Cause Of Low Back Pain Research Articles

Platelet-Rich Plasma in the Treatment of Facet Mediated Low Back Pain: A Comprehensive Review.

Facet-mediated pain is a major cause of low back pain and as a result, is a significant cause of morbidity, including disability and reduced functionality. The present investigation involved a PubMed literature review between June 1, and 2021-January 1, 2022. We systematically reviewed was carried Pubmed using the search terms "platelet-rich plasma", "inflammatory mediators", "facet arthropathy", "axial back pain", and "leukoreduction". Data extraction and quality assessment were performed by 3 independent reviewers. Out of the studies analyzed 2 were retrospective, while 1 was a prospective study. PRP injections for facet mediated or modulated pain are an alternative to conventional pharmacotherapies and interventional injections/radiofrequency. There are limited numbers of studies in world literature at present. Small number of articles in the world literature and small numbers of patients in those published studies. At present, there are limited studies in the literature; however, larger well-designed studies are warranted to precisely understand efficacy, potential side effects and best practice techniques for PRP injections for facet mediated or modulated pain.

The Relationship between CC Ligand 5 Plasma Levels and Modic Changes in Low Back Pain Patients’ Severity

Background: Low back pain (LBP) is one of the global health problems. The most common cause of LBP is disc degeneration. Modic changes (MC) are the most common MRI features in patients with disc degeneration. As a result of cartilage and disc tissue damage, CCL 5 is released and modulates pain responses in the dorsal root ganglion. This study aims to determine the relationship between CCL5 levels and the description of Modic changes on MRI with pain levels in patients with low back pain.
 Methods: This study is a cross-sectional study. The research subjects were LBP patients who were treated at the Neurology Polyclinic, Dr. M. Djamil General Hospital, Padang, in the range of March 2021-December 2021, who meets the inclusion and exclusion criteria. Subjects will be taken blood to assess CCL5 plasma levels, pain assessment using the McGill Pain Questionnaire, and undergo an MRI examination.
 Results: A total of 52 subjects consisted of 23 men and 29 women with an age range of 34-77 years. Most of the Modic changes were found in the type 2 group. Based on the pain scale, there were two groups with mild pain and moderate pain. On examination of plasma CCL 5 levels, the median value of plasma CCL5 levels was 303,271 ng/L. There was a significant relationship between plasma CCL5 levels and pain levels in patients with low back pain (p = 0.004). There was no significant relationship between Modic changes and the severity of pain.
 Conclusion: Plasma CCL5 levels are associated with pain levels in patients with low back pain, while Modic changes are not associated with pain severity.

Key LncRNAs Associated With Oxidative Stress Were Identified by GEO Database Data and Whole Blood Analysis of Intervertebral Disc Degeneration Patients.

Background: Intervertebral disc degeneration (IDD) is a major cause of low back pain, but the onset and progression of IDD are unknown. Long non-coding RNA (lncRNA) has been validated to play a critical role in IDD, while an increasing number of studies have linked oxidative stress (OS) to the initiation and progression of IDD. We aim to investigate key lncRNAs in IDD through a comprehensive network of competing endogenous RNA (ceRNA) and to identify possible underlying mechanisms. Methods: We downloaded IDD-related gene expression data from the Gene Expression Omnibus (GEO) database and obtained differentially expressed-lncRNAs (DE-lncRNA), -microRNAs (DE-miRNA), and -messenger RNAs (DE-mRNA) by bioinformatics analysis. The OS-related lncRNA-miRNA-mRNA ceRNA interaction axis was constructed and key lncRNAs were identified based on ceRNA theory. We performed gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses on mRNAs regulated by lncRNAs in the ceRNA network. Single sample gene set enrichment analysis (ssGSEA) was used to reveal the immune landscape. Expression of key lncRNAs in IDD was assessed by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Results: In this study, 111 DE-mRNAs, 20 DE-lncRNAs, and 502 DE-miRNAs were identified between IDD patients and controls, and 16 OS-related DE-lncRNAs were also identified. The resulting lncRNA-miRNA-mRNA network consisted of eight OS-related DE-lncRNA nodes, 24 DE-miRNA nodes, 70 DE-mRNA nodes, and 183 edges. Functional enrichment analysis suggested that the ceRNA network may be involved in regulating biological processes related to cytokine secretion, lipid, and angiogenesis. We also identified four key lncRNAs, namely lncRNA GNAS-AS1, lncRNA MIR100HG, lncRNA LINC01359, and lncRNA LUCAT1, which were also found to be significantly associated with immune cells. Conclusion: These results provide novel insights into the potential applications of OS-related lncRNAs in patients with IDD.

Targeting Oxidative Stress and Inflammation in Intervertebral Disc Degeneration: Therapeutic Perspectives of Phytochemicals.

Low back pain is a major cause of disability worldwide that declines the quality of life; it poses a substantial economic burden for the patient and society. Intervertebral disc (IVD) degeneration (IDD) is the main cause of low back pain, and it is also the pathological basis of several spinal degenerative diseases, such as intervertebral disc herniation and spinal stenosis. The current clinical drug treatment of IDD focuses on the symptoms and not their pathogenesis, which results in frequent recurrence and gradual aggravation. Moreover, the side effects associated with the long-term use of these drugs further limit their use. The pathological mechanism of IDD is complex, and oxidative stress and inflammation play an important role in promoting IDD. They induce the destruction of the extracellular matrix in IVD and reduce the number of living cells and functional cells, thereby destroying the function of IVD and promoting the occurrence and development of IDD. Phytochemicals from fruits, vegetables, grains, and other herbs play a protective role in the treatment of IDD as they have anti-inflammatory and antioxidant properties. This article reviews the protective effects of phytochemicals on IDD and their regulatory effects on different molecular pathways related to the pathogenesis of IDD. Moreover, the therapeutic limitations and future prospects of IDD treatment have also been reviewed. Phytochemicals are promising candidates for further development and research on IDD treatment.

The Combined Effectiveness of Piriformis Stretch and Muscle Activation Exercises in Patients with Sacroiliac Joint Pain.

Sacroiliac joint pain is one of the common misdiagnosed orthopedic causes of low back pain, which affects between 15 to 30 percent of individuals with mechanical low back pain below L5. The sacroiliac joint is found out to be a source of dysfunction and pain in 10% to 27% of suspected cases of patients with chronic low back pain. Clinicians use different electrotherapy modalities, biomechanical correction techniques, and exercises for addressing SI joint pain. Many studies have been undertaken to find out the efficacy of different treatment tools in combination or isolation. Likewise, there are studies done to understand the effect of piriformis stretch and muscles activation exercises on sacroiliac joint pain but, there exists very little evidence studying the combined effect of both the treatment tools. So our study aims to determine the combined effect of piriformis stretch and muscles activation exercises in patients with sacroiliac joint pain. About 30 subjects, both male and female with a primary diagnosis of sacroiliac joint pain by the physician were recruited into two groups. Group A having 15 patients received piriformis stretch and muscles activation exercises, and Group B having 15 patients received only muscles activation exercises. All the subjects received therapy sessions thrice weekly for four weeks. Outcome measures used were the visual analog scale (VAS) and oswestry disability index(ODI). Pre- intervention assessment and post-intervention assessment was carried out for both groups and the received data was analyzed using paired and independent t-test. According to the results of the analysis, the average improvement of VAS for Group A and Group B were 2.33 and 3.53 respectively. The paired t-test was 23.129 and 14.270, which is statistically highly significant (p-value = 0.000). The average improvement in oswestry disability index for group A and group B were 16.13 and 26.13 respectively using mean and standard deviation. The paired t-test was 11.014 and 6.934 respectively, which is statistically highly significant (p-value = 0.000). There is a significant improvement in both Group A and Group B. However, Group A (piriformis stretch and muscle activation exercises) showed significant improvement in the treatment of sacroiliac joint pain. The results indicated that both Group A and Group B had significant improvement in the scores of VAS and ODI scores at the 4th week when compared to baseline values, but when comparing the end results of group A and group B, it has been found out that group A intervention is more effective than Group B in treating patients with sacroiliac joint pain. From the data analysis reports, it can be concluded that when these treatment tools i.e piriformis stretch and muscles activation exercises are applied in combination, it gives better results in the management of sacroiliac joint pain

Circ_0005918 Sponges miR-622 to Aggravate Intervertebral Disc Degeneration

Intervertebral discdegeneration (IDD) is the most common cause of lower back pain, but the exact molecular mechanism of IDD is still unknown. Recently, studies have shown that circular RNAs (circRNAs) regulate diverse biological procedures such as cell metastasis, growth, metabolism, migration, apoptosis, and invasion. We demonstrated that IL-1β and TNF-α induced circ_0005918 expression in the NP cell, and circ_0005918 was overexpressed in the IDD group compared with the control group. Moreover, the upregulated expression of circ_0005918 was associated with disc degeneration degree. The elevated expression of circ_0005918 promoted cell growth and ECM degradation, and it induced secretion of inflammatory cytokines including IL-1β, IL-6, and TNF-α. Moreover, we found that circ_0005918 sponged miR-622 in the NP cell. In addition, the exposure to IL-1β and TNF-α suppressed the expression of miR-622, which was downregulated in the IDD group compared with the control group. Furthermore, the downregulated expression of miR-622 was associated with disc degeneration degree. The expression level of miR-622 was negatively associated with circ_0005918 expression in the IDD group. In conclusion, circ_0005918 regulated cell growth, ECM degradation, and secretion of inflammatory cytokines by regulating miR-622 expression. These data suggested that circ_0005918 played important roles in the development of IDD via sponging miR-622.

Effectiveness of motor control exercises versus other musculoskeletal therapies in patients with pelvic girdle pain of sacroiliac joint origin: A systematic review with meta-analysis of randomized controlled trials.

Pelvic girdle pain represents a group of musculoskeletal pain disorders associated with the sacroiliac joint and/or the surrounding musculoskeletal and ligamentous structures. Its physical management is still a serious challenge as it has been considered the primary cause of low back pain. This review sought to determine the effectiveness of motor control exercises for two clinically relevant measures; i.e., pain and disability, on patients with pelvic girdle pain of sacroiliac joint origin. This review covered only randomized controlled studies. Online databases, such as PubMed, Embase, Scopus, and Cochrane Library, were searched from January 1, 1990, to December 31, 2019. PEDro scale was used to assess the methodological quality of included studies, while Review Manager was employed to synthesize data in view of meta-analysis. The PRISMA guidelines were applied for this review. Twelve randomized controlled trials of moderate-to-high quality were included in this review. The studies involved 1407 patients with a mean age ranging from 25.5 to 42.1 years as well as intervention and follow-up durations from 1week to 2years. Motor control exercises alone for pelvic girdle pain of sacroiliac joint origin were not effective in terms of pain reduction (SMD = 0.29 [-0.64,1.22]) compared to control interventions whereas they were slightly effective in terms of disability reduction (SMD =-0.07 [-0.67, 0.53]) at short-term. The combination of motor control exercises with other musculoskeletal therapies, however, revealed to be more effective than control interventions in terms of pain reduction (SMD =-1.78 [-2.49, -1.07]; 95%CI) and lessened disability (SMD =-1.80 [-3.03, -0.56]; 95%CI) at short-term. Motor control exercises alone were not found to be effective in reducing pain at short-term. However, their combination with other musculoskeletal therapies revealed a significant and clinically-relevant decrease in pain and disability at short-term, especially in peripartum period.

Lumbar instability as an etiology of low back pain and its treatment by prolotherapy: A review.

BACKGROUND: Low back pain is a significant spinal disorder that affects much of the population at some point during their lives.OBJECTIVE: While proper diagnosis is key, diagnosing the underlying cause of low back pain may often be unclear.METHOD: In this review article, we discuss lumbar instability as an etiology of low back pain and its treatment by prolotherapy.RESULTS: Spinal ligaments may be an underlying culprit in the development of lumbar instability with resultant low back pain and associated disorders.CONCLUSION: In these cases, adequate treatment consisting of non-biologic prolotherapy or cellular prolotherapy, including platelet rich plasma (PRP), can be beneficial in restoring spinal stability and resolving chronic low back pain.

Initial presentation for acute low back pain: is early physical therapy associated with healthcare utilization and spending? A retrospective review of a National Database

BackgroundEarly initiation of physical therapy (PT) has been associated with lower healthcare costs and utilization; however, these studies have been limited to single institutions or healthcare systems. Our goal was to assess healthcare utilization and spending among patients who present for the first time with low back pain (LBP), according to whether they received early physical therapy (PT), using a large, nationwide sample; and geographic variation in rates of early PT and 30-day LBP-related spending.MethodsUsing the Truven MarketScan database, we identified nearly 980,000 US adults ages 18–64 years who initially presented with acute LBP from 2010 through 2014 and did not have nonmusculoskeletal causes of LBP. Approximately 110,000 patients (11%) received early PT (≤2 weeks after presentation). We compared healthcare utilization and spending at 30 days and 1 year after presentation between patients who received early PT and those who did not. Alpha = 0.05.ResultsAt 30 days, early PT was associated with lower odds of chiropractor visits (odds ratio [OR] = 0.41, 95% confidence interval [CI] = 0.40–0.42), pain specialist visits (OR = 0.49, 95% CI = 0.47–0.51), emergency department visits (OR = 0.51, 95% CI = 0.49–0.54), advanced imaging (OR = 0.57, 95% CI = 0.56–0.58), orthopaedist visits (OR = 0.67, 95% CI = 0.66–0.69), and epidural steroid injections (OR = 0.68, 95% CI = 0.65–0.70). At 1 year, early PT was associated with less healthcare utilization. At 30 days, patients with early PT had lower mean LBP-related spending ($1180 ± $1500) compared with those without early PT ($1250 ± $2560) (P < 0.001). At 1 year, LBP-related spending was significantly less among patients who did not receive early PT ($2510 ± $3826) versus those who did ($2588 ± $3704). Early PT rates (range, 4–25%; P < 0.001) and 30-day LBP-related spending differed by state (range, $421 to −$410; P < 0.001).ConclusionEarly PT for acute LBP was associated with less 30-day and 1-year healthcare utilization and less 30-day LBP-related spending. Early PT rates and 30-day spending differed by US state.Level of evidenceIV

Anti-Degenerative Effect of Melatonin on Intervertebral Disc: Protective Contribution against Inflammation, Oxidative Stress, Apoptosis, and Autophagy

Intervertebral disc (IVD) degeneration is a leading cause of lower back pain. Although the etiology of IVD degeneration (IVDD) is unclear, excessive oxidative stress, inflammation and apoptosis, and disruption of autophagy play an important role in the pathogenesis of IVDD. Therefore, finding a solution to mitigate these processes could stop or reduce the development of IVDD. Melatonin, a powerful antioxidant, plays an important role in regulating cartilage tissue hemostasis. Melatonin inhibits the destruction of the extracellular matrix (ECM) of the disc. Melatonin preserves ECM contents, including sox-9, aggrecan, and collagen II through inhibiting matrix degeneration enzymes such as MMP-13. These protective effects may be mediated by the inhibition of oxidative stress, inflammation and apoptosis, and regulation of autophagy in IVD cells.

Exercise-induced FNDC5/irisin protects nucleus pulposus cells against senescence and apoptosis by activating autophagy

Intervertebral disc degeneration (IVDD) is a major cause of low back pain (LBP), and excessive senescence and apoptosis of nucleus pulposus (NP) cells are major pathological changes in IVDD. Physical exercise could effectively delay the process of intervertebral disc degeneration; however, its mechanism is still largely unknown. Irisin is an exercise-induced myokine released upon cleavage of the membrane-bound precursor protein fibronectin type III domain-containing protein 5 (FNDC5), and its levels increase after physical exercise. Here, we show that after physical exercise, FNDC5/irisin levels increase in the circulation and NP, senescence and apoptosis are reduced, autophagy is activated in NP tissue, and the progression of IVDD is delayed. Conversely, after knocking out FNDC5, the benefits of physical exercise are compromised. Moreover, the overexpression of FNDC5 in NP tissue effectively alleviated the degeneration of the intervertebral disc (IVD) in rats. By showing that FNDC5/irisin is an important mediator of the beneficial effects of physical exercise in the IVDD model, the study proposes FNDC5/irisin as a novel agent capable of activating autophagy and protecting NP from senescence and apoptosis.

Low-back pain in adolescents with an osteopathic component

Low-back pain (LBP) is a common symptom presenting in adolescents. Most back pain in adolescents is benign and musculoskeletal in nature, due to trauma or congenital anomalies. Other less common causes include infection, inflammatory conditions or neoplasm. A comprehensive history and physical focusing on posture, muscle tenderness, range of motion, muscle strength and neurological function is essential in understanding the cause of low-back pain. Identification of risk factors for low-back pain will help the clinician in managing their patient. Treatment includes rest, avoiding activities that cause pain, physical therapy, osteopathic manipulative treatment, limited use of non-steroidal anti-inflammatory drugs and family and patient education. Assessing for warning signs or red flags of serious causes of LBP is a fundamental part of the clinical assessment. Pain that awakens from sleep, pain lasting longer than 4 weeks, sudden onset pain, systemic findings such as fever or weight loss and abnormal neurological findings should warrant immediate evaluation as these may suggest serious infectious conditions, malignancy or fracture. This article presents a comprehensive review of the epidemiology, relevant anatomy, biomechanics, causes and major risk factors for adolescent low-back pain. A diagnostic algorithm utilizing a step-by-step approach is also introduced to aid the clinician in management of the patient. Finally, the article presents guidelines for management of the adolescent with low-back pain including conservative, pharmacologic, as well as the osteopathic approach to treatment. Evidence-based recommendations on osteopathic approach to treatment has been reviewed from meta-analysis data and randomized controlled trials.

Functional &amp; Neurological outcome of Lumbar Microdiscectomy at L4/5 and L5/S1

Objectives: To evaluate the Functional &amp; Neurological outcome of Lumbar Microdiscectomy at L4/5 and L5/ S1 Background: Lumbar disc herniation (LDH) is the most common specific cause for low back pain (LBP). It is a degenerative process causing annular tear with extrusion of the nucleus pulposus through posterior midline or posterolateral aspect of the disc leading to compression of the thecal sac and nerve roots with radicular symptoms. Surgery is reserved for only those who are refractory for a fair trial of nonsurgical management for at least 6 weeks, need of decompression for conus and cauda equina compression, needing immediate attention. There have been various modalities of treatment that have evolved over the years. Micro-lumbar discectomy is one of the latest additions of surgical management modality

Mesenchymal Stem Cell-Derived Exosomes and Intervertebral Disc Regeneration: Review.

Intervertebral disc degeneration (IVDD) is a common cause of lower back pain (LBP), which burdens individuals and society as a whole. IVDD occurs as a result of aging, mechanical trauma, lifestyle factors, and certain genetic abnormalities, leads to loss of nucleus pulposus, alteration in the composition of the extracellular matrix, excessive oxidative stress, and inflammation in the intervertebral disc. Pharmacological and surgical interventions are considered a boon for the treatment of IVDD, but the effectiveness of those strategies is limited. Mesenchymal stem cells (MSCs) have recently emerged as a possible promising regenerative therapy for IVDD due to their paracrine effect, restoration of the degenerated cells, and capacity for differentiation into disc cells. Recent investigations have shown that the pleiotropic effect of MSCs is not related to differentiation capacity but is mediated by the secretion of soluble paracrine factors. Early studies have demonstrated that MSC-derived exosomes have therapeutic potential for treating IVDD by promoting cell proliferation, tissue regeneration, modulation of the inflammatory response, and reduced apoptosis. This paper highlights the current state of MSC-derived exosomes in the field of treatment of IVDD with further possible future developments, applications, and challenges.

Delamination of the Annulus Fibrosus of the Intervertebral Disc: Using a Bovine Tail Model to Examine Effect of Separation Rate.

The intervertebral disc (IVD) is a complex structure, and recent evidence suggests that separations or delamination between layers of the annulus may contribute to degeneration development, a common cause of low back pain The purpose of the present experiment was to quantify the mechanical response of the layer-adjoining interlamellar matrix at different rates of separation. Understanding the rate-dependency of the interlamellar matrix, or the adhesion between adjacent layers of the disc, is important as the spine experiences various loading velocities during activities of daily living. Twelve discs were dissected from four bovine tails (three extracts per tail). Two multi-layered annulus samples were collected from each IVD (total = 24, mean bond width = 3.82 ± 0.96 mm) and randomly assigned to a 180° peel test at one of three delamination rates; 0.05 mm/s, 0.5 mm/s, or 5 mm/s. Annulus extracts were found to have similar maximal adhesion strengths (p = 0.39) and stiffness (p = 0.97) across all rate conditions. However, a significant difference in lamellar adhesion strength variability was observed between the 5 mm/s condition (0.96 N/mm ± 0.31) when compared to the 0.5 mm/s (0.50 N/mm ± 0.19) and 0.05 mm/s (0.37 N/mm ± 0.13) conditions (p < 0.05). Increased variability may be indicative of non-uniform strength due to inconsistent adhesion throughout the interlamellar matrix, which is exacerbated by increased rates of loading. The observed non-uniform strength could possibly lead to a scenario more favourable to the development of microtrauma, and eventual delamination.

ANALISIS PREVALENSI LOW BACK PAIN PADA PERAWAT DI DUNIA : LITERATURE REVIEW

Low Back Pain (LBP) is a condition presenting sustain pain in area between waist and gluteal fold. The prime cause of LBP is ergonomic position. Nurse does a lot of bending, twisting, lifting patients or in a certain position for along time. This positions are ergonomically bad. Some interventions are done on researches gave positive result for one year. On another hand prevalence of LBP on nurses in the world is not changing for 12 years (2008-2019), between 50-70%. This prevalence is consistent whether in the poor countries, developing countries or developed countries. Psychological factors, deficiency of health allied sources and time management of the health human resource also interference the LBP prevalence on nurses. It is need to do ergonomic intervention and time human management for nurses in the workplace to know its efficiency towards decreasing LBP prevalence

Association between serum β-oestradiol and health-related quality of life in postmenopausal women with degenerative lumbar scoliosis.

Degenerative lumbar scoliosis (DLS) is an age-related spinal disease. It is an important cause of low back pain, lower limb painand intermittent claudication, which seriously affects the quality of life of middle-aged and elderly people. This article aims to study the changes in serum oestrogen levels in postmenopausal women with DLS and its relationship. One hundred and sixty-eightpostmenopausal women diagnosed with DLS (DLS group) and 140 healthy postmenopausal women (control group) were recruited. Lumbar spinal bone mineral density (LSBMD) was measured by dual-energy X-ray absorptiometryand a chemiluminescence immunoassay analyser was used to detect serum β-oestradiol (E2) levels. The severity of lower back painwas assessed by the visual analogue scalescore and dysfunction was evaluated by Oswestry Disability Index (ODI). The quality of life was evaluated by Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Diagnostic efficiency was evaluated by the receiver-operating characteristics curve (ROC). LSBMD and the level of E2 in the serum in DLS patients were significantly reduced when compared with the control group. The levels of E2 in the serum of postmenopausal women are reliable for predicting DLS revealed by ROC (p < .001). Serum E2 levels were negatively correlated with Cobb angle, VASand ODIand were positively correlated with LSBMD and SF-36 scores. In postmenopausal women, serum E2 levels in DLS patients are significantly reduced and low levels of E2 are associated with lower bone density and poorer quality of life.

Clinical Radiofrequency Ablation Outcomes of Combined Sensory Nerve Branch and Dorsal Entry Root Zone Complex Lesions for Sacroiliac Joint Complex Pain.

Chronic lower back pain (LBP) with or without leg pain (LP) is the most commonly reported anatomical site of pain among Canadian adults with chronic pain. A common cause for LBP and LP arises from dysfunction of the sacroiliac joint (SIJ) complex. When conventional medical management or rehabilitative efforts for SIJ-related LBP and LP fail to provide analgesia, pulsed radiofrequency (PRF) and/or radiofrequency ablation (RFA) of the dorsal entry root zone complex lesions (DREZC) and/or their more peripheral branches can also be a suitable means for treatment. Both PRF and RFA are interventional techniques that utilize heat to attenuate or ablate transmission of painful signals, respectively. The purpose of this chart review is to explore the clinical outcomes of patients experiencing SIJ-related pain who have undergone procedures with combined sensory nerve branch RFA and DREZC PRF lesions targeting the SIJ complex. Following institutional review board approval, a retrospective chart review was performed from June 2018 to February 2021 for patients with LBP and/or LP refractory to physical rehabilitative efforts and medical management that underwent combined PRF and RF treatments for a diagnosis of SIJ complex pain. RF and PRF procedures were anatomically guided with the addition of sensory stimulation to ensure appropriate needle placement. Charts were reviewed for percentage of analgesia at final follow-up, duration of effect, degree of analgesia, patients' functional improvements, and changes in medication use patterns. Data was reviewed from 180 patients with LBP or LP who underwent combined PRF and RF treatments for a diagnosis of SIJ complex pain. The group consisted of 69 men and 111 women with a mean age of 59years. All patients had lesions to their dorsal roots and/or branches (lumbar medial and sacral lateral), as determined using their pain profile as well as sensory stimulation. In the sample of 180 patients a total of 276 SIJs were treated over the period of data collection. Overall, 85.0% (n = 234) of procedures were considered successful with more than 50% analgesic relief at final follow-up. Of 234 successful outcomes, 110 reported ongoing analgesia (mean = 80.3% pain relief, SD ± 18.0) on the last date of follow up (mean = 53.2days, SD ± 41.8) prior to being lost to follow-up. For patients not lost to follow-up, the mean amount of analgesia was reported to be 83.9% with an average duration of 86.3days. Among all treatments, 6.9% (n = 19) provided no analgesic effect. Among the successful procedure outcomes, 54.4% (n = 150) reported increased activity/mobility, 24.3% (n = 67) reported improved sleep, 49.3% (n = 136) reported improved mood, and 11.6% (n = 32) reported decreased medication usage. Nine patients reported complications following the procedure. Complications included transient soreness, bruising, tenderness, myofascial pain, and two mild vagal responses without lasting sequelae. This review suggests that combined sensory nerve branch RFA and DREZC PRF lesions targeting the SIJ complex is a suitable intervention to treat SIJ-related LBP and/or LP refractory to physical rehabilitative efforts and medical management. Approximately 85% of these cases were successfully treated with the majority of patients report lasting analgesic effects with minimal complications, supporting the use of sensory stimulation-guided combined RF and PRF lesions for treatment of refractory SIJ complex pain.

Recent Advances in Managing Spinal Intervertebral Discs Degeneration.

Low back pain (LBP) represents a frequent and debilitating condition affecting a large part of the global population and posing a worldwide health and economic burden. The major cause of LBP is intervertebral disc degeneration (IDD), a complex disease that can further aggravate and give rise to severe spine problems. As most of the current treatments for IDD either only alleviate the associated symptoms or expose patients to the risk of intraoperative and postoperative complications, there is a pressing need to develop better therapeutic strategies. In this respect, the present paper first describes the pathogenesis and etiology of IDD to set the framework for what has to be combated to restore the normal state of intervertebral discs (IVDs), then further elaborates on the recent advances in managing IDD. Specifically, there are reviewed bioactive compounds and growth factors that have shown promising potential against underlying factors of IDD, cell-based therapies for IVD regeneration, biomimetic artificial IVDs, and several other emerging IDD therapeutic options (e.g., exosomes, RNA approaches, and artificial intelligence).

Omentin-1 promoted proliferation and ameliorated inflammation, apoptosis, and degeneration in human nucleus pulposus cells

PurposeIntervertebral disc degeneration is an abnormal, cell-mediated process of tissue remodeling, recognized as the principal cause of low back pain affecting 80% of the population worldwide. Inflammatory cytokine, Interleukin-1beta (IL-1β) is involved in the intervertebral disc degeneration (IDD) process, and it is upregulated in degenerated discs. Omentin-1, also known as intelectin-1, is an adipokine with anti-inflammatory, anti-apoptosis, pro-proliferation, and proangiogenic properties in various types of cells. However, little is known about the effects of omentin-1 on human nucleus pulposus cells (HNPCs). This study aims to investigate the effects of omentin-1 on healthy HNPCs regarding proliferation and further investigate the effects of omentin-1 on IL-1β-induced inflammation, apoptosis, and degeneration in HNPCs. MethodsGenes and proteins of interest were measured by qRT-PCR, immunoblotting, and immunofluorescence to conduct related experiments. Cell viability (CCK-8), EdU, and mitochondrial membrane potential (JC-1), flow cytometry assays were used to assess proliferation and apoptosis, respectively. ResultsOur study showed that omentin-1 promoted proliferation in normal HNPCs. Furthermore, omentin-1 expression was decreased in IL-1β-treated HNPCs. Omentin-1 protected against IL-1β-induced inflammation, apoptosis, and degeneration in HNPCs in vitro via the activation of the PI3K/Akt signaling pathway. ConclusionThese findings may contribute to understanding the role of omentin-1 in HNPCs and may be a potential therapeutic candidate for intervertebral disc degeneration.