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Effects of alendronateon lumbar intervertebral disc degeneration with bone loss in ovariectomized rats

Publication date: Available online 10 March 2017
Source:The Spine JournalAuthor(s): Huiping Song, Yang Luo, Wenya Wang, Shuyang Li, Kai Yang, Muwei Dai, Yong Shen, Yingze Zhang, Liu ZhangBackground Context Osteoporosis adversely affects disc degeneration cascades, and prophylactic alendronate (ALN) helps delay intervertebral disc degeneration (IDD) in ovariectomized (OVX) rats. However, there remains no information regarding whether ALN affects IDD with bone loss. PurposeThis study aimed to observe the effects of ALN on degenerative discs with bone loss induced by OVX in rats. Study Design Controlled in vivo experiments in rodents. Methods Thirty female Sprague-Dawley rats were randomly assigned to undergo sham surgery (n=10) or OVX surgery (n=20); 3 months later, the OVX animals were injected with either ALN (OVX+ALN, 15µg/kg/2w, n=10) or normal saline (OVX+V, n=10). At 3 months after the ALN intervention, van Gieson staining and immunohistochemistry were used to investigate histological and metabolic changes in the discs. Bone mineral density (BMD), micro-CT and biomechanical tests were conducted to determine the biological properties of the vertebrae. Results The OVX+ALN group exhibited significantly reduced morphological degenerative alterations in both the nucleus pulposus and annulus fibrosus, with a markedly lower IDD score than that of the OVX+V group. The OVX+ALN samples showed increased disc height and decreased cartilage endplate thickness and bony area compared with the OVX+V group. Compared with saline, ALN administration markedly inhibited the type I collagen, matrix metalloprotease (MMP)-1 and MMP-13 expression levels while increasing the type II collagen and aggrecan expression levels in the disc matrix. OVX+ALN vertebrae revealed significantly enhanced BMD with increased biomechanical strength, as well as increased percent bone volume and trabecular thickness, compared with the OVX+V group. Conclusions ALN has favourable effects on disc degeneration with bone loss and helps to alleviate IDD while enhancing the biological and mechanical properties of vertebrae and endplates.

Chronic low back pain and the risk of depression or anxiety symptoms: Insights from a longitudinal twin study

Publication date: Available online 4 March 2017
Source:The Spine JournalAuthor(s): Matt Fernandez, Lucia Colodro-Conde, Jan Hartvigsen, Manuela L. Ferreira, Kathryn M. Refshauge, Marina B. Pinheiro, Juan R. Ordoñana, Paulo H. FerreiraBackground context Pain is commonly associated with symptoms of depression or anxiety, although this relationship is considered bi-directional. There is limited knowledge regarding causal relationships. Purpose To investigate whether chronic low back pain (LBP) increases the risk of depression or anxiety symptoms, after adjusting for shared familial factors. Study Design A longitudinal, genetically informative study design from the Murcia Twin Registry in Spain. Patient Sample Patient sample included 1269 adult twins with a mean age of 53 years. Outcome MeasuresThe outcome of depression or anxiety symptoms was evaluated with EuroQol (EQ-5D) questionnaire. Methods Using logistic regression analyses, twins were initially assessed as individuals in the total sample analysis, followed by a co-twin case-control, which partially [dizygotic twins (DZ)] and fully [monozygotic twins (MZ)] adjusts for shared familial factors. There was no external funding for this study and no conflict of interest is declared. Results There was a significant association between chronic LBP and the risk of depression or anxiety symptoms in the unadjusted total sample analysis – odds ratio (OR): 1.81 (95% Confidence Interval [CI]: 1.34 – 2.44). After adjusting for confounders, the association remained significant (OR: 1.43 (95% CI: 1.05 – 1.95), although adjusted co-twin case-control were non-significant in DZ (OR: 1.03, 95% CI: 0.50-2.13) and MZ twins (OR: 1.86, 95% CI: 0.63-5.51). Conclusion The relationship between chronic LBP and the future development of depression or anxiety symptoms is not causal. The relationship is likely to be explained by confounding from shared familial factors, given the non-statistically significant associations in the co-twin case-control analyses.

The prevalence of spinal epidural lipomatosis on magnetic resonance imaging

Publication date: Available online 3 March 2017
Source:The Spine JournalAuthor(s): Nina C. Theyskens, Nuno Rui Paulino Pereira, Stein J. Janssen, Christopher M. Bono, Joseph H. Schwab, Thomas D. ChaBackground Spinal epidural lipomatosis (SEL) refers to an excessive accumulation of fat within the epidural space. It can be idiopathic or secondary, resulting in significant morbidity. The prevalence of SEL, including idiopathic and secondary SEL, and its respective risk factors are poorly defined. We therefore sought to: (1) assess the prevalence of SEL among patients who underwent a dedicated Magnetic Resonance Imaging (MRI) scan of the spine –including: incidental SEL (i.e. SEL without any spine-related symptoms), SEL with spine-related symptoms, and symptomatic SEL (i.e. with symptoms specific for SEL), and (2) assess factors associated with overall SEL and subgroups. In addition, we assessed differences between SEL subgroups. Methods We reviewed the records of 28,902 patients, aged 18 years and older with a spine MRI (2004 to 2015) at two tertiary care centers. We identified SEL cases by searching radiology reports for spinal epidural lipomatosis, including synonyms and misspellings. Prevalence numbers were calculated as a percentage of the total number of patients. We used multivariate logistic regression analysis to identify factors associated with overall SEL and subgroups. Results The prevalence of overall SEL was 2.5% (731/28,902): incidental SEL 0.6% (168/28,902), SEL with symptoms 1.8% (526/28,902), and symptomatic SEL 0.1% (37/28,902). Factors associated with overall SEL in multivariate analysis were: older age (OR: 1.01 95%CI: 1.01 – 1.02, p < 0.001), higher Modified Charlson Comorbidity Index (OR: 1.10, 95%CI: 1.07 – 1.13, p < 0.001), male sex (OR: 2.01, 95%CI: 1.71 – 2.37, p < 0.001), BMI > 30 (OR: 2.59, 95%CI: 1.97 – 3.41, p < 0.001), Black/African American race (OR: 1.66, 95%CI: 1.24 – 2.23, p = 0.001), systemic corticosteroid use (OR: 2.59, 95%CI: 1.69 – 3.99, p < 0.001), and epidural corticosteroid injections (OR: 3.48, 95%CI: 2.82 – 4.30, p < 0.001).Conclusions We found that about 1 in 40 patients undergoing a spine MRI had SEL; 23% of whom with no symptoms, 72% with spine-related symptoms, and 5% with symptoms specific for SEL. Our data help identify patients that might warrant an increased index of suspicion for SEL.

Editorial Board

Publication date: March 2017
Source:The Spine Journal, Volume 17, Issue 3, Supplement
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