Endplate Sclerosis Research Articles

Prevalence of presumed endplate junction failure at the lumbosacral intervertebral junction in dogs on computed tomography.

Lumbosacral intervertebral disc herniation (IVDH) is a common cause of lower back pain in dogs and humans. In humans, the vertebral endplate to annulus fibrosus (AF) attachment was implicated as an alternative failure site besides rupture through the dorsal AF (AFF). Endplate junction failure (EPJF) is characterized by IVDH, accompanied by endplate irregularities (type A), rim avulsions (type B), or larger bony avulsions on one (type C) or both endplates (type D), associated with an adjacent endplate defect. This retrospective study reports the CT prevalence of presumed EPJF in dogs and its associations with signalment and other lumbosacral CT abnormalities. CT scans, including the lumbosacral spine of dogs obtained at two institutions, were assessed, yielding 324 scans. Presumed EPJF was found in 69 dogs (21%) and AFF in 68 dogs (21%), commonly at the caudal endplate of the last lumbar vertebra (71%). The remaining 187 dogs did not show presumed EPJF or AFF. Presumed EPJF type A occurred in 49/69, type B in 19/69, and type C in 1/69 dogs. Univariable logistic regression showed that presumed EPJF was associated with significantly higher IVDH grades than AFF. In the multiple regression model, presumed EPJF and AFF remained associated with increasing age and spondylosis deformans. Presumed EPJF was associated with vertebral endplate sclerosis and AFF with zygapophyseal joint osteoarthritis. In conclusion, presumed EPJF was observed on CT in 21% of dogs with lumbosacral IVDH. Prospective studies correlating EPJF on CT with clinical, surgical, and histopathological findings are needed for a better understanding of the underlying pathology and clinical relevance.

Slit3 by PTH-Induced Osteoblast Secretion Repels Sensory Innervation in Spine Porous Endplates to Relieve Low Back Pain.

During aging, the spine undergoes degenerative changes, particularly with vertebral endplate bone expansion and sclerosis, that is associated with nonspecific low back pain (LBP). We reported that parathyroid hormone (PTH) treatment could reduce vertebral endplate sclerosis and improve pain behaviors in aging, SM/J and young lumbar spine instability (LSI) mice. Aberrant innervation noted in the vertebral body and endplate during spinal degeneration was reduced with PTH treatment in aging and LSI mice as quantified by PGP9.5 + and CGRP + nerve fibers, as well as CGRP expression in dorsal root ganglia (DRG). The neuronal repulsion factor Slit3 significantly increased in response to PTH treatment mediated by transcriptional factor FoxA2. PTH type1 receptor (PPR) and Slit3 deletion in osteoblasts prevented PTH-reduction of endplate porosity and improvement in behavior tests, whereas PPR deletion in chondrocytes continued to respond to PTH. Altogether, PTH stimulates Slit3 to repel sensory nerve innervation and provides symptomatic relief of LBP associated with spinal degeneration.

Can magnetic resonance imaging findings effectively diagnose the instability observed on radiographs in patients with degenerative lumbar spinal stenosis?

BackgroundDegenerative lumbar spinal stenosis (LSS) is a common condition that involves the narrowing of the spinal canal. Diagnosing instability traditionally requires standing lateral radiographs to detect dynamic translation, but there is debate about relying solely on radiographs due to challenges like patient discomfort and radiation exposure. This study aimed to evaluate if Magnetic Resonance Imaging (MRI) findings could effectively diagnose instability observed on radiographs.MethodsWe reviewed 478 consecutive patients with degenerative LSS who had surgery at our institution. Instability was defined as a sagittal translation exceeding 3 mm on standing lateral radiographs in both extension and flexion. Patients were divided into stable (those with < 3 mm translation) and unstable groups (those with > 3 mm translation). The study assessed potential variables for instability, including MRI findings like facet joint effusion, facet joint angle, disk height index, intradiscal vacuum presence, endplate sclerosis, ligamentum flavum hypertrophy, and multifidus muscle fatty degeneration, comparing these factors between the two groups.ResultsA total of 478 consecutive patients diagnosed with degenerative Lumbar Spinal Stenosis (LSS) were included. The average age of the patients was 66.32 years, with 43.3% being male. Approximately 27.6% of the cases exhibited signs of instability on the standing lateral radiograph during extension and flexion. The multivariate analysis using binary logistic regression revealed that facet joint effusion (odds ratio [OR] 2.73; 95% confidence interval [CI] 1.27–3.94; P = 0.002), disk height index (OR 2.22; 95% CI 1.68–3.35; P = 0.009), and the presence of the Vacuum sign (OR 1.77; 95% CI 1.32–2.84; P = 0.021) were identified as factors associated with instability.ConclusionsOur findings showed thata higher facet joint effusion, the presence of Vacuum sign, and a greater Disk Height Index were associated with the presence of instability on the standing lateral radiograph in extension and flexion in patients with degenerative LSS.

Senescent-like macrophages mediate angiogenesis for endplate sclerosis via IL-10 secretion in male mice

Endplate sclerosis is a notable aspect of spine degeneration or aging, but the mechanisms remain unclear. Here, we report that senescent macrophages accumulate in the sclerotic endplates of lumbar spine instability (LSI) or aging male mouse model. Specifically, knockout of cdkn2a (p16) in macrophages abrogates LSI or aging-induced angiogenesis and sclerosis in the endplates. Furthermore, both in vivo and in vitro studies indicate that IL-10 is the primary elevated cytokine of senescence-related secretory phenotype (SASP). Mechanistically, IL-10 increases pSTAT3 in endothelial cells, leading to pSTAT3 directly binding to the promoters of Vegfa, Mmp2, and Pdgfb to encourage their production, resulting in angiogenesis. This study provides information on understanding the link between immune senescence and endplate sclerosis, which might be useful for therapeutic approaches.

Predictive Value of Cervical Degenerative Quantitative Scoring System on Postoperative Disc Height Loss After Cervical Disc Replacement.

A retrospective study. In this study, a cervical degenerative quantitative scoring system was used to identify the risk factors for disc height loss after cervical disc replacement (CDR) and to verify their accuracy. Disc height loss after CDR is drawing much attention. Preoperative cervical degeneration has been proven related to postoperative disc height loss but lacked quantitative verification. A total of 160 patients who underwent CDR with the Prestige-LP disc at our hospital between January 2011 and December 2016 were retrospectively reviewed. Disc height loss was defined as a reduction of more than 2 mm from postoperative to the final follow-up. A quantitative scoring system was used to evaluate preoperative degeneration on radiographs. Multivariate logistic regression was applied to determine predictive factors and calculate the logistic regression formula. Moreover, receiver operating characteristic curve analysis was conducted to obtain the optimal cutoff value and the area under the receiver operating characteristic curve [areas under the curve (AUC)]. Study subjects had a mean age of 43.51 ± 8.51 years, with a mean follow-up time of 60.14 ± 12.75 months. The overall incidence rate of disc height loss was 65.62%. Multivariate logistic regression analysis showed that endplate sclerosis ( P = 0.000) and low preoperative disc height ( P = 0.000) were independent risk factors for postoperative disc height loss. In addition, the calculated optimal cutoff point was 1 point of endplate sclerosis (AUC = 0.768) and 4.5 mm of preoperative disc height (AUC = 0.795). The regression formula established by multivariate logistic regression analysis was composed of preoperative disc height (odds ratio: 2.995, P = 0.000) and endplate sclerosis (odds ratio: 18.131, P = 0.000), with an AUC of 0.879. Our findings suggest that a comprehensive preoperative assessment is essential when patients with apparent endplate sclerosis and low preoperative disc height are being considered for CDR.

Lateral fenestration of lumbar intervertebral discs in rabbits: development and characterisation of an in vivo preclinical model with multi-modal endpoint analysis

PurposeTo evaluate the biological and biomechanical effects of fenestration/microdiscectomy in an in vivo rabbit model, and in doing so, create a preclinical animal model of IVDD.MethodsLateral lumbar IVD fenestration was performed in vivo as single- (L3/4; n = 12) and multi-level (L2/3, L3/4, L4/5; n = 12) fenestration in skeletally mature 6-month-old New Zealand White rabbits. Radiographic, micro-CT, micro-MRI, non-destructive robotic range of motion, and histological evaluations were performed 6- and 12-weeks postoperatively. Independent t tests, one-way and two-way ANOVA and Kruskal–Wallis tests were used for parametric and nonparametric data, respectively. Statistical significance was set at P < 0.05.ResultsAll rabbits recovered uneventfully from surgery and ambulated normally. Radiographs and micro-CT demonstrated marked reactive proliferative osseous changes and endplate sclerosis at fenestrated IVDs. Range of motion at the fenestrated disc space was significantly reduced compared to intact controls at 6- and 12-weeks postoperatively (P < 0.05). Mean disc height index percentage for fenestrated IVDs was significantly lower than adjacent, non-operated IVDs for both single and multi-level groups, at 6 and 12 weeks (P < 0.001). Pfirrmann MRI IVDD and histological grading scores were significantly higher for fenestrated IVDs compared to non-operated adjacent and age-matched control IVDs for single and multi-level groups at 6 and 12 weeks (P < 0.001).ConclusionsFenestration, akin to microdiscectomy, demonstrated significant biological, and biomechanical effects in this in vivo rabbit model and warrants consideration by veterinary and human spine surgeons. This described model may be suitable for preclinical in vivo evaluation of therapeutic strategies for IVDD in veterinary and human patients.

Mechanical crosstalk between the intervertebral disc, facet joints, and vertebral endplate following acute disc injury in a rabbit model.

Vertebral endplate sclerosis and facet osteoarthritis have been documented in animals and humans. However, it is unclear how these adjacent pathologies engage in crosstalk with the intervertebral disc. This study sought to elucidate this crosstalk by assessing each compartment individually in response to acute disc injury. Eleven New Zealand White rabbits underwent annular disc puncture using a 16G or 21G needle. At 4 and 10 weeks, individual compartments of the motion segment were analyzed. Discs underwent T 1 relaxation mapping with MRI contrast agent gadodiamide as well T 2 mapping. Both discs and facets underwent mechanical testing via vertebra-disc-vertebra tension-compression creep testing and indentation testing, respectively. Endplate bone density was quantified via μCT. Discs and facets were sectioned and stained for histology scoring. Intervertebral discs became more degenerative with increasing needle diameter and time post-puncture. Bone density also increased in endplates adjacent to both 21G and 16G punctured discs leading to reduced gadodiamide transport at 10 weeks. The facet joints, however, did not follow this same trend. Facets adjacent to 16G punctured discs were less degenerative than facets adjacent to 21G punctured discs at 10 weeks. 16G facets were more degenerative at 4 weeks than at 10, suggesting the cartilage had recovered. The formation of severe disc osteophytes in 16G punctured discs between 4 and 10 weeks likely offloaded the facet cartilage, leading to the recovery observed. Overall, this study supports that degeneration spans the whole spinal motion segment following disc injury. Vertebral endplate thickening occurred in response to disc injury, which limited the diffusion of small molecules into the disc. This work also suggests that altered disc mechanics can induce facet degeneration, and that extreme bony remodeling adjacent to the disc may promote facet cartilage recovery through offloading of the articular cartilage.

AXIN1 bi-allelic variants disrupting the C-terminal DIX domain cause craniometadiaphyseal osteosclerosis with hip dysplasia

Sclerosing skeletal dysplasias result from an imbalance between bone formation and resorption. We identified three homozygous, C-terminally truncating AXIN1 variants in seven individuals from four families affected by macrocephaly, cranial hyperostosis, and vertebral endplate sclerosis. Other frequent findings included hip dysplasia, heart malformations, variable developmental delay, and hematological anomalies. In line with AXIN1 being a central component of the β-catenin destruction complex, analyses of primary and genome-edited cells harboring the truncating variants revealed enhanced basal canonical Wnt pathway activity. All three AXIN1-truncating variants resulted in reduced protein levels and impaired AXIN1 polymerization mediated by its C-terminal DIX domain but partially retained Wnt-inhibitory function upon overexpression. Addition of a tankyrase inhibitor attenuated Wnt overactivity in the AXIN1-mutant model systems. Our data suggest that AXIN1 coordinates the action of osteoblasts and osteoclasts and that tankyrase inhibitors can attenuate the effects of AXIN1 hypomorphic variants.

Comparing CT-Like Images Based on Ultra-Short Echo Time and Gradient Echo T1-Weighted MRI Sequences for the Assessment of Vertebral Disorders Using Histology and True CT as the Reference Standard.

Several magnetic resonance (MR) techniques have been suggested for radiation-free imaging of osseous structures. To compare the diagnostic value of ultra-short echo time and gradient echo T1-weighted MRI for the assessment of vertebral pathologies using histology and computed tomography (CT) as the reference standard. Prospective. Fifty-nine lumbar vertebral bodies harvested from 20 human cadavers (donor age 73 ± 13 years; 9 male). Ultra-short echo time sequence optimized for both bone (UTEb) and cartilage (UTEc) imaging and 3D T1-weighted gradient-echo sequence (T1GRE) at 3 T; susceptibility-weighted imaging (SWI) gradient echo sequence at 1.5 T. CT was performed on a dual-layer dual-energy CT scanner using a routine clinical protocol. Histopathology and conventional CT were acquired as standard of reference. Semi-quantitative and quantitative morphological features of degenerative changes of the spines were evaluated by four radiologists independently on CT and MR images independently and blinded to all other information. Features assessed were osteophytes, endplate sclerosis, visualization of cartilaginous endplate, facet joint degeneration, presence of Schmorl's nodes, and vertebral dimensions. Vertebral disorders were assessed by a pathologist on histology. Agreement between T1GRE, SWI, UTEc, and UTEb sequences and CT imaging and histology as standard of reference were assessed using Fleiss' κ and intra-class correlation coefficients, respectively. For the morphological assessment of osteophytes and endplate sclerosis, the overall agreement between SWI, T1GRE, UTEb, and UTEc with the reference standard (histology combined with CT) was moderate to almost perfect for all readers (osteophytes: SWI, κ range: 0.68-0.76; T1GRE: 0.92-1.00; UTEb: 0.92-1.00; UTEc: 0.77-0.85; sclerosis: SWI, κ range: 0.60-0.70; T1GRE: 0.77-0.82; UTEb: 0.81-0.92; UTEc: 0.61-0.71). For the visualization of the cartilaginous endplate, UTEc showed the overall best agreement with the reference standard (histology) for all readers (κ range: 0.85-0.93). Morphological assessment of vertebral pathologies was feasible and accurate using the MR-based bone imaging sequences compared to CT and histopathology. T1GRE showed the overall best performance for osseous changes and UTEc for the visualization of the cartilaginous endplate. 1 TECHNICAL EFFICACY: Stage 2.

Lumbosacral endplate contour defect is frequently observed concurrent with other lumbosacral abnormalities on spinal CT of French Bulldogs.

Lumbosacral osteochondrosis has been previously described in large breed dogs with variable clinical signs. Its CT features are a contour defect at the dorsal aspect of either vertebral endplate, commonly with an adjacent fragment. Descriptions of this condition have not been previously published in an increasingly popular breed, French Bulldogs. Aims of this retrospective, descriptive, single center study were to evaluate CT lumbosacral abnormalities and the frequency of lumbosacral endplate contour defect in a large sample of French Bulldogs. The presence and location of lumbosacral endplate contour defect and the presence of a concurrent osseous fragment were recorded. Other abnormal CT findings such as L7-S1 disc herniation, cauda equina nerve roots compression or thickening, disc mineralization, endplate sclerosis, spondylosis deformans, S1 articular processes hypertrophy, transitional vertebrae, hemivertebrae, spina bifida, and block vertebrae were recorded. Lumbosacral CT abnormalities were present in 91.8% of dogs (168/183). The most common abnormality was an L7-S1 dorsal disc herniation (77.4%, 130/168). Among dogs with lumbosacral abnormalities, the frequency of a lumbosacral endplate contour defect was 47% (79/168). It mostly involved L7 (78.5%, 62/79) at its dorsolateral aspect (61.3%, 38/62). A mineralized fragment was identified in 62% of the defects (49/79). Endplate contour defects were most frequently seen with a concurrent disc herniation (93.7%, 74/79) causing nerve root compression in 63.3% (50/79) and with sclerosis (65.8%, 52/79). There was no definitive evidence of a relationship with clinical presentation in this sample of French Bulldogs; therefore, this finding should be interpreted with caution. The etiology remains unclear.

Investigate the situation of knee osteoarthristic and evaluate the results of treatment in Ha Dong general hospital in 2021

Objective: To investigate the situation of knee osteoarthritis and evaluate the results of treatment of primary knee osteoarthritis at Ha Dong General Hospital in 2021.Subjects and methods: A retrospective descriptive study on 93 medical records with a diagnosis of knee osteoarthritis according to the standards of the American College of Rheumatology ACR 1991, VAS scale &lt; 6 points, and Damp-Cold combined with Liver and Kidney deficiency according to TCM at Ha Dong General Hospital in 2021. Experimental group: Moxibustion-infrared lamp + Doc hoat ky sinh thang decoction + Electro- acupuncture for 20 days. Control group: Doc hoat ky sinh thang decoction + Electro-acupuncture for 20 days.Results: Physical workers and BMI ≥ 23 increase the risk of knee osteoarthritis. X-ray characteristics of the knee joint: mainly degeneration with 92.47% and inflammation with 60.81%. Features of knee joint ultrasound: Knee effusion accounted for 37.84%, Baker cyst accounted for 11.86%; 83.87% had osteophyte, 51.61% had endplate sclerosis and 39.78% had joint space narrowing. According to modern medicine: the number of patients with knee osteoarthritis and inflamed knee osteoarthritis has a similar incidence. According to traditional medicine: 81.72% were diagnosed with Damp-Cold combined with Liver and Kidney deficiency; 18.28% were Damp-Heat combined with Liver and Kidney deficiency, 9.68% were Damp-Cold standalone. The pain reduction efficiency according to VAS of the experimental group was 5.96 ± 1.09 points, higher than that of the control group which was 4.56 ± 0.77 points with statistical significance (p&lt;0.05). In the experimental group, 30% of patients had no pain, 70% of patients had mild pain. In the control group, 10% of patients had moderate pain, 86.7% had mild pain and only 3.3% of patients had no pain. The difference between the two groups was statistically significant (p&lt;0.05). The improvement effect of the experimental group was better than the control group, the difference was statistically significant (p &lt; 0.05). During 20 days of treatment, there were no unwanted clinical effects.

Does a Temporary Increase in Glycosaminoglycan (GAG) Indicate Positive Intervertebral Disc Adaptation?

Many in the scientific community have been debating the extent to which the spine can adapt. While it is widely accepted that vertebral bones can adapt and become stronger/denser with appropriately dosed loading, many unanswered questions remain regarding intervertebral discs (IVDs). Recently, some claim that IVDs can adapt to stress under load and become stronger and more resilient over time based on the findings from a recent study “Imaging of exercise-induced spinal remodeling in elite rowers” by Frenken et al 2022 in the Journal of Science and Medicine in Sport. The Frenken paper investigated the IVD Glycosaminoglycan (GAG) increases in elite rowers over the course of a training period, which was to indicate a positive adaptation to training based on the assumption that GAG is decreased in discs with degeneration. A cause-and-effect relationship does not exist and in fact, is unlikely to exist particularly with a historically high prevalence of disc degeneration in rowers. The Frenken paper supports the notion that the GAG content alters in response to certain stimuli; however, we cannot conclude that a temporary increase in GAG content supports the hypothesis that the IVD adapts positively to load. An alternative postulate is that repetitive biomechanical loading of the intervertebral disc through intra-lumbar flexion (as observed in rowing) does stimulate nutrient transport across the vertebral endplates; however, this biochemical response is of limited benefit and should not be perceived as a positive adaptation to the overall longevity and health of the disc. In this context, the elevation in GAG may be more appropriately interpreted as a maladaptive indicator of undesirable biomechanical intra-lumbar flexion stress that progressively drives cartilaginous endplate sclerosis leading ultimately to the clinically observed accelerated disc degeneration, future back pain symptoms, and reduced GAG concentration in rowers. This contrasting interpretation is consistent with the clinical observation of intra-lumbar flexion biomechanical stress, the transient rise in GAG followed by a reduction that correlates with the radiological findings and back pain symptoms evolving over time in elite rowers.

Application of oblique lateral interbody fusion in the treatment of lumbar intervertebral disc degeneration in patients with Modic change and endplate sclerosis

To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis. A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L2,3 in 2 cases, L3,4 in 5 cases, and L4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed. There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved. As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.

Development and validation of a diagnostic model for differentiating tuberculous spondylitis from brucellar spondylitis using machine learning: A retrospective cohort study.

Tuberculous spondylitis (TS) and brucellar spondylitis (BS) are commonly observed in spinal infectious diseases, which are initially caused by bacteremia. BS is easily misdiagnosed as TS, especially in underdeveloped regions of northwestern China with less sensitive medical equipment. Nevertheless, a rapid and reliable diagnostic tool remains to be developed and a clinical diagnostic model to differentiate TS and BS using machine learning algorithms is of great significance. A total of 410 patients were included in this study. Independent factors to predict TS were selected by using the least absolute shrinkage and selection operator (LASSO) regression model, permutation feature importance, and multivariate logistic regression analysis. A TS risk prediction model was developed with six different machine learning algorithms. We used several metrics to evaluate the accuracy, calibration capability, and predictability of these models. The performance of the model with the best predictability was further verified with the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and the calibration curve. The clinical performance of the final model was evaluated by decision curve analysis. Six variables were incorporated in the final model, namely, pain severity, CRP, x-ray intervertebral disc height loss, x-ray endplate sclerosis, CT vertebral destruction, and MRI paravertebral abscess. The analysis of appraising six models revealed that the logistic regression model developed in the current study outperformed other methods in terms of sensitivity (0.88 ± 0.07) and accuracy (0.79 ± 0.07). The AUC of the logistic regression model predicting TS was 0.86 (95% CI, 0.81-0.90) in the training set and 0.86 (95% CI, 0.78-0.92) in the validation set. The decision curve analysis indicated that the logistic regression model displayed a higher clinical efficiency in the differential diagnosis. The logistic regression model developed in this study outperformed other methods. The logistic regression model demonstrated by a calculator exerts good discrimination and calibration capability and could be applicable in differentiating TS from BS in primary health care diagnosis.

Эффективность рентгенологических методов диагностики нестабильности позвоночно-двигательного сегмента в шейном отделе

Introduction. Standard spine radiography is the basic method of radiodiagnosis, used for screening. X-ray imaging allows you to assess the anatomy of spinal motion segments in the cervical spine, determine the period of osteochondrosis and the tactics of further examination and treatment. Various types of dislocation of vertebrae are much more common than can be determined by spinal radiography in standard projections; as a result of dislocation, a pain syndrome occurs. Aim. To study the effectiveness of conventional methods for diagnosis of instability in the spinal motion segment (SMS) in the cervical spine. Materials and methods. We observed 50 patients (mean age 50.6 ± 2.19 years) who were admitted to the Clinic of the Irkutsk Scientific Center for Surgery and Traumatology (Neurosurgical Department) with a diagnosis Adult osteochondrosis of spine (ICD-10 code – M42.1). Conventional methods were used to diagnose SMS instability: plain radiography in anteroposterior and lateral projections, functional cervical spine radiography. Results. It was stated that the most common changes are characteristic of II and III periods of osteochondrosis: straightening of cervical lordosis – in 48 patients (96%), decrease in intervertebral disc height – in 46 patients (92%), anterior wedging of vertebral bodies – in 48 patients (96%), endplate sclerosis – in 37 patients (74%), presence of marginal osteophytes – in 45 patients (90%). In maximum flexion and extension, the CII–CVI vertebrae were involved in the formation of pathological mobility of the intervertebral segments, while the CI and CVII vertebrae remained stable. Instability in one cervical vertebra was revealed in 15 patients (30%). Most often, excessive mobility of 2 vertebrae was observed – in 22 people (44%), less often of 3 vertebrae – in 5 patients (10%). The dislocation of 4 vertebrae was quite rare – in 2 patients (4%). When analyzing the data of functional cervical spine radiography, we have found that the SMS instability in patients with intervertebral disc degeneration develops most often in the following segments: CII–CIII – 13 people (26%), СIII–СIV – 34 people (70%), CIV–CV – 29 people (58%), СV–СVI – 12 people (24%). Conclusion. The SMS instability still remains an urgent problem in neurology and neurosurgery. Plain radiography reveals only indirect signs of SMS instability. Diagnosis by functional spondylography made it possible to verify the SMS instability only in 36% of cases.

Beyond the AJR: Lack of Association Between Radiographic Changes and Back Pain-Related Disability in the Chingford 1000 Study.

This study [1] characterizes the longitudinal and cross-sectional associations between lumbar radiographic findings and back pain-related disability (BPRD) in the Chingford 1000 Women Study, a population-based longitudinal cohort. One rheumatologist classified the degree of disc space narrowing (DSN), endplate sclerosis or deformity, and osteophytes by combining the number of vertebral bodies involved and type of osteoarthritic changes using the Kellgren-Lawrence grading (KLG) system and a previously described semiquantitative method. The researchers generated separate composite scores for KLG, DSN, and osteophyte grade. The data were derived from different study stages including year 6 physical activity score; year 9 imaging, other covariates, and cross-sectional outcomes; and year 15 longitudinal outcomes. The primary outcome was self-reported back pain of at least one day in the last 12 months from the St. Thomas disability questionnaire. Covariates included age, body mass index, smoking, back pain, bisphosphonate usage, and self-reported physical activity. A total of 650 women and 443 women met inclusion criteria for the cross-sectional and longitudinal analyses, respectively. Median BPRD was zero; approximately two thirds of participants reported no BPRD. No lumbar spine radiographic findings were found in 154/650 women. Of the women with one or more KLG composite changes, osteophyte composite changes, or DSN composite changes, no association was found with BPRD in either analysis. In summary, in this cohort, no association was found between the number of segments with radiographic changes (KLG composite, osteophyte composite, DSN composite) and more severe BPRD.

Deletion of ApoE Leads to Intervertebral Disc Degeneration via Aberrant Activation of Adipokines.

Animal experiment: a mouse model of intervertebral disc (IVD) degeneration induced by deletion of apolipoprotein E (apoE). The aim of this study was to investigate the role and mechanism of apoE on the process of IVD degeneration. Abnormal lipid metabolism has been demonstrated to be closely related to IVD degeneration, a common chronic degenerative joint disease. ApoE, a component of apolipoproteins, plays a crucial role in lipid transportation and metabolic balance. But the relationship between apoE and IVD degeneration remains largely unknown. ApoE knockout (KO) mouse was employed to investigate the progressive disc degeneration. The changes of vertebral bone and intervertebral disc space were measured by micro-computed tomography (micro-CT). The histo-morphological changes of cartilage endplate (CEP) and underlying signals were tested using immunohistochemistry and immunofluorescence staining. The deletion of apoE gene accelerated the lumbar spine degeneration. Compared with WT mice, apoE KO mice showed reduced IVD space and increased vertebral bone mass. The progressive CEP degeneration was further found with cartilage degradation and endplate sclerosis in apoE KO mice. The deletion of apoE stimulated abnormal CEP bone remodeling and activation of adipokines signals. The deletion of apoE gene induced abnormal activation of adipokines signals, thus contribute to the CEP degeneration. N/A.

From bowel inflammation to the bone and joints: musculoskeletal examination in inflammatory bowel disease (IBD)

BackgroundOne of the most important complications in inflammatory Bowel Disease (IBD) are musculoskeletal manifestations that are reported in more than 50% of patients.ObjectivesIn this study, we aimed to evaluate the musculoskeletal and radiologic manifestations in our IBD patients.MethodsIn this cross-sectional study on 96 mild-to-moderate IBD patients (76 UC, 18 CD and 2 undifferentiated IBD) with mean (SD) age of 39.28 (11.42) years, 44 (45.8%) were males and 52 were (54.2%) females. Patients were examined by an expert rheumatologist and their musculoskeletal symptoms were assessed. The musculoskeletal system was evaluated by Modified Schober test, Thoracic expansion (TE), Occiput to wall distance (OWD), and Patrick’s or FABER test. Peripheral joints were also examined in all four extremities. Then patients were referred for pelvic and lumbosacral x-ray. Sacroiliitis grading was performed using the New York criteria.ResultsInflammatory low back pain was reported in 5 (5.2%), enthesopathy in 6 (6.5%) and dactylitis in 1 (1.1%). Positive Schober test was recorded in 5 (5.2%) and Patrick test in 3 (3.1%). Forty-nine (51%) cases had normal imaging with no sacroiliitis, endplate sclerosis was seen in 33 cases (34.4%), grade 3 and grade 4 were seen in 10 cases (10.4%).ConclusionsIn the present study, 34.4% of the IBD patients had mild radiologic changes as endplate sclerosis and 95% had a normal physical examination.

Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion

During lateral lumbar interbody fusion (LLIF), unintended intraoperative endplate injury (IEPI) can occur and thereafter lead cage subsidence. The aim of this study was to investigate the incidence of IEPI during LLIF, and its predisposing factors. A retrospective review was conducted on consecutive patients (n = 186; mean age, 70.0 ± 7.6 years) who underwent LLIF at 372 levels. Patient’s demographic and surgical data were compared between patients with and without IEPI. Also, the radiographic data of each level were compared between intact and IEPI segments. IEPI was identified at 76 levels (20.4%) in 65 patients. The incidences of IEPI at every 100 consecutive segments were not different. When 372 segments were analyzed independently, sagittal disc angle (DA) in the extended position (4.3° ± 3.6° at IEPI segments vs. 6.4° ± 4.0° at intact segments), the difference between sagittal DA in the extended position and cage angle (− 2.2° ± 4.0° vs. 0.0° ± 3.9°), and the difference between preoperative disc height and cage height (− 5.4 mm ± 2.4 mm vs. − 4.7 mm ± 2.0 mm) were different significantly. Also, endplate sclerosis was more common at intact segments than IEPI segments (33.2% vs. 17.3%). Multivariate analysis showed that male sex (odds ratio [OR] 0.160; 95% confidence interval [CI] 0.036–0.704), endplate sclerosis (OR 3.307; 95% CI 1.450–8.480), and sagittal DA in the extended position (OR 0.674; 95% CI 0.541–0.840) were significant associated factors for IEPI. IEPI was correlated not with surgeon’s experience, but with patient factors, such as sex, preoperative disc angle, and endplate sclerosis. Careful surgical procedures should be employed for patients with these predisposing factors.

Impact of adjacent pre-existing disc degeneration status on its biomechanics after single-level anterior cervical interbody fusion

Background and objectiveMechanics and biology may be interconnected and amplify each other during disc degeneration. It remains unknown the influence of pre-existing disc degeneration and its impact on adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF). This study aimed to discuss the necessity of including degenerated adjacent segments in single-level ACDF surgery from a biomechanical view. MethodsA poroelastic C2-T1 finite element model was created and validated. A C5-C6 ACDF model was developed based on this normal model. Moderate C4-C5 disc degeneration was created by appropriately modifying the morphology and tissue material properties in this fusion model. Degenerative morphology was modeled based on Thompson's grading system and Walraevens's scoring system for cervical spine, including disc height, whole disc area, nucleus pulposus (NP) area, endplate sclerosis and curvature. Stresses in disc and endplate and loads in facet joint were computed under moment loads in the fusion models with normal and pre-existing degenerative disc condition. ResultsAs for the adjacent disc, the stress values in degenerative condition were 7.41%, 5% and 5.26% larger than that in normal situation during extension, axial rotation and lateral bending motion, respectively. The disc stress changes mainly stemmed from annulus fibrosus (AF) tissue, but not NP. In the endplate, stress values of degeneration status were 4.17, 4.35 and 6.06% larger than that of normal condition under axial rotation, lateral bending and extension. The facet load magnitudes of pre-existing degeneration were 11.28, 11.57, 11.78 and 11.42% greater than that of normal condition in flexion, extension, axial rotation and lateral bending motion. ConclusionPre-existing degenerated disc experience increased biomechanical changes in adjacent segment after single-level ACDF. It may pose a long-term cumulative problem related to biomechanics in cervical spine after fusion. Before surgery, surgeons should be careful about selecting the fusion level.