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Prognostic factors in the progression of intervertebral disc degeneration: Which patient should be targeted with regenerative therapies?
OBJECTIVE: Possible regenerative treatments for lumbar intervertebral disc degeneration (DD) are rapidly emerging. There is consensus that the patient that would benefit most has early‐stage DD, with a predicted deterioration in the near future. To identify this patient, the aim of this study was to...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons, Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764790/ https://www.ncbi.nlm.nih.gov/pubmed/31572980 http://dx.doi.org/10.1002/jsp2.1063 |
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author | Rustenburg, Christine M. E. Faraj, Sayf S. A. Ket, Johannes C. F. Emanuel, Kaj S. Smit, Theodoor H. |
author_facet | Rustenburg, Christine M. E. Faraj, Sayf S. A. Ket, Johannes C. F. Emanuel, Kaj S. Smit, Theodoor H. |
author_sort | Rustenburg, Christine M. E. |
collection | PubMed |
description | OBJECTIVE: Possible regenerative treatments for lumbar intervertebral disc degeneration (DD) are rapidly emerging. There is consensus that the patient that would benefit most has early‐stage DD, with a predicted deterioration in the near future. To identify this patient, the aim of this study was to identify prognostic factors for progression of DD. STUDY DESIGN: Systematic review. METHODS: A systematic search was performed on studies evaluating one or more prognostic factor(s) in the progression of DD. The criteria for inclusion were (a) patients diagnosed with DD on MRI, (b) progression of DD at follow‐up, and (c) reporting of one or more prognostic factor(s) in progression of DD. Two authors independently assessed the methodological quality of the included studies. Due to heterogeneity in DD determinants and outcomes, only a best‐evidence synthesis could be conducted. RESULTS: The search generated 3165 references, of which 16 studies met our inclusion criteria, involving 2.423 patients. Within these, a total of 23 clinical and environmental and 12 imaging factors were identified. There was strong evidence that disc herniation at baseline is associated with progression of DD at follow‐up. There is limited evidence that IL6 rs1800795 genotype G/C male was associated with no progression of DD. Some clinical or environmental factors such as BMI, occupation and smoking were not associated with progression. CONCLUSIONS: Disc herniation is strongly associated with the progression of DD. Surprisingly, there was strong evidence that smoking, occupation, and several other factors were not associated with the progression of DD. Only one genetic variant may have a protective effect on progression, otherwise there was conflicting or only limited evidence for most prognostic factors. Future research into these prognostic factors with conflicting and limited evidence is not only needed to determine which patients should be targeted by regenerative therapies, but will also contribute to spinal phenotyping. |
format | Online Article Text |
id | pubmed-6764790 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley & Sons, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-67647902019-09-30 Prognostic factors in the progression of intervertebral disc degeneration: Which patient should be targeted with regenerative therapies? Rustenburg, Christine M. E. Faraj, Sayf S. A. Ket, Johannes C. F. Emanuel, Kaj S. Smit, Theodoor H. JOR Spine Review OBJECTIVE: Possible regenerative treatments for lumbar intervertebral disc degeneration (DD) are rapidly emerging. There is consensus that the patient that would benefit most has early‐stage DD, with a predicted deterioration in the near future. To identify this patient, the aim of this study was to identify prognostic factors for progression of DD. STUDY DESIGN: Systematic review. METHODS: A systematic search was performed on studies evaluating one or more prognostic factor(s) in the progression of DD. The criteria for inclusion were (a) patients diagnosed with DD on MRI, (b) progression of DD at follow‐up, and (c) reporting of one or more prognostic factor(s) in progression of DD. Two authors independently assessed the methodological quality of the included studies. Due to heterogeneity in DD determinants and outcomes, only a best‐evidence synthesis could be conducted. RESULTS: The search generated 3165 references, of which 16 studies met our inclusion criteria, involving 2.423 patients. Within these, a total of 23 clinical and environmental and 12 imaging factors were identified. There was strong evidence that disc herniation at baseline is associated with progression of DD at follow‐up. There is limited evidence that IL6 rs1800795 genotype G/C male was associated with no progression of DD. Some clinical or environmental factors such as BMI, occupation and smoking were not associated with progression. CONCLUSIONS: Disc herniation is strongly associated with the progression of DD. Surprisingly, there was strong evidence that smoking, occupation, and several other factors were not associated with the progression of DD. Only one genetic variant may have a protective effect on progression, otherwise there was conflicting or only limited evidence for most prognostic factors. Future research into these prognostic factors with conflicting and limited evidence is not only needed to determine which patients should be targeted by regenerative therapies, but will also contribute to spinal phenotyping. John Wiley & Sons, Inc. 2019-09-21 /pmc/articles/PMC6764790/ /pubmed/31572980 http://dx.doi.org/10.1002/jsp2.1063 Text en © 2019 The Authors. JOR Spine published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Review Rustenburg, Christine M. E. Faraj, Sayf S. A. Ket, Johannes C. F. Emanuel, Kaj S. Smit, Theodoor H. Prognostic factors in the progression of intervertebral disc degeneration: Which patient should be targeted with regenerative therapies? |
title | Prognostic factors in the progression of intervertebral disc degeneration: Which patient should be targeted with regenerative therapies? |
title_full | Prognostic factors in the progression of intervertebral disc degeneration: Which patient should be targeted with regenerative therapies? |
title_fullStr | Prognostic factors in the progression of intervertebral disc degeneration: Which patient should be targeted with regenerative therapies? |
title_full_unstemmed | Prognostic factors in the progression of intervertebral disc degeneration: Which patient should be targeted with regenerative therapies? |
title_short | Prognostic factors in the progression of intervertebral disc degeneration: Which patient should be targeted with regenerative therapies? |
title_sort | prognostic factors in the progression of intervertebral disc degeneration: which patient should be targeted with regenerative therapies? |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764790/ https://www.ncbi.nlm.nih.gov/pubmed/31572980 http://dx.doi.org/10.1002/jsp2.1063 |
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