Top PDF Understanding Intervertebral Disc Disease in Dogs

Understanding Intervertebral Disc Disease in Dogs

Understanding Intervertebral Disc Disease in Dogs

When a patient is determined to need surgery, and plain x-rays fail to clearly identify the level of the disc displacement, a more refined form of diagnostic evaluation is called for. Usually this means performing a myelogram, MRI, or CT scan. A myelogram is a spinal x-ray taken after a contrast agent (dye) has been injected into the cerebrospinal fluid which normally surrounds the spinal cord. Because it outlines the previously invisible spinal cord, a myelogram is usually able to pinpoint the precise location for the surgeon to operate on. Although it is an invasive procedure (requiring a spinal tap), it is done under general anesthesia in dogs (therefore, no concerns about undue discomfort or inadvertent movement), and is only uncommonly a cause of severe complications. A computed tomography or CT scan (CAT scan) is a very specialized x-ray technique that can produce cross-sectional images of the spine and discs. It is especially useful when used in combination with a myelogram, since the former may be hampered by swelling in the injured spinal cord, rendering interpretation more difficult. Combining a CT with a myelogram usually circumvents problems associated with swelling. The sine qua non of spinal cord imaging is the magnetic resonance imaging scan (MRI). This technique is non-invasive and produces the most detailed images currently available of the spine, spinal cord, nerve roots, and discs. It also permits examination in multiple planes (side- to-side, top-to-bottom, and front-to-back) so that no macroscopic lesions escape detection, and it permits the most precise surgical planning.
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MRI signal changes and their association with intervertebral disc disease in canine vertebral endplates

MRI signal changes and their association with intervertebral disc disease in canine vertebral endplates

The results of this study suggest that T1- and T2- hyperintense changes of the canine vertebral endplate are significantly associated with the presence of interver- tebral disc disease. A previous study suggested that there was an overlap between signal patterns of reactive changes, discospondylitis, and vertebral osteochondrosis in dogs [3], although neither of these conditions were observed in our study. As intervertebral disc disease is a common incidental finding on MRI evaluation of the canine vertebral column, their role in contributing to vertebral column pathology warrants further consideration. In par- ticular, undertaking a longitudinal re-evaluation of cases where vertebral endplate changes were identified without intervertebral disc disease would be of value, in order to assess whether vertebral endplate changes are precedent of intervertebral disc disease development. In this study, inter- vertebral disc disease was as common in dogs with vertebral endplate changes as in dogs without them (Table 5.) The majority of the vertebral endplate changes that were noted in the study was hyperintense in both T1WI and T2WI (35 out of 36–97.22%).
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A retrospective study of canine cervical disk herniation and the beneficial effects of rehabilitation therapy after ventral slot decompression

A retrospective study of canine cervical disk herniation and the beneficial effects of rehabilitation therapy after ventral slot decompression

There are several methods for surgical treat- ment of cervical IVDH, including ventral slot de- compression (VSD), VSD with fixation, modified slanted slot, cervical hemilaminectomy and dorsal laminectomy. Methods can be applied according to the cause, pathologic condition, position and surgeon preference. Several studies have reported that surgeries alleviate pain intensity and correct neurologic deficits. Overall functional success is achieved in 70–90% of cases (Shamir et al. 2008; Hillman et al. 2009; Rossmeisl et al. 2013), and the recurrence rate is 20–28% in dogs (Shamir et al. 2008). Furthermore, fewer than 60% of paraplegic dogs without pain perception have positive clinical outcomes, and many of these dogs suffer from lack of strength and quadrupedal coordination (Zidan et al. 2018). These circumstances indicate the need for a structured physiotherapy program designed to overcome these difficulties. In veterinary prac- tice, there have been few reports about the effect of physiotherapy rehabilitation for patients with disc disease with contrasting findings (Bennaim et al. 2017; Hodgson et al. 2017; Zidan et al. 2018), such as no difference in recovery-related variables among dogs that received physiotherapy (Bennaim et al. 2017), improved neurologic function and re- duced postoperative complications (Hodgson et al. 2017), and safety without improvement of rate or impact on recovery level (Zidan et al. 2018). These contrasting outcomes might be due to variation in physiotherapeutic content and techniques. There is a scarcity of well-defined, structured physi- otherapy programs. The main objective of this retrospective study was to investigate the benefits of well-structured rehabilitation physiotherapy af- ter surgery for cervical disc disease with respect to neurologic function for a five-year (2012–2017) period to increase understanding of cervical IVDH in our hospital.
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A Dose–response relationship between severity of disc degeneration and intervertebral disc height in the lumbosacral spine

A Dose–response relationship between severity of disc degeneration and intervertebral disc height in the lumbosacral spine

3 and 4 disc degeneration, respectively. Such a small magnitude of disc narrowing is unlikely to be qualitatively discernible to assessors for distinguishing an increasing severity of disc degeneration. However we have demon- strated that for each grade increase in disc degeneration (grades 2 to 4) there was significant disc narrowing at each lumbosacral level (all p ≤0.03). In a previous study we have demonstrated that reduced intervertebral disc height in the lumbar spine was associated with an increased risk of low back pain [12]. We corroborate this in the current study, showing that intervertebral disc height was smaller among people with greater pain and or dis- ability compared to those without. Similarly, a case–con- trol study of older adults with and without chronic low back pain found that people with more severe degen- erative disc disease had a two-fold increased risk of chronic low back pain [2], a finding that has been substantiated elsewhere [3]. Taken together, these data indicate that although both disc degeneration and intervertebral disc height likely measure similar constructs, intervertebral disc height, being a continuous measure, shows concur- rent validity in relation to disc degeneration and may provide a more sensitive means for understanding the pathogenesis of lumbosacral disc degeneration.
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Clinical presentation and outcome of dogs treated medically or surgically for thoracolumbar intervertebral disc protrusion

Clinical presentation and outcome of dogs treated medically or surgically for thoracolumbar intervertebral disc protrusion

Twelve (22.6%) dogs had concurrent disease at the time of presentation. Five dogs (9.4%) had non- orthopaedic concurrent disease, including a heart murmur (1), anal furunculosis (1), urinary tract infection (1), laryngeal paralysis (1) and chronic diarrhea (1). Seven (13.2%) dogs had concurrent orthopaedic conditions, including osteoarthritis of multiple joints (4), hip osteoarthritis (1) elbow osteoarthritis (1) and partial cruciate ligament rupture (1). Five dogs underwent a myelogram, and the remaining 48 underwent MRI of the thoracolumbar spinal cord. Nineteen dogs (35.8%) had a single IVDP, and 34 dogs (64.2%) had multiple IVDPs (19 dogs had 2 sites of IVDP, 14 had 3 sites and 1 had 4 sites). Intramedullary signal intensities at the site of the compressive IVDP(s) were detected in 17 dogs (32.1%). The mean remaining spinal cord area was 54.8% (SD ±21.3), at the site of most severe compression.
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Estimate of heritability and genetic trend of intervertebral disc calcification in Dachshunds in Finland

Estimate of heritability and genetic trend of intervertebral disc calcification in Dachshunds in Finland

Background: Intervertebral disc disease (IDD) is a hereditary condition particularly common in Dachshunds. The breed is predisposed to early intervertebral disc degeneration and intervertebral disc calcification (IDC). When calci‑ fied, these severely degenerated discs are visible in spinal radiographs. Since the number of calcified discs (NCD) is associated with IDD, spinal radiography can be utilized in screening programmes in attempts to diminish the inci‑ dence of IDD in Dachshunds. Our aims were to estimate the heritability and genetic trend of NCD in Dachshunds in Finland and to explore the effect of age at the time of radiographic screening. Since the NCD has a highly skewed distribution, a log‑transformed NCD (lnNCD) was also used as an analysed trait. The variance components for both traits were estimated, using the restricted maximum likelihood method. The fixed effects of breed variant, sex, as well as year of screening and the random effects of litter and animal were included in the model. The genetic trends in the NCD and lnNCD were assessed from the estimated breeding values (EBVs) of individual dogs by comparing the mean EBV of dogs born in different years. The breeding values were estimated, using the best linear unbiased prediction animal model. The pedigree in the genetic analyses included a total of 9027 dogs, of which 1567 showed results for NCDs.
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Ventral Slot Surgery to Manage Cervical Intervertebral Disc Disease in Three Cats

Ventral Slot Surgery to Manage Cervical Intervertebral Disc Disease in Three Cats

Medical and surgical treatment options exist for the management of intervertebral disc disease in both dogs and cats (2, 5, 8-10). Clinically relevant cervical(C) intervertebral disc disease accounts for approximately 16% of canine cases, while the incidence appears to be lower in cats, with most studies evaluating thoracolumbar disc disease (1, 11). Various surgical techniques have been reported in the management of cervical intervertebral disc disease in dogs, including ventral slot, dorsal laminectomy and cervical hemilaminectomy. A ventral slot provides direct access to ventrally herniated disc material, and has been
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Veterinary Specialists of Alaska, P.C. Client Information Sheet: Intervertebral Disc Disease (IVDD)

Veterinary Specialists of Alaska, P.C. Client Information Sheet: Intervertebral Disc Disease (IVDD)

Patients suffering from thoracolumbar IVDD often appear to have a painful or tender abdomen. This is due to compression of the nerve roots serving the abdominal wall. In more severe cases, there is evidence of back pain. These patients often vocalize in pain when they are picked up. These dogs often are reluctant to move from a comfortable, sheltered location. With increasing severity, these patients will exhibit abnormal function of the hind legs. Some can walk, although they drag their toes and sway from side to side. More severe cases result in paralysis of the hind legs. If the problem is in the thoracolumbar vertebral column front leg function will remain normal.
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The biological basis of degenerative disc disease: proteomic and biomechanical analysis of the canine intervertebral disc

The biological basis of degenerative disc disease: proteomic and biomechanical analysis of the canine intervertebral disc

The gross pathological and biochemical characteristics (including matrix metalloproteinase [MMP] activity and GAG content) are similar in canine and human IVD NP, such that the hallmarks of DDD at different stages (both dogs and humans) include chondroid cell clusters, dis- organization of the AF, and increasing appearance of clefts and cracks of increasing severity [14]. These histological characteristics are supported by magnetic resonance im- aging (MRI) scans showing striking similarities between the appearance of DDD in the different stages of degener- ation in humans and dogs [14]. However, despite these im- aging comparisons and assessment of GAG content, most comparisons are qualitative in nature, and the degenerative phenotype often ascribed to the CD IVD NP has not been quantified. In the present study, we used high-throughput quantitative proteomic analysis to compare the secretome of the CD canine (beagle) IVD NP (similar to the human disc) with that of the NCD (mongrel) canine subspecies, which is analogous to the IVD of a healthy, young human. We validated our proteomic investigation using Western blot analysis and immunohistochemical assays for both NCD and CD canines. After proteoglycan extraction, we characterized the integrity of the core proteins of the SLRPs decorin and biglycan obtained from the IVD NP of these animals. Finally, we quantified and compared the bio- mechanical properties of spinal motion segments obtained from both subspecies using robotic biomechanical testing.
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DachsLife 2015: an investigation of lifestyle associations with the risk of intervertebral disc disease in Dachshunds

DachsLife 2015: an investigation of lifestyle associations with the risk of intervertebral disc disease in Dachshunds

Intervertebral disc disease (IVDD) is the most common spinal disorder in domestic dogs [1]. IVDD represents a major problem in Dachshunds particularly, with the breed at a relative risk of IVDD 10–12 times higher than other breeds [2, 3], and 19–24 % of Dachshunds are estimated to show clinical signs related to IVDD during their lifetime [3–6]. Histological evidence of interverte- bral disc mineralisations, which can result in IVDD, have been reported to be present in 46–48 % of Dachshund intervertebral discs [5, 7]. Increased risk of IVDD in Dachshunds has been primarily attributed to their chondrodystrophic ‘long and low’ conformation [8, 9], with exaggeration of these length-to-height proportions associated with increased risk of disc extrusions [10]. Chondrodystrophy is associated with the expression of a retrogene encoding fibroblast growth factor 4 (FGF4) located on chromosome 18 [11]; however, a continuous spectrum of disc degeneration and IVDE/IVDP is seen both among and within chondrodystrophic breeds, sug- gesting a multi-factorial aetiology involving cumulative effects of several genes and environmental interactions [10]. The Dachshund’s predisposition to IVDD has been demonstrated to be highly heritable [12, 13]; however, reducing the incidence of IVDD is not as simple as devising genetic tests of susceptibility, as has been successfully developed for Lafora’ s disease, an autosomal recessive neurological disorder in Miniature Wirehaired Dachshunds [14, 15]. In contrast, IVDD is likely a
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Comparison between Hemilaminectomy with either Anulectomy or Partial Discectomy for Treatment of Thoracolumbar Intervertebral Disc Protrusion in Dogs

Comparison between Hemilaminectomy with either Anulectomy or Partial Discectomy for Treatment of Thoracolumbar Intervertebral Disc Protrusion in Dogs

Degenerative intervertebral disc disease is the most common pathological condition affecting the canine thoracolumbar vertebral column (1). Two types of degenerative intervertebral disc disease have historically been recognized. Type I intervertebral disc disease, or intervertebral disc extrusion, is seen most commonly in chondrodystrophic dog breeds and involves the acute herniation of degenerate and calcified nucleus pulposus material through all layers of the ruptured anulus fibrosus into the vertebral canal (1-3). Type II intervertebral disc disease, or intervertebral disc protrusion, typically affects non-chondrodystrophic large breed dogs and the pathological abnormalities are predominantly seen in the anulus fibrosus. The weakened, hypertrophied anulus fibrosus protrudes into the vertebral canal, leading to chronic progressive spinal cord compression (2-4). Various surgical techniques have been reported in the management of thoracolumbar intervertebral disc protrusion, including hemilaminectomy with anulectomy, dorsal laminectomy and partial lateral corpectomy (5- 10). These techniques are often technically demanding and complicated by the fact that affected dogs may present with multiple sites of spinal cord compression (1, 9).
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Degenerative Disc Disease in Dogs

Degenerative Disc Disease in Dogs

The spinal cord is one of the most important and sensitive organ systems in the body. If it is damaged, the nerve cells do not regenerate but are replaced with fibrous or scar tissue. Spinal cord injuries usually result in permanent, irreversible damage. To protect it from damage, the spinal cord runs through a bony canal within the spine and is surrounded by protective bone everywhere except the junction of the vertebrae. These junctions are filled by rubber-like cushions called intervertebral discs . The individual vertebrae and intervertebral discs allow the back to move up and down and sideways without allowing contact between the bones of the spinal column. This extreme protection of the spinal cord reflects its importance and fragility.
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Thoracolumbar partial lateral corpectomy for the treatment of chronic intervertebral disc disease in 107 dogs

Thoracolumbar partial lateral corpectomy for the treatment of chronic intervertebral disc disease in 107 dogs

Finally, diagnostic imaging was lacking for the follow-up, especially in dogs that did not show a complete recovery. This could first have helped to determine if the lack of re- covery was due to an incomplete decompression of the spinal cord, a technically induced injury, or a definitive le- sion of the spinal cord secondary to chronic compression. Second, the quality of the decompression was not compared between the different surgeons; we found that dogs treated by a senior surgeon have significantly higher odds of walking at discharge than those treated by a resident, but we could not conclude whether the surgeon’ s experience was import- ant for the quality of the decompression. However, the ex- perience level of the surgeon did not significantly influence the long-term outcome or the ability to walk. Visual assess- ment of the spinal cord and the vertebral plateau at the end of the surgery (the absence of a bulging plateau or disc and a straight spinal cord) are interesting criteria for spinal cord decompression but are certainly not as accurate as a post- operative CT scan or MRI.
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Surgical Decompression in Dogs with Thoracolumbar Intervertebral Disc Disease and Loss of Deep Pain Perception: A Retrospective Study of 46 Cases

Surgical Decompression in Dogs with Thoracolumbar Intervertebral Disc Disease and Loss of Deep Pain Perception: A Retrospective Study of 46 Cases

Laitinen OM, Puerto DA: Surgical decompression in dogs with thoracolumbar in- tervertebral disc disease and loss of deep pain perception: a retrospective study of 46 cases. Acta vet. scand. 2005, 46, 79-85. – The case details and outcome after surgi- cal decompression of 46 dogs with thoracolumbar intervertebral disc disease with loss of deep pain perception prior to surgery were reviewed. Nineteen dogs (41.3%) recov- ered with a median follow-up period of 12.5 months. Recovery was defined as an am- bulatory paraparesis, or better, with urinary and fecal continence. There was a better outcome in dogs with loss of deep pain for less than 24 hours prior to surgery (19/41; 46.3% recovered) than in dogs without deep pain perception for more than 24 hours (0/5; 0% recovered). Dogs with deep pain perception present at two weeks postopera- tively had significantly higher success rate (8/12; 66.7% recovered) than dogs without deep pain perception at this time period (1/10; 10.0% recovered). The return of deep pain perception by two weeks postoperatively can be a useful positive prognostic indi- cator.
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Intervertebral disc disease in Dachshunds radiographically screened for intervertebral disc calcifications

Intervertebral disc disease in Dachshunds radiographically screened for intervertebral disc calcifications

An association between the existence or number of calcifications and risk for IDD has been previously shown; in a population of Danish Dachshunds, the lower the number of calcifications, the smaller the risk for IDD [5]. In a study of Finnish miniature Dachshunds, only one out of 25 dogs without calcifications had had signs of IDD [26]. The association between IDC and IDD has been established as a tool to reduce the occurrence of IDD. Radiographic screening for IDC has been recommended in three Nordic countries (Denmark, Finland and Norway). In Finland, the protocol includes laterolateral radiographs of the cervical, thoracic and lumbar spine. IDC is graded as follows: no calcifications = free (IDC 0), 1 – 2 calcifications = mild (IDC 1), 3 – 4 calcifications = moderate (IDC 2) and ≥ 5 calcifications = severe (IDC 3). The same grading is used also in Denmark and Norway. The preferred age range for screening in Finland is 24 – 42 months, but Dachshunds aged between 12 and 24 months old or older than 42 months have also been radiographed. In Denmark and Norway, the preferred age range is set at 24 – 48 months.
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Original Article The role of lncRNA MALAT1 in intervertebral degenerative disc disease

Original Article The role of lncRNA MALAT1 in intervertebral degenerative disc disease

Intervertebral disc degeneration disease (IDDD) is a common clinical disease. As a common bone disease, it can lead to neck and shoulder pain which brings severe problem to the global health [1, 2]. Chronic low back pain is the most common clinical symptom, which can be induced by IDDD, lumbar disc herniation, lum- bar spondylolisthesis, and lumbar spinal steno- sis. IDDD is the main cause of chronic low back pain and has gradually become one of the glob- al public health problems [3, 4]. The incidence of IDDD in China increases year by year and exhibits the younger trend [5]. IDDD is induced by a variety of physical and chemical factors, as well as molecular biology and mechanical fac- tors. Intervertebral disc cell structure and func- tion changes, thereby affecting the nucleus pulposus cells and destroying the boundaries
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Expression of the RANK/RANKL/OPG system in the human intervertebral disc: implication for the pathogenesis of intervertebral disc degeneration

Expression of the RANK/RANKL/OPG system in the human intervertebral disc: implication for the pathogenesis of intervertebral disc degeneration

ADAMTS: A disintegrin and metalloprotease with thrombospondin motif; AF: Annulus fibrosus; ahRANKL-mAB: anti human RANKL mouse monoclonal antibody; ALN: alendronate; ANOVA: Analysis of variance; CEP: Cartilaginous endplate; DRG: Dorsal root ganglion; ELISA: Enzyme-linked immunosorbent assay; FBS: Fetal bovine serum; HE: Hematoxylin and eosin; HRP: Horseradish peroxidase; IgG: Immunoglobulin G; IL-1 β : Interleukin-1 beta; IRB: Institutional Review Board; IVD: Intervertebral disc; MMP: Matrix metalloproteinase; MRI: Magnetic resonance imaging; NF- κ B: Nuclear factor kappa B;

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Correlation between lumbar intervertebral disc height and lumbar spine sagittal alignment among asymptomatic Asian young adults

Correlation between lumbar intervertebral disc height and lumbar spine sagittal alignment among asymptomatic Asian young adults

Methods: A cohort of 169 cases of asymptomatic volunteers was enrolled from January 2014 to July 2016. All participants underwent magnetic resonance imaging of the lumbar spine and panoramic radiography of the spine. Panoramic radiographs of the spine were taken to evaluate pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) using Surgimap® software. Roussouly classification was utilized to categorize all subjects according to the four subtypes of sagittal alignment. The IDH was measured on the MRI mid-saggital section of the vertebral body. The relationships between lumbar IDH and spine-pelvic parameters were also assessed using the Spearman correlation analysis. Results: The reference value ranges of IDH in asymptomatic Asian volunteers between L1/2, L2/3, L3/4, L4/5, and L5/S1 were (6.25, 10.99), (6.97, 12.08), (7.42, 13.3), (7.76, 14.57),and (7.11, 13.12) mm, respectively. Based on the above reference value, the high lumbar intervertebral space is defined as more than 14 mm. According to the Roussouly Classification, there are 33 cases in type I, 48 in type II, 66 in type III, and 22 in type IV. According to the definition of the high IDH, there are two cases in type I, three in type II, nine in type III, and eight in type IV. The results indicated that people in the Roussouly III and IV subtypes had greater values for IDH compared to those of Roussouly I and II subtypes, and the spinopelvic parameters were partly correlated with IDH in different subtypes. In addition, levels L4 – L5 showed the highest IDH for all four groups followed by the L3 – L4 and L5 – S1 levels, and the value of L3 – L4 is equivalent to that of L5 – S1. All type groups showed moderate and positive correlations between the PI and IDH except the level of L1 – L2 in type IV. Conclusions: The IDH may influence the lumbar spine sagittal alignment in asymptomatic Asian adults. Moreover, pre-operative evaluation of IDH is useful for selection of optimal cage size and reconstruction of spinal alignment.
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Comparison of trace element concentration in bone and intervertebral disc tissue by atomic absorption spectrometry techniques

Comparison of trace element concentration in bone and intervertebral disc tissue by atomic absorption spectrometry techniques

Zinc and Mg showed no deviation from previous find- ings. The biological role of magnesium ions is quite exten- sive [17]: they take part in nucleic acid chemistry with DNA and RNA synthesis; an array of enzymes requires their presence as the reaction co-factor; and they have a role in energetic nucleotide formation (ATP as the chelate with Mg ion). Magnesium also plays a role in the active transport of calcium and potassium ions across cell mem- branes, a process that is important to nerve impulse con- duction, muscle contraction, and normal heart rhythm. Magnesium levels are well documented in a variety of tissues, including IVD and the similar temporomandibular joint disc [34]. Tohno et al. [4] have reported Mg at almost all levels of the spine, with an average Mg content of 1,196 mg kg −1 , ranging from 600 to 2,200 mg kg −1 , in agreement with our results of 758.17 mg kg −1 (range 182.6–2,132 mg kg −1 dw). Differing slightly from our findings are values for the temporomandibular joint disc [34] reported by Takano et al. of 524.74 vs 758.17 mg kg −1 dw, respectively. Similar values for Mg were also reported in the posterior longitudinal ligaments of the cervical spine (445 mg kg −1 ) [35], which also were less than our results (161 and 494.8 mg kg −1 of SD, respectively). In soft tissue of the stomach, the concentration seems to be the lowest compared to tissues described in the literature, ranging from 30 to 300 mg kg −1 dw [36]. Compared to IVD, the average concen- tration of Mg in bones may be more than two times higher at 1,792.9 mg kg −1 [26]. Our study confirms the literature data for bone and IVD performed separately. Magnesium concentration was approximately two times higher in bone (1,661.21 and 1,458.49 mg kg −1 in femoral neck and head, respectively) compared to disc (758.17 mg kg −1 ).
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Serum lipid levels are positively correlated with lumbar disc herniation—a retrospective study of 790 Chinese patients

Serum lipid levels are positively correlated with lumbar disc herniation—a retrospective study of 790 Chinese patients

Low back pain (LBP) is a major public health problem that causes individual suffering and economic loss. Moreover, 70 to 85 % of people suffer from low back pain at some time during their lifetime [1]. Sciatica, which is character- ized by low back pain with radiculopathy, is a common clinical symptom that affects approximately 40 % of the adult population at some time [2], often has a lengthy course and causes long-term disability [3]. Lumbar disc herniation (LDH) is a major cause of low back pain and sciatica. Lumbar disc abnormalities are frequently found in asymptomatic individuals by magnetic resonance im- aging [4]. However, only 4 % to 6 % of the population presents with symptomatic sciatica [2]. Though many scholars have investigated the aetiology and treatment of intervertebral disc degeneration (IVDD) [5–8], the underlying pathophysiologic mechanism remains unclear. Furthermore, abnormal serum lipid levels are well-known risk factors for the development of atherosclerosis [9, 10]. We therefore asked whether there was an association between serum lipid levels and IVDD.
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