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Pinto SM, Cheung JPY, Samartzis D, Karppinen J, Zheng Y, Pang MYC, Fortin M, Wong AYL. Relationship Between Lumbar Multifidus Morphometry and Pain/Disability in Individuals With Chronic Nonspecific Low Back Pain After Considering Demographics, Fear-Avoidance Beliefs, Insomnia, and Spinal Degenerative Changes. JOR Spine 2025; 8:e70071. [PMID: 40376565 PMCID: PMC12080348 DOI: 10.1002/jsp2.70071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 03/11/2025] [Accepted: 04/12/2025] [Indexed: 05/18/2025] Open
Abstract
Background Although individuals with chronic low back pain (CLBP) show increased fatty infiltration in the lumbar multifidus muscle (LMM), it remains unclear whether LMM changes are related to clinical outcomes (such as pain and disability) after considering confounders (spinal phenotypes, fear-avoidance beliefs [FABs] and insomnia). This study examined: (1) differences in confounders and LMM characteristics between individuals with and without CLBP; and (2) associations between confounders, LMM parameters, and clinical outcomes in the CLBP group alone. Methods Participants (CLBP = 70 and asymptomatic people = 67) underwent lumbar magnetic resonance imaging. Outcome measures comprised the numeric pain rating scale, the Roland-Morris Disability Questionnaire, the Fear-Avoidance Beliefs Questionnaire (FABQ), and the Insomnia Severity Index (ISI) Scale. LMM morphometry at L3-S1 (cross-sectional area, total volume, and fatty infiltration) was measured using a customized MATLAB program. Spinal phenotypes (disc degeneration, high-intensity zones, Modic changes [MCs], Schmorl's nodes, facet joint degeneration [FJD], and facet tropism [FT]) were scored. The between-group differences were analyzed using linear mixed models and chi-squared/Fisher's exact tests. Univariate and multivariate analyses evaluated associations between clinical outcomes and other outcome measures in the CLBP group. Results The CLBP group demonstrated more severe disc degeneration and FJD at all levels, and greater FT at L5/S1 than asymptomatic participants (p < 0.05). The average LMM total volume at L3/4 and the percentage of fatty infiltration in LMM in the L3-S1 region were greater in the CLBP group than in asymptomatic counterparts (p < 0.05). The presence of MC at L4 and FJD at L4/5 and L4-S1 was significantly related to pain intensity in the CLBP group. Similarly, FABQ-Work and ISI scores were significantly related to pain intensity (explaining 37% of the variance in pain). Conclusions The CLBP group displays more fatty infiltration in the LMM, but their LMM morphometric parameters are unrelated to pain/disability after considering spinal phenotypes, FABs, and insomnia.
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Affiliation(s)
- Sabina M. Pinto
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong Kong SARChina
| | - Jason P. Y. Cheung
- Department of Orthopaedics and TraumatologyThe University of Hong KongHong Kong SARChina
| | - Dino Samartzis
- Department of Orthopaedics SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Jaro Karppinen
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
- Rehabilitation Services of Wellbeing Services County of South KareliaLappeenrantaFinland
- Research Unit of Health Sciences and TechnologyUniversity of OuluOuluFinland
| | - Yong‐Ping Zheng
- Department of Biomedical EngineeringThe Hong Kong Polytechnic UniversityHong Kong SARChina
| | - Marco Y. C. Pang
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong Kong SARChina
| | - Maryse Fortin
- Department of Health, Kinesiology & Applied PhysiologyConcordia UniversityMontrealQuebecCanada
- School of HealthConcordia UniversityMontrealQuebecCanada
| | - Arnold Y. L. Wong
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong Kong SARChina
- Research Institute for Smart Ageing, The Hong Kong Polytechnic UniversityHong Kong SARChina
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Huang Y, Sun H, Chen H, Wang X, Zhao J, Jiao Y, Zhou H, Cai H, Dai J, Huang X, Chen W, Shen J. Mechanical Load-Induced Upregulation of Talin2 through Non-Canonical Deubiquitination of OTUB1 Drives Facet Joint Osteoarthritis Pathogenesis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2025:e2501046. [PMID: 40279639 DOI: 10.1002/advs.202501046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 03/17/2025] [Indexed: 04/27/2025]
Abstract
Facet joint osteoarthritis (FJOA) is a prevalent degenerative condition in the aging population; however, the underlying pathophysiological mechanisms remain poorly understood and current therapeutic strategies remain limited to palliative pain management. In this study, novel potential therapeutic targets and prevention paradigms for FJOA are systematically explored. Proteomic screening and validation show that Talin2 is specifically upregulated in FJOA samples. Immunoprecipitation-mass spectrometry, transcriptome RNA sequencing, and bioinformatics simulation analyses, combined with in vitro and in vivo experiments, are conducted to elucidate the molecular mechanism of the role of Talin2 in FJOA. Increased expression levels of Talin2 in FJOA promote the degradation of the extracellular matrix and inhibit its synthesis. Talin2 is found to be stabilized via non-canonical deubiquitination and direct interaction with ovarian tumor domain-containing ubiquitin aldehyde-binding protein 1 (OTUB1). C-C motif ligand 2 (CCL2), an inflammatory chemoattractant, is identified to be a target gene of Talin2. Furthermore, mechanical loading potentiates the Talin2/OTUB1 interaction, resulting in the stabilization of Talin2 and enhances non-canonical deubiquitination. Therefore, Talin2 regulates CCL2 expression and promotes FJOA. Given that Talin2 is stabilized and deubiquitinated by OTUB1, especially under mechanical load, the Talin2/OTUB1 interaction may be a promising therapeutic target for FJOA.
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Affiliation(s)
- Yizhen Huang
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Heng Sun
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Haojie Chen
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Xiangpeng Wang
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Junduo Zhao
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Yang Jiao
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Hongyi Zhou
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Haoyu Cai
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Jiafeng Dai
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Xuan Huang
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Weiyun Chen
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
- Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Jianxiong Shen
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
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Schmidt H, Reitmaier S, Yang D, Duda G, Pumberger M. Degenerative relationships in lumbar intervertebral discs and facet joints: an MRI-based comparative study of asymptomatic individuals and patients with chronic and intermittent low back pain. Front Bioeng Biotechnol 2025; 13:1502082. [PMID: 40271348 PMCID: PMC12014670 DOI: 10.3389/fbioe.2025.1502082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 03/27/2025] [Indexed: 04/25/2025] Open
Abstract
Degeneration of intervertebral discs and facet joints are common conditions that are thought to be interrelated. This study aimed to investigate the morphological interplay between disc and facet degeneration, as well as relationships between adjacent discs and facets. This prospective study involved 712 participants (307 males, 405 females) categorized into three groups: no back pain (no-BP), intermittent (iLBP), and chronic low back pain (cLBP). The Pfirrmann classification was used to assess intervertebral disc degeneration of index and adjacent segments, while the Fujiwara classification evaluated facet joint degeneration. Spearman's correlation coefficient analyzed relationships between degenerative changes in discs and facets. Overall, from the 712 participants 254 were with no-BP, 159 with intermittent LBP, and 299 with chronic LBP. The severity of both intervertebral disc and facet joint degeneration in the MRI sequences increased from upper to lower segments, with a significant clear directionality in differences between the uppermost and lowermost levels (p < 0.01). A strong positive correlation was observed between degenerative changes of adjacent intervertebral discs, especially in the upper and middle lumbar spine (ρ > 0.69). However, correlations between intervertebral disc and facet joint degeneration were weak in all populations studied (ρ < 0.31). The data indicate a directionality in the disease progression, with a strong correlation observed between adjacent intervertebral discs, suggesting a concurrent degenerative process. In contrast, the weak correlations between disc and facet joint degeneration imply that these structures undergo independent degenerative processes, particularly in the early stages of degeneration. Further research is essential to elucidate the underlying mechanisms and to develop precise therapeutic interventions for lumbar spine degeneration.
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Affiliation(s)
- Hendrik Schmidt
- Julius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Reitmaier
- Julius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Daishui Yang
- Julius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Sancar KS, Şeref Ç, Hamit G, Yavuz AE, Şaziye Ş. Does the severity of facet joint osteoarthritis affect facet medial branch radiofrequency thermocoagulation results? NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2025; 30:144-149. [PMID: 40199535 PMCID: PMC11977580 DOI: 10.17712/nsj.2025.30.4.20240037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 01/21/2025] [Indexed: 04/10/2025]
Abstract
OBJECTIVES To assess how facet medial branch radiofrequency thermocoagulation (FMB-RFT) outcomes are affected by severe facet joint osteoarthritis (FJO). METHODS This retrospective study involved 91 individuals with lumbar facet joint disease-related chronic lower back pain (CLBP), all of whom underwent FMB-RFT. The patients were assigned to 3 groups using the Weishaupt facet grading system (WFGS). Pain scores were assessed prior to treatment, as well as at the 1-, 6-, and 12-month marks. RESULTS Based on the WFGS, 38 of the 91 patients were assigned a grade 1 FJO, 28 a grade 2 FJO, and 25 a grade 3 FJO. The percentage of patients in each group who saw a 50% or greater improvement in their pain scores at 1, 6, and 12 months did not differ significantly. CONCLUSION For patients with CLBP, FMB-RFT has been shown to be safe and effective in both the short and long terms. The results from FMB-RFT do not seem to be affected by the severity of FJO.
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Affiliation(s)
- Kaya S. Sancar
- From the Deparment of Pain Medicine (Sancar), Adiyaman University Training and Research Hospital, Adıyaman, from the Deparment of Pain Medicine (Şeref, Yavuz, Şaziye), University of Health Sciences Ankara City Hospital, and from the Deparment of Pain Medicine (Hamit), Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Çelik Şeref
- From the Deparment of Pain Medicine (Sancar), Adiyaman University Training and Research Hospital, Adıyaman, from the Deparment of Pain Medicine (Şeref, Yavuz, Şaziye), University of Health Sciences Ankara City Hospital, and from the Deparment of Pain Medicine (Hamit), Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Göksu Hamit
- From the Deparment of Pain Medicine (Sancar), Adiyaman University Training and Research Hospital, Adıyaman, from the Deparment of Pain Medicine (Şeref, Yavuz, Şaziye), University of Health Sciences Ankara City Hospital, and from the Deparment of Pain Medicine (Hamit), Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Akçaboy E. Yavuz
- From the Deparment of Pain Medicine (Sancar), Adiyaman University Training and Research Hospital, Adıyaman, from the Deparment of Pain Medicine (Şeref, Yavuz, Şaziye), University of Health Sciences Ankara City Hospital, and from the Deparment of Pain Medicine (Hamit), Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Şahin Şaziye
- From the Deparment of Pain Medicine (Sancar), Adiyaman University Training and Research Hospital, Adıyaman, from the Deparment of Pain Medicine (Şeref, Yavuz, Şaziye), University of Health Sciences Ankara City Hospital, and from the Deparment of Pain Medicine (Hamit), Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
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Zhang Y, Li C, Dong Q, Sun J, Zhou C, Chen X, Tian Y, Yuan S, Liu X, Wang L. Prevalence and distribution of cervical facet joint degeneration in patients with cervical spondylotic myelopathy without/with instability and ossification of the posterior longitudinal ligament-a comparative study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2025; 34:1229-1237. [PMID: 40029353 DOI: 10.1007/s00586-025-08761-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 10/28/2024] [Accepted: 02/23/2025] [Indexed: 03/05/2025]
Abstract
OBJECTIVES To compare the prevalence and distribution characteristics of the grade of cervical facet joint degeneration (FJD) among patients with cervical spondylotic myelopathy without/with instability (CSM/CSMI), and ossification of the posterior longitudinal ligament (OPLL). Furthermore, to compare the differences in sagittal parameters and preoperative clinical symptoms between patients with mild and severe FJD. METHODS The study enrolled 253 patients who underwent surgical treatment at our institution (90 CSM, 79 CSMI, 84 OPLL). A 5-grade computed tomography classification was used to assess bilateral cervical facet joint degeneration from C2/3 to C6/7, with higher grades indicating more severe degeneration. Patients in CSM, CSMI, and OPLL groups were divided into two subgroups separately according to the sum of bilateral FJD grades from C2/3 to C6/7: mild group and severe group. The sagittal parameters of the cervical spine on X-ray, as well as the preoperative Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) for neck pain, were compared between the subgroups. RESULTS The prevalence of grade 1 to 5 FJD in CSM, CSMI, and OPLL patients was: 77.5%, 17.8%, 3.6%, 1.1%, and 0% for CSM; 62.0%, 25.2%, 7.7%, 3.0%, and 2.1% for CSMI; and 72.4%, 24.4%, 2.2%, 0.3%, and 0.7% for OPLL. The grade of FJD at C2-6 was significantly higher in the CSMI group than the CSM and OPLL groups (P < 0.05). The grade of FJD was highest at C4-C5 in CSM and CSMI groups, while it gradually increased from C3-C4 to C6-C7 in the OPLL group. Patients in severe subgroup exhibited pronounced cervical lordosis, T1 slope, cervical sagittal vertical axis (cSVA), and neck pain (P < 0.05). CONCLUSIONS The grade of FJD is more severe in patients with CSMI than others. The grade of FJD in CSM and CSMI patients was most severe at C4-C5 level, while OPLL patients had increasingly severe FJD from C3-C7 levels, with maximal degeneration observed at C6-C7. Patients with severe cervical FJD in CSM, CSMI and OPLL groups exhibited pronounced cervical lordosis, increased T1 slope, elevated cSVA, and heightened neck pain.
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Affiliation(s)
- Yuchen Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Xilu Jinan, Jinan, 250012, Shandong, P.R. China
| | - Chao Li
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Quanmin Dong
- Department of Orthopedics, The People's Hospital of Jimo, Qingdao, Shandong, China
| | - Junyuan Sun
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Xilu Jinan, Jinan, 250012, Shandong, P.R. China
| | - Chao Zhou
- Department of Orthopedics, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Shandong University, Qingdao, Shandong, China
| | - Xing Chen
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Xilu Jinan, Jinan, 250012, Shandong, P.R. China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Xilu Jinan, Jinan, 250012, Shandong, P.R. China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Xilu Jinan, Jinan, 250012, Shandong, P.R. China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Xilu Jinan, Jinan, 250012, Shandong, P.R. China.
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Xilu Jinan, Jinan, 250012, Shandong, P.R. China.
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Sun F, Qiu H, Ji Y, Wang L, Lei W, Zhang Y. Biomechanical Comparison of a Novel Facet Joint Fusion Fixation Device With Conventional Pedicle Screw Fixation Device: A Finite Element Analysis. Orthop Surg 2025; 17:1230-1242. [PMID: 40016885 PMCID: PMC11962293 DOI: 10.1111/os.70003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 01/21/2025] [Accepted: 02/09/2025] [Indexed: 03/01/2025] Open
Abstract
PURPOSE The biomechanics of a novel facet joint fusion device is unknown. The objective of this study is to analyze and compare the biomechanical properties of a novel facet joint fusion device integrated with oblique lateral interbody fusion (OLIF) to those of a conventional pedicle screw fixation device, employing finite element analysis. METHODS A comprehensive three-dimensional finite element model of the L3-S1 lumbar spine was developed and validated. Based on this model, three surgical groups were created: OLIF combined with the bilateral facet joint fusion fixation (BFJFF + OLIF), unilateral pedicle screw fixation (UPSF + OLIF), and bilateral pedicle screw fixation (BPSF + OLIF), focusing on the L4-L5 level. A torque of 7.5 Nm was applied to simulate vertebral activities under six conditions: flexion, extension, lateral bending (left and right), and axial rotation (left and right). The maximum displacement at the L4-L5 segment was then calculated. The maximum stress values were recorded at the L4-L5 interbody fusion cage and the L3-L4 and L5-S1 segments. RESULTS When compared to the other two models, the BFJFF + OLIF model exhibited the smallest maximum displacement value at the L4-L5 segment across all six working conditions. The BFJFF + OLIF model also demonstrated the lowest maximum stress value at the L4-L5 segment interbody fusion cage under flexion, as well as left and right lateral bending and axial rotation conditions when compared with the other models. However, under the extension condition at the L4-L5 interbody fusion cage, the BPSF + OLIF model showed the lowest maximum stress value. At the adjacent L3-L4 segments, the BFJFF + OLIF model registered the lowest maximum stress value during flexion and left lateral bending conditions. At L3-L4, under extension and right lateral bending conditions, the UPSF + OLIF model exhibited the lowest maximum stress value. Under left axial rotation at the L3-L4 segment, both the BFJFF + OLIF and UPSF+OLIF models demonstrated the smallest maximum stress values. Under right axial rotation at the L3-L4 segment, the BPSF + OLIF model recorded the smallest maximum stress value. Concurrently, at the L5-S1 segment, the BFJFF + OLIF model presented the lowest maximum stress value under conditions of flexion, as well as left and right lateral bending and axial rotation. In the L5-S1 segment during the extension condition, the UPSF+OLIF model exhibited the lowest maximum stress value. CONCLUSIONS This study demonstrates that the novel device, when combined with OLIF, achieves 360° lumbar fusion by fusing the lumbar facet joints, thereby enhancing spinal stability post-fusion. Concurrently, stress on adjacent segments was diminished. The findings suggest that this device may serve as a novel internal fixation method. It may provide a new option for the surgical treatment of patients with low back pain in the future.
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Affiliation(s)
- Feilong Sun
- Department of Orthopedics, Xijing HospitalAir Force Medical UniversityChina
| | - Haiyang Qiu
- Department of Orthopedics, Xijing HospitalAir Force Medical UniversityChina
| | - Yufei Ji
- Department of Orthopedics, Xijing HospitalAir Force Medical UniversityChina
| | - Longchao Wang
- Department of Orthopedics, Xijing HospitalAir Force Medical UniversityChina
| | - Wei Lei
- Department of Orthopedics, Xijing HospitalAir Force Medical UniversityChina
| | - Yang Zhang
- Department of Orthopedics, Xijing HospitalAir Force Medical UniversityChina
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Matheson BE, Jaremko JL, Dowhanik A, Gill J, Gallant C, Walker J, Armani N, Leslie WD, Kolinsky M, Boyd SK, Ye C. Assessing the effects of immune checkpoint inhibitors on bone utilizing machine learning-assisted opportunistic quantitative computed tomography. J Bone Miner Res 2025; 40:396-403. [PMID: 39849845 PMCID: PMC11909731 DOI: 10.1093/jbmr/zjaf009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 12/10/2024] [Accepted: 01/14/2025] [Indexed: 01/25/2025]
Abstract
Immune checkpoint inhibitors (ICIs) are widely used in cancer treatment, yet their impact on bone health remains unclear. This study aimed to perform a retrospective cohort study utilizing routine CT scans from patients with melanoma to perform opportunistic QCT analysis to investigate the effects of ICI treatment on skeletal health, including volumetric BMD (vBMD) measurements and osteoarthritis (OA) parameters. A previously established machine learning-assisted opportunistic QCT pipeline was used to estimate lumbar spine vBMD from baseline and 12-mo follow-up CT scans in patients with melanoma treated with ICI therapy and those not treated with ICI therapy. Facet joint OA, osteophyte formation, and endplate sclerosis were also graded. Independent and paired t tests were used to determine any differences in vBMD and OA parameters between ICI users and non-ICI users. Multivariable linear regression models were used to control for confounding variables. Non-ICI users had a significant decrease in vBMD of -6.96 mg/cm3 from baseline to follow-up, whereas the ICI users had no significant change. There was a significant difference in change in vBMD from baseline to follow-up between the 2 groups, with the non-ICI users experiencing a 11.22 mg/cm3 larger decrease in vBMD. After adjusting for baseline age, sex, baseline vBMD, and change in OA parameters, this difference remained significant at -13.04 mg/cm3. Among the ICI users, those who had a decline in vBMD had a lower baseline vBMD compared with those who had increased vBMD. Neither group showed a significant change in OA parameters over the follow-up period, nor a difference in change between ICI and non-ICI users, even after adjusting for sex, age, and baseline OA parameters. While the effects of ICI treatment on vBMD may vary based on baseline bone health, ICIs do not significantly impact OA parameters in the short term.
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Affiliation(s)
- Bryn E Matheson
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jacob L Jaremko
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Alexandra Dowhanik
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Jasmine Gill
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Cassandra Gallant
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - John Walker
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Nathan Armani
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - William D Leslie
- Departments of Internal Medicine and Radiology, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Michael Kolinsky
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Radiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Carrie Ye
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
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Soydan Z, Bayramoglu E, Altas O. The Impact of Spinopelvic Alignment on the Facet Joint Degeneration. Global Spine J 2025; 15:306-313. [PMID: 36893076 PMCID: PMC11877576 DOI: 10.1177/21925682231162813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVES This study aims to evaluate the relations between facet joint degeneration (FD) and sagittal spinopelvic parameters. Second, the association of FD with degenerative disc disease (DDD) and lumbar disc herniations (LDH) was assessed. METHODS The radiologic data of 192 patients was retrospectively analyzed. Total, proximal, and distal lumbar lordosis (LL, PLL, and DLL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sacral table angle (STA) were measured on lumbar x-ray plates. DDD and FD was graded on the MRI images. The apex of lumbar lordosis and PI-LL imbalance were noted in each patient. Correlation analyses were performed. RESULTS Age and body mass index (BMI) were correlated with FD. LL and DLL are positively associated with upper-level FDs (L1-2 and L2-3) (P < 0,05). PLL were positively associated with lower level FD (L5-S1) (P < 0,05). A significant increase in PI was associated with FD in L2-3 and L4-5. A larger PT was found in FD in L4. The PI-LL imbalance was not correlated with the FD. Correlation between DDD and LDH and FD was observed in each level (P < 0,01). The level of FD is not affected by the apex of the curve. CONCLUSION Age and BMI have a direct impact on FD. However, spinopelvic parameters influence the severity of FD rather than its occurrence. In addition to the effects of lumbar lordosis as a single entity, it is essential to consider separately the effects of proximal and distal lumbar lordosis at the FD level.
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Affiliation(s)
- Zafer Soydan
- Department of Orthopaedics and Traumatology, Bhtclinic İstanbul Tema Hospital, Nisantasi University, Istanbul, Turkey
| | - Emru Bayramoglu
- Orthopedics and Traumatology, Bursa City Hospital, Istanbul, Turkey
| | - Okyar Altas
- Orthopaedics and Traumatology, Basaksehir Cam Sakura City Hospital, Istanbul, Turkey
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9
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Kaye AD, Brouillette AE, Howe CA, Wajid S, Archer JR, Bartolina R, Hirsch JD, Howard JT, Bass D, Fox CJ, Ahmadzadeh S, Shekoohi S, Manchikanti L. Efficacy of Steroid Facet Joint Injections for Axial Spinal Pain and Post Radiofrequency Ablation Neuritis: A Systematic Review. Curr Pain Headache Rep 2025; 29:53. [PMID: 39982588 DOI: 10.1007/s11916-025-01369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2025] [Indexed: 02/22/2025]
Abstract
PURPOSE OF REVIEW Chronic axial spinal pain is a leading cause of disability and healthcare spending in the United States. A common source of axial spinal pain is the facet joint. Current treatments for facet joint-mediated pain include conservative treatments and interventions such as intra-articular facet joint injections (FJI), medial branch blocks (MBB), and radiofrequency ablation (RFA). While facet joint interventions are one of the most common spinal procedures, current scientific literature demonstrates conflicting results regarding the use of corticosteroids in these interventions. RECENT FINDINGS A systematic review was conducted to determine the efficacy of local corticosteroid usage in facet joint interventions for treating chronic axial spinal pain. Separate literature searches were performed using PubMed, Google Scholar, Embase, and Cochrane Library to evaluate the use of local corticosteroids in intra-articular FJI, MBB, and for the prevention of post-neurotomy neuritis (PNN). Inclusion criteria included a randomized clinical trial (RCT) or control trial while unique inclusion criteria was used for the differing uses of local corticosteroids. The exclusion criteria for studies included (i) studies written in a non-English language; (ii) articles without full-text access or abstract-only papers; (iii) and studies focused on non-human subjects. Final literature searches were conducted in August 2024. Two studies with 131 patients, four studies with 440 patients, and two studies with 203 patients were selected for the assessment of local corticosteroid use on intra-articular FJI, MBB, and PNN, respectively. A quality assessment tool recommended by The Cochrane Collaboration was used to assess bias risk in included studies. Results were synthesized through a meta-analysis to evaluate intra-articular FJI while a literature analysis was completed to investigate MBB and PNN. This study found that the use of corticosteroid intra-articular FJI and MBB provides significant improvement in pain relief and functionality from baseline for the treatment of lower back pain and chronic axial spinal pain, respectively. However, the use of corticosteroids post-RFA has not been proven to reduce the occurrence of PNN. Limitations to the studies used included blinding bias, absence of placebo groups, subjective inclusion criteria, limited generalizability and small sample sizes.
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Affiliation(s)
- Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Amy E Brouillette
- Louisiana State University Health Sciences Center New Orleans School of Medicine, New Orleans, LA, 70112, USA
| | - Cameron A Howe
- Louisiana State University Health Sciences Center Shreveport School of Medicine, Shreveport, LA, 71103, USA
| | - Sheeza Wajid
- Louisiana State University Health Sciences Center New Orleans School of Medicine, New Orleans, LA, 70112, USA
| | - Joseph R Archer
- Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Rachael Bartolina
- Louisiana State University Health Sciences Center Shreveport School of Medicine, Shreveport, LA, 71103, USA
| | - Jon D Hirsch
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Jeffrey T Howard
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Daniel Bass
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Charles J Fox
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
| | - Laxmaiah Manchikanti
- Pain Management Centers of America, Paducah, KY, USA
- Departments of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
- Department of Anesthesiology, School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
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10
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Jones-Whitehead C, Tran J, Wilson TD, Loh E. Evaluation of a novel nerve ablation technique to relieve lower back pain: a cadaveric feasibility pilot study. PAIN MEDICINE (MALDEN, MASS.) 2025; 26:70-75. [PMID: 39504454 PMCID: PMC11789780 DOI: 10.1093/pm/pnae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 10/06/2024] [Accepted: 10/24/2024] [Indexed: 11/08/2024]
Abstract
INTRODUCTION Radiofrequency ablation is a treatment for facetogenic low back pain that targets medial branches of lumbar dorsal rami to denervate facet joints. Clinical outcomes vary; optimizing cannula placement to better capture the medial branch could improve clinical outcomes. A novel parasagittal technique was proposed from an anatomic model; this technique was proposed to optimize capture of the medial branch. The anatomic feasibility of the novel technique has not been evaluated. OBJECTIVE To simulate and evaluate the proposed parasagittal technique in its ability to achieve proper cannula placement and proximity of uninsulated cannula tips to the medial branches of the dorsal rami in cadaveric specimens. METHODS Under fluoroscopic guidance, the parasagittal technique was used to place 14 cannulae targeting the lumbar medial branches of 2 cadavers. Meticulous dissection was undertaken to assess cannula alignment and measure proximities to target nerves with a digital caliper. RESULTS The novel parasagittal technique was successfully performed in a cadaveric model in 12 of 14 attempts. The technique achieved close proximity of cannula tips to medial branches (0.8 ± 1.1 mm). In 2 instances, cannulae were placed unsuccessfully; in one instance, the cannula was too far anterior, and in the other, it was too far retracted. CONCLUSION In this cadaveric simulation study, the feasibility of performing the parasagittal technique for lumbar radiofrequency ablation was evaluated. This study suggests that the parasagittal technique is a feasible option for lumbar medial branch radiofrequency ablation.
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Affiliation(s)
- Charlotte Jones-Whitehead
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - John Tran
- Surgery (Division of Anatomy), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
| | - Timothy D Wilson
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Eldon Loh
- Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
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11
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Zhao J, Zheng L, Dai G, Sun Y, He R, Liu Z, Jin Y, Wu T, Hu J, Cao Y, Duan C. Senolytics cocktail dasatinib and quercetin alleviate chondrocyte senescence and facet joint osteoarthritis in mice. Spine J 2025; 25:184-198. [PMID: 39343238 DOI: 10.1016/j.spinee.2024.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 08/22/2024] [Accepted: 09/14/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is a pervasive issue, causing substantial economic burden and physical distress worldwide. Facet joint osteoarthritis (FJ OA) is believed to be a significant contributor to this problem. However, the precise role of chondrocyte senescence in FJ OA remains unclear, as does whether the clearance of chondrocyte senescence can alleviate the progression of FJ OA. PURPOSE The goal of this study was to understand the potential of Dasatinib (D) and Quercetin (Q) as a treatment to clear chondrocyte senescence during the progression of FJ OA. STUDY DESIGN We used a preclinical bipedal standing mice model with the administration of Dasatinib (D) (5 mg/kg) and Quercetin (Q) (50 mg/kg) after 10 weeks of bipedal standing. MATERIALS AND METHODS Human degenerative lumbar facet joint (LFJ) samples were obtained to investigate the relationship between chondrocyte cellular senescence and LFJ osteoarthritis (OA). Subsequently, we established an in vitro model of excessive mechanical stress on chondrocytes and an in vivo bipedal standing mice model to induce LFJ OA. IHC (immunohistochemistry) staining in vivo and SA-β-gal staining, qRT-PCR and Western blot analysis were applied to test the senolytic effect of the combination of Dasatinib (D) and Quercetin (Q). IHC staining and X-ray microscope were also performed to examine the contribution of D+Q to the anabolism in cartilage and subchondral bone recoupling. Immunofluorescence and Western blot analysis in vitro and IHC staining in vivo were conducted to assess the impact of D+Q on the regulation of the NF-κB pathway activation during chondrocyte senescence. RESULTS We observed that facet joint cartilage degeneration is associated with chondrocyte cellular senescence in both human and mouse degenerative samples. Following treatment with D+Q in vitro, cellular senescence was significantly reduced. Upon oral gavage administration of D+Q in the bipedal standing mice model, decreased cellular senescence and reversed chondrocyte anabolism were observed. Furthermore, administration of D+Q maintained subchondral bone remodeling homeostasis and potentially reversed the activation of the NF-κB pathway in chondrocytes of the lumbar facet joint. CONCLUSIONS In summary, our investigation unveiled a significant correlation between chondrocyte senescence and LFJOA. Treatment with the senolytic combination of D+Q in FJ OA yielded a notable reduction in chondrocyte senescence, along with a decrease in the release of SASP factors. Additionally, it facilitated the promotion of cartilage anabolism, maintenance of subchondral bone coupling, and amelioration of NF-κB pathway activation. CLINICAL SIGNIFICANCE Our outcomes revealed that D+Q, the renowned combination used for senolytic treatment, alleviate the progression of LFJ OA. The utilization of D+Q as a senolytic demonstrates a novel and promising alternative for LFJ OA treatment.
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Affiliation(s)
- Jinyun Zhao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
| | - Lifu Zheng
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
| | - Guoyu Dai
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
| | - Yi Sun
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
| | - Rundong He
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
| | - Zhide Liu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
| | - Yuxin Jin
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
| | - Tianding Wu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
| | - Jianzhong Hu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
| | - Yong Cao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China.
| | - Chunyue Duan
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
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12
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Tomé-Bermejo F, Otero-Romero D, Javier-Martínez E, Sutil-Blanco Á, de la Rosa-Zabala KL, Avilés-Morente C, Oliveros-Escudero B, Núñez-Torrealba AA, Moreno-Mateo F, Cervera-Irimia J, Mengis-Palleck CL, Garzón-Márquez F, Plais N, Guerra-Gutiérrez F, Álvarez-Galovich L. How much does an MRI change over a period of up to 2 years in patients with chronic low back pain? Is a repeated MRI really necessary in the follow-up of patients with chronic low back pain? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:4563-4571. [PMID: 39394387 DOI: 10.1007/s00586-024-08416-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/24/2024] [Accepted: 07/15/2024] [Indexed: 10/13/2024]
Abstract
PURPOSE Clinical practices vary between healthcare providers when it comes to asking for a Magnetic Resonance Imaging (MRI) during follow-up for chronic low-back pain (LBP). The association between progressive changes on the MRI and the clinical relevance of these findings is not clearly defined. The objective of our study is to investigate to what extent do MRI findings change during a period less than or equal to two years in patients with chronic LBP. We question the efficacy of its routinary use as a tool for follow-up and we also study the correlation between new changes on MRI and modifications in therapeutic attitude. METHODS Data was collected from 468 lumbar spine MRIs from 209 patients undergoing two or more MRIs between January 2015 and December 2019 with a mean of 2.24 MRIs per patient. The evaluated data included diagnosis, reason for request, MRI findings and treatment offered post-MRI. MRIs were assessed according to a standardized scoring system from 0 to 14 points according to the severity in findings (modified Babinska Score). Radiological changes were defined as increased severity of findings in the most affected segment. RESULTS 51.06% of MRI requests had no documented reason to be asked for. The average score of the findings on the first MRI was 5,733 (SD 2,462) and 6,131 (SD 2,376) on the second, not reaching a statistically significant difference (p = 0.062). There was no difference on the findings between the first and the second MRI in 40, 15% (n = 104) and up to 89, 96% with only mild changes (-1/ + 2 points over 14 possibles). After repeating the MRI, no modification to the treatment plan was made in 44, 79% of patients (n = 116) and only in 11.58% (n = 30) was surgical treatment indicated. CONCLUSION The rate of lumbar MRI has risen to an alarming pace without evidence of consequent improvements in patient outcomes. A significant number of repeated MRIs did not show radiological changes, nor did they give rise to further surgical treatment after obtaining these images. This study should help to review the real applications of clinical guides on the appropriate use for image tests.
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Affiliation(s)
- Félix Tomé-Bermejo
- Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049, Madrid, Spain.
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain.
- Department of Orthopaedic Surgery and Traumatology, Villalba University General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Madrid, Spain.
| | - Daniel Otero-Romero
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - Elías Javier-Martínez
- Department of Orthopaedic Surgery and Traumatology, Villalba University General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Madrid, Spain
| | - Ángel Sutil-Blanco
- Department of Orthopaedic Surgery and Traumatology, Villalba University General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Madrid, Spain
| | - Kelman Luis de la Rosa-Zabala
- Department of Orthopaedic Surgery and Traumatology, Villalba University General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Madrid, Spain
| | - Carmen Avilés-Morente
- Department of Orthopaedic Surgery and Traumatology, Villalba University General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Madrid, Spain
| | - Beatriz Oliveros-Escudero
- Department of Orthopaedic Surgery and Traumatology, Villalba University General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Madrid, Spain
| | - Alexa Anaís Núñez-Torrealba
- Department of Orthopaedic Surgery and Traumatology, Villalba University General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Madrid, Spain
| | - Fernando Moreno-Mateo
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - Javier Cervera-Irimia
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - Charles Louis Mengis-Palleck
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - Francisco Garzón-Márquez
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - Nicolas Plais
- Department of Orthopaedic Surgery and Traumatology, San Cecilio de Granada University Hospital, Av. del Conocimiento, S/N, 18016, Granada, Spain
| | - Félix Guerra-Gutiérrez
- Department of Radiology, Villalba University General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Madrid, Spain
| | - Luis Álvarez-Galovich
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
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13
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Van Oosterwyck W, Vander Cruyssen P, Castille F, Van de Kelft E, Decaigny V. Lumbar Facet Joint Disease: What, Why, and When? Life (Basel) 2024; 14:1480. [PMID: 39598277 PMCID: PMC11595282 DOI: 10.3390/life14111480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 10/31/2024] [Accepted: 11/12/2024] [Indexed: 11/29/2024] Open
Abstract
Low back pain (LBP) affects over 60% of individuals in their lifetime and is a leading cause of disability and increased healthcare expenditure. Facet joint pain (FJP) occurs in 27% to 40% of LBP patients but is often overlooked or misdiagnosed. Additionally, there is no clear correlation between the clinical examination, radiological findings, and clinical presentation, complicating the diagnosis and treatment of FJP. This narrative review aims to provide an overview of the literature regarding facet joint pain and discusses the utility of medial branch blocks (MBBs) and intra-articular (IA) injections as diagnostic and therapeutic tools prior to radiofrequency ablation (RFA). RFA is considered the gold standard for managing FJP, employing techniques that include precise needle placement and stimulation parameters to disrupt pain signals. Promising alternatives such as cooled RFA and cryodenervation require further research on their long-term efficacy and safety. Endoscopic denervation and multifidus stimulation are emerging therapies that may benefit chronic LBP patients, but additional research is needed to establish their effectiveness. When conservative management fails, RFA provides significant and lasting relief in well-selected patients and has a favourable safety profile. The current literature does not support surgical interventions for FJP management.
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Affiliation(s)
- Wout Van Oosterwyck
- Department of Anaesthesia, Intensive Care and Pain Medicine, General Hospital Maria Middelares, 9000 Ghent, Belgium
| | - Pieter Vander Cruyssen
- Department of Anaesthesia, Intensive Care and Pain Medicine, General Hospital Maria Middelares, 9000 Ghent, Belgium
| | - Frédéric Castille
- Department of Anaesthesia, Intensive Care and Pain Medicine, General Hospital Maria Middelares, 9000 Ghent, Belgium
| | - Erik Van de Kelft
- Department of Neurosurgery, Vitaz Hospital, 9100 St-Niklaas, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium
| | - Veronique Decaigny
- Department of Anaesthesia, Intensive Care and Pain Medicine, General Hospital Maria Middelares, 9000 Ghent, Belgium
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14
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Yan D, Zubair AC, Osborne MD, Pagan-Rosado R, Stone JA, Lehman VT, Durand NC, Kubrova E, Wang Z, Witter DM, Baer MM, Ponce GC, Quiñones-Hinojosa A, Qu W. CellKine clinical trial: first report from a phase 1 trial of allogeneic bone marrow-derived mesenchymal stem cells in subjects with painful lumbar facet joint arthropathy. Pain Rep 2024; 9:e1181. [PMID: 39300992 PMCID: PMC11412710 DOI: 10.1097/pr9.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/13/2024] [Accepted: 06/30/2024] [Indexed: 09/22/2024] Open
Abstract
Background Lumbar facet joint arthropathy (LFJA) is a major cause of low back pain (LBP), with current treatments offering limited long-term benefits. Bone marrow-derived mesenchymal stem cells (BM-MSCs) show promise due to their immunomodulatory and trophic effects, potentially addressing underlying degenerative processes in LFJA. Objectives This initial report describes the outcomes of the first treated patient in an ongoing mutidisciplinary phase 1 clinical trial evaluating the safety and feasibility of intra-articular allogeneic BM-MSCs for painful LFJA. Methods Following enrollment in our IRB-approved protocol, symptomatic LFJA was confirmed through double blocks on L4 and L5 medial branches. Two 1-mL syringes, each containing 10 million BM-MSCs, were prepared in the cGMP facility and administered bilaterally to the patient's L4-L5 lumbar facet joints. The patient underwent standardized follow-ups, including clinical examinations and functional and imaging assessments for 2 years, utilizing patient-reported outcomes measurement information system-computer adaptive tests (PROMIS CATs), visual analogue scale, Oswestry disability index, work functional status and opioid pain medication use, and MR imaging Fenton-Czervionke score. Results The patient tolerated the procedure well, with no drug-related adverse events during the study period. Pain, spine function, and work functional status improved at multiple follow-ups. This patient also reported improvements in mental and social health, along with a notable improvement in the grade of facet synovitis observed at the one-year follow-up MRI evaluation. Conclusions This case report suggests the safety and feasibility of administering intra-articular allogeneic BM-MSCs, offering therapeutic benefits for pain management and functional activities.
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Affiliation(s)
- Dan Yan
- Department of Pain Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Abba C Zubair
- Transfusion Medicine, Department of Pathology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - Vance T Lehman
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Nisha C Durand
- Transfusion Medicine, Department of Pathology, Mayo Clinic, Jacksonville, FL, USA
- Center for Regenerative Biotherapeutics, Mayo Clinic, Jacksonville, FL, USA
| | - Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Zhen Wang
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Drew M Witter
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
| | - Meghan M Baer
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Gabriela C Ponce
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Wenchun Qu
- Department of Pain Medicine, Mayo Clinic, Jacksonville, FL, USA
- Center for Regenerative Biotherapeutics, Mayo Clinic, Jacksonville, FL, USA
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15
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Lee JY, Lee HI, Lee SH, Kim NH. Mechanical influence of facet tropism in patients with chronic discogenic pain disorder. Bone Joint Res 2024; 13:452-461. [PMID: 39231531 PMCID: PMC11374417 DOI: 10.1302/2046-3758.139.bjr-2023-0363.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Abstract
Aims The presence of facet tropism has been correlated with an elevated susceptibility to lumbar disc pathology. Our objective was to evaluate the impact of facet tropism on chronic lumbosacral discogenic pain through the analysis of clinical data and finite element modelling (FEM). Methods Retrospective analysis was conducted on clinical data, with a specific focus on the spinal units displaying facet tropism, utilizing FEM analysis for motion simulation. We studied 318 intervertebral levels in 156 patients who had undergone provocation discography. Significant predictors of clinical findings were identified by univariate and multivariate analyses. Loading conditions were applied in FEM simulations to mimic biomechanical effects on intervertebral discs, focusing on maximal displacement and intradiscal pressures, gauged through alterations in disc morphology and physical stress. Results A total of 144 discs were categorized as 'positive' and 174 discs as 'negative' by the results of provocation discography. The presence of defined facet tropism (OR 3.451, 95% CI 1.944 to 6.126) and higher Adams classification (OR 2.172, 95% CI 1.523 to 3.097) were important predictive parameters for discography-'positive' discs. FEM simulations showcased uneven stress distribution and significant disc displacement in tropism-affected discs, where loading exacerbated stress on facets with greater angles. During varied positions, notably increased stress and displacement were observed in discs with tropism compared to those with normal facet structure. Conclusion Our findings indicate that facet tropism can contribute to disc herniation and changes in intradiscal pressure, potentially exacerbating disc degeneration due to altered force distribution and increased mechanical stress.
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Affiliation(s)
- Jun Y. Lee
- Department of Physical Medicine and Rehabilitation, Korea University Ansan Hospital, Ansan, South Korea
| | - Hae I. Lee
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, South Korea
| | - Sang-Heon Lee
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, South Korea
| | - Nack H. Kim
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, South Korea
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16
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Xu B, Zhao X, Zhang L, Feng S, Li J, Xu Y. Radiofrequency vs Steroid Injections for Spinal Facet and Sacroiliac Joint Pain: A Systematic Review and Meta-Analysis. J Pain Res 2024; 17:2903-2916. [PMID: 39247173 PMCID: PMC11380878 DOI: 10.2147/jpr.s469615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 08/18/2024] [Indexed: 09/10/2024] Open
Abstract
Purpose Pain management for spinal facet joint (SFJ) and sacroiliac joint (SIJ) pain is challenging, often requiring interventions like radiofrequency ablation (RFA) or corticosteroid injections (CI). This study aims to assess and compare the effectiveness of CI and RFA in treating SFJ and SIJ pain. We combine these treatments due to their shared pathophysiology, similar therapeutic interventions, and the necessity for an integrated approach to spinal pain management. Patients and methods Literature search from PubMed, Scopus, CENTRAL and Google Scholar for published studies upto 31st December 2023, and reporting data of patients who were treated using CI of RFA for SFJ and SIJ pain. Pooled standardized mean difference (SMD) with a 95% Confidence Interval (CI) was calculated. Results Our meta-analysis incorporated thirteen studies. Overall, patients, treated with CI had a higher pain intensity score compared to patients treated with RFA (SMD=0.92; 95% CI: 0.19 to 1.65) at 3 months, and at 6 months (SMD=1.53; 95% CI: 0.66 to 2.40) after the treatment. No significant association was reported at 12 months (SMD=1.47; 95% CI: -0.03 to 2.97). Subgroup analysis based on joint types revealed increased pain intensity scores in patients who were treated with CI for SIJ (SMD=1.25; 95% CI: 0.39 to 2.11) and SFJ (SMD=1.33; 95% CI: 0.09 to 2.57) pain. A negative but not significant effect was detected in patients, treated with CI for cervical joint pain (SMD=-0.40; 95% CI: -0.90 to 0.10). Patients treated with CI exhibited higher functional disability score compared to patients treated with RFA at 3 months (SMD=1.28; 95% CI: 0.20 to 2.35) post-treatment. Conclusion This study suggests that RFA may offer superior pain relief with longer duration compared to steroid injections for spinal facet and sacroiliac joint pain. Decision regarding specific interventions should be individualized and consider patient preferences, clinical context, and potential risks.
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Affiliation(s)
- Bo Xu
- Acupuncture and Rehabilitation Department, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, People's Republic of China
| | - Xudong Zhao
- Physical Therapy Center, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, People's Republic of China
| | - Lei Zhang
- Acupuncture and Rehabilitation Department, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, People's Republic of China
| | - Shouhan Feng
- Oncology Department, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, People's Republic of China
| | - Jinxia Li
- Acupuncture and Rehabilitation Department, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, People's Republic of China
| | - Ye Xu
- Rehabilitation Department, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, People's Republic of China
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17
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Bogduk N, MacVicar J. Osteoarthritis of zygapophysial joints as a cause of back pain and neck pain: a scoping review. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:541-552. [PMID: 38702827 PMCID: PMC11369356 DOI: 10.1093/pm/pnae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Zygapophysial joints (Z joints) can be a source of back pain and of neck pain, but the cause of pain is not known. Some authors attribute the pain to osteoarthritis but without citing evidence. OBJECTIVES The present review was undertaken to determine if there was sufficient evidence of association between spinal pain and osteoarthritis of Z joints to justify osteoarthritis being held to be the cause of pain. The null hypothesis was that osteoarthritis of Z joints does not cause back pain or neck pain. ELIGIBILITY CRITERIA Relevant studies were ones that provided primary data on the association between pain and osteoarthritis of Z joints. These could be population studies, diagnostic studies, or case-control studies. SOURCES OF EVIDENCE The database of PubMed was searched using the terms: Lumbar or cervical, zygapophysial or facet, pain, and osteoarthritis or degeneration or degenerative. CHARTING METHODS Data pertinent to the research question were extracted from original articles and tabulated for reporting. Odds ratios for associations were calculated, as were the prevalence rates of osteoarthritis in subjects with pain, and conversely the prevalence rates of pain in subjects with osteoarthritis. RESULTS The searches retrieved 11 population studies, 4 diagnostic studies, and 3 cases control studies. No study showed any positive association between osteoarthritis of Z joints and pain. All studies found pain to be independent of the presence or severity of osteoarthritis. Osteoarthritis was as common in subjects with no pain as in subjects with pain. The null hypothesis was not refuted. CONCLUSION The published evidence does not support the belief that osteoarthritis causes Z joint pain. All the evidence contradicts this belief.
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Affiliation(s)
- Nikolai Bogduk
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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18
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Qiu C, Cheng L, Liu J, Ding Z, Sun M, Yu Y, An D, Wang L, Gao X, Pan X, Liu X, Wang S. The Comparison between Spinal Facet Joint Toothed Plate and Traditional Pedicle Screw-rod on Reduction of Thoracolumbar Fracture. Orthop Surg 2024; 16:1592-1602. [PMID: 38766812 PMCID: PMC11216825 DOI: 10.1111/os.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE Thoracolumbar fractures are one of the most common fractures in clinical practice. Surgical intervention is recommended to restore spinal alignment or decompress the nerves when there are unstable fractures or neurological injuries. However, after excessive forward thrust force restoration, facet joint dislocation often occurs between the upper vertebra and the fractured vertebra, which usually leads to unsatisfactory reduction outcomes. Herein, we propose a novel spinal facet joint toothed plate to assist in fracture reduction. The purpose of this study is to evaluate the effectiveness of the new spinal facet joint toothed plate in preventing facet joint dislocation, and its advantages compared to traditional pedicle screw-rod decompression. METHODS A total of 26 patients in the toothed plate group and 93 patients in the traditional group who experienced thoracolumbar fracture with reduction were retrospectively included. Relevant patients' information and clinical parameters were collected. Furthermore, visual analogue scores (VAS) scores and Oswestry disability index (ODI) scores were also collected. Moreover, imaging parameters were calculated based on radiographs. Correlated data were analyzed by χ2 test and t test. RESULTS All patients in this study had no postoperative complications. Postoperative VAS scores and ODI scores (p < 0.001) were statistically significant (p < 0.001) in both groups compared with preoperative scores and further decreased (p < 0.001) at final follow-up. In addition, the postoperative vertebral margin ratio (VMR) (p < 0.001) and vertebral angle of the injured vertebrae (p < 0.001) were significantly improved compared with the preoperative period. There were no significant differences in postoperative VAS scores and ODI scores between the two groups. However, toothed plate reduction significantly improved the VMR (p < 0.05) and vertebral angle (p < 0.05) compared with conventional reduction. Ultimately, the total screw accuracy was 98.72% (sum of levels 0 and I), with 100% screw accuracy in the segment related to the tooth plate in the tooth plate group. The dislocation rate was higher in the conventional group (6.45%) than in the new serrated plate repositioning group (0.00%). CONCLUSION The facet toothed plate assisted reduction method prevents facet joint dislocation and improves fracture reduction compared to traditional reduction technique, hence it could be considered as a novel surgical strategy for thoracolumbar fracture reduction.
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Affiliation(s)
- Cheng Qiu
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanChina
- Cheeloo College of Medicine, Shandong UniversityJinanChina
| | - Lin Cheng
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanChina
- Cheeloo College of Medicine, Shandong UniversityJinanChina
- Department of Emergency MedicineQilu Hospital of Shandong UniversityJinanChina
| | - Jingwei Liu
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanChina
- Cheeloo College of Medicine, Shandong UniversityJinanChina
- Department of Pediatric SurgeryQilu Hospital of Shandong UniversityJinanChina
| | - Zhiguo Ding
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanChina
- Department of OrthopedicsShouguang People's HospitalWeifangChina
| | - Musen Sun
- Department of Orthopaedic SurgeryHuimin County People's HospitalBinzhouChina
| | - Yanyong Yu
- Department of Orthopaedic SurgeryYucheng People's HospitalDezhouChina
| | - Dingling An
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanChina
| | - Lianlei Wang
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanChina
| | - Xianlei Gao
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanChina
| | - Xin Pan
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanChina
| | - Xinyu Liu
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanChina
| | - Songgang Wang
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanChina
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19
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Gou Y, Li H, Sun X, Chen D, Tian F. Parathyroid hormone (1-34) retards the lumbar facet joint degeneration and activates Wnt/β-catenin signaling pathway in ovariectomized rats. J Orthop Surg Res 2024; 19:352. [PMID: 38877549 PMCID: PMC11177467 DOI: 10.1186/s13018-024-04817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/28/2024] [Indexed: 06/16/2024] Open
Abstract
PURPOSE Facet joint degeneration (FJD) is a major cause of low back pain. Parathyroid hormone (PTH) (1-34) is commonly used to treat osteoporosis. However, little is known about its effects on FJD induced by estrogen deficiency. This study aims to investigate the effects of PTH (1-34) on FJD induced by estrogen deficiency and the underlying pathogenesis of the disease. METHODS Forty 3-month-old female Sprague-Dawley rats were randomly divided into four groups: 30 received bilateral ovariectomy (OVX) followed by 12 weeks of treatment with normal saline, PTH (1-34) or 17β-estradiol (E2), and 10 received sham surgery followed by administration of normal saline. Status and Wnt/β-catenin signaling activity in the cartilage and subchondral bone of the L4-L5 FJs and serum biomarkers were analyzed. RESULTS Administration of PTH (1-34) and E2 ameliorated cartilage lesions, and significantly decreased MMP-13 and caspase-3 levels and chondrocyte apoptosis. PTH (1-34) but not E2 significantly increased cartilage thickness, number of chondrocytes, and the expression of aggrecan. PTH (1-34) significantly improved microarchitecture parameters of subchondral bone, increased the expression of collagen I and osteocalcin, and decreased RANKL/OPG ratio. E2 treatment significantly increased the OPG level and decreased the RANKL/OPG ratio in the subchondral bone of ovariectomized rats, but it did not significantly improve the microarchitecture parameters of subchondral bone. Wnt3a and β-catenin expression was significantly reduced in the articular cartilage and subchondral bone in OVX rats, but PTH (1-34) could increase the expression of these proteins. E2 significantly increased the activity of Wnt/β-catenin pathway only in cartilage, but not in subchondral bone. The restoration of Wnt/β-catenin signaling had an obvious correlation with the improvement of some parameters associated with the FJs status. CONCLUSION Wnt/β-catenin signaling may be a potential therapeutic target for FJD induced by estrogen deficiency. PTH (1-34) is effective in treating this disease with better efficacy than 17β-estradiol, and the efficacy may be attributed to its restoration of Wnt/β-catenin signaling.
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Affiliation(s)
- Yu Gou
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Hetong Li
- Department of Orthopaedics, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xun Sun
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Desheng Chen
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin University, Tianjin, China.
| | - Faming Tian
- School of Public Health, North China University of Science and Technology, Tangshan, China.
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20
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Ding S, Chen L, Fu C, Liu M, Yuan Y, Battié MC, Wang Y. Lumbar foraminal stenosis was associated with back pain and leg pain: epidemiological evidence from a population-based cohort. Neuroradiology 2024:10.1007/s00234-024-03391-2. [PMID: 38871880 DOI: 10.1007/s00234-024-03391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES To determine the characteristics of lumbar foraminal stenosis (LFS) on magnetic resonance (MR) images and their association with back pain and radiating leg pain in a population-based sample of Chinese subjects. METHODS This study was an extension of the Hangzhou Lumbar Spine Study, a cross-sectional study focusing on back pain and lumbar spine MR imaging findings. Questionnaire data, including demographics, lifestyle, occupational exposures, back pain and radiating leg pain were included. On lumbar spine MR images, disc degeneration was assessed using Pfirrmann grade and Modic changes were evaluated. Using Lee's scale, the L3-S1 intervertebral foramina were evaluated, with grade 2-3 representing substantial LFS and grade 0-1 no LFS. Characteristics of LFS were noted, and associations of LFS with back pain and radiating leg pain were examined. RESULTS Among the 644 study subjects, 141 (21.9%) had at least one LFS, and its occurrence was associated with greater age (OR = 1.93 for each 10 years, p < 0.001). Substantial LFS was associated with the presence of back pain (OR = 1.92, p = 0.001) and the intensity of the worst back pain (Coef = 8.30, p < 0.001) over the past 12 months, and disabling back pain during their lifetime (OR = 2.25, p < 0.001). Substantial LFS was also associated with leg pain (OR = 14.27, p < 0.001), with a sensitivity of 75.7% for the presence of radiating leg pain and a specificity of 81.4%. CONCLUSION Substantial LFS on MR images was a common age-related degenerative phenotype in adults, and appears to be an independent risk factor for back pain and leg pain.
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Affiliation(s)
- Shuchen Ding
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, Zhejiang, 310003, China
- Center of Orthopedics, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China
| | - Lunhao Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Chudi Fu
- Center of Orthopedics, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China
| | - Miao Liu
- Department of Radiology, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China
| | - Ying Yuan
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Michele C Battié
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, ON, Canada
| | - Yue Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, Zhejiang, 310003, China.
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21
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Saremi A, Goyal KK, Benzel EC, Orr RD. Evolution of lumbar degenerative spondylolisthesis with key radiographic features. Spine J 2024; 24:989-1000. [PMID: 38199449 DOI: 10.1016/j.spinee.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Spondylolisthesis is a common finding in middle-aged and older adults with back pain. The pathophysiology of degenerative spondylolisthesis is a subject of controversy regarding not only its etiology but also the mechanisms of its progression. It is theorized that degeneration of the facets and discs can lead to segmental instability, leading to displacement over time. Kirkaldy-Willis divided degenerative spondylolisthesis into three phases: dysfunction, instability, and finally, restabilization. There is a paucity of literature on the unification of the radiological hallmarks seen in spondylolisthesis within these phases. The radiographic features include (1) facet morphology/arthropathy, (2) facet effusion, (3) facet vacuum, (4) synovial cyst, (5) interspinous ligament bursitis, and (6) vacuum disc as markers of dysfunction, instability, and/or restabilization. We discuss these features, which can be seen on X-ray, CT, and MRI, with the intention of establishing a timeline upon which they present clinically. Spondylolisthesis is initiated as either degeneration of the intervertebral disc or facet joints. Early degeneration can be seen as facet vacuum without considerable arthropathy. As the vertebral segment becomes increasingly dynamic, fluid accumulates within the facet joint space. Further degeneration will lead to the advancement of facet arthropathy, degenerative disc disease, and posterior ligamentous complex pathology. Facet effusion can eventually be replaced with a vacuum in severe facet osteoarthritis. Intervertebral disc vacuum continues to accumulate with further cleft formation and degeneration. Ultimately, autofusion of the vertebra at the facets and endplates can be observed. With this review, we hope to increase awareness of these radiographical markers and their timeline, thus placing them within the framework of the currently accepted model of degenerative spondylolisthesis, to help guide future research and to help refine management guidelines.
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Affiliation(s)
- Arvin Saremi
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH 44106, USA.
| | - Kush K Goyal
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Edward C Benzel
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - R Douglas Orr
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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22
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Acosta Julbe JI, Gottreich JR, Ermann J, Isaac Z, DeFilipp M, Andrew MN, Chang Y, Zampini JM, Katz JN, Mandell JC. Reporting of Facet Joint Inflammation in Lumbar Spine MRI Studies in Patients With Low Back Pain. Spine (Phila Pa 1976) 2024; 49:733-740. [PMID: 38229507 PMCID: PMC11042993 DOI: 10.1097/brs.0000000000004923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE We aimed to assess the frequency of facet joint inflammatory features noted in routine radiology reports of lumbar spine magnetic resonance imaging (MRI) studies among patients with chronic low back pain. SUMMARY OF BACKGROUND DATA Facet joint arthropathy is one of the most common causes of chronic low back pain. It may encompass various inflammatory imaging characteristics, such as facet joint effusion, bone marrow edema, and soft tissue edema. The extent to which radiology reports mention inflammatory features of the lumbar facet joints and the accuracy of these reports have not been investigated. MATERIALS AND METHODS The authors performed a chart review on 49 subjects with previous facet-related interventions ( i.e . medial branch blocks or intra-articular facet joint injection) and MRI available in the medical record. One senior musculoskeletal radiologist and a musculoskeletal radiology fellow graded the inflammatory features using a published facet joint inflammation grading system [Gold Standard (GS)]. The authors identified the inflammatory markers mentioned in the radiology reports and calculated the sensitivity and positive predictive value of the radiology reports compared with GS readings. RESULTS Compared with the GS, the sensitivity of radiology reports for facet joint effusion, bone marrow, and soft tissue edema ranged from 6% to 22%, and the positive predictive value ranged from 25% to 100%. L4/5 had the highest number of cases with inflammatory features noted on the reports. CONCLUSION Inflammatory findings, such as facet joint effusion, bone marrow edema, and soft tissue edema, are not commonly identified in radiology reports. Further investigations are needed to determine the clinical importance of MRI-detected lumbar facet joint inflammatory features as a potential mechanism of nociception and as a predictor of outcomes following injections or other therapies.
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Affiliation(s)
- José I. Acosta Julbe
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Julia R. Gottreich
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joerg Ermann
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Miriam DeFilipp
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael N. Andrew
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Yuchiao Chang
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jay M. Zampini
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jacob C. Mandell
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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23
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Kobayashi K, Otani K, Sekiguchi M, Kato K, Tominaga R, Konno SI. Relationship between lumbar facet joint osteoarthritis and comorbidities: A cross-sectional study in the Japanese community. J Orthop Sci 2024; 29:769-774. [PMID: 37270372 DOI: 10.1016/j.jos.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/17/2023] [Accepted: 05/04/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Few epidemiological studies have evaluated associations between lumbar facet joint (LFJ) osteoarthritis (OA) and comorbidities. This study aimed to investigate the prevalence of LFJ OA in a Japanese community population and associations between LFJ OA and underlying diseases, including lower extremity OA. METHODS This epidemiological cross-sectional study evaluated LFJ OA in 225 Japanese community residents (81 males, 144 females; median age, 66 years) using magnetic resonance imaging (MRI). LFJ OA from L1-L2 to L5-S1 was evaluated using a 4-grade classification. Associations between LFJ OA and comorbidities were examined using multiple logistic regression analyses adjusting for age, sex, and body mass index. RESULTS Prevalences of LFJ OA were 28.6% at L1-L2, 36.4% at L2-L3, 48.0% at L3-L4, 57.3% at L4-L5, and 44.2% at L5-S1. Males were significantly more likely to have LFJ OA at several spinal levels (L1-L2 45.7% vs 18.9%, p < 0.001; L2-L3 46.9% vs 30.6%, p < 0.05; L4-L5 67.9% vs 51.4%, p < 0.05). LFJ OA was present in 50.0% of residents <50 years old, 68.4% at 50-59 years old, 86.3% at 60-69 years old, and 85.1% at ≥70 years old. Multiple logistic regression analysis showed no associations between LFJ OA and comorbidities. CONCLUSIONS The prevalence of LFJ OA as evaluated by MRI was >85% at ≥60 years old and highest at the L4-L5 spinal level. Males were significantly more likely to have LFJ OA at several spinal levels. Comorbidities were not associated with LFJ OA.
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Affiliation(s)
- Kenji Kobayashi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ryoji Tominaga
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shin-Ichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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24
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Park JS, Goh TS, Lee JS, Lee C. Analyzing isolated degeneration of lumbar facet joints: implications for degenerative instability and lumbar biomechanics using finite element analysis. Front Bioeng Biotechnol 2024; 12:1294658. [PMID: 38600941 PMCID: PMC11005061 DOI: 10.3389/fbioe.2024.1294658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/26/2024] [Indexed: 04/12/2024] Open
Abstract
The facet joint contributes to lumbar spine stability as it supports the weight of body along with the intervertebral discs. However, most studies on the causes of degenerative lumbar diseases focus on the intervertebral discs and often overlook the facet joints. This study aimed to investigate the impact of facet joint degeneration on the degenerative changes and diseases of the lumbar spine. A finite element model of the lumbar spine (L1-S1) was fabricated and validated to study the biomechanical characteristics of the facet joints. To simulate degeneration of the facet joint, the model was divided into four grades based on the number of degenerative segments (L4-L5 or L4-S1) and the contact condition between the facet joint surfaces. Finite element analysis was performed on four spine motions: flexion, extension, lateral bending, and axial torsion, by applying a pure moment to the upper surface of L1. Important parameters that could be used to confirm the effect of facet joint degeneration on the lumbar spine were calculated, including the range of motion (ROM) of the lumbar segments, maximum von Mises stress on the intervertebral discs, and reaction force at the facet joint. Facet joint degeneration affected the biomechanical characteristics of the lumbar spine depending on the movements of the spine. When analyzed by dividing it into degenerative onset and onset-adjacent segments, lumbar ROM and the maximum von Mises stress of the intervertebral discs decreased as the degree of degeneration increased in the degenerative onset segments. The reaction force at the facet joint decreased with flexion and increased with lateral bending and axial torsion. In contrast, lumbar ROM of the onset-adjacent segments remained almost unchanged despite severe degeneration of the facet joint, and the maximum von Mises stress of the intervertebral discs increased with flexion and extension but decreased with lateral bending and axial torsion. Additionally, the facet joint reaction force increased with extension, lateral bending, and axial rotation. This analysis, which combined the ROM of the lumbar segment, maximum von Mises stress on the intervertebral disc, and facet joint reaction force, confirmed the biomechanical changes in the lumbar spine due to the degeneration of isolated facet joints under the load of spinal motion. In the degenerative onset segment, spinal instability decreased, whereas in the onset-adjacent segment, a greater load was applied than in the intact state. When conducting biomechanical studies on the lumbar spine, considering facet joint degeneration is important since it can lead to degenerative spinal diseases, including adjacent segment diseases.
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Affiliation(s)
- Jun Sung Park
- Department of Biomedical Engineering, Graduate School, Pusan National University, Busan, Republic of Korea
| | - Tae Sik Goh
- Department of Orthopaedic Surgery, School of Medicine, Pusan National University, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, School of Medicine, Pusan National University, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Chiseung Lee
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Biomedical Engineering, School of Medicine, Pusan National University, Busan, Republic of Korea
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Scholten P, Sheikh M, Atchison J, Eldrige JS, Garcia D, Sandhu S, Qu W, Nottmeier E, Fox WC, Buchanan I, Pirris S, Chen S, Quinones-Hinojosa A, Abode-Iyamah K. Correlating SPECT-CT activity in lumbar facet joints with response to lumbar medial branch and L5 dorsal ramus blocks. INTERVENTIONAL PAIN MEDICINE 2024; 3:100387. [PMID: 39239486 PMCID: PMC11372969 DOI: 10.1016/j.inpm.2024.100387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/30/2023] [Accepted: 01/15/2024] [Indexed: 09/07/2024]
Abstract
Introduction Lumbar facet arthritis is a significant source of back pain and impaired function that is amenable to treatment with medial branch radiofrequency neurotomy (RFN). Identifying appropriate patients for this treatment requires integration of information from the history, physical exam, and diagnostic imaging, but the current diagnostic standard for facet-mediated pain is positive comparative medial branch blocks (MBBs). Lumbar SPECT-CT has recently been evaluated as a potential predictor of positive MBBs with mixed results. The purpose of this retrospective analysis was to determine if the level of concordance between SPECT-CT uptake and facet joints targeted with MBB was associated with a positive block. Methods A retrospective review was performed to identify all patients undergoing lumbar MBB within 12 months after having a lumbar SPECT-CT. Each procedure was classified into one of four categories based on the level of concordance between facet joints demonstrating increased 99mTc uptake on SPECT-CT and those being blocked: 1) Complete Concordance (all joints demonstrating increased uptake were blocked and no additional joints blocked); 2) Partial Concordance (all joints demonstrating increased uptake were blocked, with at least one joint not demonstrating increased uptake blocked); 3) Partial Discordance (at least one but not all joints demonstrating increased uptake were blocked); 4) Complete Discordance (all blocks performed at joints not demonstrating increased uptake). Statistical analysis was performed to determine if the level of concordance between increased uptake on SPECT-CT and joints undergoing MBB was associated with a positive block using cutoffs of 50 % and 80 % pain relief. Results A total of 180 procedures were analyzed (23 % Complete Concordance, 22 % Partial Concordance, 31 % Partial Discordance, 24 % Complete Discordance) and all groups demonstrated improvement in pain Numeric Rating Scale (NRS) scores. There was no significant association between level of concordance and having a positive block using thresholds of 50 % pain relief, χ 2(3, N = 180) = 4.880, p = .181; or 80 % pain relief, χ 2(3, N = 180) = 1.272, p = .736. Conclusion SPECT-CT findings do not accurately predict positive lumbar MBB but may provide valuable information that can be considered with other factors when deciding which joints to treat.
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Affiliation(s)
- Paul Scholten
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Mateen Sheikh
- University of North Florida, 1 UNF Dr., Jacksonville, FL, 32224, USA
| | - James Atchison
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Jason S Eldrige
- Department of Pain Medicine, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Diogo Garcia
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Sukhwinder Sandhu
- Department of Neuroradiology, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Wenchun Qu
- Department of Pain Medicine, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Eric Nottmeier
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - W Christopher Fox
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Ian Buchanan
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Stephen Pirris
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Selby Chen
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Alfredo Quinones-Hinojosa
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Kingsley Abode-Iyamah
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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26
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Acosta JI, Ermann J, Isaac Z, DeFilipp M, Gottreich JR, Andrew MN, Chang Y, Zampini JM, Katz JN, Mandell JC. Comprehensive Grading System of Inflammatory Features of the Lumbar Facet Joints on Magnetic Resonance Imaging. Spine (Phila Pa 1976) 2024; 49:332-340. [PMID: 37798843 PMCID: PMC10922347 DOI: 10.1097/brs.0000000000004846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE We aimed to describe a magnetic resonance imaging (MRI)-based grading system of inflammatory features of the lumbar facet joints using an atlas and assess its reliability. SUMMARY OF BACKGROUND DATA Chronic low back pain is often caused by facet joint arthropathy. Inflammatory features are often evident on MRI. While several grading systems of facet arthropathy have been described, there is scant data on the reliability of these systems, and none focus exclusively on inflammatory features. MATERIALS AND METHODS We describe a grading system that assesses facet joint effusion, bone marrow edema, and soft tissue edema. Each feature was graded from 0 to 3 (facet edema) or 0 to 2 (bone marrow edema intensity and extent, soft tissue edema intensity and extent). Four spine experts graded MRIs of 50 subjects at the bilateral L3/4, L4/5, and L5/S1 levels. All subjects had symptomatic facet arthropathy and received therapeutic facet joint injections. We assessed the intra-reader and inter-reader reliability of each feature at each joint and summarized across all six joints. RESULTS The mean age of subjects was 56 years (SD = 17), and 48% were female. The injections occurred at the L3/4 level in 12% of cases, at L4/5 in 88%, and at L5/S1 in 80% of cases. The intra-reader reliability kappa's for each feature ranged from 0.42 to 0.81. In contrast, the inter-reader reliability kappa values for each feature ranged from 0.37 to 0.54. CONCLUSION MRI inflammatory features of the lumbar facet joints are often noted in patients with low back pain. The proposed grading system is reliable and could serve as a research tool for studies assessing the clinical relevance and prognostic value of these features.
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Affiliation(s)
- José I. Acosta
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joerg Ermann
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Miriam DeFilipp
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Julia R. Gottreich
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael N. Andrew
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Yuchiao Chang
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jay M. Zampini
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jacob C. Mandell
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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27
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Ray BM, Washington L, Thompson BL, Kelleran K. An exploration of low back pain beliefs held by health care professionals in Northern America. Musculoskeletal Care 2024; 22:e1877. [PMID: 38520493 DOI: 10.1002/msc.1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Prior research demonstrated that people in the United States and Canada (Northern America) hold predominantly biomedical beliefs about Low back pain (LBP); such beliefs were attributed to healthcare professionals (HCP). Further investigation is needed to understand HCP' LBP beliefs, preferred management strategies, and sources of beliefs. METHODS Participants were recruited via social media to complete a qualitative cross-sectional online survey. The survey was distributed to assess LBP beliefs in a U.S. and Canadian-based clinician population. Participants answered questions about the cause of LBP, reasons for recurrence or persistence, use of imaging, management strategies, and sources of beliefs. Responses were analysed using an inductive thematic analysis. RESULTS One hundred and sixty three participants were included, reporting multiple causes for LBP. However, many references were anchored to biological problems. When psychological variables were mentioned, it typically involved patient blaming. Like prior research studies, minimal attention was given to societal and environmental influences. Management strategies often aligned with guideline care except for the recommendation of inappropriate imaging and a reliance on passive interventions. CONCLUSIONS These findings align with prior research studies on general population beliefs, demonstrating a preference for biological causes of LBP. Further updates are needed for clinical education, while future studies should seek to assess the translation of clinician beliefs into clinical practice and health system constraints.
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Affiliation(s)
- B Michael Ray
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, Virginia, USA
| | - Leah Washington
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, Virginia, USA
| | - Bronwyn Lennox Thompson
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand, USA
| | - Kyle Kelleran
- Department of Emergency Medicine, University at Buffalo, Buffalo, New York, USA
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28
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Chen C, Xu G, Chen J, Wu C, Zhang J, Jiang J, Hong H, Cui Z. Decreased FoxO1 expression contributes to facet joint osteoarthritis pathogenesis by impairing chondrocyte migration and extracellular matrix synthesis. Cell Signal 2024; 113:110942. [PMID: 37890685 DOI: 10.1016/j.cellsig.2023.110942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
Facet joint osteoarthritis (FJOA), a condition commonly observed in individuals of middle to old age, has been relatively under-researched compared to other subtypes of osteoarthritis (OA). This study investigated the role of transcription factor FoxO1 in FJOA using a Col2a1-creERT knock-in mouse model. It was found that FoxO1 deletion led to severe osteoarthritic changes, indicating that FoxO1 played a critical role in cartilage homeostasis. Transcriptome sequencing was performed on degenerated cartilage from FoxO1-deleted mice. This process identified differentially expressed genes (DEGs), offering insights into the molecular mechanisms underlying FJOA. Bioinformatics analysis, including Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Set Enrichment Analysis (GSEA) and protein-protein interaction (PPI) network analysis, identified Itgb3, Itga1, Itga6, Itga7, Itga8, Itga10, Col1a1, and Il6, as potential key contributors to FJOA after FoxO1 deletion. Importantly, overexpression of Itgb3 and inhibition of Il6 counteracted FoxO1 knockdown-induced impairments in chondrocyte migration and extracellular matrix synthesis, respectively. This study discovered FoxO1 as a key regulator of the pathogenesis of FJOA, helped unravel the complex molecular mechanisms underlying FJOA, and contributed to the development of promising therapeutic avenues toward FJOA.
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Affiliation(s)
- Chu Chen
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China
| | - Guanhua Xu
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China; Spinal Degenerative Disease, Research Institute for Spine and Spinal Cord Disease of Nantong University, Nantong, Jiangsu 226001, China
| | - Jiajia Chen
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China
| | - Chunshuai Wu
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China
| | - Jinlong Zhang
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China
| | - Jiawei Jiang
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China
| | - Hongxiang Hong
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China.
| | - Zhiming Cui
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China; Spinal Degenerative Disease, Research Institute for Spine and Spinal Cord Disease of Nantong University, Nantong, Jiangsu 226001, China.
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29
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Yu H, Han Y, Zhang R, Sun C, Wang M, Yue B, Chou K, Li B, Zhang N. Relative risk factors of nerve root sedimentation sign (SedSign) in patients with severe central lumbar spinal stenosis (LSS). ALL LIFE 2023. [DOI: 10.1080/26895293.2023.2172460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Haiming Yu
- Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, People’s Republic of China
| | - Yunfeng Han
- Department of statistics, Qiqihar Medical College, Qiqihar, People’s Republic of China
| | - Rui Zhang
- Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, People’s Republic of China
| | - Chu Sun
- Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, People’s Republic of China
| | - Mingda Wang
- Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, People’s Republic of China
| | - Bo Yue
- Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, People’s Republic of China
| | - Kaiping Chou
- Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, People’s Republic of China
| | - Bin Li
- Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, People’s Republic of China
| | - Nan Zhang
- Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, People’s Republic of China
- Affiliated Xinhua Hospital of Dalian University, Dalian, People’s Republic of China
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30
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Fainor M, Orozco BS, Muir VG, Mahindroo S, Gupta S, Mauck RL, Burdick JA, Smith HE, Gullbrand SE. Mechanical crosstalk between the intervertebral disc, facet joints, and vertebral endplate following acute disc injury in a rabbit model. JOR Spine 2023; 6:e1287. [PMID: 38156057 PMCID: PMC10751980 DOI: 10.1002/jsp2.1287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/21/2023] [Accepted: 09/06/2023] [Indexed: 12/30/2023] Open
Abstract
Background Vertebral endplate sclerosis and facet osteoarthritis have been documented in animals and humans. However, it is unclear how these adjacent pathologies engage in crosstalk with the intervertebral disc. This study sought to elucidate this crosstalk by assessing each compartment individually in response to acute disc injury. Methods Eleven New Zealand White rabbits underwent annular disc puncture using a 16G or 21G needle. At 4 and 10 weeks, individual compartments of the motion segment were analyzed. Discs underwent T 1 relaxation mapping with MRI contrast agent gadodiamide as well T 2 mapping. Both discs and facets underwent mechanical testing via vertebra-disc-vertebra tension-compression creep testing and indentation testing, respectively. Endplate bone density was quantified via μCT. Discs and facets were sectioned and stained for histology scoring. Results Intervertebral discs became more degenerative with increasing needle diameter and time post-puncture. Bone density also increased in endplates adjacent to both 21G and 16G punctured discs leading to reduced gadodiamide transport at 10 weeks. The facet joints, however, did not follow this same trend. Facets adjacent to 16G punctured discs were less degenerative than facets adjacent to 21G punctured discs at 10 weeks. 16G facets were more degenerative at 4 weeks than at 10, suggesting the cartilage had recovered. The formation of severe disc osteophytes in 16G punctured discs between 4 and 10 weeks likely offloaded the facet cartilage, leading to the recovery observed. Conclusions Overall, this study supports that degeneration spans the whole spinal motion segment following disc injury. Vertebral endplate thickening occurred in response to disc injury, which limited the diffusion of small molecules into the disc. This work also suggests that altered disc mechanics can induce facet degeneration, and that extreme bony remodeling adjacent to the disc may promote facet cartilage recovery through offloading of the articular cartilage.
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Affiliation(s)
- Matthew Fainor
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Brianna S. Orozco
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Victoria G. Muir
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sonal Mahindroo
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- Department of BiologySt. Bonaventure UniversitySt. BonaventureNew YorkUSA
| | - Sachin Gupta
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Robert L. Mauck
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jason A. Burdick
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- BioFrontiers Institute and Department of Chemical and Biological EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Harvey E. Smith
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Sarah E. Gullbrand
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
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31
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Kook M, Kim I, Seo J, Kim H, Nam H, Han N. The Relationship Between Low Back Pain and Sagittal Spinal Alignment and Back Muscle Mass in Korean Fishery Workers. Ann Rehabil Med 2023; 47:459-467. [PMID: 37990502 PMCID: PMC10767211 DOI: 10.5535/arm.23075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To investigate the relationship between low back pain (LBP) and sagittal spino-pelvic parameters along with the relationship between LBP and back muscle mass in Korean male and female fishery workers. METHODS This retrospective study included a total of 146 subjects who underwent Fishermen's health survey conducted between June 2018 and August 2020. LBP was evaluated through visual analogue scale (VAS) and Oswestry Disability Index (ODI). Sagittal spino-pelvic parameters were measured from whole spine standing X-rays. Back muscle cross-sectional areas were identified through lumbar spine magnetic resonance imaging and body composition was analyzed through bioelectrical impedance analysis. RESULTS The study included 75 males and 71 females, with an average age of 58.33 years for males and 56.45 years for females. Female subjects exhibited higher VAS and ODI scores, larger pelvic tilt (PT) and trunk fat mass and smaller trunk muscle mass compared to males. In female, ODI positively correlated with sagittal vertical axis (SVA) and PT. No significant correlations were found between ODI scores and body composition in either sex. The high ODI group showed greater SVA, PT, and pelvic incidence-lumbar lordosis and higher trunk fat/muscle ratio. Psoas muscle mass, total and skeletal muscle mass and trunk muscle mass of that group were smaller than those of low ODI group. CONCLUSION Spino-pelvic parameters and back muscle mass were associated with ODI and there were differences between Korean male and female fishery workers.
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Affiliation(s)
- Minjung Kook
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Insuh Kim
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jeongyeon Seo
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyundong Kim
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- Center for Fishermen’s Safety and Health, Inje University Busan Paik Hospital, Busan, Korea
| | - Heesung Nam
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nami Han
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- Center for Fishermen’s Safety and Health, Inje University Busan Paik Hospital, Busan, Korea
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32
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McCormick ZL, Conger A, Kendall R, Wagner G, Henrie AM, Littell M, Sperry BP, Petersen R, Cooper AN, Teramoto M, Burnham TR. A pragmatic randomized prospective trial of cooled radiofrequency ablation of the medial branch nerves versus facet joint injection of corticosteroid for the treatment of lumbar facet syndrome: 12 month outcomes. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1318-1331. [PMID: 37578437 PMCID: PMC10690866 DOI: 10.1093/pm/pnad107] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Lumbar medial branch radiofrequency ablation (LRFA) and intraarticular facet steroid injections (FJI) are commonly performed for recalcitrant facet joint-mediated pain. However, no study has compared clinical outcomes of the two treatments in patients selected using dual medial branch blocks (MBBs) with an 80% relief threshold. OBJECTIVE Compare the effectiveness of cooled LRFA (C-LRFA) to FIJ as assessed by pain and functional improvements. DESIGN Prospective randomized comparative trial. METHODS Patients with dual MBB-confirmed facet joint-mediated pain were randomized to receive C-LRFA or FIJ. Outcomes were assessed at 1, 3, 6, and 12 months. The primary outcome was ≥50% improvement in numerical pain rating scale (NPRS) score at 3 months. Secondary outcomes included ≥30% Oswestry Disability Index (ODI) improvement and Patient Global Impression of Chance (PGIC) ≥6 points, among others. Data were analyzed using contingency tables and mixed-effects logistic regression models. RESULTS Of 1128 patients screened, 32 met eligibility criteria, were randomized, and received their allocated study treatment. In total, 20 (62.5%) and 12 (37.5%) participants received C-LRFA and FIJ, respectively. In the C-LRFA group, 70% (95% CI 48-85), 55% (95% CI 34-74), and 45% (95% CI 26-66) of participants met the NPRS responder definition, compared to 25% (95%CI 9-53), 25% (95% CI 9-53), and 17% (95% CI 5-45) in the FJI group at 3, 6, and 12 months, respectively (P = .014 at 3 months). The PGIC responder proportion was higher in the C-LRFA compared to FJI group at 3 and 6 months (P < .05). CONCLUSIONS C-LRFA demonstrated superior success rates compared to FJI across pain and functional outcome domains. TRIAL REGISTRATION DETAILS ClinicalTrials.gov (NCT03614793); August 3, 2018.
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Affiliation(s)
- Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Aaron Conger
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Richard Kendall
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Graham Wagner
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - A Michael Henrie
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Madelaine Littell
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Beau P Sperry
- University of California Los Angeles School of Medicine, Los Angeles, CA 90095, United States
| | - Russel Petersen
- Alabama College of Osteopathic Medicine, Dothan, AL, United States
| | - Amanda N Cooper
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Masaru Teramoto
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Taylor R Burnham
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
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Yahara Y, Seki S, Makino H, Futakawa H, Kamei K, Kawaguchi Y. Asymmetric Load Transmission Induces Facet Joint Subchondral Sclerosis and Hypertrophy in Patients with Idiopathic Adolescent Scoliosis: Evaluation Using Finite Element Model and Surgical Specimen. JBMR Plus 2023; 7:e10812. [PMID: 38130755 PMCID: PMC10731138 DOI: 10.1002/jbm4.10812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 12/23/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) with thoracic curvature primarily progresses from the thoracolumbar region, causing abnormal twisting and rotation of the spinal column. This results in unbalanced, asymmetric loads on each vertebrae and increased demands on the thoracic facet joints to withstand rotational stress from adjacent vertebrae. However, no studies have focused on the stress distribution on the facet joints of the thoracic spine in patients with AIS. This study aimed to investigate the mechanical loading and its distribution on the thoracic facet joints of AIS patients using finite element (FE) analysis and surgical specimens. FE models of the thoracic spine were created from a total of 13 female AIS patients (Lenke type 1, n = 4; Lenke type 2, n = 4; Lenke type 3, n = 5). A load of 200 N on the T3 vertebrae and 30 N each on the bilateral superior articular processes were applied vertically to quantify the contact force on the facet joints from T3 to T11. In addition, morphological and histological analyses were performed on the inferior articular processes obtained during surgery. FE analysis demonstrated that contact forces of the facet joint progressively increased from the mid to lower thoracic spine of the concave side, reaching a maximum around the apex. More than 91% of the load was transmitted by the facet joints at the concave side, resulting in facet joint subchondral sclerosis and hypertrophy. The apical facet joint in AIS helps counteract rotational stress between vertebrae and transfers most stress through the concave side. In conclusion, this study found that asymmetric load transfer in the facet joints leads to subchondral sclerosis and hypertrophy. These findings can enhance our understanding of the stress loading on facet joints and the resulting biological changes and help clarify the mechanisms involved in scoliosis progression. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Yasuhito Yahara
- WPI‐Immunology Frontier Research CenterOsaka UniversitySuitaJapan
- Department of Orthopaedic Surgery, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Hayato Futakawa
- Department of Orthopaedic Surgery, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of MedicineUniversity of ToyamaToyamaJapan
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Fukuda T, Yonenaga T, Miyasaka T, Kimura T, Jinzaki M, Ojiri H. CT in osteoarthritis: its clinical role and recent advances. Skeletal Radiol 2023; 52:2199-2210. [PMID: 36287235 DOI: 10.1007/s00256-022-04217-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 02/02/2023]
Abstract
Computed tomography (CT) is a widely available imaging method and considered as one of the most reliable techniques in bone assessment. Although CT has limited tissue contrast and needs radiation exposure, it has several advantages like fast scanning time and high spatial resolution. In this regard, CT has unique roles in osteoarthritis (OA) and its variable utilities have been reported. Hence, this review highlights the clinical role of CT in OA of representative joints. In addition, CT showed the several technical advancements recently, for example, acquiring the CT image with standing, obtaining the dual-energy data, and novel photon-counting detector development. Therefore, the recent studies and potential utility of these new CT systems in OA are also discussed.
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Affiliation(s)
- Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, Japan.
| | - Takenori Yonenaga
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Teruyuki Miyasaka
- Department of Orthopedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Tadashi Kimura
- Department of Orthopedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
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Acosta Julbe JI, Mandell JC, Ermann J, Isaac Z, Gottreich JR, Zampini JM, DeFilipp M, Andrew MN, Katz JN. Predictors of Outcomes After Lumbar Intra-Articular Facet Joint Injections and Medial Branch Blocks: A Scoping Review. Spine (Phila Pa 1976) 2023; 48:1455-1463. [PMID: 37470372 PMCID: PMC10528906 DOI: 10.1097/brs.0000000000004776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023]
Abstract
STUDY DESIGN A scoping review. OBJECTIVE We aimed to identify and describe the factors associated with the patient-reported response after lumbar intra-articular facet joint (FJ) injections or medial branch blocks (MBBs). SUMMARY OF BACKGROUND DATA FJ osteoarthritis is among the most common causes of chronic low back pain. Management often includes FJ intra-articular injection and MBBs (which may be followed by radiofrequency ablation of the nerves innervating these joints). However, the success of these approaches is variable, prompting interest in identifying patient characteristics (imaging features, clinical signs, and among others) associated with response to these types of facet injections. MATERIALS AND METHODS We performed a literature search on factors associated with patient-reported outcomes after lumbar FJ intra-articular injections or MBBs for patients with low back pain published in English or Spanish between 2000 and 2023. We excluded duplicate papers that did not describe factors associated with outcomes or those describing other interventions. We collected data on the association of these factors with patient-reported outcomes. RESULTS Thirty-seven studies met the inclusion criteria and were analyzed. These studies evaluated factors, such as age, depression, and single photon emission computed tomography (SPECT), and among variables. Age and imaging findings of facet arthropathy were the most frequently described factors. Imaging findings of FJ arthropathy and positive SPECT were often associated with positive results after intra-articular FJ injections or MBBs. In contrast, younger age and smoking were frequently associated with less favorable clinical outcomes. CONCLUSION Numerous factors were considered in the 37 studies included in this review. Imaging findings of facet arthropathy, duration of pain, and positive SPECT were consistently associated with favorable results after facet interventions.
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Affiliation(s)
- José I. Acosta Julbe
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jacob C. Mandell
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joerg Ermann
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Julia R. Gottreich
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jay M. Zampini
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Miriam DeFilipp
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael N. Andrew
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Gupta A, Maffulli N. Amniotic membrane and/or umbilical cord tissue for treatment of facet joint syndrome: a narrative review. J Orthop Surg Res 2023; 18:744. [PMID: 37784162 PMCID: PMC10544465 DOI: 10.1186/s13018-023-04241-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023] Open
Abstract
Musculoskeletal spine disorders, especially low back pain, induce enormous amounts of stress and financial burden on individuals and healthcare systems throughout the world. Disorders of the facet joints in the lumbar spine are the most predominant cause of back pain, resulting in facet joint syndrome (FJS). Conventional treatments for FJS are short-lived and have limitations and side effects. Thus, safer and more effective alternatives that can reduce pain and improve patient-reported outcomes are needed. Recently, the utilization of biologics, including the ones derived from perinatal tissue such as amniotic membrane (AM) and umbilical cord (UC), has significantly increased for regenerative medicine applications. This manuscript summarizes the outcomes of preclinical and clinical studies utilizing AM and/or UC for FJS. We identified no preclinical studies and 3 retrospective studies utilizing the search terms "amniotic membrane" and/or "umbilical cord" and "facet joint syndrome". The administration of AM + UC is safe and potentially efficacious for patients with FJS. However, more preclinical studies and appropriately powered, multi-center, prospective non-randomized and randomized controlled studies with longer follow-up are warranted to further evaluate the efficacy of AM + UC to justify its clinical use.
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Affiliation(s)
- Ashim Gupta
- Regenerative Orthopaedics, Noida, India.
- Future Biologics, Lawrenceville, GA, USA.
- BioIntegrate, Lawrenceville, GA, USA.
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX, USA.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Fisciano, Italy
- San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Ortopedica" Department, Hospital of Salerno, Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke On Trent, UK
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Dzefi-Tettey K, Edzie EKM, Mensah SK, Osei S, Piersson AD, Amedi MK, Asemah AR, Kusodzi H. Lumbar facet joint arthrosis on magnetic resonance imaging and its association with low back pain in a selected Ghanaian population. J Neurosci Rural Pract 2023; 14:681-685. [PMID: 38059220 PMCID: PMC10696332 DOI: 10.25259/jnrp_94_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/27/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Facet joint arthrosis is a common radiologic finding but remains controversial as a source of low back pain. We conducted a study to evaluate some of the potential risk factors contributing to the development of facet joint arthrosis, such as age, gender, and body mass index (BMI). The study aimed at establishing an association between these factors and facet joint arthrosis in the Ghanaian population, as a foundation for further research on low back pain. Materials and Methods This was a retrospective study done at the Department of Radiology, Korle Bu Teaching Hospital from January 2019 to December 2021. The study population included all cases referred to our department with complaints of low back pain. Patients below 18 years and those with a history of congenital lesions, trauma, infection, and malignancies were excluded. A total of 1017 cases were identified with facet joint arthrosis. The mean difference in age and BMI between males and females was compared using an independent sample t-test. Statistical association was done using Pearson's Chi-square test. P ≤ 0.05 was used as statistical significance. Results Majority of the study subjects were overweight with a mean BMI of 27.31 ± 5.37 kg/m2. The mean age was 53.61 ± 16.22 years, and majority were within the age of 51-60 years. Age was significantly associated with the prevalence of facet joint arthrosis. Conclusion The prevalence of facet joint arthrosis is significantly associated with increasing age but not with the BMI. Lumbar facet joint arthrosis is more prevalent in women than in men, which may be due to the sensitivity of cartilage to female sex hormones.
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Affiliation(s)
| | - Emmanuel Kobina Mesi Edzie
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, Cape Coast, Ghana
| | | | - Samson Osei
- Department of Radiology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Albert Dayor Piersson
- Department of Imaging Technology and Sonography, University of Cape Coast, Cape Coast, Ghana
| | | | - Abdul Raman Asemah
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, Cape Coast, Ghana
| | - Henry Kusodzi
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, Cape Coast, Ghana
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Pereira Pires JA, Rey Moura EC, de Oliveira CMB, Vieira Dibai-Filho A, Soares Brandão Nascimento MDD, da Cunha Leal P. Hypertonic glucose in the treatment of low back pain: A randomized clinical trial. Medicine (Baltimore) 2023; 102:e35163. [PMID: 37747016 PMCID: PMC10519545 DOI: 10.1097/md.0000000000035163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Chronic low back pain (LBP) is defined as pain lasting longer than 3 months and is one of the conditions with the most significant social impact. Treatment is complex and includes proliferative agents used in prolotherapy. The mechanism is not known, but osmotic agents (hypertonic solutions of dextrose or glucose) cause cellular rupture and an inflammatory response that releases cytokines and growth factors that lead to scarring and reinnervation. METHODS Patients with chronic LBP (>12 weeks) who were non-traumatic and unresponsive to at least 1 month of physical therapy were selected. All patients were followed up at a return visit at 1, 3, and 6 months for pain assessment using validated pain questionnaires and scales. RESULTS Nineteen patients were included in the conservative group and 19 in the glucose group, with the majority being women (57.9%). The patients were between 47 and 59 years of age (39.5%), mixed race (76.33%), married or in a committed relationship (73.7%), and had completed the study for 5.2 years. Overall mean body mass index was 27.3 ± 4.4 kg/m 2 and was higher in the conservative group (28.0 ± 4.7 kg/m 2 ). The groups showed differences in Visual Analog Scale scores, with median and amplitude values close to each other between the time points evaluated and increasing values in the glucose group, which had significantly higher values for this scale at the third evaluation ( P = .031). When comparing the Rolland-Morris scale scores between the groups, there was a significant difference only in the 3-m assessment ( P = .021). In the follow-up assessment, both groups showed significant improvement between T0 and the other assessment time points ( P < .05) in all evaluations. CONCLUSION Both groups significantly improved on the evaluated scales during follow-up. Overall, no effects were attributable to the glucose components or the prolotherapy protocol.
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Affiliation(s)
- Jose Alberto Pereira Pires
- Department of Neuro-Orthopedics, University Hospital of the Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Ed Carlos Rey Moura
- Department of Medicine I, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | - Plinio da Cunha Leal
- Department of Medicine I, Federal University of Maranhão, São Luís, Maranhão, Brazil
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Wang S, Aikeremu D, Kahaer A, Maimaiti A, Xiao Y, Tuoheti A, Zhang R, Maimaiti X, Guo H, Rexiti P. Anatomical and imaging measurements of the angle between the axis of the lumbar pedicle and lateral isthmus margin and its clinical significance. J Orthop Surg Res 2023; 18:509. [PMID: 37464385 DOI: 10.1186/s13018-023-03983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND This study aims to explore the measurement of the angle between the axis of the pedicle and the lateral margin of the isthmus on the lumbar spine, and investigate its clinical significance. METHODS The angle was measured on 120 normal adults' X-ray and 25 dry anatomical specimens. 60 screws were placed by junior residents on 6 wet specimens through the freehand technique. 30 screws were placed on one side with their original experience. After learning the techniques mentioned in the study, 30 screws were placed on the other side. The specimens were examined by X-ray and CT, and the angles of the screw paths and the integrity of the pedicle were evaluated. RESULTS The angles of 120 subjects and 25 anatomical specimens show a gradually increasing trend. The differences among each segment were statistically significant (P < 0.05), but the difference in the same segment between the X-ray and the anatomical specimens was not statistically significant (P > 0.05). Furthermore, the differences in L1, L2, and L3 between the two genders were not statistically significant (P > 0.05). However, the angles were larger in female group than in male group in L4 and L5, and the differences were statistically significant (P < 0.05). The difference in the deviation rate of screw placement before and after the learning was statistically significant only in the L5 segment (P < 0.05). The difference in overall excellence rate was statistically significant (P < 0.05). CONCLUSIONS The measurement of the angle between the axis of the pedicle and the lateral margin of the isthmus on the lumbar can improve the accuracy of the lumbar sagittal screw angle.
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Affiliation(s)
- Shuiquan Wang
- Department of Anatomy, College of Basic Medicine, Xinjiang Medical University, Urumqi, China
| | - Dilimulati Aikeremu
- Department of 2nd Spine Surgery, People's Hospital of Xinjiang, Urumqi, China
| | - Alafate Kahaer
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Xiao
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudusalamu Tuoheti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xieraili Maimaiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Paerhati Rexiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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Özcan-Ekşi EE, Börekci A, Ekşi MŞ. Facet Joint Orientation/Tropism Could Be Associated with Fatty Infiltration in the Lumbar Paraspinal Muscles. World Neurosurg 2023; 173:e606-e615. [PMID: 36863453 DOI: 10.1016/j.wneu.2023.02.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Facet joint orientation (FJO) and facet joint tropism (FJT) are associated with intervertebral disc degeneration and paraspinal muscle atrophy. However, none of the previous studies has evaluated the association of FJO/FJT with fatty infiltration in the multifidus, erector spinae, and psoas muscles at all lumbar levels. In the present study, we aimed to analyze whether FJO and FJT were associated with fatty infiltration in the paraspinal muscles at any lumbar level. METHODS Paraspinal muscles and FJO/FJT were evaluated from L1-L2 to L5-S1 intervertebral disc levels on T2-weighted axial lumbar spine magnetic resonance imaging. RESULTS Facet joints were more sagittally and coronally oriented at the upper and lower lumbar levels, respectively. FJT was more obvious at lower lumbar levels. The FJT/FJO ratio was higher at upper lumbar levels. Patients with sagittally oriented facet joints at the L3-L4 and L4-L5 levels had fattier erector spinae and psoas muscles at the L4-L5 level. Patients with increased FJT at upper lumbar levels had fattier erector spinae and multifidus at lower lumbar levels. Patients with increased FJT at the L4-L5 level had less fatty infiltration in the erector spinae and psoas at the L2-L3 and L5-S1 levels, respectively. CONCLUSIONS Sagittally oriented facet joints at lower lumbar levels could be associated with fattier erector spinae and psoas muscles at lower lumbar levels. The erector spinae at upper lumbar levels and psoas at lower lumbar levels might have become more active to compensate the FJT-induced instability at lower lumbar levels.
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Affiliation(s)
- Emel Ece Özcan-Ekşi
- Bahçeşehir University, School of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Ali Börekci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Murat Şakir Ekşi
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
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Acosta JI, Mandell JC, Ermann J, Isaac Z, Zampini JM, DeFilipp M, Gottreich JR, Andrew M, Katz JN. Grading Systems of Lumbar Facet Joint Inflammatory Changes on Magnetic Resonance Imaging: A Scoping Review. Spine (Phila Pa 1976) 2023; 48:636-644. [PMID: 36856452 PMCID: PMC10101880 DOI: 10.1097/brs.0000000000004609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/13/2023] [Indexed: 03/02/2023]
Abstract
STUDY DESIGN A scoping review. OBJECTIVE We aimed to identify and characterize grading systems of the inflammatory features of the lumbar facet joints (FJs) noted on magnetic resonance imaging and summarize their reliability. SUMMARY OF BACKGROUND DATA Chronic low back pain is one of the most common causes of disability worldwide and is frequently accompanied by FJ osteoarthritis. Inflammatory changes in the lumbar FJs are commonly noted in imaging studies of patients with FJ osteoarthritis and low back pain. Several grading systems for these inflammatory changes have been developed. However, these grading system's features and reliability have yet to be reviewed. MATERIALS AND METHODS We performed a literature search of studies reporting grading systems for FJ inflammatory changes published in English or Spanish between 1985 and 2022. We collected data on reported interreader reliability measures of each grading system. Finally, we compared the features of inflammation described by each system. RESULTS Six studies met the inclusion criteria and were used in our analysis. Features commonly graded in these systems are the hyperintensity signal noted within the FJ, bone marrow edema, and the extent of the soft-tissue edema surrounding the FJs. We found that the interreader reliability measures ranged from 0.56 to 0.96. CONCLUSIONS Only 6 studies have reported methods for documenting inflammation in the FJs. Studies varied in the precise tissues and phenomena included in the grading systems. However, the systems were generally reliable. Future studies should document the reliability of these methods when independent investigators are not involved in developing the classification schemes. Further work might combine one or more of these measures to establish a standard and reliable grading system for inflammatory changes in the FJs, including signal intensity within the joint, bone marrow edema, and soft-tissue inflammation.
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Affiliation(s)
- José I. Acosta
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jacob C. Mandell
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joerg Ermann
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jay M. Zampini
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Miriam DeFilipp
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Julia R. Gottreich
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael Andrew
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Farooque M. Specific and Nonspecific Low Back Pain-Mind the Gap and its Impact in Clinical Practice: Opinion of a Recovering Interventional Spine Physiatrist. Spine J 2023:S1529-9430(23)00170-5. [PMID: 37116719 DOI: 10.1016/j.spinee.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Mustafa Farooque
- Department of Medicine at the University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Back & Spine Program at Aurora St. Luke's Medical Center, Milwaukee, WI, 2901 W Kinnickinnic River Pkwy, Suite 310, Milwaukee, WI.
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Bauones S, Cazzato RL, Dalili D, Koch G, Garnon J, Gantzer J, Kurtz JE, Gangi A. Precision pain management in interventional radiology. Clin Radiol 2023; 78:270-278. [PMID: 36931782 DOI: 10.1016/j.crad.2022.09.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 03/17/2023]
Abstract
Pain is a common manifestation of several benign and malignant conditions. Inadequate response to conservative therapies is often succeeded by incremental use of analgesics and opioids; however, such an approach is often ineffective, not well tolerated by patients, and carries the risk of addiction leading to the opioid crisis. Implementing minimally invasive percutaneous procedures, performed by interventional radiologists has proven to be successful in providing safe, effective, and patient-specific therapies across a wide range of painful conditions. In the present narrative review, we will review the repertoire of minimally invasive imaging guided interventions, which have been successfully used to treat common painful benign and malignant conditions. We briefly describe each technique, common indications, and expected results.
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Affiliation(s)
- S Bauones
- Medical Imaging Administration, Musculoskeletal Imaging Department (AlAwaji, Banuones), King Fahad Medical City, Riyadh, Saudi Arabia; Radiology and Medical Imaging Department (Alsaadi), College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz Alkharj, Saudi Arabia
| | - R L Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000, Strasbourg, France; Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033, Strasbourg, France.
| | - D Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, KT18 7EG, UK; Department of Diagnostic and Interventional Radiology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, Epsom, KT18 7EG, UK
| | - G Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000, Strasbourg, France; Institut of Human Anatomy, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - J Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - J Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033, Strasbourg, France; Department of Cancer and Functional Genomics INSERM UMR_S1258, Institute of Genetics and of Molecular and Cellular Biology, 67400, Illkirch, France
| | - J E Kurtz
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033, Strasbourg, France
| | - A Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000, Strasbourg, France; School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, London, WC2R 2LS, UK
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Sayed D, Grider J, Strand N, Hagedorn JM, Falowski S, Lam CM, Tieppo Francio V, Beall DP, Tomycz ND, Davanzo JR, Aiyer R, Lee DW, Kalia H, Sheen S, Malinowski MN, Verdolin M, Vodapally S, Carayannopoulos A, Jain S, Azeem N, Tolba R, Chang Chien GC, Ghosh P, Mazzola AJ, Amirdelfan K, Chakravarthy K, Petersen E, Schatman ME, Deer T. The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain. J Pain Res 2022; 15:3729-3832. [PMID: 36510616 PMCID: PMC9739111 DOI: 10.2147/jpr.s386879] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.
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Affiliation(s)
- Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA,Correspondence: Dawood Sayed, The University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA, Tel +1 913-588-5521, Email
| | - Jay Grider
- University of Kentucky, Lexington, KY, USA
| | - Natalie Strand
- Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Steven Falowski
- Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Christopher M Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Nestor D Tomycz
- AHN Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Rohit Aiyer
- Interventional Pain Management and Pain Psychiatry, Henry Ford Health System, Detroit, MI, USA
| | - David W Lee
- Physical Medicine & Rehabilitation and Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Hemant Kalia
- Rochester Regional Health System, Rochester, NY, USA,Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Soun Sheen
- Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Mark N Malinowski
- Adena Spine Center, Adena Health System, Chillicothe, OH, USA,Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Michael Verdolin
- Anesthesiology and Pain Medicine, Pain Consultants of San Diego, San Diego, CA, USA
| | - Shashank Vodapally
- Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA
| | - Alexios Carayannopoulos
- Department of Physical Medicine and Rehabilitation, Rhode Island Hospital, Newport Hospital, Lifespan Physician Group, Providence, RI, USA,Comprehensive Spine Center at Rhode Island Hospital, Newport Hospital, Providence, RI, USA,Neurosurgery, Brown University, Providence, RI, USA
| | - Sameer Jain
- Interventional Pain Management, Pain Treatment Centers of America, Little Rock, AR, USA
| | - Nomen Azeem
- Department of Neurology, University of South Florida, Tampa, FL, USA,Florida Spine & Pain Specialists, Riverview, FL, USA
| | - Reda Tolba
- Pain Management, Cleveland Clinic, Abu Dhabi, United Arab Emirates,Anesthesiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA,Center for Regenerative Medicine, University Southern California, Los Angeles, CA, USA
| | | | | | | | - Krishnan Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA,Va San Diego Healthcare, San Diego, CA, USA
| | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA,Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Du R, Xu G, Bai X, Li Z. Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment. J Pain Res 2022; 15:3689-3710. [PMID: 36474960 PMCID: PMC9719706 DOI: 10.2147/jpr.s389602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/17/2022] [Indexed: 11/16/2023] Open
Abstract
Facet joint osteoarthritis (OA) is the most frequent form of facet joint syndrome. Medical history, referred pain patterns, physical examination, and diagnostic imaging studies (standard radiographs, magnetic resonance imaging, computed tomography and single-photon emission computed tomography) may suggest but not confirm lumbar facet joint (LFJ) syndrome as a source of low back pain (LBP). However, the diagnosis and treatment of facet joint syndrome is still controversial and needs further study. It is widely acknowledged that block with local anesthetic is perhaps the most effective method to establish a diagnosis of pain from LFJ. Particularly, there are different rates of success among different populations selected for diagnostic block with various positive criteria. Currently, in addition to conservative treatments for pain such as painkillers, functional exercises, and massage, there are many other methods, including block, denervation of the nerves that innervate the joints by radiofrequency, freezing or endoscopy, and injections. Due to the limited duration of pain relief from neurolysis of medial branch, many scholars have recently turned their targets to dorsal roots and LFJ capsules. Therefore, we reviewed the latest research progress of facet joint syndrome from diagnosis to treatment.
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Affiliation(s)
- Ruihuan Du
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Gang Xu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian, People’s Republic of China
| | - Xujue Bai
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian, People’s Republic of China
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Goode AP, Cleveland RJ, George SZ, Schwartz TA, Kraus VB, Renner JB, Gracely RH, DeFrate LE, Hu D, Jordan JM, Golightly YM. Predictors of Lumbar Spine Degeneration and Low Back Pain in the Community: The Johnston County Osteoarthritis Project. Arthritis Care Res (Hoboken) 2022; 74:1659-1666. [PMID: 33973412 PMCID: PMC8578580 DOI: 10.1002/acr.24643] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the incidence and worsening of lumbar spine structure and low back pain (LBP) and whether they are predicted by demographic characteristics or clinical characteristics or appendicular joint osteoarthritis (OA). METHODS Paired baseline (2003-2004) and follow-up (2006-2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for osteophytes (OST), disc space narrowing (DSN), spondylolisthesis, and presence of facet joint OA (FOA). Spine OA was defined as at least mild OST and mild DSN at the same level for any level of the lumbar spine. LBP, comorbidities, and back injury were self-reported. Weibull models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of spine phenotypes accounting for potential predictors including demographic characteristics, clinical characteristics, comorbidities, obesity, and appendicular OA. RESULTS Obesity was a consistent and strong predictor of incidence of DSN (HR 1.80 [95% CI 1.09-2.98]), spine OA (HR 1.56 [95% CI 1.01-2.41]), FOA (HR 4.99 [95% CI 1.46-17.10]), spondylolisthesis (HR 1.87 [95% CI 1.02-3.43]), and LBP (HR 1.75 [95% CI 1.19-2.56]), and worsening of DSN (HR 1.51 [95% CI 1.09-2.09]) and LBP (HR 1.51 [95% CI 1.12-2.06]). Knee OA was a predictor of incident FOA (HR 4.18 [95% CI 1.44-12.2]). Spine OA (HR 1.80 [95% CI 1.24-2.63]) and OST (HR 1.85 [95% CI 1.02-3.36]) were predictors of incidence of LBP. Hip OA (HR 1.39 [95% CI 1.04-1.85]) and OST (HR 1.58 [95% CI 1.00-2.49]) were predictors of LBP worsening. CONCLUSION Among the multiple predictors of spine phenotypes, obesity was a common predictor for both incidence and worsening of lumbar spine degeneration and LBP.
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Affiliation(s)
- Adam P. Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca J. Cleveland
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Steven Z. George
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Todd A. Schwartz
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Virginia B. Kraus
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Richard H. Gracely
- Department of Endodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - David Hu
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Physical Therapy, University of North Carolina, Chapel Hill, NC, USA
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Le VT, Do PT, Nguyen AM, Nguyen Dao LT. Thermal Radiofrequency Ablation Combined with Corticosteroid Injection in Management of Lumbar Facet Joint Pain: A Single-Center Study in Vietnam. World Neurosurg 2022; 166:237-243.e1. [PMID: 35953043 DOI: 10.1016/j.wneu.2022.07.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We sought to evaluate the effectiveness of thermal radiofrequency ablation combined with corticosteroid injection for medial branch block in the management of chronic low back pain, which originates from lumbar facet joint (LFJ) pain. METHODS A prospective observational study of 82 patients with chronic LFJ pain undergoing thermal radiofrequency ablation combined with corticosteroid injection was conducted. Primary outcomes included pain relief and functional recovery, measured by the visual analog scale (VAS) and Oswestry Disability Index, respectively. Secondary outcome was the time of recurrent low back pain at the same spinal segment after treatment. Adverse events were also recorded. RESULTS Mean age is 55.7 ± 15.2 years old, and duration of LFJ pain was 18.2 ± 9.5 months. Median VAS at baseline was 7.0 (7.0-9.0) for all ages. After intervention, VAS and Oswestry Disability Index improved significantly (P < 0.001). Pain relief lasted for 1 month, 3 months, 6 months, 12 months, and 12-24 months' follow-up. During this period, only 5 patients required another radiofrequency neurotomy procedure (6.1%). No complications occurred in the study group. CONCLUSIONS Thermal radiofrequency ablation combined with corticosteroid injection should be a potential method of choice for its effectiveness, long-lasting effect, and safety in the management of LFJ pain.
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Affiliation(s)
- Viet-Thang Le
- Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam; Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Phuoc Trong Do
- Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Anh Minh Nguyen
- Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam; Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
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Chen Z, He L, Di J, Huang L, Feng F, Yang B, Xie P, Rong L. Lumbar facet joint osteoarthritis as the underlying reason for persistent low back pain after minimally invasive discectomy. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04595-y. [PMID: 36114871 DOI: 10.1007/s00402-022-04595-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A post-hoc subgroup analysis of prospective collected data in a randomized controlled trial (RCT) of minimally invasive discectomy was conducted, to find out the possible underlying reasons for patients with persistent low back pain (LBP) following surgery. MATERIALS AND METHODS Patients who were diagnosed with lumbar disc herniation (LDH) and underwent either percutaneous transforaminal endoscopic discectomy or microendoscopic discectomy in our RCT were analyzed. Patients with persistent LBP in 2-year follow-up were compared with the non-LBP patients to determine the underlying reasons. Then, the demographic characteristics, clinical outcomes and radiological parameters of patients with preoperative lumbar facet joint osteoarthritis (LFJOA) were assessed and compared with the non-LFJOA subgroup. RESULTS 18 patients (8.1%) were reported to have persistent LBP in 2-year follow-up. Significantly higher proportion of preoperative LFJOA were found in the persistent LBP subgroup and was considered to be a risk factor using multivariate analysis. The prevalence of LFJOA is strongly associated with older age, female, high BMI and heavy labor in the LDH population. All of the clinical outcomes including ODI, SF36-PF, SF36-BP, EQ-5D, VAS-back and VAS-leg were worse in LFJOA subgroup in 2-year follow-up. LFJOA subgroup was associated with more adjacent segment degeneration and more lateral recess stenosis. CONCLUSIONS LFJOA is a possible underlying reason for patients with persistent LBP after minimally invasive discectomy. Surgeons should carefully review the preoperative radiological images to find out whether there is LFJOA in the LDH segment, and kindly diminish the expectation of back pain relief for those patients. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov at November 14, 2013, registration number NCT01997086. ( https://clinicaltrials.gov/ct2/show/NCT01997086 ).
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Affiliation(s)
- Zihao Chen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Lei He
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Jiawei Di
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Lijun Huang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Feng Feng
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Bu Yang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Peigen Xie
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China. .,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China. .,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China.
| | - Limin Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China. .,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China. .,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China.
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Nordberg RC, Kim AN, Hight JM, Meka RS, Elder BD, Hu JC, Athanasiou KA. Biochemical and biomechanical characterization of the cervical, thoracic, and lumbar facet joint cartilage in the Yucatan minipig. J Biomech 2022; 142:111238. [PMID: 35933954 PMCID: PMC9910803 DOI: 10.1016/j.jbiomech.2022.111238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
Facet joint arthrosis causes pain in approximately 7 % of the U.S. population, but current treatments are palliative. The objective of this study was to elucidate structure-function relationships and aid in the development of future treatments for the facet joint. This study characterized the articular surfaces of cervical, thoracic, and lumbar facet cartilage from skeletally mature (18-24 mo) Yucatan minipigs. The minipig was selected as the animal model because it is recognized by the U.S. Food and Drug Administration (FDA) and the American Society for Testing and Materials (ASTM) as a translationally relevant model for spine-related indications. It was found that the thoracic facets had a ∼2 times higher aspect ratio than lumbar and cervical facets. Lumbar facets had 6.9-9.6 times higher % depth than the cervical and thoracic facets. Aggregate modulus values ranged from 135 to 262 kPa, much lower than reported aggregate modulus in the human knee (reported to be 530-701 kPa). The tensile Young's modulus values ranged from 6.7 to 20.3 MPa, with the lumbar superior facet being 304 % and 286 % higher than the cervical inferior and thoracic superior facets, respectively. Moreover, 3D reconstructions of entire vertebral segments were generated. The results of this study imply that structure-function relationships in the facet cartilage are different from other joint cartilages because biochemical properties are analogous to other articular cartilage sources whereas mechanical properties are not. By providing functional properties and a 3D database of minipig facet geometries, this work may supply design criteria for future facet tissue engineering efforts.
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Affiliation(s)
- Rachel C Nordberg
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA 92617, USA
| | - Andrew N Kim
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA 92617, USA
| | - Justin M Hight
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA 92617, USA
| | - Rithika S Meka
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA 92617, USA
| | - Benjamin D Elder
- Department of Neurosurgery, Orthopedics, and Biomedical Engineering, Mayo Clinic School of Medicine, 200 1st St. SW, Rochester, MN 55905, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA 92617, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA 92617, USA.
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50
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Goode AP, Hu D, George SZ, Schwartz TA, Kraus VB, Huebner JL, Cleveland RJ, Taylor KA, Jordan JM, Golightly YM. Biomarker clusters differentiate phenotypes of lumbar spine degeneration and low back pain: The Johnston County Osteoarthritis Project. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100270. [PMID: 35991624 PMCID: PMC9387345 DOI: 10.1016/j.ocarto.2022.100270] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Describe the association between biomarkers and lumbar spine degeneration (vertebral osteophytes [OST], facet joint osteoarthritis [FOA], and disc space narrowing [DSN]), for persons with and without low back pain (LBP) and determine whether clusters based on biomarkers differentiate lumbar spine structure with and without LBP. Methods Using data from the Johnston County Osteoarthritis Project (2006-2010), we measured serum N-cadherin, Keratin-19, Lumican, CXCL6, RANTES, HA, IL-6, BDNF, OPG, and NPY, and urinary CTX-II. Biomarkers were used to group participants using k-means cluster analysis. Logistic regression models were used to compare biomarker clusters. Results The sample consisted of 731 participants with biospecimens and lumbar spine radiographic data. Three biomarker subgroups were identified: one characterized by structural degenerative changes; another characterized by structural degenerative changes and inflammation, with pain; and a referent cluster with lower levels of biomarkers, pain, and structural degenerative changes. Compared to the referent subgroup, the structural change subgroup was associated with DSN (OR = 1.94, 95% CI 1.30-2.90) and FOA (OR = 1.72, 95% CI 1.12-2.62), and the subgroup with structural degenerative change, inflammation, and pain was associated with OST with LBP (OR = 1.60, 95% CI 1.04-2.46), FOA with LBP (OR = 1.59, 95% CI 1.04-2.45), and LBP (OR = 1.63, 95% CI 1.11-2.41). The subgroup with structural degenerative changes was more likely to have OST (OR = 1.82, 95% CI 1.06-3.13) and less likely to have FOA with LBP (OR = 0.62, 95% CI 0.40-0.96) compared to the group with inflammation and pain. Conclusion Clustering by biomarkers may assist in differentiating patients for specific clinical interventions aimed at decreasing LBP.
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Affiliation(s)
- Adam P. Goode
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - David Hu
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Steven Z. George
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Todd A. Schwartz
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Virginia B. Kraus
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, NC, USA
| | - Janet L. Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca J. Cleveland
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Kenneth A. Taylor
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Physical Therapy, University of North Carolina, Chapel Hill, NC, USA
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