INTRODUCTION
Intervertebral disc degeneration (IVDD) is a significant cause of low back pain and incurs substantial socioeconomic costs globally. Its development is attributed to multiple factors, including aging, heredity, mechanical stress, and lifestyle-related issues, including obesity, muscle deterioration, and loss of bone density. Furthermore, smoking, hypertension, diabetes, metabolic syndrome, anemia, and hormonal factors, including estrogen, along with inflammation and oxidative stress, also contribute to IVDD. Periostin, a key component of the extracellular matrix, has been identified as being closely related to IVDD due to its connections with mechanical stress, inflammation, and aging. This study aimed to investigate the correlation between the severity of IVDD and serum periostin levels, delving into a relatively unexplored area. It also sought to understand the potential relationship between IVDD and various clinical and demographic factors, filling a gap in existing research.
METHODS
This retrospective cohort study included 198 patients who underwent lumbar disc herniation and lumbar canal stenosis between January 2020 and December 2022. The Pfirrmann grade (1–5) was used to evaluate IVDD severity using magnetic resonance images. To assess the severity of IVDD, the Pfirrmann grades of all lumbar discs were summed to calculate a cumulative grade in accordance with previous reports (Guo, Eur Spine J. 2022). Serum periostin levels were quantified using ELISA kits for human periostin. Collected demographic data, including age, body mass index (BMI), comorbidities (anemia, and osteoporosis), were also collected.
RESULTS
This study demonstrated a significant correlation between high serum periostin levels and IVDD severity, as indicated by a high cumulative Pfirrmann score. Serum periostin levels were an independent risk factor for IVDD in a multivariate regression model. There was a correlation between periostin and Pfirrmann grade at each lumbar level (ρ= 0.458–0.550, p<0.001) and a strong correlation with cumulative Pfirrmann score (ρ= 0.690, p<0.001).
DISCUSSION
The results of our study suggest that higher serum periostin level is correlated with a higher cumulative Pfirrmann score, indicating a higher severity of IVDD; and serum periostin is associated with the cumulative Pfirrmann score. IVDD is affected by mechanical stress.Periostin is highly expressed in mechanically stressed tissues and promotes injury repair in many tissues. Inflammation is another important feature of the IVDD environment. IVDD occurs when the nucleus pulposus, which has no blood vessels, is exposed to circulation, resulting in inflammation and triggering an autoimmune inflammatory response. High levels of TNF-α, IL-6, and other proinflammatory cytokines, are released by disc cells, exacerbating inflammation through interaction with periostin, contributing to IVDD progression. Thus, periostin may be involved in the pathogenesis of IVDD via mechanical stress and inflammation. Hence, periostin may serve as a clinically relevant and useful biomarker that can aid in the diagnosis, estimating disease progression, activity and prognosis, and selecting appropriate treatment modalities for IVDD.