Dataset Information

In Vivo Characteristics of Nondegenerated Adjacent Segment Intervertebral Foramina in Patients With Degenerative Disc Disease During Flexion-Extension.

ABSTRACT: In vivo patient biomechanical study.To investigate the dimensions of lumbar intervertebral foramen (LIVF) of patients with degenerative disc disease (DDD) during a flexion-extension motion of the body.LIVF narrowing may result in nerve root compression. The area changes of degenerated and adjacent nondegenerated LIVFs in DDD patients under physiologic loading conditions are unknown.Nine symptomatic low back pain patients with radiological evidence of L4-S1 DDD were recruited. Each subject was magnetic resonance imaging scanned for construction of three-dimensional lumbar vertebral models, and fluoroscopically imaged when the body extended from 45 flexion to full extension for reconstruction of LIVF dimensions. The data of the adjacent segment L3/4 and diseased segments L4/5 and L5/S1 were compared with a normal control group at 45 flexion, upright, and full extension of the body.The mean LIVF areas of DDD segments were significantly smaller than those of the normal subjects in all positions (P?<0.05). In upright position, the LIVF areas of the DDD patients were 32.8% and 33.6% smaller than the normal subjects for L4/5 and L5/S1, respectively. For the adjacent L3/4, the LIVF area of the DDD patients was 32.3% smaller than that of the normal controls (P?<0.05). The total change of L3/4 LIVF area in DDD patients from flexion to extension was significantly smaller than that of the normal subjects, but the changes in L4/5 and L5/S1 LIVF areas were similar between the two groups (P?>0.05).Similar reductions of the LIVF dimensions were observed at the adjacent and the involved levels of the DDD patients, implying that biomechanical changes might have already occurred at the adjacent segment despite the lack of radiographic evidence of degeneration. Subsequent research should focus on the effects of surgical fusion on the biomechanical features of the adjacent segment.N/A.

SUBMITTER: Cha TD

PROVIDER: S-EPMC5203984 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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In Vivo Characteristics of Nondegenerated Adjacent Segment Intervertebral Foramina in Patients With Degenerative Disc Disease During Flexion-Extension.

Cha Thomas D TD Moore Gregory G Liow Ming Han Lincoln MHL Zhong Weiye W Wu Minfei M Wang Shaobai S Kang James D JD Wood Kirkham B KB Li Guoan G

Spine 20170301 6

<h4>Study design</h4>In vivo patient biomechanical study.<h4>Objective</h4>To investigate the dimensions of lumbar intervertebral foramen (LIVF) of patients with degenerative disc disease (DDD) during a flexion-extension motion of the body.<h4>Summary of background data</h4>LIVF narrowing may result in nerve root compression. The area changes of degenerated and adjacent nondegenerated LIVFs in DDD patients under physiologic loading conditions are unknown.<h4>Methods</h4>Nine symptomatic low back ...[more]

PMID: 27379419

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Project description:Discogenic low back pain (LBP) is a main cause of disability and inflammation is presumed to be a major driver of symptomatic intervertebral disc degeneration (IDD). Anti-inflammatory agents are currently under investigation as they demonstrated to alleviate symptoms in patients having IDD. However, their underlying anti-inflammatory and regenerative activity is poorly explored. The present study sought to investigate the potential of Etanercept and Tofacitinib for maintaining disc homeostasis in a preclinical intervertebral disc (IVD) organ culture model within IVD bioreactors allowing for dynamic loading and nutrient exchange. Bovine caudal IVDs were cultured in a bioreactor system for 4 days to simulate physiological or degenerative conditions: (1) Phy-physiological loading (0.02-0.2 MPa; 0.2 Hz; 2 h/day) and high glucose DMEM medium (4.5 g/L); (2) Deg+Tumor necrosis factor ? (TNF-?)-degenerative loading (0.32-0.5 MPa; 5 Hz; 2 h/day) and low glucose DMEM medium (2 g/L), with TNF-? injection. Etanercept was injected intradiscally while Tofacitinib was supplemented into the culture medium. Gene expression in the IVD tissue was measured by RT-qPCR. Release of nitric oxide (NO), interleukin 8 (IL-8) and glycosaminoglycan (GAG) into the IVD conditioned medium were analyzed. Cell viability in the IVD was assessed using lactate dehydrogenase and ethidium homodimer-1 staining. Immunohistochemistry was performed to assess protein expression of IL-1?, IL-6, IL-8, and collagen type II in the IVD tissue. Etanercept and Tofacitinib downregulated the expression of IL-1?, IL-6, IL-8, Matrix metalloproteinase 1 (MMP1), and MMP3 in the nucleus pulposus (NP) tissue and IL-1?, MMP3, Cyclooxygenase-2 (COX2), and Nerve growth factor (NGF) in the annulus fibrosus (AF) tissue. Furthermore, Etanercept significantly reduced the IL-1? positively stained cells in the outer AF and NP regions. Tofacitinib significantly reduced IL-1? and IL-8 positively stained cells in the inner AF region. Both, Etanercept and Tofacitinib reduced the GAG loss to the level under physiological culture condition. Etanercept and Tofacitinib are able to neutralize the proinflammatory and catabolic environment in the IDD organ culture model. However, combined anti-inflammatory and anabolic treatment may be required to constrain accelerated IDD and relieving inflammation-induced back pain.

Project description:BackgroundThe quality of flexion-extension motion after cervical disc arthroplasty has been a subject of interest due to the number of available devices with different designs and kinematics. Previous studies of motion quality have been limited to measuring the range of motion using two radiographs taken at the extremes of flexion and extension. This is the first study evaluating the in vivo quality of index segment motion using fluoroscopic images collected over the arc of flexion-extension after M6-C cervical disc arthroplasty surgery.MethodsEligible participants had previously undergone a single-level cervical disc arthroplasty surgery for degenerative cervical spine disease performed by the senior author. Study participants underwent dynamic lateral fluoroscopic imaging to capture the C2-C7 motion between maximal flexion and extension. The amount of motion contribution by individual segments to the C2-C7 motion (termed segmental motion fraction) and its variation throughout the arc of flexion-extension were compared between the index and adjacent segments. The shift of centre of rotation during the arc of motion was also assessed.ResultsTen subjects with a mean age of 43.8 years old were recruited, with an average follow-up of 16.2 months at the time of fluoroscopy. The C2-C7 cervical spine had an average flexion-extension range of 66.7 degrees. The contribution of the index segment averaged over the flexion-extension arc of motion was 18.9% (peak contribution 24.4%) for the C5-C6 group; and 15.5% (peak contribution 25.5%) for the C6-C7 group. The mean cranial-caudal location of the centre of rotation progressively shifted in the cranial direction from C2-C3 to C6-C7 motion segment.ConclusionsOur results demonstrated physiologic quality of motion at the index segment and harmony among its neighbouring segments following cervical disc arthroplasty, without gearshift-like intermittent locking of the prosthesis during the arc of flexion-extension motion. This pilot study provides a basis for the design of future long-term studies with larger sample size to compare the quality of motion between different cervical disc prostheses using the concept of segmental motion fraction as a motion-quality metric.

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Project description:A precise and comprehensive definition of "normal" in vivo cervical kinematics does not exist due to high intersubject variability and the absence of midrange kinematic data. In vitro test protocols and finite element models that are validated using only end range of motion data may not accurately reproduce continuous in vivo motion.The primary objective of this study was to precisely quantify cervical spine intervertebral kinematics during continuous, functional flexion-extension in asymptomatic subjects. The advantages of assessing continuous intervertebral kinematics were demonstrated by comparing asymptomatic controls with patients with single-level anterior arthrodesis.Cervical spine kinematics were determined during continuous in vivo flexion-extension in a clinically relevant age group of asymptomatic controls and a group of patients with C5-C6 arthrodesis.The patient sample consisted of 6 patients with single-level (C5-C6) anterior arthrodesis (average age: 48.8±6.9 years; 1 male, 5 female; 7.6±1.2 months postsurgery) and 18 asymptomatic control subjects of similar age (average age: 45.6±5.8 years; 5 male, 13 female).Outcome measures included the physiologic measure of continuous kinematic motion paths at each cervical motion segment (C2-C7) during flexion-extension.Participants performed flexion-extension while biplane radiographs were collected at 30 images per second. A previously validated tracking process determined three-dimensional vertebral positions with submillimeter accuracy. Continuous flexion-extension rotation and anterior-posterior translation motion paths were adjusted for disc height and static orientation of each corresponding motion segment.Intersubject variability in flexion-extension angle was decreased 15% to 46% and intersubject variability in anterior-posterior translation was reduced 14% to 33% after adjusting for disc height and static orientation angle. Average intersubject variability in continuous motion paths was 1.9° in flexion-extension and 0.6 mm in translation. Third-order polynomial equations were determined to precisely describe the continuous flexion-extension and anterior-posterior translation motion path at each motion segment (all R2>0.99).A significant portion of the intersubject variability in cervical kinematics can be explained by the disc height and the static orientation of each motion segment. Clinically relevant information may be gained by assessing intervertebral kinematics during continuous functional movement rather than at static, end range of motion positions. The fidelity of in vitro cervical spine mechanical testing protocols may be evaluated by comparing in vitro kinematics to the continuous motion paths presented.

Project description:BACKGROUND:Physiological motion of the lumbar spine is a subject of interest for musculoskeletal health care professionals, as abnormal motion is believed to be related to lumbar conditions and complaints. Many researchers have described ranges of motion for the lumbar spine, but only a few have mentioned specific motion patterns of each individual segment during flexion and extension. These motion patterns mostly comprise the sequence of segmental initiation in sagittal rotation. However, an adequate definition of physiological motion of the lumbar spine is still lacking. The reason for this is the reporting of different ranges of motion and sequences of segmental initiation in previous studies. Furthermore, due to insufficient fields of view, none of these papers have reported on maximum flexion and extension motion patterns of L1 to S1. In the lower cervical spine, a consistent pattern of segmental contributions was recently described. In order to understand physiological motion of the lumbar spine, it is necessary to systematically study motion patterns, including the sequence of segmental contribution, of vertebrae L1 to S1 in healthy individuals during maximum flexion and extension. OBJECTIVE:This study aims to define the lumbar spines' physiological motion pattern of vertebrae L1, L2, L3, L4, L5, and S1 by determining the sequence of segmental contribution and the sequence of segmental initiation of motion in sagittal rotation of each vertebra during maximum flexion and extension. The secondary endpoint will be exploring the possibility of analyzing the intervertebral horizontal and vertical translation of each vertebra during maximum flexion and extension. METHODS:Cinematographic recordings will be performed in 11 healthy male participants, aged 18-25 years, without a history of spine problems. Cinematographic flexion and extension recordings will be made at two time points with a minimum 2-week interval in between. RESULTS:The study has been approved by the local institutional medical ethical committee (Medical Research Ethics Committee of Zuyderland and Zuyd University of applied sciences) on September 24, 2018. Inclusion of participants will be completed in 2020. CONCLUSIONS:If successful, these physiological motion patterns can be compared with motion patterns of patients with lumbar conditions before or after surgery. Ultimately, researchers may be able to determine differences in biomechanics that can potentially be linked to physical complaints like low back pain. TRIAL REGISTRATION:ClinicalTrials.gov NCT03737227; https://clinicaltrials.gov/ct2/show/NCT03737227. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/14741.

Dataset Information

In Vivo Characteristics of Nondegenerated Adjacent Segment Intervertebral Foramina in Patients With Degenerative Disc Disease During Flexion-Extension.

Publications

In Vivo Characteristics of Nondegenerated Adjacent Segment Intervertebral Foramina in Patients With Degenerative Disc Disease During Flexion-Extension.

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