bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Epidural Administration of Anti-Interleukin-6 Receptor Antibody onto Spinal Nerve for Treatment of Sciatica
Authors: Ohtori S. , Miyagi M. , Eguchi Y. , Inoue G. , Orita S. , Aoki Y. , Ishikawa T. , Kamoda H. , Suzuki M. , Kubota G. , Sakuma Y. , Oikawa Y. , Takahashi K. 
Published: June 2012

Introduction Interleukin-6 (IL-6) is considered to play a crucial role in the radicular pain caused by lumbar spinal stenosis (LSS). However, efficacy of inhibition of IL-6 for sciatica in patients with LSS has not been clarified. The purpose of the current study was to examine the effect of the anti-IL-6 receptor monoclonal antibody, tocilizumab, on radicular pain by its epidural administration onto spinal nerves in patients with LSS. Materials and Methods A total of 60 patients with low back and radicular leg pain caused by spinal stenosis were investigated. In 30 patients, we infiltrated 2.0 mL of lidocaine and 80 mg of tocilizumab onto the affected spinal nerve, and 2.0 mL of lidocaine and 3.3 mg of dexamethasone were used in 30 patients. Low back pain (LBP), leg pain, and leg numbness were evaluated during 1 month after spinal nerve infiltration. Results Infiltration of tocilizumab was more effective than dexamethasone for leg pain (3 days, 1, 2, and 4 weeks), LBP (3 days, 1, 2, and 4 weeks), and leg numbness (3 days, 1 and 2 weeks). No adverse event was observed in either group. Conclusion Our results indicate that epidural administration of an anti-IL-6 receptor monoclonal antibody and, tocilizumab, onto the spinal nerve produced reduction of radicular leg pain, numbness, and LBP without adverse event. IL-6 may be one of the inducers of pain caused by spinal stenosis in humans. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Heart Rate Variability in Sciatica Patients Referred to Spine Surgery
Authors: Södervall J. , Karppinen J. , Puolitaival J. , Siltala J. , Kiviniemi A. , Tulppo M. , Hautala A. 
Published: June 2012

Introduction There is some data that pain patients may have impaired autonomic nervous system function assessed by heart rate variability (HRV). However, only few studies have evaluated the effect of low back disorders on HRV. In this study, we evaluated whether HRV differs between sciatica patients referred to spine surgery and age-matched healthy controls. Materials and Methods We measured HRV in standing position (5 minutes) after 10 minutes rest for patients ( n = 201, age 42 ± 11 years, 113 men and 88 women) and healthy controls ( n = 138, age 42 ± 11 years, 39 men and 99 women). Vagally mediated high frequency (HF) power of R-R intervals and low-to-high frequency (LF/HF) ratio as an index of sympathovagal balance were analyzed. Pain intensity was assessed by 100-mm visual analog scale (VAS) and perceived disability by Oswestry low back pain disability index. Analysis of variance and chi-square test were used to analyze differences between groups, and correlation analysis for the associations between pain and HRV. Results Oswestry index (37 ± 14 vs. 2 ± 3%) and VAS (5.8 ± 2.5 vs. 0.6 ± 1.0 cm) differed between the patients and controls ( p < 0.0001 for both). Body mass index was higher ( p < 0.0001) in patients (26.4 ± 4.4 kg/m2) compared with controls (23.9 ± 3.6 kg/m2). There were more smokers among patients ( p < 0.0001) and gender distribution differed between the groups ( p < 0.0001). Groups did not differ from each other in relation to physical activities and comorbidities. HF power was 4.5 ± 1.2 ln ms2 for patients and 5.1 ± 1.2 ln ms2 for controls ( p < 0.0001). LF/HF ratio was higher in patients (7.9 ± 6.4) compared with controls (5.8 ± 5.2) ( p = 0.002). After adjusting with sex, smoking, and BMI, HF power still differed between the groups ( p = 0.003), but the difference between groups disappeared in LF/HF power ( p = 0.134). Among patients, Oswestry index and VAS did not correlate with HRV ( r = −020 to −061). Conclusion Sciatica patients referred to spine surgery had decreased vagal activity compared to age-matched healthy controls. Impaired functional capacity caused by pain or pain intensity were not associated with vagal activity among patients. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Regulation of Neurotrophic Factor Expression in Nerve Cells and Intervertebral Disk Cells by Inflammatory Cytokines, Implications for Pain Pathways
Authors: Thomas S. , Colletta R. , Phillips K. L. , Chiverton N. , Cross A. , Le Maitre C. L. 
Published: June 2012

Introduction Intervertebral disk (IVD) degeneration and prolapse contribute significantly to low back pain and sciatica cases. Within the IVD, the nucleus pulposus cells are known to produce a number of catabolic cytokines which have been shown to elicit a wide range of effects including increased production of degradation enzymes and decreased production of matrix molecules. Here, we investigate the hypothesis that cytokines induce neurotrophic and angiogenic factors in nucleus pulposus cells and nerve cells and induce neurite outgrowth within nerve cells. Materials and Methods Human NP cells were isolated via collagenase digestion from human IVD obtained from surgical samples. Following expansion in monolayer culture, cells were transferred to alginate bead cultures at P2 and maintained for 2 weeks before stimulation with cytokines to enable re-differentiation to take place. Cells were then stimulated with IL-1 (0.001 to 100 ng/mL), IL-6 (1 to 100 ng/mL), or IL-8 (1 to 100 ng/mL) for 48 hours, RNA extracted and real time PCR performed to investigate expression of nucleus growth factor (NGF), BDNF, NTF3, and VEGF together with the housekeeping genes GAPDH and 18 s. In addition, SHSY-5Y nerve cell line were cultured in the presence of retinoic acid for 7 days before stimulation with IL-1, IL-6, IL-8, or TNF (1 to 100 ng/mL) to investigate the gene expression of NGF, BDNF, and NTF3 together with effects on neurite outgrowth. Results Human NP cells showed a biphasic response to IL-1 in terms of NGF expression with expression decreased at low doses of IL-1 (0.001–0.01 ng/mL) but an increase in NGF expression at high IL-1 doses (1 ng/mL–100 ng/mL) (Fig. 1). A Small but nonsignificant increase in NTF3 was seen following IL-1 stimulation, whereas IL-6 treatment of NP cells showed a 10-fold increase in NTF 3 expression in some patient samples. Within SH-SY5Y cells interestingly, NGF and BDNF expression was not observed but NTF-3 was downregulated by IL-1 and IL-8 treatments and stimulated by IL-6 stimulation. TNF and IL-1 appeared to induce the greatest effects on neurite outgrowth and number of neurites per cell, both of which increased at doses above 1 ng/mL stimulation. VEGF was also upregulated in human NP cells following IL-1 stimulation even at low doses. Conclusion Here, we demonstrate that a number of cytokines which are upregulated during human disk degeneration and prolapse induce a number of neurotrophic factors and angiogenic factors within human NP cells in 3D cultures. A number of cytokines also induce neurotrophic factor expression and neurite outgrowth in a nerve cell line suggesting a role for these cytokines both within the nerve ingrowth seen in an intact disk and intact disks and following prolapse. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Clinical Analysis following Minimally Invasive Treatment of Lumbar Spinal Stenosis with Interspinous Devices: Where We Are and Where We Go
Authors: Grasso G. , Certo F. , Pirrone A. G. , iacopino D. 
Published: June 2012

Introduction Insertion of an interspinous device has become a common procedure for the treatment of different clinical pictures of degenerative spinal disease. We present our experience with patients treated with interspinous devices because affected by claudication neurogenic, by lumbar disk herniation (LDH) where the interspinous system has been inserted following microdiscectomy. Materials and Methods This study included patients ( n = 200) with neurogenic intermittent claudication (NIC) secondary to LSS (group 1) and patients ( n = 150) with LDH (group 2) in whom the interspinous device has been implanted following radicular decompression in a period spanning 6 years. The latter have been compared with a homogenous group of patients ( n = 150) where no interspinous system has been implanted following microdiscectomy (group 3). We observed clinical and neuroradiological findings preoperatively and 3, 6, 12 months and every year postoperatively using dedicated questionnaires (Zurich Claudication Questionnaire, SF-36, ODI) and X-ray imaging. Results After 6 years of surgical treatment 85% of patients of group 1 presented a very good improvement of symptoms and 90% of patients referred satisfaction for surgery. Only 2% of the cases needed re-operation to change the implant. In one case the device was removed and in two cases we observed recurrence of symptoms and we changed surgical procedure. Overall patients of group 2 presented significantly less lumbar disk recurrences compared with group 3 ( p < 0.05) and better clinical outcome when compared with the same group ( p < 0.01). Conclusion According to our features, no significant complications were associated with such kind of surgery. In particular, interspinous systems showed significant and clinically meaningful improvements in pain and disability for up to 6 years. Furthermore, interspinous devices have shown better clinical outcome and less lumbar disk recurrences when associated with standard microdiscectomy. These data, however, need further studies and a longer period of follow-up. I confirm having declared any potential conflict of interest for all authors listed on this abstract No Disclosure of Interest None declared
The Prognostic Role of Modic Changes for Lumbar Discectomy: A Prospective Study
Authors: Määttä J. , Leinonen V. , Niinimäki J. , Koskelainen T. , Mäkelä P. , Pesälä J. , Haapea M. , Nyyssönen T. , Savolainen S. , Airaksinen O. , Kyllönen E. , Cheung K. M. , Karppinen J. 
Published: June 2012

Introduction There is a controversy regarding the prognostic role of Modic changes (MC's) for lumbar discectomy. The aim of this study was to evaluate whether Modic changes affect the results of lumbar discectomy 1 year after surgery. Materials and Methods The study population consisted of 180 sciatica patients from Northern and Eastern Finland who underwent discectomy. Pain intensity (low back and leg pain) and disability on Oswestry Disability Index (ODI) were evaluated preoperatively and 1 year after surgery. Lumbar MC's on magnetic resonance imaging were classified into: “No MC,” “Type I” (Type I or I/II), and “Type II” (Type II, II/III, or III). The analyses were performed using the analysis of covariance (ANCOVA) with adjustments for age, gender, and disk degeneration (DD) sum score. Results At baseline, 83 (46%) patients had MC's. Of MC's, 33% were Type I. Patients with MC's were older, more likely female and had a higher degree of DD than patients without MC's. Patients with Type I MC's had smaller improvement in ODI than patients with No MC ( p = 0.045) or Type II MC's ( p = 0.037). The improvements in low back and leg pain were similar than in ODI but the differences were not significant. Conclusion Type I MC's indicated a poorer prognosis of lumbar discectomy. The previous contradictory results may be due to smaller study sample sizes. Patients with ‘Type I’ MC's had smaller disability improvement than patients without MC's or with Type II MC's 1 year after discectomy. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Course of Recovery in Patients with Acute Low Back Pain: Does Depression Matter?
Authors: Melloh M. , Käser A. , Rolli Salathé C. , Elfering A. 
Published: June 2012

Introduction While there is extensive knowledge on the course of acute low back pain (LBP), little is known about the course of recovery of acute LBP patients as a function of depression. The aims of our study were to determine if the course of recovery in patients with acute LBP differs in relation to the presence/absence of depression and to identify the best time point for an intervention against LBP-associated depression. Materials and Methods This is a prospective cohort study of 286 patients with acute LBP. Patients were assessed at baseline and followed up over 6 months addressing psychological, occupational, biomedical, and demographic/lifestyle factors. Recovery was defined as improvement in functional limitation measured by the Oswestry disability index (ODI); depression was defined by the Zung depression scale. Repeated-measures analysis of covariance (ANCOVA) was employed with ODI as repeated factor, age, gender, and body mass index as covariates, depression and all other potential prognostic factors as between-subject factors. A second ANCOVA was performed with depression as dependent variable and functional limitation, pain intensity, and job stressors as potential predictor variables. Results A total of 18% of study participants were classified as depressive. In these patients, the course of recovery was slower than in nondepressive patients. ODI scores in the nondepression-LBP group decreased over time, whereas scores in the depression-LBP group remained at the same level (F(3.295, 431.607) = 4.63; p < 0.01, partial η2 = 0.034; Fig. 1). High functional limitation (F(1.261) = 15.79; p < 0.001, partial η2 = 0.057), high pain intensity (F(1.260) = 6.84; p < 0.01, partial η2 = 0.026), and a high job stressor index (F(1.252) = 8.95; p < 0.01, partial η2 = 0.034) were predictors of depression at baseline. Further, the presence of depression caused maintenance of LBP especially after 6 weeks. Conclusion The presence of depression has a negative influence on the course of recovery in patients presenting with a new episode of LBP. Therefore, depression should be included in screening instruments for patients with acute LBP to identify those at risk of delayed recovery at an early stage. Further research is required investigating interventions at different time points, to identify the optimal time at which to treat acute LBP patients with concomitant depression to reduce the socioeconomic costs of delayed recovery. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Personal, Psychosocial, and Occupational Resources for Preventing Persistent Low Back Pain in Primary Care
Authors: Melloh M. , Rolli Salath C. , Käser A. , Elfering A. 
Published: June 2012

Introduction Socioeconomic costs of persistent low back pain (LBP) exceed the costs of acute and subacute LBP by far. This makes the early identification of modifiable factors of the progression of acute/subacute LBP essential to the persistent state. Modifiable protective factors could be addressed proactively, for example, in workplace interventions, to limit the associated socioeconomic burden. Aim of our study was to identify modifiable protective factors against the progression of acute/subacute LBP to the persistent state. Materials and Methods Prospective cohort study of patients attending a health practitioner for their first episode of acute/subacute LBP. Patients were assessed at baseline addressing occupational, psychological, biomedical and demographic lifestyle factors and followed up over 12 weeks according to the recommendations from the Multinational Musculoskeletal Inception Cohort Study (MMICS) Statement. We completed Pearson correlations between these baseline factors and the presence of nonpersistent LBP at 12-week follow-up. For those factors found to be significant, multivariate logistic regression analyses were performed. Results The final two predictor model (χ2 = 34.7, df = 7, p < 0.001) included “social support” (OR 1.78; 95% CI, 1.20–2.66) and “mental health” (OR 1.06; 95% CI, 1.02–1.10). All factors and control variables predicted 24% variance in nonpersistent LBP. The accuracy of the model was 72%, with 81% (sensitivity) of nonpersistent and 60% (specificity) of persistent LBP patients correctly identified. Conclusion In this study of patients with acute/subacute LBP from a primary care setting, good “social support” reduced the likelihood of persistent LBP at 12 weeks. Findings from this study confirm the importance of personal and psychosocial resources for preventing the development of persistent LBP. Resources, easily identified with use of widely available screening tools, will facilitate the provision of necessary strategies to reduce the societal and financial burden of persistent LBP. The benefit of including modifiable protective factors such as “social support” in screening tools is that these factors can be addressed in primary and secondary prevention, for example, in workplace intervention. Further research is required to confirm the role of different types of “social support” and “social support at work” regarding their prognostic influence on the development of persistent LBP. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared
Intervertebral Disk Degeneration is not a Direct Cause of Pain Behavior: An Experimental Study Using a Disk Puncture Model in Rats
Authors: Zheng Z. , Liu H. , Li Z. , Wang J. , Yang H. , Sribastav S. S. 
Published: June 2012

Introduction Low back pain (LBP) is a common symptom in patients with lumbar diseases. But the relationship between lumbar intervertebral disk degeneration and LBPis still a controversial issue. Some animal models were used to discuss this issue in prior studies. A recent study1 suggested that the pain behavior changes might be related to the epidural presence of the oozed nucleus pulposus in the posterior rat disk puncture model. In this study, an anterior rat disk puncture model was applied to exclude the epidural presence of nucleus pulposus, and the objectives of this study were to establish an intervertebral disk degeneration model in rats and to analyze the relationship between disk degeneration and pain behavior changes in this model. Materials and Methods Total 18 male Sprague-Dawley rats with an average bodyweight of 230 g were used in this study. The anterior intervertebral disk annular puncture model was established as follows: the L5/6 lumbar disks were punctured using a 0.4-mm-diameter injection needle under microscope in nine rats; another nine rats receiving same surgery were considered as control group. Magnetic resonance imaging (MRI) of the punctured rats' spine was taken to confirm the degeneration of the disk. Behavioral tests including assessment of motor function, mechanical threshold, and thermal withdrawal latency were performed before and after surgery in both groups. The behavior tests were performed on days 1, 3, 7, 14, 21, 30, and 45 after the surgery. Results MRI results showed visible degeneration in rats at about 3 weeks after disk puncture (Fig. 1A). There was no degenerative change in the control group in all time points. Regarding motor function, both groups exhibited normal gait during the entire observation period. No significant statistical difference was found between the two groups in both mechanical threshold and thermal withdrawal latency tests at different time points (Fig. 1B, C). Conclusion The degenerative lumbar intervertebral disk model in rats was successfully established by anterior disk annulus needle puncture. The degeneration of the lumbar disk caused by anterior puncture could not induce pain behavior change in rats. I confirm having declared any potential conflict of interest for all authors listed on this abstract No Disclosure of Interest None declared Elin Nilsson, Toshio Nakamae, Kjell Olmarker. Pain behavior changes following disc puncture relate to nucleus pulposus rather than to the disc injury per se: an experimental study in rats. The Open Orthopaedics Journal 2011;5:72–77.
Effect of Spino-Pelvic Sagittal Balance on Degree of Disk Degeneration in the Lumbar Spine
Authors: Zheng Z. , Liu H. , Sribastav S. S. , Li Z. , Wang J. , Yang H. 
Published: June 2012

Introduction Recent studies have focused on spino-pelvic sagittal balance. Changes in sagittal balance could alter the load on the spine and may affect spinal mobility. Increasing recognition of the clinical impacted that sagittal alignment has on back pain and adjacent segment degeneration. But recent studies focused only on the effects of lumbar sagittal alignment to the disk degeneration. The relationship between spino-pelvic sagittal balance and lumbar disk degeneration has yet to be determined. The objective of this research was to study the effect of spino-pelvic sagittal balance on degree of disk degeneration in the lumbar spine. Materials and Methods The lumbar spine magnetic resonance imaging (MRI) and whole spine X-ray of 32 patients (13 males and 19 females) with a mean age of 57.92 years (range: 25 to 84 years) were retrospectively evaluated. Patients with history of prior spinal surgery, serious congenital anomalies, infection, spinal trauma, tumorn or ankylosing spondylitis were excluded from the study. In every patient, spino-pelvic sagittal parameters such as sagittal vertical axis (SVA), thoracic Kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), C7 tilt (C7T), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), spino-sacral angle (SSA), spino-pelvic angle (SPA), T1 spiono-pelvic inclination (T1-SPI), and T9 spino-pelvic inclination (T9-SPI) were measured in the whole spine X-ray to evaluate the sagittal balance. And lumbar intervertebral disk degeneration grade for each level (L1/2, L2/3, L3/4, L4/5 and L5/S1) was assessed using the lumbar MRI according to the Pfirrmann grading. The relationship between sagittal parameters and disk degeneration grade was analyzed. Results There was significant correlation between SVA and disk degeneration grade in level L5/S1 ( r = 0.565, p = 0.003) but not significant correlation in level L1/2, L2/3, L3/4 or L4/5. Similarly, significant correlation has been determined between C7T and degree of disk degeneration at the level of L5/S1 ( r = 0.557, p = 0.004), between PT and L2/3 ( r = 0.519, p = 0.008), between SSA and L5/S1 ( r = 0.466, p = 0.019), between SPA and L2/3 ( r = 0.466, p = 0.019), and between T1-SPI and L5/S1 ( r = 0.398, p = 0.049). No significant effect was detected for the degree of disk degeneration with the changes in spino-pelvic parameters like TK, TLK, LL, PI, SS, and T9-SPI. Conclusion Spino-pelvic parameters such as SVA, C7T, SSA, and T1-SPI may have effects on the degeneration of L5/S1 disk. And parameters such as SPA and PT may have effects on the degeneration of L2/3 disk. Changes in spino-pelvic parameters may influence the degree of disk degeneration, but all the parameters are not equally involved in the degree of disk degeneration. I confirm having declared any potential conflict of interest for all authors listed on this abstract No Disclosure of Interest None declared