Treatment Of Degenerative Disc Disease Research Articles

Regeneration Potential of Stem Cell in the Treatment of IVD

Abstract: Degenerative disc disease is a prevalent musculoskeletal disorder in which damaged spinal discs cause pain upon aging, accidental injuries. Spinal discs connect adjacent vertebrae and help in maintaining mobility, flexibility and rotation of spinal cord. Spinal discs also act as shock absorbers. Intervertebral disc (IVD) degeneration is often associated with low back and neck pain, which accounts for disability worldwide. Physical therapy, spinal fusion surgeries reduce severity and symptoms of degenerative disc disease but they are not complete cure for this disease. Current preclinical studies show that mesenchymal stem cells have the capacity to repair degenerative disks by differentiation to chondrocyte-like cells, which produce proteoglycans and type II collagen. Mesenchymal stem cells (MSCs) isolated from bone marrow (BM-MSCs), adipose tissue (AD-MSCs) and umbilical cord (UC-MSCs) show potential use in cartilage and intervertebral disc (IVD) repair. Regenerative medicine and stem cell therapy hold great promise for treatment of intervertebral disc (IVD) disease. This review discusses about progression of degenerative disc disease, various types of stem cells, potential use of mesenchymal stem cells (MSCs) and embryonic stem cells (ESCs) for the treatment of degenerative disc disease. This review also focuses upon challenges encountered by the application of stem cell therapy for treating degenerative disc disease as well as future perspectives. Keywords: IVD, Stem cell therapy, AF & NP cells, MSCs, Scaffolds, Cell therapy

161. Metal-on-metal vs metal-on-plastic artificial discs in 2-level anterior cervical disc replacement: a meta-analysis with follow up of 5 years or more

<h3>BACKGROUND CONTEXT</h3> Anterior cervical discectomy and fusion (ACDF) is a well-established procedure that has long been considered the standard treatment for degenerative disc disease (DDD). Despite positive clinical outcomes, accelerated rates of adjacent segment disease (ASD) in ACDF, especially in two-level surgery, has led spinal surgeons to increasingly use anterior cervical disc replacement (ACDR) as an alternative. However, long-term success may be limited by the properties inherent to the devices utilized. The use of metal-on-metal (MM) bearings in total joint replacement, for example, has been hypothesized to significantly decrease volumetric wear rates, but subsequent complications associated with metallosis have prompted joint surgeons toward using metal-on-plastic (MP) or ceramic implants more commonly. Furthermore, MP implants in total hip arthroplasty have been associated with superior clinical outcomes and durability when compared to MM implants. Although highlighted in joint arthroplasty studies, long-term outcomes between differing biomaterial composites in ACDR have not been thoroughly investigated. <h3>PURPOSE</h3> The purpose of this study was to evaluate the rates of ASD, reoperation rates, complications and patient reported clinical outcomes of MM vs MP artificial discs in two-level ACDR for the treatment of cervical DDD. <h3>STUDY DESIGN/SETTING</h3> Meta-analysis and systematic review. <h3>PATIENT SAMPLE</h3> A total of 980 patients (442 MM, 538 MP). <h3>OUTCOME MEASURES</h3> 1) Rate of ASD, 2) reoperation rate, 3) complications, 4) patient reported clinical outcomes (NDI, VAS-neck, VAS-arm). <h3>Methods</h3> A systematic search strategy of three electronic databases (PubMed, CINAHL Plus and SCOPUS) was conducted utilizing terms related to 2-level ACDR. All studies included were published in the past 5 years, had a sample size of >10 patients, and reported data on adjacent segment disease. Cadaver studies, non-English manuscripts and studies in which only single-level ACDR was investigated were excluded. A total of 7 studies were included in this analysis. Studies were analyzed for demographic data, clinical outcome scores (NDI, VAS-neck and VAS-arm), rates of ASD, complications and reoperation proportions. A random-effects model of meta-analysis was used for groups that were determined to be heterogenous and a fixed-effects model was utilized for groups that were not. An overlap of 95% confidence intervals suggests no statistically significant difference at the p<0.05 level. <h3>Results</h3> Seven studies were included with data on 980 patients (442 MM, 538 MP). The study population was 52.84% female, with a mean age of 48.01 years, and a mean follow-up of 85.66 months. The mean improvement in NDI was 34.42 (95% CI, 32.49-36.36) and 29.72 (95% CI, 27.15-32.29) for the MM and MP groups, respectively. The mean improvement in VAS-neck was 11.20 (95% CI, 10.69-11.70) and 8.78 (95% CI, 7.81-9.74) for the MM and MP groups, respectively. The mean improvement in VAS-arm was 10.73 (95% CI, 9.83-11.63) and 8.49 (95% CI, 7.59-9.39) for the MM and MP groups, respectively. Reoperation was needed in 1.36% (95% CI, 0.61-2.99) of patients who underwent ACDR with an MM implant compared to 5.33% (95% CI, 3.68-7.65) of patients with an MP implant. The MM cohort had a larger proportion of patients with ASD who underwent subsequent surgery at an adjacent level (7.89% MM vs 1.91% MP). Heterotopic ossification and dysphagia were the most common complications in both groups, and the incidence of each was significantly higher in the MP cohort. <h3>Conclusions</h3> Our present meta-analysis suggests that the use of MM artificial discs in 2-level ACDR results in superior clinical outcome scores with a lower complication profile and reoperation rate, but higher rates of ASD compared to MP discs after a follow-up period of 5 years or more. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Truss Implant Technology™ for Interbody Fusion in Spinal Degenerative Disorders: Profile of Advanced Structural Design, Mechanobiologic and Performance Characteristics

Introduction Interbody fusion devices are customarily used in fusion of the anterior spinal column for treatment of degenerative disc disease. Their traditional role is to reestablish and maintain intervertebral disc height, contain bone graft and provide mechanical support for the spine while osseointegration takes place. Utilizing the principles of mechanobiology, a unique biokinetic interbody fusion device has been developed that employs an advanced structural design to facilitate and actively participate in the fusion consolidation process. Areas covered This article profiles and characterizes 4WEB Medical’s Truss Implant Technology™ which includes a range of 3D-printed titanium spinal interbody implants and non-spinal implants whose design is based on truss structures enabled by advances in additive manufacturing. Four main areas of the implant design and functionality are detailed: bio-architecture, mechanobiologic underpinnings, bioactive surface features, and subsidence resistance. Pre-clinical and clinical examples are provided to describe and specify the bioactive roles and contributions of each design feature. Expert opinion The distinct and unique combination of features incorporated within the truss cage design results in a biokinetic implant that actively participates in the bone healing cascade and fusion process.

Are injectable regenerative therapies effective in the treatment of degenerative disc disease? A systematic review.

Degenerative disc disease is a major health concern in spine surgery. The aim of this systematic review was to summarize the current knowledge about injectable regenerative therapies (mesenchymal stem cells [MSC] or platelet rich plasma [PRP]) in degenerative disc disease. A research and analysis of the literature on Pubmed, Medscape, Medline, Google Scholar and Cochrane databases was performed, in accordance with the Preferential Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart. Only peer-reviewed randomized controlled trials (RCTs), prospective single-arm trials, case series, and cohort studies were included. A total of 17 studies were included. All were homogeneous regarding indications to the procedure: discogenic low-back pain for at least 3-6 months, failure of conservative treatment, MRI evidence of disc degeneration. A total of 182 patients were treated with MSC and 198 patients were treated with PRP. Considering the efficacy, the studies were heterogeneous in clinical evaluation systems; however, they all reported significant improvement in clinical and functional scores. Neither major complications nor adverse effects were reported by any author. As for radiographical outcome none of the studies reported a disc height improvement after treatment. Degenerative disc disease is a major health concern. Regenerative therapies could play a role in the treatment of its symptoms, as they have been proven to be clinically effective, cheap, and safe. Nevertheless, further studies are needed, in order to establish evidence based standardized treatments.

Retroperitoneal pneumatosis and subcutaneous emphysema after oblique lateral interbody fusion surgery: a case report

BackgroundThe oblique lateral interbody fusion technique has received increasing attention for the treatment of degenerative disc disease in recent years. A series of complications have been reported, such as vascular injury, sympathetic chain injury, and transient psoas weakness, although it is regarded as a relatively safe technique.Case presentationA 55-year-old male patient of Han nationality was diagnosed with lumbar spinal stenosis and underwent standalone oblique lateral interbody fusion surgery under general anethesia. Three days after the operation, subcutaneous gas accumulation appeared in the left lower abdomen of the patient with no inflammatory reaction of the wound. He was treated with conservative management, and the retroperitoneal pneumatosis and subcutaneous emphysema had disappeared completely 1 month later.ConclusionsTo date, this is the first reported case of retroperitoneal pneumatosis and subcutaneous emphysema related to oblique lateral interbody fusion surgery, which broadens the scope of the complications of oblique lateral interbody fusion surgery.

Investigational Research: Timeline, Trials, and Future Directions of Spinal Disc Arthroplasty.

Spinal disc arthroplasty (SDA) has been a rising alternative to fusion for the treatment of degenerative disc disease (DDD). This review aims to provide an overview of the timeline, approvals, and limitations of SDA through analysis of U.S. Food and Drug Administration (FDA)-approved trials. Clinical studies have shown more successful outcomes when comparing cervical disc arthroplasty (CDA) with anterior cervical decompression and fusion, with the key benefits of decreased risk of nerve root compression and adjacent disc disease. CDA is currently approved by the FDA for one- and two-level disc pathologies. However, there are no approved trials for three-level or more cervical pathologies. The FDA approved its usage for the treatment of one-level lumbar disc pathologies in 2007 and recently approved two-level disc pathologies in 2020. Thoracic SDA has not been approved by the FDA, and there are no currently occurring clinical trials. While multilevel SDA has been approved in the cervical and lumbar spine, it has not been approved in more than two adjacent vertebral levels. Based on these clinical studies, future research is needed to compare the success of SDA for three-level or more disc pathologies. There have been recent publications showing promising results, though no FDA-approved clinical trials exist. Furthermore, a hybrid construct has been a recent surgical method to treat multilevel DDD. In this approach, arthroplasty and fusion techniques are combined in alternating fashion at adjacent levels to treat two- and three-level disc disease. Hybrid arthroplasty compared with SDA is currently being studied in clinical trials. As such, long-term research with FDA-approved clinical trials is needed to understand the benefits and limitations of different approaches in the treatment of DDD.

Treatment of Degenerative Disc Disease associated with Modic changes, with ozone therapy. A new therapeutic proposal.

Introduction.&#x0D; Modic Changes (MCs) represent signal changes in the vertebral endplate and subchondral bone region visualized on T1 and T2 weighted magnetic resonance images (MRI). Three types of MCs It have been identified (Types 1 to 3). Modic changes are commonly associated with low-back pain (LBP). &#x0D; In the last few years scientific papers have shown that one of the causes of MCs (fundamentally, the MCs type 1) is the infection caused by an anaerobic bacterium of very low virulence: Propionibacterium acnes (P. acnes). This bacterium resides on the human skin, oral cavity, intestinal tract, and external ear canal as normal flora. As a consequence of tooth brushing and endodontic-therapy, could invade the blood stream leading to transient bacteremia. The authors propose a treatment which consists of Amoxicillin-clavulanate (500 mg/125 mg) three times a day, at 8-hour intervals, for 90 days/100 days.&#x0D; Objectives.&#x0D; Ozone therapy could be the gold standard therapy for MC1 because ozone is a powerful anti-microbial, anti-inflammatory and analgesic agent, which regulates oxidative stress, immune system and oxygen metabolism. &#x0D; Materials and Methods &#x0D; Patients with LBP lasting 6 months or more and MC1 confirmed by MRI of lumbar spine L3/L4 or L4/L5 or L5/S1 and who responded with 5 or more points on the VAS scale were treated with three intradiscal sessions of ozone therapy and ten paravertebral sessions. &#x0D; Results.&#x0D; Patients who were treated with ozone therapy according to our treatment proposal showed a substantial improvement on VAS comparing the beginning and the end of the treatment. They show a significant difference in pain, and general condition. However, these results were not reflected on ODI scale, neither on the MRI but we could notice certain improvements.

A comparative study of mesenchymal stem cell transplantation and NTG-101 molecular therapy to treat degenerative disc disease

Cellular replacement therapy using mesenchymal stem cells (MSCs) and/or the delivery of growth factors are at the forefront of minimally invasive biological treatment options for Degenerative Disc Disease (DDD). In this study, we compared the therapeutic potential of a novel drug candidate, NTG-101 to MSCs, including rat cartilage derived stem cells (rCDSCs), bone marrow stem cells (rBMSCs) and human Umbilical Cord Derived Mesenchymal Stem Cells (hUCMSCs) for the treatment of DDD. We induced DDD using a validated image-guided needle puncture injury in rat-tail IVDs. Ten weeks post-injury, animals were randomized and injected with MSCs, NTG-101 or vehicle. At the end of the study, histological analysis of the IVD-Nucleus Pulposus (NPs) injected with NTG-101 or rCDSCs showed a healthy or mild degenerative phenotype in comparison to vehicle controls. Immunohistochemical analysis revealed strong expression of aggrecan, collagen 2, brachyury and Oct4 in IVD-NPs injected with NTG-101. Our results also demonstrated suppression of inflammation induced p38 and NFκB resulting in inhibition of catabolic genes, but activation of Smad-2/3, Erk-1/2 and Akt-dependent signaling inducing anabolic genes in IVD-NP on treatment with NTG-101. In conclusion, a single injection of NTG-101 into the degenerative disc demonstrated superior benefits compared to stem cell transplantation.

Cervical Disc Arthroplasty for Axial Neck Pain: Comparison of Outcomes to 2 Other Common Cervical Conditions.

Cervical disc arthroplasty (CDA) is an established treatment for degenerative disc disease with radiculopathy and/or myelopathy. There is, however, little published evidence of its effectiveness to relieve pain and improve function in patients with a primary diagnosis of axial neck pain. Such patients were excluded from all previous Food and Drug Administration clinical trials for CDA. We compare the outcomes of patients who underwent CDA for 3 common cervical conditions from 2003 to 2018. Seven hundred and eighty-two CDA patients at a single site were grouped by primary diagnosis: predominant axial neck pain (ANP) (n = 257), predominant radiculopathy (RAD) (n = 331), or a combination of both (ANP + RAD) (n = 195). Mixed models for repeated measures predicted and analyzed scores at all time points, adjusting for diagnosis group, time point, and, if statistically significant, number of operative levels and demographic characteristics. Outcome measures included the Neck Disability Index, numerical pain scales (intensity plus frequency), the Veterans RAND 12 Item Health Survey (VR-12) Physical Component Score, the Mental Component Score, and reoperations. Patients were assessed preoperatively and postoperatively at 6 weeks, 3 months, 6 months, 1 year, and annually thereafter. At baseline, arm pain scores in the ANP group were statistically lower (P = .0002) than in the RAD and ANP + RAD groups, consistent with preoperative diagnoses. Surgeries included 40.8% 1-level, 41.6% 2-level, 14.7% 3-level, and 2.9% 4-level. For all outcome measures, improvements were statistically significant from baseline to each postoperative time point without statistical difference between the 3 diagnosis groups. In total, 45/782 patients (5.8%) underwent a secondary surgery: 3.5% ANP, 5.8% RAD, and 8.7% ANP + RAD. Days to reoperation did not statistically differ between groups (P = .489). Appropriately selected patients with predominant axial neck pain treated with CDA may achieve clinical and functional outcomes comparable to patients with a primary diagnosis of radiculopathy or of axial neck pain with concomitant radiculopathy. This study provides information that should help clinicians decide whether to offer CDA for patients with a primary diagnosis of axial neck pain and to appropriately counsel such patients about expected outcomes. 4.

The Role of Cervical Muscles Morphology in the Surgical Treatment of Degenerative Disc Disease: Clinical Correlations Based on Magnetic Resonance Imaging Studies.

Cervical spine musculature still remains a less studied component of the cervical spine anatomical compartments, although it plays a significant role in the mobility of the head and the preservation of cervical spine alignment. The goal of this study was to extract any significant information from the literature regarding the role of cervical spine muscles morphology in the outcome of surgically treated patients for degenerative disc disease (DDD) based on preoperative magnetic resonance imaging (MRI) studies. Eleven clinical case series were found, from which four were prospective and seven were retrospective. Six studies were concentrated on anterior approaches and five studies on posterior approaches in the cervical spine. In posterior approaches aiming at the preservation of muscles attachments and overall less surgical manipulations, results on cervical lordosis, axial pain and patient’s functionality were found superior to traditional laminectomies. The study of cross-sectional areas (CSAs) of deep paraspinal muscles in the cervical spine could add significant information for the spine surgeon such as the prediction of adjacent level disease (ALD), fusion failure, axial pain persistence, postoperative cervical alignment and patient’s postoperative functionality. It seems that MRI studies focusing on muscle layers of the cervical spine could add significant information for the spinal surgeon regarding the final surgical outcome in terms of pain and function expression. Larger multicenter clinical studies are a necessity in defining the role of the muscle component of the cervical spine in the surgical treatment of DDD.

Stem cell therapy for degenerative disc disease: A review

Degenerative Disc Disease (DDD) is a prevalent musculoskeletal disorder associated with lower back pain that typically occurs with age but can also be precipitated by other factors. At present, the available treatments such as physical therapy, analgesics, anti-inflammatory drugs, and surgical interventions are aimed at addressing the symptoms of the disease but not the degeneration process. Among the various biological disc repair therapies, cell therapy has gained interest as it offers a disc regenerative potential while being minimally invasive. Stem cells have the unique property of differentiating into chondrocytes (specialized cells found in cartilage) that resemble Nucleus Pulposus (NP) cells of the disc. Therefore, stem cells can be used to replace the lost NP cells in the degenerated disc. This reduces inflammation and helps in the regeneration of the degenerated disc. In vitro studies, several animal-based studies, and a few human pilot studies have demonstrated safety and efficacy in the treatment of DDD with different types of Mesenchymal Stem Cells (MSCs), Induced Pluripotent Stem Cells (IPSCs), and Intervertebral Disc Stem Cells (IVDSCs). This review aims to address the current status, recent advancements, and different types of stem cells in degenerated disc therapy.

The nucleus pulposus microenvironment in the intervertebral disc: the fountain of youth?

The intervertebral disc (IVD) is a complex tissue, and its degeneration remains a problem for patients, without significant improvement in treatment strategies. This mostly age-related disease predominantly affects the nucleus pulposus (NP), the central region of the IVD. The NP tissue, and especially its microenvironment, exhibit changes that may be involved at the outset or affect the progression of IVD pathology. The NP tissue microenvironment is unique and can be defined by a variety of specific factors and components characteristic of its physiology and function. NP progenitor cell interactions with their surrounding microenvironment may be a key factor for the regulation of cellular metabolism, phenotype, and stemness. Recently, celltransplantation approaches have been investigated for the treatment of degenerative disc disease, highlighting the need to better understand if and how transplanted cells can give rise to healthy NP tissue. Hence, understanding all the components of the NP microenvironment seems to be critical to better gauge the success and outcomes of approaches for tissue engineering and future clinical applications. Knowledge about the components of the NP microenvironment, how NP progenitor cells interact with them, and how changes in their surroundings can alter their function is summarised. Recent discoveries in NP tissue engineering linked to the microenvironment are also reviewed, meaning how crosstalk within the microenvironment can be adjusted to promote NP regeneration. Associated clinical problems are also considered, connecting bench-to-bedside in the context of IVD degeneration.

Long-term Radiologic and Clinical Outcomes after Three-level Contiguous Anterior Cervical Diskectomy and Fusion without Plating: A Multicentric Retrospective Study.

Anterior cervical diskectomy and fusion (ACDF) has been providing good surgical, clinical, and radiologic outcomes in patients suffering from cervical degenerative disk disease (DDD). However, the role of anterior plating is still debated, especially in three-level procedures. This study aimed to investigate long-term clinical and radiologic outcomes and complications after three-level contiguous ACDF without plating for cervical DDD. Two institutional databases were retrieved (January 2009-December 2014) for patients treated with three-level contiguous ACDF without plating. Minimum follow-up (FU) was 5 years. Demographical data, smoking status, implant types, Neck Disability Index (NDI), visual analog scale (VAS) for neck pain, complications, fusion rate, adjacent segment degeneration (ASD), cervical lordosis (CL), and residual segmental mobility were evaluated. We enrolled 21 patients. Tantalum and carbon fiber cages were implanted, respectively, in 13 and 8 patients. The mean FU length was 5.76 ± 0.87 years. Mean NDI score was 78.29 ± 9.98% preoperatively and 8.29 ± 1.67% at last FU (p < 0.01), whereas mean VAS score decreased from 7.43 ± 1.14 preoperatively to 0.95 ± 0.95 at last FU (p < 0.01). Complications were one postoperative hematoma, one superficial wound infection, and five cases of postoperative dysphagia (recovered within 3 days). The fusion rate was 90% and ASD was reported in three (14%) cases. The mean CL was 6.33 ± 2.70 degrees preoperatively, 8.19 ± 1.97 degrees 3 months after surgery (p = 0.02), and 7.62 ± 1.96 degrees at latest FU. There was no residual mobility on every operated segment at last FU. The smoking status was an independent risk factor for nonfusion in this case series (p = 0.02). Three-level contiguous ACDF without plating seems to be an effective treatment for cervical DDD. Properly designed comparative clinical trials are needed to further investigate this topic.

Advanced meta-analyses comparing the three surgical techniques total disc replacement, anterior stand-alone fusion and circumferential fusion regarding pain, function and complications up to 3 years to treat lumbar degenerative disc disease

The purpose of our meta-analyses is to find the most appropriate surgical technique treating lumbar degenerative disc disease (DDD). Spinal fusion is the conventional treatment for lumbar DDD. Total disc replacement (TDR) has been developed to avoid negative effects of fusions by preserving functionality. To our knowledge, there is no evaluation comparing meta-analytically the clinical results of three different surgical techniques with same inclusion and exclusion criteria for treating DDD. The surgical techniques TDR, anterior lumbar interbody fusion (ALIF) and circumferential fusion (CFF) are pairwise meta-analytically compared. Primary outcomes are pain measured by the Visual Analogue Scale (VAS) and function measured by the Oswestry Disability Index (ODI). Secondary outcomes are the mean number of complications per case (MNOC) at surgery and follow-up and the overall MNOC. In our systematic search, we found finally six prospective studies with the minimum follow-up of two years: four randomized controlled trials and two cohort studies. In VAS and ODI, TDR is proved to be superior to ALIF and CCF (p < 0.05), whereat ALIF is more effective than CFF without statistical significance. CFF presents the best result in complications with the lowest overall MNOC (0.1), followed by TDR (1.2) and ALIF (1.5). According to our meta-analyses, we regard TDR to be the most appropriate surgical technique treating DDD, followed by ALIF. Further studies with a longer follow-up are needed using the same methodical approach to strengthen the VAS and ODI results and to explain the discrepant result to complications.

EVALUATION OF POSTERIOR LUMBER INTERBODY FUSION WITHOUT INSTRUMENTATION IN LUMBER DEGENERATIVE DISC DISEASES

Background: Degenerative disc disease represents a common cause of chronic low back pain that makes some disabling and requires surgical intervention. Posterior lumbar interbody fusion (PLIF) represents one of the techniques used to deal with this disabling. Objective: To assess the results of the posterior lumbar interbody fusion (PLIF) without instrumentation in cases of degenerative disc diseases without instability. Patient and method: This was a prospective study of twenty patients who underwent surgical lumbar laminectomy and discectomy with interbody fusion and graft for degenerative lumbar diseases that not responsive to medical treatment for 6 months at Sayed Galal Hospital, Al-Azhar Faculty of Medicine. Result: There was a highly statistically significant decrease in the level of pain (VAS score) one week postoperatively compared to preoperative level with p-value < 0.001, and a statistically significant difference was found between preoperative pain (VAS score) level ,and post 6 months level with p-value < 0.001. Conclusion: Posterior lumbar interbody fusion technique without instrumentation showed several potential benefits in the treatment of degenerative disc disease (DDD).

A Combinational Approach Using Cell Therapy, Tissue Engineering, and Distracting Device for the Treatment of Degenerative Disc Disease

The Intervertebral Disc (IVD) is a fibrocartilaginous tissue instrumental in spine flexibility, allowing for the bending and twisting motion between vertebral bodies. Degenerative Disc Disease (DDD) results from the complex and chronic deterioration in IVD organization, structure, and function

Novelties in etiopathogenesis, diagnosis and treatment of patients with lumbar intevrertebral disc degeneration

Low-back pain is one of the most common causes of physical disability, most often originating from intervertebral disc degeneration. Lack of pinpointing the exact source of pain is the limiting factor in more efficient prevention and treatment. New findings, especially in the fields of genetics and mass spectometry based protein analysis, shed a new light to the understanding of etiopathogenesis of disc degenerative disease. New imaging methods like chemical exchange saturation transfer (CEST)MRI or apparent diffusion coefficient (ADC)MRI can detect early degenerative changes. Advances have been made regarding elucidating the role of physical load, as well as the type of exercise that can have an impact on the development and treatment of patients with degenerative disc disease. Finally, a significant progress has been made in the surgical treatment ecouraging of these patients, with an emphasis on minimally invasive techniques. Other surgical modalities have also shown improvement, like total disc replacement and mesenchymal stem cells treatments. These, and other novelties in the diagnosis and treatment of degenerative disc disease of lumbar spine are discussed in this article.

Characterization and cytocompatibility of 3D porous biomimetic scaffold derived from rabbit nucleus pulposus tissue in vitro

Intervertebral disc (IVD) degeneration is one of the most important causes of lower back pain. Tissue engineering provides a new method for the experimental treatment of degenerative disc diseases. This study aims to develop a natural, acellular, 3D interconnected porous scaffold derived from the extracellular matrix (ECM) of nucleus pulposus. The nucleus pulposus (NP) was decellularized by sequential detergent-nuclease methods, including physical crushing, freeze-drying and cross-linking. These 3D porous scaffolds were fabricated with a high porosity of (81.28 ± 4.10)%, an ideal pore size with appropriate mechanical properties. Rabbit bone marrow mesenchymal stem cells (rBMSCs) were seeded and cultured on the scaffolds. And the mechanical tests showed the compressive elastic modulus of the scaffolds cultured for 4 weeks reached 0.12 MPa, which was better than that of the scaffolds cultured for 2 weeks (0.07 MPa) and that of the control group (0.04 MPa). Scanning electron microscopy (SEM), histological assays, molecular biology assays revealed that the scaffolds could provide an appropriate microstructure and environment for the adhesion, proliferation, migration and secretion of seeded cells in vitro. As assays like histology, immunohistochemistry and the real-time qRT-PCR showed, NP-like tissues were preliminarily formed. In conclusion, the 3D porous scaffold derived from NP ECM is a potential biomaterial for the regeneration of NP tissues.A natural, acellular, 3D interconnected porous scaffold derived from the extracellular matrix (ECM) of nucleus pulposus was developed by sequential detergent-nuclease and freeze-drying method, which can reduce the damage of protein activity to the minimum. It is very similar to the composition and internal environment of the natural nucleus pulposus, because it derived from the natural nucleus pulposus. Scanning electron microscopy (SEM), histological assays, molecular biology assays revealed that the scaffolds could provide an appropriate microstructure and environment for the adhesion, proliferation, migration, and secretion of seeded cells in vitro.

Anterior cervical discectomy and fusion by polyetheretherketon cage in degenerative disc diseases

Background Anterior cervical discectomy has proven to be a safe and effective procedure for the treatment of degenerative disc disease. The anterior approach allows direct visualization of the entire interspace and wide decompression of the anterior aspect of cervical spinal cord and nerve roots; it may be undertaken in cases of multilevel disease and interbody fusion may be performed if required. Patients and methods A total of 20 patients aged from 20 to 65 years, 16 females and four males with symptomatic cervical disc disease, presented in the outpatient clinic, Menoufia University hospital from 2012 to 2014, were examined and followed up prospectively, The mean age was 43.25±9.06 (range: 28–60) years. There were 13 patients (65%) with radiculopathy only, two patients (10%) with mylopathy only, and five patients (10%) with radiculomylopathy; seven cases were affected by mylopathy graded according to Ranawat grading. There were 37 levels affected among the 20 patients. C5,6 was the commonly affected level 1 (40.5%), then C4,5 11 (29.7%), then C6,7 7 (18.9%), and the least one was C3,4 4 (10.8%). Five cases were operated by using a microscope. Anterior cervical discectomy and fusion (ACDF) were performed using polyetheretherketone (PEEK) cages and local bone graft. Results The mean operative time per microscopic level was 64.5 min, the nonmicroscopic level was 47 min.The only intraoperative complication was external jugular-vein ligation that occurred in two cases (nonmicroscopic). The only postoperative complication was difficulty in swallowing, which occurred in 13 cases (11 nonmicroscopic and two microscopic). The mean of preoperative interbody ratio was 1.8±0.2, 12 months postoperatively the mean was 1.9± 0.2.There was a statistically significant difference in the mean of the interbody ratio preoperative and at 12 months. The mean preoperative disc space height was 3.3±0.8 mm, 12 months postoperative was 5.8±0.9. There was a statistically significant difference in the mean disc space height preoperative and 12 months postoperative. Rate of fusion at 12 months: three levels were average fusion, 26 levels were good fusion, and eight levels were excellent fusion. Conclusion Patients receiving ACDF with local bone graft combined with a PEEK cage had significantly shorter operation time, lower perioperative complication rates, and better radiological results comparing with those with an iliac bone graft alone. It seems that the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft for ACDF.

COMPREHENSIVE TREATMENT OF DISCOPATHIES OF THE LUMBAR SPINE

Introduction. Degenerative disc disease is one of the most common diseases of the musculoskeletal system, characterized by dystrophic changes in the intervertebral disc and vertebral bodies adjacent to it. The main symptoms of this disease are pain and sensory and motor disorders, which, according to various authors, occur in 50–80% of adults. The main objective of the study was to find and implement the optimal set of treatment measures for degenerative disc disease depending on the age of a patient. Materials and Methods. The medical records of inpatients who were treated in the Neurosurgical Department of the Sumy Regional Clinical Hospital in 2019–2020 were analyzed. The course of treatment of 93 patients (61 men and 32 women) was studied. The patients were divided into groups according to their age: young age (under 25) – 13 men and 8 women; middle age (under 60) – 24 men and 19 women; and elderly age (over 60 years) – 18 men and 11 women. The combined use of pathogenetically justified physiotherapeutic measures in the treatment complex is gaining more and more interest. Their distinctive features are physiologic nature, absence of allergic manifestations, the ability to influence most of the pathogenesis of the disease, and the organic combination with other therapeutic factors. Unfortunately, there is an increase in the incidence of temporary incapacitation and progressive course, which often leads to disability and significant financial costs associated with expensive modern methods of diagnosis, treatment, and further provision of employment to patients. The results of our study show that complex treatment including pathogenetic drug therapy, complex paravertebral block, therapeutic physical exercise, and physiotherapy treatment methods provides adequate recovery of spinal function regardless of dystrophic and degenerative changes severity and patient's age. Treatment of degenerative disc disease should be comprehensive and directed at the various symptoms and links of the pathological process.