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This study aimed to delineate trends in intervertebral disc degeneration among Mexican patients, specifically focusing on the distribution and correlation between BMI and Pfirrmann classification results within the Mexican population. Conducted using the public health database of Mexico City. The study involved 51 patients sampled via convenience sampling, with exclusive utilization of internal MRI data from L4-L5 and L5-S1 discs. Data encompassed gender, age, height, weight, BMI, and radiographic findings. The dataset was stratified by gender and BMI categories, with analyses including measures of distribution and association, notably employing the Dunn test to compare BMI groups. Visualization tools such as violin plots and box-and-whisker charts were employed to elucidate the relationships between BMI, age, and Pfirrmann classification results. In both female and male groups, increasing BMI exhibited a positive correlation with disc degeneration severity, particularly pronounced in the obesity category. Statistical analyses revealed differences between normal BMI and overweight/ obesity groups. Furthermore, there is also an increase in severity between overweight and obesity groups. The odds ratios (ORs) for disc degeneration severity, comparing different BMI categories, reveal significant associations. Among women, overweight individuals have 3.333 times higher odds of presenting a Pfirrmann classification result ≥ 4 at L4-L5, and 6.545 times higher odds at L5-S1, compared to those with normal BMI. Similarly, women with obesity have 8 times higher odds of disc degeneration at both levels. For men, the ORs were 1.6 and 2.222 at L4-L5 and L5-S1, respectively, comparing normal BMI to overweight individuals, the ORs were 5 at L4-L5 and 4.166 at L5-S1 when comparing normal BMI to obesity. This study offers persuasive evidence that, among Mexican patients, body mass index (BMI) is probably correlated with the severity of lumbosacral degenerative disc degeneration (DDD). Acknowledging limitations in sample size, future investigations should delve into elucidating the underlying mechanisms driving this correlation. Multi-center studies with larger, diverse cohorts are warranted to validate and enhance the generalizability of our findings. We promote the focus on early detection and prevention, marking a paradigm change in the treatment of degenerative spine disorders and opening the door for creative methods of patient care and public health campaigns. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine if surface electromyography (sEMG) demonstrates differences in muscle activation between normal and dogs recovering from spinal cord injury due to intervertebral disk extrusion. Animals: Two groups of client-owned small-breed chondrodysplastic-type dogs were tested. Group 1 consisted of seven ambulatory paraparetic dogs that had undergone a hemilaminectomy procedure in the T3-L3 region for intervertebral disk extrusion 1 month prior. Group 2 was made up of seven normal dogs that had no history of intervertebral disk disease or spinal surgery. Procedures: Each subject walked 10 feet on a nonslip surface for at least five gait cycles for the sEMG to capture muscle activation of the vastus lateralis and gluteus medius, bilaterally. Muscle activation was quantified as the total myoelectric output area under the curve, averaged across all gait cycles. Results: Muscle activation was significantly greater in the post-operative hemilaminectomy group (p = 0.012). There was a significant difference in muscle activation between each hindlimb in the post-operative hemilaminectomy group, but not in the normal group. The muscle activation was significantly lower on the side that underwent surgery compared to the opposite limb (p = 0.0034). Conclusion and clinical importance: Post-operative hemilaminectomy dogs have greater hindlimb muscle activation compared to normal dogs, which likely represents a lack of descending inhibition secondary to upper motor neuron syndrome. The side of surgery is correlated with decreased muscle activation. Surface EMG can be used to evaluate muscle activity in dogs recovering from spinal decompression surgery. [ABSTRACT FROM AUTHOR]

Simple Summary: Simple Summary: Nineteen geriatric dogs (aged 8–20 years) with chronic diseases, including myxomatous mitral valve disease, chronic kidney disease, intervertebral disk disease, cognitive dysfunction syndrome, degenerative joint disease, osteoarthritis, and progressive retinal atrophy, were included in this retrospective study. They were divided into two groups: a control group treated with adipose tissue-derived mesenchymal stem cells (MSCs) (n = 9) and a treatment group receiving MSCs derived from gonadal tissue (n = 10). MSC therapies were administered intravenously at monthly intervals, with multiple frequencies, using allogeneic MSCs. Safety was evaluated through short-term and long-term physical exams, blood tests, imaging studies, and the monitoring of adverse events. No clinical adverse effects were observed in the dogs treated with gonadal tissue-derived MSCs. Ensuring the safety of mesenchymal stem cell (MSC) therapy is a fundamental requirement in clinical practice. This study aimed to assess the safety of using gonadal tissue-derived MSCs (n = 10) compared to the commonly utilized adipose tissue-derived MSCs (n = 9) in geriatric dogs with chronic diseases. All participants received allogeneic MSC therapy, and no allergic reactions due to allogeneic cell immunogenicity were noted. Both groups showed no adverse changes in physical exams or hematological parameters before and after therapy. Importantly, there were no instances of tumor formation or growth post-treatment in either group. The findings demonstrated that dogs treated with gonadal tissue-derived MSCs experienced no clinical adverse effects. However, clinical adverse effects were reported in one case of adipose tissue-derived MSC therapy. Despite limitations in monitoring beyond one year and constraints due to a small and diverse patient group, this pioneering study validates the safe use of gonadal tissue-derived MSCs in aged companion animals. It underscores the potential of utilizing tissues from neutering procedures to advance regenerative medicine and expand cell banks and therapy options for companion animals. [ABSTRACT FROM AUTHOR]

Background: Syndecan‐1 (SDC1) is an established marker of endothelial glycocalyx shedding. Most research on SDC1 has focused on plasma or serum concentrations, and little is known about urine concentrations. Objectives: Measure urinary SDC1 concentrations in dogs undergoing anesthesia with either sevoflurane or isoflurane and assess the effects of anesthesia duration and IV crystalloids on urinary SDC1 concentrations. Animals: Thirty‐one client‐owned dogs undergoing anesthesia for magnetic resonance imaging (MRI) with or without surgery for suspected intervertebral disk disease (IVDD) were used. Methods: Dogs with suspected IVDD were randomized to undergo anesthesia with either sevoflurane or isoflurane. Urine was collected before and immediately after anesthesia for the analysis of SDC1. Urinary creatinine concentrations also were measured, and the ratio of urinary SDC1 to urinary creatinine (USCR) was used to account for dilution. Results: Median (range) USCR was significantly higher after anesthesia compared with baseline for all groups combined (P <.05). No significant difference was found between the groups for age, sex, weight, and type of anesthesia. Multiple regression analysis of the effect of the independent variables inhalant type, age, weight, sex, anesthesia time, surgery, and quantity of IV fluids on the dependent variable SDC1 found that only the quantity of IV fluids significantly predicted a change (P <.001). Conclusions and Clinical Importance: The total volume of lactated Ringer's solution administered to anesthetized dogs may affect USCR. Further investigations are warranted to evaluate the relationship between IV fluids and SDC1. [ABSTRACT FROM AUTHOR]

Background: The objectives of this research were to establish an animal model of adjacent segment degeneration (ASD) bordering lumbar fusion and to investigate the expression of autophagy factors in nucleus pulposus cells of adjacent intervertebral disks. Materials and Methods: Twenty-four adult New Zealand white rabbits were enrolled and divided into two groups: group A (n=12) and group B (n=12). Posterolateral fusion and fixation were performed after intervertebral disk degeneration occurred in group A, and the rabbits were monitored for 6 months. Group B was the control group and did not undergo fusion surgery. These rabbits were monitored for 6 months. Real-time quantitative polymerase chain reaction and immunohistochemistry were performed to detect the mRNA and protein expressions of PTEN-induced kinase 1 (PINK1), Parkin, ADAMTS-4, and MMP-3. An external database, the GEO database, was used to examine the expression of these genes and analyze them for differential expression. Results: After lumbar fusion in rabbits, the animal model of ASD exhibited gradual degeneration of adjacent intervertebral disks over time. Group A displayed significantly higher mRNA and protein expressions of PINK1 and MMP-3 but lower expression of ADAMTS-4 compared with group B (P<.05). The results analyzed in the GEO database showed that the expression of PINK1 was higher in group A than in group B, while the expression of ADAMTS-4 was lower in group A than in group B. Conclusion: After posterolateral lumbar fusion in rabbits, the animal ASD model showed gradual deterioration of adjacent intervertebral disks with prolonged follow-up. The findings indicate the important role of autophagy in the apoptosis of nucleus pulposus cells in adjacent intervertebral disks. [Orthopedics. 2024;47(4):e167–e173.] [ABSTRACT FROM AUTHOR]

Two medium-sized, 7-year-old dogs, with no previous history of pain, presented with acute neurologic symptoms consistent with intervertebral disk disease. Both cases had CT, where cervical pathology was identified. In one dog, the diagnosis was singular extensive cervical disk herniation with possible epidural hemorrhage and in the other, the diagnosis was multiple-site cervical disk herniation. The first dog, a Shar-Pei, underwent treatment with two standard adjacent ventral slots between the C4-C5 and C5-C6 intervertebral disk spaces and a fenestration between the C3 and C4 intervertebral disk spaces. The second case, a beagle, underwent a double adjacent standard ventral slot between the C5-C6 and C6-C7 intervertebral disk spaces. Both dogs recovered uneventfully after the surgery and showed no signs of recurrence during a 2-year follow-up period. This is the first detailed report of the use of a double adjacent ventral slot as a treatment for spinal decompression in medium-sized dogs with multiple-site spinal cord compression. [ABSTRACT FROM AUTHOR]

Purpose: Although studies have suggested that gut microbiota may be associated with intervertebral disk disease, their causal relationship is unclear. This study aimed to investigate the causal relationship between the gut microbiota and its metabolic pathways with the risk of intervertebral disk degeneration (IVDD), low back pain (LBP), and sciatica. Methods: Genetic variation data for 211 gut microbiota taxa at the phylum to genus level were obtained from the MiBioGen consortium. Genetic variation data for 105 taxa at the species level and 205 metabolic pathways were obtained from the Dutch Microbiome Project. Genetic variation data for disease outcomes were obtained from the FinnGen consortium. The causal relationships between the gut microbiota and its metabolic pathways and the risk of IVDD, LBP, and sciatica were evaluated via Mendelian randomization (MR). The robustness of the results was assessed through sensitivity analysis. Results: Inverse variance weighting identified 46 taxa and 33 metabolic pathways that were causally related to IVDD, LBP, and sciatica. After correction by weighted median and MR-PRESSO, 15 taxa and nine pathways remained stable. After FDR correction, only the effect of the genus_Eubacterium coprostanoligenes group on IVDD remained stable. Sensitivity analyses showed no evidence of horizontal pleiotropy, heterogeneity, or reverse causation. Conclusion: Some microbial taxa and their metabolic pathways are causally related to IVDD, LBP, and sciatica and may serve as potential intervention targets. This study provides new insights into the mechanisms of gut microbiota-mediated development of intervertebral disk disease. [ABSTRACT FROM AUTHOR]

This article discusses the use of acupuncture and bee venom injections as treatments for dogs with spinal cord injuries. The studies reviewed suggest that acupuncture, when combined with medical management, can improve the recovery of dogs with less severe injuries. However, the evidence for bee venom injections is less robust. The studies have some limitations, such as small sample sizes and lack of blinding, but overall suggest that these alternative treatments may be beneficial for certain dogs. It is important to consider individual expertise, patient circumstances, and available resources when applying this evidence in practice. The article also provides information on how individuals can contribute to the evidence base in veterinary medicine through sharing information needs and writing Knowledge Summaries. [Extracted from the article]

A 9‐year‐old, male, neutered, cross‐breed dog was presented for a 6‐month history of spinal pain, mild pelvic limbs proprioceptive ataxia and discrete ambulatory paraparesis. Computed tomography myelography identified focal gas accumulation in the left aspect of the vertebral canal at the level of T11–T12, resulting in moderate extradural spinal cord compression. Minor chronic intervertebral disk protrusion was also identified at this level with no evidence of spinal cord compression. An encapsulated space‐occupying gas accumulation was identified and removed during a left‐sided T11–T12 hemilaminectomy. On histopathological analysis, the capsule was formed by connective and inflammatory tissue. Early neurological deterioration following surgery was observed due to persistent extradural material causing spinal cord compression. Widening of the previous hemilaminectomy window was performed to remove the compressive material, and progressive improvement was noted during the following weeks. This is the first case of computed tomography myelography description of pneumorrhachis in a dog. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to characterize and determine the prevalence of spinal disease in nondomestic felids within a sanctuary population. A review of 304 postmortem examination reports in Panthera species from 2003 to 2021 revealed that 86/304 (28%) were diagnosed with spinal disease. Spinal lesions were categorized according to pathologic process: degenerative (78/86, 91%), developmental (8/86, 9%), inflammatory (6/86, 7%), or neoplastic (8/86, 9%). Degenerative lesions included intervertebral disk disease (IVDD; 66/78, 85%), spondylosis without concurrent IVDD (4/78, 5%), and idiopathic (noncompressive) degenerative myelopathies (8/78, 10%). Fourteen individuals had lesions in more than 1 category. Developmental cases were vertebral (4/8) or spinal cord (3/8) malformations or both (1/8). Inflammatory lesions included meningitis (4/6) and meningomyelitis (2/6). Neoplasia included vertebral multiple myeloma (4/8) and others (4/8). IVDD often involved multiple disks but primarily affected the cervical (41/66, 62%) and thoracic spine (32/66, 48%). A multivariate binary logistic model predicted the diagnosis of IVDD at postmortem examination, where odds of being affected were highest for males, lions (Panthera leo), and geriatric age group (> 14 years). The spinal lesions documented in this study provide insight into high-risk signalment categories and predominant associated lesions affecting captive Panthera populations. Specifically, spinal disease, especially cervical IVDD, is common among Panthera species, and lions, males, and older felids are at increased risk. [ABSTRACT FROM AUTHOR]

Purpose: Verifying lumbar disc pain can present a clinical challenge. Low-pressure provocative discography (PD) has served as the gold standard, although it is invasive and often a challenge to interpret. We reported that magnetic resonance spectroscopy (MRS) biomarkers accurately predict PD results in lumbar discs and improved outcomes for patients with surgery at positive MRS levels versus nonsurgery. To further substantiate MRS for diagnosing painful discs, we report a prospective comparison of 2 MRS-derived measures: NOCISCORE (pain) and SI-SCORE (degeneration severity). Methods: Lumbar MRS and software-based postprocessing (NOCISCAN-LS, Aclarion Inc.) was performed in 44 discs in 14 patients (prospective cohort [PC]). PC data were compared to prior data used to establish the NOCISCORE (training cohort [TC]). The NOCISCORE was converted to an ordinal value (high/intermediate/low; NOCI+/mild/-) and compared against painful (P) versus nonpainful (NP) control diagnosis (PD) for 19 discs where PD was performed in the PC (12 NP; 7 P). Sensitivity, specificity, and positive and negative predictive values were calculated. The SI-SCORE was compared against MRI Pfirrmann Grades for 465 discs in 126 patients (PC plus TC). Results: For the PC, MRS (NOCI+/-) compared to PD (P/NP) with an accuracy of 87%, sensitivity of 100%, and specificity of 80%. The positive predictive value (PPV) in herniated discs, and negative predictive value (NPV) in non-herniated discs, were 100%. NOCISCOREs were significantly higher for PD+ versus PD-discs for PC and TC (P < 0.05), and the NOCISCORE distributions for PD+/- group were not statistically different between the PC and TC (P > 0.05). SI-SCORES differed between Pfirrmann Grades 1 and 2 (less degenerated) versus Grades 3 and 4 (more degenerated; P < 0.05), with a progressively decreasing trend with Pfirrmann Grades 1-5. Conclusion: These current data provide prospective confirmation of the predictive value of disc MRS for distinguishing painful discs and for assessing the disc structural integrity. Clinical Relevance: NOCISCAN is an adoptable, noninvasive, and objectively quantitative test to improve management of low back pain patients. Level of Evidence: 2. Lumbar Spine. [ABSTRACT FROM AUTHOR]

This document provides a summary of several studies investigating the effects of rehabilitation on dogs recovering from intervertebral disc disease (IVDD) surgery. The studies examined the use of basic and intense rehabilitation techniques, including passive range of motion exercises, cold pack application, and various therapies. The findings suggest that basic rehabilitation alone did not significantly impact recovery time or rate. However, the combination of intense and basic rehabilitation was associated with a higher recovery rate. It is important to note that there is limited research specifically on basic rehabilitation techniques for postoperative IVDD patients, and further studies are needed to explore this area. The article discusses the effectiveness of different rehabilitation techniques for dogs recovering from intervertebral disc disease (IVDD) surgery. The study found that none of the papers reviewed reported increased rates of adverse effects. One study showed a lower complication rate in dogs that received a post-hospitalization rehabilitation program. However, there is contradictory evidence on the effectiveness of specific rehabilitation techniques. The article suggests that a multimodal approach to rehabilitation may be important for treating dogs with IVDD. The evidence is weak due to the lack of isolated studies on specific rehabilitation techniques. [Extracted from the article]

Intervertebral disc degeneration is a leading cause of disability in the elderly population. Rigid extracellular matrix is a critical pathological feature of disc degeneration, leading to aberrant nucleus pulposus cells (NPCs) proliferation. However, the underlying mechanism is unclear. Here, we hypothesize that increased matrix stiffness induces proliferation and thus degenerative phenotypes of NPCs through YAP/TEAD1 signaling pathway. We established hydrogel substrates to mimic stiffness of degenerated human nucleus pulposus tissues. RNA-sequencing identified differentially expressed genes between primary rat NPCs cultured on rigid and soft hydrogels. Dual luciferase assay and gain- and loss-function experiments evaluated the correlation between YAP/TEAD1 and Cyclin B1. Furthermore, single-cell RNA-sequencing of human NPCs was performed to identify specific cell clusters with high YAP expression. Matrix stiffness increased in severely degenerated human nucleus pulposus tissues (p < 0.05). Rigid substrate enhanced rat NPCs proliferation mainly through Cyclin B1, which was directly targeted and positively regulated by YAP/TEAD1. Depletion of YAP or Cyclin B1 arrested G2/M phase progression of rat NPCs and reduced fibrotic phenotypes including MMP13 and CTGF (p < 0.05). Fibro NPCs with high YAP expression were identified in human tissues and responsible for fibrogenesis during degeneration. Furthermore, inhibition of YAP/TEAD interaction by verteporfin suppressed cell proliferation and alleviated degeneration in the disc needle puncture model (p < 0.05). Our results demonstrate that elevated matrix stiffness stimulates fibro NPCs proliferation through YAP/TEAD1-Cyclin B1 axis, indicating a therapeutic target for disc degeneration. [ABSTRACT FROM AUTHOR]

Background: Previous studies have explored the biochemical changes of disc degeneration and its relevance in low back pain using various quantitative magnetic resonance imaging (MRI) techniques. However, quantitative evaluation of intervertebral disc (IVD) with MRI such as T1rho, T2, and T2* have not been previously analyzed and compared directly in the same patients. Purpose: To investigate T1rho, T2, and T2* of IVD degeneration in the same patients, reveal the correlation coefficients of these values, and evaluate which values are more sensitive to detect the degree of IVD degeneration. Material and Methods: The participants were 55 patients who underwent MRI examinations which the investigator classified the degree of IVD degeneration according to the Pfirrmann classification. The T1rho, T2, and T2* values of IVD were analyzed for their classification and were compared. Results: T1rho, T2, and T2* values were 74.3 ± 7.1, 61.2 ± 6.7, and 46.5 ± 16.3 ms (grade II); 61.6 ± 11.8, 48.9 ± 8.2, and 34.1 ± 11.8 ms (grade III); 50.8 ± 10.8, 38.9 ± 9.8, and 25.4 ± 8.1 ms, (grade IV); 44.5 ± 13.3, 34.8 ± 9.5, and 11.2 ± 6.6 ms (grade V), respectively. Those values significantly decreased with increasing grades, but T1rho and T2 values for grades IV and V were not different. Conclusion: The T1rho and T2 values were excellent for the evaluation of initial to moderate IVD degeneration with water and proteoglycan content. In contrast, the T2* value was suitable for detailed evaluation of progressive IVD, even with poor water content. [ABSTRACT FROM AUTHOR]

Introduction: Low back pain is one of the most common causes of short-term, and sometimes long-term, disability in the population younger than 45 years old. Approximately 60% to 80% of the population in developed countries experience back pain in various locations (neck, mid and lower back) at least once in their lifetime. Guidelines regarding back pain treatment are undergoing constant modifications and improvements. The relevance of dorsalgia as a significant medical problem and its management is shown by the increased number of recently published papers, which has tripled in the past several years (from 22% to 65%). Aim: To analyze the most critical risk factors of the degenerative intervertebral disk disease, and to review the effectiveness of invasive and noninvasive methods of treatment of the lower back pain syndrome. Material and methods: Recently published papers focusing on invasive and noninvasive treatments of low back pain syndrome. Results and discussion: Surgical intervention as a single method of back pain treatment is indicated in a small number of cases. The risk of repeated surgeries for intravertebral disk herniation should be considered before any surgical intervention. A wide variety of treatment options allows to choose the most effective approach based on individual needs. Conclusions: Conservative, noninvasive approach has shown to be an effective alternative for lower back pain and radiculopathy treatment. It has been determined that ozone therapy is an appropriate, relevant, and affordable treatment method for patients with vertebral degenerative changes and intravertebral disk diseases. [ABSTRACT FROM AUTHOR]

An 8-y-old Labrador Retriever dog had mild ataxia of the hindlimbs 4 mo after lumbosacral dorsal laminectomy for intervertebral disk disease. Ataxia of the hindlimbs gradually worsened over the next 6 y. On autopsy, gross lesions were not recognized in the spinal cord. Histopathology revealed an intradural extraparenchymal cholesterol granuloma in the cauda equina associated with remnant nerve roots. Nerves associated with the cholesterol granuloma had axonal degeneration, myelin vacuolation, and edema. In those foci, macrophages were increased in number between nerve fibers. Immunohistochemistry for neurofilament protein and Luxol fast blue staining highlighted the presence of remnant axons and myelin sheaths within the granuloma. Inflammatory cell infiltrates in the granuloma were mainly macrophages and CD3- or CD20-immunopositive T or B lymphocytes, respectively. We conclude that the cholesterol granuloma likely formed subsequent to degenerative neuropathy in the cauda equina. [ABSTRACT FROM AUTHOR]

Roman Macedonia has been largely neglected by bioarcheological research. As a result, little is known about the imprint of living conditions of that time on the skeletons of its inhabitants, especially those of the lower classes. This paper presents the paleopathological study conducted on a Roman period (1st–4th c. CE) skeletal assemblage from Pontokomi‐Vrysi, a site in the semi‐mountainous region of Eordaea in Upper Macedonia (now in Kozani Prefecture, Greece). The aim is to investigate differences in the frequency of multiple paleopathological conditions in the buried population and to assess whether these are linked to sex‐ or age‐related differences. The study examines cribra orbitalia (CO), porotic hyperostosis (PH), enamel hypoplasia (EH), osteoarthritis (OA), vertebral osteoarthritis (VOA), intervertebral disk disease (IDD), Schmorl's nodes (SNs), trauma (Tr), and lower limb periostitis/periostosis (PO). The results show higher frequencies of OA, IDD, PO, and Tr among males compared with those among females. These results suggest increased male physical hardship, pointing to a possible gender division of labor with the men of the community being mostly responsible for the physically demanding agricultural and animal husbandry activities. Additionally, comparisons of the CO, PH, and EH patterns in adults and nonadults support that, in general, the Pontokomi‐Vrysi community was resilient enough to overcome stress. Overall, these findings make an important contribution to both the bioarcheology and social history of Roman Macedonia and stress the need for more studies that combine historical, archeological (cultural), and bioarcheological data. [ABSTRACT FROM AUTHOR]

The article discusses the North Carolina State University College of Veterinary Medicine's establishment of the Center for Healthy Ageing. Topics discussed include the missions of the center, the career highlights of the Dr. Kady M. Gjessing and Rahan M. Davidson Distinguished Chair in Gerontology Natasha Olby who will lead the center, and the center's plan to create fellowships in geroscience and establish a hospice service for pets.

Introduction: Magnetic resonance imaging (MRI) is the most appropriate imaging method to investigate low back pain. As low back pain is very common, a large number of MRI scans are performed. Objective: To evaluate the extraspinal findings and clinical effect of the T1-weighted spin echo (T1W SE) coronal sequence added to the lumbar MRI protocol for low back pain. Materials and methods: In 2015, we added a T1-weighted (T1W) coronal sequence to our routine lumbar MRI protocol. We retrospectively evaluated 969 lumbar MRI images for low back pain performed with this protocol. The extraspinal MRI findings obtained from them were then grouped as associated with low back pain (Category 1) and not associated with low back pain (Category 2). We also evaluated whether the recorded incidental extraspinal findings could be detected on conventional sagittal and axial images. Results: Ninety-six (63%) of the extraspinal findings were associated with low back pain (Category 1) and 56 (37%), Category 2. Seventy-eight percent of the extraspinal findings were detected only on coronal-T1W images and not on conventional images. Conclusion: Adding coronal-T1W sequence to the routine protocol of lumbar MRI can help to identify extraspinal findings and guide clinical treatment. [ABSTRACT FROM AUTHOR]

Diagnostic imaging of the equine cervical spine - Are radiographs enough? Keywords: horse; radiology; computed tomography; cervical spine EN horse radiology computed tomography cervical spine 23 25 3 12/14/22 20230101 NES 230101 Horses with abnormalities of the cervical spine can present with a wide variety of clinical signs such as ataxia, gait abnormalities, dysmetria, weakness, paresis, localised sweating, pain, bony or muscular asymmetry (Hoffman & Clark, [17]; Journée et al., [19]; Levine et al., [22]). Cross-sectional imaging, such as computed tomography (CT) can overcome the limitations of radiographs and due to the increased gantry dimensions of modern CT machines, these have become more and more common in horses (Gough et al., [13]; Lindgren et al., [23]). However, MRI examinations in these studies were only possible after disarticulating the spine and studies as well as facilities to image the caudal cervical spine in live horses are still lacking. [Extracted from the article]

Purposes: This study aimed to investigate the histopathological changes that occur within 2 weeks following spinal cord injury (SCI) in dogs. Methods: Eight adult female Beagle dogs were included in this study, and SCI was induced using an epidural balloon catheter. Two dogs were killed at each of the following four time points: immediately after the procedure and 1 day, 1 week, and 2 weeks after the procedure. Neurological status was evaluated with five categories. Histopathological changes were visually observed for stained sections of formalin-fixed spinal cord to evaluate hemorrhage, spongiosis, necrosis, and gliosis morphologically. Results: Along the 2 weeks post-injury, severe hemorrhage was observed at the primary injury site, the average diameter of which expanded quickly from 8 to 10 mm in 1 day and then decreased to 5 mm in 1 week. This indicates that the bleeding cavity expanded at the initial injury site to produce ascending and descending hemorrhage. The hemorrhage at the injury site resolved in 2 weeks. In contrast, spongiosis, parenchymal necrosis, and gliosis were first inconspicuous or mild and then became severe in 1 week or 2 weeks. Hemorrhage, hematoma, and other similar changes occurred at the regions approximately 20-mm rostral and caudal to the primary injury site. These changes were observed in both gray matter and white matter. Conclusions: This study is the first to assess the sequential histopathological changes in the acute and intermediate phases following SCI in dogs. Our findings enhance the usefulness of the canine intervertebral disk disease model in the assessment of secondary spinal cord histopathology in human SCI. [ABSTRACT FROM AUTHOR]

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Back pain is a common condition with a high social impact and represents a global health burden. Intervertebral disc disease (IVDD) is one of the major causes of back pain; no therapeutics are currently available to reverse this disease. The impact of bone mineral density (BMD) on IVDD has been controversial, with some studies suggesting osteoporosis as causative for IVDD and others suggesting it as protective for IVDD. Functional studies to evaluate the influence of genetic components of BMD in IVDD could highlight opportunities for drug development and repurposing. By taking a holistic 3D approach, we established an aging zebrafish model for spontaneous IVDD. Increased BMD in aging, detected by automated computational analysis, is caused by bone deformities at the endplates. However, aged zebrafish spines showed changes in bone morphology, microstructure, mineral heterogeneity, and increased fragility that resembled osteoporosis. Elements of the discs recapitulated IVDD symptoms found in humans: the intervertebral ligament (equivalent to the annulus fibrosus) showed disorganized collagen fibers and herniation, while the disc center (nucleus pulposus equivalent) showed dehydration and cellular abnormalities. We manipulated BMD in young zebrafish by mutating sp7 and cathepsin K, leading to low and high BMD, respectively. Remarkably, we detected IVDD in both groups, demonstrating that low BMD does not protect against IVDD, and we found a strong correlation between high BMD and IVDD. Deep learning was applied to high-resolution synchrotron µCT image data to analyze osteocyte 3D lacunar distribution and morphology, revealing a role of sp7 in controlling the osteocyte lacunar 3D profile. Our findings suggest potential avenues through which bone quality can be targeted to identify beneficial therapeutics for IVDD. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare the incidence of MRI lesions between dogs weighing < 15 kg 33 lb) and dogs weighing 2 15 kg. ANIMALS 494 dogs with clinical signs of thoracolumbar disease. PROCEDURES Electronic medical records of affected dogs that underwent MRI of the thoracolumbar vertebral column between January 2016 and July 2018 were reviewed. Data extracted included age, body weight, breed, sex, MRI findings, and lesion location. Data were compared between dogs weighing < 15 kg and dogs weighing 2 15 kg. RESULTS Of dogs weighing < 15 kg, 94.4% (371/393) were chondrodystrophic breeds. Only 24.8% (25/101) of dogs weighing 2 15 kg were chondrodystrophic breeds. Lesions consistent with intervertebral disk disease (IVDD) had an overall incidence of 8Z2% (431/494). In dogs weighing < 15 kg, the incidence of IVDD was 94.7% (372/393), compared with 58.4% (59/101) in dogs weighing Z 15 kg. Dogs weighing < 15 kg had a significantly higher incidence of IVDD lesions in the T12-13 segment, compared with dogs weighing 2 15 kg. Dogs weighing 2 15 kg were 11.9 times (95% Cl. 5.1 t02Z9) and Z4 times (95% Cl, 2.3 to 23) as likely to have a neoplastic lesion and fibrocartilaginous embolic myelopathy, respectively, compared with dogs weighing <15 kg. CONCLUSIONS AND CLINICAL RELEVANCE IVDD was the mostcommon MRI finding in the study population. Dogs weighing 2 15 kg had a higher incidence of nonintervertebral disk lesions, compared with dogs weighing < 15 kg. [ABSTRACT FROM AUTHOR]

The term 'vacuum phenomenon' (VP), is characterized by gas-like density areas due to a rapid increase in the joint space volume ('acute VP') or represent a chronic gas collection. It can occur within a collapsed vertebral body, the spinal canal, joints but mainly the intervertebral disc. Studies support that VP is originated by a dynamic process involving the balance between tissues' liquid and gaseous components, influenced by the duration and the depth of mechanical and metabolic alterations, by the nature of neighboring tissues and the variability in both pressure and permeability of disc or vertebral or joint structures. Prevalence of VP in the general population is about 2%, reaching 20% in the elderly with disc degeneration. Although it's often a random finding in asymptomatic patients, VP is an eventually painful expression of disc degeneration, or disc or vertebral fracture, or bone lesions. In sporadic cases, intradiscal gas can be expelled (all-in-one or gradually), resulting in a gaseous cyst, causing pain and neurological symptoms. Considering that spontaneous resolution and recurrence after surgery are both possible, most of the authors recommend conservative treatment in patients with intradiscal and intravertebral VP; occasionally percutaneous CT(computed tomography) -guided aspiration or vertebral stabilization. [ABSTRACT FROM AUTHOR]

The anaerobic bacterium Cutibacterium acnes has been increasingly linked to the development of degenerative disc disease (DDD), although causality is yet to be conclusively proven. To better study how this organism could contribute to the aetiology of DDD, improved animal models that are more reflective of human disc anatomy, biology and mechanical properties are required. Against this background, our proof-of concept study aimed to be the first demonstration that C. acnes could be safely administered percutaneously into sheep intervertebral discs (IVDs) for in vivo study. Following our protocol, two sheep were successfully injected with a strain of C. acnes (8.3 x 106 CFU/disc) previously recovered from a human degenerative disc. No adverse reactions were noted, and at one-month post inoculation all triplicate infected discs in our first animal grew C. acnes, albeit at a reduced load (5.12 × 104 to 6.67 × 104 CFU/disc). At six months, no growth was detected in discs from our second animal indicating bacterial clearance. This pilot study has demonstrated the feasibility of safe percutaneous injection of C. acnes into sheep IVDs under fluoroscopic guidance. The design of follow-up sheep studies to investigate the potential of C. acnes to drive pathological changes within infected discs should now be pursued. [ABSTRACT FROM AUTHOR]

Bell's palsy is the most common cause of unilateral facial paralysis and is defined as an idiopathic and acute inability to control movements of the facial muscles on the affected side. While the pathogenesis remains unknown, previous studies have implicated post-viral inflammation and resulting compression of the facial nerve. Reported heritability estimates of 4–14% suggest a genetic component in the etiology and an autosomal dominant inheritance has been proposed. Here, we report findings from a meta-analysis of genome-wide association studies uncovering the first unequivocal association with Bell's palsy (rs9357446-A; P = 6.79 × 10−23, OR = 1.23; Ncases = 4714, Ncontrols = 1,011,520). The variant also confers risk of intervertebral disc disorders (P = 2.99 × 10−11, OR = 1.04) suggesting a common pathogenesis in part or a true pleiotropy. [ABSTRACT FROM AUTHOR]

Background and Aim: Lumbosacral intervertebral disk disease (IVDD) in cats usually develops concurrent with constipation, spondylosis deformans, and sacralization. However, the prevalence of lumbar IVDD in cats was considered low, and there was less information on the incidence of non-traumatic lumbosacral vertebral abnormalities that may affect large bowel dysfunction. This study aimed to retrospectively investigate the relationship between non-traumatic lumbosacral vertebral abnormalities, both congenital and acquired, and large bowel dysfunction in cats. Materials and Methods: Of 3108 cats that were presented to the Diagnostic Imaging Unit, the Small Animal Teaching Hospital, Faculty of Veterinary Science, Chulalongkorn University, between March 2016 and February 2018, 1365 cats met the inclusion criteria. All abdominal radiographs were reviewed, and all subsequent data were recorded, including the presence of congenital or acquired lumbosacral lesions, number of lumbar vertebrae, and length of the second, fifth, and last lumbar vertebrae, including the type of lumbar abnormalities. Moreover, radiographic information relating to constipation and megacolon was also collected. Results: Non-traumatic lumbosacral vertebral abnormalities were observed in 29.74% of cats. The most common congenital lumbosacral vertebral abnormalities were six lumbar vertebrae, sacralization, and lumbarization, whereas most common acquired lumbosacral abnormalities were bone spur, narrowing disk space, spondylosis deformans, and lumbosacral degeneration, respectively. Cats with abnormal lumbosacral vertebrae are prone to have more problems with the large bowel (p=0.0057; odds ratio=1.731). Moreover, congenital and acquired lumbosacral abnormalities were also at risk of large bowel abnormalities (p=0.0069; odds ratio=1.920 and p<0.0001; odds ratio=4.107, respectively). Conclusion: This study revealed the evidence and distribution of the variation in feline lumbar anatomy and also elucidated that cats with abnormal lumbar vertebral columns were more likely to have problems with distal gastrointestinal tracts than those without. [ABSTRACT FROM AUTHOR]

Traditional Chinese veterinary medicine (TCVM) including acupuncture, Chinese herbal medicine, food therapy and Tui-na is focused on providing a unique group of strategies for therapy of neurological disorders. Recent studies have looked at improved treatment of neurological disease by optimizing strategies using traditional Chinese veterinary medicine versus the sole use of conventional treatments. In this case series, successful management of brain and spinal cord disease with acupuncture as the sole treatment or acupuncture and Chinese herbal medicine combined is documented in 3 dogs. [ABSTRACT FROM AUTHOR]

Hypercortisolism is a common endocrinopathy in dogs; however, in a few cases, bilateral functional adrenocortical adenomas cause spontaneous disease, and thrombotic events are considered uncommon complications. The aim of this report was to describe a case of bilateral adrenocortical adenoma in a dog with hyperadrenocorticism associated with distal aortic and iliac thrombosis, with emphasis on clinical and pathological aspects. A 15-year-old spayed female Dachshund with a previous clinical history of hyperadrenocorticism presented with acute bilateral hindlimb paraparesis. A vertebral thoracolumbar radiography was performed and did not present any evidence of intervertebral disk disease or vertebral abnormalities; however, abdominal ultrasound and vascular Doppler evaluation revealed bilateral adrenal enlargement in addition to an aortic and external iliac artery thrombus. The animal was euthanized. At necropsy, both adrenal glands were enlarged by well-demarcated neoplastic nodules in the parenchyma, and a thrombus caudal to the abdominal aorta bifurcation within the external iliac arteries that extended to the left external iliac artery was noted. Histological evaluation revealed a well-differentiated neoplastic proliferation of cortical epithelial cells, consistent with bilateral adenoma, and muscular necrosis in the pelvic limbs was also observed. Bilateral functional adrenocortical adenoma; although, very rare, should be considered as a cause of hypercortisolism, and aortic thrombosis in dogs should be considered as a possible consequence. [ABSTRACT FROM AUTHOR]

Background: Chronic low back pain (CLBP) due to the degenerative intervertebral disk diseases is one of the most common musculoskeletal conditions in contemporary societies. A variety of pharmacological, nonpharmacological and surgical options is available for treatment of CLBP. The use of non-pharmacological methods have drastically increased in recent years, offering fewer complications and expenses. This study was conducted to compare the efficacy of the neuromuscular electrical stimulation (NMES) and electro acupuncture (EAP) with exercise therapy alone in patients with chronic low back pain. Materials and Methods: This was a randomized case-controlled clinical trial. Sixty patients with CLBP were randomly assigned to 3 groups (20 cases each) of the EAP with exercise therapy, NMES with exercise therapy, and exercise therapy only. Severity of pain and disability improvement were assessed using the visual analog scale (VAS) and Quebec back pain disability scale respectively. Results: A total of 66 individuals were enrolled, out of which 6 were excluded due to patients' lack of cooperation. A significant decline in the amounts of Quebec and VAS was observed in the three groups (p<0.001). The pain and disability improvements did not display any significant difference in the NMES or EAP groups compared to the control group. However, the severity of disability and pain in the NMES group were significantly higher than the EAP group (p<0.05). Conclusion: These findings may indicate an almost identical efficacy of exercise therapy alone compared to the combination with electrical stimulation techniques in improving the pain and disability in patients suffering CLBP. [ABSTRACT FROM AUTHOR]

Aim: We aimed to determine C-reactive protein (CRP) levels in patients with intervertebral disc disease (IDD) and to evaluate these patients’ radiological and clinical characteristics. Material and Methods: A total of 102 patients were divided into four groups according to lumbar MRI results using the Macnab classification: bulging, protrusion, extrusion-sequestration, and normal. Straight leg raising test (SLR) and visual analogue scale (VAS) were used for clinical evaluation. Patients with bulging and protrusion were treated with conservative therapy within 5-10 days and bed-rest. Blood samples, SLR values and VAS scores were obtained from these patients before and after conservative therapy. The extrusion-sequestration group underwent lumbar spinal surgery. Medical treatment was not applied to this group and blood samples were collected only preoperatively. Individuals with normal MRI findings and no spinal complaints were evaluated as controls. Results: CRP levels were found to be 6.61 ± 7.78 in controls, 6.62 ± 5.28 in the bulging group, 11.50 ± 21.71 in the protrusion group and 17.18 ± 48.22 in the extruded-sequestration group (p=0.321). CRP levels were significantly decreased after treatment in the bulging group (p=0.001). Positive correlations were found between post-treatment VAS scores and pre-treatment WBC in the protrusion group, and with CRP levels in the bulging group. Conclusion: Although no statistically significant difference was determined, we observed higher mean serum CRP levels in the surgical group (extrusion-sequestration). We believe that further studies must be performed to determine whether serum CRP levels can be used as a prognostic marker in surgical decision making. [ABSTRACT FROM AUTHOR]

Background Context: Nonphysiological mechanical loading and inflammation are both critically involved in intervertebral disc (IVD) degeneration, which is characterized by an increase in cytokines and matrix metalloproteases (MMPs) in the nucleus pulposus (NP). This process is known to be mediated by the NF-κB pathway.Clinical Significance: Current clinical treatments for IVD degeneration focus on the alleviation of symptoms rather than targeting the underlying mechanism. Injection of an NF-κB inhibitor may attenuate the progression of IVD degeneration.Purpose: To investigate the ability of the NF-κB inhibitor, NEMO binding domain peptide (NBD), to alter IVD degeneration processes by reducing IL-1β- and mechanically-induced cytokine and MMP levels in human nucleus pulposus cells in vitro, and by attenuating IVD degeneration in an in vivo rat model for disc degeneration.Study Design: Experimental in vitro and animal model.Patient Sample: Discarded specimens of lumbar disc from 21 patients, and 12 Sprague Dawley rats.Outcome Measures: Gene and protein expression, cell viability, µMRI and histology.Methods: IL-1β-prestimulated human nucleus pulposus cells embedded into fibrin constructs were loaded in the Flexcell FX-5000 compression system at 5 kPa and 1 Hz for 48 hours in the presence and absence of NBD. Unloaded hNPC/fibrin constructs served as controls. Cell viability in loaded and unloaded constructs was quantified, and gene and protein expression levels determined. For in vivo testing, a rat needle disc puncture model was employed. Experimental groups included injured discs with and without NBD injection and uninjured controls. Levels of disc degeneration were determined via µMRI, qPCR and histology. Funding sources include $48,874 NASS Young Investigator Research Grant and $119,174 NIH 5K01AR071512-02. There were no applicable financial relationships or conflicts of interest.Results: Mechanical compression of hNPC/fibrin constructs resulted in upregulation of MMP-3 and IL-8. Supplementation of media with 10 μM NBD during loading increased cell viability, and decreased MMP-3 gene and protein levels. IVD injury in rat resulted in an increase in MMP-3, IL-1β and IL-6 gene expression. Injections of 250 µg of NBD during disc injury resulted in decreased IL-6 gene expression. µMRI analysis demonstrated a reduction of disc hydration in response to disc needle injury, which was attenuated in NBD-treated IVDs. Histological evaluation showed NP and AF lesion in injured discs, which was attenuated by NBD injection.Conclusions: The results of this study show NBD peptide's capacity to reduce IL-1β- and loading-induced MMP-3 levels in hNPC/fibrin constructs while increasing the cells' viability, and to attenuate IVD degeneration in rat, involving downregulation of IL-6. Therefore, NBD may be a potential therapeutic agent to treat IVD degeneration. [ABSTRACT FROM AUTHOR]

Cervical radicular pain is often due to a combination of factors including intervertebral disc prolapse or herniation, narrowing of the intervertebral foramen, osteoarthritis of facet joints, and spondylolisthesis. Cervical Epidural with local anesthetics along with steroids is used for evaluation and management of radicular pain in patients with pathology that exists at multiple vertebral levels. Medial branch block is given for facet joint arthropathy both for diagnostic and therapeutic purposes. Therefore, the aim of performing this procedure was to provide an interlaminar epidural steroid injection at C7-T1 vertebral level along with a diagnostic right medial branch block under fluoroscopic guidance to 86 years old hypertensive female, with complaints of pain in the neck lower portion, upper part of back and shoulder on the right side, radiating down the arm up to medial two fingers and thumb for 2 years. An interlaminar epidural steroid injection was planned on the right side at the C7-T1 vertebral level under C-arm guidance. A diagnostic right medial branch block was also planned to be given on the same day at 2 levels C5/C6 and C6/C7 facet joint each using 2 mg dexamethasone (0.5 ml) and 1.5 ml of 1% lignocaine. A repeat epidural injection was given using a combination of 1 ml of steroid dexamethasone (4 mg) and 3 ml of 1% lignocaine along with facet medial branch block injection at the same levels using 0.5% bupivacaine 1.5 ml and 2 mg dexamethasone (0.5 ml) on her follow-up visit after 6 weeks. Following the block patient on her first visit, she had considerable pain relief with a visual analog scale (VAS) of 3. She was prescribed gabapentin, methyl-cobalamine and clonazepam. After 6 weeks, the patient had VAS score of 6. She looked comfortable and her paresthesia had grossly improved. At the end of the procedure, patient had good pain relief with no deficit. She was advised to continue gabapentin. On her third follow-up after 3 months, the patient presented with >70% relief in her initial pain with a VAS of <3 and minimal paresthesia along the distribution of the ulnar nerve and hence required no intervention. Cervical epidural steroid injections under fluoroscopy guidance are being used for the conservative management of neck pain or cervical radiculopathy. Facet joint injections and medial branch blocks aim to diagnose and treat the pain arising from facet joints in the spine. It is also important to prescribe drugs to manage the neuropathic component of the pain. [ABSTRACT FROM AUTHOR]

Purpose: To develop an automated pipeline based on convolutional neural networks to segment lumbar intervertebral discs and characterize their biochemical composition using voxel‐based relaxometry, and establish local associations with clinical measures of disability, muscle changes, and other symptoms of lower back pain. Methods: This work proposes a new methodology using MRI (n = 31, across the spectrum of disc degeneration) that combines deep learning–based segmentation, atlas‐based registration, and statistical parametric mapping for voxel‐based analysis of T1ρ and T2 relaxation time maps to characterize disc degeneration and its associated disability. Results: Across degenerative grades, the segmentation algorithm produced accurate, high‐confidence segmentations of the lumbar discs in two independent data sets. Manually and automatically extracted mean disc T1ρ and T2 relaxation times were in high agreement for all discs with minimal bias. On a voxel‐by‐voxel basis, imaging‐based degenerative grades were strongly negatively correlated with T1ρ and T2, particularly in the nucleus. Stratifying patients by disability grades revealed significant differences in the relaxation maps between minimal/moderate versus severe disability: The average T1ρ relaxation maps from the minimal/moderate disability group showed clear annulus nucleus distinction with a visible midline, whereas the severe disability group had lower average T1ρ values with a homogeneous distribution. Conclusion: This work presented a scalable pipeline for fast, automated assessment of disc relaxation times, and voxel‐based relaxometry that overcomes limitations of current region of interest–based analysis methods and may enable greater insights and associations between disc degeneration, disability, and lower back pain. [ABSTRACT FROM AUTHOR]

Lumbar disc degeneration is defined as the wear and tear of lumbar intervertebral disc, and it is mainly occurring at L3-L4 and L4-S1 vertebrae. Lumbar disc degeneration may lead to disc bulging, osteophytes, loss of disc space, and compression and irritation of the adjacent nerve root. Clinical presentations associated with lumbar disc degeneration and lumbosacral nerve lesion are discogenic pain, radical pain, muscular weakness, and cutaneous. Discogenic pain is usually felt in the lumbar region, or sometimes, it may feel in the buttocks, down to the upper thighs, and it is typically presented with sudden forced flexion and/or rotational moment. Radical pain, muscular weakness, and sensory defects associated with lumbosacral nerve lesions are distributed on lower extremities, the buttock, lower abdomen, and groin region. A lumbosacral plexus lesion presents different symptoms in the territories of the lumbar and sacral nerves. Patients with lumbar plexus lesion clinically present with weakness of hip flexion, knee extension, thigh adduction, and sensory loss in the lower abdomen, inguinal region, and over the entire medial, lateral, and anterior surfaces of the thigh and the medial lower leg, while sacral plexus lesion presents clinical symptoms at nerve fibers destined for the sciatic nerve, common peroneal nerve, and pudendal nerve. Weakness of ankle inversion, plantar flexion, and foot drop are the main clinical manifestations of the sacral plexus lesion area. Numbness and decreased sensation are also present along the anterolateral calf and dorsum of the foot. On examination, foot eversion is usually stronger than foot dorsiflexion. The patients may also present with pain and difficulty of bowel movements, sexual dysfunction assessments, and loss of cutaneous sensation in the areas of the anal canal, anus, labia major, labia minor, clitoris, penis, and scrotum. [ABSTRACT FROM AUTHOR]

Objective: The T2 value of lumbar cartilage endplates was measured using the T2 mapping imaging technique, aiming to explore the correlation between the T2 value and Pfirrmann grading of intervertebral discs. Methods: A total of 130 patients with lumbar spine MR examination due to persistent low back pain were enrolled, including 71 men and 59 women (age: 21–63 years). Lumbar Modic changes and Schmorl nodules were recognized by conventional T1WI and T2WI images in 49 patients, and these patients were excluded from the study. A total of 81 patients were enrolled in this study, including 45 men (45.16 ± 12.20 years) and 36 women (43.33 ± 11.27 years). Pfirrmann (Pm) grading of each lumbar disc was performed based on conventional T2WI median sagittal images and the position of cartilage endplates (CEP) was determined by IDEAL‐SPGR images. Meanwhile, the T2 mapping technique was used to obtain T2 values of cartilage endplates. The T2 values of CEP corresponding to different Pm grade discs were compared, and the correlation between the T2 value and the Pm grade of intervertebral discs was analyzed. Results: The T2 values of cephalic and caudal CEP of L1–2 in Pm grades I–II, Pm grades III, and Pm grades IV–V were 61.96 ± 5.89 ms, 54.45 ± 3.29 ms, 42.47 ± 3.69 ms and 64.35 ± 5.93 ms, 55.28 ± 3.97 ms, 44.75 ± 2.12 ms, respectively. For cephalic and caudal CEP of L2–3, the T2 values in Pm grades I–II, Pm grades III, and Pm grades IV–V were 62.96 ± 6.93 ms, 55.19 ± 4.02 ms, 48.67 ± 4.56 ms and 65.51 ± 6.49 ms, 57.16 ± 5.55 ms, 52.05 ± 4.20 ms, respectively. The T2 values of cephalic and caudal CEP from L3–4 to L5–S1 in Pm grades I–II, Pm grades III, and Pm grades IV–V were (63.72 ± 5.76 ms, 53.96 ± 6.52 ms, 48.05 ± 5.00 ms), (65.46 ± 6.37 ms, 55.70 ± 7.50 ms, 48.10 ± 3.27 ms); (66.34 ± 7.68 ms, 56.76 ± 9.48 ms, 47.80 ± 4.33 ms), (64.44 ± 4.65 ms, 59.30 ± 8.80 ms, 47.30 ± 5.78 ms), (65.32 ± 5.11 ms, 55.33 ± 6.65 ms, 48.18 ± 5.37 ms), and (63.47 ± 4.92 ms, 50.32 ± 8.86 ms, 44.77 ± 4.69 ms), respectively. There were significant differences in T2 values of cartilage endplates between the Pm grades I–II, III, and IV–V of intervertebral discs (P = 0.000). T2 values corresponding to Pm I–II grades were higher than those in Pm III grade, while T2 values in Pm grades IV–V were lowest. The T2 value of the L4–5, L5–S1 segment endplates was highly correlated with the Pm grades (r = −0.711, −0.721, −0.796, −0.745; P = 0.000) and that of L1–2, L2–3 endplates were moderately correlated (r = −0.542, −0.562, −0.637, −0.612; P = 0.000). Conclusion: The T2 values of cartilage endplates revealed varying degrees of degeneration of intervertebral discs, and more severe degeneration corresponded to lower T2 values. Measurement of changes in the T2 value through cartilage endplates can be useful for the diagnosis of early intervertebral disc degeneration and the prevention of disc degeneration. [ABSTRACT FROM AUTHOR]

Intervertebral disc (IVD) degeneration with chronic low back pain is associated with neo-vascularisation into the deeper IVD regions. During this process, endothelial cells (ECs), which are primarily responsible for angiogenesis, interact with the adjacent annulus fibrosus (AF) cells, which are the first line of defence against the invasion of vascular structures into deeper IVD regions. However, the accumulation of inflammatory and catabolic enzymes that results from this interaction promotes matrix degradation and an inflammatory response. Thus, regulating the production of these mediators and catabolic enzymes could ameliorate IVD degeneration. Photobiomodulation (PBM) therapy is a non-invasive stimulation known to have biologically beneficial effects on wound healing, tissue repair, and inflammation. Here, we examined the effects of PBM, administered at various wavelengths (645, 525, and 465 nm) and doses (16, 32, and 64 J/cm2), on EC-stimulated human AF cells. Our results show that PBM selectively inhibited the EC-mediated production of inflammatory mediators, catabolic enzymes, and neurotrophins by human AF cells in a dose- and wavelength-dependent manner. These results suggest that PBM could be a superior and advanced treatment strategy for IVD degeneration. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is a leading cause of global disability. Multiple anatomical, cellular, and molecular factors are implicated in LBP, including the degeneration of lumbar intervertebral discs (IVDs). We previously described a mouse model that displays behavioral symptoms of chronic LBP. Here, we investigated the development of pathological innervation and macrophage infiltration into injured IVDs following a puncture injury in mice over 12 months. 2‐month old CD1 female mice underwent a single puncture of the ventral L4/5 IVD using a 30G needle, and were sacrificed 4 days and 0.5‐, 3‐, 6‐ and 12‐months post‐injury. Severity of disc degeneration was assessed using colorimetric staining. IVD innervation was measured by PGP9.5‐immunoreactivity (‐ir) and calcitonin gene‐related peptide‐ir (CGRP‐ir). Macrophage accumulation into IVDs was detected by F4/80‐ir. Mechanical IVD injury resulted in severe degeneration and increased PGP9.5‐ir nerve fiber density starting at 4 days that persisted for up to 12 months and dorsal herniations began to occur at 3 months. CGRP‐ir was also upregulated in injured IVDs, with the largest increase at 12 months after injury. Infiltration of F4/80‐ir macrophages was observed in injured IVDs by day 4 both dorsally and ventrally, with the latter diminishing in the later stage. Persistent LBP is a complex disease with multiple underlying pathologies. By highlighting pathological changes in IVD innervation and inflammation, our study suggests that strategies targeting these mechanisms might be useful therapeutically. [ABSTRACT FROM AUTHOR]

Introduction: Chronic low back pain (LBP) caused by intervertebral disc herniation was reported in the 2010 Global Burden of Disease study to be the main reason for years lived with disability. It causes significant personal, social, and economic burdens. Many of those who suffer from LBP find conventional medical treatments to be unsatisfactory for treating their pain, so they are increasingly resorting to complementary and alternative medicine (CAM) therapies. Given that the population is aging, there is an urgent need to characterize the combinations of complementary therapies that yield the best outcomes and treatments, even for prolonged periods. This observational study aimed to evaluate the effect of ultramicronized palmitoylethanolamide (umPEA) + CAM (daily functional rehabilitation + decontracting massage) therapies on chronic pain in patients suffering from multiple herniated discs in the lumbar spine. Methods: Eligible patients received 600 mg of umPEA twice a day in combination with a daily functional rehabilitation session according to the McKenzie Method of Mechanical Diagnosis and Therapy plus a decontracting massage for 20 consecutive days, followed by 600 mg of umPEA once a day for 40 days in addition to standard therapy. Results: The results showed that the average pain intensity score, evaluated via the Numeric Rating Scale, progressively decreased during the study period, reaching a value that was not clinically relevant at the end of the observation period. Pain relief was paralleled by improvements in the physical and mental components of quality of life as evaluated with the SF-36 questionnaire as well as in disability for low back pain as evaluated with the Oswestry Disability Questionnaire. Collectively, the results demonstrate that umPEA in combination with CAM therapies could be an important strategy for combating LBP. Conclusions: The multiple action of PEA in combination with CAM therapies may represent the multitarget approach needed to tackle the as-yet unsolved problem of chronic pain resistant to conventional therapies. [ABSTRACT FROM AUTHOR]

Background: The pathogenesis of intervertebral disc (IVD) degeneration is complex and involves the interaction of multiple factors. However, few systemic studies have explored the associations of metabolic disorders and age-related musculoskeletal disorders with the development of IVD degeneration.Methods: We analyzed clinical data obtained from healthy individuals who had undergone a musculoskeletal checkup. In total, 276 subjects comprising 142 males and 134 females were enrolled. The subjects were divided into two groups based on the degree of IVD degeneration according to Pfirrmann grading: those with grades 1-3, the group with non-degenerative discs; and grades 4 and 5, the group with degenerative discs. The subjects underwent examinations including abdominal circumference, blood pressure, bilateral hand grip strength, abdominal computed tomography, magnetic resonance imaging of the lumbar spine, and dual X-ray absorptiometry. To examine the independent association with IVD degeneration at L3/4, L4/5, and L5/S levels, we constructed a Poisson regression model and estimated relative risks (RRs) and 95% confidence intervals (CIs) of IVD degeneration.Results: Multivariable analysis showed that advanced age was markedly associated with IVD degeneration at all levels and that men had an inverse association with the IVD degeneration, particularly at the L4/5 level (RR = 0.7, 95% CI = 0.6-0.9). In addition, metabolic syndrome was significantly associated with IVD degeneration at the L5/S level (RR = 1.4, 95% CI = 1.1-1.8). Meanwhile, sarcopenia showed no significant association with IVD degeneration at any level. Osteoporosis was inversely associated with IVD degeneration, particularly at the L4/5 level (RR = 0.7, 95% CI = 0.6-0.9).Conclusions: Our data suggest that advanced age, female sex, and metabolic syndrome are associated with IVD degeneration. In addition, osteoporosis showed an inverse association with IVD degeneration. Our data should promote understanding of the etiology of lumbar IVD degeneration. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is a major health issue resulting in a huge economic burden on the community. It not only increases the medical costs directly, but also raises the disability and loss of productivity in the general population. Symptoms include local pain over the spinal area, pain radiating to the lower leg, stiffness, and muscle tension. LBP is strongly linked with intervertebral disc degeneration that is further associated with the disruption of the complex anatomy of nucleus pulposus, annulus fibrosus, and adjacent supporting structures of the spine. Change in the shape and intensity of nucleus pulposus, decreased disc height, disc herniation, vertebral endplate changes, presence of osteophyte, and posterior high intensity zones are degenerative changes found in imaging studies. Every feature is considered while grading the severity score. Modic changes, DEBIT (disc extension beyond interspace) score, and Pfirrmann criteria are some of the scoring criteria used for evaluating disc degeneration severity. Moreover, the total number and contiguous pattern of affected discs play a crucial role in symptom generation of back pain. Many studies have reported asymptomatic patients. Thus, the correlation between degeneration severity found in imaging study and symptom severity of LBP remain unclear. This review discusses and summarizes the available literature on the significance of the association between the severity of degenerative changes found in imaging study with the presence and intensity of LBP. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical effect of Duhuo Jisheng Decoction in the treatment of lumbar disc herniation. Methods: CNKI, VIP, Wan Fang Data, Pubmed, Cochrane Library, Medline Complete and Embase databases were searched by computer. The randomized controlled trial (RCT) of Duhuo Jisheng Decoction combined with western medicine in the treatment of lumbar intervertebral disc herniation was studied. The searching time was from the establishment of the database to July 20, 2019. Data were extracted and analyzed by Revman 5.3 software. Results: Twenty-four literatures involving 1980 patients were included. Meta-analysis showed that the total effective rate of Duhuo Jisheng Decoction group was significantly higher (OR = 5.26, 95% CI (4.13, 6.69), Z = 13.47, P < 0.00001) and the incidence of adverse reactions was significantly lower (OR = 0.45, 95% CI (0.23, 0.87), Z = 2.36, P = 0.00001) than that of Western medicine group. 02). Conclusion: Duhuo Jisheng Decoction is effective and safe in the treatment of lumbar intervertebral disc herniation. However, the literature included in this study is limited, and the quality of the literature is low. It is necessary to carry out in-depth verification of high-quality, large-sample RCT. [ABSTRACT FROM AUTHOR]

Intervertebral disc degeneration is the primary cause of back pain and associated with neurological disorders including radiculopathy, myelopathy, and paralysis. The currently available surgical treatments predominantly include the excision of pathological discs, resulting in the function loss, immobilization, and potential additional complications due to the altered biomechanics. Gene therapy approach involves gene transfer into cells, affects RNA and protein synthesis of the encoded genes in the recipient cells, and facilitates biological treatment. Relatively long-exerting therapeutic effects by gene therapy are potentially advantageous to treat slow progressive degenerative disc disease. In gene therapy, the delivery method and selection of target gene(s) are essential. Although gene therapy was first mediated by viral vectors, technological progress has enabled to apply nonviral vectors and polyplex micelles for the disc. While RNA interference successfully provides specific downregulation of multiple genes in the disc, clustered regularly interspaced short palindromic repeats (CRISPR) system has increased attention to alter the process of intervertebral disc degeneration. Then, more recent findings of our studies have suggested autophagy, the intracellular self-digestion, and recycling system under the negative regulation by the mammalian target of rapamycin (mTOR), as a gene therapy target in the disc. Here we briefly review backgrounds and applications of gene therapy for the disc, introducing strategies of autophagy and mTOR signaling modulation through selective RNA interference. [ABSTRACT FROM AUTHOR]