• Eur Spine J · May 2023

    ISSLS PRIZE in basic science 2023: Lactate in lumbar discs-metabolic waste or energy biofuel? Insights from in vivo MRS and T2r analysis following exercise and nimodipine in healthy volunteers.

    • B T Pushpa, S Rajasekaran, Murugesh Easwaran, Chandhan Murugan, Raksha Algeri, K S Sri Vijay Anand, Mugesh KannaRishiR0000-0001-5817-4909Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India., and Ajoy Prasad Shetty.
    • Department of Radiodiagnosis, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India.
    • Eur Spine J. 2023 May 1; 32 (5): 149115031491-1503.

    PurposeTo quantitatively assess the dynamic changes of Lactate in lumbar discs under different physiological conditions using MRS and T2r.MethodsIn step1, MRS and T2r sequences were standardized in 10 volunteers. Step2, analysed effects of high cellular demand. 66 discs of 20 volunteers with no back pain were evaluated pre-exercise (EX-0), immediately after targeted short-time low back exercises (EX-1) and 60 min after (EX-2). In Step 3, to study effects of high glucose and oxygen concentration, 50 lumbar discs in 10 volunteers were analysed before (D0) and after 10 days intake of the calcium channel blocker, nimodipine (D1).ResultsLactate showed a distinctly different response to exercise in that Grade 1 discs with a significant decrease in EX-1 and a trend for normalization in Ex-2. In contrast, Pfirrmann grade 2 and 3 and discs above 40 years showed a higher lactate relative to proteoglycan in EX-0, an increase in lactate EX-1 and mild dip in Ex-2. Similarly, following nimodipine, grade 1 discs showed an increase in lactate which was absent in grade 2 and 3 discs. In contrast, exercise and Nimodipine had no significant change in T2r values and MRS spectrum of proteoglycan, N-acetyl aspartate, carbohydrate, choline, creatine, and glutathione across age groups and Pfirrmann grades.ConclusionMRS documented changes in lactate response to cellular demand which suggested a 'Lactate Symbiotic metabolic Pathway'. The differences in lactate response preceded changes in Proteoglycan/hydration and thus could be a dynamic radiological biomarker of early degeneration.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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