bluuebunny/crossref_metadata_2025_split huggingface dataset:
Innate Lymphoid Cells are Present at Healthy Patients Spinal Enthesis, Providing a Potential Mechanism for Spondyloarthropathy Pathogenesis
Authors: Cuthbert Richard , Fragkakis Evangelos M. , Giannoudis Peter , Dunsmuir Robert , Millner Peter , McGonagle Dennis 
Published: April 2016

Background The pathogenesis of murine spondyloarthropathy (SpA) has been intimately linked to the presence of Interleukin(IL)-23 responsive, innate like lymphocytes at different anatomical regions including spinal enthesis. Human SpAs are associated with Single nucleotide polymorphisms (SNPs) in genes related to the IL-23 pathway and drugs that block IL-12/23 have shown efficacy. We hypothesized that the normal human enthesis has a population of resident innate lymphoid cells (ILCs) that could be involved in governing entheseal immune homeostasis. In particularly entheseal resident type 3 ILCs (ILC3s) may be critical, since ILC3s in other tissues have been shown to produce inflammatory cytokines in response to IL-23. Methods Normal spinal enthesis were harvested from healthy patients undergoing spinal surgery and enzymatically digested prior to fluorescence activated cell sorting (FACS). Cellular immunophenotyping and cell sorting was performed on enthesis samples harvested from 6 patients; ILC3s, were identified as lineage (CD3- TCRγδ- TCRαβ- CD19- CD14- CD11c- CD1a- CD303- FcεRI- CD34- CD123-) and cellular surface marker CRTH2 negative with positive expression of CD45, CD127, CD117. ILC2s, which have been linked to fibrotic reactions, were identified as lineage negative with positive expression of CD45, CD127 and CRTH2. The expression of RORγt transcript was tested in sorted populations by RTqPCR. Anterior cruciate ligament (femoral enthesis) was obtained from subjects with knee OA and injured enthesis undergoing repair were also collected and analyzed by immunohistochemistry (IHC). Results All sorted samples contained ILC3s, median proportion 0.09% (range 0.015–0.63). Transcript analysis confirmed the expression of RORγt, transcript, an ILC3 related transcription factor, in sorted ILC3 populations, with ILC3s expressing 51-fold greater relative expression in comparison to unsorted digests. 5 of 6 sorted samples contained ILC2s, median proportion 0.20% (range 0–0.49). RORγt expression was detected in knee OA and there was widespread expression of RORγt in inflammatory infiltrates in injured enthesis as shown by IHC. Conclusions Our findings show that ILCs are present in the normal human spinal enthesis and may be greatly increased in frequency following injury. These findings provide strong evidence of ILC presence in normal human enthesis and suggest a potential link between cellular dysregulation of the IL-23/17 axis and SpA pathology at sites of micro damage.
Stand-Alone Cages in Anterior Cervical Discectomy & Fusion: Mid-term Outcomes
Authors: ElAbed Khaldoun 
Published: April 2016

Introduction To review and analyze the clinical outcome and radiological changes of one-level and two-level anterior cervical discectomy and fusion (ACDF) with stand-alone Trabecular Metal™ cages. ACDF using a stand-alone cage is a popular procedure with little published long-term follow-up, we reviewed our cases performed between 2001–2011. Material and Methods Patients between 36 and 64 years of age, diagnosed with cervical radiculopathy, who underwent ACDF were available for at least 3 years follow-up and included in this study. All levels were low-cervical (below C4). Clinical outcomes were assessed using Odom's Criteria, VAS, and by assessing axial neck pain, radicular arm pain, upper extremity weakness, and upper extremity numbness. Fusion was assessed by lateral radiographs looking for bone breaching and radiolucent lines around the device, in addition to dynamic radiographs, postoperative cervical lordosis was measured by the Drexler Method Results Ninety patients were included in the study, 51 patients underwent two-level ACDF modified Robinson approach, and 39 patients underwent one-level ACDF. Mean age was 44 ± 10.4 years and mean follow-up time was 4.5 ± 2.6 years. Patients reported excellent or good outcomes (90%), VAS improved in 90% of patients from a mean of 3 preoperatively, to a mean of 9 at 1 year, and a mean of 8 at 3 years follow up. Improvement in axial neck pain (80%), radicular arm pain (95%), upper extremity weakness (85%), and upper extremity numbness (90%). No cage extrusion or migration occurred. Subsidence occurred in 8% of levels fused. Clinical improvements were not related to the occurrence of subsidence. Radiographs confirmed restoration of cervical lordosis above 45 degrees, with maintenance over the follow up period. There was symptomatic anterior osteophytes formation or calcifications of anterior longitudinal ligament in 25% of patients at the final follow-up; the reoperation rate was 3.6%. There was no persistent dysphagia, or voice complaints, no dural tear, tracheal or oesophageal perforation. One patient developed deep MRSA infectious infarction of spinal cord, treated with antibiotics, and recovered totally upon one-year follow up. Based on the 3 criteria for fusion, 90% of patients confirmed fusion at 1 year follow up. Conclusion Mid- to long-term results show that ACDF with Trabecular Metal™ cages is safe and effective treatment of single and two-level cervical disc radiculopathy and neck pain.
Global Tilt: A Single Parameter Incorporating the Spinal and Pelvic Parameters Correlates with Health-Related Quality of Life Parameters
Authors: Yilgor Caglar , Enercan Meric , Hamzaoglu Azmi , Pellise Ferran , Perez-Grueso Francisco Javier Sanchez , Acaroglu Emre , Obeid Ibrahim , Kleinstuck Frank , Alanay Ahmet ,   ESSG European Spine Study Group
Published: April 2016

Introduction Surgical goals and alignment objectives mostly depend on sagittal plane parameters. SVA, C7 tilt and T1 tilt account for spinal balance and PI, PT, SS, PI-LL account for pelvic compensatory mechanism, which are all affected by patient positioning. GT is the angle between the line drawn from the center of C7 to the center of the sacral endplate and a line drawn from the center of the sacral endplate to the center of the femoral head. GT is a single parameter that takes both balance and pelvic compensation into account as a single parameter. GT has been shown to be less affected by patient positioning compared with SVA and PT. Aim was to analyze the correlation of GT with HRQoL parameters and compare with other sagittal plane parameters. Material and Methods A retrospective analysis of a multicenter, prospective, consecutive patient series. 337 patients (285F,52M) with adult spinal deformity were included, (mean age: 58.2± 15.7). Pelvic parameters (PT, PI, SS), sagittal balance parameters (SVA, T1 tilt), GT and lordosis gap(LGap) were measured by using Surgimap. HRQoL instruments included: Oswestry Disability Index(ODI), Short Form-36, SRS-22. Correlation analysis between radiographic pelvic and sagittal balance parameters, GT and LGap was pursued. Kruskal-Wallis test was used to compare GT, SVA and PT for ODI < 20, 20–40 and > 40 disability groups. Results Global tilt significantly correlated with ODI, SRS-22 pain, function, self image, and subtotal scores and SF-36 PCS ( p < 0.01) similar to SVA, PT and LGap. None of the radiographic parameters correlated with SRS-22 mental health or SF-36 MCS (Table 1). GT was more sensitive in detecting ODI disability groups when compared with SVA and PT ( p < 0.01) Conclusion GT has a similar or better correlation with HRQoL domains compared with PT and SVA. This information adds another important feature of this parameter in addition to being a single parameter taking into account both the spinal balance and pelvic compensation and being less affected by patient positioning.
Is Sacro-femoral-pubic Angle a Good Indicator of Pelvic Tilt?
Authors: You Jee Young , Le Phuong , Cho Woojin 
Published: April 2016

Introduction The spino-pelvic alignment is increasingly recognized as crucial in the assessment of patients with spinal deformities. Three pelvic parameters originally described include pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). PT, a positional parameter, has been demonstrated to correlate with quality of life and clinical outcomes. Although measuring the PT on sagittal radiographs is simple, underexposed films and malposition of X-rays often result in poor visibility of the femoral heads. In 2012, a novel measurement, the sacro-femoral-pubic (SFP) angle was introduced to estimate the PT using coronal films. The formula PT = 75 – (SFP angle) was derived to correlate the two parameters. Subsequently, the formula was validated in predicting the pelvic tilt in patients with lumbar and thoracic scoliosis. However, more recently another study showed that the SFP angle correlated poorly with the PT. The objective of our study was to analyze whether a correlation exists between the SFP angle and PT in our patient population and to validate the conventional formula (PT = 75 – (SFP angle). We also aimed to identify factors that may contribute to the formula if our data sample fails to validate the formula. Materials and Methods A retrospective chart review was performed on 106 adult patients who visited an orthopedic spine surgeon of a university hospital. Entire spine posteranterior and lateral spine radiographs were used to measure the PT and SFP, and correlation between PT and SFP was calculated. The validity of the conventional Eq. (75 - SFP =PT) was also tested. In addition, clinical data including age, body mass index (BMI), and gender and other radiographic data including PI, sagittal balance, and presence of scoliosis were analyzed to see if there was any influence of those on using the formula. Results The conventional Eq. (75 - SFP =PT) did not fit our data. However, the regression model to correlate PT and SFP angle yielded the following formula: PT = 62 – 0.72*SFP (R-square = 0.36). The higher the PI, the greater the tendency of the conventional formula to underestimate the PT and with a lower PI, the conventional formula tended to overestimate the PT (R = −0.38, p < 0.001). Age, BMI, and gender and sagittal balance did not determine significantly whether the conventional formula worked or not. The conventional formula worked poorer on the patients with scoliosis than patients without scoliosis. Conclusion The conventional Eq. 75 - SFP =PT did not match our data. However, SFP angle may correlate with PT, but possibly by a nonlinear formula which indicates that there might be additional factors that can contribute to creating such formula such as PI. In reality, however, like PT, PI is obtained from lateral view X-rays. Therefore, a lateral X-ray image with good visibility of the femoral heads would be the best way to measure the PT.
The Prevalence of High-Intensity Zone in Symptomatic Patients and Its Correlation with the Disc Degeneration and Segmental Motion
Authors: Yang Jui-Jung , Huang Hsiang-Ming , Acosta Frank , Chen Thomas , Buser Zorica , Wang Jeffrey C. 
Published: April 2016

Introduction The high intensity zone (HIZ) represents a high signal change on lumbar spine T2 MRI images. HIZ has been involved in disc degeneration and its presence was associated with inflammation and vascular granular tissue within the annulus fibrosus. Aim of our study was to investigate the HIZ prevalence, its relationship with disc degeneration and the effect on lumbar segmental motion using kinetic magnetic resonance imaging (kMRI). Material and Methods kMRI images of 353 symptomatic patients were analyzed. Data including age, gender, and radiologic assessments based on neutral images including disc degeneration grade of all lumbar spine units from L1/2 to L5/S1 and the presence of HIZ were recorded for all the patients. Demographics and disc degeneration were used for calculating HIZ prevalence. Dynamic flexion and extension images from 168 patients were used for segmental motion comparison between the discs with HIZ and without HIZ. Patients with isthmic or degenerative spondylolisthesis grade 2 or higher, Modic disc or Schmorl's node were excluded due to the potential effect on lumbar kinematics. We used chi-square test and multivariate logistic regression for our statistical analysis. Results Among 353 patients, 107 had HIZ in at least one lumbar disc. The overall HIZ prevalence was the highest in age group 40–49 years of age, followed by 50–59 years irrespectively of disc level. The HIZ prevalence was the highest in grade IV degenerative discs, followed by grade III degenerative discs. For L4/5 segment, HIZ prevalence was the highest in age group 50–59 years and disc degeneration grade IV. For L5/S1 segment, HIZ prevalence was the highest in age group 40–49 years and disc degeneration grade III. The multivariate logistic regression model indicated that the age groups (30–39 and 40–49 years), levels (L4/5 and L5/S1) and disc degeneration grades (III and V) were risk factors for HIZ. The segmental angular motion was signicantly greater in discs with HIZ than those without HIZ on L4/5 and L5/S1. However, the differences were reduced to insignificant when adjusted for disc degeneration grade. Conclusion HIZ prevalence was the highest in the middle age patients (30–39 and 40–49 years) and in the moderately degenerated discs (III and IV). The lower prevalence was observed in the older patients and grade V degenerative discs. The possible reason of increased segmental angular motion at L4/5 and L5/S1 discs with HIZ may be due to the moderate disc degeneration than HIZ itself.
Novel Circulating microRNA Signature as a Potential Non-invasive Test in LDH Patients: a Cohort Study
Authors: Zhou Xiaoya , Chen Lili , Grad Sibylle , Alini Mauro , Pan Haobo , Lu William , Huang Shishu , Peng Songlin 
Published: April 2016

Introduction Lumbar disc herniation (LDH) is one of the major causes for back and sciatic pain that costs large medical expense. Accumulating evidence has indicated that microRNAs (miRNAs), a small non-coding RNA molecule, are associated with disc degeneration, the profile of miRNAs in the LDH patients with indication for laminectomy remains unclear. Material and Methods MicroRNA profiling was performed on plasma samples of 4 groups: LDH-young group ( n = 8, average age is 31), LDH-old group ( n = 8, average age is 56), healthy control-young group ( n = 4, average age is 20), healthy control-old group ( n = 6, average age is 58). The miRNAs expression were further validated by qRT-PCR. Results The miRNAs with p-values < 0.05 and fold change values ≥2 or ≤ 0.5 compared with healthy control were regarded as dysregulated miRNAs. 61 miRNAs were upregulated and 302 were downregulated in LDH-young group compared with healthy control-young group. In addition, there are 46 upregulated miRNAs and 115 downregulated in LDH-old group compared with healthy control-old group. In particular, 12 upregulated and 71 downregulated miRNAs expressed significant differences both in the LDH-young group vs healthy control-young group and the LDH-old group vs healthy control-old group. Among them, miR-224 was upregulated 4.04-, 16.99-fold in LDH-young and LDH-old groups compared with healthy control-young and healthy control-old groups, respectively ( p < 0.01 for both). Besides, relative to old groups, miR-130b and miR-147b were downregulated significantly in young groups, both of which were reported to be associated with disc degeneration. Conclusion The selected miRNAs might play a vital role in the molecular pathogenesis of LDH and further research for the understanding of the functionality and pathological mechanism of the miRNAs in LDH is important and would shed new light on LDH.
Association Analysis of Col9A1, Col9A2, Col9A3, Aggrecan and TNF-α Gene Polymorphisms with Early Onset of Disc Herniation in Indian Population
Authors: Rajsekar Kavitha , Narayanasamy Nandita , Kuhar Meenakshi , Vaishya Sandeep , Shanmuganathan Rajasekaran , Devaraj Niranjali 
Published: April 2016

Introduction Intervertebral disc being an avascular tissue, the extracellular matrix protein play a major role in its structural stability. The pathophysiology underlying the process of Disc Herniation is still not clear but genetic factors play a vital role in the early occurrence of the disease. The study was initiated to determine the association of Collagen9A1, Collagen9A2, Collagen9A3 and TNF-α gene polymorphisms in Disc herniated patients in comparison to healthy individuals in Indian population. Methods Pre Operative blood samples were collected from 20 patients under going surgery for disc herniation between the age group of 20–60years and 10 samples from healthy individuals with no history of Intervertebral disc disease. DNA was isolated, primers designed for selected exonic regions in the triple helical binding sites for Collagen and for complete 2763 bp of TNF-α and VNTR in exon 12 for aggrecan, performed PCR and samples sequenced for analysis of polymorphic variants. Genotypic and phenotypic distributions were compared with Healthy controls. Hardy Weinberg calculations were done to correlate the allelic/genotypic frequencies in the both study groups. Results The PCR sample analysis resulted in identification of 11 variants in complete TNF-α gene, 8 variants in Col9A1, 6 variants in Col9A2 and 3 variants in Col9A3 gene.Polymorphic variants pro620thr, gln621arg and a splicesite variant at intron-exon29 A > C for Col9A1,gln326arg for Col9A2 and ser2 gly and ala16 to arg for TNF-α were statistically significant. These variants were predominant in lower age groups of 40 years. Aggrecan showed the allele 14 and 15 to be common among both the study groups. The healthy subjects for Collagen9 did not show any variant where as TNF-α showed 3 variants which were not statistically significant. Conclusion The SNP at amino acid proline 620, glutamine 621 in Col9A1, glutamine 326 in Col9A2 and arginine 103 for Col9A3 are important for the stability of the triple helical structure of collagen9 and can be directly corelated to the early occurrence of the disease in younger patients. There was no association between an aggrecan VNTR polymorphism and disc herniation. The TNF-α gene variants were not directly correlated to the onset or progression of the disease but could influence their expression levels which could trigger additional inflammatory response as in rheumatoid arthritis. PCR genetic markers can be used as a diagnostic tool to identify the progression of the disease as in Ankylosing spondilosis. This is a first report on Indian population in Disc Herniated patients.
Functional Outcomes of Microdiscectomy- Does Obesity affect Early Postoperative Outcomes?
Authors: Foodoul Mazin , Baco Abdul Moeen , Attia Ahmed 
Published: April 2016

Introduction Lumbar Disc pathology remains one of the leading causes of back pain with a multitude of surgical options. Choosing the best management option remains a challenge for many practitioners due to the individualized needs and variables of each patient. Obesity poses a challenge to surgeons regarding anesthesia, positioning and adequate exposure which required longer incisions. Studies showed that in selected patient population, microdiscectomy achieved favorable short and long term outcomes with most patients achieving a good to excellent recovery on Macnab Classification up to 10 years post operatively. Studies also showed that obesity was not associated with increased risk of herniated nucleus pulposus after microdiscectomy, However, increased BMI was associated with significantly increased estimated blood loss (EBL) and operative time without affecting the surgical outcomes such as length of hospital stay, recurrent disc herniation, and intra-operative durotomy. Methods Study subjects were identified through the microdiscectomy registry at Hamad Medical Corporation. 50 patients who had microdiscectomy over one year prior to the closure of the study were enrolled. The study population was divided into two groups according to their BMI. Group A had BMI less than 25 kg/m2while group B included those with a BMI equal to and above 25 kg/m2. Patients' medical records were reviewed for demographics, complications and radiographic findings. Patients were interviewed and Short Form 12 (SF-12) and Visual Analogue Scale (VAS) scores were obtained and compared with their preoperative counterparts. Results Statistical analysis showed no significant differences in SF-12 or VAS scores between the 2 groups at one year follow up. Conclusion In the early post operative period, quality of life and pain following microdiscectomy is not affected by the patient's BMI.
Qualitative Grading on Magnetic Resonance Imaging as a Tool for Decision Making in Lumbar Spinal Stenosis
Authors: Soman Shardul , Modi Jayprakash 
Published: April 2016

Introduction Several parameters exist for assessment of lumbar spinal stenosis (LSS) but none has shown to be an absolute criteria for defining the condition. Moreover these parameters lack clinical correlation to help physicians to decide on the plan of management. Aim To assess the clinical relevance of the qualitative grading described for LSS and to formulate a protocol for management of these group of patients. Materials and Methods A prospective study was undertaken between the period of 2014–15 using the qualitative grading based on T2 weighted MRI1 to assess the clinical outcome of 83 patients with clinical signs and symptoms suggestive of lumbar spinal stenosis at a single level to divide them into 7 morphological categories A 1–4,B, C, and D. Patients with more than two level stenosis, congenital stenosis, instability, having undergone previous surgery, other neurological disease were excluded. The diagnosis and the qualitative grading was done by a Senior surgeon not part of the study. Irrespective of the grade every patient underwent a minimum three month period of conservative management after which depending on the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for pain was grouped into success or failure and the failed patients were advised for decompression surgery in form of laminectomy at the involved level. These patients were further grouped into success or failure after a period of three months after surgery. A 15 point decrease in ODI and a VAS scale of less than 5 on admission into the study was considered as a success. Results Out of the 83 patients there were 57 failure in conservative group while out of these 50 were operated of which only 10 did not match the success criteria, while the other 7 either refused surgery or were lost to follow up. As per the grading in types A1 and 2 only 2 patients out of 17 failed conservative trial while in all the other grades from A3 to D there was a gradual decline in success of conservative trial. In patients with grades C and D all patients failed conservative trial and required surgery. In comparison for grades A3 to D operative outcome had a significantly better outcomes as measured by the Chi-square test with p-value < 0.05 considered significant. Conclusion We conclude that the qualitative grading can be used as a tool for decision making in LSS. Patients with grade A4, B, C and D should be advised for an early surgery to achieve a good functional outcome as there was a high incidence of failure of conservative management in these patients. While in patients with grade A1 to A3 a conservative management is to be recommended. Reference Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine 2010;35(21):1919–1924