ABSTRACT
STUDY DESIGN: Retrospective evaluation. OBJECTIVES: To analyze the effect of cervical lordosis on cervical disc degeneration in patients with a high T1 slope. SUMMARY OF LITERATURE REVIEW: The T1 slope is known to be a parameter that may be very useful in evaluating sagittal balance. We previously reported that a low T1 slope was a potential risk factor for cervical spondylosis, especially in the C6–7 cervical segment. However, no study has analyzed the effect of cervical lordosis in patients with a high T1 slope (>25) on cervical disc degeneration. MATERIALS AND METHODS: Seventy-seven patients with a high T1 slope who underwent cervical spine MRI in our orthopedic clinic were enrolled. Patients were divided into 2 groups according to cervical compensation. The radiologic parameters obtained from radiography and cervical spine MRI were compared between the uncompensated group (cervical lordosis <25) and the compensated group (cervical lordosis ≥25). RESULTS: In the uncompensated group, the average degeneration grade of each segment was 2.72 (±0.70) in C2–3, 3.00 (±0.76) in C3–4, 3.02 (±0.91) in C4–5, 3.37 (±0.95) in C5–6, and 2.95 (±0.98) in C6–7. The average degeneration grade of each segment in the compensated group was 2.38 (±0.78) in C2–3, 2.38 (±0.60) in C3–4, 2.62 (±0.60) in C4–5, 2.82 (±0.72) in C5–6, and 2.41 (±0.74) in C6–7. The degeneration grade was significantly higher in the uncompensated group than in the compensated group for all cervical segments. The risk of high-grade degeneration of C3–4 was significantly higher in the uncompensated group (odds ratio = 6.268; 95% CI, 2.232–17.601; p<.001). CONCLUSIONS: Patients with a high T1 slope without compensation of cervical lordosis had a higher grade of degeneration in all cervical segments.
Subject(s)
Animals , Humans , Compensation and Redress , Intervertebral Disc Degeneration , Lordosis , Magnetic Resonance Imaging , Orthopedics , Radiography , Retrospective Studies , Risk Factors , Spine , SpondylosisABSTRACT
Objective To propose the three heights of intervertebral disc during cervical disc degeneration by measuring the cervical intervertebral disc heights in patients with cervical spondylosis. Methods Totally 96 patients with cervical spondylosis undergoing surgery in our hospital from Jan. 2017 to May 2017 were enrolled in this study, and their intervertebral disc heights of C2-7 were measured by the lateral X-ray. The patients were divided into 3 groups according to the Pfirrmann score: anatomical height group (Pfirrmann score-Ⅱ grade without height loss), natural height group (Pfirrmann score III grade), and pathological height group (Pfirrmann score -grade with moderate and severe intervertebral height loss). Two-way ANOVA and LSD analysis were performed to compare the intervertebral disc heights between the three groups. Results The average age of 96 patients was (53.4±19.6) years old, with 57 males and 39 females. Fifty-nine cases were diagnosed with cervical spondylotic myelopathy, 25 with nerve root type cervical spondylosis, and 12 with mixed cervical spondylosis. The average intervertebral disc heights in the anatomic height, natural height and pathological height groups were (7.7±1.2) mm, (7.1±0.9) mm and (5.9±1.0) mm, respectively, and there were significant differences between the three groups (all P<0.01). The cut-off values (sensitivity, specificity) of the anatomical heights and natural heights, natural heights and pathological heights of C3-4, C4-5, C5-6 and C6-7 were 7.45 mm (0.62, 0.65) and 6.95 mm (0.63, 1.00), 7.75 mm (0.49, 0.85) and 6.10 mm (0.89, 0.43), 7.75 mm (0.59, 0.77) and 6.95 mm (0.66, 0.91), and 7.85 mm (0.61, 0.89) and 5.95 mm (0.86, 0.73), respectively. Conclusion During the process of degeneration, cervical disc height can be classified as anatomical height, natural height (degenerative height) and pathological height. We should pay attention to the intervertebral disc height before operation and suggest to restore natural disc height.
ABSTRACT
Aim To observe the effect of pyrimidine dithiocarbamate (PDTC) on the variance of disc morphology and the expressions of TNF-α, MMP-9 in the cervical disc in cervical dynamic equilibrium rat models, and to investigate the roles of PDTC in the process of intervertebral disc degeneration and the mechanism involved.Methods Fifty-four SD rats were divided into three groups randomly, then the dynamic equilibrium rat model was established by cutting the nuchal superficial and deep muscle of the rats.The dynamic equilibrium rats with PDTC solution intraperitoneal injection after operations were defined as PDTC group (group A), the models with saline intraperitoneal injection after operations as saline group (group B), the rats of fake operation with saline intraperitoneal injection as blank group (group C), and the animals were sacrificed in batches 10 weeks, 12 weeks, 16 weeks respectively after operation.The C5, C6 vertebrae and C5/6 discs were harvested, and the disc morphology was observed.TNF-α, MMP-9 mRNA expressions were detected by q-PCR and protein expression was observed by Western blot.Results Compared with the saline group, the morphology of disc in PDTC group was destructed slightly and fiber ring arranged orderly.TNF-α, MMP-9 gene and protein expressions had no obvious changes (P>0.05) in blank group (group C) at each time point.The expressions of IL-6, MMP-9 mRNA increased with time in group B, but the amount increased fast firstly, and slow lately, reaching peak in 12 weeks.The expression of TNF-α, MMP-9 protein became steady in group B from 10 weeks compared with other time points(P>0.05).TNF-α, MMP-9 genes and proteins expression decreased obviously in PDTC group (group A) compared with saline group (group B) (P<0.01) at each time point, but higher than blank group C(P<0.01) at each time point.Conclusions TNF-α and MMP-9 are important inflammatory factors involved in rat cervical disc degeneration, PDTC relieves the degeneration of rat cervical disc by reducing the expression of TNF-α and MMP-9 via disturbing the NF-κB signal pathway probably, and PDTC may become potential medicine for disc degeneration.