Degenerative Disc Changes Research Articles

The correlation between microvessel pathological changes of the endplate and degeneration of the intervertebral disc in diabetic rats

In this study, the pathological microvessel changes to the endplate and the degeneration of the intervertebral disc of diabetic rats were examined in order to identify the possible mechanism by which diabetes mellitus (DM) induces degeneration of the intervertebral disc. A total of 30 Sprague-Dawley rats were randomly divided into two groups. DM was induced in one of the groups by streptozotocin (STZ) administration. The rats were sacrificed 4, 8 and 12 weeks later. Five rats from each group were sacrificed at each time interval and lumbar disc and endplate tissue were obtained from each rat. The histological changes, collagen expression, microvessel density (MVD) and apoptosis of the disc were investigated by different methods. The expression of collagen I in the diabetic DM group was higher compared to the control group at the three time points (P<0.01), in contrast to the expression of collagen II. The factor VIII-related antigen (FVIII RAg) was expressed in the control and DM groups, while its expression was relatively low in the DM group. The MVD of the DM group was smaller compared to that of the control group at the three time points (P<0.01). The apoptotic index (AI) in the diabetic group was significantly higher compared to that of the control group at the three time points (P<0.01). A negative correlation was observed between the MVD of the endplates and the notochordal cell AI in the two groups. Compared to the control group, the endplate MVD decreased and the cavity became smaller or disappeared in the diabetic rats. In conclusion, there was a negative correlation between MVD and degenerative changes of the intervertebral disc in diabetic rats.

Genotoxic stress accelerates age-associated degenerative changes in intervertebral discs

Intervertebral disc degeneration (IDD) is the leading cause of debilitating spinal disorders such as chronic lower back pain. Aging is the greatest risk factor for IDD. Previously, we demonstrated IDD in a murine model of a progeroid syndrome caused by reduced expression of a key DNA repair enzyme. This led us to hypothesize that DNA damage promotes IDD. To test our hypothesis, we chronically exposed adult wild-type (Wt) and DNA repair-deficient Ercc1−/Δ mice to the cancer therapeutic agent mechlorethamine (MEC) or ionization radiation (IR) to induce DNA damage and measured the impact on disc structure. Proteoglycan, a major structural matrix constituent of the disc, was reduced 3–5× in the discs of MEC- and IR-exposed animals compared to untreated controls. Expression of the protease ADAMTS4 and aggrecan proteolytic fragments was significantly increased. Additionally, new PG synthesis was reduced 2–3× in MEC- and IR-treated discs compared to untreated controls. Both cellular senescence and apoptosis were increased in discs of treated animals. The effects were more severe in the DNA repair-deficient Ercc1−/Δ mice than in Wt littermates. Local irradiation of the vertebra in Wt mice elicited a similar reduction in PG. These data demonstrate that genotoxic stress drives degenerative changes associated with IDD.

Peripheral Arterial Disease Masquerading as Low Back Pain

A 49-yr old man was referred by primary care for evaluation of low back pain. The patient reported chronic mild axial lumbar region pain with a more recent onset of left gluteal/hip and thigh region pain, with the latter being more bothersome. This newer pain was described as a “fatigue” sensation that only occurred after walking for approximately 15 mins and promptly resolved with rest. He denied any radiation of this pain to the distal lower limb or any lower limb neurologic symptoms. His medical history was significant for hypercholesterolemia, hypertension, and a 70–pack year smoking history. Lumbar examination was benign, with no tenderness and full pain-free range of motion. Lower limb neurologic examination result was normal as well. Vascular examination was notable for an absent left pedal pulse and reproduction of the patient’s typical left gluteal/hip region symptoms after ambulating 10 mins. Lumbar radiographs demonstrated degenerative disc changes at L4–5 and L5–S1. The patient was referred for Ankle-Brachial Index measurements. Results revealed moderately severe left peripheral arterial disease (Ankle-Brachial Index: left, 0.62; right, 0.91). Vascular surgery was consulted and a computed tomography angiogram (Fig. 1) demonstrated occlusion of the entire left external iliac artery. One month later, the patient underwent left ileofemoral bypass, which resulted in the complete resolution of his left gluteal/hip region claudication symptoms. Follow-up Ankle-Brachial Index measurement 3 days after surgery showed marked improvement (left, 1.02; right, 1.10).FIGURE 1: Computed tomography angiogram demonstrating a long segment occlusion of the left external iliac artery.Low back pain remains one of the most common reasons for physician visits in the United States.1 A single specific etiologic diagnosis is infrequently identified in most low back pain patients.2 Although the differential for low back pain is quite broad, physicians must remain cognizant of less common but treatable causes of regional low back pain. This case highlights the importance of paying close attention to the salient aspects of a patient’s history. In this patient with multiple cardiovascular risk factors, the recent onset of new proximal limb symptoms was exacerbated by exertion and was alleviated with rest, and an absent lower limb pulse on examination all pointed to vascular claudication as the etiology for his pain. Peripheral arterial disease typically presents with posterior distal leg pain. However, this patient’s symptoms were more consistent with proximal vessel peripheral arterial disease, and this suspicion was confirmed with the Ankle-Brachial Index measurement and computed tomography angiogram. Complete and successful resolution of his symptoms with a vascular bypass procedure further confirmed this diagnosis.

Intervertebral disc degeneration and ectopic bone formation in apolipoprotein E knockout mice

Cardiovascular risk factors are known to be associated with intervertebral disc degeneration, but the underlying mechanism is still unclear. The ApoE knockout (KO) mouse is a well-established model for atheroscelorosis. We hypothesized that ApoE is involved in maintaining disc health and that ApoE KO mice will develop early disc degeneration. Discs of ApoE KO and wild-type (WT) mice were characterized with histological/immunological, biochemical, and real-time RT-PCR assays. A comparison of the extracellular matrix production was also performed in disc cells. We demonstrated that ApoE was highly expressed in the endplates of WT discs, and ectopic bone formed in the endplates of ApoE KO discs. Glycosaminoglycan content was decreased in both ApoE KO annulus fibrosus (AF) and nucleus pulposus (NP) cells. Collagen levels were increased in AF and decreased in NP cells. Matrix metalloproteinase-3, -9, and -13 expressions were increased, which may partially explain the impaired matrix production. We also found collagen I, II, aggrecan, and biglycan mRNA expressions were increased in AF cells but decreased in NP cells. Apoptosis was increased in the ApoE KO NP tissue. These results suggest early disc degeneration changes in the ApoE KO mice. ApoE may play a critical role in disc integrity and function.

Experimental model of intervertebral discs degeneration in rat’s tail

Introduction. Main groups of experimental models of degenerative and trophic changes in intervetebral discs are given.Materials and methods. An experimental model for study of sequence of degenerative changes forming in intervetebral discs was proposed.Results. Morphological changes were studied after 30 days and 2 and 3 months. It is established that compression factor plays a key role in degenerative and trophic changes of intervertebral discs.Conclusions. The obtained results confirm adequacy of the created experimental model of osteochondrosis.

Reviewer’s comment concerning “The influence of preoperative MRI findings on lumbar fusion clinical outcomes” (doi:10.1007/s00586-012-2244-9 Mladen Djurasovic, Leah Y. Carreon, Charles H. Crawford III, Jason Zook, Kelly Bratcher, Steven D. Glassman)

The authors of this study address the important question, whether any of the well-known and accepted MRI parameters has a predictive value in regard to outcome. In our daily clinical routine indication for surgery and the expected outcome are to a considerable degree based on the MRI findings in a particular patient. Therefore, the results of this study are of value. The authors included 51 patients with 71 treated disc levels to investigate which of the well-known disc changes [disc desiccation, disc contour, presence of a high-intensity zone (HIZ) annular tear, presence of Modic endplate changes, disc height] has an influence on the 2-year outcome after lumbar fusion. Disc height was the only parameter correlated to outcome, with disc heights less than 5 mm showing the best improvement in the various outcome scores. This result is not surprising since most spine surgeons would agree that advanced degenerative disc changes, if causative, benefit from fusion. On the other way round, the fact that patients with large disc height do not improve considerably is more interesting. This finding argues in favour of the non-fusion strategies currently under investigation. In summary, I consider the paper an important approach for a better understanding of indications and outcome after lumbar fusion. However, due to the retrospective study design, the mixture of patients and the integration of patients fused at multiple levels, the results have to be interpreted with caution. Further studies focusing on well-defined patient groups need to be conducted.

Injection of a polymerized hyaluronic acid/collagen hydrogel matrix in an in vivo porcine disc degeneration model

Disc degeneration and re-herniation after nucleotomy procedures are common problems. Simultaneous application of hyaluronic acid (HA)-based matrix has been proposed to limit disc degeneration. This, however, is hampered by loss of the substituted matrix out of the disc. Hence, in situ polymerization of the injected matrix with ultraviolet light (UVL) directly used after injection may be useful. Therefore, this study evaluates a new HA/collagen hydrogel matrix with in situ polymerization after implantation in an established porcine nucleotomy model. 12 mature minipigs were used. A total of 60 lumbar discs were analyzed. 36 discs underwent partial nucleotomy with a 16G biopsy needle. Of those, 24 discs received matrix (porcine nucleus pulposus collagenous scaffold component and chemically modified HA) which was in situ polymerized using UVL immediately after transplantation. 12 nucleotomized discs and 24 non-nucleotomized discs served as controls. After 24 weeks, animals were killed. X-rays, MRIs, histology, and gene expression analysis were done. Disc height was reduced equally after sole nucleotomy and nucleotomy with HA treatment and in MRIs signal intensity decreased. For both nucleotomy groups, the nucleus histo-degeneration score showed a significant increase compared to controls. In histology, HA treatment resulted in more scarring and inflammation in the annulus. Gene expression of catabolic MMPs was up-regulated, whereas IFN-gamma, IL-6, and IL-1b were unchanged. Although nucleotomy and administration of the implant material did not cause generalized inflammation of the disc, localized annular damage with annulus inflammation and scarring resulted in detrimental degenerative disc changes. As a result, therapeutic strategies should strongly focus on the prevention of annular damage or techniques for annular repair to remain disc integrity.

Evaluation of the correlation between disc displacements and degenerative bone changes of the temporomandibular joint by means of magnetic resonance images

The aim was to evaluate the correlation between disc displacements and degenerative bone changes in magnetic resonance images (MRI) of 112 patients of both genders, with signs and symptoms of temporomandibular disorder. For this purpose, a calibrated examiner evaluated 224 MRI by assigning scores for the displacement of the disc and degenerative bone changes. Disc displacement was found in 58.42% of the temporomandibular joints (TMJs) evaluated. Anterior displacement of the disc with reduction was the most common, occurring in 67.18% cases of joints with disc displacement. Degenerative bone changes were observed in 53.94% of the TMJs analysed. There was significant correlation between disc displacement with reduction and condylar flattening, disc displacement without reduction and condylar flattening, disc displacement without reduction, and associated degenerative bone changes (flattening and erosion, flattening, osteophyte and erosion; flattening and osteophytes, erosion and sclerosis, flattening and sclerosis, flattening, osteophytes and sclerosis). The correlation between advanced cases of disc displacement and the occurrence of degenerative bone changes emphasises the importance of MRI for an accurate diagnosis and development of an appropriate treatment plan and in cases in which clinical examination is not sufficient for these purposes.

MRI FEATURES OF CERVICAL ARTICULAR PROCESS DEGENERATIVE JOINT DISEASE IN GREAT DANE DOGS WITH CERVICAL SPONDYLOMYELOPATHY

Cervical spondylomyelopathy or Wobbler syndrome commonly affects the cervical vertebral column of Great Dane dogs. Degenerative changes affecting the articular process joints are a frequent finding in these patients; however, the correlation between these changes and other features of cervical spondylomyelopathy are uncertain. We described and graded the degenerative changes evident in the cervical articular process joints from 13 Great Danes dogs with cervical spondylomyelopathy using MR imaging, and evaluated the relationship between individual features of cervical articular process joint degeneration and the presence of spinal cord compression, vertebral foraminal stenosis, intramedullary spinal cord changes, and intervertebral disc degenerative changes. Degenerative changes affecting the articular process joints were common, with only 13 of 94 (14%) having no degenerative changes. The most severe changes were evident between C4-C5 and C7-T1 intervertebral spaces. Reduction or loss of the hyperintense synovial fluid signal on T2-weighted MR images was the most frequent feature associated with articular process joint degenerative changes. Degenerative changes of the articular process joints affecting the synovial fluid or articular surface, or causing lateral hypertrophic tissue, were positively correlated with lateral spinal cord compression and vertebral foraminal stenosis. Dorsal hypertrophic tissue was positively correlated with dorsal spinal cord compression. Disc-associated spinal cord compression was recognized less frequently.

The Association of Lumbosacral Sagittal Alignments and the Patterns of Lumbar Disc Degeneration

Results: This study found a moderate correlation between pelvic incidence, sacral slope, lumbar lordosis, and the number of lumbar degenerative disc (r =-0.451, p <0.001; r =-0.433, p <0.001; r =-0.425, p <0.001). We calculated the most proper cut-off value of pelvic incidence associated with more than three segments of multiple lumbar disc degeneration, using a minimum p-value approach. Conclusions: As pelvic incidence, sacral slope, and lumbar lordosis indicating the parameters of lumbosacral sagittal alignments get smaller, the numbers of lumbar disc degenerations and herniated intervertebral discs increase. When pelvic incidence is below 45.6 degrees, it is more likely for degenerative changes of lumbar disc to affect more than three segments.

The objective evaluation of effectiveness of manual treatment of spinal function disturbances

SummaryBackgroundThe aim of this paper is the evaluation of effectiveness of manual therapy in the treatment of functional disturbances of the spine.Material/MethodsThe study subjects were 40 persons aged 45–60 years, in whom degenerative changes in intervertebral discs and physical limitations within the spine were found (NMR), which were manifested as pain. Subjects were randomly divided into 2 groups of 20 persons each. The first group went on a monthly rehabilitation tour, where the manual therapy methods were applied. The second group was treated by means of physical methods. In order to verify the results of effectiveness of the therapies, the examination of the sectional mobility and the evaluation of the spinal curvatures before and after the completion of the therapy were made by means of a tensiometric electrogoniometer.ResultsThe percentage differences in significance result from the lower value of parameter t1 in the group of persons treated physically. The dynamics of changes in the parameters in the sectional mobility in both tested groups was highest in the cervical and lumbar spine. The manually treated group had greater dynamics of changes in functional parameters of the spine.ConclusionsManual therapy is an effective method for treatment of functional changes and early structural changes within the spine, and may be used as supplementary therapy in relation to the standard model of treatment of spinal pain.

Quebec Back Pain Disability Scale, Low Back Outcome Score and Revised Oswestry Low Back Pain Disability Scale for Patients With Low Back Pain Due to Degenerative Disc Disease

Evaluation and comparison of translated and culturally adapted self-reported measurements. The aim of this prospective study was to cross-culturally adapt the Polish versions of Revised Oswestry Disability Index (RODI-PL), Quebec Back Pain Disability Scale (QDS-PL), and the Low Back Outcome Score (LBOS-PL). The application of instruments in English, which have undergone translation must be subjected to validation studies. Such studies are necessary above all for instruments that have been adapted to establish their value and usefulness in studies of patient populations where English is not the native language. The translation was carried out according to International Quality of Life Association (IQOLA) Project and consisted of the following stages: translation, synthesis of the translations, back translation, expert committee, and testing of the prefinal versions of questionnaires. Eighty-five consecutive patients with low back pain due to spinal disc herniation and degenerative changes completed the QDS-PL, RODI-PL, LBOS-PL, and a Visual Analogue Scale twice within 2-day intervals. Mean duration of LBP was 45.9 months SD 55.5. The evaluation of degenerative changes in the lumbar region was carried out according to the Modic scale. Twenty-nine patients were categorized at type I, 4 patients were registered as type II, and 52 patients were type III. Cronbach α values for the LBOS-PL equaled 0.77, for the RODI-PL 0.85, and 0.95 for the QDS-PL. Item-total correlation confirmed that all scales are internally consistent. Test-retest reliability was excellent for RODI-PL and QDS-PL, but poor for LBOS-PL (0.88, 0.93, and 0.34, respectively). All questionnaires were significantly intercorrelated. We identified the strongest correlation between QDS-PL and RODI-PL (0.823, P < 0.001). The statistically significant correlation was identified between the QDS-PL and Modic Classification (rS = 0.226 P = 0.038). QBPDS-PL and RODI-PL are reliable and valid. Furthermore, investigation of the psychometric properties of the LBOS-PL in different spinal conditions is required. There is a relation between the results of the QDS-PL, and different levels of advancement in degenerative disease of the lumbar spine, according to the Modic Classification.

Correlation Between Vacuum Phenomenon on CT and Fluid on MRI in Degenerative Disks

The purpose of this study is to correlate the presence of intradiscal vacuum phenomenon on CT to that of intradiscal fluid on MRI. In a prospective study, 20 patients with lumbar vacuum phenomenon on CT underwent two MRI examinations. One was performed after mobilization, and the other was performed after 6 hours of bed rest. T2-weighted turbo-spin echo (TSE), STIR, T1-weighted TSE, and four consecutive T2-weighted TSE sequences were performed on a 1.5-T scanner. Ninety-five discal segments were assessed for the presence of intradiscal fluid or hyperintense signal on the T2-weighted MRI examinations and were correlated with the presence of vacuum phenomenon on CT, degenerative endplate abnormalities on CT, and edema on MRI. Sixty-nine of 95 discal segments (72.6%) showed vacuum phenomenon on CT. Sixteen of those 69 discal segments (23.1%) showed intradiscal fluid (n = 12) or hyperintense signal (n = 4) on MRI examinations performed after mobilization. Forty-one of 69 discal segments (59.4%) with vacuum phenomenon showed intradiscal fluid (n = 29) or hyperintense signal (n = 12) on MRI examinations performed after bed rest. Seventeen segments showed only fluid after bed rest. Nine segments showed more fluid after bed rest than after mobilization. Three segments showed an unchanged amount of fluid. There was a significant correlation between the presence of intradiscal fluid and the amount of bone marrow edema on MRI and the presence of degenerative endplate abnormalities on CT, respectively. The replacement of intradiscal vacuum phenomenon by intradiscal fluid is a time- and position-dependent dynamic process and is related to Modic type 1 degenerative disk disease and degenerative endplate changes.

Interrater and intrarater reliability of lumbar spine magnetic resonance assessment of military aircraft pilot candidates

The development of diagnostic imaging facilitates evaluation of spinal anatomy, but there is no full correspondence between morphologic and pathologic changes observed in radiographic studies and clinical findings. The aim of the study was to: 1. Evaluate the degree of signal intensity and degenerative changes of intervertebral discs in the lumbar spine on MRI. 2. Estimate interrater reliability of classification of pathology between experienced and inexperienced medical doctors. The sample consisted of 89 persons aged between 18 and 21 years. MRI scans of the lumbar spine were evaluated by the use of a console for digital analysis by three medical doctors with different levels of experience. Evidence of dehydration of intervertebral disc was found in 3.37%-4.49% at the L4-L5 level, and in 13.48%-15.73% of cases at the L5-S1 level. Interrater reliability ranged from full agreement at levels where degenerative changes are rarely observed to fair and poor agreement at L4-L5 and L5-S1. Intrarater reliability showed full agreement on higher levels to good and very good at l4-l5 and l5-S1 levels. Interrater reliability concerning the degree of degenerative changes was 0.6 for Th12 to L4, but was poor at L4-L5 and L5-S1. Intrarater reliability ranged from full agreement at higher levels to poor at L3-L4-L5 and moderate at L5-S1. 1. Asymptomatic intervertebral disk changes were found in 30% of the study participants. 2. Evaluation of the degree of degenerative changes of intervertebral discs requires specialist training and experience.

The effect of sustained compression on oxygen metabolic transport in the intervertebral disc decreases with degenerative changes.

Intervertebral disc metabolic transport is essential to the functional spine and provides the cells with the nutrients necessary to tissue maintenance. Disc degenerative changes alter the tissue mechanics, but interactions between mechanical loading and disc transport are still an open issue. A poromechanical finite element model of the human disc was coupled with oxygen and lactate transport models. Deformations and fluid flow were linked to transport predictions by including strain-dependent diffusion and advection. The two solute transport models were also coupled to account for cell metabolism. With this approach, the relevance of metabolic and mechano-transport couplings were assessed in the healthy disc under loading-recovery daily compression. Disc height, cell density and material degenerative changes were parametrically simulated to study their influence on the calculated solute concentrations. The effects of load frequency and amplitude were also studied in the healthy disc by considering short periods of cyclic compression. Results indicate that external loads influence the oxygen and lactate regional distributions within the disc when large volume changes modify diffusion distances and diffusivities, especially when healthy disc properties are simulated. Advection was negligible under both sustained and cyclic compression. Simulating degeneration, mechanical changes inhibited the mechanical effect on transport while disc height, fluid content, nucleus pressure and overall cell density reductions affected significantly transport predictions. For the healthy disc, nutrient concentration patterns depended mostly on the time of sustained compression and recovery. The relevant effect of cell density on the metabolic transport indicates the disturbance of cell number as a possible onset for disc degeneration via alteration of the metabolic balance. Results also suggest that healthy disc properties have a positive effect of loading on metabolic transport. Such relation, relevant to the maintenance of the tissue functional composition, would therefore link disc function with disc nutrition.

Relationships between disk displacement, joint effusion, and degenerative changes of the TMJ in TMD patients based on MRI findings

This study was performed to investigate the relationships between disk displacement, joint effusion, and degenerative changes in patients with temporomandibular disorders using MRI. Randomly selected MRIs of 508 temporomandibular joints of 254 patients (92 males and 162 females, mean age was 30.5±12.0 years) were reviewed retrospectively. Seventy-eight percent (198 out of 254) of the patients complained of joint pain. Compared with joints with a normal disk position, the joints with anterior disk displacement with reduction showed a 2.01 odds ratio (P<0.01) of degenerative changes and a 2.85 odds ratio (P<0.001) of joint effusions. The joints with anterior disk displacement without reduction showed a 4.43 odds ratio (P<0.001) of degenerative changes and a 4.61 odds ratio (P<0.001) of joint effusions. These results clearly show that the risk of degenerative changes and joint effusions increase with displacement of the disk position in patients with temporomandibular disorders. Although all disk displacement situations do not progress to painful joints and/or degenerative joint diseases, the possibility of an increased risk of progression by a breakdown in the balance between a patient’s adaptive capacity and functional loading of the TMJ should be assessed in each and every patient through comprehensive evaluation of various contributing factors.

Adjacent segment degenerative disease: is it due to disease progression or a fusion-associated phenomenon? Comparison between segments adjacent to the fused and non-fused segments

The purpose of this study was to determine whether fusion causes adjacent segment degeneration or whether degeneration is due to disease progression. Eighty-seven patients that had undergone single level anterior cervical decompression and fusions with at least 5years of follow-up were enrolled in this retrospective study. Segments adjacent to fusion levels (above or below) were allocated to group A, and all others were allocated to group B. Radiographic evaluations of adjacent level changes included assessments of; disc degenerative changes, anterior ossification formation, and segmental instability. The developments of new clinical symptoms were also evaluated. In group A, adjacent segment degenerative change developed in 28 segments (16%) and two cases (2%) developed new clinical symptoms. In group B, adjacent segment degenerative change developed in 10 segments (3%), and two cases (0.7%) also developed new clinical symptoms. Additional operations were performed in one patient in each group. Although, fusion per se can accelerate the severity of adjacent level degeneration, no significant difference was observed between adjacent and non-adjacent segments in terms of the incidence of symptomatic disease. The authors conclude that adjacent segment disease is more a result of the natural history of cervical spondylosis than the presence of fusion.

The effect of degenerative morphological changes of the intervertebral disc on the lumbar spine biomechanics: a poroelastic finite element investigation

Intervertebral disc degeneration involves changes in the spinal anatomical structures. The mechanical relevance of the following changes was investigated: disc height, endplate sclerosis, disc water content, permeability and depressurisation. A poroelastic nonlinear finite element model of the L4–L5 human spine segments was employed. Loads represented a daily cycle (500 N compression combined with flexion–extension motion for 16 h followed by 200 N compression for 8 h). In non-degenerative conditions, the model predicted a diurnal axial displacement of 1.32 mm and a peak intradiscal pressure of 0.47 MPa. Axial displacement, facet force and range of motion in flexion–extension are decreased by decreasing disc height. By decreasing the initial water content, axial displacement, facet force and fluid loss were all reduced. Endplate sclerosis did not have a significant influence on the calculated results. Depressurisation determined an increase of the disc effective stress, possibly inducing failure. Degenerative instability was not calculated in any simulations.

Association Between Disk Position and Degenerative Bone Changes of the Temporomandibular Joints: An Imaging Study in Subjects with TMD

The aim of this study was to determine the frequency and relationship between disk position and degenerative bone changes in the temporomandibular joints (TMJ), in subjects with internal derangement (ID). MRI and CT scans of 180 subjects with temporomandibular disorders (TMD) were studied. Different image parameters or characteristics were observed, such as disk position, joint effusion, condyle movement, degenerative bone changes (flattened, cortical erosions and irregularities), osteophytes, subchondral cysts and idiopathic condyle resorption. The present study concluded that there is a significant association between disk displacement without reduction and degenerative bone changes in patients with TMD. The study also found a high probability of degenerative bone changes when disk displacement without reduction is present. No association was found between TMD and condyle range of motion, joint effusion and/or degenerative bone changes. The following were the most frequent morphological changes observed: flattening of the anterior surface of the condyle; followed by erosions and irregularities of the joint surfaces; flattening of the articular surface of the temporal eminence, subchondral cysts, osteophytes; and idiopathic condyle resorption, in decreasing order.

Nucleus disc arthroplasty with the NUBAC™ device: 2-year clinical experience

Low back pain (LBP) due to degenerative disc disease (DDD) is a common condition that can be treated along a continuum of care: from conservative therapies to several surgical choices. Nucleus arthroplasty is an emerging technology that could potentially fill part of the gap in the spine continuum of care. The introduction of recent technologies that allow the replacement of the degenerated disc nucleus using prosthetic devices may be considered an additional therapeutic tool that can be used by the surgeon in selected cases of LBP due to DDD. Nucleus arthroplasties are designed to treat early stages of DDD, which are one of the most common spinal disorders in the population under 65 years of age. NUBAC™ is the first articulating nucleus disc prosthesis, designed to optimally respect the lumbar anatomy, kinematics, and biomechanics, constructed in unique two-piece manufactured from polyetheretherketone (PEEK) with an inner ball/socket articulation. The optimal indications for NUBAC™ implantation are: disc height >5 mm, degenerative disc changes at an early stage (Pfirmann 2, 3), single level affection, integrity of posterior facet joints, lack of local anatomical contraindication, failure of conservative treatment for at least 6 months. From December 2006 to January 2009, a total of 39 patients underwent nucleus disc arthroplasty with NUBAC™ device. 22 cases have 2-year follow up. There have been no major intra-operative or post-operative vascular or neurological complications in this series. The data showed that there were significant decreases in both Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) after the procedure, with a meaningful improvement of symptoms in all patients. Although preliminary, the initial results are encouraging. The absence of any major intra-operative and post-operative complications supports the design rationale of the NUBAC™, being less invasive comparing to total disc replacement (TDA) and with a low rate of surgical risk. The effectiveness of data as seen in 2-year follow-up on both VAS and ODI have also suggested that the NUBAC™ could be considered a viable treatment option for patients with LBP caused by DDD.