Is the determination of bone turnover markers and vitamin D useful in the diagnosis of degeneration spine disease?

Degenerative disease of the lumbar spine is one of the most common diseases of the human musculoskeletal system and a significant public health problem. The main manifestation of degenerative spine disease is back pain, which in most cases is treated symptomatically rather than causally. The diagnosis of degenerative spine disease has been previously based on medical history and diagnostic imaging. Recently, much attention has been devoted to the biochemical indicators of bone and cartilage metabolism, which are well understood among patients with osteoporosis. Bone turnover markers indicate the metabolic activity of bone and cartilage. They occur in blood serum, urine, and synovial fluid in the form of collagen-derived proteins or enzymes, involved in the formation or resorption of bone and cartilage tissue. The study below was aimed at assessing the usefulness of determining the markers of bone turnover and cartilage damage in the blood serum of people with degenerative disease of the lumbar spine diagnosed by MRI. The biochemical diagnostics included the measurement of inflammatory parameters. The results show that the degenerative disease of the spine is local, accompanied by inflammation, and vitamin D deficiency is among the factors leading to its development.

Impact of predominant symptom location among patients undergoing cervical spine surgery on 12-month outcomes: an analysis from the Quality Outcomes Database

OBJECTIVE The impact of the type of pain presentation on outcomes of spine surgery remains elusive. The aim of this study was to assess the impact of predominant symptom location (predominant arm pain vs predominant neck pain vs equal neck and arm pain) on postoperative improvement in patient-reported outcomes. METHODS The Quality Outcomes Database cervical spine module was queried for patients undergoing 1- or 2-level anterior cervical discectomy and fusion (ACDF) for degenerative spine disease. RESULTS A total of 9277 patients were included in the final analysis. Of these patients, 18.4% presented with predominant arm pain, 32.3% presented with predominant neck pain, and 49.3% presented with equal neck and arm pain. Patients with predominant neck pain were found to have higher (worse) 12-month Neck Disability Index (NDI) scores (coefficient 0.24, 95% CI 0.15–0.33; p < 0.0001). The three groups did not differ significantly in odds of return to work and achieving minimal clinically important difference in NDI score at the 12-month follow-up. CONCLUSIONS Analysis from a national spine registry showed significantly lower odds of patient satisfaction and worse NDI score at 1 year after surgery for patients with predominant neck pain when compared with patients with predominant arm pain and those with equal neck and arm pain after 1- or 2-level ACDF. With regard to return to work, all three groups (arm pain, neck pain, and equal arm and neck pain) were found to be similar after multivariable analysis. The authors’ results suggest that predominant pain location, especially predominant neck pain, might be a significant determinant of improvement in functional outcomes and patient satisfaction after ACDF for degenerative spine disease. In addition to confirmation of the common experience that patients with predominant neck pain have worse outcomes, the authors’ findings provide potential targets for improvement in patient management for these specific populations.