bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum Levels of the Pro-Inflammatory cytokines IL-6 and TNF-alpha Vary Based on Diagnoses in Individuals with Low Back Pain
Authors: Weber Kathryn , Bloom Ona , Quraishi Shaheda , Overby M. Chris , Levine Mitchell , Chahine Nadeen 
Published: April 2016

Introduction Many intervertebral disc diseases cause low back pain (LBP). Pro-inflammatory cytokines and matrix metalloproteinases (MMPs) participate in disc pathology. This study examines levels of serum cytokines and MMPs in human subjects with diagnosis of disc herniation (DH), spinal stenosis (SS) or degenerative disc disease (DDD) relative to levels in control subjects. Comparison between subjects with DH versus other diagnoses (Other Dx, grouped from SS and DDD) was performed to elaborate a pathological mechanism based on systemic cytokine levels. Material and Methods Study participants were recruited from a spine neurosurgery practice ( n = 80), back pain management practice ( n = 27), or a control cohort ( n = 26). Serum samples were collected prior to treatment and were assayed by multiplex assays for levels of IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IFN-γ, TNF-α, MMP-1, MMP-3 and MMP-9. Inflammatory and degradative mediator levels were compared between diagnosis and treatment groups. Multivariate regression for relationships with age, BMI, pain duration and smoking history were also performed. Results Serum levels of IL-6 were significantly higher in LBP participants compared with controls. Participants with LBP due to Other Dx had significantly higher levels of IL-6 and TNF-α compared with DH and controls. Positive correlations were found between BMI and IL-6 levels, and TNF-α levels were positively correlated with age and BMI. Conclusion The findings of the current clinical study are the first to examine systemic cytokine levels in DDD and SS and provide evidence for a more extensive role of IL-6 and TNF-α in disc diseases and LBP, where patients with DDD or SS have even higher serum cytokine levels compared with those with DH or control subjects. These findings may assist in refining personalized diagnosis using systemic biochemical profiling of disc diseases.
Generation of a Vascularized, Scaffold Free Bone Graft by Direct Transdifferentiation of Fat Tissue
Authors: Eder Claudia , Schildboeck Sabrina , Klughofer Julia , Ogon Michael 
Published: April 2016

Introduction Bone grafts play an important role in spinal fusion surgery. Despite tremendous research efforts, synthetic or biological grafting materials equaling autologous bone habe not been developed so far. One of the major reasons is the achievement of sufficient graft vascularization. Aim of the presented study ist to test the concept of an autologous, scaffold-free, vascularized bone graft by converting the patient's fat tissue into bone. Methods and Materials: 10 fat tissue biopsies deriving from surgical waste material were used for the experiments. Samples were washed in sterile saline solution and divided into two parts. Part A served as control group and was cultivated in DMEM-F12 medium supplemented with 10% fetal calf serum and 2 mM L-Glutamine. Part B was transdifferentiated in toto using osteogenic differentiation medium and cultivated at 37°C, 95% humidity and 5% CO2 for 3 weeks. Histological evaluation of tissue mineralization was performed using H/E, van Kossa and Alizarin Red staining. Mineralization was quantified and angiogenesis and tissue integration were evaluated using the chick chorionallantoic membrane assay. Quantitative analysis were performed in triplicates. Statistical evaluation was performed using the Student's T-Test at a 0,05 level of significany. Results The osteogenic transdifferentiated fat graft showed an increase in collagen content and signs of mineralization as indicated by positive van Kossa and Alizarin Red staining. Average Calcium OD/mm sample was 50 for the transdifferentiated grafts after 3 weeks vs 24 for the corresponding control tissue ( p < 0,005). Transplantation onto the chick chorionallantoic membrane demonstrated excellent tissue integration and connection to the recipients vascular system after 5 days in vivo. Numerous small blood vessels were visible within the graft. Despite the deprivation of osteogenic differentiation factors, the osteogenic phenotype was maintained after heterotopic implantation. Conclusion The patient's own fat tissue can be transdifferented toward an osteogenic phenotype i n vitro and demonstrates excellent angiogenetic properties after in vivo implantation without losing the osteogenic phenotype. A transdifferentiated fat pat might therefore have the potential to serve as a fully autologous, vascularized graft to enhance osteogenesis in spinal fusion surgery.
Role of Bone Marrow Mesenchymal Stem Cells Concentrate Using Selective Retention Cell Technology in Posterolateral Spinal Fusion
Authors: Yousef Mohamed Abdelhamid Ali , La Maida Giovanni Andrea , Dionigi Paolo , Misaggi Bernardo , Re Valentina Vanessa , Frau Silvia 
Published: April 2016

Introduction With increasing rate of spinal fusion, the problem of pseudarthrosis which contributes to recurrent pain with patient disability is considered to be the most common cause of revision lumbar spine surgery. Intensive research is being performed to develop an alternative source of bone grafting and improve the spinal fusion rate. Purpose Was to evaluate the long-term clinical and radiological outcome of the use bone marrow mesenchymal stem cell concentrate obtained with selective cell retention technology using Cellect (Depuy Spine, USA) with a particular collagen scaffold, Healos (Depuy Spine, USA) for posterolateral spinal fusion. Patient and Methods Retrospective review of the hospital records was performed. Then, the identified patients were contacted to have a clinical and radiological evaluation follow-up visit. Demographic data were reported. Preoperative diagnosis, surgical procedure report, previous spine surgery, postoperative complications and any re-operations were registered. Clinical outcome was evaluated using visual analog scales for the back pain (VAS), Oswestry Disability Index (ODI) scores, and quality of life (EQ-5D) questionnaire. Radiological outcome was evaluated by performing plain radiographs including anterior-posterior and dynamic flexion/extension lateral views. Segmental Cobb angle of the fused segment was calculated in the flexion/extension lateral views. Any implant associated complication, development of adjacent segment degeneration and any alteration of normal spinal curvature were reported. Computed tomography (CT) scans were also performed. Results All patients (100%) achieved successful fusion. The mean difference of the segmental Cobb angle was 0.5°, ranging from 0.3°-0.7°. CT scans showed solid bilateral fusion with bridging bone (Grade I) in all patients but solid unilateral fusion with bridging bone (Grade II) was detected at 1 patient at one level. Patients started to resume working activities within a mean period of 3.5 months. The VAS score for the residual back pain was 4.2 ±2 while the ODI was 10.7± 5.6 points with the mean disability index was 21.4%. Conclusion The use of bone marrow mesenchymal stem cells concentrate obtained with selective cell retention technology is shown be an effective mean for augmentation of spinal fusion.
Postoperative Complications Associated with rhBMP2 use in Posterior Lumbar Fusion
Authors: Buser Zorica , Brodke Darrel , Esmail Nabil , Meisel Hans-Joerg , Park Jong-Beom , Myhre Sue Lynn , Youssef Jim , Wang Jeffrey C. , Yoon S. Tim 
Published: April 2016

Introduction The growing number of degenerative conditions in aging population has contributed to the increased rates of lumbar posterior spinal fusion (PLF). While PLF has been shown to be effective for the treatment of various different spinal disorders, variations in surgical technique (such as bone graft used) for PLF have potential for different complication profiles. Human recombinant bone morphogenetic protein 2 (rhBMP2) is a bone graft material commonly used in the US to enhance spinal fusion rates after PLF. There are some reports of complications related to the use of rhBMP-2 in PLF arising from relatively small case series. Aim of our study was to quantify the frequency of various complications in elderly patients undergoing PLF with and without rhBMP2. Material and Methods We queried the orthopaedic subset of the Medicare database (PearlDiver) between 2005 and 2011. Current Procedure Terminology (CPT) codes were used to identify patients undergoing PLF procedures with and without rhBMP2, and International Statistical Classifcation of Diseases 9 (ICD-9) codes were used for complications. Complication and re-operation rates were analyzed within 1 year after the index procedure. Complications included: Acute Renal Failure, Deep Vein Thrombosis, Dural Tear, Hematoma, Heterotopic Ossification, Incision and Drainage, Myocardial Infarction or other cardiac complication, Nerve, Osteolysis, PLF Reoperation, Pneumonia, Pseudoarthrosis, Pulmonary Embolism, Radiculopathy, Respiratory Complications, Sepsis, Urinary Retention, Urinary Tract Infection, Mechanical (failure of other internal orthopedic device, implant, and graft) and Wound Complications. Chi-square analysis was used to calculate the complication differences between the groups. Results There were 20,143 patients who underwent a PLF from 2005–2011, and 27% (5421) of those cases received rhBMP2, while 73% (14722) had the PLF procedure without it. The majority of PLF cases were female (62%) and 65–69 years of age (27%) patients. The overall complication rate was similar between the rhBMP2 and no-rhBMP2 groups, 78.8% and 76.4%, respectively. However, most of the complications had a significantly lower rate in the rhBMP2 group compared with the no-rhBMP2 group (Dural tear 2.2% versus 3%; Incision and Drainage 6.9% vs 7.8%; Myocardial Infraction 3.8% vs 4.4%; Nerve 1.1% vs 2%; Pulmonary Embolism 2.2% vs 2.8%; Radiculopathy 9.4% vs 11.1%; Sepsis 3% vs 3.9%; Wound 8.2% vs 9.6%, respectively). Complications that were in the rhBMP2 group were Mechanical 8% vs 6.2%; Pseudoarthrosis 3% vs 1.8%; Urinary retention 9.9% vs 8.7% ( p < 0.05) and Urinary Tract Infection 30.30% vs 29.60%. Interestingly, heterotopic ossification, demonstrated less than 11 patients in both groups.
The Relationship between HELQ Expression and Intervertebral Disc Degeneration
Authors: Huang Shanhu , Zhang Yu , Liu Zhili , Liu Jiaming 
Published: April 2016

Introduction Degeneration of the intervertebral disc, mainly of nucleus pulposus, is strongly implicated as a cause of low back pain. However, the mechanism of disc degeneration is not clear. This study is to investigate the expression level of HELQ protein in nucleus pulposus tissues and the relationship between HELQ expression and intervertebral disc degeneration. Materials and Methods A total of 84 samples of lumbar intervertebral disc degenerated of different degree were obtained from patients undergoing lumbar spinal surgery for low back pain. Degeneration degrees of all samples were classified by radiological and histopathologic methods. Immunohistochemistry (IHC) staining was performed to evaluate the expression level of HELQ protein in nucleus pulposus tissues. And the relationship between HELQ expression and radiological degeneration grades, histopathological degeneration grades of nucleus pulposus were analyzed. Results HELQ was expressed in human nucleus pulposus. The expression level of HELQ protein was significantly lower in nucleus pulposus with higher degeneration degree than those with lower degeneration degree. And HELQ expression level had significantly negative correlation with radiological degeneration grades(r = 0.333, p = yyyy0.002) and histopathological degeneration grade (r = −0.519, p = 0.000). However, no correlation were detected between HELQ expression and age ( p = 0.374), gender ( p = 0.063) or segments ( p = 0.676). Conclusion The results indicated that down-regulated expression of HELQ is a possible reason of intervertebral disc degeneration. Thus, targeting HELQ gene will be a new therapeutic strategy for patients with intervertebral discs degeneration.
The Intervertebral Disc Functional Cell Models: a New Revolution for in vitro Toxicology Testing
Authors: Velnar Tomaz , Bunc Gorazd , Maver Uros , Gradisnik Lidija 
Published: April 2016

Introduction For diagnostics of discogenic low back pain, local anaesthetics are often used, which may be cytotoxic to intervertebral disc cells. Studies so far have been mainly performed on animal cells. The study aim was to evaluate the effect of local anaesthetics on human intervertebral disc cells in vitro. Material and Methods Annulus fibrosus and nucleus pulposus cells were isolated from human lumbar intervertebral disc fragments and exposed to various concentrations of lidocaine, bupivacaine and their mixture. Saline solution was used as a control. Three different dilutions (undiluted, 1:2 and 1:4) of anaesthetics were tested. The cells were treated for 6, 24 and 48 hours and examined with for viability. Results Nulceus pulposus cells were more susceptible than annulus fibrosus cells to the toxic effects of both anaesthetics. Lidocaine was more toxic with the final cell survival fraction of 0%, 10% and 20%. Bupivacaine presented less cytotoxicity with the final survival of 10%, 60% and 80%. Lidocaine-bupivacaine mixture showed an intermediate toxicological effect. Conclusion Human intervertebral disc cells in vitro are useful for various toxicology tests. They are a valuable model for testing of anesthetic agents. According to the analysis, lidocaine and its mixtures should be avoided due to its high toxicity to the intervertebral disc cells. Bupivacaine was less toxic, especially in 1:4 dilutions and may be recommended for the intradiscal diagnostics.
Static Test of Flexo Compression in Posterior Thoracolumbar Spinal Fixation with Conical Cylindrical Screws
Authors: Nirino Carlos Mariano , Nemirovsky Carlos Eduardo 
Published: April 2016

Introduction The aim of this paper is to describe the results obtained of a static test of flexo compression in polyaxial transpedicular conical cylindrical screws; which we have used for more than 20 years; in posteriors thoracolumbar spine fixings based on the ASTM F 1717–04 standard. This trial was made at the National Institute of Industrial Technology at its Center for Research and Development in Mechanical in Buenos Aires, Argentina. Material and Methods Two spinal fixation systems were evaluated, both composed by transpedicular conical soul and cylindrical thread screws, bars and tulips. In Table 1 the information provided by the manufacturer of the screws and identification adopted in the test for each sample is presented. [Table: see text] A universal testing machine Tinius Olsen H50-KT was used for the study. The proposed paragraph 8.1.1 of ASTM F1717–04 procedure was followed. The assembly of the samples was performed using the steps proposed by us, the tulips were set at the distance established by the Standard and the terminal screw of them was set by applying a torque of 10 Nm. The assays were performed at a speed of 10 mm / min and were interrupted when the load drop was observed in the instant graphic verifying in this way the loss of poliaxiality. The test setup used and the location of the devices during the test are shown in Fig. 1 . [Figure: see text] The active length of longitudinal component (L) was revealed (see Fig. 1 ). From this value the corresponding displacement of 2% of the permanent deformation was calculated, Point B =Lx 0, 02 (see Fig. 2 ). From the assay were obtained (see Fig. 2 ): The Load-displacement curve; The fluence load flexo-compression (N) (point D); The fluence displacement 2% (mm) (point A) # the elastic displacement (mm): difference between the value of point A and point B. Elastic displacement = Point A-Point B # the flexo-compression rigidity (N / mm): ratio between the loading of flexo-compression fluence and the elastic displacement. Rigidity = Point D Point A – Point B # the final displacement (mm), and # the final load (N) [Figure: see text] Results Fig. 3 shows the curve Load versus Displacement obtained for samples 018565- (1–2) [Figure: see text] In Table 2 the results are described. [Table: see text] Conclusion Screws and prisoners remained adjusted and there were not apparent permanent deformation in any of the system components. Its cylindrical thread and conical soul provides a high strength profile improving primary fixation and the resistance to the pull out. The major diameter of the soul in the pedicle region increases the bending and the resistance in fixations without arthrodesis preventing the breaking of the screw. All tests were performed within the framework of Management System for Quality Assurance of INTI-Mechanics.
Spontaneous Resolution of Sequestrated Lumbar Disc Herniation: A Prospective Cohort Study
Authors: Rahimizadeh Abolfazl , Saghri Mohammad 
Published: April 2016

Objective Spontaneous regression of sequestrated lumbar disc well known entity. But, the current reports about this scenario are confined to case reports or small case series. To assess the chance of complete spontaneous resolution of sequestrated lumbar disc herniation and to report the outcome of regressed cases in a prospective study. Method From January 2010 to July 2015, 103 patients with acute lower limb mono-radiculopathy, but without neurological motor deficit secondary to a migrated lumbar disc herniation thought to be a sequestrated free disc fragment were prospectively studied for the possibility of their spontaneous regression with time. All the qualified patients initially fulfilled the study criteria. But seven patients were lost to follow up and 9 more cases preferred to do surgery within a few days to three weeks after clinical trial. Eighty seven patients remained for clinical evaluation and periodic magnetic resonance imaging for the possibility of spontaneous regression. These patients include 39 males and 48 females. The age of the patients ranged from 22 to67 years with the mean of 42.96, SD= 10.65. Results In 75 of these cases complete resolution of the offending disc occurred. This was associated with marked improvement or even disappearance of pain intensity in short and mid-term follow-up. Furthermore, where a case of same level contralateral disc herniation was seen, not a single case of same level same side recurrence could be encountered. The cost of treatment and work status of the patients were significantly better than surgically treated patients according to previously published reports. In mid-term follow, recovery rate (McNab Criteria %) of these 75 patients was either good or excellent. All these were satisfied and recommend this type of treatment for similar patients. The remaining 12 patients, ultimately underwent surgery. Surprisingly, all had subligamentous location Conclusion This study clarifies that conservative management might be considered as an appropriated cost-effective option in treatment of sequestrated lumbar disc herniation in the patients with minimal neurological impairment, with probably high chance of spontaneous regression of the offending disc. However, to compare conservative versus surgery, in this sub-type of disc herniation, further clinical trials are recommended.
Long-Term Follow-up of Disc Degeneration after Discography: Minimum 5-Year Follow-Up at a Single Center Experience
Authors: Hur Jung-Woo , Ryu Kyeong-Sik , Kim Jin-Sung , Seong Ji-Hoon 
Published: April 2016

Introduction Experimental studies have demonstrated accelerated disc degeneration after various intradiscal procedures. However, there are only a few long-term follow-up studies using MRI images to confirm the progressive disc degeneration after discography. The aim of this study is to evaluate disc degeneration after discography over 5-year follow-up and to determine possible risk factors for enhancing disc degenerations after discography Material and Methods 239 subjects with chronic low back pain underwent multi-level discography to confirm discogenic pain in our institute from January 2006 to June 2009. Thirty-eight subjects who did not operate due to negative study with normal (Grade 1 and 2) to moderate (Grade 3) disc degeneration prior to discography and followed for more than 5 years were enrolled in our study. The routine multi-level discography technique and determination of positive study using original work by Walsh et al was performed in all study subjects. Pre- and post-discography MRI and CT scan were analyzed by two blind independent observers to evaluate degree of disc and endplate degenerations. The progression of disc degeneration was analyzed for correlation with 1) subjects demographic data, 2) pre-discography disc degeneration, 3) levels of discography and 4) discography findings. Results Mean age of the subjects at time of discography was 38.1 ± 6.4 years and mean time to final MRI follow-up was 68.0 ± 3.1 months. 2-level discography was done in 19 subjects and 3-level in 18; total 92 disc (L2/3: 5, L3/4: 30, L4/5: 36, L5/S1: 21) There was progression of disc degeneration in 23 disc (23.9%); 5 (6.4%) from normal and 18 (19.5%) from moderate disc degeneration group. There were 16 (17.3%) new disc herniation and 9 (9.7%) new HIZ, however, there was no significant difference between the locations of herniation. Moreover, the differences of mean disc height and endplate degeneration were not statistically significant. The progression of disc degeneration was significantly higher in young age group (<35 years), lower level disc group (L4/5 and L5/S1) and moderate (Grade 3 to 4) disc degeneration group. Multi-level injection, failed discography (annulography) and higher grade of discography findings revealed no positive correlation with progression of disc degeneration. Conclusion Diagnostic discography resulted in accelerated disc degeneration in 5-year follow-up study. However, MR findings suggested that annulus puncture with small gauze needle may not be the cause of new disc herniation. Younger age, lower level disc and advanced degeneration prior to discography were the risk factors for progression of disc degeneration. Careful consideration of risk and benefit should be used in recommending procedures involving disc injection.