New Treatments and Imaging Strategies in Degenerative Disease of the Intervertebral Disks

Abstract

Magnetic resonance (MR) imaging in patients with persistent low back pain and sciatica effectively demonstrates spine anatomy and the relationship of nerve roots and intervertebral disks. Except in cases with nerve root compression, disk extrusion, or central stenosis, conventional anatomic MR images do not help distinguish effectively between painful and nonpainful degenerating disks. Hypoxia, inflammation, innervation, accelerated catabolism, and reduced water and glycosaminoglycan content characterize degenerated disks, the extent of which may distinguish nonpainful from painful ones. Applied to the spine, "functional" imaging techniques such as MR spectroscopy, T1ρ calculation, T2 relaxation time measurement, diffusion quantitative imaging, and radio nucleotide imaging provide measurements of some of these degenerative features. Novel minimally invasive therapies, with injected growth factors or genetic materials, target these processes in the disk and effectively reverse degeneration in controlled laboratory conditions. Functional imaging has applications in clinical trials to evaluate the efficacy of these therapies and eventually to select patients for treatment. This report summarizes the biochemical processes in disk degeneration, the application of advanced disk imaging techniques, and the novel biologic therapies that presently have the most clinical promise.

T1ρ and T2 Mapping of the Intervertebral Disk: Comparison of Different Methods of Segmentation

“…Our results suggest that about 50% of the disk structure needs to be segmented so that the results would be comparable with those extracted via WDS on intervertebral disks with Pfirrmann grades I and II. As previously described in the literature, 3,11,19 if the extraction of T2 and T1 emphasizes the central sec- tions, it may overestimate the glycosaminoglycan content of the disk. In the degenerated disk group, partial segmentation methods and CROI showed results similar to those of the full segmentation.…”

“…3 The need for a better understanding of physiologic and pathologic processes in the disk led to the application of quantitative techniques in MR imaging such as T1 and T2 mapping. 3,4 For the extraction of quantitative data from a given region of interest, it is necessary to perform segmentation procedures that involve selecting the region to be analyzed. 5 This segmentation can be manual, semiautomatic, or automatic.…”

Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review

“…Degenerative spine disease comprises a group of conditions characterised by loss of normal spinal structure and function, most frequently affecting the lumbar spine [1]. Spinal degeneration is mainly a consequence of physiologic aging and is a major cause of chronic disability.…”

Fibrin-genipin annulus fibrosus sealant as a delivery system for anti-TNFα drug

“…Pro-inflammatory cytokines have an important role in all aspects of IVD disease including pain and are a relevant therapeutic target [3, 16]. TNFα and IL1-β increase with severity of disease [17, 18] and TNFα up-regulates pain-related proteins [19].…”