bluuebunny/crossref_metadata_2025_split huggingface dataset:
Body Mass Index and Smoking Predict Lumbar Disk Degeneration among Young Finnish Males
Authors: Takatalo J. , Karppinen J. , Taimela S. , Niinimäki J. , Laitinen J. , Blanco Sequeiros R. , Paananen M. , Remes J. , Näyhä S. , Tammelin T. , Korpelainen R. , Tervonen O. 
Published: June 2012

Introduction The role of environmental factors in lumbar intervertebral disk degeneration (DD) in young adults is largely unknown. Therefore, we investigated whether body mass index (BMI), smoking, and physical activity are associated with lumbar DD among young adults. Materials and Methods The study population, Oulu Back Study (OBS), belongs to the 1986 Northern Finland Birth Cohort (NFBC 1986), consisting originally of 9479 children. Of 2969 eligible cohort members, 1987 subjects answered to a survey at the mean age of 18. Of these, 874 participated in physical examination at the mean age of 19 and were invited to lumbar MRI study. A total of 558 young adults (325 females and 233 males) underwent MRI that used a 1.5-T scanner at the mean age of 21. Each lumbar intervertebral disk was graded as normal (0), mildly (1), moderately (2), or severely (3) degenerated. We calculated a sum score of the lumbar DD, and analyzed the associations between environmental risk factors and DD using ordinal logistic regression. In the univariate models, the determinants included pack-years of smoking at 19 years, mean level of physical activity in metabolic equivalent hours per week at 16 and 19 years, body mass index (BMI), weight, height and waist circumference (WC) at 16 and 19 years. Because of collinearity, only one weight-related factor was included in the multivariate model. All analyses were stratified by gender. Results Of the 558 subjects, 257 (46%) had no DD, 117 (21%) had sum score of one, 93 (17%) sum score of two, 43 (8%) sum score of three, and 49 (8%) sum score of four or higher. In the univariate analyses, BMI, height, weight, and WC at 16 and 19 years were associated with DD among males. Among females, height at 16 and 19 years was associated with DD. Smoking of at least four pack-years was associated with DD among males. In the multivariate model, BMI at 16 years was associated with DD sum score among males (OR 2.35; 95% CI, 1.19–4.65) but not among females (OR 1.29; 95% CI, 0.72–2.32). Smoking of at least four pack-years tended to be associated with DD among males, but not among females (OR 2.41; 95% CI, 0.99–5.86 and 1.59; 95% CI, 0.67–3.76, respectively). Level of physical activity was not associated with DD. Conclusion BMI at 16 years and 19 years predicted lumbar DD at 21 years among young males whereas no associations were found among females. Smoking of at least four pack-years tended to be associated with DD among males. These results suggest that environmental factors are associated with DD among young males. I confirm having declared any potential conflict of interest for all authors listed on this abstract No Disclosure of Interest None declared
Surgical Soft Tissue Trauma Can Cause Disk Degeneration—An in Vivo Animal Study on Goettingen Minipigs
Authors: Omlor G. , Huettner F. , Lorenz S. , Holschbach J. , Richter W. , Gühring T. 
Published: June 2012

Introduction Biological treatment options, such as disk-cell-therapy, have been proposed for only moderately degenerated disks. Therefore, surgical exposition of the disk is needed. However, the effect of surgery related soft-tissue damage on the maintenance of disk degeneration is poorly understood. Therefore, this study analyzes, if disk degeneration can be induced only by the surgical approach. Materials and Methods We used an established model with adult minipigs offering biomechanical properties similar to humans. Total 12 animals underwent surgery using an anterolateral retroperitoneal approach to the lumbar spine. At each animal, two disks were only exposed whereas two other disks were exposed and partially nucleotomized with a 16G-biopsy-needle. Animals received a second revision surgery after 12 weeks, using the same approach and all disks were exposed again. Total 13 or 24 weeks after first surgery, animals were sacrificed. Disk height was measured in the central part of the disk by micro-CT. Disk degeneration was evaluated by a semiquantitative histo-degeneration-score. Three untreated control animals served as controls. Results After the second surgery, increased scar tissue and less vascularization was found around the lumbar vertebral bodies on the side of the approach. Most degenerative changes were found after partial nucleotomy ( p < 0.05) and additional annular damage was detectable, with a trend to higher degeneration scores after 24 weeks; disk height was significantly reduced compared to all other groups ( p < 0.05; 3.2 and 3.3 mm). Disks that were only surgically exposed also revealed significant degenerative changes including increased osteophytes; disk height was also significantly reduced compared to healthy control disks from animals without surgery ( p < 0.05; 3.7 and 3.8 mm vs. 4.6 mm). Conclusion Surgical exposure of lumbar disks caused significant disk degeneration without further disk manipulations. Reduced nutrient supply to the disk caused by less vascularized scar tissue seems to be a reason, which will be analyzed by additional immunohistological stainings against CD31. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Retrograde Vertebral Bone Drilling-How does it Influence Vertebral Endplates and the Course of Disk Degeneration?
Authors: Omlor G. , Huettner F. , Lorenz S. , Holschbach J. , Richter W. , Gühring T. 
Published: June 2012

Introduction Retrograde extra-articular bone drilling is a common procedure in orthopaedic surgery and offers good results in the therapy of osteochondral defects. It induces an inflammatory reaction in the bone underneath cartilage defects leading to decompression, revascularization, and consequent cartilage healing. For the treatment of disk degeneration or injury such an approach has not been tested so far. Therefore, the goal of this study was to evaluate if retrograde extra-articular drilling can be transferred to the lumbar motion segment consisting of subchondral bone, vertebral endplate, and the disk. Materials and Methods We used an established porcine disk degeneration model. To induce disk degeneration, 12 animals received surgery over an anterolateral approach to pierce the annulus and perform a partial nucleotomy in a total of 48 lumbar disks. Total 24 disks served as internal controls. After 12 weeks, all nucleotomized disks were degenerated and a second surgery was done to perform retrograde drilling of the vertebral bone in 24 of the nucleotomized disks using a customized drilling device. Drilling was stopped at the vertebral endplate, to avoid additional endplate and disk damage. Animals were sacrificed 13 or 24 weeks after the first surgery. Results Drilling was accurate and reproducible, but five disks had to be excluded because vertebral endplates were reached with possible endplate damage. Compared to segments only nucleotomized, additional drilling did not cause statistically significant morphometric changes to the adjacent subchondral vertebral bone of the endplates in micro-CT-analysis ( p > 0.05 for BV/TV and trabecular thickness). Disks from both groups showed equal disk height reduction, compared to internal controls and disk degeneration was not significantly different in segments with additional drilling (semi-quantitative histo-degeneration-score). Osteophytes were increased. Conclusion Retrograde bone drilling underneath the vertebral endplate did not result in disk regeneration or a limitation of the degeneration process induced by annular damage and partial nucleotomy. Contrary to articular cartilage, the degenerated disk may not be treatable by retrograde bone drilling. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Micromorphological Investigations of Intervertebral Disk Degeneration using Electron Microscopy
Authors: Friedmann A. , Schwan S. , Goehre F. , Heilmann A. , Meisel H. J. 
Published: June 2012

Introduction Intervertebral disk (ID) degeneration can be distinguished by various changes in the tissue structure like delamination and crack formation of the collagenous matrix as well as cellular changes like cell aging and variances in the amount and allocation of the cells. These indications of ID degeneration are shifting while increasing grade of degeneration. It has been confirmed that the ultrafine structure of disk tissue significantly influence the disk stability. Conventional clinical imaging techniques like CT and MRI are not able to visualize tissue morphology and tissue damages on this structure level. Materials and Methods To get detailed information about the degeneration and to achieve deeper insights into the morphology and microstructure of disk tissue, samples are investigated by scanning electron microscopic (SEM) techniques with corresponding sample preparations. The method allows the determination of the tissue morphology at high resolution. During this study, sequester material, achieved by standard sequestrectomy of 48 patients of different grades of degeneration, has been investigated. Results In the extracted tissue, we visualize different regions with characteristic microstructural damage behaviors, such as regions of prevalent micro cracks, or regions of fiber matrix delamination or fiber bridging. Furthermore, variations in cell density and cell morphology conditioned by the grade of degradation have been analyzed. Identified microstructural characteristics are correlated with MRI-based clinical rating scale for degeneration. Conclusion Investigations of degeneration characteristics of ID tissues by SEM propose high resolved analysis of both the tissue structure and the cell morphology. Correlation of the gleaned data regarding studies and classifications like Thompson scale shows a diffuse incidence of degeneration characteristic. The estimation of the grade of ID tissue degeneration, only by date achieved from MRI, is insufficient to appoint tissue-specific grade of degeneration. It is necessary to develop a new rating system considering variances within the tissue macro- and micromorphology as well as MRI data. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Genetic Association Studies in Lumbar Disk Degeneration: A Systematic Review
Authors: Eskola P. J. , Lemmelä S. , Kjaer P. K. , Solovieva S. , Männikkö M. , Tommerup N. , Lind-Thomsen A. , Husgafvel-Pursiainen K. , Cheung K. M. , Chan D. , Samartzis D. , Karppinen J. 
Published: June 2012

Introduction Low back pain (LBP) is one of the most disabling conditions associated with substantial socioeconomic and health care consequences. LBP is associated with lumbar disk degeneration, which is mainly accounted for genetic predisposition. The objective was to perform a systematic review to assess the level of evidence of polymorphisms associated with lumbar disk degeneration as defined on magnetic resonance imaging (MRI) in humans, evaluate study methods and findings to facilitate further efforts, and assess the clinical relevance of current information. Materials and Methods We performed a systematic literature search on MEDLINE, MEDLINE In-Process, SCOPUS, ISI Web of Science, The Genetic Association Database, and The Human Genome Epidemiology Network for information published between 1990 and 2011 addressing genes and lumbar disk degeneration. Two investigators independently identified studies to determine inclusion and study selection, and to perform data extraction, which consisted of study characteristics, population structure, phenotypes, genotyping details, possible biases, and significance of the association results. Results Total 52 studies were included for review. Total 48 studies reported at least one positive association between a genetic marker and lumbar disk degeneration. Level of evidence for the genetic associations was analyzed according to The HuGENet Working Group guidelines. Phenotype definition of lumbar disk degeneration was highly variable between the studies and replications were inconsistent. Most of the associations presented with weak level of evidence. Due to the heterogeneity between studies, meta-analyses could not be justified. The level of evidence was moderate for ASPN (D-repeat), COL11A1 (rs1676486), GDF5 (rs143383), SKT (rs16924573), THBS2 (rs9406328), and MMP9(rs17576). Conclusion Based on this first extensive systematic review on the topic, the credibility of reported genetic associations is mostly weak. Phenotype definitions of disk degeneration were inconsistent in studies, which impeded meta-analysis. Clear definition of lumbar disk degeneration and large population-based cohorts are needed. An international consortium is needed to establish standardization of genetic association studies in relation to disk degeneration. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Does Erythropoietin and Its Receptor may Play a Role in Human Intervertebral Disk Degeneration?
Authors: Grasso G. , Certo F. , Pirrone A. G. , Iacopino D. 
Published: June 2012

Introduction Degeneration of lumbar intervertebral discs is considered to be a cause of low back pain and radiculopathy. Many studies have shown that intervertebral disk inflammation and axonal growth of afferent fibers innervating the disk degeneration have a principal role in this pathological process. Both mechanical compression and chemical factors within nucleus pulposus (NP) are associated with the occurrence of radiculopathy. NP contains various proinflammatory cytokines that play important roles in the chemical pathogenesis of NP-induced peripheral nerve injury. The proinflammatory cytokine tumor necrosis factor alpha (TNF-α) is a key trigger in the pathogenesis of NP-induced inflammation and apoptosis and its inhibition can reduce NP degeneration. A class of MAPKs and p38 MAPK is phosphorylated by stress signals such as inflammatory cytokineso, smotic shock, and ischemia. Spinal cord and peripheral nerve injury cause the activation of p38 in dorsal root ganglion (DRG) neurons and spinal cord microglia. Furthermore, TNF-α phosphorylates p38 and activated p38 MAPK upregulates the biosynthesis of TNF- α. TNF and p38 are involved in neuronal cell apoptosis in peripheral nerve injuries. Erythropoietin (EPO) is a pleiotropic cytokine originally identified for its role in erythropoiesis. Recent studies have demonstrated that EPO and its receptor (EPO-R) are expressed in the central nervous system, where EPO exerts neuroprotective functions. Materials and Methods The aim of the present study was to investigate whether the resident EPO and EPO-R network is present and functional in the NP of intervertebral disk in different grade of degeneration. In this study, we analyzed 20 human NP obtained following microdiscectomy. The expressions of p-p38, TNF- α, EPO, and EPOR were assessed by immunohistochemical and immunoblotting analysis. Data were analyzed by unpaired Student t-test and Dunnett t-test (significance level, p < 0.05). Results In barely degenerated disk, significantly weak expression of EPO and EPO-R was observed ( p < 0.05). Accordingly, the expression of both p-p38 and TNF in the NP was significantly lower than in well-degenerated disk ( p < 0.05). In clearly degenerated disc, a marked increase of expression of EPO and EPO-R was observed ( p < 0.05) and a consensual increase of both p-p38 and TNF in the NP was observed ( p < 0.05). Conclusion These observations suggest that the local EPO and EPO-R system is markedly engaged in the degeneration of intervertebral disk by a feasible cross-talk with network of proinflammatory cytokine such as TNF- α. These data may increase our knowledge on mechanisms underlying intervertebral disk degeneration and strongly support the possible usefulness of a therapeutic approach based on exogenous EPO administration. I confirm having declared any potential conflict of interest for all authors listed on this abstract No Disclosure of Interest None declared
Intraoperative Epidural Pressure in Patients with Positive Vs. Negative Sedimentation Sign Undergoing Spinal Surgery
Authors: Melloh M. , Barz T. , Staub L. , Lange J. , Merk H. R. , Follak N. 
Published: June 2012

Introduction The nerve root Sedimentation Sign (SedSign) in transverse magnetic resonance imaging (MRI) has been shown to discriminate well between selected patients with and without lumbar spinal stenosis (LSS). Previously it was demonstrated that a positive SedSign appears to identify patients who are less likely to benefit from nonsurgical treatment. It is still unknown which potential mechanisms may be responsible for the absence of nerve root sedimentation in transverse MRI scans in cases of severe LSS. Aim of our study was to identify the pressure values causing a positive SedSign in patients undergoing spinal surgery for LSS. Materials and Methods We measured the intraoperative epidural pressure in five patients with LSS and a positive SedSign and in five patients without LSS and a negative SedSign. Epidural pressure was measured using a Codman catheter in prone position under radioscopy at different locations in the lumbar spinal canal. Results: Patients with a negative SedSign had a mean epidural pressure of 9 mm Hg (minimum 8, maximum 11 mm Hg) independent of the location of the measurement. Breath and pulse-synchronous waves accounted for 1 to 3 mm Hg. In patients with mono-segmental LSS and a positive SedSign, the epidural pressure above and below the stenosis was similar (8 and 9 mm Hg respectively; minimum 7, maximum 12 mm Hg). At the level of the stenosis, the mean epidural pressure was 23 mm Hg (minimum 21, maximum 26 mm Hg). Whereas cranial of the stenosis breath and pulse-synchronous wave could be demonstrated, this wave was absent below the stenosis. There was no significant correlation between the diameter of the spinal canal and the level of the stenosis. Conclusion We conclude that in patients with LSS as a consequence of the increased epidural pressure (1) lumbar nerve roots are tethered at the level of the stenosis inhibiting the sedimentation of these nerve roots to the dorsal part of the dural sac in supine position, and (2) no breath and pulse-synchronous wave below the stenosis can be detected. However, these findings need confirmation in larger patient samples. Future research is warranted investigating the correlation between an increased epidural pressure and the level of lumbar stenosis. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared Barz T, Melloh M, Staub LP, et al. Nerve root sedimentation sign-evaluation of a new radiological sign in lumbar spinal stenosis. Spine 2010;;35(8):892–897.
Chemical Exchange Saturation Transfer and T2 Mapping in Subjects with Intervertebral Disk Degeneration
Authors: Kim M. , Chan Q. , Anthony M. P. , Samartzis D. , Cheung K. , Khong P. 
Published: June 2012

Introduction Intervertebral disk degeneration (IVD) on magnetic resonance imaging (MRI) is an etiological factor associated with low back pain. The (IVD) has been well acknowledged to degenerate as characterized by biochemical and morphological changes. T2 relaxation time has been suggested to be sensitive to changes in collagen and water content in cartilage and in the IVD. In the disk, the investigators have quantified chemical exchange saturation transfer (CEST) and its specificity as well as its correlation capacity for glycosaminoglycan (GAG) content (gagCEST). However, the correlation between conventional qualitative MRI assessment (T2-weighted) and quantitative MRI measurement, such as T2 and CEST, remains unknown. In this study, we aimed to investigate the association between CEST, T2 and degenerative grades in IVD using T2-weighted MRI in human subjects. Materials and Methods Total 21 subjects (8 females, 13 males; median age 34; age range: 24 to 58 years) with no prior spine surgery were recruited. Sagittal T2-weighted, CEST, and T2 MRI of the lumbar spine were obtained. All images of the lumbar spine were acquired using a 3T Achieva scanner. High-resolution T2-weighted disks were qualitatively graded according to Schneiderman's classification (score range: 0 to 3). CEST and T2 maps were quantitatively assessed based on a voxel-by-voxel basis. Results A decreasing trend of CEST and T2 values with increasing grade of degeneration was noted. The mean CEST values in L3/4, L4/5 and L5/S1 discs with Schneiderman grades 0 ( n = 41), 1 ( n = 10), 2 ( n = 7) and 3 ( n = 5) were 7.17 ± 1.10%, 6.00 ± 0.83%, 2.85 ± 0.39%, and 1.84 ± 0.27%, respectively. The mean T2 values in discs with Schneiderman grades 0 ( n = 41), 1 ( n = 10), 2 ( n = 7) and 3 ( n = 5) were 109.74 ± 12.40 ms, 83.84 ± 6.19 ms, 71.70 ± 3.44 ms, and 65.16 ± 2.97 ms, respectively. Schneiderman grade was correlated with both CEST (r = -0.67, p < 0.001) and T2 (r = -0.71, p) Conclusion Our results showed that CEST and T2 decreases with increasing grade of disk degeneration and that CEST values significantly correlated with T2. Our findings propose useful quantitative imaging tools with discriminatory capacity to assess early and end-stage IVD degeneration. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared