Radiological Degeneration Research Articles

Prospective validity of a clinical prediction rule for response to non-surgical multidisciplinary management of knee osteoarthritis in tertiary care: a multisite prospective longitudinal study

ObjectivesWe tested a previously developed clinical prediction tool—a nomogram consisting of four patient measures (lower patient-expected benefit, lower patient-reported knee function, greater knee varus angle and severe medial knee radiological...

Long-term clinical and radiological outcomes following arthroscopic microfracture of the glenohumeral joint for chondral defects

The primary aim of this study was to evaluate mid- and long-term outcomes following microfracture in patients with glenohumeral chondral lesions. This prospective cohort study assessed patients with shoulder pain who were treated with arthroscopic microfracture for full-thickness chondral lesions of the glenohumeral joint. Outcomes included the Simple Shoulder Test at baseline, mid-term (approximately 1 year) and long-term (approximately 10 years), and the Oxford Shoulder Score, shoulder pain (0-10 numerical scale) and radiological assessment using a modified Samilson & Prieto score at long-term follow-up. Data were analyzed with paired t-tests and Wilcoxon's signed rank tests, which were considered significant if P<.05. Twenty-five patients with a mean age of 52.7±12.1 were enrolled. The mean Simple Shoulder Test score improved from baseline to 1 year (6.7±2.5 to 11.0±1.4, P<.001), which was maintained at long-term follow-up (10.3±2.1, P<.001). Additionally, at long-term follow-up, Oxford Shoulder Score and Verbal Pain Score scores were 43±4.8 and 1.1±1.5, respectively while median modified Samilson & Prieto scores increased from 1 preoperatively to 2 at 10 years (P<.001). Patients undergoing microfracture for full-thickness chondral lesions of the glenohumeral joint reported substantial improvements in shoulder pain and function at 1 and 10 years, despite progressive radiological degeneration.

The lumbar adjacent-level syndrome: analysis of clinical, radiological, and surgical parameters in a large single-center series.

The development of specific clinical and neurological symptoms and radiological degeneration affecting the segment adjacent to a spinal arthrodesis comprise the framework of adjacent-level syndrome. Through the analysis of a large surgical series, this study aimed to identify possible demographic, clinical, radiological, and surgical risk factors involved in the development of adjacent-level syndrome. A single-center retrospective analysis of adult patients undergoing lumbar fusion procedures between January 2014 and December 2018 was performed. Clinical, demographic, radiological, and surgical data were collected. Patients who underwent surgery for adjacent-segment disease (ASD) were classified as the ASD group. All patients were evaluated 1 month after the surgical procedure clinically and radiologically (with lumbar radiographs) and 3 months afterward with CT scans. The last follow-up was performed by telephone interview. The median follow-up for patients included in the analysis was 67.2 months (range 39-98 months). A total of 902 patients were included in this study. Forty-nine (5.4%) patients required reoperation for ASD. A significantly higher BMI value was observed in the ASD group (p < 0.001). Microdiscectomy and microdecompression procedures performed at the upper or lower level of an arthrodesis without fusion extension have a statistically significant impact on the development of ASD (p = 0.001). Postoperative pelvic tilt in the ASD group was higher than in the non-ASD group. Numeric rating scale, Core Outcome Measures Index, and Oswestry Disability Index scores at the last follow-up were significantly higher in patients in the ASD group and in patients younger than 65 years. Identifying risk factors for the development of adjacent-level syndrome allows the implementation of a prevention strategy in patients undergoing lumbar arthrodesis surgery. Age older than 65 years, high BMI, preexisting disc degeneration at the adjacent level, and high postoperative pelvic tilt are the most relevant factors. In addition, patients older than 65 years achieve higher levels of clinical improvement and postsurgical satisfaction than do younger patients.

Relationship between ARID1A, HIF1A expression, vascular with histopathological and radiological degeneration classifications

Relationship between ARID1A, HIF1A expression, vascular with histopathological and radiological degeneration classifications

A descriptive study on the adjacent segment degeneration related signs following a lumbar fusion procedure.

Adjacent segment degeneration (ASD) is a frequent complication following vertebral fusion procedures and is defined as the condition where patients recover after the initial procedure but develop compatible symptoms with radiological injuries in the segments adjacent to the fused ones at a later stage. The objective of the study was to describe the frequency and analysis of ASD related signs following a lumbar fusion procedure. Observational descriptive retrospective study on patients with degenerative or instability conditions, operated on by posterolateral or circumferential lumbar fusion procedure. Pedicle screws, interbody peek cages (polyether-ether-ketone) and autologous bone graft were used. Clinical (pain and disability) and radiological (instability, rotation, disc height loss, radiological degeneration evaluated by X-ray and MR) variables were analysed. Postoperative disc height loss was observed in 159 free discs among 112 patients (42.6%) (95% CI: 36.4-48.8%). Anterior or posterior slippage (anterolisthesis or retrolisthesis) at the end of the follow-up period was observed in 33 patients (12.5%). Upper segment rotation increased in the postoperative period in 36 patients (13.6%). Radiological disc degeneration was observed in 107 discs among 72 patients, being more frequent in the immediate upper disc with grade 2 and 3 changes at the end of follow-up in 48 discs from 35 patients (13.6%) (95% CI: 13.4-23.1%). Radiological ASD signs were observed in 151 patients (57.4%; 95% CI: 51.2-63.6%) and 53 of them (20.2%; 95% CI: 15.1-25.2%) who also showed clinical ASD symptoms (clinical and radiological ASD). Degeneration changes with degrees IV and V shown by a preoperative and magnetic resonance (MR) study at end of the follow-up period performed in 73 patients (27.7%), were observed in 46 discs among 32 patients (43.8%) (95% CI: 31.8-55.9%). Radiological ASD signs evaluated in every free disc following a lumbar fusion procedure are observed with a variable frequency. All free discs after fusion were assessed as they could indicate mechanisms of compensation of lordosis loss and should be taken into consideration in a prospective revision surgery.

Adjacent-segment disease after L3-4 posterior lumbar interbody fusion: does L3-4 fusion have cranial adjacent-segment degeneration similar to that after L4-5 fusion?

Posterior lumbar interbody fusion (PLIF) is a widely accepted procedure for degenerative lumbar diseases, and there have been many reports concerning adjacent-segment disease (ASD) after PLIF. In the reports of ASD in which the fusion level was limited to 1 segment, all reports describe ASD of the L3-4 segment after L4-5 PLIF. On the basis of these reports, it is thought that ASD mainly occurs at the cranial segment. However, no report has covered ASD after L3-4 PLIF. Therefore, the authors investigated ASD after L3-4 PLIF. In conducting a retrospective case series analysis, the authors reviewed a surgical database providing details of all spine operations performed between 2006 and 2017 at a single institution. During that period, PLIF was performed to treat 632 consecutive patients with degenerative lumbar diseases. Of these patients, 71 were treated with L3-4 PLIF alone, and 67 who were monitored for at least 2 years (mean 5.8 years; follow-up rate 94%) after surgery were enrolled in this study. Radiological ASD (R-ASD), symptomatic ASD (S-ASD), and operative ASD (O-ASD) were evaluated. These types of ASD were defined as follows: R-ASD refers to radiological degeneration adjacent to the fusion segment as shown on plain radiographs; S-ASD is a symptomatic condition due to neurological deterioration at the adjacent-segment degeneration; and O-ASD refers to S-ASD requiring revision surgery. All patients had initial improvement of neurological symptoms after primary PLIF. R-ASD was observed in 32 (48%) of 67 patients. It occurred at the cranial segment in 12 patients and at the caudal segment in 24; R-ASD at both adjacent segments was observed in 4 patients. Thus, the occurrence of R-ASD was more significant in the caudal segment than in the cranial segment. S-ASD was observed in 10 patients (15%), occurring at the cranial segment in 3 patients and at the caudal segment in 7. O-ASD was observed in 6 patients (9%): at the cranial segment in 1 patient and at the caudal segment in 5. Thus, the rate of involvement of the caudal segment was 67% in R-ASD, 70% in S-ASD, and 83% in O-ASD. The incidences of R-ASD, S-ASD, and O-ASD were 48%, 15%, and 9%, respectively, after L3-4 PLIF for degenerative lumbar diseases. In contrast to ASD after L4-5 PLIF, ASD after L3-4 PLIF was more frequently observed at the caudal segment than at the cranial segment. In follow-up for patients with L3-4 PLIF, surgeons should pay attention to ASD in the caudal segment.

Non-traumatic primary and secondary osteoarthritis of the distal radioulnar joint.

A retrospective radiographic study was conducted to determine the prevalence and severity of non-traumatic primary and secondary osteoarthritis of the distal radioulnar joint in a group of 718 patients. Non-traumatic primary and secondary osteoarthritis was found in 77 patients (11%) with a mean age of 63 years. In 34 cases it was bilateral. Mild signs of osteoarthritis were present in 53, moderate in 17 and severe in seven patients. The prevalence of primary osteoarthritis was 8.2% and 2.5% had secondary non-traumatic osteoarthritis. The prevalence and severity of the osteoarthritis were similar in women and men. Ulnar wrist pain was associated with osteoarthritis of the distal radioulnar joint in 13% of patients with mild, 35% with moderate and 43% with severe radiological degeneration. Level of evidence: IV.

Are Modic Vertebral End-Plate Signal Changes Associated with Degeneration or Clinical Outcomes in the Cervical Spine?

To report on the incidence of Modic changes (MCs) in patients with cervical radiculopathy due to a herniated disc. Presence of MCs was correlated to clinical outcomes and the presence of radiological degeneration. Patients that underwent anterior discectomy for a cervical radiculopathy due to a herniating disc were analyzed for the presence of MCs at baseline and at 1-year follow-up after surgery. Neck Disability Index, physical component summary, mental component summary, and visual analog scale for neck pain and for arm pain were evaluated as clinical outcomes. The presence of radiological degeneration was defined by the method of Goffin. The prevalence of MCs was found at 18% at baseline and increased to 28% one year after surgery. Both at baseline and at 1-year follow-up, the percentage of patients with and without MCs reporting neck pain was comparable. Likewise, both at baseline and at 1-year follow-up, the percentage of patients with and without MCs reporting disabling arm pain was comparable. At baseline, the patients with MC demonstrated more radiologic degeneration than those without MC (OR 0.42), but this difference disappeared at 1 year after surgery. MCs were not associated with neck pain, nor with arm pain. Furthermore, there was a tendency for a correlation between the presence of MCs and radiological degeneration.

A comparative study of adjacent segment degeneration following discectomy and instrumented fusion in lumbar Spine

Adjacent segment degeneration following lumbar spine fusion and lumbar discectomy remains a widely known problem, but due to insufficient knowledge regarding the factors that contribute to its occurrence it is difficult to diagnose considering the fact that it has variable presentation in terms of the symptoms it produces, the time frame for its occurance and radiological changes. Our study shows that both in single level discectomy and post instrumented fusion and is marginally more in post single level discectomy without fusion. In both groups cephalic segment is more affected as compared to the caudad segment. There is a significant relationship between radiological degeneration and the clinical adjacent segment degeneration. It has been seen that there is a significant relation between degeneration and chronic smokers both radiologically and clinically. Since there is only marginally difference, we hold on to our hypothesis that the role of natural degeneration is more compared to the role of instrumented fusion causing adjacent segment degeneration. Thus we have to rule out natural and post surgical causes of adjacent segment degeneration leading to different clinical complaints of the patient and manage it accordingly.

Adjacent segment degeneration and reoperation after lumbar surgery

Lumbar adjacent segment degeneration is defined as degenerative changes cranial or caudal to surgical segments. Some patients developed corresponding clinical symptoms in addition to radiological degeneration, which is called adjacent segment disease. Although many new surgical techniques emerged in recent years, the problem of adjacent segment degeneration has not really been resolved. MEDLINE/PubMed, Cochrane Controlled Trials Registry and EMBASE were comprehensively searched. All randomized or nonrandomized clinical studies of lumbar degenerative diseases treated by fusion/fixation, decompression-alone or artificial lumbar disc replacement were included. The number of cases enrolled in these studies was greater than or equal to 20 cases and the minimum age of the patients was 18 years old. Case reports, reviews or meta-analyses, papers with unobtainable text and abstract, and studies of trauma, infection, oncology and inflammatory disease were all excluded. The diagnostic criteria of adjacent segment degeneration, as well as the incidence and risk factors of adjacent segment degeneration and reoperation were reviewed. The concepts of adjacent segment degeneration in different literatures were very confusing, and radiological degeneration was often mixed in use with symptomatic degeneration. It was therefore difficult to make any conclusion due to lack of a standard. In addition, the previous studies did not fully understand the pathogenesis and risk factors of the disease, especially the effect of the index level on adjacent segments. Moreover, most of the current studies were retrospective, therefore, convincing conclusions can hardly be drawn due to lack of high-level evidence. The main reason for reoperation after lumbar fusion is adjacent segment degeneration. Therefore, the most important way to reduce the rate of reoperation is to reduce the incidence of adjacent segment degeneration. In the future, the diagnostic criteria for adjacent segment degeneration should be unified first. And it is extremely important to thoroughly understand the mechanism and risk factors of adjacent segment degeneration by comprehensive studies and clarify them through high-level evidence.

Spondylolisthesis adjacent to a cervical disc arthroplasty does not increase the risk of adjacent level degeneration.

To understand whether a spondylolisthesis in the sub-axial spine cranial to a cervical disc arthroplasty (CDA) construes a risk of adjacent level disease (ALD). A retrospective review of 164 patients with a minimum 5-year follow-up of a cervical disc arthroplasty was performed. Multi-level surgeries, including hybrid procedures, were included. Multiple implant types were included. The two inter-vertebral discs (IVD) cranial of the CDA were monitored for evidence of radiologic degeneration using the Kettler criteria. The rate of ALD in CDA found in this series was 17.8%, with most affecting the immediately adjacent IVD (27.4 and 7.6%, respectively p = 0.000). Pre-operative mild spondylolisthesis adjacent to a planned CDA was not found to be a risk factor for ALD within 5years. Those with a degenerative spondylolisthesis are at higher risk of ALD (33%) than those with a non-degenerative cause for their spondylolisthesis (11%). Post-operative CDA alignment, ROM or induced spondylolisthesis do not affect the rate of ALD in those with an adjacent spondylolisthesis. Patients with ALD experience significantly worse 5-year pain and functional outcomes than those unaffected by ALD. A pre-operatively identified mild spondylolisthesis in the sub-axial spine cranially adjacent to a planned CDA is not a risk factor for ALD within 5years. These slides can be retrieved under Electronic Supplementary Material.

Comparison of the biochemical and radiological criteria for lumbar disc degeneration

BackgroundThe relationship between radiological degeneration criteria on lumbar magnetic resonance imaging (MRI) and both the keratan sulfate (KS) and chondroitin sulfate (ChS) levels was examined in disc material taken from patients undergoing lumbar disc herniation (LDH) surgery. To examine whether the biochemical and radiological degeneration criteria testing the reliability of radiological degeneration findings agreed and to evaluate the contribution of the KS/ChS ratio to disc form (protruding or extruding). MethodsThis was a prospective experimental cohort study. Using enzyme-linked immunosorbent assay, KS and ChS levels were measured in the degenerate nucleus pulposus taken from 71 patients with a diagnosis of LDH who underwent surgery. The degeneration levels and disc form (protruding or extruding) were determined according to the Pfirrmann five-stage grading system on preoperative T2-weighted lumbar MRIs. According to the Pfirrmann system, 28 patients were grade III and 43 were grade IV. The relationship between radiological criteria and the KS/ChS ratio was statistically evaluated. ResultsThe KS levels (p=0.046) and the KS/ChS ratio (p=0.001) were significantly higher in grade IV patients than in grade III patients. However, there was no difference between the KS and ChS levels and the KS/ChS ratio when patients were classified as protruding or extruding according to their disc structure. Disc structure and biochemical degeneration indicators were not correlated. ConclusionsThe KS level and the KS/ChS ratio were high in patients with marked radiological degeneration on lumbar MRI, demonstrating the sensitivity and reliability of the Pfirrmann five-stage grading system for showing radiological degeneration.

Measurement of the nerve root of the lower lumbar region using digital images

The purpose of this study was to evaluate the relationship between the nerve root of lower lumbar and the surrounding structures using three-dimensional computed tomography (3D CT).Twenty-three consecutive patients with thoracolumbar fractures without obvious radiological degeneration were retrospectively studied at the spinal surgery department of the hospital. The parameters of the relationship between the nerve root of the lower lumbar and the surrounding structures were measured using 3D CT in the work station of the picture archiving and communication system.The size of the dorsal root ganglion (DRG) of the L4 was 5.5 ± 0.4 mm on the right side and 5.8 ± 0.3 mm on the left side. The size of the DRG of the L5 was 6.1 ± 0.5 mm on the right side and 5.7 ± 0.4 mm on the left side. The value of the preganglionic nerve root of the L4 was 11.2 ± 0.6 mm on the right side and 12.3 ± 0.8 mm on the left side, and the value of the preganglionic nerve root of the L5 was 15.1 ± 1.1 mm on the right side and 14.9 ± 0.9 mm on the left side.Using 3D CT imaging constructed in the picture archiving and communication system is a practical and convenient method for evaluating the relationship between the nerve root and the surrounding structures in the routine clinical work of a spinal surgeon. The data obtained through 3D CT imaging will be helpful for surgeons, allowing them to become more familiar with correlating anatomical knowledge of individual patient.

ADJACENT SEGMENT DISEASE IN THE LONG TERM AFTER ANTERIOR STABILIZATION FOR SUBAXIAL CERVICAL SPINE INJURY

Objective. To estimate degenerative changes at adjacent spinal segments after surgical treatment of unstable uncomplicated injury of subaxial cervical spine in remote period. Material and Methods. Data from patients operated on for uncomplicated unstable injury of subaxial cervical spine were analyzed. Functional activity of the patients was assessed on the Neck Disability Index, and radiologic degeneration - on Hilibrand and Parks scales. Results. Fusion of the spinal motion segment of the subaxial cervical spine leads to aggravation of initial degenerative changes at one of adjacent levels in some patients. Conclusion. Issues of the etiology of the adjacent segment disease are debatable and need further study.

Assessment of the correlation between histological degeneration and radiological and clinical parameters in a series of patients who underwent lumbar disc herniation surgery

Background and objectiveThe use of histological degeneration scores in surgically-treated herniated lumbar discs is not common in clinical practice and its use has been primarily restricted to research. The objective of this study is to evaluate if there is an association between a higher grade of histological degeneration when compared with clinical or radiological parameters. Patients and methodRetrospective consecutive analysis of 122 patients who underwent single-segment lumbar disc herniation surgery. Clinical information was available on all patients, while the histological study and preoperative magnetic resonance imaging were also retrieved for 75 patients. Clinical variables included age, duration of symptoms, neurological deficits, or affected deep tendon reflex. The preoperative magnetic resonance imaging was evaluated using Modic and Pfirrmann scores for the affected segment by 2 independent observers. Histological degeneration was evaluated using Weiler's score; the presence of inflammatory infiltrates and neovascularization, not included in the score, were also studied. Correlation and chi-square tests were used to assess the association between histological variables and clinical or radiological variables. Interobserver agreement was also evaluated for the MRI variables using weighted kappa. ResultsNo statistically significant correlation was found between histological variables (histological degeneration score, inflammatory infiltrates or neovascularization) and clinical or radiological variables. Interobserver agreement for radiological scores resulted in a kappa of 0.79 for the Pfirrmann scale and 0.65 for the Modic scale, both statistically significant. ConclusionsIn our series of patients, we could not demonstrate any correlation between the degree of histological degeneration or the presence of inflammatory infiltrates when compared with radiological degeneration scales or clinical variables such as the patient's age or duration of symptoms.

Osteoarthritis model induced by intra-articular monosodium iodoacetate in rats knee.

To evaluate the usefulness of a knee osteoarthritis model through functional, radiological and microscopic changes of the synovial membrane. Forty eight rats were divided randomly into two groups. The first received 0.9% saline in the joint and corresponded to the control group. The second was submitted to experimental osteoarthritis of the right knee induced by monosodium iodoacetate and corresponded to the osteoarthritis group. All animals were subjected to comparative tests of forced ambulation and joint movements, inability to articulate and tactile allodynia on day 1 post-experiment by forced ambulation (Roto-rod test), joint assessment of disability (weight bearing test) and assessment of tactile allodynia (Von Frey test). After inflammatory induction they were divided into four sub-groups corresponding to the scheduled death in 7, 14, 21 and 28 days when they were submitted to radiographic examination of the knee, arthrotomy and collection of the synovial membrane. The osteoarthritis group showed significant differences compared to control group on days 7 and 14 in Roto-rod, in weight bearing and Von Frey tests in all days, and in radiological evaluation. Microscopic examination of the synovial membrane showed abnormalities of inflammatory character at all stages. The osteoarthritis induced by intra-articular monosodium iodoacetate in rats knee is a good model to be used in related research, because it provides mensurable changes on joint movements, tactile allodynia, progressive radiological degeneration and microscopic inflammation of the synovial membrane, that represent markers for osteoarthritis evaluation.

The Relationship between HELQ Expression and Intervertebral Disc Degeneration

Introduction Degeneration of the intervertebral disc, mainly of nucleus pulposus, is strongly implicated as a cause of low back pain. However, the mechanism of disc degeneration is not clear. This study is to investigate the expression level of HELQ protein in nucleus pulposus tissues and the relationship between HELQ expression and intervertebral disc degeneration. Materials and Methods A total of 84 samples of lumbar intervertebral disc degenerated of different degree were obtained from patients undergoing lumbar spinal surgery for low back pain. Degeneration degrees of all samples were classified by radiological and histopathologic methods. Immunohistochemistry (IHC) staining was performed to evaluate the expression level of HELQ protein in nucleus pulposus tissues. And the relationship between HELQ expression and radiological degeneration grades, histopathological degeneration grades of nucleus pulposus were analyzed. Results HELQ was expressed in human nucleus pulposus. The expression level of HELQ protein was significantly lower in nucleus pulposus with higher degeneration degree than those with lower degeneration degree. And HELQ expression level had significantly negative correlation with radiological degeneration grades(r = 0.333, p = yyyy0.002) and histopathological degeneration grade (r = −0.519, p = 0.000). However, no correlation were detected between HELQ expression and age ( p = 0.374), gender ( p = 0.063) or segments ( p = 0.676). Conclusion The results indicated that down-regulated expression of HELQ is a possible reason of intervertebral disc degeneration. Thus, targeting HELQ gene will be a new therapeutic strategy for patients with intervertebral discs degeneration.

Radiologic study of disc behavior following compression fracture of the thoracolumbar hinge managed by kyphoplasty: A 52-case series

IntroductionKyphoplasty has proved effective for durable correction of traumatic vertebral deformity following Magerl A fracture, but subsequent behavior of the adjacent discs is unclear. The objective of the present study was to analyze evolution according to severity of initial kyphosis and quality of fracture reduction. Material and methodA single-center prospective study included cases of single compression fracture of the thoracolumbar hinge managed by Kyphon Balloon Kyphoplasty with polymethylmethacrylate bone cement. Radiology focused on traumatic vertebral kyphosis (VK), disc angulation (DA) and disc height index (DHI) in the adjacent discs. Linear regression assessed the correlation between superior disc height index (SupDHI) and postoperative VK on the one hand and correction gain on the other, using the Student t test for matched pairs and Pearson correlation coefficient. ResultsFifty-two young patients were included, with mean follow-up of 18.6 months. VK fell from 13.9° preoperatively to 8.2° at last follow-up. DHI found significant superior disc subsidence (P=0.0001) and non-significant inferior disc subsidence (P=0.116). DA showed significantly reduced superior disc lordosis (P=4*10−5). SupDHI correlated with VK correction (r=0.32). Preoperative VK did not correlate with radiologic degeneration of the adjacent discs. ConclusionCorrection of traumatic vertebral deformity avoids subsidence and loss of mechanical function in the superior adjacent disc. The underlying disc compensates for residual deformity. Balloon kyphoplasty is useful in compression fracture, providing significant reduction of traumatic vertebral deformity while conserving free and healthy adjacent discs. Level of evidenceIV.

Effects of MMP-1 and MMP-3 gene polymorphisms on gene expression and protein level in lumbar disc herniation.

The aim of this study was to identify the possible correlation between polymorphisms in matrix metalloproteinase (MMP)-1 and MMP-3 and their corresponding protein levels in disc tissues obtained from patients with lumbar disc herniation (LDH) using biochemical and immunohistochemical analyses. Blood and disc samples were obtained from 100 patients with LDH who underwent a lumbar microdiscectomy. Based on the radiological degeneration, the patients were diagnosed with grade 2, 3, or 4 LDH. MMP-1 -1607 1G/2G and MMP-3 -1171 5A/6A were analyzed by real-time polymerase chain reaction. The expressions of MMP-1 and MMP- 3 were detected by biochemical and immunohistochemical analyses. We found no association between the MMP-1 polymorphism and disc degeneration and MMP-1 expression. However, patients expressing the 6A/6A and 5A/6A alleles of MMP-3 -11715A/6A showed higher MMP-3 expression, compared to those expressing the 5A/5A genotype. Additionally, the radiological degeneration grades were correlated with the histological degeneration scoring. Protein levels and immunopositive cell rates of MMP-1 and MMP-3 were associated with disc degeneration grades. Moreover, the MMP-1 and MMP-3 expression and the histological and radiological scores were positively correlated and the MMP-3 -11715A/6A polymorphism was associated with MMP-3 expression in herniated disc tissues. This study is the first to investigate polymorphisms in MMP-1 and MMP-3, as well as their corresponding protein expressions. We also quantified an association between the radiological degeneration grades and MMP-1 and MMP- 3 expression. Further genomic studies on MMPs could focus on the utilization of MMP-1 and MMP-3 as markers for the prevention and treatment of this disease.

The Effects of Polymorphisms of Death Pathway Genes and Mitochondrial Pathway Genes in Intervertebral Disc Degeneration.

It has been proposed that apoptosis is effective on intervertebral disc degeneration. This study is the first study in which both polymorphisms and expressions of apoptotic genes in patients with intervertebral disc degeneration (IVDD) are evaluated together. The aim of our study is to determine whether polymorphisms and expressions of apoptotic genes involved in both pathways are related with grades of IVDD or not. Blood and tissue samples of 100 patients diagnosed with lumbar disc degeneration were collected. Patients were divided into 2 groups according to their radiological degeneration grades; grade 2 (mild), and grade 3 and 4 (severe). Polymorphisms in Fas (rs 2234767), Bcl-2 (rs 1801018) and Bax (rs 4645878) genes were determined with real-time PCR. Expressions of these genes were analyzed immunohistochemically following histological degeneration scoring. Whereas no relationship was found among polymorphisms of Fas and Bax genes and their expressions, we have determined a relationship among GG genotype of Bcl-2 and their expressions. Additionally, the ratio of Bax-positive cells was related with IVDD grades. Moreover, radiological degeneration grades were compatible with histological degeneration scores. GG genotype of Bcl-2 gene may influence the level of its expression and may be effective on the development of IVDD. Additionally, expression of Bax gene may be related with different grades of IVDD.