Correlation of the single-segment dynamic stabilization with different segmental mobility and zygapophysial (facet) joint degeneration: a retrospective study in northern China.

OBJECTIVE: To compare the clinical and radiographic outcomes of single-segment posterior decompression combined with two different non-fusion dynamic stabilization systems, Isobar EVO and Isobar TTL, in the context of facet joint degeneration and segmental mobility. METHOD: A retrospective study was conducted on 47 patients who underwent single-segment surgery at the L4/5 level using either the Isobar EVO (n = 23) or Isobar TTL (n = 24) systems. We assessed facet joint degeneration on both sides of the fixed (L3/4, L4/5) and superior adjacent (L2/3) segments using the Fujiwara MRI grading system. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain at baseline, 12 months, and 24 months postoperatively. RESULT: Both groups exhibited significant facet joint degeneration at the fixed segments (L3/4 and L4/5) at 24 months. The TTL group also showed significant degeneration at the superior adjacent segment (L2/3), whereas the EVO group did not. Restoration of lumbar lordosis was significantly better in the EVO group. Pain and disability scores improved more in the EVO group than in the TTL group at both 12 and 24 months postoperatively. CONCLUSION: The Isobar EVO system, with its enhanced mobility, may delay facet joint degeneration in the superior adjacent segment compared to the Isobar TTL system. However, both systems result in degeneration at the fixed segment, indicating a need for further improvements to mimic the natural biomechanics of the spine more closely.

Patterns of osteoarthritis in long finger joints: an observational cadaveric study with potential biomechanical considerations.

PURPOSE: To explore the distribution and prevalence of osteoarthritis in metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints in long fingers in a cadaveric study, and to discuss potential biomechanical influences on these patterns. METHODS: This cadaveric study evaluated 144 metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints from 12 embalmed cadaver hands. A dorsal dissection approach was used to expose the joints, which were then marked with color-coded pegs for consistent orientation during imaging. High-resolution digital images of the distal articular surfaces were captured for analysis. The images were analyzed using custom software to quantify osteoarthritic areas, distinguishing between radial and ulnar aspects. Percentage affected joint surface was calculated using pixel-based measurements. Statistical analysis was used the Student t-test and ANOVA, with the significance threshold set at p < 0.05 and 95% confidence intervals RESULTS: The ulnar side of the proximal interphalangeal joint in digits 2 and 3 showed higher prevalence of osteoarthritis (59.31% ± 15.48%) than the radial side (40.68% ± 15.48%), p = 0.007; in contrast, for digits 4 and 5, prevalence was greater on the radial (54.3% ± 10.99%) than the ulnar side (45.7% ± 10.99%), p = 0.007. No significant differences were noted in osteoarthritis distribution between the radial and ulnar aspects of the metacarpophalangeal and distal interphalangeal joints. CONCLUSIONS: This study identified distinct patterns of osteoarthritis distribution in long-finger joints, with greater prevalence in the proximal interphalangeal joints. Although there were differences between stable (digits 2 and 3) and mobile (digits 4 and 5) fingers, further research is necessary to conclusively determine the role of biomechanical forces in the development of osteoarthritis. These findings lay the groundwork for future studies of the pathophysiology of osteoarthritis in the hand, and could guide the development of preventive and therapeutic interventions.

In Silico Modeling of Stress Distribution in the Diseased Ankle Joint.

Background/Objectives: Osteoarthritis is a feature of the aging process. Here, we adopted in silico 2D finite element modeling (FEM) for the simulation of diseased ankle joints. We delved into the influence of body weight intensity on the stress distribution caused by subchondral cysts imitating degenerative age-related arthritic changes. Methods: FEM was performed using virtually generated pictorial schemes of the ankle joint skeletal contour. It included a constellation of scenarios with solitary or multiple cysts, or the lack thereof, located centrally, peripherally, or both in the talus and tibia at increased fixed levels of body weight. Results: The modeling showed that the highest stress was in the presence of a solitary central cyst in the talus and two centrally located cysts in the talus and the tibia, with the averaged values of 1.81 ± 0.52 MPa and 1.92 ± 0.55 MPa, respectively; there was a significant increase compared with the 1.24 ± 0.35 MPa in the control condition without cysts. An increase in body weight consistently increased the strain on the ankle joint. In contrast, peripherally located cysts failed to affect the stress distribution significantly. Conclusions: We conclude that subchondral central cysts substantially enhance the stress exerted on the ankle joint and its vicinity with body weight dependence. FEM's ability to predict the location and magnitude of subchondral stress changes when confirmed in clinical trials might help to optimize the management of age-related degenerative joint changes.

Oromandibular dystonia as a cause of temporomandibular disorder (Case report) / Distonia oromandibular como causa de disfunção temporomandibular (Relato de caso)

Temporomandibular disorders (TMD) can have multiple etiologies, including oromandibular dystonia (OMD). However, in a few cases, the OMD can evolve from cervical dystonia (CD), leading to severe bone degeneration. The purpose of this case report of a 64-year-old woman presenting to the Outpatient Neurology Clinic of the Federal University of Bahia is to illustrate the development of oromandibular dystonia with temporomandibular joint (TMJ) dysfunction after 10 years of cervical dystonia. Clinical examination showed bone degeneration of the mandibular ramus and right TMJ click, a prevalent sound in patients with temporomandibular disorders when they open their mouths or chew. After onabotulinum toxin type A injections in the right lateral pterygoid muscle, the patient improved in swallowing and pain. This case highlights the importance of close follow-up of cervical dystonia patients to identify new dystonic muscles. In our patient, lateral pterygoid muscle involvement was followed by several comorbidities, such as dysphagia and jawbone abnormalities.

Os distúrbios temporomandibulares (DTM) podem ter múltiplas etiologias, incluindo a distonia oromandibular (DO). No entanto, em raros casos, a DO pode evoluir a partir da distonia cervical (DC) e raramente pode levar a degeneração óssea. O objetivo deste relato de caso de uma mulher de 64 anos atendida no Ambulatório de Neurologia da universidade Federal da Bahia é ilustrar o desenvolvimento de distonia oromandibular com disfunção da articulação temporomandibular (ATM) após 10 anos de distonia cervical. O exame clínico mostrou degeneração óssea do ramo mandibular e clique na ATM direita, um som prevalente em pacientes com distúrbios temporomandibulares quando abrem a boca ou mastigam. Após injeções de toxina botulínica tipo A no músculo pterigoideo lateral direito, a paciente apresentou melhora na deglutição e na dor. Este caso destaca a importância do acompanhamento próximo de pacientes com distonia cervical para identificar novos músculos distônicos. Em nossa paciente, o envolvimento do músculo pterigoide lateral foi seguido por várias comorbidades, como disfagia e anormalidades ósseas da mandíbula.

Biomechanical Predictors of Sacroiliac Joint Uptake on Single-Photon Emission Computed Tomography/Computed Tomography.

OBJECTIVE: Single-photon emission computed tomography/computed tomography (SPECT/CT) is an emerging imaging modality that identifies sites of heightened bone metabolism in response to increased stresses. The relationship between sacroiliac (SI) joint radiotracer uptake and anatomic biomechanical parameters is poorly understood. METHODS: Adult patients with SPECT/CT scans performed at our institution between 2021 and 2023 for the workup of low back pain were included. Patient charts were reviewed for demographic factors including age, gender, and prior thoracolumbar fusion history. Biomechanical spinopelvic parameters were measured from standing scoliosis radiographs. SPECT/CT scans were reviewed for uptake at the SI joint. Patients were stratified into 2 cohorts; patients with SI uptake greater than iliac crest uptake were designated "hot," whereas those with less or equal uptake were labeled "cold." RESULTS: One-hundred and sixty patients met inclusion criteria. Patients were slightly more male (55%) with average age 55 ± 14.9 years. Sixty-eight patients (43%) had evidence of increased SI activity. Interrater reliability showed substantial agreement (kappa = 0.62). The hot cohort demonstrated greater pelvic incidence (54.8 ± 14.0 degrees vs. 51.0 ± 11.0 degrees, P = 0.031) and pelvic tilt (20.8 ± 9.5 degrees vs. 18.4 ± 8.6 degrees, P =0.047) compared with the cold cohort. Patients were otherwise similar between cohorts (P > 0.05). CONCLUSIONS: Increased pelvic incidence and pelvic tilt angles are associated with SPECT/CT uptake at the SI joint, which may reflect altered biomechanics at the spinopelvic junction. SPECT/CT may be a valuable tool to assess SI degeneration. Future studies are warranted to better characterize the clinical applications of these findings.

Parathyroid hormone (1-34) retards the lumbar facet joint degeneration and activates Wnt/ß-catenin signaling pathway in ovariectomized rats.

PURPOSE: Facet joint degeneration (FJD) is a major cause of low back pain. Parathyroid hormone (PTH) (1-34) is commonly used to treat osteoporosis. However, little is known about its effects on FJD induced by estrogen deficiency. This study aims to investigate the effects of PTH (1-34) on FJD induced by estrogen deficiency and the underlying pathogenesis of the disease. METHODS: Forty 3-month-old female Sprague-Dawley rats were randomly divided into four groups: 30 received bilateral ovariectomy (OVX) followed by 12 weeks of treatment with normal saline, PTH (1-34) or 17ß-estradiol (E2), and 10 received sham surgery followed by administration of normal saline. Status and Wnt/ß-catenin signaling activity in the cartilage and subchondral bone of the L4-L5 FJs and serum biomarkers were analyzed. RESULTS: Administration of PTH (1-34) and E2 ameliorated cartilage lesions, and significantly decreased MMP-13 and caspase-3 levels and chondrocyte apoptosis. PTH (1-34) but not E2 significantly increased cartilage thickness, number of chondrocytes, and the expression of aggrecan. PTH (1-34) significantly improved microarchitecture parameters of subchondral bone, increased the expression of collagen I and osteocalcin, and decreased RANKL/OPG ratio. E2 treatment significantly increased the OPG level and decreased the RANKL/OPG ratio in the subchondral bone of ovariectomized rats, but it did not significantly improve the microarchitecture parameters of subchondral bone. Wnt3a and ß-catenin expression was significantly reduced in the articular cartilage and subchondral bone in OVX rats, but PTH (1-34) could increase the expression of these proteins. E2 significantly increased the activity of Wnt/ß-catenin pathway only in cartilage, but not in subchondral bone. The restoration of Wnt/ß-catenin signaling had an obvious correlation with the improvement of some parameters associated with the FJs status. CONCLUSION: Wnt/ß-catenin signaling may be a potential therapeutic target for FJD induced by estrogen deficiency. PTH (1-34) is effective in treating this disease with better efficacy than 17ß-estradiol, and the efficacy may be attributed to its restoration of Wnt/ß-catenin signaling.

Impact of bilateral facet joint violation on radiographic degeneration of superior adjacent segments and clinical outcomes.

OBJECTIVE: Facet joint violation (FJV) is associated with postoperative low-back pain and is a confirmed risk factor for adjacent-segment degeneration, a long-term complication of lumbar fusion surgery. The authors' knowledge of its mechanisms comes from in vitro biomechanical research only; there is a lack of radiographic evidence of the effects of violation on the superior adjacent-segment facet joint, intervertebral disc, and other local radiographic parameters. Furthermore, any differences between unilateral and bilateral violation remain relatively unclear. The authors therefore aimed to explore the effects of nonviolation and unilateral and bilateral violation on radiographic degeneration of the facet joint and intervertebral disc at the fusion and superior adjacent segment. Patient-reported clinical outcomes were compared at the 2-year follow-up. METHODS: The authors retrospectively analyzed data from 148 patients with lumbar degenerative diseases who underwent single-segment minimally invasive transforaminal lumbar interbody fusion between 2016 and 2020. FJV and facet joint degeneration were evaluated and graded using Shah's method and Pathria's standard, respectively. Radiographic parameters, including disc height and intervertebral Cobb angle at the fusion and superior adjacent segment, were measured. Clinical outcomes were evaluated using visual analog scale (VAS) and Japanese Orthopaedic Association scores. RESULTS: Preoperative data were comparable among the 3 groups (nonviolation, unilateral violation, and bilateral violation) (p > 0.05). Patient-reported clinical outcomes were followed up for at least 2 years (average duration 28.17 ± 6.17 months). At the last follow-up, facet joint degeneration grades were sequentially increased in the nonviolation, unilateral violation, and bilateral violation groups (p = 0.006). The unilateral (2.45 ± 2.17 mm) and bilateral (2.70 ± 1.94 mm) violation groups had more severe losses of disc height in the superior adjacent segment than did the nonviolation group (1.31 ± 2.01 mm). The VAS low-back pain and Japanese Orthopaedic Association scores in the bilateral (2.57 ± 1.44 and 19.83 ± 2.84, respectively) and unilateral (2.26 ± 0.79 and 20.43 ± 3.85, respectively) violation groups were significantly worse than in the nonviolation group (1.69 ± 1.12 and 21.80 ± 3.36, respectively) (p < 0.05). By contrast, there were no significant between-group differences in disc height, intervertebral Cobb angle in the fusion segment, or VAS leg pain scores (p > 0.05). CONCLUSIONS: FJV was associated with postoperative low-back pain and worse functional outcomes. It also aggravated facet joint and intervertebral disc changes in the superior adjacent segment, especially when bilateral violation occurred; this may be part of the mechanisms of adjacent-segment degeneration.

Development and validation of a nomogram to predict the risk of residual low back pain after tubular microdiskectomy of lumbar disk herniation.

OBJECTIVE: Tubular microdiskectomy (tMD) is one of the most commonly used for treating lumbar disk herniation. However, there still patients still complain of persistent postoperative residual low back pain (rLBP) postoperatively. This study attempts to develop a nomogram to predict the risk of rLBP after tMD. METHODS: The patients were divided into non-rLBP (LBP VAS score < 2) and rLBP (LBP VAS score ≥ 2) group. The correlation between rLBP and these factors were analyzed by multivariate logistic analysis. Then, a nomogram prediction model of rLBP was developed based on the risk factors screened by multivariate analysis. The samples in the model are randomly divided into training and validation sets in a 7:3 ratio. The Receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the diskrimination, calibration and clinical value of the model, respectively. RESULTS: A total of 14.3% (47/329) of patients have persistent rLBP. The multivariate analysis suggests that higher preoperative LBP visual analog scale (VAS) score, lower facet orientation (FO), grade 2-3 facet joint degeneration (FJD) and moderate-severe multifidus fat atrophy (MFA) are risk factors for postoperative rLBP. In the training and validation sets, the ROC curves, calibration curves, and DCAs suggested the good diskrimination, predictive accuracy between the predicted probability and actual probability, and clinical value of the model, respectively. CONCLUSION: This nomogram including preoperative LBP VAS score, FO, FJD and MFA can serve a promising prediction model, which will provide a reference for clinicians to predict the rLBP after tMD.

Curcumin and Resveratrol: Nutraceuticals with so Much Potential for Pseudoachondroplasia and Other ER-Stress Conditions.

Natural products with health benefits, nutraceuticals, have shown considerable promise in many studies; however, this potential has yet to translate into widespread clinical use for any condition. Notably, many drugs currently on the market, including the first analgesic aspirin, are derived from plant extracts, emphasizing the historical significance of natural products in drug development. Curcumin and resveratrol, well-studied nutraceuticals, have excellent safety profiles with relatively mild side effects. Their long history of safe use and the natural origins of numerous drugs contrast with the unfavorable reputation associated with nutraceuticals. This review aims to explore the nutraceutical potential for treating pseudoachondroplasia, a rare dwarfing condition, by relating the mechanisms of action of curcumin and resveratrol to molecular pathology. Specifically, we will examine the curcumin and resveratrol mechanisms of action related to endoplasmic reticulum stress, inflammation, oxidative stress, cartilage health, and pain. Additionally, the barriers to the effective use of nutraceuticals will be discussed. These challenges include poor bioavailability, variations in content and purity that lead to inconsistent results in clinical trials, as well as prevailing perceptions among both the public and medical professionals. Addressing these hurdles is crucial to realizing the full therapeutic potential of nutraceuticals in the context of pseudoachondroplasia and other health conditions that might benefit.

Evaluation and analysis of surgical treatment for single-level or multi-level lumbar degenerative disease based on radiography.

Background: Radiography has a low level of radiation exposure while providing valuable information. Due to its cost effectiveness and widespread availability, the preoperative radiographic imaging examination is a valuable approach for assessing patients with spinal disease. This study aimed to examine the influence of preoperative X-ray evaluation on the surgical treatment of patients with single- or multi-level lumbar degenerative disease (LDD). Methods: A retrospective cohort analysis was conducted of 172 patients diagnosed with LDD who underwent transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) surgery between December 2021 and February 2023 at the Shanghai Changzheng Hospital. Various parameters were measured on preoperative radiographs, including the iliac crest height, median iliac angle (MIA), lumbar lordosis (LL), intervertebral facet joint degeneration, lumbosacral angle (LSA), intervertebral foramen height (IFH), and surgical segment. The surgical treatment was evaluated based on the operative time, intraoperative blood loss, and postoperative complications. A correlation analysis and independent sample t-tests were used to assess the relationship between preoperative radiographic variables and surgical treatments. Further, a multivariate linear regression analysis was employed to identify the risk factors affecting the clinical outcomes. Results: The correlation analysis and t-test results showed that the MIA, height of the iliac crest, intervertebral facet joint degeneration, and surgical segment were significantly correlated with the surgical treatments (P<0.05). Specifically, the height of the iliac crest, intervertebral facet joint degeneration, and surgical segment were positively correlated with the surgical treatments. Conversely, the MIA was negatively correlated with the surgical treatments. However, no significant differences were observed between the IFH, LSA, and LL in relation to posterior lumbar surgery (P>0.05). The multiple linear regression analysis showed that the height of the iliac crest, MIA, intervertebral facet joint degeneration, and surgical segment were independent factors affecting the surgical treatments of patients with single- or multi-level LDD. These findings highlight the importance of considering these factors when planning and performing lumbar surgery. Conclusions: The measurements taken from radiographs, including the height of the iliac crest, MIA, intervertebral facet joint degeneration, and surgical segment, demonstrate potential influences on the treatment of single- and multi-level lumbar spine surgery. These variables can be captured in plain film imaging and can provide valuable insights into the surgical procedure and offer guidance for the operation. By analyzing these radiographic measurements, surgeons can gain a better understanding of a patient's condition and tailor the surgical approach accordingly, thus optimizing the outcomes of the surgery.

Molecular mechanisms of autophagy-apoptosis interactions in osteoarthritis / 中国组织工程研究

BACKGROUND:With the deepening of the aging of the world population,the prevalence rate of osteoarthritis is increasing.In recent years,more and more attention has been paid to the study of osteoarthritis.Studies have shown that autophagy and apoptosis are strongly associated with the occurrence and development of osteoarthritis,and play an important role in it. OBJECTIVE:To review the molecular mechanisms of the interaction between autophagy and apoptosis in osteoarthritis,aiming to explore the relationship between autophagy and apoptosis in osteoarthritis and the coupling mechanism of the two to mediate the occurrence and development of osteoarthritis,so as to provide new ideas for the treatment of osteoarthritis. METHODS:The Chinese and English key words"osteoarthritis,autophagy,apoptosis"were searched in the CNKI and PubMed.After screening by reading the title,abstract and key words,the relevant literature was carefully read.After excluding studies unrelated to the content of the paper and repetitive studies,68 articles were finally included for the summary. RESULTS AND CONCLUSION:(1)The occurrence and development of osteoarthritis are related to autophagy and apoptosis of chondrocytes.Autophagy protects chondrocytes from stress damage,but excessive autophagy also induces or promotes chondrocyte apoptosis and reduces the survival rate of chondrocytes.The two perturb each other to regulate the degeneration of articular cartilage.(2)miRNA,Beclin-1 and oxidative stress are all involved in the regulation of autophagy and apoptosis on osteoarthritis,and affect the development of osteoarthritis.

Hip joint and muscle loading for persons with bilateral transfemoral/through-knee amputations: biomechanical differences between full-length articulated and foreshortened non-articulated prostheses.

BACKGROUND: Currently, there is little available in-depth analysis of the biomechanical effect of different prostheses on the musculoskeletal system function and residual limb internal loading for persons with bilateral transfemoral/through-knee amputations (BTF). Commercially available prostheses for BTF include full-length articulated prostheses (microprocessor-controlled prosthetic knees with dynamic response prosthetic feet) and foreshortened non-articulated stubby prostheses. This study aims to assess and compare the BTF musculoskeletal function and loading during gait with these two types of prostheses. METHODS: Gait data were collected from four male traumatic military BTF and four able-bodied (AB) matched controls using a 10-camera motion capture system with two force plates. BTF completed level-ground walking trials with full-length articulated and foreshortened non-articulated stubby prostheses. Inverse kinematics, inverse dynamics and musculoskeletal modelling simulations were conducted. RESULTS: Full-length articulated prostheses introduced larger stride length (by 0.5 m) and walking speed (by 0.3 m/s) than stubbies. BTF with articulated prostheses showed larger peak hip extension angles (by 10.1°), flexion moment (by 1.0 Nm/kg) and second peak hip contact force (by 3.8 bodyweight) than stubbies. There was no difference in the hip joint loading profile between BTF with stubbies and AB for one gait cycle. Full-length articulated prostheses introduced higher hip flexor muscle force impulse than stubbies. CONCLUSIONS: Compared to stubbies, BTF with full-length articulated prostheses can achieve similar activity levels to persons without limb loss, but this may introduce detrimental muscle and hip joint loading, which may lead to reduced muscular endurance and joint degeneration. This study provides beneficial guidance in making informed decisions for prosthesis choice.

Comparison of Intraoperative Endplate Injury between Mini-Open Lateral Lumbar Interbody Fusion (LLIF) and Transforaminal Lumbar Interbody Fusion (TLIF) and Analysis of Risk Factors: A Retrospective Study.

OBJECTIVE: The study aimed to compare the incidence of intraoperative endplate injury in patients who underwent Transforaminal interbody fusion (TLIF) and mini-open lumbar interbody fusion (LLIF) surgery. The independent risk factors related to endplate injury in LLIF procedure were analyzed. METHODS: A total of 199 patients who underwent LLIF (n = 106) or TLIF (n = 93) surgery from June 2019 to September 2021 were reviewed. The endplate injury was assessed by postoperative sagittal CT scan. A binary logistic analysis model were used to identify independent risk factors related to LLIF endplate injury based on univariate analysis. RESULTS: There was an obvious difference in the occurrence of intraoperative endplate injury between LLIF (42/106, 39.6%) and TLIF group (26/93, 28%), although it did not reach the significant level. L1 CT value (OR = 0.985, 95% CI = 0.972-0.998), cage position (OR = 3.881, 95% CI = 1.398-10.771) and height variance (OR = 1.263, 95% CI = 1.013-1.575) were independent risk factors for endplate injury in LLIF procedure. According to the cage settlement patterns, there 5 types of A to E. The severity of the facet joint degeneration was positively related to the occurrence of endplate injury. CONCLUSIONS: The incidence of intraoperative endplate injury is higher in LLIF than in TLIF procedures. Low bone quantity, cage posterior position and larger height variance are risk factors to induce endplate injury in LLIF surgery. The facet joint degeneration may be related to severe endplate injuries and even fractures.

Early Resveratrol Treatment Mitigates Joint Degeneration and Dampens Pain in a Mouse Model of Pseudoachondroplasia (PSACH).

Pseudoachondroplasia (PSACH), a severe dwarfing condition associated with early-onset joint degeneration and lifelong joint pain, is caused by mutations in cartilage oligomeric matrix protein (COMP). The mechanisms underlying the mutant-COMP pathology have been defined using the MT-COMP mouse model of PSACH that has the common D469del mutation. Mutant-COMP protein does not fold properly, and it is retained in the rough endoplasmic reticulum (rER) of chondrocytes rather than being exported to the extracellular matrix (ECM), driving ER stress that stimulates oxidative stress and inflammation, driving a self-perpetuating cycle. CHOP (ER stress signaling protein) and TNFα inflammation drive high levels of mTORC1 signaling, shutting down autophagy and blocking ER clearance, resulting in premature loss of chondrocytes that negatively impacts linear growth and causes early joint degeneration in MT-COMP mice and PSACH. Previously, we have shown that resveratrol treatment from birth to 20 weeks prevents joint degeneration and decreases the pathological processes in articular chondrocytes. Resveratrol's therapeutic mechanism of action in the mutant-COMP pathology was shown to act by primarily stimulating autophagy and reducing inflammation. Importantly, we demonstrated that MT-COMP mice experience pain consistent with PSACH joint pain. Here, we show, in the MT-COMP mouse, that resveratrol treatment must begin within 4 weeks to preserve joint health and reduce pain. Resveratrol treatment started at 6 or 8 weeks (to 20 weeks) was not effective in preventing joint degeneration. Collectively, our findings in MT-COMP mice show that there is a postnatal resveratrol treatment window wherein the inevitable mutant-COMP joint degeneration and pain can be prevented.

Bixa orellana ethyl acetate fraction and its isolated compound ellagic acid attenuate the progression of MIA-induced osteoarthritis in rat knees.

Osteoarthritis (OA) is a pathology that is characterized by progressive erosion of articular cartilage. In this context, medicinal plants have become relevant tools regarding their potential role in the prevention and treatment of OA, being safe and effective. The aim of this work was investigate the therapeutic efficacy of the ethyl acetate fraction of Bixa orellana leaves (BoEA) and ellagic acid (ElAc) for the therapeutic treatment of OA induced by monosodium iodoacetate (MIA) in rats. The plant material was extracted via maceration with 70 % hydroalcoholic solvent (BoHE). The ethyl acetate (BoEA) fraction was by solvents in increasing order of polarity. The ElAc was identified and isolated in BoEA using high performance liquid chromatography (HPLC-DAD) and analytical curve. The OA was induced using MIA in the right knee at the knee joint. Doses of BoEA and ElAc were administered daily (every 24 h, orally) at concentrations of 50, 100 and 50 mg/kg, respectively, for 28 days after induced OA. We evaluated the animals through clinical and radiological examinations every 7 days and, on the 29th day, the animals were euthanized, the joints being removed for histopathological analysis and the serum for cytokine analysis. BoEA and ElAc compounds reduced inflammation and nociception in OA and were as effective as indomethacin in clinical parameters of joint discomfort and allodynia in rats, in addition to showing improvements in radiological and histopathological images, acting on the progress of cartilage deterioration, proving properties related to anti-inflammatory and analgesic processes, being important allies for new therapeutic interventions for the treatment of OA.

Risk Factors of Low Back Pain Aggravation After Tubular Microdiscectomy of Lumbar Disc Herniation.

BACKGROUND: Although lumbar disc herniation (LDH) patients' sciatic symptoms such as leg pain can be improved by decompressive surgery, some patients report postoperative aggravated low back pain (LBP). However, the exact reason for this phenomenon remained unknown. METHODS: We retrospectively analyzed the prospectively collected LDH data of patients who underwent tubular microdiscectomy between December 2015 and December 2020. The patients were divided into aggravated and non-aggravated group according to whether the postoperative LBP visual analogue scale (VAS) score was higher than the preoperative score. We analyzed the relationship of the clinical and radiologic parameters with aggravated LBP. RESULTS: Postoperative aggravated LBP cases accounted for 14.1% (57 of 404) of this series. Of the 57 patients, 88% (50 of 57) had mild postoperative LBP aggravation (1-2), and 12% (7 of 57) had severe LBP aggravation (>2). The preoperative LBP VAS score of the aggravated group was significantly lower than that of the non-aggravated group (P < 0.001), while the LBP VAS score and Oswestry Disability Index at final follow-up was significantly higher in the aggravated group (P < 0.05). Additionally, the proportion of preoperative moderate-to-severe multifidus fatty atrophy (MFA) and lumbar facet joint degeneration (LFJD) was significantly higher in the aggravated group. A multiple stepwise logistic regression analysis indicated that the preoperative LBP VAS score (P < 0.001, odds ratio 0.266, 95% CI 0.161-0.439) and MFA (P < 0.001, odds ratio 4.491, 95% CI 2.092-9.640) were the risk factors for postoperative aggravated LBP. CONCLUSIONS: A preoperative lower LBP VAS score and moderate-to-severe MFA were associated with postoperative aggravated LBP. This will provide important guidance for patient's preoperative assessment and education.

A retrospective cohort study on the significance of preoperative radiological evaluation of lumbar degenerative diseases for surgical reference.

Background: Radiography has low radiation exposure and the ability to acquire information. Due to its cost-effectiveness and availability, preoperative radiographic imaging examination is considered to be a valuable method to evaluate the condition of patients with spinal disease. The aim of this cohort study is to analyze the impact of evaluating preoperative X-rays on the surgical management of lumbar degenerative diseases (LDD). Methods: We reviewed 49 patients with LDD underwent single-level posterior instrumented lumbar fusion (PILF) between November 2017 and October 2022 in this cohort study. The median iliac angle (MIA), iliac crest height, intervertebral facet joint degeneration, lumbosacral angle (LSA), L5/S1 intervertebral space angle (ISA), intervertebral foramen height (IFH) and intervertebral space height (ISH) were measured on preoperative radiographs. In addition, operative time, intraoperative blood loss and postoperative complications were used to evaluate the surgical management. Correlation analysis was used to determine the correlation between preoperative radiographic presentation and surgical managements. Multivariate linear regression analysis was used for determination of risk factors for surgical management. Results: Correlation analysis showed that the median iliac angle, height of iliac crest, lumbosacral angle and intervertebral facet joint degeneration were significantly correlated with surgical managements (P<0.05). Height of iliac crest, intervertebral facet joint degeneration and lumbosacral angle were positively correlated with surgical management. Meanwhile, MIA was negatively correlated with surgical management. No significant difference was found between the IFH, ISA, ISH and surgical managements in posterior lumbar surgery (P>0.05). After multiple linear regression analysis, height of iliac crest, median iliac angle and intervertebral facet joint degeneration were independent influence factors for the single-level lumbar surgical managements. Conclusions: Some variables measured in radiograph shows that height of iliac crest, median iliac angle and intervertebral facet joint degeneration have a potential influence on surgical managements. The lumbosacral angle was positively associated with surgical management, but it was not statistically significant in multiple linear regression analysis (P>0.05). The above measurements in plain film can reflect the surgical procedure and have some guiding implications for the operation.

Geyser Sign: An Eruption of Fluid through the Acromioclavicular Joint in Chronic Rotator Cuff Degeneration.

Teaching Point: Leakage of fluid or intra-articular contrast from the subacromial bursa through the acromioclavicular joint, also known as the 'geyser sign', is an uncommon presentation of chronic rotator cuff injury and acromioclavicular joint degeneration.

[Effect of adjacent segmental facet joint degeneration on adjacent segment disease after lumbar fusion and fixation].

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.

Long-term whole-body vibration induces degeneration of intervertebral disc and facet joint in a bipedal mouse model.

Background: Whole body vibration (WBV) has been used to treat various musculoskeletal diseases in recent years. However, there is limited knowledge about its effects on the lumbar segments in upright posture mice. This study was performed to investigate the effects of axial Whole body vibration on the intervertebral disc (IVD) and facet joint (FJ) in a novel bipedal mouse model. Methods: Six-week-old male mice were divided into control, bipedal, and bipedal + vibration groups. Taking advantage of the hydrophobia of mice, mice in the bipedal and bipedal + vibration groups were placed in a limited water container and were thus built standing posture for a long time. The standing posture was conducted twice a day for a total of 6 hours per day, 7 days per week. Whole body vibration was conducted during the first stage of bipedal building for 30 min per day (45 Hz with peak acceleration at 0.3 g). The mice of the control group were placed in a water-free container. At the 10th-week after experimentation, intervertebral disc and facet joint were examined by micro-computed tomography (micro-CT), histologic staining, and immunohistochemistry (IHC), and gene expression was quantified using real-time polymerase chain reaction. Further, a finite element (FE) model was built based on the micro-CT, and dynamic Whole body vibration was loaded on the spine model at 10, 20, and 45 Hz. Results: Following 10 weeks of model building, intervertebral disc showed histological markers of degeneration, such as disorders of annulus fibrosus and increased cell death. Catabolism genes' expression, such as Mmp13, and Adamts 4/5, were enhanced in the bipedal groups, and Whole body vibration promoted these catabolism genes' expression. Examination of the facet joint after 10 weeks of bipedal with/without Whole body vibration loading revealed rough surface and hypertrophic changes at the facet joint cartilage resembling osteoarthritis. Moreover, immunohistochemistry results demonstrated that the protein level of hypertrophic markers (Mmp13 and Collagen X) were increased by long-durationstanding posture, and Whole body vibration also accelerated the degenerative changes of facet joint induced by bipedal postures. No changes in the anabolism of intervertebral disc and facet joint were observed in the present study. Furthermore, finite element analysis revealed that a larger frequency of Whole body vibration loading conditions induced higher Von Mises stresses on intervertebral disc, contact force, and displacement on facet joint. Conclusion: The present study revealed significant damage effects of Whole body vibration on intervertebral disc and facet joint in a bipedal mouse model. These findings suggested the need for further studies of the effects of Whole body vibration on lumbar segments of humans.