistically significant. CONCLUSION Administration of AVG halted and reversed disk degeneration in an annular puncture-induced disk degeneration rabbit model.
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Affiliation(s)
- Busuyi Kolade Akinola
- Federal University of Technology, Akure, Nigeria,Busuyi Kolade Akinola, Department of Human Anatomy, Federal University of Technology, Akure, Ondo +234, Nigeria.
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Chi KY, Cheng SH, Kuo YK, Lin EY, Kang YN. Safety of Lumbar Interbody Fusion Procedures for Degenerative Disc Disease: A Systematic Review With Network Meta-Analysis of Prospective Studies. Global Spine J 2021; 11:751-760. [PMID: 32720524 PMCID: PMC8165923 DOI: 10.1177/2192568220938024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
STUDY DESIGN A network meta-analysis. OBJECTIVES Lumbar degenerative disc disease (LDDD) is an important issue in aging population, for which lumbar interbody fusion (LIF) is a feasible management in cases refractory to conservative therapy. There are various techniques available to perform LIF, including posterior (PLIF), transforaminal (TLIF), and anterior (ALIF) approaches. However, the comparative safety profile of these procedures remains controversial. Our study aimed to evaluate comparative adverse events of the LIF procedures in patients with LDDD. METHODS We searched 5 databases for relevant prospective cohort studies and randomized clinical trials. After quality assessments, we extracted neural, spinal, vascular, and wound events for conducting contrast-based network meta-analysis. Results were reported in risk ratio (RR), 95% confidence interval (CI), and surface under the cumulative ranking (SUCRA). RESULTS We identified 14 studies involving 921 participants with LDDD. Pooled result showed that open PLIF (OPLIF) leads to significantly higher overall adverse event rate than does open TLIF (OTLIF; RR = 3.43, 95% CI = 1.21-9.73). OTLIF confers the highest SUCRA in neural (78.7) and spinal (80.8) event rates. Minimally invasive TLIF has the highest SUCRA in vascular event (84.2), and minimally invasive PLIF has the highest SUCRA in wound event (88.1). No inconsistency or publication bias was detected in the results. CONCLUSIONS Based on our results, perhaps OPLIF should be avoided in the management of LDDD due to the inferiority of overall complications. Specifically, TLIF seems to have the safest profile in terms of neural, spinal, and vascular events. Nevertheless, shared decision making is still mandatory when choosing the proper LIF procedure for patients with LDDD in clinical practice.
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Affiliation(s)
| | - Shih-Hao Cheng
- Wan Fang Hospital, Taipei Medical University, Taipei,Cheng Hsin General Hospital, Taipei
| | | | - En-Yuan Lin
- Taipei Medical University, Taipei,Taiwan Adventist Hospital, Taipei,Yi-No Kang, Taipei Municipal Wan-Fang Hospital, No. 111, Section 3, Xing-Long Road, Taipei 116.
| | - Yi-No Kang
- Wan Fang Hospital, Taipei Medical University, Taipei,Taipei Medical University, Taipei,National Taiwan University, Taipei,En-Yuan Lin, Taiwan Adventist Hospital, Taipei.
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Wang X, Gawri R, Lei C, Lee J, Sowa G, Kandel R, Vo N. Inorganic polyphosphates stimulates matrix production in human annulus fibrosus cells. JOR Spine 2021; 4:e1143. [PMID: 34337332 PMCID: PMC8313173 DOI: 10.1002/jsp2.1143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/20/2021] [Accepted: 02/13/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Ubiquitously found in all life forms, inorganic polyphosphates (polyP) are linear polymers of repeated orthophosphate units. Present in intervertebral disc tissue, polyP was previously shown to increase extracellular matrix production in nucleus pulposus (NP) cells. However, the effects of polyP on human annulus fibrosus (hAF) cell metabolism is not known. METHODS AND RESULTS Here, hAF cells cultured in the presence of 0.5 to 1 mM polyP, chain length 22 (polyP-22), showed an increase in glycosaminoglycan content, proteoglycan and collagen synthesis, and aggrecan and collagen type 1 gene expression. Gene expression level of matrix metalloproteinases 1 was reduced while matrix metalloproteinases 3 level was increased in hAF cells treated with 1 mM polyP. Adenosine triphosphate (ATP) synthesis was also significantly increased in hAF cell culture 72 hours after the exposure to 1 mM polyP-22. CONCLUSIONS PolyP thus has both anabolic and bioenergetic effects in AF cells, similar to that observed in NP cells. Together, these results suggest polyP as a potential energy source and a metabolic regulator of disc cells.
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Affiliation(s)
- Xiangjiang Wang
- McGowan Institute for Regenerative MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Orthopaedic SurgeryThe Sixth Affiliated Hospital of Guangzhou Medical UniversityQingyuanChina
- Department of OrthopedicsThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Rahul Gawri
- Lunenfeld‐Tanenbaum Research InstituteMount Sinai HospitalTorontoCanada
- Pathology and Laboratory MedicineMount Sinai HospitalTorontoCanada
- Laboratory Medicine and PathobiologyUniversity of TorontoTorontoCanada
- Institute of Biomaterials and Biomedical EngineeringUniversity of TorontoTorontoCanada
| | - Changbin Lei
- Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Orthopaedic SurgeryAffiliated Hospital of Xiangnan UniversityChenzhouChina
- Department of Clinical Medical Research CenterAffiliated Hospital of Xiangnan UniversityChenzhouChina
| | - Joon Lee
- McGowan Institute for Regenerative MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Gwendolyn Sowa
- Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Physical Medicine and RehabilitationUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Rita Kandel
- Lunenfeld‐Tanenbaum Research InstituteMount Sinai HospitalTorontoCanada
- Pathology and Laboratory MedicineMount Sinai HospitalTorontoCanada
- Laboratory Medicine and PathobiologyUniversity of TorontoTorontoCanada
| | - Nam Vo
- McGowan Institute for Regenerative MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of PathologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
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Intervertebral Disc Degeneration Induced by Needle Puncture and Ovariectomy: A Rat Coccygeal Model. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5510124. [PMID: 34055972 PMCID: PMC8147532 DOI: 10.1155/2021/5510124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/01/2021] [Accepted: 05/07/2021] [Indexed: 12/25/2022]
Abstract
Objectives To establish a novel animal model of intervertebral disc degeneration (IVDD) in rats and to investigate the effect of 17β-estradiol (E2) intervention in this model. Methods This study was divided into two parts: animal model (four groups: Sham, ovariectomy (OVX), Puncture, and OVX+Puncture; three-time points: 4, 8, and 12 weeks; three female rats/group/time point) and drug intervention (Sham, OVX+Puncture+corn oil, and OVX+Puncture+E2; three female rats/group). The rats were analyzed by micromagnetic resonance imaging (MRI), hematoxylin and eosin (HE) staining, and safranin-O staining. Results MRI and histological scores significantly differed among the four groups at the three-time points (all P < 0.05). IVDD progressed with time in the OVX, Puncture, and OVX+Puncture groups (all P < 0.05). The changes were the most obvious in the OVX+Puncture group. In the E2 intervention part, the Veh group had the worst MRI signals and histological scores (P < 0.05). The MRI scores in the E2 group were less obvious compared to the Sham group (P > 0.05). Also, the histological scores were significantly different between the Sham and E2 groups (P < 0.05). Conclusions The combination of ovariectomy and needle puncture can synergically induce IVDD in rat coccygeal discs. Estrogen treatment can effectively ameliorate IVDD progression in the newly established IVDD models.
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Jain D, Goyal T, Verma N, Paswan AK, Dubey RK. Intradiscal Platelet-Rich Plasma Injection for Discogenic Low Back Pain and Correlation with Platelet Concentration: A Prospective Clinical Trial. PAIN MEDICINE 2021; 21:2719-2725. [PMID: 32869064 DOI: 10.1093/pm/pnaa254] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Discogenic pain is common cause of low back ache and may result in significant morbidity. Platelet-rich plasma (PRP) is an upcoming regenerative therapy that has treatment potential for this condition. The objective of this study was to correlate platelet concentration in intradiscal PRP injection with improvement in low back pain and functional status at three and six months. DESIGN Prospective single-arm interventional study. SETTING Outpatient pain clinic and operation theater. SUBJECTS Twenty-five patients with discogenic pain diagnosed by clinical means and imaging with confirmation by provocative discography were recruited. METHODS The patients received PRP injection at a single or multiple disc levels. Preprocedure numerical rating scale (NRS) pain scores and Oswestry Disability Index (ODI) scores were calculated. Platelet counts of patients and PRP samples were measured. At three and six months postprocedure, NRS and ODI scores were measured, and improvement in these scores was correlated with platelet concentrations in the PRP sample. RESULTS Twenty patients completed the study. The improvement in NRS and ODI scores positively correlated with platelet concentrations in the PRP sample. We determined the correlation coefficient (r) of platelet concentrations with a reduction in NRS at three months (r = 0.65) and six months (r = 0.73) and in ODI score at three months (r = 0.72) and six months (r = 0.7). CONCLUSIONS This study supports the use of intradiscal PRP for treatment of discogenic pain with preferably higher platelet counts to elicit a favorable response.
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Affiliation(s)
- Dhruv Jain
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Titiksha Goyal
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Nimisha Verma
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anil Kumar Paswan
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rajeev Kumar Dubey
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Zhang W, Wang H, Yuan Z, Chu G, Sun H, Yu Z, Liang H, Liu T, Zhou F, Li B. Moderate mechanical stimulation rescues degenerative annulus fibrosus by suppressing caveolin-1 mediated pro-inflammatory signaling pathway. Int J Biol Sci 2021; 17:1395-1412. [PMID: 33867854 PMCID: PMC8040478 DOI: 10.7150/ijbs.57774] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/22/2021] [Indexed: 12/29/2022] Open
Abstract
Mechanical loading can induce or antagonize the extracellular matrix (ECM) synthesis, proliferation, migration, and inflammatory responses of annulus fibrosus cells (AFCs), depending on the loading mode and level. Caveolin-1 (Cav1), the core protein of caveolae, plays an important role in cellular mechanotransduction and inflammatory responses. In the present study, we presented that AFCs demonstrated different behaviors when subjected to cyclic tensile strain (CTS) for 24 h at a magnitude of 0%, 2%, 5% and 12%, respectively. It was found that 5% CTS had positive effects on cell proliferation, migration and anabolism, while 12% CTS had the opposite effects. Besides, cells exposed to interleukin-1β stimulus exhibited an increase expression in inflammatory genes, and the expression of these genes decreased after exposure to moderate mechanical loading with 5% CTS. In addition, 5% CTS decreased the level of Cav1 and integrin β1 and exhibited anti-inflammatory effects. Moreover, the expression of integrin β1 and p-p65 increased in AFCs transfected with Cav1 plasmids. In vivo results revealed that moderate mechanical stimulation could recover the water content and morphology of the discs. In conclusion, moderate mechanical stimulation restrained Cav1-mediated signaling pathway and exhibited anti-inflammatory effects on AFCs. Together with in vivo results, this study expounds the underlying molecular mechanisms on the effect of moderate mechanical stimulation on intervertebral discs (IVDs) and may provide a new therapeutic strategy for the treatment of IVD degeneration.
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Affiliation(s)
- Weidong Zhang
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Huan Wang
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Zhangqin Yuan
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Genglei Chu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Heng Sun
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Zilin Yu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Huan Liang
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Tao Liu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Feng Zhou
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Bin Li
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China.,China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, Zhejiang, China
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Kilitci A, Asan Z, Yuceer A, Aykanat O, Durna F. Comparison of the histopathological differences between the spinal material and posterior longitudinal ligament in patients with lumbar disc herniation: A focus on the etiopathogenesis. Ann Saudi Med 2021; 41:115-120. [PMID: 33818148 PMCID: PMC8020649 DOI: 10.5144/0256-4947.2021.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Lumbar disc herniation (LDH) occurs owing to the inability of the posterior longitudinal ligament (PLL) to preserve the disc material within the intervertebral space. There is apparently no study that has investigated the histopathological changes occurring in both PLL and disc material in patients with LDH. OBJECTIVE Investigate and compare the histopathological changes occurring in PLL and disc material of the patients who underwent a surgical operation for LDH. DESIGN Descriptive, cross-sectional. SETTING Pathology and neurosurgery departments of a tertiary health care institution PATIENTS AND METHODS: The study included patients who underwent surgical operation for LDH from January 2018 to May 2019 and whose PLL and disc material were removed together, and had disc degeneration findings that were radiologically and histologically concordant. MAIN OUTCOME MEASURES PLL degeneration scores according to the histopathological findings, changes in disc materials according to the MRI findings, disc degeneration scores according to the histo-pathological findings. SAMPLE SIZE 50. RESULTS MRI and histological examinations showed fully degenerated black discs (Grade 2) in 12 patients, partially degenerated discs (Grade 1) in 29 patients and fresh/acute discs (Grade 0) in 9 patients. The PLL showed grade 0 degeneration in 2 patients, grade 1 degeneration in 23 patients, and grade 2 degeneration in 25 patients. PLL degeneration grades were higher than the disc degeneration grades (P=.002). CONCLUSION Longitudinal ligament degeneration can play a significant role in the pathogenesis of LDH. To the best of our knowledge, this study represents the first to focus on the histopathological changes occurring in both the PLL and disc material in patients with LDH. LIMITATIONS Small sample, retrospective CONFLICT OF INTEREST: None.
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Affiliation(s)
- Asuman Kilitci
- From the Department of Pathology, Faculty of Medicine, Ahi Evran University, Kirsehir, Turkey
| | - Ziya Asan
- From the Department of Neurosurgery, Ahi Evran University, Kirsehir 40100, Turkey
| | - Abdulbaki Yuceer
- From the Department of Neurosurgery, Ahi Evran University, Kirsehir 40100, Turkey
| | - Omer Aykanat
- From the Department of Neurosurgery, Ahi Evran University, Kirsehir 40100, Turkey
| | - Fatih Durna
- From the Department of Neurosurgery, Ahi Evran University, Kirsehir 40100, Turkey
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Niu S, Zhai X, Chen Y, Yang H, Yang C, Li M. Optimal indicators for identification of compensatory sagittal balance in patients with degenerative disc disease. BMC Musculoskelet Disord 2021; 22:211. [PMID: 33612102 PMCID: PMC7898748 DOI: 10.1186/s12891-021-04063-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/20/2021] [Indexed: 01/20/2023] Open
Abstract
Study design A retrospective study. Background To determine whether radiological parameters such as maximal lumbar lordosis-maximal thoracic kyphosis (maxLL-maxTK), sacral slope-pelvic tilt(SS-PT) and sacral slope/pelvic tilt (SS/PT) could be used as indicators for the diagnosis of degenerative disc disease (DDD) in compensatory sagittal balanced patients. Methods Medical records of sagittal balanced DDD patients and asymptomatic adults within our hospital registry from July 2019 to November 2019 were reviewed. General characteristics and radiological parameters were evaluated between the two groups. Analysis of covariance with age as a covariate was conducted, followed by receiver operating characteristic (ROC) analysis and areas under the curve (AUC) calculation. The max Youden index was calculated to identify the optimal sensitivity specificity pairs. Results A total of 42 DDD patients and 199 asymptomatic adults were included. For those parameters that showed significant differences between the two groups, AUC for SS/PT and SS-PT were the largest, reaching 0.919 and 0.936, respectively. The sensitivity was 0.749, the specificity was 0.952 and the max Youden index was 0.701 when SS/PT = 1.635 was used as threshold. The max Youden index was found for a threshold of SS-PT =8.500, for which the sensitivity increased to 0.854, while the specificity decreased to 0.857. Conclusions Both SS/PT and SS-PT were significantly different between sagittal balanced DDD patients and asymptomatic adults. SS/PT < 1.6 and SS-PT < 8.5 could be used as indicators for the diagnosis of DDD patients with compensatory sagittal balance.
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Affiliation(s)
- Shengbo Niu
- Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xiao Zhai
- Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yuanyuan Chen
- Reproductive Medicine Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Huan Yang
- Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Changwei Yang
- Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, China.
| | - Ming Li
- Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, China.
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Xu H, Qi G, Li K, Yang K, Luo D, Cai Z. Impact of NF-κB pathway on the intervertebral disc inflammation and degeneration induced by over-mechanical stretching stress. JOURNAL OF INFLAMMATION-LONDON 2021; 18:6. [PMID: 33531032 PMCID: PMC7851949 DOI: 10.1186/s12950-021-00273-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/22/2021] [Indexed: 12/21/2022]
Abstract
Background Intervertebral disk degeneration (IVDD) contributes to low back pain. Increased cell apoptosis and inflammation, decreased extracellular matrix are associated with IVDD. Nuclear factor-kappa B (NF-κB) signaling pathway and inflammatory cytokines are implicated in the pathophysiology of IVDD. Methods In present study, we established a mechanical stretching stress-stimulated nucleus pulposus (NP) cell model. We knocked down NF-κB p65 by siRNA transfection to inhibit NF-κB and evaluated the effects of NF-κB inhibition on intervertebral disk degeneration. We applied the mechanical stretching stress on NP cells and inhibited NF-κB by siRNA, then evaluated the expression of inflammatory cytokines, matrix metalloproteinase (MMP), aggrecan, collagen II, and monitored viability and apoptosis of NP cells. Results Mechanical stretching stress induced the expression of TNF-α, IL-1β, NF-κB, MMP-3 and MMP-13, while inhibited the production of aggrecan and collagen II in NP cells. Mechanical stretching stress decreased the cell viability and induced apoptosis in NP cells. Inhibition of NF-κB by siRNA suppressed the production of TNF-α, IL-1β, NF-κB, MMP-3 and MMP-13, while upregulated the expression of aggrecan and collagen II in NP cells. Conclusions Inhibition of NF-κB by knocking down p65 suppressed over-mechanical stretching stress-induced cell apoptosis and promoted viability in NP cell. Inhibition of NF-κB suppressed inflammation and degeneration of NP cells in IVDD.
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Affiliation(s)
- Hui Xu
- Department of Spinal Surgery, Liaocheng People's Hospital, No. 67, Dongchang Xilu Road, 252000, Liaocheng, Shandong, China
| | - Guobao Qi
- Department of Spinal Surgery, Dongying People's Hospital, No. 317, Nanyi Road, 257091, Dongying, Shandong, China
| | - Kunpeng Li
- Department of Spinal Surgery, Liaocheng People's Hospital, No. 67, Dongchang Xilu Road, 252000, Liaocheng, Shandong, China
| | - Keshi Yang
- Department of Spinal Surgery, Liaocheng People's Hospital, No. 67, Dongchang Xilu Road, 252000, Liaocheng, Shandong, China
| | - Dawei Luo
- Department of Spinal Surgery, Liaocheng People's Hospital, No. 67, Dongchang Xilu Road, 252000, Liaocheng, Shandong, China
| | - Zhongxu Cai
- Department of Spinal Surgery, Dongying People's Hospital, No. 317, Nanyi Road, 257091, Dongying, Shandong, China.
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Guo Z, Qiu C, Mecca C, Zhang Y, Bian J, Wang Y, Wu X, Wang T, Su W, Li X, Zhang W, Chen B, Xiang H. Elevated lymphotoxin-α (TNFβ) is associated with intervertebral disc degeneration. BMC Musculoskelet Disord 2021; 22:77. [PMID: 33441130 PMCID: PMC7807514 DOI: 10.1186/s12891-020-03934-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background Intervertebral disc degeneration (IVDD) is a primary cause of degenerative disc diseases; however, the mechanisms underlying the degeneration remain unclear. The immunoinflammatory response plays an important role in IVDD progression. The inflammatory cytokine lymphotoxin-α (LTα), formerly known as TNFβ, is associated with various pathological conditions, while its role in the pathogenesis of IVDD remains elusive. Methods Real-time quantitative polymerase chain reaction (RT-qPCR), Western blotting (WB), and enzyme-linked immunosorbent assays were used to assess the levels of LTα in human nucleus pulposus (NP) tissues between degeneration and control groups. The plasma concentrations of LTα and C-reactive protein (CRP) were compared between healthy and IVDD patients. Rat primary NP cells were cultured and identified via immunofluorescence. Methyl-thiazolyl-tetrazolium assays and flow cytometry were used to evaluate the effects of LTα on rat NP cell viability. After NP cells were treated with LTα, degeneration-related molecules (Caspase-3, Caspase-1, matrix metalloproteinase (MMP) -3, aggrecan and type II collagen) were measured via RT-qPCR and WB. Results The levels of both the mRNA and protein of LTα in human degenerated NP tissue significantly increased. Plasma LTα and CRP did not differ between healthy controls and IVDD patients. Rat primary NP cells were cultured, and the purity of primary NP cells was > 90%. Cell experiments showed inversely proportional relationships among the LTα dose, treatment time, and cell viability. The optimal conditions (dose and time) for LTα treatment to induce rat NP cell degeneration were 5 μg/ml and 48 ~ 72 h. The apoptosis rate and the levels of Caspase-3, Caspase-1, and MMP-3 significantly increased after LTα treatment, while the levels of type II collagen and aggrecan were decreased, and the protein expression levels were consistent with their mRNA expression levels. Conclusions This study demonstrated that elevated LTα is closely associated with IVDD and that LTα may induce NP cell apoptosis and reduce important extracellular matrix (ECM) proteins, which cause adverse effects on IVDD progress. Moreover, the optimal conditions for LTα treatment to induce NP cell degeneration were determined. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03934-7.
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Affiliation(s)
- Zhu Guo
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Chensheng Qiu
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.,Department of Orthopedic Surgery, Qingdao Municipal Hospital (Group), Qingdao, 266011, Shandong, China
| | - Christina Mecca
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Yang Zhang
- Department of Spine Surgery, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Jiang Bian
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266000, Shandong, China
| | - Yan Wang
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Xiaolin Wu
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Tianrui Wang
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Weiliang Su
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Xianglin Li
- School of Medical Imaging, Bin Zhou Medical University, Yantai, 264003, China
| | - Wei Zhang
- School of Medical Imaging, Bin Zhou Medical University, Yantai, 264003, China
| | - Bohua Chen
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
| | - Hongfei Xiang
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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Bivona LJ, Camacho JE, Usmani F, Nash A, Bruckner JJ, Hughes M, Bhandutia AK, Koh EY, Banagan KE, Gelb DE, Ludwig SC. The Prevalence of Bacterial Infection in Patients Undergoing Elective ACDF for Degenerative Cervical Spine Conditions: A Prospective Cohort Study With Contaminant Control. Global Spine J 2021; 11:13-20. [PMID: 32875844 PMCID: PMC7734272 DOI: 10.1177/2192568219888179] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES To determine the prevalence of bacterial infection, with the use of a contaminant control, in patients undergoing anterior cervical discectomy and fusion (ACDF). METHODS After institutional review board approval, patients undergoing elective ACDF were prospectively enrolled. Samples of the longus colli muscle and disc tissue were obtained. The tissue was then homogenized, gram stained, and cultured in both aerobic and anaerobic medium. Patients were classified into 4 groups depending on culture results. Demographic, preoperative, and postoperative factors were evaluated. RESULTS Ninety-six patients were enrolled, 41.7% were males with an average age of 54 ± 11 years and a body mass index of 29.7 ± 5.9 kg/m2. Seventeen patients (17.7%) were considered true positives, having a negative control and positive disc culture. Otherwise, no significant differences in culture positivity was found between groups of patients. However, our results show that patients were more likely to have both control and disc negative than being a true positive (odds ratio = 6.2, 95% confidence interval = 2.5-14.6). Propionibacterium acnes was the most commonly identified bacteria. Two patients with disc positive cultures returned to the operating room secondary to pseudarthrosis; however, age, body mass index, prior spine surgery or injection, postoperative infection, and reoperations were not associated with culture results. CONCLUSION In our cohort, the prevalence of subclinical bacterial infection in patients undergoing ACDF was 17.7%. While our rates exclude patients with positive contaminant control, the possibility of contamination of disc cultures could not be entirely rejected. Overall, culture results did not have any influence on postoperative outcomes.
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Affiliation(s)
- Louis J. Bivona
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jael E. Camacho
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Farooq Usmani
- Department of General Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Alysa Nash
- Department of Orthopaedics, University of North Carolina at Chapel Hill, NC, USA
| | - Jacob J. Bruckner
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Meghan Hughes
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amit K. Bhandutia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eugene Y. Koh
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kelley E. Banagan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel E. Gelb
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven C. Ludwig
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA,Steven C. Ludwig, Department of Orthopaedics, University of Maryland, 110 South Paca Street, 6th Floor, Suite 300, Baltimore, MD 21201, USA.
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Sun Z, Zhao H, Liu B, Gao Y, Tang WH, Liu ZH, Luo ZJ. AF cell derived exosomes regulate endothelial cell migration and inflammation: Implications for vascularization in intervertebral disc degeneration. Life Sci 2020; 265:118778. [PMID: 33217442 DOI: 10.1016/j.lfs.2020.118778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/01/2020] [Accepted: 11/14/2020] [Indexed: 12/19/2022]
Abstract
AIMS The intervertebral disc is the largest avascular organ of the body. Vascularization of the disc has been typically regarded as a pathological feature of intervertebral disc degeneration (IDD). However, the underlying mechanism of vascularization in IDD is still unclear. The current study aimed to investigate the role of AF cell derived exosome (AF-exo) in the interaction with human umbilical vein endothelial cells (HUVECs) and its potential role in the regulation of vascularization in IDD. MAIN METHODS Human AF tissues were obtained from patients with IDD and idiopathic scoliosis. The AF-exo were isolated and identified by transmission electron microscopy (TEM), nanoparticle trafficking analysis (NTA) and Western blotting. Then, the AF-exo were used for HUVECs cultures. The migration of HUVECs was observed in 2D and 3D cultures. The inflammatory phenotype of HUVECs was examined by Real-time PCR and enzyme-linked immunosorbent assay (ELISA). Additionally, apoptosis of HUVECs were analyzed by flow cytometry. KEY FINDINGS Here, we for the first time found that AF cells could secrete AF-exo and that the AF-exo could be phagocytosed by HUVECs. Additionally, we found that degenerated AF-exo exerted pro-vascularization effect on HUVECs by promoting cell migration (in 2D and 3D cultures) and inflammatory factor expression including IL-6, TNF-α, MMP-3, MMP-13 and VEGF, whereas the application of non-degenerated AF-exo demonstrated inverse effects. SIGNIFICANCE These results showed that AF-exo is an essential regulator mediating intercellular communication between AF cells and HUVECs, suggesting its important role in vascularization in the intervertebral disc.
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Affiliation(s)
- Zhen Sun
- Department of Orthopedic, Xijing Hospital, Fourth Military Medical University, Western Changle Road, Xi'an, Shaanxi Province, PR China.
| | - Hang Zhao
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Western Changle Road, Xi'an, Shaanxi Province, PR China; Department of Pharmacy, The 456th Hospital of the People's Liberation Army, Jinan, PR China
| | - Bing Liu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Western Changle Road, Xi'an, Shaanxi Province, PR China
| | - Yang Gao
- Department of Orthopedic, Xijing Hospital, Fourth Military Medical University, Western Changle Road, Xi'an, Shaanxi Province, PR China
| | - Wen-Hao Tang
- Department of Orthopedic, Xijing Hospital, Fourth Military Medical University, Western Changle Road, Xi'an, Shaanxi Province, PR China
| | - Zhi-Heng Liu
- Department of Orthopedic, 986 Air Force Hospital of China, Xi'an, Shaanxi Province, PR China
| | - Zhuo-Jing Luo
- Department of Orthopedic, Xijing Hospital, Fourth Military Medical University, Western Changle Road, Xi'an, Shaanxi Province, PR China.
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Deshmukh V, Ibanez M, Hu H, Cahiwat J, Wei Y, Stewart J, Hood J, Yazici Y. A small-molecule inhibitor of the Wnt pathway, lorecivivint (SM04690), as a potential disease-modifying agent for the treatment of degenerative disc disease. Spine J 2020; 20:1492-1502. [PMID: 32413487 DOI: 10.1016/j.spinee.2020.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/10/2020] [Accepted: 04/28/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Abnormal Wnt signaling in intervertebral discs (IVDs) progresses degenerative disc disease (DDD) pathogenesis by impairing nucleus pulposus cell function, decreasing matrix deposition, and accelerating fibrosis. PURPOSE This study was conducted to evaluate the effects of lorecivivint (LOR; SM04690), a small-molecule Wnt pathway inhibitor, on IVD cells and in an animal model of DDD. STUDY DESIGN We used in vitro assays and a rat model of DDD to test the effects of LOR on nucleus pulposus cell senescence and viability, annulus fibrosus (AF) cell fibrosis, and cartilage regeneration and protection. METHODS Wnt pathway gene expression was measured in human NP and AF cell cultures treated with LOR or DMSO (vehicle). Chondrocyte-like differentiation of rat and human NP cells, NP cell senescence and protection, and AF cell fibrosis were assessed using gene expression and immunocytochemistry. Disc and plasma pharmacokinetics were analyzed following intradiscal LOR injection in rats. In vivo effects of LOR and vehicle on AF integrity, AF/NP junction, NP cellularity and matrix, and disc height were compared using histopathology and radiography in a rat coccygeal IVD needle-puncture model of DDD. RESULTS In NP and AF cell cultures, LOR-inhibited Wnt pathway gene expression compared with vehicle. In NP cells, LOR inhibited senescence, decreased catabolism, and induced differentiation into chondrocyte-like cells; in AF cells, LOR decreased catabolism and inhibited fibrosis. A single intradiscal LOR injection in rats resulted in therapeutic disc concentrations (~30 nM) for >180 days and minimal systemic exposure. DDD-model rats receiving LOR qualitatively demonstrated increased cartilage matrix and reduced AF lamellar disorganization and fragmentation with significantly (p<.05) improved histology scores and increased disc height compared with vehicle. CONCLUSIONS LOR showed beneficial effects on IVD cells in vitro and reduced disease progression in a rat model of DDD compared with vehicle, suggesting that LOR may have disease-modifying therapeutic potential. CLINICAL SIGNIFICANCE The current therapeutic options for DDD are pain management and surgical intervention; there are no approved therapies that alter the progression of DDD. Our data support advancing LOR into clinical development as an injectable, small-molecule, potential disease-modifying treatment for DDD in humans.
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Affiliation(s)
| | | | - Haide Hu
- Formerly Samumed, LLC, San Diego, CA, USA
| | | | - Ying Wei
- Formerly Samumed, LLC, San Diego, CA, USA
| | | | - John Hood
- Formerly Samumed, LLC, San Diego, CA, USA
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Ammar A, Alwadei A, Al Hayek A, Alabbas FM, Almatrafi FR, Elshawarby M. The Correlation between Histopathology of Herniated Lumbar Intervertebral Disc and Clinical Findings. Asian J Neurosurg 2020; 15:545-553. [PMID: 33145205 PMCID: PMC7591170 DOI: 10.4103/ajns.ajns_193_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/26/2020] [Accepted: 06/11/2020] [Indexed: 11/04/2022] Open
Abstract
Objective Prolapsed lumbar disc is one of the most frequent diseases, which is usually presented by motor and sensory deficits. Consistency of herniated disc may play a significant role in surgical treatment and postoperative improvement. The objective of this study is to assess whether the histopathological degeneration in the sample of lumbar discs operated on is correlated to clinical variables and surgical outcomes. Materials and Methods A randomized double-blind prospective study of lumbar disc prolapse cases over a period of 24 months was done. Forty cases were initially included in the study. All the included cases with a scheduled lumbar discectomy in the Department of Neurosurgery, King Fahd University Hospital, Al-Khobar, Saudi Arabia, during this period were examined histologically. Results Finally, 21 patients were only considered in this study due to loss of follow-up of the other 19 patients; of these 21 patients, 18 were male and 3 were female. The youngest patient was 32 years old, and the oldest was 72 years old. There is no significant correlation between the major histopathological changes of the prolapsed discs and the clinical findings of low back pain (correlation coefficient = 0.058, P < 0.8), duration of sciatica (correlation coefficient = -0.337, P < 0.1), paresthesia (correlation coefficient = 0.111, P < 0.6), motor weakness (correlation coefficient = 0.274, P < 0.2), and reflex (correlation coefficient = 0.081, P < 0.7). Meanwhile, the correlation coefficient between numbness and histopathological degeneration score (HPDS) is not defined because all reported cases were presented with numbness. Conclusions There is no significant correlation between the histopathological changes of the prolapsed discs and some clinical findings. Moreover, the different types of prolapsed discs' histopathological changes have no impact on the outcome of the surgery. We also concluded that the disc material undergoes certain degenerative processes with age.
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Affiliation(s)
- Ahmed Ammar
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ali Alwadei
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ali Al Hayek
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal M Alabbas
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal Rashed Almatrafi
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Elshawarby
- Department of Pathology, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Deer T, Sayed D, Michels J, Josephson Y, Li S, Calodney AK. A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis. PAIN MEDICINE 2020; 20:S32-S44. [PMID: 31808530 PMCID: PMC7101166 DOI: 10.1093/pm/pnz161] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective Lumbar spinal stenosis (LSS) is a degenerative spinal condition affecting nearly 50% of patients presenting with lower back pain. The goal of this review is to present and summarize the current data on how LSS presents in various populations, how it is diagnosed, and current therapeutic strategies. Properly understanding the prevalence, presentation, and treatment options for individuals suffering from LSS is critical to providing patients the best possible care. Results The occurrence of LSS is associated with advanced age. In elderly patients, LSS can be challenging to identify due to the wide variety of presentation subtleties and common comorbidities such as degenerative disc disease. Recent developments in imaging techniques can be useful in accurately identifying the precise location of the spinal compression. Treatment options can range from conservative to surgical, with the latter being reserved for when patients have neurological compromise or conservative measures have failed. Once warranted, there are several surgical techniques at the physician’s disposal to best treat each individual case.
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Affiliation(s)
- Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, West Virginia
| | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, Kansas
| | | | | | - Sean Li
- Premier Pain Centers, Shrewsbury, New Jersey
| | - Aaron K Calodney
- Precision Spine Care, Texas Spine and Joint Hospital, Tyler, Texas, USA
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Ghasemi AA, Ramezanpour S. Evaluation of concordance between degenerative changes on neck X-ray and symptomatic cervical disc herniation. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sahu PK, Shankar Ganesh G. Physiotherapeutic management of a patient with spinal Schwannoma: A case report. J Bodyw Mov Ther 2020; 24:56-62. [PMID: 31987563 DOI: 10.1016/j.jbmt.2019.05.028] [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: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Tumors are generally considered as red flags to manual therapy. The purpose of this report is to describe the clinical course of a patient diagnosed with spinal Schwannoma at L2-L3 level, who was referred to physiotherapy (PT) for the treatment of low back pain radiating to the left lower limb. CASE DESCRIPTION A 30-year old man previously diagnosed with L2-L3 Schwannoma was referred for physiotherapy for the treatment of radiating pain. The patient had not responded favorably to symptomatic management. As the patient's history and physical examination were consistent with a mechanical dysfunction, it was decided to manage the patient along similar lines. The patient was treated with McKenzie extension and central postero-anterior mobilization over T4-T6 vertebrae. This intervention was followed up with strengthening and aerobic exercises. RESULTS The outcomes were measured by the numerical rating scale (NRS), Oswestry Disability Index (ODI) and the Global rate of Change (GRC) scale. The patient responded well to McKenzie extension exercises and Thoracic mobilization. The NRS (7 at rest; 10 on activity) at the time of referral reduced to (2 on activity) at the time of discharge. The outcomes were maintained after 7 months. CONCLUSION This case suggests that there is a need to undertake a detailed musculoskeletal examination and mobilization may be safely performed in patients diagnosed with spinal schwannomas. An individualized tailored approach may be beneficial in these patients.
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Affiliation(s)
- Pradeep Kumar Sahu
- Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - G Shankar Ganesh
- Composite Regional Centre for Skill Development, Rehabilitation and Empowerment of Persons with Disabilities, Lucknow, Uttar Pradesh, India.
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Wang X, Sun J, Tan J, Fang P, Chen J, Yuan W, Chen H, Liu Y. Effect of sIL-13Rα2-Fc on the progression of rat tail intervertebral disc degeneration. J Orthop Surg Res 2019; 14:386. [PMID: 31775818 PMCID: PMC6880576 DOI: 10.1186/s13018-019-1361-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of degenerative disc disease caused by intervertebral disc injury is increasing annually, seriously affecting the quality of life of patients and increasing the disease burden on society. The mechanisms of intervertebral disc degeneration include changes in extracellular matrix (ECM) deposition and tissue fibrosis. sIL-13Rα2-Fc potently inhibits interleukin (IL)-13, as well as blocks related cell signaling pathways and inhibits fibrosis in certain tissues. However, it is unknown whether sIL-13Rα2-Fc inhibits fibrosis in injured intervertebral discs and slows the process of degeneration. We hypothesized that sIL-13Rα2-Fc delays the progression of intervertebral disc degeneration by inhibiting intervertebral disc fibrosis and improving ECM deposition. METHODS A rat tail intervertebral disc degeneration model was established. Pathological changes in rat intervertebral disc tissue were observed by hematoxylin and eosin staining and Masson staining. Glycosaminoglycan (GAG), chondroitin sulfate (CS), keratan sulfate (KS), and hyaluronic acid (HA) contents were quantitatively analyzed by enzyme-linked immunosorbent assay. Type I and type II collagen expression levels were analyzed by reverse transcription-PCR and western blotting. RESULTS Hematoxylin and eosin staining and Masson staining revealed annulus fibrosus rupture, disordered arrangement, decreased nucleus pulposus tissue, and decreased collagen fiber in the rat intervertebral disc tissue. Following treatment with sIL-13Rα2-Fc, pathological changes in the rat intervertebral disc were reduced. Rat intervertebral disc tissue showed decreased GAG, CS-KS, and (HA) contents, increased type I collagen levels, and decreased type II collagen levels in degenerated intervertebral discs. sIL-13Rα2-Fc intervention increased the contents of GAG, CS, KS, and HA; inhibited the expression of type I collagen; and promoted the expression of type II collagen. CONCLUSION These results demonstrate that intervertebral disc degeneration is associated with tissue fibrosis. sIL-13Rα2-Fc can regulate type I and type II collagen expression levels by increasing GAG, CS, KS, and HA contents, thereby slowing the progression of intervertebral disc degeneration.
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Affiliation(s)
- Xin Wang
- Department of Orthopedics, First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China. .,Changzheng Orthopedics Hospital, Second Military Medical University, Shanghai, 200003, China.
| | - Junhao Sun
- Department of Orthopedics, First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Jianshi Tan
- Department of Orthopedics, First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Pengzhong Fang
- Department of Orthopedics, First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Jinlei Chen
- Department of Orthopedics, First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Wen Yuan
- Changzheng Orthopedics Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Huajiang Chen
- Changzheng Orthopedics Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Yang Liu
- Changzheng Orthopedics Hospital, Second Military Medical University, Shanghai, 200003, China.
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Bony stress in the lumbar spine is associated with intervertebral disc degeneration and low back pain: a retrospective case-control MRI study of patients under 25 years of age. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2470-2477. [PMID: 31529214 DOI: 10.1007/s00586-019-06148-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/04/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Abnormal stress in the lumbar vertebra, also known as bony stress, can be a precursor to degenerative changes which may manifest as low back pain (LBP). However, the prevalence of bony stress in the lumbar spine and its relationship with degenerative changes and LBP is unclear. The purpose of this study was to evaluate the prevalence of bony stress in the lumbar spine and its relationship with intervertebral disc (IVD) degeneration, facet osteoarthritis and LBP in patients under 25 years of age. METHODS A retrospective case-control study of 130 patients under 25 years of age was conducted from a population of 493 patients who had lumbar MRI across three imaging centres over three years. A cohort of 55 consecutive patients with bony stress was identified. A control group of consecutive patients (n = 75) without bony stress was also selected from the population. RESULTS Bony stress was prevalent in 11% (95% CI [8.4-14.5%]) of patients and was not diagnosed in 36% (95% CI [22-55%]) of these cases. Patients with bony stress had over twofold (OR 2.3, 95% CI [1.1-4.8]) and fivefold (OR 5.3, 95% CI [2.11-13.3]) higher likelihood of having IVD degeneration and LBP, respectively, when compared with the control group. Bony stress was not found to be associated with facet osteoarthritis. CONCLUSION Bony stress in the lumbar spine was prevalent in 11% of patients under 25 years of age. It was commonly undiagnosed in radiology reports (not reported in 36% of the cases). Being significantly associated and with an increased likelihood of IVD degeneration and LBP, we posit that bony stress is likely a symptomatic and clinically meaningful diagnostic entity in the assessment of LBP. These slides can be retrieved under Electronic Supplementary Material.
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