Journal of Orthopaedic Research - Spine®

Graphical depiction of the proposed pre-operative planning workflow.

Check out recent perspective piece by Nima Ashjaee & coauthors in JOR Spine, on "Subject-Specific Musculoskeletal Modelling: The Future of Predicting and Preventing Proximal Junctional Failure in Adult Spinal Deformity": onlinelibrary.wiley....

Bone homeostasis and osteoporosis-related challenges in spinal fusion in the vertebrae. This figure illustrates the key biological & mechanical challenges affecting spinal fusion in elderly patients. In normal vertebrae, MSCs within the bone marrow differentiate into osteoblasts, which mature into osteocytes and maintain bone formation. Concurrently, hematopoietic stem cells (HSCs) differentiate into OCs, which mediate bone resorption. Under normal vascular conditions, bone formation and resorption remain balanced. In aged vertebrae, MSCs exhibit impaired osteogenic differentiation, coupled with reduced vascular supply, leading to decreased bone formation. Meanwhile, osteoblasts and osteocytes secrete increased levels of RANKL (receptor activator of nuclear factor kappa-B ligand), disrupting the OPG (osteoprotegerin)/RANKL balance and excessively activating OCs, resulting in accelerated bone resorption. Osteoporosis and degenerative disc changes contribute to fragility in the elderly.

Check out "Therapeutic Approaches for Enhancing Spinal Fusion in Low Back Pain: A Review With a Focus on the Elderly", by Shuimu Chen & coauthors in JOR Spine: onlinelibrary.wiley....

Flowchart of the literature search.

Xuejiu Cai & coauthors performed a meta-analysis to evaluate the diagnostic efficacy of metagenomic next-generation sequencing in infectious diseases of the spine: onlinelibrary.wiley....

Multiple omics in intervertebral disc (IVD) regeneration research—overview of the five main omics disciplines, genomics, epigenomics, transcriptomics, proteomics, and metabolomics, and key factors within each category that influence IVD health, IVD degeneration (IDD), and potential mechanisms for regeneration.

Check out recent review, "Advancing Intervertebral Disc Biology via Omics: Implications for Nucleus Pulposus Progenitor Cell-Based Regeneration" by Anja Stirnimann, Leon Schlagenhof, Benjamin Gantenbein, & Fabian Ille: onlinelibrary.wiley....

HPSEC profiles of CS and condoliase digestion products. (A) HPSEC profiles of undigested CS derived from shark and the digestion products of CS. One mL of CSC (1 mg/mL) was digested overnight with condoliase (0.25 U) at pH 8.0 and 37°C. (B) HPSEC profiles of extract solution from porcine nucleus pulposus and the digestion products. One mL of extract solution from porcine nucleus pulposus was digested overnight with condoliase (2 U) at pH 8.0 and 37°C.

Condoliase is a treatment for lumbar disc herniation, but its behavior in the nucleus pulposus is not clear. Ippei Watanabe, Ko Takeda & Taiichi Shirogane evaluated the properties of condoliase in the nucleus pulposus: onlinelibrary.wiley....

(A) The disc height index (%DHI) values of different treatment groups at 6 weeks after puncture injury (6 W) and 4 weeks after intradiscal administration of proposed agents (10 W). (B) Radiographs and MR images of rat caudal discs at 4 weeks after intradiscal administration of proposed treatment agents. Intact: disc without puncture injury and treatment. (Error bars represent standard error).

Chih-Wei Chen & coauthors developed lovastatin-loaded nanoparticles incorporated into thermosensitive chitosan/gelatin/glycerophosphate hydrogel for the treatment of intervertebral disc degeneration: onlinelibrary.wiley....

Design of the mHealth system.

Chronic low back pain requires precise phenotyping for tailored treatments. Zakiy F. Alfikri & coauthors introduce a mobile health system that collects biomechanics & behavior data from in-clinic and 7-day at-home assessments from 1000 individuals: onlinelibrary.wiley....

Immunohistochemical results of rat IVDs. (a) From left to right: Aggrecan expression in IVD, Aggrecan expression in nucleus pulposus, SOD2 expression in IVD, and SOD2 expression in nucleus pulposus. From top to bottom: 31G needle group, vehicle group, 0.5 μg AGEs group, 1 μg AGEs group, 2 μg AGEs group, 4 μg AGEs group, and non-ovariectomy group. (b) Statistical results of Aggrecan expression in the nucleus pulposus of the coccygeal disc of rats. (c) Statistical results of SOD2 expression in the nucleus pulposus of the coccygeal disc of rats. Those labeled with the same letter indicate no statistical difference between groups, and those with different letters indicate a statistical difference between groups (p < 0.05).

Xiao Liang & coauthors developed a reliable and reproducible rat model of intervertebral disc degeneration by injecting advanced glycation end products into the intervertebral discs of ovariectomized rats: onlinelibrary.wiley....

UNET++ appropriately segments disc tissues with high performance. (A) Mean (averaged across tissues) intersection over union (mIOU) and tissue frequency weighted mean intersection over union. Each dot is one histology section from one rat (n = 11), mean and standard deviation are also plotted. (B) Mean intersection over union for each tissue. Each dot is one histology section from one rat (n = 11), mean and standard deviation are also plotted. (C) Representative H&E images of rat representing healthy (Ci, Di, and Ei), moderate (Cii, Dii, and Eii), and severely degenerated samples (Civ, Div, and Eiv). Region of interest (ROI) shown for moderate (Ciii, Diii, and Eii) and severely degenerated samples (Cv, Dv, and Ev) where modest misclassification of the NP, AF, Endplate, and Granulation tissue occur (Noted with Arrow) (D) Representative H&E images of rat disc tissue with ground truth (GT) annotations with respective ROIs. (E) Representative H&E images of rat disc tissue with model ROIs.

Richard D. Bell & coauthors developed a segmentation model to identify seven distinct disc tissues and to use these segmented areas, along with other derived measures, to estimate pathological changes that align with traditional histological scoring: onlinelibrary.wiley....

Approximate range of motion (ROM) (A-C) of animal cervical and lumbar spine segments in axial rotation (A) flexion-extension, (B) lateral-bending (C) as a percentage of human lumbar ROM and axial rotation at different spinal levels for the kangaroo and humans (D).15, 97-101 References for benchmark data are: Human Lumbar,101, 102 Porcine Lumbar and Porcine Cervical,98 Ovine Lumbar and Ovine Cervical,99 Caprine Lumbar,15 Calf Lumbar.103 Relative sizes of human and kangaroo lumbar and cervical Llama and Alpaca IVDs (E). Macroscopic views of horizontally bisected kangaroo L1L2 (F), L2L3 (G) L4L5 (H), human L4L5 (I) and Llama C4C5 (J) and Alpaca C3C4 (K) IVDs. Images F-H were kindly supplied by Dr Uphar Chamoli, Director of Engineering, Kunovus Pty Ltd, School of Biomedical Engineering, University of Technology, and St. George Clinical School, University of NSW, Sydney, Australia. Images J, K reproduced from21 with permission.

Mauro Alini & coauthors discuss animal models of intervertebral disc degeneration and low back pain, with an exploration of artificial intelligence in research analysis and development of prospective therapeutics: onlinelibrary.wiley....

Percentage of studies using selected grading systems over time from 2000 to present. Pfirrman grading (~10% in 2000 to ~80% by 2015) is consistently used more than Modified Pfirrman and T2 mapping (<20% at all timepoints until ~2025). Over time, the Pfirrmann grading system was consistently used, particularly between the early 2000s and mid-2010s, where it was used in over 50% of studies. In contrast, T2 mapping showed minimal use in early years but increased steadily over time, particularly from 2010 to onwards. This trend reflects a gradual shift toward incorporating more objective, quantitative imaging methods in DD research.

Dean Esposito & coauthors present a scoping review of MRI-based lumbar disc degeneration grading systems: onlinelibrary.wiley....

The flowchart of this study. GTEx, genotype-tissues expression project; GWAS, genome-wide association; FUSION, functional summary-based imputation; MAGMA, multi-marker Analysis of GenoMic Annotation; TWAS, transcriptome-wide association studies; UTMOST, unified test for molecular signatures.

A cross-tissue transcriptome-wide association study by Li Zhang & coauthors identified susceptibility genes for intervertebral disc degeneration. Learn more in JOR Spine: onlinelibrary.wiley....

WJ-MSC-derived EVs promoted hNPC proliferation and viability. (A) Cell content significantly increased after treatment with 10 μg/mL WJ-MSC-EVs at day 4, 10, and 14, as compared with the IL-1β control group (n = 4). Data were analyzed through two-way ANOVA with Dunnett's multiple comparisons test, where each group was compared with IL-1β. Within each timepoint, values were analyzed using unpaired t tests with a false discovery rate approach. (B) After 24 h, the WJ-MSC-EV treatment significantly reduced IL-1β-pre-treated hNPC death at 100 μg/mL at flow cytometry (n = 4). Data were analyzed through two-way ANOVA with Dunnett's multiple comparisons test, where each group was compared with IL-1β. (C) Live/Dead staining showed reduced cell death in hNPCs treated with 10 and 100 μg/mL WJ-MSC-EVs (n = 4). Magnification: 20×, scale bar: 100 μm.*p < 0.05, **p < 0.01, compared to the control group. #p < 0.05, ##p < 0.01, ###p < 0.001 compared to the IL-1β group. Abbreviations: AM, acetoxymethyle

Veronica Tilotta & coauthors found that Wharton's Jelly mesenchymal stromal cell-derived extracellular vesicles attenuate intervertebral disc degeneration under inflammatory stress in an in vitro 3D culture system: onlinelibrary.wiley....

The left most image displays the locations of inertial measurement unit (IMU) sensors on the body during in-clinic testing. Sensors were positioned at the following locations: T1/T2, T12/L1, L5/S1, and right lateral thigh and display the IMU segments. The two images to the right are still images illustrating the preparation and placement of IMUs. Top: Four IMUs are powered on and placed on a flat surface as the physical therapist applies skin adhesive to each unit (skin adhesive in white on lower right sensor). Bottom: The physical therapist palpates the L5/S1 anatomical landmark to ensure accurate placement of the sensors, while the T12/S1 sensor is already affixed on the skin over the spine.

Kevin M. Bell & coauthors report findings from multi-level inertial measurement unit (IMU) kinematic data collected during performance-based tests in participants with chronic low back pain: onlinelibrary.wiley....

Schematic depiction of the innervation of the degenerate IVD and associated tissues. Figure part (a) reproduced from [3], (b) modified from [35] with permission. ALL, anterior longitudinal ligament; DRG, dorsal root ganglion; PLL, posterior longitudinal ligament; and (c) schematic depiction of the dorsal root ganglion in relation to the IVD and associated spinal tissues, SC, spinal cord.

James Melrose & coauthors present a conceptual review exploring the published evidence and mechanistic rationale on naturally occurring toxins and venoms as peptide calcium channel blockers for chronic low back pain: onlinelibrary.wiley....

Workflow overview: PROMs were collected from workers suffering from cLBP during the first visit. Each questionnaire was preprocessed separately for features encoding, reduction, and normalization. Two slightly different preprocessing modalities were employed before clustering and profiling. The encoded questionnaire was ultimately employed for patient profiling according to the predicted cluster labels. Occupational queries were used for profiling only. CLBP, chronic low back pain; PCA, principal component analysis; PHQ-2, Patient Health Questionnaire 2; PROM, patient-reported outcome measure; ODI, Oswestry Disability Index; VAS, Visual Analog Scale; WAI, Work Ability Index.

Check out "Exploring the Biopsychosocial Impact of Chronic Low Back Pain in Workers Through Artificial Intelligence-Driven Phenotyping", by Paolo Giaccone & coauthors: onlinelibrary.wiley....

Partial correlations between the quantitative MRI and disc health measures in the (A) nucleus pulposus (NP), (B) ventral aspect of the annulus fibrosus (vAF), and (C) dorsal aspect of the annulus fibrosus (dAF) using linear models with “dog” and “disc level” as block effects. Crossed out values (×) are nonsignificant (p ≥ 0.0125 or p ≥ 0.025 with Bonferroni correction for four (A and B) or two (C) disc health measures, respectively). In the NP, the relaxation times were moderately and negatively correlated with Pfirrmann grade and histology score, and moderately and positively correlated with water content. T2 and aT2ρ were also weakly and positively correlated with GAG content. In the vAF and dAF, aT2ρ was weakly and positively correlated with Pfirrmann grade. Additionally, in the vAF, T1ρ and aT1ρ were weakly and positively correlated with water content. Additional details of these relationships are shown in Tables 4–6.

Alaina L. Falck & coauthors looked at the sensitivity of quantitative MRI techniques in detecting disc degeneration in client-owned, nonchondrodystrophic-breed dogs: onlinelibrary.wiley....

Graft microstructure represented by scanning electron micrographs. sCaP granules (A, B) isolated from sCaP/AOC graft and (C, D) embedded within the collagen matrix of sCaP/Col I graft. (E, F) mCaP granules embedded within the collagen matrix of mCaP/Col I graft.

Calcium phosphate (CaP) biomaterials are widely used in surgical applications such as spinal fusion to substitute for or extend autogenous bone graft. William R. Walsh & coauthors compared three clinically available CaP-based materials: onlinelibrary.wiley....

Distribution of Pro-Inflammatory cytokines across Pain and ODI categories. Each panel shows box-and-whisker plots of cytokine levels (TNF, IL-15, Leptin, IFN-γ) across three categories of pain (in blue; mild, moderate, severe) and three categories of disability (in red; mild, moderate, severe, per the Oswestry Disability Index [ODI]). The box boundaries represent the 25th and 75th percentiles, the horizontal line within each box is the median, and the whiskers extend to the minimum and maximum values (excluding outliers). Numeric annotations (e.g., mean, median, min, max) are displayed above each group.

Valerio Tonelli Enrico & coauthors report the quantification of key circulatory cytokines in a chronic low back pain cohort: onlinelibrary.wiley....

Carol M. Greco & coauthors present findings for "Patient-Reported Outcomes Among an Observational Cohort of Individuals With Chronic Low Back Pain": onlinelibrary.wiley....

Dark blue bars represent main categories whereas light blue bars represent sub-categories. Treatments are presented in categories from most to least frequent.

Sara R Piva & coauthors performed a descriptive analysis of demographic and biomedical factors in a large sample of individuals with chronic low back pain. Learn more in JOR Spine: onlinelibrary.wiley....

Temporal summation: X-axis displays the mean differences in pain ratings associated with pinprick stimuli. In each of three trials, participants received a set of 10 pinpricks; participants then numerically rate the pain elicited after the initial (first) and final (10th) pinprick. The 0–10 pain rating of the first pinprick is subtracted from the 0–10 rating of the 10th pinprick, for each trial. The mean values were derived from the three applications of pinpricks, each performed over the low back (site of pain) and the palmar forearm (control site). A negative value indicates that the first pinprick is rated as more painful than the 10th pinprick. A positive value indicates that the 10th pinprick is rated as more painful than the first pinprick.

Michael J. Schneider & coauthors present findings from quantitative sensory testing in an observational cohort of adults with chronic low back pain: onlinelibrary.wiley....

Graphic representation of vertebral height measurements. The lighter bars show the right, or convex side, height and the left, or concave side, height. The darker bars show the anterior height and the posterior height.

Vertebral tethers for growth modulation can be used to treat adolescent idiopathic scoliosis. Taylor J. Jackson & coauthors explored the relationship between vertebral body growth modulation under varying tether tension: onlinelibrary.wiley....

Classic CPG model diagrams at three different levels.

Check out this recent review by Hao Su & coauthors on "Central Pattern Generators in Spinal Cord Injury: Mechanisms, Modulation, and Therapeutic Strategies for Motor Recovery": onlinelibrary.wiley....

Data analysis flowchart. The data collection inputs are highlighted in the green column (left). Tantalum beads, digitized in both CT and experimentally, are used to co-register the vertebrae. Pure moment bending (simulated axial rotation shown) is performed using the spine kinetic simulator and motion is recorded via optical motion capture. Helical axes were computed throughout motion and used to derive the helical compliance vector and corresponding kinetic measures: compliance, directional compliance, deviation angle, and variability of the deviation angle. Disc and facet joint health are measured via magnetic resonance imaging.

Matthew R. MacEwen & coauthors introduce the helical compliance vector, a novel measuring parameter that quantifies the orientation and magnitude of joint compliance (inverse of stiffness) by integrating kinetic and kinematic data within the helical axis framework: onlinelibrary.wiley....

The flowchart of this study.

Sitan Feng & coauthors developed and validated a predictive model for 1-year outcomes in cervical spondylosis patients after anterior cervical discectomy and fusion using multiple machine learning algorithms: onlinelibrary.wiley....

In vitro effects of ultrafine-grained stainless steel implants on Staphylococcus aureus biofilms.

Mitsuhiro Nishizawa & coauthors present their findings on the antibacterial properties of ultrafine-grained steel wire implants: onlinelibrary.wiley....

The figure combines ferroptosis and cuproptosis in IVDD and identifies five key targets of GSH, oxidative stress, TCA cycle, autophagy, and copper.

Zhongpan Li & coauthors present a review on "Crosstalk Between Ferroptosis and Cuproptosis in Intervertebral Disc Degeneration: Mechanisms, Therapeutic Targets, and Future Directions": onlinelibrary.wiley....

MRI analyses of mean modified Pfirrmann scores (A), DHI (B) and T2 relaxation times in the study groups. DHI and T2 relaxation time have been calculated as percent change compared to baseline. *p < 0.05, ****p < 0.0001 between groups. #p < 0.05, ##p < 0.01, ###p < 0.001 compared to baseline. BM-MSC = bone marrow-derived stromal cell; DHI = disc height index.

Gianluca Vadalà & coauthors present a preliminary report of a randomized clinical trial of intradiscal mesenchymal stromal cell therapy for low back pain due to multilevel disc degeneration: onlinelibrary.wiley....

Summary of study findings concerning adipokine function in vertebral pathology, sarcopenia, degenerative disc disease and ligament ossification. (OP) = osteoporosis. (MMP) = matrix-metalloproteinases. (ADAMTs5) = a disintegrin and metalloproteinase with thrombospondin motifs 5. (mFb) = mineralized fibroblast. (Ca2+) = calcium. (Green Triangle) = positive/anti-inflammatory role. (Red Triangle) = negative/inflammatory role. (Green-Red Triangle) = Conflicting results reported in the literature regarding inflammatory/anti-inflammatory role.

Check out this narrative review of the role of adipokines in spinal disease by Jake M. McDonnell, Stacey Darwish, Joseph S. Butler, and Conor T. Buckley: onlinelibrary.wiley....