bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiological, Histological and Biochemical Characterization of a Novel Ovine Lumbar Intervertebral Disc Injury Model
Authors: Daly Christopher , Goldschlager Tony , Ghosh Peter , Jenkin Graham , Cooper-White Justin , Naidoo Taryn 
Published: April 2016

Introduction Numerous animal models of degenerative disc disease exist. Debate exists as to the ideal animal model and optimal method of inducing degeneration. The ovine lumbar spine is one accepted animal model of degenerative intervertebral disc disease. The goal of this study is to describe and characterize a novel, simple, reproducible ovine disc-injury model utilizing a drill bit inserted into the lumbar intervertebral disc to mimic disc degeneration. Material and Methods Six female sheep underwent pre-operative MRI followed by lumbar intervertebral disc injury at two levels via insertion of a 3.5mm diameter drill bit to a depth of 12 mm via a lateral retroperitoneal approach. Necropsies were performed two months following injury. Lumbar spines were explanted and underwent 9.4T MRI, radiographic imaging, gross morphological, histological and biochemical analysis. Gross morphologic assessment consisted of horizontal section of the intervertebral disc, digital photography of the surfaces. Biochemical analysis was performed for sulphated glycosaminoglycans, type I and type II collagen and DNA. Histological analysis utilized a semiquantitative grading system. Results There was no evidence of disc degeneration on pre-operative MRI. Drill bit injured discs demonstrated increased Pfirrmann degenerative scores relative to controls and pre-operative scores. Injured levels demonstrated significantly greater reductions in Disc Height Index than control levels. Gross morphological assessment similarly revealed significantly higher degenerative morphological scores in injured disc relative to pre-operative scores and controls. On biochemical analysis the annulus fibrosus (AF) at the entry point in injured discs contained less type II collagen and proteoglycans than the AF of non-injured control discs. Histological assessment demonstrated increased degenerative scores in injured disc on semiquantitative scoring. Conclusion These finding demonstrate that the 3.5mm drill bit ovine lumbar intervertebral-disc injury model produced macroscopic, radiological, biochemical and histological changes consistent with disc degeneration.
Analysis of Serum C-reactive Protein in Patients with Lumbar Disc Herniation
Authors: Dewan Aarti 
Published: April 2016

Introduction We measured the serum concentration of C-reactive protein (CRP) by a high-sensitive method in patients with lumbar disc herniation. The level and type of herniation were evaluated. Inflammatory cytokines, such as interleukins are produced at the site of disc herniation and are now considered responsible for the pain perceived by the patient. Thus, purpose of this study is to test whether HSCRP can stand as an objective tool to predict postoperative recovery in patients undergoing lumbar discectomy. That is, to study association between preoperative HSCRP blood level and postoperative recovery with the help of modified Oswestry Back Disability Score. Materials and Methods A study group consisting of 50 cases of established lumbar disc disease and control group of 50 normal subjects, matched with the study group. Both the study and control groups were subjected to detailed evaluation with the help of modified Oswestry Low Back Pain Scale both pre andpostoperatively at 4 months, 8 months and 1-year. The preoperative blood samples were analyzed to assess the HSCRP concentration. All the cases underwent surgery over a period. Results The level of HSCRP in the study group was between 0.050– and 0.710 mg/dL and in the control group, 0.005–0.020 mg/dL. There was highly significant positive correlation between preoperative HSCRP level and postoperative score at p < 0.005. Cases with HSCRP level in the range of 0.1820 ± 0.079 mg/dL, showed better recovery (score improved > 10 points), while those with HSCRP level in the range of 0.470 ± 0.163 mg/dL, showed poor recovery (score improved < 10 points). Conclusion The significantly high concentration of serum hs-CRP might indicate a systemic inflammatory response to impingement of the nerve root caused by disc herniation and might be a predictor of recovery after operation.
Proteomic Analysis of Degenerated Intervertebral Disc- identification of Biomarkers of Degenerative Disc Disease and Development of Proteome Database
Authors: Ranjani Veera , Sreemol G. , Muthurajan Raveendran , Natesan Senthil , Gnanam R. , Kanna Rishi M. , Rajasekaran S. 
Published: April 2016

Introduction Low back pain (LBP) is a leading cause of disability resulting from musculoskeletal disorders among general population. The life time prevalence of single episode of low back pain in general population is reported to be around 80%. It is a leading cause of loss of productivity and the resulting economic burden due to loss of productivity is enormous. Degenerative disc disease (DDD) is a leading cause for LBP however, molecular mechanism underlying DDD are largely unknown. To date, there are few reports available on Intervertebral Disc (IVD) proteomics. Hence, weundertook the analysis of the intervertebral disc using a proteomic based approach to develop a database which may be helpful to isolate probable biomarkers and better understand the molecular basis of DDD. Methods Sample for proteomic analysis was obtained during lumbar discectomy in a case of intervertebral disc prolapse from a 50 year old female. IVD tissue sample was pulverizedusing liquid nitrogen and proteins were extracted. Extracted proteins were subjected to Two-Dimensional Polyacrylamide Gel Electrophoresis (2D-PAGE) analysis. Reproducible and abundantly expressed proteins were analyzed using Matrix Assisted Laser Desorption/Ionisation- Time of Flight (MALDI-TOF)Mass Spectrometry. The peptide mass fingerprinting data from the MALDI-TOF were analyzed by MASCOT online tool for the identification of proteins. Database was developed based on the results obtained from the MASCOT analysis. Results Thirty protein spots were identified from the degenerated IVD tissue by proteomic profiling techniques. Out of these 30 proteins, 25 proteins showed significant matches against human proteins in the NCBI database; remaining 5 spots did not generate any significant matches. The proteins which showed a significant match provide authentic evidence of the presence of these proteins in the IVD. The database was developed based on a three layer architecture model which could help investigator identify target proteins consisting of presentation layer, application layer and the data storage layer. This database would prove useful in future proteomic research into DDD. Conclusion Following the genomic era, molecular analysis at the proteomic level is a developing technology. This technology has the scope to identify the functions of the differently expressed proteins, from control and degenerated discs and may provide an opportunity to design novel strategies to treat degenerative disc disease in the future. Our study provides early data in the field of proteomic profiling in the clinical disease scenario of DDD.
Outcome and Differences in the Clinical Results of Three Different Surgical Methods for Lumbar Disk Herniation
Authors: Haghnegahdar Ali , Sedighi Mahsa 
Published: April 2016

Introduction We aimed to study the following gaps in the literature. (1) Clinical results of spinous process osteotomy for the treatment of LDH is scarce in the literature. (2) Studies comparing clinical outcomes between laminectomy and osteotomy have not been reported. (3) Results of MAPN with open techniques have not been compared. We sought to study the outcome of surgery for LDH by conducting a comparative study between three different surgical techniques; we aimed to find whether any of these approaches were more efficacious in reducing pain or improving patients' quality of life. In addition, factors that could predict the outcome of LDH surgery were assessed. Materials and Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated by JOA Back Pain Evaluation Questionnaire–Low Back Pain (JOABPQ-LBP) and lumbar function functional scores, laminectomy achieved significantly better outcome compared with other methods. It is worth mentioning that relief of radicular pain was associated with subjective satisfaction with the surgery among our study population.
Microdiscectomy Results using the Caspar Technique
Authors: Velnar Tomaz , Bunc Gorazd 
Published: April 2016

Introduction The degenerative disease of the intervertebral disc and back pain are chronic conditions and represent an important cause of morbidity and mortality. Treatment of lumbar radicular compressive syndromes is described, as well as the success of microsurgical procedure according to the Caspar technique. Material and Methods In the prospective study, 100 patients were included. All suffered from the radiculopathy due to the nerve compression. Conservative treatment was not successful and operation was then performed. The follow up of patients was evaluated from 1 to 3 years after the operation, the average time was 17 months. Results The results showed excellent outcome in 67%, good outcome in 28%, fair in 1% and poor in 3% of patients. One patient died one month after the operation due to unrelated reasons and was not included in the final assessment. Thus, the total result was satisfactory in 95%. Conclusion The results of microsurgical approach showed that the efficiency of such operation in this series can be compared with similar results elsewhere according to the international criteria (88% to 98%). The successfulness of the microsurgical method is due to gentle tissue handling, especially with respect to the nerve structures in the spinal canal and considerably smaller injury if muscles and bone. This is achieved by better visibility and field magnification with the operative microscope.
The Role of Caveolin-1 in Intervertebral Disc Degeneration and Regeneration
Authors: Bach Frances , Zhang Ying , Verdondschot Lucy , Bedate Alberto Miranda , Creemers Laura , Ito Keita , Meij Björn , Sakai Daisuke , Chan Danny , Tryfonidou Marianna 
Published: April 2016

Introduction During intervertebral disc (IVD) degeneration, the main cell type in the nucleus pulposus (NP) shifts from notochordal cells (NCs) to chondrocyte-like cells (CLCs). Microarray analysis revealed that caveolin-1 expression was correlated with IVD degeneration. The aim of this study was to determine the role of caveolin-1 in NC and CLC physiology to assess its potential role in IVD regeneration. Material and Methods Protein expression (caveolin-1, apoptosis, progenitor cell markers, extracellular matrix, TGF-β-signaling pathway) was determined in IVDs of wild type (WT) and caveolin-1 knockout (KO) mice and canine IVDs of different degeneration grades (immunofluorescence, immunohistochemistry, TUNEL assay). Micro-aggregate cultures of CLCs from canine and human degenerated IVDs (Thompson grade III) were treated with chondrogenic medium (incl. TGF-β1) alone or in combination with (a) caveolin-1 scaffolding domain peptide (CSD) and/or (b) siRNA against caveolin-1. DNA, glycosaminoglycan (GAG) content, collagen type I and II immunohistochemistry and gene expression profiling (RT-qPCR) for extracellular matrix production/degradation-, cell proliferation- and apoptosis markers was performed. Results The NP of WT mice was rich in viable NCs, whereas the NP of caveolin-1 KO mice contained more collagen type II-rich matrix and less cells together with an increased progenitor cell surface marker (Tie2+/GD2+) expression and a higher apoptotic activity. Caveolin-1 expression increased in the later stages of canine IVD degeneration, together with a significantly increased apoptotic activity. Caveolin-1 knockdown significantly decreased GAG deposition in the CLC aggregates (6–14%), whereas CSD treatment significantly rescued and increased GAG deposition (11–16%). Conclusion Caveolin-1 plays a crucial role in preservation of NCs, underscored by the NP phenotype of caveolin-1 KO mice. Caveolin-1 may be related with cell senescence given its increased expression in degenerated IVDs. However, caveolin-1 knockdown decreased extracellular matrix production, while CSD supplementation rescued this effect. The latter implies that CSD may be a useful disease modifying agent since it is known to influence degeneration-related signaling pathways (incl. TGF-β signaling). Altogether, this indicates that the increased caveolin-1 expression during IVD degeneration may also be a repair mechanism rather than being merely a senescence marker. Acknowledgment This work was supported by AOSpine Research Network grants (SRN2011_11, AOSPINE 106540) and the Dutch Arthritis Foundation (LLP22).
New 5-Grade Scale for Anterior Fusion Estimation: Validation for Infectious Spondylitis
Authors: Mushkin Alexander , Baulin Ivan , Pavel Gavrilov , Nina Sovetova , Naumov Denis 
Published: April 2016

Introduction Fusion status assessed using plain radiograph or CTs, according to the 4-grade scale published by Bridwell et al (1995). Unfortunately, this method is based on the measuring of bone density and bone sclerosis and it's not completely definite for dynamic analysis, especially for early post-op period. Methods 5–grade scale based on the quantities evaluation characterized by implant's position between vertebral bodies and descriptive characteristic of the zone between transplant(implant) and implant site. 1 grade – dislocation of the transplant (implant): one or both ends are dislocated from the vertebral end plate(s); 2 grade – transplant (implant) is located between vertebral bodies, the size between blocked vertebra and end of transplant ≥ 3 mm; 3 grade – transplant (implant) is located between vertebral bodies, the size between blocked vertebra and end of transplant 1 ≤…≤ 3 mm; 4 grade – the diastasis between vertebra and transplant (implant) is not visualized; non-clear bone structure of fusion zone; with local sclerosis (similar to the grade 2 according Bridwell's scale); 5 grade – structural bone block with a clear bone trabeculars between transplant (implant) and contacted vertebral body (similar to the grade 1 according Bridwell's scale). Results 109 patients aged from 21 till 76 years (average - 59,2 years) were included into prospective CT-study 3, 6, 12 months post-op. All patients were consequently operated between 2010 – 2013 in one clinic. Indications for surgery was chronic spinal infections (TB or osteomyelitis) with un-effective previous course of conservative treatment. According to the variant of anterior fusion patients were divided into 2 groups: group 1 ( n = 40) - autologous bone graft; group 2 ( n = 69) – autologous bone graft inserted into the titanium mesh cage. Fusion was estimated separately for cranial and caudal contact zone. Statistically confirmed differences between compared groups in fusion status in early post-op (3 and 6 month) evaluation. The results were more differential in compare with Bridwell's scale. The differences completely disappeared till 12 month after surgery. Conclusions New 5-grade scale for anterior fusion estimation doesn't depend on the technical characteristic of CT-images; it is more objective for estimation of early results of spinal reconstruction. The proposed method could be more informative for comparative studies of the different spine pathologies.
A Study of Sacral Anthropometry to Determine S1 Sacral Screw Placement for Spinal Lumbosacral Fixation in the Korean Population
Authors: Ha Kee-Yong , Oh In-Soo 
Published: April 2016

Introduction There are various methods of S1 pedicular screw fixation, and every method has its own advantages and disadvantages. But, anatomical variation of the posterior superior iliac spine (PSIS) was not considered in any method. Therefore, little is known about the safe angle for screw fixation in the Asian population. Material and Methods We performed our study in 160 sacra including the pelvic ring obtained from 80 Korean cadavers. The bony measurements were obtained by performing 1 mm computed tomography (CT) cuts from the L5 lumbar vertebra to the pelvic ring and excluding other structures. We evaluated the incidence of anatomic variation of the PSIS and measured the safe marginal length and angle for screw fixation considering the PSIS and course of the external iliac vein, using a Korean sacrum model. Results Our study showed that the closed type of PSIS is more frequent in males than in females. The optimal angle for screw fixation is 16.91 ± 6.85 (°), while the Lt. side S1 pedicle insertion angle (SPIA) is 16.00 ± 6.20 (°). The average Korean optimal screw length is 58.35 ± 14.90 (cm) for the Rt. Side and 55.89 ± 16.16 (cm) for the Lt. side. Conclusion With reference to these parameters, the optimal screw length and angle can be chosen and bicortical anteromedial screw fixation can be easily and safely performed.
New Motor Deficit after Adult Spinal Deformity Surgery Leads to Worsened Early HRQOL: Subanalysis of 273 Patients from Scoli Risk 1 Prospective Study
Authors: Saigal Rajiv , Berven Sigurd , Lafage Virginie , Kelly Michael , Kopjar Branko , Smith Justin , Dahl Benny , Cheung Kenneth M. C. , Carreon Leah Y. , Schwab Frank , Rebmann Kathrin , Shaffrey Christopher , Fehlings Michael , Lenke Lawrence , Ames Christopher 
Published: April 2016

Introduction An International, ambispective, multi-center observational cohort study (Scoli-Risk-1) was completed to determine the impact of neural injury on Health-related Quality of Life scores (HRQOLs). 30.9% of patients suffered any ASIA lower extremity motor score (LEMS) worsening during the first 6 months after surgery. The purpose of this analysis is to define the impact of new LEMS deficit on HRQOL metrics and recovery of those measures after surgery in the first 6 months. We hypothesized that new motor deficits (defined by LEMS worsening) will lead to worsened HRQOL scores, after correction of adult spinal deformity. Material and Methods Patients aged 18–80 years with a diagnosis of adult spinal deformity were eligible for enrollment at 15 sites worldwide. Other inclusion criteria included major Cobb > 80 degrees, C7-L2 curve apex, and any patient undergoing 3 column osteotomy. ASIA scores and standard HRQOL scores (ODI, SRS, SF-36 mental, and SF-36 physical) were recorded pre-op, 6 weeks and 6 months. Patients were subdivided into three subcategories of LEMS change (≥2 points worsening, 1 pt worsening to no change, or LEMS improvement). Results 273 complex adult spinal deformity (ASD) patients enrolled, with 184 female (67%) and 89 male (33%) patients. Mean age was 56.9 years (SD 15.3, range 18–81). 30.9% of patients suffered a worsening of LEMS within the first 6 months post-surgery. HRQOL scores worsened as LEMS worsened. The 6 week HRQOL changes for LEMS ≤2 patients vs LEMS −1 to 0 vs improved LEMS patients were: ODI (11.6 vs 0.7 vs −0.6), SF-36 physical (−3.9 vs −1.6 vs 1.0), SF-36 mental (−1.5 vs 1.4 vs 0.6), and SRS total change (0 vs 0.4 vs 0.5), respectively. The 6 month HRQOL changes for LEMS < =2 patients vs LEMS −1 to 0 vs improved LEMS were: ODI (−6.8 vs −9.5 vs −14), SF-36 physical (0.6 vs 2.6 vs 6.2), SF-36 mental (−1.1 vs 3.8 vs 5.9), and SRS total change (0.3 vs 0.7 vs 0.8), respectively. Table 1 shows these data. While the database is not yet locked, these data are subject to minor changes. Conclusion In the subgroup of patients who developed a new lower extremity motor deficit after adult spinal deformity surgery, total HRQOLs and HRQOL changes were negatively impacted. Patients with 2 or more points of LEMS worsening had the worst HRQOL changes. However, even these patients showed overall improvement in ODI, SF-36 physical and SRS total scores at 6 months compared with pre-op baseline.
Efficacy of En Bloc Direct Vertebral Body Derotation (Dvbd) in Idiopathic Scoliosis Treatment
Authors: Urbanski Wiktor , Wolanczyk Michal , Dragan Szymon 
Published: April 2016

Introduction Vertebral axial rotation in horizontal plane is a component of spinal deformity in scoliosis. Greater axial rotation is related with inclination to curve progression, contributes to rib hump development. Therefore the correction of axial deformity appears as an obvious component of scoliosis correction. However clinical efficiency and complication risk of derotation maneuvers is still not established. The object of the study was to assess horizontal correction obtained with en bloc direct vertebral body derotation (DVBD) and the influence of the maneuver on coronal and sagittal correction of the spine in patients undergoing surgical scoliosis correction. Material and Methods 36 patients after surgical correction of idiopathic scoliosis were included into study. Authors analyzed two groups; adolescents and adults. All patients underwent posterior fusion with pedicle screws only instrumentation. 15 (20 curves) patients were corrected by rod derotation only and 21 (26 curves) underwent rod derotation and direct en bloc vertebral derotation (DVBD). Measurements according to Cobb method were performed on X-rays obtained before and post surgery - coronal plane curves, sagittal profile (T2-T12, T5-T12, L1-S1). Spine flexibility was assessed of prone bending X-rays. Axial rotation was determined on CT scans obtained intraoperatively (O-Arm, Medtronic) and postoperative CT scan. Rotation assessment was done according to the method described by Aaro and Dahlborn. Results The comparison of axial rotation prior to correction and post correction revealed decrease of axial apical vertebral rotation in both DVBD and non DVBD groups. However in DVBD group vertebral derotation was greater than in non DVBD group and it was confirmed in statistic analysis. Amount of axial derotation was similar in both adults and adolescents. Analysis of coronal curves showed statistically significant better correction in (DVBD) group and obviously better correction was possible in flexible than stiff curves. DVBD did not improve but also did not decrease kyphosis comparing to pre op measurements and results from non DVBD group. This statement concerned both T2-T12, T5-T12 measurements. Neither flexibility nor stiffness of the curves influenced kyphosis results. Conclusion Direct vertebral body derotation is a relevant maneuver to improve correction in idiopathic scoliosis, either in coronal or sagittal plane. It may be useful technique in adolescent as well as adult patients.