Cervical Intervertebral Disc Degeneration Research Articles

Intervertebral Cervical Disc Intensity (IVCDI) Detection and Classification on MRI Scans Using Deep Learning Methods

ABSTRACTRadiologists manually interpret magnetic resonance imaging (MRI) scans for the detection of intervertebral cervical disc degeneration, which are often obtained in a primary care or emergency hospital context. The ability of computer models to work with pathological findings and aid in the first interpretation of medical imaging tests is widely acknowledged. Deep learning methods, which are commonly employed today in the diagnosis or detection of many diseases, show great promise in this area. For the detection and segmentation of intervertebral cervical disc intensity, we propose a Mask‐RCNN‐based deep learning algorithm in this study. The provided approach begins by creating an original dataset using MRI scans that were collected from Yozgat Bozok University. The senior radiologist labels the data, and three classes of intensity are chosen for the classification (low, intermediate, and high). Two alternative network backbones are used in the study, and as a consequence of the training for the Mask R‐CNN algorithm, 98.14% and 96.72% mean average precision (mAP) values are obtained with the ResNet50 and ResNet101 architectures, respectively. Utilizing the five‐fold cross‐validation approach, the study is conducted. This study also applied the Faster R‐CNN method, achieving a mAP value of 85.2%. According to the author's knowledge, no study has yet been conducted to apply deep learning algorithms to detect intervertebral cervical disc intensity in a patient population with cervical intervertebral disc degeneration. By ensuring accurate MRI image interpretation and effectively supplying supplementary diagnostic information to provide accuracy and consistency in radiological diagnosis, the proposed method is proving to be a highly useful tool for radiologists.

Induction of cervical disc degeneration and discogenic pain by low concentration Propionibacterium acnes infection: an in vivo animal study

BackgroundAlthough cervical intervertebral disc (IVD) degeneration is closely associated with neck pain, its cause remains unclear. In this study, an animal model of cervical disc degeneration and discogenic neck pain induced by a low concentration of Propionibacterium acnes (P. acnes-L) is investigated to explore the possible mechanisms of cervical discogenic pain.MethodsCervical IVD degeneration and discitis was induced in 8-week-old male rats in C3–C6 IVDs through the anterior intervertebral puncture with intradiscal injections of low and high concentrations of P. acnes (P. acnes-L, n = 20 and P. acnes-H, n = 15) or Staphylococcus aureus (S. aureus, n = 15), compared to control (injection with PBS, n = 20). The structural changes in the cervical IVD using micro-CT, histological evaluation, and gene expression assays after MRI scans at 2 and 6 weeks post-modeling. The P. acnes-L induced IVD degeneration model was assessed for cervical spine MRI, histological degeneration, pain-like behaviors (guarding behavior and forepaw von Frey), nerve fiber growth in the IVD endplate region, and DRG TNF-α and CGRP.ResultsIVD injection with P. acnes-L induced IVD degeneration with decreased IVD height and MRI T2 values. IVD injection with P. acnes-H and S. aureus both lead to discitis-like changes on T2-weighted MRI, trabecular bone remodeling on micro-CT, and osseous fusion after damage in the cartilage endplate adjacent to the injected IVD. Eventually, rats in the P. acnes-L group exhibited significant nociceptive hypersensitivity, nerve fiber ingrowth was observed in the IVD endplate region, inflammatory activity in the DRG was significantly increased compared to the control group, and the expression of the pain neurotransmitter CGRP was significantly upregulated.ConclusionP. acnes-L was validated to induce cervical IVD degeneration and discogenic pain phenotype, while P. acnes-H induced was identified to resemble septic discitis comparable to those caused by S. aureus infection.

The Impact of Cervical Degeneration and Sagittal Balance on Retro-Odontoid Soft-Tissue Thickness

ObjectiveTo investigate whether retro-odontoid soft-tissue thickness (ROSTT) is associated with cervical degeneration, cervical spine mobility, and sagittal balance of cervical spine. MethodsThe data of 151 patients who presented at our hospital with cervical spondylosis were reviewed. The ROSTT was measured using T1-weighted sagittal cervical MRI fundings. The assessment of the degree of cervical intervertebral disc degeneration (IVDD) was conducted using sagittal T2-weighted imaging. The T1 slope (T1S), C1–C2 angle, C2−C7 angle, C1−C7 sagittal vertical axis (SVA) and C2−C7 SVA were measured. The range of motion (ROM) was assessed by measuring the flexion-extension radiographs. According to the ROSTT, those measuring less than 3mm were classified as normal group and those measuring larger than 3mm were classified as thickened group. ResultsThe thickened group had larger cervical IVDD grade, age, C2−C7 angle, and T1S compared to the normal group (all P<0.05). Additionally, the C0−2 angle was significantly smaller in the thickened group than in the normal group (P<0.05). ROSTT showed a negative correlation with C0−C2 angle (r=-0.181, P<0.05), but positive correlations with both C2−C7 angle (r=0.255, P<0.05) and T1S (r=0.240, P<0.05). Furthermore, ROSTT was positively correlated with age (r=0277, P<0.05) and cervical IVDD grade (Spearman, r=0.299, p<0.05). ConclusionsCervical sagittal balance and cervical degeneration have a significant impact on ROSTT. Patients with a higher T1S and severe cervical degeneration are more likely to result in greater ROSTT.

Characteristics of cervical intervertebral disc signal intensity: an analysis of T2-weighted magnetic resonance imaging in 5843 asymptomatic Chinese subjects.

The study aimed to observe cervical intervertebral discs (IVDs) in asymptomatic subjects and to explore the factors associated with cervical intervertebral disc degeneration (IVDD). Cervical spine MRI of 5843 subjects was retrospectively analyzed. On the sagittal T2-weighted MR images, the mean signal intensities of the nucleus pulposus were obtained. Standard signal intensity (SSI) of intervertebral discs was defined as the ratio of mean disc signal intensity to mean CSF signal intensity. In subjects under 70years old, the SSI of IVD was lowest at the C5/6 level. In those over 70, the SSI of IVD was similar among the disc levels from C2/3 to C7/T1. The disc SSI decreased significantly with age in both genders. In subjects under 70 years old, the SSI of the discs at each level was higher in females than in males. In those over 70years old, no difference was found in disc SSI between two genders at most disc levels. Logistic regression analysis showed that kyphotic and straight cervical spine, obesity and older age were associated with higher risk of having lower disc SSI. To our knowledge, this is the largest cross-sectional study using MRI-based quantitative assessment to characterize cervical IVDD in asymptomatic subjects. Cervical IVDD was shown to progress with age and significantly correlated with gender, BMI and cervical alignment. Early intervention of related factors may help delay cervical IVDD and prevent future neck and shoulder pain.

Melatonin restores endoplasmic reticulum homeostasis to protect injured neurons in a rat model of chronic cervical cord compression.

Cervical spondylotic myelopathy (CSM) refers to a chronic injury of the cervical cord caused by cervical intervertebral disc degeneration. Endoplasmic reticulum (ER) homeostasis is essential to counteract neuronal apoptosis. ER stress, an integral part of ER homeostasis, was observed in a rat model of chronic cervical cord compression in our previous study. However, the correlation between ER homeostasis and CSM remains unknown. The antioxidant melatonin is known to exert therapeutic effects in acute spinal cord injury, but the specific effects and their potential mechanisms in the pathological processes of CSM require further exploration. The present study hypothesized that ER homeostasis is essential for neuronal apoptosis in the CSM and that melatonin maintains this homeostasis. The results showed that ER stress led to neuronal apoptosis in rats with chronic cervical cord compression. Conversely, melatonin attenuates protein kinase R-like ER kinase-eukaryotic initiation factor 2α-C/EBP-homologous protein, inositol-requiring enzyme 1, and transcription factor 6 signaling pathways to release ER stress and prevents Bax translocation to the mitochondrion, thereby promoting motor recovery and protecting neurons in vivo. It also rescued primary rat cortical neurons from ER stress-induced glutamate toxicity in vitro. Moreover, melatonin remodels the ER morphology and restores homeostasis via ER-phagy in injured neurons. FAM134B, CCPG1, RTN3, and Sec. 62 are four known ER-phagy receptors. In this study, Sec. 62 was identified as a key melatonin factor in promoting ER-phagy and restoring ER homeostasis in damaged neurons in vivo and in vitro. In conclusion, melatonin suppresses neuronal apoptosis by reducing ER stress and promoting ER-phagy to restore ER morphology and homeostasis. The current results suggested that melatonin is a promising treatment for CSM owing to its restorative effect on ER homeostasis; however, well-designed randomized controlled trials must be carried out to further investigate its clinical effects.

Effect of "nape seven needles" on expression of hypoxia inducible factor-1α and Notch1 in cervical intervertebral disc degeneration rats

To observe the effect of "nape seven needles" on the expressions of hypoxia inducible factor-1α (HIF-1α) and Notch1 in cervical intervertebral disc of cervical disc degeneration (CDD) rats, so as to reveal its underlying mecha-nisms in improving CDD. SD male rats were randomly divided into normal, model, non-acupoint and nape seven needles groups, with 10 rats in each group. Staticdynamic imbalance method was used to establish CDD model. Rats in the nape se-ven needles group were treated with acupuncture at "Fengfu"(GV16), and bilateral "Fengchi"(GB20), "Wangu"(GB12) and "Tianzhu"(BL10), and rats in the non-acupoint group received acupuncture at the sham acupoints at the caudal tip and armpit, both for 20 min, 6 days a week for 4 weeks. After intervention, tilted plane test and spiral CT were used to assess the neck movement function and cervical degeneration degree of rats; immunohistochemistry was used to observe the protein expression levels of HIF-1α and Notch1 in cervical discs tissue; Western blot and real-time quantitative PCR were used to detect the protein and mRNA expression levels of HIF-1α and Notch1 in cervical discs tissue, respectively. After modeling, the cervical curvature was straightened, with narrowed intervertebral space, rough and hardened articular surface, osteophytes, and blurred articular space and articular process, which was relatively milder in the nape seven needles group. Compared with the normal group, the angle of tilted plane was significantly reduced (P<0.05), while cervical scores, HIF-1α mRNA expression level in cervical intervertebral disc tissue were significantly increased (P<0.05) in the model group. Compared with the model and the non-acupoint groups, cervical scores were significantly reduced (P<0.05), while the angle of tilted plane, HIF-1α and Notch1 positive expressions, HIF-1α mRNA expression level, Notch1 protein and mRNA expression levels in cervical intervertebral disc tissue were significantly increased (P<0.05) in the nape seven needles group. Acupuncture of "nape seven needles" can reduce the degree of cervical degeneration in rats, which was possibly associated with its effects in up-regulating the expressions of HIF-1α and Notch1 in cervical intervertebral disc tissue, promoting the proliferation and recovery of endogenous cells in nucleus pulposus.

The relationship between the flexor and extensor muscle areas and the presence and degree of intervertebral disc degeneration in the cervical region.

Background:This study aimed to investigate the relationship between the presence and degree of cervical intervertebral disc degeneration (IVDD) and the cervical region muscle areas.Methods:The magnetic resonance imaging (MRI) examination of the patients who were sent to our clinic for investigation of neck pain between 2019 and 2020 years were evaluated retrospectively. 143 Turkish women patients between 30 and 40 ages were examined in the study. The presence and degree of IVDD was evaluated for each patient. The areas of the cervical flexor and extensor paravertebral muscles were measured.Results:No cervical disc degeneration was present in 44 (30.76%) patients (grade 1). The cervical intervertebral disc degeneration was grade 2 in 28 (19.58%), grade-3 in 41 (28.67%), and grade 4 in 30 (20.97%) patients. In early stage degeneration (grade 2), an increase was observed in the area of all cervical paravertebral flexor and extensor muscles examined. As the degree of degeneration increased (grades 3 and 4), a decrease was observed in the areas of all muscles. Statistical significance was found for musculus (m) sternocleidomastoideus, m. levator scapulae, m. splenius capitis, m. semispinalis capitis, and m. multifidus muscles (P = .009, r = −0.261; P = .014, r = −0.248; P = .008, r = −0.267; P = .002, r = −0.307; P = .028, r = −0.222, respectively).Conclusions:IVDD is common in middle-aged females with neck pain. An increase in muscles areas is observed in the early stages of cervical disc degeneration but progressive decrease develops in all cervical paraspinal muscles areas as the degree of disc degeneration increases.

12. Assessment of age-related intervertebral disc degenerations of the cervical spine in different age groups: a kinematic MRI study

<h3>BACKGROUND CONTEXT</h3> Cervical intervertebral disc (IVD) degeneration is a common cause of neck and arm pain in adults and a frequent finding in imaging studies. <h3>PURPOSE</h3> This study aimed to assess the age-related degenerations of the cervical IVDs at each cervical spinal level in different age groups using the kinematic magnetic resonance imaging (KMRI). <h3>STUDY DESIGN/SETTING</h3> Cross-sectional study using KMRI. <h3>PATIENT SAMPLE</h3> This study included 1300 symptomatic patients who had undergone upright cervical spine KMRI from February 2019 to November 2021. <h3>OUTCOME MEASURES</h3> Pfirrmann classification of intervertebral disc degeneration. <h3>METHODS</h3> Patients were divided into five equal groups, each with 260 patients based on their ages. Group 1 included patients from 20 to 29 years, group 2 from 30 to 39 years, group 3 from 40 to 49 years, group 4 from 50 to 59 years, and group 5 were patients aged 60 years and above. On T2-weighted sagittal MRI, Pfirrmann grading system was used to grade the IVD degeneration into five grades. Considerable disc degeneration was reported with a Pfirrmann grade IV or V. A total of 7800 cervical IVDs from C2/3 to C7/T1 were evaluated. The severity and pattern of IVD degeneration in each age group was analyzed. <h3>RESULTS</h3> Overall, 4.4% of discs were grade I, 21.0% grade II, 55.1% grade III, 17.1% grade IV, and 2.5% grade V. The number of degenerated discs increased gradually with age groups; 4.9%, 8.4%, 16.4%, 24.6%, and 43.4% in groups 1, 2, 3, 4, and 5, respectively, P < 0.001. In group 1, the most common grade was grade II (41.5%), and the most common degenerated level was C2/3 (25%). In group 2, the most common grade was grade III (53.1%), and the most common degenerated level was C5/6 (29.0%). In group 3, the most common grade was grade III (60.2%), and the most common degenerated level was C5/6 (33.1%). In group 4, the most common grade was grade III (67.0%), and the most common degenerated level was C5/6 (31.3%). In group 5, the most common grade was grade III (56.0%), and the most common degenerated level was C5/6 (24.8%). In all groups, C7/T1 was the least common degenerated disc (6.6%, 3.1%, 3.5%, 4.7% and 8.7% in groups 1, 4 and 5, respectively). In groups 1 and 2, 92.1% and 86.3% of subjects, did not have considerable disc degeneration. In group 5, 19.5% of patients had 2-level disc degeneration, 15.5% had 3-level disc degeneration, and the incidence of 6-level degeneration was 11.2%. In patients with single-level disc degeneration, C5/6 was the most common degenerated level (45.3%). In patients with 2-level degeneration, C5/6 and C6/7 were the most common (49.7%). In patients with 3-level degeneration, C4/5, C5/6, and C6/7 were the most common (38.5%). In patients with 4-level degeneration, C2/3, C3/4, and C5/6 were the most common (36.2%). Skip-level degeneration was found in 18.2%, 30.2%, and 20.3% of patients with 2-level, 3-level, and 4-level degeneration, respectively. <h3>CONCLUSIONS</h3> This study evaluated the severity and pattern of IVD degeneration at each level of the cervical spine in different age groups. The number and severity of degenerated discs increases with age. Adjacent-level degeneration is more common than skip-lesion degeneration in patients with multilevel disc degeneration. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Relationship between cervical posterior subcutaneous fat tissue thickness and the presence and degree of cervical intervertebral disc degeneration.

This study aimed to investigate the relationship between cervical region subcutaneous fat tissue thickness and the presence and level of cervical intervertebral disc degeneration (IVDD). Magnetic resonance imaging examinations of patients referred to our clinic for the investigation of neck pain were evaluated retrospectively. A total of 300 women aged 30-40 years were included in the study. The presence and level of IVDD were evaluated for each patient. The cervical subcutaneous fat tissue thickness was also measured. IVDD was determined as Grade 1 for 88 patients (29.3%), Grade 2 for 56 patients (18.6%), Grade 3 for 82 patients (27.3%), Grade 4 for 60 patients (20%), and Grade 5 for 14 patients (4.6%). Subcutaneous fat tissue thickness was higher in patients with cervical disc degeneration (mean: 6.28 ± 0.19 mm) than in those without cervical disc degeneration (mean: 5.33 ± 0.18 mm) (P = .001). There was a positive correlation between the degree of cervical disc degeneration and subcutaneous fat tissue thickness ( = 0.001, r = 0.245). An increase in the cervical fat tissue thickness is a predisposing factor for the development of degeneration of the intervertebral disc. There is a close relationship between subcutaneous fat tissue thickness and the degree of degeneration.

MiR-98 Protects Nucleus Pulposus Cells against Apoptosis by Targeting TRAIL in Cervical Intervertebral Disc Degeneration.

The excessive apoptosis of nucleus pulposus (NP) cells is a major risk factor in the progress of cervical intervertebral disc degeneration (IVDD). In this study, we investigated the impact of miR-98 on apoptosis of NP cells and the potential molecular mechanisms. Lipopolysaccharide (LPS) was used to establish an NP cell IVDD model. The sponging effect of miR-98 on TRAIL 3′UTR was predicted by ENCORI and assessed by the dual-luciferase reporter gene system. The expression levels of miR-98, TRAIL, and TRAIL pathway-related genes were tested by qRT-PCR, Western blot, and immunofluorescence analysis. Cell apoptosis was analyzed by Hoechst 33258 staining and flow cytometry. Cell viability was analyzed by MTT assay. It was found that the expression level of miR-98 was downregulated, while the level of TRAIL was upregulated in IVDD tissues, and their levels were negatively and positively associated with the clinical MRI grade, respectively. The LPS treatment resulted in a significant decrease of the miR-98 expression level and an increase of the TRAIL expression level in NP cells. miR-98 reduced NP cell apoptosis under LPS treatment in vitro. miR-98 directly targeted TRAIL. Moreover, the mRNA and protein levels of DR5, FADD, cleaved caspase8, cleaved caspase3, and cleaved PARP were downregulated by miR-98 overexpression. Overexpression of TRAIL partially reversed the suppressive roles of miR-98 on cell apoptosis and activation of the TRAIL pathway. We concluded that miR-98 inhibited apoptosis of NP cells by inactivating the TRAIL pathway via targeting TRAIL in IVDD NP cells. These results indicated that miR-98 might be a therapeutic target for IVDD.

Comparison of Pfirrmann classification and objective T2 signal intensity of cervical disc-cisterna magna ratio measurements in cervical intervertebral disc degeneration

ObjectiveThis study aimed to determine the relation of the intervertebral disc signal intensity to cisterna magna [1] signal intensity ratio to the morphological changes in the cervical intervertebral discs (CID) on a T2-weighted image performed on a 3.0-Tesla (3 T) magnetic resonance imaging (MRI), and its relationships to the age, disc space heights, gender, and Pfirrmann grades. Materials and MethodsOne hundred fifty patients were enrolled. Sagittal T2-weighted images were performed on 3.0-Tesla (MRI) on the cases included in the study. All intervertebral disc heights (anterior, middle, posterior), signal intensities, and cisterna magna signal intensities between C2-T1 were measured by two different researchers. Based on the resulting data, Pfirrmann scores were divided into three groups, and a cut-off value was determined between grades by using their mean and median values. ResultsWhen the data was examined, it was found that the CID-cisterna magna (CM) signal intensity ratio values were significantly statistically different in all (C2 → T1) levels according to the grades (p < 0.05); as the Pfirrmann classification goes from low to high at each intervertebral disc level (Grade 1&2 → Grade 4&5), CID-CM signal intensity ratio values statistically significantly decreased. The ROC curve obtained for each level and the area under the curve (AUC) were calculated and found to be statistically significant. ConclusionThe Pfirrmann grading system is not a reliable evaluation method for CID degeneration grading because the height of the cervical disc varies significantly according to the measurement area and level. It is thought that further research can lead to more objective classification based on widely used T2-weighted MRI intensity measurement.

The effect of cervical intervertebral disc degeneration on the motion path of instantaneous center of rotation at degenerated and adjacent segments: A finite element analysis

BackgroundThe motion path of instantaneous center of rotation (ICR) is a crucial kinematic parameter to dynamically characterize cervical spine intervertebral patterns of motion; however, few studies have evaluated the effect of cervical disc degeneration (CDD) on ICR motion path. The purpose of this study was to investigate the effect of CDD on the ICR motion path of degenerated and adjacent segments. MethodA validated nonlinear three-dimensional finite element (FE) model of a healthy adult cervical spine was used. Progressive degeneration was simulated with six FE models by modifying intervertebral disc height and material properties, anterior osteophyte size, and degree of endplate sclerosis at the C5–C6 level. All models were subjected to a pure moment of 1 Nm and a compressive follower load of 73.6 N to simulate physical motion. ICR motion paths were compared among different models. ResultsThe normal FE model results were consistent with those of previous studies. In degenerative models, average ICR motion paths shifted significantly anterior at the degenerated segment (β = 0.27 mm; 95% CI: 0.22, 0.32) and posterior at the proximal adjacent segment (β = −0.09 mm; 95% CI: −0.15, −0.02) than those of the normal model. ConclusionCDD significantly affected ICR motion paths at the degenerated and proximal adjacent segments. The changes at adjacent segments may be a result of compensatory mechanisms to maintain the balance of the cervical spine. Surgical treatment planning should take into account the restoration of ICR motion path to normal. These findings could provide a basis for prosthesis design and clinical practice.

Cervical intervertebral disc degeneration and dizziness.

Clinical studies have found that patients withcervical degenerative disease are usually accompanied by dizziness. Anterior cervical surgery can eliminate not only chronic neck pain, cervical radiculopathy or myelopathy, but also dizziness. Immunohistochemical studies show that a large number of mechanoreceptors, especially Ruffini corpuscles, are present in degenerated cervical discs. The available evidence suggests a key role of Ruffini corpuscles in the pathogenesis of dizziness caused by cervical degenerative disease (i.e. cervical discogenic dizziness). Disc degeneration is characterized by an elevation of inflammatory cytokines, which stimulates the mechanoreceptors in degenerated discs and results in peripheral sensitization. Abnormal cervical proprioceptive inputs from the mechanoreceptors are transmitted to the central nervous system, resulting in sensory mismatches with vestibular and visual information and leads to dizziness. In addition, neck pain caused by cervical disc degeneration can play a key role in cervical discogenic dizziness by increasing the sensitivity of muscle spindles. Like cervical discogenic pain, the diagnosis of cervical discogenic dizziness can be challenging and can be made only after other potential causes of dizziness have been ruled out. Conservative treatment is effective for the majority of patients. Existing basic and clinical studies have shown that cervical intervertebral disc degeneration can lead to dizziness.

An independent agreement study of modified Pfirrmann grading system for cervical inter-vertebral disc degeneration in cervical spondylotic myelopathy

Objective Neck pain, sensory disturbance and motor dysfunction in most patients suffered cervical spondylotic myelopathy (CSM). For CSM surgery, it is necessary to evaluate preoperative inter-vertebral disc degeneration (IDD) which determines whether to adopt fusion strategy, and postoperative IDD which is one of the main reasons for reoperation. Modified Pfirrmann grading system is commonly used to evaluate IDD. The objective of this study is to evaluate its reliability and reproducibility on cervical IDD in CSM patients, and to explore its clinical application value. Methods All 165 patients with CSM were enrolled. 6 physicians (3 spine surgeons and 3 radiologists) who have certain clinical experience were selected. They graded cervical inter-vertebral disc according to modified Pfirrmann grading system, we used intra-class correlation coefficient (ICC) and weighted kappa (wκ) to assess the inter- and intra-observer agreement. After 12 weeks, we repeated the analysis. Results The inter-observer reliability of modified Pfirrmann grading system was excellent with an ICC value of 0.76 and near perfect with wκ value of 0.82. The intra-observer reproducibility of modified Pfirrmann grading system was excellent with ICC values ranging from 0.80 to 0.91, and near perfect with wκ values ranging from 0.83-0.92. Conclusion Modified Pfirrmann grading system has excellent inter-observer reliability and intra-observer reproducibility on cervical IDD in CSM. In addition, it indicates a good appliance among spine surgeons and radiologists, clinical and radiological studies applying it should be deemed accurate. Thus, modified Pfirrmann grading system can be widely used as an appropriate instrument in clinical care.

Estrogen Deficiency Exacerbates Intervertebral Disc Degeneration Induced by Spinal Instability in Rats.

An experimental animal study of osteoporosis (OP) and intervertebral disc degeneration (IDD). The aim of this study was to clarify the effects of estrogen deficiency and supplement on cervical IDD induced by bilateral facetectomy in rats. The relationship between IDD and OP is still controversy with the wide prevalence in aged people. Seventy-two Sprague-Dawley female rats were randomly divided into ovariectomy (OVX) group, facet joints resection of C4-6 (FR), FR-OVX group, estrogen replacement therapy (ERT, based on the FR-OVX group) group, and sham group. Specimens of C4-6 segment were harvested at 12 and 24 weeks. The microstructures of C5 vertebrae, vertebral endplate lesions and calcification, and IDD of C5/6 disc were evaluated by micro-computed tomography (micro-CT) and histology. The protein and gene levels of aggrecan, Col2α1, matrix metalloprotease (MMP)-3, and MMP-13 in the C5/6 and C4/5 discs were measured. Microstructures of C5 vertebral body were weakened significantly after ovariectomy, while restored effectively with estradiol supplementation. The facetectomy led to significant IDD, and the IDD was aggravated when combined with OVX. The IDD of the ERT group was alleviated effectively and similar to that of the FR group in intervertebral disc height, vertebral endplate lesions and calcification, and disc degeneration scores. In addition, the estrogen supplement maintained the extracellular matrix by decreasing MMP-3 and MMP-13, and increasing aggrecan and Col2α1 expression. The present study demonstrated that estrogen deficiency exacerbated IDD induced by spinal instability, while estrogen supplementation alleviated the progression of disc degeneration related to osteoporosis. N/A.

Therapeutic evaluation of acupoint stimulation with needle-scapelon on rat model of degenerative cervical intervertebral discs

Cervical spondylosis (CS), which is resulted from degeneration of cervical intervertebral disc, is a common disease seriously threatening human health and quality of life. However, there is still no effective clinic strategies for the treatment of this disease. The acupoint stimulation with needle-scalpel is a widely used approach to treat orthopedic diseases. In the present study, we evaluated the therapeutic effects of acupoint stimulation around neck with needle-scalpel on delaying the degeneration of cervical intervertebral discs and hopefully provided an approach for the precaution and early intervention of CS. We firstly established a rat model of CS by cervical static-dynamic imbalance to mimics disc degeneration and then stimulated the acupoints around neck with needle-scalpel. The cervical intervertebral disc samples were collected to measure type I and II collagen by quantitative PCR (qPCR), immunohistochemistry, and western blot. The changes in micro-structure and ultra-structure of nucleus pulposus were analyzed under the optical microscope and electron microscope respectively. Acupoint stimulation with needle-scapelon increased type I collagen production and decreased type II collagen production, and improved the micro-structure and ultra-structure of nucleus pulposus. Our results suggest that acupoint stimulation around neck with needle-scapelon could inhibit intervertebral disc degeneration through modulating the extracellular matrix collagen system and improving the changed structure of nucleus pulposus.

Cervical disc degeneration and neck pain.

Cervical intervertebral disc has long been considered a common source of neck pain. However, the pain caused by the disc itself has not been clearly defined so far, and its diagnosis and treatment has always been controversial. Degenerative cervical disc has a rich supply of nerve fibers, is prone to inflammatory reactions, and is susceptible to pain that can be provoked by disc stimulation or distention, and can be eliminated by block. Overwhelming clinical evidence demonstrates that neck pain in patients with degenerative cervical radiculopathy or myelopathy can be subsided rapidly by anterior cervical surgery, further indicating that this neck pain stems from the pathology of cervical disc itself. Cervical discography is advocated as the only test that connects disease to symptoms, but the procedure remains controversial. If strict criteria and technique are maintained, discography can discriminate painful, symptomatic discs from nonpainful, asymptomatic discs. Discogenic neck pain alone without cervical disc herniation or cervical spondylosis accounts for a large proportion of chronic neck pain. For these patients who continue to have refractory neck pain and fail to respond to conservative treatment, anterior cervical fusion surgery or artificial cervical disc replacement may be a better choice, and preoperative cervical discography can guarantee the excellent surgical results. Existing basic and clinical studies have scientifically shown that cervical intervertebral disc degeneration can lead to neck pain.

Cervical Intervertebral Disc Degeneration Contributes to Dizziness: A Clinical and Immunohistochemical Study

Dizziness often happens in patients with chronic neck pain with only cervical disc degeneration but without cervical radiculopathy or myelopathy. We prospectively selected a series of patients who showed cervical disc degeneration with concomitant chronic neck pain and intractable dizziness who did not respond to conservative treatment to test a new diagnostic method for this dizziness, to analyze the results of anterior cervical discectomy and fusion (ACDF) surgery based on the test, and to explore its pathogenesis. Seventy-seven patients who had a transient neck pain and dizziness relief after injection of bupivacaine into a suspected disc were included in the study. In total, 52 underwent ACDF as surgery group, and 25 refused surgery and accepted conservative treatments as conservative group from June, 2015 to October, 2016 with subsequent follow-up to 1 year. The outcomes were visual analogue scale for neck pain, Neck Disability Index, and intensity and frequency of dizziness. During ACDF, the 72 specimens of degenerative cervical discs were collected to determine the innervation in degenerative cervical discs immunohistochemically. After surgery, the patients experienced a significant reduction in neck pain and dizziness. Symptomatic relief in surgery group was obviously better than conservative group at each time point of follow-up (P= 0.001). Ruffini corpuscles and substance P-positive free nerve fibers were obviously increased in the number and deeply ingrown into the inner degenerative cervical discs. Current clinical and immunohistochemical studies strongly suggest that chronic neck pain and intractable dizziness in this series of patients stem from the degenerative cervical discs.

A non-linear multiaxial fatigue damage model for the cervical intervertebral disc annulus

A significant portion of the military population develops severe neck pain in the course of their duties. It has been hypothesized that neck pain is a consequence of accelerated degeneration of the intervertebral discs in the cervical spine, but more occupational and mechanistic-based tools and research are needed to positively confirm the link between neck pain and accelerated disc degeneration. Heavy head-supported mass including helmets and accessories worn by military personnel may subject the intervertebral discs of the cervical spine to complex cyclic loading profiles. In addition, some military operational travel which includes riding on high speed planing boats has also been reported to result in high magnitude cyclic loading on cervical spine discs. In this article, we present a methodology to computationally predict fatigue damage to cervical intervertebral discs over extended periods of time, by integrating kinematics-based biomechanical models with a continuum damage mechanics-based theory of disc degeneration. Through this computational approach, we can gain insights into the relationship between these military activities and possible accelerated fatigue degeneration of cervical intervertebral discs and provide a quantitative prediction tool for decade-long time ranges. The four significant improvements this computational framework adds to the area of modeling intervertebral disc degeneration are the following: (a) it addresses the non-linear nature of fatigue damage evolution, (b) it includes the effect of aging and damage recovery to accurately simulate biological phenomena, (c) it computes fatigue damage taking into account the multiaxial stress state in the disc, and (d) it correlates the computational damage parameter with established clinical grading systems for disc degeneration.

Apparent Diffusion Coefficient of Diffusion-Weighted Imaging in Evaluation of Cervical Intervertebral Disc Degeneration: An Observational Study with 3.0 T Magnetic Resonance Imaging.

Aims To investigate the correlation between the apparent diffusion coefficient (ADC) value and cervical intervertebral disc degeneration in adult symptomatic patients. Methods A total of 52 symptomatic and 40 healthy volunteers were included. DWI and routine MRI examinations were performed to their cervical spines. The cervical discs (from C2-C3 to C6-C7) were graded according to the Pfirrmann grading system, and ADC values of the nucleus pulposus (NP) were measured. Differences of the ADC values between different genders and anatomic levels were analyzed; the correlation between the ADC value and the Pfirrmann grade was investigated. The cut-off ADC values of each Pfirrmann grade were calculated. Results The mean ADC value of the NP decreased with increasing Pfirrmann grade (I–V) upon both patients and asymptotic volunteers. The ADC value decreased descendingly from C2-C3 to C5-C6 (P < 0.05) and then increased at C6-C7 (P < 0.05). Additionally, the comparison of the ADC values between different genders achieved statistical significance at each anatomical level (P < 0.05), except at C6-C7 (P > 0.05). Significant negative correlations between the ADC value and either age or Pfirrmann grade were observed. Conclusions Our preliminary findings suggest that the ADC value obtained by DWI can provide a reliable indicator to evaluate the cervical disc degeneration.