Correlation between posterior paraspinal muscle atrophy and lumbar intervertebral disc degeneration in patients with chronic low back pain.

BACKGROUND: Although enormous studies have been devoted to solving the problem of intervertebral disc degeneration/herniation, little attention is paid to the effect of paraspinal muscles on it. We aimed to investigate the correlation between paraspinal muscle atrophy and lumbar disc degeneration to recognize paraspinal muscle atrophy and its importance to the spine. PATIENTS AND METHODS: A total of 107 patients were enrolled in the study (65 females, 42 males; age 50.87 ± 15.391 years old). Cross-sectional area, functional cross-sectional area, and fatty infiltration of the posterior paraspinal muscles were measured at the level of L4/5, and the degree of facet joint degeneration was evaluated at the levels of L3/4, L4/5, and L5/S1 by MRI. After controlling the confounding factors by multiple linear regression, the correlations among paraspinal muscle atrophy, disc degeneration, and facet joint degeneration were analyzed. Meanwhile, Pearson/Spearson rank analysis was used to analyze the correlation between clinical symptoms (VAS and ODI) and paraspinal muscle atrophy. RESULTS: There was a strong correlation between paraspinal muscle atrophy and disc degeneration after controlling the confounding factors (p < 0.05, R > 0.5). There was a weak correlation between paraspinal muscle atrophy and facet joint degeneration (p < 0.05, R < 0.5). There was a significant correlation between facet joint degeneration and intervertebral disc degeneration (p < 0.05, R > 0.7). The fatty infiltration of paraspinal muscle was weakly correlated with ODI (p < 0.05, R < 0.3), but VAS was not. CONCLUSIONS: The degree of paraspinal muscle atrophy increased with lumbar disc degeneration and facet joint degeneration and fatty infiltration of multifidus was more susceptible to weight.

N-Halaminated spermidine-containing polymeric coating enables titanium to achieve dual functions of antibacterial and osseointegration.

Titanium (Ti) and its alloys have been widely employed in the treatment of orthopedics and other hard tissue diseases. However, Ti-based implants are bioinert and suffer from bacterial infections and poor osseointegration in clinical applications. Herein, we successfully modified Ti with a porous N-halaminated spermidine-containing polymeric coating (Ti-SPD-Cl) through alkali-heat treatment, surface grafting and chlorination, and it has both excellent antibacterial and osteogenic abilities to significantly enhance osseointegration. The as-obtained Ti-SPD-Cl contains abundant N-Cl groups and demonstrates effective antibacterial ability against S. aureus and E. coli. Meanwhile, due to the presence of the spermidine component and construction of a porous hydrophilic surface, Ti-SPD-Cl is also beneficial for maintaining cell membrane homeostasis and promoting cell adhesion, exhibiting good biocompatibility and osteogenic ability. The rat osteomyelitis model demonstrates that Ti-SPD-Cl can effectively suppress bacterial infection and enhance bone-implant integration. Thus, Ti-SPD-Cl shows promising clinical applicability in the prevention of orthopedic implant infections and poor osseointegration.

Biomechanical effects of cement discoplasty on the lumbar spinal unit.

Background: Percutaneous cement discoplasty (PCD) is used to treat patients with low back and leg pain due to the intervertebral disc vacuum phenomena. Whether PCD can restore lumbar spinal stability remains unknown. Objective: The purpose of our in vitro study was to evaluate the biomechanical changes brought about by PCD. Methods: Eight fresh pig lumbar spines were tested in the following order: intact, after nucleotomy, and after discoplasty. Flexion/extension, lateral bending, and axial rotation were induced by pure moments. The range of motion and neutral zone were recorded. A CT scan was performed to assess the injection volume of the bone cement and to observe whether the bone cement was fractured. After removing the facet joint, a compression failure test was conducted to observe the fracture of bone cement. Results: Compared with nucleotomy, range of motion (ROM) after discoplasty was reduced only in lateral flexion (P < 0.05). The results of the neutral zone showed that the neutral zones in flexion-extension and lateral bending were significantly reduced after discoplasty (P < 0.05). The neutral zone was more sensitive to changes in lumbar stability than ROM. Bone cement slides were observed during the biomechanical test. The CT scan and compression failure test showed that bone cement fracture was more likely to occur at the puncture channel in the annulus fibrosus region. Conclusion: In all, the biomechanical study indicates that discoplasty helps enhance the stability of the lumbar spine in flexion-extension and lateral bending, which explains how PCD works for low back pain. Fractures and sliding of bone cement were observed after discoplasty, and this was more likely to occur at the puncture channel in the annulus fibrosus region. This suggests that bone cement displacement after PCD may cause nerve compression.

AOSRV: Development and preliminary performance assessment of a new robotic system for autonomous percutaneous vertebroplasty.

BACKGROUND: Percutaneous vertebroplasty (PVP) is one of the most effective treatments for patients with vertebral fracture that need surgical treatment, and surgical robotics are promising tools to provide surgeons with improved precision, surgical efficiency and reduce radiation exposure. However, there are currently few robotics that are developed to help assist with PVP. METHODS: A new spinal surgical robotic system 'AOSRV' for autonomous vertebral puncture and bone cement injection was designed and customised in this study. To investigate its practical abilities and the advantages, we performed single-segment/double-segment PVP simulation surgeries on pig spinal specimens manually and using AOSRV. RESULTS: By contrast with the freehand group (FG) in single-segment (SS)/double-segment (DS) surgery, the robotic group (RG) was superior in the operation time (RGSS = 21.14 ± 4.11 min, FGSS = 33.17 ± 6.83 min; RGDS = 42.39 ± 7.31 min, FGDS = 62.86 ± 20.39 min), puncture adjustments (RGSS = 2.30 ± 1.77, FGSS = 14.86 ± 5.46; RGDS = 3.91 ± 1.76, FGDS = 20.00 ± 7.76), intraoperative fluoroscopies (RGSS = 4.10 ± 1.52, FGSS = 20.57 ± 5.44; RGDS = 7.82 ± 1.40, FGDS = 25.91 ± 7.23) and bone cement leakage rate (RGSS = 30%, FGSS = 71.4%; RGDS = 38.6%, FGDS = 83.3%). CONCLUSIONS: AOSRV was successfully developed and had a promising preliminary performance. An innovative attempt was made for the blank space of the autonomous vertebroplasty surgical robotics, and it may shed a light on more promising applications in the future.

Prediction of a Potential Mechanism of Intervertebral Disc Degeneration Based on a Novel Competitive Endogenous RNA Network.

Low back pain which resulted from intervertebral disc degeneration (IDD) is a common health problem that afflicts people all over the world. Due to the lack of an overall understanding of the molecular interactions involved in IDD, we hope to better understand the pathogenetic mechanisms that drive the degenerative process. The purpose of this study is to obtain mRNAs, miRNAs, lncRNAs, and circRNAs associated with IDD gained from public databases and to establish an interaction network. According to the results of microarray analysis and bioinformatics analysis from the contrast of IDD and normal nucleus pulposus tissues, a total of 49 mRNAs, 10 miRNAs, 30 lncRNAs, and 4 circRNAs were obtained and a lncRNA/circRNA-miRNA-mRNA interaction network was constructed. NEAT1-miR-5100-COL10A1 and miR663AHG/HEIH/hsa-circ-0003600-miR-4741-HAS2/HYAL1/LYVE1 might be potential interaction axes of the molecular mechanism in IDD. The increased expression of NEAT1 might inhibit miR-5100 and subsequently upregulate the expression of COL10A1, which leads to IDD, while the increased expression of miR663AHG/HEIH/hsa-circ-0003600 might inhibit miR-4741 and indirectly upregulate HAS2/HYAL1/LYVE1, and leads to the protection from IDD. More interaction axes are to be exploited to provide theoretical bases for further study on IDD.

Integrative analysis of long non-coding RNA and messenger RNA expression in toll-like receptor 4-primed mesenchymal stem cells of ankylosing spondylitis.

BACKGROUND: The precise pathogenesis of ankylosing spondylitis (AS) is still largely unknown at present. Our previous study found that toll-like receptor 4 (TLR4) downregulated and performed immunoregulatory dysfunction in mesenchymal stem cells from AS patients (AS-MSCs). The aim of this study was to explore the expression profiles of long non-coding RNAs (lncRNAs) and messenger RNAs (mRNAs) in TLR4-primed AS-MSCs, and to clarify the potential mechanisms. METHODS: The immunoregulatory effects of MSCs were determined after TLR4 activation. Next, the differentially-expressed (DE) lncRNAs and mRNAs between AS-MSCs and TLR4-primed AS-MSCs [stimulated by lipopolysaccharide (LPS)] were identified via high-throughput sequencing followed by quantitative real-time PCR (qRT-PCR) confirmation. Finally, bioinformatics analyses were performed to identify the critical biological functions, signaling pathways, and associated functional networks involved in the TLR4-primed immunoregulatory function of AS-MSCs. RESULTS: A total of 147 DE lncRNAs and 698 DE mRNAs were identified between TLR4-primed AS-MSCs and unstimulated AS-MSCs. Of these, 107 lncRNAs were upregulated and 40 were downregulated (fold change ≥2, P<0.05), while 504 mRNAs were upregulated and 194 were downregulated (fold change ≥2, P<0.05). Five lncRNAs and five mRNAs with the largest fold changes were respectively verified by qRT-PCR. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses demonstrated that the DE mRNAs and lncRNAs were highly associated with the inflammatory response, such as NOD-like receptor (NLR) signaling pathway, the TNF signaling pathway and the NF-κB signaling pathway. Cis-regulation prediction revealed eight novel lncRNAs, while trans-regulation prediction revealed 15 lncRNAs, respectively. Eight core pairs of lncRNA and target mRNA in the lncRNA-transcription factor (TF)-mRNA network were as follows: PACERR-PTGS2, LOC105378085-SOD2, LOC107986655-HIVEP2, MICB-DT-MICB, LOC105373925-SP140L, LOC107984251-IFIT5, LOC112268267-GBP2, and LOC101926887-IFIT3, respectively. CONCLUSIONS: TLR4 activation in AS can enhance the immunoregulatory ability of MSCs. Eight core pairs of lncRNA and target mRNA were observed in TLR4-primed AS-MSCs, which could contribute to understanding the potential mechanism of AS-MSC immunoregulatory dysfunction.

Spine surgical robotics: review of the current application and disadvantages for future perspectives.

In the past decade, intelligent medical technology has been a hot research direction, which results in a series of products such as image-assisted AI and tumor diagnostic auxiliary systems. In the field of surgery, surgical robotics is one of the most attractive intelligent technologies. After nearly a decade of revolution, robots have shown much superiority in spine surgery, and many published studies on accuracy and radiation volume have reported these advantages. However, in reviewing these articles, we found that some of them mentioned the shortcomings of robots, which led us to review the comprehensive evaluation of spinal robots. In this article, we summarize the aspects that have been mentioned in published articles as well as unpublished ones that we have concluded. Through these summaries, we hope that future researchers will be able to make targeted improvements to robots and broaden the future direction of spine surgery robotics. Spine surgical robotics is still widely believed to have a brilliant future application, but it needs to solve the disadvantages of not having a wide application range, not having a deep application depth and not having prominent advantages compared with other existing application technologies.

Surgical Resection of Solitary Bone Plasmacytoma of Atlas and Reconstruction with 3-Dimensional-Printed Titanium Patient-Specific Implant.

BACKGROUND: Solitary plasmacytoma of bone (SPB) is a rare malignancy of localized osseous lesion consisting of neoplastic monoclonal plasma cells. Recommended treatment of SPB includes a combination of surgery and radiation therapy. We present a rare case of SPB lesion in the atlas requiring surgical resection, followed by restoration of atlas stability with a custom 3-dimensional-printed (3DP) patient-specific implant (PSI). CASE DESCRIPTION: A 57-year-old man presented with severe neck pain. Assessment by radiographs, computed tomography, and magnetic resonance imaging was found to harbor a single osteolytic lesion at the C1 (atlas) vertebra. Diagnostic tumor screening returned negative results. Transoral biopsy suggested solitary plasmacytoma. Spinal instability was apparent-hence the decision for surgical intervention via the retropharyngeal external approach to resect the lesion. Atlas reconstruction and stabilization were achieved using a custom 3DP titanium PSI. Subsequent pathologic findings confirmed plasma cell infiltration of the atlas. Histologic evaluations and cytogenetic risk analysis indicated a non-high-risk SPB. The patient was given localized radiation therapy at 57 Gy in 27 fractions. Her neurologic complaints were subsequently relieved, and mobility was restored 7 days postoperatively. CONCLUSIONS: No consensus on the appropriate surgical approaches and perioperative strategies for spinal SPB exists. Surgical intervention is recommended when vertebral instability is evident, followed by radiation therapy to minimize local recurrence and/or progression to multiple myeloma. The use of 3D modeling for preoperative planning improves intraoperative accuracy and avoids iatrogenic injuries to vital anatomic structures. Customized 3DP-PSI to restore atlas stability is an effective option for the treatment of spinal SPBs.

Pantoprazole (PPZ) Inhibits RANKL-Induced Osteoclast Formation and Function In Vitro and Prevents Lipopolysaccharide- (LPS-) Induced Inflammatory Calvarial Bone Loss In Vivo.

Bone remodeling is a process delicately balanced between osteoclastic bone resorption and osteoblastic bone formation. Osteoclasts (OCs) are multinucleated giant cells formed through the fusion of monocytic precursors of the hematopoietic stem cells lineage. OCs are the exclusive cells responsible for the resorption and degradation of the mineralized bone matrix. Pantoprazole (PPZ), a proton pump inhibitor (PPI), is commonly prescribed to reduce excess gastric acid production for conditions such as gastroesophageal reflux disease and peptic ulcer disease. Studies have found contradictory effects of PPI therapy on bone metabolism due to the lack of understanding of the exact underlying mechanism. In this study, we found that PPZ inhibits receptor activator of nuclear factor-κB (NF-κB) ligand- (RANKL-) induced osteoclastogenesis from bone marrow monocytic/macrophage (BMMs) precursors and the bone-resorbing activity of mature OCs. Correspondingly, the expression of OC marker genes was also attenuated. At the molecular level, PPZ treatment was associated with reduced activation of the ERK MAPK signaling pathways crucial to OC differentiation. Additionally, the in vivo administration of PPZ protected mice against lipopolysaccharide- (LPS-) induced inflammatory calvarial bone erosion, as a result of the reduced number and activity of OCs on the calvarial bone surface. Although PPI use is associated with increased risk of osteoporosis and bone fractures, our study provides evidence for the direct inhibitory effect of PPZ on OC formation and bone resorption in vitro and in vivo, suggesting a potential therapeutic use of PPZ in the treatment of osteolytic disease with localized bone destruction.