Laurie's Blogs.

A Facebook comment came about from a previous blog post – http://fourleg.com/Blog?b=625 

It made mention of x-rays not specifically showing the disc itself, about the difference between chondrodystrophic and non-chondrodystrophic disc degeneration, and specifically asked what therapies can be used to improve disc health.  So, here is my response:

While you cannot ‘see’ the disc on x-ray, typically the space between vertebral bodies is taken to represent the disc.  So, on radiograph, an area with reduced spacing, especially when compared to adjacent counterparts, is thought to represent disc disease / degeneration.  We cannot reliably correlate the disc height to back pain, or symptomology however.   However, the study highlighted here, did correlate narrowed discs to ‘behaviours that would indicate pain’.  I would want that back up by palpation finding… but these are mice in a lab and I doubt anyone is motion testing their spines!  

In regards to disc degeneration in dogs, a review paper by Hansen et al 2017 elucidated that the degenerative process in the canine disc is the same between chondrodystrophic dogs and non-chondrodystrophic dogs.  What is different is the rate/speed of degeneration.  Both suffer from a lack of oxygen & blood flow to the cells in the nucleus pulposus which could lead to failure of these cells to thrive – essentially chondroid metaplasia.

Therapies directed towards disc health is where I wanted to get to!    

Traction can help to regenerate degenerated disc – rabbit study (Kroeber et al 2005), or to slow degeneration of discs – rat study (Lai et al 2010), or to reduce the inflammation (via tracking IL-17, IL-1β, iNOS) – rat study (Han et al 2015).  And an invitro pig-disc study (Kuo et al 2014) found that traction improved cell viability of degenerative discs.  Human studies report traction improving disc height which has a correlation with decreasing pain scores (Apfel et al 2010)

Human studies report that manual therapy can help with pain associated with disc degeneration (Krekoukias et al 2017).  A rat study found that manual therapy modified the oxidative stresses at the disc which could delay degeneration of a disc (Yao et al 2022). And other invitro studies looked at photobiomodulation as strategy for treatment of intervertebral disc degeneration (Hwang MH et al 2016, 2018, 2020)

Acupuncture is known to help with pain and /or return to function following disc herniation.  (Liam et al 2009, Han et al 2010, Hayashi et al 2007, Joaquim et al 2010).

So, my only point in presenting the paper was just to present that there is a correlation to loss of disc height (presumed degeneration) with behaviours associated with pain in mice.  If this is true in mice, could it not be true in other species?  And if so, could therapies directed towards pain and disc health (as highlighted above) be prudent in our aging canine population as a way to slow down disc degeneration and be proactive about pain.  Am I making a giant leap based on this study alone?  Yep.  But based on a combination of studies, I think my thoughts are justified.

I would agree that further research in regards to interventions for chondrodystrophic breeds and their impact on IVDD is greatly lacking.

References:

1. Hansen T, Smolders LA, Tryfonidou MA, Meij BP, Vernooij JCM, Bergknut N, Grinwis GCM. The Myth of Fibroid Degeneration in the Canine Intervertebral Disc: A Histopathological Comparison of Intervertebral Disc Degeneration in Chondrodystrophic and Nonchondrodystrophic Dogs. Vet Pathol. 2017 Nov;54(6):945-952.
2. Kroeber M, Unglaub F, Guehring T, Nerlich A, Hadi T, Lotz J, Carstens C. Effects of controlled dynamic disc distraction on degenerated intervertebral discs: an in vivo study on the rabbit lumbar spine model. Spine (Phila Pa 1976). 2005 Jan 15;30(2):181-7.
3. Lai A, Chow DH. Effects of traction on structural properties of degenerated disc using an in vivo rat-tail model. Spine (Phila Pa 1976). 2010 Jun 15;35(14):1339-45.  
4. Han C, Ma XL, Wang T, Ma JX, Tian P, Zang JC, Kong JB, Li XD. Low magnitude of tensile stress represses the inflammatory response at intervertebral disc in rats. J Orthop Surg Res. 2015 Feb 7;10:26.  
5. Kuo YW, Hsu YC, Chuang IT, Chao PH, Wang JL. Spinal traction promotes molecular transportation in a simulated degenerative intervertebral disc model. Spine (Phila Pa 1976). 2014 Apr 20;39(9):E550-6.  
6. Apfel CC, Cakmakkaya OS, Martin W, Richmond C, Macario A, George E, Schaefer M, Pergolizzi JV. Restoration of disk height through non-surgical spinal decompression is associated with decreased discogenic low back pain: a retrospective cohort study. BMC Musculoskelet Disord. 2010 Jul 8;11:155.  
7. Krekoukias et al., Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial.  J Man Manip Ther 25 (2017) 66-73.
8. Yao C, Guo G, Huang R, Tang C, Zhu Q, Cheng Y, Kong L, Ren J, Fang M. Manual therapy regulates oxidative stress in aging rat lumbar intervertebral discs through the SIRT1/FOXO1 pathway. Aging (Albany NY). 2022 Mar 15;14(5):2400-2417. 
9. Hwang MH, Kim KS, Yoo CM, Shin JH, Nam HG, Jeong JS, Kim JH, Lee KH, Choi H. Photobiomodulation on human annulus fibrosus cells during the intervertebral disk degeneration: extracellular matrix-modifying enzymes. Lasers Med Sci. 2016 May;31(4):767-77. 
10. Hwang MH, Son HG, Lee JW, Yoo CM, Shin JH, Nam HG, Lim HJ, Baek SM, Park JH, Kim JH, Choi H. Photobiomodulation of extracellular matrix enzymes in human nucleus pulposus cells as a potential treatment for intervertebral disk degeneration. Sci Rep. 2018 Aug 3;8(1):11654. 
11. Hwang MH, Lee JW, Son HG, Kim J, Choi H. Effects of photobiomodulation on annulus fibrosus cells derived from degenerative disc disease patients exposed to microvascular endothelial cells conditioned medium. Sci Rep. 2020 Jun 15;10(1):9655.
12. Han HJ, Yoon HY, Kim JY, Jang HY, Lee B, Choi SH, Jeong SW.  Clinical effect of additional electroacupuncture on thoracolumbar intervertebral disc herniation in 80 paraplegic dogs. Am J Chin Med. 2010;38(6):1015-25.
13. Hayashi AM1, Matera JM, Fonseca Pinto AC.  Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs.  J Am Vet Med Assoc. 2007 Sep 15;231(6):913-8.
14. Joaquim JGF, Luna SPL, Brondani JT, et al.  Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic deficits.  J Am Vet Med Assoc.  2010, 236 (11): 1225 – 1229.
15. Laim A, Jaggy A, Forterre F, Doherr MG, Aeschbacher G, Glardon O.  Effects of adjunct electroacupuncture on severity of postoperative pain in dogs undergoing hemilaminectomy because of acute thoracolumbar intervertebral disk disease. J Am Vet Med Assoc. 2009 May 1;234(9):1141-6.