Development Of Lumbar Disc Herniation Research Articles

Regression Model for Socio-demographic, Behavioural and Occupational Risk Factors in Lumbar Disc Herniation (LDH) and Lumbar Disc Degeneration (LDHD)-In Comparison to Apparently Healthy Subjects.

Objective: Present study was aimed to develop a regression model for selected sociodemographic, behavioural and occupational factors with lumbar disc herniation (LDH) and lumbar disc hearniation and degeneration (LDHD) in a selected population in comparison to healthy individuals.Materials & Methods: The study was conducted using 104 cases with disc herniation and controls (n=104) without LDH. Analysis was conducted in sub groups of patients with LDH (n=67) and LDHD (n=37) in comparison to control subjects. Pre-tested questionnaire was administered to all participants to gather information.Results & Discussion: Among the cases 35.6 % presented with LDHD while 64.4 % had only LDH. Among the socio-demographic characters, body mass index <25 kgm-2 was a significant protective factor for both LDHD (OR=0.31; 95% CI=0.13-0.72) and LDH (OR=0.39; 95% CI=0.20-0.77). Involvement in daily activities with heavy (OR=5.1; 95 % CI=2.1-11.8) and moderate strain (OR=3.1; 95 % CI=1.5-6.6) to back, sitting more than eight hours per day (OR=5.1; 95 % CI=1.0-25.7), smoking (OR=5.0; 95 % CI=1.5-16.4) and sleeping in supine position (OR=2.09; 95% CI=1.09-4.06) were significant risk factors for LDH. Only daily physical activities with heavy strain act as a significant risk factor (OR=3.1; 95 % CI=1.1-8.5) for the development of LDHD. Types of mattresses used did not have a significant difference among cases and controls. Majority of cases (56.7 %) did not know the causative factor that led to LDH. According to the regression model, BMI, smoking and involvement in physical activities with moderate and heavy strain to back were considered as significant risk factors for the development of LDH or LDHD.Conclusion: In regression model BMI, smoking and daily physical activities with moderate and heavy strain to back were found to be the significant risk factors for development of LDH or LDHD.International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 424-434

Comprehensive analysis of molecular pathways and key genes involved in lumbar disc herniation.

Based on the Thompson classification of intervertebral discs (IVDs), we systematically analyzed gene expression differences between severely degenerated and mildly degenerated IVDs and explored the underlying molecular mechanisms using bioinformatics methods and multichip integration. We used multiomics analysis, includes mRNA microarray and methylation chips, to explore the genetic network and mechanisms of lumbar disc herniation (LDH). Subsequently, the Combat function of the R language SVA package was applied to eliminate heterogeneity between the gene expression data. And the protein–protein interaction (PPI) network, gene ontology (GO), and molecular pathways were used to constructs the mechanisms network. Consequently, we obtained 149 differentially expressed genes. Related molecular pathways are the following: ribosome activity, oxidative phosphorylation, extracellular matrix response. Besides, through PPI network analysis, genes with higher connectivity such as UBA52, RPLP0, RPL3, RPLP2, and RPL27 were also identified, suggesting that they play important regulatory roles in the complex network associated with LDH. Additionally, cg12556991 (RPL27) and cg06852319 (RPLP0) were found to be LDH-related candidate DNA methylation modification sites in the IVDs tissue of LDH patients. In conclusions, ribosome activity, oxidative phosphorylation, and extracellular matrix response may be potential molecular mechanisms underlying LDH, while hub genes involved in UBA52, RPLP0, RPL3, RPLP2, and RPL27, and candidate DNA methylation modification sites of cg12556991and cg06852319 are likely key regulators in the development of LDH.

MiRNA-495-3p Attenuates TNF-α Induced Apoptosis and Inflammation in Human Nucleus Pulposus Cells by Targeting IL5RA.

Intervertebral disc degeneration (IVDD) is considered to be the fundamental cause of the occurrence and development of lumbar disc herniation (LDH). The degeneration of IVDD is mainly caused by the participation of inflammatory factors. Thus, it is of great significance to analyze the pathogenesis of IVDD, which may guide clinical prevention and treatment of LDH. Our current study aims to identify the role of miR-495-3p in LDH and to further unravel the underlying mechanisms. Results in the current study showed that TNF-α treatment markedly inhibited cell viability of HNPC, increased the IL-1β level, and decreased the mRNA level of miR-495-3p in HNPC in a time-dependent manner. Up-regulation of miR-495-3p promoted cell proliferation and inhibited inflammation and apoptosis in TNF-α-induced HNPCs. To investigate the underlying molecular mechanism through which miR-495-3p regulates TNF-α-induced inflammation and apoptosis in HNPCs, we explored the possible target gene of miR-495-3p. Bioinformatics analysis indicated that IL5RA, which is an important gene for TNF-α-induced HNPC injury, was also a target gene of miR-495-3p. A luciferase reporter assay was applied to test and verify the direct target association between miR-495-3p and IL5RA. The results discovered that down-regulation of miR-495-3p markedly reversed the anti-apoptosis and anti-inflammation of sh-IL5RA. In short, the present study evaluated the roles of miR-495-3p and IL5RA in IVDD development and progression. All the data indicated that miRNA-495-3p may play a protective role via inhibiting inflammation and apoptosis in human nucleus pulposus cells by targeting IL5RA pathway. Therefore, miRNA-495-3p may be a potential agent for LDH, and our study may provide a novel strategy in LDH treatment.

Evaluation of Common Variants in Matrix Metalloproteinase-9 Gene with Lumbar Disc Herniation in Han Chinese Population.

Lumbar disc herniation (LDH) is a common and frequent orthopedic disease with strong genetic determinants. The disruption of the intervertebral disc extracellular matrix has been found to play a key role in the development of LDH, suggesting that abnormal matrix metalloproteinases (MMPs) may promote the degradation of the disc matrix. MMP-9, an important member of the MMP family, is a good candidate for the LDH susceptibility gene. The present study aimed to investigate the association of common variants in the MMP-9 gene with the risk, severity, and clinical characteristic variables of LDH. Fourteen tag single nucleotide polymorphisms (SNPs) entirely covering the region of the MMP-9 gene were analyzed in a sample of 845 patients and 1751 healthy controls. The SNP rs17576 was found to be significantly associated with susceptibility to LDH (OR = 0.77, p = 0.0002), which was also confirmed by haplotype-based analyses (rs79845319-rs17576-rs45437897, global p < 0.001). Our results indicated that the A allele of rs17576 reduced the risk of LDH by ∼23% on average. Furthermore, the G allele of rs17576 was found to correlate with more severe grades of disc degeneration. Our results provide additional evidence supporting an important role of the MMP-9 gene in the pathogenesis of LDH.

A genetic variant in COL11A1 is functionally associated with lumbar disc herniation in Chinese population.

This study aimed to explore whether the genetic variant of COL11A1 is functionally associated with the development of lumbar disc herniation (LDH) in Chinese population. SNP rs1676486 of COL11A1 was genotyped in 647 patients and 532 healthy controls. The differences of genotype and allele distributions between LDH patients and healthy controls were evaluated using the χ² test. One-way ANOVA test was used to compare the relationship between genotypes and clinical features including tissue expression of COL11A1 and the degree of disc degeneration. Patients were found to have a significantly higher frequency of TT than the controls (10.2% versus 7.3%, P = 0.004). Besides, the frequency of allele T was found to be remarkably higher in the patients than the controls (34.8% versus 28.1%, P < 0.001) with an odds ratio of 1.36 (95% confidential interval=1.14-1.63). Patients with genotype TT were found to have remarkably more severe disc degeneration (P = 0.02). Besides, the expression of COL11A1 in the lumbar disc was significantly lower in the patients with genotype TT than in those with genotype CT or CC (P < 0.001). Moreover, the expression level was inversely correlated with the severity of disc degeneration (P < 0.001). We confirmed that the rs1676486 of COL11A may be functionally associated with LDH in the Chinese population. Extracellular matrix related proteins may play an important role in the pathogenesis of LDH. Our findings shed light on a better understanding of the pathogenesis of LDH, which could be a promising target for a novel treatment modality of LDH.

Evaluation of ceruloplasmin levels in patients with lumbar disc herniation.

Chronic inflammation is believed to have a role in the development of lumbar disc herniation (LDH). Ceruloplasmin (CP), an acute phase protein, is known to limit inflammation. To evaluate CP levels in patients with LDH. Thirty-five patients with LDH and 35 healthy individuals were enrolled in the study. Participants were divided into two groups; group 1 (n = 35) consisted of patients with LDH, and group 2 (n = 35) consisted of healthy subjects. Surgery specimens were taken from all patients who underwent LDH-related surgery. CP levels were measured in both blood and tissue samples. Pain intensity was evaluated using a visual analog scale (VAS). There were no significant differences in gender, age, or body mass index between the control and LDH patients (p > 0.05 for all). Compared with the control patients, LDH patients had significantly higher serum CP levels (p < 0.001). In LDH patients, tissue CP levels were significantly higher than serum levels (p < 0.001). According to bivariate analysis, the serum CP levels were significantly correlated with the VAS score in group 1 (r = 0.491, p = 0.003). The present study showed that CP levels increased in both the serum and the tissues of patients with LDH compared to patients without LDH, possibly as a consequence of LDH-associated inflammation.

Irregular Alteration of Facet Orientation in Lumbar Segments: Possible Role in Pathology of Lumbar Disc Herniation in Adolescents

The role of the overall structural feature of facet joint in the development of lumbar disc herniation (LDH) is unclear. The present study aimed to investigate the role of irregular alteration of facet orientation (IAFO) in low lumbar segments in the pathology of LDH in adolescents. Sixty-five adolescents with LDH were included in the study. Facet angles were measured in magnetic resonance imaging. The IAFO was defined as the irregular orientation of the included facet joints angle, which was regularly increased from L3 to S1 in the normal group, including small-large-small (SLS) type, large-small-large (LSL) type, and large-small-smaller (LSS) type. Thirty normal adolescents without lumbar lesions were selected into the control group. Statistical analysis was performed using χ(2) test. IAFO was observed in 20 of 65 subjects in LDH group compared with 3 of 30 in the control group [P = 0.038; OR=4 (1.086, 14.735)]. The SLS type was observed in 14 patients, and the LSL type was found in 6 patients, compared with 2 and 1, respectively, in the control group, no LSS type was found in the two groups. There were 8 subjects with IAFO of SLS style herniated in L5/S1 level compared with 6 subjects in L4/5. There was 1subject with IAFO of LSL style herniated in L5/S1 level compared with 5 subjects in L4/5. The findings of this study suggest that the IAFO in the lumbar spine was associated with lumbar disc herniation in adolescents.

Lumbar disc herniation in a patient with congenital vertebral body anomaly: a case report.

Lumbar disc herniation is characterized with low back and leg pain resulting from the degenerated lumbar disc compressing the spinal nerve root. The etiology of degenerative spine is related to age, smoking, microtrauma, obesity, disorders of familial collagen structure, occupational and sports-related physical activity. However, disc herniations induced by congenital lumbar vertebral anomalies are rarely seen. Vertebral fusion defect is one of the causes of congenital anomalies. The pathogenesis of embryological corpus vertebral fusion anomaly is not fully known. In this paper, a 30-year-old patient who had the complaints of low back and right leg pain after falling from a height is presented. She had right L5-S1 disc herniation that had developed on the basis of S1 vertebra corpus fusion anomaly in Lumbar computed tomography. This case has been discussed in the light of literature based on evaluations of Lumbar Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). This case is unique in that it is the first case with development of lumbar disc herniation associated with S1 vertebral corpus fusion anomaly. Congenital malformations with unusual clinical presentation after trauma should be evaluated through advanced radiological imaging techniques.

Development of Lumbar Disc Herniation Following Percutaneous Vertebroplasty

A case report and review of the literature. To describe an extremely rare case, development of lumbar disc herniation after percutaneous vertebroplasty complicated with intradiscal cement leakage. Intradiscal cement leakages are frequently seen during vertebroplasty operations. They are generally asymptomatic. To the best of authors' knowledge, this is the first case describing development of lumbar disc herniation after percutaneous vertebroplasty complicated with intradiscal cement leakage. A 74-year-old woman with the 2-week history of percutaneous vertebroplasty of L4 vertebrae was admitted to our emergency unit. She was suffering from an excruciating low back pain radiating to her right leg. Neurologic examination and lumbar MRI revealed right L5 radiculopathy due to a sequestrated disc fragment. She underwent microlumbar discectomy. Free disc fragment on the L5 root was removed. She was pain free and her neurologic deficit immediately improved after surgery. Although extremely rare, intradiscal cement leakage during percutaneous vertebroplasty may promote development of lumbar disc herniation.

Alteration of Facet Joint Orientation and Asymmetry With Time in Lumbar Disc Herniation

In the previous studies, the facet tropism and its relation to the development of lumbar disc herniation (LDH) were investigated. However, these studies have shown inconsistent conclusions. The aim of this study was to investigate the alteration of facet joint angle and (a)symmetry in LDH. Fifty-four patients with LDH were included. In the first and second computed tomography images, all facet angles were measured from the similar axial slice by the same observer who was blinded with regard to the date of computed tomography scan. Total reproducibility of the variability was found to be ±1.85 degrees. Thirty-one patients had a change in the orientation of at least 1 facet joint. The mean rate of the change in the facet orientation varied from 2.69 to 3.63 degree/y. The most common observed change in the orientation was sagittalization. Females, taller patients, cases with median herniation, and patients with longer course of LDH had a higher risk of this change (P=0.011). The facet asymmetry was found to develop in 7 patients and to recover in 7 patients (P=0.002). The facet orientation could change and the facet asymmetry could develop or recover in the same patient with time in LDH. These results could explain contradictory results in the literature.

Facet Angles in Lumbar Disc Herniation: Their Relation to Anthropometric Features

Cross-sectional study. To investigate the alteration of facet joint angle and its relation to anthropometric features in lumbar disc herniation. In the previous studies, the facet tropism and its relation to the level, type, side, and development of lumbar disc herniation were reported. This study was the first to correlate anthropometric feature, facet angle, and asymmetry in patients with lumbar disc herniation. METHODS.: Sixty-one patients with lumbar disc herniation were included in this study. The body height, vertex-to-spina iliaca posterior superior distance, spina iliaca posterior superior-to-floor distance, and net weight were measured and body mass index calculated. The facet angles were measured for each facet joint using computed tomography. The intraobserver error was found to be +/- 1.66 degrees. We defined facet tropism as the bilateral angle difference greater than 2 intraobserver errors. The asymmetry rate was a ratio of degree of angles of the more coronally oriented facet joint to the more sagittally oriented facet joint at the same intervertebral level. The facet asymmetry was observed at the herniation level in 70.5% of the patients. There was a correlation between the degree of the more sagittally oriented facet joint angle and facet asymmetry rate at the herniation level (R = -0.684, P = 0.0001 for L4-L5 lumbar disc herniation; R = -0.509, P = 0.008 for L5-S1 lumbar disc herniation). The body height correlated with the degree of the more sagittally oriented facet joint angle, the degree of more coronally oriented facet joint angle, and asymmetry rate, respectively (R = -0.571, P = 0.0001; R = -0.474, P = 0.002; R = 0.314, P = 0.045, respectively). There was no correlation between the degree of these angles and the vertex-to-spina iliaca posterior superior distance. The spina iliaca posterior superior-to-floor distance was correlated with the degree of the more sagittally oriented facet joint angle (R = -0.457, P = 0.0001) and more coronally oriented facet joint angle (R = -0.435, P = 0.004) but not with the asymmetry rate. The degree of facet angles was not correlated with body weight and body mass index. This study revealed that patients with lumbar disc herniation had the asymmetry and sagittalization of facet joints, and these alterations were more evident in the taller patients.

Association between an aggrecan gene polymorphism and lumbar disc degeneration.

A case-control study using magnetic resonance imaging findings and a polymerase chain reaction assay to investigate the association between aggrecan gene polymorphism and lumbar disc degeneration. To analyze whether the aggrecan gene polymorphism is related to lumbar disc disease in young women. It has been suggested that a genetic factor or familial predisposition contributes to the development of lumbar disc herniation. However, the precise genetic component related to disc disease remains unclear. Recently, a polymorphism has been identified in the region of the human aggrecan gene. The expressed variable numbers of tandem repeat polymorphism occur in the highly conserved repeat region. The participants were 64 young women with or without low back problems. Magnetic resonance imaging was used to evaluate the degeneration and herniation of the intervertebral disc. Genomic deoxyribonucleic acid was extracted from all participants. A polymerase chain reaction assay was carried out to detect the alleles of the aggrecan gene. The association of intervertebral disc degeneration and herniation with the distribution of the aggrecan gene alleles was analyzed. Findings showed an overrepresentation of alleles with small numbers of repeats in subjects with multilevel disc degeneration, thus indicating a significant distribution difference. There also was a significant difference between the distribution of alleles and the severity of disc degeneration. No significant association was found between any of the alleles either in number or type of disc herniation. The current study showed that multilevel and severe disc degeneration was present in the participants with shorter variable numbers of tandem repeat length of the aggrecan gene. This suggests that subjects with shorter variable numbers of tandem repeat length of the aggrecan gene have a risk of having multilevel disc degeneration develop at an early age.

Familial predisposition for lumbar degenerative disc disease. A case-control study.

A case-control study using magnetic resonance imaging and plain radiography to evaluate whether a family history of lumbar disc herniation is a risk factor for disc degeneration. To evaluate the significance of a family history of operated lumbar disc herniation in the development of lumbar disc degeneration and lumbar disc herniation. There are only a few epidemiologic studies indicating that a family history of intervertebral disc herniation is a risk factor for juvenile disc herniation. Recently, similarities in degenerative findings of the lumbar spine between identical twins have been reported. In the case group, 24 patients who were the immediate relatives of patients who had undergone surgery for disc herniation and who presented or had a history of low back pain and/or unilateral leg pain were included. Control individuals included 72 age- and gender-matched outpatients who reported low back pain and/or leg pain without a family history of operated disc herniation. The incidence, level, and topographic location of disc herniation/diffuse bulge; the incidence and grade of disc degeneration observed on magnetic resonance images; and degenerative changes suggesting disc degeneration observed on plain radiographs were compared between the relatives of patients with disc herniation (cases) and the controls. The incidence of disc degeneration at L4-L5 and L5-S1 in cases (L4-L5, 18/24; L5-S1, 18/24) and controls (L4-L5, 45/72; L5-S1, 43/72) was similarly high. However, the grade of disc degeneration according to magnetic resonance imaging signal intensity on the T2-weighted sagittal image using Schneiderman's four-grade classification was significantly more severe in cases (L4-L5: Grade 1, 6/24; Grade 2, 4/24; Grade 3, 13/ 24; Grade 4, 1/24; L5-S1: Grade 1, 6/24; Grade 2: 3/24, Grade 3: 12/24, Grade 4: 3/24) than in controls (L4-L5: Grade 1, 27/72; Grade 2, 24/72; Grade 3, 20/72; Grade 4, 1/72; P = 0.034; L5-S1: Grade 1, 29/72; Grade 2, 23/72; Grade 3, 13/72; Grade 4, 7/72; P = 0.023; Mann-Whitney U test). The incidence of disc herniation/diffuse bulge at L4-L5 (16/24) and L5-S1 (11/24) in cases was higher than that in controls (L4-L5, 33/72; P = 0.07; L5-S1, 17/ 72; P = 0.04; chi-square test). The current study provided evidence that a family history of operated lumbar disc herniation has a significant implication in lumbar degenerative disc disease. There may be a genetic factor in the development of lumbar disc herniation as an expression of disc degeneration.