Low back pain (LBP) is a major health issue resulting in a huge economic burden on the community. It not only increases the medical costs directly, but also raises the disability and loss of productivity in the general population. Symptoms include local pain over the spinal area, pain radiating to the lower leg, stiffness, and muscle tension. LBP is strongly linked with intervertebral disc degeneration that is further associated with the disruption of the complex anatomy of nucleus pulposus, annulus fibrosus, and adjacent supporting structures of the spine. Change in the shape and intensity of nucleus pulposus, decreased disc height, disc herniation, vertebral endplate changes, presence of osteophyte, and posterior high intensity zones are degenerative changes found in imaging studies. Every feature is considered while grading the severity score. Modic changes, DEBIT (disc extension beyond interspace) score, and Pfirrmann criteria are some of the scoring criteria used for evaluating disc degeneration severity. Moreover, the total number and contiguous pattern of affected discs play a crucial role in symptom generation of back pain. Many studies have reported asymptomatic patients. Thus, the correlation between degeneration severity found in imaging study and symptom severity of LBP remain unclear. This review discusses and summarizes the available literature on the significance of the association between the severity of degenerative changes found in imaging study with the presence and intensity of LBP.

Background.Multimodality treatment, incorporating neoadjuvant chemotherapy and adjuvant chemotherapy, is the standard management plan for osteosarcoma that increases the overall survival (OS) rate. However, data regarding prognostic factors affecting the histopathological response following neoadjuvant chemotherapy is limited. Patients and Methods. We retrospectively reviewed patients diagnosed with osteosarcoma in our center between 2008 and 2018. We classified patient characteristics according to gender, age, tumor size, site and stage at diagnosis, site of metastasis, type of surgery, necrosis rate based on the Huvos grading system, and the number of neoadjuvant chemotherapy cycles. We divided response to neoadjuvant chemotherapy into poor responder for patients with Huvos grades 1 and 2 and good responder for patients with Huvos grades 3 and 4. We also documented patients’ survival and follow-up information. Results. We reviewed 64 patients within 5–65 years of age, dominated by men (62.5%). The distal femur (53.1%) was the most common site of osteosarcoma. Fifteen (23.4%) patients had a good response while 49 (76.6%) patients were poor responders to neoadjuvant chemotherapy based on the Huvos grading system. Based on multivariate analysis, gender ( p  = 0.012), age ( p  = 0.029), symptom duration ( p  = 0.004), and tumor enlargement after neoadjuvant chemotherapy ( p  < 0.001) were significantly associated with histopathological response. A scoring system was proposed integrating these significant variables (age > 20 years = 1 point, female gender = 1 point, symptom duration > 12 weeks = 1 point, and increased tumor size after neoadjuvant chemotherapy = 2 points). This scoring system divides patients into two groups with a total score of more than two predicting a poor responder to neoadjuvant chemotherapy. Conclusions. Age, gender, symptoms duration, and tumor size after neoadjuvant chemotherapy are the prognostic features that affect the histopathological response to neoadjuvant chemotherapy in patients with osteosarcoma.

Background. Vertebral bone defect represents one of the most commonly found skeletal problems in the spine. Progressive increase of vertebral involvement of skeletal tuberculosis (TB) is reported as the main cause, especially in developed countries. Conventional spinal fusion using bone graft has been associated with donor-site morbidity and complications. We reported the utilization of umbilical cord mesenchymal stem cells (UC-MSCs) combined with hydroxyapatite (HA) based scaffolds in treating vertebral bone defect due to spondylitis tuberculosis. Materials and Methods. Three patients with tuberculous spondylitis in the thoracic, thoracolumbar, or lumbar region with vertebral body collapse of more than 50 percent were included. The patient underwent a 2-stage surgical procedure, consisting of debridement, decompression, and posterior stabilization in the first stage followed by anterior fusion using the lumbotomy approach at the second stage. Twenty million UC-MSCs combined with HA granules in 2 cc of saline were transplanted to fill the vertebral bone defect. Postoperative alkaline phosphatase level, quality of life, and radiological healing were evaluated at one-month, three-month, and six-month follow-up. Results. The initial mean ALP level at one-month follow-up was 48.33 ± 8.50   U / L . This value increased at the three-month follow-up but decreased at the six-month follow-up time, 97 ± 8.19   U / L and 90.33 ± 4.16   U / L , respectively. Bone formation of 50-75% of the defect site with minimal fracture line was found. Increased bone formation comprising 75-100% of the total bone area was reported six months postoperation. A total score of the SF-36 questionnaire showed better progression in all 8 domains during the follow-up with the mean total score at six months of 2912.5 ± 116.67 from all patients. Conclusion. Umbilical cord mesenchymal stem cells combined with hydroxyapatite-based scaffold utilization represent a prospective alternative therapy for bone formation and regeneration of vertebral bone defect due to spondylitis tuberculosis. Further clinical investigations are needed to evaluate this new alternative.