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BACKGROUND: Needle-knife release of the ligamentum flavum can effectively improve symptoms in patients with lumbar degeneration, and ultrasound guidance can increase the precision of needle-knife release; however, the specific effects of needle-knife release of the ligamentum flavum on the degenerated intervertebral discs and the possible mechanisms remain to be clarified. OBJECTIVE: To investigate the effect of ultrasound-guided needle-knife release of the ligamentum flavum. METHODS: Twenty-four New Zealand rabbits were randomized into control (n=6) and model (n=18) groups. A rabbit model of lumbar disc degeneration model was established in the model group by cutting the supraspinous and interspinous ligaments of the L5/6 and L6/7 segments to maintain a standing posture and apply axial load to the lumbar spine. After successful modeling, the model rabbits were subdivided into a control group, a model group, an ultrasonic needleknife group, and a sham needle-knife group according to a random number table method, with six animals in each group. The ultrasonic needle-knife group underwent ultrasound-guided needle-knife release of the right yellow ligament of L7/S1, once every week, for a total of four times. The needle-knife approach in the sham needle-knife group was the same as that in the ultrasound needle-knife group, but the ligamentum flavum was not released. At 30 days after the intervention, MRI was used to observe the changes in the signal intensity of the nucleus pulposus within the L7/S1 segment. Hematoxylin-eosin staining was used to observe the morphological changes of the L7/S1 segment. Immunohisto-chemical staining was used to detect the expression of type I and II collagen in the nucleus pulposus of the L7/S1 segment. RT-PCR and western blot were used to detect the expression of integrin α5 and β1, p38, and nuclear factor κB in the L7/S1 segment. RESULTS AND CONCLUSION: MRI findings indicated that the nucleus pulposus of the intervertebral disc of rabbits in the model group was gray-black in color, and the gray value of the nucleus pulposus was significantly lower than that of the control group (P < 0.01). The brightness of the nucleus pulposus of the intervertebral disc of the rabbits in the ultrasonic needle-knife group was elevated compared with that of the model group, and the gray value of the nucleus pulposus was higher than that of the model group (P < 0.01). Results from hematoxylin-eosin staining showed that in the model group, the shape of the nucleus pulposus was irregular, the number of nucleus pulposus cells was reduced, the extracellular matrix was compressed, the fibrous ring was ruptured, the structure and boundary of the end plate were unclear, and the chondrocytes were arranged disorderly. Compared with the model group, the ultrasonic needle-knife group showed an increase in the number of the nucleus pulposus, an improvement in the rupture of the fibrous ring, and more regular arrangement of cartilage endplate cells. Results from immunohisto-chemical staining showed an increase in positive expression of type I collagen (P < 0.01) and a decrease in positive expression of type II collagen in the nucleus pulposus of the model group compared with the control group as well as a decrease in positive expression of type I collagen and an increase in positive expression of type II collagen in the nucleus pulposus of the ultrasonic needle-knife group compared with the model group (P < 0.01). RT-PCR and western blot assays showed that the mRNA and protein expression of integrin α5, integrin β1, p38, and nuclear factor κB in the intervertebral discs of rabbits in the model group were increased compared with that in the control group (P < 0.01); the mRNA and protein expression of integrin α5, integrin β1, p38, and nuclear factor κB in the intervertebral discs of rabbits in the ultrasonic needle-knife group was decreased compared with that in the model group (P < 0.01). To conclude, ultrasound-guided needle-knife release of the ligamentum flavum can improve the degree of lumbar disc degeneration in rabbits, which may be related to the inhibition of p38 and nuclear factor-κB expression by modulating integrin α5 and β1 expression. [ABSTRACT FROM AUTHOR]

Animal models are valuable tools for studying the underlying mechanisms of and potential treatments for intervertebral disc diseases. In this review, we discuss the advantages and limitations of animal models of disc diseases, focusing on lumbar spinal stenosis, disc herniation, and degeneration, as well as future research directions. The advantages of animal models are that they enable controlled experiments, long-term monitoring to study the natural history of the disease, and the testing of potential treatments. However, they also have limitations, including species differences, ethical concerns, a lack of standardized protocols, and short lifespans. Therefore, ongoing research focuses on improving animal model standardization and incorporating advanced imaging and noninvasive techniques, genetic models, and biomechanical analyses to overcome these limitations. These future directions hold potential for improving our understanding of the underlying mechanisms of disc diseases and for developing new treatments. Overall, although animal models can provide valuable insights into pathophysiology and potential treatments for disc diseases, their limitations should be carefully considered when interpreting findings from animal studies. [ABSTRACT FROM AUTHOR]

Background: Lumbar disc degeneration (LDD) is a ubiquitous finding in low back pain. Many different etiology factors may explain the LDD process, such as bone morphogenetic proteins (BMPs), DNA methylation, and gut microbiota. Until recently the mechanisms underlying the LDD process have been elusive. Methods: BMP‐related genes were extracted from the GeneCards database. The LDD transcriptome dataset was obtained from the Gene Expression Omnibus. We used linear regression and meta‐analysis to screen and integrate the differentially expressed genes associated with BMPs in LDD. Genome‐wide association studies (GWASs) of LDD were from FinnGen and UKBB. The expression quantitative trait loci (eQTLs) and DNA methylation quantitative trait loci from the blood were identified via the summary data‐based Mendelian randomization (SMR) method, and the possible blood BMP genes and their regulatory elements associated with the risk of LDD were prioritized. Intestinal eQTLs and fecal microbial QTLs (mbQTLs) were integrated, and the potential interactions between BMP gene expression in host intestinal tissue and the gut microbiota were revealed through SMR and colocalization analysis. The GWAS catalog (GCST90246169) was used to validate SMR results. Results: A meta‐analysis of five datasets revealed that 113 BMP genes were differentially expressed between LDD and control tissues. Seven genes were selected as candidate pathogenic genes of LDD via the three‐step SMR method: CREB1, BMP6, PTCH1, GLI1, MEG3, GALNS, and NF1. SMR analysis also revealed five possible gut genes: HFE, MET, MAPK3, NPC1, and GDF5. The correlation between the gut microbiota and BMP gene expression in intestinal tissues was verified by eQTL‐mbQTL colocalization. Conclusion: This multi‐omics study revealed that the BMP genes associated with LDD are regulated by DNA methylation. There are genetic differences between gut gene expression and the gut microbiota. These findings provide evidence for new therapeutic targets in the future. [ABSTRACT FROM AUTHOR]

Extreme lateral interbody fusion (XLIF) has been established as an effective treatment for degenerative disorders of the lumbar spine. Nevertheless, there is a potential risk of lumbar plexus damage associated with XLIF, especially during surgeries at the L4–5 segment. Diffusion tensor imaging (DTI) evaluates the directional diffusion of water molecules in tissue, providing a more intricate depiction of internal tissue microstructure compared to conventional MRI techniques. The capability of DTI sequences to elucidate the 3-dimensional interplay between lumbar nerve pathways and adjacent musculoskeletal structures, potentially reducing the incidence of nerve injury complications related to XLIF, remains to be established. This study evaluates the effectiveness of preoperative DTI in reducing neurological complications after XLIF surgeries at the L4-5 level, focusing on the interaction between lumbar nerves and the psoas major muscle. Retrospective case-control study. The study included 128 patients undergoing XLIF surgery for degenerative disorders at the L4-5 segment: 68 in the traditional group and 62 in the DTI group. The study assessed Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores, along with complication rates. It also documented psoas major muscle morphology and its correlation with nerve pathways. A retrospective analysis of 128 patients undergoing XLIF surgery for degenerative disorders at the L4–5 segment between February 2020 and August 2022 was conducted. The cohort was divided into a traditional group (68 patients) receiving presurgery MRI scans to identify surgical entry points at the intervertebral space midpoint (Zones II–III junction) and a DTI group (62 patients) who additionally underwent preoperative DTI to customize entry points. The study evaluated VAS and ODI scores, complication rates, psoas major muscle morphology, and its interaction with nerve pathways. The traditional group uniformly chose the Zone II–III junction for entry. In contrast, the DTI group's entry points varied. Postoperative follow-up revealed significant improvements in VAS and ODI scores in both groups. However, the DTI group experienced fewer immediate postoperative complications such as thigh pain, numbness, and motor disturbances. The study also noted a ventral shift in nerve positioning in patients with elevated psoas muscles. Preoperative DTI effectively maps the relationship between the psoas major muscle and lumbar nerves. Tailoring surgical entry points based on DTI results significantly reduces the risk of nerve damage in XLIF surgeries. The study underscores the importance of recognizing variability in lumbar nerve pathways due to differing psoas muscle morphologies, highlighting a higher risk of nerve injury in patients with elevated psoas muscles during XLIF procedures. [ABSTRACT FROM AUTHOR]

Animal models are valuable tools for studying the underlying mechanisms of and potential treatments for intervertebral disc diseases. In this review, we discuss the advantages and limitations of animal models of disc diseases, focusing on lumbar spinal stenosis, disc herniation, and degeneration, as well as future research directions. The advantages of animal models are that they enable controlled experiments, long-term monitoring to study the natural history of the disease, and the testing of potential treatments. However, they also have limitations, including species differences, ethical concerns, a lack of standardized protocols, and short lifespans. Therefore, ongoing research focuses on improving animal model standardization and incorporating advanced imaging and noninvasive techniques, genetic models, and biomechanical analyses to overcome these limitations. These future directions hold potential for improving our understanding of the underlying mechanisms of disc diseases and for developing new treatments. Overall, although animal models can provide valuable insights into pathophysiology and potential treatments for disc diseases, their limitations should be carefully considered when interpreting findings from animal studies.

There are many models of lumbar disc degeneration, but mechanical stress-induced lumbar disc degeneration is rare. Here we propose a mechanical stress-induced lumbar disc degeneration model to better understand the molecular mechanism of lumbar disc degeneration under stress stimulation. To design a new model of lumbar disc degeneration under mechanical stress. The anatomic approach of the oblique lateral approach to lumbar fusion surgery was used to design a longitudinal compression device across the vertebral body of the rabbit to impose longitudinal load on the lumbar disc. New Zealand white rabbits (n=30) were used. Screws were used to cross the rabbits' lumbar vertebral bodies, and both sides of the screws were pressurized. Continuous compression was then performed for 28 days. Adjacent unpressurized lumbar discs serve as controls for pressurized lumbar discs. At 28 days after surgery, micro-computed tomography (CT) and magnetic resonance imaging (MRI) were performed on the rabbits' lumbar discs. After the imaging examination, lumbar disc samples were removed, Safranin-O fast green and immunofluorescence was performed to detect the expression level of intervertebral disc degeneration-related proteins. The CT results showed that the disc height did not decrease significantly after mechanical loading. The MRI results showed that the signals in the pressurized disc decreased 28 days after loading. The results of Safranin-O fast green showed that the cartilage component of the intervertebral disc after mechanical compression was significantly reduced. The immunofluorescence results showed that the expression of ADAMTS5 and MMP13 protein in the nucleus pulposus of the intervertebral disc after mechanical compression increased, while the expression of SOX9 decreased, and the difference was statistically significant. Aggrecan's protein expression decreased, but was not statistically significant. This study designed a reliable model of disc degeneration in rabbits. It is more likely to mimic disc compression in the human body. This animal model can be used as a basic model to study the molecular physiological mechanisms of discogenic low back pain. [ABSTRACT FROM AUTHOR]

Abstract Background Lumbar disc degeneration (LDD) is a ubiquitous finding in low back pain. Many different etiology factors may explain the LDD process, such as bone morphogenetic proteins (BMPs), DNA methylation, and gut microbiota. Until recently the mechanisms underlying the LDD process have been elusive. Methods BMP‐related genes were extracted from the GeneCards database. The LDD transcriptome dataset was obtained from the Gene Expression Omnibus. We used linear regression and meta‐analysis to screen and integrate the differentially expressed genes associated with BMPs in LDD. Genome‐wide association studies (GWASs) of LDD were from FinnGen and UKBB. The expression quantitative trait loci (eQTLs) and DNA methylation quantitative trait loci from the blood were identified via the summary data‐based Mendelian randomization (SMR) method, and the possible blood BMP genes and their regulatory elements associated with the risk of LDD were prioritized. Intestinal eQTLs and fecal microbial QTLs (mbQTLs) were integrated, and the potential interactions between BMP gene expression in host intestinal tissue and the gut microbiota were revealed through SMR and colocalization analysis. The GWAS catalog (GCST90246169) was used to validate SMR results. Results A meta‐analysis of five datasets revealed that 113 BMP genes were differentially expressed between LDD and control tissues. Seven genes were selected as candidate pathogenic genes of LDD via the three‐step SMR method: CREB1, BMP6, PTCH1, GLI1, MEG3, GALNS, and NF1. SMR analysis also revealed five possible gut genes: HFE, MET, MAPK3, NPC1, and GDF5. The correlation between the gut microbiota and BMP gene expression in intestinal tissues was verified by eQTL‐mbQTL colocalization. Conclusion This multi‐omics study revealed that the BMP genes associated with LDD are regulated by DNA methylation. There are genetic differences between gut gene expression and the gut microbiota. These findings provide evidence for new therapeutic targets in the future.

Abstract Purpose This study aimed to investigate an early diagnostic method for lumbar disc degeneration (LDD) and improve its diagnostic accuracy. Methods Quantitative biomarkers of the lumbar body (LB) and lumbar discs (LDs) were obtained using nuclear magnetic resonance (NMR) detection technology. The diagnostic weights of each biological metabolism indicator were screened using the factor analysis method. Results Through factor analysis, common factors such as the LB fat fraction, fat content, and T2* value of LDs were identified as covariates for the diagnostic model for the evaluation of LDD. This model can optimize the accuracy and reliability of LDD diagnosis. Conclusion The application of biomarker quantification methods based on NMR detection technology combined with factor analysis provides an effective means for the early diagnosis of LDD, thereby improving diagnostic accuracy and reliability.

Purpose: This study aimed to use MRI histogram analysis to routine MRI sequences to evaluate lumbar disc degeneration (LDD), illustrate the correlation between this novel method and the traditional Pfirrmann classification method, and more importantly, perform comprehensive agreement analysis of MRI histogram analysis in various situations to evaluate its objectivity and stability. Methods: Lumbar MRI images from 133 subjects were included in this study. LDD was classified into grades by Pfirrmann classification and was measured as peak separation value by MRI histogram analysis. Correlation analysis between the two methods was performed and cutoff values were determined. In addition, the agreement analysis of peak separation value was performed by intraclass correlation coefficient (ICC) in four scenarios, including inter-resolution, inter-observer, inter-regions of interest (ROI) and inter-slice. Results: Peak separation values were strongly correlated with Pfirrmann grades (r = − 0.847). The inter-resolution agreements of peak separation value between original image resolution of 2304 × 2304 and compressed image resolutions (1152 × 1152, 576 × 576, 288 × 288) were good to excellent (ICCs were 0.916, 0.876 and 0.822), except 144 × 144 was moderate (ICC = 533). The agreements of inter-observer (ICC = 0.982) and inter-ROI (ICC = 0.915) were excellent. Compared with the mid-sagittal slice, the inter-slice agreements were good for the first adjacent slices (ICCs were 0.826 and 0.844), and moderate to good for the second adjacent slices (ICC = 0.733 and 0.753). Conclusion: MRI histogram analysis, used in routine MRI sequences, demonstrated a strong correlation with Pfirrmann classification and good agreements in various scenarios, expanding the range of application and providing an effective, objective and quantitative tool to evaluate LDD. [ABSTRACT FROM AUTHOR]

Background: Low Back Pain (LBP) is a pervasive and complex musculoskeletal condition aecting over 80% of the global population. Lumbar Disc Degeneration (LDD) significantly contributes to LBP, and MRI is crucial for its diagnosis and understanding. This study aimes to provide a comprehensive bibliometric analysis of MRI research on LDD with LBP, shedding light on research patterns, collaborations, and potential knowledge gaps. Methods: A comprehensive online search was conducted in the Scopus database to retrieve published literature on LDD with LBP. Bibliometric analysis was conducted to assess publication patterns, co-authorship networks, keyword co-occurrence, and co-citation analysis within the MRI applications for LDD research domain. Bibliometric analysis tools such as VOSviewer and the R package “bibliometrix” were utilized for quantitative assessments. Results: A total of 1,619 publications related to MRI and LDD were analyzed. The analysis indicated a consistent annual growth rate of 4.62% in publications related to MRI and lumbar disc degeneration, reflecting a steady increase in research output over the past two decades. The USA, China, and Japan emerged as leading contributors. “SPINE“, “European Spine Journal“, and “Spine Journal” were the most productive journals in this domain. Key research themes identified included lumbar spine, low back pain, and magnetic resonance imaging. Network visualization shows that low back pain and magnetic resonance imaging were the most widely used keywords. Conclusion: The comprehensive bibliometric analysis of MRI applications for Lumbar Disc Degeneration oers insights into prevailing research patterns, highlights key contributors and journals, and identifies significant research themes. This study provides a foundation for future research eorts and clinical practices in the field, ultimately contributing to the advancement of patient care for individuals suering from LDD and associated Low Back Pain. [ABSTRACT FROM AUTHOR]

Objective Lumbar disc degeneration (LDD) is a common cause of low back pain and disability, and its prevalence increases with age. The aim of this study is to investigate whether endplate Hounsfield unit (HU) values have an effect on lumbar disc degeneration (LDD) after transforaminal lumbar interbody fusion (TLIF) surgery in patients with degenerative lumbar stenosis. Methods This study was a retrospective analysis of patients who underwent TLIF surgery in January 2016 to October 2019. One hundred and fifty‐seven patients who underwent TLIF surgery for degenerative lumbar stenosis were enrolled in this study. Demographic data was recorded. VAS and ODI values were compared to assess the surgical outcomes in patients with or without process of LDD after TLIF surgery. Correlation analysis was performed to investigate associations between LDD and endplate HU value. Binary logistic regression analysis was carried out to study relationships between the DDD and the multiple risk factors. Results There was a statistically significant correlation between LDD, body mass index (BMI), age, paraspinal muscle atrophy, and total endplate scores (TEPS). Also, a strong and independent association between endplate HU value and LDD was found at every lumbar disc level (p

Background: Lumbar disc degeneration (LDD) is an important pathological basis for the development of degenerative diseases of the lumbar spine. Most clinical patients have low back pain as their main symptom. The deterioration of the biomechanical environment is an important cause of LDD. Although there is a large amount of basic research on LDD, there are fewer reports that correlate biomechanical mechanisms with basic research. Our research aims to identify 304 key genes involved in LDD due to biomechanical deterioration, using a bioinformatics approach. We focus on SMAD3, CAV1, SMAD7, TGFB1 as hub genes, and screen for 30 potential target drugs, offering novel insights into LDD pathology and treatment options. Methods: The Gene Cards, GenCLip3, OMIM and Drugbank databases were explored to obtain genes associated with biomechanics and LDD, followed by making veen plots to obtain both co-expressed genes. GO enrichment analysis and KEGG pathway analysis of the co-expressed genes were obtained using the DAVID online platform and visualised via a free online website. Protein interaction networks (PPI) were obtained through the STRING platform and visualised through Cytoscape 3.9.0. These genes were predicted for downstream interaction networks using the STITCH platform. Then, the GSE56081 dataset was used to validate the key genes. RT-PCR was used to detect mRNA expression of core genes in the degenerated nucleus pulposus (NP) samples and western bolt was used for protein expression. Lastly, the obtained hub genes were searched in the drug database (DGIdb) to find relevant drug candidates. Results: From the perspective of biomechanics-induced LDD, we obtained a total of 304 genes, the GO functional enrichment and KEGG pathway enrichment analysis showed that the functions of these genes are mostly related to inflammation and apoptosis. The PPI network was constructed and four Hub genes were obtained through the plug-in of Cytoscape software, namely SMAD3, CAV1, SMAD7 and TGFB1. The analysis of key genes revealed that biomechanical involvement in LDD may be related to the TGF-β signaling pathway. Validation of the GSE56081 dataset revealed that SMAD3 and TGFB1 were highly expressed in degenerating NP samples. RT-PCR results showed that the mRNA expression of SMAD3 and TGFB1 was significantly increased in the severe degeneration group; Western blot results also showed that the protein expression of TGFB1 and P-SMAD3 was significantly increased. In addition, we identified 30 potential drugs. Conclusion: This study presented a new approach to investigate the correlation between biomechanical mechanisms and LDD. The deterioration of the biomechanical environment may cause LDD through the TGF-β signaling pathway. TGFB1 and SMAD3 are important core targets. The important genes, pathways and drugs obtained in this study provided a new basis and direction for the study, diagnosis and treatment of LDD.

The purpose of this three-part narrative review is to examine the anatomy of, and the research which supports, either the lumbar myofascia or intervertebral disc (IVD) as principal sources of our patient’s low back pain. A comprehensive understanding of anatomical lumbar pain generators in combination with the current treatment-based classification system will further improve and enhance clinical decision-making skills. Section I reviews the anatomy of the spinal myofascia, myofascial sources of lumbar pain, and imaging of myofascial tissues. Part II reviews the anatomy of the IVD, examines the IVD as a potential lumbar pain generator, and includes detailed discussion on Nerve Growth Factor, Inflammatory Cytokines, Vertebral End Plates and Modic change, Annular tears, and Discogenic instability. Part III looks at the history of myofascial pain, lab-based research and myofascial pain, and various levels of discogenic pain provocation research including animal, laboratory and human subjects. Our review concludes with author recommendations on developing a comprehensive understanding of altered stress concentrations affecting the posterior annulus fibrosis, neo-innervation of the IVD, inflammatory cytokines, discogenic instability, and how this knowledge can complement use of the Treatment-Based Classification System. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of Bugan Jianyao Decoction on the expression of basic fibroblast growth factor (bFGF), transforming growth factor-β1 (TGF-β1) and bone morphogenetic protein-3 (BMP-3) in rat model of lumbar disc degeneration.Methods: A total of 90 SD rats were randomly divided into normal control group, sham operation group, model group, low, medium and high dose Bugan Jianyao Decoction groups, with 15 rats in each group. The normal control group was not treated. The sham operation group only exposed the intervertebral disc without intervertebral disc puncture. The remaining four groups prepared rat lumbar intervertebral disc degeneration model. After successful modeling, the low, medium and high doses of Bugan Jianyao Decoction groups were given low, medium and high doses of Bugan Jianyao Decoction by gavage. The normal control group, sham operation group and model group were given the same amount of normal saline. The contents of TGF-β1, bFGF m RNA and BMP-3 in intervertebral disc were detected before intervention, 20 d, 40 d after intervention. Results: Compared with the normal control group and the sham operation group, the expression of TGF-β1, bFGF m RNA and BMP-3 in the model group and each dose group of Bugan Jianyao Decoction increased before intervention (P＜0.05) . After 20 d and 40 d of intervention, the expression of TGF-β1, bFGF m RNA and BMP-3 in each dose group of Bugan Jianyao Decoction increased (P＜0.05) . Compared with the model group, there was no significant change in the content of TGF-β1, b FGF m RNA and BMP-3 in each dose group of Bugan Jianyao Decoction before intervention (P＞0.05) . After 20 d of intervention, the expression of TGF-β1, bFGF m RNA and BMP-3 in each dose group of Bugan Jianyao Decoction decreased (P＜0.05) . After 40 d of intervention, the expression of TGF-β1, bFGF m RNA and BMP-3 in the high dose group and the middle dose group of Bugan Jianyao Decoction decreased more significantly (P＜0.05) . The expression of TGF-β1, bFGF m RNA and BMP-3 in the low-dose group also decreased (P＜0.05) . After 40 d of intervention, the expression of TGF-β1, bFGF m RNA and BMP-3 in the high-dose group and the middledose group was significantly lower than that in the low-dose group (P＜0.05) . Conclusion: Bugan Jianyao Decoction can reduce the expression of bFGF, TGF-β1 and BMP-3 in the model of lumbar intervertebral disc degeneration in rats, and promote the repair of degenerative intervertebral disc in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

Objective: Lumbar disc degeneration (LDD) is a common cause of low back pain and disability, and its prevalence increases with age. The aim of this study is to investigate whether endplate Hounsfield unit (HU) values have an effect on lumbar disc degeneration (LDD) after transforaminal lumbar interbody fusion (TLIF) surgery in patients with degenerative lumbar stenosis. Methods: This study was a retrospective analysis of patients who underwent TLIF surgery in January 2016 to October 2019. One hundred and fifty‐seven patients who underwent TLIF surgery for degenerative lumbar stenosis were enrolled in this study. Demographic data was recorded. VAS and ODI values were compared to assess the surgical outcomes in patients with or without process of LDD after TLIF surgery. Correlation analysis was performed to investigate associations between LDD and endplate HU value. Binary logistic regression analysis was carried out to study relationships between the DDD and the multiple risk factors. Results: There was a statistically significant correlation between LDD, body mass index (BMI), age, paraspinal muscle atrophy, and total endplate scores (TEPS). Also, a strong and independent association between endplate HU value and LDD was found at every lumbar disc level (p < 0.01). After conditioning on matching factors, multivariate logistic regression analysis showed that higher endplate HU (odds ratio [OR]: 1.003, p = 0.003), higher TEPS (OR: 1.264, p = 0.002), higher BMI (odds ratio [OR]: 1.202, p = 0.002), a smaller cross‐sectional area (CSA) of the paraspinal muscle preoperatively (OR: 0.096, p < 0.001) were significant predictors of LDD development after TLIF surgery. Conclusions: There is a significant association between LDD and endplate HU value after TLIF surgery in patients with degenerative lumbar stenosis. Beyond that, results from this study provide a mechanism by which high endplate HU value predisposes to LDD after TLIF surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Lumbar disc degeneration (LDD) is associated with low back pain (LBP). Although both insomnia and mental distress appear to influence the pain experience, their role in the association between LDD and LBP is uncertain. Our objective was to investigate the role of co-occurring insomnia and mental distress in the association between LDD and LBP-related disability. Methods A total of 1080 individuals who had experienced LBP during the previous year underwent 1.5-T lumbar magnetic resonance imaging, responded to questionnaires, and participated in a clinical examination at the age of 47. Full data was available for 843 individuals. The presence of LBP and LBP-related disability (numerical rating scale, range 0–10) were assessed using a questionnaire. LDD was assessed by a Pfirrmann-based sum score (range 0–15, higher values indicating higher LDD). The role of insomnia (according to the five-item Athens Insomnia Scale) and mental distress (according to the Hopkins Symptom Check List-25) in the association between the LDD sum score and LBP-related disability was analyzed using linear regression with adjustments for sex, smoking, body mass index, education, leisure-time physical activity, occupational physical exposure, Modic changes, and disc herniations. Results A positive association between LDD and LBP-related disability was observed among those with absence of both mental distress and insomnia (adjusted B = 0.132, 95% CI = 0.028–0.236, p = 0.013), and among those with either isolated mental distress (B = 0.345 CI = 0.039 –0.650, p = 0.028) or isolated insomnia (B = 0.207, CI = 0.040–0.373, p = 0.015). However, among individuals with co-occurring insomnia and mental distress, the association was not significant (B = -0.093, CI = -0.346-0.161, p = 0.470). Conclusions LDD does not associate with LBP-related disability when insomnia and mental distress co-occur. This finding may be useful when planning treatment and rehabilitation that aim to reduce disability among individuals with LDD and LBP. Future prospective research is warranted.

The purpose of the present study was to evaluate the influence of high nerve tension on lumbar disc degeneration and sagittal morphologies. A total of 50 young and middle-aged patients (mean age 32.1 ± 7.4 years, 22 men and 28 women) who suffered from tethered cord syndrome (TCS) were retrospectively assessed by two observers. Demographic and radiological data were recorded, including lumbar disc degeneration, disc height index and lumbar spine angle, and were compared with 50 patients (mean age 29.7 ± 5.4 years, 22 men and 28 women) without spinal cord abnormalities. Statistical associations were assessed by student's t-test and chi-square test. Our results showed patients with TCS had a significantly higher rate of lumbar disc degeneration in L1/2, L2/3, L4/5 and L5/S1 than in those without TCS (P < 0.05). Moreover, the rates of multilevel disc degeneration and severe disc degeneration in TCS group were significantly higher than those in control group (P < 0.01). The mean disc height index of L3/4 and L4/5 in TCS group was significantly lower than that in control group (P < 0.05). The mean lumbosacral angle of TCS patients was significantly higher than that of patients without TCS (38.4 ± 3.5°vs. 33.7 ± 5.9°, P < 0.01). We found a certain correlation between TCS and lumbar disc degeneration and lumbosacral angle enlargement, suggesting that the spine reduces the high tension of the spinal cord through disc degeneration. Therefore, it is speculated that there is a "compromised regulation" mechanism in the body under the condition of neurological abnormalities. [ABSTRACT FROM AUTHOR]

Abstract Objective The association between the single-nucleotide polymorphisms (SNPs) rs28742109, rs12955018, rs987850, rs8093805, rs12965084 and rs145497186 related to gene named NADH dehydrogenase [ubiquinone] flavoprotein 2 (NDUFV2) and lumbar disc degeneration (LDD) was preliminary investigated in a small sample size. Methods A total of 46 patients with LDD and 45 controls were recruited at Qilu Hospital of Shandong University, and each participant provided 5 mL peripheral venous blood. NA was extracted from the blood of each participant for further genotyping. The frequency of different genotypes in the case group and control group was determined, and analysis of the risk of LDD associated with different SNP genotypes was performed. The visual analogue scale (VAS) scores of the patients’ degree of chronic low back pain were calculated, and the relationship between VAS scores and SNPs was analysed. Results After excluding the influence of sex, age, height, and weight on LDD, a significant association between SNP rs145497186 related to NDUFV2 and LDD persisted (P = 0.006). Simultaneously, rs145497186 was found to be associated with chronic low back pain in LDD populations. Conclusion NDUFV2 rs145497186 SNP could be associated with susceptibility to LDD and the degree of chronic low back pain.

Background: Lumbar disc degeneration (LDD) is associated with low back pain (LBP). Although both insomnia and mental distress appear to influence the pain experience, their role in the association between LDD and LBP is uncertain. Our objective was to investigate the role of co-occurring insomnia and mental distress in the association between LDD and LBP-related disability. Methods: A total of 1080 individuals who had experienced LBP during the previous year underwent 1.5-T lumbar magnetic resonance imaging, responded to questionnaires, and participated in a clinical examination at the age of 47. Full data was available for 843 individuals. The presence of LBP and LBP-related disability (numerical rating scale, range 0–10) were assessed using a questionnaire. LDD was assessed by a Pfirrmann-based sum score (range 0–15, higher values indicating higher LDD). The role of insomnia (according to the five-item Athens Insomnia Scale) and mental distress (according to the Hopkins Symptom Check List-25) in the association between the LDD sum score and LBP-related disability was analyzed using linear regression with adjustments for sex, smoking, body mass index, education, leisure-time physical activity, occupational physical exposure, Modic changes, and disc herniations. Results: A positive association between LDD and LBP-related disability was observed among those with absence of both mental distress and insomnia (adjusted B = 0.132, 95% CI = 0.028–0.236, p = 0.013), and among those with either isolated mental distress (B = 0.345 CI = 0.039–0.650, p = 0.028) or isolated insomnia (B = 0.207, CI = 0.040–0.373, p = 0.015). However, among individuals with co-occurring insomnia and mental distress, the association was not significant (B = -0.093, CI = -0.346-0.161, p = 0.470). Conclusions: LDD does not associate with LBP-related disability when insomnia and mental distress co-occur. This finding may be useful when planning treatment and rehabilitation that aim to reduce disability among individuals with LDD and LBP. Future prospective research is warranted. [ABSTRACT FROM AUTHOR]

Lumbar disc degeneration (LDD) is considered as one of the main causes of low back pain. For clinical diagnosis of LDD, magnetic resonance imaging (MRI) is commonly used. Schmorl's node, high intensity zone (HIZ), Modic changes, and other MRI biomarkers of intervertebral disc (IVD) degeneration are also associated with low back pain. However, the progression and natural history of these features are unclear and there is limited predictive capacity with MRI. We aim to establish and validate a deep learning pipeline, EDPP-Flow, for the 5-year progression prediction of Schmorl's node, HIZ, and Modic changes, based on clinical MRIs. An MRI dataset developed on 1152 volunteers was used in this study. For each volunteer, two MRI scans, at baseline and 5-year follow-up, were collected and pathology labels were annotated as present or absent (with/without pathology) by two specialists with over 10 years of clinical experience. Our pipeline contained the published MRI-SegFlow and state-of-the-art convolutional neural network for progression prediction of endplate defects. The label distribution of the dataset is unbalanced, where the number of present samples was much smaller than absent samples. The resampling and data augmentation strategies were adopted to increase the number of present samples in the training process and balance the influence of different samples on the model, which can improve the prediction accuracy. Our pipeline achieved high weighted accuracy, sensitivity, and specificity for progression prediction of Schmorl's node (89.46 ± 3.71%, 89.19 ± 2.70%, 89.72 ± 2.42%), HIZ (91.75 ± 2.48%, 93.07 ± 3.96%, 90.43 ± 2.51%), and Modic changes (87.51 ± 2.23%, 87.93 ± 1.72%, 87.10 ± 1.99%), on the unbalanced dataset (present sample's percentages of the 3 pathologies above were 4.3%, 11.7%, and 6.7%). We developed and validated a deep learning pipeline, for the progression prediction of endplate defects, which showed high prediction accuracy on unbalanced data. The method has significant potential for clinical implementation. [ABSTRACT FROM AUTHOR]

Background: Although enormous studies have been devoted to solving the problem of intervertebral disc degeneration/herniation, little attention is paid to the effect of paraspinal muscles on it. We aimed to investigate the correlation between paraspinal muscle atrophy and lumbar disc degeneration to recognize paraspinal muscle atrophy and its importance to the spine. Patients and methods: A total of 107 patients were enrolled in the study (65 females, 42 males; age 50.87 ± 15.391 years old). Cross-sectional area, functional cross-sectional area, and fatty infiltration of the posterior paraspinal muscles were measured at the level of L4/5, and the degree of facet joint degeneration was evaluated at the levels of L3/4, L4/5, and L5/S1 by MRI. After controlling the confounding factors by multiple linear regression, the correlations among paraspinal muscle atrophy, disc degeneration, and facet joint degeneration were analyzed. Meanwhile, Pearson/Spearson rank analysis was used to analyze the correlation between clinical symptoms (VAS and ODI) and paraspinal muscle atrophy. Results: There was a strong correlation between paraspinal muscle atrophy and disc degeneration after controlling the confounding factors (p < 0.05, R > 0.5). There was a weak correlation between paraspinal muscle atrophy and facet joint degeneration (p < 0.05, R < 0.5). There was a significant correlation between facet joint degeneration and intervertebral disc degeneration (p < 0.05, R > 0.7). The fatty infiltration of paraspinal muscle was weakly correlated with ODI (p < 0.05, R < 0.3), but VAS was not. Conclusions: The degree of paraspinal muscle atrophy increased with lumbar disc degeneration and facet joint degeneration and fatty infiltration of multifidus was more susceptible to weight. [ABSTRACT FROM AUTHOR]

Lumbar disc degeneration (LDD) is one of the fundamental causes of low back pain. The aims of this study were to determine serum 25-hydroxyvitamin D (25(OH)D) levels and physical performance and to investigate the relationship between serum vitamin D levels, muscle strength and physical activity in elderly patients with LDD. The participants were 200 LDD patients, including 155 females and 45 males aged 60 years and over. Data on body mass index and body composition were collected. Serum 25(OH)D and parathyroid hormone levels were measured. Serum 25(OH)D was classified into the insufficiency group: <30 ng/mL and the sufficiency group: ≥30 ng/mL. Muscle strength was assessed by grip strength, and physical performance (short physical performance battery) was evaluated by the balance test, chair stand test, gait speed, and Timed Up and Go (TUG) test. Serum 25(OH)D levels in LDD patients with vitamin D insufficiency were significantly lower than in those with vitamin D sufficiency (p < 0.0001). LDD patients with vitamin D insufficiency had a prolonged time in physical performance on gait speed (p = 0.008), chair stand test (p = 0.013), and TUG test (p = 0.014) compared to those with vitamin D sufficiency. Additionally, we found that serum 25(OH)D levels were significantly correlated with gait speed (r = −0.153, p = 0.03) and TUG test (r = −0.168, p = 0.017) in LDD patients. No significant associations with serum 25(OH)D status were observed for grip strength and balance tests among patients. These findings demonstrate that higher serum 25(OH)D levels are associated with better physical performance in LDD patients. [ABSTRACT FROM AUTHOR]

Abstract Background Low back pain (LBP) is associated with lumbar disc degeneration (LDD) and fatty infiltration of paraspinal muscles. However, there are some controversies about the relationship between LDD and fatty infiltration of paraspinal muscles, and the causation of them is also not clear. Thus, we investigated whether the degree of LDD was associated with fatty infiltration of paraspinal muscles and preliminarily explored the underlying mechanism. Methods A retrospective study was conducted on 109 patients with chronic LBP. The degree of LDD was assessed by the Pfirrmann classification. Total muscle cross-sectional area, L4 vertebral body endplate area, and fat cross-sectional area at axial T2-weighted MRI were measured. Multifidus and lumbar disc specimens were taken from eight individuals undergoing discectomy for disc herniation. Gene and protein expression levels of TNF were quantified through qPCR assays and ELISA, respectively. Results The relative cross-sectional area, total muscle cross-sectional area, and muscle cross-sectional area asymmetry were not related to LDD. Pfirrmann grades correlated strongly with fatty infiltration of the multifidus and moderately with fatty infiltration of the erector spinae and the psoas muscles. Linear regression analysis suggested that Pfirrmann grades were most associated with fatty infiltration of the multifidus. Compared with II-degree degeneration discs (mild-degeneration group), fatty infiltration of the multifidus in IV-degree degeneration discs (severe-degeneration group) significantly increased, accompanied by increased mRNA expression of TNF. Meanwhile, the protein expression levels of TNF (pg/g protein) in discs (16.62 ± 4.33) and multifidus (13.10 ± 2.76) of the severe-degeneration group were higher than those in the mild-degeneration group (disc: 9.75 ± 2.18; multifidus: 7.84 ± 2.43). However, the mRNA expression of TNF in the multifidus was not significantly different between the two groups. Conclusions The results suggest that LDD is associated with fatty infiltration of the multifidus. The possible underlying mechanism is that LDD induces fatty infiltration by inflammation. Furthermore, compared with the erector spinae and the psoas muscles, fatty infiltration of the multifidus shows an optimal correlation with LDD, which may contribute to further understanding of LDD pathology.

Abstract Background Although it has been suggested that lumbar disc degeneration (LDD) is a significant risk factor for low back pain (LBP), its role remains uncertain. Our objective was to clarify the association between LDD and LBP and whether mental distress modifies the association. Methods Participants of a birth cohort underwent 1.5-T lumbar magnetic resonance imaging at the age of 47. The association between the sum score of LDD (Pfirrmann classification, range 0–15) and LBP (categorized into “no pain”, “mild-to-moderate pain”, “bothersome-and-frequent pain”) was assessed using logistic regression analysis, with sex, smoking, body mass index, physical activity, occupational exposure, education, and presence of Modic changes and disc herniations as confounders. The modifying role of mental distress (according to the Hopkins Symptom Check List-25 [HSCL-25], the Beck Depression Inventory and the Generalized Anxiety Disorder Scale) in the association was analyzed using linear regression. Results Of the study population (n = 1505), 15.2% had bothersome and frequent LBP, and 29.0% had no LBP. A higher LDD sum score increased the odds of belonging to the “mild-to-moderate pain” category (adjusted OR corresponding to an increase of one point in the LDD sum score 1.11, 95% CI 1.04–1.18, P = 0.003) and the “bothersome-and-frequent pain” category (adjusted OR 1.20, 95% CI 1.10–1.31, P

Lower back pain (LBP) is common among baseball players, and the occurrence of lumbar intervertebral disc degeneration is high. The dynamic load on the lumbar spine due to the postures and movements characteristic of baseball is suspected of aggravating LBP caused by degeneration, but the difference in batting action between players with and without degeneration is not known. The purpose of this study was to investigate the difference in batting motion in the presence and absence of lumbar disc degeneration (LDD). The subjects were 18 male baseball players belonging to the University League Division I : seven with disc degeneration and 11 without. The motion task analyzed tee batting. The items examined were the angles of rotation of shoulder, pelvis, hip, and twisting motion ; rotation angular velocity ; time to maximum angular velocity ; and muscle activity potentials of the bilateral latissimus dorsi, erector spinae, multifidus, external oblique, internal oblique, rectus abdominis, and gluteus medius muscles ; at each stage of batting action. There were significant differences between the shoulder and pelvis in rotation angle, time to maximum angular velocity, and muscle activity in the presence and absence of LDD, and in the time to maximum angular velocity between the shoulder and pelvis. We infer that these differences are characteristic of batting motion due to LDD. [ABSTRACT FROM AUTHOR]

Study Design: Prospective biochemical study of comparison of A Disintegrin and Metalloproteinase with Thrombospondin motifs-4 (ADAMTS-4) and A Disintegrin and Metalloproteinase with Thrombospondin motifs 5 (ADAMTS5) levels in preoperative and postoperative venous blood, as well as in disc tissue obtained during surgery, in patients undergoing surgery for intervertebral disc disease, with enzyme levels in venous blood from a control group., Objective: To compare the levels of ADAMTS-4 and ADAMTS-5 between patients with degenerative intervertebral discs and a healthy control group, aiming to identify biomarkers associated with intervertebral disc degeneration., Literature: Although numerous studies have investigated the relationship between ADAMTS-4 and ADAMTS-5 enzymes and degeneration in experimental rat models and human tissues, no study has correlated their serum levels with intervertebral disc degeneration., Method and Materials: Venous blood samples were obtained preoperatively and postoperatively from 41 patients (age: 42 ± 9.7 years, range 20-63) diagnosed with intervertebral disc disease. The affected disc levels were L4-L5 in 22 patients and L5-S1 in 19 patients. These patients were selected based on surgical indications due to radicular pain that persisted after an adequate course of conservative management, without any non-neurological deficit. Disc tissue samples were also obtained during surgery. Additionally, venous blood samples were collected from a control group with no diagnosed diseases, and lumbar MRIs of the control group showed no significant signs of degeneration. ADAMTS-4 and ADAMTS-5 levels were measured using the ELISA method on samples obtained after centrifugation of the collected blood and tissue specimens., Results: The level of ADAMTS-4 in patient serum was found to be lower compared to the control group, while the level of ADAMTS-5 was higher in the patient serum and lower in the control group., Conclusion: Elevated levels of ADAMTS-5 in the blood may be associated with intervertebral disc degeneration., Competing Interests: The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.The authors declare no conflitcs of interests., (© 2025 The Author(s). JOR Spine published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.)

Study Design This is a prospective cohort study involving patients who were followed for 2 years after total knee replacement (TKR) to determine changes in lumbar spine and knee symptoms. Purpose The objectives of this study were to determine the percentage of patients undergoing bilateral TKR who present with coexisting lumbar spine problems and determine if TKR relieves lumbar spine symptoms. Overview of Literature No studies quantify the percentage of TKR patients who experience relief of lumbar spine symptoms after TKR surgery. Methods The study included 200 patients (164 females, 36 males) undergoing primary TKR. Follow-up was performed at 4 weeks, 3, 6, 12, and 24 months. Lumbar spine and knee symptom improvements were assessed using the Oswestry Disability Index (ODI) and Oxford Knee Score, respectively. Results All 200 patients undergoing bilateral TKR presented with radiographic lumbar spine degenerative pathology; 60% (n=120) of the patients presented with moderate to severe clinical symptoms of lumbar spondylosis, including 54% (n=108) with degenerative lumbar spondylosis and lumbar canal stenosis and 6% (n=12) with degenerative spondylolisthesis. Of the 120 patients who presented with lumbar spine problems, 90% (n=108) reported improvement in their symptoms; the ODI score improved from 42.5%±4.1% preoperative score to 15.6%±2.3% postoperative score (p-value

Objective: The association between the single-nucleotide polymorphisms (SNPs) rs28742109, rs12955018, rs987850, rs8093805, rs12965084 and rs145497186 related to gene named NADH dehydrogenase [ubiquinone] flavoprotein 2 (NDUFV2) and lumbar disc degeneration (LDD) was preliminary investigated in a small sample size. Methods: A total of 46 patients with LDD and 45 controls were recruited at Qilu Hospital of Shandong University, and each participant provided 5 mL peripheral venous blood. NA was extracted from the blood of each participant for further genotyping. The frequency of different genotypes in the case group and control group was determined, and analysis of the risk of LDD associated with different SNP genotypes was performed. The visual analogue scale (VAS) scores of the patients' degree of chronic low back pain were calculated, and the relationship between VAS scores and SNPs was analysed. Results: After excluding the influence of sex, age, height, and weight on LDD, a significant association between SNP rs145497186 related to NDUFV2 and LDD persisted (P = 0.006). Simultaneously, rs145497186 was found to be associated with chronic low back pain in LDD populations. Conclusion: NDUFV2 rs145497186 SNP could be associated with susceptibility to LDD and the degree of chronic low back pain. [ABSTRACT FROM AUTHOR]

Introduction. Although core stabilization exercises (CSEs) prove to be effective in patients with various musculoskeletal disorders, their impact in lumbar disc degeneration (LDD) has not been fully investigated. This study aimed to examine the effects of CSEs on lumbar lordotic angle (LLA), pain intensity, and functional disability in patients with LDD. Methods. Overall, 97 adult patients of both genders with LDD were randomly assigned to the study or control group. The study group (n = 48) received CSEs in addition to traditional physical therapy; the control group (n = 49) received only traditional physical therapy, 3 sessions per week for 12 weeks. LLA, pain intensity, and functional disability were determined before and after the treatment program. LLA was measured with the Surgimap Spine software on marked lateral view X-ray films (OmniDiagnost Eleva); pain intensity was evaluated with visual analogue scale (VAS); functional disability was assessed with Oswestry Disability Index (ODI). Results. There was no significant pre-treatment difference between the groups in LLA (p = 0.84), VAS (p = 0.49), or ODI (p = 0.12). Significant post-treatment differences were observed in both groups in all variables (p = 0.001). However, there was a significant decrease in the mean post-treatment values of all variables (p = 0.001) in the study group compared with the control group. Conclusions. CSEs could provide an additional effect of improving LLA, pain intensity, and functional abilities in patients with LDD. [ABSTRACT FROM AUTHOR]

Lumbar disc degeneration (LDD) contributes to low back pain. This study aimed to determine relative telomere length (RTL), oxidative stress status, and antioxidant levels and examine the relationships between RTL, oxidative stress, and the severity in LDD patients. A total of 100 subjects, 50 LDD patients and 50 healthy controls, were enrolled in the case–control study. Blood leukocyte RTL was analyzed using quantitative real-time polymerase chain reaction. Lipid peroxidation was determined by malondialdehyde (MDA) assay. Plasma 8-hydroxy 2′-deoxyguanosine (8-OHdG) values were determined using enzyme-linked immunosorbent assay. Total antioxidant capacity (TAC) and ferric reducing antioxidant power (FRAP) in plasma were also measured. The LDD patients had significantly shorter telomeres than the healthy controls (p = 0.04). Blood leukocyte RTL was inversely correlated with the LDD severity (r = −0.41, p = 0.005). Additionally, plasma MDA and 8-OHdG levels were markedly greater in LDD patients than in the controls (p = 0.01 and p = 0.002, respectively). Furthermore, the plasma MDA level showed a positive correlation with the radiographic severity (r = 0.49, p = 0.001). There was a positive correlation between plasma 8-OHdG and the severity (r = 0.60, p < 0.001). Moreover, plasma TAC and FRAP levels were significantly lower in LDD patients than in the controls (p = 0.04). No significant differences in plasma TAC and FRAP were observed among the three groups of LDD severity. We found that RTL was negatively correlated with the severity while plasma MDA and 8-OHdG levels were positively correlated with the severity. These findings suggest that blood leukocyte RTL, plasma MDA, and 8-OHdG may have potential as noninvasive biomarkers for the assessment of severity in LDD. [ABSTRACT FROM AUTHOR]

Background: Lumbar disc degeneration (LDD) may be related to aging, biomechanical and genetic factors. Despite the extensive work on understanding its etiology, there is currently no automated tool for accurate prediction of its progression. Purpose: We aim to establish a novel deep learning-based pipeline to predict the progression of LDD-related findings using lumbar MRIs. Materials and methods: We utilized our dataset with MRIs acquired from 1,343 individual participants (taken at the baseline and the 5-year follow-up timepoint), and progression assessments (the Schneiderman score, disc bulging, and Pfirrmann grading) that were labelled by spine specialists with over ten years clinical experience. Our new pipeline was realized by integrating the MRI-SegFlow and the Visual Geometry Group-Medium (VGG-M) for automated disc region detection and LDD progression prediction correspondingly. The LDD progression was quantified by comparing the Schneiderman score, disc bulging and Pfirrmann grading at the baseline and at follow-up. A fivefold cross-validation was conducted to assess the predictive performance of the new pipeline. Results: Our pipeline achieved very good performances on the LDD progression prediction, with high progression prediction accuracy of the Schneiderman score (Accuracy: 90.2 ± 0.9%), disc bulging (Accuracy: 90.4% ± 1.1%), and Pfirrmann grading (Accuracy: 89.9% ± 2.1%). Conclusion: This is the first attempt of using deep learning to predict LDD progression on a large dataset with 5-year follow-up. Requiring no human interference, our pipeline can potentially achieve similar predictive performances in new settings with minimal efforts. [ABSTRACT FROM AUTHOR]

Objective: To quantitatively evaluate lumbar disc degeneration with recently-developed quantitative magnetic resonance imaging (MRI) techniques. A series of MRI parameters, including T2*, T1rho relaxation time, apparent diffusion coefficient and gagCEST, were compared and correlated with the Pfirrmann semi-quantitative classification of lumbar intervertebral disc degeneration; the most accurate and relevant MRI parameters of lumbar disc degeneration were identified. Materials and Methods: Thirty-seven subjects (age range, 18-74 years) with non-specific low back pain (LBP) for more than 6 months were enrolled. The L1/2-L5/S1 discs of each subject were measured and then analyzed. Results: The gagCEST value of the discs showed the best negative correlation with degeneration level (nucleus pulposus: r = -0.951, P < 0.001; annulus fibrosus: r = -0.938, P < 0.001). The discriminant analysis results showed that this parameter also had the highest correct rate using a single index (gagCEST discriminant accuracy = 82%). Conclusion: Early stage lumbar disc degeneration can be quantitatively evaluated with MRI using the chemical exchange saturation transfer technique.

Hengshuo Zhang, Lu Chen, Ziyu Wang, Fuan Wang, Yu Shan, Linzeng Qi, Yunzhen Chen Department of Spine Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of ChinaCorrespondence: Yunzhen Chen Email qilucyz@yeah.netObjective: To examine the association between single nucleotide polymorphisms (SNPs) rs2228570, rs731236, rs7975232, and rs1544410 and lumbar disc degeneration (LDD) predisposition.Methods: A search strategy was carried out, and the data were extracted after being chosen by the inclusion and exclusion criteria. Pooled odds ratios and 95% confidence intervals were calculated to assess the association between the aforementioned SNPs and LDD under allelic, dominant, recessive, heterozygous, and homozygous genetic models. In addition, a case–control study involving 46 LDD cases and 45 controls was also performed in the analysis to verify the result.Results: A total of 17 studies were included in this meta-analysis. The pooled results did not show any association between vitamin D receptor (VDR) gene polymorphisms and LDD. But, interestingly, in subgroup analysis, the rs2228570 polymorphism was associated with LDD under the allelic (OR = 0.70, 95% CI = 0.56– 0.87, p = 0.002), recessive (OR = 0.60, 95% CI = 0.43– 0.84, p = 0.003), and homozygous (OR = 0.47, 95% CI= 0.28– 0.79, p = 0.004) genetic models in the Asian population. SNPs rs731236 and rs7975232 still did not show any obvious association. We obtained a similar result from the case–control study: rs2228570 had an obvious relationship with LDD under allelic and homozygous genetic models. At the same time, we found that rs2228570 was also associated with the degree of low back pain (visual analogue scale, VAS score) in LDD population.Conclusion: SNP rs2228570 was significantly associated with LDD predisposition and the degree of low back pain in the Asian population.Keywords: vitamin D receptor, single nucleotide polymorphism, lumbar disc degeneration, visual analogue scale, meta-analysis, case-control study

Background: Low back pain (LBP) is associated with lumbar disc degeneration (LDD) and fatty infiltration of paraspinal muscles. However, there are some controversies about the relationship between LDD and fatty infiltration of paraspinal muscles, and the causation of them is also not clear. Thus, we investigated whether the degree of LDD was associated with fatty infiltration of paraspinal muscles and preliminarily explored the underlying mechanism.Methods: A retrospective study was conducted on 109 patients with chronic LBP. The degree of LDD was assessed by the Pfirrmann classification. Total muscle cross-sectional area, L4 vertebral body endplate area, and fat cross-sectional area at axial T2-weighted MRI were measured. Multifidus and lumbar disc specimens were taken from eight individuals undergoing discectomy for disc herniation. Gene and protein expression levels of TNF were quantified through qPCR assays and ELISA, respectively.Results: The relative cross-sectional area, total muscle cross-sectional area, and muscle cross-sectional area asymmetry were not related to LDD. Pfirrmann grades correlated strongly with fatty infiltration of the multifidus and moderately with fatty infiltration of the erector spinae and the psoas muscles. Linear regression analysis suggested that Pfirrmann grades were most associated with fatty infiltration of the multifidus. Compared with II-degree degeneration discs (mild-degeneration group), fatty infiltration of the multifidus in IV-degree degeneration discs (severe-degeneration group) significantly increased, accompanied by increased mRNA expression of TNF. Meanwhile, the protein expression levels of TNF (pg/g protein) in discs (16.62 ± 4.33) and multifidus (13.10 ± 2.76) of the severe-degeneration group were higher than those in the mild-degeneration group (disc: 9.75 ± 2.18; multifidus: 7.84 ± 2.43). However, the mRNA expression of TNF in the multifidus was not significantly different between the two groups.Conclusions: The results suggest that LDD is associated with fatty infiltration of the multifidus. The possible underlying mechanism is that LDD induces fatty infiltration by inflammation. Furthermore, compared with the erector spinae and the psoas muscles, fatty infiltration of the multifidus shows an optimal correlation with LDD, which may contribute to further understanding of LDD pathology. [ABSTRACT FROM AUTHOR]

Background: Symptomatic disc herniation in radiographically normal intervertebral spaces explains the differences in the observed risk patterns. Objective: The aim of the study was to investigate the potential associated risk factors and the possible risk factors relevance of physical and psychosocial workload to lumbar disc herniation. Methods: A total of 100 cases with acute lumbar disc herniation and 100 as control subjects were studied. Risk factors were examined separately. Result: We have found in this study that gender, manual labour, smoking and physically demanding work having a greater risk of developing lumbar herniation. Conclusion: Further larger studies are needed to verify the concept of distinct aetiologies of lumbar disc herniation. Younger persons having relatively normal discs and older persons with structurally damaged discs having disc herniation.

Abstract Background Lumbar disc degeneration (LDD) is an essential pathological mechanism related to low back pain. Current research on spinal surgery focused on the sophisticated mechanisms involved in LDD, and autophagy was regarded as an essential factor in the pathogenesis. Objectives Our research aimed to apply a bioinformatics approach to select some candidate genes and signaling pathways in relationship with autophagy and LDD and to figure out potential agents targeting autophagy- and LDD-related genes. Materials and methods Text mining was used to find autophagy- and LDD-related genes. The DAVID program was applied in Gene Ontology and pathway analysis after selecting these genes. Several important gene modules were obtained by establishing a network of protein-protein interaction and a functional enrichment analysis. Finally, the selected genes were searched in the drug database to find the agents that target LDD- and autophagy-related genes. Results There were 72 genes related to “autophagy” and “LDD.” Three significant gene modules (22 genes) were selected by using gene enrichment analysis, which represented 4 signaling pathways targeted by 32 kinds of drugs approved by the Food and Drug Administration (FDA). The interactions between drugs and the genes were also identified. Conclusion To conclude, a method was proposed in our research to find candidate genes, pathways, and drugs which were involved in autophagy and LDD. We discovered 22 genes, 4 pathways, and 32 potential agents, which provided a theoretical basis and new direction for clinical and basic research on LDD.

Context: Low back pain is the most common clinical presentation in musculoskeletal disorder due to spinal pathology. Factors such as improper sitting postures, jerky movements in travel, sports activities, aging, and bad sleeping posture are the important factors to produce spinal disorders. Lower back pain has been associated with degeneration of the intervertebral disc. Aims: This clinical study was carried out to judge the effectiveness of Panchatikta Ksheera Basti (medicated herbal therapeutic enema) with Kati Basti in lumbar disc degeneration-induced Katishoola. Settings and Design: This was an open-labeled, single-arm, interventional clinical study. Subjects and Methods: Fifteen diagnosed cases of low backache with lumbar disc degeneration were registered from the outpatient and inpatient departments of All India Institute of Ayurveda, New Delhi, India, and Panchatikta Ksheera Basti as yoga basti followed by Kati Basti for 8 days was administered. Statistical Analysis Used: The data were statistically analyzed using paired t-test. Results: Significant (P < 0.05) result was found in all the assessment parameters, namely, pain, stiffness, and fasciculation. Conclusions: Panchatikta Ksheera Basti with Kati Basti is an effective treatment method for safe and effective management of Katishoola w. s. r lumbar disc degenerative disease.

Background: Although it has been suggested that lumbar disc degeneration (LDD) is a significant risk factor for low back pain (LBP), its role remains uncertain. Our objective was to clarify the association between LDD and LBP and whether mental distress modifies the association.Methods: Participants of a birth cohort underwent 1.5-T lumbar magnetic resonance imaging at the age of 47. The association between the sum score of LDD (Pfirrmann classification, range 0-15) and LBP (categorized into "no pain", "mild-to-moderate pain", "bothersome-and-frequent pain") was assessed using logistic regression analysis, with sex, smoking, body mass index, physical activity, occupational exposure, education, and presence of Modic changes and disc herniations as confounders. The modifying role of mental distress (according to the Hopkins Symptom Check List-25 [HSCL-25], the Beck Depression Inventory and the Generalized Anxiety Disorder Scale) in the association was analyzed using linear regression.Results: Of the study population (n = 1505), 15.2% had bothersome and frequent LBP, and 29.0% had no LBP. A higher LDD sum score increased the odds of belonging to the "mild-to-moderate pain" category (adjusted OR corresponding to an increase of one point in the LDD sum score 1.11, 95% CI 1.04-1.18, P = 0.003) and the "bothersome-and-frequent pain" category (adjusted OR 1.20, 95% CI 1.10-1.31, P < 0.001), relative to the "no pain" category. Mental distress significantly modified the association between LDD and LBP, as a linear positive association was consistently observed among individuals without mental distress according to HSCL-25 (adjusted B 0.16, 95% CI 0.07-0.26, P < 0.001), but not among individuals with higher mental distress.Conclusions: LDD was significantly associated with both mild-to-moderate and bothersome-and-frequent LBP. However, the co-occurrence of mental distress diminished the association between LDD and LBP bothersomeness. Our results strongly suggest that mental symptoms affect the pain experience. [ABSTRACT FROM AUTHOR]

Abstract Background Lumbar disc degeneration (LDD) is a condition associated with recurrent low back pain (LBP). Knowledge regarding effective management is limited. As a step towards the identification of risk, prognostic or potentially modifiable factors in LDD patients, the aim of this study was to explore the hypothesis that intrinsic lumbar spine shape is associated with LDD and clinical outcomes in symptomatic adults. Methods 3 T MRI was used to acquire T2-weighted sagittal images (L1-S1) from 70 healthy controls and LDD patients (mean age 49 years, SD 11, range 31–71 years). Statistical Shape Modelling (SSM) was used to describe lumbar spine shape. SSM identified variations in lumbar shape as ‘modes’ of variation and quantified deviation from the mean. Intrinsic shape differences were determined between LDD groups using analysis of variance with post-hoc comparisons. The relationship between intrinsic shape and self-reported function, mental health and quality of life were also examined. Results The first 7 modes of variation explained 91% of variance in lumbar shape. Higher LDD sum scores correlated with a larger lumbar lordosis (Mode 1 (55% variance), P = 0.02), even lumbar curve distribution (Mode 2 (12% variance), P = 0.05), larger anterior-posterior (A-P) vertebral diameter (Mode 3 (10% variance), P = 0.007) and smaller L4-S1 disc spaces (Mode 7 (2% variance), P ≤ 0.001). In the presence of recurrent LBP, LDD was associated with a larger A-P vertebral diameter (Mode 3) and a more even lumbar curvature with smaller L5/S1 disc spaces (Mode 4), which was significantly associated with patient quality of life (P = 0.002–0.04, rp = 0.43–0.61)). Conclusions This exploratory study provides new evidence that intrinsic shape phenotypes are associated with LDD and quality of life in patients. Longitudinal studies are required to establish the potential role of these risk or prognostic shape phenotypes.

Abstract Background The study aimed to investigate the correlation between type 1 diabetes (T1D) and lumbar disc degeneration (LDD). Methods A retrospective analysis of 118 patients with T1D recruited from January 2014 to March 2019 was performed, and multivariate logistic regression was used to analyse the incidence of T1D; the age, sex, and body mass index (BMI) of the patients; the disease duration and the glycosylated haemoglobin and venous blood glucose levels. All patients who suffered low back pain were assessed by MRI using the Pfirrmann grading system. Results A total of 118 patients with an average age of 36.99 ± 17.01 (8–85 years) were reviewed. The mean hospitalization duration, venous glucose fluctuation range, glycated haemoglobin level, highest venous glucose level, venous glucose level, and disease course duration were 13.98 ± 10.16 days, 14.99 ± 5.87 mmol/L, 9.85 ± 2.52 mmol/L, 25.29 ± 7.92 mmol/L, 13.03 ± 5.75 mmol/L and 7.30 ± 8.41 years. The average Pfirrmann scores of the different discs were 2.20 ± 0.62 (L1–2), 2.35 ± 0.67 (L2–3), 2.90 ± 0.45 (L3–4), 4.20 ± 0.52 (L4–5) and 4.10 ± 0.72 (L5–S1). The patients with T1D showed severe disc degeneration. The male sex, glycosylated haemoglobin, venous glucose and venous glucose fluctuations were significantly associated with LDD (P < 0.05). Conclusions Glycosylated haemoglobin, the male, venous glucose and the venous glucose fluctuation range were risk factors for LDD.

Abstract Background Lipid abnormality and obesity have been proposed to be associated with lumbar disc degeneration, but little is known about the effect of ‘lipid healthy but obese’ (LH-O) and ‘lipid abnormal but not obese’ (LA-NO) phenotypes on lumbar disc degeneration in Chinese. The study aims to determine the impact and distinction of LH-O and LA-NO phenotypes on lumbar disc degeneration in Chinese, and to identify the association of related factors with risk of lumbar disc degeneration. Methods A total of 678 individuals were included with lumbar magnetic resonance imaging, serum lipid levels and anthropometric measurements. Obesity was defined on the basis of body mass index or waist to hip ratio (WHR). Pfirrmann score and Weishaupt’s scale were utilized to assess the degree of disc degeneration and facet joint degeneration. Results The incidence of the LH-O and LA-NO phenotypes were 11.4% and 18.1%, respectively. LA-NO phenotype demonstrates a high incidence for disc degeneration (P 0.05). Elevated triglycerides and greater WHR may be the risk factors for lumbar disc degeneration in Chinese. Conclusion LH-O and LA-NO phenotypes are common with different status of disc degeneration in Chinese. Elevated triglycerides and abdominal obesity appear to play crucial roles in the development of lumbar disc degeneration.

Abstract Background Lumbar disc degeneration seen on magnetic resonance imaging (MRI) is defined as loss of signal intensity and/or disc height, alone or in combination with other MRI findings. The MRI findings and thresholds used to define disc degeneration vary in the literature, and their associations with low back pain (LBP) remain uncertain. Objective To explore how various thresholds of lumbar disc degeneration alter the association between disc degeneration and self-reported LBP. Methods An exploratory, cross-sectional cohort study of a general population. Participants in the cohort ‘Backs-on-Funen’ had MRI scans and completed questionnaires about LBP at ages 41, 45 and 49 years. The MRI variables, signal intensity (Grades 0–3) and disc height (Grades 0–3), were dichotomised at different thresholds. Logistic regression analyses were used to determine associations. Arbitrarily, a difference in odds ratio (OR) of > 0.5 between thresholds was considered clinically relevant. Receiver Operating Characteristic curves were used to investigate differences between diagnostic values at each threshold. Results At age 41, the difference in ORs between signal loss and LBP exceeded 0.5 between the thresholds of ≥2 (OR = 2.02) and = 3 (OR = 2.57). Difference in area under the curves (AUC) was statistically significant (p = 0.02). At ages 45 and 49, the difference in ORs exceeded 0.5 between the thresholds of ≥2 and = 3, but the differences between AUC were not statistically significant. At age 41, the difference in ORs between disc height loss and LBP at the thresholds of ≥1 (OR = 1.44) and ≥ 2 (OR = 2.53) exceeded 0.5. Differences in AUC were statistically significant (p = 0.004). At age 49, differences in ORs exceeded 0.5 (OR = 2.49 at the ≥1 threshold, 1.84 at ≥2 and 0.89 at =3). Differences between AUC were not statistically significant. Conclusion The results suggest that the thresholds used to define the presence of lumbar disc degeneration influence how strongly it is associated with LBP. Thresholds at more severe grades of disc signal and disc height loss were more strongly associated with LBP at age 41, but thresholds at moderate grades of disc degeneration were most strongly associated with LBP at ages 45 and 49.

• Serum CXCL10 concentrations were markedly raised in IDD patients with low back pain. • Serum CXCL10 concentrations were also significantly higher in IDD patients with muscle degeneration. • Increased CXCL10 levels positively correlated with clinical severity. Lumbar intervertebral degenerative disc disease (IDD) is a multifaceted progressive condition that commonly occurs in conjunction with lumbar disc herniation (LDH). CXCL10 mRNA appears to be increased in both IDD and LHD. This study was performed to identify the relationship between serum CXCL10 levels and disease severity in patients with IDD. 136 IDD patients with low back pain, 127 asymptomatic volunteers and 120 healthy controls were enrolled. Serum CXCL10 protein concentrations were detected using commercial human CXCL10 ELISA Kits. Serum CXCL10 mRNA were examined using qRT-PCR. Clinical severity was assessed using the visual analog scale (VAS) and Oswestry Disability Index(ODI) scores. Radiographic severity was defined using the MRI-based Pfirrmann classification of disc degeneration. Receiver operating characteristic (ROC) curve analysis was used in estimating the correlation between CXCL10 and Pfirrmann grade. The cross-sectional area (CSA) of the lumbar multifidus muscle (LMM) and psoas major (PM) were calculated, and fat infiltration was evaluated by Ropponen-Kjaer criteria. Serum CXCL10 concentrations were markedly raised in IDD patients with low back pain in contrast to asymptomatic individuals and healthy controls. Serum CXCL10 levels were positively associated with Pfirrmann grade. ROC curve analysis indicated that serum CXCL10 correlated well with Pfirrmann grade. In addition, serum CXCL10 concentrations were significantly higher in IDD patients with LMM and PM degeneration compared with IDD patients without degeneration. Increased CXCL10 levels positively correlated with VAS and ODI scores, as well as decreased CSA and fat filtration of the LMM and PM. Increased serum CXCL10 levels correspond to clinical severity and radiographic progression in IDD patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intervertebral disc degeneration often causes low back pain, shoulder and neck pain in the elderly, which is closely related to the apoptosis, inflammation and oxidative stress of nucleus pulposus cells in intervertebral disc degeneration. Polydatin is the main active component of Polygonum cuspidatum, which has anti-inflammatory, antioxidant and other biological activities. OBJECTIVE: To investigate the effects of polydatin on apoptosis of nucleus pulposus cells and silent information regulator 1 (SIRT1)/mammalian target of rapamycin (mTOR) pathway in mice with intervertebral disc degeneration. METHODS: Primary mouse nucleus pulposus cells were isolated and cultured by trypsin. Cell identification and cytotoxicity measurement were conducted by toluidine blue staining and type II collagen immunocytochemistry staining. The nucleus pulposus cells were randomly divided into five groups: blank group, model group, low-, middle-, and high-dose polydatin groups (10, 25, and 50 mg/L). The blank group was normally cultured; in addition, the other groups were induced by interleukin-1β to build the degenerative model of nucleus pulposus cells, followed by cultured with different doses of polydatin. Cell apoptosis in each group was detected by flow cytometry. The expression levels of oxidative stress factors and inflammatory factors were measured by enzyme-linked immunosorbent assay. The expression levels of apoptosis related proteins and SIRT1/mTOR signaling pathway related proteins in nucleus pulposus cells were detected by western blot method. The study protocol was ethically approved by the Ethics Committee of General Hospital of the Yangtze River Shipping with an approval No. L20200059. RESULTS AND CONCLUSION: The nucleus pulposus cells were successfully isolated and purified by trypsin. Compared with those in the blank group, the apoptotic rate of nucleus pulposus cells, the expression of Caspase-3 and Bax proteins, the expression levels of malondialdehyde, lactate dehydrogenase, interleukin-6, inducible nitric oxide synthase, and tumor necrosis factor α were significantly higher in the model group. Compared with the model group, these indexes were significantly decreased in the polydatin groups. Compared with the blank group, the model group showed a significant reduction in the expression levels of Bcl-2 protein, superoxide dismutase, reduced glutathione, SIRT1, phosphorylated PI3K/phosphatidylinositol-3-kinase, phosphorylated Akt/protein kinase B and mTOR protein (P < 0.05), and the polydatin groups had a significant increase in the above-mentioned indexes in a dose-dependent manner (P < 0.05). To conclude, polydatin can significantly reduce the apoptosis, inflammation and oxidative stress of nucleus pulposus cells induced by interleukin-1β, which may be achieved by activating the SIRT1/mTOR pathway. [ABSTRACT FROM AUTHOR]

Study Design: This is a prospective cohort study involving patients who were followed for 2 years after total knee replacement (TKR) to determine changes in lumbar spine and knee symptoms. Purpose: The objectives of this study were to determine the percentage of patients undergoing bilateral TKR who present with coexisting lumbar spine problems and determine if TKR relieves lumbar spine symptoms. Overview of Literature: No studies quantify the percentage of TKR patients who experience relief of lumbar spine symptoms after TKR surgery. Methods: The study included 200 patients (164 females, 36 males) undergoing primary TKR. Follow-up was performed at 4 weeks, 3, 6, 12, and 24 months. Lumbar spine and knee symptom improvements were assessed using the Oswestry Disability Index (ODI) and Oxford Knee Score, respectively. Results: All 200 patients undergoing bilateral TKR presented with radiographic lumbar spine degenerative pathology; 60% (n=120) of the patients presented with moderate to severe clinical symptoms of lumbar spondylosis, including 54% (n=108) with degenerative lumbar spondylosis and lumbar canal stenosis and 6% (n=12) with degenerative spondylolisthesis. Of the 120 patients who presented with lumbar spine problems, 90% (n=108) reported improvement in their symptoms; the ODI score improved from 42.5%±4.1% preoperative score to 15.6%±2.3% postoperative score ( p-value<0.001). Of the 12 patients with no improvement, 10 patients underwent percutaneous procedures for their lumbar spine pathology with good results, one patient underwent surgery, and one declined any intervention. Conclusions: A significant number of patients (60%) undergoing bilateral TKR also present with symptomatic lumbar spine problems. Patients with mild to moderate lumbar spine degenerative symptoms and no associated severe radiating pain on activity are more likely to experience relief of their symptoms post-TKR. [ABSTRACT FROM AUTHOR]

BACKGROUND: The diagnosis of lumbar disc degeneration is of great significance for the prevention of lumbar disease, and the diagnosis of lumbar disc degeneration mainly relies on the subjective evaluation of the imaging physician, which is likely to misjudge because of insufficient experience. OBJECTIVE: To propose a computer-aided diagnosis technique for classification on the lumbar disc degeneration, and to provide reference for imaging doctors. METHODS: Spearman correlation analysis is used to verify the correlation between magnetic resonance imaging metabolic indices of lumbar intervertebral disc and the Pfirrmann grades of lumbar disc degeneration. Several classifiers for the intelligent diagnosis of lumbar disc degeneration are developed by means of machine learning strategies such as the Softmax regression, the neural network and the support vector machine. RESULTS AND CONCLUSSION: The result of correlation analysis showed that three metabolic indices such as fat fraction (FF) of adjacent upper and lower vertebral bodies of degenerative disc, T2* values were significantly correlated with lumbar disc degeneration. The classification accuracy of the softmax regression, the neural network and the support vector machine respectively was 0.477, 0.515 and 0.523, and kappa’s coefficient of these three diagnostic models was 0.311, 0.300 and 0.330, respectively. The actual analysis indicates that it is feasible to establish a computer-aided intelligent diagnosis of lumbar disc degeneration by using the MRI metabolic indices, showing a promising approach for the diagnosis of lumbar disc degeneration. [ABSTRACT FROM AUTHOR]