Annulus Tears Research Articles

Modeling Degenerative Disc Disease under a Stochastic Disease Random Branching Process

Degenerative disc disease (DDD) is a leading source of neck and lower back pain, especially among older adults and individuals in high‐load occupations. Clinical practice currently struggles to predict DDD quantitatively, delaying effective intervention. This project proposes a three‐stage, continuous stochastic model describing disc degeneration initiation, progression, and propagation to adjacent discs. By incorporating measurable disc indicators — such as height loss, displacement, and annulus tears — into a physics–statistics‐based framework, we derive DDD metrics that estimate disc lifespans, the probability of multi‐level degeneration, and time‐to‐pain events. We then interpret these metrics to guide personalized decisions about whether to treat only severely degenerated discs or also discs likely to degenerate soon, factoring in age, occupation, and lifestyle. With real‐time MRI data, the model updates dynamically, strengthening its clinical relevance. Our findings could enhance early detection, inform optimal surgical timing, and improve outcomes for at‐risk populations, including Hong Kong’s aging workforce.

THE RELATIONSHIP OF AGE AND GENDER WITH LUMBAR SPINE DEGENERATIVE CHANGES IN PATIENTS WITH LOW BACK PAIN

Objective: To evaluate the prevalence of various types of degenerative changes and to assess the relationship between the degenerative changes with age and gender of patients presenting with low back pain. Methods: A retrospective cross-sectional observational study was conducted on patients who presented with LBP to the Radiology Department of Khyber Teaching Hospital Peshawar from June 2017 to May 2018 for a lumbosacral spine MRI. Frequencies and distribution of Pfirrman grading, Modic changes, disc herniation, and annulus tear were assessed. Additionally, their association with the age and gender of the patient was assessed by regression analysis. Statistical analysis was done using SPSS 23 software. Results: 163 MRI lumbar spine of patients between 30 and 90 years were included in our study. The mean age of patients was 46.88 with a 12.136 standard deviation. 83 patients were male (50.9%) and 80 (49.1%) were female. Age has a significant association with Pfirrman grading at L2-L3 to L5-S1 level (p-value <0.01). The proportion of degenerated segments also increased with increasing age. The greatest number of Modic changes were seen in the age range of 61-70 years (38.2%). Most annulus tears were seen at L4-L5 levels followed by L3-L4. 19% of males had annulus tears while 23.3% of females had annulus tears. The most disc bulges were seen in 31-40 years (n=155) followed by 41-50 years(n=75). Conclusion: Endplate changes and disc degenerative changes are associated with increasing age. Degenerative changes in the lumbar spine are not statistically different in male and female populations.

Nucleus high intensity in the T2-weighted MRI is a potential predictor of annulus tear in cervical injured patients: a case comparative study.

Segmental fusion operations assume paramount significance for individuals afflicted by full layers of annulus tears as they avert the perils of rapid disc degeneration and segmental instability. Structures with high signal intensity in the T2-weighted MRI can predict potential damage to the injured segment. Since local structures are shortly related biomechanically, this may be an effective predictor for annulus tears. A retrospective analysis of the clinical data of 57 patients afflicted by cervical injuries and subjected to single-segment ACDF has been performed in this study. The surgeon performed intraoperative exploration to assess the integration status of the annulus. The signal intensity of the prevertebral space, nucleus, and injured vertebral bodies were judged in the T2-weighted imaging data. Regression analyses identified independent predictors for annulus tears, and the area under the receiver operating characteristic curve (AUC) was computed to evaluate the predictive performance of potential independent predictors. The occurrence of nucleus high intensity was significantly higher among individuals with annulus tears, and the nucleus high intensity was deemed an independent predictor for determining the presence of intraoperative visible annulus tears in patients with cervical injuries. AUC for nucleus high intensity was calculated as 0.717, with a corresponding p-value less than 0.05. In the realm of diagnosing annulus tears in injured cervical patients, nucleus high intensity in the T2-weighted MRI emerges as a promising predictive factor. Notably, this applies specifically to patients devoid of fracture and visible annulus tears in their MRI scans. Such positive outcomes should be regarded as prospective indications for ACDF.

Specific Exercise for Spine can Improve Lumbar Spondylosis: A Case Report

Background: At some stage in their lives, between 60-85% of adults suffer from low back pain (LBP). Fortunately, symptoms are mild and intermittent for the vast majority of people, with 90 percent subsidization within six weeks. An approximate 15-45 percent of the individuals affected by chronic back pain, defined as symptoms such as pain that last beyond 3 months. The effect on the livelihoods and economic results are significant for the minority with intractable symptoms. Considering the high incidence of low back pain, the diagnostic strategy and treatment options are complex and sometimes conflicting and within the general population. Rising the expense and inconsistency of management throughout the nation. In fact, this is because it is impossible for most patients to establish a particular etiology, with established axial spine-wide nociceptive pain generators identified.
 Clinical Finding: Patient having complaint of pain in lower back region and Radiated in the posterior part of the thigh, as well as lower limb numbness. Morning stiffness was present. On examination active movement (Range of Motion) of lumbar flexion, lumbar Extension and lumbar lateral flexions lightly restricted and painful at the end of range of motion.
 Diagnosis: MRI was done, it shows posterior annulus tear on the level of L4-L5, L4-L5 –Diffuse disc bulge with right-sided bulge subarticular is disc protrusion causing indentation on anterior thecal sac with moderate to severe narrowing of bilateral neural foramina with propensity toward right side with compression of traversing and exiting nerve roots.
 Conclusion: This case report provides patient with inclusive recovery which helped her to relieve pain.

Mechanical Aspects of Intervertebral Disc Injury and Implications on Biomechanics.

This article comprises a review of the literature. The purpose of this study was to elucidate the different types of structural failures exhibited in intervertebral discs (IVDs), summarize their potential causes with respect to mechanical loading conditions and the consequences on cell homeostasis and biomechanics. Many studies have been performed to gain insight into how discogenic back pain progresses in humans both in vitro and in vivo as well as in animal disc models. However, there is a major need to summarize the common factors which initiate the structural failures observed in IVDs and the typical biomechanical changes. This work could help in developing mechanisms aiming to restore the biochemical and biomechanical balance of IVDs. The different types of structural failures encountered in IVDs were reviewed from published literature. The types of mechanical loading causing these injuries and their physiological and biomechanical consequences were then summarized and linked to ongoing research in this area. The most prominent structural failures associated with IVDs are annulus tears, disc prolapse, endplate damage, disc narrowing, radial bulging, and osteophyte formation in the vertebrae. IVDs were found to be vulnerable to compression, flexion, axial rotation, and complex loading mechanisms through single impact, cyclical, and continuous loading. However, chronic loadings had a more damaging impact on the spine. Significant consequences include imbalance of metabolic enzymes and growth factors, alteration in stress profiles of IVDs and a decrease in mechanical stiffness resulting in impaired biomechanics of the spine. The mode of loading has an important impact on the severity and nature of failures seen in IVDs and the resulting consequences to biomechanics. However, further research is necessary to better understand to the mechanisms that link injury to degeneration and regeneration of IVD tissues. 3.

Fibrin sealants in lumbar annuloplasty after endoscopic discectomy as a method to prevent recurrent lumbar disc herniation

Fibrin sealant as a promising agent for providing scaffold and efficient hemostasis is widely accepted in several specialties. However, the outcome of Fibrin sealants in lumbar annuloplasty after endoscopic discectomy has not been evaluated in patients with disc herniation. The goal of this study was to evaluate the efficacy, response, and probability of future recurrence rates in herniated nucleus pulposus (HNP) with the use of fibrin sealant in conjunction with endoscopic disc surgery. A total of 35 patients (28 men, 7women) were evaluated, including 18 patients who underwent endoscopic discectomy alone and 17 patients that received fibrin sealant at the site of annulus tear and endoscopic discectomy. All patients were followed through both clinical and imaging methods for an average of 10.5 months. Primary outcome measure was defined as lumbar decompression approved by imaging and symptom alleviation after endoscopic spinal discectomy with Visual Analogue Scale (VAS) score ≤ 4 (cut-off point). Median size of annular tearing was significantly lower in the endoscopic discectomy group (median, 3) (minimum, 2; maximum, 5); however, the corresponding factor in the endoscopic discectomy plus fibrin sealant group was significantly larger (median, 6) (minimum, 5; maximum, 10), with P <0.001. Only one patient in the endoscopic discectomy group had an HNP recurrence during follow-up compared to two patients in the endoscopic discectomy plus fibrin sealant group. Due to the temporary effects of fibrin sealant in preventing disc herniation and the observed recurrence rate in both the case and control groups, the results of this study suggest a role of fibrin sealants combined with endoscopic discectomy to prevent early HNP recurrence rate.

Fibrin sealants in lumbar annuloplasty after endoscopic discectomy as a method to prevent recurrent lumbar disc herniation.

Fibrin sealant as a promising agent for providing scaffold and efficient hemostasis is widely accepted in several specialties. However, the outcome of Fibrin sealants in lumbar annuloplasty after endoscopic discectomy has not been evaluated in patients with disc herniation. The goal of this study was to evaluate the efficacy, response, and probability of future recurrence rates in herniated nucleus pulposus (HNP) with the use of fibrin sealant in conjunction with endoscopic disc surgery. A total of 35 patients (28 men, 7women) were evaluated, including 18 patients who underwent endoscopic discectomy alone and 17 patients that received fibrin sealant at the site of annulus tear and endoscopic discectomy. All patients were followed through both clinical and imaging methods for an average of 10.5 months. Primary outcome measure was defined as lumbar decompression approved by imaging and symptom alleviation after endoscopic spinal discectomy with Visual Analogue Scale (VAS) score ≤ 4 (cut-off point). Median size of annular tearing was significantly lower in the endoscopic discectomy group (median, 3) (minimum, 2; maximum, 5); however, the corresponding factor in the endoscopic discectomy plus fibrin sealant group was significantly larger (median, 6) (minimum, 5; maximum, 10), with P <0.001. Only one patient in the endoscopic discectomy group had an HNP recurrence during follow-up compared to two patients in the endoscopic discectomy plus fibrin sealant group. Due to the temporary effects of fibrin sealant in preventing disc herniation and the observed recurrence rate in both the case and control groups, the results of this study suggest a role of fibrin sealants combined with endoscopic discectomy to prevent early HNP recurrence rate.

Disc lesions treated with ozone in Pakistan: experience of 23000 cases [abstract

BACKGROUND AND PURPOSE: Direct injection of Oxygen-Ozone in to the discs has proved to be the effective alternative for surgery in patients with disc herniation in many countries around the world. We report our experience with ozonucleolysis with patients effected by lower backache, sciatica and pain cervical region (brachalgia) due to disc herniation including post operative recurrence or disc prolapse.&#x0D; &#x0D; MATERIAL &amp; METHODS: Twenty-Three Thousand patients were treated with single two multiple sessions of Oxygen Ozone therapy. All the patients had CT or MRI evidence of annulus tear/ disc prolapse with clinical signs of nerve root compression. The procedure was performed under angio fluoroscopy using 22/23 G spinal needle without any form of anesthesia. All the patients received intra discal injection of Oxygen Ozone mixture with and without periganglionic infiltration at a ozone concentration 30 mcgr/mL. Among these patients 14000 were males and 9000 were females between the age of 14-80 years. Therapeutic outcome was assessed 5 months after treatment by using modified MacNab method.&#x0D; &#x0D; RESULTS: A satisfactory therapeutic outcome was obtained. 55% of the patients showed complete recovery with resolution of symptoms. 20% of the patients complained of occasional episodic pain and with no limitation of occupational activity. 15% of cases showed insufficient improvement. 5% of cases had insufficient improvement and went for surgery. 10% of cases never turned up after the first visit.&#x0D; &#x0D; CONCLUSION: Intradiscal with and without periganglionic injection of Ozone for herniated discs has revolutionized percutaneous approach to nerve root diseases making it safer, cheaper and easier to repeat than treatments currently use in Pakistan.

Transforaminal endoscopic system technique for discogenic low back pain: A prospective Cohort study

Transforaminal endoscopic system technique for discogenic low back pain: A prospective Cohort study

The dose-response relationship between cumulative lifting load and lumbar disk degeneration based on magnetic resonance imaging findings.

Lumbar disk degeneration (LDD) has been related to heavy physical loading. However, the quantification of the exposure has been controversial, and the dose-response relationship with the LDD has not been established. The purpose of this study was to investigate the dose-response relationship between lifetime cumulative lifting load and LDD. This was a cross-sectional study. Every participant received assessments with a questionnaire, magnetic resonance imaging (MRI) of the lumbar spine, and estimation of lumbar disk compression load. The MRI assessments included assessment of disk dehydration, annulus tear, disk height narrowing, bulging, protrusion, extrusion, sequestration, degenerative and spondylolytic spondylolisthesis, foramina narrowing, and nerve root compression on each lumbar disk level. The compression load was predicted using a biomechanical software system. A total of 553 participants were recruited in this study and categorized into tertiles by cumulative lifting load (ie, <4.0 × 10(5), 4.0 × 10(5) to 8.9 × 10(6), and ≥8.9 × 10(6) Nh). The risk of LDD increased with cumulative lifting load. The best dose-response relationships were found at the L5-S1 disk level, in which high cumulative lifting load was associated with elevated odds ratios of 2.5 (95% confidence interval [95% CI]=1.5, 4.1) for dehydration and 4.1 (95% CI=1.9, 10.1) for disk height narrowing compared with low lifting load. Participants exposed to intermediate lifting load had an increased odds ratio of 2.1 (95% CI=1.3, 3.3) for bulging compared with low lifting load. The tests for trend were significant. There is no "gold standard" assessment tool for measuring the lumbar compression load. The results suggest a dose-response relationship between cumulative lifting load and LDD.

339 Life-time cumulative lift load and lumbar disc degeneration

ObjectivesLumbar disc degeneration (LDD) has been associated with cumulative lift load. However, dose-response relationship has not been established in Asia workers. The goal of this study is to investigate whether...

Healing of painful intervertebral discs: implications for physiotherapy

Background: Population studies show close associations between intervertebral disc degeneration and back pain, with structural changes such as annulus tears being most closely related to pain. However, little effort has been made to link back pain to disc injury in individual patients, or to treat the disc injury in a similar way to a ligament or tendon sprain.Objectives: To re-interpret the scientific literature in order to provide a rationale for physical therapy treatments that aim to promote ‘disc healing’.Major Findings: Intervertebral discs deteriorate over many years, from the nucleus outwards, to an extent that is influenced by genetic inheritance, metabolite transport, and mechanical loading. Additionally, surgically-removed ‘painful’ human discs usually show an active inflammatory process proceeding from the outside-in. There is growing evidence that the ligamentous outer annulus can be re-innervated, and sensitized to pain by inflammatory-like responses to injury, and from displaced nucleus pulposus. Animal studies confirm that effective disc healing occurs only in the outer annulus and endplate, where cell density and metabolite transport are greatest. Identifying discogenic pain is not easy, but techniques are available. Healing of the disc periphery has the potential to relieve pain, by reducing inflammation and restoring function.Conclusion: Physical therapies should aim to promote healing in the disc periphery, by stimulating cells, boosting metabolite transport, discouraging adhesion formation, and preventing re-injury. Such an approach, which can be applied through information sessions and classes, has the potential to bring about pain relief to large numbers of back pain sufferers through self-treatment.

The Chemokines CXCL10 and XCL1 Recruit Human Annulus Fibrosus Cells

Human annulus fibrosus tissue and cells were analyzed for the presence of chemokine receptors and the migratory effect of selected chemokines. To investigate spontaneous repair mechanisms and underlying cell recruitment in response to annular tears and degenerative defects. Resorption of herniated disc tissue and the attempt to close annulus tears with repair tissue occur spontaneously. Although chemokines are suggested to play a role in resorption of herniated disc tissue, the role of chemokines in annulus fibrosus homeostasis and repair remains unclear. Cells were isolated from annulus fibrosus tissue and expanded in the presence of human serum. Multiwell chemotaxis assays were used to analyze the migratory effect of human serum and 0 to 1000 nM concentrations of the chemokines CXCL7, CXCL10, CXCL12, CCL25, and XCL1 on annulus fibrosus cells (AFCs) (n = 9 per chemokine and dose). Presence of corresponding chemokine receptors in AFCs was determined by real-time polymerase chain reaction analysis and immunohistochemistry. Serum (0.1%-10%) significantly (P < 0.01) stimulates the migration of AFCs. Compared with untreated cells, the migration of cells was significantly (P < 0.01) enhanced upon stimulation with 100 to 1000 nM CXCL10 and 1000 nM XCL1. Chemokine receptors showed low expression levels in expanded AFCs as assessed by polymerase chain reaction. Immunohistochemical staining of the CXCL10 receptor CXCR3 and the XCL1 receptor XCR1 showed that the presence of the particular receptors in AFCs expanded under conventional cell culture conditions. In native annulus fibrosus tissue, CXCR3 was evident, whereas XCR1 could not be detected. The findings suggest that chemokines, in particular CXCL10, effectively recruit isolated AFCs. This suggests that chemokines are involved in annulus fibrosus homeostasis and potentially in spontaneous annulus repair attempts. This might have important implications for biological annulus-sealing strategies.

New Back Pain In A Collegiate Wrestler With Lumbar Degenerative Disk Disease

HISTORY: A 20 year old sophomore collegiate wrestler, with known lumbar degenerative disk disease (DDD) since high school, presented with worsening back pain and bilateral proximal anterior thigh pain. An MRI done 5 months prior to presentation had shown moderate degenerative changes at several lumbar levels, with disk height and disk desiccation. There was also an L5-S1 annulus tear with disk protrusion. He had undergone relative rest, therapeutic exercises, two lumbar trigger point injections, and two epidural steroid injections (ESI) at the L5-S1level in the interim, with the most recent ESI done three weeks prior to presentation. His back pain had initially been much better after each ESI, with symptoms acutely worsening as above. He had been able to gain some weight through exercise and denied any systemic symptoms (e.g., fever, chills), although he had symptoms of a mild upper respiratory tract infection on presentation. PHYSICAL EXAMINATION: Examination in clinic showed normal vital signs. The patient had an antalgic, guarded gait, with marked restriction of lumbar flexion to due pain. There was no tenderness to palpation. Straight leg raise bilaterally was negative, and his leg neurologic exam was normal. DIFFERENTIAL DIAGNOSIS: Acute lumbar disk herniation Acute exacerbation of lumbar DDD Lumbar strain Infectious spinal process TEST AND RESULTS: MRI lumbar spine: Diffuse annular bulging with L5-S1 central disk protrusion Normal vertebral height Markedly narrowed L3-4 disk L4 superior endplate destruction Osseous edema in L3, L4 bodies, extending in to psoas adjacent to disk Labs: Aspiration of L3, L4: Few methicilliin resistant Staphylococcus aureus (MRSA) Blood cultures (2 sites): no growth Complete blood count: normal white blood cell count, hemoglobin, hematocrit, and platelets Sedimentation rate: elevated at 45 C-reactive protein: normal FINAL WORKING DIAGNOSIS: MRSA Osteomyelitis/diskitis of L3-4, likely related to epidural steroid injection for DDD TREATMENT AND OUTCOMES: Vancomycin was administered through a central line every 12 hours for 4 weeks. After Vancomycin treatment ended, the patient took sulfamethoxazole/trimethoprim, orally, every 12 hours for 4 weeks. Three months after diagnosis, he started cardiovascular exercises and light wrestling drills.

Outer annulus tears have less effect than endplate fracture on stress distributions inside intervertebral discs: Relevance to disc degeneration

Outer annulus tears have less effect than endplate fracture on stress distributions inside intervertebral discs: Relevance to disc degeneration

Degeneration of the cervical disc: histology compared with radiography and magnetic resonance imaging

Decisions about the treatment of neck pain are largely made on the basis of information gained from plain X-rays and magnetic resonance imaging (MRI), which are used routinely as part of preliminary investigation. We performed a descriptive cadaveric study to compare histology with radiography and MRI. We correlated plain radiography, disc height [Farfan index (FI)] and MRI findings with histology to assess the ability of radiology to detect significant pathologic lesions. The study included 52 motion segments from nine subjects over the age of 50, who underwent routine hospital autopsy. Disc degeneration was assessed by histology, radiography, disc height (FI: anterior disc height plus posterior disc height divided by anterioposterior diameter) and MRI using established grading systems. Most of the discs were classified radiologically as grade 1 (19/52), grade 2 (13/52), grade 3 (9/52) or grade 4 (3/52). Eight of the discs were graded as normal. The distribution of MRI grades was grade 0 (9/36), grade 1 (9/36), grade 2 (7/36), grade 3 (8/36) and grade 4 (3/36). Half of the discs (26/52) showed advanced (grade 4) degeneration histologically. FI correlated with histological grade (P = 0.013), MRI grade (P = 0.02) and radiological grade (P < 0.001) of degeneration. Radiological and histological grade of degeneration showed a weak correlation (r = 0.3, P = 0.033). MRI correlated with overall histological grade (r = 0.41, P = 0.015, n = 34). Histological features (e.g., tears, rim lesions, prolapse of nucleus material) were poorly recognised by MRI, which had a sensitivity for disc material prolapse and annulus tears of less than 40%. Our study showed that discs from patients over 50 years are histologically severely degenerated; however, these changes may not be detected by conventional radiography and MRI.

PREDICTION OF BIOMECHANICAL CHARACTERISTICS OF INTACT AND INJURED LOWER THORACIC SPINE SEGMENT UNDER DIFFERENT LOADS

In this study, the biomechanical roles of disc nucleus and ligaments of human lower thoracic spine (T10–T12) under different loads were investigated using finite element (FE) method. The T10–T12 FE model was developed and validated against the published results. The FE model was then modified accordingly to simulate the injured conditions of nucleus, ligaments and facets and loaded under different configurations to analyze the segmental gross responses and the stress distribution around the annulus circumference. The high first-principal stress of annulus at the posterolateral region has an important role on the disc annulus's tear and a flexion moment causes a high first-principal stress at posterolateral region, despite of the existence of ligaments. The study also shows that decompression in intervertebral discs can reduce the dilatation of annulus tears by 18% around the posterolateral regions of disc annulus. The disc nucleus and the posterior ligaments have important roles in resisting compression and flexion loads, respectively. The investigations in this paper not only supplement experimental research but are also helpful in the understandings of biomechanics of lower thoracic spine.

Spontaneous disc degeneration in the baboon model: magnetic resonance imaging and histopathologic correlation.

Degenerative disc disease is a major source of disability in humans. The baboon model is an excellent natural disease model to study comparable human disease, because baboons are relatively large (adult males 20-26 kg, adult females 12-17 kg), long-lived (30-45 years), well defined, easy to use, and closely related to humans. Published investigations with plain radiographs of disc degeneration in baboons indicated vertebral anatomy and changes that were remarkably similar to those seen in humans, and it would be valuable to determine if magnetic resonance imaging (MRI) and histopathologic evaluation would be useful methods for studying the model, as MRI allows multi-planar visualization of tissues without the use of intravenous contrast and it is superior for evaluating disc hydration, annulus tears, and herniations. The thoracolumbar junctions from 47 randomly selected baboons, ranging in age from 2 weeks to 34 years, were evaluated with MRI and histopathology. Excellent correlation with MRI was observed for changes in disc desiccation, height, and age (P < 0.001). The pathologic analysis demonstrated P values of < 0.001 when comparing histopathology with age and MRI results. All severely degenerated discs seen by MRI were in baboons 14 years of age or older.