Lumbar Intervertebral Disc Degeneration Research Articles

Low Back Pain and Lumbar Degeneration in Japanese Professional Baseball Players.

Background:Baseball is one of the most popular sports in Asia. It is known that baseball can easily lead to back pain. However, there has been no survey of low back pain (LBP) and lumbar disc degeneration in Japanese professional baseball players to date.Purpose:To investigate the cause of LBP and lumbar degeneration in professional Japanese baseball players.Study Design:Cross-sectional study; Level of evidence, 3.Methods:We retrospectively reviewed the medical records of Japanese professional baseball players with LBP who visited our hospital. Data were collected from July 2018 to April 2021. We also investigated whether the results differed between players in their 20s and 30s or between pitchers and fielders. Data analysis was performed using the chi-square test.Results:We surveyed 32 professional baseball players. The most frequent causes of LBP among players in their 20s (n = 21) were lumbar disc herniation (LDH; 57%) and spondylolysis (24%). Of the players with spondylolysis, 50% had adult-onset spondylolysis. Players in their 30s (n = 11) most commonly had discogenic pain (55%) as well as LDH and facet joint arthritis (each 18%). The incidence of lumbar intervertebral disc degeneration was significantly higher in players in their 30s (91%) than those in their 20s (14%), as was the incidence of Schmorl nodes and Modic type 1 changes. There was no significant difference in the cause of LBP or the incidence of lumbar intervertebral disc degeneration between pitchers and fielders (P = .59).Conclusion:Among professional baseball players in their 20s, lumbar degeneration was less common, and they most frequently developed diseases less related to degeneration, such as LDH. However, among players in their 30s, lumbar degeneration was more advanced, and degenerative diseases such as discogenic pain occurred more frequently. Research on training methods could lead to the prevention of LBP. Our data may be applicable to other professional athletes and will contribute to diagnosis and treatment.

Biomechanical effect of intervertebral disc degeneration on the lower lumbar spine

Lumbar intervertebral disc degeneration can induce bone hyperplasia, lumbar intervertebral disc herniation and other diseases, is one of the causes of low back pain, which seriously affects people’s quality of life. And the causes of degeneration are very complex, so it is essential to understand the underlying mechanism of intervertebral disc degeneration and its influence. In this study, biomechanical effects of L4∼L5 lumbar degeneration with different degrees of degeneration were studied based on the numerical simulations. The three-dimensional finite element model of normal L2∼S1 lumbar vertebrae was established based on CT images of average adult male and verified. Several key parameters (intervertebral disc height, nucleus pulposus size, properties of different materials, etc.) of the model were modified to construct L4∼L5 models with different degrees of degeneration (grade 1, grade 2, grade 3, and grade 4). The range of motion (ROM), the intradiscal pressure of the nucleus, and the maximum Von Mises stress were determined by applying torques in different directions to simulate the four postures of flexion, extension, lateral bending, and axial rotation under compression load (500 N) to simulate the upper body weight of the human body. In different postures, with the increase of L4∼L5 degeneration degree, the ROM of the L4∼L5 degeneration segment showed a decreasing trend (Grade 4 had decrease of 41.9% to 65.2% compared to normal at different postures), while the ROM of its adjacent normal segments showed an increasing trend (L3∼L4: Grade 4 had increase of 21%–94% compared to normal at different postures; L5∼S1: Grade 4 had increase of 32%–66% compared to normal at different postures). With the increase in the degree of degeneration, nucleus pulposus pressure in the L4∼L5 degeneration segment decreased continuously under different postural conditions (Grade 4 had decrease of 25%–134.6% compared to normal at different postures), while the nucleus pulposus pressure in adjacent normal segments (L3∼L4 and L5∼S1) showed a gradually increasing trend. The maximum Von Mises stress of the three segments increased with the increasing degree of degeneration at different postures (L4∼L5: Grade 4 increased to 1.75 ∼ 4 times compared to normal at different postures). In four different models of lumbar disc degeneration, the adjacent normal segment of the disc compensates for the movement and loading pattern of the degenerated segment. At the same time, the load pattern inside the degenerated segment also changes.

Intradiscal injection of human recombinant BMP-4 does not reverse intervertebral disc degeneration induced by nuclectomy in sheep.

BackgroundIntervertebral disc (IVD) degeneration is suggested as a major cause of chronic low back pain (LBP). Intradiscal delivery of growth factors has been proposed as a promising strategy for IVD repair and regeneration. Previously, BMP-4 was shown to be more potent in promoting extracellular matrix (ECM) production than other BMPs and TGF-β in human nucleus pulposus (NP) cells, suggesting its applicability for disc regeneration.MethodsThe effects of BMP-4 on ECM deposition and cell proliferation were assessed in sheep NP and annulus fibrosus (AF) cells in a pellet culture model. Further, a nuclectomy induced sheep lumbar IVD degeneration model was used to evaluate the safety and effects of intradiscal BMP-4 injection on IVD regeneration. Outcomes were assessed by magnetic resonance imaging, micro-computed tomography, histological and biochemical measurements.ResultsIn vitro, BMP-4 significantly increased the production of proteoglycan and deposition of collagen type II and proliferation of NP and AF cells. Collagen type I deposition was not affected in NP cells, while in AF cells it was high at low BMP-4 concentrations, and decreased with increasing concentration of BMP-4. Intradiscal injection of BMP-4 induced extradiscal new bone formation and Schmorl's node-like changes in vivo. No regeneration in the NP nor AF was observed.ConclusionOur study demonstrated that although BMP-4 showed promising regenerative effects in vitro, similar effects were not observed in a large IVD degeneration animal model.The Translational Potential of This ArticleThe contradictory results of using BMP-4 on IVD regeneration between in vitro and in vivo demonstrate that direct BMP-4 injection for disc degeneration-associated human chronic low back pain should not be undertaken. In addition, our results may also shed light on the mechanisms behind pathological endplate changes in human patients as a possible target for therapy.

VEGF and eNOS variants may influence intervertebral disc degeneration

Background: Intervertebral disc degeneration (IDD) is a common and complex condition. Vascular endothelial growth factor (VEGF) is one of the key regulators of angiogenesis and vascular permeability. Nitric oxide (NO) plays a role in various physiological events. The endothelial nitric oxide synthase (eNOS) that catalyses NO generation are crucial for the regulation of NO level. This study aimed to evaluate the association between VEGF/ eNOS gene variants with IDD. Materials and Methods: Two hundred ninety-one subjects (111 IDD patients and 180 controls) were included in the present case-control study. VEGF −2549 insertion/deletion (I/D) and eNOS VNTR variants were analysed by PCR method. The results of this analysis were evaluated for statistical significance. Results: There were no statistically significant differences in genotype and allele distribution of VEGF −2549 I/D/ eNOS VNTR variants between IDD patients and control subjects. We then evaluated the association between the allele frequencies of these variants and clinical features of IDD. Lumber IDD was more common in patients carrying VEGF I/D variant D allele (p < 0.001). Also, patients with lumbar disc herniation, cervical disc herniation, lumbar stenosis, and lumbar IDD had more 4 b allele (p = 0.005, p < 0.001, p < 0.001, and p = 0.03, respectively). Conclusions: In conclusion, this study demonstrates first time that some clinical characteristics of IDD have been associated with allele frequencies of VEGF −2549 I/D/ eNOS VNTR variants.

Ultrashort time-to-echo T2* and T2* relaxometry for evaluation of lumbar disc degeneration: a comparative study

BackgroundTo compare potential of ultrashort time-to-echo (UTE) T2* mapping and T2* values from T2*-weighted imaging for assessing lumbar intervertebral disc degeneration (IVDD),with Pfirrmann grading as a reference standard.MethodsUTE-T2* and T2* values of 366 lumbar discs (L1/2-L5/S1) in 76 subjects were measured in 3 segmented regions: anterior annulus fibrosus, nucleus pulposus (NP), and posterior annulus fibrosus. Lumbar intervertebral discs were divided into 3 categories based on 5-level Pfirrmann grading: normal (Pfirrmann grade I),early disc degeneration (Pfirrmann grades II-III), and advanced disc degeneration (Pfirrmann grades IV-V). Regional differences between UTE-T2* and T2* relaxometry and correlation with degeneration were statistically analyzed.ResultsUTE-T2* and T2*value correlated negatively with Pfirrmann grades (P < 0.001). In NP, correlations with Pfirrmann grade were high with UTE-T2* values (r = − 0.733; P < 0.001) and moderate with T2* values (r = -0.654; P < 0.001). Diagnostic accuracy of detecting early IVDD was better with UTE-T2* mapping than T2* mapping (P < 0.05),with receiver operating characteristic analysis area under the curve of 0.715–0.876.ConclusionsUTE-T2* relaxometry provides another promising magnetic resonance imaging sequence for quantitatively evaluate lumbar IVDD and was more accurate than T2*mapping in the earlier stage degenerative process.

Correlation Analysis between Tamoxifen and Lumbar Intervertebral Disc Degeneration: A Retrospective Case-Control Study.

Objectives To investigate the correlation between tamoxifen (TAM) and lumbar intervertebral disc (IVD) degeneration (IVDD). Methods The patients who visited the department of spine surgery from January 2015 to December 2020 were retrospectively reviewed. Those with a history of breast cancer surgery were identified and their data were collected. These data included patients' age, body mass index (BMI), menstrual history, postoperative history, drug treatment plan, and imaging data. The participants were divided into the TAM group and the non-TAM group. Lumbar IVDD was assessed by lumbar lordosis (LL), vertebral CT density, lumbar disc height index (DHI), Modic changes, and modified Pfirrmann grading score. SPSS 20 was used for statistical analysis. Results A total of 75 patients were included in this study, 46 patients in the TAM group and 29 patients in the non-TAM group. No significant differences were present in age, BMI, postoperative history, LL, and vertebral CT density between the two groups. The DHI of L1/2 and L2/3 in the TAM group was lower compared to the non-TAM group (P=0.038 and P=0.034, respectively), while comparisons regarding the DHI of L3/4, L4/5, and L5/S1, and the average DHI between TAM and non-TAM groups were not significant. The modified Pfirrmann grading scores of the L1/2 and L2/3 IVDs in the TAM group were higher than those in the non-TAM group (P=0.004 and P=0.025, respectively). Comparisons of L3/4, L4/5, and L5/S1 between the two groups were not significant. The comparisons regarding the occurrence of Modic changes did not show a significant difference between the TAM and non-TAM groups. Conclusions This study indicates that there might be some positive correlation between TAM use and lumbar IVDD. In particular, the degeneration of L1/2 and L2/3 has shown a correlation with TAM use.

Association of Paraspinal Muscle CSA and PDFF Measurements With Lumbar Intervertebral Disk Degeneration in Patients With Chronic Low Back Pain.

There is an interaction between the lumbar spine and paraspinal muscles, which may play a role in the development of intervertebral disc (IVD) degeneration and may affect CLBP. The study aims to assess the relationship between IVD degeneration and paraspinal muscle fat infiltration in CLBP patients by quantitative MR imaging, and to evaluate the influence of sex and age on CLBP muscle fat infiltration. Sixty CLBP patients (46.3 years ±17.0) and thirty-two healthy subjects (44.9 years ±17.6) were recruited for this study. 3.0 T MRI was used to perform the sagittal and axial T1, T2 of the lumbar spine, and axial paraspinal muscle IDEAL imaging at the L4/5 and L5/S1 levels. Proton density fat fraction (PDFF) of the multifidus and erector spinae at two IVD levels were measured. The Pfirrmann grades of IVD degeneration, Oswestry Disability Index (ODI), and Visual Analog Scale (VAS) were also evaluated. Compare the cross-sectional area (CSA) and PDFF of the paraspinal muscles between CLBP patients and healthy subjects, and analyze the relationship between the muscle PDFF and Pfirrmann grades, gender, and age of CLBP patients. Compared with healthy subjects, the CSA of the multifidus muscle in CLBP patients decreased (1320.2±188.1mm2 vs. 1228.7±191.0 mm2, p<0.05) at the L4/5 level, the average PDFF increased, (7.7±2.6% vs. 14.79±5.3%, 8.8±4.2% vs. 16.03±5.3%, all p<0.05) at both L4/5 and L5/S1 levels. The PDFF of paraspinal muscles were correlated with adjacent IVD degeneration, ODI and VSA in CLBP patients (all p<0.05). After using age and body mass index (BMI) as control variables, significance was retained (all p<0.05). Multiple regression analysis revealed sex and age also were significantly associated with multifidus PDFF (all p < 0.05). This study confirmed that the CSA decreased and the PDFF increased of the paraspinal muscles in CLBP patients. It reveals a significant correlation between the PDFF of CLBP paraspinal muscles and the grade of IVD degeneration. Sex and age are also important factors influencing CLBP paraspinal muscle infiltration.

Associations of Lumber Disc Degeneration With Paraspinal Muscles Myosteatosis in Discogenic Low Back Pain.

Accompanied with intervertebral disc (IVD) degeneration, increasing fat infiltration of paraspinal muscles may be related to discogenic low back pain (DLBP), but their relationship is still unclear and the classical animal models are not completely applicable. The purpose of this study was to assess the paraspinal muscle fat infiltration in patients with DLBP by quantitative MRI, and to develop a novel DLBP rat model to explore the potential relationship between DLBP paraspinal muscle fat infiltration and TNF-α levels. We measured the proton density fat fraction (PDFF) of the multifidus and erector spinae muscles of 70 DLBP patients and 36 healthy volunteers by using quantitative MRI IDEAL-IQ. In addition, we developed a DLBP experimental rat model by puncturing the L4/5 and L5/6 IVDs under the guidance of X-ray fluoroscopy. Then various behavioral experiments, MRI and pathological examination of IVDs were used to evaluate the performance of the DLBP animal model. The gait analysis, hot plate test, acetone test, grasping test and tail suspension test were used to evaluate the pain and muscle dysfunction in rats. Through quantitative MRI and histological examination, the degeneration of IVDs and fat infiltration in the muscles were observed in vivo and ex vivo. Enzyme linked immunosorbent assay detects the level of TNF-α in rat IVDs and paraspinal muscles. In the human study, compared with healthy volunteers, the PDFF of multifidus and erector muscles of DLBP patients increased significantly at L4/5 and L5/S1 levels (p<0.05). In the rat experiment, compared with control group and sham group, DLBP group had reduced gait score, shortened response time to cold and heat stimuli, prolonged bending time, and shortened struggling time. Rat lumbar MRI T2WI showed that the signal intensity of L4/5 and L5/6 IVDs were progressively decreased. Histological examination revealed that IVDs had increased collagen fibers, reduced nucleus pulposus, thickened annulus fibrosus, and distorted shape. The PDFF of multifidus muscle at L4/5 and L5/6 level in the DLBP group were more than that in other groups (p<0.05), and HE staining and oil red O staining of paraspinal muscles showed that the muscle bundle space of the DLBP group muscles increased, and the muscle tissues Increased lipid droplets. Finally, the expression of TNF-α in IVDs and paraspinal muscles in the DLBP group were significantly higher than that in the control group (p<0.05). It is reliable and feasible to establish a DLBP rat model by puncturing the lumbar IVDs under the guidance of X-ray fluoroscopy. The degeneration of lumbar IVDs with DLBP leads to the occurrence of fat infiltration of paraspinal muscles, which is related to the expression of TNF-α.

A protocol for recruiting and analyzing the disease-oriented Russian disc degeneration study (RuDDS) biobank for functional omics studies of lumbar disc degeneration

Lumbar intervertebral disc degeneration (DD) disease is one of the main risk factors for low back pain and a leading cause of population absenteeism and disability worldwide. Despite a variety of biological studies, lumbar DD is not yet fully understood, partially because there are only few studies that use systematic and integrative approaches. This urges the need for studies that integrate different omics (including genomics and transcriptomics) measured on samples within a single cohort. This protocol describes a disease-oriented Russian disc degeneration study (RuDDS) biobank recruitment and analyses aimed to facilitate further omics studies of lumbar DD integrating genomic, transcriptomic and glycomic data. A total of 1,100 participants aged over 18 with available lumbar MRI scans, medical histories and biological material (whole blood, plasma and intervertebral disc tissue samples from surgically treated patients) will be enrolled during the three-year period from two Russian clinical centers. Whole blood, plasma and disc tissue specimens will be used for genotyping with genome-wide SNP-arrays, glycome profiling and RNA sequencing, respectively. Omics data will be further used for a genome-wide association study of lumbar DD with in silico functional annotation, analysis of plasma glycome and lumbar DD disease interactions and transcriptomic data analysis including an investigation of differential expression patterns associated with lumbar DD disease. Statistical tests applied in each of the analyses will meet the standard criteria specific to the attributed study field. In a long term, the results of the study will expand fundamental knowledge about lumbar DD development and contribute to the elaboration of novel personalized approaches for disease prediction and therapy. Additionally to the lumbar disc degeneration study, a RuDDS cohort could be used for other genetic studies, as it will have unique omics data. Trial registration number NCT04600544.

Research progress in mechanism of Chinese herbal compounds and monomers in delaying lumbar intervertebral disc degeneration

Traditional Chinese medicine has unique advantages in the treatment of degenerative bone and joint diseases, and its widely used in clinical practice. In recent years, many scholars have conducted a large number of basic studies on the delay of intervertebral disc degeneration by herbal compound and monomeric components from different perspectives. In order to further elucidate its mechanism of action, this paper summarizes the in vivo and in vitro experimental studies conducted at the level of both herbal compound and single components, respectively, in order to provide references for the basic research on the treatment of lumbar intervertebral disc degeneration by Chinese medicine. A summary shows that commonly used herbal compound prescriptions include both classical prescriptions such as Duhuo Jisheng Decoction, as well as clinical experience prescriptions such as Yiqi Huoxue Recipe. Angelicae Sinensis Radix, Chuanxiong Rhizoma, Rehmanniae Radix Praeparata, Achyranthis Bidentatae Radix, and Eucommiae Cortex were used most frequently. Tonic for deficiency and blood stasis activators were used most frequently. The most utilized monomeric components include icariin, ginsenoside Re, salvianolic acid B and aucubin. The main molecular mechanisms by which herbal compound and monomeric components delay of lumbar intervertebral disc degeneration include improving the intervertebral disc microenvironment, promoting the synthesis of aggregated proteoglycans and type Ⅱ collagen in the intervertebral disc, reducing the degradation of the extracellular matrix, and inhibiting apoptosis in the nucleus pulposus cells, etc. The main signaling pathways involved include Wnt/β-catenin signaling pathway, MAPK-related signaling pathway, mTOR signaling pathway, Fas/FasL signaling pathway, PI3 K/Akt signaling pathway, NF-κB signaling pathway, JAK/STAT signaling pathway, and hedgehog signaling pathway, etc.

Comparison of MRI T1, T2, and T2* mapping with histology for assessment of intervertebral disc degeneration in an ovine model

An easy, reliable, and time-efficient standardized approach for assessing lumbar intervertebral disc (IVD) degeneration with relaxation times measurements in pre-clinical and clinical studies is lacking. This prospective study aims to determine the most appropriate method for lumbar IVD degeneration (IDD) assessment in sheep by comparing three quantitative MRI sequences (variable-flip-angle T1 mapping, and multi-echo T2 and T2* mapping), correlating them with Pfirrmann grading and histology. Strong intra- and interrater agreements were found for Nucleus pulposus (NP) regions-of-interest (ROI). T1, T2, and T2* mapping correlated with Pfirrmann grading and histological scoring (p < 0.05) except for the most ventral rectangular ROI on T2 maps. Correlations were excellent for all of the T1 ROIs and the T2* NP ROIs. Highly significant differences in T1 values were found between all Pfirrmann grades except between grades I/II and between grades III/IV. Significant differences were identified in the T2 and the T2* values between all grades except between grades I/III. T1, T2, and T2* relaxation times measurements of the NP are an accurate and time-efficient tool to assess lumbar IDD in sheep. Variable-flip-angle T1 mapping may be further considered as a valuable method to investigate IDD and to assess the efficacy of regenerative treatments in longitudinal studies.

Manual therapy regulates oxidative stress in aging rat lumbar intervertebral discs through the SIRT1/FOXO1 pathway.

With the increasing burden of a globally aging population, low back pain has become one of the most common musculoskeletal disorders, caused mainly by intervertebral disc (IVD) degeneration. There are currently several clinical methods to alleviate back pain, but there is scarce attention paid as to whether they can improve age-related IVD degeneration. It is therefore difficult to conduct an in-depth evaluation of these methods. A large number of clinical studies have shown that manual therapy (MT), a widely used comprehensive alternative method, has effects on pain, the mechanisms of which require further study. In this study, MT was performed on aging rats for 6 months, and their behaviors were compared with those of a non-intervention group of aging and young rats. After the intervention, all rats were examined by X-ray to observe lumbar spine degeneration, and the IVD tissues were dissected for detection, including pathological staining, immunofluorescence, Western bolt, etc. This study demonstrated the possibility that MT intervention delay the lumbar IVD degeneration in aging rats, specifically improving the motor function and regulating senescence-associated β-galactosidase, p53, p21, p16, and telomerase activity to retard the senescence of cells in IVDs. Moreover, MT intervention can modify oxidative stress, increase the expression of SIRT1 and FOXO1 in IVDs and decrease ac-FOXO1 expression, suggesting that MT can reduce oxidative stress through the SIRT1/FOXO1 pathway, thereby playing a role in delaying the aging of IVDs. This study shows that drug-free, non-invasive mechanical interventions could be of major significance in improving the physical function of the elderly.

Deep learning-based high-accuracy quantitation for lumbar intervertebral disc degeneration from MRI

To help doctors and patients evaluate lumbar intervertebral disc degeneration (IVDD) accurately and efficiently, we propose a segmentation network and a quantitation method for IVDD from T2MRI. A semantic segmentation network (BianqueNet) composed of three innovative modules achieves high-precision segmentation of IVDD-related regions. A quantitative method is used to calculate the signal intensity and geometric features of IVDD. Manual measurements have excellent agreement with automatic calculations, but the latter have better repeatability and efficiency. We investigate the relationship between IVDD parameters and demographic information (age, gender, position and IVDD grade) in a large population. Considering these parameters present strong correlation with IVDD grade, we establish a quantitative criterion for IVDD. This fully automated quantitation system for IVDD may provide more precise information for clinical practice, clinical trials, and mechanism investigation. It also would increase the number of patients that can be monitored.

The prevalence of spondylolysis and intervertebral disc degeneration in male pole vaulters.

The lower back is the most common injury location in pole vaulters, but the prevalence of lumbar spondylolysis and intervertebral disc degeneration is not known. This study aimed to determine the prevalence of lumbar spondylolysis and intervertebral disc degeneration in pole vaulters. This cross-sectional study was conducted in the Tokai area of Japan and included 21 pole vaulters (mean ± standard deviation [range]: age, 22.2 ± 3.2 [18-28] years; height, 172.2 ± 4.7 [165.0-182.0] cm; body weight, 67.6 ± 7.3 [54.0- 80.0] kg). The majority of pole vaulters were collegiate athletes. We performed anterior, lateral, and oblique radiography at 45∘ and magnetic resonance imaging in the sagittal and coronal planes of the lumbar spine. The evaluation was performed independently of whether the athletes had lower back pain (LBP). Moreover, we investigated the duration of pole-vaulting experience and history and current presence of LBP using a questionnaire. The prevalence of lumbar spondylolysis and intervertebral disc degeneration was 28.6% (6/21) and 38.1% (8/21), respectively. Herniation was found in six discs in four vaulters (19.0%). All athletes had a history of LBP. The prevalence of lumbar spondylolysis was high (28.6%). Sport-specific movements performed by pole vaulters may be a risk factor for lumbar spondylolysis.

Association between vitamin D receptor gene polymorphism (rs731236) and aggrecan gene VNTR polymorphism with the risk of lumbar intervertebral disc degeneration.

Background:Low back pain is one of the most common causes of referral to physicians. Lumbar disc degeneration (LDD) is the main cause of back pain in different countries. It seems that genetic factors are more effective than environmental factors in the developing of degenerative phenomena. The aim of this investigation, therefore, was to study the association of the aggrecan gene (ACAN) variable number tandem repeat (VNTR) and the vitamin D receptor (VDR) rs731236 (TaqI) polymorphisms, with lumbar intervertebral disc degeneration in a population in the North of Iran.Methods:In this study, 55 patients with symptomatic intervertebral disk degeneration and 55 control subjects were included. VDR gene polymorphism was genotyped by PCR-based RFLP. The isolated DNA was used to genotype the VNTR of ACAN gene via conventional PCR.Results:For VDR gene polymorphism, the CC genotype (OR=5.337, P=0.019) was significantly higher among the patients compared with the controls, revealing a higher frequency of the C allele in patients compared with controls (OR=2.707, P=0.005). The lower number of frequent repetitions in the VNTR aggrecan gene was associated with a six-time increase of lumbar disc degeneration. Also, high BMI can be considered as an independent factor in the incidence of this disease.Conclusion:Aggrecan gene VNTR polymorphism had an association with degeneration of lumbar intervertebral discs that the shorter VNTR repeats increasing the chance of the disc degeneration in this population in the North of Iran. Moreover, an association between the mutant allele (C) of VDR gene TaqI polymorphism and disc degeneration is found.

Lumbar Multifidus Muscle Fatty Atrophy and Lumbar Disc Degeneration: Are they Associated in Middle Aged Patients with Low Backache?

Introduction: Low backache being one of the most common problems faced in the society mainly due to sedentary lifestyle and reduced physical activity which inturn leads to overweight, obesity and atrophy of paraspinal muscles. Disc prolapse is one of the most common causes of low backache. Hence, knowing the aetiological factors and treatment of the same at an early stage is beneficial. Aim: To determine the association between the grades of lumbar disc degeneration with degree of fatty infiltration of lumbar multifidus muscle in middle aged patients with low backache using Magnetic Resonance Imaging (MRI). Materials and Methods: A prospective observational study was conducted from April 2020 to February 2021 in Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India, with a study population of 201 middle aged patients who complaints of low back pain for more than three months. All patients who met the inclusion and exclusion criteria underwent plain MRI for Lumbosacral (LS) spine with 16 channel 1.5 tesla strength MR machine. Lumbar intervertebral disc degeneration was graded according to the Pfirrmann classification using T2 sequence in the sagittal plane. For the evaluation of the degree of fatty infiltration of lumbar multifidus muscle, axial T2-weighted slices were used to detect the cross-sectional area of the right and left lumbar multifidus muscle involvement. Chi-square test was used to find the association between varying grades of disc degeneration and severity of fat infiltration at Lumbar (L)4-L5 and L5-Sacral (S) 1 regions. Results: There was significant association between the grade of lumbar disc degeneration and the degree of atrophy of multifidus muscle with p-value &lt;0.001 in middle aged patients with low backache. There was significant relation with fatty muscle infiltration with a p-value of &lt;0.001 in L4-L5 and 0.03 in L5-S1 disc spaces. Most of the patients had grade III intervertebral disc degeneration in both L4/L5 and L5/S1. Conclusion: Lumbar multifidus muscle atrophy is common in grade 3 Pfirrmann classification of lumbar disc degeneration at both L4/L5 and L5/S1 levels.

Correlation between motor behavior and age-related intervertebral disc degeneration in cynomolgus monkeys.

BackgroundThe motor behavior in patients with lumbar intervertebral disc degeneration (IDD) and animal models should be changed due to pain. However, there does not seem to be a strong correlation between IDD and motor behavior. Therefore, it is necessary to understand the correlation between motor behavior and age‐related IDD.MethodsTwenty‐one healthy male cynomolgus monkeys (Macaca fascicularis) distributed across the age range were included in this study. The experimental animals were divided into two groups: caged group (n = 14) and free‐range group (n = 7). The data of IDD and motor behavior were obtained through magnetic resonance imaging (MRI) and PrimateScan Automatic Behavior Analysis System. More than 20 basic motor behaviors could be recorded and quantified, and then reclassified into 9 combined categories. We defined the sum of the duration of activity‐related combined categories as the total duration of activity in 3 hours. The activity zone of the cynomolgus monkeys in the cage could be divided into top and bottom zones. Analyze the correlation between motor behavior and IDD.ResultsAge was correlated with both Pfirrmann grades (r = .700; P < .001) and T2 values (r = −.369; P < .001). The T2 value in the caged group was 45.97 ± 8.35 ms, which was significantly lower than the 55.90 ± 8.73 ms in the free‐range group (P < .001). The mean T2 values were positively correlated with hanging duration (r = .548, P < .05), the total duration of activity (r = .496, P < .05), and top zone duration (r = .541, P < .05).ConclusionsThere is an interactional relationship between IDD and motor behavior. Motor behavior could be used as one of the diagnostic indicators of IDD. It could also be used to infer the presence or extent of IDD in animal models. Avoiding a sedentary lifestyle and engaging in exercise in daily life could alleviate IDD.

Comprehensive analysis of N6-methyladenosine (m6A) modification during the degeneration of lumbar intervertebral disc in mice.

ObjectiveTo study the N6-methyladenosine (m6A) modification pattern of nucleus pulposus (NP) tissue during intervertebral disc degeneration (IDD).MethodsA standing mouse model was generated, and staining and imaging methods were used to evaluate the IDD model. Methylated RNA immunoprecipitation with next-generation sequencing (MeRIP-seq) was used to analyze m6A methylation-associated transcripts in the NP, and real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression of methylation-related enzymes and conduct bio-informatics analysis.ResultsThe standing mouse model caused IDD. Continuous axial pressure changed the expression of related methylases in degenerated NP tissue. Relative to the control group, the expression levels of KIAA1429, METTL14, METTL3, METTL4, WTAP, DGCR8, EIF3A and YTHDC1 in the experimental group were higher, while those of FTO, ELAVL1, HNRNPC1 and SRSF2 were lower. We identified 985 differentially expressed genes through MeRIP-Seq, among which 363 genes were significantly up-regulated, and 622 genes were significantly down-regulated. In addition, among the 9648 genes counted, 1319 m6A peaks with significant differences in methylation were identified, among which 933 were significantly up-regulated, and 386 were significantly down-regulated. Genes and pathways that were enriched in IDD have been identified.ConclusionThe results of this study elucidated the m6A methylation pattern of NP tissue in degenerated lumbar intervertebral disc of mice and provided new perspectives and clues for research on and the treatment of lumbar disc degeneration.The Translational potential of this articleAs one of the important causes of low back and leg pain, intervertebral disc degeneration brings a huge economic burden to the society, family and medical system. Therefore, understanding the molecular and cellular mechanisms of intervertebral disc degeneration is of great significance for guiding clinical treatment. In this study, methylated RNA immunoprecipitation with next-generation sequencing on mice lumbar nucleus pulposus tissues found that differentially expressed genes and changes in the expression of related methylases, confirming that RNA methylation is involved in intervertebral disc degeneration. The process provides new vision and clues for future research on intervertebral disc degeneration.

The association of lumbar intervertebral disc degeneration and lumbar spinal stenosis on magnetic resonance imaging with body mass index in overweight and obese adults in Indian population

Aims: To investigate the association of being overweight or obese with the presence, extent, and severity of lumbar disc degeneration and lumbar spinal stenosis on magnetic resonance imaging (MRI) in adults in the Indian population.Study Design: Level 4, Cross-sectional studyPlace and duration of study: Department of Orthopaedics, SVP Hospital, Ahmedabad between February 2019 and October 2019. Methodology: A population-based cross-sectional study of 500 Indian volunteers was conducted. Subjects underwent radiographic and clinical assessment, and weight and height were measured. T2-weighted MRIs of the lumbar spine were obtained. The presence, extent, and severity of disc degeneration and additional radiographic and clinical parameters were assessed. Asian-modified body mass index (BMI) (kg/m2) categories were used.Results: The study included 305 men and 195 women (mean age 50.59 years). Disc degeneration was noted in 450 (90%) subjects. BMI was significantly higher in subjects with disc degeneration (mean 29.18 kg/m2) than in subjects without degeneration (mean 23.66 kg/m2). A significant increase in the number of degenerated levels, global severity of disc degeneration, and end-stage disc degeneration with lumbar spinal stenosis was noted with elevated BMI, in particular in overweight and obese subjects. End-stage disc degeneration with disc space narrowing was significantly more pronounced in obese subject.Conclusion: Our findings, to systematically assess lumbar disc degeneration and lumbar spinal stenosis on MRI, indicated a significant association between the presence, extent, and global severity of disc degeneration and lumbar spinal stenosis with BMI (>23 kg/m2) in overweight and obese adults.

Effect Comparison Of MIS-TLIF Under MED and Quadrant Modes in The Treatment of Lu mbar Spinal Stenosis

Background Lumbar spinal stenosis is one of the common causes of low back and leg pain. Lumbar intervertebral disc degeneration leads to the decrease of intervertebral height, the limitation of vertebral activity, and the biomechanical changes of the lumbar spine, which in turn makes the lumbar anterior convex angle and sacral inclination angle smaller, and the pelvic inclination angle larger, affecting the stress distribution of the lumbar spine aggravating the intervertebral disc degeneration. If the spinal canal stenosis is not corrected for a long time, can cause the cauda equina nerve, nerve root compression, resulting in neurogenic intermittent claudication. If the spinal canal stenosis is not corrected for a long time, can cause the cauda equina nerve, nerve root compression, resulting in neurogenic intermittent claudication. Surgery can correct lumbar stenosis and reconstruct lumbar stability. But the traditional lumbar fusion trauma is huge, even can aggravate pain, spinal canal stenosis. Therefore, more and more patients are more inclined to MIS-TLIF treatment with less surgical trauma. For single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open surgery in restoring lumbar interbody height and improving lumbar-pelvis balance. Objective Discussion on the effect difference of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar spinal stenosis by Quadrant and MED methods. Methods A total of 96patients with lumbar spinal stenosis who were scheduled to undergo MIS-TLIF surgery in Our Hospital from January 2017 to October 2020 were selected and divided into group A and group B according to the surgical channel selection scheme, with 48 cases in each group. The patients in group A were treater with MED channel, and the patients in group B were treated with Quadrant channel. The degree of surgical trauma, VAS score before and postoperative, JOA score, lumbar-pelvic imaging parameters and surgical complications were compared between the two methods. Results The operation time of the A group was shorter than that of the group B(P &lt; 0.05). The blood loss, exposure time under X line, drainage flow and down-ground time in A group were lower than those in B group, which had statistical significance (P&lt;0.05) ; A and B groups of patients were compared, the difference was not statistically significant (P&gt;0.05) ; Preoperative, Comparison of VAS scores between A and B groups, the difference was not statistically significant (P&gt;0.05) . On the first day of postoperative, the VAS score of group A was lower than that of groupB, which had statistical significance (P &lt; 0.05). Preoperative, Comparison of JOA scores between A and B groups, the difference was not statistically significant (P&gt;0.05) ; Comparison of JOA scores between 1 month ,3 months and 6 months in Postoperative, the difference was not statistically significant (P&gt;0.05). The JOA scores of the two groups at 1 month, 3 months and 6 months postoperative were significantly lower than those Preoperative (P &lt; 0.05). Six months postoperative, the lumbar anterior convex angle, segmental anterior convex angle and intervertebral height of the two groups were significantly higher than those Preoperative (P&lt;0.05), and the pelvic inclination angle of the two groups was lower than that Preoperative (P&lt;0.05).Conclusion MIS-TLIF in the treatment of patients with lumbar spinal stenosis using MED channel or Quadrant channel operation has curative effect, and there is little difference in the recovery of lumbar-pelvis imaging parameters, but the former has the advantages of less surgical trauma and lower postoperative pain.