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Zhou C, Zhou N, Zheng Y, Si H, Wang Y, Yin J. The efficacy of 3D gait analysis to evaluate surgical (and rehabilitation) outcome after degenerative lumbar surgery. BMC Surg 2024; 24:197. [PMID: 38926745 PMCID: PMC11202385 DOI: 10.1186/s12893-024-02486-0] [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: 01/04/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Lumbar degenerative conditions are a major cause of back pain and disability in individuals aged 45 and above. Gait analysis utilizes sensor technology to collect movement data, aiding in the evaluation of various gait aspects like spatiotemporal parameters, joint angles, neuromuscular activity, and joint forces. It is widely used in conditions such as cerebral palsy and knee osteoarthritis. This research aims to assess the effectiveness of 3D gait analysis in evaluating surgical outcomes and postoperative rehabilitation for lumbar degenerative disorders. METHODS A prospective self-controlled before-after study (n = 85) carried out at our Hospital (Sep 2018 - Dec 2021) utilized a 3D motion analysis system to analyze gait in patients with lumbar degenerative diseases. The study focused on the multifidus muscle, a crucial spinal muscle, during a minimally invasive lumbar interbody fusion surgery conducted by Shandong Weigao Pharmaceutical Co., Ltd. Pre- and postoperative assessments included time-distance parameters (gait speed, stride frequency, stride length, stance phase), hip flexion angle, and stride angle. Changes in 3D gait parameters post-surgery and during rehabilitation were examined. Pearson correlation coefficient was employed to assess relationships with the visual analog pain scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) scores. Patient sagittal alignment was evaluated using "Surgimap" software from two types of lateral radiographs to obtain parameters like pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), intervertebral space height (DH), posterior height of the intervertebral space (PDH) at the operative segment, and anterior height of the intervertebral space (ADH). RESULTS By the 6th week post-operation, significant improvements were observed in the VAS score, JOA score, and ODI score of the patients compared to preoperative values (P < 0.05), along with notable enhancements in 3D gait quantification parameters (P < 0.05). Pearson correlation analysis revealed a significant positive correlation between improvements in 3D gait quantification parameters and VAS score, JOA score, and ODI value (all P < 0.001). CONCLUSION 3D gait analysis is a valuable tool for evaluating the efficacy of surgery and rehabilitation training in patients.
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Affiliation(s)
- Chao Zhou
- Department of Spine Surgery, Cheeloo College of Medicine, Qingdao Medical Engineering Interdisciplinary Key Laboratory, Qilu Hospital (Qingdao), Shandong University, No.758, Heifei Road, Qingdao, Shandong, 266000, China
| | - Ning Zhou
- Intensive Care Unit, Binzhou Central Hospital, No. 108, Huancheng South Road, Huimin, Binzhou, Shandong, 251700, China
| | - Yanping Zheng
- Department of Spine Surgery, Cheeloo College of Medicine, Qingdao Medical Engineering Interdisciplinary Key Laboratory, Qilu Hospital (Qingdao), Shandong University, No.758, Heifei Road, Qingdao, Shandong, 266000, China
| | - Haipeng Si
- Department of Spine Surgery, Cheeloo College of Medicine, Qingdao Medical Engineering Interdisciplinary Key Laboratory, Qilu Hospital (Qingdao), Shandong University, No.758, Heifei Road, Qingdao, Shandong, 266000, China
| | - Yanguo Wang
- Department of Spine Surgery, Cheeloo College of Medicine, Qingdao Medical Engineering Interdisciplinary Key Laboratory, Qilu Hospital (Qingdao), Shandong University, No.758, Heifei Road, Qingdao, Shandong, 266000, China
| | - Jun Yin
- Department of Spine Surgery, Cheeloo College of Medicine, Qingdao Medical Engineering Interdisciplinary Key Laboratory, Qilu Hospital (Qingdao), Shandong University, No.758, Heifei Road, Qingdao, Shandong, 266000, China.
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Jiang J, Huang Y, He B. Advances in the interaction between lumbar intervertebral disc degeneration and fat infiltration of paraspinal muscles: critical summarization, classification, and perspectives. Front Endocrinol (Lausanne) 2024; 15:1353087. [PMID: 38978618 PMCID: PMC11228240 DOI: 10.3389/fendo.2024.1353087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 06/10/2024] [Indexed: 07/10/2024] Open
Abstract
More than 619 million people in the world suffer from low back pain (LBP). As two potential inducers of LBP, intervertebral disc degeneration (IVDD) and fat infiltration of paraspinal muscles (PSMs) have attracted extensive attention in recent years. So far, only one review has been presented to summarize their relationship and relevant mechanisms. Nevertheless, it has several noticeable drawbacks, such as incomplete categorization and discussion, lack of practical proposals, etc. Consequently, this paper aims to systematically summarize and classify the interaction between IVDD and fat infiltration of PSMs, thus providing a one-stop search handbook for future studies. As a result, four mechanisms of IVDD leading to fat infiltration of PSMs and three mechanisms of fat infiltration in PSMs causing IVDD are thoroughly analyzed and summarized. The typical reseaches are tabulated and evaluated from four aspects, i.e., methods, conclusions, benefits, and drawbacks. We find that IVDD and fat infiltration of PSMs is a vicious cycle that can promote the occurrence and development of each other, ultimately leading to LBP and disability. Finally, eight perspectives are proposed for future in-depth research.
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Affiliation(s)
- Jiaqiu Jiang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yilong Huang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bo He
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Barde SM, Deshmukh PU, Laddha M, Rathi D. Anaesthesia Considerations in a Case of Alkaptonuria Posted for Total Knee Arthroplasty. Cureus 2024; 16:e61882. [PMID: 38978889 PMCID: PMC11228421 DOI: 10.7759/cureus.61882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/06/2024] [Indexed: 07/10/2024] Open
Abstract
Alkaptonuria is a rare hereditary condition in which homogentisic acid is deposited in collagenous tissues, leading to blackish discoloration, degenerative changes, restricted mobility, and pain in the affected part. The skeletal system is commonly affected, resulting in the stiffening of the vertebral spine, shoulders, knees, hip joints, and thoracic cage. Additionally, the degenerative process involves heart valves, endocardium, and kidneys, with associated pathophysiological changes. These patients present significant challenges in neuraxial anesthesia, airway management, and postoperative pain relief. In this report, we present the anesthetic management of a case of alkaptonuria undergoing total knee arthroplasty and discuss the encountered difficulties. We conclude that the perioperative anesthesia management of alkaptonuria patients requires thorough planning to effectively address the various challenges associated with the administration of anesthesia.
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Affiliation(s)
- Saurabh M Barde
- Anaesthesia, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Pratibha U Deshmukh
- Anaesthesia, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | | | - Dilip Rathi
- Orthopaedics, RNH Hospital Pvt. Ltd., Nagpur, IND
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Tsai YC, Hsu WL, Kantha P, Chen PJ, Lai DM. Virtual reality skateboarding training for balance and functional performance in degenerative lumbar spine disease. J Neuroeng Rehabil 2024; 21:74. [PMID: 38724981 PMCID: PMC11080234 DOI: 10.1186/s12984-024-01357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Degenerative lumbar spine disease (DLD) is a prevalent condition in middle-aged and elderly individuals. DLD frequently results in pain, muscle weakness, and motor impairment, which affect postural stability and functional performance in daily activities. Simulated skateboarding training could enable patients with DLD to engage in exercise with less pain and focus on single-leg weight-bearing. The purpose of this study was to investigate the effects of virtual reality (VR) skateboarding training on balance and functional performance in patients with DLD. METHODS Fourteen patients with DLD and 21 age-matched healthy individuals completed a 6-week program of VR skateboarding training. The motion capture and force platform systems were synchronized to collect data during a single-leg stance test (SLST). Musculoskeletal simulation was utilized to calculate muscle force based on the data. Four functional performance tests were conducted to evaluate the improvement after the training. A Visual Analogue Scale (VAS) was also employed for pain assessment. RESULTS After the training, pain intensity significantly decreased in patients with DLD (p = 0.024). Before the training, patients with DLD took longer than healthy individuals on the five times sit-to-stand test (p = 0.024). After the training, no significant between-group differences were observed in any of the functional performance tests (p > 0.05). In balance, patients with DLD were similar to healthy individuals after the training, except that the mean frequency (p = 0.014) was higher. Patients with DLD initially had higher biceps femoris force demands (p = 0.028) but shifted to increased gluteus maximus demand after the training (p = 0.037). Gluteus medius strength significantly improved in patients with DLD (p = 0.039), while healthy individuals showed consistent muscle force (p > 0.05). CONCLUSION This is the first study to apply the novel VR skateboarding training to patients with DLD. VR skateboarding training enabled patients with DLD to achieve the training effects in a posture that relieves lumbar spine pressure. The results also emphasized the significant benefits to patients with DLD, such as reduced pain, enhanced balance, and improved muscle performance.
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Affiliation(s)
- Yi-Ching Tsai
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei, Taiwan.
- Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Phunsuk Kantha
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei, Taiwan
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Po-Jung Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei, Taiwan
| | - Dar-Ming Lai
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Cucinotta F, Mineo R, Raffaele M, Salmeri F, Tartara F, Sfravara F. A comparison of traditional and net structured intersomatic cages in the lombosacral region: A biomechanical analysis for enhancing discopathy treatment. Heliyon 2024; 10:e28978. [PMID: 38617931 PMCID: PMC11015422 DOI: 10.1016/j.heliyon.2024.e28978] [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: 07/29/2023] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
The vertebral column represents an essential element for support, mobility, and the protection of the central nervous system. Various pathologies can compromise these vital functions, leading to pain and a decrease in the quality of life. Within the scope of this study, a novel redesign of the Intersomatic Cage, traditionally used in the presence of discopathy, was proposed. The adoption of additive manufacturing technology allowed for the creation of highly complex geometries, focusing on the lumbosacral tract, particularly on the L4-L5 and L5-S1 intervertebral discs. In addition to the tensile analysis carried out using Finite Element Analysis (FEA) in static simulations, a parallel study on the range of motion (ROM) of the aforementioned vertebral pairs was conducted. The ROM represents the relative movement range between various vertebral pairs. The introduction of the intersomatic cage between the vertebrae, replacing the pulpy nucleus of the intervertebral disc, could influence the ROM, thus having significant clinical implications. For the analysis, the ligaments were modelled using a 1D approach. Their constraint reaction and deformability upon load application were analysed to better understand the potential biomechanical implications arising from the adoption of the cages. During the FEA simulations, two types of cages were analysed: LLIF for L4-L5 and ALIF for L5-S1, subjecting them to four different loading conditions. The results indicate that the stresses exhibited by cages with a NET structure are generally lower compared to those of traditional cages. This stress reduction in cages with NET structure suggests a more optimal load distribution, but it is essential to assess potential repercussions on the surrounding bone structure.
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Affiliation(s)
| | | | | | - Fabio Salmeri
- Department of Engineering, University of Messina, Italy
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Naik A, Ramachandran K, Prasad Shetty A, Kanna RM, Shanmuganathan R. Double Level Non-Contiguous Traumatic Lumbar Disc Herniation Presenting With Cauda Equina Syndrome: A Case Report and Literature Review. JBJS Case Connect 2024; 14:01709767-202406000-00019. [PMID: 38669352 DOI: 10.2106/jbjs.cc.23.00473] [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: 04/28/2024]
Abstract
CASE A 52-year-old man presented with cauda equina syndrome after a motorcycle accident. Magnetic resonance imaging revealed traumatic disc herniation, at L2-L3 and L5-S1 levels without bony injury. He was managed successfully by wide laminectomy and microdiscectomy at both levels with complete neurological recovery at 2-month follow-up. CONCLUSION With a reported incidence of 0.4%, traumatic disc herniation in the lumbar region is an uncommon occurrence that may resemble a spinal epidural hematoma in acute trauma. Although MRI may not reliably differentiate spinal epidural hematoma from disc herniation, urgent surgical intervention may be required in profound neurological deficits.
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Affiliation(s)
- Ashish Naik
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
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Tsai PC, Liu YC, Chang TK, Chen LP, Huang YC, Lian YS, Chien KT. The novel Kambin Torpedo full-endoscopic lumbar interbody fusion technique: a case series. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:417-428. [PMID: 37389696 DOI: 10.1007/s00586-023-07836-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/10/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Full-endoscopic lumbar interbody fusion (FELIF) is a new-generation treatment for spondylolisthesis. However, owing to their unique characteristics, the two main endoscopic fusion trajectories, the trans-Kambin and posterolateral approaches, have important limitations. Herein, we aimed to introduce a new technique called Kambin Torpedo FELIF (KT-FELIF). METHODS The KT-FELIF technique is based on the trans-Kambin approach. It additionally completes ipsilateral total facetectomy and contralateral direct decompression. Thus, this novel technique combines the advantages of the trans-Kambin and posterolateral approaches. RESULTS We reported on the indications and technical steps of KT-FELIF and provided intraoperative and animated videos to clarify the procedure. Short-term follow-up based on 3-month postoperative computed tomography and plain films images taken at least 3 months after surgery showed adequate bony decompression, a large bone graft contact area, and good intervertebral trabecular bone growth without radiolucent lines between the graft, cage, and end plate. The clinical results, such as ipsilateral and contralateral visual analog scale and Oswestry disability index values, gradually improved at 1 and 3 months postoperatively. No complications were observed. CONCLUSIONS KT-FELIF is a promising FELIF technique for achieving bilateral direct decompression through a unilateral approach while accomplishing thorough discectomy and endplate preparation.
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Affiliation(s)
- Ping-Chi Tsai
- Department of Medical Education, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104217, Taiwan
| | - Yueh-Ching Liu
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Ting-Kuo Chang
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Lei-Po Chen
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Yu-Ching Huang
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Yan-Shiang Lian
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Kai-Ting Chien
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan.
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Rosenstein B, Burdick J, Roussac A, Rye M, Naghdi N, Valentin S, Licka T, Sean M, Tétreault P, Elliott J, Fortin M. The assessment of paraspinal muscle epimuscular fat in participants with and without low back pain: A case-control study. J Biomech 2024; 163:111928. [PMID: 38280825 DOI: 10.1016/j.jbiomech.2024.111928] [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: 07/02/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/29/2024]
Abstract
It remains unclear whether paraspinal muscle fatty infiltration in low back pain (LBP) is i) solely intramuscular, ii) is lying outside the epimysium between the muscle and fascial plane (epimuscular) or iii) or combination of both, as imaging studies often use different segmentation protocols that are not thoroughly described. Epimuscular fat possibly disturbs force generation of paraspinal muscles, but is seldomly explored. This project aimed to 1) compare epimuscular fat in participants with and without chronic LBP, and 2) determine whether epimuscular fat is different across lumbar spinal levels and associated with BMI, age, sex and LBP status, duration or intensity. Fat and water lumbosacral MRIs of 50 chronic LBP participants and 41 healthy controls were used. The presence and extent of epimuscular fat for the paraspinal muscle group (erector spinae and multifidus) was assessed using a qualitative score (0-5 scale; 0 = no epimuscular fat and 5 = epimuscular fat present along the entire muscle) and quantitative manual segmentation method. Chi-squared tests evaluated associations between qualitative epimuscular fat ratings and LBP status at each lumbar level. Bivariate and partial spearman's rho correlation assessed relationships between quantitative and qualitative epimuscular fat with participants' characteristics. Epimuscular fat was more frequent at the L4-L5 (X2 = 13.781, p = 0.017) and L5-S1 level (X2 = 27.825, p < 0.001) in participants with LBP compared to controls, which was not found for the higher lumbar levels. The total qualitative score (combined from all levels) showed a significant positive correlation with BMI, age, sex (female) and LBP status (r = 0.23-0.55; p < 0.05). Similarly, the total area of epimuscular fat (quantitative measure) was significantly correlated with BMI, age and LBP status (r = 0.26-0.57; p < 0.05). No correlations were found between epimuscular fat and LBP duration or intensity. Paraspinal muscle epimuscular fat is more common in chronic LBP patients. The functional implications of epimuscular fat should be further explored.
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Affiliation(s)
- Brent Rosenstein
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada.
| | - Jessica Burdick
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada
| | - Alexa Roussac
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada.
| | - Meaghan Rye
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada
| | - Neda Naghdi
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada
| | - Stephanie Valentin
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom.
| | - Theresia Licka
- Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, United Kingdom.
| | - Monica Sean
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, Canada.
| | - Pascal Tétreault
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, Canada.
| | - Jim Elliott
- University of Sydney, School of Heath Science, Department of Medicine and Health, Sydney, Australia.
| | - Maryse Fortin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada.
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Jiang L, Du X, Pan Z, Yuan Y, Battié MC, Wang Y. Lumbar disc herniation in juveniles: A case-control study of MRI characteristics and etiological insights. J Orthop Res 2023; 41:2685-2693. [PMID: 37165707 DOI: 10.1002/jor.25598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/03/2023] [Accepted: 05/08/2023] [Indexed: 05/12/2023]
Abstract
Lumbar disc herniation (LDH) is rare in juveniles. LDH occurring at age 20 years or younger is referred to as juvenile disc herniation (JDH). While adult LDH is regarded as an advanced stage of disc degeneration, it remains unclear why intervertebral discs rupture in youth. This study aimed to characterize magnetic resonance imaging (MRI) findings of JDH and investigate possible etiological factors. From 2013 to 2020, JDH patients and controls were identified and interviewed to assess demographics, general lifestyles, and family histories. MRIs were evaluated for disc degeneration, epiphyseal ring separation, Modic changes and endplate lesions. The relationships between JDH and suspected risk factors were examined. A total of 297 JDH patients (199 boys and 98 girls, age 17.3 ± 2.1 years) and 185 controls (age 17.1 ± 2.4 years) were studied. Age, body mass index, exposures to daily physical labor, regular exercise, and daily sitting time were similar between JDH cases and controls. A family medical history of serious back pain was more common in JDH patients than in controls (59.4% vs. 26.5%, p < 0.001), as well as family history of clinically established LDH (45.0% vs. 12.4%, p < 0.001). Epiphyseal ring separation was identified in 102 (29.2%) herniated discs in 91 (36.4%) JDH patients, while occurring in only 5 (1.4%) control participants (p < 0.001). Overall, severe disc degeneration was not a prominent finding in JDH patients. In conclusion, epiphyseal ring separation was a common magnetic resonance feature in JDH. Findings suggest a genetically mediated developmental model of JDH, rather than a model of premature disc degeneration.
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Affiliation(s)
- Lejian Jiang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaotian Du
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zongyou Pan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Yuan
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Michele C Battié
- Department of Physical Therapy, Faculty of Health Sciences, Western University, Canada
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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10
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Khaleque MA, Kim JH, Hwang BJ, Kang JK, Quan M, Kim YY. Role of Necroptosis in Intervertebral Disc Degeneration. Int J Mol Sci 2023; 24:15292. [PMID: 37894970 PMCID: PMC10607531 DOI: 10.3390/ijms242015292] [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: 09/20/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Apoptosis has historically been considered the primary form of programmed cell death (PCD) and is responsible for regulating cellular processes during development, homeostasis, and disease. Conversely, necrosis was considered uncontrolled and unregulated. However, recent evidence has unveiled the significance of necroptosis, a regulated form of necrosis, as an important mechanism of PCD alongside apoptosis. The activation of necroptosis leads to cellular membrane disruption, inflammation, and vascularization. This process is crucial in various pathological conditions, including intervertebral disc degeneration (IVDD), neurodegeneration, inflammatory diseases, multiple cancers, and kidney injury. In recent years, extensive research efforts have shed light on the molecular regulation of the necroptotic pathway. Various stimuli trigger necroptosis, and its regulation involves the activation of specific proteins such as receptor-interacting protein kinase 1 (RIPK1), RIPK3, and the mixed lineage kinase domain-like (MLKL) pseudokinase. Understanding the intricate mechanisms governing necroptosis holds great promise for developing novel therapeutic interventions targeting necroptosis-associated IVDD. The objective of this review is to contribute to the growing body of scientific knowledge in this area by providing a comprehensive overview of necroptosis and its association with IVDD. Ultimately, these understandings will allow the development of innovative drugs that can modulate the necroptotic pathway, offering new therapeutic avenues for individuals suffering from necroptosis.
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Affiliation(s)
| | | | | | | | | | - Young-Yul Kim
- Department of Orthopedic Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon 34943, Republic of Korea; (M.A.K.); (J.-H.K.); (B.-J.H.); (J.-K.K.); (M.Q.)
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11
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Ma B, Smith A. Outpatient minimally invasive spine surgeries during the COVID-19 pandemic - A retrospective analysis of 164 consecutive cases. World Neurosurg X 2023; 20:100229. [PMID: 37456692 PMCID: PMC10344935 DOI: 10.1016/j.wnsx.2023.100229] [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: 12/28/2022] [Revised: 05/10/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To share our surgical experiences of minimally invasive cervical and lumbar procedures for patients who suffered from non-fatal motor vehicle accidents (MVAs) in the ambulatory surgery centers (ASCs) during the coronavirus disease 2019 (COVID-19) pandemic. Methods Anterior cervical discectomy and fusion (ACDF), anterior lumbar interbody fusion (ALIF), minimally invasive laminotomy and discectomy (MILD), percutaneous endoscopic laser-assisted discectomy (PELD) and percutaneous kyphoplasty (PK) were performed on carefully selected patients. Results From January 2020 to December 2021, our group performed 164 cases on 153 patients involving 249 intervertebral disc (IVD) levels. Of these, 116 cases (70.73%) on 114 patients (74.51%) were cervical, 48 cases (29.27%) were lumbar (including 8 PK cases). Eight patients had both cervical and lumbar procedures in a single anesthetic session (SAS) and were discharged on the same day. One hundred and six ACDF cases (92.17%) were at the C4-C5 and C5-C6 levels, which comprised of 146 (76.04%) IVDs. Of the 40 non-PK lumbar cases, 38 (95.0%) were at L4 to S1 lumbar levels. Six of these cases (15.0%) involved 2 lumbar levels. In contrast, 6 out of 8 kyphoplasties (75.0%) involved lower thoracic/higher lumbar vertebral columns (T11 to L2) and 2 were at the lower lumbar L4 level. Conclusions We successfully and safely performed various cervical and lumbar spine surgeries in the ASCs amid COVID-19 pandemic and all patients achieved the same-day discharge (SDD). In the non-fatal MVAs, mid-lower cervical (C4 to C6) and lower lumbar (L4 to S1) IVDs were the most affected levels.
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12
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Jiang SH, Nico E, Bhaskara M, Patil S, Edgar MC, Sadeh M, Chiu RG, Mehta AI. Characteristics of work-related spine injury in the USA: a National Trauma Data Bank analysis. Acta Neurochir (Wien) 2023; 165:3097-3106. [PMID: 37606797 DOI: 10.1007/s00701-023-05731-2] [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: 05/29/2023] [Accepted: 07/19/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Workplace injury is a commonplace occurrence in the USA. Spine injuries are especially devastating as they can cause chronic pain and limit mobility which prevents patients from returning to work. Gaining a better understanding of the patients, mechanisms, and treatments associated with these injuries can aid in improving outcomes. The purpose of this study is to characterize the nature of work-related spine injuries. METHODS The National Trauma Data Bank was queried from 2017 to 2019 for all diagnoses involving the cervical, thoracic, lumbar, and sacral spine. Patient demographics, comorbidities, injury characteristics, spinal diagnoses, and procedures were identified for each occupation. Occupational industries, patient demographics, mechanisms of injury, diagnoses, and spinal procedures were characterized. RESULTS A total of 100,842 work-related injuries were identified between 2017 and 2019. Of those, 19,002 (19%) were spine injuries, and subsequently, 3963 (21%) required spinal surgery. Eight thousand twenty-nine (42%) cases were seen among construction workers, which had the highest proportion of Hispanic patients (36%). Smoking was prevalent in labor-intensive occupations with high rates of spine injury such as building and grounds maintenance. The most common mechanism of injury was a fall from a roof. The most common injury diagnoses were L1, L2, and L3 fractures, and the most common procedures were T12-L1 fusion, multilevel thoracic fusion, and multilevel lumbar fusion. CONCLUSION Spine injuries represent a significant portion of work-related injuries in the USA and a considerable portion require neurosurgical intervention. Initial efforts should focus on the prevention and management of lumbar spine injuries in the construction industry.
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Affiliation(s)
- Sam H Jiang
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Elsa Nico
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Mounika Bhaskara
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Shashank Patil
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Michael C Edgar
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Morteza Sadeh
- Department of Neurosurgery, University of Illinois at Chicago, 912 S. Wood, Chicago, IL, 60612, USA
| | - Ryan G Chiu
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX, 75390, USA
- Department of Neurosurgery, Parkland Hospital, Dallas, TX, 75235, USA
| | - Ankit I Mehta
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA.
- Department of Neurosurgery, University of Illinois at Chicago, 912 S. Wood, Chicago, IL, 60612, USA.
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13
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Masi S, Rye M, Roussac A, Naghdi N, Rosenstein B, Bailey JF, Fortin M. Comparison of paraspinal muscle composition measurements using IDEAL fat-water and T2-weighted MR images. BMC Med Imaging 2023; 23:48. [PMID: 36997912 PMCID: PMC10064674 DOI: 10.1186/s12880-023-00992-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/06/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the agreement between paraspinal muscle composition measurements obtained from fat-water images using % fat-signal fraction (%FSF) in comparison to those obtained from T2-weighted magnetic resonance images (MRI) using a thresholding method. METHODS A sample of 35 subjects (19 females, 16 males; 40.26 ± 11.3 years old) was selected from a cohort of patients with chronic low back pain (LBP). Axial T2-weighted and IDEAL (Lava-Flex, 2 echo sequence) fat and water MR images were obtained using a 3.0 Tesla GE scanner. Multifidus, erector spinae, and psoas major muscle composition measurements were acquired bilaterally at L4-L5 and L5-S1 using both imaging sequences and related measurement methods. All measurements were obtained by the same rater, with a minimum of 7 days between each method. Intra-class correlation coefficients (ICCs) were calculated to assess intra-rater reliability. Pearson Correlation and Bland-Altman 95% limits of agreement were used to assess the agreement between both measurement methods. RESULTS The intra-rater reliability was excellent for all measurements with ICCs varying between 0.851 and 0.997. Strong positive correlations indicating a strong relationship between composition measurements were obtained from fat-water and T2-weighted images for bilateral multifidus and erector spinae muscles at both spinal levels and the right psoas major muscle at L4-L5, with correlation coefficient r ranging between 0.67 and 0.92. Bland-Altman plots for bilateral multifidus and erector spinae muscles at both levels revealed excellent agreement between the two methods, however, systematic differences between both methods were evident for psoas major fat measurements. CONCLUSION Our findings suggest that utilizing fat-water and T2-weighted MR images are comparable for quantifying multifidus and erector spinae muscle composition but not of the psoas major. While this suggests that both methods could be used interchangeably for the multifidus and erector spinae, further evaluation is required to expand and confirm our findings to other spinal levels.
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Affiliation(s)
- Sara Masi
- Department of Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada
| | - Meaghan Rye
- Department of Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada
| | - Alexa Roussac
- Department of Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada
| | - Neda Naghdi
- Department of Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada
| | - Brent Rosenstein
- Department of Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada
| | - Jeannie F Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Maryse Fortin
- Department of Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada.
- PERFORM Centre, Concordia University, Montreal, QC, Canada.
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC, Canada.
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Lambrechts MJ, Pitchford C, Hogan D, Li J, Fogarty C, Rawat S, Leary EV, Cook JL, Choma TJ. Lumbar spine intervertebral disc desiccation is associated with medical comorbidities linked to systemic inflammation. Arch Orthop Trauma Surg 2023; 143:1143-1153. [PMID: 34623492 DOI: 10.1007/s00402-021-04194-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/24/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Symptomatic disc degeneration is a common cause of low back pain. Recently, the prevalence of low back pain has swiftly risen leading to increased patient disability and loss of work. The increase in back pain also coincides with a rapid rise in patient medical comorbidities. However, a comprehensive study evaluating a link between patient's medical comorbidities and their influence on lumbar intervertebral disc morphology is lacking in the literature. METHODS Electronic medical records (EMR) were retrospectively reviewed to determine patient-specific medical characteristics. Magnetic resonance imaging (MRI) was evaluated for lumbar spine intervertebral disc desiccation and height loss according to the Griffith-modified Pfirrmann grading system. Bivariate and multivariable linear regression analyses assessed strength of associations between patient characteristics and lumbar spine Pfirrmann grade severity (Pfirrmann grade of the most affected lumbar spine intervertebral disc) and cumulative grades (summed Pfirrmann grades for all lumbar spine intervertebral discs). RESULTS In total, 605 patients (304 diabetics and 301 non-diabetics) met inclusion criteria. Bivariate analysis identified older age, diabetes, American Society of Anesthesiologists (ASA) class, hypertension, chronic obstructive pulmonary disease (COPD), peripheral vascular disease, and hypothyroidism as being strongly associated with an increasing cumulative Pfirrmann grades. Multivariable models similarly found an association linking increased cumulative Pfirrmann grades with diabetes, hypothyroidism, and hypertension, while additionally identifying non-white race, heart disease, and previous lumbar surgery. Chronic pain, depression, and obstructive sleep apnea (OSA) were associated with increased Pfirrmann grades at the most affected level without an increase in cumulative Pfirrmann scores. Glucose control was not associated with increasing severity or cumulative Pfirrmann scores. CONCLUSION These findings provide specific targets for future studies to elucidate key mechanisms by which patient-specific medical characteristics contribute to the development and progression of lumbar spine disc desiccation and height loss. LEVEL OF EVIDENCE III (retrospective cohort).
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.
| | - Chase Pitchford
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Daniel Hogan
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Jinpu Li
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Casey Fogarty
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,School of Medicine, University of Missouri, Columbia, MO, USA
| | - Sury Rawat
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,School of Medicine, University of Missouri, Columbia, MO, USA
| | - Emily V Leary
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - James L Cook
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Theodore J Choma
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA
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Amirouche F, Dolan M, Pradhan S, Mikhael M, Monsef JB. Assessment of Cervical and Lumbar Kinematics in Simulated Open and Closed Kinetic Chain. Int J Spine Surg 2023; 17:51-59. [PMID: 36302601 PMCID: PMC10025859 DOI: 10.14444/8382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The pelvic girdle and spine vertebral column work as a long chain influenced by pelvic tilt. This study aims to assess the effect of open and closed chain anterior pelvic tilt (APT) or posterior pelvic tilt (PPT) on cervical and lumbar spine kinematics using an in vitro cadaveric spine model. METHODS Three human cadaveric spines with intact pelvis were suspended with the skull fixed in a metal frame. Optotrak 3-dimensional motion system captured coordinates of pin markers at 24 different points for real-time tracking of cervical and lumbar regions. Additional geometric parameters were measured to calculate pelvic incidence and pelvic tilt. A force-torque digital gauge applied consistent force to standardize the acetabular or sacral axis' APT and PPT during simulated open- and closed-chain movements, respectively. RESULTS In closed-chain PPT, significant differences in relative intervertebral decompression were noted between spinal levels C2/C3 (4.85 mm) and C5/C6 (1.26 mm), while compression was noted between L1/L2 (-2.54 mm) and L5/S1 (-11.84 mm) and between L3/L4 (-2.78 mm) and L5/S1 (-11.84 mm) (P < 0.05). Displacement during closed-chain PPT was significantly greater than during open-chain PPT for cervical and lumbar spines. In closed-chain APT, significant differences in relative intervertebral decompression were noted between spinal levels L1/L2 (2.87 mm) and L5/S1 (24.48 mm) and between L3/L4 (2.94 mm) and L5/S1 (24.48 mm) (P < 0.05). Pelvic incidence remained the same as the pelvis tilted anterior and posterior. CONCLUSIONS In PPT, open-chain pelvic tilts did not produce as much cervical and lumbar intervertebral displacement compared with closed-chain pelvic tilts. In contrast, APT saw fewer differences between open- and closed-chain tilting. There was a reciprocal relationship between pelvic tilt and sacral slope, producing a constant pelvic incidence throughout all pelvic tilt angles. CLINICAL RELEVANCE The results of this study may help determine how a patient's pelvic tilt is causing pain and using that knowledge to guide rehabilitation of stabilizing muscles. The data produced here may also be helpful in determining which rehabilitation exercises may be more difficult or prone to injury for patients with either excessive anterior or posterior pelvic tilt. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Farid Amirouche
- Department of Orthopaedic Surgery, Northshore University HealthSystem an Affiliate of University of Chicago Pritzker School of Medicine, Evanston, IL, USA
- Department of Orthopaedic Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - Martine Dolan
- Department of Orthopaedic Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - Sonia Pradhan
- Department of Orthopaedic Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - Mark Mikhael
- Department of Orthopaedic Surgery, Northshore University HealthSystem an Affiliate of University of Chicago Pritzker School of Medicine, Evanston, IL, USA
- Orthopaedic Spine Surgery, Illinois Bone and Joint Institute, Glenview, IL, USA
| | - Jad Bou Monsef
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Kilic G, Senol S, Baspinar S, Kilic E, Ozgocmen S. Degenerative changes of lumbar spine and their clinical implications in patients with axial spondyloarthritis. Clin Rheumatol 2023; 42:111-116. [PMID: 35922576 DOI: 10.1007/s10067-022-06321-w] [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: 06/06/2022] [Revised: 07/16/2022] [Accepted: 07/27/2022] [Indexed: 01/11/2023]
Abstract
The objective of this study was to assess degenerative changes (DCs) on magnetic resonance imaging (MRI) of lumbar spine in axial spondyloarthritis (axSpA) and non-specific mechanical low back pain (mLBP). Patients were consecutively recruited and all underwent MRI of the lumbar spine in this cross-sectional study. Disk degeneration (DD, Pfirrmann classification), endplate changes (Modic, types 1, 2, and 3), annular fissure, disk bulging, and protrusion or extrusion at each lumbar spinal level were assessed using anonymized images. Patients with axSpA were assessed for disease activity, functioning, and quality of life. Univariate and subsequent multivariate logistic regression analyses with adjustments of various covariates were used to assess association between MRI findings and clinical variables. One hundred twenty-three patients had non-radiographic (nr-axSpA) and 144 had radiographic axSpA/ankylosing spondylitis (AS). Degenerative changes were more prevalent in patients with mLBP (n = 105) than axSpA. Disk degeneration was the most prevalent MRI finding, followed by annular fissure, disk herniation (protrusion or extrusion), and Modic changes (MCs) in axSpA. Disk herniation was more prevalent in patients with nr-axSpA compared to AS. Modic changes (OR = 6.455), lumbar disk herniation (OR = 2.278), annular fissure (OR = 2.842), conventional synthetic or biologic disease-modifying antirheumatic drugs (csDMARDs) non-users (OR = 2.225), and advanced age (OR = 31.556) were factors associated with an increased risk of DD in axSpA. Coexisting DD increased the burden of disease in axSpA. A considerable proportion of patients with axSpA had DD at the lumbar spine. These degenerative changes might explain some of the complaints and should not been overlooked in patients with axSpA. Key Points • Lumbar herniated nucleus pulposus (LHNP) is more frequent in nr-axSpA while MC is more frequent in AS. • DD may cause an increase in BASFI and BASMI scores in axSpA. • Spinal DCs might be an alternative explanation for low back complaints and should not been overlooked in patients with axSpA.
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Affiliation(s)
- Gamze Kilic
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Karadeniz Technical University, Trabzon, Turkey.
| | - Serkan Senol
- Department of Radiology, Sevgi Hospital, Kayseri, Turkey
| | - Sevgi Baspinar
- Department of Physical Medicine and Rehabilitation, Ministry of Health Kayseri City Hospital, Kayseri, Turkey
| | - Erkan Kilic
- Department of Rheumatology, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Salih Ozgocmen
- Department of Rheumatology, Gaziosmanpasa Hospital, Istinye University, Istanbul, Turkey.,Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Trakya University, Edirne, Turkey
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Elfadle AA, Zarad CA, Elmaaty AAA, El-Nagaa BFA, Soliman AY. Correlation between lumbar spinal canal magnetic resonance imaging grading systems and parameters in lumbar spinal canal compromise. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is a need to assess how commonly used classification systems of intervertebral disc degeneration reflect the compromise of neural elements. This study aims to explore the relationship between lumbar discs degenerative diseases using the Pfirrmann and the Combined Task Forces (CTF) of the North American Spine Society (NASS) grading systems as well as qualitative and quantitative grades of lumbar spinal stenosis. This retrospective cohort study included adult patients undergoing non-contrast MR imaging of lumbosacral spine. The radiological assessment included the Pfirrmann grading system, Van Rijn classification, Combined Task Force (CTF) classification, measurement of the cross-sectional area of the dural sac, mid-sagittal antero-posterior diameter of the thecal sac, the degree of dural sac compression at disc level, lateral recesses heights, and intervertebral foramina diameters. The degree of stenosis of the spinal canal and intervertebral foramina was assessed.
Results
One hundred patients were included in the study. At all levels, Pfirrmann grades had a moderate, significant, positive correlation with the severity of stenosis of the central and lateral spinal canals as well as foraminal stenosis. The grades of lumbar spinal canal and foraminal stenosis had a significant positive correlation with degree of disc displacement as assessed by CTF classification and had a significant negative correlation with the quantitative lumbar spinal canal and foraminal measures.
Conclusions
There is a good correlation between Pfirrmann classification, CTF classification of NASS, qualitative grading and quantitative measures of lumbar spinal canal that reflects the severity of lumbar spinal canal stenosis and nerve root compression.
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The relationships between physical activity, lumbar multifidus muscle morphology, and low back pain from childhood to early adulthood: a 12-year longitudinal study. Sci Rep 2022; 12:8851. [PMID: 35614086 PMCID: PMC9132932 DOI: 10.1038/s41598-022-12674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/09/2022] [Indexed: 11/08/2022] Open
Abstract
We investigated the longitudinal associations between physical activity (PA), lumbar multifidus morphology, and impactful low back pain (LBP) in young people. Nine-year-old children were recruited from 25 primary schools and followed up at age 13, 16, and 21 years. We measured PA with accelerometers at age 9, 13, and 16; quantified patterns of lumbar multifidus intramuscular adipose tissue (IMAT) change from 13 to 16 years using magnetic resonance imaging; and recorded LBP and its impact with standardised questionnaires and interviews. Associations were examined with crude and adjusted logistic or multinomial models and reported with odds ratios (OR) or relative risk ratios (RRR). We included data from 364 children (mean[SD] age = 9.7[.4] years). PA behaviour was not associated with LBP. Having persistently high IMAT levels at age 13 and 16 was associated with greater odds of LBP (OR[95% CI] = 2.98[1.17 to 7.58]). Increased time in moderate and vigorous intensity PA was associated with a lower risk of higher IMAT patterns (RRR[95% CI] = .67[.46 to .96] to .74[.55 to 1.00]). All associations became non-significant after adjusting for sex and body mass index (BMI). Future studies investigating the relationships between PA behaviour, lumbar multifidus IMAT, and impactful LBP should account for potential confounding by sex and BMI.
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Azemi ES, Kola S, Kola I, Tanka M, Bilaj F, Abazaj E. Lumbar Disk Herniation: A Clinical Epidemiological and Radiological Evaluation. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space.
AIM: The study aimed to investigate and observe variation of clinical, epidemiological, and radiological aspects for patients suspected of lumbar herniation based on observed evaluation of CT and MRI imagery.
METHODS: This is a cross-sectional study conducted during the periods March 2015 and November 2019. Patients were subjected to MRI and CT based on the emergency or scheduled of diagnose. All MRI scans were obtained with 1.5 tesla MRI machine and for CT had undergone examinations with one of the following equipment: Siemens with 128 slice and Phillips 64 slice. The patients were placed in supine position.
RESULTS: Overall 194 symptomatic patients were recruited as a participant in this study, 118 men and 76 women with an average age of 44.9 ±10.4 years. Patients belong to the active age (35–44-years-old and 45–54-years-old) appeared to have the highest percentage of lumbar disk herniation (LDH) 30.9% and 25.8%, respectively. There were a significant association between such as epidemiological data (such as gender, BMI, age groups, and employment status) and presence of LDH, p ˂ 0.05. Acute pain was presented in 69.07% of patients and according to complaint associated with low back pain (LBP), most of them 47.4% appeared with Right Sciatica. MRI is the most diagnostic methods used in evaluation of LDH in 52% of patients, and CT was used in 48% of them. The most common changes were between L2-L3, L3-L4, and L4-L5. Furthermore, the grading findings which corresponding to lumbosacral segment were Grade I and Grade II. Grade V was less common.
CONCLUSION: This study involving patients with lumbar disk herniation and associated LBP showed that a combination of clinical features and epidemiological predicted the presence or absence of a significant association. Further research is required to validate these findings in different types of LDH and LBP for other findings and conditions.
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Sopaj Azemi E, Kola I, Kola S, Tanka M. Prevalence of Lumbar Disk Herniation in Adult Patients with Low Back Pain Based in Magnetic Resonance Imaging Diagnosis. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Lumbar disc degenerative disease has now been proven as the most common cause of low back pain throughout the world. Approximately 5–15% of patients with low back pain suffer from lumbar disc herniation. Presenting symptoms of lumbar disc degeneration are lower back pain and sciatica which may be aggravated by walking, sitting, standing, bending, lifting etc.
Aim: To evaluate based on MRI images the prevalence of LDH in patients with low back pain and its correlation between various demographic data.
Methods: This Cross sectional and observational study was conducted from January 2016 to December 2017 at department of Imagery in the University Hospital Center `Mother Theresa`. During the two years’ period of this study, 342 patients of low back pain were presented to department of imagery suspected for lumbar disc herniation. Diagnostic criteria were based upon abnormal findings in MRI. All MRI scans were obtained with 1.5 tesla MRI machine. Data analysis was carried out with SPSS software for Windows version 20.0.
Results: Overall 342 patients with LBP came into Imagery department, the prevalence of lumbar disc herniation resulted 31.9% (109/342). Most of patients 60.5% were presented with continuous LBP with a predominance of deterioration of pain by the walking activity 65.2%. The average age of patients with LDH resulted 51.12 years old with min 32 years and max 74 years old. The ratio M:F of LDH patients resulted 1.4, with predominance of males 59.6%. The active age 40-49 years (28.9%) old and 50-59 years (36.9%) were the most affected by LDH compared to other age groups. Based on MRI images disc herniation was most commonly present at the level of L3/L4 and L4/L5. Commonest types of disc herniation were protrusion 63.3% (69/109) followed by extrusion 21.1% (23/109). In the overall multivariate regression analysis, a significant relation between lumbar disk herniation and some of occupation was found (p˂0.05)
Conclusions: Biologically, the lumbar herniation disc is a potential contributor to low back pain. The prevalence of LDH among patients with LBP resulted 31.9%, and men were more prone to suffered from disc herniation than women, due to increased mechanical stress and injury. Results reported the frequent occurrence of lumbar disc degenerative disease in active age. The lumbar discs most often affected and leads to herniation are L3-L4, and L4–L5. Research efforts should endeavor to reduce risk factors and improve the quality of life.
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Single-level TLIF Versus LLIF at L4-5: A Comparison of Patient-reported Outcomes and Recovery Ratios. J Am Acad Orthop Surg 2022; 30:e495-e505. [PMID: 34921548 DOI: 10.5435/jaaos-d-21-00772] [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: 09/23/2021] [Accepted: 11/18/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Both transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are suitable for achievement of lumbar arthrodesis. Comparative studies have observed complications and outcomes without stratification by lumbar level. This study aims to assess patient-reported outcome measures (PROMs) and recovery in TLIF and LLIF at L4-5. METHODS Patients undergoing primary, elective, single-level, TLIF or LLIF procedures at L4-5 were grouped. Demographics, perioperative characteristics, and postoperative complication rates were collected. PROMs included Patient-Reported Outcome Measurement Information System Physical Function, visual analog scale (VAS) back and leg, Oswestry Disability Index, and 12-Item Short-Form Physical Component Summary, and Mental Component Summary and were collected at preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year time points. Delta values and recovery ratios (RRs) were calculated for all PROMs at all time points. Demographics, perioperative characteristics, and postoperative complications were compared using chi-squared and Student t-test for categorical and continuous variables, respectively. Differences in mean PROMs, delta values, and RR at each time point were evaluated using unpaired Student's t-test. RESULTS Three hundred sixty TLIF and 46 LLIF patients were included. Most (54.3%) were men, mean age 56.3 years, and mean body mass index 30.8 kg/m2. Body mass index and insurance significantly differed (P ≤ 0.045, all). TLIF showed significantly greater mean operative time, length of stay, and postoperative narcotic consumption (P < 0.033, all) and greater postoperative nausea/vomiting (P = 0.004). No preoperative PROMs significantly differed. TLIF cohort had significantly greater VAS back at 6 months and VAS leg at 12 weeks and 6 months (P < 0.034, all). No mean delta PROMs or RRs significantly differed. DISCUSSION LLIF demonstrated significantly reduced length of stay, postoperative narcotic consumption, and postoperative nausea/vomiting and significantly improved VAS back at 6 months and VAS leg at 12 weeks and 6 months versus TLIF. Although 2-year PROMs and RRs did not significantly differ, our findings may suggest improved midterm follow-up pain scores for LLIF patients.
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22
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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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23
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Chen S, Wu X, Lai Y, Chen D, Bai X, Liu S, Wu Y, Chen M, Lai Y, Cao H, Shao Z, Xiao G. Kindlin-2 inhibits Nlrp3 inflammasome activation in nucleus pulposus to maintain homeostasis of the intervertebral disc. Bone Res 2022; 10:5. [PMID: 35013104 PMCID: PMC8748798 DOI: 10.1038/s41413-021-00179-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/14/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022] Open
Abstract
Intervertebral disc (IVD) degeneration (IVDD) is the main cause of low back pain with major social and economic burdens; however, its underlying molecular mechanisms remain poorly defined. Here we show that the focal adhesion protein Kindlin-2 is highly expressed in the nucleus pulposus (NP), but not in the anulus fibrosus and the cartilaginous endplates, in the IVD tissues. Expression of Kindlin-2 is drastically decreased in NP cells in aged mice and severe IVDD patients. Inducible deletion of Kindlin-2 in NP cells in adult mice causes spontaneous and striking IVDD-like phenotypes in lumbar IVDs and largely accelerates progression of coccygeal IVDD in the presence of abnormal mechanical stress. Kindlin-2 loss activates Nlrp3 inflammasome and stimulates expression of IL-1β in NP cells, which in turn downregulates Kindlin-2. This vicious cycle promotes extracellular matrix (ECM) catabolism and NP cell apoptosis. Furthermore, abnormal mechanical stress reduces expression of Kindlin-2, which exacerbates Nlrp3 inflammasome activation, cell apoptosis, and ECM catabolism in NP cells caused by Kindlin-2 deficiency. In vivo blocking Nlrp3 inflammasome activation prevents IVDD progression induced by Kindlin-2 loss and abnormal mechanical stress. Of translational significance, adeno-associated virus-mediated overexpression of Kindlin-2 inhibits ECM catabolism and cell apoptosis in primary human NP cells in vitro and alleviates coccygeal IVDD progression caused by mechanical stress in rat. Collectively, we establish critical roles of Kindlin-2 in inhibiting Nlrp3 inflammasome activation and maintaining integrity of the IVD homeostasis and define a novel target for the prevention and treatment of IVDD.
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Affiliation(s)
- Sheng Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Department of Biochemistry, School of Medicine, Southern University of Science and Technology, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Shenzhen, 518055, China
| | - Xiaohao Wu
- Department of Biochemistry, School of Medicine, Southern University of Science and Technology, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Shenzhen, 518055, China
| | - Yumei Lai
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Di Chen
- Research Center for Human Tissues and Organs Degeneration, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Xiaochun Bai
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Sheng Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yongchao Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Mingjue Chen
- Department of Biochemistry, School of Medicine, Southern University of Science and Technology, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Shenzhen, 518055, China
| | - Yuxiao Lai
- Centre for Translational Medicine Research and Development, Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Huiling Cao
- Department of Biochemistry, School of Medicine, Southern University of Science and Technology, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Shenzhen, 518055, China.
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Guozhi Xiao
- Department of Biochemistry, School of Medicine, Southern University of Science and Technology, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Shenzhen, 518055, China.
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Biomechanical feasibility of semi-rigid stabilization and semi-rigid lumbar interbody fusion: a finite element study. BMC Musculoskelet Disord 2022; 23:10. [PMID: 34980068 PMCID: PMC8725514 DOI: 10.1186/s12891-021-04958-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 12/12/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Semi-rigid lumbar fusion offers a compromise between pedicle screw-based rigid fixation and non-instrumented lumbar fusion. However, the use of semi-rigid interspinous stabilization (SIS) with interspinous spacer and ligamentoplasty and semi-rigid posterior instrumentation (SPI) to assist interbody cage as fusion constructs remained controversial. The purpose of this study is to investigate the biomechanical properties of semi-rigidly stabilized lumbar fusion using SIS or SPI and their effect on adjacent levels using finite element (FE) method. METHOD Eight FE models were constructed to simulate the lumbosacral spine. In the non-fusion constructs, semi-rigid stabilization with (i) semi-rigid interspinous spacer and artificial ligaments (PD-SIS), and (ii) PI with semi-rigid rods were simulated (PD + SPI). For fusion constructs, the spinal models were implanted with (iii) PEEK cage only (Cage), (iv) PEEK cage and SIS (Cage+SIS), (v) PEEK cage and SPI (Cage+SPI), (vi) PEEK cage and rigid PI (Cage+PI). RESULT The comparison of flexion-extension range of motion (ROM) in the operated level showed the difference between Cage+SIS, Cage+SPI, and Cage+PI was less than 0.05 degree. In axial rotation, ROM of Cage+SIS were greater than Cage+PI by 0.81 degree. In the infrajacent level, while Cage+PI increased the ROM by 24.1, 27,7, 25.9, and 10.3% and Cage+SPI increased the ROM by 26.1, 30.0, 27.1, and 10.8% in flexion, extension, lateral bending and axial rotation respectively, Cage+SIS only increased the ROM by 3.6, 2.8, and 11.2% in flexion, extension, and lateral bending and reduced the ROM by 1.5% in axial rotation. The comparison of the von Mises stress showed that SIS reduced the adjacent IVD stress by 9.0%. The simulation of the strain energy showed a difference between constructs less than 7.9%, but all constructs increased the strain energy in the infradjacent level. CONCLUSION FE simulation showed semi-rigid fusion constructs including Cage+SIS and Cage+SPI can provide sufficient stabilization and flexion-extension ROM reduction at the fusion level. In addition, SIS-assisted fusion resulted in less hypermobility and less von Mises stress in the adjacent levels. However, SIS-assisted fusion had a disadvantage of less ROM reduction in lateral bending and axial rotation. Further clinical studies are warranted to investigate the clinical efficacy and safety of semi-rigid fusions.
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25
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What happens to the lower lumbar spine after marathon running: a 3.0 T MRI study of 21 first-time marathoners. Skeletal Radiol 2022; 51:971-980. [PMID: 34541607 PMCID: PMC8930792 DOI: 10.1007/s00256-021-03906-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To better understand the impact of long-distance running on runners' lumbar spines by assessing changes before and after their first marathon run. MATERIALS AND METHODS The lumbar spines of 28 asymptomatic adults (14 males, 14 females, mean age: 30 years old), who registered for their first marathon, the 2019 London Richmond Marathon, were examined 16 weeks before (time point 1) and 2 weeks after (time point 2) the marathon. Participants undertook a pre-race 16-week training programme. Magnetic resonance imaging (MRI) of high-resolution 3.0 Tesla was used at each time point. Senior musculoskeletal radiologists assessed the lower lumbar spine condition. RESULTS Out of 28 participants, 21 completed both the training and the race and 7 neither completed the training nor started the marathon but not due to spine-related issues. At time point 1, disc degeneration was detected in 17/28 (61%), most predominantly at spinal segments L4-L5 and L5-S1. No back pain/other symptoms were reported. When compared to time point 2, there was no progression in the extent of disc degeneration, including intervertebral disc (IVD) height (p = 0.234), width (p = 0.359), and intervertebral distance (p = 0.641). There was a regression in 2 out of 8 (25%) participants who had pre-marathon sacroiliac joint bone marrow oedema, and a small increase in the size of a pre-marathon subchondral cyst in one participant, all asymptomatic. CONCLUSION Running 500 miles over 4 months plus a marathon for the first time had no adverse effects on the lumbar spine, even when early degenerative changes were present. Additionally, there was evidence of regression of sacroiliac joint abnormalities.
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26
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Zheng J, Cheng B, Cook D, Yang Y. Gender differences in degenerative lumbar scoliosis spine flexibilities. Am J Transl Res 2021; 13:13959-13966. [PMID: 35035737 PMCID: PMC8748112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The incidence of adolescent idiopathic scoliosis is higher in girls, but spine deformities are more severe in boys. We aimed to identify gender differences of mechanical factors involved in adult degenerative scoliosis (DS). METHODS 20 male (60.35±6.77 years) and 19 female (58.89±9.15 years) specimens of cadaveric lumbar spines were divided into 3 groups comprised of a Cobb angle >10° (DS), a Cobb angle <10° but >3° (pre-degenerative scoliosis (PS)) and intervertebral disc angles <3° in which the Cobb angle could not be measured (non-degenerative scoliosis (NS)), respectively. Spine data were collected for flexion/extension (FE), lateral bending (LB), axial torsion (AT), range of motion (ROM), neutral zone (NZ) and the neutral zone ratio (NZR). RESULTS There was no significant difference regarding the severity of DS between male and female specimens. Only in males were ROMAT (P=0.001), NZAT (P<0.001), NZFE (P=0.045), NZLB (P=0.002) as well as NZRAT (P<0.001) and NZRLB (P=0.001) values significantly lower in right compared to left scoliosis. With the exception of ROMAT in DS specimens, ROMAT, ROMFE and ROMLB values were significantly higher in females than those in males for the DS, PS and NS specimens. NZAT, NZFE and NZLB values were significantly higher in PS and NS female specimens. NZRAT was significantly lower in female DS specimens (P=0.031) and significantly higher in female PS specimens (P=0.031) compared to that in male specimens. CONCLUSIONS In lumbar scoliosis specimens, the rigidness of spines was higher in males than in females and more pronounced in right than in left scoliosis, but only in males.
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Affiliation(s)
- Jie Zheng
- First Department of Orthopaedics, The 903 Hospital of PLANo. 14 Lingyin Road, Hangzhou 310012, Zhejiang, China
| | - Boyle Cheng
- Department of Neurosurgery, Spine and Biomechanics Laboratory, Allegheny Health NetworkNo. 320 East North Avenue, Pittsburgh 15212, PA, USA
| | - Daniel Cook
- Department of Neurosurgery, Spine and Biomechanics Laboratory, Allegheny Health NetworkNo. 320 East North Avenue, Pittsburgh 15212, PA, USA
| | - Yonghong Yang
- First Department of Orthopaedics, The 903 Hospital of PLANo. 14 Lingyin Road, Hangzhou 310012, Zhejiang, China
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Huang CP, Lin HH, Yao YC, Lu Y, Liu PC, Chang MC, Wang ST, Chou PH. Incidences and Risk factors of Screw-related Superior Facet Articular Surface Violation at L4 and L5 levels in Transforaminal Lumbar Interbody Fusion: Open Surgery Versus Minimally Invasive Techniques. Spine (Phila Pa 1976) 2021; 46:E1283-E1291. [PMID: 33907084 DOI: 10.1097/brs.0000000000004084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective comparative study with radiographic measurements. OBJECTIVE The aim of this study was to investigate incidences and risk factors of screw-related superior facet articular surface violation (FASV) and optimal pedicle screw angles (PSAs) to avoid FASV at L4 and L5 levels in transforaminal lumbar interbody fusion (TLIF) with either open surgery (OS) or minimal invasive (MIS) techniques with 3D C-arm navigation. SUMMARY OF BACKGROUND DATA L4 to S1 are common levels in TLIF. Adjacent segment diseases (ASD) following TLIF is not uncommon. Screw-related FASV at the superior level is one of the potential risk factors for ASD. METHODS In the OS and MIS groups, 111 and 110 screws were included at L4 level, and 114 and 110 screws at L5 level, respectively. Postoperative computed tomography examined screw-related FASV at L3-4 and L4-5 facet levels. The entry point was the location where pedicle screws placed into the facet joints. RESULTS The OS technique and insertion at the L5 level increased the likelihood of FASV 2.56 and 1.81 times, respec-tively. Multivariate logistic regressions analysis determined PSA was a significant factor associated with FASV. Pearson r between PSA and the distance between midline and entry point was 0.905 (P < .0001). Adding one degree of convergence in PSA led to a mean 0.87 lower odds of an FASV event, regardless of surgical techniques. In 90% of patients in the OS and MIS groups, PSA with FASV was < 11.9° and <15.9° at L4 level, and <15.9° and <21.8° at L5 level, respectively. CONCLUSION PSAs played an important role in FASV. MIS allowed greater PSAs and resulted in fewer incidences of FASV. To avoid FASV in 90% of patients, the PSAs might be at least 11.9° and 15.9° at L4 level, and 15.9° and 21.8° at L5 level for OS and MIS techniques, respectively.Level of Evidence: 3.
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Affiliation(s)
- Chen-Pang Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Division of Orthopedics, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan, R.O.C
| | - Hsi-Hsien Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Yu-Cheng Yao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Yi Lu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | - Po-Chun Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | - Ming-Chau Chang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Shih-Tien Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Po-Hsin Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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28
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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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29
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Mandelli F, Nüesch C, Zhang Y, Halbeisen F, Schären S, Mündermann A, Netzer C. Assessing Fatty Infiltration of Paraspinal Muscles in Patients With Lumbar Spinal Stenosis: Goutallier Classification and Quantitative MRI Measurements. Front Neurol 2021; 12:656487. [PMID: 34539538 PMCID: PMC8446197 DOI: 10.3389/fneur.2021.656487] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/23/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: Fatty infiltration of paraspinal muscle is associated with spinal disorders. It can be assessed qualitatively (i.e., Goutallier classification) and quantitatively using image processing software. The aims of this study were to compare paraspinal muscle fatty infiltration as assessed using the Goutallier classification vs. quantitative magnetic resonance images (MRI) measurements and to investigate the association between anthropometric parameters and paraspinal muscle morphology and fatty infiltration in patients with symptomatic lumbar spinal stenosis (LSS). Methods: Patients affected by symptomatic LSS scheduled for surgery with available MRI of the lumbar spine were included in this retrospective cross-sectional study. Fatty infiltration at each lumbar level was rated qualitatively according to the Goutallier classification and quantified based on the cross-sectional area (CSA) of the paraspinal muscle, of its lean fraction (LeanCSA), and the ratio between LeanCSA and CSA and the CSA relative to the CSA of vertebral body (RCSA). Considering the muscle as a single unit, overall fatty infiltration according to Goutallier, overall CSA, LeanCSA, LeanCSA/CSA, and RCSA were computed as averages (aGoutallier, aCSA, aLeanCSA, aLeanCSA/aCSA, and aRCSA). Associations among parameters were assessed using Spearman's respective Pearson's correlation coefficients. Results: Eighteen patients, with a mean age of 71.3 years, were included. aGoutallier correlated strongly with aLeanCSA and aLeanCSA/aCSA (R = −0.673 and R = −0.754, both P < 0.001). There was a very strong correlation between values of the left and right sides for CSA (R = 0.956, P < 0.001), LeanCSA (R = 0.900, P < 0.001), and LeanCSA/CSA (R = 0.827, P < 0.001) at all levels. Among all anthropometric measurements, paraspinal muscle CSA correlated the most with height (left: R = 0.737, P < 0.001; right: R = 0.700, P < 0.001), while there was a moderate correlation between vertebral body CSA and paraspinal muscle CSA (left: R = 0.448, P < 0.001; right: R = 0.454, P < 0.001). Paraspinal muscle CSA correlated moderately with body mass index (BMI; left: R = 0.423, P < 0.001; right: R = 0.436, P < 0.001), and there was no significant correlation between aLeanCSA or aLeanCSA/CSA and BMI. Conclusions: The Goutallier classification is a reliable yet efficient tool for assessing fatty infiltration of paraspinal muscles in patients with symptomatic LSS. We suggest taking body height as a reference for normalization in future studies assessing paraspinal muscle atrophy and fatty infiltration.
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Affiliation(s)
- Filippo Mandelli
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Orthopaedics, University Children's Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Yuancheng Zhang
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Florian Halbeisen
- Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Stefan Schären
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Cordula Netzer
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
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Sudhir G, Jayabalan V, Sellayee S, Gadde S, Kailash K. Is there an interdependence between paraspinal muscle mass and lumbar disc degeneration? A MRI based study at 2520 levels in 504 patients. J Clin Orthop Trauma 2021; 22:101576. [PMID: 34532219 PMCID: PMC8429962 DOI: 10.1016/j.jcot.2021.101576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 07/27/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Low back pain is one of the most common cause for outpatient visits. Though few studies have shown the vital role of paraspinal muscles in lumbar spine pathology, literature is scarce regarding the influence of the paraspinal muscles in disc degeneration. We aimed to analyse the correlation between paraspinal muscles and disc degeneration. METHODS This is a Level III Prospective Cohort Study done in MRI of lumbosacral spine in 504 patients at 2520 levels from L1-2 to L5-S1. The parameters assessed were age, Pfirrmann grade for disc degeneration and paraspinal muscle (Multifidus and Erector Spinae) mass assessed by the gross cross sectional area of the muscle.The values and their correlation was analyzed using SPSS software. RESULTS The study included a total of 504 patients (231 males and 273 females) with a mean age of 52.00 ± 15.00 (22-80) years. The mean GCSA in cm2 of the paraspinal muscles at L1-L2, L2-L3,L3-L4,L4-L5,L5-S1 were 16.177 ± 2.72, 17.275 ± 2.16, 16.900 ± 3.07, 16.800 ± 2.63, 13.426 ± 2.42 respectively. We found that the age of the patient is directly proportional to the disc degeneration and inversely proportional to GCSA of paraspinal muscle. There was a significant negative correlation between disc degeneration and paraspinal muscle mass. CONCLUSION We found that the paraspinal muscle mass reduces and Pfirrman's Grade increases as age advances. Also patients with disc degeneration tend to have wasting of paraspinal muscles and vice versa. Hence, strengthening the paraspinal muscles should be emphasised to prevent back pain and to stall the degeneration cascade.
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Affiliation(s)
| | - Vignesh Jayabalan
- Corresponding author. Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Li Z, Chen DJ, Liu Z, Tang B, Zhong Y, Li G, Wan Z. Motion characteristics of the lower lumbar spine in individuals with different pelvic incidence: An in vivo biomechanical study. Clin Biomech (Bristol, Avon) 2021; 88:105419. [PMID: 34303068 DOI: 10.1016/j.clinbiomech.2021.105419] [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: 11/02/2020] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pelvic incidence is the quantification of the pelvis anatomical shape which has significant effect on the occurrence of various lumbar degenerative diseases. The aim of this study was to measure the in vivo dynamic motion characteristics of the lower lumbar spine in people with different pelvic incidence. METHODS A total of 55 volunteers were included in the study. The participants were devided into 3 groups (A: pelvic incidence≤40°, B: 40° < pelvic incidence <60° and C: pelvic incidence ≥60°). The L3-S1 vertebrae of each subject was MRI scanned to construct 3D models. The lumbar spine was then imaged using a dual fluoroscopic imaging system as the subject performed physiological position. The 3D vertebral models and the fluoroscopic images were used to reproduce the in vivo vertebral positions along the motion path. The relative translations and rotations of each motion segment were analyzed. FINDINGS At the L5-S1 segment, the primary ranges of motion for left-right axial rotation and flexion-extension of the patients with large pelvic incidence (3.28° ± 0.79°, 7.56° ± 1.81°) were significantly larger than normal pelvic incidence (2.61° ± 1.01°, 6.57° ± 2.18°) and small pelvic incidence (2.00° ± 0.60°, 5.83° ± 1.67°). INTERPRETATION The anatomic variable pelvic incidence is associated with the ranges of motion in lower lumbar vertebrae, especially in the L4-5 and L5-S1 segments.
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Affiliation(s)
- Zhiyun Li
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China
| | - De-Jian Chen
- Department of Orthopedics, The Affiliated Nanjing Jiangbei Hospital of Nantong University, Nanjing, Jiangsu 210048, PR China
| | - Zhang Liu
- The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China
| | - Benyu Tang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China
| | - Yanlong Zhong
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China
| | - Guoan Li
- Bioengineering Lab, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRJ 1215, Boston, MA 02114, USA.
| | - Zongmiao Wan
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China.
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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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Xu WL, Zhao Y. Comprehensive analysis of lumbar disc degeneration and autophagy-related candidate genes, pathways, and targeting drugs. J Orthop Surg Res 2021; 16:252. [PMID: 33849578 PMCID: PMC8043061 DOI: 10.1186/s13018-021-02417-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background Lumbar disc degeneration (LDD) is an essential pathological mechanism related to low back pain. Current research on spinal surgery focused on the sophisticated mechanisms involved in LDD, and autophagy was regarded as an essential factor in the pathogenesis. Objectives Our research aimed to apply a bioinformatics approach to select some candidate genes and signaling pathways in relationship with autophagy and LDD and to figure out potential agents targeting autophagy- and LDD-related genes. Materials and methods Text mining was used to find autophagy- and LDD-related genes. The DAVID program was applied in Gene Ontology and pathway analysis after selecting these genes. Several important gene modules were obtained by establishing a network of protein-protein interaction and a functional enrichment analysis. Finally, the selected genes were searched in the drug database to find the agents that target LDD- and autophagy-related genes. Results There were 72 genes related to “autophagy” and “LDD.” Three significant gene modules (22 genes) were selected by using gene enrichment analysis, which represented 4 signaling pathways targeted by 32 kinds of drugs approved by the Food and Drug Administration (FDA). The interactions between drugs and the genes were also identified. Conclusion To conclude, a method was proposed in our research to find candidate genes, pathways, and drugs which were involved in autophagy and LDD. We discovered 22 genes, 4 pathways, and 32 potential agents, which provided a theoretical basis and new direction for clinical and basic research on LDD.
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Affiliation(s)
- Wei-Long Xu
- Inner Mongolia Medical University, Hohhot, 010000, China
| | - Yan Zhao
- Department of Thoracolumbar Spine Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, China.
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Chakravarthy VB, Golubovsky JL, Steinmetz MP. Minimally invasive lumbar endoscopic discectomy and interbody fusion with percutaneous posterior cortical-trajectory pedicle screw and rod stabilization – A case series. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bell J, Sequeira S, Kamalapathy P, Puvanesarajah V, Hassanzadeh H. Rheumatoid Arthritis Increases Risk of Medical Complications Following Posterior Lumbar Fusion. World Neurosurg 2021; 149:e729-e736. [PMID: 33548531 DOI: 10.1016/j.wneu.2021.01.110] [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: 09/21/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic disease with prominent musculoskeletal manifestations that is associated with increased morbidity and mortality in patients undergoing cervical spine surgery; however, few studies have specifically examined postoperative outcomes in patients with RA following lumbar surgery. The aim of this study was to evaluate whether patients with RA who underwent posterior lumbar fusion experienced increased postoperative complications and economic burden compared with patients without RA. METHODS Patients <85 years old who underwent elective 1- or 2-level instrumented posterior lumbar fusion for degenerative lumbar pathology between 2006 and 2012 were identified in the Medicare insurance claims database. Same-day revisions and cases for spinal infection, malignancy, and trauma were excluded. The resulting cohort was divided into patients with RA before fusion and patients without RA (controls). All outcomes of interest were compared using multivariate regression. Reoperation-free survival at 1- and 2-year follow-up was analyzed used log-rank test. Significance was defined as P < 0.05. RESULTS RA patients had significantly higher risk of 90-day readmission (odds ratio [OR] = 1.27, P < 0.001), thromboembolic events (OR = 1.39, P = 0.010), sepsis (OR = 2.32, P < 0.001), pneumonia (OR = 1.57, P = 0.001), and wound complications (OR = 1.41, P < 0.001). Reoperation-free survival was significantly lower in RA patients at 2-year follow-up (90.4% vs. 92.4%, P < 0.001). Following adjusted regression, RA independently contributed to a $1491 increase in additional 90-day costs (P < 0.001). CONCLUSIONS Preexisting RA may increase risk for short-term postoperative medical complications following posterior lumbar fusion, specifically infectious events. In addition, patients with RA have higher rates of subsequent reoperation following index surgery. Patients with RA be should counseled regarding these risks.
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Affiliation(s)
- Joshua Bell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sean Sequeira
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
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Verheijen EJA, Munts AG, van Haagen OBHAM, de Vries D, Vleggeert-Lankamp CLA. The Outcome of Epidural Injections in Lumbar Radiculopathy Is Not Dependent on the Presence of Disc Herniation on Magnetic Resonance Imaging: Assessment of Short-Term and Long-Term Efficacy. World Neurosurg 2021; 148:e643-e649. [PMID: 33497827 DOI: 10.1016/j.wneu.2021.01.051] [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: 10/15/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Lumbar radiculopathy is a condition with major physical, social, and economic consequences. Despite its favorable prognosis, the burden can be significant. In this study, we aimed to determine the value of magnetic resonance imaging (MRI) and the efficacy of transforaminal epidural injections (TEIs) in patients with lumbar radiculopathy secondary to lumbar disc herniation (LDH) and other causes (non-LDH). METHODS Patients with lumbar radiculopathy were reviewed for radiologic diagnosis based on MRI. For patients receiving TEI therapy, response after 6-8 weeks (short-term) and 16 weeks (long-term), number of injections, subsequent surgery, and patient outcome were evaluated. Treatment response was assessed by patient-reported symptom relief and numeric rating scale pain scores. RESULTS Overall, 66% of MRI examinations showed a clinically relevant LDH. A total of 486 of 1824 patients received TEI, of whom one third did not show LDH. Of patients, 70% reported a short-term effect with significant pain reduction and 44% reported a long-term effect. No significant differences were observed between the LDH and non-LDH groups. Of patients, 59% required multiple injections and reported similar efficacy compared with patients treated with a single injection. CONCLUSIONS A considerable part of MRI examinations in patients with lumbar radiculopathy do not show a clinically relevant LDH. Regardless of the radiologic diagnosis, most patients treated with TEI benefit in both the short-term and the long-term after a single-injection or multiple-injection regime. Subsequent injections are advisable if the effect from the first injection is unsatisfactory or wears off. MRI examination before TEI therapy may be redundant, which allows for expedition of this treatment.
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Affiliation(s)
- Eduard J A Verheijen
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | - Dirk de Vries
- Department of Anaesthesiology, Spaarne Gasthuis, Haarlem, The Netherlands
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Lee K, Jeong HS, Park C, Kim M, Ryu H, Roh J, Yeom JA, Kim JH, Kim TU, Jeon CH. The Relationship between Neural Foraminal Stenosis and Imaging Features of Lumbar Spine MRI in Patients Older Than 60 Years with Lumbar Radiculopathy. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:862-875. [PMID: 36238060 PMCID: PMC9514398 DOI: 10.3348/jksr.2020.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/01/2020] [Accepted: 10/06/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Kyeyoung Lee
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hee Seok Jeong
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chankue Park
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Maeran Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hwaseong Ryu
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jieun Roh
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong A Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jin Hyeok Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae Un Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chang Ho Jeon
- Department of Radiology, Pusan National University Hospital, Busan, Korea
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Tam V, Chen P, Yee A, Solis N, Klein T, Kudelko M, Sharma R, Chan WC, Overall CM, Haglund L, Sham PC, Cheah KSE, Chan D. DIPPER, a spatiotemporal proteomics atlas of human intervertebral discs for exploring ageing and degeneration dynamics. eLife 2020; 9:64940. [PMID: 33382035 PMCID: PMC7857729 DOI: 10.7554/elife.64940] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/30/2020] [Indexed: 12/11/2022] Open
Abstract
The spatiotemporal proteome of the intervertebral disc (IVD) underpins its integrity and function. We present DIPPER, a deep and comprehensive IVD proteomic resource comprising 94 genome-wide profiles from 17 individuals. To begin with, protein modules defining key directional trends spanning the lateral and anteroposterior axes were derived from high-resolution spatial proteomes of intact young cadaveric lumbar IVDs. They revealed novel region-specific profiles of regulatory activities and displayed potential paths of deconstruction in the level- and location-matched aged cadaveric discs. Machine learning methods predicted a ‘hydration matrisome’ that connects extracellular matrix with MRI intensity. Importantly, the static proteome used as point-references can be integrated with dynamic proteome (SILAC/degradome) and transcriptome data from multiple clinical samples, enhancing robustness and clinical relevance. The data, findings, and methodology, available on a web interface (http://www.sbms.hku.hk/dclab/DIPPER/), will be valuable references in the field of IVD biology and proteomic analytics. The backbone of vertebrate animals consists of a series of bones called vertebrae that are joined together by disc-like structures that allow the back to move and distribute forces to protect it during daily activities. It is common for these intervertebral discs to degenerate with age, resulting in back pain and severely reducing quality of life. The mechanical features of intervertebral discs are the result of their proteins. These include extracellular matrix proteins, which form the external scaffolding that binds cells together in a tissue, and signaling proteins, which allow cells to communicate. However, how the levels of different proteins in each region of the disc vary with time has not been fully examined. To establish how protein composition changes with age, Tam, Chen et al. quantified the protein levels and gene activity (which leads to protein production) of intervertebral discs from young and old deceased individuals. They found that the position of different mixtures of proteins in the intervertebral disc changes with age, and that young people have high levels of extracellular matrix proteins and signaling proteins. Levels of these proteins decreased as people got older, as did the amount of proteins produced. To determine which region of the intervertebral disc different proteins were in, Tam, Chen et al. also performed magnetic resonance imaging (MRI) of the samples to correlate image intensity (which represents water content) with the corresponding protein signature. The data obtained provides a high-quality map of how the location of different proteins changes with age, and is available online under the name DIPPER. This database is an informative resource for research into skeletal biology, and it will likely advance the understanding of intervertebral disc degeneration in humans and animals, potentially leading to the development of new treatment strategies for this condition.
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Affiliation(s)
- Vivian Tam
- School of Biomedical Sciences,, The University of Hong Kong, Hong Kong.,The University of Hong Kong Shenzhen of Research Institute and Innovation (HKU-SIRI), Shenzhen, China
| | - Peikai Chen
- School of Biomedical Sciences,, The University of Hong Kong, Hong Kong
| | - Anita Yee
- School of Biomedical Sciences,, The University of Hong Kong, Hong Kong
| | - Nestor Solis
- Centre for Blood Research, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Theo Klein
- Centre for Blood Research, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Mateusz Kudelko
- School of Biomedical Sciences,, The University of Hong Kong, Hong Kong
| | - Rakesh Sharma
- Proteomics and Metabolomics Core Facility, The University of Hong Kong, Hong Kong
| | - Wilson Cw Chan
- School of Biomedical Sciences,, The University of Hong Kong, Hong Kong.,The University of Hong Kong Shenzhen of Research Institute and Innovation (HKU-SIRI), Shenzhen, China.,Department of Orthopaedics Surgery and Traumatology, HKU-Shenzhen Hospital, Shenzhen, China
| | - Christopher M Overall
- Centre for Blood Research, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Lisbet Haglund
- Department of Surgery, McGill University, Montreal, Canada
| | - Pak C Sham
- Centre for PanorOmic Sciences (CPOS), The University of Hong Kong, Hong Kong
| | | | - Danny Chan
- School of Biomedical Sciences,, The University of Hong Kong, Hong Kong.,The University of Hong Kong Shenzhen of Research Institute and Innovation (HKU-SIRI), Shenzhen, China
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Chung NS, Lee HD, Jeon CH. Degenerative changes of sagittal alignment in patients with Roussouly type 1. Spine Deform 2020; 8:1325-1331. [PMID: 32488766 DOI: 10.1007/s43390-020-00151-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN A cross-sectional radiological study. OBJECTIVES We aimed to examine the degenerative changes of sagittal alignment in patients with Roussouly type 1. Roussouly type 1 is unique in shape, characterized by short lumbar lordosis (LL) with the apex at L5 and thoracolumbar kyphosis (TLK). Because of the unique shape of sagittal alignment and the small pelvic incidence (PI) in Roussouly type 1, the degenerative changes of sagittal alignment may differ. METHODS A total of 145 patients with Roussouly type 1 were recruited and distributed into three age groups; Group I (N = 40) were young patients (20-40 years of age), Group II (N = 47) were middle-aged patients (45-60 years of age), and Group III (N = 48) were elderly patients (>65 years of age). Sagittal parameters including sagittal vertical axis (SVA), PI, pelvic tilt (PT), L1S1 LL, L4S1 LL, thoracic kyphosis (TK), and TLK were measured using Surgimap® software. The occurrence of lumbar retrolisthesis was also examined. RESULTS The SVA, PI, PT, L1S1 LL, L4S1 LL, TK, and TLK in group I were - 25.9° ± 23.4 mm, 37.1° ± 5.3°, 10.3° ± 5.5°, 42.7° ± 8.8°, 35.5° ± 6.9°, 29.5° ± 23.5°, and 9.7° ± 5.9°, respectively. Among the Groups I, II, and III, there was a stepwise increase in the SVA, PT, TLK, and lumbar retrolisthesis (all P < 0.001). The PI, L4S1 LL, and TK were identical among the three groups. CONCLUSIONS Degenerative changes of Roussouly type 1 include increase in the SVA, PT, TLK, and lumbar retrolisthesis, while the PI, L4S1 LL, and TK remain unchanged. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Nam-Su Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea
| | - Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea
| | - Chang- Hoon Jeon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea.
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Vaccaro AR, Harris JA, Hussain MM, Wadhwa R, Chang VW, Schroerlucke SR, Samora WP, Passias PG, Patel RD, Panchal RR, D’Agostino S, Whitney NL, Crawford NR, Bucklen BS. Assessment of Surgical Procedural Time, Pedicle Screw Accuracy, and Clinician Radiation Exposure of a Novel Robotic Navigation System Compared With Conventional Open and Percutaneous Freehand Techniques: A Cadaveric Investigation. Global Spine J 2020; 10:814-825. [PMID: 32905729 PMCID: PMC7485081 DOI: 10.1177/2192568219879083] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
STUDY DESIGN Cadaveric study. OBJECTIVE To evaluate accuracy, radiation exposure, and surgical time of a new robotic-assisted navigation (RAN) platform compared with freehand techniques in conventional open and percutaneous procedures. METHODS Ten board-certified surgeons inserted 16 pedicle screws at T10-L5 (n = 40 per technique) in 10 human cadaveric torsos. Pedicle screws were inserted with (1) conventional MIS technique (L2-L5, patient left pedicles), (2) MIS RAN (L2-L5, patient right pedicles), (3) conventional open technique (T10-L1, patient left pedicles), and (4) open RAN (T10-L1, patient right pedicles). Output included (1) operative time, (2) number of fluoroscopic images, and (3) screw accuracy. RESULTS In the MIS group, compared with the freehand technique, RAN allowed for use of larger screws (diameter: 6.6 ± 0.6 mm vs 6.3 ± 0.5 mm; length: 50.3 ± 4.1 mm vs 46.9 ± 3.5 mm), decreased the number of breaches >2 mm (0 vs 7), fewer fluoroscopic images (0 ± 0 vs 108.3 ± 30.9), and surgical procedure time per screw (3.6 ± 0.4 minutes vs 7.6 ± 2.0 minutes) (all P < .05). Similarly, in the open group, RAN allowed for use of longer screws (46.1 ± 4.1 mm vs 44.0 ± 3.8 mm), decreased the number of breaches >2 mm (0 vs 13), fewer fluoroscopic images (0 ± 0 vs 24.1 ± 25.8) (all P < .05), but increased total surgical procedure time (41.4 ± 8.8 minutes vs 24.7 ± 7.0 minutes, P = .000) while maintaining screw insertion time (3.31.4 minutes vs 3.1 ± 1.0 minutes, P = .650). CONCLUSION RAN significantly improved accuracy and decreased radiation exposure in comparison to freehand techniques in both conventional open and percutaneous surgical procedures in cadavers. RAN significantly increased setup time compared with both conventional procedures.
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Affiliation(s)
| | - Jonathan A. Harris
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc, Audubon, PA, USA,Jonathan A. Harris, Globus Medical, Inc, 2560 General Armistead Avenue, Audubon, PA 19403, USA.
| | - Mir M. Hussain
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc, Audubon, PA, USA
| | - Rishi Wadhwa
- UCSF Medical Center, University of California, San Francisco, CA, USA
| | | | | | | | - Peter G. Passias
- Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, USA
| | | | - Ripul R. Panchal
- University of California, Davis Medical Center, Sacramento, CA, USA
| | | | | | - Neil R. Crawford
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc, Audubon, PA, USA
| | - Brandon S. Bucklen
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc, Audubon, PA, USA
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Wu L, Wan B, Xu M, Wang X, Li J, Chen Y, Gao W, Feng Y, Luo J. Massage for protrasion of the lumbar intervertebral disci: A systematic review protocol. Medicine (Baltimore) 2020; 99:e20614. [PMID: 32756076 PMCID: PMC7402724 DOI: 10.1097/md.0000000000020614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Lumbar disc herniation, which affects the life quality of patients and the social security system adversely, is one of the common spinal diseases. Massage is used as an alternative therapy. Currently, there are no relevant articles for systematic review. METHODS We will search the randomized controlled trials related to massage therapy lumbar disc herniation to January 2020. The following database is our focus area: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wan-Fang Database. All published randomized controlled trials in English or Chinese related to massage for lumbar disc herniation will be included. RESULTS The results will provide a high-quality synthesis of current evidence for researchers in this subject area. CONCLUSION The conclusion of our study will provide evidence to judge whether massage is an effective intervention in patients the lumbar intervertebral disci. PROSPERO REGISTRATION NUMBER CRD42020157303.
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Affiliation(s)
- Liu Wu
- Department of Tuina, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Bingyan Wan
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Mali Xu
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Xu Wang
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Jin Li
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Yang Chen
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Wen Gao
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Yinhao Feng
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Jian Luo
- Department of Tuina, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
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Stadelmann MA, Stocker R, Maquer G, Hoppe S, Vermathen P, Alkalay RN, Zysset PK. Finite element models can reproduce the effect of nucleotomy on the multi-axial compliance of human intervertebral discs. Comput Methods Biomech Biomed Engin 2020; 23:934-944. [PMID: 32543225 DOI: 10.1080/10255842.2020.1773808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Finite element (FE) models can unravel the link between intervertebral disc (IVD) degeneration and its mechanical behaviour. Nucleotomy may provide the data required for model verification. Three human IVDs were scanned with MRI and tested in multiple loading scenarios, prior and post nucleotomy. The resulting data was used to generate, calibrate, and verify the FE models. Nucleotomy increased the experimental range of motion by 26%, a result reproduced by the FE simulation within a 5% error. This work demonstrates the ability of FE models to reproduce the mechanical compliance of human IVDs prior and post nucleotomy.
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Affiliation(s)
- Marc A Stadelmann
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Roland Stocker
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Ghislain Maquer
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Sven Hoppe
- Department of Orthopedic Surgery, Bern University Hospital, Bern, Switzerland
| | - Peter Vermathen
- Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Ron N Alkalay
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Philippe K Zysset
- Department of Orthopedic Surgery, Bern University Hospital, Bern, Switzerland
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Berry DB, Rodriguez‐Soto AE, Englund EK, Shahidi B, Parra C, Frank LR, Kelly KR, Ward SR. Multiparametric MRI characterization of level dependent differences in lumbar muscle size, quality, and microstructure. JOR Spine 2020; 3:e1079. [PMID: 32613159 PMCID: PMC7323468 DOI: 10.1002/jsp2.1079] [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: 10/23/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Magnetic resonance imaging (MRI) is a diagnostic tool that can be used to noninvasively assess lumbar muscle size and fatty infiltration, important biomarkers of muscle health. Diffusion tensor imaging (DTI) is an MRI technique that is sensitive to muscle microstructural features such as fiber size (an important biomarker of muscle health), which is typically only assessed using invasive biopsy techniques. The goal of this study was to establish normative values of level-dependent lumbar muscle size, fat signal fraction, and restricted diffusion assessed by MRI in a highly active population. Forty-two active-duty Marines were imaged using a (a) high-resolution anatomical, (b) fat-water separation, and (c) DT-MRI scan. The multifidus and erector spinae muscles were compared at each level using two-way repeated measures ANOVA. Secondary analysis included Three dimensional (3D) reconstructions to qualitatively assess lumbar muscle size, fatty infiltration, and fiber orientation via tractography. The erector spinae was found to be larger than the multifidus above L5, with lower fat signal fraction above L3, and a less restricted diffusion profile than the multifidus above L4, with this pattern reversed in the lower lumbar spine. 3D reconstructions demonstrated accumulations of epimuscular fat in the anterior and posterior regions of the lumbar musculature, with minimal intramuscular fatty infiltration. Tractography images demonstrated different orientations of adjacent lumbar musculature, which cannot be visualized with standard MRI pulse sequences. The level dependent differences found in this study provide a normative baseline, for which to better understand whole muscle and microstructural changes associated with aging, low back pain, and pathology.
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Affiliation(s)
- David B. Berry
- Department of BioengineeringUniversity of CaliforniaSan DiegoCalifornia
- Department of NanoengineeringUniversity of CaliforniaSan DiegoCalifornia
| | - Ana E. Rodriguez‐Soto
- Department of BioengineeringUniversity of CaliforniaSan DiegoCalifornia
- Department of RadiologyUniversity of CaliforniaSan DiegoCalifornia
| | - Erin K. Englund
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan DiegoCalifornia
| | - Bahar Shahidi
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan DiegoCalifornia
| | - Callan Parra
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan DiegoCalifornia
| | | | - Karen R. Kelly
- Department of Exercise and Nutritional SciencesSan Diego State UniversitySan DiegoCalifornia
- Warfighter Performance DepartmentNaval Health Research CenterSan DiegoCalifornia
| | - Samuel R. Ward
- Department of BioengineeringUniversity of CaliforniaSan DiegoCalifornia
- Department of RadiologyUniversity of CaliforniaSan DiegoCalifornia
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan DiegoCalifornia
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Glaeser JD, Tawackoli W, Ju DG, Yang JH, Kanim LEA, Salehi K, Yu V, Saidara E, Vit J, Khnkoyan Z, NaPier Z, Stone LS, Bae HW, Sheyn D. Optimization of a rat lumbar IVD degeneration model for low back pain. JOR Spine 2020; 3:e1092. [PMID: 32613167 PMCID: PMC7323460 DOI: 10.1002/jsp2.1092] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/16/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Intervertebral disc (IVD) degeneration is often associated with low back pain and radiating leg pain. The purpose of this study is to develop a reproducible and standardized preclinical model of painful lumbar IVD degeneration by evaluation of structural and behavioral changes in response to IVD injury with increasing needle sizes. This model can be used to develop new therapies for IVD degeneration. METHODS Forty-five female Sprague Dawley rats underwent anterior lumbar disc needle puncture at levels L4-5 and L5-6 under fluoroscopic guidance. Animals were randomly assigned to four different experimental groups: needle sizes of 18 Gauge (G), 21G, 23G, and sham control. To monitor the progression of IVD degeneration and pain, the following methods were employed: μMRI, qRT-PCR, histology, and biobehavioral analysis. RESULTS T1- and T2-weighted μMRI analysis showed a correlation between the degree of IVD degeneration and needle diameter, with the most severe degeneration in the 18G group. mRNA expression of markers for IVD degeneration markers were dysregulated in the 18G and 21G groups, while pro-nociceptive markers were increased in the 18G group only. Hematoxylin and Eosin (H&E) and Alcian Blue/Picrosirius Red staining confirmed the most pronounced IVD degeneration in the 18G group. Randall-Selitto and von Frey tests showed increased hindpaw sensitivity in the 18G group. CONCLUSION Our findings demonstrate that anterior disc injury with an 18G needle creates severe IVD degeneration and mechanical hypersensitivity, while the 21G needle results in moderate degeneration with no increased pain sensitivity. Therefore, needle sizes should be selected depending on the desired phenotype for the pre-clinical model.
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Affiliation(s)
- Juliane D. Glaeser
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of OrthopedicsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Wafa Tawackoli
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of SurgeryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Biomedical Imaging Research InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Derek G. Ju
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of OrthopedicsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Jae H. Yang
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of Orthopedic SurgeryKorea University Guro HospitalSeoulSouth Korea
| | - Linda EA Kanim
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of OrthopedicsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Khosrowdad Salehi
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Victoria Yu
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Evan Saidara
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Jean‐Phillipe Vit
- Department of Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Zhanna Khnkoyan
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Zachary NaPier
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of OrthopedicsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Laura S. Stone
- McGill University, Faculty of DentistryAlan Edwards Centre for Research on PainMontrealCanada
| | - Hyun W. Bae
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of OrthopedicsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Dmitriy Sheyn
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of OrthopedicsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of SurgeryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
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Rahyussalim AJ, Zufar MLL, Kurniawati T. Significance of the Association between Disc Degeneration Changes on Imaging and Low Back Pain: A Review Article. Asian Spine J 2020; 14:245-257. [PMID: 31679325 PMCID: PMC7113468 DOI: 10.31616/asj.2019.0046] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/19/2019] [Accepted: 05/03/2019] [Indexed: 12/19/2022] Open
Abstract
Low back pain (LBP) is a major health issue resulting in a huge economic burden on the community. It not only increases the medical costs directly, but also raises the disability and loss of productivity in the general population. Symptoms include local pain over the spinal area, pain radiating to the lower leg, stiffness, and muscle tension. LBP is strongly linked with intervertebral disc degeneration that is further associated with the disruption of the complex anatomy of nucleus pulposus, annulus fibrosus, and adjacent supporting structures of the spine. Change in the shape and intensity of nucleus pulposus, decreased disc height, disc herniation, vertebral endplate changes, presence of osteophyte, and posterior high intensity zones are degenerative changes found in imaging studies. Every feature is considered while grading the severity score. Modic changes, DEBIT (disc extension beyond interspace) score, and Pfirrmann criteria are some of the scoring criteria used for evaluating disc degeneration severity. Moreover, the total number and contiguous pattern of affected discs play a crucial role in symptom generation of back pain. Many studies have reported asymptomatic patients. Thus, the correlation between degeneration severity found in imaging study and symptom severity of LBP remain unclear. This review discusses and summarizes the available literature on the significance of the association between the severity of degenerative changes found in imaging study with the presence and intensity of LBP.
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Affiliation(s)
- Ahmad Jabir Rahyussalim
- Department of Orthopaedic and Traumatology, Cipto Mangukusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Luqman Labib Zufar
- Department of Orthopaedic and Traumatology, Cipto Mangukusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tri Kurniawati
- Stem Cell and Tissue Engineering Cluster, Cipto Mangukusumo Hospital, MERC Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
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Yu L, Hao Y, Peng C, Zhang P, Zhu J, Cai Y, Zhu G. Effect of Ginsenoside Rg1 on the intervertebral disc degeneration rats and the degenerative pulposus cells and its mechanism. Biomed Pharmacother 2020; 123:109738. [PMID: 31951975 DOI: 10.1016/j.biopha.2019.109738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/06/2019] [Accepted: 12/08/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To explore the effect of ginsenoside Rg1 on intervertebral disc degeneration (IVDD) in vivo and in vitro and its mechanism. METHODS 60 rats were underwent surgery to construct rat models of IVDD and divided in the sham group, model group and gradient G-Rg1 groups (10 mg/kg/d, 20 mg/kg/d and 40 mg/kg/d).The change of histology was observed by HE staining, the water content and the expression of β-catenin in IVD were detected. Rat nucleus pulposus cells(NPCs) were isolated from IVDD rats and divided in D-NPCs group, and gradient G-Rg1 groups(20 μg/ml, 50 μg/ml and 100 μg/ml).The cell proliferation activity, cell apoptosis rate,the expression of proteins related to ECM and Wnt/β-catenin were detected respectively, Finally the agonist of Wnt/β-catenin pathway LiCl was used for reversed experiments. RESULTS In vivo, G-Rg1 treatment could improve the structural disorganization, low water content, NPCs number and aggrecan and collagenⅡ expression in IVD and down-regulate the expression of β-catenin. In vitro NPCs, G-Rg1 treatment could improve the low cell proliferation, high apoptosis rate and low expression of aggrecan and collagenⅡ in degenerative NPCs in a dose-dependent manner.G-Rg1 treatment could down-regulate the expression of proteins related to β-catenin signal and LiCl could reverse the increase of cell proliferation and ECM synthesis, decrease of apoptosis of degenerative NPCs induced by G-Rg1. CONCLUSION G-Rg1 could promote ECM synthesis of degenerative NPCs and inhibiting its apoptosis, improve the IVDD via inhibiting the Wnt/β-catenin pathway.
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Affiliation(s)
- Lei Yu
- Department of Orthopedics, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, 450001, Henan Province, China
| | - Yingjie Hao
- Department of Orthopedics, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, 450001, Henan Province, China.
| | - Cheng Peng
- Department of Orthopedics, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, 450001, Henan Province, China
| | - Panke Zhang
- Department of Orthopedics, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, 450001, Henan Province, China
| | - Jian Zhu
- Department of Orthopedics, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, 450001, Henan Province, China
| | - Yingchun Cai
- Department of Orthopedics, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, 450001, Henan Province, China
| | - Guangduo Zhu
- Department of Orthopedics, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, 450001, Henan Province, China
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Feasibility of ultrasound-guided lumbar epidural access using paramedian transverse scanning with the needle in-plane: a comparison with paramedian sagittal scanning. J Anesth 2019; 34:29-35. [PMID: 31667584 DOI: 10.1007/s00540-019-02704-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/23/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES The present study was designed to compare the feasibility of ultrasound (US)-guided lumbar epidural access using paramedian sagittal scanning (PMSS) and paramedian transverse scanning (PMTS) approaches. METHODS Fifty patients undergoing surgery of the lower extremities were randomly allocated into 2 groups. The patients in PMSS group received PMSS-guided in-plane epidural access, whereas patients in PMTS group received PMTS-guided in-plane epidural access. The US visibility of neuraxial structures and of Tuohy needle during US scout scan, procedure duration, the number of attempts to access epidural space, Tuohy needle puncture depth in the epidural space, and extent of sensory block after spinal block between two groups were compared. RESULTS The US visibility of Tuohy needle and neuraxial structures was comparable between two groups. There was an overall decrease in procedure duration in the PMTS group relative to the PMSS group (360 ± 42 vs. 490 ± 38 s). The number of attempts needed to access the epidural space in PMSS group was significantly higher than in PMTS group. Distances between the epidural space and the puncture site in PMSS group and PMTS group showed a significant difference (7.13 ± 0.67 vs. 5.24 ± 0.21 cm). No significant differences in the extent of sensory block after spinal block were observed. CONCLUSIONS We found that PMTS approach was superior as a means of achieving epidural access relative to the PMSS approach, since PMTS approach can be conducted more quickly given shorter path of the needle and less times needed for epidural access during this procedure. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry, clinical trial number ChiCTR1800015815, date of registration April 24, 2018.
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Palepu V, Rayaprolu SD, Nagaraja S. Differences in Trabecular Bone, Cortical Shell, and Endplate Microstructure Across the Lumbar Spine. Int J Spine Surg 2019; 13:361-370. [PMID: 31531286 DOI: 10.14444/6049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The quality of the vertebral body structures such as endplate, cortex, and trabecular bone is important for understanding the performance of implants, particularly at the bone-implant interface. Although vertebral body structures have been analyzed separately in the literature, there is no comprehensive study to assess these anatomical measurements along with their interrelationships in the lumbar spine. Therefore, the purpose of this study was to assess variations in trabecular microstructure, vertebral endplate thickness and concavity, and vertebral body cortex thickness within the lumbar spine. Methods A total of 80 lumbar vertebrae (L1-L5) were dissected from 16 human cadaver specimens and imaged with microcomputed tomography to determine trabecular microstructure, vertebral cortex thickness, endplate thickness, and maximum endplate concavity depth. A paired t test and regression analysis were used to determine significant differences (P < .05) between different vertebral levels and correlations between the analyzed anatomical parameters. Results L1 vertebra had significantly better (P < .02) trabecular bone microstructure (eg, trabecular bone volume fraction) than all other lumbar vertebrae. However, L1 vertebra also had significantly thinner (P ≤ .02) anterior, left, and right cortices compared to all other vertebral levels. Within L3-L5 intervertebral disc spaces, cranial endplates had significantly greater (P ≤ .03) thickness and maximum concavity depth compared to their respective caudal endplates. No strong correlations were observed between trabecular bone microstructure, maximum endplate concavity depth, vertebral cortex, and endplate thickness parameters. Conclusions Detailed reference data of these anatomical parameters for each lumbar vertebral body can aid in improved understanding of bone quality, particularly when assessing different implant designs and fixation approaches. Moreover, such anatomical knowledge may help clinicians with optimal implant design selection and surgical placement of these devices into their respective locations.
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Affiliation(s)
- Vivek Palepu
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, Maryland
| | - Sai Deepa Rayaprolu
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, Maryland
| | - Srinidhi Nagaraja
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, Maryland
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Genetic Predisposition to Symptomatic Lumbar Disk Herniation in Pediatric and Young Adult Patients. Spine (Phila Pa 1976) 2019; 44:E640-E649. [PMID: 30475332 DOI: 10.1097/brs.0000000000002949] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case-control whole-genome sequencing analysis of a highly select, young cohort with symptomatic lumbar disk herniation (LDH) compared with the standard variation in a large reference population. OBJECTIVE To assess genetic influences predisposing pediatric and young adult patients to symptomatic LDH. SUMMARY OF BACKGROUND DATA LDH has traditionally been attributed to natural weakening or mechanical insult, but recent literature supports a potential genetic influence. METHODS Young patients with symptomatic, clinically confirmed LDH who underwent surgical treatment were included. Patients were younger than the average age of presentation, limiting the influence of environmental risks. DNA collected from these patients was compared with a reference genome (1000 Genomes Project). A genome-wide association study using whole-genome sequencing was used to characterize genetic mutations potentially associated with LDH. RESULTS Among the 61 candidate genes flagged, 20 had missense mutations in 2 or more LDH cases. Missense mutations in collagen-encoding genes were observed in 12 of 15 patients (80%). A potential association with clinical presentation was indicated by odds ratios of key single-nucleotide polymorphism (SNP) variants in genes that encode collagen. Relative to the reference population, the LDH cohort demonstrated two statistically significant SNP variants in the gene encoding for aggrecan, a protein that facilitates load-bearing properties in the cartilaginous end plate. Aggrecan genes SNPs rs3817428 and rs11638262 were significantly associated with decreased odds of symptomatic LDH: odds ratio 0.05 (0.02-0.11) and 0.04 (0-0.26), respectively (P < 1 × 10 for both). CONCLUSION These results suggest that collagen-encoding variants may be a genetic risk factor for LDH. They also shed new light on the role of variants that impact aggrecan, which sustains the cartilaginous end plate. Genetic predisposition to LDH may therefore be related to a multimodal combination of mutations that affect the nucleus pulposus, annulus fibrosus, and the cartilaginous end plates. LEVEL OF EVIDENCE 4.
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Kinematics of the Spine Under Healthy and Degenerative Conditions: A Systematic Review. Ann Biomed Eng 2019; 47:1491-1522. [DOI: 10.1007/s10439-019-02252-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/21/2019] [Indexed: 01/05/2023]
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