Hangai M, Kaneoka K, Kuno S, et al. Factors associated with lumbar intervertebral disc degeneration in the elderly

Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Ten-nodai, Tsukuba, Ibaraki, 305-8575, Japan.
The Spine Journal (Impact Factor: 2.43). 12/2007; 8(5):732-40. DOI: 10.1016/j.spinee.2007.07.392
Source: PubMed


Lumbar intervertebral disc degeneration (DD) precedes degenerative diseases of the lumbar spine. Various factors in addition to normal aging are reported to be associated with DD, and recently atherosclerosis and risk factors for cardiovascular diseases (cardiovascular risk factors) have received much attention; however, the links between these risk factors and DD are unclear.
By correlating magnetic resonance images (MRI) with suspected degenerative disc risk factors such as obesity, cardiovascular risk factors, and atherosclerosis, we hope to clarify the factors associated with DD.
An observational study.
Two hundred seventy adults (51-86 years old) who participated in a health promotion program.
DD evaluated based on the signal intensity of MR T2-weighted mid-sagittal images of the lumbar spine.
Age, gender, body mass index (BMI), low-density lipoprotein cholesterol (LDLc), triglyceride (TG), glycosylated hemoglobin (HbA(1c)), brachial-ankle pulse wave velocity (baPWV) as an index of atherosclerosis, osteo-sono-assessment index (OSI) calculated from quantitative ultrasound assessment of the calcaneus as an index of bone mineral density (BMD), history of low back pain (LBP), smoking and drinking habits, and physical loading related to occupations and sports were assessed. The univariate relationships between DD and the variables were evaluated, and finally, odds ratios (OR) and 95% confidence intervals (CI) for the associations of each factor with DD were calculated using logistic regression at each disc level.
Aging correlated significantly with DD of L1/2 (OR, 2.14), L2/3 (OR, 3.56), L3/4 (OR, 2.84), and L4/5 (OR, 3.05); high BMI, with L2/3 (OR, 2.98), L3/4 (OR, 3.58), L4/5 (OR, 2.32), and L5/S1 (OR, 3.34); high LDLc, with L4/5 (OR, 2.65); occupational lifting, with L1/2 (OR, 4.25); and sports activities, with L5/S1 (OR, 3.36).
Aging, high BMI, high LDLc, occupational lifting, and sports activities are associated with DD. The results of this study raise our index of suspicion that cardiovascular risk factors and particular physical loading may contribute to DD; however additional studies are required to further investigate associations between DD and these factors.

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Available from: Shinya Kuno
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    • "Mechanical, nutritional, traumatic, and genetic factors have all been implicated in the cascade of disc degeneration to variable degrees [2]. Increasing age, gender, higher body mass index (BMI) scores, demanding jobs/physical activities, lower bone mineral density, and genetic factors have been associated with lumbar degenerative disc disease [3,4,5,6,7,8]. In magnetic resonance imaging (MRI), which is a sensitive imaging method for the evaluation of degenerative disc disease, disc space narrowing, loss of T2-weighted signal within the nucleus pulposus, fissures, vacuum changes and calcification, endplate changes, ligamentous and/or marrow signal changes, presence of osteophytosis, and stenosis have been reported [2,9]. "
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    ABSTRACT: Study DesignCase-control.PurposeTo determine whether a disproportion between two neighboring vertebral end plates is associated with degenerative disc disease.Overview of LiteratureRecently, it has been suggested that disproportion of the end plates of two adjacent vertebrae may increase the risk of disc herniation.MethodsMagnetic resonance (MR) images (n=160) with evidence of grades I-II lumbar degenerative disc disease (modified Pfirrmann's classification) and normal MR images of the lumbar region (n=160) were reviewed. On midsagittal sections, the difference of anteroposterior diameter of upper and lower end plates neighboring a degenerated (in the case group) or normal (in the control group) intervertebral disc was calculated (difference of end plates [DEP]).ResultsMean DEP was significantly higher in the case group at the L5-S1 level (2.73±0.23 mm vs. 2.21±0.12 mm, p=0.03). Differences were not statistically significant at L1-L2 (1.31±0.13 mm in the cases vs. 1.28±0.08 mm in the controls, p=0.78), L2-L3 (1.45±0.12 mm in the cases vs. 1.37±0.08 mm in the controls, p=0.58), L3-L4 (1.52±0.13 mm in the cases vs. 1.49±0.10 mm in the controls, p=0.88), and L4-L5 (2.15±0.21 mm in the cases vs. 2.04±0.20 mm in the controls, p=0.31) levels. The difference at the L5-S1 level did not remain significant after adjusting for body mass index (BMI), which was significantly higher in the patients.ConclusionsEnd plate disproportion may be a significant, BMI-dependent risk factor for lumbar degenerative disc disease.
    Full-text · Article · Aug 2014 · Asian spine journal
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    • "The pathogenesis of IDD has been ascribed to various etiological factors, including genetic predisposition, lifestyles (e.g. occupation, smoking, alcohol consumption), and aging [3], [4]. However, the underlying cellular and molecular mechanisms of IDD remain largely unknown. "
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    ABSTRACT: Aberrant proliferation of nucleus pulposus cell is implicated in the pathogenesis of intervertebral disc degeneration. Recent findings revealed that microRNAs, a class of small noncoding RNAs, could regulate cell proliferation in many pathological conditions. Here, we showed that miR-10b was dramatically upregulated in degenerative nucleus pulposus tissues when compared with nucleus pulposus tissues isolated from patients with idiopathic scoliosis. Moreover, miR-10b levels were associated with disc degeneration grade and downregulation of HOXD10. In cultured nucleus pulposus cells, miR-10b overexpression stimulated cell proliferation with concomitant translational inhibition of HOXD10 whereas restored expression of HOXD10 reversed the mitogenic effect of miR-10b. MiR-10b-mediated downregulation of HOXD10 led to increased RhoC expression and Akt phosphorylation. Either knockdown of RhoC or inhibition of Akt abolished the effect of miR-10b on nucleus pulposus cell proliferation. Taken together, aberrant miR-10b upregulation in intervertebral disc degeneration could contribute to abnormal nucleus pulposus cell proliferation through derepressing the RhoC-Akt pathway by targeting HOXD10. Our study also underscores the potential of miR-10b and the RhoC-Akt pathway as novel therapeutic targets in intervertebral disc degeneration.
    Full-text · Article · Dec 2013 · PLoS ONE
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    • "Biomechanical factors such as repetitive bending and twisting, routine tasks and vibrations increase the risk of LBDs in workplaces [3]. Excessive mechanical loads acting on the human spine as well as mechanical instability of the spine during daily/occupational/physical activities, amongst others, are known as important causes of LBDs [4] [5]. While there exists no direct method to measure spinal loads in vivo [3] some indirect approaches including intradiscal pressure measurement [6] to estimate disc compressive force and electromyography (EMG) [7] to predict muscle forces are proposed. "
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    ABSTRACT: The recruitment pattern of trunk muscles is determined using a three-dimensional model of the spine with two joints and six symmetric pairs of muscles in which both equilibrium and stability requirements are satisfied. Model predictions are verified using Anybody Modeling System (AMS) and Abaqus. The model is used to test the hypothesis that antagonistic muscle activities are necessary for the spinal stability. The model with stability constraints predicts muscle activities greater than those predicted without stability consideration. In agreement with experimental data, the stability-based model predicts antagonistic muscle activities. It is shown that spinal stability increases with trunk flexion and further improves at heavier tasks.
    Full-text · Conference Paper · Dec 2013
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