Dang Lei, Zhu Jinglin, Liu Zhongjun, Liu Xiaoguang, Jiang Liang, Wei Feng, Song Chunli
Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China.
Department of Orthopedics, Beijing Shijitan Hospital, No. 10 Tieyi Rd., Yangfangdian Subdistrict, Haidian District, Beijing, PR China.
Med Hypotheses. 2020 Nov;144:109900. doi: 10.1016/j.mehy.2020.109900. Epub 2020 Jun 4.
Spinal instability related low back pain is a common condition resulting from degeneration and loss of stiffness of the intervertebral joint. In order to restore stability, highly invasive surgical fusion is needed for patients who are not responding to conservative treatment. Given the risk and complications of surgery, there has been the urge for improvement with a less invasive solution. Formation of vertebral body osteophytes is a common observation that has been treated as a degenerative condition. However, recent studies have associated it with reduced motion of spinal segments. Unlike the traditional view, we regard it as adaptive reactions aiming to repair and hypothesize that the spinal segments could be stabilized or fused by intentionally induced osteophytes growth at the mobile parts of the intervertebral joint. This could be achieved by injecting Bone Morphogenetic Proteins to the anterior ends of the vertebral bodies and/or the facet joints on both sides of two consecutive vertebrae percutaneously. If verified, it would be the first time that fusion could be achieved without surgery. Hence it would provide a valuable alternative to current treatments of spinal instability. Preliminary test in favor of this hypothesis is presented and we recommend that a formal study with sufficient number of samples is needed for verification.
脊柱不稳定相关的下腰痛是一种常见病症，由椎间关节退变和刚度丧失引起。为了恢复稳定性，对于保守治疗无反应的患者需要进行高侵入性的手术融合。鉴于手术的风险和并发症，人们一直渴望通过侵入性较小的解决方案加以改进。椎体骨赘形成是一种常见现象，一直被视为一种退行性病症。然而，最近的研究将其与脊柱节段运动减少相关联。与传统观点不同，我们将其视为旨在修复的适应性反应，并假设通过在椎间关节活动部位有意诱导骨赘生长，可以稳定或融合脊柱节段。这可以通过经皮向两个连续椎体的椎体前端和/或两侧小关节注射骨形态发生蛋白来实现。如果得到证实，这将是首次无需手术即可实现融合。因此，它将为当前脊柱不稳定的治疗提供一种有价值的替代方案。本文给出了支持这一假设的初步试验，我们建议需要进行有足够样本量的正式研究以进行验证。
