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Boylan C, Thimmaiah R, McKay G, Gardner A, Newton Ede M, Mehta J, Spilsbury J, Marks D, Jones M. Does intervertebral disc degeneration in adolescent idiopathic scoliosis correlate with patient-reported pain scores? A review of 968 cases. Eur Spine J 2024; 33:687-694. [PMID: 38175248 DOI: 10.1007/s00586-023-08082-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/13/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Report the rate and severity of degenerative disc disease (DDD) in non-surgical adolescent idiopathic scoliosis (AIS) patients and correlate these findings with patient-reported symptomatology scores. Additionally, to quantify the rate of concurrent pathological radiological findings in this group. METHODS This was a retrospective chart review study at a single tertiary centre. AIS patients aged 10-16 who had received a whole spine MRI between September 2007 and January 2019 and who had not received surgical intervention to their spine were included. MRI scan reports were screened to extract those who had evidence of DDD. These were then reviewed by a blinded second reviewer who graded every disc using the Pfirrmann grading system. SRS-22 scores were extracted for patients when available. RESULTS In total, 968 participants were included in the study. Of these, 93 (9.6%) had evidence of DDD, which was Pfirrmann grade ≥ 3 in 28 (2.9%). The most commonly affected level was L5/S1 (59.1% of DDD cases). A total of 55 patients (5.7%) had evidence of syringomyelia, 41 (3.4%) had evidence of spondylolisthesis (all L5/S1), 14 (1.4%) had bilateral L5 pars defects, and 5 (0.5%) had facet joint degeneration. Spondylolisthesis and bilateral pars defects were more common in patients with DDD identified on MRI scan (p < 0.001 and p = 0.04, respectively). Function (p = 0.048) and pain (p = 0.046) scores were worse in patients with DDD. CONCLUSION We present a baseline for the rate and severity of DDD in the non-operative AIS cohort. This should assist in decision-making and counselling of patients prior to surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Conor Boylan
- University of Birmingham, Birmingham, UK.
- The Royal Orthopaedic Hospital NHS Foundation Trust, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Ravindra Thimmaiah
- University of Birmingham, Birmingham, UK
- The Royal Orthopaedic Hospital NHS Foundation Trust, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - George McKay
- The Royal Orthopaedic Hospital NHS Foundation Trust, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Adrian Gardner
- University of Birmingham, Birmingham, UK
- The Royal Orthopaedic Hospital NHS Foundation Trust, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Matthew Newton Ede
- The Royal Orthopaedic Hospital NHS Foundation Trust, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Jwalant Mehta
- The Royal Orthopaedic Hospital NHS Foundation Trust, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Jonathan Spilsbury
- The Royal Orthopaedic Hospital NHS Foundation Trust, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - David Marks
- The Royal Orthopaedic Hospital NHS Foundation Trust, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Morgan Jones
- The Royal Orthopaedic Hospital NHS Foundation Trust, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
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Nicholson T, Davis L, Davis ET, Newton Ede M, Scott A, Jones SW. e-Cigarette Vapour Condensate Reduces Viability and Impairs Function of Human Osteoblasts, in Part, via a Nicotine Dependent Mechanism. Toxics 2022; 10:506. [PMID: 36136470 PMCID: PMC9504563 DOI: 10.3390/toxics10090506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 06/16/2023]
Abstract
Cigarette consumption negatively impacts bone quality and is a risk-factor for the development of multiple bone associated disorders, due to the highly vascularised structure of bone being exposed to systemic factors. However, the impact on bone to electronic cigarette (e-cigarette) use, which contains high doses of nicotine and other compounds including flavouring chemicals, metal particulates and carbonyls, is poorly understood. Here, we present the first evidence demonstrating the impact of e-cigarette vapour condensate (replicating changes in e-cigarette liquid chemical structure that occur upon device usage), on human primary osteoblast viability and function. 24 h exposure of osteoblasts to e-cigarette vapour condensate, generated from either second or third generation devices, significantly reduced osteoblast viability in a dose dependent manner, with condensate generated from the more powerful third generation device having greater toxicity. This effect was mediated in-part by nicotine, since exposure to nicotine-free condensate of an equal concentration had a less toxic effect. The detrimental effect of e-cigarette vapour condensate on osteoblast viability was rescued by co-treatment with the antioxidant N-Acetyl-L-cysteine (NAC), indicating toxicity may also be driven by reactive species generated upon device usage. Finally, non-toxic doses of either second or third generation condensate significantly blunted osteoblast osteoprotegerin secretion after 24 h, which was sustained for up to 7 days. In summary we demonstrate that e-cigarette vapour condensate, generated from commonly used second and third generation devices, can significantly reduce osteoblast viability and impair osteoblast function, at physiologically relevant doses. These data highlight the need for further investigation to inform users of the potential risks of e-cigarette use on bone health, including, accelerating bone associated disease progression, impacting skeletal development in younger users and to advise patients following orthopaedic surgery, dental surgery, or injury to maximise bone healing.
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Affiliation(s)
- Thomas Nicholson
- Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | - Lauren Davis
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | - Edward T. Davis
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B15 2TT, UK
| | | | - Aaron Scott
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | - Simon W. Jones
- Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
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Nicholson T, Scott A, Newton Ede M, Jones SW. The impact of E-cigarette vaping and vapour constituents on bone health. J Inflamm (Lond) 2021; 18:16. [PMID: 33952248 PMCID: PMC8097983 DOI: 10.1186/s12950-021-00283-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/25/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In contrast to cigarettes, electronic cigarette use (E-cigarettes) has grown substantially over the last decade. This is due to their promotion as both a safer alternative to cigarettes and as an aide to stop smoking. Critically, upon E-cigarette use, the user may be exposed to high doses of nicotine in addition to other compounds including flavouring chemicals, metal particulates and carbonyl compounds, particularly in highly vascularised tissues such as bone. However, there has been limited investigation into the impact of E-cigarette usage on bone physiology, particularly over extended time periods and there are no clinical recommendations regarding E-cigarette usage in relation to orthopaedic surgery. This literature review draws together data from studies that have investigated the impact of E-cigarette vapour and its major constituents on bone, detailing the models utilised and the relevant mechanistic and functional results. MAIN BODY Currently there is a lack of studies both in vivo and in vitro that have utilised E-cigarette vapour, necessary to account for changes in chemical composition of E-cigarette liquids upon vaping. There is however evidence that human bone and bone cells express nicotine receptors and exposure of both osteoblasts and osteoclasts to nicotine, in high concentrations may reduce their viability and impair function. Similarly, it appears that aldehydes and flavouring chemicals may also negatively impact osteoblast viability and their ability to form bone. However, such functional findings are predominantly the result of studies utilising bone cell lines such as MG-63 or Saos-2 cells, with limited use of human osteoblasts or osteoclasts. Additionally, there is limited consideration for a possible impact on mesenchymal stem cells, which can also play an import role in bone repair. CONCLUSION Understanding the function and mechanism of action of the various components of E-cigarette vapour in mediating human bone cell function, in addition to long term studies to determine the potential harm of chronic E-cigarette use on human bone will be important to inform users of potential risks, particularly regarding bone healing following orthopaedic surgery and injury.
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Affiliation(s)
- Thomas Nicholson
- grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT UK
| | - Aaron Scott
- grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT UK
| | - Matthew Newton Ede
- grid.416189.30000 0004 0425 5852The Royal Orthopaedic Hospital, Birmingham, B31 2AP UK
| | - Simon W. Jones
- grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT UK
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Affiliation(s)
- Thomas Nicholson
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Medical School, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
| | - Aaron Scott
- Birmingham Acute Care Research Group Institute of Inflammation and Ageing (IIA), University of Birmingham, Birmingham, UK
| | | | - Simon W. Jones
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Medical School, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK,Simon W. Jones. E-mail:
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Pearson MJ, Philp AM, Haq H, Cooke ME, Nicholson T, Grover LM, Newton Ede M, Jones SW. Evidence of Intrinsic Impairment of Osteoblast Phenotype at the Curve Apex in Girls With Adolescent Idiopathic Scoliosis. Spine Deform 2019; 7:533-542. [PMID: 31202368 DOI: 10.1016/j.jspd.2018.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/07/2018] [Accepted: 11/20/2018] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN An observational descriptive study based on a single cohort of patients. OBJECTIVE To determine whether spinal facet osteoblasts at the curve apex display a different phenotype to osteoblasts from outside the curve in adolescent idiopathic scoliosis (AIS) patients. SUMMARY OF BACKGROUND DATA Intrinsic differences in the phenotype of spinal facet bone tissue and in spinal osteoblasts have been implicated in the pathology of AIS. However, no study has compared the phenotype of facet osteoblasts at the curve apex compared with outside the curve in AIS patients. METHODS Facet spinal tissue was collected perioperatively from three sites, the concave and convex side at the curve apex and from outside the curve (noncurve) from three AIS female patients aged 13-16 years. Spinal tissue was analyzed by micro-computed tomography to determine bone mineral density (BMD) and trabecular structure. Primary osteoblasts were cultured from concave, convex, and noncurve facet bone chips. The phenotype of osteoblasts was determined by assessment of cellular proliferation, cellular metabolism (alkaline phosphatase and Seahorse Analyzer), bone nodule mineralization (Alizarin red assay), and the mRNA expression of Wnt signaling genes (quantitative reverse transcriptase polymerase chain reaction). RESULTS Convex facet tissue exhibited greater BMD and trabecular thickness, compared with concave facet tissue. Osteoblasts at the convex side of the curve apex exhibited a significantly higher proliferative and metabolic phenotype and a greater capacity to form mineralized bone nodules, compared with concave osteoblasts. mRNA expression of SKP2 was significantly greater in both concave and convex osteoblasts, compared with noncurve osteoblasts. The expression of SFRP1 was significantly downregulated in convex osteoblasts, compared with either concave or noncurve. CONCLUSIONS Intrinsic differences that affect osteoblast function are exhibited by spinal facet osteoblasts at the curve apex in AIS patients. LEVEL OF EVIDENCE Level IV, Prognostic.
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Affiliation(s)
- Mark J Pearson
- Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, School of Immunity, University of Birmingham, Birmingham, United Kingdom
| | - Ashleigh M Philp
- Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, School of Immunity, University of Birmingham, Birmingham, United Kingdom
| | - Hirah Haq
- Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, School of Immunity, University of Birmingham, Birmingham, United Kingdom
| | - Megan E Cooke
- Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, School of Immunity, University of Birmingham, Birmingham, United Kingdom
| | - Thomas Nicholson
- Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, School of Immunity, University of Birmingham, Birmingham, United Kingdom
| | - Liam M Grover
- School of Chemical Engineering, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Matthew Newton Ede
- Royal Orthopaedic Hospital NHS Trust, Bristol Road South, Birmingham, United Kingdom
| | - Simon W Jones
- Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, School of Immunity, University of Birmingham, Birmingham, United Kingdom.
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Dewan V, Gardner A, Forster S, Matthews J, Newton Ede M, Mehta J, Spilsbury J, Marks D. Is the routine use of magnetic resonance imaging indicated in patients with scoliosis? J Spine Surg 2018; 4:575-582. [PMID: 30547121 DOI: 10.21037/jss.2018.07.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background To assess the reliability of the indicators for performing magnetic resonance imaging in patients with scoliosis and assess the incidence of neural axis anomalies in a population with scoliosis referred to a specialist centre. Methods A retrospective review of magnetic resonance imaging (MRI) reports of all patients under the age of 18 who underwent a pre-operative MRI for investigation of their scoliosis between 2009 and 2014 at a single institution was performed. Results There were 851 patients who underwent an MRI scan of their whole spine with a mean age of 14.08 years. There were 211 males and 640 females. One hundred and fourteen neural axis abnormalities (NAA) were identified. The presence of a left sided thoracic curve, a double thoracic curve, being male nor being diagnosed before the age of 10 were found to be statistically significant for the presence of a NAA. Furthermore, 2.34% of patients were also found to have an incidental finding (IF) of an extraspinal abnormality. Conclusions From our series, the reported indications for performing an MRI scan in the presence of scoliosis are not reliable for the presence of an underlying NAA. We have demonstrated that there is a number of intra and extra dural anomalies found on MRI without clinical symptoms and signs. This acts as normative information for this group. Keywords Scoliosis; magnetic resonance imaging (MRI); neural axis abnormalities (NAA); adolescent idiopathic scoliosis (AIS).
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Affiliation(s)
- Varun Dewan
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - Adrian Gardner
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - Stephen Forster
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - Jake Matthews
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - Matthew Newton Ede
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - Jwalant Mehta
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - Jonathan Spilsbury
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - David Marks
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
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Gardner A, Beaven A, Marks D, Spilsbury J, Mehta J, Newton Ede M. Does the law of diminishing returns apply to the lengthening of the MCGR rod in early onset scoliosis with reference to growth velocity? J Spine Surg 2017; 3:525-530. [PMID: 29354727 DOI: 10.21037/jss.2017.08.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study is a single centre retrospective review of prospectively collected data. The 'law of diminishing returns' describes the number of lengthening episodes that a traditional growth rod (TGR) can undergo before stiffness across the construct prevents further increases in overall length. It is unclear whether this will affect MCGR when used in the management of early onset scoliosis (EOS). Methods A retrospective review of prospectively collected data on the experience of MCGR lengthening in a heterogenous cohort of children with EOS from a single centre. Results There were 53 MCGRs in 28 patients with EOS with a number of different underlying diagnoses. The mean age of the cohort was 8 years 3 months (SD, 2 years 7 months). The mean follow-up period since primary rod implantation was 2 years 0 months (SD, 1 year 1 month). MCGR lengthening was performed on up to 12 occasions [median, 4; interquartile range (IQR), 4; range, 1-12]. There was no statistically significant difference in the amount of length achieved over then number of lengthening episodes (P=0.427). For those with at least 2 years follow up the median number of lengthening was 10 (IQR 2, range 9-12) and there was no statistically significant difference seen (P=0.438). Growth velocity of MCGRs against age was less than previously documented norms for the thoracic spine, but was maintained as age increased. Conclusions The 'law of diminishing returns' does not affect serial lengthening of MCGR in the way that has been observed using TGR. It was also demonstrated that in the MCGR group growth velocity was maintained relative to that of the normal spine.
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Affiliation(s)
- Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Alistair Beaven
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - David Marks
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Jwalant Mehta
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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