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1.
Bratisl Lek Listy ; 121(2): 137-142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32115967

RESUMO

AIM: The aim of this work was to investigate the effects of Impedance Therapy (IT) in the treatment of degenerative disc disease (DDD) by confirming the presence of the "disc grow-up" (DGU) phenomenon. METHOD: The set consisted of 55 patients with DDD with the average age of 51.3 years divided into two groups - the experimental group and the control group. The experimental group consisted of 29 patients with the average age of 56.7 years. The control group consisted of 26 patients with the average age of 45.8 years. RESULTS: In the experimental group of patients with DDD, who received IT, the DGU phenomenon with a success rate of 76 % was observed, with the average increase in the volume of the intervertebral disc of 31 % (p < 0.000). In the control group of patients receiving the standard electrotherapy, the DGU phenomenon was not proven - the DDD progressed normally with the mean volume reduction of 15 %       (p < 0.000). CONCLUSIONS: Degenerative disc disease, as a disease of modern civilization, is treatable. It can be concluded that the theory that degenerative disc changes are irreversible was disproven by the impact of impedance therapy (Tab. 5, Ref. 14).


Assuntos
Impedância Elétrica , Degeneração do Disco Intervertebral , Disco Intervertebral , Humanos , Degeneração do Disco Intervertebral/terapia , Vértebras Lombares , Pessoa de Meia-Idade
2.
Medicine (Baltimore) ; 99(9): e19280, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118739

RESUMO

BACKGROUND: Lumbar disc herniation (LDH) is a disease commonly seen in clinical practice. In the majority of such patients presenting in clinic, the symptoms can be relieved or even abolished after non-surgical treatment. Floating needle therapy has attracted considerable attention as a promising non-surgical technique to treat LDH, as demonstrated in previous studies. The purpose of the present study was to evaluate the outcomes of patients treated using this therapy in a single blind and randomized controlled trial by recording patient report questionnaires and objective test data, and to explore the feasibility and preliminary effects of floating needle therapy for patients with LDH. METHODS: A total of 80 patients who fulfilled the inclusion criteria were randomly divided into a Fu's subcutaneous needling (FSN) group and an acupuncture group then treated in accordance with procedures appropriate for a single blind and randomized controlled trial. The FSN group received 12 FSN therapy sessions over a 3-week period, and the acupuncture group received acupuncture therapy at specified points using acupuncture needles. The principal measurements were scored using the visual analogue scale (VAS), Japanese Orthopedic Association (JOA) Score, and Oswestry disability index (ODI) before and 3 weeks after treatment. Secondary measurements included immune function IgG and IgM measurements performed at the same time and adverse reactions during treatment. RESULTS: The results of this trial will be published on the website of China Clinical Trial Registration Center (http://www.chictr.org.cn/searchprojen.aspx) and in peer-reviewed journals or academic conferences. CONCLUSIONS: This study will explore the feasibility and preliminary effects of floating needle therapy for the treatment of patients with LDH. REGISTRATION: PROSPERO (registration number ChiCTR1900024045).


Assuntos
Terapia por Acupuntura , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Dor Intratável/terapia , Adulto , Idoso , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Degeneração do Disco Intervertebral/sangue , Deslocamento do Disco Intervertebral/sangue , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Projetos de Pesquisa , Método Simples-Cego , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
3.
Spine (Phila Pa 1976) ; 44(23): 1613-1622, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31730570

RESUMO

STUDY DESIGN: Experimental study with human mesenchymal stem cells (MSCs) and intervertebral disc (IVD) tissue samples. OBJECTIVE: This study aimed to characterize the effect of MSC homing on the Tie2-positive IVD progenitor cell population, IVD cell survival, and proliferation. SUMMARY OF BACKGROUND DATA: Homing of human MSCs has been described as potential alternative to MSC injection, aiming to enhance the regenerative capacity of the IVD. IVD cells expressing Tie2 (also known as CD202b or Angiopoietin-1 receptor TEK tyrosine kinase) represent a progenitor cell population with discogenic differentiation potential. However, the fraction of Tie2-positive progenitor cells decreases with aging and degree of IVD degeneration, resulting in a potential loss of the IVD's regenerative capacity. METHODS: Human MSCs, isolated from vertebral bone marrow aspirates, were labeled and seeded onto the endplate of bovine IVDs and human IVD tissue. Following MSC migration for 5 days, IVD cells were isolated by tissue digestion. The fractions of Tie2-positive, dead, apoptotic, and proliferative IVD cells were evaluated by flow cytometry and compared to untreated IVDs. For human IVDs, 3 groups were investigated: nondegenerated (organ donors), IVDs of patients suffering from spinal trauma, and degenerative IVD tissue samples. RESULTS: MSC homing enhanced the fraction of Tie2-positive IVD cells in bovine and human IVD samples. Furthermore, a proliferative response and lower fraction of dead cells were observed after MSC homing in both bovine and human IVD tissues. CONCLUSION: Our findings indicate that MSC homing enhances the survival and regenerative capability of IVD cells, which may be mediated by intercellular communication. MSC homing could represent a potential treatment strategy to prevent the onset of the degenerative cascade in IVDs at risk such as IVDs adjacent to a fused segment or IVDs after herniation. LEVEL OF EVIDENCE: N/A.


Assuntos
Proliferação de Células/fisiologia , Disco Intervertebral/metabolismo , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/metabolismo , Receptor TIE-2/biossíntese , Animais , Bovinos , Morte Celular/fisiologia , Diferenciação Celular/fisiologia , Células Cultivadas , Feminino , Humanos , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/metabolismo , Degeneração do Disco Intervertebral/terapia , Técnicas de Cultura de Órgãos
4.
Biomed Mater Eng ; 30(4): 403-417, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498118

RESUMO

BACKGROUND: Various biomaterials/technologies have been tested for treatment of intervertebral disc (IVD) degeneration (IDD). Only few non-surgical options exist. OBJECTIVE: Assessment of efficacy and safety of the hyaluronic acid derivative hydrogel HYADD®4-G in IDD using a well-established rabbit annular puncture model. METHODS: Rabbits were punctured at two IVDs to induce IDD. Thirty days after, IVDs were injected with HYADD®4-G or saline. IVD hydration, height, appearance and tissue organization were assessed by radiographs, MRI and histopathology. Safety of HYADD®4-G injection was evaluated in non-punctured IVDs. RESULTS: HYADD®4-G injection restored disc height to over 75% of the pre-punctured disc, saline injections led to 50% of initial disc height. Compared to saline, HYADD®4-G treatment resulted in improved water retention as revealed by MRI quantification. 83.3% of HYADD®4-G injected discs had normal appearance and reached grade I of the Pfirrmann scale. Regarding tissue organization and cellularity, HYADD®4-G treatment resulted in significantly lower IDD scores than saline (p < 0.01). HYADD®4-G injected into healthy IVDs did not induce inflammation or foreign body reactions. CONCLUSIONS: Intra-discal HYADD®4-G injection is safe and has therapeutic benefits: IDD could be limited through restoration of disc height and hydration and maintenance of normal IVD tissue organization.


Assuntos
Ácido Hialurônico/uso terapêutico , Hidrogéis/uso terapêutico , Degeneração do Disco Intervertebral/terapia , Disco Intervertebral/patologia , Viscossuplementos/uso terapêutico , Animais , Modelos Animais de Doenças , Feminino , Ácido Hialurônico/administração & dosagem , Hidrogéis/administração & dosagem , Injeções Espinhais , Disco Intervertebral/efeitos dos fármacos , Degeneração do Disco Intervertebral/patologia , Coelhos , Viscossuplementos/administração & dosagem
5.
Turk J Med Sci ; 49(4): 1095-1101, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31385489

RESUMO

Background/aim: In this study, it was aimed to investigate the effects ofpulsed electromagnetic field(PEMF) therapy on pain, disability, psychological state, and quality of life in cervical disc herniation. Materials and methods: Patients were randomly divided into two groups, including Group 1, which received a therapy consisting of transcutaneous electrical nerve stimulation (TENS), hot pack (HP), and PEMF, and Group 2, which received a magnetic field (sham magnetic field) without current flow in addition to TENS and HP therapy. Pain was assessed by a visual analog scale (VAS, 0­10 cm). The other outcome measures were function (Neck Pain and Disability Scale), anxiety-depressive mood (Hospital Anxiety and Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, in the 3rd week, and in the 12th week after treatment. Results: A significant improvement was found in the neck pain, disability, depression, anxiety, and quality of life scores of both groups after treatment when compared to those before treatment. However, in the comparison between changes within groups, significant improvements were determined only in the VAS and Nottingham Health Profile sleep subparameter in the 12th week after treatment compared to those before treatment. Conclusion: PEMF therapy in cervical disc herniation can be used safely in routine treatment in addition to conventional physical therapy modalities.


Assuntos
Dor nas Costas , Depressão , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Terapia de Campo Magnético , Qualidade de Vida , Adulto , Dor nas Costas/etiologia , Dor nas Costas/terapia , Vértebras Cervicais/fisiopatologia , Depressão/etiologia , Depressão/terapia , Avaliação da Deficiência , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
6.
Biomed Res Int ; 2019: 4732654, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31428637

RESUMO

Introduction: High levels of total cholesterol, triglycerides, and, connected with them, lipoprotein fractions may result in atherosclerosis. There are various forms of therapy used to prevent cardiovascular diseases, such as balneophysiotherapy, the effectiveness of which is confirmed by numerous scientific publications. Objective: The objective of this study was to assess the impact of balneophysiotherapeutic procedures on the systemic metabolism of lipids in patients suffering from osteoarthritis of the motor organ. Material and Methods: The study was conducted in the Health Resort Swieradów-Zdrój. Observation included patients undergoing radon water therapy. Before therapy and after 21 days of treatment, lipid profile was assessed with the use of standard colorimetric assay. Study group consisted of n=34 patients with degenerative joints and disc disease. The mean age of patients was 56.5l. The control group consisted of 17 people selected among the employees of the spa also suffering from osteoarthritis. The mean age was 54.2 years. Results: The results of the study are based on a single, 21-day health resort stay period in April/May. A statistically significant increase in HDL cholesterol levels was observed in female patients having undergone health resort treatment (P<0.01). Statistically significant drops in LDL cholesterol and TG levels were observed in the control group (P<0.01). An increase in HDL levels was observed in the male and female control subjects, with P<0.05. Conclusions: (1) After the end of therapy, there were no changes in lipid metabolism in men, while in the group of women an increase in HDL level was observed. (2) In the control group, statistically significant changes in the field of lipid metabolism may be related to lifestyle changes as a result of educational activities conducted prior to the research. (3) Due to the divergent results, it is advisable to conduct randomized studies in a larger population. This trial is registered with NCT03274128.


Assuntos
Balneologia , Degeneração do Disco Intervertebral , Lipídeos/sangue , Osteoartrite , Caracteres Sexuais , Idoso , Feminino , Humanos , Degeneração do Disco Intervertebral/sangue , Degeneração do Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/terapia , Masculino , Pessoa de Meia-Idade , Osteoartrite/sangue , Osteoartrite/fisiopatologia , Osteoartrite/terapia
7.
J Orthop Res ; 37(11): 2389-2400, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31286562

RESUMO

Intervertebral disc (IVD) degeneration is a major contributor to chronic low back pain and is characterized by decreases in cellularity and proteoglycan synthesis, upregulation of matrix degradation, and increases in pro-inflammatory factors with neurovascular invasion. Current treatments fail to target the underlying pathology or promote tissue repair and approaches such as viral transfection raise safety concerns due to mutagenesis and unwarranted immune responses. To avoid such concerns, nonviral transfection is a viable method of gene delivery into the host cell while bypassing the caveats of viral delivery. Brachyury is expressed in the developing notochord and is associated with an immature healthy nucleus pulposus (NP). We hypothesize that Brachyury can reprogram degenerate NP cells to a healthy pro-anabolic phenotype with increased proteoglycan content and decreased expression of catabolic, inflammatory, and neurovascular markers. NP cells obtained from human autopsy and surgical tissues were transfected with plasmids encoding for Brachyury or an empty vector control via bulk electroporation. Post transfection, cells were seeded in three-dimensional agarose constructs cultured over 4 weeks and analyzed for viability, gene expression, and proteoglycan. Results demonstrated successful transfection of both autopsy and surgical NP cells. We observed long-term Brachyury expression, significant increased expression of NP phenotypic markers FOXF1, KRT19, and chondrogenic marker SOX9 with decreases in inflammatory cytokines IL1-ß/IL6, NGF, and MMPs and significant increases in glycosaminoglycan accumulation. These results highlight nonviral transfection with developmental transcription factors, such as Brachyury, as a promising method to reprogram degenerate human disc cells toward a healthy NP phenotype. Clinical significance: This project proposes a novel translational approach for the treatment of intervertebral disc degeneration via direct reprogramming of diseased human patient-derived IVD cells to a healthy phenotype. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2389-2400, 2019.


Assuntos
Proteínas Fetais/genética , Terapia Genética/métodos , Degeneração do Disco Intervertebral/terapia , Núcleo Pulposo/metabolismo , Proteínas com Domínio T/genética , Transfecção/métodos , Adulto , Idoso , Citocinas/metabolismo , Feminino , Proteínas Fetais/metabolismo , Expressão Gênica , Glicosaminoglicanos/metabolismo , Humanos , Masculino , Metaloproteinases da Matriz/metabolismo , Pessoa de Meia-Idade , Fator de Crescimento Neural/metabolismo , Cultura Primária de Células , Estudo de Prova de Conceito , Proteínas com Domínio T/metabolismo , Adulto Jovem
8.
J Orthop Res ; 37(11): 2445-2456, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31287173

RESUMO

Intervertebral disc degeneration (IVDD) is a progressive condition marked by tissue destruction and inflammation. The therapeutic effector functions of mesenchymal stem cells (MSCs) makes them an attractive therapy for patients with IVDD. While several sources of MSCs exist, the optimal choice for use in the inflamed IVD remains a significant question. Adipose (AD)- and amnion (AM)-derived MSCs have several advantages compared with other sources, however, no study has directly compared the impact of IVDD inflammation on their effector functions. Human MSCs were cultured in media with or without supplementation of interleukin-1ß (IL-1ß) and tumor necrosis factor-α at concentrations reportedly produced by IVDD cells. MSC proliferation and production of pro- and anti-inflammatory cytokines were quantified following 24 and 48 h of culture. Additionally, the osteogenic and chondrogenic potential of AD- and AM-MSCs was characterized via histology and biochemical analysis following 28 days of culture. In inflammatory culture, AM-MSCs produced significantly more anti-inflammatory IL-10 (14.47 ± 2.39 pg/ml; p = 0.004) and larger chondrogenic pellets (5.67 ± 0.26 mm2 ; p = 0.04) with greater percent area staining positively for glycosaminoglycan (82.03 ± 3.26%; p < 0.001) compared with AD-MSCs (0.00 ± 0.00 pg/ml; 2.76 ± 0.18 mm2 ; 34.75 ± 2.49%; respectively). Conversely, AD-MSCs proliferated more resulting in higher cell numbers (221,000 ± 8,021 cells; p = 0.048) and produced higher concentrations of pro-inflammatory cytokines prostaglandin E2 (1,118.30 ± 115.56 pg/ml; p = 0.030) and IL-1ß (185.40 ± 7.63 pg/ml; p = 0.010) compared with AM-MSCs (109,667 ± 5,696 cells; 1,291.40 ± 78.47 pg/ml; 144.10 ± 4.57 pg/ml; respectively). AD-MSCs produced more mineralized extracellular matrix (3.34 ± 0.05 relative absorbance units [RAU]; p < 0.001) compared with AM-MSCs (1.08 ± 0.06 RAU). Under identical inflammatory conditions, a different effector response was observed with AM-MSCs producing more anti-inflammatories and demonstrating enhanced chondrogenesis compared with AD-MSCs, which produced more pro-inflammatory cytokines and demonstrated enhanced osteogenesis. These findings may begin to help inform researchers which MSC source may be optimal for IVD regeneration. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2445-2456, 2019.


Assuntos
Tecido Adiposo/citologia , Âmnio/citologia , Inflamação/fisiopatologia , Degeneração do Disco Intervertebral/terapia , Células-Tronco Mesenquimais/fisiologia , Diferenciação Celular , Proliferação de Células , Células Cultivadas , Citocinas/metabolismo , Matriz Extracelular/metabolismo , Feminino , Humanos , Inflamação/metabolismo , Gravidez
9.
Curr Pain Headache Rep ; 23(7): 52, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31270622

RESUMO

PURPOSE OF REVIEW: Back pain is a growing problem worldwide, incurring enormous economic costs and disability. Current treatment modalities often provide adequate relief but fail to address underlying conditions. Regenerative cellular modalities aim to restore anatomical function in degenerative conditions which may cause low back pain. Platelet-rich plasma (PRP) consists of an increased concentration of autologous platelets suspended in a small amount of plasma. PRP can be administered via injection or topically and is prepared using various techniques. RECENT FINDINGS: While a unifying mechanism of action is not well understood, biochemical and cellular changes involved in inflammation and mechanical structure have been detected in both in vitro and in vivo studies. At a higher level, PRP injection research utilizing animal models and patient data have provided insights into pain relief, chondroprotection, and factors that impact the therapy's efficacy. Recently, a small number of studies have promoted PRP injection as a relatively safe means of treating patients with degenerative disc disease who have failed other means of managing their lower back pain. PRP injections for sacroiliac joint-related pain are not an accepted or common treatment modality; the evidence for their efficacy remains to be seen outside of small RCTs and case reports. A small number of prospective trials have suggested there may be some benefit to using PRP injection in the treatment of pain or functional decline caused by facet joint arthropathy. These commonly used modalities require further study to improve quality of evidence and to investigate the safety and efficacy of PRP injections for various common causes of chronic low back.


Assuntos
Degeneração do Disco Intervertebral/terapia , Dor Lombar/terapia , Plasma Rico em Plaquetas , Articulação Zigapofisária/cirurgia , Humanos , Manejo da Dor/métodos , Estudos Prospectivos
10.
Curr Pain Headache Rep ; 23(9): 65, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31359164

RESUMO

PURPOSE OF REVIEW: Discogenic low back pain (DLBP) stems from pathology in one or more intervertebral discs identified as the root cause of the pain. It is the most common type of chronic low back pain (LBP), representing 26-42% of attributable cases. RECENT FINDINGS: The clinical presentation of DLBP includes increased pain when sitting, coughing, or sneezing, and experiencing relief when standing or ambulating. Dermatomal radiation of pain to the lower extremity and neurological symptoms including numbness, motor weakness, and urinary or fecal incontinence are signs of advanced disease with disc prolapse, nerve root compression, or spinal stenosis. Degenerative disc disease is caused by both a decrease in disc nutrient supply causing decreased oxygen, lowered pH, and lessened ability of the intervertebral disc (IVD) to respond to increased load or injury; moreover, changes in the extracellular matrix composition cause weakening of the tissue and skewing the extracellular matrix's (ECM) harmonious balance between catabolic and anabolic factors for cell turnover in favor of catabolism. Thus, the degeneration of the disc causes a shift from type II to type I collagen expression by NP cells and a decrease in aggrecan synthesis leads to dehydrated matrix cells ultimately with loss of swelling pressure needed for mechanical support. Cell-based therapies such as autologous nucleus pulposus cell re-implantation have in animal models and human trials shown improvements in LBP score, retention of hydration in IVD, and increased disc height. Percutaneously delivered multipotent mesenchymal stem cell (MSC) therapy has been proposed as a potential means to uniquely ameliorate discogenic LBP holistically through three mechanisms: mitigation of primary nociceptive disc pain, slow or reversal of the catabolic metabolism, and restoration of disc tissue. Embryonic stem cells (ESCs) can differentiate into cells of all three germ layers in vitro, but their use is hindered related to ethical concerns, potential for immune rejection after transplantation, disease, and teratoma formation. Another similar approach to treating back pain is transplantation of the nucleus pulposus, which, like stem cell therapy, seeks to address the underlying cause of intervertebral disc degeneration by aiming to reverse the destructive inflammatory process and regenerate the proteoglycans and collagen found in healthy disc tissue. Preliminary animal models and clinical studies have shown mesenchymal stem cell implantation as a potential therapy for IVD regeneration and ECM restoration via a shift towards favorable anabolic balance and reduction of pain.


Assuntos
Degeneração do Disco Intervertebral/terapia , Dor Lombar/terapia , Transplante de Células-Tronco Mesenquimais/métodos , Animais , Células-Tronco Embrionárias/transplante , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Transplante de Células-Tronco Mesenquimais/tendências , Resultado do Tratamento
11.
Int J Mol Sci ; 20(15)2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31344903

RESUMO

Chronic back pain is a common disability, which is often accredited to intervertebral disc degeneration. Gold standard interventions such as spinal fusion, which are mainly designed to mechanically seal the defect, frequently fail to restore the native biomechanics. Moreover, artificial implants have limited success as a repair strategy, as they do not alter the underlying disease and fail to promote tissue integration and subsequent native biomechanics. The reported high rates of spinal fusion and artificial disc implant failure have pushed intervertebral disc degeneration research in recent years towards repair strategies. Intervertebral disc repair utilizing principles of tissue engineering should theoretically be successful, overcoming the inadequacies of artificial implants. For instance, advances in the development of scaffolds aided with cells and growth factors have opened up new possibilities for repair strategies. However, none has reached the stage of clinical trials in humans. In this review, we describe the hitches encountered in the musculoskeletal field and summarize recent advances in designing tissue-engineered constructs for promoting nucleus pulposus repair. Additionally, the review focuses on the effect of biomaterial aided with cells and growth factors on achieving effective functional reparative potency, highlighting the ways to enhance the efficacy of these treatments.


Assuntos
Dor nas Costas/genética , Núcleo Celular/genética , Degeneração do Disco Intervertebral/terapia , Núcleo Pulposo/metabolismo , Dor nas Costas/terapia , Materiais Biocompatíveis/uso terapêutico , Humanos , Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/genética , Núcleo Pulposo/patologia , Engenharia Tecidual
12.
Artigo em Inglês | MEDLINE | ID: mdl-31248064

RESUMO

The newly developed cervical lordotic curve-controlled traction (C-LCCT) appears to be an ideal method to improve the treatment outcome in patients with cervical intervertebral disc disease. The purpose of this study was to investigate the treatment outcomes of C-LCCT including the functional and morphological changes of the cervical intervertebral disc compared to traditional traction (TT) with a randomized controlled trial design. A total of 40 patients with cervical intervertebral disc disease at the C5/6 level confirmed by magnetic resonance imaging were recruited and assigned to either the C-LCCT group or the TT group. The comprehensive health status changes of the patients were recorded using pain and functional scores (Visual Analogue Scale, Oswestry Disability Index) and morphological changes (cervical lordosis, cervical central canal area) before and after the traction treatment. Both groups showed a significant improvement in pain scores after traction (p < 0.05). The functional score and morphological changes improved significantly after treatment in the C-LCCT group. However, there was no significant improvement in the TT group (p < 0.05). The C-LCCT showed significant pain, functional, and morphological improvement compared to TT. C-LCCT could be effective in improving the treatment outcomes of the traction technique in patients with cervical intervertebral disc disease.


Assuntos
Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Disco Intervertebral/fisiopatologia , Lordose/terapia , Tração/métodos , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
J Orthop Surg Res ; 14(1): 178, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200736

RESUMO

BACKGROUND: Symptomatic degenerative lumbar spondylolisthesis (DLS) presents spinal problems in daily life. Shi-style lumbar manipulation (SLM), as an alternative treatment for DLS, is popular in China. SLM is based on the channels and collaterals theory of the traditional Chinese medicine, in which the symptoms are believed to result from channel blockage and joint displacement. However, there is no solid evidence to show the effect of the SLM on the management of symptomatic DLS. METHODS/DESIGN: We conduct a prospective randomized, blinded, controlled trial to compare the effectiveness of SLM with mechanical lumbar traction and explore whether it could be a potential therapy for symptomatic DLS. A total of 60 patients with symptomatic DLS will be enrolled and treated with the SLM or mechanical lumbar traction for 2 weeks. VAS score and SF-36 questionnaire were assessed at baseline and at 2, 4, 12, and 24 weeks. Any signs of acute adverse reactions, such as lower limb paralysis or syndrome of cauda equina, will be recorded at each visit during treatment. DISCUSSION: Although the SLM has been used in China for many years to treat symptomatic DLS, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of SLM on symptomatic DLS. TRIAL REGISTRATION: Registered on 6 January 2019; the trial number is ChiCTR1900020519 .


Assuntos
Degeneração do Disco Intervertebral/terapia , Vértebras Lombares , Manipulação da Coluna/métodos , Espondilolistese/terapia , Seguimentos , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/epidemiologia , Manipulação da Coluna/tendências , Estudos Prospectivos , Método Simples-Cego , Espondilolistese/diagnóstico , Espondilolistese/epidemiologia , Resultado do Tratamento
14.
Spine (Phila Pa 1976) ; 44(22): 1571-1577, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31205180

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of this investigation was to evaluate the regional variations in the use of nonoperative therapies in patients diagnosed with a lumbar intervertebral disc herniation 3 months prior to undergoing microdiscectomy surgery. SUMMARY OF BACKGROUND DATA: Regional variations in the management of chronic pain conditions have been previously identified. Patients suffering from a lumbar intervertebral disc herniation are typically treated with a brief course of conservative management prior to attempting microdiscectomy surgery. Whether regional differences exist in the utilization or costs of maximum nonoperative therapy (MNT) remains unknown. METHODS: Medical records from patients diagnosed with a lumbar intervertebral disc herniation undergoing 1, 2, or 3-level index microdiscectomy operations between 2007 and 2017 were gathered from the HORTHO insurance database consisting of private/commercially insured and Medicare Advantage beneficiaries. Patient regional designation was divided into Midwest, Northeast, South, and West territories and was derived from the insurance claim location. The utilization of MNT within 3 months after initial lumbar herniation diagnosis in adult patients was analyzed. RESULTS: Our population consisted of 13,106 patients who underwent primary index microdiscectomy surgery. Significant regional variation was identified in the nonoperative therapy failure rate (P<0.0001), with the highest proportion of Midwest patients failing (2.7%). There were statistical differences in the regional distribution of patients utilizing NSAIDs (P<0.0001), muscle relaxants (P <0.0001), lumbar epidural steroid injections (P <0.0001), physical therapy and occupational therapy sessions (P <0.0001), chiropractor treatments (P <0.0001), and emergency department services (P = 0.0049). The total direct cost associated with all MNT prior to microdiscectomy was $13,205,924, with 59.6% from the South, 31.1% from the Midwest, 8.3% from the West, and 1.1% from the Northeast. CONCLUSION: These findings indicate that regional differences exist in the utilization and costs of MNT of a lumbar intervertebral herniated disc prior to microdiscectomy surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Discotomia , Custos de Cuidados de Saúde/estatística & dados numéricos , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Vértebras Lombares , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Discotomia/economia , Discotomia/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Degeneração do Disco Intervertebral/economia , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/economia , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Medicare , Modalidades de Fisioterapia/estatística & dados numéricos , Estudos Retrospectivos , Falha de Tratamento , Estados Unidos
15.
Kaohsiung J Med Sci ; 35(8): 486-492, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31091017

RESUMO

The present study determines whether the in vivo injection of TGFß1 and CTGF mediated by AAV2 to transfect nucleus pulposus cells in degenerative lumbar discs can reverse the biological effects of rhesus lumbar disc degeneration. A total of 42 lumbar discs obtained from six rhesus monkeys were classified into three groups: experimental group, control group, and blank group. Degenerative lumbar discs were respectively injected with double gene-transfected human nucleus pulposus cells using minimally invasive techniques. Immumohistochemical staining, RT-PCR, and western blot were performed to observe the biological effects of double gene-transfected human nucleus pulposus cells in degenerative lumbar discs on rhesus lumbar disc degeneration. At 4, 8, and 12 weeks after the transplantation of nucleus pulposus cells, the expression levels of TGF-ß1, CTGF, proteoglycan mRNA, and type-II collagen were detected by RT-PCR. The values of immumohistochemical staining and RT-PCR in the experimental group increased at 8 weeks, decreased with time at 12 weeks, and remained greater than the values in the control group, and the differences were statistically significant (P < .05). The western blot revealed that the values in the experimental group decreased with time, but remained greater than those in the PBS control group and blank control group, and the differences were statistically significant (P < .05). The double gene-transfection of human nucleus pulposus cells in degenerative lumbar discs mediated by rAAV2 can be continuously expressed in vivo after transplantation in lumbar discs of rhesus monkeys, and promotes the synthesis of proteoglycan and type II collagen, achieving the treatment purpose.


Assuntos
Degeneração do Disco Intervertebral/terapia , Vértebras Lombares/patologia , Núcleo Pulposo/transplante , Transgenes , Adulto , Animais , Linhagem Celular , Colágeno Tipo II/genética , Colágeno Tipo II/metabolismo , Fator de Crescimento do Tecido Conjuntivo/genética , Fator de Crescimento do Tecido Conjuntivo/metabolismo , Modelos Animais de Doenças , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Macaca mulatta , Imagem por Ressonância Magnética , Proteoglicanas/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Tomografia Computadorizada por Raios X , Fator de Crescimento Transformador beta1/genética , Fator de Crescimento Transformador beta1/metabolismo , Adulto Jovem
16.
J Orthop Res ; 37(6): 1440-1450, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31062869

RESUMO

Intervertebral discs (IVDs) are important biomechanical components of the spine. Once degenerated, mesenchymal stem cell (MSC)-based therapies may aid in the repair of these discs. Although hypoxic preconditioning enhances the chondrogenic potential of MSCs, it is unknown whether bone marrow MSCs expanded under hypoxic conditions (1% O2 , here referred to as hypoxic MSCs) are better than bone marrow MSCs expanded under normoxic conditions (air, here referred to as normoxic MSCs) with regards to disc regeneration capacity. The purpose of this study was to compare the therapeutic effects of hypoxic and normoxic MSCs in a rabbit needle puncture degenerated disc model after intra-disc injection. Six weeks after needle puncture, MSCs were injected into the IVD. A vehicle-treated group and an un-punctured sham-control group were included as controls. The tissues were analyzed by histological and immunohistochemical methods 6 and 12 weeks post-injection. At 6 and 12 weeks, less disc space narrowing was evident in the hypoxic MSC-treated group compared to the normoxic MSC-treated group. Significantly better histological scores were observed in the hypoxic MSC group. Discs treated with hypoxic MSCs also demonstrated significantly better extracellular matrix deposition in type II and XI collagen. Increased CD105 and BMP-7 expression were also observed upon injection of hypoxic MSCs. In conclusion, hypoxic MSC injection was more effective than normoxic MSC injection for reducing IVD degeneration progression in vivo. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1440-1450, 2019.


Assuntos
Degeneração do Disco Intervertebral/terapia , Transplante de Células-Tronco Mesenquimais , Animais , Proteína Morfogenética Óssea 7/metabolismo , Hipóxia Celular , Colágeno Tipo II/análise , Colágeno Tipo X/análise , Imuno-Histoquímica , Coelhos , Transplante Homólogo
17.
Mater Sci Eng C Mater Biol Appl ; 99: 1213-1225, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30889657

RESUMO

Intervertebral disc (IVD) degeneration is associated with lower back pain, with the dysfunction of nucleus pulposus (NP) cells instigating degeneration onset. Here, we developed an optimized decellularised NP scaffold that could induce mesenchymal stem cells (MSCs) into NP-like cells in vitro and rescue the degenerated IVD in vivo. We optimized a decellularisation protocol for porcine NP and evaluated the biological properties and microstructure of the NP scaffold. Through co-culture with MSCs, we analysed scaffold bioactivity and potential signalling pathways. We tested the therapeutic efficacy of the scaffold using an IVD degeneration model in vivo. The decellularisation protocol generally removed the cellular components of the NP and preserved the majority of the biological components and regular microstructure. MSCs seeded in the NP-ECM scaffold differentiated into NP-like cells in vitro; this change was attributed to activation of the TGF-ß signalling pathway. The NP-ECM exhibited good cytocompatibility ex vivo and decelerated the degeneration of the IVD in vivo. These results indicate the successful establishment of a naturally-derived ECM material that could induce MSCs into NP cells and serve as a potential treatment for degenerated IVDs.


Assuntos
Núcleo Pulposo/fisiologia , Engenharia Tecidual/métodos , Tecidos Suporte/química , Animais , Diferenciação Celular , Proliferação de Células , DNA/metabolismo , Matriz Extracelular/metabolismo , Feminino , Humanos , Degeneração do Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/terapia , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Núcleo Pulposo/ultraestrutura , Porosidade , Coelhos , Regeneração , Transdução de Sinais , Suínos , Fator de Crescimento Transformador beta/metabolismo
18.
Bosn J Basic Med Sci ; 19(2): 130-137, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-30726701

RESUMO

Intervertebral disc (IVD) degeneration (IDD) is associated with low back pain and significantly affects the patient's quality of life. Degeneration of the IVD alters disk height and the mechanics of the spine, leading to chronic segmental spinal instability. The pathophysiology of IVD disease is still not well understood. Current therapies for IDD include conservative and invasive approaches, but none of those treatments are able to restore the disc structure and function. Recently, tissue engineering techniques emerged as a possible approach to treat IDD, by replacing a damaged IVD with scaffolds and appropriate cells. Advances in manufacturing techniques, material processing and development, surface functionalization, drug delivery systems and cell incorporation furthered the development of tissue engineering therapies. In this review, biomaterial scaffolds and cell-based therapies for IVD regeneration are briefly discussed.


Assuntos
Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Disco Intervertebral/fisiopatologia , Engenharia Tecidual/métodos , Animais , Materiais Biocompatíveis/química , Terapia Baseada em Transplante de Células e Tecidos , Sistemas de Liberação de Medicamentos , Humanos , Dor Lombar/terapia , Fenótipo , Polímeros/química , Qualidade de Vida , Tecidos Suporte/química
19.
J Am Anim Hosp Assoc ; 55(2): 83-91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30776260

RESUMO

Intervertebral disc disease is one of the leading causes of paralysis in dogs. Pulsed electromagnetic field (PEMF) therapy has been advocated for improving wound healing and pain reduction; however, robust clinical trials are lacking. The present prospective, double-blind, placebo-controlled trial evaluated targeted PEMF therapy administered to 53 client-owned dogs who underwent hemilaminectomy for naturally occurring disk extrusion intervertebral disc disease. The dogs were randomized to receive either targeted PEMF (n = 27) or placebo treatment (n = 28). Wound healing, evaluated by visual analog score and wound evaluation scale, was significantly improved at 6 wk postoperatively in the treatment compared with the control group (P = .010 and .023, respectively). Pain medications were administered less frequently in dogs receiving PEMF treatment during the 7 day postoperative period compared with the control treatment group (P = .010) with codeine administered 1.8 times more frequently in the control group. No untoward effects were recorded in either treatment group. More frequent evaluation of outcome measures with larger patient numbers, as well as histologic samples, may be useful in future studies. Dogs receiving PEMF therapy following postoperative hemilaminectomy demonstrated improved wound scores at 6 wk and reduced mean number of owner-administered pain medications compared with the control group therapy.


Assuntos
Doenças do Cão/terapia , Degeneração do Disco Intervertebral/veterinária , Deslocamento do Disco Intervertebral/veterinária , Terapia de Campo Magnético/veterinária , Animais , Cães , Método Duplo-Cego , Feminino , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Laminectomia , Masculino , Dor Pós-Operatória/terapia , Dor Pós-Operatória/veterinária , Distribuição Aleatória , Cicatrização
20.
Int J Mol Sci ; 20(3)2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30717203

RESUMO

Ozone therapy has been widely used in everyday clinical practice over the last few years, leading to significant clinical results in the treatment of herniated discs and pain management. Nevertheless, further studies have demonstrated its potential efficacy and safety under other clinical and experimental conditions. However, some of these studies showed controversial results regarding the safety and efficacy of ozone therapy, thus mining its potential use in an everyday clinical practice. To this regard, it should be considered that extensive literature review reported the use of ozone in a significant different dose range and with different delivery systems. The aim of the present review is to describe the various pharmacological effects of ozone in different organs and clinical conditions and to provide possible biochemical and molecular insights for ozone biological properties, thus providing a possible explanation for various controversial clinical outcomes described in the scientific literature.


Assuntos
Doenças Cardiovasculares/terapia , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Ozônio/administração & dosagem , Dor/prevenção & controle , Substâncias Protetoras/administração & dosagem , Dermatopatias/terapia , Doença Aguda , Doenças Cardiovasculares/genética , Doenças Cardiovasculares/imunologia , Doenças Cardiovasculares/patologia , Quimiotaxia/efeitos dos fármacos , Quimiotaxia/imunologia , Doença Crônica , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Humanos , Imunidade Inata/efeitos dos fármacos , Disco Intervertebral/efeitos dos fármacos , Disco Intervertebral/imunologia , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/genética , Degeneração do Disco Intervertebral/imunologia , Degeneração do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/genética , Deslocamento do Disco Intervertebral/imunologia , Deslocamento do Disco Intervertebral/patologia , Estresse Oxidativo , Ozônio/efeitos adversos , Dor/genética , Dor/imunologia , Dor/patologia , Manejo da Dor/métodos , Substâncias Protetoras/efeitos adversos , Dermatopatias/genética , Dermatopatias/imunologia , Dermatopatias/patologia
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