bluuebunny/crossref_metadata_2025_split huggingface dataset:
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