Implications of Age, Gender and Lumbar Disc Level on Symptomatic Herniated Nucleus Pulposus

Background: A herniated-disc inside the spinal column is a condition applying displacement of nucleus pulposus from intervertebral space causing back pain. Objective: To analyse the association of age, gender and lumbar disc level with herniated nucleus pulposus. Study Design: Retrospective study Place and Duration of Study: Department of Neurosurgery, Shaikh Zayed Hospital, Lahore from 1st January 2011 to 31st January 2020. Methodology: One hundred and twenty patients to investigate association of herniated nucleus pulposus with age, gender and lumbar disc level were enrolled. Patient’s demographic, clinical and radiological assessments were completed for categorizing their condition and level of lumbar disc involvement. Results: There were 72.5% males and 27.5% females with a mean age of 48.6±1.26 years. The study revealed that 72.5% nucleus pulposus herniation cases were within the age group of 51-70 years. L5-S1 is more susceptible to nucleus pulposus herniation (62.5%) followed by L4-L5 (34.2%), L3-L4 (2.5%) and L1-L2 (0.8%). Conclusion: Elderly population with >51 years in males is highly prone for nucleus pulposus herniation with L5-S1 to be most affected lumbar spinal segments. Key words: Nucleus pulposus herniation, Vertebral column level, Lumbar disc level

Cadaveric Thoracic Disc Herniation: Fine Architecture of the Prolapse and Relationship with the Posterior Longitudinal Ligament

Prolapse of a lower intervertebral thoracic disc (T10-11) was noticed in a cadaver following examination of serial plastinated sections of the spine. A number of structures were associated with the posteriorly herniated nucleus pulposus, including the posterior longitudinal ligament, fibrous meshworks, venous plexuses and a delicate surrounding capsule. Dimensions of the herniation suggest that the lesion was asymptomatic in life. Thoracic disc prolapse is a rare phenomenon in vivo and is even more infrequently seen in cadavers. This study adds to the minute body of literature on post-mortem thoracic disc herniation and provides insights into detailed pathological changes in the anatomy of surrounding structures following disc prolapse.

Increased hemoglobin and heme in MALDI-TOF MS analysis induce ferroptosis and promote degeneration of herniated human nucleus pulposus

Background Neovasculogenesis is characteristic of herniated lumbar discs, in which extruded nucleus pulposus is prone to heme iron-induced cytotoxicity (increased oxidative stress causing ferroptosis). However, recent analyses of neovascularization are very complicated, and the mechanism of action is rarely reported. Methods Matrix-assisted laser desorption/ionization–time-of-flight mass spectrometry (MALDI-TOF MS) was performed to analyze human herniated and nonherniated nucleus pulposus. Then, the clinical relevance of the MALDI-TOF MS results and Pfirrmann classification of the degenerative nucleus pulposus were analyzed. To explore the mechanism, the heme-induced ferroptosis effect was evaluated at both the tissue and cell levels using high-resolution MALDI-TOF MS and molecular biology methods. Results The spectra revealed that hemoglobin (Hb) and heme signals were greatly increased, thus serving as predictors of vasculogenesis in herniated nucleus pulposus. The clinical relevance analysis demonstrated that the intensity of Hb and heme peaks was closely related to the Pfirrmann classification of degenerative nucleus pulposus. Mechanistically, increased heme catabolism and downregulation of glutathione peroxidase 4 (GPX4) levels were detected in herniated nucleus pulposus, reflecting iron-dependent cell death or ferroptosis. Iron levels was also increased in herniated nucleus pulposus compared with that in nonherniated nucleus pulposus. Furthermore, accuracy mass measurements confirmed that the levels of ferroptosis-related metabolites, such as glutathione, arachidonic acid (AA), sphinganine, polyunsaturated fatty acid (PUFA), and tricarboxylic acid (TCA) cycle metabolites, were significantly different between herniated and nonherniated tissues, indicating that the interior of the herniated tissues is a pro-oxidant environment. Moreover, heme-induced ferroptosis was verified in human nucleus pulposus cells (HNPCs), and the underlying mechanism might be associated with the Notch pathway. Conclusions Neovascularization in herniated nucleus pulposus may expose tissues to high levels of heme, which can induce cytotoxicity and ferroptosis within tissues and accelerate the progressive degeneration of herniated nucleus pulposus. This study is beneficial for understanding the pathological mechanism of herniated nucleus pulposus and facilitating the development of nonoperative interventions for treating lumbar disc herniation (LDH).

The role of single nucleotide polymorphisms of IL-1A -889C>T (rs1800587), TNF-A -238G>A (rs361525), and VDR TaqI (rs731236) on susceptibility to herniated nucleus pulposus: a systematic review and meta-analysis

Background: The pathogenesis of herniated nucleus pulposus (HNP) is complex and may involve the wide variety of gene polymorphism. However, the reports from the existing studies are inconclusive. The objective of this study was to determine the role of single nucleotide polymorphisms (SNPs) in interleukin 1 alpha (IL-1A), tumor necrosis factor-alpha (TNF-A), and vitamin D receptor (VDR) genes on the susceptibility to herniated nucleus pulposus (HNP). Methods: Four databases (PubMed, Embase, Cochrane, and Web of Science) were searched as of April 1 st, 2021. Authors, publication year, targeted genes, genotype and allele frequency in each case and control groups were collected. Newcastle-Ottawa scale was used to evaluate the publication quality. The pooled estimates of association of IL-1A -889C>T (rs1800587), TNF-A -238G>A (rs361525), and VDR TaqI (rs731236) and susceptibility to HNP were assessed using Z test. Results: We screened 3,067 unique studies for eligibility and three, two and nine case-control studies on IL-1A -889C>T, TNF-A -238G>A, and VDR TaqI were included, respectively, in our meta-analysis. The studies consisting 369 HNP cases and 433 controls for IL-1A -889C>T, 252 cases and 259 controls for TNF-A -238G>A and 1130 cases and 2096 controls for VDR TaqI. Our pooled estimates indicated that there was no significant association of those SNPs with the susceptibility to HNP in any genotype, dominant model, recessive model, or allele comparations. Conclusion: Although individual studies suggested the important role of gene expression dysregulation associated with SNPs in IL-1A, TNF-A, and VDR, our data indicated that IL-1A -889C>T, TNF-A -238G>A, and VDR TaqI had weak association with HNP susceptibility in both genotypes and allele distributions. However, since heterogeneity was identified among studies included in this meta-analysis, further meta-analysis with a larger population and subgroup analysis on specific population are warranted to support this finding.

The role of single nucleotide polymorphisms of IL-1A -889C>T (rs1800587), TNF-A -238G>A (rs361525), and VDR TaqI (rs731236) on susceptibility to herniated nucleus pulposus

Background: The pathogenesis of herniated nucleus pulposus (HNP) is complex and may involve the wide variety of gene polymorphism. However, the reports from the existing studies are inconclusive. The objective of this study was to determine the role of single nucleotide polymorphisms (SNPs) in interleukin 1 alpha (IL-1A), tumor necrosis factor-alpha (TNF-A), and vitamin D receptor (VDR) genes on the susceptibility to herniated nucleus pulposus (HNP). Methods: Four databases (PubMed, Embase, Cochrane, and Web of Science) were searched as of April 1 st, 2021. Authors, publication year, targeted genes, genotype and allele frequency in each case and control groups were collected. Newcastle-Ottawa scale was used to evaluate the publication quality. The pooled estimates of association of IL-1A -889C>T (rs1800587), TNF-A -238G>A (rs361525), and VDR TaqI (rs731236) and susceptibility to HNP were assessed using Z test. Results: We screened 3,067 unique studies for eligibility and three, two and nine case-control studies on IL-1A -889C>T, TNF-A -238G>A, and VDR TaqI were included, respectively, in our meta-analysis. The studies consisting 369 HNP cases and 433 controls for IL-1A -889C>T, 252 cases and 259 controls for TNF-A -238G>A and 1130 cases and 2096 controls for VDR TaqI. Our pooled estimates indicated that there was no significant association of those SNPs with the susceptibility to HNP in any genotype, dominant model, recessive model, or allele comparations. Conclusion: Although individual studies suggested the important role of gene expression dysregulation associated with SNPs in IL-1A, TNF-A, and VDR, our data indicated that IL-1A -889C>T, TNF-A -238G>A, and VDR TaqI had weak association with HNP susceptibility in both genotypes and allele distributions. However, since heterogeneity was identified among studies included in this meta-analysis, further meta-analysis with a larger population and subgroup analysis on specific population are warranted to support this finding.

The Differences Effect Of Giving Snags And Mc Kenzie With Manual Traction And Mc Kenzie For Pain Reduction And Lumbal Disability In HNP Conditions

Latar Belakang : Herniated Nucleus Pulposus adalah kondisi penonjolan discus intervertebralis yang dapat menekan akar saraf yang keluar dari foramen intervertebralis sehingga menimbulkan nyeri radikular, dan pada akhirnya menyebabkan disabilitas lumbal. Metode Desain randomized two group pre test – post test dan menggunakan tehnik pulposive sampling bertujuan untuk mengetahui beda pengaruh pada intervensi SNAGs dan Mc kenzie dibandingkan dengan Manual Traction dan Mc.Kenzie terhadap penurunan nyeri dan disabilitas lumbal pada penderita HNP lumbal. Penelitian ini dilaksanakan di RSAD Tk. II Pelamonia Makassar dengan sampel adalah penderita HNP lumbal yang sesuai dengan kriteria inklusi. Jumlah sampel adalah 16 orang yang dibagi secara acak kedalam 2 kelompok yaitu kelompok perlakuan 1 yang diberikan SNAGs dan Mc kenzie sebanyak 8 orang dan kelompok perlakuan 2 yang diberikan Manual Traction dan Mc Kenzie sebanyak 8 orang. Alat ukur yang digunakan adalah Oswetry Disability Index (ODI). Hasil : Berdasarkan analisis uji paired sample t pada kelompok perlakuan I diperoleh nilai (p = 0.000 < 0,05) untuk nilai Oswetry Disability Index yang berarti bahwa pemberian Sustained Apophysial Glides dan Mc Kenzie dapat menghasilkan penurunan nyeri dan disabilitas lumbal yang signifikan. Sedangkan kelompok perlakuan II juga diperoleh nilai (p = 0.000 < 0,05) untuk nilai Oswetry Disability Index yang berarti bahwa pemberian Manual Traction dan Mc Kenzie dapat menghasilkan penurunan nyeri dan disabilitas lumbal yang signifikan. Kemudian berdasarkan uji Indepentent sample t diperoleh nilai (p = 0.000 < 0,05) untuk nilai Oswetry Disability Index yang berarti bahwa pemberian Sustained Apophysial Glides dan Mc Kenzie lebih efektif secara signifikan dibandingkan dengan pemberian Manual Traction dan Mc Kenzie terhadap penurunan nyeri dan disabilitas lumbal. Kesimpulan : Dapat disipulkan bahwa pemberian pemberian SNAGs dan Mc Kenzie lebih efektif dibandingkan dengan Manual Traction dan Mc Kenzie terhadap penurunan nyeri dan disabilitas lumbal pada penderita HNP. Kata kunci : Sustained Natural Apophyseal Glides, Manual traction, Mc Kenzie, ODI, HNP Lumbal