Cause Of Low Back Pain Research Articles

Exploring Back Pain Characteristics: Insights From Hilla, Iraq

Objectives: The general concern about low back pain (LBP) necessitates thoroughly examining its various causes and feasible therapies. The current study investigated the causes and surgical treatments of back pain by tailoring treatments to the patient’s specific needs. Methods: Two hundred individuals with LBP have been enrolled in this cross-sectional research. The radiological, magnetic resonance imaging (MRI) images and clinical evaluations were completed by neurosurgeons and used to categorize the selected patients from those attending neurosurgical outpatient clinics. Multiple causes of LBP, including disk prolapse, spinal stenosis, and muscular spasms, were investigated. Detailed descriptions of surgical approaches for various stages of disk prolapse and stenosis were given to help decide the optimal surgical tactics. The data were compiled into an Excel sheet, and the percentages and numbers were sorted and computed appropriately. Results: The data present an extensive overview of the distribution pattern of back pain causes, disk prolapse, and spinal stenosis in the study community, along with the surgical procedures employed. Muscle spasms, disk prolapse, and spinal stenosis are the main causes of back pain (20%, 40%, and 13%, respectively). L5 and S1 are the most commonly involved in single-level disk prolapse (10%). Different spinal levels may have varying percentages of multiple-level disk prolapse (20%). There are multiple lumbar levels where spinal stenosis can occur, but the most common are L4 and L5 (20%). Distinct surgical approaches are employed for disk prolapse and stenosis at various levels of the spine, and the most frequent intervention was laminectomy in about 39% of total participants. Discussion: The study’s results demonstrate the complexity of the etiologies of back pain and the need for advanced surgical techniques. Particular emphasis is concentrated on spinal stenosis, including single- and multiple-level disk prolapse, and the relationship between surgical methods and causes. The study’s thorough comprehension is essential for tailored interventions based on patient traits, ultimately enhancing therapy and patient care.

Meta-Analysis of the Efficacy of Rapid Rehabilitation Surgical Nursing in Lumbar Disc Herniation.

Background: Lumbar disc herniation (LDH) is a common cause of lower back pain and radiculopathy. In recent years, the enhanced recovery after surgery (ERAS) concept has been increasingly applied in orthopedics and gastrointestinal surgery. Purpose: To investigate the effect of using rapid rehabilitation surgical care for lumbar disc herniation by meta-analysis. Data source: Google Scholar, PubMed Medical, Cochrane and Embase databases were used for the analysis. Research selection: An initial search yielded a total of 322 relevant articles. Duplicate pieces of literature were screened using Endnote. In addition, non-randomized controlled trials and studies with a sample size of less than 30 were excluded. A total of seven papers were included in this study. Main outcomes: The Rapid Rehabilitation Surgical Nursing (RRSN) group showed significantly higher patient satisfaction (RR = 1.24; 95% CI: 1.06, 1.26; p < 0.01) and self-assessed health (Total MD = 5.67; 95% CI: 4.27, 7.06; p < 0.01) compared to the Normal Nursing (NN) group. Pain levels (MD = -0.66; 95% CI: -0.97, -0.36; p < 0.01), disability levels (MD = -18.64; 95% CI: -32.53, -4.76; p < 0.01), anxiety risk (SAS-MD = -4.33; 95% CI: -6.23, -2.44; p < 0.01), and depression risk (SDS-MD = -4.29; 95% CI: -7.50, -1.07; p < 0.01) were significantly lower in the RRSN group compared to the NN group. According to the GRADE classification, the certainty for patient satisfaction is high, while the certainty for post-care pain, functional capacity, risk of psychological disorders, and self-assessed health status is moderate. Conclusions: Rapid recovery surgical nursing can significantly improve postoperative recovery of lumbar disc herniation, increase patient satisfaction, reduce the risk of psychological disorders, improve lumbar function, and alleviate patient pain.

Melatonin attenuates degenerative disc degression by downregulating DLX5 via the TGF/Smad2/3 pathway in nucleus pulposus cells.

Intervertebral disc degeneration (IVDD) is the leading cause of low back pain, and apoptosis plays a key role in its pathogenesis. Distal-less homeobox 5 (Dlx5) has been reported to induce cell apoptosis. Melatonin, as a powerful antiapoptotic agent, has been widely reported. This study aimed to investigate the role of DLX5 in the pathogenesis of IVDD and the potential therapeutic role of melatonin in targeting DLX5 in IVDD. Western blotting, RT-qPCR, immunohistochemistry, si-DLX5, Ex-DLX5, flow cytometry, and immunofluorescence were used to examine the regulatory effect of DLX5 on apoptosis. Therapeutic efficacy was assessed by the intraperitoneal injection of melatonin into IVDD mice. The expression level of DLX5 is significantly increased in IVDD, and the expression levels were positively correlated with the grade of IVDD. DLX5 was significantly upregulated in TNF-α-induced degenerative NP cells. Degenerative NP cells transfected with si-DLX5 exhibited significantly less apoptosis than control cells. Melatonin significantly alleviated IVDD in surgically induced IVDD model mice. The results revealed that the expression of DLX5 was positively correlated with the severity of IVDD and that melatonin ameliorated DLX5-induced apoptosis and extracellular matrix imbalance by inhibiting the TGF-β/Smad signaling pathway. This study may provide therapeutic strategies to alleviate inflammation-induced apoptosis IVDD-associated inflammation-induced apoptosis. DLX5 plays an important role in IVDD progression by promoting apoptosis, and melatonin represents a promising therapeutic strategy for alleviating IVDD-associated inflammation and apoptosis.

Comparison of the efficacy of autologous Lp-PRP and Lr-PRP for treating intervertebral disc degeneration: in vitro and in vivo study

BackgroundIntervertebral disc degeneration (IDD) was the most common cause of low back pain. Platelet rich plasma (PRP) has the potential to repair IDD, however, there is still no conclusion on whether Leukocyte-poor platelet rich plasma (Lp-PRP) or Leukocyte-rich platelet rich plasma (Lr-PRP) is better for the treatment of IDD.MethodsFirst, we conducted an in vitro study to compare the effects of autologous Lp-PRP and Lr-PRP on human degenerated nucleus pulposus (NP) cells. Then we verified the in vivo effects of autologous Lp-PRP and Lr-PRP in treating disc degeneration through a rabbit IDD model.ResultsThe in vitro study showed both autologous Lp-PRP and Lr-PRP can promote the cell proliferation, the synthesis of COL II and Aggrecan of human degenerated NP cells, while Lp-PRP are better than Lr-PRP (P<0.05). In addition, only Lp-PRP can inhibit the apoptosis of human degenerated NP cells (P<0.05), whereas Lr-PRP activates the catabolism on the contrary (P<0.05). Further, the in vivo study through the rabbit IDD model verified that autologous Lp-PRP has better effects than autologous Lr-PRP in repairing IDD according to X-ray, MRI, histological, and immunohistochemical assessment (P<0.05, respectively). And the caspase-3 IHC results also showed that only autologous Lp-PRP treatment could inhibit apoptosis of NP cells in the rabbit IDD model (P<0.05).ConclusionCombining in vivo and in vitro studies, the present study confirmed that autologous Lp-PRP has a better effect than autologous Lr-PRP in repairing IDD, which may be due to the inflammatory factors (TNFα, IL-1β, etc.) in Lr-PRP antagonizing part of the repair effects and promoting the catabolism additionally. Therefore, our findings suggest that Lp-PRP may provide better results than Lr-PRP for treating IDD. Further randomized clinical trials will provide evidence to guide practice.

CILP-2 expression in the intervertebral discs of patients with lumbar radiculopathy

BackgroundIntervertebral disc (IVD) degeneration (IVDD) is one of the main causes of low back pain. One of the most important features of IVDD is the loss of extracellular matrix (ECM) with its structural components. Cartilage intermediate layer proteins (CILPs), minor glycoproteins residing in ECM, have been found to be increased in IVD as degeneration and aging progresses. The aim of the present study was to evaluate the expression of CILP-2 in the IVD of patients with lumbar radiculopathy.MethodsThe IVD samples were collected from 25 patients during spinal surgery (interlaminectomy, herniated disc removal). The control IVD samples were obtained from nine patients who underwent lateral corpectomies in the thoracic region. CILP-2 expression was detected by immunohistochemistry. The patients were divided into two groups – aged under or over 50 years. A standardized clinical examination with assessment of radicular signs and deficits was performed. Subjective disability and pain were assessed using the visual analogue scale and Oswestry Disability Index (ODI). The pre-operative MRI was graded for the degree of IVD degeneration by Pfirrmann grading system. IVD samples obtained during operations were subjected to the standardized histopathological analysis applying modified Boos classification. The data were analysed by t-test, Mann-Whitney U-test, and Spearman correlation test.ResultsBoth histopathology scores and Pfirrmann grades did not differ between patients’ groups. Also, no correlations were found between histopathology and Pfirrmann grades, neither were any differences seen when correlating both grades to ODI, back pain or leg pain scores. CILP-2 staining was noted in all studied samples, notably strong staining was seen around large cell clusters. However, no differences in CILP-2 staining were seen between the age groups of patients. No correlations were found between CILP-2 staining and Pfirrmann grades. Grading of CILP-2 immunostaining in nine control patient samples resulted in significantly lower values. The difference is statistically significant (P = 0.002) compared to CILP-2 staining scores of all 25 patients’ samples.ConclusionIn this study, we detected increased CILP-2 expression in the human IVD as compared to the control group patients. CILP-2 can be a possible IVDD marker; however, as knowledge about the role of CILP-2 is limited, further studies are required.

Magnetic resonance imaging (MRI) vs. computed tomography (CT) in the diagnosis and classification of spondylolysis and spondylolisthesis-a narrative review.

Spondylolysis is a lysis of the pars interarticularis, a component of the posterior arch of the vertebral body, in the face of repeated overuse and stress phenomena generally associated with sports in children and adolescent patients. This entity is one of the most common causes of low back pain in this age group. The diagnosis can be made using various imaging techniques, with computed tomography (CT) being considered the gold standard, as it provides the best visualization of the fracture, its extension and orientation, as well as an assessment of the entire bony skeleton. It is essential to understand the physiopathology and natural evolution of the disease as well as to know the typical findings of this disease in each imaging technique in order to be able to make a diagnosis in early stages of the disease. In this paper, we will review the clinical manifestations and typical radiologic findings of spondylolisthesis and spondylolisthesis, which allow a correct and early diagnosis. The literature available in English from 1976 (when the first publications on the diagnosis of this pathology appeared) up to the present day has been used for this review. In this review we will review the etiology, etiopathogenesis and natural evolution of spondylolysis and spondylolisthesis, we will place special emphasis on the radiological findings in magnetic resonance imaging with a view to an early diagnosis that allows us to slow down the evolution of the disease in its initial stages and we will look at the advantages and disadvantages of each technique. Spondylolysis is an increasingly frequent entity due to the increase in sporting activity at younger and younger ages, so radiologists should consider its existence in patients with low back pain and know the radiological signs that allow us to make an early diagnosis.

Senescence in Intervertebral Disc Degeneration: A Comprehensive Analysis Based on Bioinformatic Strategies.

Intervertebral disc degeneration (IDD) is a major cause for low back pain. Studies showed the association between senescence and degenerative diseases. Cell senescence can promote the occurrence and development of degenerative diseases through multiple mechanisms including inflammatory stress, oxidative stress and nutritional deprivation. The roles of senescence and senescence-associated genes (SAGs) remains unknown in IDD. Four differently expressed SAGs were identified as hub SAGs using "limma" package in R. We then calculated the immune infiltration of IDD patients, and investigated the relation between hub SAGs and immune infiltration. Enrichment analysis was performed to explore the functions of hub SAGs in IDD. Nomogram and LASSO model based on hub SAGs was constructed to predict the risk of severe degeneration (SD) for IDD patients. Subsequently, single cell analysis was conducted to describe the expression pattern of hub SAGs in intervertebral disc tissue. We identified ASPH, CCND1, IGFBP3 and SGK1 as hub SAGs. Further analysis demonstrated that the hub SAGs might mediate the development of IDD by regulating immune infiltration and multiple pathways. The LASSO model based on the four hub SAGs showed good performance in predicting the risk of SD. Single cell analysis revealed that ASPH, CCND1 and SGK1 mainly expressed in nucleus pulposus cells, while IGFBP3 mainly expressed in epithelial cells. Eleven candidate drugs targeting hub SAGS were predicted for IDD patients through Comparative Toxicogenomics Database (CDT). PCR and immunohistochemical analysis showed that the levels of four hub SAGs were higher in SD than MD (mild degeneration) patients. We performed a comprehensive analysis of SAGs in IDD, which revealed their functions and expression pattern in intervertebral disc tissue. Based on hub SAGs, we established a predictive model and explored the potential drugs. These findings provide new understandings of SAG mechanism and promising therapeutic strategies for IDD.

Combined Oxygen-Ozone and Porcine Injectable Collagen Therapies Boosting Efficacy in Low Back Pain and Disability.

Background/Objectives: Intervertebral disc degeneration is the most common cause of low back pain (LBP), and lumbosciatica is a major challenge to healthcare systems worldwide. For years, ozone therapy has been used with excellent results in intervertebral disc disease and in patients with LBP. In vitro studies have demonstrated the positive action of porcine collagen in extracellular matrix remodeling and homeostasis. These tissue changes, associated with LBP, may suggest an indication for combined ozone/collagen treatment in patients with LBP. However, no studies have been reported regarding this combination of treatments. Methods: The present work compared retrospective data of two treatment groups (each of 10 LBP patients): (A) oxygen-ozone therapy (OOT) vs. (B) OOT plus porcine collagen type 1 injections (COL I). Pain intensity and physiological function were assessed by the numerical rating scale (NSR) method. The Roland-Morris questionnaire was used to assess disability. Patient data were acquired before, during, and at the six-month follow-up. Significant differences were assessed by ANOVA and Student's t-test. Results: The analyses revealed significant statistical differences comparing the two arms, where the (OOT+COL I) treatment demonstrated a booster efficacy in pain (a reduction of 62% vs. 35%), while the questionnaire revealed a reduction in disability (70% vs. 31%). Conclusions: Therefore, this combination therapy (oxygen-ozone plus porcine injectable collagen) might be a promising approach for the management of patients with LBP.

Convolutional Neural Network Incorporating Multiple Attention Mechanisms for MRI Classification of Lumbar Spinal Stenosis.

Lumbar spinal stenosis (LSS) is a common cause of low back pain, especially in the elderly, and accurate diagnosis is critical for effective treatment. However, manual diagnosis using MRI images is time consuming and subjective, leading to a need for automated methods. This study aims to develop a convolutional neural network (CNN)-based deep learning model integrated with multiple attention mechanisms to improve the accuracy and robustness of LSS classification via MRI images. The proposed model is trained on a standardized MRI dataset sourced from multiple institutions, encompassing various lumbar degenerative conditions. During preprocessing, techniques such as image normalization and data augmentation are employed to enhance the model's performance. The network incorporates a Multi-Headed Self-Attention Module, a Slot Attention Module, and a Channel and Spatial Attention Module, each contributing to better feature extraction and classification. The model achieved 95.2% classification accuracy, 94.7% precision, 94.3% recall, and 94.5% F1 score on the validation set. Ablation experiments confirmed the significant impact of the attention mechanisms in improving the model's classification capabilities. The integration of multiple attention mechanisms enhances the model's ability to accurately classify LSS in MRI images, demonstrating its potential as a tool for automated diagnosis. This study paves the way for future research in applying attention mechanisms to the automated diagnosis of lumbar spinal stenosis and other complex spinal conditions.

Inactivation of Tnf-α/Tnfr signaling attenuates progression of intervertebral disc degeneration in mice.

Intervertebral disc degeneration (IVDD) is a major cause of low back pain (LBP), worsened by chronic inflammatory processes associated with aging. Tumor necrosis factor alpha (Tnf-α) and its receptors, Tnf receptor type 1 (Tnfr1) and Tnf receptor type 2 (Tnfr2), are upregulated in IVDD. However, its pathologic mechanisms remain poorly defined. To investigate the role of Tnfr in IVDD, we generated global Tnfr1/2 double knockout (KO) mice and age-matched control C57BL/6 male mice, and analyzed intervertebral disc (IVD)-related phenotypes of both genotypes under physiological conditions, aging, and lumbar spine instability (LSI) model through histological and immunofluorescence analyses and μCT imaging. Expression levels of key extracellular matrix (ECM) proteins in aged and LSI mice, especially markers of cell proliferation and apoptosis, were evaluated in aged (21-month-old) mice. At 4 months, KO and control mice showed no marked differences of IVDD-related parameters. However, at 21 months of age, the loss of Tnfr expression significantly alleviated IVDD-like phenotypes, including a significant increase in height of the nucleus pulposus (NPs) and reductions of endplates (EPs) porosity and histopathological scores, when compared to controls. Tnfr deficiency promoted anabolic metabolism of the ECM proteins and suppressed ECM catabolism. Tnfr loss largely inhibited hypertrophic differentiation, and, in the meantime, suppressed cell apoptosis and cellular senescence in the annulus fibrosis, NP, and EP tissues without affecting cell proliferation. Similar results were observed in the LSI model, where Tnfr deficiency significantly alleviated IVDD and enhanced ECM anabolic metabolism while suppressing catabolism. The deletion of Tnfr mitigates age-related and LSI-induced IVDD, as evidenced by preserved IVD structure, and improved ECM integrity. These findings suggest a crucial role of Tnf-α/Tnfr signaling in IVDD pathogenesis in mice. Targeting this pathway may be a novel strategy for IVDD prevention and treatment.

CellKine clinical trial: first report from a phase 1 trial of allogeneic bone marrow–derived mesenchymal stem cells in subjects with painful lumbar facet joint arthropathy

Abstract Background: Lumbar facet joint arthropathy (LFJA) is a major cause of low back pain (LBP), with current treatments offering limited long-term benefits. Bone marrow–derived mesenchymal stem cells (BM-MSCs) show promise due to their immunomodulatory and trophic effects, potentially addressing underlying degenerative processes in LFJA. Objectives: This initial report describes the outcomes of the first treated patient in an ongoing mutidisciplinary phase 1 clinical trial evaluating the safety and feasibility of intra-articular allogeneic BM-MSCs for painful LFJA. Methods: Following enrollment in our IRB-approved protocol, symptomatic LFJA was confirmed through double blocks on L4 and L5 medial branches. Two 1-mL syringes, each containing 10 million BM-MSCs, were prepared in the cGMP facility and administered bilaterally to the patient’s L4-L5 lumbar facet joints. The patient underwent standardized follow-ups, including clinical examinations and functional and imaging assessments for 2 years, utilizing patient-reported outcomes measurement information system—computer adaptive tests (PROMIS CATs), visual analogue scale, Oswestry disability index, work functional status and opioid pain medication use, and MR imaging Fenton–Czervionke score. Results: The patient tolerated the procedure well, with no drug-related adverse events during the study period. Pain, spine function, and work functional status improved at multiple follow-ups. This patient also reported improvements in mental and social health, along with a notable improvement in the grade of facet synovitis observed at the one-year follow-up MRI evaluation. Conclusions: This case report suggests the safety and feasibility of administering intra-articular allogeneic BM-MSCs, offering therapeutic benefits for pain management and functional activities.

Fatigue assessment for back-support exoskeletons during repetitive lifting tasks.

Fatigue is a major cause of low back pain for workers in various fields, including industry and agriculture. It has a negative impact on workers' safety, decreases their productivity, and causes a reduction in their occupational career. An exoskeleton is expected to be a solution for reducing workers' fatigue. However, assessing the safety and effectiveness of exoskeletons, except for the direct measurement of electromyography (EMG) in the human body, is challenging in real-case scenarios. Recently, simulations have been widely used to estimate biomechanical variables. Thus, we aimed to develop a method that combines an exoskeleton model and human body simulation to evaluate the effects of exoskeletons on lumbar fatigue. The strength and tendency estimated using this method are similar to those obtained from EMG devices in symmetrical repetitive lifting tasks. In addition, this method can be used to predict and simulate fatigue after a recorded motion. Our findings will help guide manufacturers in designing their products.

Diacetoxy-6-gingerdiol protects the extracellular matrix of nucleus pulposus cells and ameliorates intervertebral disc degeneration by inhibiting the IL-1β-mediated NLRP3 pathway

Intervertebral disc degeneration (IDD) is a common cause of low back pain, causing a huge emotional and economic burden on patients and society. Reduction of nucleus pulposus cells (NPC) and extracellular matrix (ECM) is the main feature of IDD, and NPC is the main source of ECM. Thermal apoptosis is a newly discovered form of cell death in recent years that differs significantly from apoptosis in terms of molecular mechanisms and cellular morphological changes. Diacetoxy-6-gingerdiol(D-6-G), a type of gingerol, has anti-inflammatory and antioxidant effects, but whether it has an inhibitory effect on cellular pyroptosis is not clear. Therefore, in the present study, we investigated the effect of D-6-G on the ECM of the nucleus pulposus oblongata under IL-1β treatment, as well as the mechanism of its effect on NLRP3 inflammasome and cellular focal death. In vitro cellular experiments demonstrated that D-6-G could bind to and inhibit the activity of NLRP3 inflammasome, and interestingly, D-6-G could also inhibit cellular pyroptosis and protect the nucleus pulposusry cellular microenvironment by activating the Nrf2/HO-1 axis. In conclusion, we found that D-6-G could inhibit NLRP3 inflammatory vesicle activity as well as cellular pyroptosis in NPCs and protect the ECM, suggesting the potential of D-6-G to delay IDD.

Effects of platelet-rich plasma injection on electrical activity and biomechanics of the erector spinae muscles in lumbar myofascial pain syndrome

Low back pain (LBP) is a highly prevalent disease. Among the various causes of LBP, one of the most frequent is myofascial pain syndrome (MPS) which affects the spinal stabilizer muscles. The aims of this study were to compare the differences in muscular electrical activity and biomechanical properties between the painful and non-painful sides in patients with unilateral MPS and to verify the feasibility of surface electromyography (sEMG) and MyotonPRO for assisting in MPS assessment. Forty patients with unilateral lumbar MPS were recruited via the Department of Rehabilitation Medicine Center of West China Hospital Sichuan University from October 2022 to October 2023. The electrical properties of the bilateral erector spinae muscles were characterized by sEMG signals during a trunk extension task. The following four time-domain features of sEMG were extracted: root mean square (RMS), mean absolute value (MAV), integrated EMG (iEMG), and waveform length (WL). And two frequency domain features were extracted: the median frequency (MDF) and mean power frequency (MPF). The mechanical properties of the muscles were assessed by MyotonPRO at rest. The following biomechanical parameters were acquired: oscillation frequency [Hz], dynamic stiffness [N/m], logarithmic decrement, relaxation time [ms], and Creep. The visual analog scale (VAS) was used to evaluate the pain severity, and the Oswestry Disability Index (ODI) was used to evaluate the severity of disability and disruption to lifestyle activities caused by LBP pain. The outcome measures were obtained prior to the Platelet-rich plasma (PRP) treatment and repeated two weeks after treatment. (1) Prior to the PRP treatment, all sEMG time-domain features on the painful side were significantly higher than those on the non-painful side (RMS, p < 0.001; MAV, p < 0.001; iEMG, p < 0.001; WL, p = 0.001). However, there was no significant difference in the sEMG frequency-domain features (MPF, p = 0.478; MDF, p = 0.758). On the mechanical side, there were significant differences in oscillation frequency (p = 0.041) and logarithmic decrement (p = 0.022) between the painful side and non-painful side, but no significant differences in dynamic stiffness, relaxation time, and creep (both p > 0.05). (2) Two weeks after the PRP treatment, statistically significant decreases were observed in both post-treatment VAS (p < 0.001) and ODI scales (p < 0.001), indicating the PRP treatment clinically significantly reduced the level of. MPS. This change coincided with all sEMG time-domain features, in which the values at the painful side decreased significantly (RMS, p = 0.001; MAV, p = 0.001; iEMG, p = 0.001; WL, p = 0.001). However, no significant difference in the sEMG frequency-domain features (MPF, p = 0.620; MDF, p = 0.850) was found. On the mechanical side, only logarithmic decrement on the painful side increased significantly (p < 0.001). Our combined MyotonPRO and sEMG results indicated that MPS likely leads to increased muscle tone and decreased muscle elasticity, manifested by abnormal time-domain features of sEMG and biomechanical properties. The changes in these objective measurements were agreed with the changes in subjective outcome measures of pain and function currently assessed in the patients with MPS. A single PRP treatment may alleviate muscle dysfunction caused by MPS. These preliminary results demonstrated the potential feasibility of using sEMG and MyotonPRO as tools for assessing the neuromuscular function of MPS.

Transforaminal Epidural Injection with Local Anesthesia and Steroid for Single-level Radiculopathy and Pain Score: A Prospective Study in the Tertiary Center of Western Nepal

Introduction: Radiculopathy resulting from prolapse of intervertebral disc commonly at L4-L5 and L5-S1, the prominent cause of low back pain affecting daily activities and has a significant socioeconomic burden. Hence, this needs to be addressed with a prominent solution, of which, the transforaminal epidural steroid injection has been one of the promising solutions these days. Aims: To assess the short term and long-term pain relief after transforaminal epidural steroid injection. Methods: 58 patients with radiculopathy at the single level of the lumbar or lumbosacral region were included for transforaminal epidural steroid injection with local anesthesia. Visual analog score, pain score was recorded before, in 15 minutes and four weeks after the steroid injection under C-arm guidance. Statistical analysis was done on the basis of Wilcoxon Signed Ranks Test, Spearman’s correlation test. A p-value &lt; 0.05 was considered to be statistically. Results: The change in Visual Analog Score from the time of presentation in relation to short and long term was significant, viz; VAS0 VAS15m p&lt;0.5 and VAS0/VAS4wks was p&lt;0.5. There was a positive correlation between immediate pain relief and long-term pain reduction however it was not significant (r=0.28, p=0.10) Conclusion: This study suggested the improvement of symptoms with transforaminal epidural steroid injection with local anesthesia and showed a positive correlation between immediate and long-term relief of pain, however it may not be significant.

Injectable PLGA Microscaffolds with Laser-Induced Enhanced Microporosity for Nucleus Pulposus Cell Delivery.

Intervertebral disc (IVD) degeneration is a leading cause of lower back pain (LBP). Current treatments primarily address symptoms without halting the degenerative process. Cell transplantation offers a promising approach for early-stage IVD degeneration, but challenges such as cell viability, retention, and harsh host environments limit its efficacy. This study aimed to compare the injectability and biocompatibility of human nucleus pulposus cells (hNPC) attached to two types of microscaffolds designed for minimally invasive delivery to IVD. Microscaffolds are developed from poly(lactic-co-glycolic acid) (PLGA) using electrospinning and femtosecond laser structuration. These microscaffolds are tested for their physical properties, injectability, and biocompatibility. This study evaluates cell adhesion, proliferation, and survival in vitro and ex vivo within a hydrogel-based nucleus pulposus model. The microscaffolds demonstrate enhanced surface architecture, facilitating cell adhesion and proliferation. Laser structuration improved porosity, supporting cell attachment and extracellular matrix deposition. Injectability tests show that microscaffolds can be delivered through small-gauge needles with minimal force, maintaining high cell viability. The findings suggest that laser-structured PLGA microscaffolds are viable for minimally invasive cell delivery. These microscaffolds enhance cell viability and retention, offering potential improvements in the therapeutic efficiency of cell-based treatments for discogenic LBP.

Deciphering the Effect of Hyaluronic Acid/Collagen Hydrogel for Pain Relief and Tissue Hydration in a Rat Model of Intervertebral Disc Degeneration.

Intervertebral disc (IVD) degeneration is one of the primary causes of low back pain, causing disability; hence, there is no regenerative nature of the current treatments. Hyaluronic acid (HA) was reported to facilitate tissue repair and alleviate pain. Herein, we determined the therapeutic effect of HA and type II collagen (COLII) hydrogel for tissue repair targeting pain in IVD degeneration. We implanted HA/COLII hydrogel following surgically induced disc injury at coccygeal levels in the rat tail model of pain. We assessed the efficacy of the HA/COLII hydrogel in reducing pain behaviour by using the von Frey assessment, protein expression of growth-associated protein (GAP) 43 for sensory nerve innervation, and disc hydration by magnetic resonance imaging (MRI). We observed the anti-nociceptive effect of the HA/COLII hydrogel in alleviating mechanical allodynia in rats. There was an inhibition of sensory hyperinnervation indicated by the GAP43 protein in the treatment group. We revealed an increase in T1ρ mapping of MRI, indicating that the hydrogel restored disc hydration in vivo. Our findings suggest the HA/COLII hydrogel alleviates pain behaviour, inhibits hyperinnervation and promotes disc hydration for tissue repair, implying that it is a potential candidate for the treatment of degenerative disc-associated low back pain.

Study on molecular mechanism of intervertebral disc degeneration by single cell hdWGCNA combined with transcriptome sequencing

BackgroundIntervertebral disc degeneration (IVDD) is one of the important causes of lower back pain, seriously affecting people's health and quality of life. This research employs single-cell analysis to identify the specific cellular subtypes and key regulatory genes associated with IVDD. MethodsWe analyzed the single-cell data and screened cells that closely associated with the development of IVDD. The differential expression of feature genes between IVDD and control groups was analyzed. Additionally, drugs and regulatory transcription factors that interact with feature genes were predicted and clinically validated by reverse transcription quantitative real-time PCR (RT-qPCR), immunohistochemistry (IHC), and enzyme-linked immunosorbent assay (ELISA). ResultsOur study identified the Chond2 cell subtype associated with IVDD and selected four feature genes influencing the development of IVDD, namely IGFBP3, ACAN, VAPA and TMEM45A, through the high-dimensional weighted gene co-expression network analysis (hdWGCNA) analysis, least absolute shrinkage and selection operator (LASSO), and random forest (RF). Besides, compared to the MDD group, IGFBP3 and TMEM45A were significantly upregulated in the SDD group, while ACAN and VAPA showed no significant difference between the two groups. ELISA testing revealed a positive correlation between IGFBP3 concentration and the grading of IVDD. Furthermore, Celecoxib may be used to treat IVDD by inhibiting IGFBP3. ConclusionOur study identified the Chond2 cell subtype associated with IVDD and selected four feature genes influencing the development of IVDD, namely IGFBP3, ACAN, VAPA and TMEM45A. Our findings establish a robust theoretical foundation for the clinical diagnosis and treatment of IVDD patients.

Prevalence of presumed endplate junction failure at the lumbosacral intervertebral junction in dogs on computed tomography.

Lumbosacral intervertebral disc herniation (IVDH) is a common cause of lower back pain in dogs and humans. In humans, the vertebral endplate to annulus fibrosus (AF) attachment was implicated as an alternative failure site besides rupture through the dorsal AF (AFF). Endplate junction failure (EPJF) is characterized by IVDH, accompanied by endplate irregularities (type A), rim avulsions (type B), or larger bony avulsions on one (type C) or both endplates (type D), associated with an adjacent endplate defect. This retrospective study reports the CT prevalence of presumed EPJF in dogs and its associations with signalment and other lumbosacral CT abnormalities. CT scans, including the lumbosacral spine of dogs obtained at two institutions, were assessed, yielding 324 scans. Presumed EPJF was found in 69 dogs (21%) and AFF in 68 dogs (21%), commonly at the caudal endplate of the last lumbar vertebra (71%). The remaining 187 dogs did not show presumed EPJF or AFF. Presumed EPJF type A occurred in 49/69, type B in 19/69, and type C in 1/69 dogs. Univariable logistic regression showed that presumed EPJF was associated with significantly higher IVDH grades than AFF. In the multiple regression model, presumed EPJF and AFF remained associated with increasing age and spondylosis deformans. Presumed EPJF was associated with vertebral endplate sclerosis and AFF with zygapophyseal joint osteoarthritis. In conclusion, presumed EPJF was observed on CT in 21% of dogs with lumbosacral IVDH. Prospective studies correlating EPJF on CT with clinical, surgical, and histopathological findings are needed for a better understanding of the underlying pathology and clinical relevance.

Deep learning-based structure segmentation and intramuscular fat annotation on lumbar magnetic resonance imaging.

Lumbar disc herniation (LDH) is a prevalent cause of low back pain. LDH patients commonly experience paraspinal muscle atrophy and fatty infiltration (FI), which further exacerbates the symptoms of low back pain. Magnetic resonance imaging (MRI) is crucial for assessing paraspinal muscle condition. Our study aims to develop a dual-model for automated muscle segmentation and FI annotation on MRI, assisting clinicians evaluate LDH conditions comprehensively. The study retrospectively collected data diagnosed with LDH from December 2020 to May 2022. The dataset was split into a 7:3 ratio for training and testing, with an external test set prepared to validate model generalizability. The model's performance was evaluated using average precision (AP), recall and F1 score. The consistency was assessed using the Dice similarity coefficient (DSC) and Cohen's Kappa. The mean absolute percentage error (MAPE) was calculated to assess the error of the model measurements of relative cross-sectional area (rCSA) and FI. Calculate the MAPE of FI measured by threshold algorithms to compare with the model. A total of 417 patients being evaluated, comprising 216 males and 201 females, with a mean age of 49 ± 15 years. In the internal test set, the muscle segmentation model achieved an overall DSC of 0.92 ± 0.10, recall of 92.60%, and AP of 0.98. The fat annotation model attained a recall of 91.30%, F1 Score of 0.82, and Cohen's Kappa of 0.76. However, there was a decrease on the external test set. For rCSA measurements, except for longissimus (10.89%), the MAPE of other muscles was less than 10%. When comparing the errors of FI for each paraspinal muscle, the MAPE of the model was lower than that of the threshold algorithm. The models demonstrate outstanding performance, with lower error in FI measurement compared to thresholding algorithms.