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Maiers MJ, Sundin AR, Oster RJ, Kreul S, Malone Q, Passmore SR. Contextual factors related to aging determine force-based manipulation dosage: a prospective cross-sectional study. Chiropr Man Therap 2025; 33:20. [PMID: 40399997 DOI: 10.1186/s12998-025-00584-1] [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] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Accepted: 05/14/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND Contextual factors influence clinicians' delivery of force-based manipulation (FBM), like spinal manipulative therapy (SMT). It is particularly important to discern how contextual factors interact with therapeutic forces delivered to an older adult population, to minimize risk and identify ideal dosage. This study aimed to determine whether contextual factors pertaining to aging result in the modulation of kinetic and kinematic parameters used by experienced clinicians when delivering SMT. METHODS Participants were randomly presented with a series of 12 AI-generated patient vignettes, featuring both visual and auditory content and representing varying age-related contextual factors. Factors included chronological (35-, 65- and 85-year-old), pathological ("healthy" vs degenerative spine), and felt (perceived as "young" vs. "old") age. Participants delivered SMT to a human analogue manikin based on each vignette, presented six times in randomized order. Kinetic and kinematic parameters were collected and analyzed for differences between "young" and "old" contextual factors of age, using a 3-way repeated measures ANOVA model. RESULTS Sixteen licensed chiropractors (8 female, 8 male) participated, with an average age of 45.4 (SD = 9.7, range 34-64) years and 18.3 (SD = 10.8, range 5-39) years of experience. A main effect in peak force was found for both chronological (F(2,30) = 26.18; p <.001, ηp2 = 0.636) and pathological age (F(1,15) = 11.58; p =.004, ηp2 = 0.436), following a stepwise progression of decreased force with increased age and with pathology. No statistically significant differences were found in peak force based on felt age, or in time to peak force for any factor. A main effect was found for chronological age with peak acceleration (F(2,20) = 9.50; p <.001, ηp2 = 0.487) and peak velocity (F(2,20) = 7.20; p =.004, ηp2 = 0.419), but not for pathological or felt age. There was a significant difference in time to peak velocity for felt age (F(1,10) = 12.23; p =.006, ηp2 = 0.550), with a shorter time to peak velocity in response to vignettes with older felt age. CONCLUSION Contextual factors of aging modulated certain kinetic and kinematic characteristics when delivering SMT. This provides evidence that practitioners differentially discern aspects of aging to inform how they deliver FBM dosage. Future research is needed to identify ideal kinetic and kinematic characteristics based on considerations of aging.
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Affiliation(s)
- Michele J Maiers
- Northwestern Health Sciences University, Bloomington, MN, USA.
- RAND Research Across Complementary and Integrative Health Institutions (REACH) Center, Santa Monica, CA, USA.
| | | | - Ryan J Oster
- Northwestern Health Sciences University, Bloomington, MN, USA
| | - Steven Kreul
- Northwestern Health Sciences University, Bloomington, MN, USA
| | - Quinn Malone
- School of Health and Exercise Sciences, University of British Columbia: Okanagan, Kelowna, BC, Canada
| | - Steven R Passmore
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
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Sancar KS, Şeref Ç, Hamit G, Yavuz AE, Şaziye Ş. Does the severity of facet joint osteoarthritis affect facet medial branch radiofrequency thermocoagulation results? NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2025; 30:144-149. [PMID: 40199535 PMCID: PMC11977580 DOI: 10.17712/nsj.2025.30.4.20240037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 01/21/2025] [Indexed: 04/10/2025]
Abstract
OBJECTIVES To assess how facet medial branch radiofrequency thermocoagulation (FMB-RFT) outcomes are affected by severe facet joint osteoarthritis (FJO). METHODS This retrospective study involved 91 individuals with lumbar facet joint disease-related chronic lower back pain (CLBP), all of whom underwent FMB-RFT. The patients were assigned to 3 groups using the Weishaupt facet grading system (WFGS). Pain scores were assessed prior to treatment, as well as at the 1-, 6-, and 12-month marks. RESULTS Based on the WFGS, 38 of the 91 patients were assigned a grade 1 FJO, 28 a grade 2 FJO, and 25 a grade 3 FJO. The percentage of patients in each group who saw a 50% or greater improvement in their pain scores at 1, 6, and 12 months did not differ significantly. CONCLUSION For patients with CLBP, FMB-RFT has been shown to be safe and effective in both the short and long terms. The results from FMB-RFT do not seem to be affected by the severity of FJO.
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Affiliation(s)
- Kaya S. Sancar
- From the Deparment of Pain Medicine (Sancar), Adiyaman University Training and Research Hospital, Adıyaman, from the Deparment of Pain Medicine (Şeref, Yavuz, Şaziye), University of Health Sciences Ankara City Hospital, and from the Deparment of Pain Medicine (Hamit), Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Çelik Şeref
- From the Deparment of Pain Medicine (Sancar), Adiyaman University Training and Research Hospital, Adıyaman, from the Deparment of Pain Medicine (Şeref, Yavuz, Şaziye), University of Health Sciences Ankara City Hospital, and from the Deparment of Pain Medicine (Hamit), Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Göksu Hamit
- From the Deparment of Pain Medicine (Sancar), Adiyaman University Training and Research Hospital, Adıyaman, from the Deparment of Pain Medicine (Şeref, Yavuz, Şaziye), University of Health Sciences Ankara City Hospital, and from the Deparment of Pain Medicine (Hamit), Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Akçaboy E. Yavuz
- From the Deparment of Pain Medicine (Sancar), Adiyaman University Training and Research Hospital, Adıyaman, from the Deparment of Pain Medicine (Şeref, Yavuz, Şaziye), University of Health Sciences Ankara City Hospital, and from the Deparment of Pain Medicine (Hamit), Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Şahin Şaziye
- From the Deparment of Pain Medicine (Sancar), Adiyaman University Training and Research Hospital, Adıyaman, from the Deparment of Pain Medicine (Şeref, Yavuz, Şaziye), University of Health Sciences Ankara City Hospital, and from the Deparment of Pain Medicine (Hamit), Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
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Im JH, Lee JW, Lee JY. Ulnar Impaction Syndrome and TFCC Injury: Their Relationship and Management. J Wrist Surg 2025; 14:14-26. [PMID: 39896911 PMCID: PMC11781856 DOI: 10.1055/s-0043-1776759] [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: 06/05/2023] [Accepted: 08/16/2023] [Indexed: 02/04/2025]
Abstract
Ulnar-sided wrist pain can be caused by a number of problems, including ulnar impaction syndrome (UIS) and triangular fibrocartilage complex (TFCC) injury. Multiple studies have described the diagnostic criteria for UIS and TFCC injuries, and excellent surgical outcomes have been reported for each condition. Few studies have examined the extent to which the two independent conditions cooccur, and little is known about their relationship. Based on theories in the literature and clinical experience, we propose the possibility of TFCC injury as the cause and result of UIS in this review.
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Affiliation(s)
- Jin-Hyung Im
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Woo Lee
- Department of Orthopedic Surgery, Eunpyoeng St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo-Yup Lee
- Department of Orthopedic Surgery, Eunpyoeng St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Liu Y, Song Y, Wang J, Shao Z. Elevating Postinjection Stability in Silk Nanofibril Hydrogels to Prevent Intervertebral Disc Degeneration. Biomacromolecules 2024; 25:7828-7837. [PMID: 39571083 DOI: 10.1021/acs.biomac.4c01118] [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: 12/10/2024]
Abstract
Injectable hydrogels offer a minimally invasive approach to treating intervertebral disc degeneration, a prevalent condition that affects 90% of individuals and often leads to significant pain and disability. Despite being a critical yet often overlooked issue that could lead to suboptimal therapeutic outcomes, the mechanical integrity of these gels frequently diminishes postinjection due to the injection process itself. To address this challenge, our research developed a silk-nanofibril-based hydrogel enhanced through simple in situ polymerization of dopamine. The resulting hydrogel not only effectively preserved its modulus at over 1000 Pa postinjection, matching the mechanical properties of the nucleus pulposus, but also significantly enhanced its antioxidative properties to four times that of the original silk nanofibril-based hydrogel. Furthermore, both cell-based and animal studies substantiated that such a silk nanofibril-based hydrogel integrated with polydopamine exhibited significant therapeutic efficacy in the injectable treatment of intervertebral disc degeneration. Therefore, this work introduced a new perspective on the design of injectable hydrogels that could effectively address both the mechanical and biochemical challenges of degenerative disc diseases, providing a platform for subsequent therapeutic interventions.
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Affiliation(s)
- Yi Liu
- State Key Laboratory of Molecular Engineering of Polymers, Lab of Advanced Materials, Department of Macromolecular Science, Fudan University, Shanghai 200433, China
| | - Yifei Song
- State Key Laboratory of Molecular Engineering of Polymers, Lab of Advanced Materials, Department of Macromolecular Science, Fudan University, Shanghai 200433, China
| | - Jin Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhengzhong Shao
- State Key Laboratory of Molecular Engineering of Polymers, Lab of Advanced Materials, Department of Macromolecular Science, Fudan University, Shanghai 200433, China
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Sun BL, Zhang Y, Zhang N, Xiong X, Zhong YX, Xing K, Wan Z, Liu ZL, Huang SH, Liu JM. Prevalence of lumbar disc herniation in populations with different symptoms based on magnetic resonance imaging study. J Clin Neurosci 2024; 129:110839. [PMID: 39326345 DOI: 10.1016/j.jocn.2024.110839] [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: 07/22/2024] [Revised: 09/01/2024] [Accepted: 09/08/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Lumbar disc herniation (LDH) is common in aged human beings. This study is to investigate the prevalence of lumbar disc herniation (LDH) in different symptomatic populations attending outpatient clinics based on magnetic resonance imaging (MRI) studies, and to analyze the characteristics, distribution, and treatment strategies thereof. METHODS Patients who visited our outpatient clinics between January 1, 2022, and December 31, 2022, with complaints of low back pain, either accompanied or unaccompanied by lower limb symptoms (radiating pain, numbness or muscle weakness), were included. All patients underwent comprehensive lumbar spine MRI examinations. The prevalence of LDH in different symptomatic populations, as well as the characteristics, distribution, and treatment strategies of disc herniation were analyzed. RESULTS Among 8,161 individuals (3,411 males and 4,750 females), 4,496 were diagnosed with LDH, resulting in a prevalence of 55.1 %. Of these, 683 (15.2 %) individuals underwent surgical treatment. Among all patients, 3,529 exhibited only low back pain symptoms, 1,820 (51.6 %) were diagnosed with LDH, and 201 (11.0 %) received surgical treatment. Additionally, 2,673 patients with low back pain accompanied by lower limb symptoms were identified, with 1,608 individuals (82.1 %) diagnosed with LDH; 319 (19.8 %) underwent surgical treatment. Furthermore, 1,959 patients presented with lower limb symptoms only, 1,068 (54.5 %) were diagnosed with LDH, and 163 received surgical treatment (P < 0.001). The prevalence rate for males was 58.8 %, compared to females with 52.4 % (P < 0.01). The prevalence of LDH exhibited an initially increasing trend, later decreasing with advancing age. L4/5 and L5/S1 were the most commonly affected segments. CONCLUSION LDH prevalence varies among patients with different symptoms, with a higher rate in those presenting with low back pain accompanied by lower limb symptoms. These symptomatic patients also exhibit a higher rate of surgical intervention.
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Affiliation(s)
- Bo-Lin Sun
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Spine and Spinal Cord Disease, Nanchang 330006, PR China
| | - Yu Zhang
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Spine and Spinal Cord Disease, Nanchang 330006, PR China
| | - Ning Zhang
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006 PR China
| | - Xu Xiong
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Spine and Spinal Cord Disease, Nanchang 330006, PR China
| | - Yan-Xin Zhong
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Spine and Spinal Cord Disease, Nanchang 330006, PR China
| | - Kai Xing
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Spine and Spinal Cord Disease, Nanchang 330006, PR China
| | - Zongmiao Wan
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China
| | - Zhi-Li Liu
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Spine and Spinal Cord Disease, Nanchang 330006, PR China
| | - Shan-Hu Huang
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Spine and Spinal Cord Disease, Nanchang 330006, PR China
| | - Jia-Ming Liu
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Spine and Spinal Cord Disease, Nanchang 330006, PR China.
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Williams CL, Curfman SE, Lindsley SR, Falyar CR, McConnell RC. Inferior-Medial Dry Needling at the Thoracolumbar Junction: A Cadaveric Study. Int J Sports Phys Ther 2024; 19:1238-1243. [PMID: 39371194 PMCID: PMC11446727 DOI: 10.26603/001c.123477] [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: 05/15/2024] [Accepted: 08/12/2024] [Indexed: 10/08/2024] Open
Abstract
Background Dry needling (DN) has emerged as a popular therapeutic intervention for managing musculoskeletal pain. While major adverse events are generally rare, those that have been reported in vulnerable areas such as the spine and thorax can be serious and warrant further investigation regarding safe techniques in and around these areas. Purpose The purpose of this study was to reproduce the methods employed by Williams et al. but with an inferior-medial multifidus DN technique to determine if a dry needle can penetrate the ligamentum flavum (LF) and breach the spinal canal at the thoracolumbar junction. Study Design Descriptive Cadaveric study. Methods The procedure was performed on a cadaver in the prone position. The needle was advanced under ultrasound guidance to determine if a 0.30 x 40 mm dry needle inserted lateral to the spinous process of T12 and directed inferior-medially could penetrate the LF and enter the spinal canal. Results A 0.30 x 40 mm dry needle inserted 1.9 cm lateral to the spinous process of T12 was able to traverse the space between the vertebral laminae of T12 and L1, penetrate the LF, and enter the spinal canal with an inferior-medial needle angulation of 33-degrees medial and 18-degrees inferior. Conclusion The results of this study demonstrate the feasibility of a dry needle entering the spinal canal at the thoracolumbar junction using an inferior-medial technique. These findings support the potential role of ultrasound guidance in the training and clinical practice of DN, especially in regions where safety issues have been documented. Level of Evidence Level IV.
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Bogduk N, MacVicar J. Osteoarthritis of zygapophysial joints as a cause of back pain and neck pain: a scoping review. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:541-552. [PMID: 38702827 PMCID: PMC11369356 DOI: 10.1093/pm/pnae036] [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: 03/28/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Zygapophysial joints (Z joints) can be a source of back pain and of neck pain, but the cause of pain is not known. Some authors attribute the pain to osteoarthritis but without citing evidence. OBJECTIVES The present review was undertaken to determine if there was sufficient evidence of association between spinal pain and osteoarthritis of Z joints to justify osteoarthritis being held to be the cause of pain. The null hypothesis was that osteoarthritis of Z joints does not cause back pain or neck pain. ELIGIBILITY CRITERIA Relevant studies were ones that provided primary data on the association between pain and osteoarthritis of Z joints. These could be population studies, diagnostic studies, or case-control studies. SOURCES OF EVIDENCE The database of PubMed was searched using the terms: Lumbar or cervical, zygapophysial or facet, pain, and osteoarthritis or degeneration or degenerative. CHARTING METHODS Data pertinent to the research question were extracted from original articles and tabulated for reporting. Odds ratios for associations were calculated, as were the prevalence rates of osteoarthritis in subjects with pain, and conversely the prevalence rates of pain in subjects with osteoarthritis. RESULTS The searches retrieved 11 population studies, 4 diagnostic studies, and 3 cases control studies. No study showed any positive association between osteoarthritis of Z joints and pain. All studies found pain to be independent of the presence or severity of osteoarthritis. Osteoarthritis was as common in subjects with no pain as in subjects with pain. The null hypothesis was not refuted. CONCLUSION The published evidence does not support the belief that osteoarthritis causes Z joint pain. All the evidence contradicts this belief.
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Affiliation(s)
- Nikolai Bogduk
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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Shen M, Shen Z, Yang G, Tian X, Zhao H, Wang W, Yang H. The Differences on the Fatty Infiltration of Paraspinal Muscles between Single- and Multiple-level Intervertebral Disc Degeneration in Patients with Lumbar Disc Herniation. Orthop Surg 2024; 16:1999-2010. [PMID: 38952024 PMCID: PMC11293918 DOI: 10.1111/os.14101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVE Multiple-level Intervertebral disc degeneration (IDD) in patients with lumbar disc herniation (LDH) is related to postoperative re-herniation and low back pain. Although many investigators believed that there is an interdependence between paraspinal muscles degeneration and IDD, few studies focused on the fatty infiltration of paraspinal muscles on single- and multiple-level IDD in patients with LDH. This study aims to investigate the difference on the fatty infiltration of paraspinal muscles between single- and multiple-levels IDD in patients with LDH. and to explore in patients with LDH whether fatty infiltration is a potential risk factor for multiple-level IDD. METHODS This study was conducted as a retrospective observational analysis of 82 patients with LDH from January 1, 2020 to December 30, 2020 in our hospital were enrolled. Twenty-seven cases had single-level IDD (Group A), and 55 cases had multiple-level IDD (Group B). We measured the mean computed tomography (CT) density value of the paraspinal muscles, including multifidus (MF), erector spinae (ES) and psoas muscle (PM) at each disc from L1 to S1. Subgroups were set to further analyze the odds ratio (OR) of fatty infiltration of paraspinal muscles in different sex and BMI groups. We measured sagittal angles and analyzed the relationships between these angles and IDD. Finally, we use logistic regression, adjusted for other confounding factors, to investigate whether fatty infiltration is an independent risk factor for multi-level IDD. RESULTS The average age in multi-level IDD (51.40 ± 15.47 years) was significantly higher than single-level IDD (33.37 ± 7.10 years). The mean CT density value of MF, ES and PM in single-level IDD was significantly higher than multi-level IDD (all ps < 0.001). There was no significant difference of the mean value of angles between the two groups. No matter being fat (body mass index [BMI] > 24.0 kg/m2) or normal, patients with low mean muscle CT density value of MF and ES are significantly easier to suffer from multiple-level IDD. In the pure model, the average CT density value of the MF, ES and PM is all significantly associated with the occurrence of multi-IDD. However, after adjusting for various confounding factors, only the OR of the average CT density value for MF and ES remains statistically significant (OR = 0.810, 0.834, respectively). CONCLUSIONS In patients with LDH, patients with multiple-level IDD have more severe fatty infiltration of MF and ES than those with single-level IDD. Fatty infiltration of MF and ES are independent risk factors for multiple-level IDD in LDH patients.
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Affiliation(s)
- Minjie Shen
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Zhijia Shen
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
- Suzhou Medical College of Soochow UniversitySuzhouChina
| | - Guanyu Yang
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
- Suzhou Medical College of Soochow UniversitySuzhouChina
| | - Xin Tian
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
- Suzhou Medical College of Soochow UniversitySuzhouChina
| | - Hongcheng Zhao
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
- Suzhou Medical College of Soochow UniversitySuzhouChina
| | - Wenhao Wang
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Huilin Yang
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
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Zhu C, Xiao G. Efficacy and safety of interspinous process device compared with alone decompression for lumbar spinal stenosis: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38370. [PMID: 38847722 PMCID: PMC11155552 DOI: 10.1097/md.0000000000038370] [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: 03/28/2024] [Accepted: 05/03/2024] [Indexed: 06/10/2024] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. BACKGROUND Interspinous process devices (IPD) were used as a treatment in selected patients with lumbar spinal stenosis (LSS). However, the use of IPD was still debated that it had significantly higher reoperation rates compared to traditional decompression. Therefore, the purpose of the meta-analysis was to evaluate the effectiveness and safety of IPD treatment in comparison to traditional treatment. METHODS The databases were searched of PubMed, Embase and the Cochrane, Chinese National Knowledge Infrastructure, Chongqing VIP Database and Wan Fang Database up to January 2024. Relevant studies were identified by using specific eligibility criteria and data was extracted and analyzed based on primary and secondary endpoints. RESULTS A total of 13 studies were included (5 RCTs and 8 retrospective studies). There was no significant difference of Oswestey Disability Index (ODI) score in the last follow-up (MD = -3.81, 95% CI: -8.91-1.28, P = .14). There was significant difference of Visual Analog Scale (VAS) back pain scoring in the last follow-up (MD = -1.59, 95% CI: -3.09--0.09, P = .04), but there existed no significant difference of leg pain in the last follow-up (MD = -2.35, 95% CI: -6.15-1.45, P = .23). What's more, operation time, bleeding loss, total complications and reoperation rate had no significant difference. However, IPD had higher device problems (odds ratio [OR] = 9.00, 95% CI: 2.39-33.91, P = .001) and lesser dural tears (OR = 0.32, 95% CI: 0.15-0.67, P = .002) compared to traditional decompression. CONCLUSION Although IPD had lower back pain score and lower dural tears compared with traditional decompression, current evidence indicated no superiority for patient-reported outcomes for IPD compared with alone decompression treatment. However, these findings needed to be verified in further by multicenter, double-blind and large sample RCTs.
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Affiliation(s)
- Changjiu Zhu
- Department of Orthopedics, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Guiling Xiao
- Department of Orthopedics, Sichuan Provincial People’s Hospital, Chengdu, China
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Weiser S, Mowery HC, Campello M, Chytas V, Cedraschi C. What do older adults want from spine care? BRAIN & SPINE 2024; 4:102844. [PMID: 38873530 PMCID: PMC11170354 DOI: 10.1016/j.bas.2024.102844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/24/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
Introduction Older adults comprise a large portion of back pain (BP) sufferers but are under-represented in the literature. Patients over age 65 present with different clinical characteristics and psychosocial needs than younger patients. Therefore, recommended patient-centered outcomes for BP may not be relevant to older patients. Research question What treatment outcomes are most important to adults over 65 years of age? Materials and methods We queried older adults seeking treatment for BP using qualitative methods. Participants were asked about their goals and expectations of treatment in an audio-taped interview. Audiotapes were transcribed, coded and analyzed by the investigators. Using thematic analysis, main themes and constructs were extracted and interpreted by the investigators. From there we were able to generate hypotheses about what older patients want from spine treatment. Results For all participants, age played a role in their treatment goals as a moderator or motivator. They were most concerned with returning to usual activities and preventing further physical limitations to maintain independence. Goals that reflect important outcomes such as increasing walking tolerance and improving balance were of particular importance. Confidence in the provider acted as a facilitator of goals. Discussion and conclusion Unlike their younger cohorts, they did not emphasize work-related outcomes and pain relief. These findings can be tested in future quantitative studies and will help to develop protocols for outcomes assessment in older adults. This study is a first step towards understanding and improving the quality of care for older patients with back pain.
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Affiliation(s)
- Sherri Weiser
- New York University Grossman School of Medicine, 550 1st Ave, New York, NY, 10016, USA
| | - Hope C. Mowery
- New York University Langone Orthopedic Hospital, 63 Downing St, New York, NY, 10014, USA
| | - Marco Campello
- New York University Grossman School of Medicine, 550 1st Ave, New York, NY, 10016, USA
| | - Vasileios Chytas
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University Hospitals, 14 - CH, Geneva, 1211, Switzerland
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Wang X, Liu W, Zhao Y, Ma P. The impact of disc degeneration on the dynamic characteristics of the lumbar spine: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1384187. [PMID: 38751866 PMCID: PMC11094277 DOI: 10.3389/fbioe.2024.1384187] [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: 02/08/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
The dynamics of disc degeneration was analyzed to determine the effect of disc degeneration at the L4-L5 segment on the dynamic characteristics of the total lumbar spine. A three-dimensional nonlinear finite element model of the L1-S1 normal lumbar spine was constructed and validated. This normal model was then modified to construct two degeneration models with different degrees of degeneration (mild, moderate) at the L4-L5 level. Modal analysis, harmonic response analysis, and transient dynamics analysis were performed on the total lumbar spine when experiencing following compressive loading (500 N). As the degree of disc degeneration increased, the vibration patterns corresponding to the first three orders of the model's intrinsic frequency were basically unchanged, with the first order being in the left-right lateral bending direction, the second order being in the forward-flexion and backward-extension direction, and the third order being in the axial stretching direction. The nucleus pulposus pressure peaks corresponding to the first order intrinsic frequency for the harmonic response analysis are all on the right side of the model, with sizes of 0.053 MPa, 0.061 MPa, and 0.036 MPa, respectively; the nucleus pulposus pressure peaks corresponding to the second order intrinsic frequency are all at the rear of the model, with sizes of 0.13 MPa, 0.087 MPa, and 0.11 MPa, respectively; and the nucleus pulposus pressure peaks corresponding to the third order intrinsic frequency are all at the front of the model, with sizes of 0.19 MPa, 0.22 MPa, and 0.22 MPa, respectively. The results of the transient analysis indicated that over time, the response curves of the healthy model, the mild model, and the moderate model all exhibited cyclic response characteristics. Intervertebral disc degeneration did not adversely affect the vibration characteristics of the entire lumbar spine system. Intervertebral disc degeneration significantly altered the dynamics of the degenerative segments and their neighboring normal segments. The process of disc degeneration gradually shifted the load from the nucleus pulposus to the annulus fibrosus when the entire lumbar spine was subjected to the same vibratory environment.
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Affiliation(s)
- Xue Wang
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Wei Liu
- The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Yaqiong Zhao
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Pengcheng Ma
- Shandong Public Health Clinical Center, Shandong University, Jinan, China
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Mathieu J, Robert MÈ, Châtillon CÉ, Descarreaux M, Marchand AA. Appropriateness of specialized care referrals for LBP: a cross-sectional analysis. Front Med (Lausanne) 2024; 10:1292481. [PMID: 38249968 PMCID: PMC10797061 DOI: 10.3389/fmed.2023.1292481] [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: 09/12/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Background Low back pain (LBP) accounts for a significant proportion of primary care visits. Despite the development of evidence-based guidelines, studies point to the inefficient use of healthcare resources, resulting in over 60.0% of patients with LBP being referred to spine surgeons without any surgical indication. Centralized waiting lists (CWLs) have been implemented to improve access to specialized care by managing asymmetry between supply and demands. To date, no study has provided data on patients' clinical profiles and referral patterns to medical specialists for LBP in the context of a publicly funded healthcare system operating a prioritization model. The objective of this study was to evaluate the appropriateness of specialized care referrals for LBP after the implementation of a CWL. Methods A retrospective cross-sectional analysis of 500 randomly selected electronic health records of patients who attended the outpatient neurosurgery clinic of the administrative Mauricie-et-Centre-du-Québec region was performed. Inclusion criteria were neurosurgery consultation referrals for adults ≥18 years suffering from a primary complaint of LBP, and performed between September 1st, 2018, and September 1st, 2021. Data relevant for drawing a comprehensive portrait of patients referred to the neurosurgery service and for judging referrals appropriateness were manually extracted. Results Of the 500 cases analyzed, only 112 (22.4%) were surgical candidates, while 221 (44.2%) were discharge from the neurosurgery service upon initial assessment. Key information was inconsistently documented in medical files, thus preventing the establishment of a comprehensive portrait of patients referred to the neurosurgery service for LBP. Nevertheless, over 80.0% of referrals made during the study period were deemed inappropriate. Inappropriate referrals were characterized by higher proportion of patients symptomatically improved, presenting a back-dominant chief complaint, exhibiting no objective neurological symptoms, and diagnosed with non-specific LBP. Conclusion This study reveals a significant proportion of inappropriate referrals to specialized care for LBP. Further research is needed to better understand the factors that prompt referrals to medical specialists for LBP, and the criteria considered by neurosurgeons when selecting the appropriate management strategy. Recent studies suggest that triaging approaches led by musculoskeletal experts may improve referral appropriateness to specialized care.
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Affiliation(s)
- Janny Mathieu
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Marie-Ève Robert
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Claude-Édouard Châtillon
- Centre intégré universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, QC, Canada
- Division of Neurosurgery, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Andrée-Anne Marchand
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Fainor M, Orozco BS, Muir VG, Mahindroo S, Gupta S, Mauck RL, Burdick JA, Smith HE, Gullbrand SE. Mechanical crosstalk between the intervertebral disc, facet joints, and vertebral endplate following acute disc injury in a rabbit model. JOR Spine 2023; 6:e1287. [PMID: 38156057 PMCID: PMC10751980 DOI: 10.1002/jsp2.1287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/21/2023] [Accepted: 09/06/2023] [Indexed: 12/30/2023] Open
Abstract
Background Vertebral endplate sclerosis and facet osteoarthritis have been documented in animals and humans. However, it is unclear how these adjacent pathologies engage in crosstalk with the intervertebral disc. This study sought to elucidate this crosstalk by assessing each compartment individually in response to acute disc injury. Methods Eleven New Zealand White rabbits underwent annular disc puncture using a 16G or 21G needle. At 4 and 10 weeks, individual compartments of the motion segment were analyzed. Discs underwent T 1 relaxation mapping with MRI contrast agent gadodiamide as well T 2 mapping. Both discs and facets underwent mechanical testing via vertebra-disc-vertebra tension-compression creep testing and indentation testing, respectively. Endplate bone density was quantified via μCT. Discs and facets were sectioned and stained for histology scoring. Results Intervertebral discs became more degenerative with increasing needle diameter and time post-puncture. Bone density also increased in endplates adjacent to both 21G and 16G punctured discs leading to reduced gadodiamide transport at 10 weeks. The facet joints, however, did not follow this same trend. Facets adjacent to 16G punctured discs were less degenerative than facets adjacent to 21G punctured discs at 10 weeks. 16G facets were more degenerative at 4 weeks than at 10, suggesting the cartilage had recovered. The formation of severe disc osteophytes in 16G punctured discs between 4 and 10 weeks likely offloaded the facet cartilage, leading to the recovery observed. Conclusions Overall, this study supports that degeneration spans the whole spinal motion segment following disc injury. Vertebral endplate thickening occurred in response to disc injury, which limited the diffusion of small molecules into the disc. This work also suggests that altered disc mechanics can induce facet degeneration, and that extreme bony remodeling adjacent to the disc may promote facet cartilage recovery through offloading of the articular cartilage.
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Affiliation(s)
- Matthew Fainor
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Brianna S. Orozco
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Victoria G. Muir
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sonal Mahindroo
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- Department of BiologySt. Bonaventure UniversitySt. BonaventureNew YorkUSA
| | - Sachin Gupta
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Robert L. Mauck
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jason A. Burdick
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- BioFrontiers Institute and Department of Chemical and Biological EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Harvey E. Smith
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Sarah E. Gullbrand
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
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Wang Z, Hu X, Cui P, Kong C, Chen X, Wang W, Lu S. Progress in understanding the role of cGAS-STING pathway associated with programmed cell death in intervertebral disc degeneration. Cell Death Discov 2023; 9:377. [PMID: 37845198 PMCID: PMC10579269 DOI: 10.1038/s41420-023-01607-7] [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: 06/19/2023] [Revised: 07/30/2023] [Accepted: 08/14/2023] [Indexed: 10/18/2023] Open
Abstract
Nucleus pulposus (NP) inflammatory response can induce intervertebral disc degeneration (IVDD) by causing anabolic and catabolic disequilibrium of the extracellular matrix (ECM). This process is accompanied by the production of endogenous DNAs, then detectable by the DNA sensor cyclic GMP-AMP synthase (cGAS). cGAS recognizes these DNAs and activates the downstream adaptor protein, a stimulator of interferon genes (STING), initiating a cascade of inflammation responses through various cytokines. This evidence implies a crucial role of the cGAS-STING signaling pathway in IVDD. Additionally, it is suggested that this pathway could modulate IVDD progression by regulating apoptosis, autophagy, and pyroptosis. However, a detailed understanding of the role of cGAS-STING pathway in IVDD is still lacking. This review provides a comprehensive summary of recent advances in our understanding of the role of the cGAS-STING pathway in modulating inflammatory response in IVDD. We delve into the connection between the cGAS-STING axis and apoptosis, autophagy, and pyroptosis in IVDD. Furthermore, we discuss the therapeutic potential of targeting the cGAS-STING signaling pathway in IVDD treatment. Overall, this review aims to provide a foundation for future directions in IVDD treatment strategies.
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Affiliation(s)
- Zheng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xinli Hu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Peng Cui
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xiaolong Chen
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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Butylina M, Wahl-Figlash K, Kothmayer M, Gelles K, Pusch O, Pietschmann P. Histopathology of the Intervertebral Disc of Nothobranchius furzeri, a Fish Model of Accelerated Aging. BIOLOGY 2023; 12:1305. [PMID: 37887015 PMCID: PMC10604764 DOI: 10.3390/biology12101305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Osteoarthritis is a classical age-related disease, which affects millions of patients worldwide. To further understand the pathophysiology and to develop therapeutic strategies for this disease, animal models play a significant role. Nothobranchius furzeri is an established model for accelerated aging that spontaneously develops spinal deformities. Although the bone properties of N. furzeri are well described, characteristics of the intervertebral discs are still unknown. The aim of this study was to investigate the characteristics of the intervertebral discs of healthy and deformed N. furzeri. MATERIAL AND METHODS Intervertebral properties of healthy and deformed N. furzeri were investigated in 8-, 12-, 18- and 21.5-week-old male fish of the GRZ strain. For histological evaluations the fish were decalcified, paraffin-embedded and stained with (1) hematoxylin and eosin, (2) toluidine blue and (3) alcian blue/picrosirius red. RESULTS 8-week-old and deformed N. furzeri showed spongy-like tissue containing vacuolated notochord cells and a beginning formation of fibrous tissue in the central area. Older healthy fish showed fibrous tissue in the central region and a spongy-like tissue in the peripheral region. CONCLUSION Our study revealed age- and disease-related alterations of the vertebral discs in N. furzeri. Further studies should investigate the utility of N. furzeri as a model for degenerative spine diseases.
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Affiliation(s)
- Maria Butylina
- Institute for Pathophysiology and Allergy Research (IPA), Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090 Vienna, Austria
| | - Katharina Wahl-Figlash
- Institute for Pathophysiology and Allergy Research (IPA), Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Kothmayer
- Center of Anatomy and Cell Biology, Medical University of Vienna, 1090 Vienna, Austria
| | - Katharina Gelles
- Institute for Pathophysiology and Allergy Research (IPA), Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090 Vienna, Austria
| | - Oliver Pusch
- Center of Anatomy and Cell Biology, Medical University of Vienna, 1090 Vienna, Austria
| | - Peter Pietschmann
- Institute for Pathophysiology and Allergy Research (IPA), Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090 Vienna, Austria
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16
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Huang L, Wang W, Xian Y, Liu L, Fan J, Liu H, Zheng Z, Wu D. Rapidly in situ forming an injectable Chitosan/PEG hydrogel for intervertebral disc repair. Mater Today Bio 2023; 22:100752. [PMID: 37576872 PMCID: PMC10415788 DOI: 10.1016/j.mtbio.2023.100752] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023] Open
Abstract
Intervertebral disc (IVD) degeneration occurred with the increasing age or accidents has puzzled peoples in daily life. To seal IVD defect by injectable hydrogels is a promising method for slowing down IVD degeneration. Herein, we reported a rapidly in situ forming injectable chitosan/PEG hydrogel (CSMA-PEGDA-L) through integrating photo-crosslink of methacrylate chitosan (CSMA) with Schiff base reaction between CSMA and aldehyde polyethylene glycol (PEGDA). The CSMA-PEGDA-L possessed a stronger compressive strength than the photo-crosslinked CSMA-L hydrogel and Schiff-base-crosslinked CSMA-PEGDA hydrogel. This chitosan/PEG hydrogel showed low cytotoxicity from incubation experiments of nucleus pulpous cells. When implanted on the punctured IVD of rat's tail, the CSMA-PEGDA-L hydrogel could well retard the progression of IVD degeneration through physical plugging, powerfully proven by radiological and histological evaluations. This work demonstrated the strategy of in situ injectable glue may be a potential solution for prevention of IVD degeneration.
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Affiliation(s)
- Lin Huang
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Wantao Wang
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510275, China
| | - Yiwen Xian
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Lei Liu
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Jinghao Fan
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Hongmei Liu
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Zhaomin Zheng
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510275, China
| | - Decheng Wu
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
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Wang H, Li N, Huang H, Xu P, Fan Y. Biomechanical effect of intervertebral disc degeneration on the lower lumbar spine. Comput Methods Biomech Biomed Engin 2023; 26:1669-1677. [PMID: 36218332 DOI: 10.1080/10255842.2022.2129970] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 11/03/2022]
Abstract
Lumbar intervertebral disc degeneration can induce bone hyperplasia, lumbar intervertebral disc herniation and other diseases, is one of the causes of low back pain, which seriously affects people's quality of life. And the causes of degeneration are very complex, so it is essential to understand the underlying mechanism of intervertebral disc degeneration and its influence. In this study, biomechanical effects of L4∼L5 lumbar degeneration with different degrees of degeneration were studied based on the numerical simulations. The three-dimensional finite element model of normal L2∼S1 lumbar vertebrae was established based on CT images of average adult male and verified. Several key parameters (intervertebral disc height, nucleus pulposus size, properties of different materials, etc.) of the model were modified to construct L4∼L5 models with different degrees of degeneration (grade 1, grade 2, grade 3, and grade 4). The range of motion (ROM), the intradiscal pressure of the nucleus, and the maximum Von Mises stress were determined by applying torques in different directions to simulate the four postures of flexion, extension, lateral bending, and axial rotation under compression load (500 N) to simulate the upper body weight of the human body. In different postures, with the increase of L4∼L5 degeneration degree, the ROM of the L4∼L5 degeneration segment showed a decreasing trend (Grade 4 had decrease of 41.9% to 65.2% compared to normal at different postures), while the ROM of its adjacent normal segments showed an increasing trend (L3∼L4: Grade 4 had increase of 21%-94% compared to normal at different postures; L5∼S1: Grade 4 had increase of 32%-66% compared to normal at different postures). With the increase in the degree of degeneration, nucleus pulposus pressure in the L4∼L5 degeneration segment decreased continuously under different postural conditions (Grade 4 had decrease of 25%-134.6% compared to normal at different postures), while the nucleus pulposus pressure in adjacent normal segments (L3∼L4 and L5∼S1) showed a gradually increasing trend. The maximum Von Mises stress of the three segments increased with the increasing degree of degeneration at different postures (L4∼L5: Grade 4 increased to 1.75 ∼ 4 times compared to normal at different postures). In four different models of lumbar disc degeneration, the adjacent normal segment of the disc compensates for the movement and loading pattern of the degenerated segment. At the same time, the load pattern inside the degenerated segment also changes.
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Affiliation(s)
- Hongkun Wang
- Key Laboratory of Biomechanics and Mechanobiology of Ministry of Education, Beijing, China
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Nan Li
- Department of Spine Surgery, Beijing Jishuitan Hospital, the Fourth Clinical Medical College of Peking University, Beijing, China
| | - Huiwen Huang
- Key Laboratory of Biomechanics and Mechanobiology of Ministry of Education, Beijing, China
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Peng Xu
- Key Laboratory of Biomechanics and Mechanobiology of Ministry of Education, Beijing, China
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology of Ministry of Education, Beijing, China
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- School of Engineering Medicine, Beihang University, Beijing, China
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Ying Y, Cai K, Cai X, Zhang K, Qiu R, Jiang G, Luo K. Recent advances in the repair of degenerative intervertebral disc for preclinical applications. Front Bioeng Biotechnol 2023; 11:1259731. [PMID: 37811372 PMCID: PMC10557490 DOI: 10.3389/fbioe.2023.1259731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
The intervertebral disc (IVD) is a load-bearing, avascular tissue that cushions pressure and increases flexibility in the spine. Under the influence of obesity, injury, and reduced nutrient supply, it develops pathological changes such as fibular annulus (AF) injury, disc herniation, and inflammation, eventually leading to intervertebral disc degeneration (IDD). Lower back pain (LBP) caused by IDD is a severe chronic disorder that severely affects patients' quality of life and has a substantial socioeconomic impact. Patients may consider surgical treatment after conservative treatment has failed. However, the broken AF cannot be repaired after surgery, and the incidence of re-protrusion and reoccurring pain is high, possibly leading to a degeneration of the adjacent vertebrae. Therefore, effective treatment strategies must be explored to repair and prevent IDD. This paper systematically reviews recent advances in repairing IVD, describes its advantages and shortcomings, and explores the future direction of repair technology.
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Affiliation(s)
- Yijian Ying
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Kaiwen Cai
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Xiongxiong Cai
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Kai Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Rongzhang Qiu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Guoqiang Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Kefeng Luo
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
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Hoffeld K, Lenz M, Egenolf P, Weber M, Heck V, Eysel P, Scheyerer MJ. Patient-related risk factors and lifestyle factors for lumbar degenerative disc disease: a systematic review. Neurochirurgie 2023; 69:101482. [PMID: 37586480 DOI: 10.1016/j.neuchi.2023.101482] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Back pain is a very widespread disease pattern and is one of the most frequent causes for consultation of a physician in general. In most cases, discogenic changes are the pathomorphological correlate of back pain. Numerous risk factors have been identified for these degenerative changes, but the influence and significance of the risk factors remain unclear, which was the aim of this systematic review. METHODS A systematic literature search of the commonly used Pubmed database was performed using specific MESH terms. Further selection of the included studies was performed according to the PRISMA scheme, taking into account scientific merit as well as the relation to the research question. RESULTS A total of 111 studies out of 1035 found were finally included in the literature search. 134 risk factors for disc degeneration and disc herniation were identified. These were divided into (1) patient-specific risk factors (n░=░34), (2) radiological risk factors (n░=░31), (3) lifestyle risk factors (n░=░6), (4) workplace-related risk factors (n░=░12), (5) genetic risk factors (n░=░50), and (6) other risk factors (n░=░1). Non-adjustable risk factors were age >50 years (OR 1.7/year), female gender (OR 1.41), family disposition (OR 4.0), comorbidities like atherosclerosis (OR 2.24), arthritic changes in other joints (OR 3.1) and history of injuries of the back (OR 3.1). Adjustable factors were elevated BMI (OR 2.77), comorbidities like hypertension (OR 1.25), dyslipidemia (OR 1.26) and diabetes mellitus (OR 6.8), as well as lifestyle habits like smoking (OR 3.8). DISCUSSION In summary, intervertebral disc degenerations and herniations represent multifactorial events whose risk factors can be partly influenced and partly not influenced. This systematic review highlights the current state of knowledge as a basis for creating patient-specific algorithms to calculate risk for the development or progression of degenerative disc changes and disc herniations.
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Affiliation(s)
- Kai Hoffeld
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany.
| | - Maximilian Lenz
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Philipp Egenolf
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Maximilian Weber
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Vincent Heck
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Peer Eysel
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany
| | - Max J Scheyerer
- University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany; University of Düsseldorf, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Moorenstraße 5, 40225 Düsseldorf, Germany
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Chamoro M, de Luca K, Ozbulut O, Oei EHG, Vleggeert-Lankamp CLA, Koes BW, Bierma-Zeinstra SMA, Chiarotto A. Association between clinical findings and the presence of lumbar spine osteoarthritis imaging features: A systematic review. Osteoarthritis Cartilage 2023; 31:1158-1175. [PMID: 37150286 DOI: 10.1016/j.joca.2023.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/16/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Spinal osteoarthritis is difficult to study and diagnose, partly due to the lack of agreed diagnostic criteria. This systematic review aims to give an overview of the associations between clinical and imaging findings suggestive of spinal osteoarthritis in patients with low back pain to make a step towards agreed diagnostic criteria. DESIGN We searched MEDLINE, Embase, Web of Science, and CINAHL from inception to April 29, 2021 to identify observational studies in adults that assessed the association between selected clinical and imaging findings suggestive of spinal osteoarthritis. Risk of bias was assessed using the Newcastle Ottawa Scale and the quality of evidence was graded using an adaptation of the GRADE approach. RESULTS After screening 7902 studies, 30 met the inclusion criteria. High-quality evidence was found for the longitudinal association between low back pain (LBP) intensity, and both disc space narrowing and osteophytes, as well as for the association between LBP-related physical functioning and lumbar disc degeneration, the presence of spinal morning stiffness and disc space narrowing and for the lack of association between physical functioning and Schmorl's nodes. CONCLUSIONS There is high- and moderate-quality evidence of associations between clinical and imaging findings suggestive of spinal osteoarthritis. However, the majority of the studied outcomes had low or very low-quality of evidence. Furthermore, clinical and methodological heterogeneity was a serious limitation, adding to the need and importance of agreed criteria for spinal osteoarthritis, which should be the scope of future research.
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Affiliation(s)
- Mirna Chamoro
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Katie de Luca
- Discipline of Chiropractic, CQ University, Brisbane, Australia.
| | - Omer Ozbulut
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Carmen L A Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Neurosurgery, Spaarne Hospital, Haarlem/Hoofddorp, the Netherlands.
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Orthopedics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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21
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Machado ES, Soares FP, Vianna de Abreu E, de Souza TADC, Meves R, Grohs H, Ambach MA, Navani A, de Castro RB, Pozza DH, Caldas JMP. Systematic Review of Platelet-Rich Plasma for Low Back Pain. Biomedicines 2023; 11:2404. [PMID: 37760845 PMCID: PMC10525951 DOI: 10.3390/biomedicines11092404] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Low back pain (LBP) has a high economic burden and is strongly related to the degenerative process of the spine, especially in the intervertebral disc and of the facet joints. Numerous treatment modalities have been proposed for the management of LBP, and the use of platelet-rich plasma (PRP) has emerged as an innovative therapeutic option for degenerative disease of the spine. The present study aims to evaluate the efficacy of PRP injections in managing low back pain. METHODS We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a registered at PROSPERO Systematic Reviews Platform, under number CRD42021268491. The PubMed, Web of Science, and Scopus databases were searched to identify relevant articles, along with hand searching to identify gray literature articles, with no language restrictions. Randomized clinical trials (RCTs), nonrandomized trials (NRTs), and case series (CSs) with more than 10 patients were considered eligible. The quality assessment and the risk of bias of the randomized clinical trials were evaluated using the RoB II tool. An evaluation of the description of the preparation methods was performed using an adapted version of the MIBO checklist. RESULTS An electronic database search resulted in 2324 articles, and after the exclusion of noneligible articles, 13 RCTs and 27 NRTs or CSs were analyzed. Of the 13 RCTs, 11 found favorable results in comparison to the control group in pain and disability, one showed no superiority to the control group, and one was discontinued because of the lack of therapeutic effect at eight-week evaluation. Description of the PRP preparation techniques were found in almost all papers. The overall risk of bias was considered high in 2 papers and low in 11. An adapted MIBO checklist showed a 72.7% compliance rate in the selected areas. CONCLUSIONS In this systematic review, we analyzed articles from English, Spanish and Russian language, from large databases and grey literature. PRP was in general an effective and safe treatment for degenerative LPB. Positive results were found in almost studies, a small number of adverse events were related, the risk of bias of the RCTs was low. Based on the evaluation of the included studies, we graded as level II the quality of the evidence supporting the use of PRP in LBP. Large-scale, multicenter RCTs are still needed to confirm these findings.
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Affiliation(s)
- Edilson Silva Machado
- REGENERAR—Pain Medical Center, Porto Alegre 90620-130, Brazil
- PhD (c) Faculty of Medicine, University of Porto, 4200-135 Porto, Portugal
| | | | - Ernani Vianna de Abreu
- REGENERAR—Pain Medical Center, Porto Alegre 90620-130, Brazil
- Spine Group, Hospital Ernesto Dornelles, Porto Alegre 90160-092, Brazil
| | | | - Robert Meves
- Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo 01224-001, Brazil (H.G.)
| | - Hans Grohs
- Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo 01224-001, Brazil (H.G.)
| | - Mary A. Ambach
- San Diego Orthobiologics Medical Group, Carlsbad, CA 92011, USA
| | - Annu Navani
- Le Reve Regenerative Wellness, Campbell, CA 95008, USA
| | | | - Daniel Humberto Pozza
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135 Porto, Portugal
| | - José Manuel Peixoto Caldas
- CIEG-ISCSP, University of Lisbon Camp, 1300-663 Lisboa, Portugal
- Instituto de Saúde Pública da Universidade do Porto (ISPUP), 4050-600 Porto, Portugal
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22
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Shin DA, Choo YJ, Chang MC. Spinal Injections: A Narrative Review from a Surgeon's Perspective. Healthcare (Basel) 2023; 11:2355. [PMID: 37628553 PMCID: PMC10454431 DOI: 10.3390/healthcare11162355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/03/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Spinal pain is one of most frequent complaints of the general population, which can cause decreased activities of daily living and absence from work. Among numerous therapeutic methods, spinal injection is one of the most effective treatments for spinal pain and is currently widely applied in the clinical field. In this review, spinal injection is discussed from a surgeon's perspective. Recently, although the number of spinal surgeries has been increasing, questions are arising as to whether they are necessary. The failure rate after spinal surgery is high, and its long-term outcome was reported to be similar to spinal injection. Thus, spinal surgeries should be performed conservatively. Spinal injection is largely divided into diagnostic and therapeutic blocks. Using diagnostic blocks, such as the diagnostic selective nerve root block, disc stimulation test, and diagnostic medial branch block (MBB), the precise location causing the pain can be confirmed. For therapeutic blocks, transforaminal nerve root injection, therapeutic MBB, and percutaneous epidural neuroplasty are used. When unbearable spinal pain persists despite therapeutic spinal injections, spinal surgeries can be considered. Spinal injection is usefully used to identify the precise location prior to a patient undergoing injection treatment or surgery and can reduce pain and improve quality of life, and help to avoid spinal surgery. Pain physicians should treat patients with spinal pain by properly utilizing spinal injection.
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Affiliation(s)
- Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea;
| | - Yoo Jin Choo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Nam-gu, Daegu 42415, Republic of Korea;
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Nam-gu, Daegu 42415, Republic of Korea;
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23
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Araghi K, Subramanian T, Haque N, Merrill R, Amen TB, Shahi P, Singh S, Maayan O, Sheha E, Dowdell J, Iyer S, Qureshi SA. Provider Referral Patterns and Surgical Utilization Among New Patients Seen in Spine Clinic. Spine (Phila Pa 1976) 2023; 48:885-891. [PMID: 37026719 DOI: 10.1097/brs.0000000000004656] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/05/2023] [Indexed: 04/08/2023]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVE The objective of this study was to elucidate the demographics of patient referrals from different sources and identify factors that affect a patient's likelihood of undergoing surgery. SUMMARY OF BACKGROUND DATA Despite baseline factors for surgical consideration, such as attempting conservative management, surgeons encounter many patients who are not surgically indicated. Overreferrals, that is, a patient referred to a surgeon that does not need surgery, can result in long wait times, delayed care, worse outcomes, and resource waste. MATERIALS AND METHODS All new patients at a single academic institution seen in the clinic by eight spine surgeons between January 1, 2018, and January 1, 2022, were analyzed. Referral types included self-referral, musculoskeletal (MSK), and non-MSK provider referral. Patient demographics included age, body mass index (BMI), zip code as a proxy for socioeconomic status, sex, insurance type, and surgical procedures undergone within 1.5 years postclinic visit. Analysis of variance and a Kruskal-Wallis test was used to compare means among normally and non-normally disturbed referral groups, respectively. Multivariable logistic regressions were run to assess demographic variables associated with undergoing surgery. RESULTS From 9356 patients, 84% (7834) were self-referred, 3% (319) were non-MSK, and 13% (1203) were MSK. A statistically significant association with ultimately undergoing surgery was observed with MSK referral type compared with non-MSK referral [odds ratio (OR)=1.37, CI: 1.04-1.82, P =0.0246]. Additional independent variables observed to be associated with patients undergoing surgery included older age (OR=1.004, CI: 1.002-1.007, P =0.0018), higher BMI (OR=1.02, CI: 1.011-1.029, P <0.0001), high-income quartile (OR=1.343, CI: 1.177-1.533, P <0.0001), and male sex (OR=1.189, CI: 1.085-1.302, P =0.0002). CONCLUSIONS A statistically significant association with undergoing surgery was observed with a referral by an MSK provider, older age, male sex, high BMI, and a high-income quartile home zip code. Understanding these factors and patterns is critical for optimizing practice efficiency and reducing the burdens of inappropriate referrals.
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Affiliation(s)
| | - Tejas Subramanian
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | | | | | | | | | | | - Omri Maayan
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Evan Sheha
- Hospital for Special Surgery, New York, NY
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24
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Gerasymchuk M, Durieux JC, Nayate AP. Why, How Often, and What Happens When We Fail: A Retrospective Analysis of Failed Fluoroscopically Guided Lumbar Punctures. AJNR Am J Neuroradiol 2023; 44:722-729. [PMID: 37169540 PMCID: PMC10249695 DOI: 10.3174/ajnr.a7867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/11/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND PURPOSE Important information regarding fluoroscopically guided lumbar puncture (FGLP) performance and referrals is lacking. The purpose of our study was to elucidate the success rate for initial FGLP attempts and re-attempts, reasons for unsuccessful FGLPs, and the relationship between clinical indications and whether patients will undergo a fluoroscopically guided re-attempt, among others. MATERIALS AND METHODS This retrospective study analyzed failed FGLP attempts in hospitalized adult patients at an academic hospital between June 2016 and March 2022. Unsuccessful FGLPs were labeled as insufficient CSF egress. FGLP reports and patients' clinical charts were analyzed for pertinent information such as clinical indication, reason for failure, whether patients received IV fluid before fluoroscopically guided spinal puncture attempt, and which patients returned for another FGLP attempt. Patients' ages and sex were analyzed using descriptive statistics. The OR was used to investigate the relationship between the clinical indications to perform FGLP and whether patients returned for a re-attempt. RESULTS Sixty-three of 1389 (4.5%) patients (median age, 62 years) had failed the initial FGLPs administered by 39 trainees. Twenty-eight of 63 (44.4%) patients (median age, 64 years) underwent a re-attempt within a median of 2 days after the first attempt, and 27/28 (96.4%) re-attempts were successful. A dry tap, no egress of CSF was the top reason (58.7%) for failed FGLP, and 12/13 of patients had a successful FGLP after IV hydration. Twenty-seven of 63 (43%) patients did not undergo a repeat attempt, and 100% were subsequently discharged from the hospital. There was no difference (P > .05) in the likelihood of patients returning for a repeat FGLP based on the clinical indications. CONCLUSIONS Initial and repeat FGLPs have very high success rates. No difference exists in the likelihood of patients returning for a re-attempt based on clinical indication.
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Affiliation(s)
- M Gerasymchuk
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - J C Durieux
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - A P Nayate
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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25
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Sheppard WL, Chiou D, Upfill-Brown A, Shah A, Edogun E, Sassoon A, Park DY. Spondylolisthesis and mismatch deformity affect outcomes after total knee arthroplasty. J Orthop Surg Res 2023; 18:157. [PMID: 36864440 PMCID: PMC9979472 DOI: 10.1186/s13018-023-03605-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/10/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Little published data currently exist regarding the potential relationships between spondylolisthesis, mismatch deformity, and clinical outcomes following total knee arthroplasty (TKA). We hypothesize that preexisting spondylolisthesis will result in decreased functional outcomes after TKA. METHODS This retrospective cohort comparison of 933 TKAs was performed between January 2017 and 2020. TKAs were excluded if they were not performed for primary osteoarthritis (OA) or if preoperative lumbar radiographs were unavailable/inadequate to measure the degree of spondylolisthesis. Ninety-five TKAs were subsequently available for inclusion and divided into two groups: those with spondylolisthesis and those without. Within the spondylolisthesis cohort, pelvic incidence (PI) and lumbar lordosis (LL) were calculated on lateral radiographs to determine the difference (PI-LL). Radiographs with PI-LL > 10° were then categorized as having mismatch deformity (MD). The following clinical outcomes were compared between the groups: need for manipulation under anesthesia (MUA), total postoperative arc of motion (AOM) both pre-MUA or post-MUA/revision, incidence of flexion contracture, and a need for later revision. RESULTS Forty-nine TKAs met the spondylolisthesis criteria, while 44 did not have spondylolisthesis. There were no significant differences in gender, body mass index, preoperative knee range of motion (ROM), preoperative AOM, or opiate use between the groups. TKAs with spondylolisthesis and concomitant MD were more likely to have MUA (p = 0.016), ROM < 0-120 (p < 0.014), and a decreased AOM (p < 0.02) without interventions. CONCLUSION Preexisting spondylolisthesis by itself may not have adverse effect clinical results following TKA. However, spondylolisthesis increases the likelihood of developing MD. In those with both spondylolisthesis and concomitant mismatch deformities, patients had statistically and clinically significantly decreased in postoperative ROM/AOM and increased need for MUA. Surgeons should consider clinical/radiographic assessments of patients with chronic back pain who present for total joint arthroplasty. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- William L. Sheppard
- grid.19006.3e0000 0000 9632 6718Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA 90404 USA
| | - Daniel Chiou
- grid.19006.3e0000 0000 9632 6718Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA 90404 USA
| | - Alexander Upfill-Brown
- grid.19006.3e0000 0000 9632 6718Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA 90404 USA
| | - Akash Shah
- grid.19006.3e0000 0000 9632 6718Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA 90404 USA
| | - Eghosa Edogun
- grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Adam Sassoon
- grid.19006.3e0000 0000 9632 6718Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA 90404 USA ,grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Don Y. Park
- grid.19006.3e0000 0000 9632 6718Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA 90404 USA ,grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
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26
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Quantitative Relationship between the Degree of Lumbar Disc Degeneration and Intervertebral Disc Height in Patients with Low Back Pain. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5960317. [PMID: 35935310 PMCID: PMC9325564 DOI: 10.1155/2022/5960317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
The aim of this study is to study the relationship between the degree of lumbar disc degeneration and the height of the disc in patients with pain in the lower back and determine whether there is a dose-response relationship between the two. Eighty-five patients were examined by magnetic resonance imaging (MRI). The grade of lumbar degeneration was determined by the Pfirrmann grading system, and the intervertebral height and VAS pain scores were measured. The height difference of intervertebral discs with different degeneration levels was measured by the F test. This difference was correlated and further quantified by regression analysis. Finally, the differences intervertebral disc heights with a VAS score of 0–6 and 7–10 were observed by an independent sample t-test. The higher degree of disc degeneration in each lumbosacral segment, the lower the intervertebral disc height (p ≤ 0.011). When discs with grade 1 and grade 5 degeneration were excluded, the results remained the same (p ≤ 0.034). To quantify correlations, at each lumbar level, the disc height was reduced for each level of lumbosacral disc degeneration, and the height of disc was reduced after adjusting according to age, sex, and BMI (β range: −1.25 mm to −1.76 mm, 95% CI: −0.83 to −2.29, all p ≤ 0.002). Subjects with a VAS score of 7–10 had a lower intervertebral disc height than those with a VAS score of 0–6, especially with respect to total height levels at L4/5, L5/S1, and L1-S1 (p ≤ 0.04). This study showed a relationship between increased degree of intervertebral disc degeneration and decreased the disc height in patients with pain in the low back. Although the assessment of lumbar and lumbosacral level disc degeneration involves many qualitative measurements, these statistical data confirm the effectiveness of lumbosacral disc height as a continuous data measure and quantification in clinical trials and epidemiological studies.
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27
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Rahman WU, Jiang W, Zhao F, Li Z, Wang G, Yang G. Biomechanical effect of C5-C6 intervertebral disc degeneration on the human lower cervical spine (C3-C7): a finite element study. Comput Methods Biomech Biomed Engin 2022; 26:820-834. [PMID: 35712878 DOI: 10.1080/10255842.2022.2089026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The biomechanical effects of intervertebral discs and facet joints degeneration on the cervical spine are essential to understanding the mechanisms of spinal disorders to improve pathological and clinical treatment. In this study, the biomechanical effects of a progressively degenerated C5-C6 segment on the human lower cervical spine are determined by a detailed simulation of intervertebral disc degeneration. A detailed asymmetric three-dimension intact finite element model was developed using computed tomography scan data of the human lower cervical spine (C3-C7). The intact finite element model was then modified at the C5-C6 segment to build three degenerated models, such as mild, moderate, and severe degeneration. The physiological compressive load 73.6 N, and moment 1 Nm were applied at the superior endplate of the vertebra C3, and the inferior endplate of the C7 vertebra was a constraint for all degrees of freedom. Range of motion, maximum von Mises stress in the annulus, intradiscal pressure, and facet joint force of the degenerated models were computed. With progressive degeneration in the C5-C6 segment, the range of motion of degenerated and normal segments decreases in all postures. Intradiscal pressure of the degenerated segment decreases but increases in normal segments of degenerated segment C5-C6, and facet joint forces increase at both degenerated and normal segments. This study emphasizes that the degenerated disc alters the degenerated and normal segments' motion and loading patterns. The abnormal increase in facet joint force in the degenerated models threatened to accelerate the degeneration in the normal segments.
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Affiliation(s)
- Waseem Ur Rahman
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Wei Jiang
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Fulin Zhao
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Zhijun Li
- Department of Orthopedics, Dalian No. 2 People's Hospital, Dalian, China
| | - Guohua Wang
- Department of Orthopedics, Dalian No. 2 People's Hospital, Dalian, China
| | - Guanghui Yang
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
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28
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Mechanisms of bone pain: Progress in research from bench to bedside. Bone Res 2022; 10:44. [PMID: 35668080 PMCID: PMC9170780 DOI: 10.1038/s41413-022-00217-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/29/2022] [Accepted: 05/09/2022] [Indexed: 12/27/2022] Open
Abstract
AbstractThe field of research on pain originating from various bone diseases is expanding rapidly, with new mechanisms and targets asserting both peripheral and central sites of action. The scope of research is broadening from bone biology to neuroscience, neuroendocrinology, and immunology. In particular, the roles of primary sensory neurons and non-neuronal cells in the peripheral tissues as important targets for bone pain treatment are under extensive investigation in both pre-clinical and clinical settings. An understanding of the peripheral mechanisms underlying pain conditions associated with various bone diseases will aid in the appropriate application and development of optimal strategies for not only managing bone pain symptoms but also improving bone repairing and remodeling, which potentially cures the underlying etiology for long-term functional recovery. In this review, we focus on advances in important preclinical studies of significant bone pain conditions in the past 5 years that indicated new peripheral neuronal and non-neuronal mechanisms, novel targets for potential clinical interventions, and future directions of research.
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29
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Martin JT, Wesorick B, Oldweiler AB, Kosinski AS, Goode AP, DeFrate LE. In vivo fluid transport in human intervertebral discs varies by spinal level and disc region. JOR Spine 2022; 5:e1199. [PMID: 35783907 PMCID: PMC9238288 DOI: 10.1002/jsp2.1199] [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: 09/17/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/25/2022] Open
Abstract
Background The lumbar discs are large, dense tissues that are primarily avascular, and cells residing in the central region of the disc are up to 6-8 mm from the nearest blood vessel in adults. To maintain homeostasis, disc cells rely on nutrient transport between the discs and adjacent vertebrae. Thus, diminished transport has been proposed as a factor in age-related disc degeneration. Methods In this study, we used magnetic resonance imaging (MRI) to quantify diurnal changes in T2 relaxation time, an MRI biomarker related to disc hydration, to generate 3D models of disc fluid distribution and determine how diurnal changes in fluid varied by spinal level. We recruited 10 participants (five males/five females; age: 21-30 years; BMI: 19.1-29.0 kg/m2) and evaluated the T2 relaxation time of each disc at 8:00 AM and 7:00 PM, as well as degeneration grade (Pfirrmann). We also measured disc height, volume, and perimeter in a subset of individuals as a preliminary comparison of geometry and transport properties. Results We found that the baseline (AM) T2 relaxation time and the diurnal change in T2 relaxation time were greatest in the cranial lumbar discs, decreasing along the lumbar spine from cranial to caudal. In cranial discs, T2 relaxation times decreased in each disc region (nucleus pulposus [NP], inner annulus fibrosus [IAF], and outer annulus fibrosus [OAF]), whereas in caudal discs, T2 relaxation times decreased in the NP but increased in the AF. Conclusions Fluid transport varied by spinal level, where transport was greatest in the most cranial lumbar discs and decreased from cranial to caudal along the lumbar spine. Future work should evaluate what level-dependent factors affect transport.
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Affiliation(s)
- John T. Martin
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Benjamin Wesorick
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Biomedical EngineeringDuke UniversityDurhamNorth CarolinaUSA
| | - Alexander B. Oldweiler
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Andrzej S. Kosinski
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Adam P. Goode
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Louis E. DeFrate
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Biomedical EngineeringDuke UniversityDurhamNorth CarolinaUSA
- Department of Mechanical Engineering and Materials ScienceDuke UniversityDurhamNorth CarolinaUSA
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30
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Gatot C, Liow MHL, Goh GS, Mohan N, Yongqiang CJ, Ling ZM, Soh RCC, Yue WM, Guo CM, Tan SB, Chen JLT. Smoking Is Associated With Lower Satisfaction in Nondiabetic Patients Undergoing Minimally Invasive Single-level Transforaminal Lumbar Interbody Fusion. Clin Spine Surg 2022; 35:E19-E25. [PMID: 34516439 DOI: 10.1097/bsd.0000000000001247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective review of prospectively collected registry data. OBJECTIVE The objective of this study was to investigate the effect of smoking on 2 years postoperative functional outcomes, satisfaction, and radiologic fusion in nondiabetic patients undergoing minimally invasive transforaminal lumbar interbody fusion (TLIF) for degenerative spine conditions. SUMMARY OF BACKGROUND DATA There is conflicting data on the effect of smoking on long-term functional outcomes following lumbar fusion. Moreover, there remains a paucity of literature on the influence of smoking within the field of minimally invasive spine surgery. METHODS Prospectively collected registry data of nondiabetic patients who underwent primary single-level minimally invasive TLIF in a single institution was reviewed. Patients were stratified based on smoking history. All patients were assessed preoperatively and postoperatively using the Numerical Pain Rating Scale for back pain and leg pain, Oswestry Disability Index, Short-Form 36 Physical and Mental Component Scores. Satisfaction was assessed using the North American Spine Society questionnaire. Radiographic fusion rates were compared. RESULTS In total, 187 patients were included, of which 162 were nonsmokers, and 25 had a positive smoking history. In our multivariate analysis, smoking history was insignificant in predicting for minimal clinically important difference attainment rates in Physical Component Score and fusion grading outcomes. However, in terms of satisfaction score, positive smoking history remained a significant predictor (odds ratio=4.7, 95% confidence interval: 1.10-20.09, P=0.036). CONCLUSIONS Nondiabetic patients with a positive smoking history had lower satisfaction scores but comparable functional outcomes and radiologic fusion 2 years after single-level TLIF. Thorough preoperative counseling and smoking cessation advice may help to improve patient satisfaction following minimally invasive spine surgery. LEVEL OF EVIDENCE Level III-nonrandomized cohort study.
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Affiliation(s)
- Cheryl Gatot
- Department of Orthopedic Surgery, Singapore General Hospital
| | | | - Graham S Goh
- Department of Orthopedic Surgery, Singapore General Hospital
| | - Niraj Mohan
- Department of Orthopedic Surgery, Singapore General Hospital
| | | | | | - Reuben C C Soh
- Department of Orthopedic Surgery, Singapore General Hospital
| | | | - Chang-Ming Guo
- Department of Orthopedic Surgery, Singapore General Hospital
| | - Seang-Beng Tan
- Orthopaedic and Spine Clinic, Mount Elizabeth Medical Centre, Singapore
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Londhe SB, Shah RV, Patwardhan M, Doshi AP, Londhe SS, Subhedar K, Kundnani V, Patel J. Study of Patients with Bilateral Knee Osteoarthritis Undergoing Total Knee Replacement Procedure with Coexisting Lumbar Spondylosis Symptoms. Asian Spine J 2021; 15:825-830. [PMID: 33355851 PMCID: PMC8696049 DOI: 10.31616/asj.2020.0279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/10/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This is a prospective cohort study involving patients who were followed for 2 years after total knee replacement (TKR) to determine changes in lumbar spine and knee symptoms. PURPOSE The objectives of this study were to determine the percentage of patients undergoing bilateral TKR who present with coexisting lumbar spine problems and determine if TKR relieves lumbar spine symptoms. OVERVIEW OF LITERATURE No studies quantify the percentage of TKR patients who experience relief of lumbar spine symptoms after TKR surgery. METHODS The study included 200 patients (164 females, 36 males) undergoing primary TKR. Follow-up was performed at 4 weeks, 3, 6, 12, and 24 months. Lumbar spine and knee symptom improvements were assessed using the Oswestry Disability Index (ODI) and Oxford Knee Score, respectively. RESULTS All 200 patients undergoing bilateral TKR presented with radiographic lumbar spine degenerative pathology; 60% (n=120) of the patients presented with moderate to severe clinical symptoms of lumbar spondylosis, including 54% (n=108) with degenerative lumbar spondylosis and lumbar canal stenosis and 6% (n=12) with degenerative spondylolisthesis. Of the 120 patients who presented with lumbar spine problems, 90% (n=108) reported improvement in their symptoms; the ODI score improved from 42.5%±4.1% preoperative score to 15.6%±2.3% postoperative score (p-value<0.001). Of the 12 patients with no improvement, 10 patients underwent percutaneous procedures for their lumbar spine pathology with good results, one patient underwent surgery, and one declined any intervention. CONCLUSIONS A significant number of patients (60%) undergoing bilateral TKR also present with symptomatic lumbar spine problems. Patients with mild to moderate lumbar spine degenerative symptoms and no associated severe radiating pain on activity are more likely to experience relief of their symptoms post-TKR.
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Affiliation(s)
| | - Ravi Vinod Shah
- Department of Orthopedic Surgery, Criticare Hospital, Mumbai,
India
| | - Meghana Patwardhan
- Department of Pain Medicine and Anesthesia, Criticare Hospital, Mumbai,
India
| | | | | | - Kavita Subhedar
- Department of Clinical Data Management, Criticare Hospital, Mumbai,
India
| | - Vishal Kundnani
- Division of Spine Surgery, Department of Orthopaedics, Bombay Hospital, Mumbai,
India
| | - Jwalant Patel
- Division of Spine Surgery, Department of Orthopaedics, Bombay Hospital, Mumbai,
India
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32
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Chen J, Zhu H, Zhu Y, Zhao C, Wang S, Zheng Y, Xie Z, Jin Y, Song H, Yang L, Zhang J, Dai J, Hu Z, Wang H. Injectable self-healing hydrogel with siRNA delivery property for sustained STING silencing and enhanced therapy of intervertebral disc degeneration. Bioact Mater 2021; 9:29-43. [PMID: 34820553 PMCID: PMC8586437 DOI: 10.1016/j.bioactmat.2021.08.003] [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: 05/21/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
Inflammatory responses of nucleus pulposus (NP) can induce imbalanced anabolism and catabolism of extracellular matrix, and the cytosolic dsDNA accumulation and STING–NF–κB pathway activation found in NP inflammation are considered as fairly important cause of intervertebral disc (IVD) degeneration. Herein, we constructed a siSTING delivery hydrogel of aldehyde hyaluronic acid (HA-CHO) and poly(amidoamine) PAMAM/siRNA complex to intervene the abnormal STING signal for IVD degeneration treatment, where the formation of dynamic Schiff base bonds in the system (siSTING@HPgel) was able to overcome the shortcomings such as low cellular uptake, short half-life, and rapid degradation of siRNA-based strategy. PAMAM not only formed complexes with siRNA to promote siRNA transfection, but also served as dynamic crosslinker to construct hydrogel, and the injectable and self-healing hydrogel efficiently and steadily silenced STING expression in NP cells. Finally, the siSTING@HPgel significantly eased IVD inflammation and slowed IVD degeneration by prolonging STING knockdown in puncture-induced IVD degeneration rat model, revealing that STING pathway was a therapeutic target for IVD degeneration and such novel hydrogel had great potential for being applied to many other diseases for gene delivery. STING-NF-κB pathway activation was identified an important cause of intervertebral disc degeneration. PAMAM was employed as both linker and gene vector for siRNA delivery. The injectable self-healing hydrogel could significantly ease the IVD inflammation and degeneration by prolonging STING knockdown. This novel hydrogel system opened new ways of thinking and had great potential for gene delivery.
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Affiliation(s)
- Jiaxin Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Musculoskeletal System Degeneration, Regeneration Translational Research of Zhejiang Province, East Qing Chun Road, Hangzhou, 310016, PR China
| | - Haifeng Zhu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Musculoskeletal System Degeneration, Regeneration Translational Research of Zhejiang Province, East Qing Chun Road, Hangzhou, 310016, PR China
| | - Yutao Zhu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Musculoskeletal System Degeneration, Regeneration Translational Research of Zhejiang Province, East Qing Chun Road, Hangzhou, 310016, PR China
| | - Chenchen Zhao
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Musculoskeletal System Degeneration, Regeneration Translational Research of Zhejiang Province, East Qing Chun Road, Hangzhou, 310016, PR China
| | - Shengyu Wang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Musculoskeletal System Degeneration, Regeneration Translational Research of Zhejiang Province, East Qing Chun Road, Hangzhou, 310016, PR China
| | - Yixin Zheng
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Musculoskeletal System Degeneration, Regeneration Translational Research of Zhejiang Province, East Qing Chun Road, Hangzhou, 310016, PR China
| | - Ziang Xie
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Musculoskeletal System Degeneration, Regeneration Translational Research of Zhejiang Province, East Qing Chun Road, Hangzhou, 310016, PR China
| | - Yang Jin
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Musculoskeletal System Degeneration, Regeneration Translational Research of Zhejiang Province, East Qing Chun Road, Hangzhou, 310016, PR China
| | - Honghai Song
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Musculoskeletal System Degeneration, Regeneration Translational Research of Zhejiang Province, East Qing Chun Road, Hangzhou, 310016, PR China
| | - Linjun Yang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Musculoskeletal System Degeneration, Regeneration Translational Research of Zhejiang Province, East Qing Chun Road, Hangzhou, 310016, PR China
| | - Jin Zhang
- College of Chemical Engineering, Fuzhou University, 2 Xueyuan Road, Fuzhou, 350108, PR China
| | - Jiayong Dai
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Musculoskeletal System Degeneration, Regeneration Translational Research of Zhejiang Province, East Qing Chun Road, Hangzhou, 310016, PR China
| | - Zhijun Hu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Musculoskeletal System Degeneration, Regeneration Translational Research of Zhejiang Province, East Qing Chun Road, Hangzhou, 310016, PR China
| | - Huaiyu Wang
- Center for Human Tissues and Organs Degeneration, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, Guangdong, PR China
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Mosich GM, Sapountzis N, Bostrom MP, Inglis AE. Three-Column Spine Fracture After Direct Anterior Total Hip Arthroplasty: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00093. [PMID: 34449446 DOI: 10.2106/jbjs.cc.20.01040] [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: 06/13/2023]
Abstract
CASE This report describes a case of an unstable spine fracture in the setting of severe degenerative disc disease in a patient who underwent a direct anterior total hip arthroplasty (THA). The patient was positioned supine on a standard operating room table and postoperatively complained of back pain and neurologic deficits. Advanced imaging identified a T12-L1 extension-distraction injury, and the patient ultimately required surgical decompression and spinal fusion. CONCLUSION This case outlines a serious complication of THA that can occur in patients with degenerative spine disease and highlights the importance of taking precautions to reduce stress on the spine during surgery.
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Kumar N, Lopez KG, Alathur Ramakrishnan S, Hallinan JTPD, Fuh JYH, Pandita N, Madhu S, Kumar A, Benneker LM, Vellayappan BA. Evolution of materials for implants in metastatic spine disease till date - Have we found an ideal material? Radiother Oncol 2021; 163:93-104. [PMID: 34419506 DOI: 10.1016/j.radonc.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/30/2021] [Accepted: 08/13/2021] [Indexed: 12/30/2022]
Abstract
"Metastatic Spine Disease" (MSD) often requires surgical intervention and instrumentation with spinal implants. Ti6Al4V is widely used in metastatic spine tumor surgery (MSTS) and is the current implant material of choice due to improved biocompatibility, mechanical properties, and compatibility with imaging modalities compared to stainless steel. However, it is still not the ideal implant material due to the following issues. Ti6Al4V implants cause stress-shielding as their Young's modulus (110 gigapascal [GPa]) is higher than cortical bone (17-21 GPa). Ti6Al4V also generates artifacts on CT and MRI, which interfere with the process of postoperative radiotherapy (RT), including treatment planning and delivery. Similarly, charged particle therapy is hindered in the presence of Ti6Al4V. In addition, artifacts on CT and MRI may result in delayed recognition of tumor recurrence and postoperative complications. In comparison, polyether-ether-ketone (PEEK) is a promising alternative. PEEK has a low Young's modulus (3.6 GPa), which results in optimal load-sharing and produces minimal artifacts on imaging with less hinderance on postoperative RT. However, PEEK is bioinert and unable to provide sufficient stability in the immediate postoperative period. This issue may possibly be mitigated by combining PEEK with other materials to form composites or through surface modification, although further research is required in these areas. With the increasing incidence of MSD, it is an opportune time for the development of spinal implants that possess all the ideal material properties for use in MSTS. Our review will explore whether there is a current ideal implant material, available alternatives and whether these require further investigation.
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Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore.
| | - Keith Gerard Lopez
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | | | | | - Jerry Ying Hsi Fuh
- Department of Mechanical Engineering, National University of Singapore, Singapore
| | - Naveen Pandita
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Sirisha Madhu
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Aravind Kumar
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore
| | - Lorin M Benneker
- Department of Orthopaedics, Spine Surgery, Sonnenhofspital, Bern, Switzerland
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Nolte MT, Jenkins NW, Parrish JM, Mohan S, Geoghegan CE, Jadczak CN, Hrynewycz NM, Singh K. The Influence of Sex on Clinical Outcomes in Minimally Invasive Lumbar Decompression. Int J Spine Surg 2021; 15:763-769. [PMID: 34315760 DOI: 10.14444/8098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Research focused on postoperative outcomes among men and women undergoing minimally invasive lumbar decompression (MIS LD) spine surgery is sparse. This study aims to assess the influence of sex on postoperative patient-reported outcome measure (PROM) evaluations and achievement of a minimum clinically important difference (MCID). METHODS A prospectively maintained surgical database was retrospectively queried for patients undergoing primary or revision, single or multilevel LD procedures from 2011 to 2019. Patients with incomplete visual analog scale (VAS) leg or back surveys were excluded. Demographic and operative variables were recorded, and a chi-squared analysis or t tests were used to compare by sex. PROMs were evaluated from preoperative to postoperative time points. PROM score differences and postoperative improvement were evaluated between sexes by a t test. Achievement of MCID by sex was compared using chi-squared analysis. RESULTS The study cohort (n = 572) was 70% male (n = 398), had an average age of 47 years, and 42% were obese. Sexes differed in preoperative VAS leg, Oswestry Disability Index (ODI), and 12-item short form (SF-12)-physical composite score (PCS) scores (all P < .05) and in ODI at 6 and 12 weeks (P = .048; P = .001) and VAS back and leg scores at 6 months (P = .039; P = .019). Both sexes significantly improved (P < .050) all PROMs at all time points except for VAS back at 1 year for women and ODI at 6 weeks and 6 months for men. The only significant difference in achievement of MCID was for ODI at 6 months (P = .008). CONCLUSIONS Significant preoperative differences were observed among sexes with ODI, SF-12-PCS, and VAS leg scores. By 1 year, there were no significant sex differences for any PROM or for achievement of MCID. MIS LD has an equivalent role for both sexes in achieving MCID. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Results demonstrate no sex difference in PROMs following LD.
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Affiliation(s)
- Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nathaniel W Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nadia M Hrynewycz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Sloan SR, Wipplinger C, Kirnaz S, Navarro-Ramirez R, Schmidt F, McCloskey D, Pannellini T, Schiavinato A, Härtl R, Bonassar LJ. Combined nucleus pulposus augmentation and annulus fibrosus repair prevents acute intervertebral disc degeneration after discectomy. Sci Transl Med 2021; 12:12/534/eaay2380. [PMID: 32161108 DOI: 10.1126/scitranslmed.aay2380] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
Abstract
Tissue-engineered approaches for the treatment of early-stage intervertebral disc degeneration have shown promise in preclinical studies. However, none of these therapies has been approved for clinical use, in part because each therapy targets only one aspect of the intervertebral disc's composite structure. At present, there is no reliable method to prevent intervertebral disc degeneration after herniation and subsequent discectomy. Here, we demonstrate the prevention of degeneration and maintenance of mechanical function in the ovine lumbar spine after discectomy by combining strategies for nucleus pulposus augmentation using hyaluronic acid injection and repair of the annulus fibrosus using a photocrosslinked collagen patch. This combined approach healed annulus fibrosus defects, restored nucleus pulposus hydration, and maintained native torsional and compressive stiffness up to 6 weeks after injury. These data demonstrate the necessity of a combined strategy for arresting intervertebral disc degeneration and support further translation of combinatorial interventions to treat herniations in the human spine.
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Affiliation(s)
- Stephen R Sloan
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Sertaç Kirnaz
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | | | - Franziska Schmidt
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Duncan McCloskey
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Tania Pannellini
- Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY 10065, USA
| | | | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA. .,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853, USA
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Stensland M. Managing the Incurable: Older Pain Clinic Patients' Experiences of Managing Treatment-Resistant Chronic Low Back Pain. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:405-422. [PMID: 33719939 DOI: 10.1080/01634372.2021.1898073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
Chronic low back pain (CLBP) is a highly prevalent disabling condition among older adults, and treatment remains a challenge. Limited research has qualitatively examined late-life CLBP and its management. Study objective was to examine how older adults experience pain management approaches for CLBP. Guided by van Manen's phenomenological method, 21 pain clinic patients (66-83) completed semi-structured interviews. Under the main theme "Managing the incurable," four subthemes emerged: (a) A quest for relief; (b) Spinal procedures offer temporary relief yet ongoing disappointment; (c) The apprehension of medication (d) Making things work for me. Social work practice implications are discussed.
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Affiliation(s)
- Meredith Stensland
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center of San Antonio, San Antonio, Texas, USA
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Abstract
Aging athletes face unique, increased adversities related to increased mobility and age-related spine issues, such as spinal stenosis, osteoporosis complicated by fragility fractures, and degenerative disk disease. This article covers various spine pathologies that aging athletes experience and ideal treatment of this population to allow safe return to activity.
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Affiliation(s)
- Pramod N Kamalapathy
- Department of Orthopaedics, University of Virginia, 400 Ray Hunt C. Drive, Charlottesville, VA 22903, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedics, University of Virginia, 400 Ray Hunt C. Drive, Charlottesville, VA 22903, USA.
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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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Effects of age and sex on the distribution and symmetry of lumbar spinal and neural foraminal stenosis: a natural language processing analysis of 43,255 lumbar MRI reports. Neuroradiology 2021; 63:959-966. [PMID: 33594502 PMCID: PMC8128837 DOI: 10.1007/s00234-021-02670-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/03/2021] [Indexed: 01/07/2023]
Abstract
Purpose The purpose of this study is to investigate relationship of patient age and sex to patterns of degenerative spinal stenosis on lumbar MRI (LMRI), rated as moderate or greater by a spine radiologist, using natural language processing (NLP) tools. Methods In this retrospective, IRB-approved study, LMRI reports acquired from 2007 to 2017 at a single institution were parsed with a rules-based natural language processing (NLP) algorithm for free-text descriptors of spinal canal stenosis (SCS) and neural foraminal stenosis (NFS) at each of six spinal levels (T12-S1) and categorized according to a 6-point grading scale. Demographic differences in the anatomic distribution of moderate (grade 3) or greater SCS and NFS were calculated by sex, and age and within-group differences for NFS symmetry (left vs. right) were calculated as odds ratios. Results Forty-three thousand two hundred fifty-five LMRI reports (34,947 unique patients, mean age = 54.7; sex = 54.9% women) interpreted by 152 radiologists were studied. Prevalence of significant SCS and NFS increased caudally from T12-L1 to L4-5 though less at L5-S1. NFS was asymmetrically more prevalent on the left at L2-L3 and L5-S1 (p < 0.001). SCS and NFS were more prevalent in men and SCS increased with age at all levels, but the effect size of age was largest at T12-L3. Younger patients (< 50 years) had relatively higher NFS prevalence at L5-S1. Conclusion NLP can identify patterns of lumbar spine degeneration through analysis of a large corpus of radiologist interpretations. Demographic differences in stenosis prevalence shed light on the natural history and pathogenesis of LSDD.
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Nuclear Medicine in the diagnosis of pathologies of the spine: the role of hybrid imaging. Rev Esp Med Nucl Imagen Mol 2021. [DOI: 10.1016/j.remnie.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Tsuji S, Shinmura K, Nagai K, Wada Y, Kusunoki H, Tamaki K, Ito M, Sano K, Amano M, Hasegawa Y, Kishimoto H, Maruo K, Iseki T, Tachibana T. Low back pain is closely associated with frailty but not with sarcopenia: Cross-sectional study of rural Japanese community-dwelling older adults. Geriatr Gerontol Int 2020; 21:54-59. [PMID: 33245209 DOI: 10.1111/ggi.14100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/20/2022]
Abstract
AIM We speculated that low back pain, which is the most common ailment in older adults, is associated with frailty and/or sarcopenia and contributes to the progression of either condition. Our objective was to evaluate the relationship between low back pain, sarcopenia and frailty in rural Japanese community-dwelling older adults. METHODS We recruited 730 participants aged ≥65 years who underwent a comprehensive health examination between November 2016 and December 2018. The Oswestry Disability Index (ODI) was used to assess low back pain quantitatively, and scores were compared for the frail groups determined by the Japanese version of Cardiovascular Health Study, and the sarcopenia groups as determined by the Asian Working Group for Sarcopenia 2019. RESULTS Among 730 participants, the prevalence of low back pain was 57.8%. There were significant differences in the ODI scores between the robust, prefrail and frail groups (P < 0.001). In contrast, there were no significant differences in the ODI scores among the robust, low appendicular skeletal muscle and sarcopenia groups. Logistic regression analysis showed that the prevalence of low back pain and the ODI scores were significantly associated with frailty after adjustment for age, sex and body mass index (odds ratio 3.41, 95% confidence interval 1.39-8.39, P = 0.008, and odds ratio 1.06, 95% confidence interval 1.04-1.09, P < 0.001, respectively). CONCLUSIONS To the best of our knowledge, this study is the first to show the close association between low back pain and frailty, and suggests that not only the decline in physical function but also neuropsychiatric factors, including chronic pain, constitute a vicious cycle of frailty in community-dwelling older adults. Geriatr Gerontol Int 2021; 21: 54-59.
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Affiliation(s)
- Shotaro Tsuji
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ken Shinmura
- Department of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Koutatsu Nagai
- School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Yosuke Wada
- Department of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroshi Kusunoki
- Department of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kayoko Tamaki
- Department of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masako Ito
- School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Kyoko Sano
- School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Manabu Amano
- School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan
| | - Yoko Hasegawa
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiromitsu Kishimoto
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Keishi Maruo
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomoya Iseki
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Du CF, Cai XY, Gui W, Sun MS, Liu ZX, Liu CJ, Zhang CQ, Huang YP. Does oblique lumbar interbody fusion promote adjacent degeneration in degenerative disc disease: A finite element analysis. Comput Biol Med 2020; 128:104122. [PMID: 33248365 DOI: 10.1016/j.compbiomed.2020.104122] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/14/2020] [Accepted: 11/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The number of oblique lumbar interbody fusion (OLIF) procedures has continued to rise over recent years. Adjacent segment degeneration (ASD) is a common complication following vertebral body fusion. Although the precise mechanism remains uncertain, ASD has gradually become more common in OLIF. Therefore, the present study analyzed the association between disc degeneration and OLIF to explore whether adjacent degeneration was promoted by OLIF in degenerative disc disease. METHODS A three-dimensional nonlinear finite element (FE) model of the L3-S1 lumbar spine was developed and validated. Three lumbar spine degeneration models with different degrees of degeneration (mild, moderate and severe) and a model of OLIF surgery were constructed at the L4-L5 level. When subjected to a follower compressive load (500 N), hybrid moment loading was applied to all models of the lumbar spine and the range of motion (ROM), intradiscal pressure (IDP), facet joint force (FJF), average mises stress in the annulus (AMSA), average tresca stress in the annulus (ATSA) and average endplate stress (AES) were measured. RESULTS Compared with the healthy lumbar spine model, the ROM, IDP, FJF, AMSA, ATSA and AES of the segments adjacent to the degenerated segment increased in each posture as the degree of disc degeneration increased. In different directions of motion, the ROM, IDP, FJF, AMSA, ATSA and AES in the OLIF model in the L3-L4 and L5-S1 segments were higher than those of the healthy model and each degenerated model. Compared with the healthy model, the largest relative increase in biomechanical parameters above (ROM, IDP, FJF, AMSA, ATSA or AES) was observed in the L3-L4 segment in the OLIF model, of 77.13%, 32.63%, 237.19%, 45.36%, 110.92% and 80.28%, respectively. In the L5-S1 segment the corresponding values were 68.88%, 36.12%, 147.24%, 46.00%, 45.88% and 51.29%, respectively. CONCLUSIONS Both degenerated discs and OLIF surgery modified the pattern of motion and load distribution of adjacent segments (L3-L4 and L5-S1 segments). The increases in the biomechanical parameters of segments adjacent to the surgical segment in the OLIF model were more apparent than those of the degenerated models. In summary, OLIF risked accelerating the degeneration of segments adjacent to those of a surgical segment.
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Affiliation(s)
- Cheng-Fei Du
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, China; National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, 300384, China
| | - Xin-Yi Cai
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, China; National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, 300384, China
| | - Wu Gui
- Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China
| | - Meng-Si Sun
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, China; National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, 300384, China
| | - Zi-Xuan Liu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, China; National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, 300384, China
| | - Chun-Jie Liu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, China; National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, 300384, China
| | - Chun-Qiu Zhang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, China; National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, 300384, China
| | - Yun-Peng Huang
- Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China.
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Nuclear Medicine in the diagnosis of pathologies of the spine: role of hybrid imaging. Rev Esp Med Nucl Imagen Mol 2020; 40:37-49. [PMID: 33041242 DOI: 10.1016/j.remn.2020.08.011] [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: 06/29/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
Clinical problems in the human spine are still common in our society, often causing pain and can also limit movement. Back pain is a very common clinical entity, although difficult to diagnose due to its multifactorial nature. There are multiple processes that can alter the structure of the spine, injure vertebrae and/or the surrounding tissue. For the study of the spine, image diagnosis is essential, and within this, molecular hybrid techniques play an important role by providing us with an image of functional and morphological fusion. Among these, SPECT/CT is key in the diagnosis of traumatic and stress pathology, allowing us to locate hidden vertebral fractures, and is also very useful in degenerative and post-surgical pathology. On the other hand, PET/CT with 18F-FDG also plays an important role in the management and monitoring of infectious and oncological processes. This review describes the application of these hybrid techniques in the different pathologies of the spine and the findings of their images, being very useful for the diagnostic assessment and therapeutic management of the patient.
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Schröder C, Nienhaus A. Intervertebral Disc Disease of the Lumbar Spine in Health Personnel with Occupational Exposure to Patient Handling-A Systematic Literature Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4832. [PMID: 32635557 PMCID: PMC7370072 DOI: 10.3390/ijerph17134832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023]
Abstract
Lifting or carrying loads or working while the trunk is in a bent position are well established risk factors for the development of disc disease of the lumbar spine (LDD). Patient handling is associated with certain hazardous activities, which can result in exposure to heavy loads and high pressure for the discs of the lumbar spine of the nurses performing these tasks. The purpose of this review was to examine the occurrence of work-related LDD among health personnel (HP) with occupational exposure to patient handling activities in comparison to un-exposed workers. A systematic literature search was conducted using the following databases: PubMed, CINAHL, Scopus, and Web of Science. A meta-analysis of odds ratios (OR) was conducted by stratifying for various factors. Five studies reported a higher prevalence for LDD among nurses and geriatric nurses (11.3-96.3%) compared to all controls (3.78-76.47%). Results of the meta-analysis showed a significantly increased OR for LDD among HP compared to all controls (OR 2.45; 95% confidence interval (CI) 1.41, 4.26). In particular, the results of this review suggest that nurses have a higher probability of developing disc herniation than office workers.
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Affiliation(s)
- Christofer Schröder
- Department of Occupational Medicine, Public health and Hazardous Substances, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, 22089 Hamburg, Germany;
| | - Albert Nienhaus
- Department of Occupational Medicine, Public health and Hazardous Substances, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, 22089 Hamburg, Germany;
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
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Cao Y, Guo QW, Wan YD. Significant Association between the T2 Values of Vertebral Cartilage Endplates and Pfirrmann Grading. Orthop Surg 2020; 12:1164-1172. [PMID: 32583598 PMCID: PMC7454146 DOI: 10.1111/os.12727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/24/2020] [Accepted: 05/17/2020] [Indexed: 12/13/2022] Open
Abstract
Objective The T2 value of lumbar cartilage endplates was measured using the T2 mapping imaging technique, aiming to explore the correlation between the T2 value and Pfirrmann grading of intervertebral discs. Methods A total of 130 patients with lumbar spine MR examination due to persistent low back pain were enrolled, including 71 men and 59 women (age: 21–63 years). Lumbar Modic changes and Schmorl nodules were recognized by conventional T1WI and T2WI images in 49 patients, and these patients were excluded from the study. A total of 81 patients were enrolled in this study, including 45 men (45.16 ± 12.20 years) and 36 women (43.33 ± 11.27 years). Pfirrmann (Pm) grading of each lumbar disc was performed based on conventional T2WI median sagittal images and the position of cartilage endplates (CEP) was determined by IDEAL‐SPGR images. Meanwhile, the T2 mapping technique was used to obtain T2 values of cartilage endplates. The T2 values of CEP corresponding to different Pm grade discs were compared, and the correlation between the T2 value and the Pm grade of intervertebral discs was analyzed. Results The T2 values of cephalic and caudal CEP of L1–2 in Pm grades I–II, Pm grades III, and Pm grades IV–V were 61.96 ± 5.89 ms, 54.45 ± 3.29 ms, 42.47 ± 3.69 ms and 64.35 ± 5.93 ms, 55.28 ± 3.97 ms, 44.75 ± 2.12 ms, respectively. For cephalic and caudal CEP of L2–3, the T2 values in Pm grades I–II, Pm grades III, and Pm grades IV–V were 62.96 ± 6.93 ms, 55.19 ± 4.02 ms, 48.67 ± 4.56 ms and 65.51 ± 6.49 ms, 57.16 ± 5.55 ms, 52.05 ± 4.20 ms, respectively. The T2 values of cephalic and caudal CEP from L3–4 to L5–S1 in Pm grades I–II, Pm grades III, and Pm grades IV–V were (63.72 ± 5.76 ms, 53.96 ± 6.52 ms, 48.05 ± 5.00 ms), (65.46 ± 6.37 ms, 55.70 ± 7.50 ms, 48.10 ± 3.27 ms); (66.34 ± 7.68 ms, 56.76 ± 9.48 ms, 47.80 ± 4.33 ms), (64.44 ± 4.65 ms, 59.30 ± 8.80 ms, 47.30 ± 5.78 ms), (65.32 ± 5.11 ms, 55.33 ± 6.65 ms, 48.18 ± 5.37 ms), and (63.47 ± 4.92 ms, 50.32 ± 8.86 ms, 44.77 ± 4.69 ms), respectively. There were significant differences in T2 values of cartilage endplates between the Pm grades I–II, III, and IV–V of intervertebral discs (P = 0.000). T2 values corresponding to Pm I–II grades were higher than those in Pm III grade, while T2 values in Pm grades IV–V were lowest. The T2 value of the L4–5, L5–S1 segment endplates was highly correlated with the Pm grades (r = −0.711, −0.721, −0.796, −0.745; P = 0.000) and that of L1–2, L2–3 endplates were moderately correlated (r = −0.542, −0.562, −0.637, −0.612; P = 0.000). Conclusion The T2 values of cartilage endplates revealed varying degrees of degeneration of intervertebral discs, and more severe degeneration corresponded to lower T2 values. Measurement of changes in the T2 value through cartilage endplates can be useful for the diagnosis of early intervertebral disc degeneration and the prevention of disc degeneration.
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Affiliation(s)
- Yi Cao
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Qing-Wei Guo
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ye-da Wan
- Department of Radiology, Tianjin Hospital, Tianjin, China
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Cai XY, Sun MS, Huang YP, Liu ZX, Liu CJ, Du CF, Yang Q. Biomechanical Effect of L 4 -L 5 Intervertebral Disc Degeneration on the Lower Lumbar Spine: A Finite Element Study. Orthop Surg 2020; 12:917-930. [PMID: 32476282 PMCID: PMC7307239 DOI: 10.1111/os.12703] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/22/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To ascertain the biomechanical effects of a degenerated L4 -L5 segment on the lower lumbar spine through a comprehensive simulation of disc degeneration. METHODS A three-dimensional nonlinear finite element model of a normal L3 -S1 lumbar spine was constructed and validated. This normal model was then modified such that three degenerated models with different degrees of degeneration (mild, moderate, or severe) at the L4 -L5 level were constructed. While experiencing a follower compressive load (500 N), hybrid moment loads were applied to all models to determine range of motion (ROM), intradiscal pressure (IDP), maximum von Mises stress in the annulus, maximum shear stress in the annulus, and facet joint force. RESULTS As the degree of disc degeneration increased, the ROM of the L4 -L5 degenerated segment declined dramatically in all postures (flexion: 5.79°-1.91°; extension: 5.53°-2.62°; right lateral bending: 4.47°-1.46°; left lateral bending: 4.86°-1.61°; right axial rotation: 2.69°-0.74°; left axial rotation: 2.69°-0.74°), while the ROM in adjacent segments increased (1.88°-8.19°). The largest percent decrease in motion of the L4 -L5 segment due to disc degeneration was in right axial rotation (75%), left axial rotation (69%), flexion (67%), right lateral bending (67%), left lateral bending right (67%), and extension (53%). The change in the trend of the IDP was the same as that of the ROM. Specifically, the IDP decreased (flexion: 0.592-0.09 MPa; extension: 0.678-0.334 MPa; right lateral bending: 0.498-0.205 MPa; left lateral bending: 0.523-0.272 MPa; right axial rotation: 0.535-0.246 MPa; left axial rotation: 0.53-0.266 MPa) in the L4 -L5 segment, while the IDP in adjacent segments increased (0.511-0.789 MPa). The maximum von Mises stress and maximum shear stress of the annulus in whole lumbar spine segments increased (L4 -L5 segment: 0.413-2.626 MPa and 0.412-2.783 MPa, respectively; adjacent segment of L4 -L5 : 0.356-1.493 MPa and 0.359-1.718 MPa, respectively) as degeneration of the disc progressively increased. There was no apparent regularity in facet joint force in the degenerated segment as the degree of disc degeneration increased. Nevertheless, facet joint forces in adjacent healthy segments increased as the degree of disc degeneration increased (extension: 49.7-295.3 N; lateral bending: 3.5-171.2 N; axial rotation: 140.2-258.8 N). CONCLUSION Degenerated discs caused changes in the motion and loading pattern of the degenerated segments and adjacent normal segments. The abnormal load and motion in the degenerated models risked accelerating degeneration in the adjacent normal segments. In addition, accurate simulation of degenerated facet joints is essential for predicting changes in facet joint loads following disc degeneration.
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Affiliation(s)
- Xin-Yi Cai
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Meng-Si Sun
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Yun-Peng Huang
- Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Zi-Xuan Liu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Chun-Jie Liu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Cheng-Fei Du
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
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Dombrowski ME, Olsen AS, Vaudreuil N, Couch BK, Dong Q, Tucci M, Lee JY, Vo NV, Sowa G. Rabbit Annulus Fibrosus Cells Express Neuropeptide Y, Which Is Influenced by Mechanical and Inflammatory Stress. Neurospine 2020; 17:69-76. [PMID: 32252156 PMCID: PMC7136102 DOI: 10.14245/ns.2040046.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/26/2020] [Indexed: 12/17/2022] Open
Abstract
Objective Rabbit annulus fibrosus (AF) cells were exposed to isolated or combined mechanical and inflammatory stress to examine the expression of neuropeptide Y (NPY). This study aims to explore the ability of AF cells to produce NPY in response to mechanical and inflammatory stress.
Methods Lumbar AF cells of 6- to 8-month-old female New Zealand white rabbits were harvested and exposed to combinations of inflammatory (interleukin-1β) and mechanical (6% or 18%) tensile stress using the Flexcell System. NPY concentrations were measured in the media via enzyme-linked immunosorbent assay. The presence of NPY receptor-type 1 (NPY-1R) in AF cells of rabbit intervertebral discs was also analyzed via immunohistochemistry and immunofluorescence.
Results Exposure to inflammatory stimuli showed a significant increase in the amount of NPY expression compared to control AF cells. Mechanical strain alone did not result in a significant difference in NPY expression. While combined inflammatory and mechanical stress did not demonstrate an increase in NPY expression at low (6%) levels of strain, at 18% strain, there was a large—though not statistically significant—increase in NPY expression under conditions of inflammatory stress. Lastly, immunofluorescence and immunohistochemistry of AF cells and tissue, respectively, demonstrated the presence of NPY-1R.
Conclusion These findings demonstrate that rabbit AF cells are capable of expressing NPY, and expression is enhanced in response to inflammatory and mechanical stress. Because both inflammatory and mechanical stress contribute to intervertebral disc degeneration (IDD), this observation raises the potential of a mechanistic link between low back pain and IDD.
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Affiliation(s)
- Malcolm E Dombrowski
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam S Olsen
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicholas Vaudreuil
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brandon K Couch
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Qing Dong
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle Tucci
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Joon Y Lee
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nam V Vo
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gwendolyn Sowa
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Spondyloarthrosis: pathogenesis, clinic, diagnosis and treatment (literature review and own experience). КЛИНИЧЕСКАЯ ПРАКТИКА 2020. [DOI: 10.17816/clinpract18813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
8590% of the elderly people are diagnosed with spondyloarthrosis There are various synonyms for this disease in the literature: facet syndrome, facet pain syndrome, arthrosis of the intervertebral joints, zygapophysial joint arthrosis and spondyloarthropathy. The article analyzes the pathogenesis, clinical picture and methods of diagnosis of this disease. Modern types of conservative and surgical treatment are presented. The advantages and disadvantages of the surgical methods for the facet syndrome treatment are analyzed: instrumental denervation (radio frequency, laser, etc.), chemical denervaion and intraarticular administration of drugs. The results of our own clinical work are presented. The facet joint denervation appears to be a productive minimally invasive method of treatment of the reflex forms of spondyloarthrosis. In the early and long-term postoperative period, it leads to a persistent decrease in the intensity of pain and improvement of the quality of life with a low risk of perioperative complications.
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50
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Weiner DK, Gentili A, Rossi M, Coffey-Vega K, Rodriguez KL, Hruska KL, Hausmann L, Perera S. Aging Back Clinics-a Geriatric Syndrome Approach to Treating Chronic Low Back Pain in Older Adults: Results of a Preliminary Randomized Controlled Trial. PAIN MEDICINE 2020; 21:274-290. [PMID: 31503275 DOI: 10.1093/pm/pnz179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Treating chronic low back pain (CLBP) with spine-focused interventions is common, potentially dangerous, and often ineffective. This preliminary trial tests the feasibility and efficacy of caring for CLBP in older adults as a geriatric syndrome in Aging Back Clinics (ABC). DESIGN Randomized controlled trial. SETTING Outpatient clinics of two VA Medical Centers. SUBJECTS Fifty-five English-speaking veterans aged 60-89 with CLBP and no red flags for serious underlying illness, prior back surgery, dementia, impaired communication, or uncontrolled psychiatric illness. METHODS Participants were randomized to ABC care or usual care (UC) and followed for six months. ABC care included 1) a structured history and physical examination to identify pain contributors, 2) structured participant education, 3) collaborative decision-making, and 4) care guided by condition-specific algorithms. Primary outcomes were low back pain severity (0-10 current and seven-day average/worst pain) and pain-related disability (Roland Morris). Secondary outcomes included the SF-12 and health care utilization. RESULTS ABC participants experienced significantly greater reduction in seven-day average (-1.22 points, P = 0.023) and worst pain (-1.70 points, P = 0.003) and SF-12 interference with social activities (50.0 vs 11.5%, P = 0.0030) at six months. ABC participants were less likely to take muscle relaxants (16.7 vs 42.3%, P = 0.0481). Descriptively, UC participants were more likely to experience pain-related emergency room visits (45.8% vs 30.8%) and to be exposed to non-COX2 nonsteroidal anti-inflammatory drugs (73.1% vs 54.2%). CONCLUSIONS These preliminary data suggest that ABC care for older veterans with CLBP is feasible and may reduce pain and exposure to other potential morbidity.
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Affiliation(s)
- Debra K Weiner
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Medicine (Geriatric Medicine), University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Angela Gentili
- Hunter Holmes McGuire VA Medical Center, Richmond, Pennsylvania.,Department of Medicine (Geriatric Medicine), Virginia Commonwealth University, Richmond, Virginia
| | - Michelle Rossi
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Medicine (Geriatric Medicine), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katherine Coffey-Vega
- Department of Medicine (Geriatric Medicine), University of Virginia, Charlottesville, Virginia
| | - Keri L Rodriguez
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristina L Hruska
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Leslie Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Department of Medicine (Geriatric Medicine), University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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