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Agustini D, Heimann MK, Co M, Walter BA, Purmessur D, Moore SA. Modic changes in the lumbar vertebral column of chondrodystrophic and non-chondrodystrophic dogs with intervertebral disc disease. Front Vet Sci 2024; 11:1359016. [PMID: 38566749 PMCID: PMC10985344 DOI: 10.3389/fvets.2024.1359016] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Modic changes (MC) are signs of vertebral pathology visible on magnetic resonance (MR) images that have been associated with low back pain (LBP) and disc degeneration in people. Multiple breeds of dogs also develop MCs and coincident back pain. However, the association between breed, MC, and spinal pathologies has yet to be fully elucidated. This study aimed to identify the prevalence of MC that occur spontaneously in the lumbar vertebral column of dogs diagnosed with intervertebral disc disease (IVDD) and examine their association with demographic criteria and the disc width index (DWI). Methods Medical records and lumbar vertebral column MR images were examined from 104 dogs (831 intervertebral disc spaces and adjacent vertebrae), which were divided into three groups: chondrodystrophic dogs (CD; n =54) and non-chondrodystrophic dogs (NCD; n =30) with IVDD as the primary diagnosis, and control dogs (n =20) with other spinal diseases as their primary diagnosis. Results Increasing age and a diagnosis of IVDD were significantly associated with MC in dogs (p < 0.001 and p = 0.0062, respectively). In CD dogs with IVDD, Type 2 MC were most prevalent, whereas, in NCD dogs, Type 3 MC were the most prevalent type. Type 2 MC were distributed nearly equally across the lumbar vertebral column, while Type 3 MC were primarily detected at the level of L7-S1. Discussion This study demonstrated that MC developed spontaneously in dogs, are common in dogs diagnosed with IVDD, and the type observed varies by breed. Further research is needed to understand the pathogenesis of MC; however, the increased presence of Type 2 MC in CD dogs, similar to what is found in people with disc degeneration, suggests that CD dogs could serve as models for MC in people.
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Affiliation(s)
- Dyah Agustini
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Mary K Heimann
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Megan Co
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Benjamin A Walter
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Devina Purmessur
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Sarah A Moore
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
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Wakefield B, Tang J, Hutchinson JL, Kanji R, Brooks C, Grol MW, Séguin CA, Penuela S, Beier F. Pannexin 3 deletion in mice results in knee osteoarthritis and intervertebral disc degeneration after forced treadmill running. J Orthop Res 2024. [PMID: 38499500 DOI: 10.1002/jor.25830] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/10/2023] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
Pannexin 3 (Panx3) is a glycoprotein that forms mechanosensitive channels expressed in chondrocytes and annulus fibrosus cells of the intervertebral disc (IVD). Evidence suggests Panx3 plays contrasting roles in traumatic versus aging osteoarthritis (OA) and intervertebral disc degeneration (IDD). However, whether its deletion influences the response of joint tissue to forced use is unknown. The purpose of this study was to determine if Panx3 deletion in mice causes increased knee joint OA and IDD after forced treadmill running. Male and female wildtype (WT) and Panx3 knockout (KO) mice were randomized to either a no-exercise group (sedentary; SED) or daily forced treadmill running (forced exercise; FEX) from 24 to 30 weeks of age. Knee cartilage and IVD histopathology were evaluated by histology, while tibial secondary ossification centers were analyzed using microcomputed tomography (µCT). Both male and female Panx3 KO mice developed larger superficial defects of the tibial cartilage after forced treadmill running compared with SED WT mice. Additionally, Panx3 KO mice developed reduced bone volume, and female PANX3 KO mice had lengthening of the lateral tubercle at the intercondylar eminence. In the lower lumbar spine, both male and female Panx3 KO mice developed histopathological features of IDD after running compared to SED WT mice. These findings suggest that the combination of deleting Panx3 and forced treadmill running induces OA and causes histopathological changes associated with the degeneration of the IVDs in mice.
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Affiliation(s)
- Brent Wakefield
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Western's Bone and Joint Institute, The Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital, London, Ontario, Canada
| | - Justin Tang
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Western's Bone and Joint Institute, The Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital, London, Ontario, Canada
| | - Jeffrey L Hutchinson
- Western's Bone and Joint Institute, The Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital, London, Ontario, Canada
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Rehanna Kanji
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Courtney Brooks
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Matthew W Grol
- Western's Bone and Joint Institute, The Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital, London, Ontario, Canada
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Cheryle A Séguin
- Western's Bone and Joint Institute, The Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital, London, Ontario, Canada
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Silvia Penuela
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Western's Bone and Joint Institute, The Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital, London, Ontario, Canada
| | - Frank Beier
- Western's Bone and Joint Institute, The Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital, London, Ontario, Canada
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
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Park J, Cho H, Ji Y, Lee K, Yoon H. Detection of spondylosis deformans in thoracolumbar and lumbar lateral X-ray images of dogs using a deep learning network. Front Vet Sci 2024; 11:1334438. [PMID: 38425836 PMCID: PMC10902442 DOI: 10.3389/fvets.2024.1334438] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Spondylosis deformans is a non-inflammatory osteophytic reaction that develops to re-establish the stability of weakened joints between intervertebral discs. However, assessing these changes using radiography is subjective and difficult. In human medicine, attempts have been made to use artificial intelligence to accurately diagnose difficult and ambiguous diseases in medical imaging. Deep learning, a form of artificial intelligence, is most commonly used in medical imaging data analysis. It is a technique that utilizes neural networks to self-learn and extract features from data to diagnose diseases. However, no deep learning model has been developed to detect vertebral diseases in canine thoracolumbar and lumbar lateral X-ray images. Therefore, this study aimed to establish a segmentation model that automatically recognizes the vertebral body and spondylosis deformans in the thoracolumbar and lumbar lateral radiographs of dogs. Methods A total of 265 thoracolumbar and lumbar lateral radiographic images from 162 dogs were used to develop and evaluate the deep learning model based on the attention U-Net algorithm to segment the vertebral body and detect spondylosis deformans. Results When comparing the ability of the deep learning model and veterinary clinicians to recognize spondylosis deformans in the test dataset, the kappa value was 0.839, indicating an almost perfect agreement. Conclusions The deep learning model developed in this study is expected to automatically detect spondylosis deformans on thoracolumbar and lumbar lateral radiographs of dogs, helping to quickly and accurately identify unstable intervertebral disc space sites. Furthermore, the segmentation model developed in this study is expected to be useful for developing models that automatically recognize various vertebral and disc diseases.
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Affiliation(s)
- Junseol Park
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
- Biosafety Research Institute and College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Hyunwoo Cho
- Department of Electronic Engineering, Sogang University, Seoul, Republic of Korea
| | - Yewon Ji
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Kichang Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Hakyoung Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
- Biosafety Research Institute and College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
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Sawalkar RG, Athawale V, Fating T. Comprehensive Physiotherapeutic Management of Cervical and Lumbar Disc Disease: A Case Study. Cureus 2024; 16:e52543. [PMID: 38371115 PMCID: PMC10870066 DOI: 10.7759/cureus.52543] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
This case report focuses on a 75-year-old male diagnosed with cervical and lumbar disc disease, common conditions associated with intervertebral disc degeneration. The study aims to highlight the significance of physiotherapy in managing these conditions. The patient presented with neck and lower back pain radiating to the limbs which was managed conservatively with analgesics and physiotherapy. The physiotherapeutic intervention included a tailored regimen involving cryotherapy, transcutaneous electrical nerve stimulation (TENS), strengthening exercises, task-specific training, and the use of a stabilometric platform. The pre- and post-intervention assessments revealed improvements in range of motion, muscle strength, and various outcome measures, emphasizing the effectiveness of the holistic physiotherapy approach. The case underscores the importance of physiotherapy in addressing degenerative disc diseases, offering insights into specific interventions such as cryotherapy, targeted exercises, and advanced technologies like stabilometric platforms. This study contributes to the existing literature on the role of physiotherapy in managing cervical and lumbar disc diseases, emphasizing the need for patient education and a comprehensive approach to improve overall physical functioning.
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Affiliation(s)
- Rutuja G Sawalkar
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vrushali Athawale
- Oncology Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Sadeghpour Ezbarami S, Zarei F, Haghani S. Evaluation of a mobile-application educational intervention on the knowledge, attitude, and practice of patients in postoperative care for lumbar disk herniation surgery: A randomized control trial. SAGE Open Med 2023; 11:20503121231203684. [PMID: 37900969 PMCID: PMC10612435 DOI: 10.1177/20503121231203684] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/06/2023] [Indexed: 10/31/2023] Open
Abstract
Objective We aimed to evaluate the impact of a mobile-based educational program on patients' postoperative care for lumbar disk herniation surgery. Methods A randomized controlled trial was conducted at Fayaz-Bakhsh Hospital, Tehran, Iran. Patients with lumbar disc herniation surgery experience were randomized to the intervention and control groups (learning with the LUmbar CAring Training-app). Participants' knowledge, attitudes, and practices of postoperative care for lumbar disc herniation surgery were assessed using a validated questionnaire at three-time points: pre-test (baseline), post-test one (immediately after program completion), and post-test two (8 weeks after program completion). The primary outcome measures were knowledge, attitudes, and practices scores variations. Secondary outcomes were not considered in our study. Results In total, 150 patients were enrolled, with 75 patients in each group. Patients in the intervention group demonstrated increased knowledge, modified attitudes, and practice than those in the control group (p < 0.05). The post-test knowledge, attitudes, and practices scores in the intervention group were significantly higher than those in the control group (p < 0.05). Conclusion Mobile-application-based education was a practical and feasible approach to improve patients' postoperative care for lumbar disc herniation surgery in Iran.
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Affiliation(s)
- Sohaila Sadeghpour Ezbarami
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University (TMU), Tehran, Iran
| | - Fatemeh Zarei
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University (TMU), Tehran, Iran
| | - Shima Haghani
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
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Albayrak S, Atcı İB. A Retrospective Study of Far Lateral Midline Microlumbar Discectomy in 20 Patients at a Single Center in Turkey. Med Sci Monit 2023; 29:e941257. [PMID: 37695750 PMCID: PMC10503398 DOI: 10.12659/msm.941257] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/18/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Microdiscectomy is a minimally-invasive surgical technique for treating far lateral lumbar disc herniation (FLLDH). This retrospective study from a single center in Turkey aimed to evaluate midlinelumbar discectomy in 20 patients with far lateral lumbar disc herniation. MATERIAL AND METHODS We collected clinical data of 20 patients (11 men, 9 women) operated for FLDDH between January 2006 and January 2022. Patients' age, sex, surgical level, examination findings, motor deficit, duration of operation, complications during the operation and preoperative/postoperative 6 month visual analogue Scala (VAS), preoperative/postoperative 6th month Oswestry Disability Index (ODI) scores were evaluated. RESULTS The patients were 11 men (55%) and 9 women (45%), with a mean age of 52.08±11.21 years. The mean duration of symptoms before the operation was 3.4 weeks. Laseque sign positivity was found in 86.4% of the patients. Motor deficit was present in 30% of the patients. After 6-month follow-up, preoperative VAS value decreased from 9.35±0.75 to 0.84±0.75. Preoperative and postoperative VAS score averages were significantly different (P=0.0001). Operation ODI values were 73.63±3.76 before and after surgery, and decreased to 14.81±3.63 at 6 months. CONCLUSIONS The term distal lateral disc herniation was first defined in the literature in 1974 when the disc was seen in a different location than the normal location compared to the facet. Far lateral disc herniation can be operated on successfully with midline skin incision.
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Affiliation(s)
- Serdal Albayrak
- Department of Neurosurgery, Elazig Fethi Sekkin Training and Research Hospital, Elazig, Turkey
| | - İbrahim Burak Atcı
- Department of Neurosurgery, İstanbul Training and Research Hospital, İstanbul, Turkey
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Albertini GM, Stabile F, Marsh O, Uriarte A. Clinical, magnetic resonance imaging, surgical features and comparison of surgically treated intervertebral disc extrusion in French bulldogs. Front Vet Sci 2023; 10:1230280. [PMID: 37720470 PMCID: PMC10501390 DOI: 10.3389/fvets.2023.1230280] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/11/2023] [Indexed: 09/19/2023] Open
Abstract
Intervertebral disc (IVD) extrusion (IVDE) is the most reported neurological condition in French bulldogs (FBD). The aim of this study was to retrospectively evaluate neurological grade, magnetic resonance imaging (MRI), surgical findings and short-term recovery in surgically treated FBD diagnosed with IVDE referred to a single institution between January 2020 and March 2022 and to compare cervical and thoracolumbar IVDE. Data was gathered from medical records and analysed via Fischer's Exact-Test and Kruskal Wallis-tests. Statistical significance was assumed when p < 0.05. Thirty-nine FBD were diagnosed with IVDE. Cervical IVDE (C-IVDE) was diagnosed in 11/39 cases; the C3-C4 IVD space was the most commonly affected site (5/11). Thoracolumbar IVDE (TL-IVDE) was diagnosed in 28 cases; the L3-L4 IVD space was the most commonly affected site (7/28). At admission, C-IVDE was significantly associated with less severe neurological grade (grade 1-2) compared to TL-IVDE (grade 2-5) (p < 0.001). The extruded IVD material (EIVDM) was hypointense in T2w images in 11/11C-IVDE vs. 2/28TL-IVDE, and hypointense in T1w images in 10/11C-IVDE vs. 1/28TL-IVDE. The EIVDM was hyperintense in T2w images in 0/11C-IVDE vs. 26/28TL-IVDE and iso-to-hypointense in T1w images in 1/11C-IVDE vs. 27/28TL-IVDE (p < 0,001). The EIVDM extended over ≥2 IVD spaces in 0/11C-IVDE vs. 19/28TL-IVDE (p < 0,001). 10/11C-IVDE underwent single ventral slot, 1/11C-IVDE underwent unilateral cervical hemilaminectomy. All TL-IVDE underwent unilateral hemilaminectomy and 19/28TL-IVDE underwent unilateral hemilaminectomy over ≥2 IVD spaces (p < 0,001). Haemorrhagic EIVDM was noticed intraoperatively in 1/11C-IVDE vs. 28/28TL-IVDE (p < 0,001). Spinal cord compression was mild in 2/11C-IVDE and 3/28TL-IVDE; moderate in 9/11C-IVDE and 16/28TL-IVDE; severe in 0/11C-IVDE and 8/28TL-IVDE. There was no spinal cord compression in 1/28TL-IVDE with foraminal IVDE. There was no statistical difference between spinal cord compression and IVDE location (p = 0.112). The mean time to improvement was 1.1 day in C-IVDE (range 1-2 days). 90.1% of C-IVDE improved within the first 24 h. The mean time to improvement was 2.1 days in TL-IVDE (range from 1 day to 4 days). All dogs that did not improve (5/39) were grade 5 TL-IVDEs at presentation. In FBD, TL-IVDE tended to cause higher grade of neurological dysfunction, tended to result in compression of neural structures over multiple IVD spaces and required more extensive surgical treatment than C-IVDE.
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Affiliation(s)
- Guillaume Marc Albertini
- Neurology and Neurosurgery Department, Southfields Veterinary Specialists Part of Linnaeus Veterinary Limited, Basildon, United Kingdom
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Cordle KJ, Seiler GS, Barnes D, Olby NJ. MRI features can help to confirm a diagnosis of progressive myelomalacia, but may not be accurate in dogs lacking characteristic clinical signs at the time of imaging. Vet Radiol Ultrasound 2023; 64:283-293. [PMID: 36660871 DOI: 10.1111/vru.13178] [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] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 01/21/2023] Open
Abstract
Progressive myelomalacia (PMM) is a fatal sequela of acute thoracolumbar intervertebral disc extrusion in dogs, with unpredictable onset in the days after the inciting injury. No single reliable diagnostic test is currently available. Magnetic resonance imaging (MRI) features such as T2-weighted spinal cord hyperintensity and loss of subarachnoid signal in a half-Fourier single-shot turbo spin echo (HASTE) sequence have been associated with PMM, but are sometimes present in other dogs with severe deficits. Magnetic resonance imaging findings in 22 dogs with a clinical or histopathologic diagnosis of PMM and 38 deep pain-negative paraplegic dogs were compared in a retrospective case-control study. Length of T2-weighted hyperintense spinal cord change and HASTE signal loss were significantly associated with clinically evident PMM (P = .0019 and P = .0085), however, there were no significant differences between groups when analysis was restricted to dogs not yet showing clinical signs of PMM. The PMM group also had significantly shorter compressive lesions than the control group (P = 0.026), suggesting a possible role of more severe focal pressure at the extrusion site. A segment of total loss of contrast enhancement in the venous sinuses and meninges, a feature not previously described, was more common in the PMM group and the difference approached significance (P = 0.054). Findings show that MRI features can support the diagnosis in dogs with clinical evidence of PMM, and absence of these features supports absence of PMM at time of imaging. However, their absence does not reliably differentiate dogs with imminent progressive myelomalacia from other dogs with severe deficits following intervertebral disc extrusion.
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Affiliation(s)
- Katelyn J Cordle
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Gabriela S Seiler
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Danielle Barnes
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Javeed F, Khan J, Rehman L. Herniating Intradural Disc at Lumbar L4-L5 Level: A Case Report. Cureus 2023; 15:e35067. [PMID: 36942166 PMCID: PMC10024570 DOI: 10.7759/cureus.35067] [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] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 02/18/2023] Open
Abstract
Prolapse of intervertebral disc is a common pathology seen in the neurosurgery field but intradural lumbar disc herniation is a rare entity encountered only during the surgical treatment of prolapse. We present a 30-year-old male who reported lower back pain radiating to the right lower limb for the last 2.5 years. The pain started after a brief history of weight lifting. There were no associated motor or sensory deficits. The magnetic resonance imaging of the lumbosacral spine showed prolapse of intervertebral disc at the level of lumbar L4-L5. The patient underwent laminectomy and intradural discectomy of L4-L5. Patient had a smooth post-operative recovery with no neurological deficits. A thorough radiological examination can aid in the pre-operative diagnosis of an intradural lumbar disc herniation.
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Affiliation(s)
- Farrukh Javeed
- Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Javeria Khan
- Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Lal Rehman
- Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Murthy VD, Phillips K, Knipe M, Giuffrida M, Li CF. Horner syndrome as a physiological biomarker of disease in canine cervical myelopathy. J Vet Intern Med 2023; 37:598-605. [PMID: 36704850 DOI: 10.1111/jvim.16588] [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] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/11/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Horner syndrome often occurs with cervical myelopathies and might provide insight into the underlying disease and prognosis. OBJECTIVES To describe the clinical and imaging features of dogs with cervical myelopathy and concurrent Horner syndrome and to determine association of Horner syndrome with diseases or magnetic resonance images (MRI). ANIMALS Ninety-three client-owned dogs with cervical myelopathy and concurrent Horner syndrome and 99 randomly selected client-owned dogs with cervical myelopathy without Horner syndrome (control cases). METHODS Retrospective study. Medical records were reviewed to identify Horner and control cases and clinical findings recorded. MRI were reviewed, and lesions characterized and recorded. Descriptive and comparative statistics were performed. RESULTS Non-compressive disease occurred more frequently in the Horner group compared with controls (58%; 95% CI: 48-68 vs 9%; 95% CI: 5-16; P < .0001). The most common diseases were fibrocartilaginous embolism in the Horner group (44/93; 47%) and intervertebral disc extrusion (76/99; 77%) amongst controls. On MRI, parenchymal hyperintensity was seen more commonly in the Horner group (95%; 95% CI: 88-98) compared with controls (51%; 95% CI: 41-60; P < .0001). In the Horner group, dogs that did not survive to discharge (N = 13) had more extensive MRI lesions relative to the adjacent vertebral length (200%; IQR 110%-575%) compared with survivors (N = 80; 110%; IQR 40%-250%; P = .02). Lateralization of Horner signs and MRI changes matched in 54% of cases. The overall survival rate was high in both Horner (80/93; 86%) and control (95/99; 96%) groups. CONCLUSIONS AND CLINICAL IMPORTANCE Horner syndrome in cervical myelopathy is commonly associated with noncompressive intraparenchymal disease.
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Affiliation(s)
- Vishal D Murthy
- Department of Surgical and Radiological Sciences, College of Veterinary Medicine, University of California, Davis, California, USA
| | - Kathryn Phillips
- Department of Surgical and Radiological Sciences, College of Veterinary Medicine, University of California, Davis, California, USA
| | - Marguerite Knipe
- Department of Surgical and Radiological Sciences, College of Veterinary Medicine, University of California, Davis, California, USA
| | - Michelle Giuffrida
- Department of Surgical and Radiological Sciences, College of Veterinary Medicine, University of California, Davis, California, USA
| | - Chai-Fei Li
- Department of Surgical and Radiological Sciences, College of Veterinary Medicine, University of California, Davis, California, USA
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Bach FS, Mai W, Weber LFS, Villanova Junior JA, Bianchi de Oliveira L, Montiani-Ferreira F. Association between spinal cord compression ratio in magnetic resonance imaging, initial neurological status, and recovery after ventral slot in 57 dogs with cervical disc extrusion. Front Vet Sci 2023; 9:1029127. [PMID: 36686187 PMCID: PMC9853044 DOI: 10.3389/fvets.2022.1029127] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
This retrospective, unblinded, single rater study evaluated images obtained from magnetic resonance imaging (MRI) of dogs with cervical intervertebral disc extrusion before being submitted to ventral slot decompression (VSD). Dogs were re-evaluated systematically at 10 and 30 days after VSD. The objectives of this study were to investigate the associations between the following parameters: (1) The maximal spinal cord compression ratio (SCCR) as seen on transverse MRI and pre-surgical neurological status (NS) grade; we hypothesized that dogs with greater SCCR will have worse pre-surgical NS grade at presentation; (2) Pre-surgical NS grade and postoperative recovery; we hypothesized that worse pre-surgical NS grade will be associated with longer postoperative recovery time; (3) SCCR and postoperative recovery; we hypothesized that dogs with higher SCCR will have longer recovery time; (4) Location of extrusion (cranial vs. caudal) and initial NS grade and outcomes; we hypothesized that caudal cervical extrusion will have worse NS grade and longer time to recovery; (5) Longitudinal extension of ventral CSF signal loss on HASTE pulse sequence and NS grade and time to recovery; we hypothesized that dogs with longer HASTE CSF attenuation will have higher NS grade and longer time to recovery. There was no significant association between SCCR and NS grade, suggesting that this relationship in the cervical region is similar to what is observed in the thoracolumbar region, rejecting our first hypothesis. There was a significant difference between ambulatory tetraparesis dogs versus non-ambulatory tetraparesis dogs regarding complete recovery at 10 days: dogs with NS grade 1, 2, or 3 overall recovered faster than dogs with NS grade 4. However, there was no significant difference between these groups regarding complete recovery at 30 days, thereby accepting our second hypothesis at 10 days and rejecting it at 30 days. There was no correlation between SCCR and recovery time, rejecting our third hypothesis. Caudal cervical extrusion did not show higher NS grade or longer recovery time than cranial extrusion, rejecting our fourth hypothesis. CSF attenuation length ratio on HASTE images was not significantly correlated with NS grade but weakly correlate with post-surgical recovery time, partially accepting our fifth hypothesis.
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Affiliation(s)
- Fernando Swiech Bach
- Neurology Service, Clinivet Veterinary Hospital, Curitiba, Brazil,Comparative Ophthalmology Lab (LABOCO), Federal University of Paraná, Curitiba, Brazil
| | - Wilfried Mai
- Department of Clinical Sciences and Advanced Medicine, Section of Radiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - José Ademar Villanova Junior
- School of Veterinary Medicine, Small Animal Surgery Service, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Brazil
| | | | - Fabiano Montiani-Ferreira
- Comparative Ophthalmology Lab (LABOCO), Federal University of Paraná, Curitiba, Brazil,*Correspondence: Fabiano Montiani-Ferreira ✉
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González-Rodríguez M, Ait Edjoudi D, Cordero Barreal A, Ruiz-Fernández C, Farrag M, González-Rodríguez B, Lago F, Capuozzo M, Gonzalez-Gay MA, Mera Varela A, Pino J, Farrag Y, Gualillo O. Progranulin in Musculoskeletal Inflammatory and Degenerative Disorders, Focus on Rheumatoid Arthritis, Lupus and Intervertebral Disc Disease: A Systematic Review. Pharmaceuticals (Basel) 2022; 15. [PMID: 36558994 DOI: 10.3390/ph15121544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
Progranulin (PGRN) is a glycoprotein formed by 593 amino acids encoded by the GRN gene. It has an important role in immunity and inflammatory response, as well as in tissue recovery. Its role in musculoskeletal inflammatory diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and intervertebral disc degeneration disease (IVDD), is, nowadays, an important target to investigate. The objective of this review is to systematically sum up all the recent findings concerning PGRN as a target in the development and resolution of the inflammatory diseases. PubMed was examined with the terms combinations (Progranulin) AND (Lupus Erythematosus, Systemic), (Progranulin) AND (Arthritis, Rheumatoid), and (Progranulin) AND (Intervertebral Disc Degeneration). PubMed was examined with the terms combinations (Atsttrin) AND (Lupus Erythematosus, Systemic), (Atsttrin) AND (Arthritis, Rheumatoid), and (Atsttrin) AND (Intervertebral Disc Degeneration). Moreover, research through Web of Science was performed searching the same items. The inclusion criteria were: studies whose main topic were progranulin, or atsttrin, with emphasis on the three selected diseases. On the other hand, the exclusion criteria were studies that only focused on diseases not related to RA, lupus or IVDD, in addition to the previous published literature reviews. Since few results were obtained, we did not filter by year. The records assessed for eligibility were 23, including all the studies with the information in state of art of progranulin and its capability to be a potential target or treatment for each one of the selected diseases. As these results are descriptive and not clinical trials, we did not perform risk of bias methods. Within these results, many studies have shown an anti-inflammatory activity of PGRN in RA. PGRN levels in serum and synovial fluids in RA patients were reported higher than controls. On the other hand, serum levels were directly correlated with SLE disease activity index, suggesting an important role of PGRN as a player in the progression of inflammatory diseases and a therapeutical approach for the recovery. This review has some limitations due to the small number of studies in this regard; therefore, we highlight the importance and the necessity of further investigation. No external funding was implicated in this systematical review.
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13
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Bibbiani L, Gelendi S, Bernardini M, Balducci F, Contiero B, Canal S. Prevalence, clinical presentation and MRI of intervertebral disc herniations in cats. J Feline Med Surg 2022; 24:e443-e452. [PMID: 36172921 DOI: 10.1177/1098612x221121893] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate the prevalence and to describe the clinical and diagnostic imaging features of the different types of feline intervertebral disc herniation (IVDH). METHODS Medical records and imaging studies were retrospectively reviewed for cats diagnosed with IVDH between January 2008 and October 2020. Information obtained from the clinical records included signalment, clinical presentation, the presence of spinal hyperaesthesia and neurolocalisation. Diagnostic imaging findings, including type (ie, intervertebral disc extrusion [IVDE], intervertebral disc protrusion [IVDP] or acute non-compressive nucleus pulposus extrusion (ANNPE), site and number of IVDHs, were recorded. The association between breed, age, sex, duration and severity of neurological signs, the presence of spinal pain and MRI features was evaluated. RESULTS Forty-three cats were included. A total of 50 IVDHs were identified: 39 cats were diagnosed with a single IVDH and four with multiple IVDHs. The most common type of IVDH was ANNPE (n = 22), followed by IVDP (n = 19) and IVDE (n = 9). Neuroanatomical localisation included L4-S3 (n = 19/43), T3-L3 (n = 18/43) and C1-C5 (n = 6/43). Cats with a single IVDH were statistically significantly associated with a diagnosis of ANNPE (P = 0.023) compared with cats with multiple IVDHs affected by IVDP (P = 0.004). Males were more commonly affected by IVDE (P = 0.020) and females by ANNPE (P = 0.020). Cats with IVDP had a longer duration of clinical signs (P <0.001) than cats with ANNPE and demonstrated milder neurological deficits (P = 0.005). IVDEs were statistically significantly associated with spinal hyperaesthesia (P = 0.013), while ANNPEs were not (P = 0.014). CONCLUSIONS AND RELEVANCE ANNPE, IVDP and IVDE are each associated with distinctive clinical scenarios. Thoracolumbar and mid-to-caudal lumbar regions are the most affected, followed by the cranial cervical spine segment.
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Affiliation(s)
- Leonardo Bibbiani
- Neurology/Neurosurgery Unit, Anicura Portoni Rossi Veterinary Hospital, Zola Predosa, Italy
| | - Stefania Gelendi
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Marco Bernardini
- Neurology/Neurosurgery Unit, Anicura Portoni Rossi Veterinary Hospital, Zola Predosa, Italy.,Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Federica Balducci
- Neurology/Neurosurgery Unit, Anicura Portoni Rossi Veterinary Hospital, Zola Predosa, Italy
| | - Barbara Contiero
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Sara Canal
- Neurology/Neurosurgery Unit, Anicura Portoni Rossi Veterinary Hospital, Zola Predosa, Italy
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14
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Seki S, Iwasaki M, Makino H, Yahara Y, Miyazaki Y, Kamei K, Futakawa H, Nogami M, Tran Canh Tung N, Hirokawa T, Tsuji M, Kawaguchi Y. Direct Reprogramming and Induction of Human Dermal Fibroblasts to Differentiate into iPS-Derived Nucleus Pulposus-like Cells in 3D Culture. Int J Mol Sci 2022; 23:4059. [PMID: 35409417 DOI: 10.3390/ijms23074059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 12/14/2022] Open
Abstract
Intervertebral disc (IVD) diseases are common spinal disorders that cause neck or back pain in the presence or absence of an underlying neurological disorder. IVD diseases develop on the basis of degeneration, and there are no established treatments for degeneration. IVD diseases may therefore represent a candidate for the application of regenerative medicine, potentially employing normal human dermal fibroblasts (NHDFs) induced to differentiate into nucleus pulposus (NP) cells. Here, we used a three-dimensional culture system to demonstrate that ectopic expression of MYC, KLF4, NOTO, SOX5, SOX6, and SOX9 in NHDFs generated NP-like cells, detected using Safranin-O staining. Quantitative PCR, microarray analysis, and fluorescence-activated cell sorting revealed that the induced NP cells exhibited a fully differentiated phenotype. These findings may significantly contribute to the development of effective strategies for treating IVD diseases.
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15
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McBride R, Parker E, Garabed RB, Olby NJ, Tipold A, Stein VM, Granger N, Hechler AC, Yaxley PE, Moore SA. Developing a predictive model for spinal shock in dogs with spinal cord injury. J Vet Intern Med 2022; 36:663-671. [PMID: 35001437 PMCID: PMC8965241 DOI: 10.1111/jvim.16352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/14/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Reduced pelvic limb reflexes in dogs with spinal cord injury typically suggests a lesion of the L4-S3 spinal cord segments. However, pelvic limb reflexes might also be reduced in dogs with a T3-L3 myelopathy and concurrent spinal shock. HYPOTHESIS/OBJECTIVES We hypothesized that statistical models could be used to identify clinical variables associated with spinal shock in dogs with spinal cord injuries. ANIMALS Cohort of 59 dogs with T3-L3 myelopathies and spinal shock and 13 dogs with L4-S3 myelopathies. METHODS Data used for this study were prospectively entered by partner institutions into the International Canine Spinal Cord Injury observational registry between October 2016 and July 2019. Univariable logistic regression analyses were performed to assess the association between independent variables and the presence of spinal shock. Independent variables were selected for inclusion in a multivariable logistic regression model if they had a significant effect (P ≤ .1) on the odds of spinal shock in univariable logistic regression. RESULTS The final multivariable model included the natural log of weight (kg), the natural log of duration of clinical signs (hours), severity (paresis vs paraplegia), and pelvic limb tone (normal vs decreased/absent). The odds of spinal shock decreased with increasing weight (odds ratio [OR] = 0.28, P = .09; confidence interval [CI] 0.07-1.2), increasing duration (OR = 0.44, P = .02; CI 0.21-0.9), decreased pelvic limb tone (OR = 0.04, P = .003; CI 0.01-0.36), and increased in the presence of paraplegia (OR = 7.87, P = .04; CI 1.1-56.62). CONCLUSIONS AND CLINICAL IMPORTANCE A formula, as developed by the present study and after external validation, could be useful for assisting clinicians in determining the likelihood of spinal shock in various clinical scenarios and aid in diagnostic planning.
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Affiliation(s)
- Rebecca McBride
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Elizabeth Parker
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Rebecca B Garabed
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Veronika Maria Stein
- Department of Clinical Veterinary Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Nicolas Granger
- Department of Small Animal Clinical Sciences, School of Veterinary Sciences, University of Bristol, Bristol, United Kingdom
| | - Ashley C Hechler
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Page E Yaxley
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Sarah A Moore
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
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16
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Ravichandran D, Pillai J, Krishnamurthy K. Genetics of intervertebral disc disease: A review. Clin Anat 2021; 35:116-120. [PMID: 34689354 DOI: 10.1002/ca.23803] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/23/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023]
Abstract
Intervertebral disc disease (IVDD) is a common musculoskeletal disease affecting about 5% of all individuals. It is characterized by lumbar disc herniation, which causes nerve root irritation, either mechanically or via inflammatory mediators, and results in radiating pain, known as sciatica. Numerous studies have been conducted to identify the causes and risk factors for IVDD. Lifting heavy loads, torsional stress, and motor vehicle driving are among the best-identified environmental risk factors. However, it has become evident recently from family and twin studies that genetic factors may also be important in IVDD. This hypothesis was strengthened by the identification of two collagen IX alleles associated with sciatica and lumbar disc herniation. In addition, disc degeneration has been shown to be related to an aggrecan gene polymorphism, a Vitamin D receptor and matrix metalloproteinase-3 gene alleles. This review highlights the genetic role and occupational aspects of IVDD.
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17
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Lee WJ, Han CH, Yang C, Lee SH, Kim D, Ha I, Song HJ, Lee YJ. Analysis of outpatient expenditure trends using Korean Health Panel Survey data of patients diagnosed with lumbar intervertebral disc herniation. J Int Med Res 2021; 49:3000605211051583. [PMID: 34670423 PMCID: PMC8543728 DOI: 10.1177/03000605211051583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/26/2022] Open
Abstract
Objective In this study, we aimed to analyze cost trends for the outpatient treatment
of lumbar intervertebral disc herniation (LDH). Methods We used cross-sectional data obtained from the Korea Health Panel Survey from
2011 to 2015. We compared outpatient medical expenses for conservative
treatment of LDH using traditional Korean medicine (TKM) or Western medicine
(WM). Results This analysis revealed that the total medical expenses for outpatient
treatment of LDH using WM treatment methods increased by 30% from 2011 to
2015, and self-payment expenses increased by 50%. The total medical expenses
for outpatient treatment of LDH using TKM methods increased by 8%, and
self-payment expenses decreased by 33%. The National Health Insurance
Service (NHIS) expenditure for WM increased by 7%, and non-covered costs
increased by 83%. The NHIS expenditure for TKM increased by 41%, and
non-covered costs decreased by 66%. Conclusions The total medical expenses for WM treatments are increasing in Korea,
especially for non-covered treatments. The non-covered costs for TKM
treatments are decreasing, suggesting a change in medical cost trends
according to whether Korea’s actual medical expense insurance scheme is
applied.
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Affiliation(s)
- Won-Jun Lee
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Chang-Hyun Han
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.,Korean Convergence Medicine, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sook-Hyun Lee
- Jaseng Spine and Joint Research Institute, 567125Jaseng Medical Foundation, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Doori Kim
- Jaseng Spine and Joint Research Institute, 567125Jaseng Medical Foundation, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Inhyuk Ha
- Jaseng Spine and Joint Research Institute, 567125Jaseng Medical Foundation, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Hyun Jin Song
- Department of Pharmaceutical Outcomes and Policy, 3463University of Florida, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, 567125Jaseng Medical Foundation, Jaseng Medical Foundation, Seoul, Republic of Korea
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18
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LePage EC, Stoker AM, Kuroki K, Cook JL. Effects of cyclic compression on intervertebral disc metabolism using a whole-organ rat tail model. J Orthop Res 2021; 39:1945-1954. [PMID: 33073417 DOI: 10.1002/jor.24886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/15/2020] [Revised: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 02/04/2023]
Abstract
Many factors contribute to the development and progression of intervertebral disc (IVD) degeneration. This study was designed to assess the effects of compressive load magnitude on IVD metabolism. It was hypothesized that as load magnitude increased, there would be a significant increase in release of proinflammatory and degradative biomarkers, and a significant decrease in tissue proteoglycan (GAG) and collagen contents compared with unloaded controls. IVD whole organ functional spinal units (FSU) consisting of cranial and caudal body halves, cartilage endplates, and IVD (n = 36) were harvested from the tails of six Sprague Dawley rats, and FSUs were cultured at 0.0 MPa, 0.5 MPa, or 1.0 MPa at 0.5 Hz for 3 days. After culture, media were collected for biomarker analysis and FSUs were analyzed for extracellular matrix composition. Significant differences were determined using a one-way analysis of variance or Kruskal-Wallis test and post hoc analyses. Media concentrations of IFN-γ, IL-6, IL-1β, and MMP-8 were significantly higher in the 0.5 MPa compared with the 0.0 MPa group. Media concentrations of PGE2 and TIMP-1 were significantly higher in the 1.0 MPa group compared with the 0.0 MPa group, and media PGE2 was significantly higher in the 1.0 MPa group compared with the 0.5 MPa group. Media GAG content was significantly higher in the 1.0 MPa group compared with the 0.0 MPa group, and percent GAG in the tissue was significantly lower in 0.5 MPa and 1.0 MPa groups compared with the 0.0 MPa group. Clinical Significance: These data suggest that there are magnitude-dependent inflammatory and degradative IVD responses to cyclic loading, which may contribute to IVD degeneration.
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Affiliation(s)
- Emma C LePage
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - Aaron M Stoker
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - Keiichi Kuroki
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
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19
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Trefilova VV, Shnayder NA, Petrova MM, Kaskaeva DS, Tutynina OV, Petrov KV, Popova TE, Balberova OV, Medvedev GV, Nasyrova RF. The Role of Polymorphisms in Collagen-Encoding Genes in Intervertebral Disc Degeneration. Biomolecules 2021; 11:1279. [PMID: 34572492 DOI: 10.3390/biom11091279] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 12/31/2022] Open
Abstract
(1) Background: The purpose of this review is to analyze domestic and foreign studies on the role of collagen-encoding genes polymorphism in the development of intervertebral discs (IVDs) degeneration in humans. (2) Methods: We have carried out a search for full-text articles published in e-Library, PubMed, Oxford Press, Clinical Case, Springer, Elsevier and Google Scholar databases. The search was carried out using keywords and their combinations. The search depth was 5 years (2016–2021). In addition, this review includes articles of historical interest. Despite an extensive search, it is possible that we might have missed some studies published in recent years. (3) Results: According to the data of genome-wide and associative genetic studies, the following candidate genes that play a role in the biology of IVDs and the genetic basis of the processes of collagen degeneration of the annulus fibrosus and nucleus pulposus of IVDs in humans are of the greatest interest to researchers: COL1A1, COL2A1, COL9A2, COL9A3, COL11A1 and COL11A2. In addition, the role of genes COL1A2, COL9A1 and others is being actively studied. (4) Conclusions: In our review, we summarized and systematized the available information on the role of genetic factors in IVD collagen fibers turnover and also focused on the functions of different types of collagen present in the IVD. Understanding the etiology of impaired collagen formation can allow doctors to prescribe pathogenetically-based treatment, achieving the most effective results.
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Abstract
OBJECTIVES The aim of this study was to evaluate the outcome and prognosis of thoracolumbar feline intervertebral disc disease (IVDD) treated by surgical decompression. METHODS This was a multi-institutional retrospective study evaluating the age, breed, sex, body weight, presenting complaint, neuroanatomic diagnosis at presentation, diagnostic imaging results, surgery performed and the overall outcome at discharge and at recheck. Bivariable associations between variables were assessed using the Kruskal-Wallis test (age and grade of IVDD at presentation) and Fisher's exact test (grade of IVDD at presentation and outcome). RESULTS A total of 35 cats met the inclusion criteria for the study. The most frequently reported clinical sign was difficulty walking (54.2%). The majority of cats presented with an L4-S3 localization (57%). The most common site of intervertebral disc herniation (IVDH) was at L6-L7 (34%). The majority of feline patients that received surgery had a positive outcome at the time of discharge (62.5%; n = 20/32) and at the time of the 2-week recheck (91.3%; n = 21/23). No association was identified between the age of the patient and the grade of IVDD. No association was identified between the presenting grade of IVDD and the clinical outcome at the time of discharge or at the time of recheck evaluation. CONCLUSIONS AND RELEVANCE Cats undergoing spinal decompressive surgery for thoracolumbar IVDH appear to have a favorable prognosis independent of the initial presenting grade of IVDD. A larger sample size and a longer length of follow-up is necessary to obtain statistical associations between the presenting grade of IVDD and overall clinical outcome.
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Affiliation(s)
- Kayla M Fowler
- Department of Small Animal Clinical Sciences - Neurology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Theresa E Pancotto
- Small Animal Clinical Sciences - Neurology, Auburn University College of Veterinary Medicine, Auburn, AB, USA
| | - Stephen R Werre
- Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Michaela J Beasley
- Neurology Department, Mississippi State University College of Veterinary Medicine, Starkville, MS, USA
| | - William Kay
- Neurology Department, Garden State Veterinary Specialists, Tinton Falls, NJ, USA
| | - Casey P Neary
- Neurology Department, Bush Veterinary Neurology Service, Atlanta, GA, USA
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21
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Echt M, Holland R, Mowrey W, Cezayirli P, Ramos RDLG, Hamad M, Gelfand Y, Longo M, Kinon MD, Yanamadala V, Chaudhary S, Cho SK, Yassari R. Surgical Outcomes for Upper Lumbar Disc Herniations: A Systematic Review and Meta-analysis. Global Spine J 2021; 11:802-813. [PMID: 32744112 PMCID: PMC8165931 DOI: 10.1177/2192568220941815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To conduct a literature review on outcomes of discectomy for upper lumbar disc herniations (ULDH), estimate pooled rates of satisfactory outcomes, compare open laminectomy/microdiscectomy (OLM) versus minimally invasive surgical (MIS) techniques, and compare results of disc herniations at L1-3 versus L3-4. METHODS A systematic review of articles reporting outcomes of nonfusion surgical treatment of L1-2, L2-3, and/or L3-4 disc herniations was performed. The inclusion and exclusion of studies was performed according to the latest version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS A total of 20 articles were included in the quantitative meta-analysis. Pooled proportion of satisfactory outcome (95% CI) was 0.77 (0.70, 0.83) for MIS and 0.82 (0.78, 0.84) for OLM. There was no significant improvement with MIS techniques compared with standard OLM, odds ratio (OR) = 0.86, 95% CI (0.42, 1.74), P = .66. Separating results by levels revealed a trend of higher satisfaction with L3-4 versus L1-3 with OLM surgery, OR = 0.46, 95% CI (0.19, 1.12), P = .08. CONCLUSION Our analysis reveals that discectomy for ULDH has an overall success rate of approximately 80% and has not improved with MIS. Discectomy for herniations at L3-4 trends toward better outcomes compared with L1-2 and L2-3, but was not significant.
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Affiliation(s)
- Murray Echt
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
,Icahn School of Medicine at Mount Sinai, New York, NY, USA,Murray Echt, Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 439 Calhoun Avenue, Bronx, NY 10467, USA.
| | - Ryan Holland
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wenzhu Mowrey
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Phillip Cezayirli
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Mousa Hamad
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yaroslav Gelfand
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Longo
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Merritt D. Kinon
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vijay Yanamadala
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Saad Chaudhary
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reza Yassari
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Nakatani JY, Greer LL, Wilson GL, Cabrera SY. SURGICAL AND POSTOPERATIVE TREATMENT OF INTERVERTEBRAL DISC DISEASE IN A MOUNTAIN COATI ( NASUELLA OLIVACEA) USING BEHAVIORAL MANAGEMENT AND PHYSICAL THERAPY. J Zoo Wildl Med 2019; 50:727-30. [PMID: 33517646 DOI: 10.1638/2018-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2019] [Indexed: 11/21/2022] Open
Abstract
A captive 8-yr-old female mountain coati, Nasuella olivacea, presented with intermittent paresis of the pelvic limbs. The coati was anesthetized for radiographs, which showed mineralized discs in the thoracolumbar region. After 3 mo of daily prednisone, its condition further declined. Magnetic resonance imaging confirmed extradural disc herniation, spinal cord compression, and requirement for a left-sided hemilaminectomy. Postoperatively, the coati received prednisolone, gabapentin, tramadol, and clavamox. An established history of positive reinforcement training allowed caretakers to implement physical therapy walks and novel exercises designed for its condition. The coati showed improvement with appropriate proprioceptive positioning and improved balance. Intervertebral disc disease is common in dogs and cats, and although physical therapy is routinely implemented in recovering neurologic patients of those species, it is relatively new in zoologic medicine. This report highlights the benefits of behavioral management in postoperative management of nondomestic species.
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Wielechowski A, Keil A, Hamstra-Wright K. Referral patterns for surgical consult in the management of patients with foot drop due to acute lumbar disc herniation: a survey study of physical therapists in the United States. J Man Manip Ther 2021; 29:99-106. [PMID: 32530795 PMCID: PMC8023593 DOI: 10.1080/10669817.2020.1776491] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND There is a lack of consensus for optimal management of patients with foot drop due to acute lumbar disc herniation (LDH) with lumbar radiculopathy (LR), which is a clinical scenario that may be encountered by physical therapists. Consequently, it is important to explore physical therapists' referral practice patterns for surgical consult. Currently, physical therapist referral patterns for surgical consult in this patient population are unknown. OBJECTIVES To describe physical therapist referral patterns for immediate neurosurgical consult in patients with foot drop due to suspected acute LDH with LR. DESIGN Cross-sectional descriptive research design using an electronic, internet-based survey that utilized two clinical vignettes. METHOD An electronic survey was developed by an expert peer review panel. Survey participants were licensed physical therapists in the United States and members of the Orthopedic Section of the American Physical Therapy Association. RESULTS Of the individuals receiving the survey invitation, 2172 completed the survey. Depending on the severity of foot drop, 34-61% were likely to refer for immediate neurosurgical consult. Presence of imaging to confirm suspected clinical diagnosis slightly affected the likelihood of referral (4-12% increase) for immediate neurosurgical consult. CONCLUSION In patients with foot drop due to suspected acute LDH with LR, this study found that physical therapist referral patterns for immediate neurosurgical consult varied and are likely influenced by the severity of weakness and availability of MRI findings. Further research regarding the optimal management of this patient population and potential reasons for variation in practice is warranted.
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Affiliation(s)
- Adam Wielechowski
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Aaron Keil
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Karrie Hamstra-Wright
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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24
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Zhang Y, Zhang Z, Chen P, Ma CY, Li C, Au TYK, Tam V, Peng Y, Wu R, Cheung KMC, Sham PC, Tse HF, Chan D, Leung VY, Cheah KSE, Lian Q. Directed Differentiation of Notochord-like and Nucleus Pulposus-like Cells Using Human Pluripotent Stem Cells. Cell Rep 2021; 30:2791-2806.e5. [PMID: 32101752 DOI: 10.1016/j.celrep.2020.01.100] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 10/15/2019] [Accepted: 01/28/2020] [Indexed: 12/26/2022] Open
Abstract
Intervertebral disc degeneration might be amenable to stem cell therapy, but the required cells are scarce. Here, we report the development of a protocol for directed in vitro differentiation of human pluripotent stem cells (hPSCs) into notochord-like and nucleus pulposus (NP)-like cells of the disc. The first step combines enhancement of ACTIVIN/NODAL and WNT and inhibition of BMP pathways. By day 5 of differentiation, hPSC-derived cells express notochordal cell characteristic genes. After activating the TGF-β pathway for an additional 15 days, qPCR, immunostaining, and transcriptome data show that a wide array of NP markers are expressed. Transcriptomically, the in vitro-derived cells become more like in vivo adolescent human NP cells, driven by a set of influential genes enriched with motifs bound by BRACHYURY and FOXA2, consistent with an NP cell-like identity. Transplantation of these NP-like cells attenuates fibrotic changes in a rat disc injury model of disc degeneration.
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Affiliation(s)
- Yuelin Zhang
- Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong; Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong 510080, China
| | - Zhao Zhang
- Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong; Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong 510080, China
| | - Peikai Chen
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Chui Yan Ma
- Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Cheng Li
- Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Tiffany Y K Au
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Vivian Tam
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Yan Peng
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Ron Wu
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Pak C Sham
- Centre for PanorOmic Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Hung-Fat Tse
- Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Danny Chan
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Victor Y Leung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Kathryn S E Cheah
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong.
| | - Qizhou Lian
- Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong; Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong 510080, China; The State Key Laboratory of Pharmaceutical Biotechnology, the University of Hong Kong, Hong Kong.
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25
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Affiliation(s)
- Natasha J Olby
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC, United States
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
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26
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Elliott RC, Berman CF, Lobetti RG. A comparative study between high-definition volumetric imaging computed tomography and multi-slice computed tomography in the detection of acute thoraco-lumbar disc extrusions in dogs. J S Afr Vet Assoc 2021; 92:e1-e7. [PMID: 33764127 PMCID: PMC8007992 DOI: 10.4102/jsava.v92i0.2010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022] Open
Abstract
Computed tomography (CT) is commonly used to image intervertebral disc extrusion (IVDE) in dogs. The current gold standard for CT imaging is the use of multi-slice CT (MS CT) units. Smaller high-definition volumetric imaging (HDVI) mobile CT has been marketed for veterinary practice. This unit is described as an advanced flat panel. The goal of this manuscript was to evaluate the ability of the HDVI CT in detecting IVDE without the need for CT myelography, compared with the detection of acute disc extrusions with a MS CT without the need for MS CT myelogram. Retrospective blinded analyses of 219 dogs presented for thoraco-lumbar IVDE that had a HDVI CT (n = 123) or MS CT (n = 96) were performed at a single referral hospital. A total of 123 cases had HDVI CT scans with surgically confirmed IVDE. The IVDE was identified in 88/123 (72%) dogs on pre-contrast HDVI CT. The remaining 35/128 (28%) cases required a HDVI CT myelogram to identify the IVDE. Ninety-six cases had MS CT scans with surgically confirmed IVDE. The IVDE was identified in 78/96 (81%) dogs on the pre-contrast MS CT. The remaining 18/96 (19%) cases had a MS CT myelogram to identify the IVDE. Multi-slice CT detected IVDE significantly more than HDVI CT (p = 0.032). This study showed that the ability of HDVI CT for detecting IVDE is lower than that of MS CT. The HDVI CT system may be useful in smaller referral practices, with a lower case load where space is limited.
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Affiliation(s)
- Ross C Elliott
- Department of Companion Animal and Clinical Studies, Onderstepoort, South Africa; and, Bryanston Veterinary Hospital, Johannesburg.
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27
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Kim J, Kim H, Hwang J, Eom K. Preliminary study of presumptive intradural-intramedullary intervertebral disc extrusion in 20 dogs. J Vet Sci 2020; 21:e52. [PMID: 32735091 PMCID: PMC7402930 DOI: 10.4142/jvs.2020.21.e52] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/05/2019] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 11/20/2022] Open
Abstract
Background Intradural-intramedullary intervertebral disc extrusion (IIVDE) is a rare condition of intervertebral disc disease. However, the diagnosis of IIVDE is challenging because the prognosis and imaging characteristics are poorly characterized. Objectives We aimed to describe the clinical and imaging characteristics of tentatively diagnosed IIVDE in dogs to assess the prognostic utility of neurological grade and magnetic resonance imaging (MRI) findings. Methods Twenty dogs were included in this retrospective cohort study. Results Nonchondrodystrophic breeds (n = 16) were more predisposed than chondrodystrophic breeds. Most dogs showed acute onset of clinical signs. Neurological examination at admission showed predominant non-ambulatory paraparesis (n = 9); paresis (n = 16) was confirmed more frequently than paralysis (n = 4). Follow-up neurological examination results were only available for 11 dogs, ten of whom showed neurological improvement and 8 showed successful outcomes at 1 month. The characteristic MRI findings include thoracic vertebra (T)2 hyperintense, T1 hypointense, intramedullary linear tracts with reduced disc volume, and cleft of the annulus fibrosus. None of the MRI measurements were significantly correlated with neurological grade at admission. Neurological grade did not differ according to the presence of parenchymal hemorrhage, parenchymal contrast enhancement, and meningeal contrast enhancement. Neurological grades at admission showed a statistical correlation with those observed at the 1-month follow-up (r = 0.814, p = 0.02). Conclusions IIVDE is a rare form of disc extrusion commonly experienced after physical activity or trauma and most frequently affects the cranial-cervical and thoracolumbar regions of nonchondrodystrophic dog breeds. Neurological score at admission emerged as a more useful prognostic indicator than MRI findings in dogs with suspected IIVDE.
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Affiliation(s)
- Jaehwan Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Hyoju Kim
- Helix Animal Medical Center, Seoul 06546, Korea
| | | | - Kidong Eom
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea.
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28
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Lewis MJ, Granger N, Jeffery ND. Emerging and Adjunctive Therapies for Spinal Cord Injury Following Acute Canine Intervertebral Disc Herniation. Front Vet Sci 2020; 7:579933. [PMID: 33195591 PMCID: PMC7593405 DOI: 10.3389/fvets.2020.579933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/04/2020] [Indexed: 11/13/2022] Open
Abstract
Some dogs do not make a full recovery following medical or surgical management of acute canine intervertebral disc herniation (IVDH), highlighting the limits of currently available treatment options. The multitude of difficulties in treating severe spinal cord injury are well-recognized, and they have spurred intense laboratory research, resulting in a broad range of strategies that might have value in treating spinal cord-injured dogs. These include interventions that aim to directly repair the spinal cord lesion, promote axonal sparing or regeneration, mitigate secondary injury through neuroprotective mechanisms, or facilitate functional compensation. Despite initial promise in experimental models, many of these techniques have failed or shown mild efficacy in clinical trials in humans and dogs, although high quality evidence is lacking for many of these interventions. However, the continued introduction of new options to the veterinary clinic remains important for expanding our understanding of the mechanisms of injury and repair and for development of novel and combined strategies for severely affected dogs. This review outlines adjunctive or emerging therapies that have been proposed as treatment options for dogs with acute IVDH, including discussion of local or lesion-based approaches as well as systemically applied treatments in both acute and subacute-to-chronic settings. These interventions include low-level laser therapy, electromagnetic fields or oscillating electrical fields, adjunctive surgical techniques (myelotomy or durotomy), systemically or locally-applied hypothermia, neuroprotective chemicals, physical rehabilitation, hyperbaric oxygen therapy, electroacupuncture, electrical stimulation of the spinal cord or specific peripheral nerves, nerve grafting strategies, 4-aminopyridine, chondroitinase ABC, and cell transplantation.
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Affiliation(s)
- Melissa J Lewis
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, United States
| | - Nicolas Granger
- The Royal Veterinary College, University of London, Hertfordshire, United Kingdom.,CVS Referrals, Bristol Veterinary Specialists at Highcroft, Bristol, United Kingdom
| | - Nick D Jeffery
- Department of Small Animal Clinical Sciences, Texas A & M College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States
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29
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Moore SA, Tipold A, Olby NJ, Stein V, Granger N. Current Approaches to the Management of Acute Thoracolumbar Disc Extrusion in Dogs. Front Vet Sci 2020; 7:610. [PMID: 33117847 PMCID: PMC7521156 DOI: 10.3389/fvets.2020.00610] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Abstract
Intervertebral disc extrusion (IVDE) is one of the most common neurologic problems encountered in veterinary clinical practice. The purpose of this manuscript is to provide an overview of the literature related to treatment of acute canine thoracolumbar IVDE to help construct a framework for standard care of acute canine thoracolumbar IVDE where sufficient evidence exists and to highlight opportunities for future prospective veterinary clinical research useful to strengthen care recommendations in areas where evidence is low or non-existent. While there exist a number of gaps in the veterinary literature with respect to standards of care for dogs with acute thoracolumbar IVDE, recommendations for standard care can be made in some areas, particularly with respect to surgical decompression where the currently available evidence supports that surgery should be recommended for dogs with nonambulatory paraparesis or worse. While additional information is needed about the influence on timing of decompression on outcome in dogs that are deep pain negative for longer than 48 h duration, there is no evidence to support treatment of the 48 h time point as a cut off beyond which it becomes impossible for dogs to achieve locomotor recovery. Surgical decompression is best accomplished by either hemilaminectomy or mini-hemilaminectomy and fenestration of, at a minimum, the acutely ruptured disc. Adjacent discs easily accessed by way of the same approach should be considered for fenestration given the evidence that this substantially reduces future herniation at fenestrated sites. Currently available neuroprotective strategies such as high does MPSS and PEG are not recommended due to lack of demonstrated treatment effect in randomized controlled trials, although the role of anti-inflammatory steroids as a protective strategy against progressive myelomalacia and the question of whether anti-inflammatory steroids or NSAIDs provide superior medical therapy require further evaluation.
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Affiliation(s)
- Sarah A Moore
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, United States
| | - Andrea Tipold
- Department Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Natasha J Olby
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
| | - Veronica Stein
- Division of Clinical Neurology, Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Nicolas Granger
- The Royal Veterinary College, University of London, Hatfield, United Kingdom.,CVS Referrals, Bristol Veterinary Specialists at Highcroft, Bristol, United Kingdom
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30
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Shamov T, Al-Hashel JY, Rоusseff RT. Fluoroscopic Epidural Steroid Injection: Pain Relief in Discogenic Sciatica Versus Lumbar Spinal Stenosis. A Study on Middle Eastern Patients. Acta Medica (Hradec Kralove) 2020; 63:73-78. [PMID: 32771072 DOI: 10.14712/18059694.2020.20] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the effect of epidural steroid injections (ESI) in patients with discogenic sciatica (Sci) versus patients with lumbar canal stenosis (LSS), not controlled by conservative treatment. MATERIALS AND METHODS In our study, 80 patients with Sci and 66 with LSS were included. A single ESI (10 mg dexamethasone in 3 cc 0.25% bupivacaine) was applied under fluoroscopic control: one level above the highest stenotic level, in the posterior epidural space, via interlaminar approach in LSS and at the prolapse level, in the anterior epidural space, via transforaminal route in Sci. Pain intensity was assessed by VAS at baseline and on days 1, 15 and 30 after intervention. RESULTS The procedure was successful in 78 Sci and 63 LSS patients. Patients with Sci responded significantly better. At one month, pain reduction over 50% was achieved in 63% (52.3-73.7% at p = 0.95) of Sci but only in 35% (23.2-46.8%) of LSS (p = 0.03). Return to pre-intervention level happened in 47% (34.7-59.3%) of LSS versus 14% (6.3-21.7%) of Sci patients (p = 0.01). In 5 patients the procedure failed, without resulting morbidity. CONCLUSION ESI are more effective in patients with Sci than in single level LSS. In multiple level LSS, results are disappointing.
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Affiliation(s)
- Todor Shamov
- Armed Forces Hospital "Jaber Al-Ahmad Al-Sabah", Subhan, 46012, Kuwait.,Department of Neurosurgery, Military Medical Academy, St Georgi Sofijski Str 3, 1606, Sofia, Bulgaria
| | - Jasem Y Al-Hashel
- Department of Neurology, Ibn-Sina Hospital, Sabah Health Area, Safat 13115, Kuwait
| | - Rossen T Rоusseff
- Department of Neurology, Ibn-Sina Hospital, Sabah Health Area, Safat 13115, Kuwait.
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31
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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. Int J Environ Res Public Health 2020; 17:ijerph17134832. [PMID: 32635557 PMCID: PMC7370072 DOI: 10.3390/ijerph17134832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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;
- Correspondence:
| | - 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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Rossmeisl JH, Cecere TE, Kortz GD, Geiger DA, Shinn RL, Hinckley J, Caudell DL, Stahle JA. Canine Snake-Eye Myelopathy: Clinical, Magnetic Resonance Imaging, and Pathologic Findings in Four Cases. Front Vet Sci 2019; 6:219. [PMID: 31334255 PMCID: PMC6624786 DOI: 10.3389/fvets.2019.00219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/09/2019] [Accepted: 06/18/2019] [Indexed: 12/03/2022] Open
Abstract
Intramedullary signal change (ISC) is a non-specific finding that is frequently observed on magnetic resonance imaging (MRI) examinations of the canine spinal cord. ISC can represent a variety of primary pathological processes such as neoplasms or myelitides or secondary changes such as edema, cysts, gliosis, or myelomalacia. An unusual phenotype of ISC is the “snake-eye” myelopathy (SEM), which refers to bilaterally symmetric T2 hyperintensities preferentially affecting the ventral horn gray matter on transverse MR images, which resemble a pair of snake's eyes. The pathophysiology of SEM is poorly understood in humans, and this imaging finding may be associated with cervical spondylotic myelopathy, spinal cord ischemia, ossification of the posterior longitudinal ligament, amyotrophic lateral sclerosis, and Hirayama disease. Here we describe four dogs with cervical MRI examinations consistent with an SEM-like phenotype. All dogs initially presented with a central cord syndrome or tetraparesis referable to a C6-T2 neuroanatomic localization, which was attributed to disc-associated spinal cord compression in three cases, while one dog had the SEM-like phenotype with no identifiable etiology. Once the SEM-like phenotype was present on MRI examinations, dogs demonstrated insidious clinical deterioration despite therapeutic interventions. Deterioration was characterized by lower motor neuron weakness and neurogenic muscle atrophy progressing to paralysis in the thoracic limbs, while neurological functions caudal to the level of the SEM-like lesion remained largely preserved for months to years thereafter. Neuropathological features of the SEM-like phenotype include multisegmental cavitations and poliomyelomalacia of laminae VI-IX of the caudal cervical spinal cord, although the lesion evolved into pan-necrosis of gray matter with extension into the adjacent white matter in one case with an 8 years history of progressive disease. Although the pathophysiology of SEM remains unknown, the topographical distribution and appearance of lesions is suggestive of a vascular disorder. As the SEM-like phenotype was uniformly characterized by longitudinally and circumferentially extensive neuronal necrosis, results of this small case series indicate that dogs with clinical signs of central cord syndrome and the SEM-like phenotype involving the cervicothoracic intumescence on MR examinations have a poor prognosis for the preservation or recovery of thoracic limb motor function.
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Affiliation(s)
- John H Rossmeisl
- Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Thomas E Cecere
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Gregg D Kortz
- Department of Neurology, VCA Sacramento Veterinary Referral Center, Sacramento, CA, United States
| | - David A Geiger
- Geiger Veterinary Neurology, Redwood City, CA, United States
| | - Richard L Shinn
- Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Jonathan Hinckley
- Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - David L Caudell
- Department of Pathology and Comparative Medicine, School of Medicine, Wake Forest University, Winston-Salem, NC, United States
| | - Jessica A Stahle
- Department of Diagnostic Imaging, Red Bank Veterinary Hospital, Tinton Falls, NJ, United States
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33
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Mella SL, Cardy TJ, Volk HA, De Decker S. Clinical reasoning in feline spinal disease: which combination of clinical information is useful? J Feline Med Surg 2019; 22:521-530. [PMID: 31251096 DOI: 10.1177/1098612x19858447] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate if a combination of discrete clinical characteristics can be used to identify the most likely differential diagnoses in cats with spinal disease. METHODS Two hundred and twenty-one cats referred for further evaluation of spinal disease were included and categorised as follows: non-lymphoid neoplasia (n = 44); intervertebral disc disease (n = 42); fracture/luxation (n = 34); ischaemic myelopathy (n = 22); feline infectious peritonitis virus myelitis (n = 18); lymphoma (n = 16); thoracic vertebral canal stenosis (n = 11); acute non-compressive nucleus pulposus extrusion (n = 11); traumatic spinal cord contusion (n = 8); spinal arachnoid diverticula (n = 7); lumbosacral stenosis (n = 5); and spinal empyema (n = 3). Information retrieved from the medical records included signalment, clinical history and clinical presentation. Univariate analyses of variables (clinical history, breed, age, sex, general physical examination findings, onset, progression, spinal hyperaesthesia, asymmetry, ambulatory status and neuroanatomical location) were performed, and variables were retained in a multivariate logistic regression model if P <0.05. RESULTS Multivariate logistic regression revealed that intervertebral disc disease most often occurred in middle-aged, purebred cats with a normal general physical examination and an acute onset of painful and progressive clinical signs. Ischaemic myelopathy occurred most often in older cats with a stable or improving, non-painful, lateralising, C6-T2 myelopathy. Spinal fracture/luxation occurred most often in younger cats and resulted most often in a peracute onset, painful, non-ambulatory neurological status. Concurrent systemic abnormalities or abnormal findings detected on general physical examination were significantly associated with feline infectious peritonitis virus myelitis, spinal lymphoma or spinal empyema. CONCLUSIONS AND RELEVANCE This study suggests that using easily identifiable characteristics from the history and clinical examination can assist in obtaining a preliminary differential diagnosis when evaluating cats with spinal disease. This information could aid veterinary practitioners in clinical decision-making.
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Affiliation(s)
- Stephanie L Mella
- Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - Thomas Ja Cardy
- Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK.,Cave Veterinary Specialists, West Buckland, Wellington, UK
| | - Holger A Volk
- Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK.,Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Steven De Decker
- Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
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Batcher K, Dickinson P, Giuffrida M, Sturges B, Vernau K, Knipe M, Rasouliha SH, Drögemüller C, Leeb T, Maciejczyk K, Jenkins CA, Mellersh C, Bannasch D. Phenotypic Effects of FGF4 Retrogenes on Intervertebral Disc Disease in Dogs. Genes (Basel) 2019; 10:E435. [PMID: 31181696 DOI: 10.3390/genes10060435] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 01/31/2023] Open
Abstract
Two FGF4 retrogenes on chromosomes 12 (12-FGF4RG) and 18 (18-FGF4RG) contribute to short-limbed phenotypes in dogs. 12-FGF4RG has also been associated with intervertebral disc disease (IVDD). Both of these retrogenes were found to be widespread among dog breeds with allele frequencies ranging from 0.02 to 1; however, their additive contribution to disease is unknown. Surgical cases of IVDD (n = 569) were evaluated for age of onset, disc calcification, and genotypes for the FGF4 retrogenes. Multivariable linear regression analysis identified the presence of one or two copies of 12-FGF4RG associated with significantly younger age at first surgery in a dominant manner. 18-FGF4RG had only a minor effect in dogs with one copy. Multivariable logistic regression showed that 12-FGF4RG had an additive effect on radiographic disc calcification, while 18-FGF4RG had no effect. Multivariable logistic regression using mixed breed cases and controls identified only 12-FGF4RG as highly associated with disc herniation in a dominant manner (Odds Ratio, OR, 18.42, 95% Confidence Interval (CI) 7.44 to 50.26; p < 0.001). The relative risk for disc surgery associated with 12-FGF4RG varied from 5.5 to 15.1 within segregating breeds and mixed breeds. The FGF4 retrogene on CFA12 acts in a dominant manner to decrease the age of onset and increase the overall risk of disc disease in dogs. Other modifiers of risk may be present within certain breeds, including the FGF4 retrogene on CFA18.
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35
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Park JW, Lee BJ, Jeon SR, Rhim SC, Park JH, Roh SW. Surgical Treatment of Lumbar Spinal Discal Cyst: Is It Enough to Remove the Cyst Only without Following Discectomy? Neurol Med Chir (Tokyo) 2019; 59:204-212. [PMID: 31068543 PMCID: PMC6580042 DOI: 10.2176/nmc.oa.2018-0219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 12/19/2022] Open
Abstract
Discal cysts are a rare cause of low back pain and radiculopathy with unknown pathophysiologic mechanism. Associated symptoms are difficult to distinguish from those caused by extruded discs and other spinal canal lesions. Most discal cysts are treated surgically, but it is unclear whether the corresponding intervertebral disc should be excised along with cyst. We conducted a retrospective clinical review of 27 patients who underwent discal cyst excision at our institution between 2000 and 2017. The mean follow-up period was 63.6 months. We recorded symptoms, radiographs, operative findings, postoperative complications, and short- and long-term outcomes. Structured outcome assessment was based on Numeric Rating Scale (NRS) for pain intensity, Oswestry disability index, and Macnab classification. All patients underwent partial hemilaminectomy and microscopic cyst resection without discectomy. All patients had preoperative back or leg pain. Other preoperative clinical features included motor weakness, neurogenic intermittent claudication, and cauda equina syndrome. After surgery, NRS scores of back and leg pain decreased. The other symptoms also improved. During long-term follow-up, patients reported no restrictions on daily life activities, and were satisfied with our intervention. There were no cases of cyst recurrence. We conducted a review of the literature on lumbar discal cysts published before January, 2018. Including our cases, 126 patients were described. We compared two surgical modalities—cystectomy with and without discectomy—to elucidate both effectiveness and long-term complications. We found that microsurgical cystectomy without corresponding discectomy is an effective surgical treatment for lumbar discal cysts, and is associated with a low recurrence rate.
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Affiliation(s)
- Jung Won Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Byung-Jou Lee
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Neuroscience & Radiosurgery Hybrid Research Center
| | - Sang-Ryong Jeon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Seung-Chul Rhim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Sung Woo Roh
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
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36
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Olby NJ, Lim JH, Wagner N, Zidan N, Early PJ, Mariani CL, Muñana KR, Laber E. Time course and prognostic value of serum GFAP, pNFH, and S100β concentrations in dogs with complete spinal cord injury because of intervertebral disc extrusion. J Vet Intern Med 2019; 33:726-734. [PMID: 30758078 PMCID: PMC6430936 DOI: 10.1111/jvim.15439] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 06/20/2018] [Accepted: 01/18/2019] [Indexed: 01/12/2023] Open
Abstract
Background A noninvasive biomarker is needed to predict recovery from severe spinal cord injury (SCI) because of thoracolumbar intervertebral disc extrusion (TL‐IVDE). Proteins released from neural and glial cells can be detected in the blood and show promise as prognostic tools, but their concentration is influenced by time after injury. Hypothesis/Objectives Serum concentrations of glial fibrillary acidic protein (GFAP), phosphorylated neurofilament heavy chain (pNFH), and S100β will follow different time courses; measurement of combinations of these proteins will predict outcome. Animals Thirty‐one dogs with TL‐IVDE causing paralysis with no pain perception. Methods Prospective study. Serum samples were taken at presentation and intervals over 56 days and banked at −80°C. Glial fibrillary acidic protein, pNFH, and S100β concentrations were measured using ELISA tests and plotted against time from onset of nonambulatory status. Outcome was established at 6 months. The association between biomarker concentration and outcome was examined using logistic regression, receiver operator characteristics curve analysis, and model development. Results Thirty‐one dogs participated, 3/31 (10%) developed progressive myelomalacia and 19/31 (62%) recovered ambulation. Glial fibrillary acidic protein and S100β concentrations rose for the first 1 to 3 days, and were undetectable by 14 and 28 days, respectively. Phosphorylated neurofilament heavy chain concentrations peaked at 14 days and were detectable at 56 days. Glial fibrillary acidic protein concentrations in the first 72 hours after onset of nonambulatory status predicted recovery with an accuracy of 76.7%‐89% depending on sample timing. Conclusions and Clinical Importance Serum GFAP concentrations can be used to predict outcome in clinically complete SCI. A rapid inexpensive bedside test is needed.
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Affiliation(s)
- Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Ji-Hey Lim
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO
| | - Nikki Wagner
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Natalia Zidan
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Peter J Early
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Christopher L Mariani
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Karen R Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Eric Laber
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
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37
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Siddiq MAB, Rahim MA, Khan MTI, Shikder AZH. Lumbar Ligament Sprain-degeneration and Prolapsed Lumbar Intervertebral Disc: A Frequent Missed Combination. Cureus 2019; 11:e3958. [PMID: 30956911 PMCID: PMC6436675 DOI: 10.7759/cureus.3958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/03/2019] [Accepted: 01/24/2019] [Indexed: 12/28/2022] Open
Abstract
Low back pain (LBP) is a frequent complaint in the working milieu of pain physicians. Common LBP generators are the lumbar spine, soft tissues around the spine, and intra-abdominal viscera; however, in recent times, lumbar spine ligament (LL) degeneration is increasingly getting more coverage as an important LBP source. Among various LLs, interspinous and supraspinatus ligaments' sprain-degeneration can perpetuate localized central LBP as described in the present case study. Localized LL sprain-degeneration in association with radiating LBP from prolapsed lumbar intervertebral disc (PLID) compressing adjacent nerve roots might further impair a patient's quality of life. In the present report, we describe both LL sprain-degeneration and PLID (a dual source of LBP) in a 26-year-old Bangladeshi woman; physicians often fail to notice this combination in their regular clinical practice.
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Affiliation(s)
- Md Abu B Siddiq
- Physical Medicine and Rehabilitation, Brahmanbaria Medical College, Brahmanbaria, BGD
| | - Mohammad A Rahim
- Physical Medicine and Rehabilitation, Cox's Bazar Medical College, Chittagong, BGD
| | - Md Tariqul I Khan
- Physical Medicine and Rehabilitation, Rajshahi Medical College, Rajshahi, BGD
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38
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Kennon JC, Awad ME, Chutkan N, DeVine J, Fulzele S. Current insights on use of growth factors as therapy for Intervertebral Disc Degeneration. Biomol Concepts 2018; 9:43-52. [PMID: 29779014 DOI: 10.1515/bmc-2018-0003] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 03/23/2018] [Indexed: 02/07/2023] Open
Abstract
Chronic low back pain is a critical health problem and a leading cause of disability in aging populations. A major cause of low back pain is considered to be the degeneration of the intervertebral disc (IVD). Recent advances in therapeutics, particularly cell and tissue engineering, offer potential methods for inhibiting or reversing IVD degeneration, which have previously been impossible. The use of growth factors is under serious consideration as a potential therapy to enhance IVD tissue regeneration. We reviewed the role of chosen prototypical growth factors and growth factor combinations that have the capacity to improve IVD restoration. A number of growth factors have demonstrated potential to modulate the anabolic and anticatabolic effects in both in vitro and animal studies of IVD tissue engineering. Members of the transforming growth factor-β superfamily, IGF-1, GDF-5, BMP-2, BMP-7, and platelet-derived growth factor have all been investigated as possible therapeutic options for IVD regeneration. The role of growth factors in IVD tissue engineering appears promising; however, further extensive research is needed at both basic science and clinical levels before its application is appropriate for clinical use.
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Affiliation(s)
- Justin C Kennon
- Department of Orthopaedic Surgery, Augusta University, Augusta, GA, USA
| | - Mohamed E Awad
- Department of Oral Biology, Augusta University, Augusta, GA, USA
| | - Norman Chutkan
- Banner University Medical Center, University of Arizona College of Medicine - Phoenix, The CORE Institute, Phoenix, AZ, USA
| | - John DeVine
- Department of Orthopaedic Surgery, Augusta University, Augusta, GA, USA
| | - Sadanand Fulzele
- Department of Orthopaedic Surgery, Augusta University, Augusta, GA, USA.,Institute of Regenerative and Reparative Medicine, Augusta University, Augusta, GA, USA
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39
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Frank LR, Roynard PFP. Veterinary Neurologic Rehabilitation: The Rationale for a Comprehensive Approach. Top Companion Anim Med 2018; 33:49-57. [PMID: 30236409 DOI: 10.1053/j.tcam.2018.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/07/2018] [Accepted: 04/18/2018] [Indexed: 12/30/2022]
Abstract
The increase in client willingness to pursue surgical procedures, the heightened perceived value of veterinary patients, and the desire to provide comprehensive medical care have driven the recent demand of using an integrative treatment approach in veterinary rehabilitation. Physical therapy following neurologic injury has been the standard of care in human medicine for decades, whereas similar rehabilitation techniques have only recently been adapted and utilized in veterinary medicine. Spinal cord injury is the most common neurologic disease currently addressed by veterinary rehabilitation specialists and will be the primary focus of this review; however, research in other neurologic conditions will also be discussed. Of particular interest, to clients and veterinarians are techniques and modalities used to promote functional recovery after neurologic injury, which can mean the difference between life and death for many veterinary patients. The trend in human neurologic rehabilitation, often regardless of etiology, is a multimodal approach to therapy. Evidence supports faster and improved recoveries in people after neurologic injury using a combination of rehabilitation techniques. Although the primary neurological disorders researched tend to be spinal cord injury, peripheral neuropathies, allodynia, multiple sclerosis, and strokes-many correlations can be made to common veterinary neurological disorders. Such comprehensive protocols entail gait training activities in combination with neuromuscular electrical stimulation and directed exercises. Additionally, pain-relieving and functional benefits are bolstered when acupuncture is used in addition to rehabilitation. Studies, both laboratory and clinical, support the use of acupuncture in the management of neurologic conditions in small animals, specifically in cases of intervertebral disc disease, other myelopathies, and neuropathic pain conditions. Acupuncture's ability to promote analgesia, stimulate trophic factors, and decrease inflammation, including neuroinflammation, make it an alluring adjunct therapy after neurologic injury. Although there is limited research in veterinary medicine on physical techniques that expedite recovery after neurologic injury, there are sparse publications on clinical veterinary research suggesting the benefits of acupuncture, rehabilitation, and LASER in dogs with intervertebral disk disease. Accordingly, due to the relative lack of evidence-based studies in veterinary neurologic rehabilitation, much of the data available is human or laboratory-animal based, however, evidence supports the utilization of an early, comprehensive treatment protocol for optimal neurologic recovery. The rationale for why an integrative approach is critical will be detailed in this review; in addition, literature on specific physical rehabilitation techniques that have evidence of improved recoveries after neurologic injury, will be addressed.
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Affiliation(s)
- Lauren R Frank
- Physical Rehabilitation and Acupuncture Service, Long Island Veterinary Specialists, Plainview, NY, USA
| | - Patrick F P Roynard
- Neurology/Neurosurgery Department, Long Island Veterinary Specialists, Plainview, NY, USA; Fipapharm, Mont-Saint-Aignan, France.
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40
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Senneca C, Garcia G, Rosenberg JF, Heard D, Porter E, Olivera L, Farina L. ACUTE NONCOMPRESSIVE NUCLEUS PULPOSUS EXTRUSION CAUSING PARAPLEGIA IN A SIBERIAN TIGER ( PANTHERA TIGRIS ALTAICA). J Zoo Wildl Med 2018; 49:189-92. [PMID: 29517456 DOI: 10.1638/2017-0079R1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A neutered male Siberian tiger ( Panthera tigris altaica) presented with paraplegia of 5 days' duration. Thoracolumbar magnetic resonance imaging (MRI) revealed a focal, linear T2-W hyperintense intramedullary lesion at the level of T10-11 as well as reduced size of the nucleus pulposus of the T10-11 intervertebral disc. The animal was humanely euthanatized as a result of the severity of clinical signs and the poor prognosis. Gross necropsy revealed a dark red, firm focus on the spinal cord at the level of the T11 nerve roots. Histopathology revealed liquefactive necrosis of the ventral spinal cord at the level of T9-11, with hemorrhage and vascular changes within the cord and associated meninges. Fibrovascular tissue with hemorrhage, fibrin, and fragments of cartilage consistent with nucleus pulposus material was identified extradurally at this level. The findings were consistent with acute noncompressive nucleus pulposus extrusion.
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41
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Emery L, Hecht S, Sun X. Investigation of parameters predicting the need for diagnostic imaging beyond computed tomography in the evaluation of dogs with thoracolumbar myelopathy: Retrospective evaluation of 555 dogs. Vet Radiol Ultrasound 2017; 59:147-154. [PMID: 29160005 DOI: 10.1111/vru.12576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/08/2017] [Accepted: 09/10/2017] [Indexed: 11/27/2022] Open
Abstract
Thoracolumbar myelopathy encompasses a number of disease processes such as intervertebral disc disease, discospondylitis, trauma, congenital malformations, neoplasia, and intramedullary spinal cord disease. Compressive disc herniations are most common in dogs and require imaging procedures such as myelography, computed tomography (CT), and/or magnetic resonance imaging (MRI) to determine the need and location for decompressive surgery. The purposes of this retrospective, cross-sectional study were to evaluate all dogs undergoing thoracolumbar CT imaging as the initial diagnostic step between 2010 and 2015 and determine whether any of the imaging characteristics could be used to predict the need for additional imaging in the form of myelography, CT myelography, and/or MRI. A total of 555 dogs were identified in this time frame which underwent CT imaging for myelopathy of the thoracolumbar region. Various parameters including age, gender, sexual status, breed, chronicity, site of lesion, time of study, and contrast administration were evaluated. Findings indicated that 7.6% of dogs needed additional imaging after CT. Dachshunds were less likely to need additional imaging (P = 0.0111) as were patients scanned during normal business hours (P = 0.0075). Increasing age of the patient increased the likelihood of additional imaging (P = 0.0107). Dogs which did not have additional imaging performed were 21.89 times more likely to require surgery than those which did have additional imaging (P < 0.0001). Findings supported the use of CT as a first-line imaging modality for dogs presenting with thoracolumbar myelopathy.
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Affiliation(s)
- Lee Emery
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, 37996, USA
| | - Silke Hecht
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, 37996, USA
| | - Xiaocun Sun
- Office of Information Technology, University of Tennessee, Knoxville, TN, 37996, USA
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42
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Rosenberg GJ, Yee AJM, Erwin WM. Bedside to bench and back to bedside: Translational implications of targeted intervertebral disc therapeutics. J Orthop Translat 2017; 10:18-27. [PMID: 29662757 DOI: 10.1016/j.jot.2017.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 12/25/2022] Open
Abstract
Spinal pain and associated disability is a leading cause of morbidity worldwide that has a strong association with degenerative disc disease (DDD). DDD can begin in early–late adolescence and has a variable course. Biologically based therapies to treat DDD face significant challenges posed by the unique milieu of the environment within the intervertebral discs. Many potential promising therapies are still in the early stages of development with a hostile microenvironment within the disc presenting unique challenges. The translational potential of this article: Patient selection, reasonable therapeutic goals, approach, and timing will need to be discerned in order to successfully translate potential therapeutics.
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43
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Flegel T, Münch M, Held K, Salger F, Ziegler L, Böttcher P. Multiple thoracolumbar partial lateral corpectomies in 17 dogs. Tierarztl Prax Ausg K Kleintiere Heimtiere 2016; 44:397-403. [PMID: 27778019 DOI: 10.15654/tpk-160433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/03/2016] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To report feasibility and outcome of multiple thoracolumbar partial lateral corpectomies (TLPLCs) in dogs with predominantly ventral spinal cord compression caused by intervertebral disc disease (IVDD) in the light of reported decreased spinal stability following single TLPLC. Material und methods: In a retrospective study the records of dogs treated by multiple TLPLCs for ventral spinal cord compression caused by Hansen type I or type II IVDD were reviewed. Presurgical spinal cord compression and postsurgical decompression, as well as slot dimensions were determined based on computed tomography (CT)-myelography images. Neurological outcome was assessed based on repetitive examinations applying a modified Frankel Score as well as on an owner questionnaire. RESULTS Seventeen dogs with a mean body weight of 20.3 kg (range 4.0-49.0 kg) were included. Fourteen dogs had two TLPLCs, two dogs had three TLPLCs and one dog had four TLPLCs performed. The mean slot depth was 63% of entire vertebral body width, the mean slot height was 29% of the entire vertebral body height, the mean slot length was 25% of the entire vertebral body length and the mean residual vertebral interslot length between two adjacent TLPLCs was 55% of the vertebral body length. At reevaluation 4 weeks after surgery, 6/17 dogs (35.3%) had the same modified Frankel Score as before surgery, whereas 11/17 dogs (64.7%) showed a neurological improvement. According to the owners 78.5% of dogs were walking normally within 6 months after surgery. The mean survival time of 16 dogs, where follow-up was available, was 951 days. CONCLUSION AND CLINICAL RELEVANCE Multiple spinal cord compressions caused by IVDD can be eliminated by multiple, even consecutive, TLPLCs without the risk of a clinically significant risk of spinal instability.
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Affiliation(s)
- Thomas Flegel
- PD Dr. Thomas Flegel, Klinik für Kleintiere der Universität Leipzig, An den Tierkliniken 23, 04103 Leipzig, E-Mail:
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44
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Harder LK. [Diagnostic imaging of changes of the canine intervertebral disc]. Tierarztl Prax Ausg K Kleintiere Heimtiere 2016; 44:359-371. [PMID: 27658268 DOI: 10.15654/tpk-160468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/16/2016] [Indexed: 12/27/2022]
Abstract
Intervertebral disc degeneration can cause intervertebral disc herniation. Diagnostic imaging, including radiography, computed tomography and magnetic resonance imaging, is the most important tool in diagnosis. Firstly, an overview of macroscopic and biochemical physiology and pathology of the intervertebral disc will be given. Subsequently, the physics of diagnostic imaging and the appearance of intervertebral disc degeneration and displacement in several imaging methods are described.
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Affiliation(s)
- Lisa K Harder
- Lisa K. Harder, Klinik für Kleintiere, Stiftung Tierärztliche Hochschule Hannover, Bünteweg 9, 30559 Hannover, E-Mail:
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45
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Kim Y, Lee SH, Kim WH, Kweon OK. Transplantation of adipose derived mesenchymal stem cells for acute thoracolumbar disc disease with no deep pain perception in dogs. J Vet Sci 2016; 17:123-6. [PMID: 27051350 PMCID: PMC4808638 DOI: 10.4142/jvs.2016.17.1.123] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 01/16/2015] [Revised: 05/27/2015] [Accepted: 07/03/2015] [Indexed: 11/20/2022] Open
Abstract
Thirty-four dogs with no deep pain perception due to acute thoracolumbar intervertebral disc disease underwent decompression surgery within 1 week of diagnosis. All dogs underwent hemilaminectomy. Adipose derived mesenchymal stem cells (AD-MSCs) were transplanted into the injured spinal cord parenchyma for the AD-MSCs transplant dogs. Long-term outcome was evaluated at the end of the follow-up period (> 6 months). AD-MSCs combination treatment showed better recovery outcomes compared to decompression surgery alone. These results indicate that this stem cell therapy is a potential therapeutic strategy to overcome the limitations of treatment for spinal cord injury in clinical medicine.
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Affiliation(s)
- Yongsun Kim
- BK21 PLUS Program for Creative Veterinary Science Research, Research Institute for Veterinary Science and College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Seung Hoon Lee
- BK21 PLUS Program for Creative Veterinary Science Research, Research Institute for Veterinary Science and College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Wan Hee Kim
- BK21 PLUS Program for Creative Veterinary Science Research, Research Institute for Veterinary Science and College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Oh-Kyeong Kweon
- BK21 PLUS Program for Creative Veterinary Science Research, Research Institute for Veterinary Science and College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
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Hamilton T, Glass E, Drobatz K, Agnello KA. Severity of spinal cord dysfunction and pain associated with hydrated nucleus pulposus extrusion in dogs. Vet Comp Orthop Traumatol 2014; 27:313-8. [PMID: 24992451 DOI: 10.3415/VCOT-13-06-0076] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 05/08/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the severity of neurological deficits, presence of signs of cervical pain, and the site of intervertebral disc space extrusion in 21 dogs diagnosed via magnetic resonance imaging (MRI) with a hydrated nucleus pulposus extrusion (HNPE) and compare those findings to dogs with other compressive cervical myelopathies. METHODS Medical records and MRI findings were reviewed in dogs that were presented to two veterinary hospitals between 2006 and 2012 and subsequently diagnosed by MRI to have a HNPE (n = 21) or other compressive cervical myelopathies originating from the intervertebral disc (n = 174). Information obtained included signalment, severity of neurological deficits, presence of signs of neck pain, and site of HNPE. The severity of clinical neurological spinal cord dysfunction was determined for each dog in both groups using the Frankel scoring system (0-4). The MRI were reviewed for confirmation of diagnosis and site of HNPE. An ANOVA was used to compare age between groups and a Mann-Whitney test for pairwise comparisons of the Frankel score between groups. Values of p <0.05 were considered statistically significant. RESULTS Significantly more severe Frankel scores and less severe signs of cervical pain detected on palpation were observed in dogs with a HNPE as compared to dogs with other compressive myelopathies. The sites of HNPE were C3-C4 (8/21), C4-C5 (12/21), and C5-C6 (1/21). CLINICAL SIGNIFICANCE Dogs affected with HNPE have more severe clinical neurological deficits and less severe signs of cervical pain as compared to dogs with other compressive cervical myelopathies.
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Woiciechowsky C, Abbushi A, Zenclussen ML, Casalis P, Krüger JP, Freymann U, Endres M, Kaps C. Regeneration of nucleus pulposus tissue in an ovine intervertebral disc degeneration model by cell-free resorbable polymer scaffolds. J Tissue Eng Regen Med 2012; 8:811-20. [PMID: 22865642 DOI: 10.1002/term.1582] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 05/25/2012] [Accepted: 06/26/2012] [Indexed: 01/07/2023]
Abstract
Degeneration of intervertebral discs (IVDs) occurs frequently and is often associated with lower back pain. Recent treatment options are limited and treat the symptoms rather than regenerate the degenerated disc. Cell-free, freeze-dried resorbable polyglycolic acid (PGA)-hyaluronan implants were used in an ovine IVD degeneration model. The nucleus pulposus of the IVD was partially removed, endoscopically. PGA-hyaluronan implants were immersed in autologous sheep serum and implanted into the disc defect. Animals with nucleotomy only served as controls. The T2-weighted/fat suppression sequence signal intensity index of the operated discs, as assessed by magnetic resonance imaging (MRI), showed that implantation of the PGA-hyaluronan implant improved (p = 0.0066) the MRI signal compared to controls at 6 months after surgery. Histological analysis by haematoxylin and eosin and safranin O staining showed the ingrowth of cells with typical chondrocytic morphology, even cell distribution, and extracellular matrix rich in proteoglycan. Histomorphometric analyses confirmed that the implantation of the PGA-hyaluronan scaffolds improved (p = 0.027) the formation of regenerated tissue after nucleotomy. Disc heights remained stable in discs with nucleotomy only as well as after implantation of the implant. In conclusion, implantation of cell-free polymer-based implants after nucleotomy induces nucleus pulposus tissue regeneration and improves disc water content in the ovine model.
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Affiliation(s)
- Christian Woiciechowsky
- Tissue Engineering Laboratory, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Germany; Spine Centre Berlin, Germany
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Rathod TN, Chandanwale AS, Gujrathi S, Patil V, Chavan SA, Shah MN. Association between single nucleotide polymorphism in collagen IX and intervertebral disc disease in the Indian population. Indian J Orthop 2012; 46:420-6. [PMID: 22912517 PMCID: PMC3421932 DOI: 10.4103/0019-5413.97261] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Symptomatic intervertebral disc degeneration is being recently reported in younger population, questions the basis of its degenerative etiology. Latest evidences show that genetics play a significant role. Collagen IX, an important constituent of disc, is found to be altered in genetically predisposed individuals. Mutations have been reported in COL9A2 and COL9A3 genes, which encode Collagen IX, in Finnish and various other populations. The purpose of the present study is to test the significance of these genes in the Indian population. MATERIALS AND METHODS One hundred proven cases of intervertebral disc disease (IDD) of various regions of spine were selected for the study, along with matched controls. They were tested for the above mentioned alleles by allelic discrimination method with real-time polymerase chain reaction (PCR) study after isolation of DNA from blood sample. Each blood sample was classified into one of the three types - homozygous, heterozygous, and wild (normal) type allele - separately for COL9A2 and COL9A3 genes. RESULTS Homozygosity for COL9A2 allelic variation was associated with 100% occurrence of the disease. Heterozygous allele of COL9A2 was significantly higher in the study group (42%) as compared to the control group (17%). In contrast, allelic variation in COL9A3 gene was found to have no significant correlation with disc disease. There was no single patient with homozygous allelic variation for COL9A3, suggesting predominance of COL9A2 variation in the Indian population. CONCLUSION This candidate gene strategy approach adds considerably to our knowledge of genetic makeup of Indian populations in relation with disc disease. This study highlights importance of COL9A2 gene variation especially of homozygous variety in contrast to COL9A3 variation in causing disc disease in Indian population.
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Affiliation(s)
- Tushar N Rathod
- Department of Orthopaedics, Grant Medical College, Sir J. J. Group of Hospitals, Mumbai, India,Address for correspondence: Dr. Tushar N Rathod, Flat No. 704, Building no. H7, Gulmohar Hsg. Soc., Pratiksha Nagar, Sion (East), Mumbai 400 022, India. E-mail:
| | - Ajay S Chandanwale
- Department of Orthopaedics, Grant Medical College, Sir J. J. Group of Hospitals, Mumbai, India
| | - Shubhangi Gujrathi
- Department of Biochemistry, Grant Medical College, Sir J. J. Group of Hospitals, Mumbai, India
| | - Vinayak Patil
- Department of Biochemistry, Grant Medical College, Sir J. J. Group of Hospitals, Mumbai, India
| | - Shital A Chavan
- Department of Medicine, Grant Medical College, Sir J. J. Group of Hospitals, Mumbai, India
| | - Munjal N Shah
- Student, Grant Medical College, Sir J. J. Group of Hospitals, Mumbai, India
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