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Dudli S, Sing DC, Hu SS, Berven SH, Burch S, Deviren V, Cheng I, Tay BKB, Alamin TF, Ith MAM, Pietras EM, Lotz JC. ISSLS PRIZE IN BASIC SCIENCE 2017: Intervertebral disc/bone marrow cross-talk with Modic changes. Eur Spine J 2017; 26:1362-1373. [PMID: 28138783 DOI: 10.1007/s00586-017-4955-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 01/15/2017] [Indexed: 12/18/2022]
Abstract
STUDY DESIGN Cross-sectional cohort analysis of patients with Modic Changes (MC). OBJECTIVE Our goal was to characterize the molecular and cellular features of MC bone marrow and adjacent discs. We hypothesized that MC associate with biologic cross-talk between discs and bone marrow, the presence of which may have both diagnostic and therapeutic implications. BACKGROUND DATA MC are vertebral bone marrow lesions that can be a diagnostic indicator for discogenic low back pain. Yet, the pathobiology of MC is largely unknown. METHODS Patients with Modic type 1 or 2 changes (MC1, MC2) undergoing at least 2-level lumbar interbody fusion with one surgical level having MC and one without MC (control level). Two discs (MC, control) and two bone marrow aspirates (MC, control) were collected per patient. Marrow cellularity was analyzed using flow cytometry. Myelopoietic differentiation potential of bone marrow cells was quantified to gauge marrow function, as was the relative gene expression profiles of the marrow and disc cells. Disc/bone marrow cross-talk was assessed by comparing MC disc/bone marrow features relative to unaffected levels. RESULTS Thirteen MC1 and eleven MC2 patients were included. We observed pro-osteoclastic changes in MC2 discs, an inflammatory dysmyelopoiesis with fibrogenic changes in MC1 and MC2 marrow, and up-regulation of neurotrophic receptors in MC1 and MC2 bone marrow and discs. CONCLUSION Our data reveal a fibrogenic and pro-inflammatory cross-talk between MC bone marrow and adjacent discs. This provides insight into the pain generator at MC levels and informs novel therapeutic targets for treatment of MC-associated LBP.
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Affiliation(s)
- Stefan Dudli
- Department of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Ave, S-1164, San Francisco, CA, 94143, USA.
| | - David C Sing
- Department of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Ave, S-1164, San Francisco, CA, 94143, USA
| | - Serena S Hu
- Stanford Spine Clinic, Stanford University Medical Center, Stanford, USA
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Ave, S-1164, San Francisco, CA, 94143, USA
| | - Shane Burch
- Department of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Ave, S-1164, San Francisco, CA, 94143, USA
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Ave, S-1164, San Francisco, CA, 94143, USA
| | - Ivan Cheng
- Stanford Spine Clinic, Stanford University Medical Center, Stanford, USA
| | - Bobby K B Tay
- Department of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Ave, S-1164, San Francisco, CA, 94143, USA
| | - Todd F Alamin
- Department of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Ave, S-1164, San Francisco, CA, 94143, USA
| | | | - Eric M Pietras
- Division of Hematology, University of Colorado Denver, Denver, USA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Ave, S-1164, San Francisco, CA, 94143, USA
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Biswal S, Behera D, Yoon DH, Holley D, Ith MAM, Carroll I, Smuck M, Hargreaves B. [18F]FDG PET/MRI of patients with chronic pain alters management: early experience. EJNMMI Phys 2016; 2:A84. [PMID: 26956346 PMCID: PMC4798651 DOI: 10.1186/2197-7364-2-s1-a84] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sandip Biswal
- Stanford University School of Medicine, California, USA
| | - Deepak Behera
- Stanford University School of Medicine, California, USA
| | - Dae Hyun Yoon
- Stanford University School of Medicine, California, USA
| | - Dawn Holley
- Stanford University School of Medicine, California, USA
| | | | - Ian Carroll
- Stanford University School of Medicine, California, USA
| | - Matthew Smuck
- Stanford University School of Medicine, California, USA
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