bluuebunny/crossref_metadata_2025 huggingface dataset:
Diffusion Tensor Imaging for Quantitative Evaluation of Lumbar Intervertebral Disc Degeneration
Authors: Oikawa Y. , Eguchi Y. , Watanabe A. , Orita S. , Yamauchi K. , Suzuki M. , Sakuma Y. , Kubota G. , Inage K. , Sainoh T. , Sato J. , Fujimoto K. , Takahashi K. , Ohtori S.
Published: May 2014

Introduction

Pfirrmann classification, T2- and T1ρ mapping using MRI are tools to evaluate intervertebral disc (IVD) degeneration. Diffusion tensor imaging (DTI) and diffuion tensor tractography (DTT) are neuroimaging tools for visualizing highly anisotropic tissues. Recently, DTI is used for evaluation of degenerated IVDs. The purpose of this study is to provide evidence for the efficacy of DTI and DTT in the quantitative evaluation of degenerated IVDs.

Materials and Methods

Three patients with discogenic low back pain underwent DTI and DTT on a 3.0 T MR scanner. We evaluated 12 discs from L2-3 to L5-S in each patient. Pfirrmann classification on conventional MR imaging, fractional anisotropy (FA) value, morphological classification on DTT, and number of tracking fibers were evaluated. IVD was divided into three layers in a concentric manner from the center; FA value was measured at each layer. DTT was classified into ring, donut, and disk type.

Results

With Pfirrmann classifications, six, two, and four discs were grades 2, 3, and 4, respectively. With DTT classification, six, one, and five discs were ring, donut, and disk types, respectively. All grades 2,1, and3 discs corresponded to ring type, and all grade 4 and the other grade 3 discs corresponded to disk type. FA value of the intermediate layer was 0.10 for ring type, 0.21 for donut, and 0.23 for disk type. FA value of the inner layer was 0.06 for ring type, 0.09 for donut, and 0.20 for disk type. The number of tracking fibers was increased in disk types.

Conclusion

This study showed that shape on DTT correlated to Pfirrmann classification, and DTT of discs can describe the IVD degeneration process. A previous study showed that water content tended to decrease in IVD degeneration. The increasing FA value and number of the tracking fibers may reflect a decreased water content and tissue degeneration. Thus, DTI and DTT can visualize and quantitatively evaluate IVD degeneration. DTI and DTT may detect degeneration and evaluate repair and regeneration. Disclosure of Interest None declared
In Vitro Tissue Regeneration by Human Degenerated Nucleus Pulposus Cells in Hyperosmotic Culture Medium
Authors: Krouwels A. , Popov J. , Plomp S. , Dhert W. , Oner C. , Bank R. , Creemers L.
Published: May 2014

Introduction

Healthy intervertebral disc (IVD) cells normally reside in a high osmolality environment of 450 to 550 mOsm/kg and extracellular matrix production by MSC cells has been shown to increase with increasing osmolality. However, it is not known how human degenerated disc cells are affected by osmolality. The aim of the current study was to determine the effects of osmolality on tissue regeneration by human degenerated NP cells.

Materials and Methods

The osmolality of standard chondrogenic culture medium (DMEM, 2% ascorbic acid-2 phosphate, 2% human serum albumin, 2% insulin-transferring selenium-X, 1% penicillin/streptomycin, 10 ng/mL transforming growth factor β2 [TGF-β2]) was adjusted with NaCl and sucrose from 340 to 400, 450, and 500 mOsm/kg. IVD cells from four human donors (Thompson grade III) were cultured for 28 days in high density (1*10^6 cells/cm2) on collagen II coated filters. LDH analysis was performed to analyze toxicity. Samples were stained with Safranin-O for glycosaminoglycans (GAGs) and with immunohistochemistry for collagen II. Gene expression was evaluated by qPCR and a collagen low-density array. Matrix content as reflected by glycosaminoglycan (GAG) production was measured with a dimethylmethylene blue (DMMB) assay and DNA content with a Picogreen assay. Statistical analysis included univariate analysis of variance with randomized block design and post hoc Dunnet t-test.

Results

No cytotoxic effects were found in any of the conditions tested. Gene expression showed an osmolality-dependent increase compared with standard medium in collagen II and aggrecan only when NaCl was used (see Fig. 1A, B for p-values). However, at the protein level, no effect of increased osmolality using NaCl was found. This could not be explained by MMP gene expression levels, as these seemed lower at high osmolality. Tissues cultured in the presence of the osmolyte sucrose appeared to contain less proteoglycans, but this difference was not significant.

Conclusion

In conclusion, in the current culture system, the increased expression of matrix genes with osmolality appears to be osmolyte dependent rather than osmolality dependent. Moreover, the absence of an effect at the protein level suggests adjusting osmolality with NaCl to enhance matrix production by IVD cells is not required. Disclosure of Interest None declared
Neither a Lumbar Disc nor a Thoracic Disc; L1-L2 Disc Located in Region of Spine Biomechanical and Neural Transition Zone
Authors: Sharifi G. , Abolhasani E. , Hosseinzadeh M. , Shafizadeh M. , Mousavi A.
Published: May 2014

Introduction

Although L1-L2 disc is anatomically located in lumbar region, its specific location poses a caveat to the surgeon for both conus medullaris present in this area and the great biomechanical standpoint in thoracolumbar region.

Materials and Methods

In our experience with this group of patients, we used trans-facet pedicle-sparing approach to care for conus medullaris. In addition, we performed short segment fusion to augment this highly demanding biomechanical region. Since the year 2008, we operated 13 cases with L1-L2 disc with this technique. Only two cases presented with severe L2 radiculopathy and the rest came with feature of cauda equine or conus problem. Axial back pain was crucial symptom in eight cases. Two patients had simultaneous disc problem in L2-L3 and one patient had T12-L1 disc protrusion. After operation, patients received Jewett hyperextension brace for 3 months. In one patient with central hard calcified disc, we performed thoracoabdominal approach and decompression from anterior. All surgery performed under high magnification of microscope and bone removal was done by powered drill.

Results

In six cases, decompression was performed bilaterally to reach the central portion of the disc. Pedicle screw was used for fixation in all patients. TLIF banana cage was used in five cases and spinous process bone used as interbody graft in four cases. There was no aggravation in neurological deficit and we have no problem with CSF leak or wound. Fusion achieved in all patients and axial back pain resolved successfully.

Conclusion

Although L1-L2 innately considered a lumbar disc, we suggest that they should be considered as thoracic disc and the surgeon should not solely rely on where the conus terminated in MRI. In this location, small traction can lead to catastrophic neurological damage; therefore, by using trans-facet pedicle-sparing under microscopic guide the cord should be decompressed by drill. In addition, to prevent neurological injury, Kerrison should not be placed under already stenotic canal. Disclosure of Interest None declared
The Optimal Insertion Position of the Lumbar Interspinous Dynamic Stabilization Device: A Biomechanical Evaluation
Authors: Hai Y. , Zu D.
Published: May 2014

Introduction

To evaluate the optimal insertion position of the Coflex lumbar interspinous dynamic stabilization device, a biomechanical study was conducted.

Materials and Methods

Six fresh adult human cadaveric lumbar spine specimens (L1-L5) were mounted in a materials testing machine (MTS) by embedding to clamps with L1 and L5 vertebrae. L3/4 motion segment of each specimen was operated by selective decompression and Coflex interspinous device insertion. The L3 and L4 vertebrae was inserted one needle attached with four marker points, respectively, which were used to record the range of motion (ROM). Each lumbar spine specimen was tested according to the loading sequence at five condition models: intact (keeping lumbar ligamenta and facet joints intact); partial destabilized (resection of L3/4 interspinous ligamenta, ligamentum flavum, facet capsule, and bilateral resection 50% of L3 inferior facets); 10 mm insertion (distance between apex of U-shaped Coflex and dural sac was 10 mm), 5 mm insertion (the distance was 5 mm), and 0 mm insertion (the distance was 0 mm). Each lumbar spine specimen was tested according to a loading sequence consisting of flexion, extension, left/right lateral bending, left/right axial rotation, loaded with pure moments of 8 Nm, and was recorded the ROM of operative segment at the third time. ROM of five condition models in six directions, respectively, was analyzed with one-way ANOVA test and multiple comparisons are based on LSD method.

Results

The ROMs of the 5 and 0 mm group were on significant differences ( p > 0.05) comparing with the intact group in flexion (F = 8.472), extension (F = 18.310), left (F = 16.809), and right axial rotation (F = 6.624), but they were significantly different comparing with the partial destabilized group in the same directions ( p < 0.01). There were significant differences ( p < 0.01) in the ROM of left lateral bending (F = 7.700) and right lateral bending (F = 12.473) between the 5 and 0 mm group and the intact group, but there was no difference comparing with the partial destabilized group in the same directions ( p > 0.05). The 10 mm group had significant high ROM in six directions than the intact group ( p < 0.01), but were no differences comparing with the partial destabilized group ( p > 0.05).

Conclusion

The insertion of Coflex interspinous dynamic stabilization device can maintain the stability of a partially destabilized specimen back to an intact one in flexion, extension, and axial rotation when distance between apex of U-shaped Coflex and dural sac was 5 mm or less, but cannot return the stability in lateral bending. The Coflex cannot return the stability of a partially destabilized specimen back to an intact one in six directions when distance between apex of U-shaped Coflex and dural sac was or more 10 mm. Disclosure of Interest None declared
Correlation of Clinical Outcome and Radiological Parameters for Activ L Total Disc Replacement
Authors: Shi Lu B.
Published: May 2014

Introduction

Summary of Background Data Radiological results are important parameters for total disc replacement (TDR) patients, but the correlation of various radiological parameters with clinical results is still controversial. Study design A prospective clinical study. Purpose To assess the clinical and radiological results for patients who underwent Activ L total disc replacement, and to correlate various radiological parameters with clinical outcome.

Materials and Methods

From March 2009 to March 2012, 32 patients with degenerative disc diseases (DDD) underwent either mono- or bi-segmental lumbar TDR, of whom 30 (93.7%) with 36 prosthesis had an average follow-up of 28.8 months (12-46 months). Clinical parameters such as Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) were evaluated preoperatively and at 1, 2, and 3 years postoperatively. Radiological parameters as range of motion (ROM), intervertebral disc height (IDH) of the index and adjacent segments, coronal and sagittal positions of the prosthesis, and lumbar lordosis were also performed. Prosthesis subsidence and heterotopic ossification were observed during the follow-up period.

Results

Thirty patients had 1 year follow-up, 20 of whom had 2 years follow-up and 15 of whom had 3 years follow-up. The VAS (back pain), VAS (leg pain), and ODI score showed significant improvement after surgery ( p < 0.001), and there was no significant difference between each follow-up ( p > 0.8754). At the 3-year follow-up, ROM of the index level and the upper adjacent level showed significant increase ( p < 0.0128), while the lower adjacent level showed no obvious increase of ROM ( p = 0.4205). Immediately after surgery, IDH of the index level showed a significant increase ( p < 0.0071), but the difference disappeared at the 3-year follow-up ( p = 0.0597). The IDH of the upper and lower adjacent level showed no significant difference during the 3-year follow-up ( p > 0.6669). Compared with preoperative data, the lumbar lordosis showed no obvious difference during the 3-year follow-up ( p = 0.2643). According to one of the radiological criteria, 75% of the prostheses were rated as ideally positioned, 16.7% were discretely shifted, 5.6% were slightly shifted, and 2.7% were markedly shifted in the coronal plane. In the sagittal plane, 13.9% of the prostheses were rated as ideally positioned, 22.2% were discretely shifted, and 63.9% were suboptimally placed. At each patient's final follow-up, the radiological parameters did not correlate with clinical results ( p < 0.001).

Conclusion

The short- and mid-term results of Activ L prosthesis for degenerative disc diseases are satisfying. Our data indicate poor correlation between various radiological parameters and clinical outcome. Disclosure of Interest None declared
The Sagittal Balance of Cervical Spine after Posterior Open-Door Laminoplasty: Comparison between the Modification by Preserving Unilateral Musculoligament Complex and Anchor Method
Authors: Feifei Z. , Sun Y.
Published: May 2014

Introduction

A balanced sagittal alignment of the spine has been shown to strongly correlate with less pain, less disability, and greater health status scores. The profile of sagittal balance after posterior laminoplasty of cervical spine has not been evaluated extensively. The aim of this study is to investigate parameters of cervical spine sagittal balance after posterior open-door laminoplasty and compare the difference between modified surgery with preservation of unilateral musculo-ligament complex (PUMLC) and anchor method (AM) operation.

Materials and Methods

A retrospective review of 96 patient records from January 2008 to July 2011 was performed. All patients were diagnosed cervical spondylotic myelopathy (CSM) and underwent C3-7 posterior open-door laminoplasty with preservation of unilateral musculo-ligament complex (5 cases) and anchor method (40 cases). Cervical digital radiographs showed all the important skeletal landmarks necessary for accurate measurement. The radiographs were measured using standard techniques to obtain the following parameters both pre- and postoperation: C2-C7 sagittal vertical axis (C2-C7 SVA), C0-2 lordosis (Cobb angle formed between Occiput-C2), C2-7 lordosis (Cobb angle formed between C2-C7), T1 slope (angle between a horizontal line and the superior end plate of T1), range of motion from C2-C7 (C2-C7 ROM). The status of neurologic function was evaluated by modified JOA score (mJOA). Comparisons of these radiological and neurological assessments before and after surgery and difference between two surgical manipulations were under analysis.

Results

With an average follow-up period of 16.7 months, there was a significant increase ( p < 0.05) in C2-C7SVA (22.99 ± 1.23 mm), C0-2 lordosis (22.89 ± 0.75 degrees), and T1 slope (25.13 ± 0.67 degrees) postoperatively compared with preoperation (C2-C7SVA 20.82 ± 1.05 mm, C0-2 lordosis 19.56 ± 0.78 degrees, T1 slope 26.22 ± 0.71 degrees). The alignment of lower cervical spine (C2-7 lordosis) did not change significantly after the surgery ( p = 0.09). Both C0-2 lordosis and T1 slope positively correlated with increased C2-C7SVA ( r = 0.44, p < 0.001, and r = 0.27, p < 0.05). All patients experienced an improvement of mJOA (12.23 ± 0.31) compared with pre-op (14.56 ± 0.21). PUMLC had a smaller loss of C2-7 lordosis and C2-7 ROM than AM, but parameters of sagittal balance (C2-C7SVA, C0-2 lordosis, and T1 slope) did not show any statistical significant difference.

Conclusion

There was a positive sagittal malalignment trend after posterior open-door laminoplasty expressed by enlargement of T1 slope and compensated by increased C0-2 lordosis. Two surgical methods, PUMLC and AM, did not show any statistical significant difference of sagittal balance parameters, but PUMLC had the advantage of maintaining the alignment and range of motion of lower cervical spine. Disclosure of Interest None declared
C1, 2 Pedicle Screw Fixation in Treating Atlantoaxial Instability Guided by Surgical CT Navigation
Authors: Jiang T. , Ren X. , Wang J. , Chu T. , Zhang Z. , Wang W.
Published: May 2014

Introduction

To evaluate the accurate rate of insertion and the short-term curative effect of C1, 2 pedicle screw internal fixation for atlanto-axial instability guided by surgical CT navigation.

Materials and Methods

Seven patients with atlanto-axial instability were treated by C1, 2 pedicle screw internal fixation and bone graft fusion, guided by surgical CT navigation, including three cases of congenital dysplasia of odontoid process, three cases of atlantoaxial instability, and one case of old odontoid process fracture.

Results

There was no vascular or neural injury found. The patients were followed up for 3 to 15 months. The clinical symptom was improved in some extent after operation. No looseness or breakage of screw occurred and bony fusion was achieved in all cases.

Conclusion

C1, 2 pedicle screw fixation is a reliable method for atlanto-axial instability. Accurate rate of insertion can be improved by surgical CT navigation. Disclosure of Interest None declared
Interspinous Dynamic Stabilization with DIAM (Silicone) or InSWing (PEEK) Interspinous Implants
Authors: Berg A. James , Tankel J. A. , Hernandez M. , Jensen C. D. , Purushothaman B. , Reddy G. Raj , Friesem T.
Published: May 2014

Introduction

Foraminal and spinal canal stenosis causes neurogenic claudication. Interspinous devices provide an indirect decompression by distracting the involved vertebrae, thereby tightening the buckled flavum and opening the foramina and attempting to restore normal loading patterns in the lumbar spine which have altered due to disc degeneration. When used for indirect decompression alone, they avoid scar tissue formation in the canal. The DIAM (Medtronic, United States) is made of silicone and therefore conforms more to the interspinous space. The InSWing (Orthofix, United States) is made of PEEK (polyether ether ketone) and is noncompressible. We report the outcomes between these devices and between direct and indirect decompressions.

Materials and Methods

Retrospective analysis performed for surgery in July 2009 to 2011. Paired and unpaired t-test used to assess statistical significance ( p < 0.05).

Results

A total of 60 patients were included (22 females, 38 males), age 46 (21-78) years. Preoperative duration of symptoms was 65 (4-420) months. The numbers in each implant/decompression group and follow-up are shown in Table 1. Statistically significant improvement observed in all outcome measures in direct and InSWing groups and all outcomes except MCS in DIAM group. Indirect group improved in all outcomes, but these were significant only in VAS Back/Leg. InSWing and direct group scores improved more than the DIAM and indirect groups, respectively, but these differences were only significant in Oswestry in the decompression group. All five patients requiring revision surgery were in the DIAM group.

Conclusion

Statistically significant improvement was seen in all outcome measures in patients undergoing direct decompressions or implantation with InSWing implants. Improvement in scores was greater in these groups compared with the indirect decompression or DIAM groups. Disclosure of Interest A. Berg: None declared J. Tankel: None declared M. Hernandez: None declared C. Jensen: None declared B. Purushothaman: None declared G. Reddy: None declared T. Friesem: Conflict with RTI Surgical, Globus Medical
Direct Repair for Treatment of Lumbar Symptomatic Spondylolysis without Spondylolisthesis in Young Patients Using Gillet Technique (V-Shaped Rod)
Authors: Zhang X. , Liang Y. , Wu W. , Cao P.
Published: May 2014

Introduction

Spondylolysis developed during individual growth. In this article, direct repair of the pars defect was used to treat lumbar symptomatic spondylolysis without spondylolisthesis in young patients. Indication and postoperative outcomes of this operation were analyzed, to investigate the method of early treatment of spondylolysis, which can avoid the complication of spinal fusion for delayed isthmic spondylolisthesis caused by spondylolysis.

Materials and Methods

Twelve cases of lumbar symptomatic spondylolysis were retrospectively reviewed; all the cases received direct repair for the pars defect during 2005 to 2011, and was followed up for at least 2 years. Among them, there are eight cases of male and four cases of female, average 24.5 years old; there are 10 L5 spondylolysis and 4 L4 spondylolysis. They have low back pain and X-ray-confirmed bilateral spondylolysis without spondylolisthesis. There was no disc degeneration on MRI. The operation includes pars debridement, pedicle screw insertion, V-shaped rod connection, and bone autograft. VAS score was used to evaluate the pain status of the patient.

Results

All the patients got symptoms relieved, VAS score was reduced from 4.8 preoperation to 2.3 postoperation, and they all resumed to original work. During follow-up, the pars defect attained bony union in X-ray and 3D CT scan.

Conclusion

For the developmental spondylolysis with severe local symptom, but no disc degeneration, direct repair for the pars defect with pedicle screw and V-shaped rod and bone autograft can be used to heal the pars defect. This treatment, which is safe and effective, can reduce occurrence of disc degeneration caused by lumbar instability and delayed spondylolisthesis, avoid complications caused by spinal fusion. Disclosure of Interest None declared
Comparative Evaluation of in Vivo Radiographic Outcomes between Different Implants in Single-Level Cervical Disc Arthroplasty at Greater than 2 Years
Authors: Berg A. James , Tankel J. A. , Jensen C. D. , Irwin A. , Purushothaman B. , Reddy G. Raj , Friesem T.
Published: May 2014

Introduction

Cervical fusion alters the biomechanics of the cervical spine. Adjacent levels compensate for motion lost at the fused levels. This may lead to or accelerate the development of symptomatic adjacent segment disease (ASD). Cervical disc arthroplasty (CDA) is a safe and effective alternative to fusion. It is postulated that by preserving motion at the operated level, the adjacent levels will be protected from ASD potentially related to fusion. ASD will develop over the long-term and therefore CDA implants must maintain motion and mimic the normal biomechanics of a native disc to have the protective effect. Implant design may influence a CDA implant's ability to do this. We aim to assess if the three implants with different designs do display different radiographic outcomes in vivo.

Materials and Methods

All one-level CDA patients with greater than 2-year radiographic follow-up were identified from hospital records. The C2 to C7 Cobb angle was measured on neutral lateral radiographs. The segmental Cobb angle was measured on lateral neutral, flexion, and extension radiographs with motion of the CDA calculated as the difference between the two later measurements. Any disc with < 2 degrees motion was identified as not exhibiting motion.

Results

A total of 55 patients were included. Average follow-up was 145 weeks. Three different implants were used—Discocerv (Scient’x-Alphatec Spine, France), NuNec (Pioneer Surgical Technology, United States) and PRESTIGE LP (Medtronic Ltd., United States). The most common operated level was C5/6 with 40 implants. Other levels consisted of one C3/4, four C4/5, and ten C6/7. The number of implants, cervical alignment, segment alignment, and segmental motion (in degrees) is shown in Table 1. There was no statistically significant difference in any outcome between the implants. One PRESTIGE LP required revision after 2 years. Bony fusion was observed in 12.5% of Discocerv, 14.3% of NuNec, and 12.1% of PRESTIGE LP. Twenty-five percent of Discocerv cases had some degree of subsidence, while this was seen in 7.1% of NuNec and 6.1% of PRESTIGE LP implants.

Conclusion

Our results indicate that CDA implant type influences the alignment of the replaced segment and preservation of motion. This may be due to the different biomechanical designs of the implants. While statistically significant differences were not observed, differences may be clinically significant. We acknowledge that limited conclusions can be drawn from our results due to differing group sizes, but our study serves as a basis and highlights the need for further in vivo and in vitro studies. Disclosure of Interest A. Berg: None declared J. Tankel: None declared C. Jensen: None declared A. Irwin: None declared B. Purushothaman: None declared G. Reddy: None declared T. Friesem: Conflict with RTI Surgical, Globus Medical
An Imaging Anatomical Study on Percutaneous Kyphoplasty for Lumbar via a Unilateral Transverse Process-Pedicle Approach
Authors: Wang Q. , Wang S.
Published: May 2014

Introduction

Objective

The aim of the study is to investigate the anatomical feasibility of percutaneous kyphoplasty for lumbar osteoporotic vertebral compression fractures via a unilateral transverse process-pedicle approach (TPA).

Summary of Background

Kyphoplasty via a unilateral approach has been reported and good clinical results have been achieved. However, because of the lack of an anatomical study, these approaches have yet to be popularized.

Materials and Methods

A total of 150 lumbar vertebral bodies of 30 patients were simulated kyphoplasty on computed tomography (CT) films through conventional pedicle approach (CTA) and the TPA, respectively. Anatomical parameters including the distance between the entry point and the midline of the vertebral body, the puncture inclination angle of medial inclination, were measured and compared.

Results

The distance between the entry point and the midline from L1 to L5 lumbar levels varied from 20.6 ± 2.2 mm to 28.6 ± 2.9 mm in the CTA group and from 23.6 ± 2.2 mm to 33.6 ± 2.9 mm in the TPA group. The entry point in the TPA group was 3.0 ± 2.1 mm to 5.1 ± 2.7 mm more lateral than that in the CTA group. The medial inclination angles in the TPA group were greater than that in the CTA group and the safe range of the puncture angles was also wider.

Conclusion

The entry point through a transverse process-pedicle approach was localized at the midline of the transverse process, 3.0 to 5.1 mm outside the lateral margin of the pedicle projection. Compared with CTA, the angle of inclination in the TPA approach was much larger with a wider safe puncture range. The TPA approach allowed an easy puncture to meet or surpass the midline of the lumbar vertebral body. Disclosure of Interest None declared
Comparison of Cervical Motor Function between Artificial Cervical Disc Replacement with Prodisc-C and Anterior Cervical Discectomy and Fusion for the Treatment of Cervical Spondylotic Myelopathy
Authors: Zhou Q. , Chen D. , Kopjar B. , Shi R. , Xu J. , Luo F. , Dai F. , He Q. , Li H.
Published: May 2014

Introduction

The objective of this study was to compare outcomes of cervical disc replacement (ACDR) using Prodisc-C (Synthes, Inc.) and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic cervical spondylotic myelopathy.

Materials and Methods

A total of 40 patients with radiologically confirmed symptomatic cervical spondylotic myelopathy were enrolled between March 2008 and August 2011 into prospective ongoing study and received ACDR ( N = 20) or ACDF ( N = 20) at discretion of operating surgeon. Patients were followed up at pre-specified intervals at 1, 3, 6, 12, and 24 months postoperative. Follow-up evaluations consisted of visual analogue scale (VAS) for neck and arm pain intensity, Neck Disability Index (NDI), and radiologic evaluations of intervertebral disc height, cervical curvature, total cervical range of motion, and segment contribution to total cervical range of motion (ROM).

Results

Both groups improved in VAS and NDI scores after surgery. The NDI score improved ( p < 0.01) from 34.06 preoperative to 16.81 at 24 months in the ACDR group and from 35.60 preoperatively to 17.28 at 24 months in the ACDF group. The difference between the groups was not significant. The VAS for neck and arm pain intensity showed better outcomes in ACDR than in ACDG group at 6 months follow-up ( p < 0.05). This difference disappeared at 24 months follow-up. The disk height at the index level increased in both groups postoperatively. There were no changes in disk height at the first cephalic and caudal levels in either group at any follow-up. The total cervical range of motion (ROM) improved at all follow-up evaluations in the ACDR group ( p < 0.05). There were no changes in overall ROM in the ACDF group (Fig. 1). The overall ROM was higher at 24 months in ACDR compared with ACDF (49.93 ± 11.91 and 41.11 ± 9.80, respectively, p < 0.05).

Conclusion

ACDR and ACDF are effective in improving functional outcomes in subjects with symptomatic cervical spondylotic myelopathy. Range of motion outcomes are superior in ACDR compared with ACDF. Disclosure of Interest Q. Zhou: Conflict with AO International, Southwest Hospital D. Chen: None declared B. Kopjar: Conflict with AO Foundation, Smith & Nephew, Cerapedics R. Shi: None declared J. Xu: None declared F. Luo: None declared F. Dai: None declared Q. He: None declared H. Li: None declared
The Influences of Different Insertion Conditions of Coflex Interlaminar Dynamic Stabilization on the Lumbar Spine Sagittal Alignment: A Perspective Clinical Study
Authors: Hai Y. , Liu Y. , Yang J.
Published: May 2014

Introduction

Selective decompression with interspinous distractive device insertion is one of the surgical options for the treatment of degenerative lumbar spine stenosis. Concerns of loss of lordosis and change of the sagittal alignment of the lumbar spine after interspinous distractive device insertion have been raised. To evaluate the influence of interspinous distractive device insertion on the sagittal alignment of the lumbar spine, a perspective clinical study was conducted.

Materials and Methods

From 2008 to 2010, 59 consecutive patients with single level degenerative lumbar stenosis at L45 were treated with selective decompression and Coflex interlaminar dynamic stabilization. There were 21 male and 38 female with an average age of 62.4 years (52-73). After decompression, Coflex device was inserted randomly under nonload condition (no distraction between spinous processes, NL group) and preload condition (3-5 mm distraction between spinous processes, PL group). Radiographic evaluation of the change of sagittal angle of the index level (IA), sagittal lordosis of the lumbar spine (LL), and the range of motion of the lumbar spine (ROM) were using standing lateral and flexion-extension lateral X-rays, pre- and postoperatively and 6 months postoperatively. Statistical analysis was conducted and t-test comparison was evaluated utilizing SPSS 16 computer software.

Results

All patients underwent surgery safely and no major intraoperative complications such as neurological injury, dural tear, spinous fracture, and infection were occurred. The change of sagittal alignment of index segment and lumbar spine, as well as the ROM of the lumbar spine, is shown in Table 1. The sagittal lordosis at the index segment and lumbar spine was decreased in the PL group comparing with the NL group ( p < 0.05), but there was no significant change of the ROM of the lumbar spine in both groups.

Conclusion

Although Coflex inter-laminar insertion under pre-load condition decreased the sagittal lordosis of the index segment and the lumbar spine, the range of motion of the lumbar spine was maintained. Large patients and longer follow-up evaluation is warranted to evaluate the influence of the sagittal alignment as well as the relationship with the clinical outcome. Disclosure of Interest None declared
The Role of Statins in the Osteogenesis on Bone Fusion Using Bone Marrow-Derived and Adipose-Derived Stem Cells
Authors: Kim J. , Shim H. , Kim S. , Hong Y. , Choi N. , Hwang J. , Kwon B.
Published: May 2014

Introduction

Statins are commonly prescribed drugs that inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG Co-A) reductase, decreasing hepatic cholesterol biosynthesis by reducing serum cholesterol concentrations. Several studies demonstrated statins enhance new bone formation and increase bone volume in an animal. In this study, simvastatin and lovastatin were employed to elucidate the osteogenic effects of stains on the culture system of two stem cells; human bone marrow-derived (hMSC) and adipose-derived stem cell (hADSC).

Materials and Methods

In this study, simvastatin and lovastatin were employed to elucidate the osteogenic effects of stains on the culture system of two stem cells; human bone marrow-derived (hMSC) and adipose-derived stem cell (hADSC). There are two experimental conditions: (1) statins supplemented along with other osteoinductive supplements and (2) without them. The statins increased the expression of the osteogenic markers, such as alkaline phosphatase (ALP) activity and alizarin red S staining(ARS) on both conditions. These results were verified with gene mRNA levels using PCR. Finally, ex vivo calvaria organ culture model was investigated by H&E and Masson trichrome staining.

Results

The statins increased the expression of the osteogenic markers, such as alkaline phosphatase (ALP) activity and alizarin red S staining (ARS) on both conditions. These results were verified with gene mRNA levels using PCR. There were almost the same trends in the expression of osteogenic makers induced from stem cell, although MSC was differentiated slower than ADSC. Also, neonatal murine calvarial was introduced to find the osteogenic effects of statins in ex vivo. It is observed that the bone density and thickness in the dissected calvarial tissue was enhanced in culture system including statins.

Conclusion

Our results suggests that statins could stimulate the differentiation of stem cell into osteoblasts and also affect the process of bone formation, resulting in the increase of mineralization induced by them. It implies that statins can be candidates as osteoinductive materials for bone fusion Disclosure of Interest None declared
Lumbar Facet Joint Orientation in Degenerative Spondylolisthesis: The Role of Ethnic Variation in Asia Pacific—A Study from the AOSAP Research Collaboration
Authors: Williams R. , Rajasekaran S. , Kawaguchi Y. , Acharya S. , Kawakami M. , Satoh S. , Chen W. J. , Park C. K. , Lee C. S. , Foocharoen T. , Nagashima H. , Kuh S. , Zheng Z. , Condor R. , Ito M. , Iwasaki M. , Jeong J. H. , Luk K. , Prijambodo B. , Rege A. , Jahng T. A. , Luo Z. , Tassanawipas W. A. , Acharya N. , Pokharel R. , Shen Y. , Ito T. , Zhang Z. , Aithala J. , Kumar G. Vijay , Jabir R. Ahmad , Basu S. , Li B. , Moudgil V. , Sham P. , Samartzis D.
Published: May 2014

Introduction

Degenerative spondylolisthesis (dSpl) can lead to various symptoms, including low back pain. Lumbar facet joint orientation has been reported to be associated with the development of dSpl. The role of ethnicity regarding facet joint orientation remains uncertain. As such, the following study was performed across a wide-ranging population base to assess the role of ethnicity in facet joint orientation in patients with dSpl in the Asia Pacific region.

Materials and Methods

A multinational, multiethnic cross-sectional image-based study was performed in 34 institutions in Asia Pacific, identifying 448 cases. Lateral standing X-rays and axial MRIs and/or CT scans were obtained for patients with lumbar dSpl. Magnitude of slip displacement, level of dSpl, and left/right facet joint angulation, width-curvature ratio, and gap width were noted on image assessment. Facet joint measurements were performed at each level from L3-S1. Gender, age, BMI, and ethnicity were also noted.

Results

The study included 389 patients with known ethnic origin (mean age: 61.4 years; 36.7% males, 63.3% females). The mean BMI was 25.6 kg/m2. The level of dSpl was most prevalent at L4/L5 (72.4%). There were 28.8% Indian, 28.5% Japanese, 17.5% Chinese, 8.2% Korean, 6.2% Thai, 4.6% Caucasian, 2.3% Filipino, 2.3% Malay, and 1.3 were of mixed Asian origin. Accounting for patient demographics and displacement, there was a statistically significant difference between ethnicity to that of left/right facet joint angulations, width-curvature ratios, and gap widths from L3-S1 between specific ethnic groups ( p < 0.05).

Conclusion

This is the largest study to address the role of ethnicity upon lumbar facet joint orientation in dSpl. Ethnicity plays a role in facet joint orientation and may influence the occurrence and severity of dSpl or be a potential consequence. An understanding of ethnic variability may be one factor which assists in identifying those patients at risk of postsurgical development or progression of dSpl. Acknowledgments This study was funded by AOSpine Asia Pacific. Disclosure of Interest None declared
Expandable PEEK Spacers for Interbody Distraction in the Lumbar Spine
Authors: Alimi M. , Shin B. , Macielak M. , Hofstetter C. P. , Njoku I. , Tsiouris A. J. , Elowitz E. , Hartl R.
Published: May 2014

Introduction

StaXx XD is an expandable PEEK wafer implant that has been used in the treatment of lumbar degenerative disease. PEEK implants have been successfully used as interbody devices. There have been little studies evaluating the outcome of expandable PEEK devices. The aim of the current study was to determine the clinical effectiveness and radiographic outcome of expandable PEEK cages for interbody fusion.

Materials and Methods

This was a retrospective study of 49 consecutive patients who underwent lumbar interbody fusion with implantation of expandable PEEK cages in combination with posterior instrumentation using pedicle screw-rod constructs primarily for degenerative disorders. The patient's clinical outcomes were evaluated using the visual analog scale (VAS) and the Oswestry disability index (ODI). In addition, disc height, foraminal height, listhesis, local disc angle, lumbar lordosis, and graft subsidence were evaluated on pre-op, post-op, and on latest follow-op imaging.

Results

A total of 16 patients (32.6%) had undergone previous surgery at the index level. From pre-op to an average follow-up of 19.3 months, there was significant improvement in VAS back (6.42 vs. 3.11, p < 0.001), VAS buttock (4.66 vs. 1.97, p = 0.002), VAS leg (4.55 vs. 1.96, p < 0.001), and ODI (21.7 vs. 12.1, p < 0.001) scores. In addition, there was significant increase in the average disc height (6.49 vs. 8.18 mm, p = 0.037) and foraminal height (15.6 vs. 18.53, p = 0.0001), and there was a significant reduction in the amount of listhesis (5.13 vs. 3.15, p = 0.005). The increase in average local disc angle and overall lumbar lordosis was not significant. Subsidence of 0.66 mm (7.4%) was observed at the latest follow-up ( p = 0.35).

Conclusion

Our mid-term results indicate that in situ expandable PEEK spacers for lumbar interbody distraction can effectively and durably restore the disc height and foraminal height and are associated with significant improvement in the clinical outcome. Disclosure of Interest None declared
Minimally Invasive Foraminotomy through Tubular Retractors via a Contralateral Approach in Patients with Unilateral Radiculopathy
Authors: Alimi M. , Njoku I. , Cong G. T. , Pyo S. Y. , Hofstetter C. P. , Grunert P. , Hartl R.
Published: May 2014

Introduction

Radiculopathy caused by foraminal nerve root compression is a common pathology of the lumbar spine. Surgical decompression through conventional open foraminotomy is the treatment of choice when surgery indicated. Minimally invasive tubular foraminotomy through a contralateral approach is a potentially effective treatment approach. The aim of this retrospective cohort study was to evaluate the efficacy and benefits of this approach for treatment of radiculopathy.

Materials and Methods

Patients with unilateral lower extremity radiculopathy, who underwent minimally invasive lumbar foraminotomy through tubular retractors via a contralateral approach between 2010 and 2012 were included. Oswestry disability index (ODI) and the visual analogue scale (VAS) for back, and leg pain were evaluated preoperatively, postoperatively, and at the latest follow-up. Functional outcome was evaluated using MacNab's criteria.

Results

For the total of 32 patients, postoperatively there was significant improvement in the ODI ( p = 0.006), VAS back pain ( p < 0.0001), and VAS leg pain on the pathology and the approach side ( p = 0.004, p = 0.021, respectively). At follow-up of 12.3 ± 1.7 months, there was also significant improvement in the ODI ( p < 0.0001), VAS back pain ( p = 0.001), and VAS leg pain on the pathology and the approach side ( p < 0.0001, p = 0.001, respectively). The functional outcome was excellent and good in 95.2%. One patient required fusion (3.1%).

Conclusion

A minimally invasive, facet-sparing contralateral approach is an effective technique for treatment of radiculopathy due to foraminal compression. It also allows for decompression of lumbar spinal stenosis and bilateral lateral recess decompression without the need for a fusion. Disclosure of Interest None declared
Prevention of Cement Leakage during Kyphoplasty by using the Eggshell Technique
Authors: Lo H.
Published: May 2014

Introduction

The most common complication of osteoporotic is vertebral compression in aged people. Pain and disability pose major problems in these patients. To restore the vertebral height for driving physical stiffness, and loading bearing toward normal limited, kyphoplasty and vertebroplasty with variable filling materials (PMMA, CPC, etc.) have been used for the treatment. For decreasing the rate of PMMA leakage, we performed kyphoplasty with eggshell technique in different characteristics of vertebral wall.

Materials and Methods

Twenty symptomatic vertebral fractures were enrolled. Visual analogue scale (VAS), the oswestry disability index (ODI), and vertebral wall injury score were assessed. The vertebral height loss and changes of kyphotic angle were also recorded by plain X-ray. Three-dimensional CT will be arranged for evaluating the condition of deficiency vertebral wall and central body collapse if needed. After creating cavity by percutaneous bipedicular balloon device, PMMA was injected into weak wall site according the preoperative evaluation or intraoperative finding. The balloon was once again introduced into the created cavity and inflated to achieve the PMMA shield (eggshell method). Outcome, PMMA leakage condition, X-ray, and CT were reviewed postoperatively.

Results

Symptomatic cement extravasation-related complications or leakage on X-ray were not observed in follow-up. Only one adjacent compression fracture has happened in 1 month. Improvement in vertebral height and the mean kyphotic angle was also noted. The mean VAS and ODI decreased significantly from preoperation to postoperation ( p < 0.05). The vertebral wall injury score reviews also told us that the eggshell technique is fit for multiple conditions of wall injury.

Conclusion

It is always concerned for the leakage of PMMA during spine surgery. There are many options of new implant for decreasing the rate of leakage. Greene introduces the eggshell technique since 2007. According to our experiences of kyphoplasty with this eggshell technique, the technique is a safe and significantly functional works for decreasing the leakage of PMMA and pain scale in various wall injury conditions. Disclosure of Interest None declared Reference Greene DL, Isaac R, Neuwirth M, Bitan FD. The eggshell technique for prevention of cement leakage during kyphoplasty. J Spinal Disord Tech 2007;20(3):229–232
Treatment of Refractory Low Back Pain Caused by Degenerative Spine Disease with Minimally Invasive Techniques
Authors: Tyulikov K. Vladimirovich , Korostelev K. , Manukovsky V. , Litvinenko V. , Badalov V.
Published: May 2014

Introduction

Puncture techniques—nucleoplasty and radio frequency denervation—have recently been widely used for the treatment of pain syndrome caused by intervertebral disc protrusion. The purpose of the study was to assess the effectiveness of nucleoplasty and radio frequency denervation of intervertebral joints as advanced minimally invasive surgical techniques for alleviating pain in the case of intervertebral disc disease, spondylarthrosis, and other vertebroneurologic diseases accompanying degenerative disc disease.

Materials and Methods

All patients had a history of pain syndrome for not less than 3 months and were followed up after undergoing minimally invasive procedures for 1 year. To assess the effectiveness, the visual analogue scale and treatment satisfaction scale were used. A total of 81 patients, aged between 30 and 57 years, underwent nucleoplasty and radio frequency denervation. Of the 81 patients, 70 patients of control group were treated therapeutically.

Results

No complications were noted. At 12-month follow-up all operated patients showed the decrease of pain syndrome intensity according to the visual analogue scale ( p < 0.0001), and treatment satisfaction scores were higher compared with patients treated therapeutically ( p < 0.001).

Conclusion

Minimally invasive electrosurgical techniques appeared to be safe and effective in the treatment of carefully selected patients suffering from low back pain and leg pain caused by a degenerative-dystrophic process. Nucleoplasty technique is more effective in younger patients. Procedures performed at several levels also result in marked clinical improvement. Primary advantages of these techniques were their safety and efficacy, minimal invasiveness, and the absence of a peridural scar. They do not complicate further microsurgical intervention. Disclosure of Interest None declared