Pain Management by Ayurveda in Lumbar Spondylosis– A Case Study and Selective Review of Literature

Introduction: In Ayurveda, Snehana is an important method of treatment for diseases of the spine. As per Ayurveda, fatty substances are having properties opposite to that of Vata Dosha which is the root of many diseases. Therefore, Sneha (fatty substances) have an important position in Ayurvedic treatment. Fatty substances are of 4 types of Ghrita (Ghee), Taila (oil), Vasa (muscle fat), and Majja (bone marrow fat). Among these types, the literature is available about Ghrita (ghee), Taila (oil), and Majja (bone marrow fat) only, but Vasa (muscle fat) is not currently practiced. We got a case study, in which cod liver oil capsules were used as a representative of Vasa Sneha. A male of 35 suffering from lumbar spondylosis approached for moderate to severe low back pain. We successfully used cod liver oil capsules as representative of Vasa Sneha in this case. Study Design: A single case study and selective review of the literature. Place and Duration of Study: Panchakarma OPD, Yashwant Ayurvedic medical college, PGTRC, Kodoli, 416114, Dist. – Kolhapur, Maharashtra, India. Presentation of Case: This is a single case study in which a male of 35 years was suffering from chronic low back pain (CLBP) due to lumbar spondylosis The patient had chronic low back pain which was aggravated for 3 months. We prescribed him Ayurvedic medicines and cod liver oil capsules orally. The patient was followed for 16 months. Results: The outcome measure was assessed by the Oswestry low back pain disability questionnaire. The low back pain score was measured in different positions. The before treatment value was 36 (median ẋ = 3.5) and the score was 72, and after treatment value was 2 (median ẋ = 0) and the score was 4. The Mann Whitney U test was performed. The p was 0.00009 (<0.05). Conclusion: It is concluded that cod liver oil can be successfully used as a representative of vasa Sneha, and it is very effective in relieving chronic low back pain in lumbar spondylosis along with other ayurvedic preparations.

The contributions of cartilage endplate composition and vertebral bone marrow fat to intervertebral disc degeneration in patients with chronic low back pain

Purpose: The composition of the subchondral bone marrow and cartilage endplate (CEP) could affect intervertebral disc health by influencing vertebral perfusion and nutrient diffusion. However, the relative contributions of these factors to disc degeneration in patients with chronic low back pain (cLBP) have not been quantified. The goal of this study was to use compositional biomarkers derived from quantitative MRI to establish how CEP composition (surrogate for permeability) and vertebral bone marrow fat fraction (BMFF, surrogate for perfusion) relate to disc degeneration. Methods: MRI data from 60 patients with cLBP were included in this prospective observational study (28 female, 32 male; age = 40.0 ± 11.9 years, 19–65 [mean ± SD, min–max]). Ultra-short echo-time MRI was used to calculate CEP T2* relaxation times (reflecting biochemical composition), water-fat MRI was used to calculate vertebral BMFF, and T1ρ MRI was used to calculate T1ρ relaxation times in the nucleus pulposus (NP T1ρ, reflecting proteoglycan content and degenerative grade). Univariate linear regression was used to assess the independent effects of CEP T2* and vertebral BMFF on NP T1ρ. Mixed effects multivariable linear regression accounting for age, sex, and BMI was used to assess the combined relationship between variables. Results: CEP T2* and vertebral BMFF were independently associated with NP T1ρ (p = 0.003 and 0.0001, respectively). After adjusting for age, sex, and BMI, NP T1ρ remained significantly associated with CEP T2* (p = 0.0001) but not vertebral BMFF (p = 0.43). Conclusion: Poor CEP composition may play a significant role in disc degeneration severity and can affect disc health both with and without deficits in vertebral perfusion.

I Can Get Fat Where? The Other Types of Fat

This chapter considers the more obscure non-white types of adipose tissue present in the human body. The first and better-known type discussed is brown fat, which contributes to the regulation of body temperature as it burns (excess) calories to generate heat. The second section explores the biology of bone marrow fat, whose enigmatic behaviour in the context of starvation and obesity does little to help define its role. After considering the relationship between bone marrow adipose tissue, bone strength, and overall metabolic health, this chapter concludes by briefly reviewing other, lesser-known types of (white) fat (e.g., epicardial fat) and their potential contribution to human biology.

Novel MRI technique for the quantification of biochemical deterioration in steroid-induce osteonecrosis of femoral head: a prospective diagnostic trial

To explore the novel magnetic resonance imaging techniques, IVIM-DWI and IDEAL-IQ in detecting bone marrow fat and microcirculation in steroid-induced osteonecrosis of the femoral head (SIONFH). In this prospective study, 49 patients (80 hips) with SIONFH taking glucocorticoids and 24 healthy volunteers (48 hips) were recruited and assessed by T1WI, T2WI/fs, IDEAL-IQ and IVIM-DWI. The affected hips, contralateral asymptomatic hips and normal hips, as well as normal, penumbra and necrotic areas in the affected hips, were classified and evaluated. Imaging results were compared with histologic bone sections obtained from SIONFH patients undergoing surgery. The fat fraction (FF) and perfusion fraction (f) differences between groups were analyzed using analysis of variance, the LSD t-test, Pearson correlation analysis and ROC curve analysis. Our results demonstrate that IDEAL-IQ (FF) and IVIM-DWI (f) enable the classification of SIONFH at different ARCO stages. The FF was positively associated with the progression of the disease (r = 0.72), in contrast to f (r = −0.17). The FF and f were significantly different among the necrotic, penumbra and normal areas, and they were negatively correlated with each other (r = −0.37). The diagnostic sensitivity and specificity of IDEAL-IQ were 96.9% and 86.7%, and those of IVIM-DWI were 72.34% and 58.33%, respectively. The FF in contralateral asymptomatic hips was significantly higher than in normal hips, but no difference was found for f. IDEAL-IQ, and not IVIM-DWI, was identified to successfully detect bone marrow fat, which is beneficial to the diagnosis of the severity of SIONFH.

Bone Marrow Adipocytes and Hematology: A Literature Review

This review focuses on the impact of bone marrow adipocytes on hematopoiesis and the development of hematological diseases. Bone marrow fat is a metabolically active organ capable of accumulating energy required for active hematopoiesis as well as of performing endocrine functions and participating in bone formation. Adipocytes can interact with the surrounding cells both directly and indirectly via cytokines and chemokines. Apart from their active involvement in the normal hematopoiesis, BMA have also been shown to play an important role in such diseases as leukemia, multiple myeloma and aplastic anemia. The role of fat cells in hematopoiesis is still unclear and not well studied, yet it is undoubtedly important, as demonstrated by the ever increasing number of publications supporting this conclusion.