• ageing
• cynomolgus monkey
• intervertebral disc degeneration
• motor behavior
• pain

• Fundamental Research Funds for the Central Universities
• National Natural Science Foundation of China
• Sanming Project of Medicine in Shenzhen

• Diagnostic imaging
• Intervertebral disc degeneration
• Low back pain

• Ristekdikti Kalbe Science Award

An in vivo histologic and magnetic resonance imaging (MRI) study of lumbar intervertebral disc (IVD) degeneration was conducted.

To clarify the sensitivity and efficacy of T1ρ/T2 mapping for IVD degeneration, the correlation between T1ρ/T2 mapping and degenerative grades and histological findings in the lumbar IVD were investigated.

The early signs of IVD degeneration are proteoglycan loss, dehydration, and collagen degradation. Recently, several quantitative MRI techniques have been developed; T2 mapping can be used to evaluate hydration and collagen fiber integrity within cartilaginous tissue, and T1ρ mapping can be used to evaluate hydration and proteoglycan content.

Using New Zealand White rabbits, annular punctures of the IVD were made 10 times at L2/3, 5 times at L3/4, and one time at L4/5 using an 18-gauge needle (n=6) or a 21-gauge needle (n=6). At 4 and 8 weeks post-surgery, MRI was performed including T1ρ and T2 mapping. The degree of IVD degeneration was macroscopically assessed using the Thompson grading system. All specimens were cut for hematoxylin and eosin, safranin-O, and toluidine blue staining.

Disc degeneration became more severe as the number of punctures increased and when the larger needle was used. T1ρ and T2 values were significantly different between grade 1 and grade 3 IVDs, grade 1 and grade 4 IVDs, grade 2 and grade 3 IVDs, and grade 2 and grade 4 IVDs (p<0.05). There was a significant difference between grade 1 and grade 2 IVDs only in terms of T1ρ values (p<0.05).

T1ρ and T2 quantitative MRI could detect these small differences. Our results suggest that T1ρ and T2 mapping are sensitive to degenerative changes of lumbar IVDs and that T1ρ mapping can be used as a clinical tool to identify early IVD degeneration.

• Animal experiment
• Histology
• Intervertebral disc degeneration
• Magnetic resonance imaging

Discogenic back pain remains poorly understood with respect to etiopathogenesis, despite being a considerable burden. We sought to examine the expression of vascular endothelial growth factor in injured intervertebral discs in rat caudal vertebrae.

Forty-eight male Sprague Dawley rats were assigned to 2 groups according to disc puncture injury: puncture (n = 32) or non-puncture (n = 16). Disc puncture was performed percutaneously such that the incision would be in the primary plane of motion for the coccygeal discs 5-6, 6-7, and 7-8. A 26-gauge needle was used to puncture each disc 10 times. Punctured discs were examined histologically by hematoxylin and eosin staining at 1, 7, 14, and 28 days post-injury.

Vascular endothelial growth factor was localized immunohistochemically, and determined quantitatively using an enzyme-linked immunosorbent assay. Peak inflammation occurred on the 7th day post-injury, but tissue degeneration continued until day 28. Local expression of vascular endothelial growth factor tended to be highest in the annulus fibrosus on the 7th and 14th days after puncture injury. The level of vascular endothelial growth factor was highest 1-day post-injury, and then gradually decreased thereafter. Furthermore, vascular endothelial growth factor levels in the puncture group were significantly higher than those in the non-puncture control group (p < 0.05).

We found increased expression of the inflammatory cytokine vascular endothelial growth factor in injured intervertebral discs, suggesting that vascular endothelial growth factor may be clinically important in discogenic back pain.

• cytokine
• inflammation
• intervertebral disc
• rat
• vascular endothelial growth factor

• Adult
• Aged
• Aged, 80 and over
• Etanercept/administration & dosage
• Etanercept/therapeutic use
• Female
• Humans
• Intervertebral Disc Displacement/complications
• Intervertebral Disc Displacement/drug therapy
• Japan
• Low Back Pain/drug therapy
• Male
• Middle Aged
• Pain Measurement
• Prospective Studies
• Treatment Outcome
• Tumor Necrosis Factor-alpha/antagonists & inhibitors
• Young Adult

The spine surgeons have been combining anterior and posterolateral fusion (circumferential fusion) as the final solution to treat spinal disorders and many have been using it to treat failed back surgery syndrome (FBSS). In present study, we analyzed and compared the clinical and radiological outcomes in patients with transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or in patients with transpedicular screw fixation and intervertebral B-Twin system for FBSS with a follow-up period of 10 years after the surgery.

This study was a retrospective case study performed on 55 patients with FBSS. Clinical and radiological changes were compared between the two groups of patients on the basis of improvement of back pain, radicular pain, and work capacity. Outcome was measured in terms of Oswestry Low Back Pain Disability Index, and the changes in pain and function were documented every year from before surgery until 2012. We analyzed the evolution of 55 cases of FBSS those underwent segmental circumferential posterior fusions from June 2001 to February 2003, operated by a single surgeon and followed up during 10 years until February 2012. The patients were divided into 2 groups: In 25 patients, posterolateral fusions with Legacy™ (Medtronic, Inc. NYSE: MDT) screws and intersomatic autogenous posterior iliac crest bone graft was performed, and, in 30 patients, posterolateral fusions with the same screws and intersomatic fusion B-Twin (Biomet Spain Orthopaedics, S.L.) system was performed. In all cases, we used posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) approach for intervertebral graft, and the artrodesis was supplemented at intertransverse level with Autologus Growth Factor (AGF-MBA INCORPORADO, S.A.). The outcome was measured in terms of Oswestry Low Back Pain Disability Index, and the changes in pain and function were documented every year and compared from before surgery to the final follow-up visit. Preoperative and postoperative scores were available for all patients.

The average age of these patients was comparable in both groups (mean age 42.6 versus 50.2 years). The average follow-up period was 200.6 months in the first group (screws and intersomatic bone) and 184.4 months in the second group (screws and B-Twin). In the autologus bone graft group, the CT scan and Rx study revealed loss of height of intervertebral space between 25% and 45% of 24 h postoperative height of intervertebral operated disc, and the patients continued to lose the height until 20 months after the surgery. In the B Twin group, the CT scan and Rx study revealed a loss of height of the intervertebral level of 8-12% over a period of 9 months follow-up, followed by stability. A total of 31 patients (55%) had improved Oswestry Low Back Pain Disability Index >40% of the total possible points, although this did not reflect in PSI or return to work rate.

The patients with rigid fixation do well in terms of correction of lumbar lordosis, but they do not do well in terms of recurrence of pain. Furthermore, they need some kind of intervention to control pain after the first year after surgery. In patients in whom bone graft is used, although they do not maintain and sustain the lumbar lordosis in the long term, they have less recurrence of pain with less chances of intervention for pain control.

• Chronic low back pain
• degenerative disc disease
• failed back surgery syndrome
• functional outcome
• lumbar spinal fusion
• spondylosis

• CT
• MR
• Spinal pain
• Spine degeneration

• Adult
• Diagnostic Imaging/methods
• Humans
• Intervertebral Disc Degeneration/complications
• Intervertebral Disc Degeneration/diagnosis
• Intervertebral Disc Displacement/complications
• Intervertebral Disc Displacement/diagnosis
• Low Back Pain/etiology
• Male
• Spine/innervation

• Assessment
• Low back pain
• PainVision
• Tool

• Aetiologic treatment
• Approche muti-disciplinaire
• Back pain generators
• Failed back surgery syndrome
• Générateurs de lombalgies
• Lombalgies
• Lombo-radiculalgies postopératoires
• Low back pain
• Multidisciplinary management
• Pathophysiology
• Physiopathologie
• Traitement étiologique

• Lumbar
• bupivacaine
• intervertebral disc
• pain
• spine

• Adolescent
• Adult
• Anesthetics, Local
• Bupivacaine
• Female
• Humans
• Injections, Intralesional
• Intervertebral Disc/diagnostic imaging
• Intervertebral Disc/pathology
• Intervertebral Disc Degeneration/diagnosis
• Intervertebral Disc Degeneration/surgery
• Low Back Pain/diagnosis
• Low Back Pain/etiology
• Lumbar Vertebrae/surgery
• Male
• Middle Aged
• Postoperative Complications/diagnosis
• Radiography
• Spinal Fusion/adverse effects
• Treatment Outcome
• Young Adult

Prospective study of changes in intervertebral disc degeneration after injection of bupivacaine.

To examine whether injection of bupivacaine into human intervertebral discs accelerates their degeneration.

Bupivacaine is commonly used for therapy and diagnosis of discogenic low back pain. However, several in vitro studies have reported toxic effects of bupivacaine to disc cells. We sought to evaluate whether this finding is clinically relevant.

We selected 46 patients with low back pain who showed disc degeneration at only one level (L4-L5 or L5-S1) on magnetic resonance imaging (MRI) (discography group, n=18), discoblock group (injection of bupivacaine, n=18), and a control group, n=10). There were no significant differences in baseline characteristics across the 3 groups. The two experimental groups underwent either discography or anesthetic discoblock, respectively. All three groups were followed up 5 years after the examination.

At 5 years follow-up, there was no significant difference in the rate of disc degeneration among the 3 groups (p>0.1). Moreover, X-ray images showed that there was no significant difference in disc height, range of motion, or translation between flex and extension position (p>0.1).

In conclusion, radiologic and MRI findings did not show acceleration of intervertebral disc degeneration at 5 years after a single injection of bupivacaine into human discs.

• Bupivacaine
• Intervertebral disc degeneration
• Lumbar vertebrae

• Adolescent
• Adult
• Aged
• Chi-Square Distribution
• Decompression, Surgical
• Evaluation Studies as Topic
• Female
• Humans
• Intervertebral Disc Displacement/surgery
• Low Back Pain/surgery
• Male
• Middle Aged
• Pain Measurement
• Time Factors
• Treatment Outcome

• Classification
• Degeneration
• Diagnosis
• Discogenic low back pain
• Internal annular disruption
• Internal disc disruption
• Internal endplate disruption
• Intervertebral disc
• Treatment

Chronic low back pain without disc herniation is common. Various modalities of treatments are utilized in managing this condition, including epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections.

A randomized, double-blind, actively controlled trial was conducted. The objective was to evaluate the ability to assess the effectiveness of caudal epidural injections of local anesthetic with or without steroids for managing chronic low back pain not caused by disc herniation, radiculitis, facet joints, or sacroiliac joints. A total of 120 patients were randomized to two groups; one group did not receive steroids (group 1) and the other group did (group 2). There were 60 patients in each group. The primary outcome measure was at least 50% improvement in Numeric Rating Scale and Oswestry Disability Index. Secondary outcome measures were employment status and opioid intake. These measures were assessed at 3, 6, 12, 18, and 24 months after treatment.

Significant pain relief and functional status improvement (primary outcome) defined as a 50% or more reduction in scores from baseline, were observed in 54% of patients in group 1 and 60% of patients in group 2 at 24 months. In contrast, 84% of patients in group 1 and 73% in group 2 saw significant pain relief and functional status improvement in the successful groups at 24 months.

Caudal epidural injections of local anesthetic with or without steroids are effective in patients with chronic axial low back pain of discogenic origin without facet joint pain, disc herniation, and/or radiculitis.

• caudal epidural injections
• chronic axial low back pain
• disc herniation
• discogenic pain

The principle etiology of leg pain (sciatica) from lumbar disc herniation is mechanical compression of the nerve root. Sciatica is reduced by decompression of the herniated disc, i.e., removing mechanical compression of the nerve root. Decompression surgery typically reduces sciatica more than lumbar back pain (LBP). Decompression surgery reduces mechanical compression of the nerve root. However, decompression surgery does not directly reduce sensitization of the sensory nerves in the epidural space and disc. In addition, sensory nerves in the annulus fibrosus and epidural space are not protected from topical interaction with pain mediators induced by decompression surgery. The secondary etiology of sciatica from lumbar disc herniation is sensitization of the nerve root. Sensitization of the nerve root results from a) mechanical compression, b) exposure to cellular pain mediators, and/or c) exposure to biochemical pain mediators. Although decompression surgery reduces nerve root compression, sensory nerve sensitization often persists. These observations are consistent with continued exposure of tissue in the epidural space, including the nerve root, to increased cellular and biochemical pain mediators following surgery. A potential contributor to lumbar back pain (LBP) is stimulation of sensory nerves in the annulus fibrosus by a) cellular pain mediators and/or b) biochemical pain mediators that accompany annular tears or disruption. Sensory fibers located in the outer one-third of the annulus fibrosus increase in number and depth as a result of disc herniation. The nucleus pulposus is comprised of material that can produce an autoimmune stimulation of the sensory nerves located in the annulus and epidural space leading to LBP. The sensory nerves of the annulus fibrosus and epidural space may be sensitized by topical exposure to cellular and biochemical pain mediators induced by lumbar surgery. Annulotomy or annular rupture allows the nucleus pulposus topical access to sensory nerve fibers, thereby leading to LBP. Coverage of the annulus and adjacent structures in the epidural space by absorbable viscoelastic gels appears to reduce LBP following surgery by protecting sensory fibers from cellular and biochemical pain mediators.

• Animals
• Chronic Disease
• Humans
• Intervertebral Disc/innervation
• Low Back Pain/physiopathology
• Lumbar Vertebrae/innervation
• Lumbosacral Region/innervation
• Nerve Endings/physiopathology
• Rats
• Spinal Nerves/physiopathology

Spinal pain is a common problem, and disability related to spinal pain has great consequence in terms of human suffering, medical costs and costs to society. The traditional approach to the non-surgical management of patients with spinal pain, as well as to research in spinal pain, has been such that the type of treatment any given patient receives is determined more by what type of practitioner he or she sees, rather than by diagnosis. Furthermore, determination of treatment depends more on the type of practitioner than by the needs of the patient. Much needed is an approach to clinical management and research that allows clinicians to base treatment decisions on a reliable and valid diagnostic strategy leading to treatment choices that result in demonstrable outcomes in terms of pain relief and functional improvement. The challenges of diagnosis in patients with spinal pain, however, are that spinal pain is often multifactorial, the factors involved are wide ranging, and for most of these factors there exist no definitive objective tests.

The theoretical model of a diagnosis-based clinical decision rule has been developed that may provide clinicians with an approach to non-surgical spine pain patients that allows for specific treatment decisions based on a specific diagnosis. This is not a classification scheme, but a thought process that attempts to identify most important features present in each individual patient. Presented here is a description of the proposed approach, in which reliable and valid assessment procedures are used to arrive at a working diagnosis which considers the disparate factors contributing to spinal pain. Treatment decisions are based on the diagnosis and the outcome of treatment can be measured.

In this paper, the theoretical model of a proposed diagnosis-based clinical decision rule is presented. In a subsequent manuscript, the current evidence for the approach will be systematically reviewed, and we will present a research strategy required to fill in the gaps in the current evidence, as well as to investigate the decision rule as a whole.

• Decision Support Techniques
• Humans
• Low Back Pain/diagnosis
• Low Back Pain/physiopathology
• Low Back Pain/rehabilitation
• Models, Biological
• Recovery of Function
• Risk Factors

• Adult
• Aged
• Aged, 80 and over
• Anesthetics, Local/administration & dosage
• Anesthetics, Local/pharmacokinetics
• Chronic Disease
• Contrast Media/pharmacokinetics
• Female
• Humans
• Low Back Pain/diagnostic imaging
• Low Back Pain/drug therapy
• Lumbar Vertebrae/diagnostic imaging
• Male
• Mepivacaine/administration & dosage
• Mepivacaine/pharmacokinetics
• Middle Aged
• Myofascial Pain Syndromes/drug therapy
• Nerve Block/methods
• Pilot Projects
• Spinal Nerve Roots
• Tomography, X-Ray Computed
• Treatment Outcome

• discogenic low back pain
• discography
• methylene blue
• injection

• Adult
• Aged
• Analgesics/administration & dosage
• Analgesics/therapeutic use
• Benzenesulfonates/administration & dosage
• Benzenesulfonates/therapeutic use
• Chronic Disease
• Female
• Humans
• Injections, Spinal
• Low Back Pain/drug therapy
• Male
• Middle Aged
• Pain Measurement
• Prospective Studies
• Treatment Outcome

• Adult
• Aged
• Female
• Follow-Up Studies
• Humans
• Internal Fixators
• Lumbar Vertebrae
• Male
• Middle Aged
• Prospective Studies
• Radiography
• Sacrum
• Spinal Fusion/methods
• Spondylolisthesis/diagnostic imaging
• Spondylolisthesis/surgery
• Treatment Outcome
• Video-Assisted Surgery

• Adult
• Aged
• Anthropometry/methods
• Humans
• Intervertebral Disc/anatomy & histology
• Intervertebral Disc/pathology
• Low Back Pain/pathology
• Lumbar Vertebrae/anatomy & histology
• Lumbar Vertebrae/pathology
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Motion
• Posture
• Reference Values
• Supine Position

• Humans
• Laparoscopy/methods
• Lumbar Vertebrae/surgery
• Prospective Studies
• Spinal Fusion/methods

• Animals
• Cicatrix/diagnostic imaging
• Cicatrix/pathology
• Disease Models, Animal
• Intervertebral Disc/diagnostic imaging
• Intervertebral Disc/injuries
• Intervertebral Disc/pathology
• Intervertebral Disc Displacement/diagnostic imaging
• Intervertebral Disc Displacement/pathology
• Lumbar Vertebrae/diagnostic imaging
• Lumbar Vertebrae/injuries
• Lumbar Vertebrae/pathology
• Male
• Nerve Fibers/diagnostic imaging
• Nerve Fibers/pathology
• Punctures
• Rabbits
• Radiography
• Wounds, Penetrating/diagnostic imaging
• Wounds, Penetrating/pathology

• Adult
• Female
• Humans
• Intervertebral Disc/chemistry
• Intervertebral Disc/pathology
• Intervertebral Disc Displacement/metabolism
• Intervertebral Disc Displacement/physiopathology
• Lumbar Vertebrae/chemistry
• Lumbar Vertebrae/innervation
• Lumbar Vertebrae/pathology
• Male
• Middle Aged
• Nerve Fibers/chemistry
• Nerve Fibers/pathology
• Neurons, Afferent/chemistry
• Neurons, Afferent/pathology
• Neuropeptides/analysis
• Neuropeptides/metabolism
• Spinal Diseases/pathology

• Activating Transcription Factor 3/metabolism
• Animals
• Biomarkers/metabolism
• Fluorescent Dyes
• GAP-43 Protein/metabolism
• Ganglia, Spinal/injuries
• Ganglia, Spinal/metabolism
• Ganglia, Spinal/pathology
• Ganglia, Spinal/physiopathology
• Immunohistochemistry
• Intervertebral Disc/injuries
• Intervertebral Disc/innervation
• Lumbar Vertebrae/injuries
• Male
• Nerve Fibers
• Nerve Regeneration
• Neurons, Afferent/metabolism
• Rats
• Rats, Sprague-Dawley
• Stilbamidines
• Wounds, Penetrating/metabolism
• Wounds, Penetrating/physiopathology

• Animals
• Carrageenan/pharmacology
• Discitis/physiopathology
• Electric Stimulation
• Evoked Potentials/physiology
• Intervertebral Disc/drug effects
• Intervertebral Disc/physiopathology
• Low Back Pain/physiopathology
• Lumbar Vertebrae
• Male
• Nerve Fibers/physiology
• Neurons, Afferent/physiology
• Physical Stimulation/methods
• Rats
• Rats, Inbred Lew
• Spinal Nerve Roots/physiopathology
• Stimulation, Chemical
• Sympathetic Nervous System/physiopathology

• AR41739 NIAMS NIH HHS

• Adolescent
• Adult
• Female
• Humans
• Intervertebral Disc/innervation
• Intervertebral Disc/metabolism
• Intervertebral Disc/pathology
• Intervertebral Disc Displacement/metabolism
• Intervertebral Disc Displacement/pathology
• Intervertebral Disc Displacement/physiopathology
• Low Back Pain/metabolism
• Low Back Pain/pathology
• Low Back Pain/physiopathology
• Lumbar Vertebrae
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Nerve Fibers/metabolism
• Nerve Fibers/pathology
• Tumor Necrosis Factor-alpha/metabolism
• Ubiquitin Thiolesterase/metabolism

• Adult
• Aged
• Female
• Fibroblast Growth Factor 2/metabolism
• Filaggrin Proteins
• Granulation Tissue/metabolism
• Granulation Tissue/pathology
• Humans
• Immunohistochemistry
• Intervertebral Disc/metabolism
• Intervertebral Disc/pathology
• Intervertebral Disc Displacement/complications
• Intervertebral Disc Displacement/pathology
• Intervertebral Disc Displacement/physiopathology
• Low Back Pain/etiology
• Low Back Pain/pathology
• Low Back Pain/physiopathology
• Macrophages/pathology
• Magnetic Resonance Imaging
• Male
• Mast Cells/pathology
• Middle Aged
• Proliferating Cell Nuclear Antigen/metabolism
• Receptor, Fibroblast Growth Factor, Type 1/metabolism
• Receptors, Transforming Growth Factor beta
• Spinal Fusion
• Transforming Growth Factor beta/metabolism
• Transforming Growth Factor beta1