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OBJECTIVE: To observe the expression levels of interleukin-1a (IL-1a) and matrix metalloproteinase-9 (MMP-9) in degenerated lumbar disc tissues and to investigate their clinical significance. PATIENTS AND METHODS: Fifty patients with lumbar disc degeneration received the operative treatment were divided into three groups according to the magnetic resonance imaging (MRI) results: protrusion group, extrusion group, and free group. The degenerated intervertebral disc tissues were taken, and the normal intervertebral disc tissues of 20 patients received the operative treatment due to lumbar bursting fracture, and were selected as the control group. The bone mineral densities of all patients were measured. The mRNA and protein expression levels of MMP-9 and IL-1a were detected via Real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA), respectively. RESULTS: The bone mass of patients with lumbar disc degeneration was significantly decreased compared with that of the control group, and the bone mass was decreased more significantly in a free group than that in protrusion group. The mRNA and protein levels in IL-1a and MMP-9 of patients with lumbar disc degeneration were significantly increased compared with those in control group; the mRNA and protein levels in IL-1a and MMP-9 of extrusion group and free group were significantly higher than those in protrusion group, and the mRNA and protein levels in IL-1a and MMP-9 of free group were significantly higher than those in extrusion group. CONCLUSIONS: The levels of IL-1a and MMP-9 in degenerated lumbar disc tissues are higher than normal levels, and the increasing levels are positively correlated with the disease condition. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The value of diagnosing lumbar disc degeneration with T1p magnetic resonance imaging (MRI), T2 mapping and diffusion-weighted imaging (DWI) technologies. PATIENTS AND METHODS: We selected 30 patients diagnosed with lumbar disc herniation (group A), 30 patients with lumbar disc degeneration (group B) and 30 healthy volunteers (group C) and carried out Pfirrmann grading of intervertebral discs (L1-S1 segment) based on conventional T2WI median sagittal images. T1p, T2 mapping and DWI were then applied. RESULTS: Group A primarily had Pfirrmann grades of III-IV, group B had Pfirrmann grades of I-IV and group C had Pfirmann grades of I-II. The differences between the groups were statistically significant (p <0.05). The average T1p, T2 mapping and apparent diffusion coefficient (ADC) values of the nucleus pulposus and annulus fibrosus in group A were significantly lower than in group B. The highest values were in group C, and the differences were statistically significant (p <0.05). CONCLUSIONS: T2WI, T1p MRI, T2 Mapping and DWI technologies have different capacities to diagnose lumbar disc degeneration, and have great value in improving diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Objective: To assess the clinical validity of a new grading system based on T2-weighted magnetic resonance imaging (MRI) for lumbar disc degeneration Study Design: Retrospective study Overview of the Literature: Various MRI classification criteria have been widely used for evaluation of intervertebral disc pathology. However, there is still considerable controversy regarding the MRI factors that allow accurate diagnosis. Materials and Methods: Data were collected from 570 lumbar discs in 114 patients and evaluated. The new grading system based on T2-weighted MRI was developed for lumbar disc degeneration, and its clinical validity was assessed. Symptoms were categorized according to the Japanese Orthopaedic Association's low back pain score (JOA score; 15-point-method). Moreover, the intraobserver reproducibility and interobserver reliability of the new grading system were compared with those obtained by using the commonly-used Schneiderman's criteria. Results: The shape of nucleus pulposus and signal intensity could be evaluated in the new grading system. Leg symptoms and walking ability graded by JOA score correlated with a new grading system (p < 0.05). The rate of intraobserver reproducibility of the new grading system showed a little higher agreement (85.0%) compared with Schneiderman's criteria (81.5%). The rate of interobserver reliability was similar. Conclusion: The new T2-weighted MRI grading system for disc degeneration was primarily useful for assessing leg symptoms and walking ability. Intraobserver reproducibility of the new grading system was higher than those of Schneiderman's criteria. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The present study aimed to determine whether the -735 C/T polymorphism of the Matrix Metalloproteinase 2 (MMP2) gene is associated with the risk and severity of lumbar disc degeneration (LDD) in the Chinese Han population. PATIENTS AND METHODS: A total of 1008 patients with LDD and 906 healthy controls were enrolled in this study. The grade of disc degeneration was determined according to Schneiderman's classification for Magnetic Resonance Imaging (MRI). The -735 C/T polymorphism of MMP2 was genotyped using polymerase chain reaction and the restriction fragment length polymorphism method. RESULTS: The genotype frequency of the -735 C/T polymorphism was in agreement with the Hardy-Weinberg equilibrium (p = 0.087). The frequencies of the -735CT and TT genotypes were significantly lower among LDD patients compared with normal controls (p < 0.001); CT and TT genotype were significantly associated with a decreased risk of LDD compared with the CC genotype (for TT genotype, p = 0.031; OR 0.413; 95% CI 0.184-0.924; for CT genotype, p < 0.001, OR 0.645, 95% CI 0.506-0.822). Patients with LDD showed significantly higher frequencies of the C allele than normal controls (p < 0.001), T allele was significantly associated with a decreased risk of LDD compared with the C allele (p < 0.001; OR 0.631; 95% CI 0.508-0.783). In addition, the -735TT and CT genotypes, as well as the T allele were associated with lower degenerative grades of LDD compared with CC genotype and the C allele, respectively (both p < 0.001). CONCLUSIONS: The -735 C/T polymorphism of MMP2 may be associated with the risk and severity of LDD in the Chinese Han population. [ABSTRACT FROM AUTHOR]

Summary: Spinal fusion for low back pain (LBP) in the absence of serious underlying disease is controversial. The cause of serious LBP illness is not well understood, there is poor correlation of the presence and degree of degenerative changes with symptoms and non-structural factors such as central pain intolerance, psychological distress, social and economic issues of compensation and participation, appear to act as co-morbidities to LBP illness. Fusion surgery appears to offer only limited relative benefits over cognitive behavioural therapy and intensive rehabilitation in RCTs of surgical vs. non-operative care. At best, possibly 50% of fusion patients in this setting have high-quality outcomes. Artificial disc replacement has approximately the same outcomes as fusion in short-term studies but the long-term risks of prosthesis placement in relatively young patients is a concern. Future surgical advances may be limited by a lack of clear diagnostic certainty and the high prevalence of serious co-morbidities that impair recovery. [Copyright &y& Elsevier]