Intervertebral Disc Herniation Research Articles

Incidental Finding of Intervertebral Disc Herniation With Increased 18F-FAPI-04 Uptake in a Healthy Volunteer.

A 44-year-old healthy volunteer received an 18F-FAPI-04 scan for a normal biodistribution and dosimetry study. An incidental finding of an increased uptake of the radiotracer at the L4/5 subarticular disc herniation was noted, and a subsequent MRI scan confirmed the degenerative nature of the lesion.

Immunoglobulin profiling with large high-density peptide microarrays as screening method to detect candidate proteins for future biomarker detection in dogs with steroid-responsive meningitis-arteritis.

Large high-density peptide microarrays are a suitable screening method to detect possible autoantigens which might be involved in the pathogenesis of SRMA. The IgA and IgG profile of pooled serum samples of 5 dogs with SRMA and 5 dogs with neck pain due to intervertebral disc herniation (IVDH) without ataxia or paresis were compared via commercially available high-density peptide microarrays (Discovery Microarray) containing 29,240 random linear peptides. Canine distemper virus nucleoprotein (CDVN) served as positive control as all dogs were vaccinated. Common motifs were compared to amino acid sequences of known proteins via databank search. One suitable protein was manually selected for further analysis with a smaller customized high-density peptide microarray. Pooled serum of dogs with SRMA and IVDH showed different IgA and IgG responses on Discovery Microarray. Only top IgG responses of dogs with SRMA showed a common motif not related to the control protein CDVN. This common motif is part of the interleukin 1 receptor antagonist protein (IL1Ra). On IL1Ra, dogs with SRMA displayed IgA binding to an additional epitope, which dogs with IVDH did not show. IL1Ra is an anti-inflammatory acute phase protein. Different immunoglobulin binding patterns on IL1Ra could be involved in the pathogenesis of SRMA and IL1Ra might be developed as future biomarker for SRMA.

Targeting Endogenous Reactive Oxygen Species Removal and Regulating Regenerative Microenvironment at Annulus Fibrosus Defects Promote Tissue Repair

The excessive reactive oxygen species (ROS) level, inflammation, and weak tissue regeneration ability after annulus fibrosus (AF) injury constitute an unfavorable microenvironment for AF repair. AF integrity is crucial for preventing disc herniation after discectomy; however, there is no effective way to repair the AF. Herein, a composite hydrogel integrating properties of antioxidant, anti-inflammation, and recruitment of AF cells is developed through adding mesoporous silica nanoparticles modified by ceria and transforming growth factor β3 (TGF-β3) to the hydrogels. The nanoparticle loaded gelatin methacrylate/hyaluronic acid methacrylate composite hydrogels eliminate ROS and induce anti-inflammatory M2 type macrophage polarization. The released TGF-β3 not only plays a role in recruiting AF cells but is also responsible for promoting extracellular matrix secretion. The composite hydrogels can be solidified in situ in the defect area to effectively repair AF in rats. The strategies targeting endogenous ROS removal and improving the regenerative microenvironment by the nanoparticle-loaded composite hydrogels have potential applications in AF repair and intervertebral disc herniation prevention.

Reabsorption of intervertebral disc prolapse after conservative treatment with traditional Chinese medicine: A case report

Conservative treatments have been reported to diminish or resolve clinical symptoms of lumbar intervertebral disc herniation (LIDH) within a few weeks. Computed tomography and magnetic resonance imaging (MRI) of the lumbar region of a 25-year-old male diagnosed with LIDH showed prolapse of the L5/S2 disc. The disc extended 1.0 cm beyond the vertebral edge and hung along the posterior vertebral edge. The patient elected a conservative treatment regimen that included traditional Chinese medicine (TCM), acupuncture, and massage. During a follow-up period of more than 12 mo, good improvement in pain was reported without complications. MRI of the lumbar region after 12 mo showed obvious reabsorption of the herniation. A conservative treatment regimen of TCM, acupuncture, and massage promoted reabsorption of a prolapsed disc.

Role of triamcinolone acetate in treatment of symptomatic intervertebral disc herniations via interlaminar vs transforaminal approach

Role of triamcinolone acetate in treatment of symptomatic intervertebral disc herniations via interlaminar vs transforaminal approach

Inferior ST segment elevation myocardial infarction combined with hyperextension cervical spine injury: A rare case report.

Inferior ST-segment elevation myocardial infarction (STEMI) is usually caused by acute occlusion of the right coronary artery or left circumflex coronary artery (LCX). Inferior STEMI can cause a high-grade atrioventricular block, sinus bradycardia, and hypotension, leading to hemodynamic collapse, syncope, and disturbance of consciousness. A case of a sudden disturbance of consciousness after chest tightness as the initial symptom, followed by incomplete paralysis and paresthesia of the extremities due to the collision of the face with the ground. Coronary angiography showed about 99% of stenosis in the LCX. Cervical spine magnetic resonance imaging showed C2/3, C3/4, C4/5, and C5/6 intervertebral disc herniation with secondary spinal stenosis, spinal cord compression, and edema. The patient was diagnosed with inferior STEMI combined with hyperextension cervical spine injury. Bivalirudin was used for anticoagulation, the LCX lesion was pre-expanded with a balloon and the thrombus was removed, and anti-platelet aggregation therapy was given postoperatively. After rehabilitation therapy, hyperextension cervical spine injury improved. There was no recurrence of syncope and precordial pain during the 6-month follow-up. Hyperextension cervical spine injury has unique hemodynamic features that mimic those associated with inferior STEMI, so a detailed medical history inquiry and physical examination should be carried out to avoid missed diagnoses.

Differentiated tactics of surgical treatment of intervertebral disc herniation complicated by spinal canal stenosis

Objective: to conduct a retrospective analysis and evaluate the results of various methods of surgical treatment of patients with intervertebral disc herniation (IDH), which is complicated by spinal canal stenosis (SCS) of the lumbar spine.Materials and methods: 80 patients (36 (45%) men and 44 (55%) women) with a diagnosis of IDH complicated by SCS took part in the study. The average age of patients is under 50 years. All patients were operated on in the neurosurgery department of Zaporizhzhya Regional Clinical Hospital between 2016 and 2020. Patients were divided into two groups depending on the area of ​​the spinal canal and the method of surgical treatment. Group A (n=20) – relative SCS, area of the spinal canal – 75‒100 mm2, the presence of IDH >6 mm (according to magnetic resonance imaging). These patients underwent a standard microdiscectomy. Group B (n=60) ‒ absolute SCS, spinal canal area <75 mm2, the presence of IDH <6 mm (according to magnetic resonance imaging). This category of patients underwent surgery with wide decompression of the spinal canal and stabilization of the spinal motion segment using the method of interbody and transpedicular fixation of the corresponding spinal motion segment. The postoperative follow-up period is up to 6 months. A visual analogue scale was used to assess the pain syndrome in the lower limb and back and the degree of its reduction in the postoperative period. The impact of surgical treatment on the quality of life of patients with IDH complicated by SCS was assessed using the Oswestry Disability Index questionnaire (ODI).Results. Before the operation in group B, an inversely proportional dependence of the pain syndrome level on the visual analogue scale on the age of the patients (p<0.05) and the duration of the disease (p<0.05) was recorded. No such dependence was found in group A. In both groups, a significant decrease in pain syndrome was noted at the end of the first day after surgery, with a further gradual decrease until the end of the observation period. When comparing groups at the end of the first day after surgery, after 3 and 6 months, no statistically significant differences were found (p>0.05). In both groups, a significant decrease in the Oswestry index was registered immediately after surgery and its further decrease until the end of the follow-up period. When comparing the groups at the end of the first day after the operation, after 3 and 6 months, no statistically significant differences were found (p>0.05), but preoperative Oswestry index was significantly higher in group B, (р=0.04 according to the Mann‒Whitney test).Conclusions. In group A, the treatment effectiveness of patients reached 80‒85%, in the observation period on the 3 and 6 months. In group B, the treatment effectiveness of patients was also high and amounted to 75‒80%, in the observation period on the 3 and 6 months. Thus, taking into account the high variability of clinical and morphological changes in patients with IDH complicated by SCS, it is optimal to use differentiated surgical treatment tactics.

Lumbosacral transitional vertebrae: An overlooked cause of back pain on MRI

To evaluate the frequency of lumbosacral transitional vertebrae (LSTV) on MRI in patients with backpain and clinically suspected of sacroiliitis. Sacroiliac MRI of patients who had backpain and were clinically suspicious for sacroiliitis between November 2021-March 2022 were retrospectively analyzed from the hospital database by two different radiologists. LSTV cases were identified and subgrouped according to Castellvi classification. Presence of sacroiliitis, degeneration and /or herniation of cranial segment intervertebral disc, facet joint hypertrophy, coxarthrosis and psoas atrophy were recorded. In cases where radiologists were in conflict, consensus was made. Between November 2021-March 2022, 614 sacroiliac MRIs were obtained and 81 (13%) had LSTV. Fifty-nine patients were female (72.8%). Mean age was 43.4. The most common identified LSTV was type 1a (n=30, 10 right-sided, 20 left-sided). Sacroiliitis was significantly more common in younger patients (p=0.04) and in males (p=0.009). Disc degeneration, disc herniation, facet joint hypertrophy and psoas atrophy increased significantly with age (p=0.007, p=0.001, p=0.002 and p=0.013 respectively). No correlation was found between gender or presence of sacroiliitis and any type of LSTV.LSTV may present with backpain and should be considered in patients where sacroiliitis is clinically suspected. MRI is a useful tool to identify other accompanying pathologies in these cases.

PetSavers research

In 2019, Paul Freeman received a BSAVA PetSavers grant of £13,000 (including £5,000 donated by The Debs Foundation) for a project entitled Recovery of ambulation in medically-managed non-ambulatory Dachshund dogs with thoracolumbar intervertebral disc herniation at the University of Cambridge Queen’s Veterinary School Hospital with Sam Khan.

The volume of extruded materials is correlated with neurologic severity in small-breed dogs with type I thoracolumbar intervertebral disk herniation.

To assess whether the volume of extruded materials is correlated with neurologic severity in dogs with type I thoracolumbar intervertebral disk herniation (TL-IVDH). 70 client-owned small-breed dogs with type I TL-IVDH diagnosed between July 1, 2016, and June 30, 2018. For this retrospective cohort study, the medical records of 70 dogs with surgically confirmed type I TL-IVDH were reviewed. The volume and height of the intervertebral disk and the area of the maximal transverse compressed spinal cord were measured using CT myelographic images. For each dog, the volume of the disk immediately cranial to the herniated disk was an internal control. Dogs were grouped on the basis of grade of neurologic severity. Preoperative grades of neurologic severity were grade 2 in 7 (10%) dogs, grade 3 in 16 (23%) dogs, grade 4 in 28 (40%) dogs, and grade 5 in 19 (27%) dogs. The total volume of the affected intervertebral disks was significantly larger than the internal control. Weak positive correlation was found between the volume of the extruded materials into the vertebral canal and the grade of neurologic severity. Our findings indicated that the total volume of the affected intervertebral disks is larger in dogs with type I TL-IVDH, and the volume of the extruded materials into the vertebral canal is weakly correlated with the neurologic severity.

Are paraspinal muscle quantity, lumbar indentation value, and subcutaneous fat thickness related to disc degeneration? An MRI-based study

IntroductionThe aim of the study was to investigate the relationship between lumbar disc herniation and Goutallier classification (GC), lumbar indentation value, and subcutaneous adipose tissue thickness. Methods102 consecutive patients (59 female and 43 male) with lumbar back pain, numbness, tingling, or pain in the lower extremity indicating radiculopathy who had undergone lumbar magnetic resonance imaging (MRI) and had an intervertebral disc herniation in the L4-5 level, were included in the study. 102 patients who have undergone lumbar MRI in the same time period and have no disc herniation were chosen to be the control group and were selected so as to match the herniated group for sex and age. All these patients’ scans were re-interpreted regarding paraspinal muscle atrophy (using the GC), lumbar indentation value, and subcutaneous adipose tissue thickness in the L4-5 level. ResultsThe Goutallier score was higher in the herniated group, compared with the non-herniated group (p < 0.001). There was no statistical difference between herniated and non-herniated groups regarding lumbar indentation value (LIV) and subcutaneous adipose tissue thickness (SATT). A Goutallier score of 1.5 provided the highest sensitivity x specificity value to indicate the disc herniation according to the statistical results. The individuals with a Goutallier score of 2, 3, and 4 have 2.87 times more likely to have disc herniation in their MRIs than the ones with a score of 0 and 1. ConclusionParaspinal muscle atrophy seems to be related to the presence of disc herniations. The cut-off value of GC to indicate the disc herniation in this study might be useful to predict the risk for disc herniation regarding the Goutallier score. The LIV and SATT measured in magnetic resonance images were randomly distributed between individuals with herniated and non-herniated groups, and statistically, no relationship was observed between these groups regarding these parameters. Implications for practiceThe effect of the parameters studied in this research on disc herniations are expected to be an added value to the literature. The awareness of risk factors for intervertebral disc herniations might be used in preventive medicine to predict the risk and understand the tendency of an individual for disc herniations to occur in the future. Further investigations are needed to establish whether there is a causal relationship or correlation between these parameters and disc herniation.

Diagnosis of Lumbar Intervertebral Disc Herniation and Pathological Characteristics Based on Artificial Intelligence Neural Network

Diagnosis of Lumbar Intervertebral Disc Herniation and Pathological Characteristics Based on Artificial Intelligence Neural Network

Accuracy of Coronal Magnetic Resonance Imaging Diagnosis of Multi-Segmental Lumbar Disc Herniation: A Single-Center Retrospective Analysis.

BACKGROUND Multi-segment herniation of lumbar intervertebral discs is a complex lumbar spine disease, and it is difficult to identify the responsible segment using only magnetic resonance imaging (MRI). The present study screened 47 patients with multi-segment lumbar disc herniation (MSLDH) to evaluate coronal magnetic resonance imaging (CMRI) of three-dimensional fast-field echo with water-selective excitation to identify the responsible segment of multi-segment lumbar disc herniation (MSLDH) and to assess the accuracy and utility of CMRI. MATERIAL AND METHODS This retrospective study included 44 patients with low back pain or lower-extremity symptoms from January 2019 to December 2021. The imaging (including CMRI) and clinical data of the patients were analyzed by 3 independent, blinded experts. The Kappa statistical method was used to characterize the reader-to-reader reliability to qualitatively evaluate the data. RESULTS CMRI showed high diagnostic performance, with 90.2% sensitivity, 94.9% positive predictive value (PPV), 80% negative predictive value (NPV), and 83.4% accuracy, and there were significant differences in hospital length of stay (P=0.013) and surgical bleeding (P=0.006) (P<0.01) between single-segment and multi-segment patients. CONCLUSIONS CMRI is highly accurate in revealing the shape, signal, and position of the intraspinal and extraspinal lumbosacral plexus, and reducing surgical segments can help improve postoperative outcomes for patients.

Opioid Usage in Lumbar Disc Herniation Patients with Nonsurgical, Early Surgical, and Late Surgical Treatments

To assess opioid usage in surgical and nonsurgical patients with lumbar disc herniation receiving different treatments and timing of treatments. Individuals with newly diagnosed lumbar intervertebral disc herniation without myelopathy were queried from a health claims database. Patients were categorized into 3 cohorts: nonsurgical, early surgery, and late surgery. Early surgery cohort patients underwent surgery within 30 days postdiagnosis; late surgery cohort patients had surgery after 30 days but before 1 year postdiagnosis. The index date was defined as the diagnosis date for nonsurgical patients and the initial surgery date for surgical patients. The primary outcome was the average daily opioid morphine milligram equivalents (MME) prescribed. Additional outcomes included percentage of opioid-using patients and cumulative opioid burden. Inclusion criteria were met by 573,082 patients: 533,226 patients received nonsurgical treatments, 22,312 patients received early surgery, and 17,544 patients received late surgery. Both surgical cohorts experienced a postsurgical increase in opioid usage, which then sharply declined and gradually plateaued, with daily opioid MME consistently lower in the early versus late surgery cohort. The early surgery cohort also consistently had a lower prevalence of opioid-using patients than the late surgery cohort. Patients receiving nonsurgical treatment demonstrated the highest 1-year post index cumulative opioid burden, and the early surgery cohort consistently had lower cumulative opioid MME than the late surgery cohort. Early surgery in patients with lumbar disc herniation is associated with lower long-term average daily MME, incidence of opioid use, and 1-year cumulative MME burden compared with nonsurgical and late surgery treatment approaches.

Mechanically conditioned multilayered angle-ply collagen scaffolds promote annulus fibrosus regeneration

Annulus fibrosus (AF) injury, as a result of intervertebral disk degeneration (IVDD) or herniation, is very difficult to heal due to its avascular characteristics. Tissue engineering strategies have become increasingly promising to treat IVDD. However, in light of the fact that AF displays an anisotropic microstructure that results in gradient mechanical properties, fabrication of tissue engineered AF remains challenging. In this study, we fabricated micropatterned collagen scaffolds with angle-ply structure mimicking the microstructural features of AF. Following that, we cultured bone marrow mesenchymal stromal cells (BMSCs) in the scaffolds and applied cyclic stretching to them to mechanically stimulate the cells. We found that aligned cells under mechanical loading showed elevated expression of matrix anabolism-related genes and proteins. Further studies indicated that Caveolin-1 (CAV1) might mediate the nuclear translocation of Yes-associated protein (YAP) in response to external mechanical cues of microgroove-patterned membranes and mechanical loading. Micropatterned collagen membranes, with cells aligning at ±30° along the longitudinal dimension, were rolled up together to form an angle-ply and multilayered tissue. After being implanted into the caudal vertebra in a rat model for 4 weeks, biomimetic tissues showed improved restoration of the disk. In general, our biomimetic collagen membranes exhibit great potential in terms of AF regeneration, with AF-like heterogeneous microstructures that satisfy the biomechanical property of the native disk.

Bee Venom Acupuncture for Neck Pain: A Review of the Korean Literature.

Bee venom is a natural toxin that is effective in treating various types of pain. The purpose of this paper was to review all the features of clinical studies conducted on bee venom acupuncture (BVA) for the treatment of neck pain in Korean publications. Six Korean databases and 16 Korean journals were searched in August 2022 for clinical studies on BVA for neck pain. We identified 24 trials that met our inclusion criteria, of which 316 patients with neck pain were treated with BVA. The most common diagnosis in the patients with neck pain was herniated intervertebral discs (HIVDs) of the cervical spine (C-spine) (29.2%), and the concentration and dosage per session were 0.05-0.5 mg/mL and 0.1-1.5 mL, respectively. The visual analog scale was most often measured for neck pain severity (62.5%), and all clinical research reported improvements in 16 outcome measures. This study shows that BVA could be recommended for the treatment of neck pain, especially HIVD of the C-spine; however, the adverse effects of BVA must be examined in future studies.

Clinical Observation of Gongshi Naoacupuncture Combined with Shentongzhuyu Decoction in the Treatment of Intervertebral DISC Herniation

Background: Our country gradually entered an aging society, the incidence of lumbar disc herniation increases year by year, the clinical symptoms such as the pain, seriously affect the elderly's daily life movement, long-term pain will also lead to psychological barriers, seriously affect patient's daily life and work. The purpose of this study was to investigate the clinical efficacy and safety of Gongshi Naoacupuncture combined with Shentongzhuyu Decoction in the treatment of lumbar disc herniation, and to provide a treatment method for the clinical treatment of lumbar disc herniation. Objective: To observe the clinical effect of Gongshi Naoacupuncture combined with Shentongzhuyu Decoction in the treatment of disc herniation. Methods: 120 cases were randomly divided into treatment group (60 cases) and control group (60 cases). Both groups were given Shentongzhuyu decoction, and the observation group was given Gongshi brain needle. The observation period of both groups was 30 days, and the curative effect was evaluated after the treatment. Results: After treatment, VAS score of 2 groups was decreased compared with before treatment (p<0.05), observation group was significantly lower than control group (P<0.05); The score of JOA low back pain scale in 2 groups was higher than before treatment (p<0.05), and the observation group was higher than the control group (P<0.05). The improvement effect (significant efficiency, effective rate) of clinical symptoms in the observation group was better than that in the control group (p<0.05). Conclusion: In the treatment of lumbar intervertebral disc herniation, Gongshi Naoacupuncture combined with Shantong Zhuyu Decoction can significantly improve clinical efficacy, shorten the time of pain relief, significantly reduce the pain symptoms of patients, improve lumbar function, improve the quality of life of patients, with low recurrence rate, remarkable effect and innovation, and solve the dilemma of poor long-term therapeutic effect of lumbar intervertebral disc herniation. With the characteristics of "simple, fast, standard, safe, effective", it is worth trying a kind of treatment method, worthy of clinical promotion and application.

Protocol for treating lumbar spinal canal stenosis with a combination of ultrapurified, allogenic bone marrow-derived mesenchymal stem cells and in situ-forming gel: a multicentre, prospective, double-blind randomised controlled trial

IntroductionIn patients with combined lumbar spinal canal stenosis (LSCS), a herniated intervertebral disc (IVD) that compresses the dura mater and nerve roots is surgically treated with discectomy after laminoplasty. However,...

Are there correlations between facet joint parameters and lumbar disk herniation laterality in young adults?

ObjectiveWe aimed to determine whether there is an association, in young adults, between the occurrence of lumbar disk herniation (LDH) at a given segment and the segment’s facet joint parameters [facet orientation (FO) and tropism (FT)]. In addition, associations between facet joint parameters in the corresponding segment and LDH laterality were also investigated. MethodsWe retrospectively analyzed data from 529 patients who were between 18 and 35 years old, who had experienced single-level LDH (L4–5 or L5–S1) between June 2017 and December 2019, and with<2 years of clinical history. We included an additional 122 patients with no history of LDH as an age-matched control group. LDH were classified by laterality (left-sided, right-sided, or central herniation). At each level, we investigated the relationship between facet joint parameters and herniation laterality. ResultsFOA values at the L4–L5 level and the L5–S1 level were significantly lower and FT was higher for the LDH group compared with those for the control group. The level at which LDH occurred, FOL, FOR, and FT differed significantly among the three groups. There was a significant association between herniationlaterality and FO at the L4–L5 level but not at the L5–S1 level. ConclusionsAbnormal facet joint parameters are significantly associated with LDH. Young adults with higher FT should be paid more attention, to prevent the occurrence of LDH. Compared with L5–S1 level, intervertebral disk herniation at the L4–L5 level tended to occur ipsilateral to the side with a lower facet joint angle when FT was present.

Influence of macrophage polarization in herniated nucleus pulposus tissue on clinical efficacy after lumbar discectomy.

Low back pain or sciatic pain because of lumbar intervertebral disc herniation (LDH) is caused by mechanical compression and/or an inflammatory component on the nerve root. However, it is difficult to define to what extent each component contributes to the pain. This study attempted to explore the effects of macrophage polarization on clinical symptoms in patients experiencing LDH after surgery, and investigated the association between macrophage cell percentages and clinical efficacy. This study retrospectively harvested nucleus pulposus (NP) tissue samples from 117 patients. Clinical symptoms and efficacy using the visual analog scale (VAS) and Oswestry Disability Index (ODI) were evaluated at different time points preoperatively and postoperatively. CD68, CCR7, CD163, and CD206 were selected as macrophage phenotypic markers. Seventy-six samples showed positive expression of macrophage markers in NP samples of patients with LDH, whereas 41 patients displayed negative results. No significant differences were detected between the two groups, involvement of several demographic data, and preoperative clinical findings. With respect to the macrophage-positive group, no significant correlation was detected between the positive rate of the four markers and the VAS score or ODI after surgery. However, patients with NP samples positive for CD68 and CCR7 expression showed significantly lower VAS scores 1 week after surgery compared with those in the negative group. Moreover, the improvement in VAS score showed a strong positive correlation with CD68- and CCR7-positive cell percentages. Our results indicated that pro-inflammatory M1 macrophages may be associated with the reduction of chronic pain after surgery. Therefore, these findings contribute to better personalized pharmacological interventions for patients with LDH, considering the heterogeneity of pain.