Acidic Environment Induces Pyroptosis of NLRP3 Inflammatory Vesicle-Mediated Nucleus Pulposus Cells Through Up-Regulation of POSTN Expression

SUMMARY: Intervertebral disc degeneration (IVDD) is induced by nucleus pulposus (NP) dysfunction as a result of massive loss of NP cells. It has been reported that the acidic microenvironment of the intervertebral disc (IVD) can induce NP cell pyroptosis, and that up-regulation of periostin (POSTN) expression has a negative effect on NP cell survival. However, the relationship between the acidic environment, POSTN expression level and NP cell pyroptosis is unclear. Therefore, the aim of this study was to explore the relationship between acidic environment and POSTN expression level in NP cells, as well as the effect of POSTN in acidic environment on NP cell pyroptosis. NP cells were obtained from the lumbar vertebrae of Sprague Dawley (SD) male rats. These cells were divided into normal and acidic groups according to whether they were exposed to 6 mM lactic acid solution. And NP cells in the acidic group were additionally divided into three groups: (1) Blank group: no transfection; (2) NC group: cells transfected with empty vector plasmid; (3) sh-POSTN group: cells transfected with sh-POSTN plasmid to knock down the expression level of POSTN. Quantitative real-time PCR (qRT-PCR) and western blot was performed to assess the expression of POSTN at the mRNAand protein levels. CCK8 was used to evaluate cell survival. Western blot, in addition, was performed to examine acid-sensing ion channels (ASIC)-related proteins. And pyroptosis was detected by ELISA and western blot. The expression level of POSTN was significantly increased in NP cells in acidic environment. Knockdown of POSTN expression promoted the survival of NP cells in acidic environment and reduced the protein levels of ASIC3 and ASIC1a in NP cells. Moreover, knockdown of POSTN expression decreased the pyroptosis proportion of NP cells and the levels of pro-inflammatory cytokines interleukin (IL)-1β and IL-18. The levels of pyroptosis-related proteins NLRP3, ASC, cleaved-Caspase-1, and cleaved-GSDMD were also affected by the decreased POSTN expression. The extracellular acidic environment created by lactic acid solution activated NLRP3 inflammatory vesicle-induced caspase-1 to get involved in NP cell pyroptosis by up-regulating POSTN expression.

La degeneración del disco intervertebral (DDIV) es inducida por una disfunción del núcleo pulposo (NP) como resultado de una pérdida masiva de células NP. Se ha informado que el microambiente ácido del disco intervertebral (DIV) puede inducir la piroptosis de las células NP y que la regulación positiva de la expresión de periostina (POSTN) tiene un efecto negativo en la supervivencia de las células NP. Sin embargo, la relación entre el ambiente ácido, el nivel de expresión de POSTN y la piroptosis de las células NP es poco clara. Por lo tanto, el objetivo de este estudio fue explorar la relación entre el ambiente ácido y el nivel de expresión de POSTN en células NP, así como el efecto de POSTN en ambiente ácido sobre la piroptosis de las células NP. Las células NP se obtuvieron de las vertebras lumbares de ratas macho Sprague Dawley (SD). Estas células se dividieron en grupos normales y ácidos según se expusieron a una solución de ácido láctico 6 mM. Las células NP en el grupo ácido se dividieron adicionalmente en tres grupos: (1) Grupo en blanco: sin transfección; (2) grupo NC: células transfectadas con plásmido vector vacío; (3) grupo sh-POSTN: células transfectadas con plásmido sh-POSTN para reducir el nivel de expresión de POSTN. Se realizó una PCR cuantitativa en tiempo real (qRT-PCR) y una transferencia Western para evaluar la expresión de POSTN en los niveles de ARNm y proteína. Se utilizó CCK8 para evaluar la supervivencia celular. Además, se realizó una transferencia Western para examinar las proteínas relacionadas con los canales iónicos sensibles al ácido (ASIC). La piroptosis se detectó mediante ELISA y Western blot. El nivel de expresión de POSTN aumentó significativamente en células NP en ambiente ácido. La eliminación de la expresión de POSTN promovió la supervivencia de las células NP en un ambiente ácido y redujo los niveles de proteína de ASIC3 y ASIC1a en las células NP. Además, la eliminación de la expresión de POSTN disminuyó la proporción de piroptosis de las células NP y los niveles de citocinas proinflamatorias interleucina (IL) - 1β e IL-18. Los niveles de proteínas relacionadas con la piroptosis NLRP3, ASC, Caspasa-1 escindida y GSDMD escindida también se vieron afectados por la disminución de la expresión de POSTN. El ambiente ácido extracelular creado por la solución de ácido láctico activó la caspasa-1 inducida por vesículas inflamatorias NLRP3 para involucrarse en la piroptosis de las células NP mediante la regulación positiva de la expresión de POSTN.

Correlation between spinous process deviation and lumbar disc herniation in young patients / 中国骨伤

OBJECTIVE@#To explore the relationship between spinous process deviation and lumbar disc herniation in young patients.@*METHODS@#From March 2015 to January 2022, 30 treated young (under the age of 30) patients with lumbar disc herniation were included as the young group. In addition 30 middle-aged patients (quinquagenarian group) with lumbar disc herniation and 30 patients with non-degenerative spinal diseases (young non-degenerative group) were selected as control groups. The angle of the spinous process deviation was measured on CT and statistically analyzed by various groups. All the data were measured twice and the average value was taken and recorded.@*RESULTS@#The average angle of spinous process deviation in the degenerative lumbar vertebra of young patients were (3.89±3.77) degrees, similar to the (3.72±2.98) degrees of quinquagenarian patients(P=0.851). The average angle of s spinous process deviation young non-degenerative group were (2.20±2.28) degrees, significantly less than young group(P=0.040). The spinous process deviation angle of the superior vertebral of the degenerative lumbar in the young group was (4.10±3.44) degrees, which similar to the (3.47±2.87) degrees in the quinquagenarian group (P=0.447). A total of 19 young patients had the opposite deviation direction of the spinous process of the degenerative lumbar vertebra and upper vertebra, while only 7 quinquagenarian patients had this condition(P=0.02). The type of lumbar disc herniation in young patients had no significant relationship with the direction of spinous process deflection of the degenerative or upper lumbar vertebra (P>0.05).@*CONCLUSION@#Spinous process deviation is a risk factor of young lumbar disc herniation patients. If the deviation directions of adjacent lumbar spinous processes are opposite, it will increase the incidence of lumbar disc herniation in young patients. There was no significant correlation between the type of disc herniation and the deviation direction of the spinous process of the degenerative or upper lumbar vertebra. People with such anatomical variation can strengthen the stability of spine and prevent lumbar disc herniation through reasonable exercise.

Research progress of Wallis dynamic stabilization system for lumbar degenerative diseases / 中国骨伤

Wallis dynamic stabilization system is a surgical approach in the non-fusion technique of lumbar spine, consisting of interspinous blockers and dacron artificial ligaments that provide stability to the spine while maintaining a degree of motion in the affected segment. Recent studies have demonstrated the significant benefits of Wallis dynamic stabilization system in treating lumbar degenerative diseases. It not only improves clinical symptoms, but also effectively delays complications such as adjacent segmental degeneration. This paper aims to review the literature related to the Wallis dynamic stabilization system and degenerative diseases of the lumbar spine to describe the long-term prognostic effect of this system in the treatment of such diseases. This review provides a theoretical basis and reference for selecting surgical methods to treat degenerative diseases of the lumbar spine.

Effect of adjacent segmental facet joint degeneration on adjacent segment disease after lumbar fusion and fixation / 中国骨伤

OBJECTIVE@#To explore the effect of facet joint degeneration in adjacent segments on the incidence of adjacent segment disease (ASD) after lumbar fusion and fixation.@*METHODS@#A retrospective analysis was performed on 138 patients who underwent L5S1 posterior lumbar interbody fusion (PLIF) from June 2016 to June 2019. Patients were divided into a degeneration group (68 cases) and a non-degenerative group (70 cases) based on the presence or absence of L4,5 facet joint degeneration before surgery (graded using the Weishaupt standard). Age, gender, body mass index (BMI), follow-up time, and preoperative L4,5 intervertebral disc degeneration (graded using the Pfirrmann standard) were collected for both groups. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 and 3 months after surgery. The incidence and time of ASD after surgery were analyzed.@*RESULTS@#There were no significant differences between the two groups in age, gender, BMI, follow-up time, or preoperative L4,5 intervertebral disc degeneration. Both groups showed significant improvement in VAS and ODI at 1 and 3 months after surgery (P<0.001), with no significant difference between the groups(P>0.05). However, there was a statistically significant difference in the incidence and timing of ASD between the groups (P<0.05). The degeneration group had 2 cases of ASD in gradeⅠdegeneration, 4 cases of ASD in gradeⅡdegeneration, and 7 cases of ASD in grade Ⅲ degeneration. There was a statistically significant difference between the number of patients with grade Ⅲ degeneration and those with gradesⅠandⅡASD (P<0.0167, Bonferroni correction).@*CONCLUSION@#Preoperative degeneration of adjacent articular processes will increase the risk of ASD after lumbar fusion fixation, whereas gradeⅢ degeneration will further increase the risk.

Application of oblique lateral interbody fusion in the treatment of lumbar intervertebral disc degeneration in patients with Modic change and endplate sclerosis / 中国骨伤

OBJECTIVE@#To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis.@*METHODS@#A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L2,3 in 2 cases, L3,4 in 5 cases, and L4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed.@*RESULTS@#There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved.@*CONCLUSION@#As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.

Research Progressin the Relationship between Interleukin-6 and Intervertebral Disc Degeneration / 中国医学科学院学报

Intervertebral disc degeneration (IDD) is one of the main diseases causing low back pain,which seriously affects the quality of life of patients.Recent studies have discovered that interleukin-6 (IL-6) is highly expressed in the tissues and cells of degenerative intervertebral disc and is closely related to the occurrence and development of IDD.However,the signaling pathway and role of IL-6 in IDD remain to be understood.Therefore,this article reviews the recent studies about the signaling pathway and role of IL-6 in IDD,aiming to facilitate the clinical work and subsequent research progress.

Kinesiotaping in discopathies and degenerative spinal diseases: systematic review / Kinesiotaping em discopatias e doenças degenerativas da coluna vertebral: revisão sistemática / Kinesiotaping en discopatías y enfermedades degenerativas de la columna vertebral: revisión sistemática

ABSTRACT Neuromuscular taping or kinesiotaping is a technique widely used in spinal disorders. However, the scientific evidence of its use in discopathies and degenerative spine pathology is unknown. This study aimed to analyze the published clinical trials on neuromuscular taping in subjects with discopathies and degenerative spinal injuries. For this purpose, a literature search was performed following PRISMA guidelines in the following databases: PubMed, Web of Science (WOS), Scopus, Medline, and Cinahl. In analyzing bias and methodological quality, we used: the PEDro scale, Van Tulder criteria, and risk of bias analysis of the Cochrane Collaboration. A total of 5 articles were included that obtained a mean score of 6.2 on the PEDro scale. There is moderate evidence that, in the short term, neuromuscular taping reduces analgesic consumption and improves the range of motion and muscle strength in the posterior musculature. In addition, there is limited evidence that it can improve quality, while the scientific evidence on the effect of neuromuscular taping on pain is contradictory. The application of neuromuscular taping on discopathies and degenerative processes of the spine should be cautiously undertaken until more conclusive results are obtained, and the long-term effects are assessed. Level of evidence I; Systematic review.

Resumo: A bandagem neuromuscular ou kinesiotaping é uma técnica de bandagem amplamente utilizada em distúrbios da coluna vertebral. Entretanto, a evidência científica para seu uso em discopatias e na patologia degenerativa da coluna são desconhecidas. Objetivo: O objetivo deste trabalho foi analisar ensaios clínicos publicados sobre bandagem neuromuscular em sujeitos com discopatias e lesões degenerativas da coluna vertebral. Para este fim, foi realizada uma pesquisa bibliográfica seguindo as diretrizes do PRISMA nas seguintes bases de dados: PubMed, Web of Science (WOS), Scopus, Medline e Cinahl. Na análise de viés e qualidade metodológica, foram utilizados: escala PEDro, critérios de Van Tulder e análise de risco de viés da Colaboração Cochrane. Um total de 5 artigos foi incluído com uma pontuação média de 6,2 na escala PEDro. Há evidências moderadas de que, a curto prazo, a bandagem neuromuscular reduz o consumo de analgésicos, melhora a amplitude de movimento e a força muscular na musculatura posterior. Além disso, há evidências limitadas de que pode melhorar a qualidade, enquanto as evidências científicas sobre o efeito da bandagem neuromuscular na dor são contraditórias. A aplicação da bandagem neuromuscular em discopatias e processos degenerativos da coluna vertebral deve ser feita com cautela até que resultados mais conclusivos sejam obtidos e os efeitos a longo prazo sejam avaliados. Nível de evidência I; Revisão sistemática.

Resumen: El vendaje neuromuscular o kinesiotaping es una técnica de vendaje que se utiliza ampliamente en trastornos raquídeos. Sin embargo, se desconoce la evidencia científica de uso en discopatías y patología degenerativa de la columna. El objetivo de este trabajo consistió en analizar los ensayos clínicos publicados sobre el vendaje neuromuscular en sujetos con discopatías y lesiones degenerativas del raquis. Para ello, se realizó una búsqueda bibliográfica siguiendo las directrices PRISMA en las siguientes bases de datos: PubMed, Web of Science (WOS), Scopus, Medline y Cinahl. En el análisis de sesgo y calidad metodológica se utilizaron: escala PEDro, criterios de Van Tulder y análisis del riesgo de sesgo de la Colaboración Cochrane. Se incluyeron un total de 5 artículos que obtuvieron una puntuación media de 6,2 en la escala PEDro. Existe evidencia moderada de que, a corto plazo, el vendaje neuromuscular reduce el consumo de analgésicos, mejora el rango de movimiento y fuerza muscular en la musculatura posterior. Además, existe evidencia limitada de que puede mejorar la calidad, mientras que la evidencia científica sobre el efecto del vendaje neuromuscular en el dolor es contradictoria. La aplicación de vendaje neuromuscular es discopatías y procesos degenerativos del raquis debe realizarse con cautela a la espera de que se obtengan resultados más concluyentes y se valoren los efectos a largo plazo. Nivel de evidencia I; Revisión sistemática.

Anterior lumbar interbody fusion (alif): epidemiological and radiological profile / Artrodese lombar anterior: perfil epidemiológico, radiológico / Artrodesis lumbar anterior: perfil epidemiológico, radiológico

ABSTRACT: Objective: Evaluate the epidemiological and radiographic data of patients submitted to the Anterior Lumbar Interbody Fusion (ALIF) technique and the possible complications related to this procedure. Methods: A longitudinal and retrospective study was carried out to analyze electronic medical records and image files of patients who underwent spinal surgery using the ALIF technique between February 2019 and January 2021. Epidemiological data such as age, gender, and level of surgery were analyzed. Radiographic evaluations of lumbar lordosis from L1 to S1 were performed using the COBB technique and the anterior and posterior height of the disc space. The presence of intraoperative and postoperative complications in the patients was analyzed. Results: Initially, 70 patients were analyzed. The most prevalent operated level was L5-S1. The length of stay of the patients varied between 36 and 72 hours. Intraoperative bleeding ranged from 20mL to 400mL. Three patients had significant venous lesions. Differences between anterior and posterior lordosis and height measurements were significant (p < 0.001). Lordosis had a mean increase of 10.3°, anterior height had a mean increase of 7.9mm, and posterior height of 4.0mm. Six cases of intra and postoperative complications were observed. Conclusion: The patients showed improvement in the radiological parameters of the anterior and posterior height of the vertebral discs, with a significant increase in lumbar lordosis. Complication rates were 9.8%, and we had a short hospital stay. Level of Evidence II; Retrospective Longitudinal Study.

RESUMO: Objetivo: Avaliar os dados epidemiológicos e radiográficos de pacientes submetidos à técnica de Artrodese Lombar Anterior (ALIF) e avaliar as possíveis complicações relacionadas a este procedimento. Métodos: Realizou-se um estudo longitudinal e retrospectivo com análise dos prontuários eletrônicos e arquivos de imagem dos pacientes submetidos a cirurgia da coluna pela técnica de ALIF, no período entre fevereiro de 2019 e janeiro de 2021. Dados epidemiológicos como idade, sexo e nível de cirurgia foram analisados. Foram feitas avaliações radiográficas da lordose lombar de L1 a S1 através da técnica de COBB e da altura anterior e posterior do espaço discal. Foram analisados a presença de complicações intra e pós-operatórias dos pacientes. Resultados: Foram analisados inicialmente 70 pacientes. O nível operado mais prevalente foi L5-S1. O tempo de internamento dos pacientes variou entre 36 e 72 horas. O sangramento intraoperatório variou de 20mL a 400mL. Três pacientes apresentaram lesões venosas importantes. As diferenças entre as medidas de lordose e altura anterior e posterior foram significativas (p < 0,001). A lordose teve aumento médio de 10,3°, a altura anterior teve aumento médio de 7,9mm e a altura posterior de 4,0mm. Foram observados 06 casos de complicações intra e pós-operatórias. Conclusão: Os pacientes apresentaram melhora nos parâmetros radiológicos de altura anterior e posterior dos discos vertebrais, com um aumento da lordose lombar significativo. As taxas de complicações foram de 9,8 % e tivemos um curto período de internação hospitalar. Nível de Evidência II; Estudo Longitudinal e Retrospectivo.

RESUMEN: Objetivo: Evaluar los datos epidemiológicos y radiográficos de pacientes sometidos a la técnica de Artrodesis Lumbar Anterior (ALIF) y evaluar las posibles complicaciones relacionadas con este procedimiento. Métodos: Se realizó un estudio longitudinal y retrospectivo con análisis de historias clínicas electrónicas y archivos de imágenes de pacientes intervenidos de columna vertebral mediante la técnica ALIF, en el período comprendido entre febrero de 2019 y enero de 2021. Datos epidemiológicos como edad, sexo y nivel quirúrgico fueron analizados. Las evaluaciones radiográficas de la lordosis lumbar de L1 a S1 se realizaron mediante la técnica COBB y la altura anterior y posterior del espacio discal. Se analizó la presencia de complicaciones. Resultados: Se analizaron 70 pacientes. El nivel operado más prevalente fue L5-S1. El tiempo de estancia de los pacientes varió entre 36 y 72 horas. El sangrado intraoperatorio osciló entre 20 ml y 400 ml. Tres pacientes tenían lesiones venosas importantes. Las diferencias entre la lordosis anterior y posterior y las medidas de altura fueron significativas (p < 0,001). La lordosis tuvo un aumento medio de 10,3°, la altura anterior tuvo un aumento medio de 7,9 mm y la altura posterior de 4,0 mm. Se observaron seis casos de complicaciones intra y postoperatorias. Conclusiones: Los pacientes mostraron mejoría en los parámetros radiológicos de altura anterior y posterior de los discos vertebrales, con aumento significativo de la lordosis lumbar. Las tasas de complicaciones fueron del 9,8% y hubo una corta estancia hospitalaria. Nivel de Evidencia II; Estudio Longitudinal y Retrospectivo.

Mri morphometry of lumbar discs and vertebral bodies in correlation with serum vitamin d level / Morfometria de rm de discos lombares e corpos vertebrais em correlação com o nível sérico de vitamina d / Morfometría de rm de discos lumbares y cuerpos vertebrales en correlación con el nivel sérico de vitamina d

ABSTRACT: Introduction: The knowledge of the intervertebral disc morphology and its relation with the vertebrae is vital for managing degenerative spine disease. It is imperative to study the role of preventable and treatable causes, such as Vitamin D deficiency, so that standard guidelines can be framed for apt management. Objective: To evaluate the correlation between serum vitamin D levels and MRI morphometry of lumbar intervertebral discs. Methods: A total of 100 subjects (20-40 years) underwent an MRI of the lumbosacral spine. Intervertebral disc and vertebral body heights were measured, and disc degenerative changes were noted. Serum vitamin D levels were correlated with disc changes using the Pearson/Spearman rank correlation coefficient. A p-value of <0.05 was considered significant. Results: Vitamin D deficiency showed a high prevalence in patients with disc degenerative diseases, even in young adults and females with more severe vitamin D deficiency than males (p-value < 0.001). However, a significant relationship between vitamin D levels and disc or vertebral body heights could not be established. Conclusion: Vitamin D deficiency is more prevalent in patients with disc degenerative changes; however, its effect on disc and vertebral body heights needs to be extrapolated further in larger studies. Level of Evidence I; Cross-Sectional, Observational Study.

RESUMO: Introdução: O conhecimento da morfologia do disco intervertebral e sua relação com as vértebras é vital para o manejo da doença degenerativa da coluna. É imperativo estudar o papel das causas evitáveis e tratáveis, como a deficiência de vitamina D, para que possam ser elaboradas diretrizes padrão para um manejo adequado. Objetivo: Avaliar a morfometria da ressonância magnética dos discos intervertebrais lombares em correlação com os níveis séricos de vitamina D. Métodos: Um total de 100 indivíduos (20-40 anos) foram submetidos a ressonância magnética da coluna lombossacra. As alturas do disco intervertebral e do corpo vertebral foram medidas e alterações degenerativas do disco foram anotadas. Os níveis séricos de vitamina D foram correlacionados com alterações discais usando o coeficiente de correlação de Pearson/Spearman. Um valor de p <0,05 foi considerado significativo. Resultados: A deficiência de vitamina D apresentou alta prevalência em pacientes com doenças degenerativas do disco, mesmo em adultos jovens e mulheres que apresentavam deficiência de vitamina D mais grave que os homens (valor p < 0,001). No entanto, não foi possível estabelecer uma relação significativa entre os níveis de vitamina D e a altura do disco ou do corpo vertebral. Conclusão: A deficiência de vitamina D é mais prevalente em pacientes com alterações degenerativas do disco, no entanto, seu efeito na altura do disco e do corpo vertebral precisa ser extrapolado em estudos maiores. Nível de Evidência I; Estudio Observacional Transversal.

RESUMEN: Introducción: El conocimiento de la morfología del disco intervertebral y su relación con las vértebras es vital para el tratamiento de las enfermedades degenerativas de la columna vertebral. Es imprescindible estudiar el papel de las causas prevenibles y tratables, como la deficiencia de vitamina D, para poder elaborar directrices estándar para un tratamiento adecuado. Objetivo: Evaluar la morfometría por resonancia magnética de los discos intervertebrales lumbares en correlación con los niveles séricos de vitamina D. Métodos: Un total de 100 individuos (20-40 años) se sometieron a una resonancia magnética de la columna lumbosacra. Se midieron las alturas del disco intervertebral y del cuerpo vertebral y se observaron cambios degenerativos en el disco. Los niveles séricos de vitamina D se correlacionaron con los cambios discales mediante el coeficiente de correlación Pearson/Spearman. Se consideró significativo un valor p <0,05. Resultados: La deficiencia de vitamina D mostró una elevada prevalencia en pacientes con enfermedad degenerativa discal, incluso en adultos jóvenes y mujeres que presentaban una deficiencia de vitamina D más grave que los hombres (valor p < 0,001). Sin embargo, no fue posible establecer una relación significativa entre los niveles de vitamina D y la altura del disco o del cuerpo vertebral. Conclusión: La deficiencia de vitamina D es más prevalente en pacientes con cambios degenerativos del disco; sin embargo, su efecto sobre la altura del disco y del cuerpo vertebral debe extrapolarse en estudios mayores. Nivel de Evidencia I; Estudio Observacional Transversal.

Facet Tropism/Inclination and Its Association with Intervertebral Disc Herniation in the Lumbar Spine - A Radiological Evaluation / Tropismo/inclinação facetária e sua associação com hérnia de disco intervertebral na região lombar da coluna - Uma avaliação radiológica

Abstract Objective To assess the role of facet tropism (FT) in intervertebral disc prolapse. Methods A total 98 patients with lower back pain were included in the study. Magnetic resonance imaging scans were performed and analyzed. The angles of the right and left facets were measured on the axial section. Patients without disc prolapse at the L3-L4, L4-L5 and L5-S1 levels act as controls for those with disc prolapse at the same levels. A statistical analysis was also performed. Results The incidence of FT at the L3-L4 level was of 85.2% in patients with disc herniation (n= 27), and of 56.3% in the control group, which was statistically significant (p= 0.008). Similarly, at the L4-L5 level, incidence of FT among cases and controls was of 71.4% (n= 35) and 52.4% respectively (p= 0.066). At the L5-S1 the incidence was of 66% and 51% among cases and controls respectively (p= 0.13). Conclusion We found a positive association between FT and disc herniation at the L3-L4 level, but no association at the L4-L5 and L5-S1 levels.

Resumo Objetivo Avaliar o papel do tropismo facetário (TF) no prolapso discal intervertebral. Métodos Um total de 98 pacientes com dor lombar foram incluídos no estudo. Exames de ressonância magnética foram realizados e analisados, e os ângulos das facetas direita e esquerda foram medidos na seção axial. Os pacientes sem prolapso discal nos níveis L3-L4, L4-L5 e L5-S1 atuam como controles para aqueles com prolapso nos mesmos níveis. Fez-se também uma análise estatística. Resultados A incidência de TF no nível L3-L4 foi de 85,2% em pacientes com hérnia discal (n= 27), e de 56,3% no grupo controle, o que foi estatisticamente significativo (p= 0,008). Da mesma forma, a incidência de TF no nível L4-L5 entre casos e controles foi de 71,4% (n= 35) e 52,4%, respectivamente (p= 0,066). No nível L5-S1, a incidência foi de 66% e 51% nos caso e nos controles, respectivamente (p= 0,13). Conclusão Encontramos associação positiva entre TF e hérnia de disco no nível L3-L4, mas nenhuma associação nos níveis L4-L5 e L5-S1.

Study of nonlinear viscoelastic mechanical properties of degenerated intervertebral discs / Estudio de las propiedades mecánicas viscoelásticas no lineales de discos intervertebrales degenerados

SUMMARY: Biomechanical factors are important factors in inducing intervertebral disc degeneration, in this paper, the nonlinear viscoelastic mechanical properties of degenerated intervertebral discs were analyzed experimentally. Firstly, the loading and unloading curves of intervertebral discs before and after degeneration at different strain rates were compared to analyze the changes of their apparent viscoelastic mechanical properties; The internal stress/strain distribution of the disc before and after degeneration was then tested by combining digital image technology and fiber grating technology. The results show that the intervertebral disc is strain-rate- dependent whether before or after degeneration; The modulus of elasticity and peak stress of the degenerated disc are significantly reduced, with the modulus of elasticity dropping to 50 % of the normal value and the peak stress decreasing by about 55 %; Degeneration will not change the distribution of the overall internal displacement of the intervertebral disc, but has a greater impact on the superficial and middle AF; The stress in the center of the nucleus pulposus decreases, and the stress in the outer AF increases after degeneration. Degeneration has a great impact on the nonlinear viscoelastic mechanical properties of intervertebral disc, which has reference value for the mechanism, treatment and prevention of clinical degenerative diseases.

RESUMEN: Los factores biomecánicos son importantes en la inducción de la degeneración del disco intervertebral. En este estudio se analizaron experimentalmente las propiedades mecánicas viscoelásticas no lineales de los discos intervertebrales degenerados. En primer lugar se compararon las curvas de carga y descarga de los discos intervertebrales, antes y después de la degeneración, a diferentes velocidades de deformación para analizar los cambios aparentes de sus propiedades mecánicas viscoelásticas. La distribución interna de tensión/deformación del disco antes y después de la degeneración se probó luego combinando tecnología de imagen digital y tecnología de rejilla de fibra. Los resultados mostraron que el disco intervertebral depende de la velocidad de deformación antes o después de la degeneración; El módulo de elasticidad y la tensión máxima del disco degenerado se reducen significativamente, cayendo el módulo de elasticidad al 50 % del valor normal y la tensión máxima disminuyendo en aproximadamente un 55 %; La degeneración no cambiará la distribución del desplazamiento interno general del disco intervertebral, pero tiene un mayor impacto en la FA superficial y media; El estrés en el centro del núcleo pulposo disminuye y el estrés en el FA externo aumenta después de la degeneración. La degeneración tiene un gran impacto en las propiedades mecánicas viscoelásticas no lineales del disco intervertebral, que tiene valor de referencia para el mecanismo, tratamiento y prevención de enfermedades clínicas degenerativas.

Is There Any Association between the Severity of Disc Degeneration and Low Back Pain? / Existe alguma associação entre gravidade de degeneração discal e dor lombar?

Abstract Objective To access the possibility that higher degrees of disc degeneration lead to higher levels of pain and dysfunction. Methods Magnetic resonance imaging (MRI) scans of 85 patients with low back pain lasting for more than 12 weeks were evaluated, and the degree of disc degeneration was quantified according to the Pfirrmann grading system. The Pfirrmann degree in each disc space from L1-L2 to L5-S1, the maximum degree of Pfirrmann (Pfirrmannmax) between the lumbar discs, and the sum of Pfirrmann (Pfirrmann-sum) degrees were correlated (through the Spearman test) with the Oswestry Disability Index (ODI) and the Visual Analogical Scale (VAS) for pain. Results In total, 87% of the patients had moderate to severe lumbar disc degeneration measured by Pfirrmann-max, and the most degenerated discs were L4-L5 and L5S1. There was a week to moderate correlation regarding the Pfirrmann-max (r » 0,330; p» 0.002) and the Pfirrmann-sum (r » 0,266; p» 0,037) and the ODI, and the Pfirrmann scores in L1-L2 were correlated with the ODI and the VAS. Conclusion Patients with chronic idiopathic low back pain frequently have moderate to severe lumbar disc degeneration, which has a negative impact on the quality of life of the patients. Low degrees of degeneration in L1-L2 might be related with higher degrees of pain and of functional disability.

Resumo Objetivo Avaliar a possibilidade de maiores graus de degeneração discal levarem a maiores dor e disfunção. Métodos Exames de imagem por ressonância magnética (IRM) de 85 pacientes com lombalgia idiopática por mais de 12 semanas foram avaliados, sendo quantificado o grau de degeneração discal de acordo com a escala de Pfirrmann. O grau de Pfirrmann em cada espaço discal de L1-L2 a L5-S1, o grau máximo de Pfirrmann (Pfirrmann-max) entre os discos lombares, e a soma dos graus de Pfirrmann (Pfirrmann-soma) foram correlacionados (por meio do teste de Spearman) com o Índice de Incapacidade de Oswestry (IIO) e a escala visual analógica (EVA) de dor. Resultados No total, 87% dos pacientes tinha degeneração discal moderada ou acentuada medida pelo Pfirrmann-max, sendo L4-L5 e L5-S1 os discos mais degenerados. Houve uma correlação de fraca a moderada entre o Pfirrmann-max (r » 0,330; p» 0.002) e a Pfirrmann-soma (r » 0,266; p» 0,037) e o IIO, e entre o grau de Pfirrmann em L1-L2 e o IIO e a EVA. Conclusão A degeneração discal lombar moderada ou acentuada é frequente em indivíduos com lombalgia crônica idiopática, e tem um impacto negativo na qualidade de vida dos pacientes. Pequenos graus de degeneração discal em L1-L2 podem determinar maior grau de dor e maior incapacidade funcional.

Improvement in Radicular Pain after Endoscopic Transforaminal Lumbar Discectomy at Discs with Advanced Degenerative Changes / Melhora da dor radicular após discectomia lombar transforaminal endoscópica em discos com alterações degenerativas avançadas

Abstract Objectives To evaluate the correlation between radiologic changes (Pfirrmann and Modic) and radicular pain intensity in patients who underwent transforaminal endoscopic surgery for lumbar disc herniation. Methods Series of cases with 39 patients, 50 intervertebral discs in preoperative evaluation from January 29, 2018 to August 28, 2019 in an endoscopic spine surgery service. Demographic data, surgical indication, operative details and complications were obtained from medical records. The patients were divided into three groups based on the Modic classification (Modic absence, Modic 1 and Modic 2) and into two groups considering the Pfirrmann classification (Pfirrmann IV and Pfirrmann V). Data were processed in IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA), with a significance level of p< 0,05. Results There was no difference between genders; age: 50,36 ± 15,05 years old; disease level: L2-L3 1 (2%), L3-L4 2 (4%), L4-L5 9 (18%), L5-S1 8 (16%), L3-L4 + L4-L5 4 (8%), and L4-L5 + L5-S1 26 (52%); location: right foraminal 7 (14%), left foraminal 15 (30%), central 9 (18%) and diffuse 19 (38%); radicular pain: left 25 (50%), right 11 (22%), and bilateral 14 (28%); preoperative visual analogue scale (VAS): 9,5 ± 0,91, postoperative: 2,5 ± 1,79; surgery duration: 100 ± 31,36 minutes; and follow-up: 8,4 ± 6,7 months. Less postoperative sciatica was registered in the Modic 2 versus Modic 1 group (p< 0,05). There was no difference in the postoperative radicular pain between the Pfirrmann groups (IV versus V). Conclusion Although there is no clinical difference between the groups, in advanced stages of disc degeneration, endoscopic transforaminal discectomy proved to be effective in diminishing radicular pain in patients with lumbar disc herniation.

Resumo Objetivos Avaliar a correlação entre as alterações radiológicas (Pfirrmann e Modic) e a intensidade da dor radicular em pacientes submetidos a cirurgia endoscópica transforaminal para hérnia de disco lombar. Métodos Uma sequência de casos com 39 pacientes, 50 discos intervertebrais em avaliação pré-operatória, no período de 29 de janeiro de 2018 a 28 de agosto de 2019, no serviço de cirurgia endoscópica da coluna vertebral. Os dados demográficos, indicação cirúrgica, detalhes operatórios e complicações foram todos obtidos junto aos prontuários clínicos. Os pacientes foram divididos em três grupos, com base na classificação Modic (ausência de Modic, Modic 1 e Modic 2) e em dois grupos, considerando a classificação de Pfirrmann (Pfirrmann IV e Pfirrmann V). Os dados foram processados no software IBM SPSS Statistics for Windows, versão 22.0 (IBM Corp., Armonk, NY, EUA), com nível de significância de p <0,05. Resultados Não houve diferença entre os gêneros; idade: 50,36 ± 15,05 anos; nível da doença: L2-L3 1 (2%), L3-L4 2 (4%), L4-L5 9 (18%), L5-S1 8 (16%), L3-L4 + L4-L5 4 (8%), e L4-L5 + L5-S1 26 (52%); localização: foraminal direito em 7 pacientes (14%), foraminal esquerdo em 15 pacientes (30%), central em 9 pacientes (18%), e difuso em 19 pacientes (38%); dor radicular: esquerda em 25 pacientes (50%), direita em 11 pacientes (22%), e bilateral em 14 pacientes (28%); escala visual analógica (EVA) pré-operatório: 9,5 ± 0,91, pós-operatório: 2,5 ± 1,79; tempo cirúrgico: 100 ± 31,36 minutos; e acompanhamento de 8,4 ± 6,7 meses. Foi registrada menos dor ciática pós-operatória nos grupos Modic 2 versus Modic 1 (p< 0,05). Não houve diferença na dor radicular pós-operatória entre os grupos Pfirrmann (IV versus V). Conclusão Embora não exista diferença clínica entre os grupos, em estágios avançados da degeneração discal, a discectomia transforaminal endoscópica mostrou-se eficaz na redução da dor radicular em pacientes com hérnia de disco lombar.

Minimally invasive swine spine surgery training: technical aspects, benefits, and anatomical limitations

ABSTRACT Objective To describe the technical specificities and feasibility of simulation of minimally invasive spine surgery in live pigs, as well as similarities and differences in comparison to surgery in humans. Methods A total of 22 Large White class swine models, weighing between 60 and 80kg, were submitted to surgical simulations, performed during theoretical-practical courses for training surgical techniques (microsurgical and endoscopic lumbar decompression; percutaneous pedicular instrumentation; lateral access to the thoracic spine, and anterior and retroperitoneal to the lumbar spine, and management of complications) by 86 spine surgeons. For each surgical technique, porcine anatomy (similarities and differences in relation to human anatomy), access route, and dimensions of the instruments and implants used were evaluated. Thus, the authors describe the feasibility of each operative simulation, as well as suggestions to optimize training. Study results are descriptive, with figures and drawings. Results Neural decompression surgeries (microsurgeries and endoscopic) and pedicular instrumentation presented higher similarities to surgery on humans. On the other hand, intradiscal procedures had limitations due to the narrow disc space in swines. We were able to simulate situations of surgical trauma in surgical complication scenarios, such as cerebrospinal fluid fistulas and excessive bleeding, with comparable realism to surgery on humans. Conclusion A porcine model for simulation of minimally invasive spinal surgical techniques had similarities with surgery on humans, and is therefore feasible for surgeon training.

Early efficacy of three dimensional printed anatomical biomimetic cervical artificial disc replacement in the treatment of cervical degenerative diseases / 中华外科杂志

Objective: To investigate the efficacy and safety of a new cervical artificial disc prosthesis in the treatment of cervical degenerative diseases. Methods: The clinical data of 18 patients with single-level cervical degenerative diseases who underwent three dimensional printed anatomical bionic cervical disc replacement at Department of Spinal Surgery,Honghui Hospital,Xi'an Jiaotong University from May 2019 to July 2020 were analyzed retrospectively. There were 7 males and 11 females,aged (45±8) years old(range:28 to 58 years).The surgical segment was located at C3－4 level in 2 cases, C4－5 level in 5 cases, C5－6 level in 9 cases, and C6－7 level in 2 cases.The clinical and radiographic outcomes were recorded and compared at preoperative,postoperative times of one month and twelve months.The clinical assessments contained Japanese orthopedic association (JOA) score,neck disability index (NDI) and visual analogue scale (VAS).Imaging assessments included range of motion (ROM) of cervical spine, prosthesis subsidence and prosthesis anteroposterior migration.Repeated measurement variance analysis was used for comparison between groups,and paired t test was used for pairwise comparison. Results: All patients underwent the operation successfully and were followed up for more than 12 months.Compared with preoperative score,the JOA score,NDI and VAS were significantly improved after surgery (all P<0.01).There was no significant difference in postoperative ROM compared with 1-and 12-month preoperative ROM (t=1.570,P=0.135;t=1.744,P=0.099). The prosthesis subsidence was (0.29±0.13) mm (range: 0.18 to 0.50 mm) at 12-month postoperatively.The migration of prosthesis at 12-months postoperatively were (0.71±0.20) mm (range: 0.44 to 1.08 mm).There was no prosthesis subsidence or migration>2 mm at 12-month postoperatively. Conclusion: Three dimensional printed anatomical biomimetic cervical artificial disc replacement has a good early clinical effect in the treatment of cervical degenerative diseases, good mobility can be obtained while maintaining stability.

The development of artificial cervical disc replacement from the perspective of orthopedic bionic therapy / 中华外科杂志

The modern surgical treatment of cervical degenerative disc disease can be traced back to the advent of anterior cervical decompression and fusion.With the emergence of fusion-related complications,different scholars have promoted the gradual transformation of cervical degenerative disc diseases from "fusion fixation" to "non-fusion reconstruction" through in-depth fusion with materials science,engineering mechanics and other disciplines.The innovation of this treatment concept is consistent with the original intention of "structural remodeling,functional reconstruction,maximum repair and reconstruction of the morphology and function of skeletal muscle system" in orthopedic bionic treatment,which is essentially in line with the "bionic alternative therapy" in orthopedic bionic therapy.This paper focuses on the surgical treatment of cervical degenerative disc diseases,reviews the development history of artificial cervical disc replacement,analyzes the evolution from orthopedic biomimetic therapy,and explores a new direction for the design of artificial cervical disc prostheses and the treatment of cervical degenerative disc diseases in the future.

Percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion / 中国骨伤

OBJECTIVE@#To explore the clinical effect of percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion.@*METHODS@#From February 2010 to June 2018, 64 patients with adjacent segment lumbar disc herniation after lumbar fusion were retrospectively analyzed and divided into observation group and control group. In observation group, there were 23 males and 10 females performed with percutaneous endoscopic lumbar discectomy, including 27 cases of single segment fusion and 6 cases of double segment fusion, aged from 55 to 83 years old with an average of (65.7±7.4) years old. In control group, there were 22 males and 9 females performed with traditional open fusion revision, including 25 cases of single-segment fusion and 6 cases of double segment fusion, aged from 51 to 78 years old with an average of(64.8±7.8) years old. The operative time, intraoperative blood loss, fluoroscopy times, postoperative ambulation time and length of postoperative hospital stay were recorded. The clinical efficacy was evaluated by visual analogue scale(VAS) and Oswestry Disability Index(ODI). The complications between two groups were observed.@*RESULTS@#All patients were followed up for at least 2 years. The observation group patients were followed up with an average of (2.4±0.5) years. The control group patients were followed up with an average of(2.6±0.7) years. Compared with control group, operation time, intraoperative blood loss, postoperative ambulation time and length of postoperative hospital stay of the observation group were significantly reduced (P<0.05), and the fluoroscopy times of observation group were significantly increased compared with control group(P<0.05). The VAS of low back and lower limb, and ODI at the latest follow-up between two groups were all significantly improved compared to those of pre-operation (P<0.05). The VAS of low back at each point and ODI at 1, 3 months after operation in observation group was significantly reduced compared with control group(P<0.05), however there was no significant difference in VAS for lower limb between two groups (P>0.05). The difference of complications between two groups was statistically significant (P<0.05).@*CONCLUSION@#Compared with traditional open fusion revision surgery, percutaneous endoscopic lumbar discectomy for the treatment of adjacent segment lumbar disc herniation after lumbar fusion has the advantages of reducing operation time and intra-operative blood loss, shortening ambulation time and the length of postoperative hospital stay, and promoting pain and functional improvement, and decrease incidence of complications. However, long-term clinical efficacy needs further study.

Research progress in mechanism of Chinese herbal compounds and monomers in delaying lumbar intervertebral disc degeneration / 中国中药杂志

Traditional Chinese medicine has unique advantages in the treatment of degenerative bone and joint diseases, and its widely used in clinical practice. In recent years, many scholars have conducted a large number of basic studies on the delay of intervertebral disc degeneration by herbal compound and monomeric components from different perspectives. In order to further elucidate its mechanism of action, this paper summarizes the in vivo and in vitro experimental studies conducted at the level of both herbal compound and single components, respectively, in order to provide references for the basic research on the treatment of lumbar intervertebral disc degeneration by Chinese medicine. A summary shows that commonly used herbal compound prescriptions include both classical prescriptions such as Duhuo Jisheng Decoction, as well as clinical experience prescriptions such as Yiqi Huoxue Recipe. Angelicae Sinensis Radix, Chuanxiong Rhizoma, Rehmanniae Radix Praeparata, Achyranthis Bidentatae Radix, and Eucommiae Cortex were used most frequently. Tonic for deficiency and blood stasis activators were used most frequently. The most utilized monomeric components include icariin, ginsenoside Re, salvianolic acid B and aucubin. The main molecular mechanisms by which herbal compound and monomeric components delay of lumbar intervertebral disc degeneration include improving the intervertebral disc microenvironment, promoting the synthesis of aggregated proteoglycans and type Ⅱ collagen in the intervertebral disc, reducing the degradation of the extracellular matrix, and inhibiting apoptosis in the nucleus pulposus cells, etc. The main signaling pathways involved include Wnt/β-catenin signaling pathway, MAPK-related signaling pathway, mTOR signaling pathway, Fas/FasL signaling pathway, PI3 K/Akt signaling pathway, NF-κB signaling pathway, JAK/STAT signaling pathway, and hedgehog signaling pathway, etc.

Value of magnetic resonance combined with dual-source spectral computed tomography in improving the clinical diagnosis and treatment efficiency of lumbar disk herniation

SUMMARY OBJECTIVE: This study aims to investigate the value of magnetic resonance combined with dual-source spectral computed tomography in improving the clinical diagnosis and treatment efficiency of lumbar disk herniation. METHODS: Two hundred patients with lumbar disk herniation were enrolled. Magnetic resonance and dual-source spectral computed tomography were used to perform the diagnosis. The treatment efficiency and effectiveness of different diagnostic methods were determined. Results: Eighty cases of lumbar disk herniation, 40 cases of prolapse, 33 cases of bulge, 27 cases of sequestration, and 20 cases of nodules were diagnosed based on pathologic evaluation. magnetic resonance detected lumbar disk herniation in 172 cases, with a detection rate of 86.00%. Dual-source spectral computed tomography detected 171 cases, with a detection rate of 85.50%. Magnetic resonance combined with dual-source spectral computed tomography detected 195 cases, with a detection rate of 97.50%. There was no significant difference between magnetic resonance and dual-source spectral computed tomography (p>0.05), but compared with the combined detection, there was a significant difference (p<0.05). One hundred and two cases of calcification, 83 cases of spinal cord deformity, 70 cases of intervertebral disk degeneration, 121 cases of intervertebral disk gas, 85 cases of dural sac compression, and 78 cases of nerve root compression were surgically demonstrated. The detection rate of diagnostic signs based on imaging by magnetic resonance or dual-source spectral computed tomography alone was lower than that of combined detection (p<0.05). Conclusion: Magnetic resonance combined with dual-source spectral computed tomography can improve the diagnosis and treatment efficiency and effectiveness of lumbar disk herniation.