SubclinicalPropionibacterium acnesinfection estimation in the intervertebral disc (SPInE-ID): protocol for a prospective cohort

IntroductionLow back pain and vertebral endplate abnormalities are common conditions within the population. Subclinical infection caused by indolent pathogens can potentially lead to these findings, with differentiation between them notably challenging from a clinical perspective. Progressive infection of the intervertebral disc has been extensively associated with increasing low back pain, withPropionibacterium acnesspecifically implicated with in relation to sciatica. The main purpose of this study is to identify if the presence of an infective pathogen within the intervertebral disc is primary or is a result of intraoperative contamination, and whether this correlates to low back pain.Methods and analysisAn open prospective cohort study will be performed. Subjects included within the study will be between the ages of 18 and 65 years and have a diagnosis of lumbar disc herniation requiring open decompression surgery. Excised herniated disc fragments, muscle and ligamentum flavum samples will be collected during surgery and sent to microbiology for tissue culture and pathogen identification. Score questionnaires for pain, functionality and quality of life will be given preoperatively and at 1, 3, 6 and 12 months postoperatively. A MRI will be performed 12 months after surgery for analysis of Modic changes and baseline comparison. The primary endpoint is the rate of disc infection in patients with symptomatic degenerative disc disease. The secondary endpoints will be performance scores, Modic incidence and volume.Ethics and disseminationThis study was approved by our Institutional Review Board and was only initiated after it (CAAE 65102617.2.0000.0071). Patients agreeing to participate will sign an informed consent form before entering the study. Results will be published in a peer reviewed medical journal irrespective of study findings. If shown to be the case, this would have profound effects on the way physicians treat chronic low back pain, even impacting health costs.Trials registration numberNCT0315876; Pre-results.

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Lumbago is different from prolapse of lumbar intervertebral disc

Advanced Emergency Medicine ◽

10.18686/aem.v6.78 ◽

2018 ◽

Vol 6 (2) ◽

Author(s):

Wei Zhou ◽

Yanbo Qiu ◽

Shaoqiu Zhou ◽

Wei Zhao

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Lumbar Disc ◽

Posterior Longitudinal Ligament ◽

Low Back ◽

Lumbar Intervertebral Disc ◽

Disc Protrusion ◽

Medical Reform ◽

System Disease

There are many errors found in the content of textbook in National Higher Education.For example:One of the errors found in the“Surgery”version no 418 is about movement system disease section.In chapter 677 Section III,the content misinterpretation of the cause of low back pain is the intervertebral disc protrusion that stimulate the outer annulus and the posterior longitudinal ligament in the sinus nerve fibers.For the past twenty years,feedbacks had been reflected repeatedly to the involved party but no one had admitted the contents of the textbook are wrong.The errors had brought great economy loss,physical and mental pain to patients.Every year,the country has to spend billions of dollars in the waste of medical reform reimbursement.This article is aimed to discuss about low back pain is not due to lumbar disc herniation.

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Establishment of a New Model of Lumbar Intervertebral Disc Degeneration With Pathological Characteristics

Global Spine Journal ◽

10.1177/21925682211012323 ◽

2021 ◽

pp. 219256822110123

Author(s):

Yongming Jin ◽

Guangfeng Mao ◽

Chen Yang ◽

Chen Xia ◽

Chuyong Chen ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Disc Degeneration ◽

Lumbar Disc ◽

Enzyme Linked Immunosorbent Assay ◽

Low Back ◽

Lumbar Disc Degeneration ◽

Discogenic Low Back Pain ◽

Collagen Ii

Study Design: A prospective study. Objectives: Intervertebral disc degenerative disease is a common and frequently-occurring disease in adults and is the main cause of lower back pain. However, there is a lack of universal animal models to study disc degeneration. Methods: Forty-two male New Zealand white rabbits aged 12 months were used in this study. We established an endplate ischemic disc degeneration model though surgical ligation of rabbit lumbar vertebral body segment arteries. Two weeks after surgery, 6 experimental animals were randomly selected for follow-up tests. First, ischemia and lumbar disc degeneration were confirmed using imaging techniques. Then, immunohistochemical staining was performed to observe the growth of the annulus fibrosus. Finally, quantitative polymerase chain reaction, enzyme-linked immunosorbent assay, and western blotting were used to detect mRNA expression and protein content of IL-1α, TNFα, collagen II, MMP-3, aggrecan, and PLA2 in the nucleus pulposus of the disc. Results: Imaging examination confirmed the successful construction of a lumbar disc degeneration model. Histological analysis and biochemical analysis showed a damaged intervertebral disc structure, and collagen II and aggrecan, the key extracellular matrix components of intervertebral discs, were reduced in synthesis and content. The synthesis and expression of IL-1α, TNFα, PLA2, and MMP-3 related to disc catabolism and inflammatory response were enhanced. Conclusions: We successfully constructed a lumbar disc degeneration ischemia model, which provides a novel approach to study the pathological mechanisms involved in discogenic low back pain and to prevent and treat discogenic low back pain.

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Ozonetherapy in the treatment of Low Back Pain associated to Lumbar Disk Herniation – A systematic review

Revista Pesquisa em Fisioterapia ◽

10.17267/2238-2704rpf.v8i4.2107 ◽

2018 ◽

Vol 8 (4) ◽

pp. 579-587

Author(s):

Natália da Rocha Sampaio ◽

Luís Rogério Oliveira Cruz ◽

Alena Peixoto Medrado

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Therapeutic Option ◽

Lumbar Disc ◽

Low Back ◽

Disk Herniation ◽

Lumbar Disk Herniation ◽

Lumbar Disk ◽

Study Results

INTRODUCTION: Ozonetherapy is a therapeutic tool used in the treatment of low back pain associated to herniation of lumbar disks. OBJECTIVE: The objective of this systematic review was to ratify the relevance of this treatment in clinical practice, besides emphasizing its possible utilization on physiotherapy. MATERIALS AND METHODS: PRISMA and PICOS were used to analyze the manuscripts design. Manuscripts selection was made by a research in the PUBMED, Periódicos CAPES and Scielo databases. Four clinical trials were selected according to the inclusion criterias designer for the study. RESULTS: All the authors confirmed the efficiency of ozonetherapy as a therapeutic method in reversing the algic symptomatology of pacients whit lumbar disc herniation. Ozonetherapy associated to the physiotherapeutic treatment can contribute pain relief related to low back pain by influencing the improvement in patients quality of life. CONCLUSION: Ozonetherapy is an effective therapeutic option for patients whit low back pain associated whit lumbar disk herniation.

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Epidemiology of lumbar disc herniations in adults with low back pain in Enugu, Nigeria

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195791 ◽

2019 ◽

Vol 6 (1) ◽

pp. 1

Author(s):

Godson E. Anyanwu ◽

Remigius T. Ekwunife ◽

Emmanuel C. Iyidobi ◽

Cajetan U. Nwadinigwe ◽

Henry C. Ekwedigwe ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Low Back ◽

Inclusion Criteria ◽

Laptop Computer ◽

Disc Herniations

Background: Lumbar intervertebral disc herniation is used to describe a spectrum of anatomical abnormalities involving disc extension beyond the interspace. It follows a tear in the annulus fibrosus of the intervertebral disc. It is one of the most common causes of low back pain among adults. The study aims to assess the epidemiological pattern of lumbar disc herniations among adults with low back pain in Enugu urban.Methods: The study was a prospective study at National Orthopedic Hospital Enugu and Annunciation Specialist Hospital Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The MRI scans of the participants were viewed using DICOM® (Digital Imaging and Communications in Medicine) software on laptop computer. The data included the patients’ demographics, functional disability index for back pain, weight, height, the anatomical level(s) and site(s) of the herniated disc among other parameters.Results: A total of 81 subjects who met the inclusion criteria were included and analyzed using SPSS version 20.0. The mean age of the subjects is 52.99±13.13 years. The most common affected age group is 51-60 years (27.2%). Majority of the subjects (68; 84%) had multiple level herniations which usually includes L4 level(74; 91.4%).Conclusions: That multilevel lumbar disc herniation is far more common than single level herniation with a prevalence of 84% among adults with low back pain in Enugu urban. That, there is statistically significant association of lumbar disc herniation and increasing age.

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PET imaging in patients with Modic changes

Nuklearmedizin ◽

10.3413/nukmed-0202 ◽

2009 ◽

Vol 48 (03) ◽

pp. 110-112 ◽

Cited By ~ 5

Author(s):

H. Petersen ◽

C. Manniche ◽

P. F. Høilund-Carlsen ◽

H. B. Albert

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pet Imaging ◽

Lumbar Disc ◽

Modic Changes ◽

Herniated Disc ◽

Low Back ◽

Modic Type ◽

Magnetic Resonance Imaging Mri

SummaryThe aim of this study was via PET imaging to reveal if any highly metabolic processes were occurring in Modic changes type 1 and/or in the adjacent discs. Modic changes (MC) are signal changes in the vertebral endplate and body visualised by magnetic resonance imaging (MRI). MC are strongly associated with low back pain (LBP). MC type 1 appear to be inflammation on MRI, and histological and biochemical findings make it highly likely that an inflammation is present. Though MC is painful no known treatment is available, and it is unknown which entities affect the progress or regress of MC. The changes observed on MRI are slow and take months to develop, but faster changes in the metabolism might provide a platform for monitoring patients. Patients, methods: Patients from The Back Centre Funen, with low back pain in the area of L1 to S1, MC type 1 in L1 to L5, and a previous herniated lumbar disc. All patients had a PET scan using FDG (18F-fluorodeoxyglucose) as tracer. Results: Included in the study were 11 patients, 4 women and 7 men, mean age 48.1 year (range 20–65). All MC were situated in the vertebrae both above and below the previously herniated disc/discs. Ten patients had MC at 1 level, and 1 had MC at 2 levels. The affected levels were 1 at L2/L3, 6 at L4 /L5, and 5 at L5/S1. All had a previous disc herniation and MC larger than 4 mm in diameter. Technically satisfactory PET scans were obtained. However, PET imaging showed no increases in metabolism in any vertebra or disc of any patient. Conclusion: Modic type 1 changes do not reveal themselves by showing increased metabolism with ordinary FDG PET imaging. PET tracers illuminating inflammation are being developed and hopefully may become more successful.

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Molecular detection of Propionibacterium acnes in biopsy samples of intervertebral disc with modic changes in patients undergoing herniated disc surgery

Iranian Journal of Microbiology ◽

10.18502/ijm.v12i6.5025 ◽

2020 ◽

Author(s):

Sharif Najafi ◽

Pedram Mahmoudi ◽

Seyed Alireza Bassampour ◽

Babak Shekarchi ◽

Mohammad Soleimani ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Laboratory Data ◽

Modic Changes ◽

Herniated Disc ◽

Low Back ◽

Duration Of Symptoms ◽

Cutibacterium Acnes ◽

The Mean

Background and Objectives: Recent studies have hypothesized that sterile disc infection with the anaerobic Propionibac- terium acnes, recently renamed Cutibacterium acnes, occurs in people with intervertebral disc (IVD) herniation. This study aimed to examine the presence of P. acnes in patients who have Low back pain (LBP) with Modic changes observed in their Magnetic Resonance Imaging (MRI). Materials and Methods: Thirty-seven patients who were candidates for surgery due to disc herniation and demonstrated Modic changes in MRI were included in the study. Before the surgery, the level of pain in patients was assessed using the visual analog score (VAS). All patients were asked to fill in the Oswestry Low Back Pain Disability Questionnaire. Interver- tebral disc changes observed in MRI were recorded for all patients. Then, during surgery, sterile intervertebral disc samples were taken. P. acnes detection was performed using PCR in the laboratory. Data analysis with Chi-squared test, independent samples t-test, and Mann-Whitney U test in SPSS 18.0. Results: The mean age of 37 patients equaled 43.64 years and the mean duration of symptoms was 11.05 months. In molec- ular examination, of the 37 individuals, the genome of P. acnes was positive in 23 cases (62.2%) and negative in 14 (37.8%). The relationship between VAS, disability score, changes in MRI, and patients’ age with the positivity of the intervertebral disc sample was also assessed. Of these variables, only age was significantly correlated with the positive molecular finding, such that with an increase in age, the probability of positive findings was increased (p = 0.022). Conclusion: Based on the results, lumbar disc infection with P. acnes may play a significant role in causing Modic changes and the progression of the disease in patients with LBP.

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Oxygen-Ozone Therapy for Herniated Lumbar Disc in Patients with Subacute Partial Motor Weakness Due to Nerve Root Compression

Interventional Neuroradiology ◽

10.15274/inr-2014-10078 ◽

2014 ◽

Vol 20 (5) ◽

pp. 547-554 ◽

Cited By ~ 10

Author(s):

Massimo Dall'Olio ◽

Ciro Princiotta ◽

Luigi Cirillo ◽

Caterina Budai ◽

Fabio de Santis ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Nerve Root ◽

Lumbar Disc ◽

Herniated Disc ◽

Low Back ◽

Nerve Root Compression ◽

Disc Disease ◽

Motor Weakness ◽

Anti Inflammatory

Intradiscal oxygen-ozone (O2-O3) chemonucleolysis is a well-known effective treatment for pain caused by protruding disc disease and nerve root compression due to bulging or herniated disc. The most widely used therapeutic combination is intradiscal injection of an O2-O3 mixture (chemonucleolysis), followed by periradicular injection of O2-O3, steroid and local anaesthetic to enhance the anti-inflammatory and analgesic effect. The treatment is designed to resolve pain and is administered to patients without motor weakness, whereas patients with acute paralysis caused by nerve root compression undergo surgery 24–48h after the onset of neurological deficit. This paper reports on the efficacy of O2-O3 chemonucleolysis associated with anti-inflammatory foraminal injection in 13 patients with low back pain and cruralgia, low back pain and sciatica and subacute partial motor weakness caused by nerve root compression unresponsive to medical treatment. All patients were managed in conjunction with our colleagues in the Neurosurgery Unit of Bellaria Hospital and the IRCCS Institute of Neurological Sciences, Bologna. The outcomes obtained are promising: 100% patients had a resolution of motor weakness, while 84.6% had complete pain relief. Our results demonstrate that O2-O3 therapy can be considered a valid treatment option for this category of patients.

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MRI spectrum and prevalence of lumbar spinal degenerative disease in patients with non-traumatic low back pain

Romanian Neurosurgery ◽

10.33962/roneuro-2020-068 ◽

2020 ◽

pp. 427-433

Author(s):

Neha Singh ◽

Deepak Kumar Singh

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Facet Joint ◽

Imaging Modality ◽

Imaging Techniques ◽

Lumbar Disc ◽

Degenerative Disease ◽

Low Back ◽

Study Results ◽

The Common

Background: Low back pain (LBP) is a frequent cause of global disability and activity limitation. In the majority of cases, LBP is nonspecific, yet diagnostic confirmation is required to rule out serious underlying pathologies such as infection, tumour, fracture or degenerative disease. It can be done by a number of imaging techniques. Of all available techniques, MRI is currently the imaging modality of choice owing to lack of radiation, multiplanar reformation capabilities and high contrast resolution. Objectives: To determine various MRI patterns and the common sites of spinal degenerative lesions among patients with LBP. Method: This study was conducted on 622 patients suffering from non-traumatic LBP, referred for MRI of the lumbar spine. MRI database of the study population were analysed using axial T2-weighted, sagittal STIR, T1and T2-weighted and coronal STIR images. After excluding patients with h/o prior surgery and MR findings suggesting infective or neoplastic etiologies, 598 patients constituted the sample size of our study. Results: A review of 598 patients with LBP revealed that degenerative changes in intervertebral disc were the most common abnormality detected. Among these, Disc bulge was the most common abnormality followed by disc desiccation, protrusion, extrusion, HIZ/annular tear, reduced IVD space and Schmorl’s nodes. Other non- disc degenerative findings were Modic endplate changes, facet joint arthropathy, osteophytes, Spinal canal stenosis and Ligamentum Flavum hypertrophy. Conclusions: Results reported the common occurrence of lumbar disc degenerative disease in patients with low backache. Research efforts should attempt to trim down risk factors and perk up the quality of life.

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