• Title, Summary, Keyword: Disc degeneration

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Scoring System for Factors Affecting Aggravation of Lumbar Disc Herniation

  • Lee, Sung Wook;Kim, Sang Yoon;Lee, Jee Young
    • Investigative Magnetic Resonance Imaging
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    • v.22 no.1
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    • pp.18-25
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    • 2018
  • Purpose: To investigate the various imaging factors associated with aggravation of lumbar disc herniation (LDH) and develop a scoring system for prediction of LDH aggravation. Materials and Methods: From 2015 to 2017, we retrospectively reviewed the magnetic resonance imaging (MRI) findings of 60 patients (30 patients with aggravated LDH and 30 patients without any altered LDH). Imaging factors for MRI evaluation included the level of LDH, disc degeneration, back muscle atrophy, facet joint degeneration, ligamentum flavum thickness and interspinous ligament degeneration. Flexion-extension difference was measured with simple radiography. The scoring system was analyzed using receiver operating characteristic (ROC) analysis. Results: The aggravated group manifested a higher grade of disc degeneration, back muscle atrophy and facet degeneration than the control group. The ligamentum flavum thickness in the aggravated group was thicker than in the group with unaltered LDH. The summation score was defined as the sum of the grade of disc degeneration, back muscle atrophy and facet joint degeneration. The area under the ROC curve showing the threshold value of the summation score for prediction of aggravation of LDH was 0.832 and the threshold value corresponded to 6.5. Conclusion: Disc degeneration, facet degeneration, back muscle atrophy and ligamentum flavum thickness are important factors in predicting aggravation of LDH and may facilitate the determination of treatment strategy in patients with LDH. The summation score is available as supplemental data.

Biomechanical Behaviors of Disc Degeneration on Bending Loads (굽힘하중에 대한 퇴행성 추간판의 생체역학적 특성 분석)

  • Lee, Hyun-Ok;Lee, Sung-Jae;Shin, Jung-Woog
    • The Journal of Korean Physical Therapy
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    • v.13 no.1
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    • pp.1-18
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    • 2001
  • Aging has been recognized as the primary cause of disc degeneration. A biomechanical characteristics of disc degeneration has been demonstrated that intradiscal pressure is reduced. With the increasing population of elderly people, disc degeneration and associated problems of nerve entrapment are becoming more prevalent. Presently, research on reduced intradiscal pressure associated with degeneration is insufficient. In this study. we used the Finite Element Method (FEM) of computerized simulations to investigate the effects of variation in intradiscal pressure on mechanical behaviours of L4-5 intervertebral disc degeneration. Degeneration was classified using four grades based on initial intradiscal pressure; Normal (135 kPa), mild(107 kPa), moderate (47 kPa) and severe (15 kPa). The predicted results f3r bending loads were as follows; 1 . Range of motion increased progressively with severity of degeneration with flexion and lateral bending moments, but decreased with extension moments. 2. Discal bulging of posterolateral aspect was larger in lateral bending and extension moment. But bulging was increased with severity of degeneration in lateral bending and torsion(same side).3. The rate of increasing intradiscal pressure was decreased in all bending motions with severity of degeneration. In conclusion, lateral bending and extension moment yield greatest bulging in severe degeneration. In torsion, although bending load produces disc bulging, disc bulging was associated more strongly with severity of degeneration than increasing torsional moments. Clinical Implications: Discal bulging may produce nerve root impingement and irritation. The effect of loading and posture on the varying degrees of disc degeneration has important implications especially in the elderly. In the presence of disc degeneration, avoidance of end range postures, especially extension and lateral bending may help reduce discal bulging and in turn, nerve entrapment.

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Rabbit Model for in vivo Study of Intervertebral Disc Degeneration and Regeneration

  • Kong, Min-Ho;Do, Duc-H.;Miyazaki, Masashi;Wei, Feng;Yoon, Sung-Hwan;Wang, Jeffrey C.
    • Journal of Korean Neurosurgical Society
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    • v.44 no.5
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    • pp.327-333
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    • 2008
  • Objective: The purpose of this study is to verify the usefulness of the rabbit model for disc degeneration study. Materials: The L1-L2, L2-L3, L3-L4. or L4-L5 lumbar intervertebral disc (IVD) of 9 mature male New Zealand White rabbits were injured by inserting a 16-gauge needle to a depth of 5 mm in the left anterolateral annulus fibrosus while leaving L5-L6 IVD uninjured. Three other rabbits also received intradiscal injections of rabbit disc cells transfected with adenovirus and bone morphogenetic protein-2 (ad-BMP-2) at L4-L5 in addition to injury by 16-gauge needle at the L1-L2 level. Using digitized radiographs, measurements of IVD height were made and analyzed by using the disc height index (DHI). Magnetic resonance imaging (MRI) scans of the injured discs, injected discs, and uninjured L5-L6 discs were performed at 15 weeks post surgery and compared with preoperative MRI scans. Results: All twelve rabbits showed consistent results of disc degeneration within 15 weeks following annular puncture. DHIs of injured discs were significantly lower than that of the uninjured L5-L6 discs (p<0.05). The mean value of disc degeneration grade of injured discs was significantly higher than that of uninjured discs (p<0.05). The injection of disc cell transfected with ad-BMP-2 did not induce disc regeneration at 15 weeks after injection. Conclusion: This study showed that the injured disc had a significant change in DHI on simple lateral radiograph and disc degeneration grade on MRI scans within 15 weeks in all rabbits. Rabbit annular puncture model can be useful as a disc degeneration model in vivo.

Comparison of the Extent of Degeneration among the Normal Disc, Immobilized Disc, and Immobilized Disc with an Endplate Fracture

  • Choi, Wonki;Song, Sukkyun;Chae, Seungbum;Ko, Sangbong
    • Clinics in Orthopedic Surgery
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    • v.9 no.2
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    • pp.193-199
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    • 2017
  • Background: This study attempts to prove a cause and effect relationship between spine immobilization following posterior fixation for unstable burst fractures and degeneration observed following hardware removal. Methods: We enrolled 57 patients (259 intervertebral discs [IVDs]) who underwent only posterior instrumentation without fusion for thoracolumbar and lumbar unstable burst fractures. We arbitrarily named the IVD that has an endplate fracture after immobilization using pedicle screws as the fractured endplate and immobilized disc (FEID), the IVD that has no endplate fracture after immobilization using pedicle screws as the nonfractured endplate and immobilized disc (NFEID), and the IVD that has no endplate fracture and no immobilization instrumentation as the normal disc (ND). At 2 years after implant removal, magnetic resonance imaging (MRI) was performed again for comparison. The extent of disc degeneration was classified using the Pfirrmann classification system. Results: FEIDs were present in 67 levels, NFEIDs in 78 levels, and NDs in 114 levels. According to the Pfirrmann classification, 7.9% of the NDs, 32.1% of the NFEIDs, and 43.3% of the FEIDs were more degenerated at 2 years after implant removal. The FEIDs and NFEIDs were more degenerated than the NDs and the FEIDs were more degenerated than the NFEIDs at statistically significant levels (p < 0.001 for both). Conclusions: Spine immobilization with transpedicular screws has a significant influence on disc degeneration, and an endplate fracture accelerates the degeneration process.

A Minimally Invasive Rabbit Model of Progressive and Reproducible Disc Degeneration Confirmed by Radiology, Gene Expression, and Histology

  • Kwon, Young-Joon
    • Journal of Korean Neurosurgical Society
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    • v.53 no.6
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    • pp.323-330
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    • 2013
  • Objective : To develop a simple, reproducible model of disc degeneration in rabbits through percutaneous annular puncture and to confirm the degree of degeneration over time. Methods : Fifteen New Zealand white rabbits (4 to 5 months old and weighing approximately 3 to 3.5 kg each) underwent annular puncture of the L2-L3, L3-L4, and L4-L5 discs. Rabbits were sacrificed at 4, 8, or 20 weeks after puncture. For a longitudinal study to assess changes in disc height over time, serial X-rays were performed at 0, 2, 4, 8, and 20 weeks for rabbits in the 20-week group. Upon sacrifice, the whole spinal column and discs were extracted and analyzed with magnetic resonance imaging (MRI), real time reverse transcriptase-polymerase chain reaction, and histological staining. Results : The X-rays showed a slow, progressive decrease in disc height over time. Significant disc space narrowing compared to preoperative disc height was observed during the time period (p<0.001). The MRI grade, aggrecan, and matrix metalloprotease-13 mRNA expression and hematoxylin and eosin/safranin O/anti-collagen II staining were consistently indicative of degeneration, supporting the results of the X-ray data. Conclusion : Percutaneous annular puncture resulted in slow, reproducible disc degeneration that was confirmed by radiology, biochemistry, and histology. This in vivo model can be used to study and evaluate the safety and efficacy of biologic treatments for degenerative disc disease.

Prevalence of Disc Degeneration in Asymptomatic Korean Subjects. Part 1 : Lumbar Spine

  • Kim, Sang Jin;Lee, Tae Hoon;Lim, Soo Mee
    • Journal of Korean Neurosurgical Society
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    • v.53 no.1
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    • pp.31-38
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    • 2013
  • Objective : Asymptomatic patients show high degeneration prevalence at lumbar disc in previous literatures. Unfortunately, there are few Korean data, so the authors attempted to analyze the prevalence of disc degeneration in highly selective asymptomatic Korean subjects using MRI. Methods : We performed 3 T MRI sagittal scans from T12 to S1 on 102 asymptomatic subjects (50 men and 52 women) who visited our hospital between the ages of 14 and 82 years (mean age 46.3 years). All images were read independently by three observers (two neurosurgeons and one neuroradiologist) who were not given any information about the subjects. We classified grading for lumbar disc herniation (HN), annular fissure (AF), and nucleus degeneration (ND), using disc degeneration classification. Results : The prevalence of HN, AF, and ND were 81.4%, 76.1%, and 75.8% respectively. Almost all levels showed an age-related proportional tendency with some exceptions. Conclusion : In asymptomatic Korean subjects, the abnormal findings showed high prevalence of AF, ND, and extrusion. Especially in young ages, the authors found that bulging, protrusion, and AF showed high prevalence at L4/5 and L5/S1. And ND showed high prevalence at L5/S1. So, all lumbar disc degenerations are not pathologic, especially in children and adolescents.

Analysis of Disc Degeneration in a Poroelastic Spinal Motion Segment FE Model (다공탄성체 척추운동분절 유한요소 모델을 이용한 추간판의 퇴화과정 분석)

  • Woo D.G.;Kim Y.E.
    • Proceedings of the Korean Society of Precision Engineering Conference
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    • pp.248-251
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    • 2005
  • To investigate the degeneration process in the intervertebral disc, a three dimensional (3D) poroelastic finite-element (FE) model was developed. Disc was modeled as two different regions, such as annulus modeled with fiber reinforced 20 node poroelastic ground matrix and nucleus having large porosity. Excess Von Mises stress in the disc element assumed to be a possible source of degeneration under compressive loading condition. Recursive calculation was continued until the desired convergence was attained by changing the permeability and porosity of those elements, which could be predicted from the previous iteration. The degenerated disc model showed that relatively small compressive stresses were generated in the nucleus elements compared to normal disc. Its distribution along the sagittal plane was matched well with a previously reported experimental result. Contrasts to this result, pore pressures in the nucleus were higher than those in the normal disc. Total stress indicated similar values for two different models. This new approach using poroelastic modeling could provide the explanation of the interaction between fluid and solid matrix in the disc during the degeneration process.

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Roentgenographic Analysis of Cervical Lordosis and Disc Degeneration in Neck Pain Patients with or without Low Back Pain (요통 유무에 따른 경항통 환자의 경추 전만각 퇴행성 변화 비교분석)

  • Lee, Sang-Ho;Chung, Seok-Hee;Lee, Jong-Soo;Kim, Sung-Soo;Shin, Hyun-Dae
    • The Journal of Korea CHUNA Manual Medicine
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    • v.2 no.1
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    • pp.85-92
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    • 2001
  • Objectives : To study the cervical lordosis and disc degeneration in neck pain patients with or without low back pain. Subjects. The study was composed of 57 neck pain patients with low back pain(LBP group) and 40 neck pain patients without low back pain(Non-LBP group). Methods : Radiographic measures of spinal lordosis(cervical and lumbar) and disc degeneration were collected, and statistically analyzed. Results: LBP group showed a significant increase in cervical lordotic angle as compared with Non-LBP group, whereas no significant change in cervical disc degeneration. A relationship was found between cervical and lumbar disc degeneration in LBP $group({\gamma}-0.3064)$. Conclusions : The findings from this study suggest that the curvature of the cervical spine is related to the subject's low back pain.

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Prevalence of Disc Degeneration in Asymptomatic Korean Subjects. Part 2 : Cervical Spine

  • Lee, Tae Hoon;Kim, Sang Jin;Lim, Soo Mee
    • Journal of Korean Neurosurgical Society
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    • v.53 no.2
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    • pp.89-95
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    • 2013
  • Objective : Similar to back pain, neck pain has recently shown to have increasing prevalence. Magnetic resonance imaging (MRI) is useful in identifying the causes of neck pain. However, MRI shows not only pathological lesions but also physiological changes at the same time, and there are few Korean data. The authors have attempted to analyze the prevalence of disc degeneration in highly selective asymptomatic Korean subjects using MRI. Methods : We performed 3 T MRI sagittal scans from C2 to T1 on 102 asymptomatic subjects (50 men and 52 women) who visited our hospital between the ages of 14 and 82 years (mean age 46.3 years). All images were read independently by three observers (two neurosurgeons and one neuroradiologist) who were not given any information about the subjects. We classified grading for cervical disc herniation (HN), annular fissure (AF), and nucleus degeneration (ND), using disc degeneration classification. Results : The prevalence of HN, AF, and ND were 81.0%, 85.9%, and 95.4%, respectively. High prevalence of HN, AF, and ND was shown compared to previous literature. Conclusion : In asymptomatic Korean subjects, the abnormal findings of 3 T MRI showed a high prevalence in HN, AF, and ND. Several factors might play important roles in these results, such as population-specific characters, MRI field strength, and disc degeneration grading system.

Disparity between MR Imaging and Histochemical Grading in Human Intervertebral Disc Degeneration

  • Lee, June-Ho;Chung, Chun-Kee;Kim, Hyun-Jib
    • Journal of Korean Neurosurgical Society
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    • v.39 no.6
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    • pp.432-437
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    • 2006
  • Objective : In order to establish the index of degeneration, the authors performed a histochemical study with Safranin-O staining and investigated the occurrence of apoptosis in the human intervertebral disc. Methods : Eighteen intervertebral disc specimens surgically extracted from the patients and two additional specimens from the autopsied cases were stained with Safranin-O for proteoglycan according to a standard protocol. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate- biotin nick end labeling[TUNEL] was used to detect the fragmented DNA known to be associated with apoptotic cell death and classification scheme was formulated for categorization of the degree of Safranin-O staining [normal, moderate reduction, faint] by modification of Makin's histological-histochemical grading. The Kruskal-Wallis H test and Chi-square test were used for statistical analysis. Results : The statistical results showed a significant difference in the mean age between "normal" Safranin-O staining group and the others [19.3 versus 55, 43.4, p=0021]. However, there was no statistically significant correlation between Safranin-O staining and MR grading of disc degeneration. Only six of eighteen surgical specimens and none in autopsies showed positive apoptotic cells in TUNEL staining. Conclusion : The determination of the degree of degeneration in surgically obtained disc tissue per se by histochemical staining or by the degree of apoptosis that corresponds to its morphologic change was not feasible.