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2.
PLoS One ; 15(12): e0243861, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33315945

RESUMO

The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was created to evaluate specific treatment outcomes in terms of physical functioning, social ability, and mental health in patients with back pain-related diseases. In this study, we investigated whether the JOABPEQ could be used to construct a regression model to quantify low back pain and lower limb symptoms in patients with lumbar disc herniation (LDH). We reviewed 114 patients with LDH scheduled to undergo surgery at our hospital. We measured the degrees of 1) lower back pain, 2) lower limb pain, and 3) lower limb numbness using the visual analog scale before the surgery. All answers and physical function data were subjected to partial least squares regression analysis. The degrees of lower back and lower limb pain could be used as a regression model from the JOABPEQ and had a significant causal relationship with them. However, the degree of lower limb numbness could not be used for the same. Based on our results, the questions of the JOABPEQ can be used to multilaterally understand the degree of lower back pain and lower limb pain in patients with LDH. However, the degree of lower limb numbness has no causal relationship, so actual measurement is essential.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Dor Lombar/diagnóstico , Extremidade Inferior/patologia , Ortopedia , Sociedades Médicas , Inquéritos e Questionários , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Japão , Análise dos Mínimos Quadrados , Dor Lombar/complicações , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Escala Visual Analógica
3.
J Vet Sci ; 21(4): e52, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32735091

RESUMO

BACKGROUND: Intradural-intramedullary intervertebral disc extrusion (IIVDE) is a rare condition of intervertebral disc disease. However, the diagnosis of IIVDE is challenging because the prognosis and imaging characteristics are poorly characterized. OBJECTIVES: We aimed to describe the clinical and imaging characteristics of tentatively diagnosed IIVDE in dogs to assess the prognostic utility of neurological grade and magnetic resonance imaging (MRI) findings. METHODS: Twenty dogs were included in this retrospective cohort study. RESULTS: Nonchondrodystrophic breeds (n = 16) were more predisposed than chondrodystrophic breeds. Most dogs showed acute onset of clinical signs. Neurological examination at admission showed predominant non-ambulatory paraparesis (n = 9); paresis (n = 16) was confirmed more frequently than paralysis (n = 4). Follow-up neurological examination results were only available for 11 dogs, ten of whom showed neurological improvement and 8 showed successful outcomes at 1 month. The characteristic MRI findings include thoracic vertebra (T)2 hyperintense, T1 hypointense, intramedullary linear tracts with reduced disc volume, and cleft of the annulus fibrosus. None of the MRI measurements were significantly correlated with neurological grade at admission. Neurological grade did not differ according to the presence of parenchymal hemorrhage, parenchymal contrast enhancement, and meningeal contrast enhancement. Neurological grades at admission showed a statistical correlation with those observed at the 1-month follow-up (r = 0.814, p = 0.02). CONCLUSIONS: IIVDE is a rare form of disc extrusion commonly experienced after physical activity or trauma and most frequently affects the cranial-cervical and thoracolumbar regions of nonchondrodystrophic dog breeds. Neurological score at admission emerged as a more useful prognostic indicator than MRI findings in dogs with suspected IIVDE.


Assuntos
Doenças do Cão/diagnóstico , Degeneração do Disco Intervertebral/veterinária , Deslocamento do Disco Intervertebral/veterinária , Vértebras Torácicas/patologia , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Imagem por Ressonância Magnética/veterinária , Masculino , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem
4.
Pain Physician ; 23(4): 365-374, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709171

RESUMO

BACKGROUND: Previous meta-analyses examined only the short-term differences between lidocaine and steroids vs lidocaine alone in treating lumbar degenerative diseases. Long-term outcomes (1-2 years) in patients with lumbar disc herniation (LDH) and lumbar central spinal stenosis (LCSS) have not yet been systematically evaluated. OBJECTIVE: The objective of our study was to assess quantitatively the difference in efficacy at 1 to 2 years between lidocaine alone vs lidocaine and steroids for the management of LDH or LCSS. STUDY DESIGN: We conducted a meta-analysis. METHODS: PubMed, EMBASE, and the Cochrane library were electronically searched up to July 22, 2016, for randomized controlled trials comparing lidocaine alone vs in combination with steroids for the treatment of LDH and LCSS. Effective pain relief (EPR), Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), opioid intake (OI), and total employed increased rate (TEIR) were the endpoints. Risk ratios (RRs) or weighted mean difference (WMD) with 95% confidence intervals (CIs) were calculated, and the pooled analysis was conducted using RevMan 5.2. RESULTS: Seven trials were included. EPR was not significantly different at 1 and 2 years, with RR = 1.08 (95% CI, 0.90-1.30; P = .39) and RR = 1.04 (95% CI, 0.92-1.18; P = .51), respectively, in patients treated with lidocaine alone vs in combination with steroids. The NRS-11 was also similar at 1 and 2 years. ODI and OI were not significantly different at 1 and 2 years. A similar TEIR effect was also observed for the 2 treatments. LIMITATIONS: This meta-analysis relied on a small sample size of trials. Significant heterogeneity among studies was observed. Several significant differences in terms of age of the patients were reported in one included trial. CONCLUSION: This meta-analysis confirmed the similar effects associated with lidocaine alone vs in combination with steroids for the management of LDH and LCSS. Studies with longer follow-up periods are still recommended. KEY WORDS: Effective pain relief, lidocaine, long-term, lumbar central spinal stenosis, lumbar disc herniation, Numeric Rating Scale, opioid intake, Oswestry Disability Index, steroids, total employed increased rate.


Assuntos
Degeneração do Disco Intervertebral/tratamento farmacológico , Deslocamento do Disco Intervertebral/tratamento farmacológico , Lidocaína/administração & dosagem , Vértebras Lombares , Manejo da Dor/métodos , Estenose Espinal/tratamento farmacológico , Esteroides/administração & dosagem , Anestésicos Locais/administração & dosagem , Ensaios Clínicos como Assunto/métodos , Quimioterapia Combinada , Feminino , Humanos , Injeções Epidurais/métodos , Injeções Epidurais/tendências , Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Manejo da Dor/tendências , Estenose Espinal/diagnóstico , Esteroides/uso terapêutico , Resultado do Tratamento
5.
Acta Orthop Traumatol Turc ; 54(3): 287-292, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32544064

RESUMO

OBJECTIVE: The aim of this study was to detect the relationship between the development of Schmorl's nodes (SNs) and bone mineral density (BMD) in young patients. METHODS: Computerized tomography (CT) images of the thoracolumbar vertebral column were retrospectively examined by two experienced radiologists for SNs. The diagnostic criterion for SN was defined as a node size larger than one-third but not more than two-thirds of the relevant vertebral endplate. Considering the eligibility criteria, a total of 74 individuals (60 males and 14 females; mean age: 24.3 years; age range: 18-40 years) with SN at the thoracolumbar vertebrae were included in the patient group, and a total of 38 age- and gender-matched individuals (30 males and 8 females; mean age: 25 years) with no evidence of SN were included in the control group. All these individuals were younger than 40 years. In the patient group, SNs were assessed in terms of the distribution of the thoracolumbar vertebrae, the location of the upper and lower endplates, and the total number of lesions. In all individuals included in the study, BMD was measured from the axial CT sections by quantitative CT and then compared between the two groups. RESULTS: The distribution of age and gender was comparable between the two groups (p=0.438). A total of 208 SNs were identified in the patient group. Of these, 92 (44%) were located at the thoracic vertebrae and 116 (56%) at the lumbar vertebrae. The mean BMD was 131.6 g/cm3 in the patient group and 140.7 g/cm3 in the control group (p=0.03). There was no significant relationship between the total number of SNs per patient and the mean BMD (p=0.156). CONCLUSION: Evidence from this study revealed that low BMD may be a predisposing factor for the development of SNs in patients younger than 40 years. LEVEL OF EVIDENCE: Level III, Diagnostic Study.


Assuntos
Densidade Óssea , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Vértebras Lombares , Vértebras Torácicas , Adulto , Causalidade , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Tomografia Computadorizada por Raios X/métodos
6.
Clin Immunol ; 214: 108390, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32200113

RESUMO

Psoriatic arthritis (PsA) is a chronic heterogeneous inflammatory musculoskeletal disease. The non-specific and often subtle manifestations make early diagnosis and subsequent treatment challenging. In the absence of diagnostic criteria and biomarkers, the diagnosis is often delayed leading to poor long-term outcomes. In addition, the differential diagnosis of a patient presenting with arthritis in the setting of skin psoriasis is wide due to symptom overlap with many other diseases. Peripheral arthritis, dactylitis, enthesitis and axial arthritis are the 4 domains of musculoskeletal involvement in PsA and careful examination of each domain by a rheumatologist is the first step for a correct diagnosis. Other extra-musculoskeletal features such as the presence of uveitis, inflammatory bowel disease, nail psoriasis and elevated acute phase reactants aid in the diagnosis of PsA. Screening patients with skin psoriasis using validated questionnaires might help in early diagnosis especially when coupled with imaging.


Assuntos
Artrite Psoriásica/diagnóstico , Artrite Psoriásica/complicações , Artrite Psoriásica/diagnóstico por imagem , Dor nas Costas/etiologia , Biomarcadores , Diagnóstico Diferencial , Progressão da Doença , Entesopatia/etiologia , Dedos/patologia , Gota/diagnóstico , Humanos , Hiperostose/diagnóstico , Doenças Inflamatórias Intestinais/complicações , Degeneração do Disco Intervertebral/diagnóstico , Articulações/diagnóstico por imagem , MicroRNAs/sangue , Doenças da Unha/etiologia , Osteoartrite/diagnóstico , Inquéritos e Questionários , Sinovite/etiologia , Dedos do Pé/patologia , Ultrassonografia , Uveíte/etiologia
7.
BMC Musculoskelet Disord ; 21(1): 77, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024487

RESUMO

BACKGROUND: The leptin receptor-deficient knockout (db/db) mouse is a well-established model for studying type II diabetes mellitus (T2DM). T2DM is an important risk factor of intervertebral disc degeneration (IVDD). Although the relationship between type I diabetes and IVDD has been reported by many studies, few studies have reported the effects of T2DM on IVDD in db/db mice model. METHODS: Mice were separated into 3 groups: wild-type (WT), db/db, and IGF-1 groups (leptin receptor-deficient mice were treated with insulin-like growth factor-1 (IGF-1). To observe the effects of T2DM and glucose-lowering treatment on IVDD, IGF-1 injection was used. The IVD phenotype was detected by H&E and safranin O fast green staining among db/db, WT and IGF-1 mice. The levels of blood glucose and weight in mice were also recorded. The changes in the mass of the trabecular bone in the fifth lumbar vertebra were documented by micro-computed tomography (micro-CT). Tunnel assays were used to detect cell apoptosis in each group. RESULTS: The weight of the mice were 27.68 ± 1.6 g in WT group, which was less than 57.56 ± 4.8 g in db/db group, and 52.17 ± 3.7 g in IGF-1 injected group (P < 0.05). The blood glucose levels were also significantly higher in the db/db mice group. T2DM caused by leptin receptor knockout showed an association with significantly decreased vertebral bone mass and increased IVDD when compared to WT mice. The db/db mice induced by leptin deletion showed a higher percentage of MMP3 expression as well as cell apoptosis in IVDD mice than WT mice (P < 0.05), while IGF-1 treatment reversed this situation (P < 0.05). CONCLUSIONS: T2DM induced by leptin receptor knockout led to IVDD by increasing the levels of MMP3 and promoting cell apoptosis. IGF-1 treatment partially rescue the phenotype of IVDD induced by leptin receptor knockout.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Fator de Crescimento Insulin-Like I/administração & dosagem , Degeneração do Disco Intervertebral/etiologia , Receptores para Leptina/deficiência , Animais , Apoptose , Glicemia/análise , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/genética , Modelos Animais de Doenças , Humanos , Disco Intervertebral/citologia , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/sangue , Degeneração do Disco Intervertebral/diagnóstico , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Camundongos , Camundongos Knockout , Receptores para Leptina/genética , Proteínas Recombinantes/administração & dosagem , Fatores de Risco , Microtomografia por Raio-X
8.
BMC Musculoskelet Disord ; 21(1): 72, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32019544

RESUMO

BACKGROUND: Lumbar spinal disease causes disabilities in performing daily activities. Operative treatments are aimed at pain relief and rapid return to routine activity. Patient-based outcome measures are used to evaluate pathologies and therapeutic effects associated with lumbar spinal disease. Nevertheless, it remains unknown as to how much such treatment improves activity levels. The purpose of the current study was to measure changes in activity levels before and after lumbar spinal surgery using a wearable activity tracker and to analyze the differences between results and patient-based outcomes. METHODS: Sixty patients who underwent lumbar surgery were studied. The physical activity of participants was objectively evaluated using a wearable Micro-Motion logger system (Actigraph). We measured the amount of activity before and at 1, 3, 6, and 12 months after the surgery to evaluate postoperative changes. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, Oswestry Disability Index, Roland-Morris Disability Questionnaire and visual analog scale were used to assess patient-based outcomes of pain and activities of daily living-related scores; we analyzed the relationships between scores and actual activity levels. RESULTS: The amount of actual activity decreased significantly 1 month after the surgery compared to that during the preoperative period, which then improved after 3 months postoperatively (p < 0.01). Furthermore, there was a significant improvement 6 months after the surgery compared to that during the preoperative period (p < 0.05). The changes in activity for each period were strongly correlated, regardless of the period. In contrast, a significant improvement was observed at 1 month after the surgery in almost all items of the patient-based questionnaires (p < 0.05). CONCLUSIONS: The objective activity tracker demonstrated that lumbar surgery results in the amount of activity decreasing 1 month just after surgery followed by gradual postoperative recovery within 3 months. By contrast, patient-based outcomes showed improvement in 1 month that was significantly different from the change in actual activity, indicating a gap between patient-oriented clinical scores and their actual activities.


Assuntos
Atividades Cotidianas , Descompressão Cirúrgica , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Dor Lombar/cirurgia , Recuperação de Função Fisiológica , Fusão Vertebral , Acelerometria/instrumentação , Acelerometria/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Monitores de Aptidão Física , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/patologia , Dor Lombar/etiologia , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Estudos Prospectivos , Autorrelato/estatística & dados numéricos , Resultado do Tratamento
9.
PLoS One ; 15(2): e0227894, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32101549

RESUMO

OBJECTIVE: Based on the theoretical basis of Gabor wavelet transformation, the application effects of feature extraction algorithm in Magnetic Resonance Imaging (MRI) and the role of feature extraction algorithm in the diagnosis of lumbar vertebra degenerative diseases were explored. METHOD: The structure of lumbar vertebra and degenerative changes were respectively introduced to clarify the onset mechanism and pathological changes of lumbar vertebra degenerative changes. Most importantly, the theoretical basis of Gabor wavelet transformation and the extraction effect of feature information in lumbar vertebra MRI images were introduced. The differentiation effects of feature information extraction algorithm on annulus fibrosus and nucleus pulposus were analyzed. In this study, the data of lumbar spine MRI was randomly selected from the Wenzhou Lumbar Spine Research Database as research objects. A total of 130 discs were successfully fitted, and 109 images were graded by a doctor after observation, which was compared with the results of the artificial diagnosis. Through the comparison with the results of observation and diagnosis by professional doctors, the accuracy of feature extraction algorithm based on Gabor wavelet transformation in the diagnosis of lumbar vertebra degenerative changes was analyzed. RESULTS: 1. Compared with the results of the manual diagnosis, the accuracy of the classification method was 88.3%. In addition, the specificity (SPE), accuracy (ACC), and sensitivity (SEN) of the classification method were respectively 89.5%, 92.4%, and 87.6%. 2. The mutual information method and the KLT algorithm were utilized for vertebral body tracking. The maximum mutual information method was more effective in the case of fewer image sequences; however, with the increase of image frames, the accumulation of errors would make the tracking effects of images get worse. Based on the KLT algorithm, the enhanced vertebral boundary information was selected; the soft tissues showed in the obtained images were smooth, the boundary information of vertebral body was enhanced, and the results were more accurate. CONCLUSION: The feature extraction algorithm based on Gabor wavelet transformation could easily and quickly realize the localization of the lumbar intervertebral disc, and the accuracy of the results was ensured. In addition, from the aspect of vertebral body tracking, the tracking effects based on the KLT algorithm were better and faster than those based on the maximum mutual information method.


Assuntos
Algoritmos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/diagnóstico , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Análise de Ondaletas , Anel Fibroso/diagnóstico por imagem , Anel Fibroso/patologia , Humanos , Imagem por Ressonância Magnética , Núcleo Pulposo/diagnóstico por imagem , Núcleo Pulposo/patologia
10.
Eur Radiol ; 30(4): 2270-2279, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31900693

RESUMO

OBJECTIVES: Radiating pain in degenerative scoliosis is primary indication for surgery. However, axial and sagittal MR images are limited for identifying nerve root compromise. Therefore, we aimed to assess the value of coronal images for evaluating nerve root compromise in degenerative scoliosis. METHODS: Forty-six patients (mean 70 years; range 41-91 years; 8 men) with degenerative scoliosis were enrolled. Coronal images were added to routine MRI. Two radiologists independently reviewed 350 nerve roots in two MRI sets: sagittal images alone (set 1) and coronal and sagittal images combined (set 2). The following features were evaluated: interpedicular height, lateral osteophyte, asymmetric bulging disc, lateral listhesis, anterolisthesis, axial rotation angle, facet arthrosis, ligamentum flavum thickening, and pseudoarticulation. Symptomatic levels were determined by transforaminal selective nerve root block. RESULTS: There were 80 symptomatic and 270 asymptomatic nerve roots. The sensitivity (86%) and accuracy (93%) of set 2 were significantly higher than set 1 (53% and 87%) for radiculopathy, while specificity was similar between two sets (set 1, 97%; set 2, 95%). The AUC was significantly different between two sets (set 1, 0.853; set 2, 0.942). The negative interpedicular height difference, longer lateral osteophyte, asymmetric bulging disc, lateral listhesis, negative axial rotation angle difference, and pseudoarticulation were associated with change of grades between set 1 and set 2. CONCLUSION: Coronal images are helpful for diagnosing nerve root compromise in patients with degenerative scoliosis. KEY POINTS: • Sagittal and axial images have low sensitivity for detection of extraforaminal nerve root compromise in degenerative scoliosis. • Addition of coronal images may improve the sensitivity in nerve root compromise. • The structural changes that may contribute to nerve root compromise can also be easily assessed with coronal images.


Assuntos
Degeneração do Disco Intervertebral/complicações , Vértebras Lombares , Imagem por Ressonância Magnética/métodos , Radiculopatia/diagnóstico , Escoliose/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Masculino , Pessoa de Meia-Idade , Radiculopatia/etiologia , Escoliose/complicações
11.
Spine (Phila Pa 1976) ; 45(11): E616-E623, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31923126

RESUMO

STUDY DESIGN: Meta-analysis to collect relevant studies to assess the association between COL11A1 and GDF5 genetic variants and susceptibility to IDD. OBJECTIVE: The aim of this study was to assess whether or not COL11A1 and GDF5 genetic variants were associated with susceptibility to IDD. SUMMARY OF BACKGROUND DATA: IDD or LDH is a major public health problem. There have been several studies evaluating the relationship between COL11A1 and GDF5 genetic variants with risk of intervertebral disc degeneration (IDD). However, the studies were limited in discrete outcome and sample size, and some of the results were contradictory. METHODS: We systematically searched the relevant publications in electronic databases. Eligible studies were included based on the defined criteria. The pooled odds ratios (ORs) with its 95% confidence intervals (CIs) were received using STATA 15. Subgroup analysis, sensitivity analysis, publication bias, and the "Trim and fill" method were performed in the meta-analysis. RESULTS: A total of 3287 IDD cases and 5115 controls were incorporated into the meta-analysis. Our results demonstrated that COL11A1 rs1676486 was significantly associated with increased IDD susceptibility under all genetic models (allele model T vs. C: OR = 1.40, 95% CI 1.23-1.59, P = 0.000; homozygote model TT vs. CC: OR = 1.89, 95%CI 1.40-2.56, P = 0.000; dominant model TT+TC vs. CC: OR = 1.52, 95% CI 1.29-1.80, P = 0.000; recessive model TT vs. TC + CC: OR = 1.58, 95% CI 1.18-2.12, P = 0.002). However, GDF5 rs143383 was not (allele model T vs. C: OR = 1.15, 95% CI 0.91-1.44, P = 0.244; homozygote model TT vs. CC: OR = 1.22, 95% CI 0.75-2.00, P = 0.429; dominant model TT vs. CC+CT: OR = 1.22, 95% CI 0.95-1.57, P = 0.112; recessive model TC + TT vs. CC: OR = 1.12, 95% CI 0.73-1.73, P = 0.594). Subgroup analysis indicated ethnicity was not the source of heterogeneity. Sensitivity analysis, publication bias, and the "Trim and fill" method demonstrated the meta-analysis was of reliability. CONCLUSION: Our results suggested that COL11A1 rs1676486 was significantly associated with IDD and the T allele was a risky factor. However, GDF5 rs143383 was not. LEVEL OF EVIDENCE: 1.


Assuntos
Colágeno Tipo XI/genética , Predisposição Genética para Doença/genética , Variação Genética/genética , Fator 5 de Diferenciação de Crescimento/genética , Degeneração do Disco Intervertebral/genética , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Polimorfismo de Nucleotídeo Único/genética , Reprodutibilidade dos Testes , Fatores de Risco
12.
Spine (Phila Pa 1976) ; 45(9): E499-E507, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31770330

RESUMO

MINI: Circulating microRNAs provide an insight into current disease states. Comparing patients with degenerative disc disease to healthy controls, patients with disc disease were found to have significantly downregulated levels of miR-155-5p. This marker was found to be an accurate diagnostic predictor for the presence of degeneration (P = 0.006). STUDY DESIGN: Case-control study measuring differential gene expression of circulating microRNA (miRNA) in patients with degenerative disc disease (DDD). OBJECTIVE: To identify miRNA dysregulation in serum samples of patients with DDD compared to healthy controls (HC). SUMMARY OF BACKGROUND DATA: Early DDD can be a difficult diagnosis to make clinically, with lack of positive and specific findings on physical exam or advanced imaging. miRNAs are a class of molecules that act as gene regulators and have been shown to be dysregulated in local degenerative disc tissue. However, to date no studies have identified dysregulation of serum miRNA in patients with DDD. METHODS: Whole blood samples were obtained from 69 patients with DDD and 16 HC. Patient-reported outcomes were collected preoperatively and degree of DDD was classified using Pfirrmann grade on preoperative imaging. Differential gene expression analysis using a screening assay for several hundred miRNAs and further characterization for five specific miRNAs (miR-16-5p, miR-21-5p, miR-142-3p, miR-146a-5p, and miR-155-5p) was performed. In addition, a pro-inflammatory cytokine multiplex assay and bioinformatics analysis were done. RESULTS: The initial screening assay showed 13 miRNA molecules that were significantly dysregulated in DDD patients, with miR-155-5p showing significant downregulation (p = 0.027) and direct interactions with the pro-inflammatory cytokine IL-1ß, and the tumor suppressor genes p53 and BRAF. Analyzing the whole cohort, miR-155 showed an almost four-fold downregulation in DDD patients (-3.94-fold, P < 0.001) and was the sole miRNA that accurately predicted the presence of disc degeneration (P = 0.006). Downregulation of miR-155 also correlated with increased leg pain (P = 0.018), DDD (P = 0.006), and higher Pfirrmann grade (P = 0.039). On cytokine analysis, TNF-α (0.025) and IL-6 (P < 0.001) were significantly higher in DDD patients. CONCLUSION: Serum miR-155-5p is significantly downregulated in patients with DDD and may be a diagnostic marker for degenerative spinal disease. LEVEL OF EVIDENCE: N/A.


Assuntos
Degeneração do Disco Intervertebral/sangue , Degeneração do Disco Intervertebral/genética , Vértebras Lombares , MicroRNAs/sangue , MicroRNAs/genética , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
World Neurosurg ; 134: 540-543, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31786381

RESUMO

BACKGROUND: Intradural disk herniation (IDH) is defined as the displacement of the intervertebral disk nucleus pulposus into the dural sac. In this lumbar lesion, the affected level differs from that of a traditional extradural herniation: 55% of cases occur at the level of L4-5, 16% at L3-4, and 10% at L5-S1. Upper lumbar IDH is extremely rare. We present a case of an IDH at the level of L2-3 that was diagnosed during endoscopic surgery. CASE DESCRIPTION: A 65-year-old male patient presented with severe radiating pain in the anterior right thigh that was accompanied by a tingling sensation in the right calf and difficulty in walking. Physical examination showed normal strength. Bladder and bowel function was normal, but mild hypesthesia of the L3 sensory dermatome was observed. Magnetic resonance imaging revealed a herniated disk at the level of L2-L3 that was compressing the right side of the dura. A percutaneous transforaminal endoscopic lumbar diskectomy was planned. After foraminoplasty, no ruptured disk fragments could be found. During dissection of the adhesion between the dura and protruded disk, the dura was torn. Interestingly, through this dural opening, multiple fragmented disk portions were visualized among the nerve rootlets. We removed some of the soft disk material; however, complete removal of the disk fragments was predicted to damage the rootlets, and we decided to convert to microscopic surgery. The disk fragments were successfully removed via durotomy under microscopic assistance. The incised dorsal dura was primarily sutured with continuous stitches, and the defect on the ventrolateral side of the dura was patched and sealed using a harvested inner ligamentum flavum and Gelfoam (Pfizer, New York, New York, USA). After the operation, the patient's symptoms improved. There was no cerebrospinal fluid leakage. CONCLUSIONS: If there is any preoperative clinical or radiologic suspicion of IDH, a microscopic surgical approach should be considered to be the first-line option, as this is a safe and effective method for achieving IDH removal and dura repair without a postoperative neurologic deficit. Even during endoscopic surgery, if the surgeon expects even minor complications, we suggest converting to open surgery. In addition, the adequate sealing of the dura may be sufficient to prevent cerebrospinal fluid leakage, without the need for dural suture and lumbar drainage.


Assuntos
Dura-Máter/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Idoso , Discotomia Percutânea/métodos , Endoscopia/métodos , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Região Lombossacral/cirurgia , Imagem por Ressonância Magnética , Masculino
14.
JAAPA ; 32(12): 14-20, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31714344

RESUMO

Low back pain in adolescents is a common complaint in primary care. With an average prevalence rate of 40%, adolescent low back pain correlates with greater healthcare use, higher incidences of adult back pain, and negative effects on overall well-being. A thorough history and physical examination can increase early detection and accurate diagnosis while ensuring the judicious use of diagnostic modalities. Although underlying serious pathology is rare in adolescents with low back pain, clinicians should recognize specific signs and symptoms that necessitate urgent evaluation and intervention. This article emphasizes the value of using a thorough history and physical examination to guide the initial diagnostic workup and to enhance the early detection and accurate diagnosis of adolescents who present with low back pain.


Assuntos
Dor Lombar/diagnóstico , Anamnese , Exame Físico , Adolescente , Criança , Diagnóstico Diferencial , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Oncologia , Ortopedia , Radiografia , Encaminhamento e Consulta , Reumatologia , Sarcoma de Ewing/complicações , Sarcoma de Ewing/diagnóstico , Escoliose/complicações , Escoliose/diagnóstico , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico , Espondilolistese/complicações , Espondilolistese/diagnóstico , Espondilólise/complicações , Espondilólise/diagnóstico , Entorses e Distensões/complicações , Entorses e Distensões/diagnóstico , Adulto Jovem
15.
Artigo em Russo | MEDLINE | ID: mdl-31626184

RESUMO

In 2018, the World Health Organization introduced a new version of the International Classification of Diseases (ICD-11), which is preliminary and introductory in nature and will come into force on 1 January 2022. One of the most changed sections compared to ICD-10 is the section characterizing the spine pain syndrome and other manifestations of discogenic pathology. The article describes the terms and codes for the degenerative lesion of the intervertebral disk (IVD) in accordance with the requirements of ICD-11, which also agree with the definitions of the 2nd revision of the nomenclature and classification of the pathology of the lumbar IVD from 2014. The basic concepts of IVD degenerative changes are also revealed. The need to create a new revision of the domestic clinical classification of vertebrogenic neurologic pathology adapted to ICD-11 codes is underlined.


Assuntos
Classificação Internacional de Doenças , Degeneração do Disco Intervertebral , Disco Intervertebral , Dor nas Costas , Humanos , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/classificação , Degeneração do Disco Intervertebral/diagnóstico , Região Lombossacral
16.
Einstein (Sao Paulo) ; 17(4): eAO4637, 2019 Aug 29.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31482941

RESUMO

OBJECTIVE: To evaluate intervertebral disc levels of inflammatory factor (interleukin 6) and proteinase activity (cathepsin B) in patients with a degenerative disease and serum levels of interleukin 6, serum cathepsin B activity and hyaluronic acid biomarkers. METHODS: We conducted immunohistochemistry studies of intervertebral discs to analyze interleukin 6 and cathepsin B levels of patients with degenerative disease and spine fracture (Control Group) and to measure hyaluronic acid, interleukin 6 and cathepsin B activity from sera of intervertebral disc degeneration patients, fracture patients, and healthy individuals. RESULTS: Interleukin 6 and cathepsin B seem to be related with physiopathology of intervertebral disc degeneration, since the levels of both were higher in discs of patients with intervertebral disc degeneration. Interleukin 6 and cathepsin B do not represent good biomarkers of degenerative intervertebral disc disease, since the level of such compounds is increased in the plasma of patients with fractures. CONCLUSION: Hyaluronic acid can be a biomarker for intervertebral disc degeneration, because hyaluronic acid levels were higher only in sera of patients with intervertebral disc degeneration.


Assuntos
Adjuvantes Imunológicos/sangue , Biomarcadores/sangue , Catepsina B/sangue , Ácido Hialurônico/sangue , Interleucina-6/sangue , Degeneração do Disco Intervertebral/diagnóstico , Adulto , Análise de Variância , Estudos de Casos e Controles , Feminino , Humanos , Imuno-Histoquímica , Mediadores da Inflamação/sangue , Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/sangue , Degeneração do Disco Intervertebral/fisiopatologia , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade
17.
Arthritis Res Ther ; 21(1): 201, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481088

RESUMO

BACKGROUND: Intervertebral disc degeneration (IDD) has a complicated and enigmatic pathogenic process. Accumulating evidence shows that long non-coding RNAs (LncRNAs) play a role in the pathogenesis of IDD. This study aimed to investigate the expression and role of the LncRNA HOTAIR in IDD pathogenesis. METHODS: Nucleus pulposus (NP) tissue samples from 10 patients with idiopathic scoliosis and 10 patients with lumbar disc herniation were collected. qRT-PCR was used to assess the expression of HOTAIR and ECM-related genes; western blotting was used to detect the expression of senescence biomarkers, apoptosis-related proteins, and Wnt/ß-catenin pathway; flow cytometry was used to detect apoptosis; and the MTT assay was used to determine cell proliferation. Moreover, a classic needle-punctured rat tail model was used to investigate the role of HOTAIR in IDD in vivo. RESULTS: The results showed that the expression of HOTAIR significantly increased during IDD progression. The overexpression of HOTAIR was found to induce nucleus pulposus (NP) cell senescence, apoptosis, and extracellular matrix (ECM) degradation. HOTAIR silencing by RNA interference in NP cells prevented interleukin-1ß-induced NP cell senescence, apoptosis, and ECM degradation. Furthermore, we found that the Wnt/ß-catenin pathway played a role in regulating HOTAIR to induce these changes in NP cells. Moreover, HOTAIR inhibition in a rat model effectively attenuated IDD symptoms in vivo. CONCLUSIONS: Our findings confirmed that HOTAIR promoted NP cell senescence, apoptosis, and ECM degradation via the activation of the Wnt/ß-catenin pathway, while silencing HOTAIR attenuated this degeneration process, indicating a potential therapeutic target against IDD.


Assuntos
Regulação da Expressão Gênica , Degeneração do Disco Intervertebral/genética , RNA Longo não Codificante/genética , RNA/genética , Vértebras Torácicas/diagnóstico por imagem , Adolescente , Adulto , Apoptose , Western Blotting , Proliferação de Células , Células Cultivadas , Feminino , Citometria de Fluxo , Humanos , Imuno-Histoquímica , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/metabolismo , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Adulto Jovem
18.
Vet Pathol ; 56(6): 895-902, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31526126

RESUMO

Chondrodystrophy results in predictable and progressive biochemical and structural changes to the intervertebral disc, resulting in early onset degeneration and dystrophic mineralization of the disc. Accelerated degeneration and mineralization of the intervertebral disc are common in multiple dog breeds and can result in compromised function, herniation, pain, and a variety of neurological sequelae. A mutation responsible for chondrodystrophy in dogs has been identified as an aberrant fibroblast growth factor 4 (FGF4) retrogene insertion on chromosome 12 (CFA12) and is associated with short stature of the Nova Scotia Duck Tolling Retriever. Segregation of the CFA12 FGF4 retrogene in this dog breed provides an opportunity to examine the effect of retrogene presence on radiographic and histologic appearance of chondrodystrophic disc degeneration within a single breed. Here we found that in the intervertebral discs isolated from 2 dogs with the CFA12 FGF4 genotype, the nucleus pulposus was largely replaced by cartilaginous tissue, and physaliferous notochordal cells were rarely if ever identified. These findings are in contrast to the normal histologic findings in 2 breed-matched dogs lacking the mutation. The findings are consistent with premature chondroid degeneration of the intervertebral disc and suggest that the presence of the CFA12 FGF4 retrogene is sufficient to cause the chondrodystrophic phenotype.


Assuntos
Doenças das Cartilagens/veterinária , Doenças do Cão/patologia , Fator 4 de Crescimento de Fibroblastos/genética , Degeneração do Disco Intervertebral/veterinária , Animais , Doenças das Cartilagens/diagnóstico , Doenças das Cartilagens/genética , Doenças das Cartilagens/patologia , Doenças do Cão/diagnóstico , Doenças do Cão/genética , Cães , Genótipo , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/genética , Degeneração do Disco Intervertebral/patologia , Fenótipo
19.
BMC Musculoskelet Disord ; 20(1): 414, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488112

RESUMO

BACKGROUND: Chronic low back pain (LBP) is common and associated with lumbar disc herniation. The purpose of this study was to investigate if the grade of lumbar disc degeneration correlates with the degree of lumbar multifidus muscle (LMM) fatty atrophy. METHODS: A retrospective analysis on 16 males and 19 females with chronic LBP and a mean age of 47.2 years. Using MRI, the grade of lumbar intervertebral discs degeneration was assessed according to the Pfirrmann classification at L4/L5 and L5/S1 levels. Fatty infiltration of the LMM was graded as normal, mild, moderate and severe. Adobe Photoshop CS6 was used for qualitative image analysis by measuring the Cross-sectional area (CSA) of the pure fat component of LMM. RESULTS: There was a low correlation (R = 0.37) and significant association (ANOVA, p = 0.001, 95% CI 2.07-8.14) between the grade of lumbar disc degeneration and the degree of LMM fatty atrophy. Mean value of intervertebral disc degeneration was 2.9 for the L4/L5 level and 3.2 for L5/S1 respectively. The percentage of fat infiltration of the LMM at both studied levels showed a mean value of 22.91+/- 13.19% for L4/L5 and a higher mean value of 26.37+/- 12.89% for L5/S1. There were higher fatty atrophy scores in women and more disc degeneration in men. CONCLUSION: The percentage of LMM atrophy is higher in the lower levels (L5/S1) and shows a low correlation with the grade of disc degeneration.


Assuntos
Dor Crônica/etiologia , Degeneração do Disco Intervertebral/complicações , Dor Lombar/etiologia , Atrofia Muscular/complicações , Músculos Paraespinais/patologia , Adulto , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/diagnóstico , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Atrofia Muscular/diagnóstico , Atrofia Muscular/patologia , Músculos Paraespinais/diagnóstico por imagem , Estudos Retrospectivos , Índice de Gravidade de Doença
20.
Biotech Histochem ; 94(7): 540-545, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31537133

RESUMO

Interleukin-23 (IL-23, IL-23p19) is a proinflammatory cytokine in the IL-12-related family. Although inflammatory cells in herniated discs have been shown to contain IL-23, little is known about the presence and role of IL-23 in human disc cells. We analyzed disc specimens for IL-23 localization using immunohistochemistry in control, herniated and non-herniated discs from which annulus fibrosus (annulus) cells were isolated and cultured to identify IL-23 gene expression and production. Microarray analysis was used to assess the expression of IL-23 in disc tissue and in cells exposed to two proinflammatory cytokines, IL-1ß and TNF-α. IL-23 was present in annulus cells at the protein level and its expression was up-regulated significantly in herniated compared to control disc tissue. Direct measurement of medium components confirmed production of IL-23 and its receptor, IL-23R, by annulus cells in vitro. Annulus cells in three-dimensional culture exposed to TNF-α, but not IL-1ß, resulted in significant up-regulation of IL-23 expression compared to control cells. Our findings are evidence for the constitutive presence of IL-23 in the human disc and that its expression in vitro is modified by exposure to TNF-α.


Assuntos
Subunidade p19 da Interleucina-23/metabolismo , Degeneração do Disco Intervertebral/metabolismo , Deslocamento do Disco Intervertebral/metabolismo , Disco Intervertebral/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Anel Fibroso/metabolismo , Células Cultivadas , Citocinas/metabolismo , Expressão Gênica/fisiologia , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Regulação para Cima
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