Three Cases of Insomnia in Herniated Intervertebral Disk Patients Treated with Uhwangchungsim-won

Objective: This study examined a case in which insomnia and pain due to herniated intervertebral disks were improved by treatment with an oriental herbal and the administration of Uhwangchungsim-won.Case Summary: Three patients with insomnia diagnosed with herniated intervertebral disks were treated with a series of Korean medical therapies, including the herbal medication Uhwangchungsim-won, acupuncture, herbal acupuncture, and physical therapy. We used the Numerical Rating Scale (NRS) to measure subjective sleep states and the European Quality of Life Five Dimensions (EQ-5d) Scale to evaluate the therapeutic effect. Following treatment, subjective sleep states and the overall scores for pain had improved.Conclusion: The results indicate that Korean medical therapies with Uhwangchungsim-won have beneficial effects on insomnia for patients with herniated intervertebral disks.

Advances and Prospects in Biomaterials for Intervertebral Disk Regeneration

Low-back and neck-shoulder pains caused by intervertebral disk degeneration are highly prevalent among middle-aged and elderly people globally. The main therapy method for intervertebral disk degeneration is surgical intervention, including interbody fusion, disk replacement, and diskectomy. However, the stress changes caused by traditional fusion surgery are prone to degeneration of adjacent segments, while non-fusion surgery has problems, such as ossification of artificial intervertebral disks. To overcome these drawbacks, biomaterials that could endogenously regenerate the intervertebral disk and restore the biomechanical function of the intervertebral disk is imperative. Intervertebral disk is a fibrocartilaginous tissue, primarily comprising nucleus pulposus and annulus fibrosus. Nucleus pulposus (NP) contains high water and proteoglycan, and its main function is absorbing compressive forces and dispersing loads from physical activities to other body parts. Annulus fibrosus (AF) is a multilamellar structure that encloses the NP, comprises water and collagen, and supports compressive and shear stress during complex motion. Therefore, different biomaterials and tissue engineering strategies are required for the functional recovery of NP and AF based on their structures and function. Recently, great progress has been achieved on biomaterials for NP and AF made of functional polymers, such as chitosan, collagen, polylactic acid, and polycaprolactone. However, scaffolds regenerating intervertebral disk remain unexplored. Hence, several tissue engineering strategies based on cell transplantation and growth factors have been extensively researched. In this review, we summarized the functional polymers and tissue engineering strategies of NP and AF to endogenously regenerate degenerative intervertebral disk. The perspective and challenges of tissue engineering strategies using functional polymers, cell transplantation, and growth factor for generating degenerative intervertebral disks were also discussed.

MDCT-Based Finite Element Analysis for the Prediction of Functional Spine Unit Strength—An In Vitro Study

(1) Objective: This study aimed to analyze the effect of ligaments on the strength of functional spine unit (FSU) assessed by finite element (FE) analysis of anatomical models developed from multi-detector computed tomography (MDCT) data. (2) Methods: MDCT scans for cadaveric specimens were acquired from 16 donors (7 males, mean age of 84.29 ± 6.06 years and 9 females, mean age of 81.00 ± 11.52 years). Two sets of FSU models (three vertebrae + two disks), one with and another without (w/o) ligaments, were generated. The vertebrae were segmented semi-automatically, intervertebral disks (IVD) were generated manually, and ligaments were modeled based on the anatomical location. FE-predicted failure loads of FSU models (with and w/o ligaments) were compared with the experimental failure loads obtained from the uniaxial biomechanical test of specimens. (3) Results: The mean and standard deviation of the experimental failure load of FSU specimens was 3513 ± 1029 N, whereas of FE-based failure loads were 2942 ± 943 N and 2537 ± 929 N for FSU models with ligaments and without ligament attachments, respectively. A good correlation (ρ = 0.79, and ρ = 0.75) was observed between the experimental and FE-based failure loads for the FSU model with and with ligaments, respectively. (4) Conclusions: The FE-based FSU model can be used to determine bone strength, and the ligaments seem to have an effect on the model accuracy for the failure load calculation; further studies are needed to understand the contribution of ligaments.

Spatially defined single-cell transcriptional profiling characterizes diverse chondrocyte subtypes and nucleus pulposus progenitors in human intervertebral discs

A comprehensive understanding of the cellular heterogeneity and molecular mechanisms underlying the development, homeostasis, and disease of human intervertebral disks (IVDs) remains challenging. Here, the transcriptomic landscape of 108 108 IVD cells was mapped using single-cell RNA sequencing of three main compartments from young and adult healthy IVDs, including the nucleus pulposus (NP), annulus fibrosus, and cartilage endplate (CEP). The chondrocyte subclusters were classified based on their potential regulatory, homeostatic, and effector functions in extracellular matrix (ECM) homeostasis. Notably, in the NP, a PROCR+ resident progenitor population showed enriched colony-forming unit-fibroblast (CFU-F) activity and trilineage differentiation capacity. Finally, intercellular crosstalk based on signaling network analysis uncovered that the PDGF and TGF-β cascades are important cues in the NP microenvironment. In conclusion, a single-cell transcriptomic atlas that resolves spatially regulated cellular heterogeneity together with the critical signaling that underlies homeostasis will help to establish new therapeutic strategies for IVD degeneration in the clinic.

“WHAT MRI CAN DO IN SUSPECTED NON-DEGENRATIVE CASES OF COMPRESSIVE MYELOPATHY”

BACKGROUND: Compressive Myelopathy is described as the spinal cord compression either from outside or within the cord itself. Compression may be due to Herniated disc, post traumatic compression by fracture / displaced Vertebra, epidural hemorrhage / abscess or Epidural / Intradural (Intramedullary and Extramedullary) neoplasm. Study aimed to to study the role of MRI in evaluation of compressive myelopathy MATERIAL & METHOD: It is a cross sectional observational study conducted during Jan 2019 to June 2020 in patients presenting to the Department of Radiodiagnosis with features of compressive myelopathy at Sharda Hospital, SMS&R. Total of 30 patients who fullled inclusion criteria and provided the informed consent. Philips Achieva 3.0T MRI. Standard surface coils and body coils, were used for cervical, thoracic and Lumbar spine for acquisition of images was used to assess the compressive myelopathy. RESULTS: In present study, total of 30 patients were included in the present study. Among them 20 were males and 10 were female with the ratio of 2:1 showing the male predominance. The mean age of the patients was found to be 39.23 years. Extra dural compartment was the most commonly involved (n=26). POTTs (n=12) and TM (n=11) were most common located in extradural compartment, followed by metastasis (n=2). (p<0.001) CONCLUSION: MRI was able to successfully classify the spinal tumor based on Extradural / Intradural position and evaluate the integrity of the spinal cord, intervertebral disks and ligament following acute spinal trauma.

Sonographic Assessment of Human Lumbar Intervertebral Disks: A Cadaveric Study

Objectives: The intervertebral disk has traditionally been imaged by magnetic resonance imaging (MRI); however, advances in sonography mean it can now be visualized with this modality. The objectives of this human cadaveric study were to visualize the internal structure of the lumbar intervertebral disks and map any defects. Shear wave sonography was explored as a method for assessing the disks. Materials and Methods: In a human cadaver, L4-L5 and L5-S1 disks were imaged with sonography through the anterior abdominal wall and directly through the anterior longitudinal ligament. Gray-scale images and shear wave elastography velocities were obtained. An MRI was performed for image comparison. Results: Defects in the disks were clearly seen with sonography, imaging through the anterior abdominal wall and also directly through the anterior longitudinal ligament. The defects identified on sonography were less well visualized on MRI. Shear wave velocities could only be obtained from the anterior aspect of the disk and were unreliable, primarily owing to the stiffness of the tissues. Conclusion: Sonography can provide an accurate map of defects within the disk, corresponding with MRI. Shear wave elastography should be used with caution in the human cadaveric intervertebral disk, acknowledging the many confounding factors influencing the measurements.

Non-Specific Low Back Pain and Lumbar Radiculopathy: Comparison of Morphologic and Compositional MRI as Assessed by gagCEST Imaging at 3T

Using glycosaminoglycan Chemical Exchange Saturation Transfer (gagCEST) magnetic resonance imaging (MRI), this study comparatively evaluated the GAG contents of lumbar intervertebral disks (IVDs) of patients with non-specific low back pain (nsLBP), radiculopathy, and asymptomatic volunteers to elucidate the association of clinical manifestation and compositional correlate. A total of 18 patients (mean age 57.5 ± 22.5 years) with radiculopathy, 16 age-matched patients with chronic nsLBP and 20 age-matched volunteers underwent standard morphologic and compositional gagCEST MRI on a 3T scanner. In all cohorts, GAG contents of lumbar IVDs were determined using gagCEST MRI. An assessment of morphologic IVD degeneration based on the Pfirrmann classification and T2-weighted sequences served as a reference. A linear mixed model adjusted for multiple confounders was used for statistical evaluation. IVDs of patients with nsLBP showed lower gagCEST values than those of volunteers (nsLBP: 1.3% [99% confidence intervals (CI): 1.0; 1.6] vs. volunteers: 1.9% [99% CI: 1.6; 2.2]). Yet, IVDs of patients with radiculopathy (1.8% [99% CI: 1.4; 2.1]) were not different from patients with nsLBP or volunteers. In patients with radiculopathy, IVDs directly adjacent to IVD extrusions demonstrated lower gagCEST values than distant IVDs (adjacent: 0.9% [99% CI: 0.3; 1.5], distant: 2.1% [99% CI: 1.7; 2.5]). Advanced GAG depletion in nsLBP and directly adjacent to IVD extrusions in radiculopathy indicates close interrelatedness of clinical pathology and compositional degeneration.

Software Programming with Lumbar Spine Cadaveric Specimens for Computational Biomedical Applications

This contribution deals with demonstration of software-computational methods (CAD) to digitalize, simulate, and fit mathematically the anterior vertebral body morphometry of cadaveric lumbar spines. From previous research publications, computational techniques are developed and explained. Based on anatomical-cadaveric spinal specimens, experimental data was implemented to obtain practical surgical applications. With these anatomical samples, large sets of surface digital points were generated. Complete anterior vertebral body morphologies were visualized and analyzed with designed software-engineering. Selection method for extraction of Regions of Interest (ROIs) is presented. Applications of Lumbar anterior, vertebras, and intervertebral disks surfaces, are explained. Further biomedical anatomical analysis applications are included. Results comprise realistic anatomical representations of lumbar spine. Important applications in computational design, surgical robotics, and optimization of surgery tools and techniques are presented.

9 Spine Infections

Spine infections can have significant morbidity and mortality if not identified and treated appropriately. This category of orthopaedic infections can include infections involving the epidural space (spinal epidural abscesses), vertebral column (vertebral osteomyelitis), or the intervertebral disks (diskitis). These conditions can predispose patients to significant consequences including neurologic compromise, deformity, and pain. Accurate diagnosis of spine infections is based on clinical history and examination, along with appropriate imaging and laboratory tests. Treatment of these infections entails medical management with antibiotic therapy, or, in cases with progressive neurologic deficit or deformity, surgical methods that include open decompression with correction of deformity as indicated.