New complex cell junctions in and around the intervertebral discs discovered using autoantibodies from patients affected by endemic pemphigus foliaceus in El Bagre, Colombia, South America.

BACKGROUND: Traditionally, the intervertebral disks' (IVD) nucleus pulposus (NP) and annulus fibrosus (AF) are considered to have few cellular components and cell junctions. Patients affected by a new variant of endemic pemphigus foliaceus in El Bagre, Colombia, experience back pain in the spinal areas of the lower and upper back. Here, we investigate the reactivity of the patient's autoantibodies to structures in and around the IVDs at the cellular level. METHODS: We first administered a questionnaire and performed a medical examination. We then tested for autoreactivity against IVDs by indirect immunofluorescence, confocal microscopy, and reflectance confocal microscopy using bovine and human tissues as antigen sources. We tested 45 sera from patients affected by the disease and 45 control sera from the endemic area matched by age, gender, demographics, and work activity. RESULTS: Most of the patient sera revealed polyclonal antibodies against newly discovered cell junctions in the NP and AF, including their translamellar cross-bridges. Additional reactivities were detected against cell junctions in the spinal cord neurons, paraspinal nerves, blood vessels, anterior and posterior longitudinal ligaments, and paraspinal skeletal muscles. The reactivities of the patient's autoantibodies co-localized with those of commercially available antibodies to desmoplakins I-II, armadillo repeat gene deleted in velo-cardio-facial syndrome, plakophilin-4, and myocardium-enriched zonula occludens-1-associated protein (p < 0.001). CONCLUSIONS: We discovered novel complex cell junctions in the IVDs using patients' autoantibodies. These discoveries open a new chapter in the knowledge of IVD, representing a breakthrough pertinent to many diseases.

Polyurethane as a strategy for annulus fibrosus repair and regeneration: a systematic review.

AIM: Disc herniation is a spine disease that leads to suffering and disability. Discectomy is a Janus-faced approach that relieves pain symptoms but leave the intervertebral discs predisposed to herniation. This systematic review discussed the mechanical and biological requirements for a polyurethane-based biomaterial to be used in annular repair. METHODS: Search strategy was performed in PubMed, Web of Science and Scopus databases to define the main mechanical properties, biological findings and follow-up aspects of these biomaterials. The range was limited to articles published from January 2000 to December 2017 in English language. RESULTS: The search identified 82 articles. From these, a total of 18 articles underwent a full-text analysis, and 16 studies were included in the review. CONCLUSION: The polyurethane presents suitable properties to be used as an engineered solution to re-establish the microenvironment and biomechanical features of the intervertebral disc.

Energy supply and demand in the intervertebral disc / Fornecimento e demanda de energia no disco intervertebral / Suministro de energía y demanda en el disco intervertebral

ABSTRACT The intervertebral disc (IVD) is one of the parts of the body most commonly affected by disease, and it is only recently that we have come closer to understanding the reasons for its degeneration, in which nutrient supply plays a crucial role. In this literature review, we discuss the basic principles and characteristics of energy supply and demand to the IVD. Specifically, we review how different metabolites influence IVD cell activity, the effects of mechanical loading on IVD cell metabolism, and differences in energy metabolism of the annulus fibrous and nucleus pulposus cell phenotypes. Determining the factors that influence nutrient supply and demand in the IVD will enhance our understanding of the IVD pathology, and help to elucidate new therapeutic targets for IVD degeneration treatment.

RESUMO O disco intervertebral (IVD) é uma das partes mais comuns do corpo e apenas recentemente nos aproximamos de compreender as razões da sua degeneração, em que o suprimento de nutrientes desempenha um papel crucial. Nesta revisão da literatura, discutimos os princípios básicos e as nuances do fornecimento e da demanda de energia para o IVD. Específicamente, analisamos como os diferentes metabólitos influenciam na atividade das células IVD, os efeitos da carga mecânica no metabolismo das células IVD, a diferença no metabolismo energético dos fenótipos das células fibrosas e do núcleo do pulposus anelar. A determinação de fatores que influenciam o suprimento e a demanda de nutrientes no IVD aumentará nossa compreensão da patologia IVD e ajudará a elucidar novos alvos terapêuticos para o tratamento da degeneração IVD.

RESUMEN El disco intervertebral (IVD, por sus siglas en inglés) es una de las partes más comúnmente enfermas del cuerpo y solo recientemente nos acercamos a la comprensión de los motivos de su degeneración, de los cuales el suministro de nutrientes juega un papel crucial. En esta revisión de la literatura discutimos los principios básicos y los matices de la oferta y demanda de energía para el IVD. Específicamente, revisamos cómo los diferentes metabolitos influyen en la actividad de las células IVD, los efectos de la carga mecánica sobre el metabolismo de las células IVD y las diferencias en el metabolismo energético de los fenotipos de las células del anillo fibroso y el núcleo pulposo. La determinación de los factores que influyen en la oferta y demanda de nutrientes en el IVD mejorará nuestra comprensión de la patología IVD y ayudará a dilucidar nuevos objetivos terapéuticos para el tratamiento de la degeneración IVD.

Outcomes of surgical treatment of lumbar disk herniation using an annular closure device / Desfechos do tratamento cirúrgico da hérnia de disco lombar com aparelho de fechamento anular / Resultados del tratamiento quirúrgico de la hernia de disco lumbar utilizando un dispositivo de cierre anular

ABSTRACT Objective: The aim of the study was to investigate the clinical and radiological results of using the annular closure device in patients with lumbar disc herniation (LDH). Methods: The study involved 120 patients with LDH operated on by limited discectomy and annular closure using the Barricaid device. A literature review was conducted to evaluate the effectiveness of the annuloplasty. Results: All patients showed postoperative regression of the radicular pain syndrome and were mobilized on the day of surgery. The correlation between the removed nucleus pulposus and changes in DHI was studied by linear regression. The results revealed that disc height loss is directly correlated with the volume of removed nucleus pulposus (p <0.05). Modic changes were present in 22 (22%) patients. Endplate changes (resorption and erosion) were present in 25 patients (20.7%). We found that these changes in MR and CT images have no effect on the clinical presentation of the disease. No intraoperative complications, such as severe hemorrhage requiring blood transfusion, or injury to the dura mater or nerve roots, were observed in our case series. Postoperative complications occurred in 3 (2.5%) patients. The reoperation rate was 4.2%. Conclusions: The use of the Barricaid annular closure device in 120 patients with lumbar disc herniation and high risk of recurrent herniation showed good clinical and radiographic outcomes. The reoperation rate in our study was 2.5%; disc reherniation at the operated level was observed in 1.7% of patients. This is a good outcome compared to the data reported for patients having a high risk of disc reherniation. Level of Evidence IV; Case series.

RESUMO Objetivo: O objetivo do estudo foi estudar os resultados clínicos e radiológicos do uso do dispositivo de fechamento anular em pacientes com hérnia discal lombar (HDL). Métodos: O estudo envolveu 120 pacientes com LDH operados por discectomia limitada e fechamento anular usando o dispositivo Barricaid. Uma revisão da literatura foi realizada para avaliar a eficácia da anuloplastia. Resultados: Todos os pacientes apresentaram regressão pós-operatória da síndrome da dor radicular e foram mobilizados no dia da cirurgia. A correlação entre o núcleo pulposo removido e as alterações no DHI foi estudada por regressão linear. Revelou-se que a perda de altura discal está diretamente correlacionada com o volume do núcleo pulposo removido (p <0,05). Alterações modicadas reveladas em 22 (22%) pacientes. As alterações no endplate foram reveladas em 25 pacientes (20,7%). Descobrimos que essas mudanças nas imagens de RM e TC não têm efeito sobre a apresentação clínica da doença. Não foram observadas complicações intraoperatórias, como hemorragia grave que necessitou de transfusão sanguínea, lesão da dura-máter ou raízes nervosas, em nossa casuística. Complicações pós-operatórias foram reveladas em 3 (2,5%) pacientes. A taxa de reoperação foi de 4,2%. Conclusão: O uso do dispositivo de fechamento anular Barricaid em 120 pacientes com hérnia discal lombar e alto risco de hérnia recorrente mostrou bons resultados clínicos e radiográficos. A taxa de reoperação em nosso estudo foi de 2,5%; reinteriato discal no nível operado foi observado em 1,7% dos pacientes. É um bom resultado comparado aos dados relatados para pacientes com alto risco de reintervenção com disco. Nível de evidência IV; Série de casos.

RESUMEN Objetivo: El objetivo del estudio fue estudiar los resultados clínicos y radiológicos del uso del dispositivo de cierre anular en pacientes con hernia de disco lumbar (LDH). Métodos: El estudio involucró a 120 pacientes con LDH operados por discectomía limitada y cierre anular usando el dispositivo Barricaid. Se realizó una revisión de la literatura para evaluar la efectividad de la anuloplastia. Resultados: Todos los pacientes mostraron regresión postoperatoria del síndrome de dolor radicular y se movilizaron el día de la cirugía. La correlación entre el núcleo pulposo retirado y los cambios en DHI se estudiaron mediante regresión lineal. Los resultados revelaron que la pérdida de altura del disco se correlaciona directamente con el volumen del núcleo pulposo retirado (p <0,05). Cambios módicos revelados en 22 (22%) pacientes. Los cambios de placa terminal (resorción y erosión) se revelaron en 25 pacientes (20,7%). Descubrimos que estos cambios en las imágenes de RM y TC no tienen ningún efecto sobre la presentación clínica de la enfermedad. En nuestra serie de casos no se observaron complicaciones intraoperatorias, como hemorragia severa que requiriera transfusión de sangre, lesión de la duramadre o raíces nerviosas. Las complicaciones postoperatorias se revelaron en 3 (2,5%) pacientes. La tasa de reoperación fue del 4,2%. Conclusiones: El uso del dispositivo de cierre anular Barricaid en 120 pacientes con hernia de disco lumbar y alto riesgo de hernia recurrente mostró buenos resultados clínicos y radiográficos. La tasa de reoperación en nuestro estudio fue del 2.5%; la hernia recurrente del disco en el nivel operado se observó en el 1,7% de pacientes. Es un buen resultado en comparación con los datos informados para pacientes que tienen un alto riesgo de hernia recurrente del disco. Nivel de evidencia IV; Serie de casos.