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J Ultrasound Med 2022 Apr 14. Epub 2022 Apr 14.

Department of Orthopedics, Nara Medical University, Kashihara, Nara, Japan.

Cervical disc degeneration commonly results in referred neck pain, which is traditionally diagnosed via fluoroscopy-guided provocative discography. Herein, we discuss three cases of neck and shoulder pain treated with cervical intradiscal injections administered under ultrasound (US) guidance. The most painful intervertebral disc was identified using the sonopalpation technique, which involved palpation while visualizing anatomical structures using US. Read More

Biomedicines 2022 Feb 26;10(3). Epub 2022 Feb 26.

School of Medicine, China Medical University, Taichung 40402, Taiwan.

(1) Background: Inexplicable low back and neck pain frequently results from spinal disc degeneration with an imbalanced intervertebral disc (IVD) cell homeostasis. We hypothesize that introducing MSC expressing a sustained cartilage-anabolic factor in the IVD may stimulate the mucoid materials secreted from the IVD cells, promote the MSC's chondrogenesis and maintain the hydration content providing mechanical strength to decelerate the disc degeneration progression; (2) Methods: This study expressed a cartilage-anabolic factor runx1 by a baculoviral vector (BV) transduced MSCs through a Cre/LoxP gene editing and recombination system for sustained recombinant runx1 transcription factor production. The Cre/LoxP BV modified MSCs were encapsulated by hyaluronan hydrogel, due to its' vital composition in ECM of a healthy disc and transplanted to a punctured coccygeal disc in rats through micro-injection, followed by X-ray radiography and histological analysis at the 4- and 12-weeks post-transplantation; (3) Results: Data reveals the Cre/LoxP BV system-mediated long-termed runx1 gene expression, possessing good biosafety characteristics in the in vitro cell transduction and in vivo MSCs transplantation, and maintained superior hydration content in the disc than that of mock transduced MSCs; (4) Conclusions: This proof-of-concept study fulfills the need of implanting therapeutic cells accompanied with microinjection in the disc, such as a discography and paves a road to manufacture composite hyaluronan, such as peptide modified hyaluronan as an MSC carrier for IVD regeneration in the future study. Read More

Georgian Med News 2022 Feb(323):60-67

2Vita Medical Clinic, Kyiv, Ukraine.

Intervertebral disc degeneration often is a cause of low back pain (LBP) and radicular pain even without severe compression of the nerve root by hernial material. Thermodiscoplasty, or intradiscal electrothermal therapy (IDET) is used for minimally invasive treatment of discogenic pain. Pulsed radiofrequency (PRF) of the dorsal root ganglion (DRG) is used as an interventional method for radicular pain elimination. Read More

J Comput Assist Tomogr 2022 May-Jun 01;46(3):487-491. Epub 2022 Mar 14.

From the Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO.

Objective: To gain better insight into the magnetic resonance imaging (MRI) appearance of morphological intervertebral disc (IVD) details, such as annular and nucleus pulposus dimensions, by comparing contemporaneously obtained MRI and postdiscogram computed tomography (CT) scans of nondegenerated IVDs.

Methods: Axial T2-weighted images and same-day postdiscography CTs, acquired after the MRI, of 26 normal-appearing lumbar IVDs (control IVDs at discography) were compared. The location and extent of central hyperintense zone on MRI and the extent of contrast distribution on CT relative to the IVD width (in anteroposterior [AP] and lateral planes) were assessed, with difference in measures between the modalities used to provide apparent inner annulus thickness and to estimate dimensions of also the outer annulus and location of nucleus pulposus. Read More

Adv Sci (Weinh) 2022 04 6;9(10):e2105466. Epub 2022 Feb 6.

Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, P. R. China.

Discography often destroys the hypoxic environment in the intervertebral disc and accelerates intervertebral disc degeneration (IVDD). Therefore, it often fails to meet the requirements for application in clinical practice. This technology mainly increases the reactive oxygen species (ROS) in the IVD. Read More

NMC Case Rep J 2021 10;8(1):189-194. Epub 2021 Jun 10.

Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan.

Discal cysts are rare intraspinal extradural cysts that communicate with the corresponding intervertebral discs, and the diagnosis is difficult to distinguish from other causes of low back pain and radiculopathy. Optimal management for this type of cyst has not been determined because of its rarity. Here, we report successful treatment of a discal cyst and lumbar disc herniation using full endoscopic surgery in a professional baseball player with a chief complaint of weakness in his left lower leg. Read More

Case Rep Orthop 2021 24;2021:5546530. Epub 2021 Dec 24.

Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan.

Objective: We report two cases of iatrogenic deterioration of lumbar foraminal disc herniations following lumbar disc injections. . Complications associated with discography were reported. Read More

Diagnostics (Basel) 2021 Dec 9;11(12). Epub 2021 Dec 9.

Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.

Neck and back pain is increasingly prevalent, and has increased exponentially in recent years. As more resources are dedicated to the diagnosis of pain conditions, it is increasingly important that the diagnostic techniques used are as precise and accurate as possible. Traditional diagnostic methods rely heavily upon patient history and physical examination to determine the most appropriate treatments and/or imaging studies. Read More

Eur Spine J 2021 Dec 2. Epub 2021 Dec 2.

Departmetn of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.

Purpose: It is suggested that non-specific low back pain (LBP) can be related to nerve ingrowth along granulation tissue in disc fissures, extending into the outer layers of the annulus fibrosus. Present study aimed to investigate if machine-learning modelling of magnetic resonance imaging (MRI) data can classify such fissures as well as pain, provoked by discography, with plausible accuracy and precision.

Methods: The study was based on previously collected data from 30 LBP patients (age = 26-64 years, 11 males). Read More

Korean J Pain 2021 Oct;34(4):447-453

Department of Neurosurgery, All India Institute of Medical Science, Bhopal, India.

Background: Provocative discography (PD) is a test that is useful in diagnosing discogenic pain (DP). In this study, to diagnose DP, we used a posterolateral approach of needle placement and followed pressure criteria laid down by the Spine Intervention Society. The aim was to identify the correlation between magnetic resonance imaging (MRI) findings (desiccation, high intensity zone and change in shape and size of the disc) and the results of PD. Read More

Sci Rep 2021 09 28;11(1):19195. Epub 2021 Sep 28.

Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.

Low back pain (LBP) is often a result of a degenerative process in the intervertebral disc. The precise origin of discogenic pain is diagnosed by the invasive procedure of provocative discography (PD). Previously, we developed quantitative chemical exchange saturation transfer (qCEST) magnetic resonance imaging (MRI) to detect pH as a biomarker for discogenic pain. Read More

Cureus 2021 Jul 11;13(7):e16308. Epub 2021 Jul 11.

Biomedical Engineering, SpineOvations, Linden, USA.

Background Low back pain (LBP) costs the healthcare system billions of dollars each year. Intervertebral disc (IVD) degeneration is a significant cause of LBP, due to structural defects, biomechanical instability, and inflammation. First-line therapy for patients with LBP includes physical therapy, medication, and steroid injections. Read More

Spine J 2022 02 2;22(2):226-237. Epub 2021 Aug 2.

Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.

Background Context: There are limited treatments for discogenic low back pain. Intradiscal injections of biologic agents such as platelet-rich plasma (PRP) or stem cells (SC) are theorized to have regenerative properties and have gained increasing interest as a possible treatment, but the evidence supporting their use in clinical practice is not yet well-defined.

Purpose: Determine the effectiveness of intradiscal biologics for treating discogenic low back pain. Read More

Spine (Phila Pa 1976) 2022 Mar;47(5):430-437

Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Study Design: Retrospective analysis of prospectively collected data.

Objective: To investigate whether intervertebral disc (IVD) image features, extracted from magnetic resonance (MR) images, can depict the extension and width of annular fissures and associate them to pain.

Summary Of Background Data: Annular fissures are suggested to be associated with low back pain (LBP). Read More

Front Bioeng Biotechnol 2021 9;9:676003. Epub 2021 Jun 9.

PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France.

Low back pain is a dramatic burden worldwide. Discography studies have shown that 39% of chronic low back pain patients suffer from discogenic pain due to a radial fissure of intervertebral disc. This can have major implications in clinical therapeutic choices. Read More

Pain Med 2021 08;22(8):1735-1742

Department or Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Objective: While provocation lumbar discography has been used to identify discs responsible for low back pain, the biomechanical effects of disc injection have received little attention. The purpose of this study was to assess the motion of the functional spinal unit including the endplate and facet/pedicle region during disc injection including comparison between normal and degenerative discs.

Subjects: Subjects represent 91 consecutive patients referred for discography with chronic low back pain. Read More

Front Med (Lausanne) 2021 18;8:622573. Epub 2021 Mar 18.

Canadian Centre for Regenerative Therapy, Toronto, ON, Canada.

Spinal degenerative joint disease (DJD) is associated with lower back pain (LBP) arising from the degeneration of intervertebral discs (IVD), facet joints, intertransversarii muscles, and interspinous ligaments among other anatomical structures. To circumvent the socioeconomic burdens and often-problematic surgical options imposed by DJD therapy, cell-based biologic modalities like bone marrow aspirate concentrate (BMAC) have been investigated in pre-clinical and clinical settings, mostly for IVD degeneration (IDD), with encouraging outcomes. In this study, we evaluated the differences in therapeutic benefits of BMAC between IVD- and facet joint-originating chronic LBP. Read More

J Mech Behav Biomed Mater 2021 06 16;118:104458. Epub 2021 Mar 16.

College of Engineering, Mathematics & Physical Sciences, Physics Building, Stocker Road, Exeter, EX4 4QL, UK.

Needle injection has been widely used in spinal therapeutic or diagnostic processes, such as discography. The use of needles has been suspected in causing mild disc degeneration which can lead to long-term back pain. However, the localised microscopic damage caused by needles has not been well studied. Read More

Spine J 2021 08 21;21(8):1268-1285. Epub 2021 Mar 21.

Department of Orthopaedic Surgery, Changi General Hospital, Singapore.

Objectives: Pars repair is less explored in adults due to associated disc degeneration with advancing age. The aim of our systematic review was to define optimal characteristics of adults with spondylolysis/grade-I spondylolisthesis suitable for pars repair and evaluate the feasibility, effectiveness, and safety of standard repair techniques in these adults.

Methods: This systematic review is reported in line with PRISMA-P and protocol is registered with PROSPERO (CRD42020189208). Read More

Pain Physician 2021 03;24(2):101-116

Department of Physiatry, Hospital for Special Surgery, New York, NY; Regenerative SportsCare Institute, New York, NY.

Background: Interventional spine procedures, such as discography, epidural steroid injections (ESIs), facet joint procedures, and intradiscal therapies, are commonly used to treat pain and improve function in patients with spine conditions. Although infections are known to occur following these procedures, there is a lack of comprehensive studies on this topic in recent years.

Objectives: To assess and characterize infections following interventional spine procedures. Read More

Neuroradiol J 2021 Aug 8;34(4):313-319. Epub 2021 Mar 8.

Division of Radiology, University Hospital Policlinico 'Tor Vergata', Italy.

Background And Purpose: Cervical discogenic pain originates from degenerated intervertebral discs and is a common condition in the middle-aged population. Cervical discs may herniate and give compressions to cervical nerves, with pain and functional limitation of the arms. DiscoGel is a device that can be useful in the treatment of cervical disc herniation, with very short operating time and low radiation dose. Read More

Medicine (Baltimore) 2021 Jan;100(3):e24026

Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, Wuhan, 430079, Hubei.

Rationale: Percutaneous endoscopic lumbar discectomy (PELD) is an effective treatment for lumbar disc herniation and postoperative discal pseudocyst (PDP) can rarely develop after PELD.

Patient Concerns: A 30-year-old man experienced low back pain and pain in the right lower extremity for 1 month, which aggravated for 3 days.

Diagnoses: Preoperative CT and MRI showed lumbar disc herniation at the L4/5 level. Read More

Br J Neurosurg 2020 Dec 22:1-6. Epub 2020 Dec 22.

Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China.

We presented a 47-year old male diagnosed as a discal cyst with concurrent isthmic lumbar spondylolisthesis, which was not reported in the literature previously. A cystectomy with two-segmental transforaminal lumbar interbody fusion and instruments was performed. The association between concurrent discal cyst and isthmic spondylolisthesis may be illuminated by excessive strain and focal degeneration of the disc. Read More

J Pain Res 2020 20;13:2125-2129. Epub 2020 Aug 20.

Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan.

Chronic neck pain has a high incidence and prevalence in urban society. Cervical disc-related chronic neck pain with its referred pain is one of the most common causes. Traditionally, pain caused by a cervical disc is diagnosed by fluoroscopy-guided provocative discography. Read More

Pain Med 2020 11;21(11):2719-2725

Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Objective: Discogenic pain is common cause of low back ache and may result in significant morbidity. Platelet-rich plasma (PRP) is an upcoming regenerative therapy that has treatment potential for this condition. The objective of this study was to correlate platelet concentration in intradiscal PRP injection with improvement in low back pain and functional status at three and six months. Read More

Spine (Phila Pa 1976) 2020 Nov;45(22):E1500-E1506

Department of Radiology, Sahlgrenska Academy, University of Gothenburg, Sweden.

Study Design: Retrospective analysis of prospectively collected data.

Objective: The aim of this study was to investigate whether spinal loading, depicted with magnetic resonance imaging (MRI), induces regional intervertebral disc (IVD) differences associated with presence and width of annular fissure and induced pain at discography.

Summary Of Background Data: Annular fissures play a role in low back pain (LBP) but cannot be accurately characterized with conventional MRI. Read More

Spine J 2021 01 18;21(1):71-79. Epub 2020 Jul 18.

Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Nadong-Gu, Incheon, 21565, South Korea.

Background Context: The diagnosis of discogenic low back pain (LBP) from disc degeneration of the lumbar spine is often evaluated with discography. Noninvasive, simple screening methods other than invasive discography are useful, as evidence supporting clinical findings and magnetic resonance imaging (MRI) have come to the forefront.

Purpose: To investigate disc height (DH) discrepancy between supine and standing positions on simple radiography to clarify its clinical screening value in individuals with discogenic LBP. Read More

Clin Spine Surg 2021 12;34(10):355-358

School of Medicine & Medical Science, University College Dublin.

World J Clin Cases 2020 Jun;8(11):2318-2324

Department of Spinal Surgery, the Third Medical Center, PLA General Hospital, Beijing 100039, China.

Background: Chronic neck pain is a common clinical problem. It has long been considered that degenerative cervical disc is an important source of chronic neck pain. In the clinic, cervical discography is thought to be a useful and safe method to distinguish aging discs from pathological discs, and the probability of complications caused by it is really rare. Read More