• Journal of Korean Neurosurgical Society
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• 제29권2호
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• pp.180-187
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• 2000

Objective : A number of evidence have suggested a pivotal role of matrix metalloproteinases(MMP) on the degeneration of intervertebral disc. Proteins of intervertebral disc mainly consist of collagen and proteoglycan. These proteins can be destructed by MMP, resulting in changes of main collagen type and degeneration of matrix proteins. The present study was to determine the different effects of MMP-1 and MMP-2 on the degenerative spinal diseases, resulting from aging process. Clinical Materials & Methods : Thirty-one patients were randomly selected among 350 patients whose discs were resected during operation from March 1997 to February 1999. Patients were divided into two groups: group I with spinal stenosis and group II with herniated intervertebral disc. Group II was subdivided into the ruptured(Group Iia) and unruptured(Group Iib). Increases in MMP-1 immunopositive cells were observed in both groups, as evidenced by immunocytochemical staining. However, in marked contrast, the number of MMP-2 immunopositive cells were only seen in group II. There was no significant difference between Group IIa and Group IIb. The MMP-2 immunopositive cells were increased in the anulus fibrosus of ruptured(Group Iia) more than unruptured(Group Iib), but statistically it was not significant. In addition, the immunopositivity of MMP-1 and MMP-2 was proportional to patients's age. Conclusion : These results strongly suggests the possible involvement of MMP-2, but not MMP-1 in progressive herniated intervertevral disc.

• Physical Therapy Rehabilitation Science
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• 제10권2호
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• pp.235-243
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• 2021

Objective: This study aimed to investigate the short-term effects of flexion-distraction spinal manipulation on intervertebral height, pain, spine mobility in patients with lumbar degenerative disc disease. Design: Randomized controlled trial with a pretest-posttest control group design Methods: A total of 96 participants with degenerative disc disease participated in the study and were randomly divided into two groups. Both groups received intervention for 3-5 minutes a day. The experimental group (n=48) underwent flexion-distraction spinal manipulation for 3-5 minutes, and the control group (n=48) was maintained in the same position as the experimental group for 5 minutes without any intervention. The intervertebral height was measured by computed tomography, pain was assessed using visual analog scale, and the spine in flexion mobility was measured using the finger-to-floor distance test and passive straight leg raise test. Pre-test and post-test measurements were obtained. Results: The experimental group showed significant improvement in intervertebral height, degree of pain, and spinal mobility (p<0.05). The intervertebral height increased from 6.32±1.90 to 6.93±1.85 mm (p<0.05), lower back pain decreased from 69.17±13.35 mm to 48.48±12.20 mm (p<0.05), lumbar spine mobility changed from 17.37±4.49 to 12.69±4.34 cm (p<0.05), and passive straight leg raise test range increased from 46.94±13.05° to 56.01±12.20° (p<0.05). Conclusions: This study suggests that flexion-distraction spinal manipulation could be an effective treatment for decreasing pain and improving function in patients with degenerative disc disease.

• Journal of Korean Neurosurgical Society
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• 제53권4호
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• pp.207-212
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• 2013

Objective : Recent studies have shown encouraging progress toward the use of autogenic and allogenic mesenchymal stem cells (MSCs) to arrest, or even lead to partial regeneration in, intervertebral disc (IVD) degeneration. However, this technology is still in its infancy, and further development is required. The aim of this study was to analyze whether rat adipose-derived mesenchymal stem cells (ADMSC) can differentiate towards IVD-like cells after treatment with transforming growth factor ${\beta}3$ (TGF-${\beta}3$) in vitro. We also performed quantitative analysis of gene expression for ADMSC only, ADMSCs treated with TGF-${\beta}3$, and co-cultured ADMSCs treated with TGF-${\beta}3$. Methods : ADMSCs were sub-cultured to homogeneity and used in fluorocytometry assays for CD11, CD45, and CD90/Thy1. ADMSCs were differentiated in spheroid culture towards the chondrogenic lineage by the presence of TGF-${\beta}3$, dexamethasone, and ascorbate. We also co-cultured pure ADMSCs and nucleus pulposus cells in 24-well plates, and performed immunohistochemical staining, western blotting, and RT-PCR for quantitative analysis of gene expression. Results : Results of fluorocytometry were positive for CD90/Thy1 and negative for CD11 and CD45. TGF-${\beta}3$-mediated induction of ADMSCs led to the expression of the differentiation markers of intervertebral disc-like cells, such as aggrecan, collagen II, and sox-9. Co-cultured ADMSCs treated with TGF-${\beta}3$ showed higher expression of differentiation markers and greater extracellular matrix production compared with ADMSCs treated with TGF-${\beta}3$ alone. Conclusion : ADMSC treated with TGF-${\beta}3$ may be an attractive source for regeneration therapy in degenerative IVD. These findings may also help elucidate the pathologic mechanism of MSC therapy in the degeneration of IVD in vivo.

• 대한정형도수물리치료학회지
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• 제16권2호
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• pp.88-92
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• 2010

Purpose: This study was undertaken to evaluate the effect analysis of clinical sing in 40 patients with lumbar intervertebral disc. Methods: All patients were assessed by the low back pain protocol which was composed of symptom, clinical sing before and after the treatment. The effect of clinical sing was analyzed by age, occupation, duration of symptom. Results: Occupation by clinical sing of after the treatment was desking job s from 3.6 to 5.2 scores(p<0.05). Duration of symptoms by clinical sing of after the treatment was over 4 months from 3.8 to 5.5 scores(p<0.05). Clinical sing of after the treatment was straight leg raising test from 1.275 to 1.850 scores, sensory disturbances from 1.425 to 2.575 scores, manual muscle testing from 1.525 to 4.625 scores. Conclusion: Herniated disks are most common in middle age, especially between 35 and 45, due to aging-related degeneration of the disks. Significant or increasing pain, numbness or weakness spreading to one or both legs. Progressive loss of sensation in areas that would touch a saddle (inner thighs, back of legs and area around the rectum).

• The Journal of Korean Physical Therapy
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• 제12권3호
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• pp.455-467
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• 2000

The purpose of this study was to analyse the effects of disc degeneration on the biomechanical behaviors of the intervertebral disc in term of axial displacement, intradiscal pressure. disc bulge at the 1.4-1.5 functional spinal unit(FSU). The degeneration is divided 4 grade by initial intradiscal pressure: normal: 135kPa. mild: 107kPa. moderate: 47kPa, severe: 15kPa, The predicted results were follows: 1. The magnitude of the bulge is found to be maximum at the anterior, minimum at the postero-lateral portion. The bulge of lateral, postero-lateral is found to be maximum in severe grade. followed by moderate. mild, normal grade. 2. Tho displacement was increased with increasing compressive load in all four grades.'rho stiffness of disc was found to be reduced by progressing from normal to severe grade. 3. The intradiscal pressure was increased nearly linearly with increasing compressive load in normal and mild grade. But the increasing rate in moderate and severe grade was showed apparently different from nomal and mild grade. Specially, it was increased very slightly in severe grade. In conclusion, decreased intradiscal pressure resulted in increase of axial displacement and disc bulge with compressive load increasing. these may compromise the nerve root impingement or irritation. Therefore posture and activities must be focus to reduce compressive load applied on the back or disc.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.69-77
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• 2021

Objective : Classification systems for cervical ossification of the posterior longitudinal ligament (OPLL) have traditionally focused on the morphological characteristics of ossification. Although the classification describes many clinical features associated with the shape of the ossification, including the concept of spondylosis seems necessary because of the similarity in age distribution. Methods : Patients diagnosed with OPLL who presented with increase signal intensity (ISI) on magnetic resonance imaging were surgically treated in our department. The patients were divided into two groups (pure versus degenerative) according to the presence of disc degeneration. Results : Of 141 patients enrolled in this study, more than half (61%) were classified into the degenerative group. The pure group showed a profound male predominance, early presentation of myelopathy, and a different predilection for ISI compared to the degenerative group. The mean canal compromise ratio (CC) of the ISI was 47% in the degenerative group versus 61% in the pure group (p<0.0000). On the contrary, the global and segment motions were significantly larger in the degenerative group (p<0.0000 and p=0.003, respectively). The canal diameters and global angles did not differ between groups. Conclusion : Classifying cervical OPLL based on the presence of combined disc degeneration is beneficial for understanding the disorder's behavior. CC appears to be the main factor in the development of myelopathy in the pure group, whereas additional dynamic factors appear to affect its development in the degenerative group.

• The Korean Journal of Pain
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• 제34권4호
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• pp.447-453
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• 2021

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. Methods: Records of 50 patients who underwent PD for DP were analyzed. A total of 109 PDs were performed, with 54 suspect and 55 control discs. Alternate pain generators were ruled out. Results: A total of 35 suspect discs were positive on PD. The mean disc pressure in the suspect disc was 31.9 ± 7.9 psi (range, 15-44). Of the 50 patients who underwent PD, 35 had positive MRI findings. A significant positive correlation was found only between disc desiccation and discography result (r = 0.6, P < 0.001). Logistic regression analysis revealed that only desiccation successfully predicted the result of discography (OR = 26.5, P < 0.001); a high intensity zone and a disc protrusion/extrusion had an OR 2.3 and 1.24, respectively. Disc desiccation of Pfirmann grade 3 or more had a sensitivity and specificity of 0.93 and 0.64 respectively in identifying painful discs; the positive likelihood ratio was 2.58 while the negative likelihood ratio was 0.11. Conclusions: In patients with DP, disc desiccation is the most useful MRI feature that predicts a painful disc on PD.

• 척추신경추나의학회지
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• 제6권2호
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• pp.13-22
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• 2011

Objectives : The purpose of this study is to find out the characteristics of intervertebral disc changes and relative factors of the spondylolisthesis patients in fifties by type of spondylolisthesis. Methods : We investigated 69 cases of patients who visited one Korean traditional medicine hospital and were diagnosed as spondylolisthesis on L-spine X-ray and L-spine magnetic resonance imaging(MRI). We selected 37 lytic spondylolisthesis patients and 32 degenerative spondylolisthesis patients. We analysed the relativity between the numbers of changed discs, types of changed disc, locations of nerve compression and types of spondylolisthesis. Results : 1. The number of changed discs increase in lytic type, but there is no statistically significant difference. 2. Bulging disc is the dominant type of disc change. There is no significant difference between two types. 3. Both foraminal type was shown dominantly in lytic spondylolisthesis, diffuse type in degenerative spondylolisthesis by the analysis of the location of the nerve compression. But the symptoms of patients and dermatome did not match in most of the cases. Conculsions : The direction of nerve compression is different while the disc changing aspects are similar in both types. In several spondylolisthesis patients in fifties, symptoms of patient are related to degeneration of vertebrae, not to the type of spondylolisthesis.

• 대한영상의학회지
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• 제85권1호
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• pp.3-23
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• 2024

임상에서 자주 접하게 되는 추간판탈출증 중 분리추간판은 추간판의 성분이 원래의 수질핵과 완전히 분리되는 특별한 경우를 의미한다. 이러한 분리추간판은 척추관 내부뿐만 아니라 외부에도 위치할 수 있으며, 주변 구조물에 압력을 가하거나 신경 경로를 압박하게 되고 이로 인해 다양한 임상 증상을 유발할 수 있다. 특히 경막 내에 위치한 분리추간판의 경우, 경막절개술을 통해서만 병변을 식별할 수 있다. 따라서 수술 전에 분리추간판의 정확한 위치와 범위를 파악하는 것은 수술 계획을 세우는 데 중요하다. 자기공명영상에서 분리추간판은 초기에는 모체 추간판과 유사한 신호강도를 보이지만 이후 독립적인 퇴행 변화를 거치며 신호강도가 달라질 수 있다. 또한 대부분의 분리추간판 조각은 염증 반응의 결과로 인해 인접한 혈관발생과 육아조직의 형성 정도에 따라 다양한 정도의 주변 조영증강을 보일 수 있다. 이종설에서는 분리추간판의 다양한 영상 소견과 위치를 소개하여 환자에게 정확한 진단과 적절한 치료 방향을 제시하는 데 도움이 되고자 한다.

• Korean Journal of Radiology
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• 제23권6호
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• pp.638-648
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• 2022

Objective: The study aimed to investigate the diurnal variation in cervical disc hydration and its relationship with cervical degeneration. Materials and Methods: C3-C7 discs of 86 prospectively enrolled participants (37 males, 49 females; mean age ± standard deviation, 23.5 ± 2.5 years) were assessed using T2 mapping in the morning and evening. All discs were stratified by Miyazaki grade or C2-C7 Cobb angle and T2 values (T2). The degree of diurnal T2 variation (T2-DDV), defined as (morning T2 - evening T2)/morning T2 x 100%, was measured for the entire disc, annulus fibrosus (AF), nucleus pulposus (NP), and endplate zones. Results: T2 of the entire disc decreased significantly after the daytime load (p < 0.001), with a T2-DDV of 13.3% for all discs and 16.0%, 12.2%, and 13.0% for healthy (grade I), mild degenerative (grade II), and advanced degenerative (grade III/IV) discs, respectively. T2 of regional NPs and AFs decreased significantly from morning to evening (p ≤ 0.049) except in the healthy anterior inner AF (p = 0.092). Compared with healthy discs, mild degenerative discs displayed lower T2 and T2-DDV in regional NPs (p < 0.001). Advanced degenerative discs showed higher T2-DDV in the anterior inner AF compared with healthy discs (p = 0.050). Significant diurnal T2 changes in the endplate zones were observed only in healthy discs (p = 0.013). Cervical discs in the low Cobb angle group showed higher T2-DDV in the anterior AFs and anterior NP and lower T2-DDV in the posterior AF than those in the high Cobb angle group (p ≤ 0.041). Conclusion: This study characterized the diurnal variation in hydration of the cervical discs as assessed using T2 mapping and revealed early chemo-mechanical coupling dysfunction in degenerating discs. Cervical sagittal alignment on MRI can affect the diurnal stress patterns of the cervical discs. T2 mapping is sensitive to disc biomechanical dysfunction and offers translational potential from biomechanical research to clinical application.