Early Disc Research Articles

An Early Disc Herniation Identification System for Advancement in the Standard Medical Screening Procedure Based on Bayes Theorem.

The aim of this research was to analyze objectively the process of disc herniation identification using Bayes Theorem. One of the symptoms of discus hernia is muscle weakness on the foot that is caused by displaced discs in the space of two vertebrae. This fact is used by experts in initial diagnosis of herniated discs and we used it to create non-invasive platform for the same purposes by measuring force values from four sensors placed on both feet (first, second, and fourth metatarsal head as well as the heel). Dataset consisted of several minute force recordings of 56 subjects with discus hernia and 15 healthy individuals during normal standing, standing on forefeet and heels. The subjects were diagnosed by a specialist with either L4/L5 or L5/S1 discus hernia. Collected recordings were processed in several steps including filtering, extraction of forefeet and heel recordings, classification of average values for forefeet, and heel sensors to the groups with or without foot muscle weakness. Application of Bayes Theorem on the attributes of interest showed average 78.3% accuracy with 62.6% sensitivity and 80.9% specificity, while application of naive Bayes Network showed average 83.1% accuracy with 57.6% sensitivity and 88.2% specificity. Very weak or no correlation was observed between gender and disc hernia diagnosis (or obesity type and disc hernia diagnosis). Obtained results show that this method can be used in initial screening of patients and be a supportive tool to doctors to send the same patients for further examination.

Tracing the formation of the Milky Way through ultra metal-poor stars

We use Gaia DR2 astrometric and photometric data, published radial velocities and MESA models to infer distances, orbits, surface gravities, and effective temperatures for all ultra metal-poor stars ($\FeH<-4.0$ dex) available in the literature. Assuming that these stars are old ($>11\Gyr$) and that they are expected to belong to the Milky Way halo, we find that these 42 stars (18 dwarf stars and 24 giants or sub-giants) are currently within $\sim20\kpc$ of the Sun and that they map a wide variety of orbits. A large fraction of those stars remains confined to the inner parts of the halo and was likely formed or accreted early on in the history of the Milky Way, while others have larger apocentres ($>30\kpc$), hinting at later accretion from dwarf galaxies. Of particular interest, we find evidence that a significant fraction of all known UMP stars ($\sim26$\%) are on prograde orbits confined within $3\kpc$ of the Milky Way plane ($J_z < 100 \kms \kpc$). One intriguing interpretation is that these stars belonged to the massive building block(s) of the proto-Milky Way that formed the backbone of the Milky Way disc. Alternatively, they might have formed in the early disc and have been dynamically heated, or have been brought into the Milky Way by one or more accretion events whose orbit was dragged into the plane by dynamical friction before disruption. The combination of the exquisite Gaia DR2 data and surveys of the very metal-poor sky opens an exciting era in which we can trace the very early formation of the Milky Way.

Assessment of Glycosaminoglycan Content of Lumbar Intervertebral Discs in Patients with Radiculopathy

Objective: To assess glycosaminoglycan (GAG) content of lumbar intervertebral discs (IVDs) in patients with radiculopathy compared with healthy volunteers with glycosaminoglycan chemical exchange saturation transfer (gagCEST). Methods: The lumbar spines of 15 patients with radiculopathy (9 women, 6 men; mean age 45 years; range: 19 - 80 years) and 13 healthy controls (10 women, 3 men; mean age 29 years; range: 19 - 38 years) without lumbar back pain or previous spine surgery were examined at a 3 Tesla (T) magnetic resonance imaging (MRI) scanner in this prospective study. The MRI protocol included standard morphological, sagittal, and transverse T2-weighted (T2w) images of the five lumbar IVDs (L1-S1) to assess Pfirrmann score and to detect disc disorders according to the Combined Task Force classification. To analyze biochemically the lumbar IVDs, a gagCEST sequence was applied to measure the GAG content of the nucleus pulposus (NP) and annulus fibrosus (AF). Results: Patients with radiculopathy indicated significantly lower gagCEST values in NP than healthy volunteers (2.82% ± 3.12% vs. 4.09% ± 2.25%, P = 0.017). The GAG content of AF showed no significant difference between volunteers and patients (2.66% ± 2.01% vs. 1.92% ± 2.56%; P = 0.175). Conclusions. Patients with radiculopathy presented with lower GAG values than healthy volunteers in NP, indicating an association between pain and IVD degeneration. gagCEST of lumbar IVDs is a powerful, non-invasive tool to investigate early disc degeneration, which we could demonstrate in the NP in our study collective.

Multi-epoch L-band Spectroscopy of the Be Star μ Centauri Prior to Outburst

Abstract With the aim of contributing to the understanding of the disk formation process in Be stars, we pursued a one-year spectroscopic observing campaign of the Be star μ Centauri in the L-band, using VLT/ISAAC. We present the nine near-IR spectra we obtained in an epoch of relative photometric quiescence prior to an outburst of ΔV = 0.4 magnitude. Visual estimates during the epoch of our L-band spectroscopy are also presented for the first time, together with the unpublished complete visual light curve between the years 1998 and 2014. We observe significant and monotonic changes in emission line strength of Bracket-α and Pfund-γ lines relative to Humphreys lines, and also in the continuum slope. We interpret these observed changes in terms of important changes to the column density of the line emitting regions, moving from an optically thin to an optically thick stage just prior to a major outburst. For each observing date, we provide estimates for the column density and relative extension of the line emitting region. If the changes observed toward the end of our observing campaign were related to mass-loss changes from the central star, they would correspond to an increase in a factor of two in the mass of the disk in the innermost region. If related to the visual outburst observed one month later, the variability observed in our spectra would be the first detection of the early disk formation process in the L-band.

The impact of non-ideal effects on the circumstellar disk evolution and their observational signatures

AbstractIt has been recognized that non-ideal MHD effects (Ohmic diffusion, Hall effect, ambipolar diffusion) play crucial roles for the circumstellar disk formation and evolution. Ohmic and ambipolar diffusion decouple the gas and the magnetic field, and significantly reduces the magnetic torque in the disk, which enables the formation of the circumstellar disk (e.g., Tsukamoto et al. 2015b). They set an upper limit to the magnetic field strength of ∼ 0.1 G around the disk (Masson et al. 2016). The Hall effect notably changes the magnetic torques in the envelope around the disk, and strengthens or weakens the magnetic braking depending on the relative orientation of magnetic field and angular momentum. This suggests that the bimodal evolution of the disk size possibly occurs in the early disk evolutionary phase (Tsukamoto et al. 2015a, Tsukamoto et al. 2017). Hall effect and ambipolar diffusion imprint the possibly observable characteristic velocity structures in the envelope of Class 0/I YSOs. Hall effect forms a counter-rotating envelope around the disk. Our simulations show that counter rotating envelope has the size of 100–1000 au and a recent observation actually infers such a structure (Takakuwaet al. 2018). Ambipolar diffusion causes the significant ion-neutral drift in the envelopes. Our simulations show that the drift velocity of ion could become 100-1000 ms–1.

Is exclusion of leukocytes from platelet-rich plasma (PRP) a better choice for early intervertebral disc regeneration?

BackgroundPlatelet-rich plasma (PRP) is becoming a promising strategy to treat early intervertebral disc degeneration (IDD) in clinics. Pure PRP without leukocytes (P-PRP) may decrease the catabolic and inflammatory changes in the early degenerated intervertebral discs. The aim of this study was to investigate the effects of P-PRP on nucleus pulposus-derived stem cells (NPSCs) isolated from early degenerated intervertebral discs in vitro.MethodsNPSCs isolated from early degenerated discs of rabbits were treated with P-PRP or leukocyte-platelet-rich PRP (L-PRP) in vitro, followed by measuring cell proliferation, stem cell marker expression, inflammatory gene expression, and anabolic and catabolic protein expression by immunostaining, quantitative real-time polymerase chain reaction, Western blot, and enzyme-linked immunosorbent assay.ResultsCell proliferation was induced by P-PRP in a dose-dependent manner with maximum proliferation at 10% P-PRP dose. P-PRP induced differentiation of NPSCs into active nucleus pulposus cells. P-PRP mainly increased the expression of anabolic genes and relative proteins, aggrecan (AGC), collagen types II (Col II), while L-PRP predominantly increased the expression of catabolic and inflammatory genes, matrix metalloproteinase-1 (MMP-1), MMP-13, interleukin-1 beta (IL-1β), IL-6, tumor necrosis factor alpha (TNF-α), and protein production of IL-1β and TNF-α.ConclusionsLeukocytes in PRP activate inflammatory and catabolic effects on NPSCs from early degenerated intervertebral discs. Hence, P-PRP may be a more suitable therapeutic strategy for early IDD.

Early changes in the extracellular matrix of the degenerating intervertebral disc, assessed by Fourier transform infrared imaging

Mechanical overloading induces a degenerative cell response in the intervertebral disc. However, early changes in the extracellular matrix (ECM) are challenging to assess with conventional techniques. Fourier Transform Infrared (FTIR) imaging allows visualization and quantification of the ECM. We aim to identify markers for disc degeneration and apply these to investigate early degenerative changes due to overloading and katabolic cell activity. Three experiments were conducted; Exp 1.: Invivo, lumbar spines of seven goats were operated: one disc was injected with chondroitinase ABC [cABC (mild degeneration)] and compared to the adjacent disc (control) after 24 weeks. Exp 2a: Exvivo, caprine discs received physiological loading (n=10) or overloading (n=10) in a bioreactor. Exp 2b: Cell activity was diminished prior to testing by freeze-thaw cycles, 18 discs were then tested as in Exp 2a. In all experiments, FTIR images (spectral region: 1000-1300cm-1) of mid-sagittal slices were analyzed using multivariate curve resolution. Invivo, FTIR was more sensitive than biochemical and histological analysis in identifying reduced proteoglycan content (P=0.046) and increased collagen content in degenerated discs (P<0.01). Notably, FTIR analysis additionally showed disorganization of the ECM, indicated by increased collagen entropy (P=0.011). Exvivo, the proteoglycan/collagen ratio decreased due to overloading (P=0.047) and collagen entropy increased (P=0.047). Cell activity affected collagen content only (P=0.044). FTIR imaging allows a more detailed investigation of early disc degeneration than traditional measures. Changes due to mild overloading could be assessed and quantified. Matrix remodeling is the first detectable step towards intervertebral disc degeneration.

Changes in Intervertebral Disk Mechanical Behavior During Early Degeneration.

Intervertebral disk (IVD) degeneration is commonly described by loss of height and hydration. However, in the first stage of IVD degeneration, this loss has not yet occurred. In the current study, we use an ex vivo degeneration model to analyze the changes in IVDs mechanical behavior in the first phase of degeneration. We characterize these changes by stretched-exponential fitting, and suggest the fitted parameters as markers for early degeneration. Enzymatic degeneration of healthy lumbar caprine IVDs was induced by injecting 100 μL of Chondroïtinase ABC (Cabc) into the nucleus. A no-intervention and phosphate buffered saline (PBS) injected group were used as controls. IVDs were cultured in a bioreactor for 20 days under diurnal, simulated-physiological loading (SPL) conditions. Disk deformation was continuously monitored. Changes in disk height recovery behavior were quantified using stretched-exponential fitting. Disk height, histological sections, and water- and glycosaminoglycan (GAG)-content measurements were used as gold standards for the degenerative state. Cabc injection caused significant GAG loss from the nucleus and had detrimental effects on poro-elastic mechanical properties of the IVDs. These were progressive over time, with a propensity toward more linear recovery behavior. On histological sections, both PBS and Cabc injected IVDs showed moderate degeneration. A small GAG loss yields changes in IVD recovery behavior, which can be quantified with stretched-exponential fitting. Parameters changed significantly compared to control. Studies on disk degeneration and biomaterial engineering for degenerative disk disease (DDD) could benefit from focusing on IVD biomechanical behavior rather than height and water-content, as a marker for early disk degeneration.

Testaments to Bach

This batch of recordings testifies to the ongoing appetite for new releases of Johann Sebastian Bach’s major works for strings. The eleven discs discussed in this review focus on Bachian works for violin, including those for solo violin, violin and harpsichord as well as the violin concertos. Testament: Complete sonatas and partitas for solo violin (Avie av2360, rec 2015, 125′) is Rachel Barton Pine’s first complete recording of the Bach solos. She previously recorded the Sonata in G minor (bwv1001) and Partita in D minor (bwv1004) as part of Solo Baroque (Cedille cdr90000 078, rec 2004, 73′)—a recording reviewed for this journal by Stephen Rose (Early Music, xxxiv/2 (2006), p.325). The earlier disc used a period-instrument setup, but for Testament she opts for her primary concert combination of a modernized Guarneri del Gesù violin with a Baroque bow. The playing is technically immaculate and successfully combines mainstream and historically informed performance sensibilities. The slow sonata movements are eloquently phrased and the HIP elements are even more pronounced in the partitas. For example, the Partita in E major (bwv1006) features metric articulation, restrained notes inégales in Menuet I, and delightful embellishments in repeated sections, particularly in the Loure and final Gigue. For those interested in the continuing influence of HIP on mainstream performance, Dorottya Fabian’s A musicology of performance: theory and method based on Bach’s solos for violin (2015) provides a detailed investigation of 40 recent recordings, including unreleased concert recordings by Pine made prior to this commercial release.

Spatial geometric and magnetic resonance signal intensity changes with advancing stages of nucleus pulposus degeneration

BackgroundWith advancing stages of degeneration, denaturation and degradation of proteoglycans in the nucleus pulposus (NP) lead to tissue dehydration and signal intensity loss on T2-weighted MR images. Pfirrmann grading is widely used for grading degeneration of intervertebral discs (IVDs). The criterion to differentiate IVDs of Pfirrmann Grade I from the other grades is NP homogeneity. Pfirrmann grading is qualitative and its assessment may be subjective. Therefore, assessment of quantitative objective measures correlating with early disc degeneration may complement the grading. This study aimed to evaluate the applicability of the distance between the center weighted by signal intensity (weighted center) and the geometric center as a parameter of NP homogeneity. Other phenomena related to advancing stages of degeneration were also investigated.MethodsMR images of 65 asymptomatic volunteers with a total of 288 lumbar IVDs with clearly identifiable nucleus pulposus boundary (Pfirrmann Grade I, II and III) were included in this study. A custom-written program was developed to determine the IVD longitudinal axis, define the NP boundary, and to locate the coordinates of geometric and weighted NP centers on the mid-sagittal image of each studied IVD. The distances between the weighted and geometric centers on the longitudinal axis and the perpendicular axis of each IVD were calculated.ResultsThe weighted center located posterior to the geometric center, which indicated the signal intensity was lower at the anterior portion of the NP, in 85.8% of studied IVDs. The distance between the weighted and geometric center on the longitudinal axis was significantly shorter in homogeneous (Pfirrmann Grade I) than in inhomogeneous (Grade II) IVDs. The distance on the perpendicular axis in Grade III IVDs was significantly larger than that in Grade I and Grade II IVDs.ConclusionThe relationship between the weighted and geometric centers can serve as an indicator for NP homogeneity. The distance between both centers through advancing stages of degeneration demonstrated decrease of signal intensity progressing along the longitudinal axis initially and then along the cranio-caudal direction at later stages. These findings could provide insights of initiation and subsequent progression of degenerative changes in IVDs.

The impact of the Hall effect during cloud core collapse: Implications for circumstellar disk evolution

Abstract We perform three-dimensional radiation non-ideal magnetohydrodynamics simulations and investigate the impact of the Hall effect on the angular momentum evolution in collapsing cloud cores in which the magnetic field B and angular momentum Jang are misaligned with each other. We find that the Hall effect noticeably changes the magnetic torques in the pseudo-disk, and strengthens and weakens the magnetic braking in cores with acute and obtuse relative angles between B and Jang, respectively. This suggests that the bimodal evolution of the disk size may occur in the early disk evolutionary phase even if B and Jang are randomly distributed. We show that a counter-rotating envelope forms in the upper envelope of the pseudo-disk in cloud cores with obtuse relative angles. We also find that a counter-rotating region forms at the midplane of the pseudo-disk in cloud cores with acute relative angles. The former and latter types of counter-rotating envelopes may be associated with young stellar objects with large (r ∼ 100 au) and small (r ≲ 10 au) disks, respectively.

Preliminary study of intervention in effect of Bushen Huoxue recipe on calcification of lumbar vertebra cartilage endplate of the aging gerbils

To study the effect of Bushen Huoxue decoction on calcification of cartilage endplate in lumbar vertebrae. Six healthy male gerbils with 2-month-old were selected as normal control group, and 24 7-month-old healthy male gerbils were fed to 12-month-old to establish the aged gerbil model. Thirty gerbils were randomly divided into five groups as follow: the normal control group (n=6), model group (n=6, normal saline 4 ml/kg, intragastric 30 d), Bushen Huoxue low dose group(n=6, 1.9× 10⁻ ³ ml/g given Bushen Huoxue recipe orally, 30 d), Bushen Huoxue middle dose group(n=6, 3.8× 10⁻ ³ ml/g given Bushen Huoxue recipe orally, 30 d), Bushen Huoxue high dose group(n=6, 7.6× 10⁻ ³ ml/g given Bushen Huoxue recipe orally, 30 d), the intervention group administered for 1.36 g from 7-month-old age, 30 d. The animals were sacrificed at the age of 2 months in the normal control group and 12 months of age in the other groups. The morphology of the lumbar vertebral cartilage endplate, the area of vascular bud, the ratio of non-calcified/calcified layer were analysis by HE chromosome visual method. The expression of type X collagen and BMPs in cartilage endplates were detected by rabbit monoclonal immunohistochemical staining. The relative area of the vascular buds cartilage endplate measurements showed that compared with the model group, middle dose group and normal control group increased (P<0.05), high and low dose groups all had different degrees of increase, but no statistical significance(P>0.05). The ratio of cartilage endplate thickness of non-calcified/calcified showed that compared with the model group, Bushen Huoxue middle dose, normal control group increased, with statistical significance(P<0.05), and high and low dose groups all had different degrees of increase, but there were no statistical significance(P>0.05). Compared with the model group, the expression of type X collagen in the cartilage endplate of the normal group, the Bushen Huoxue low, middle and high dose groups decreased, and had statistical significance(P<0.01); compared with the model group, the expression of BMPs in the normal group, Bushen Huoxue middle dose group increased, with statistically significant(P<0.01), while the high and low dose groups increased in different degrees, but there was no statistical significance(P>0.05). Bushen Huoxue prescription can delay the calcification of cartilage endplate in the process of aging, suggesting that it can be used as a preventive medicine for early disc degeneration.

Intervertebral Disc Characteristic on Progressive Neurological Deficit

Objective: To examine the intervertebral disc characteristic on magnetic resonance imaging (MRI) in lumbar herniated disc (LHD) patients with progressive neurological deficit. Methods: Patients were collected retrospectively from Dr. Hasan Sadikin General Hospital Database from 2011–2013 with LHD, had neurological deficit such as radiculopathy and cauda equine syndrome for less than four weeks with a positive sign confirmed by neurological examination and confirmatory with MRI examination. Results: A total of 14 patients with lumbar herniated disc disease (10 males, 4 females) suffered from progressive neurological deficit with an average age of (52.07±10.9) years old. Early disc height was 9.38±0.5 mm and progressive neurological deficit state disc height was 4.03±0.53 mm, which were significantly different statisticaly (p<0.01). Symptoms of radiculopathy were seen in 11 patients and cauda equine syndrome in three patients. Modic changes grade 1 was found in five patients, grade 2 in eight patients,grade 3 in one patient, Pfirmman grade 2 in eleven patients and grade 3 in three patients. Thecal sac compression 1/3 compression was seen in four patients and 2/3 compression in ten patients. Conclusions: Neurosurgeon should raise concerns on the characteristic changes of intervertebral disc in magnetic resonance imaging examination to avoid further neural injury in lumbar herniated disc patients. Keywords: Lumbar herniated disc, magnetic resonance imaging, progressive neurological deficit DOI: 10.15850/ijihs.v5n2.1042

Ozone discolysis in lumbar disc prolapse

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Treatment of low back ache due to prolapsed intervertebral disc is still controversial. Several conservative modalities are available with varied results. Surgical discectomy may lead to failed back syndrome due to change in vertebral column anatomy and its mechanics. To prevent it, conservative means are better and Ozone discolysis is one of the nonsurgical methods. The indications and effectiveness of this condition is not well defined. The present study was done to correlate the clinical outcome of this technique.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This was a prospective study conducted on 67 patients presenting with symptoms of back pain with arid without radicular symptoms. X ray and MRI were done in all cases. Then intradiscal ozone gas was given at one level from a specialized machine under C arm guidance. For evaluation Oswestry disability index and Macnab scoring system was used. Post injection patients were evaluated at 2, 6 weeks and 6 months&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Sixty seven patients with mean age of 47.7 years were followed up for 7.8 months. Low back pain was the commonest symptom and SLR was positive in 5.36%. The modified Macnab scoring with good and fair score improved from 16% to 89% and Oswestry disability index with minimal and moderate disability improved from 41% to 91% at end of 6 months. Seven patients had relapse of pain due to repeat disc prolapse. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Ozone discloses is better modality of treatment for low back pain with disc bulge and early disc prolapsed.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Asthma and early herniated intervertebral disc disease

Background: The etiology of herniated intervertebral disc (HIVD) disease in children and adolescents is multifactorial and not merely related to disc degeneration. Therefore, in the present study, we investigated the relationship between young asthma patients and the risk of early HIVD disease in a population under 30 years of age.Methods: Data from the National Health Insurance Research Database (NHIRD) of Taiwan were used to conduct a retrospective longitudinal cohort study. The study cohort comprised 23,470 patients with asthma (asthma group) and 23,470 patients without asthma (non-asthma group), who were selected through frequency matching on the basis of sex, age, and the index year. The study patients were followed until HIVD disease occurrence, withdrawal from the National Health Insurance program, or 31 December 2013. Cox proportional hazards regression analysis was conducted to assess the risk of HIVD disease in the asthma group after adjustment for sex, age, and comorbidities.Results: After adjustment for sex, age, and comorbidities, the asthma group had a 1.69-fold (95% confidence interval [CI] = 1.29–2.23) higher risk of HIVD disease than did the non-asthma group. In addition, the asthma group had a higher risk of cervical and lumbar HIVD diseases than did the non-asthma group (adjusted hazard ratio [HR] = 2.38; 95% CI = 1.25–4.57 and adjusted HR = 1.56; 95% CI = 1.15–2.12, respectively).Conclusions: Young patients with asthma are at a significantly higher risk of early cervical or lumbar HIVD disease.

Meta-analysis of the effects of genetic polymorphisms on intervertebral disc degeneration.

Chronic low back pain is a significant public health issue. Both its direct and indirect cost represents tens of billions of US dollars. Although chronic low back pain can be the result of many factors, the predominant cause is disc degeneration. Recent studies have shown genetic involvement in up to 74% of cases. This study aimed to evaluate genetic risk factors of disc degeneration by performing a systematic analysis of association studies. The objective is to provide a guide for practice by assessing the clinical relevance of current information. We performed a meta-analysis of 3122 items collected from 6 databases. 74 articles were selected according to our inclusion criteria. 18 (24%) could be grouped into 16 meta-analyses of 16 mutations in 12 genes. The statistics of the meta-analysis were conducted through Revman 5.1 software. The items included are 10,250 cases and 14,136 controls. The GOLD range from 3.42 to 0.38. Two alleles were significantly associated with disc degeneration: IL-6 rs1800797 and MMP-9 rs17576 and one proved to be protective: IL-6 rs1800795. 13 meta-analyses did not yield significant results and methodological heterogeneity. The results highlight the lack of methodological rigor in most of the studies. The absence of international clinical and radiological classification of early disc degeneration, limits the homogeneity of studies. Understanding which populations are predisposed to this significant public health problem may change our approach to diagnostic and therapeutic methods. This work opens up enormous opportunities to provide a genetic solution and consider new diagnostic and therapeutic means to this public health problem.

Neurological and spinal manifestations of the Ehlers-Danlos syndromes.

The Ehlers-Danlos syndromes (EDS) are a heterogeneous group of heritable connective tissue disorders characterized by joint hypermobility, skin extensibility, and tissue fragility. This communication briefly reports upon the neurological manifestations that arise including the weakness of the ligaments of the craniocervical junction and spine, early disc degeneration, and the weakness of the epineurium and perineurium surrounding peripheral nerves. Entrapment, deformation, and biophysical deformative stresses exerted upon the nervous system may alter gene expression, neuronal function and phenotypic expression. This report also discusses increased prevalence of migraine, idiopathic intracranial hypertension, Tarlov cysts, tethered cord syndrome, and dystonia, where associations with EDS have been anecdotally reported, but where epidemiological evidence is not yet available. Chiari Malformation Type I (CMI) has been reported to be a comorbid condition to EDS, and may be complicated by craniocervical instability or basilar invagination. Motor delay, headache, and quadriparesis have been attributed to ligamentous laxity and instability at the atlanto-occipital and atlantoaxial joints, which may complicate all forms of EDS. Discopathy and early degenerative spondylotic disease manifest by spinal segmental instability and kyphosis, rendering EDS patients prone to mechanical pain, and myelopathy. Musculoskeletal pain starts early, is chronic and debilitating, and the neuromuscular disease of EDS manifests symptomatically with weakness, myalgia, easy fatigability, limited walking, reduction of vibration sense, and mild impairment of mobility and daily activities. Consensus criteria and clinical practice guidelines, based upon stronger epidemiological and pathophysiological evidence, are needed to refine diagnosis and treatment of the various neurological and spinal manifestations of EDS. © 2017 Wiley Periodicals, Inc.

Meta-analysis of the effects of genetic mutations on intervertebral disc degeneration

Introduction Chronic low back pain is a significant public health issue. Both its direct and indirect cost represents tens of billions of dollars. Although chronic low back pain can be the result of many factors, the predominant cause is disc degeneration. Recent studies have shown genetic involvement in up to 74% of cases. This study aimed to evaluate genetic risk factors of disc degeneration by performing a systematic analysis of association studies. The objective is to provide a guide for practice by assessing the clinical relevance of current information. Methods and materials We performed a meta-analysis of 3122 items collected from 6 databases. Seventy-four articles were selected according to our inclusion criteria. Eighteen (24%) could be grouped into 16 meta-analyses of 16 mutations in 12 genes. The statistics of the meta-analysis were conducted through Revman 5.1 software. Results The items included are 10,250 cases and 14,136 controls. The Gold range from 3.42 to 0.38. Two alleles were significantly associated with disc degeneration (IL-6 rs1800797 and MMP-9 rs17576) and one proved to be protective (IL-6 rs1800795). Thirteen meta-analyses did not yield significant results and methodological heterogeneity. Discussion The results highlight the lack of methodological rigor in most of the studies. The absence of international clinical and radiological classification of early disc degeneration limits the homogeneity of studies. Understanding which populations are predisposed to this significant public health problem may change our approach to diagnostic and therapeutic methods. This work opens up enormous opportunities to provide a genetic solution and consider new diagnostic and therapeutic means to this public health problem.

Association Between Lumbar Spine Sagittal Alignment and L4-L5 Disc Degeneration Among Asymptomatic Young Adults.

Cross-sectional observational study on the relationship between the degrees of disc degeneration and sagittal alignment in asymptomatic healthy individuals. This study sought to determine whether the sagittal spine alignment subtype is related to the prevalence of lumbar disc degeneration. Sagittal balance and spinopelvic parameters might be risk factors for disc degeneration. A total of 70 asymptomatic participants (36 women and 34 men) without regular physical activity were categorized according to the four subtypes of sagittal alignment proposed by Roussouly. All participants underwent magnetic resonance imaging of the lumbar spine (1.5T) and panoramic radiography of the spine. The degree of disc degeneration was graded using T2-weighted images according to the Pfirrmann classification. Spinopelvic parameters and vertebral curvatures were measured on digital panoramic radiographs using Surgimap software. Interobserver analyses for the Pfirrmann classification and spinopelvic parameters were assessed using the weighted Kappa and intraclass correlation coefficient (ICC), respectively. The Kappa associated with disc degeneration classification was 0.79 (95% confidence intervals 0.72-0.87). The ICCs were excellent, with small confidence intervals for all spinopelvic parameters. The type II group (flat lordosis) showed a higher frequency of degenerated discs at L4-L5 (P = 0.03) than the type IV group (long and curved lumbar spine). No significant differences in disc degeneration were observed among the four subtypes at the other disc levels. We found a negative, moderate correlation between the spinopelvic parameters and the occurrence of disc degeneration in the type II group. The Roussouly subtype II sagittal alignment is significantly associated with disc degeneration at L4-L5 in asymptomatic young adults. Our results support the hypothesis that spinal sagittal alignment plays a role in early disc degeneration. 3.

FACET GEOMETRY AND UNILATERAL LUMBAR DISC HERNIATION

Up to now there have been two contradictory opinions in regard to lumbar facet role in the development of disc degeneration and herniation. To reconfirm the clinical validity of facet arrangement in the development of early disc degeneration and herniation, this study was carried out. For this purpose, the relationship between lumbar unilateral disc protrusion and geometry of the facet joints in the transverse plane was investigated. Method: The facet geometry was measured at the L4 disc level in the 35 protruded disc patients and L5 disc level in the 19 protruded disc patients. The computed tomographic scan sections were made 2[Formula: see text]mm intervals. The discs of L4 and L5 levels in the patients without disc protrusion and patients with spine injury were used as control. Results: 1. The facet angle showed the different individual variance. Among the L[Formula: see text] disc herniation group, the mean facet angle in the protruded and opposite sides and control were [Formula: see text] (29–70[Formula: see text]), [Formula: see text] (29–65[Formula: see text]), and [Formula: see text] (30–65[Formula: see text]). Those values at L5-S1 level were [Formula: see text] (35–79[Formula: see text]), [Formula: see text] (36–79[Formula: see text]), and [Formula: see text] (36–79[Formula: see text]), respectively. 2. Transverse interfacet angle (TIFA) of the L[Formula: see text] protruded disc level and that of control were 97–14[Formula: see text] (59–125[Formula: see text]) and [Formula: see text] (66–127[Formula: see text]). Those of L5-S1 level were [Formula: see text] (70–132[Formula: see text]) and [Formula: see text] (76–151[Formula: see text]). 3. The angle difference between both sides in the case of the facet asymmetry at L[Formula: see text] disc level was [Formula: see text] (0–30[Formula: see text]), and that of the control was [Formula: see text] (0–15[Formula: see text]), and those of L5-S1 level were [Formula: see text] (0–24[Formula: see text]) and [Formula: see text] (0–24[Formula: see text]), respectively. Disc herniation developed toward the more obliquely aligned facet joint side in 19 (54.2%) out of the 35 patients at the L[Formula: see text] disc, while disc herniation at L5-S1 level developed toward the more obliquely aligned facet joint side in 11 (57.9%) out of the 19 patients. 4. Among the L[Formula: see text] disc level, the mean moment arm angles in the disc-protruded side, the opposite side and control were [Formula: see text] (16–40[Formula: see text]), [Formula: see text] (15–35[Formula: see text]), and [Formula: see text] (16–35[Formula: see text]). Those of L5-S1 level each were [Formula: see text] (21–36[Formula: see text]), [Formula: see text] (17–35[Formula: see text]), and [Formula: see text] (16–35[Formula: see text]), respectively. 5. At the L[Formula: see text] level, the mean non-dimensional facet depths in the disc-protruded side, the opposite side, and control were [Formula: see text] (0–0.36[Formula: see text]), [Formula: see text] (0–0.41[Formula: see text]), and [Formula: see text] (0.02–0.28[Formula: see text]). Those facet depths at L5-S1 level were [Formula: see text] (0.02–0.28[Formula: see text]), [Formula: see text] (0.02–0.2[Formula: see text]), and [Formula: see text] (0.02–0.28[Formula: see text]). Conclusion: The five parameters including facet angle showed clinically no significant correlation with the disc herniation.