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Facet joint degeneration

A very recent study from 2019, 1 in the Journal of Biomechanics offered some interesting results. It set out to analyze the relationship between IVD intervertebral disc (IVD) and facet joint (FJ) degeneration with regards to chronic low back pain. The results suggested that FJ loading is significantly impacted by the early mechanical changes linked to IVD degeneration. However, the said impact decreased as the degeneration progressed.

What Was the Context?

LBP or low back pain has been researched to be the most common condition (musculoskeletal), negatively affecting humans around the world. The impact of LBP is psychological, physical, economic, and sociological. While a majority of LBP cases are non-specific or generalized (which at our company does not exist), individual research studies have identified several specific causes behind LBP. The most common of these causes are IVD degeneration as well as FJ degeneration. Even though genetics is considered to be a contributor to degeneration, an important role is played by the mechanical environment with regards to pathogenesis. Furthermore, as degenerative changes occur, so can the load transfer from the disc to facets and vice-versa. The present study decided to look deeper into this relationship.

The Study

The current research effort developed a parametric finite element (FE) model using ANSYS APDL of an L4-L5 human motion segment. A total of five loading scenarios were considered for this experiment. The degree of disc degeneration was analyzed for each model based on the ratio of the intact disc height to the actual disc height. A similar method was used for FJ degeneration. Four groups were made to cover grades 0 to 3; Grade 0 = non-degenerated disc, Grade 1 = mild degeneration, Grade 2 = moderately degenerated, and Grade 3 = severely degenerated.

The analysis was conducted using a custom Python code. Volumetric operations and imaging were done using the vtk module v6.3. The statistical module of the SciPy library was used for data analysis. (To understand more we advise getting a hold of the full text)

What Were the Results?

Of the total of 1000 models, 14 of them were excluded from further evaluation. This was because they didn’t converge in a single loading scenario. The remaining models showed some interesting results. In the four groups made for disc degeneration (from grade 0 to 3), the said groups, respectively, had 248, 245, 246, and 247 models. In the FJ group, it was 178, 427, 330, and 51.

In Grade 0, 141 showed non-degenerated FJ. Grade 1 had 106 mild degeneration of FJ. The FJ was moderately degenerated in only one sample in Grade 2. Coming to the mildly degenerated disc group, there was an affinity toward higher FJ degeneration grades. The moderately degenerated disc group showed four instances of non-degenerated faces, with 111 being Grade 1, 126 being Grade 2, and 5 being Grade 3. In the severely degenerated disc group, the results showed FJ degeneration in 27 instances in Grade 1, 174 in Grade 2, and 64 models in Grade 3. A strong association between intervertebral disc and facet joint degeneration was observed. A strong positive correlation was analyzed between the FJ gap as well as both the strain in the anterior annulus and the force acting on the IVD.

What was Concluded?

The results of the current study put forth a strong association between IVD degeneration and FJ. The results were backed by previous literature. The gap width of the FJ showed the strongest correlation with disc load (the load which comes through the IVD). The research team of this study agreed that FJ degeneration causes loading and abnormal motion of the IVD, leading to the latter’s degeneration.

Furthermore, the team observed a strong negative correlation existing between FJ capsule tension and disc degeneration. The results of the study suggested that early mechanical changes linked to IVD degeneration had a significant effect on FJ loading. Also, as the degeneration progressed, the said impact is decreased. FJ degeneration also continued to affect disc loading, pointing toward a possible increase in support of disc degeneration.

The results of the current research study tend to suggest that early mechanical changes linked to IVD degeneration have the highest effect on the FJ loading. And as the degeneration continues, the said effect is lowered, whereas FJ degeneration seems to increasingly influence the disc loading, which might indicate increasing support of the disc degeneration.

The research team hopes their efforts help others in further understanding the existing link between FJ and IVD degeneration.

 

 

 

 

spinal shrinkage

There’s some interesting data shared in a study 1 found in the journal of Physiotherapy Theory and Practice. It looked at the possible reversal of spinal shrinkage through press-ups and spinal loading.

Understanding Spinal Height and LBP

Press-up exercises are commonly recommended by clinicians for preserving spinal health as well as to lower changes of Low back pain (LBP). There’s still a lot of research required in the field of LBP to help millions of people around the globe.

Take note, degenerative lumbar intervertebral disc or IVD conditions are highly prevalent in asymptomatic individuals aged 10 to 29 years. According to past studies, spinal degeneration is associated with spinal height loss and thus, leading to LBP, nerve root compression syndrome, and spinal stenosis.

What was the Objective?

The said study was conducted to investigate whether or not sustained, and repetitive prone press-ups (following spinal loading) could possibly play a role in reversing decreased spinal height. It was also to monitor any possible correlation between spinal height gains and the degree of end range of motion spinal extension.

seated unloading

Seated unloading research in The Spine Journal referenced in this article , Jerome Fryer lead author, owner of Dynamic Disc Designs Corp.

The Study

A Pretest-posttest crossover design was implemented for the current study. A total of 32 participants (20 females and 12 males) were a part of it. The participants (between 20 to 45 years of age) were asymptomatic with no current complaints of spinal related symptoms. They had no history of LBP.

The study involved participants being seated in the stadiometer. They sat for 5 minutes with a 4.5-kg weight placed on each shoulder. The said load was removed for 5 minutes. A stadiometer was used to measure the participant’s spinal height before and after 5 minutes of sustained or repetitive prone press-ups.

This study used Two-by-two repeated-measures ANOVA. This was done to identify any possible significant interactions as well as main effects.

What were the Results?

The results of the study showed that there wasn’t a significant interaction present between sustained vs repetitive press-ups as well as the time before and after each prone press-up strategy and no main effect for strategy (repetitive vs. sustained press-ups).

However, a significant main effect for time (after vs. before press-ups) was observed. Furthermore, no correlation was seen between spinal height changes and the degree of end ROM spinal extension after press-up strategies.

The Limitations

This involved the measurements being taken at different times during the day. Also, the sample size of 32 participants didn’t achieve the projected number of 34.

What does it all mean?

The conclusion offered by this study was that spinal height was increased by repetitive and sustained press-ups following a period of spinal loading.

The study’s conclusion put forth the observation that such strategies could be utilized to aid in recovering spinal height as well as to reduce the effects associated with decreased spinal height due to certain daily activities.

Lumbar Spinal Stenosis Model

Due to the differences between Degenerative Disc Disease and Disc Prolapse not being well-known, with regards to patterns of Lumbar Disc Degeneration, a study 1 was conducted to find some answers. The study shared results (it suggested) would help with better disc degeneration-related treatments.

Why was it Conducted?

According to the current study, there a lot of inconclusiveness in the field of lumbar disc degeneration. This is particularly true when focusing on lumbar disc degeneration’s pathogenesis, prevention, management, etiology, and symptomatology. DDD (degenerative disc disease) and DP (disc prolapse) are two of the common ailments that affect lumbar discs. While these two ailments do manifest differently (in a clinical sense), numerous studies tend to include both and thus, have led to varying observations.

The current study was conducted to better evaluate the possible link between DP and DDD. The objective was to analyze lumbar disc degeneration patterns in patients with acute DP and those with chronic back pain and DDD.

The Study

This was a prospective, magnetic resonance imaging-based radiological study. Two groups of participants (aged between 20 to 50 years) were studied. Group 1 was made of 91 participants that required a single level microdiscectomy for acute DP. 133 Participants with chronic low back pain and DDD were part of Group 2. The study assessed discs by MRI through Pfirmann grading, Schmorl nodes, Modic changes, and the total end-plate damage score for all the five lumbar discs.

What were the Results?

The study’s results showed there were significant differences between DDD and DP patients with regards to the extent, number, and severity of degeneration. A significantly higher number of degeneration discs were analyzed in DDD patients compared to DP patients. The DDD group also showed a higher incidence of multilevel and pan-lumbar degeneration. The DP patients had lower lumbar degeneration while it was upper lumbar involvement in the DDD group. Modic changes were also observed to be more common in DP patients. Furthermore, both groups showed a positive correlation for the total end-plate damage score with disc degeneration.

What does it Mean?

The results of the study suggested that patients with DP as well as the ones with back pain and DDD were radiologically and clinically different groups. They varied when it came to the severity, pattern, and extent of disc degeneration. Understanding the differences between the two groups of patients could help with future studies when dealing with disc degeneration.