bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Site of Symptoms Influence the Surgical Results for Discogenic Low Back Pain Treatment?
Authors: Ohtori S. , Orita S. , Yamauchi K. , Miyagi M. , Sakuma Y. , Kubota G. , Oikawa Y. , Inage K. , Sainoh T. , Sato J. , Fujimoto K. , Suzuki M. , Takahashi K.
Published: May 2014

Introduction

Surgical results for discogenic low back pain (DLBP) treatment remain controversial. The method of diagnosis of DLBP generally used is MRI and discography. However, this imaging sometime fails to diagnose DLBP. Symptoms from DLBP are varied and include back pain alone, referred leg pain, and referred inguinal pain. In the current study, we aimed to evaluate whether the site of symptoms influences surgical results for DLBP treatment.

Materials and Methods

The site of symptoms before surgery and the surgical result were retrospectively evaluated in 62 DLBP patients. Symptom sites before surgery were divided into (1) back pain alone, (2) back pain + referred inguinal pain, (3) back pain + referred thigh pain, and (4) back pain + referred lower leg pain. The patients showed disc degeneration only at one level (L4-5 or L5-S1) on MRI, pain provocation on discography, and underwent anterior interbody fusion. Visual analog scale (VAS) of back pain and the Roland-Morris disability questionnaire (RDQ) were evaluated before and 2 years after surgery.

Results

VAS and RDQ were not significantly different between the four groups before surgery, but were significantly improved in all four groups 2 years after surgery ( p < 0.05). The greatest improvement of back pain was found in the group with back pain + referred inguinal pain compared with the other three groups ( p < 0.05). Less improvement of back pain in the back pain alone group was seen compared with the back pain + referred thigh and back pain + referred lower leg pain groups ( p < 0.05).

Conclusion

If DLBP is strictly diagnosed using several imaging modes, surgical results were superior in patients with both back pain and either referred inguinal or leg pain compared with those having back pain alone. Disclosure of Interest None declared
Histological and Immunohistochemical Protocol to Study Different Degrees of Severity of Lumbar Degenerative Discopathy
Authors: Falavigna A. , Peletti-Figueiró M. , Aguiar I. Silvera , Roesch-Ely M. , Machado D. Cantarelli , Pêgas Henriques J. A. , Righesso O.
Published: May 2014

Introduction

Literature on histological and immunohistochemical protocols that relate degenerative discopathy and its degree of wear is scarce. The purpose of this study was to analyze the structural degeneration of the intervertebral disc of patients with different degrees of degeneration, through histopathology, immunohistochemical, and cellular proliferation and apoptosis studies.

Materials and Methods

The intervertebral disc was obtained from patients with lumbar disc degenerative disease refractory to conservative treatment who required surgical treatment. The material was sent for histological study with hematoxylin and eosin stain (H&E), Alcian/PAS, Masson trichrome, and safranin O/FCF, and immunohistochemistry through expression of the proteins to mark cell proliferation, Ki-67, and apoptosis, p53. MRI defined the degree of disc degeneration according to Pfirmann classification, and it was correlated with the evaluations of the different histological stains, and the positivity of the immunohistochemical markers. The present study was authorized by the ethics committee under number 0513.

Results

H&E was effective to evaluate fissures of the fibrous ring, necrosis, and inflammation. Alcian/PAS stain allowed a better visualization of the chondrocyte clusters and of the acid mucopolysaccharide deposits in 86.7% of the samples. Masson trichrome identified the misalignment of collagen fibers in 93.4% of the samples, with greater definition. The safranin technique was considered the most sensitive and efficient stain to study the number and diameter of chondrocyte clusters. Immunohistochemistry showed 73% of positive expression of Ki-67 and p53, which are related, respectively, to the cell proliferation followed by cellular apoptosis.

Conclusion

The protocol enabled a better histological and molecular characterization of the degenerative disc according to different stages of degenerative disc disease. Disclosure of Interest A. Falavigna: Conflict with CNPq, FAPERGS, and AOSpine Latin America M. Peletti-Figueiró: None declared I. S. Aguiar: None declared M. Roesch-Ely: None declared D. C. Machado: None declared J. A. P. Henriques: None declared O. Righesso: None declared
iPSC-Derived Mesenchymal Stem Cells from Blood Cells as a New Source for Disc Repair
Authors: Liu T.
Published: May 2014

Introduction

A cell-based therapy is a promising concept that uses various cell types to repair the degenerative disc. Stem cells appear to be an excellent candidate for this purpose, based on their ability to differentiate into various connective tissue lineages. The blood cells could serve as a good source of adult stem cells because of its vast abundance throughout the human body. The aim of the study is to examine the feasibility to induced pluripotent stem cells derived from blood cells as the seed cell for disc repair in vitro.

Materials and Methods

We obtain iPSC-derived mesenchymal stem cells (iPSC-MSCs) from blood cells, and then investigate chondrogenic differentiation of iPSC-MSCs. iPSCs were cultured to form embryoid bodies (EBs), and MSCs were migrated out of EBs. Flow cytometry indicated that iPSC-MSCs expressed typical surface antigen profile of MSCs. Mesenchymal differentiation of iPSC-MSCs demonstrated that the iPSC-MSCs had the potential to differentiate into adipocytes, chondrocytes, and osteoblasts.

Results

iPSC-MSCs cultured in chondrogenic medium yielded higher gene expressions of chondrogenic markers including Aggrecan (Agg), Sox9, and collagen type II (Col II) ( p < 0.05).

Conclusion

The data from this study show blood cells can be a possible candidate for disc repair in vitro. iPSCs were derived from adult blood cells which were reprogrammed, were generated from the EBs. iPSC-MSCs showed good viability and chondrogenic differentiation. Disclosure of Interest None declared
The Effects of Link N and Bone Marrow-Derived Mesenchymal Stem Cells on the Regeneration of Intervertebral Disc
Authors: Mwale F. , Wang H. T. , Roughley P. J. , Antoniou J. , Haglund L.
Published: May 2014

Introduction

Link N is a naturally occurring peptide that can stimulate regeneration of the intervertebral disc (IVD). IVD repair can also potentially be enhanced by mesenchymal stem cell (MSC) supplementation to maximize extracellular matrix production. In a previous study, we have shown that Link N can inhibit osteogenesis and increase the chondrogenesis of MSCs in vitro. The aim of the present study is to determine the effects of injecting MSCs and Link N alone or together on the repair of degenerated discs.

Materials and Methods

The largest first four caudal discs with intact cartilaginous endplates were isolated from the tails of 24- to 30-month-old bovines. After a 3-day preconditioning period, the discs were injected with 100 μg trypsin in 75 μL PBS, to induce degeneration. They were then cultured for another 4 days, followed by the injection of MSCs (105), Link N (75 μg), or a combination of MSCs and Link N, in a final volume of 75 μL PBS. Seven of the trypsin-treated discs were injected with PBS alone to serve as a degeneration control. After the discs were cultured for another 14 days, the extracellular matrix (ECM) proteins and proteoglycans were extracted from the inner nucleus pulposus of the discs by guanidinium chloride. Sulfated glycosaminoglycans (GAGs) were analyzed in tissue extracts ( n = 7/group) by the dimethyl methylene blue (DMMB) dye-binding assay. The expression of type II collagen was analyzed by Western blot. To track the MSCs after injection, MSCs were labeled with PKH67 and observed under confocal microscopy when the discs were dissected.

Results

After injection, MSCs were distributed throughout the discs and retained their morphology. When the trypsin-treated discs were injected with PBS only, the final GAG concentration in the ECM was 15.12 µg/mg wet weight tissue. When the degenerated discs were injected with MSCs only, the GAG concentration increased to 25.66 µg/mg wet weight tissue. When the degenerated discs were injected with Link N alone or both Link N and MSCs, the GAG concentrations increased to 29.63 and 32.66 µg/mg wet weight tissue, respectively. Compared with the degeneration control, the expression of type II collagen also increased when the degenerated discs were injected with MSCs and Link N, either alone or together.

Conclusion

MSCs and Link N can both increase GAG production in degenerated discs, with Link N showing a greater effect than MSCs when administered separately. However, an additive effect was found when MSCs and Link N were administered together. The injection of MSCs and Link N can also increase the expression of type II collagen in the degenerated discs. Thus, the administration of MSCs and Link N has therapeutic potential in intervertebral disc repair. Disclosure of Interest None declared
Collagen II/Hyaluronan/Chondroitin-6-Sulfate Tri-copolymer Scaffold for Nucleus Pulposus Tissue Engineering
Authors: Huang B. , Li C. , Zhou Y.
Published: May 2014

Introduction

This study aims to investigate the bioactivity of collagen II/hyaluronan/chondroitin-6-sulfate tri-copolymer as bionic scaffold for nucleus pulposus (NP) tissue engineering.

Materials and Methods

Collagen II (C II) (pH 1-2) was mixed with hyaluronan (HyA) and lyophilized to prepare C II/HyA matrices. Chondroitin 6-sulfate (6-CS) was covalently attached to the C II/HyA matrices using 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide (EDC) and N-hydroxysuccinimide (NHS). Then, cells were expanded from rabbit NP and seeded in the tri-copolymer scaffold. Cell-scaffold hybrids were maintained for up to 28 days in culture. Cell viability/proliferation, extracellular matrix (ECM)-related gene expression, and the content of sulfated glycosaminoglycans (s-GAG) were evaluated.

Results

When cultured for 28 days, the cell-scaffold hybrids maintained active cell viability/proliferation and exhibited a significantly increased s-GAG content. In addition, rabbit NP cells cultured in the scaffold demonstrated a significantly higher level of C II and aggrecan gene expression and a significantly lower level of Collagen I (C I) gene expression when compared with that of monolayer cells. Histological studies and scanning electron microscopy (SEM) further indicated newly secreted ECM deposits in the scaffolds.

Conclusion

In conclusion, the C II/HyA-CS scaffold may be an alternative material for NP tissue engineering due to its satisfactory bioactivity, and it deserves further in vivo investigation. Disclosure of Interest None declared
The Safety and Efficacy of Mesenchymal Stem Cells for Prevention or Regeneration of Intervertebral Disc Degeneration: A Systematic Review and Meta-Analyses
Authors: Yim R. Lok-hay , Lee J. , Bow C. , Leung V. , Cheung K. M. C. , Meij B. , Vavken P. , Samartzis D.
Published: May 2014

Introduction

Intervertebral disc degeneration is associated with low back pain. Mesenchymal stem cells (MSCs) have been used to halt the progression or regenerate the disc with hopes to prevent or treat discogenic back pain. However, the safety and efficacy of the use of MSCs for such treatment in animal and human models at short- and long-term assessment (i.e., greater than 48 weeks) have not been systematically addressed. Therefore, the aim of this study was to perform a systematic review of comparative controlled studies addressing the use of MSCs to that of no treatment/saline for the treatment of disc degeneration.

Materials and Methods

Online databases PubMed, PubMed Central, EMBASE, BIOSIS, and MEDLINE were searched. Controlled trials in animal models and humans were eligible for inclusion. Trial design, MSC characteristics, injection method, disc assessment, outcome intervals, and complication events were assessed. Validity of each study was assessed by appropriateness of randomization, blindness of outcome assessment, and sample size. Two individuals independently searched the literature, extracted data parameters, and assessed validity.

Results

Twenty-four animal studies were included but no controlled studies in humans were identified. All three types of MSCs (i.e., bone marrow, synovial, and adipose tissue) showed successful tissue inhibition of disc degeneration. Bone marrow-derived MSC showed superior quality of disc repair that was marked with restoration of extracellular matrix in the disc when it was compared with other treatments, including TGF-β1, nucleus pulposus bilaminar coculture, and axial distraction regimen. However, osteophyte development was reported in two studies as a potential complication of MSC transplantation. Overall, the incidence of MSC-related complications was < 0.5%. Meta-analyses indicated that MSC increased disc space height in the majority of animal models.

Conclusion

Based on the first systematic review addressing the safety and efficacy of the use of MSCs for disc degeneration prevention/regeneration, the current evidence, based on animal models, suggests that in the short-term MSC transplantation is safe and effective in halting disc degeneration; however, additional and larger studies are needed to assess the long-term regenerative effects and potential complications. Inconsistency in methodological design and outcome parameters prevent any robust conclusions. In addition, randomized controlled trials in humans are needed to assess the safety and efficacy of such therapy. Disclosure of Interest None declared
Implant Motion at Greater than 1-Year Follow-up in Multilevel Cervical Disc Arthroplasty Constructs
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 with adjacent levels compensating for the lost motion. If multiple levels are fused, then the compensatory motion is even greater at the nonfused levels. This may be associated with the development of symptomatic adjacent segment disease. In addition, through motion preservation, postoperative morbidity associated with multilevel surgery is reduced—a single transverse anterior incision can be used, less pain is associated with posterior approach, and no collar or motion restrictions. Multilevel cervical disc arthroplasty is therefore an alternative to fusion to preserve motion and reduce the incidence of recurrence of symptomatic disease.

Materials and Methods

Lateral flexion and extension radiographs were analyzed for motion at the level of the disc arthroplasty using the posterior vertebral body angle. The difference between the posterior vertebral body angle in flexion and extension was taken. We classified any disc that had less than 2 degrees change in angle not to be exhibiting motion.

Results

Postoperative radiographs of 100 patients (59 two level, 34 three level, 7 four level) who had undergone anterior cervical decompression and cervical arthroplasty at two, three, or four levels with at least 1 year radiographic follow-up were reviewed. Radiographic data were available for 239 discs: 77% ( n = 185) of discs maintained motion of greater than 2 degrees. Average follow-up in this group was 94 (range, 52-291) weeks. In the group of 54 discs that exhibited less than 2 degrees, motion average follow-up was 110 (range, 54-291) weeks. In seven two-level constructs and in one three-level construct, all replaced levels showed less than 2 degrees of motion.

Conclusion

Multilevel cervical disc arthroplasty provides a viable option for maintaining motion at operated levels beyond 1 year and therefore may reduce the potential for symptomatic adjacent segment disease. Disclosure of Interest None declared
Imaging Observation of Deformities and Injuries Affecting Posterior Screw Fixations after Hangman fracture
Authors: Wang Q. , Wang G. , Wang S.
Published: May 2014

Introduction

Objective

The aim of the study is to observe the incidence of C1 to C3 deformities and injuries in patients with hangman fracture that affected the placement of screws for posterior short-segment fixation.

Materials and Methods

Seventy-eight patients with hangman fracture were retrospectively reviewed with three-dimensional computed tomographic scans of bony structures. The C1 to C3 screw trajectory designs were performed in the workstation to identify the presence of any deformities or injuries that would preclude safe screw placement in these segments.

Results

The presence of regional deformities or injuries was identified in 21 cases (27%). Six (7.6%) cases were not fit for C1 posterior arch screw fixation, including small size of posterior arch in two cases and fractures of C1 posterior arch in four cases. Ten (13%) cases were precluded from C2 trans-pedicle screw placement, including small pedicle size and high riding of vertebral artery and fractured fragments encased into vertebral canal or transverse process foramen. Nine (12%) cases were precluded from C3 trans-pedicle screw fixation due to small pedicle size, sclerotic pedicle, and pedicle fractures or vertebral body fractures.

Conclusion

There is a high incidence of regional deformities and injuries in the C1 to C3 region after hangman fracture that affects the placement of posterior screws. Preoperative evaluation of these conditions using 3D-CT scans is of paramount importance for the choice of proper surgical technique and avoid risk of fatal complications. Disclosure of Interest None declared
Posterior Intersegmental Fusion of Unstable Jefferson Fracture
Authors: Sharifi G. , Abolhasani E. , Mousavinejad A. , Farzin N.
Published: May 2014

Introduction

The patient was a 37-year-old man who was a victim of a motor-vehicle accident. On arrival at the emergency department, the patients’ vital signs were all within normal physiological range. His GCS was 15/15. He had suffered from neck pain. In physical examination, he had upper cervical spine tenderness but there was no abnormal palpable deformity. Other physical examinations were normal. Plain X-ray of the cervical spines was nonconclusive. Cervical-spine CT scan demonstrated an isolated unstable Jefferson fracture associated with Spence's criteria. Cervical CT angiography was normal.

Materials and Methods

The patient was placed in the prone position and the alignment and the position of the atlantoaxial complex was verified by the use of real-time fluoroscopy. The cervical spine was exposed subperiosteally from the occiput to the level of C3-4. The C1-2 articulation was exposed. After the dorsal root ganglion of C2 was retracted inferiorly, the middle of the junction of the posterior arch of C1 and the midpoint of the inferoposterior part of the C1 lateral mass was exposed. The screws were placed via Magerl trans-facet screw technique. Then screws were connected with a rod and nuts to reduce lateral spread of the lateral masses.

Results

Postoperative cervical CT scan showed that the screws are in favorable position.

Conclusion

The treatment of unstable Jefferson fractures remains controversial. Conservative treatment usually associates with the longtime of immobilization in halo vest, whereas conventional posterior surgical treatments generally eliminate the range of motion of the upper cervical spines. With the posterior intersegmental fusion of unstable atlas fracture, the stabilization of anterior arch of atlas can be achieved while at the same time atlantoaxial rotation is preserved. Disclosure of Interest None declared
Morphological and Clinical Feasibility of C3 Pedicle Screw Instrumentation in Patients with Congenital C2-3 Fusion
Authors: Wang Q. , Xiu P.
Published: May 2014

Introduction

Incidence of C2 pedicle narrowing is high in patients with congenital C2-3 fusion (C2-3CF). An alternative would be C3 pedicle screw (PS) instrumentation, which will not sacrifice an additional motion segment; however, its feasibility has not yet been reported in the literature.

Materials and Methods

Twenty-eight patients with C2-3CF were enrolled to this study, including 22 atlantoaxial dislocations and 6 odontoid fractures. They underwent the procedures of occiput or C1 to caudal vertebrae fixation and fusion. The pedicle trajectories of C2 and C3 were evaluated using three-dimensional computed tomography (CT). The width, height, length, and medial and superior angle of the trajectories and the posterior projection of C3 pedicle were evaluated. Trajectory was considered narrow when the diameter was less than 4.0 mm. The clinical results were followed. There were no funding sources or potential conflicts of interest to disclose.

Results

The incidence of C2 and C3 pedicle narrowing were 53.6 and 21.4%, respectively. The mean dimension of C3 pedicle was 4.9 mm in width, 4.9 mm in height, and 28.5 mm in length; the mean inclination angle was 8 degrees superior and 35 degrees medial. Using the midline of the fused C2-3 lamina as the superior border of C3 articular mass, posterior projection of the C3 pedicle lied 3 mm inferior to the superior border and 3.2 mm medial to the lateral border of the articular mass. It was located roughly at the upper lateral quadrant of the articular mass. During the operation, the caudal spinal fixation patterns were 16 bilateral C3, 7 bilateral C2, 3 bilateral C4, and 2 contralateral C2/3. Postoperative CT revealed 3 C2 and 5 C3 pedicle trajectory breaches. No vertebral artery or spinal cord injury occurred. The mean follow-up time was 4 years and no implant failure developed.

Conclusion

The morphology of C3 pedicle is suitable for PS instrumentation in a large proportion of patients with C2-3CF. C3PS instrumentation is a feasible technique for selective patients with C2-3CF and may serve as another reliable choice for this condition. Disclosure of Interest None declared
Efficacy of Topping-Off Surgery in Preventing Adjacent Segment Degeneration of the Lumbar Spine: A Radiographic Study
Authors: Hai Y. , Chen X. , Yang J.
Published: May 2014

Introduction

The aim of the study is to investigate the image change of adjacent segment degeneration after topping-off (posterior lumbar interbody fusion + above segment interspinous implant).

Materials and Methods

All lumbar spinal stenosis cases from the department of orthopedics of Beijing Chaoyang Hospital that received PLIF + above segment Coflex between August 2008 and October 2012 were analyzed retrospectively. Analysis the gender, age, body mass index of all the patients was done. The X-ray films before and after surgery were measured and got some data (total lordosis, the height of disc, range of motion, lordosis and olithesis). Modic changes (modic grades) of endplate and disc changes (modified Pfirrmann grades) were recorded. All data used SPSS 12.0 to analysis.

Results

There were 32 patients in Topping-off (male 21, female 11), including group 1 (L4/5 PLIF+L5S1 Coflex) 12 patients and group 2 (L3/4 PLIF+ L4/5 Coflex) 20 patients. Age averaged 61.5 years old (range, 30-79 years), follow-up averaged 24.6 months (range, 63-11 years). The average surgery time was 110 ± 21 minutes. The average blood loss was 401 ± 110 mL. Postoperatively, the ODI, JOA, and VAS score improved. There was no significant difference in the height of disc of the Coflex segment and above segment between before and after surgery. Segmental lordosis of Coflex and total lordosis were all increased significantly ( t = −1.9 and −2.0, p < 0.05). There was no significant difference in the number of the disc change by modic grade of endplate ( p > 0.05). Preoperative MRI: the disc change of Coflex segment (modified Pfirrmann grades)—9 patients grade 4, 15 patients grade 5, 8 patients grade 6 and modic changes of endplate 6 patients grade 2, 4 patients grade 1, all the others grade 0. The adjacent segment (modified Pfirrmann grades) 27 patients grade 1, 5 patients grade 2, and all the patients of the modic changes of endplate grade 0; over 24 months postoperation 24 patients made MRI, there was no significant difference in the number of the disc changes and modic changes of endplate ( p > 0.05).

Conclusion

Topping-off surgery is fit for the patients who have serious stenosis of lumbar spinal cord with mild and moderate stenosis of adjacent segment, which can restrict the adjacent segment's range of motion in both extension and flexion, also can sustain the height of Coflex segment. After follow-up over 24 months, MRI indicates that topping-off surgery can prevent the adjacent segmental degeneration. Disclosure of Interest None declared
Clinical Results of Interspinous Dynamic Stabilization with STENOFIX Device
Authors: Zubovic A.
Published: May 2014

Introduction

The objective of our study was to evaluate the efficacy of STENOFIX interspinous dynamic stabilization device in different spinal conditions including discectomies and central and foraminal spinal stenoses, with minimum of 1 year of patient follow-up.

Materials and Methods

We performed a prospective case series on 64 patients over a period of 3 years who underwent spinal surgeries in our institutions with a minimum of 1 year follow-up. Spinal procedures included discectomies, one or two level Stenofix implant insertions for patients with central spinal stenosis and one or two level Stenofix implant insertions for patients with lateral recess foraminal stenosis. Pre- and postoperatively disability and pain scores were measured using the Oswestry Disability Index (ODI), visual analogue scale (VAS), SF 36 scores, and EQ-5D-3L scores in conjunction with radiographic evaluation of disc height and sagittal alignment.

Results

All follow-up patients demonstrated significant improvement in ODI, VAS, SF 36, and EQ-5D-3L pain scores in comparison to those of preoperation ( p < 0.05). We observed no significant difference in sagittal alignment post-interspinous dynamic stabilization with Stenofix implant. No complications such as implant loosening, immigration, and spinal process fracture were observed.

Conclusion

The STENOFIX implant demonstrates significant improvement in clinical outcomes when used as the treatment of choice in patients with central and/or lateral recess lumbar spinal stenosis, as well as when used as a supplement to discectomies. Disclosure of Interest None declared
Selectively Decompressive Nerve Root Surgery for Degenerative Lateral Lumbar Spinal Canal Stenosis in Elderly Patients
Authors: Zhou H. , Cao D. , Feng S. , Ning G. , Zhang C. , Hao Y. , Liu Y. , Zheng Y. , Ma X. , Wang P.
Published: May 2014

Introduction

A literature review demonstrated conflicting results with different lumbar spine surgery techniques for LSS in the elderly.

Materials and Methods

From 2004 to 2011, a total of 183 consecutive patients at least 65 years old with degenerative LSS underwent decompressive surgery. Patients were divided into two groups: open decompression (Group A, 85 patients) and selective decompression (Group B, 98 patients). All patients were followed for at least 1 year and clinical outcomes were assessed using Visual Analog Scale pain scores (VAS), Oswestry Disability Index (ODI), and MacNab criteria preoperatively, 6 months postoperatively, and at the final follow-up.

Results

A total of 161 patients met the study criteria. The two groups were similar in age, sex, involved levels, preoperative neurologic status distribution, and comorbidities. The mean follow-up period was 22.3 ± 6.7 months (Group A) versus 23.0 ± 7.1 months (Group B) ( p > 0.05). Operation time, blood loss, and duration of hospitalization were significantly lower in the selective decompression group. The clinical outcomes (VAS, ODI) were maintained preoperatively, 6 months postoperatively, and at the final follow-up. Mean VAS scores were 7.4 ± 1.7 versus 7.9 ± 1.8; 4.0 ± 2.0 versus 2.6 ± 1.4; and 2.9 ± 1.3 versus 2.5 ± 1.5, respectively. Mean ODI scores were 60.3% ± 11.0% versus 65.1% ± 11.5%; 39.6% ± 8.7% versus 33.0% ± 8.5%; and 42.5% ± 10.8% versus 31.2% ± 8.8%, respectively. Sixty-seven patients (83.8%) versus 74 patients (91.4%) had good to excellent results 6 months postoperatively and 62 patients (77.5%) versus 72 patients (88.9%) had good to excellent results at the final follow-up. There were no surgery-related complications and no deaths among the patients at the last follow-up.

Conclusion

Compared with the open decompression group, selective decompression provided satisfactory clinical outcomes with significant reductions in operation time, blood loss, and duration of hospitalization. Selective decompression of the nerve root canal under direct vision was a safe and effective alternative to microsurgical procedures for elderly patients with LSS. Disclosure of Interest None declared
Artificial Disc Replacement versus Fusion in the Cervical Spine: A Systematic Review of Systematic Reviews
Authors: Aneiba K. Muftah , Tashani O. A.
Published: May 2014

Introduction

Artificial disc replacement versus fusion in the cervical spine: A systematic review of systematic reviews.

Materials and Methods

A combination of the following keywords was used in the search for systematic reviews: ( total disk replacement, prosthesis, implantation, diskectomy, arthroplasty) and ( cervical vertebrae, cervical spine, spine) and ( pain, disability, quality of life) and ( systematic reviews, reviews, meta-analysis) . These keywords were used as MESH headings where appropriate. The search was conducted on August 18, 2013, by a Cochrane-trained academic librarian. The following databases were searched: [Medline via Ovid, Embase, Cochrane Database of Systematic Reviews, Google scholar]. Manual search of reviews and discussion articles and case studies were also attempted by the two authors. The authors screened the results of the search independently according to pre-designed eligibility criteria. For the article to be selected for further consideration it has to be a systematic review and/or meta-analysis of randomized controlled trials that attempted to compare between the two interventions at the cervical region.

Results

The electronic search produced 881 hits of which 145 were duplicates. Initial screening of the abstracts resulted in selection of 68 articles for further evaluation. Five more articles were identified through manual search. The final judgment of the two reviewers was to include 10 systematic reviews and/or meta-analyses in this overview. The number of randomized trials reviewed by the selected reviews varies from 2 to 27. Other discrepancies between the reviews included: the follow up period, the outcomes considered and reporting of heterogeneity or publication bias of the included studies. Eight reviews and meta-analyses concluded that overall C-ADR is more effective and probably superior to ACDF specifically in neurological success, low rate of secondary operation and most pain outcomes. One meta-analysis concluded that ACDF is associated with shorter operative time and less blood loss compared with C-ADR. However, a Cochrane review critically evaluated the differences between the clinical outcomes of the two interventions and while confirmed that C-ADR superiority may be statistically significant in many of these outcomes, the differences between C-ADR and ACDF is small. This was also evident in all meta-analyses evaluated here.

Conclusion

C-ADR may be superior, or at least equivalent, to ACDF in most clinical and patients’ outcomes but the effect size of the difference is small and more time and research is needed to reach a definitive conclusion. A robust systematic reviewing is also recommended. Disclosure of Interest K. Aneiba: Conflict with research supported by Trimedica/Poinnner O. Tashani: None declared
The New Dynamic Interlaminar Device for the Treatment of Early and Late Lumbar Degenerative Problems
Authors: Darwono A. B.
Published: May 2014

Introduction

The ultimate Clinical goal of Dynamic Stabilization using motion preservation Devices is to relieve Pain and to improve the function of the spinal motion segment (SMS). Essentially it should preserve and restore physiologic motion, while maintaining the balance and stability of the SMS by controlling motion and unloading the disk and or the facet joint. Since the Degenerative cascade cannot be stopped, so the Key is: 1. Try to treat in the early stage with Dynamic stabilization or 2. Try to treat in the late stage with decompression and Dynamic stabilization.

Materials and Methods

Three years nonrandomized prospective follow-up study of dynamic stabilization using IntraSpine for the treatment of early and late degenerative cases. Follow-up: 2 weeks, 1, 2, 3, and 6 months after surgery. The dynamic stabilization using IntraSpine was performed by single surgeon. Assessment by dynamic X-ray, MRI, Ct-scan, and VAS before and after surgery.

Results

In 3 years, 67 cases of 23 males and 44 females, average age 56.9 (27 - 85 years old), were treated using IntraSpine. The variation levels of dynamic stabilization are related to the degenerative levels, from 1 to 5 levels, and from L1-2, until L5-S1. The skin incision is from 3 to 10 cm, the surgical time for 1 level with decompression is 45 to 4 hours for 4 to 5 levels. After 6 months, the result is excellent: VAS from average 8.3 to 1.2, dynamic X-ray stable, patient can do normal daily activity. Discussion The fundamental feature in the design of the new device IntraSpine is related to the anatomical reconstruction of the SMS and regarding the overturned anvil the anterior part (nose) of the device should be placed in between the laminae (Middle Column of Roy Camille) to control the load distribution and to achieve the “Sagital Balance” The interlaminar area is closer to the axis of instantaneous rotation of the SMS. The Complex Fascia Supraspinatus (CFS) is used as Natural Connector for this system, while the connector of pedicle system is metal connector. The IntraSpine is made of Medical Grade Silicone 65 shore coated by a pure PET sleeve

Conclusion

This report shows a good result of IntraSpine and match with the goals of Dynamic stabilization: 1. Stabilize the Segmental Instability, 2. Maintain the Sagittal Balance, and 3. Restore the physiologic movement of SMS. Disclosure of Interest None declared
Clinical, Radiological, and Safety Results of the Carbon Composite Cage (OSTAPEK) in Anterior Cervical Diskectomy and Fusion (ACDF): Retrospective Analysis of 54 Cases
Authors: Carrabs G. , Sessa G. , Oliva G. , Pipola A. M. , Silvestro A. , Sica G.
Published: May 2014

Introduction

Anterior cervical microdiskectomy and fusion with an intervertebral cage is a widely accepted procedure for the treatment of herniated cervical disc. Traditional titanium or simple plastic implant materials can limit implant performance below optimal needs: in some indications, legacy materials can be too stiff, in others not strong enough. Spinal implants constructs should not be so stiff that over time the implant works against bone's natural renewal. The Osta-Pek composite biomaterial satisfies the needs of cervical arthrodesis with motion preservation and because of the intrinsic radiolucency permits a simple and reliable radiological follow-up.

Materials and Methods

We operated on 54 patients (24 males and 30 females) with a mean age of 56.7 years (ranging from 26 to 65 years) at our institution. The mean follow-up was 6 months. We evaluated patients with to end points: clinical outcome (according to Odom criteria) and radiological “fusion” (fusion rate and motility).

Results

A total 75 cage in Osta-Pek were implanted in 32 single-level and 22 two-level procedures (one patient in two-level group had an Osta-Pek cage at one level and a Mobi-C prosthesis). Six months after surgery, there was radiographic evidence of fusion in 92% (69/75) of implants. According to Odom criteria, all patients experienced good to excellent functional recovery with preservation of cervical motility. There was any space disc collapse/pseudoarthrosis phenomenon. We experienced complications related to anterior cervical microdiskectomy in 6/54 (11%) of patients including 4 cases of transitory vocal cord paresis, 1 case of Bernard-Horner syndrome, 1 case of subfascial hematoma, and 2 cases of crashed cage during arthrodesis (evacuated in the first 24 hours).

Conclusion

The clinical and radiological results suggest that the carbon composite Osta-Pek frame cages are safe and effective alternative to autologous bone graft and other type of cages after anterior cervical discectomy for treatment of degenerative cervical disease Disclosure of Interest None declared References Han KW, Kim JS, Kim KH, Cho YW, Lee IC, Bae SD. Anterior cervical interbody fusion with the carbon composite Osta-Pek frame cage in degenerative cervical diseases. J Korean Neurosurg Soc 2005;37(6):422–426 Jagannathan J, Shaffrey CI, Oskouian RJ, et al. Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar. J Neurosurg Spine 2008;8(5):420–428 Jacobs W, Willems PC, Kruyt M, et al. Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease. Spine 2011;36(14):E950–E960
Classification of Chronic Back Muscle Degeneration after Spinal Surgery, and Its Relationship to Low Back Pain
Authors: Ohtori S. , Orita S. , Yamauchi K. , Miyagi M. , Sakuma Y. , Kubota G. , Oikawa Y. , Inage K. , Sainoh T. , Sato J. , Suzuki M. , Fujimoto K. , Takahashi K.
Published: May 2014

Introduction

Back muscle injury and degeneration often occurs after posterior lumbar surgery, and back muscle degeneration may be a cause of back pain after surgery. However, the relationship between back muscle degeneration and back pain remains controversial. In the current study, we aimed to classify back muscle degeneration using MRI and investigate its relationship with back pain after surgery.

Materials and Methods

A total of 84 patients (average age: 65.1 years, 38 men, 46 women) with lumbar spinal stenosis underwent only posterior decompression surgery. MRI (1.5 T) was evaluated before and more than a year after surgery in all patients. Muscle on MRI was classified into three categories: low intensity in T1-weighted image, high in T2-weighted image (type 1), high in both T1- and T2-weighted images (type 2), and low in both T1- and T2-weighted images (type 3). The proportion of types and their relationship with back pain (visual analog scale: VAS) was evaluated.

Results

MRI revealed muscle degeneration in all patients after surgery (type 1: 6%, type 2: 82%, and type 3: 12%). Type 2 was significantly frequent as compared with types 1 and 3 ( p < 0.01). Low back pain before surgery (average: VAS 7.5) significantly improved after surgery (average: VAS 2.0) ( p < 0.01). Low back pain was not associated with any muscle degeneration MRI types after surgery ( p > 0.05).

Conclusion

The current study showed the pathology of back muscle degeneration was various after posterior lumbar surgery. Type 2 (fatty change) was most frequent, and some patients were classified into type 3 (scar change), and type 1 (inflammation or water-like change). Modic classification is used for bone marrow change, and type 1 is associated with inflammation and back pain. However, no type of back muscle degeneration was correlated with back pain after surgery. Disclosure of Interest None declared
Lumbar Spinal Canal Stenosis: Expression and Functional Investigations on a Library of Different Chondroitin Sulphate Molecules in Normal and Hypertrophic Ligamentum Flavum
Authors: Lee H. C. , Loo W. L. , Yip G.
Published: May 2014

Introduction

The hypertrophy of the ligamentum flavum is known to be related to degenerative changes that are secondary to the aging process or mechanical instability. However, there has been no study to investigate the effect of chondroitin sulfate on hypertrophy of the ligamentum flavum. We aim to investigate the role of chondroitin sulfate on hypertrophy of the ligamentum flavum in lumbar spinal stenosis compared with that of lumbar disc herniation.

Materials and Methods

The concentrations of chondroitin sulfate were analyzed in the surgically obtained ligamentum flavum specimens from lumbar spinal stenosis ( n = 34; mean age 65 years) and disc herniation ( n = 24; mean age = 39.7 years) by immunohistochemical evaluation. The staining intensity and percentage of cells stained were recorded and these figures were converted into a weighted average intensity (WAI). The immunoreactivity score (IRS) was then calculated by multiplying WAI with TPS (total percentage of cells stained). The thickness of the ligamentum flavum was measured with axial T1-weighted magnetic resonance imaging. The biochemical and radiologic results were compared for these two conditions.

Results

A total of 94% (34/36) of specimens in the lumbar spinal stenosis had a IRS >50 as compared with 72% (16/22) in lumbar disc herniation; this difference is statistically significant ( p = 0.011). The mean thickness of the ligamentum flavum was 3.96 mm (range, 2.67-5.75 mm) in lumbar spinal stenosis and 2.59 mm (range, 1.41-4.17 mm) in lumbar disc herniation; the difference between lumbar spinal stenosis and disc hernation was statistically significant ( p < 0.05).

Conclusion

The current results suggest that higher expression of chondroitin sulfate might be related to the development of hypertrophy of the ligamentum flavum in lumbar spinal stenosis. Disclosure of Interest None declared
Minimally Invasive Laminectomy for Lumbar Spinal Stenosis in Patients with and without Preoperative Spondylolisthesis: Clinical Outcome and Reoperation Rate
Authors: Alimi M. , Hofstetter C. P. , Pyo S. Y. , Paulo D. , Hartl R.
Published: May 2014

Introduction

Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when nonoperative treatment has failed. Standard open laminectomy is an effective procedure. Minimally invasive laminectomy through tubular retractors is an alternative procedure. The aim of our cohort study was to evaluate the clinical and radiographic outcome of this procedure in LSS patients with or without preoperative spondylolisthesis.

Materials and Methods

Patients with LSS without spondylolisthesis and with stable spondylolisthesis who underwent MIS tubular laminectomy between 2004 and 2011 were included. Demographic, perioperative, and radiographic data were collected. Clinical outcome was evaluated by Oswestry disability index (ODI) and visual analog scale (VAS) scores, as well as by MacNab criteria.

Results

In a total of 110 patients, preoperative spondylolisthesis at the level of spinal stenosis was present in 52.5%. ODI and VAS pain scores at a mean follow-up of 28.8 months revealed a median improvement of 16% in ODI, 2.75 in VAS back, and 3 in VAS leg scores, compared with the preoperative baseline ( p < 0.0001). The reoperation rate requiring fusion was 3.5%. Patients with and without preoperative spondylolisthesis had no significant differences in their clinical outcome or the reoperation rate.

Conclusion

MIS laminectomy is an effective procedure for treatment of LSS. Reoperation rates for instability are lower than reported after open laminectomy. Functional improvement is similar in patients with and without preoperative spondylolisthesis. This procedure can be a viable alternative to open laminectomy. Routine fusion may not be indicated in all patients with LSS and spondylolisthesis. Disclosure of Interest None declared
Spinal Abscess after Epidural Catheter Insertion: A Case Report
Authors: Velnar T. , Bunc G. , Ravnik J.
Published: May 2014

Introduction

Epidural anesthesia has become a common practice for treatment of acute surgical pain and to relieve chronic pain syndromes. Despite its many qualities, potential risks have been described. Spinal epidural abscess is one of its most perilous complications.

Materials and Methods

A 72-year-old patient was treated due to lung cancer. After the operation, the pain was worsening progressively for many months. As a pain relieving measure, an epidural catheter was inserted into the upper thoracic spinal canal. In the reconvalescent period, progressive weakness of lower extremities suddenly developed and advanced rapidly into paraplegia. There was no fever observed by the patient.

Results

At admission, hypoesthesia from the upper thoracic level and anesthesia from the lower thoracic level was observed, accompanied with paraplegia. Muscle tone was appropriate and Babinski sign was present bilaterally. MRI revealed epidural fluid formation at the posterior aspect of the spinal canal with an intense compression of the cord at levels Th1 to Th4. An immediate operation followed during which a wide decompression of the spinal cord with complete evacuation of the abscess was performed. In the epidural fluid collection, the tip of the epidural catheter was found. Appropriate antibiotic therapy was started instantly. From the abscess, Staphylococcus epidermidiswas isolated. Postoperative CT scan revealed sufficient decompression of the spinal cord. Unfortunately, initially promising recovery was complicated with pneumonia and lung cancer progression that led to the death of the patient.

Conclusion

Although rare, the epidural abscess is a dangerous complication, resulting in high morbidity and mortality despite rapid surgical and postoperative interventions. Clinical signs and symptoms may be confusing and may point to other forms of pathology. The importance of very strict sterile procedures during catheter insertion and removal or close monitoring of patients with inserted catheters cannot be overemphasized. Disclosure of Interest None declared References Stäbler A, Reiser MF. Imaging of spinal infection. Radiol Clin North Am 2001;39(1):115–135 Tompkins M, Panuncialman I, Lucas P, Palumbo M. Spinal epidural abscess. J Emerg Med 2010;39(3):384–390 Ugarriza LF, Porras LF, Lorenzana LM, Rodríguez-Sánchez JA, García-Yagüe LM, Cabezudo JM. Brucellar spinal epidural abscesses. Analysis of eleven cases. Br J Neurosurg 2005;19(3):235–240 von Albert HH. [Lumbalgia, lumboischialgia. 2: Instrumental diagnosis, differential diagnosis]. Fortschr Med 1990;108(18):363–364
Lumbar Interbody Fusion Rates with Actifuse, i-FACTOR, and Vitoss BA Synthetic Bone Grafts
Authors: Berg A. James , Tankel J. A. , Jensen C. D. , Irwin A. , Purushothaman B. , Reddy G. Raj , Friesem T.
Published: May 2014

Introduction

One surgical treatment modality for the management of degenerative disc disease causing back and/or leg pain is interbody fusion. Nonunion is associated with poor outcomes. The gold standard bone graft for augmenting and achieving fusion is iliac crest autograft but significant donor morbidity is associated with its harvest. Allografts require processing, to prevent transmission of infections, which impairs their osteogenic and osteoinductive properties. An alternative synthetic bone graft that avoids the morbidity of autograft is safe, and provides reliable fusion and is therefore desired. In our institution, we have used three synthetic bone grafts, Actifuse (Baxter, USA), i-FACTOR (Cerapedics, USA) and Vitoss BA (Stryker, USA), which all report to be bioactive and to enhance bone fusion in transforaminal lumbar interbody fusion (TLIF) procedures. They were all used in combination with morselized local autograft.

Materials and Methods

Patients undergoing TLIF surgery with one of the mentioned bone grafts were identified from hospital records. Postoperative radiographs were reviewed by an independent blinded radiologist for evidence of spanning trabeculae on orthogonal radiographs.

Results

A total of 40 patients (55 levels) were included. The number of patients, operated levels, follow-up, and cumulative and overall fusion rates for each bone graft group are demonstrated in Table 1.

Conclusion

Patients who underwent TLIF with a mixture of i-FACTOR combined morselized local autograft had a higher rate of fusion with a similar mean follow-up and higher cumulative fusion rates over the period studied than Actifuse and Vitoss BA. The smaller patient numbers in the Actifuse and Vitoss BA groups does limit comparisons. Disclosure of Interest None declared