Anti-degenerative effect of melatonin on intervertebral disc: protective contribution against inflammation, oxidative stress, apoptosis, and autophagy

Intervertebral disc (IVD) degeneration is a leading cause of lower back pain. Although the etiology of IVD degeneration (IVDD) is unclear, excessive oxidative stress, inflammation and apoptosis and disruption of autophagy play important role in the pathogenesis of IVDD. Therefore, finding a solution to mitigate these processes could stop or reduce the development of IVDD. Melatonin, a powerful antioxidant, plays an important role in regulating cartilage tissue hemostasis. Melatonin inhibits destruction of extracellular matrix (ECM) of disc. Melatonin preserves ECM contents including sox-9, aggrecan, and collagen II through inhibiting matrix degeneration enzymes such as MMP-13. These protective effects may be mediated by the inhibition of oxidative stress, inflammation and apoptosis, and regulation of autophagy in IVD cells.

Optimising treatment expectations in chronic lower back pain through observing others: a study protocol for a randomised clinical trial

IntroductionChronic lower back pain (CLBP) is a frequent cause of medical consultations worldwide, and it results in decreased quality of life and disability. Current treatments for CLBP are often not effective, and alternatives are urgently needed. Three promising possibilities have emerged: (1) open-label placebo treatment reduces chronic pain, (2) placebo treatment is as efficacious as opioid treatment with a high correlation between patient expectation and treatment outcome, and (3) observing positive effects in another patient can improve functional capacity. We hypothesise that treatment expectations can be positively influenced through social observation and improve treatment outcome.Methods and analysisIn our clinical trial, we will randomise patients with CLBP into five groups. Two groups receive either a 3 week course of treatment with an analgesic (ANA) (metamizole/dipyrone) or with open-label placebos (OLP). For one of each group, we will build treatment expectations through observational learning and assess its impact on the treatment. For this purpose, one group each will watch either a positive or a neutral video. The intervention groups will be compared with a control group that will not be given any medication or observational learning. Participants will be recruited via all institutions in the Hamburg metropolitan area that treat patients with CLBP. Patients are eligible for inclusion if they are at least 18 years or older, have CLBP (of at least 3 months duration), and agree to potentially receive an active ANA or an OLP. Patients with pain-related “red flags” will be excluded. The study requires 150 participants (30 participants per group) to assess the differences in the primary outcome, pain intensity. Secondary outcomes include changes in treatment expectations, anxiety, comorbid depression, stress-related neuroendocrine measures, functional and structural connectivity, functional capacity, and ANA consumption. All outcomes and treatment expectations will be measured before and after the intervention and 3 months post-intervention.Ethics and disseminationEthical approval was obtained in January 2020 from the Hamburg Medical Ethics Council (ref number PV7067). Outcomes will be disseminated through publications in peer-reviewed journals and presentations at national and international conference meetings.Trial registration numberThe approved trial protocol was registered at the German Clinical Trials Register (DRKS) and can be found at drks.de (Identifier: DRKS00024418).

Evaluation of injectable nucleus augmentation materials for the treatment of intervertebral disc degeneration

Lower back pain affects a person’s health and mobility as well as creating a large economic cost. This is often caused by degeneration of the intervertebral disc. Current operative and...

The Effect of the Baduanjin Exercise on the Covid-19-Related Anxiety, Psychological Well-being and Lower Back Pain of College Students During the Pandemic

Background Baduanjin exercise is recognized as having a beneficial effect on both physical and mental health. However, studies lacked consideration of its potential advantageous outcomes during the coronavirus pandemic. This study aimed to examine the effect of Baduanjin exercise on the COVID-19-related anxiety, psychological well-being, and the lower back pain of college students during the coronavirus pandemic in China. Methods Participants consisted of 387 people, ranging in age from 20 to 30 years (M = 23.55; SD = 3.13), and were randomly divided into two groups: 195 participated in the 12-week Baduanjin exercise program, and 192 learned health knowledge during this time. Subsequently, the two groups were analyzed and compared in terms of an intervention effect on the COVID-19-related anxiety, psychological well-being, and lower back pain. Results The intervention effect on the Baduanjin exercise group was remarkably better than that of the control group (p < 0.05). With the intervention of the Baduanjin exercise, the COVID-19-related anxiety score decreased from 5.22±0.45 to 5.07±0.27. The total psychological well-being score increased from 70.11±8.65 to 84.12±7.38, and the prevalence of low back pain decreased from 22.45±1.67 to 18.35±1.05 among college students. Conclusion During the pandemic, the Baduanjin exercise contributes to the reduction of the perceived anxiety related to the COVID-19, decreases the prevalence of the lower back pain, and improves the psychological well-being of college students.

Analysis of the paraspinal muscle morphology of the lumbar spine using a convolutional neural network (CNN)

Purpose This single-center study aimed to develop a convolutional neural network to segment multiple consecutive axial magnetic resonance imaging (MRI) slices of the lumbar spinal muscles of patients with lower back pain and automatically classify fatty muscle degeneration. Methods We developed a fully connected deep convolutional neural network (CNN) with a pre-trained U-Net model trained on a dataset of 3,650 axial T2-weighted MRI images from 100 patients with lower back pain. We included all qualities of MRI; the exclusion criteria were fractures, tumors, infection, or spine implants. The training was performed using k-fold cross-validation (k = 10), and performance was evaluated using the dice similarity coefficient (DSC) and cross-sectional area error (CSA error). For clinical correlation, we used a simplified Goutallier classification (SGC) system with three classes. Results The mean DSC was high for overall muscle (0.91) and muscle tissue segmentation (0.83) but showed deficiencies in fatty tissue segmentation (0.51). The CSA error was small for the overall muscle area of 8.42%, and fatty tissue segmentation showed a high mean CSA error of 40.74%. The SGC classification was correctly predicted in 75% of the patients. Conclusion Our fully connected CNN segmented overall muscle and muscle tissue with high precision and recall, as well as good DSC values. The mean predicted SGC values of all available patient axial slices showed promising results. With an overall Error of 25%, further development is needed for clinical implementation. Larger datasets and training of other model architectures are required to segment fatty tissue more accurately.

Clinical Effectiveness of Percutaneous Full-endoscopy Spine Surgery Combined With Holmium Laser in the Treatment of Lumbar Disc Herniation

Background Oxidative stress has been considered a critical mediator in the pathogenesis of lumbar disc degeneration, which can lead to the severe lower back pain. Inhibition of the excessive oxidative stress has become a therapeutic target for controlling discogenic lower back pain. Recently, more studies have shown that holmium laser can effectively suppress oxidative stress. This work aims to study the clinical outcomes of percutaneous full-endoscopy spine surgery combined with holmium laser for treating symptomatic lumbar disc degeneration (IDD). Methods We designed and conducted a retrospective study on the patients with lumbar disc herniation who had been treated by percutaneous full-endoscopy spine surgery at Shanghai General Hospital from June 2018 to March 2020. The patients were divided into group A (holmium laser treatment group) and group B (Elliquence radiofrequency group) according to the medical record. Operation time and hospitalization time of both groups were recorded and compared. Additionally, VAS scores and ODI scores were used to evaluate the lower back pain, lower extremity radiation pain and quality of life before and 3 days, 6 months, and 12 months after surgery. Results Forty-five patients were included in group A while the other 55 patients were included in group B. Operation time of group A was significantly shorter than that of group B (40.60±5.59 minutes vs. 50.80±3.19 minutes). VAS scores of lower back pain and lower extremity radiation pain at postoperative 3 days, 6 months, and 12 months were significantly lower than those before surgery in both groups. The postoperative lower back pain VAS scores of group A were significantly lower than those of group B, while the postoperative lower extremity radiation pain VAS scores had no significant difference between both groups. The ODI scores of both groups at postoperative 3 days, 6 months, and 12 months were significantly lower than those before surgery. Conclusions These findings confirmed that application of holmium laser can significantly improve the clinical outcomes in percutaneous full-endoscopy spine surgery.

Lower Back Pain as an Occupational Hazard Among Ugandan Health Workers

Background: Lower back pain is a public health concern affecting 70–85% of the world's population. There is paucity of published data on the prevalence, disability and risk factors for lower back pain among health workers in Uganda.Objective: To determine the frequency rate (note that is it implicit that frequency is a rate like incidence so including rate seems redundant here. This is bounded by zero and infinity. In contrast, prevalence is bounded by 0 and 1 and is thus a proportion not a rate) of lower back pain and its associated risks amongst health professionals in the Arua District of Uganda.Methods: Cross-sectional descriptive study of 245 consecutive participants conducted during February-April 2020. We stratified risks as individual or work related and analyzed the data using IBM SPSS version 25. Chi-square was used to measure the significance of association between categorical variables at 95% confidence interval, regarding a p ≤ 0.05 as significant.Results: The mean age of participants was 40.87 years ± 8.74 (SD), with female predominance (69.8%). Majority were either general nurses or midwives (64.9%) and more than half had practiced for over 6–10 years. The frequency rate of lower back pain was 39.6% (n = 97). Individual factors associated with LBP were; cigarette smoking (X2 = 33.040; P ≤ 0.001), alcohol consumption (X2 = 13.581; P ≤ 0.001), age (X2 = 14.717; P = 0.002), and female gender (X2 = 4.802; P = 0.028). The work related factors significantly associated with lower back pain were: being a nurse/midwife (X2 = 9.829; P = 0.007), working in the outpatient department (X2 = 49.752; P ≤ 0.001), bending (X2 = 43.912; P ≤ 0.001), lifting (X2 = 33.279; P &lt; 0.001), over standing (X2 = 40.096; P ≤ 0.001), being in awkward positions (X2 = 15.607; P= &lt; 0.001), and pushing patients (X2 = 21.999; P ≤ 0.001).Conclusion: The frequency rate of low back pain was high amongst health workers and its main associated individual and work related factors could have been prevented. Health workers should strike a balance between caring for their personal back-health and meeting clients' needs while manually handling patients. Ergonomic structuring, job organization, back health care courses and use of assistive equipment could reduce such occupational hazards in our low resourced settings.