[Effect of acupotomy intervention on the expressions of proteoglycans in lumbar intervertebral disc of rabbits with lumbar intervertebral disc degeneration].

OBJECTIVE: To observe the effect of acupotomy intervention on the expressions of biglycan(BGN), decorin(DCN) and Caspase-3 in lumbar intervertebral disc of rabbits with lumbar intervertebral disc degeneration (LIDD), so as to explore its possible mechanism in relieving LIDD. METHODS: Thirty male Japanese white rabbits were randomly divided into normal, model and acupotomy groups, with 10 rabbits in each group. The LIDD model was established by axial compression method, and magnetic resonance imaging (MRI) was used to judge whether the model was successful or not. After modeling, the acupotomy was applied to lumbar (L)4-L5 spinous process space and bilateral transverse processes for loosening, twice a week for 4 weeks. The structural changes of L4-L5 intervertebral disc were observed by MRI. The morphological changes of lumbar spine were observed by HE staining. The expression of Caspase-3 in nucleus pulposus was observed by immunohistochemistry, and the protein expressions of DCN and BGN in intervertebral disc were detected by Western blot, separatively. RESULTS: After mode-ling, the rabbits showed slow movement, stiff back muscles with cords or nodules, the fibrous ring structure of lumbar intervertebral disc was disordered, the number of nucleus pulposus cells was reduced, and the signal intensity of L4-L5 intervertebral disc was decreased in the model group relevant to the normal group. At the same time, the expression of Caspase-3 in nucleus pulposus was increased significantly (P<0.05), and the expression levels of DCN and BGN in intervertebral disc were decreased significantly (P<0.05). After acupotomy treatment, the modeling induced slow movement, stiff back muscles and disordered structure of lumbar intervertebral disc were significantly improved. The number of nucleus pulposus cells was increased, the signal intensity of L4-L5 intervertebral disc was enhanced, the expression of Caspase-3 in nucleus pulposus was decreased significantly (P<0.05), and the expression levels of DCN and BGN in intervertebral disc were increased significantly (P<0.05) compared with the model group. CONCLUSION: Acupotomy intervention can inhibit cell apoptosis, reduce the degradation of extracellular matrix in nucleus pulposus of intervertebral disc, and restore the normal force balance and dynamic balance of lumbar spine, which may be one of its mechanisms underlying improving LIDD.

Supplementation with a new food grade delivery system of Boswellia and Centella in the intervertebral discs registry: the Sager study.

BACKGROUND: The aim of this registry study was to investigate the potential of a new food-grade formulation of the association of Boswellia serrata and Centella asiatica extracts (Boswellia/Centella Phytosome, [BCP]) in combination with standard management (SM) to produce a faster re-expansion of the intervertebral disks in symptomatic subjects with "flattened" disks in the lower spine, due to wrong posture and compression after repeated trauma. METHODS: The study was designed as a 3-6 months pilot registry. Three groups of subjects were comparable for characteristics and symptoms at baseline: SM+BCP; SM; SM+glucosamine. RESULTS: No side effects were observed. Regarding target measurements at 3 and 6 months, height increased in the BCP group vs. the other two groups. The total spine length improved in the BCP group (P<0.05); in particular at 6 months the increase was doubled with BCP. SM was effective in producing elongation but the association with BCP made spinal elongation faster, more effective, with a better expansion of the intervertebral disks. Regarding ultrasound measurements, BCP was able to significantly ameliorate the posterior disk space (P<0.05) and decreased disk density more than the other groups of the study. Signs/symptoms and mobility were improved with BCP (P<0.05), while rescue medications decreased. The loss of working days was reduced with all managements (significantly more in BCP group than in the other two). CONCLUSIONS: The relative effects on spinal elongation, disk space, signs/symptoms of BCP appeared to double the efficacy of SM, improving symptoms associated to a very good tolerability of BCP.

The Effects of Elgucare on Degenerated Intervertebral Disc-Induced Low Back Pain and Disc Regeneration: A Clinical Trial.

INTRODUCTION: Chronic low back pain (LBP) has a wide range of causes. However, most cases are induced by degeneration of the lumbar intervertebral discs (IVDs), and the aching caused by local compression of the affected region has considerable impacts on quality of life. This clinical trial investigated the use of Elgucare, a Chinese herbal formula, as a food supplement to reduce the pain of patients with LBP induced by degeneration of the lumbar IVDs. METHODS: The study assessed patient subjective quality of life, functional limitations caused by LBP, and variations in pain. The assessment was done through the visual analogue scale (VAS) and effects on lumbar IVD thickness, water content, and bone mineral density (BMD). These parameters were evaluated before and after the administration of Elgucare or a placebo, one of which was taken by each participant for a 12-month period. RESULTS: Elgucare reduced the patients' mean VAS pain score by 2.25 points and improved their mean LBP-hampered mobility as assessed by the Roland-Morris Questionnaire by 5.17 points. The results of another questionnaire indicated that Elgucare slowed the LBP-induced deterioration of patients' quality of life, while objective assessment indices obtained through X-ray and magnetic resonance imaging showed that the height and water retention of their IVDs were increased. However, the BMD results showed no improvements. CONCLUSIONS: Elgucare can increase the water retention and height of IVDs and reduce LBP, thereby enhancing quality of life. Therefore, Elgucare can potentially be used as a clinical supplement.

Posteroanterior Segmental Displacement of the Lumbar Spine: Assessment Using Ultrasound in Asymptomatic Men.

OBJECTIVE: This study aimed to assess posteroanterior (PA) segmental displacement of the lumbar spine using ultrasound (US). METHODS: Eight asymptomatic male participants (20.1 ± 0.4 years) were included in this study. The relative depth between the tip of the L4 and L3 spinous processes from the US probe (mm) was measured using US in the following 7 conditions, which were without PA force, applying PA force of 9.8 newton (N), 19.6 N, 29.4 N, 39.2 N, 49.0 N, and 58.8 N to both sides of the L4 costal processes. The measurements were repeated twice within a day. The intraclass correlation coefficient, standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. A repeated-measures analysis of variance was also used to determine the influence of PA force on the relative depth. RESULTS: The intraclass correlation coefficients for the intrarater reliability of the 7 conditions were 0.95 (SEM: 0.43 mm, MDC: 1.19 mm), 0.93 (SEM: 0.45 mm, MDC: 1.25 mm), 0.93 (SEM: 0.47 mm, MDC: 1.30 mm), 0.95 (SEM: 0.37 mm, MDC: 1.02 mm), 0.95 (SEM: 0.40 mm, MDC: 1.10 mm), 0.96 (SEM: 0.38 mm, MDC: 1.04 mm), and 0.95 (SEM: 0.42 mm, MDC: 1.15 mm), respectively. The intrarater reliability of the relative depth using US was reliable. There was no significant change in the relative depth among the 7 conditions (F = 0.88, P = .41). Incrementally greater PA force was not related to greater intersegmental translation. CONCLUSION: Our US method could not detect PA segmental displacement of the lumbar spine.

MR-Guided Percutaneous Intradiscal Thermotherapy (MRgPIT): Evaluation of a New Technique for the Treatment of Degenerative Disc Disease in Cadaveric Lumbar Spine.

PURPOSE: Evaluation of MR feasibility and real-time control of an innovative thermoablative applicator for intradiscal thermotherapy and histological analysis of laser annuloplasty in human ex vivo intervertebral discs. MATERIALS AND METHODS: We evaluated a new MR-compatible applicator system for MR-guided percutaneous intradiscal thermotherapy (MRgPIT) in an open 1.0-T MRI-system. Needle artefacts and contrast-to-noise ratios (CNR) of six interactive sequences (PD-, T1-, T2w TSE, T1-, T2w GRE, bSSFP) with varying echo-times (TE) and needle orientations to the main magnetic field (B0) were analysed. Additionally, five laser protocols (Nd: YAG Laser, 2-6 W) were assessed in 50 ex vivo human intervertebral discs with subsequent histological evaluation. RESULTS: In vitro, we found optimal needle artefacts of 1.5-5 mm for the PDw TSE sequence in all angles of the applicator system to B0. A TE of 20 ms yielded the best CNR. Ex vivo, ablating with 5 W induced histological denaturation of collagen at the dorsal annulus, correlating with a rise in temperature to at least 60 °C. The MRgPIT procedure was feasible with an average intervention time of 17.1 ± 5.7 min. CONCLUSION: Real-time MR-guided positioning of the MRgPIT-applicator in cadaveric intervertebral disc is feasible and precise using fast TSE sequence designs. Laser-induced denaturation of collagen in the dorsal annulus fibrosus proved to be accurate.

Effect of needle diameter, type and volume of contrast agent on intervertebral disc degeneration in rats with discography.

PURPOSE: Discography can increase disc degeneration, but the influence of different discography variables on the degeneration of discs has not been reported. The aim of this study was to investigate the effects of discography variables of needle diameter, type of contrast agent and volume of contrast agent on disc degeneration. METHODS: Three separate experiments examined needle diameter, and type and volume of contrast agent. Coccygeal discs (Co7-10) adult male rats were used. X-rays were used to detect the disc height degeneration index at 1, 2 and 4 weeks after the procedure. MRI was used to study the changes in the disc structure and the signal intensity of IVD 2 and 4 weeks after the procedure. Disc water content and histology were measured at 4 weeks after the procedure. RESULTS: A 21-g needle significantly increased disc degeneration when compared with the 30-g needle as detected by X-ray, MRI, disc water content and histology (P < 0.05). Two microlitres of iodine significantly decreased the disc MRI signal and water content at 4 weeks compared with the same volume of normal saline (P < 0.05). Three microlitres of iodine significantly increased disc degeneration when compared with 2 µl iodine, as detected by X-ray, MRI, disc water content and histology at 4 weeks (P < 0.05). CONCLUSION: To reduce disc degeneration after discography, it may be best to choose a smaller needle size, minimize the use of contrast agent and use non-ionic contrast agents with osmotic pressure similar to the intervertebral disc. These slides can be retrieved under Electronic Supplementary Material.

A Novel Non-invasive Effective Method for Potential Treatment of Degenerative Disc Disease: A Hypothesis.

The pathophysiology of the intervertebral discs plays a significant role in the people's life quality. There is not adequate research done in the pathogenesis and treatment of intervertebral disc degeneration. Alternately, self-educated physiology offers a novel and noninvasive method to reverse the degenerated discs. In this single case study, report attempts have been made to highlight the effect of the self-educative physiology, on magnetic resonance imaging investigations, of progressive healing, on the degenerated intervertebral discs. Based on this novel method, an effort has been made to review literature on the degeneration of intervertebral discs and available mode of treatments and then to propose a hypothesis for the biochemical mechanisms of healing. The idea is that transforming growth factor-ß1 from seminal plasma secretions may contribute to releasing the osteogenic protein- 1 which induces nucleus pulposus and annulus fibrosus cells in intervertebral discs for repairs. In addition, the patient's medical history is presented with background information.

Intradiscal ozone therapy for lumbar disc herniation.

The rationale behind intradiscal O2-O3 therapy is the pain elicited by the mechanical compression of the nerve root, which is associated with periganglionic and periradicular inflammation. This study aimed to determine the effect of intradiscal ozone injection on pain score and satisfaction of patients with low back pain (LBP) secondary to disc herniation. Patients with LBP diagnosed with disc herniation were enrolled in this clinical trial. After prepping and draping the area, intradiscal injection of ozone/oxygen mixture (10 ml, 25µg/ml) was performed under fluoroscopy guide (c-arm). Pain score and patient satisfaction were assessed prior to the injection (baseline) and 1, 3, 6, 12 and 24 months after the injection. Sixty three patients (24 males, 39 females) with mean age of 53.3 ±2.0 y enrolled in the study. The mean±standard deviation (SD) of pain score before intervention was 6.968 ±0.11. Pain score was reduced to 4.25±0.19 at 1 month, 4.33±0.20 at 3 months, 4.87 ±0.21 at 6 months and 5.22 ±0.20 at 24 months. According to the modified MacNab scale success of pain relief was as follows: excellent: 4 (6.3%), good: 17 (26.98 %), sufficient: 13 (20.63 %), poor: 13 (20.63 %), no result: 11 (17.46%), negative: 4 (6.3 %). Intradiscal ozone therapy was determined to provide improved outcomes in patients with single level of bulging and protrusion.

Hypericum perforatum to improve post-operative Pain Outcome after monosegmental Spinal microdiscectomy (HYPOS): a study protocol for a randomised, double-blind, placebo-controlled trial.

BACKGROUND: Spinal disc herniation is a frequently occurring degenerative disease of the spine. Many patients undergoing surgery suffer from radicular pain, known as memory pain, beginning from the third post-operative day. This results in the prescription of high-dose opioid medications. In homeopathy, Hypericum perforatum is known as a remedy for unbearable, shooting or jabbing pain especially when neural damage is involved. Reduction of pain after application of H. perforatum has been observed in previous studies. This study is aimed to investigate whether homeopathic H. perforatum in a potentisation of C200 leads to the reduction of post-operative pain and a decrease of pain medication compared to placebo. METHODS/DESIGN: This is a monocentric, double-blind, randomised placebo-controlled trial conducted at the Department of Neurosurgery at the Community Hospital Herdecke, Germany. One hundred study participants are being recruited from inpatients undergoing elective, monosegmental, lumbar microdiscectomy surgery. Patients are randomly allocated to receive homeopathic treatment or placebo in addition to usual pain management after surgery. The primary clinical outcome is pain reduction after 3 days of inpatient care as measured by pain reduction of subjective pain on a 100-mm Visual Analogue Scale (VAS) at the third post-operative day. Statistical analysis will be carried out by means of a covariance model with adjustment for baseline values and patient expectation for all randomised patients. DISCUSSION: This study is the first trial of classical homeopathy that will evaluate the efficacy of homeopathic H. perforatum after monosegmental spinal microdiscectomy. We intend to clarify the potential of homoeopathic H. perforatum to reduce surgery-associated pain. TRIAL REGISTRATION: German Clinical Trials Register, ID: DRKS00007913 . Registered on 17 October 2014. EudraCT - Nr: 2013-001383-31. Data sets from the German Clinical Trials Register (DRKS, Deutsches Register Klinischer Studien) are updated every 4 weeks automatically to the International Clinical Trials Registry Platform of World Health Organisation: http://apps.who.int/trialsearch/ . Responsibilities Sponsor: Witten/Herdecke University Alfred-Herrhausen-Straße 50 58,448 Witten Deputy of the sponsor: Dr. Wolfgang Eglmeier (Head of Centre for Clinical Trials Witten/Herdecke) Alfred-Herrhausen-Straße 50 58,448 Witten E-mail: wolfgang.eglmeier@uni-wh.de Principal investigator: Prof. Dr. med. Wolfram Scharbrodt Community Hospital Herdecke Department for Neurosurgery Gerhard-Kienle-Weg 4 58,313 Herdecke w.scharbrodt@gemeinschaftskrankenhaus.de Project coordination: Christa Raak Faculty for Health (Department for Integrative and Anthroposophic Medicine) University Witten/Herdecke gGmbh Gerhard-Kienle-Weg 4 58,313 Herdecke christa.raak@uni-wh.de Project manager/data analysis/biometry: Prof. Dr. Thomas Ostermann Faculty for Health (Department for Psychology and Psychotherapy) University Witten/Herdecke gGmbh Alfred-Herrhausen-Straße 50 58,448 Witten thomas.ostermann@uni-wh.de.

Morphometric changes of the cervical intervertebral foramen: A comparative analysis of pre-manipulative positioning and physiological axial rotation.

BACKGROUND: Cervical foraminal impingement has been described as a source of radicular pain. Clinical tests and head motions have been reported for affecting the intervertebral foramen (IVF) dimensions. Although manual approaches are proposed in the management of cervical radiculopathy, their influence on the foraminal dimensions remains unclear. OBJECTIVES: To investigate the influence of pre-manipulative positioning versus cervical axial rotation on the foraminal dimensions of the lower cervical spine. METHODS: Thirty asymptomatic volunteers underwent CT scan imaging in neutral position and axial rotation or pre-manipulative positioning. The manipulation task was performed at C4-C5 following a multiple components procedure. 3D kinematics and IVF (height, width and area) were computed for each cervical segment. RESULTS: The results showed that foraminal changes are dependent on motion types and cervical levels. With reference to head rotation, IVF opening occurred on the ipsilateral side during pre-manipulative positioning while axial rotation involved the contralateral side. Regardless of the side considered, magnitudes of opening were similar between both attitudes while narrowing was lower at the target and adjacent levels during the pre-manipulative positioning. Some associations between segmental motion and IVF changes were observed for the target level and the overlying level. CONCLUSIONS: The present study demonstrated that pre-manipulative positioning targeting C4-C5 modified IVF dimensions differently than the passive axial rotation. The findings suggest that techniques which incorporate combined movement positioning influence segmental motion and IVF dimensions differently at the target segment, compared to unconstrained rotation. Further investigations are needed to determine the clinical outcomes of such an approach.

Initial investigation of individual and combined annulus fibrosus and nucleus pulposus repair ex vivo.

Novel tissue engineered and biomaterial approaches to treat intervertebral disc (IVD) degeneration focus on single aspects of the progressive disease and hence are insufficient repair strategies. In this study, annulus fibrosus (AF) and nucleus pulposus (NP) biomaterial repair strategies were used individually and combined to treat IVD degeneration modeled in ex vivo rat-tail motion segments by annulotomy and nucleotomy. An injectable riboflavin cross-linked high-density collagen gel patched defects in the AF, while NP repair consisted of injections of a modified hyaluronic acid (HA) hydrogel. Qualitative imaging showed the annulotomy and nucleotomy successfully herniated NP material, while the HA NP injections restored intact NP morphology and the collagen AF patches sealed AF defects. Assessed by quantitative T2 magnetic resonance imaging, combined repair treatments yielded disc hydration not significantly different than intact hydration, while AF and NP repairs alone only restored ∼1/3 of intact hydration. Mechanical testing showed NP injections alone recovered on average ∼35% and ∼40% of the effective instantaneous and equilibrium moduli. The combined treatment comprising biomaterial AF and NP repair was effective at increasing NP hydration from NP repair alone, however HA injections alone are sufficient to improve mechanical properties. STATEMENT OF SIGNIFICANCE: Intervertebral disc degeneration affects an estimated 90% of individuals throughout their life, and is a candidate pathology for tissue engineered repair. The current standard of clinical care reduces spinal articulation and leads to further degeneration along the spine, hence great interest in a regenerative medicine therapy. Literature studies focused on biomaterial repair strategies for treating degenerated discs have partially restored native disc function, however no studies have reported the use of combined therapies to address multiple aspects of disc degeneration. This initial investigation screened injectable biomaterial repair strategies ex vivo, and through complementary outcome measures showed a combined therapy restores disc function better than individual approaches. This study is the first of its kind to address multiple aspects of disc degeneration, using clinically-oriented biomaterials in a well-established animal model.

Relationship of Modic Changes, Disk Herniation Morphology, and Axial Location to Outcomes in Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation: A Prospective Study.

OBJECTIVE: The purpose of this study was to evaluate whether cervical disk herniation (CDH) location, morphology, or Modic changes (MCs) are related to treatment outcomes. METHODS: Magnetic resonance imaging (MRI) and outcome data from 44 patients with CDH treated with spinal manipulative therapy were evaluated. MRI scans were assessed for CDH axial location, morphology, and MCs. Pain (0-10 for neck and arm) and Neck Disability Index (NDI) data were collected at baseline; 2 weeks; 1, 3, and 6 months; and 1 year. The Patient's Global Impression of Change data were collected at all time points and dichotomized into "improved," yes or no. Fischer's exact test compared the proportion improved with MRI abnormalities. Numerical rating scale and NDI scores were compared with MRI abnormalities at baseline and change scores at all time points using the t test or Mann-Whitney U test. RESULTS: Patients who were Modic positive had higher baseline NDI scores (P = .02); 77.8% of patients who were Modic positive and 53.3% of patients who were Modic negative reported improvement at 2 weeks (P = .21). Fifty percent of Modic I and 83.3% of Modic II patients were improved at 2 weeks (P = .07). At 3 months and 1 year, all patients with MCs were improved. Patients who were Modic positive had higher NRS and NDI change scores. Patients with central herniations were more likely to improve only at the 2-week time point (P = .022). CONCLUSIONS: Although patients who were Modic positive had higher baseline NDI scores, the proportion of these patients improved was higher for all time points up to 6 months. Patients with Modic I changes did worse than patients with Modic II changes at only 2 weeks.

Assessment of Lumbar Spine Height Following Sustained Lumbar Extension Posture: Comparison Between Musculoskeletal Ultrasonography and Stadiometry.

OBJECTIVES: The purpose of this study was to correlate sitting height measured by stadiometry with lumbar spine height (LSH) modifications measured by musculoskeletal ultrasonography (MSU). METHODS: Eighteen healthy young adults were recruited for this study (mean age: 21.5 ± 1.5 years). All subjects were tested in the following sequence: (1) lying supine for 10 minutes, (2) sitting under loaded (9.5 kg) and unloaded conditions for 5 minutes each, (3) lying supine for 15 minutes with passive lumbar extension, and (4) sitting unloaded for 5 minutes. Both stadiometry and MSU measurements were taken after each step of the testing sequence. RESULTS: Following the loaded sitting step, sitting height (measured by stadiometry) decreased by 3.4 ± 1.6 mm, whereas following sustained lumbar extension, sitting height increased by 5.4 ± 3.5 mm (P < .05). Following loaded sitting and sustained lumbar extension, LSH decreased by 3.8 ± 1.7 mm and increased by 6.2 ± 4.1 mm, respectively (P < .05). On the basis of the mean differences (between the different steps of the testing sequence), the mean correlation coefficient and the mean coefficient of determination between stadiometry and MSU measurements were calculated at 0.93 ± 0.07 and 0.88 ± 0.13, respectively, and no statistical differences were observed (P > .05). CONCLUSIONS: In vivo measurements of sitting height changes, measured using stadiometry, were strongly correlated with LSH changes, measured using ultrasonography.

Effects of Axial Torsion on Disc Height Distribution: An In Vivo Study.

OBJECTIVES: Axial rotation of the torso is commonly used during manipulation treatment of low back pain. Little is known about the effect of these positions on disc morphology. Rotation is a three-dimensional event that is inadequately represented with planar images in the clinic. True quantification of the intervertebral gap can be achieved with a disc height distribution. The objective of this study was to analyze disc height distribution patterns during torsion relevant to manipulation in vivo. METHODS: Eighty-one volunteers were computed tomography-scanned both in supine and in right 50° rotation positions. Virtual models of each intervertebral gap representing the disc were created with the inferior endplate of each "disc" set as the reference surface and separated into 5 anatomical zones: 4 peripheral and 1 central, corresponding to the footprint of the annulus fibrosus and nucleus pulposus, respectively. Whole-disc and individual anatomical zone disc height distributions were calculated in both positions and were compared against each other with analysis of variance, with significance set at P < .05. RESULTS: Mean neutral disc height was 7.32 mm (1.59 mm). With 50° rotation, a small but significant increase to 7.44 mm (1.52 mm) (P < .0002) was observed. The right side showed larger separation in most levels, except at L5/S1. The posterior and right zones increased in height upon axial rotation of the spine (P < .0001), whereas the left, anterior, and central decreased. CONCLUSIONS: This study quantified important tensile/compressive changes disc height during torsion. The implications of these mutually opposing changes on spinal manipulation are still unknown.

L5-S1 Achromobacter xylosoxidans infection secondary to oxygen-ozone therapy for the treatment of lumbosacral disc herniation: a case report and review of the literature.

STUDY DESIGN: Case report and literature review. OBJECTIVE: To present a unique case of Achromobacter xylosoxidans infection secondary to oxygen-ozone therapy for the treatment of L5-S1 disc herniation. SUMMARY OF BACKGROUND DATA: Oxygen-ozone therapy is a minimally invasive technique for the treatment of lumbar disc herniations, with unproven efficacy and few reported complications. Achromobacter xylosoxidans is an opportunistic pathogen that inhabits aquatic environments and is a rare cause of osteomyelitis. To the best of our knowledge, this is the first report of A. xylosoxidans spondylodiscitis in the lumbar spine and the third report of spinal infection after intradiscal oxygen-ozone chemonucleolysis in the English literature. METHODS: The medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed. RESULTS: A 29-year-old female patient who previously underwent oxygen-ozone therapy for L5-S1 disc herniation presented to our institution with a 5-month history of intractable back and leg pain. The patient's laboratory studies were within normal limits and did not indicate signs of an active infection. Her physical examination revealed globally decreased muscle strength (4/5) and hyperesthesia in the lower extremities. Magnetic resonance imaging and computed tomography revealed severe disc degeneration and vertebral body endplate changes at L5-S1, in addition to paravertebral soft tissue swelling consistent with a previous infection. Given the severity of symptoms, the patient underwent anterior lumbar interbody fusion and posterior segmental instrumentation at L5-S1. Histopathological evaluation of the disc material confirmed the diagnosis of chronic osteomyelitis and septic discitis at L5-S1. Intraoperative cultures grew A. xylosoxidans and Propionibacterium acnes. The patient had prompt improvement in her level of pain and was discharged on a 6-week course of piperacillin-tazobactam without complication. CONCLUSION: This first report of A. xylosoxidans vertebral infection secondary to oxygen-ozone therapy illustrates the wide variety of environmental pathogens that can complicate the percutaneous treatment of degenerative vertebral disease.

[An experimental study on effect of autologous platelet-rich plasma on treatment of early intervertebral disc degeneration].

OBJECTIVE: Platelet-rich plasma (PRP) can stimulate intervertebral disc cell proliferation, promote extracellular matrix synthesis, and inhibit annulus fibrosus cell apoptosis. To investigate the effects of autologous PRP on the treatment of the early intervertebral disc degeneration (IDD) so as to provide the experimental basis for its clinical application. METHODS: Forty-five healthy New Zealand white rabbits (male or female, weighing 2.5-3.0 kg) were randomly divided into the experimental group (n = 15), the control group (n = 15), and the sham group (n = 15). PRP was prepared from the arterial blood of rabbit's ears of the experimental group with Landesberg's method. The platelet concentrations in both whole blood and PRP were detected. The rabbit model of early IDD was established by annulus fibrosus puncture (L4, 5, L5, 6) in both the experimental group and the control group; 100 microL autologous PRP and 100 microL PBS were injected into the degenerative intervertebral discs respectively after 2 weeks of models creation. In sham group, intervertebral discs were separated and exposed without treatment. The general conditions of the rabbits were observed after building models; at 2 weeks after degeneration, 1 and 2 weeks after intervention, 5 rabbits were selected randomly from each group respectively for MRI observation, histological observation by using HE staining and collagen type II immunohistochemical staining. The signal of lumbar MRI was assessed and the contents of collagen type II were detected. RESULTS: The platelet concentration of PRP was about 4.92 times as much as that of the whole blood. All the animals survived to the end of the experiment. At 2 weeks after degeneration, a lower T2 signal was observed in both the experimental group and the control group; the nucleus pulposus cells decreased and extracellular matrix degenerated; and the expression of collagen type II decreased in both the experimental group and control group. The degenerative grade of lumbar MRI in the experimental group and control group were significantly higher than that in the sham group (P < 0.05), and the content of collagen type II were significantly lower than that in the sham group (P < 0.05). At 1, 2 weeks after intervention, disc degeneration in the experimental group was significantly lower than that in control group (P < 0.05), and significant difference was found between experimental group and sham group (P < 0.05). The nucleus pulposus cells and chondroid matrix in the experimental group were more than those in the control group, showing slight stromal fibrosis; but the expression of collage type II was significantly higher than that in the control group (P < 0.05). CONCLUSION: The disc injection of autologous PRP may terminate or even reverse the progress of rabbit early IDD, which may be associated with the role of multiple growth factors of PRP in regulating cell function, improving the tissue microenvironment, and promoting tissue regeneration.

Constrained Bayesian streak artifact reduction approach for contrast enhanced computed tomography imaging of the intervertebral disc.

A promising approach for the study of progressive herniation damage of the intervertebral discs under flexion/extension motions as well as compressive loads is the use of contrast-enhanced computed tomography (CECT). One of the biggest limitations of using CECT is the presence of significant streak artifacts in the acquired tomograms, due primarily to the contrast agent injected into the intervertebral disc. To address this issue, a novel constrained Bayesian approach to streak artifact reduction in CECT imagery is introduced in this paper. The problem of artifact reduction is formulated as a constrained Bayesian estimation problem in projection space, and a non-parametric Parzen window estimation approach is employed to estimate the underlying posterior distributions. Experimental results show that the proposed approach provides significant artifact reduction while preserving the intervertebral disc regions to allow for clear visualization of progressive intervertebral disc damage.

Lumbar spine and pelvic posture between standing and sitting: a radiologic investigation including reliability and repeatability of the lumbar lordosis measure.

OBJECTIVE: Sitting has been identified as a cause of mechanical low back pain. The purpose of this study was to use plain film x-rays to measure lumbar spine and pelvic posture differences between standing and sitting. METHODS: Eight male subjects were radiographed standing and sitting in an automobile seat. Measures of lumbar lordosis, intervertebral disk angles, lumbosacral angle, lumbosacral lordosis, and sacral tilt were completed. One-way analysis of variance (alpha = .05) was conducted on the variables stated above. A Bland-Altman analysis was conducted to assess agreement and repeatability of the lumbar lordosis angle using 2 raters. RESULTS: Lumbar lordosis values in standing (average, 63 degrees +/- 15 degrees ) and sacral inclination (average, 43 degrees +/- 10 degrees ) decreased by 43 degrees and 44 degrees , respectively, in sitting. Intervertebral joint angles in sitting underwent substantial flexion (L1/L2-5 degrees [+/-3 degrees ], L2/L3-7 degrees [+/-3 degrees ], L3/L4-8 degrees [+/-3 degrees ], L4/L5-13 degrees [+/-3 degrees ], and L5/S1-4 degrees [+/-10 degrees ]). Measures of lumbar lordosis; intervertebral disk angles between L2/L3, L3/L4, and L4/L5; lumbosacral lordosis; lumbosacral angle; and sacral tilt were significantly decreased between standing and sitting (P < .001). Intervertebral disk angle between L5/S1 was not significantly different. Analysis using the Bland-Altman technique found good agreement and stable repeatability of measures with no statistical significant differences between or within raters (R1, P = .8474; R2, P = .4402; and R-R2, P = .8691). CONCLUSION: The significant differences in lumbar and pelvic measures from standing to sitting further emphasize the range of motion experienced at vertebral levels in sitting. Based on the results of this study, interventions to return motion segments to a less flexed posture should be investigated because they may play a role in preventing injury and low back pain.

Intervertebral disc segmentation and volumetric reconstruction from peripheral quantitative computed tomography imaging.

An automatic system for segmenting and constructing volumetric representations of excised intervertebral discs from peripheral quantitative computed tomography (PQCT) imagery is presented. The system is designed to allow for automatic quantitative analysis of progressive herniation damage to the intervertebral discs under flexion/extension motions combined with a compressive load. Automatic segmentation and volumetric reconstruction of intervertebral disc from PQCT imagery is a very challenging problem due to factors such as streak artifacts and unclear material density separation between contrasted intervertebral disc and surrounding bone in the PQCT imagery, as well as the formation of multiple contrasted regions under axial scans. To address these factors, a novel multiscale level set approach based on the Mumford-Shah energy functional in iterative bilateral scale space is employed to segment the intervertebral disc regions from the PQCT imagery. A Delaunay triangulation is then performed based on the set of points associated with the intervertebral disc regions to construct the volumetric representation of the intervertebral disc. Experimental results show that the proposed system achieves segmentation and volumetric reconstructions of intervertebral discs with mean absolute distance error below 0.8 mm when compared to ground truth measurements. The proposed system is currently in operational use as a visualization tool for studying progressive intervertebral disc damage.

Acute histologic effects and thermal distribution profile of disc biacuplasty using a novel water-cooled bipolar electrode system in an in vivo porcine model.

BACKGROUND: Thermal treatment of the lumbar intervertebral disc has been suggested for the treatment of chronic discogenic pain. Disc biacuplasty (D-BAC) is a novel procedure that uses two water-cooled radiofrequency electrodes in a bipolar configuration to heat a large volume of the posterior annulus fibrosus. METHODS: Seven porcine lumbar discs were treated with D-BAC to assess acute effects on the treated tissue in a "worst-case"in vivo model. Intradiscal and peridiscal temperatures were measured during treatment and histologic analysis was used to assess for evidence of acute thermal injury. RESULTS: Temperature monitoring at designated safety zones outside the disc demonstrated maintenance of near-physiologic conditions while temperature in the inner posterior annulus reached 65 degrees C. Histologic sections of treated discs demonstrated no evidence of thermal damage to the dorsal root ganglia or spinal nerve roots when compared with controls. Increased coarseness of the fibrillar matrix and loss of cellular detail were noted in the nucleus pulposus of treated discs. DISCUSSION: Disc biacuplasty, in a porcine model, achieves suitable temperatures to induce thermal transition of collagen and thermoneurolysis while showing no evidence of damage to neural tissue in safety zones surrounding the disc.