Disc Degeneration Research Articles

Self-healing hydrogels loaded with Spatholobi Caulis alleviate disc degeneration by promoting autophagy in nucelus pulposus

Intervertebral disc degeneration (IDD) is a common degenerative disease of the spine that has a significant impact on both society and human health. Many studies have confirmed that there is a close relationship between IDD and senescence and apoptosis, and autophagy can combat apoptosis and senescence. Spatholobi caulis (SC) is an herb that contains various active compounds that are effective in tissue repair and regeneration, but it has not been explored in field of IDD. In this study, it was first found that SC can boost autophagy and reduce the apoptosis and senescence of Nucleus pulposus cell (NPCs). However, our animal studies revealed limited absorption of SC. To improve the bioavailability and efficacy of SC, we developed a hydrogel incorporating quaternary ammonium chitosan (QCS) and oxidized starch (OST) as carriers for SC. The QCS-OST/SC hydrogel exhibits excellent compatibility with cells, can be easily injected, and can release SC durably. At the cellular level, the QCS-OST/SC hydrogel enhances cell viability, initiates autophagy and release of the extracellular matrix (ECM), and inhibits cellular senescence and apoptosis. The injection of the QCS-OST/SC hydrogel via microneedles (MNs) into discs had successfully diminished disc degeneration in rats, which shows that this hydrogel has broad potential in the treatment of IDD.

Evaluation of Lumbar Spine on MRI in Young Adults presenting with Chronic Backaches

Objective: This study aimed to establish a correlation between clinical symptoms and MRI findings in individuals with chronic back pain. Methodology: This Descriptive cross-sectional study was conducted over a period of four months after ethical approval in the Radiology department at a Tertiary Care Hospital in Lahore. Acohort of 135 young adults were assessed through a consecutive sampling method and underwent lumbar spine MRI examinations. Results: The pool of participants in the study encompassed 42.2% males and 57.8% females, aged between 18 and 40 years, with an average age of 31.5 years and a standard deviation of 6.06. There were four prominent MRI findings: Lumbar Spondylosis (46%, Disc Degeneration (25%, Disc Bulge (10%), and Disc Desiccation (9%). The study also found significant correlations between these findings and clinical characteristics, with Lumbar Spondylosis linked to lower limb numbness and mobility difficulties, and Disc Bulge correlated with pain duration. Conclusion: The findings underscore the effectiveness of MRI scans in identifying underlying causes of chronic back pain in young adults in Pakistan. Keywords: Lumber spondylosis, disc degeneration, disc bulge, Lower Limb Numbness, and Magnetic Resonance Imagin

YAP1 exacerbates pyroptosis and senescence in nucleus pulposus cells by promoting BNIP3-mediated mitophagy

Yes-associated protein 1 (YAP1) is a crucial downstream effector of the Hippo pathway that plays a role in regulating inflammation and mitochondrial function. However, whether YAP1 regulates pyroptosis in nucleus pulposus (NP) cells caused by inflammation via mitophagy remains unclear. This study aimed to investigate the effects of YAP1 on the pyroptosis of NP cells induced by LPS. Here, we demonstrated that the protein expression of YAP1 in the NP tissue of degenerative discs was significantly reduced. Next, we found that NLRP3 inflammasome activation in YAP1-overexpressing (YAP1-ov) NP cells was further enhanced in the LPS-induced inflammatory microenvironment. YAP1-ov strongly aggravated inflammation-induced pyroptosis and senescence, but these effects were reversed by the inhibition of BNIP3-mediated mitophagy. However, comparative analysis of the overexpression of YAP1 in normal discs and discs after annulus fibrosus puncture revealed that YAP1-ov accelerated the degeneration of normal discs and attenuated the degeneration of annulus fibrosus punctured discs in vivo. Additionally, YAP1-ov upregulated the expression of TNFAIP3, an anti-inflammatory protective protein, and CLPP, a vital protein in the mitochondrial unfolded protein response, in NP cells. Collectively, the above results revealed that YAP1 exacerbates LPS-induced pyroptosis and senescence of NP cells by promoting BNIP3-mediated mitophagy, which causes disc degeneration. Notably, YAP1-ov mitigated the degeneration of the disc caused by annular needle puncture in vivo, suggesting its potential as a therapeutic candidate foracute IDD injury.

Oxygen-controllable injectable hydrogel alleviates intervertebral disc degeneration by balancing extracellular matrix metabolism

Nucleus pulposus (NP) cells, situated at the core of intervertebral discs, have acclimated to a hypoxic environment, orchestrating the equilibrium of extracellular matrix metabolism (ECM) under the regulatory influence of hypoxia inducible factor-1α (HIF-1α). Neovascularization and increased oxygen content pose a threat, triggering ECM degradation and intervertebral disc degeneration (IVDD). To address this, our study devised an oxygen-controllable strategy, introducing laccase into an injectable and ultrasound-responsive gelatin/agarose hydrogel. Laccase-mediated reactions were employed to deplete oxygen, establishing a hypoxic microenvironment that upregulated HIF-1α expression. The activation of hypoxia-inducible factors significantly enhanced the expression of aggrecan and collagen II, concurrently suppressing Matrix metalloproteinases (MMP13) and A Disintegrin and Metalloproteinase with Thrombospondin motifs (ADAMTS5) levels, thereby restoring the equilibrium of ECM metabolism. Simultaneously, the hydrogel facilitated the recruitment of stem cells into the NP through the controlled release of ATI2341, activating C-X-C chemokine receptor type 4 (CXCR4). Moreover, ultrasound amplification enhanced ATI2341 release, promoting the migration of NP stem cells. The hydrogel's efficacy in mitigating metabolic imbalances and inhibiting IVDD progression was substantiated in a rat puncture IVDD model through hydrogel injection into the discs. In conclusion, this hypoxia-inducible hydrogel, responsive to thermal stimuli from ultrasound, presents a promising avenue for IVDD treatment.

The effects of extracellular matrix-degrading enzymes polymorphisms on intervertebral disc degeneration.

The objective of the current study was to investigate the correlation between polymorphisms in extracellular matrix-degrading enzymes and the risk of intervertebral disc degeneration (IDD) diseases. The databases PubMed, Embase, and Cochrane Database were systematically queried from the inception until March 2023 to ascertain studies that meet the eligibility criteria. Utilizing a standardized data collection form to extract data from individual studies. The data were quantified using odds ratio (OR) along with its corresponding 95% confidence interval (95% CI), following an allelic model of inheritance. The study included a total of nine studies and indicated that the presence of rs17576 in the MMP9 gene was significantly associated with an increased risk of IDD diseases (GG: 1.30, 95% CI [1.09-1.55], p = 0.004). The presence of other polymorphisms in extracellular matrix-degrading enzymes did not exhibit a significant association with the susceptibility to IDD. The current study demonstrated a noteworthy correlation between the GG genotype of MMP-9 rs17576 and susceptibility to IDD. The available evidence is insufficient to substantiate the correlation between other extracellular matrix-degrading enzymes and susceptibility to IDD. The constraints of this analysis necessitate further research involving larger sample sizes across diverse ethnicities to provide a comprehensive understanding of the true impact of these polymorphisms on susceptibility to IDD.

Assessing MRI Scans of Spinal Disc Degeneration Using Machine Learning

Abstract: Chronic back pain caused by degenerative changes in the spinal disc has significantly impacted the quality of life of patients. Magnetic resonance imaging gives a very clear visualization of the intervertebral disc; however, it is still subjective and more mentally demanding when it is a manual assessment. Therefore, the present paper discusses the possibility of integrating image processing techniques with machine learning algorithms in order to arrive at more accurate diagnosis for spinal disc degeneration. Preprocessing the image, segmentation, and feature extraction are incorporated along with various machine learning models like convolutional neural networks (CNN) and support vector machines (SVM) into the review of present methodologies. Our results show that these hybrid approaches improve classification accuracy and aid in early detection for better management of the patient. This project helps in identifying the four stages of spinal disc degeneration.

Comparison of Disc Degeneration between Pyogenic Spondylitis and Noninfected Lumbar Spondylosis: A Multicenter Retrospective Study with Propensity Score Matching

Comparison of Disc Degeneration between Pyogenic Spondylitis and Noninfected Lumbar Spondylosis: A Multicenter Retrospective Study with Propensity Score Matching

Efficacy of Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty in the Treatment of Cervical Degenerative Disc Disease, Radiculopathy, and Myelopathy: A Systematic Review.

Cervical degenerative disc disease (DDD) is a condition in which the discs in the neck deteriorate, causing symptoms including neck and arm pain, muscle weakness, and incoordination. In severe cases, it can lead to nerve and spinal cord compression, resulting in radiculopathy and myelopathy. This review aimed to assess the effectiveness of two surgical treatments, anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA), for addressing cervical DDD, radiculopathy, and myelopathy. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search was conducted in the PubMed and BioMed Central databases, from January to March 2024. Thirty-one studies were included, comparing the outcomes of ACDF and CDA in patients with cervical DDD, radiculopathy, and myelopathy. Data were analyzed to evaluate outcomes such as the Neck Disability Index (NDI), pain levels, neurological status, incidence of secondary surgeries, range of motion (ROM) maintenance, and occurrence of adjacent segment disease. CDA demonstrated comparable or superior clinical success to ACDF. Both the techniques showed similar improvements in NDI, pain levels, and neurological status during medium- and long-term follow-ups. CDA had lower rates of secondary surgeries and adverse events related to surgery or implants compared to ACDF. It also demonstrated a lower incidence of adjacent segment disease and better ROM preservation. The evidence supports CDA as a safe and effective alternative to ACDF for patients with cervical DDD, particularly those who may benefit from motion preservation. However, further long-term, multicenter randomized controlled trials are needed to provide more definitive guidance for clinical practice.

Is Cervical Disc Degeneration a Compensatory Mechanism in Hirayama Disease? A Retrospective Case‒Control Study.

Retrospective Cohort Study. This study aimed to explore the association between cervical disc degeneration and disease progression in patients with Hirayama disease, with a particular focus on changes in the cervical intervertebral disc space height and potential compensatory mechanisms. This retrospective study included 35 patients diagnosed with Hirayama disease (HD), who were compared with 35 healthy control subjects matched for age and sex. This study focused on collecting and analyzing cervical disc grades and intervertebral space heights from C2 to C7, aiming to assess the extent of cervical disc degeneration between HD patients and the control group. The analysis used independent sample t tests and Mann‒Whitney U tests for demographic data and Spearman's correlation coefficient to explore the relationship between disc degeneration and age. Compared with the control group, patients with Hirayama disease presented significant reductions in intervertebral disc height (P < .01) and increased disc degeneration. Within the HD group, most patients displayed multisegment degeneration (30 out of 35), and more than half presented with full-segment disc degeneration (20 out of 35), which was significantly different from the normal population (P < .01). Patients with Hirayama disease exhibit disc degeneration and reduced intervertebral space height, which may represent a compensatory response.

PCRX-201, a novel IL-1Ra gene therapy treatment approach for low back pain resulting from intervertebral disc degeneration.

Low back pain is the leading cause of global disability with intervertebral disc (IVD) degeneration a major cause. However, no current treatments target the underlying pathophysiological causes. PCRX-201 presents a novel gene therapy approach that addresses this issue. PCRX-201 codes for interleukin-1 receptor antagonist, the signalling inhibitor of the pro-inflammatory cytokine interleukin-1, which orchestrates the catabolic degeneration of the IVD. Here, the ability of PCRX-201 to transduce human nucleus pulposus cells to increase IL-1Ra production was assessed together with effects on catabolic pathways. When transduced with PCRX-201, the production and release of IL-1Ra was increased in degenerate human nucleus pulposus cells and tissue. Whereas, the production of downstream proteins, including IL-1β, IL-6, MMP3, ADAMTS4 and VEGF were decreased in both cells and tissue, indicating a reduction in IL-1-induced catabolic signalling. Here, a novel gene therapy vector, PCRX-201, was shown to transduce degenerate NP cells and tissue, increasing the production of IL-1Ra. The increased IL-1Ra resulted in decreased production of catabolic cytokines, enzymes and angiogenic factors, whilst also increasing aggrecan expression. This demonstrates PCRX-201 enables the inhibition of IL-1-driven IVD degeneration. The ability of PCRX-201 to elicit anti-catabolic responses is promising and warrants further development to determine the efficacy of this exciting, novel gene therapy.

Elevating Postinjection Stability in Silk Nanofibril Hydrogels to Prevent Intervertebral Disc Degeneration.

Injectable hydrogels offer a minimally invasive approach to treating intervertebral disc degeneration, a prevalent condition that affects 90% of individuals and often leads to significant pain and disability. Despite being a critical yet often overlooked issue that could lead to suboptimal therapeutic outcomes, the mechanical integrity of these gels frequently diminishes postinjection due to the injection process itself. To address this challenge, our research developed a silk-nanofibril-based hydrogel enhanced through simple in situ polymerization of dopamine. The resulting hydrogel not only effectively preserved its modulus at over 1000 Pa postinjection, matching the mechanical properties of the nucleus pulposus, but also significantly enhanced its antioxidative properties to four times that of the original silk nanofibril-based hydrogel. Furthermore, both cell-based and animal studies substantiated that such a silk nanofibril-based hydrogel integrated with polydopamine exhibited significant therapeutic efficacy in the injectable treatment of intervertebral disc degeneration. Therefore, this work introduced a new perspective on the design of injectable hydrogels that could effectively address both the mechanical and biochemical challenges of degenerative disc diseases, providing a platform for subsequent therapeutic interventions.

Efficacy and Safety of Vuong Hoat Natural Health Supplement in Managing Low Back Pain: A Randomized Clinical Trial.

This clinical study aimed to assess the effectiveness and safety of Vuong Hoat (VH) natural health supplement for reducing the negative impact of low back pain, improving the quality of life, and enhancing functional activities in patients with lumbar degenerative disc disease (LDD). The open-label, randomized, controlled clinical trial involved 60 patients suffering from low back pain caused by LDD. The participants were randomly assigned to either a study group (SG) comprising 30 subjects or a control group (CG) comprising 30 subjects. Patients in the CG received treatment with electro-acupuncture, while those in the SG were administered VH in conjunction with the same electro-acupuncture protocol for 28 days. The clinical progression and tolerability of both groups were compared based on seven objective measurements: visual analog scale index, Schober test, fingertip-to-floor distance, spinal flexion, spinal extension, spinal tilt, and spinal rotation. After 14 days of treatment, the SG showed a significant improvement in overall outcomes compared to the CG. Specifically, 43.3% of SG patients achieved very good results, 53.3% had good results, and 3.4% had moderate results, whereas corresponding figures for the CG were 6.7%, 76.7%, and 16.6%, respectively (P < .05). After 28 days of treatment, both groups demonstrated a shift toward very good results, with the SG continuing to show better outcomes than the CG (P < .05). In the SG, the very good results increased to 76.7%, good results decreased to 20%, and moderate results were 3.3%. On the other hand, the CG had 46.7% very good results, 43.3% good results, and 10% moderate results. Notably, no side effects were reported from the VH treatments during the study. The findings of this study indicate that VH health supplement is a safe and effective approach for managing low back pain and limited spinal movement in patients with LDD.

PLGA/BK microspheres targeting the bradykinin signaling pathway as a therapeutic strategy to delay intervertebral disc degeneration

Intervertebral disc degeneration(IVDD) is a common spinal condition with limited effective treatments available. This study aims to investigate the impact of poly(lactic-co-glycolic acid)/Bradykinin (PLGA/BK) microspheres on IVDD and its underlying mechanisms. We collected nucleus pulposus samples from both healthy and degenerated human intervertebral disks and conducted immunohistochemical analyses, revealing reduced BK expression in degenerated tissues. Subsequently, we used BK to treat nucleus pulposus cells and conducted Bulk RNA sequencing (RNA-seq), identifying BK’s involvement in cellular senescence, extracellular matrix metabolism, and the PI3K signaling pathway. Further experiments using tert-butyl hydroperoxide (TBHP)-induced cell senescence showed that BK treatment reduced senescence, enhanced extracellular matrix synthesis, and inhibited degradation, along with activation of the PI3K pathway. These effects were mediated through B2R (BK receptor 2) and the downstream PI3K pathway. Following this, we developed sustained-release BK microspheres with an optimized manufacturing process. In vitro co-culture experiments showed no observable toxicity. We established an IVDD model in rat tail vertebrae through fine needle puncture, administering local injections of BK sustained-release microspheres. Using various experimental methods, including X-ray, MRI, histopathology, and immunohistochemistry, we found that these microspheres could slow the progression of IVDD. This study highlights the potential of injectable PLGA/BK microspheres to regulate cellular senescence and extracellular matrix metabolism via the B2R and PI3K pathways, ultimately delaying IVDD.

Risk factors and treatment strategies for adjacent segment disease following spinal fusion (Review).

Adjacent segment disease (ASD) is a significant clinical complication following cervical and lumbar spinal fusion surgery, characterized by the degeneration of spinal segments adjacent to the fused area. The present literature review aimed to elucidate the risk factors contributing to ASD and to evaluate current and emerging treatment strategies. Epidemiological data indicate that patient‑related factors such as age, pre‑existing spinal degeneration and comorbidities, along with surgical factors including the type of fusion, instrumentation and alignment correction, play pivotal roles in ASD development. Biomechanical alterations post‑fusion further exacerbate the risk. The underlying mechanisms of ASD involve changes in spinal kinematics and disc degeneration, driven by inflammatory and degenerative processes. Diagnostic modalities, such as magnetic resonance imaging and computed tomography scans, are essential for early detection and accurate diagnosis. Preventive strategies emphasize meticulous preoperative planning, advanced surgical techniques and postoperative rehabilitation. Treatment approaches range from conservative methods such as physical therapy and pharmacological interventions to surgical solutions, including revision surgeries and the use of motion‑preserving technologies. Emerging therapies, particularly in regenerative medicine, show promise in mitigating ASD. The present review underscored the necessity of a multidisciplinary approach to optimize patient outcomes and highlighted the need for ongoing research to address gaps in the current understanding of ASD in both cervical and lumbar regions.

Classification of lumbar spine disorders using large language models and MRI segmentation

BackgroundMRI is critical for diagnosing lumbar spine disorders but its complexity challenges diagnostic accuracy. This study proposes a BERT-based large language model (LLM) to enhance precision in classifying lumbar spine disorders through the integration of MRI data, textual reports, and numerical measurements.MethodsThe segmentation quality of MRI data is evaluated using dice coefficients (cut-off: 0.92) and intersection over union (IoU) metrics (cut-off: 0.88) to ensure precise anatomical feature extraction. The CNN extracts key lumbar spine features, such as lumbar lordotic angle (LLA) and disc heights, which are tokenized as direct scalar values representing positional relationships. A data source of 28,065 patients with various disorders, including degenerative disc disease, spinal stenosis, and spondylolisthesis, is used to establish diagnostic standards. These standards are refined through post-CNN processing of MRI texture features. The BERT-based spinal LLM model integrates these CNN-extracted MRI features and numerical values through early fusion layers.ResultsSegmentation analysis illustrate various lumbar spine disorders and their anatomical changes. The model achieved high performance, with all key metrics nearing 0.9, demonstrating its effectiveness in classifying conditions like spondylolisthesis, herniated disc, and spinal stenosis. External validation further confirmed the model’s generalizability across different populations. External validation on 514 expert-validated MRI cases further confirms the model’s clinical relevance and generalizability. The BERT-based model classifies 61 combinations of lumbar spine disorders.ConclusionsThe BERT-based spinal LLM significantly improves the precision of lumbar spine disorder classification, supporting accurate diagnosis and treatment planning.

Cartilage Endplate‐Targeted Engineered Exosome Releasing and Acid Neutralizing Hydrogel Reverses Intervertebral Disc Degeneration

AbstractCartilage endplate cell (CEPC) and nucleus pulposus cell (NPC) inflammation are critical factors that contribute to intervertebral disc degeneration (IVDD). Recent evidence indicated that iron ion influx, reactive oxygen species (ROS), and the cGAS‐STING pathway are involved in CEPC inflammatory degeneration. Moreover, cytokines produced by degenerating CEPCs and lactic acid accumulation within the microenvironment significantly contribute to NPC inflammation. Consequently, simultaneous alleviation of CEPC inflammation and correction of the acidic microenvironment are anticipated to reverse IVDD. Herein, CEPC‐targeted engineered exosomes loaded with salvianolic acid A are incorporated into a CaCO3/chitosan hydrogel, forming a composite gel, CAP‐sEXOs@Gel. Notably, CAP‐sEXOs@Gel shows long local retention, realizes the slow release of CAP‐sEXOs and specific uptake by CEPCs. After uptake by CEPCs, CAP‐sEXOs reduce intracellular iron ion and ROS by inhibiting hypoxia‐inducible factor‐2α (HIF‐2α)/TfR1 expression. Iron ion influx and ROS inhibition contribute to the maintenance of normal mitochondrial function and reduced mtDNA leakage, suppresing the cGAS‐STING pathway. Additionally, the CaCO3 component of CAP‐sEXOs@Gel neutralizes H+, thereby alleviating NPC inflammation. Collectively, this novel composite hydrogel demonstrates the ability to concurrently inhibit CEPC and NPC inflammation, thereby presenting a promising therapeutic approach for IVDD.

Clinical Outcomes Following Treatment of Cervical Spondylotic Radiculopathy With Cervical Posterior Decompression Using Unilateral Biportal Endoscopic Technique: A Single Center Retrospective Series of 20 Patients.

Unilateral biportal endoscopy (UBE) is a minimally invasive approach to treat cervical spondylotic radiculopathy (CSR), which is a common condition caused secondary to disc herniation, disc degeneration, uncal osteophytes, and other conditions manifesting as neuropathic radicular pain. Anterior cervical discectomy and fusion (ACDF) is the gold standard surgical technique for treating CSR. However, it has several disadvantages, including loss of mobile segment, adjacent segment degeneration (ASD), implant- and approach-related complications, and high hospitalization costs. The current study aimed to evaluate the safety and efficacy of UBE decompression for CSR. After obtaining IRB approval, a single-center retrospective study was undertaken. Included patients underwent UBE decompression for CSR with a minimum of 6 months of follow-up. Patient demographics, perioperative data, and length of hospital stay were reviewed. Clinical outcomes were assessed using VAS scores for neck and arm pain, and NDI scores were measure preoperatively and at 1 and 6 months after UBE decompression. A repeated analysis of variance test was performed to measure the difference between VAS and NDI scores. Twenty patients (M: 15, F: 5) with a mean age of 56.7 ± 10.2 years were included. The mean follow-up period was 8.4 ± 1.8 months. The mean surgical time was 64.3±10.6 minutes. The average length of hospital stay was 1 day. At the final follow-up, the mean VAS for arm pain improved from 6.4 ± 0.7 to 0.6 ± 0.5 (92% improvement) and the mean VAS for neck pain improved from 3.3 ± 0.4 to 2.0 ± 0.2 (40% improvement). NDI score improved from 23.2 ± 1.95 to 5.7 ± 0.6 at the final follow-up (75% improvement). There were no complications. UBE is a safe and effective surgical treatment option for patients with CSR with excellent clinical outcomes. Clinical relevance of this case series study is to demonstrate the safety and efficacy of the novel unilateral biportal endoscopic decompression of cervical spondylotic radiculopathy and its short term clinical outcomes.

Effectiveness of robot-assisted minimally invasive and open freehand transforaminal lumbar interbody fusion in treatment of single-level degenerative lumbar spondylolisthesis and the influence on adjacent segment degeneration

To compare the effectiveness of robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open freehand TLIF for the treatment of single-level degenerative lumbar spondylolisthesis (DSL) and analyse the influence on postoperative adjacent segmental degeneration (ASD). The clinical data of 116 patients with L 4、5 DLS who were admitted between November 2019 and October 2021 and met the selection criteria were retrospectively analyzed. According to the surgical methods, they were divided into the robotic group (45 cases, who underwent robot-assisted MIS-TLIF) and the open group (71 cases, who underwent open freehand TLIF). There was no significant difference in baseline data such as gender, age, body mass index, DLS Meyerding grading, and preoperative Pfirrmann grading, Weishaupt grading, L 3, 4 intervertebral disc height (DH), L 3, 4 intervertebral mobility, sagittal parameters [including pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT)], and Cage height ( P>0.05). The grade of facet joint violation (FJV) by pedicle screws on the superior articular process was assessed postoperatively. Sagittal parameters, L 3, 4 DH, L 3, 4 DH loss, and L 3, 4 intervertebral mobility were measured preoperatively and at last follow-up in order to determine whether ASD occurred. Based on the occurrence of postoperative ASD, logistic regression analysis was used to identify the risk factors for ASD after TLIF. Patients in both groups were followed up 21-47 months, with a mean of 36.1 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The occurrence of postoperative FJV was significantly better in the robotic group than in the open group ( P<0.05). At last follow-up, the difference in the change values of sagittal parameters PI, PT, SS, and LL was not significant when comparing the two groups of patients ( P>0.05); the change values of L 3, 4 DH and L 3, 4 DH loss in the robotic group were smaller than those in the open group, and the change value of L 3, 4 intervertebral mobility was larger than that in the open group, and the differences were significant ( P<0.05). At last follow-up, ASD occurred in 8 patients (17.8%) in the robotic group and 35 patients (49.3%) in the open group, and the difference in ASD incidence between the two groups was significant ( P<0.05). logistic regression analysis showed that open surgery, preoperative Pfirrmann grading Ⅳ-Ⅴ, preoperative Weishaupt grading ≥2, and postoperative FJV grading ≥1 were risk factors for the development of ASD after TLIF ( P<0.05). Compared with traditional open surgery, orthopedic robot-assisted MIS-TLIF in the treatment of single-level DLS can more accurately insert pedicle screws, reduce the loss of DH and the occurrence of FJV, and effectively reduce the incidence of mid-postoperative ASD. Preoperative disc and synovial joint degeneration in adjacent segments, nonrobotic-assisted minimally invasive therapy, and FJV are risk factors for ASD after TLIF.

The association of limited or painful spinal range of motion with lumbar disc degeneration: the back complaints in older adults (BACE) study

BackgroundWe currently lack clear definitions for structural and symptomatic spinal osteoarthritis (OA). To define spinal OA and create diagnostic criteria for this condition, it is necessary to determine the relationship between clinical signs and symptoms of back pain and radiographic features of OA. Notably, recent studies suggest a defining sign of spinal OA could be a limited or painful spinal range of motion (ROM). Therefore, our objective was to assess the association between restricted or painful active spinal ROM, and multilevel structural features of lumbar disc degeneration (LDD) (i.e., disc space narrowing, osteophytes) on radiographs.MethodsWe used the baseline data from the’Back Complaints in Older Adults’ (BACE) study. The association between a limited or painful active spinal ROM, and multilevel disc space narrowing or osteophytes was assessed using multivariable logistic regression adjusted for age, mean pain intensity in the previous week, sex, BMI, and the Fear Avoidance Belief Questionnaire score. Primary analyses were performed on imputed datasets.ResultsWe included 675 patients with a mean age of 66.52 years (SD 7.69). Limited latero-flexion (fingertip that at best reached halfway up the upper leg) was associated with increased odds of having multilevel osteophytes (OR 1.85; 95% CI: 1.13 to 3.01). However, a limited or painful ROM in other directions (i.e., rotation, ante-flexion) was not associated with multilevel osteophytes, and a limited or painful active ROM in any direction was found to have no association with multilevel disc space narrowing.ConclusionsOur study indicates that a restricted ROM in latero-flexion could potentially be a defining sign in future definitions of symptomatic spinal OA. However, since our results partially differ from previous studies, further research is needed to explore the association between active ROM and LDD.

"Elucidating the immunomodulatory role of endocannabinoids in intervertebral disc degeneration".

The endocannabinoid system (ECS) has been well-established to play a crucial role in the regulation of several physiological processes as well as many inflammatory disease conditions. However, its role in intervertebral disc degeneration has been least explored. We aim to investigate the immunomodulatory role of endocannabinoids in regulating IVD health. The study population included 20 healthy volunteers (controls) and 40 patients with disc degeneration (disease group) (20 Modic and 20 Non Modic). 16S metagenome sequencing of the V3-V4 region was performed for the DNA extracted from NP tissue samples of both control and disease groups. Sequencing was carried out using the Novaseq 6000 platform using 250bp paired-end chemistry. A global metabolic profile was obtained using the uHPLC system coupled with Q Exactive Plus Hybrid Quadrupole-Orbitrap mass spectrometer. Our study revealed a higher prevalence of gram-negative bacteria, particularly opportunistic pathogens like Pseudomonas, in diseased discs (71-81%) compared to healthy controls (54%). Further investigation using metabolomics identified significant changes in the lipid profiles of diseased discs. We found that the signalling molecules of the ECS, 2-arachidonylglycerol (2-AG) and N-arachidonoylethanolamine (AEA), were significantly lower in diseased discs compared to controls (Log2FC -2.62 for 2-AG and -3.15 for AEA). Conversely, pro-inflammatory metabolites like LTA4, HPETE, HETE, and Prostaglandin G2 were elevated in diseased discs, with a Log2 fold increase greater than 2.5. The study reveals that the endocannabinoid metabolites (2-AG and AEA) of the ECS could be a significant molecule influencing susceptibility to infection and inflammation within the intervertebral discs, which could be a potential target for improving disc health. Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.