Research - Spinal Injury
Smoking linked to cervical degenerative disc disease
Adding to the already length list of reasons not to smoke, researchers have connected smoking to worsening degenerative disc disease in the cervical spine, according to research presented this week at the Association of Academic Physiatrists Annual Meeting in Sacramento, Calif.
The cervical spine is located in the neck and is made up of bones called vertebrae. Between these bones are cervical discs that absorb shock to the spine. Through the normal aging process, these discs slowly degenerate, which means they become dehydrated and shrink. This may result in a person experiencing chronic neck pain that may be difficult to treat. In some cases, the drying of the disc may result in the formation of cracks and tears, through which some of the jelly-like central portion of the disc may spill out and irritate local nerves, which much of the time results in pain in the shoulders, arms, hands and fingers.
It isn’t only wear and tear over time that can damage these discs. Some unhealthy habits, such as smoking, can add to cervical disc degeneration, according to Mitchel Leavitt, MD; resident physician at Emory University’s Department of Physical Medicine and Rehabilitation and the lead investigator of a new study looking at smoking and cervical disc disease. “Smoking is not healthy for a person’s intervertebral discs given the risk of developing microvascular disease – a disease of the small blood vessels – due to nicotine abuse,” Dr. Leavitt explains. “Intervertebral discs receive their nourishment from the microvasculature that line the endplates on either side of each disc; when these blood vessels are damaged, the discs do not receive nourishment and this may speed up the degenerative process.”
While smoking has been associated with degeneration in the lumbar spine (toward the base of the spine), no studies have been able to make this association with the cervical spine. To address this, Dr. Leavitt’s team evaluated the CT scans of 182 consecutive patients who were scanned for various reasons.
“There are more and more high-quality studies coming out that show an association between healthy lifestyle and improved quality and quantity of life as well as better disease management. Spine health is no different, and this study adds to existing studies that have looked at blood vessel health as it relates to chronic back pain,” Dr. Leavitt says.
The patients evaluated by Dr. Leavitt’s team were mostly female (57 percent), and 34 percent were smokers. The researchers utilized a radiologist with subspecialty training in neuroradiology and a physiatrist – a physician who specializes in physical medicine and rehabilitation – to review the CT scans, and they provided documentation on the severity of cervical degenerative disc disease.
Each disc was rated as normal (no loss of disc height), mild (one to 33 percent loss of disc height), moderate (34 to 66 percent loss of disc height), or severe with (greater than 66 percent loss of disc height or having a condition called vacuum disc where gas has accumulated in the discs). Based on this, scores of zero (normal) to three (severe) were given to each disc, and a cumulative cervical degenerative disc disease score was given for the entire cervical spine with a range of zero to 15.
The researchers considered each patient’s smoking status and his or her number of pack years smoked, which is the number of packs of cigarettes the patient smokes each day multiplied by the number of years he or she has smoked. Finally, the researchers collected and considered other health information such as age, body mass index, high blood pressure (called hypertension), high cholesterol and diabetes.
Current smokers were found to have more cervical degenerative disc disease by one point, on average. Additionally, the researchers found that increased age was associated with worsening cervical degenerative disc disease, but co-existing diseases – such as diabetes, hypertension, high cholesterol and high BMI – were not associated with the disease.
“This is another example of the detrimental effects of smoking. Tobacco abuse is associated with a variety of diseases and death, and there are lifestyle factors associated with chronic neck pain,” explains Dr. Leavitt of the study’s findings. “Pain and spine clinics are filled with patients who suffer chronic neck and back pain, and this study provides the physician with more ammunition to use when educating them about their need to quit smoking.”
Dr. Leavitt suggests more research should be conducted on other lifestyle factors (e.g., diets high in fat vs. plant-based, alcohol use, obesity, etc.) as they relate to chronic back and neck pain, as well as identifying any objective changes on advanced imaging or autopsy.
“As the population continues to get older, more and more patients are wanting, if not demanding, that they be given the opportunity to be as active as they were in their 40s. They want to play golf, run triathlons, work in their garden, etc.; however, chronic pain originating from the spine makes these activities difficult,” says Dr. Leavitt. “Virtually everyone knows that moderate exercise somewhere around four to five times per week is beneficial, plus other lifestyle factors like avoidance of smoking and a proper diet are equally important. However, these topics are usually geared towards heart health, lowering blood pressure, managing diabetes, or controlling other medical conditions, and not specific to the spine. It is one thing to live to the age of 95, and it is another to live to 95 while retaining one's mobility and being free of pain. Lifestyle medicine will likely play a large role in the future of healthcare, and having plenty of data to support lifestyle management is critical for a provider who practices evidenced-based medicine. The lifestyle approach may allow us to not only live longer and healthier lives, but we may also be able to take less medication in the process, thereby sparing us the risk of medication side effects.”
Smoking and Cervical Degenerative Disc Disease as Seen on Computed Tomography
Mitchel Leavitt, MD; William Beckworth, MD
Objectives: This study seeks to evaluate the association between cigarette smoking and cervical degenerative disc disease (DDD) via advanced imaging using computed tomography (CT). This has been reported in the lumbar spine but not in the cervical spine except for an x-ray study suggesting that smoking had no effect.
Design: A radiologist with subspecialty training in neuroradiology along with a physiatrist reviewed 182 consecutive CT scans which had been completed at a university hospital for various reasons. Documentation was done in regards to severity of the cervical DDD. Each disc was rated as normal, mild (0-33% loss of disc height), moderate (33-66% loss of disc height), or severe (>66% loss of disc height or vacuum disc). Scores of 0 (normal) to 3 (severe) were given for each disc. A cumulative cervical DDD score was given for the entire cervical spine (C2-7), with a range of 0-15. Other health information was collected including age, smoking status, pack years smoked, BMI, hypertension, dyslipidemia and diabetes. A linear regression model was used to evaluate for a correlation with cervical DDD while accounting for age.
Results: Of the 182 patients there were 61 smokers (34%) and 103 females (57%). Age correlated with worsening cervical DDD (correlation coefficient 0.636, p < 0.0001). Current smokers were found to have more severe cervical DDD after controlling for age (p=0.0203). Active smokers had a worse cumulative cervical DDD score by one point on average. There was no statistical significance for pack years (p=0.164). Comorbidities including diabetes, hypertension, hyperlipidemia and BMI did not correlate with worsening cervical DDD.
Conclusions: There is a positive correlation between active smoking and cervical DDD after controlling for age, although the effect was small. This has not been previously described in the cervical spine.
Source : Newswise
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Novel Chinese Herbal Medicine JSK Improves Spinal Cord Injury Outcomes in Rats
A new study published in Restorative Neurology and Neuroscience demonstrates that Chinese herbal medicine Ji-Sui-Kang (JSK), given systemically for three weeks after injury in rats, improved locomotor function, reduced tissue damage, and preserved the structure of neural cells compared to control rats. The report also includes data showing that JSK may first act to reduce inflammation and cell apoptosis and death, and boost local oxygen supply while, later on, it appears to restore function and promote tissue regeneration.
Although Chinese herbal medicines have traditionally been used for a variety of ailments, the rationale for their use relies more on anecdotal evidence than the results of modern-day controlled experiments.
"A number of anecdotal reports from Chinese medicine practitioners indicate that treatment with a novel herbal formulation, JSK, for periods of one week or three months improved functional recovery," explains co-lead investigator Shucui Jiang, MD, PhD, head of the Hamilton NeuroRestorative Group at McMaster University in Hamilton, Ontario, Canada. "Our present study provides an important and necessary foundation for further studies of JSK."
In this study rats began JSK treatment immediately after undergoing spinal cord injury. Within 7 days, hindlimb locomotor function was significantly better in JSK-treated rats compared to those receiving only saline. JSK-treated rats continued to have better motor function than controls throughout the 21-day test period and treated animals appeared to support their weight better and have more coordinated movements.
When the investigators looked at histological samples of the spinal cord, they found that the architecture of the spinal cord was better preserved in JSK-treated animals and the size of the injured area was significantly smaller 7 days after injury. JSK-treated animals also showed more intact axons and myelin in the injured areas compared to controls. Other encouraging signs were less deposition of fibrinogen in the injured areas of JSK-treated animals, a decrease in pro-inflammatory COX-2 expression, and fewer cell deaths at the lesion site (as measured by caspase-3 staining).
JSK also increased the expression of growth associated protein 43 (GAP43), a marker of neuronal development and axonal regeneration, and neuroglobulin, a protein found in cerebral neurons that is thought to help neurons survive and recover after trauma. "Our data suggest that JSK may enhance tissue recovery by reducing cell growth inhibitors and by promoting the proliferation of cells within the injured spinal cord," says co-lead investigator Michel P. Rathbone, MD, CHB, PhD, Professor, Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Other findings suggest JSK might help protect against injury caused by damage to spinal cord blood vessels. For instance, JSK increased vascular endothelial growth factor (VEGF), a protein involved in the formation and growth of blood vessels, down-regulated clotting-associated genes, and promoted factors that contribute to vasodilation.
The authors say that JSK targets multiple biochemical and cellular pathways that may help protect against the primary traumatic injury as well as subsequent secondary injuries that evolve over time.
The authors do not disclose the complete herbal composition of JSK for proprietary reasons. Some of its ingredients include Ginseng, Rhizoma (chuan xiong), Glycyrrhizae Radix (gan cao), Paeoniae Alba Radix (bai shao) and Cinnamomi Cortex (rou gui)
Source : Newswise
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