Endplate role in the degenerative disc disease:A brief review

The degenerative disease of the intervertebral disc is nowadays an important health problem,which has still not been understood and solved adequately.The vertebral endplate is regarded as one of the vital elements in the structure of the intervertebral disc.Its constituent cells,the chondrocytes in the endplate,may also be involved in the process of the intervertebral disc degeneration and their role is central both under physiological and pathological conditions.They main functions include a role in homeostasis of the extracellular environment of the intervertebral disc,metabolic support and nutrition of the discal nucleus and annulus beneath and the preservation of the extracellular matrix.Therefore,it is understandable that the cells in the endplate have been in the centre of research from several viewpoints,such as development,degeneration and growth,reparation and remodelling,as well as treatment strategies.In this article,we briefly review the importance of vertebral endplate,which are often overlooked,in the intervertebral disc degeneration.

Cortical bone trajectory screws in the treatment of lumbar degenerative disc disease in patients with osteoporosis

Lumbar degenerative disc disease(DDD)in the elderly population remains a global health problem,especially in patients with osteoporosis.Osteoporosis in the elderly can cause failure of internal fixation.Cortical bone trajectory(CBT)is an effective,safe and minimally invasive technique for the treatment of lumbar DDD in patients with osteoporosis.In this review,we analyzed the anatomy,biomechanics,and advantages of the CBT technique in lumbar DDD and revision surgery.Additionally,the clinical trials and case reports,indications,advancements and limitations of this technique were further discussed and reviewed.Finally,we concluded that the CBT technique can be a practical,effective and safe alternative to traditional pedicle screw fixation,especially in DDD patients with osteoporosis.

Outcomes of cervical degenerative disc disease treated by anterior cervical discectomy and fusion with self-locking fusion cage

BACKGROUND Cervical degenerative disc(CDD)disease is a common type of spondylosis.Although anterior cervical discectomy and fusion(ACDF)is the preferred treatment for CDD disease,internal fixation with a titanium plate may cause various complications.The invention of the ACDF with a self-locking fusion cage(ROI-C)has effectively decreased the incidence of postoperative complications.AIM To observe the outcomes of CDD disease treated by ACDF with a ROI-C.METHODS Ninety patients with CDD disease treated at our hospital from March 2019 to March 2021 were included.They were divided into two groups(control group and observation group,n=45 in each)using a random number table.Patients in the control group received ACDF plus internal fixation with a titanium plate.Those in the observation group received ACDF+ROI-C placement.The two groups of patients were compared in terms of surgical parameters,pain,cervical spine function,range of motion,and complications.RESULTS The two groups of patients showed no significant differences in surgical time,blood loss,drainage volume,and length of hospital stay(P>0.05).No significant differences in the visual analogue scale(VAS),Japanese Orthopedic Association(JOA),and neck disability index(NDI)scores were observed between the two groups before surgery(P>0.05).The VAS and NDI scores in the observation group were considerably lower than those in the control group after surgery;however,the JOA scores in the observation group were significantly higher than those in the control group(P<0.05).No significant differences were observed in cervical disc height and the range of motion of the superior or inferior adjacent vertebrae between the two groups before surgery(P>0.05).The disc height in the observation group was larger than that in the control group after surgery.The range of motion of both the superior and inferior adjacent vertebrae was significantly smaller in the observation group than in the control group(P<0.05).The incidence of complications was only 2.22% in the observation group compared to 15.56% in the control group,and the difference was statistically significant(P<0.05).CONCLUSION Cervical spine function restoration was better with ROI-C with internal fixation in ACDF than with conventional titanium plates in ACDF for CDD disease.

Etiology for Degenerative Disc Disease

Degenerative disc disease is a multifaceted progressive irreversible condition and an inevitable part of aging,which has been found to be a contributing factor for low back pain and might cause radiculopathy,myelopathy,spinal stenosis,degenerative spondylolisthesis,and herniations.Its etiology is complex and multifactorial.Although genetics influence more dominant,the occupational and mechanical influences still persist as a major risk factor.This review emphasizes up-to-date knowledge regarding etiology of disc degeneration with special consideration on occupational,lifestyle factors,and genetic polymorphisms.

Follow-up Study on the Motion Range after Treatment of Degenerative Disc Disease with the Bryan Cervical Disc Prosthesis

This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients＇ ability to perform daily activities, reducing pain, and maintaining the stability and segmental motion. From December 2003 to October 2004, 12 patients, who had received 14 replacements of cervical artificial discs, were followed-up for 2 to 8 months （with a mean of 5.2 months）. Of them 5 had cervical spondylotic myelopathy and 7 had cervical disc herniation. The patients included 7 males and 5 females, with their age ranging from 35 to 62 y and a mean of 50.3 y. Single-level replacements were performed in 10 cases and 2 cases received two-level replacement. Operation time of the single-level surgery averaged 130±50 rain and the time of two-level surgery was 165±53 min on average （from skin incision to skin suturing）. Neurological or vascular complications during or after surgery was not observed. Japanese Orthopedic Association scores （JOA scores） increased from 8.6 to 15.8 on average. There was no prothesis subsidence or excursion. Replaced segments were stable and the range of motion was partially restored, being 4.68° （3.6°-6.1°） in flexion and extension position and 3.51 ° （2.5°-4.6°）, 3.42° （2.6°-4.3°） in left and right bending position. No obvious loss of physiological curvature was noted. CT or MRI follow-up showed that excursion was less than 1.5 mm） in 2 of 14 levels and between 1.5 mm and 3 mm） in 1 of 14 levels. No ossification in the replaced levels was observed. It is concluded that satisfactory short-term results were achieved in the 12 cases of artificial disc replacements. Different from anterior cervical discectomy and fusion, the replacement could achieve quick functional recovery and did not lead to the movement limitation of cervical vertebrae. At least a 5-years follow-up was needed to assess the long-term effect of the prosthesis on its neighboring segments.

Mineralized collagen-modified PMMA cement enhances bone integration and reduces fibrous encapsulation in the treatment of lumbar degenerative disc disease

As a minimally invasive surgery,percutaneous cement discoplasty(PCD)is now contemplated to treat lumbar disc degeneration disease in elder population.Here,we investigated whether the osteogenic mineralized collagen(MC)modified polymethylmethacrylate(PMMA)cement could be a suitable material in PCD surgery.Injectability,hydrophilicity and mechanical properties of the MC-modified PMMA(PMMA-MC)was characterized.The introduction of MC did not change the application and setting time of PMMA and was easy to be handled in minimally invasive operation.Hydrophilicity of PMMA-MC was greatly improved and its elastic modulus was tailored to complement mechanical performance of bone under dynamic stress.Then,PCD surgery in a goat model with induced disc degeneration was performed with implantation of PMMA-MC or PMMA.Three months after implantation,micro-computed tomography analysis revealed a 36.4%higher circumferential contact index between PMMA-MC and bone,as compared to PMMA alone.Histological staining confirmed that the surface of PMMA-MC was in direct contact with new bone,while the PMMA was covered by fibrous tissue.The observed gathering of macrophages around the implant was suspected to be the cause of fibrous encapsulation.Therefore,the interactions of PMMA and PMMA-MC with macrophages were investigated in vitro.We discovered that the addition of MC could hinder the proliferation and fusion of the macrophages.Moreover,expressions of fibroblaststimulating growth factors,insulin-like growth factor,basic fibroblast growth factor and tumor necrosis factor-b were significantly down-regulated in the macrophages cocultured with PMMA-MC.Together,the promoted osteointegration and reduced fibrous tissue formation observed with PMMA-MC material makes it a promising candidate for PCD surgery.

Diagnosis of lumbar degenerative disc disease by using L^(p)-spaces related to generalized interval-valued m-polar neutrosophic choquet integral Operator

Innovative and astonishing developments in the field of spine analysis can commence with this manuscript.The lumbar disks(L1−L2 to L5−S1)are most commonly impaired by degeneration due to their long-standing degeneration and associated strain.We investigate the indications,purposes,risk factors,and therapies of lumbar degenerated disc disease(L-DDD).We assume that the degeneration of five discs creates many effects,making it difficult to differentiate between the different types of degenerated discs and their seriousness.Since the indeterminacy and falsity portions of science or clinical diagnosis are often ignored.Due to this complexity,the reliability of the patient’s progress report cannot be calculated,nor can the period of therapy be measured.The revolutionary concept of interval-valued m-polar neutrosophic Choquet integral aggregation operator(IVmPNCIAO)is proposed to eliminate these problems.We associate generalized interval-valued m-polar neutrosophic Choquet integral aggregation operator(GIVmPNCIAO)with the statistical formulation of L^(p)-spaces and use it to identify the actual kind of degenerative disc in the lumbar spine.For the classification of interval-valued m-polar neutrosophic numbers(IVMPNNs),we set the ranking index and score function.These concepts are appropriate and necessary in order to better diagnose degeneration by associating it with mathematical modeling.We construct a pre-diagnosis map based on the fuzzy interval[0,1]to classify the types of degenerative discs.We develop an algorithm by using GIVmPNCIAO based on interval-valued m-polar neutrosophic sets(IVMPNNs)to identify the degenerative disc appropriately and to choose the most exquisite treatment for the corresponding degeneration of every patient.Furthermore,we discuss the sensitivity analysis with parameter p in GIVmPNCIAO to investigate the patient’s improvement record.

Lumbar disc rehydration in the bridged segment using the BioFlex dynamic stabilization system: A case report and literature review

BACKGROUND In recent years,the mechanical concept of intervertebral disc regeneration has become more and more popular due to the increasing awareness of the importance of preservation of spine movement.Interestingly,there is increasing evidence,however,that dynamic stabilization systems may compensate nonphysiological loads,limit pathological movement,normalize disc height and intradiscal pressure,and provide an adaptive environment for disc regeneration.CASE SUMMARY The patient was a 54-year-old man,who presented with a 10-year history of mechanical back pain,which had become progressively serious and radiated into the left lower limb with numbness 3 mo prior.He had decreased muscle strength(class IV)of the left dorsal extensor and plantar flexor.Magnetic resonance imaging scans showed L3-S1 disc degeneration and L4-L5 disc herniation.Because the patient did not respond to various conservative treatments,he underwent a posterior L4-5 discectomy with fixation of the BioFlex dynamic stabilization system(Bio-Spine,Seoul,Korea).Preoperative symptoms were relieved and lumbar function was markedly improved after the operation.L4-L5 disc rehydration of instrumented segment was noted on magnetic resonance imaging at the 2-year follow-up.CONCLUSION Rehydration of the degenerated disc in our patient indicates that the BioFlex dynamic stabilization system may promote disc regeneration.Further research is needed to provide more evidence to support lumbar disc rehydration in the bridged segment using this system.

Asporin, a candidate protein for treatment of disc degenerative disease

The human spine carries the weight of the trunk, upper extremities, and head, and provides an extensiverange of motion. Due to heavy use and lack of vasculature, the intervertebral discs degenerate much more rapidly than other structures of the human body.1 Intervertebral disc degeneration is mostly age-related, 2 and spinal disorders associated with disc degeneration have a significant impact on society.3,4 Indeed, low back