bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Prospective Study of Correlation between Clinical Disability and Radiological Features in Degenerative Lumbar Canal Stenosis (LCS)
Authors: Kanna R. , Nanjayan K. , Shetty A. Prasad , Shanmuganathan R. 
Published: May 2014

Introduction The relationship between clinical disability and various parameters such as degree of constriction of dural sac, radiological pelvic parameters, facet joint orientation in patients with degenerative LCS has not been clearly defined. Materials and Methods A total of 50 patients with LCS were selected prospectively and divided into two groups (20 patients responding to conservative therapy and 30 requiring surgery) and compared with 16 controls. Patients were clinically evaluated by Oswestry disability index (ODI), SF-12, and neurogenic claudication outcome score (NCOS). All patients underwent anteroposterior, lateral dynamic radiographs of lumbar spine, and whole spine standing lateral radiograph. The spinopelvic parameters measured were spinosacral angle, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. Dural sac cross-sectional area, lateral recess angle and height, and facet joint orientation were assessed in MRI. Results Between conservative and operated group, the mean ODI score (55.5 vs. 62.99, p = 0.014) and NCOS (37.7 vs. 29.47, p = 0.06) were significantly different. Dural sac area significantly differed ( p < 0.001) between control (113.97 ± 57.58), conservative (47.57 ± 24.77), and operated groups (20.66 ± 14.49). NCOS had significant positive correlation with dural sac area ( r = 0.296, p = 0.037) than ODI. In patients with degenerative spondylolisthesis, there was a significant sagittal orientation of facet joints, high pelvic incidence (58.79 vs. 50.57, p = 0.047), and an increased pelvic tilt (18.99 vs. 11.25, p = 0.045). Conclusion Degree of dural sac stenosis corresponds to clinical disability and NCOS is a better indicator of dural sac compression than ODI score. LCS patients with sagittal facet orientation, high pelvic incidence, and high pelvic tilt develop spondylolisthesis. Disclosure of Interest None declared
Clinical Outcome after Cervical Arthroplasty Using the Novel One-Piece Viscoelastic Freedom Prosthesis
Authors: Boss O. Louis , Bäurle B. , Hausmann O. Nic 
Published: May 2014

Introduction The objective of this study was to evaluate the patients’ clinical condition after cervical arthroplasty using the Freedom Cervical Disc (AxioMed). Cervical arthroplasty is one possible treatment option for cervical degenerative disc disease (CDDD), offering an alternative to cervical decompression and fusion. As opposed to first generation ball and socket artificial disc devices, the freedom prosthesis is a one-piece viscoelastic artificial disc. This design is meant to re-establish the function of the spinal segment, mimicking the biomechanics of a healthy intervertebral disc and restoring segmental lordosis. Materials and Methods A total of 12 patients (women: 8; men: 4; mean age: 44.5 years, range: 37-59 years) received a prosthetic disc due to CDDD between April and September 2013. Follow-up assessment took place 6 weeks and 3 months after surgery and included clinical evaluation. The patients rated their clinical condition subjectively using the VAS for neck and arm pain, the North American Spine Society patient questionnaire for cervical pain and neurology (COSS), EuroQoL-5D, and the Neck Disability Index (NDI). Results All clinical indices indicated a clinically significantly improved condition of the patients after surgery. Mean VAS score for neck pain decreased from 6.36 preoperatively to 1.66 cm 3 months after surgery. Similarly, VAS score for radicular pain decreased from 6.81 to 1.33 cm. As expected, VAS for health state increased from 5.0 to 7.83 cm. Mean working capacity improved up to 75% at the 6 weeks and up to 91.66% at the 3 months follow-up. Furthermore, the COSS as well as the EuroQoL-5D and NDI showed an improvement of patients’ well-being. Mean improvement of the COSS for cervical pain and cervical neurology was 1.7 points. EuroQol-5D rose from 0.64 points preoperatively to 0.86 points 3 months after the procedure. NDI decreased from 48.6 to 16.3%. Conclusion At this early follow-up, our data indicate that the freedom prosthesis is a good treatment option in patients with CDDD. The clinical indices markedly improved after surgery. However, further data collection, as well as statistical analyses are needed to prove our preliminary results. Disclosure of Interest O. Boss: None declared B. Bäurle: None declared O. Hausmann: Conflict with Axiomed Spine Corporation
Thermally Triggered Injectable Hydrogel Carrier System for Mesenchymal Stem Cell Delivery to Promote Intervertebral Disc Regeneration
Authors: Boyes V. , Barthrop B. , Chiverton N. , Cole A. , Michael A. R. , Breakwell L. , Sammon C. , Le Maitre C. L. 
Published: May 2014

Introduction Instability of the motion segment as a result of intervertebral disc (IVD) degeneration is well known as a major cause of low back pain. Several tissue engineering and stem cell approaches have been investigated to attempt to regenerate the degenerate IVD. However, many of the proposed therapies would entail lengthy/risky operations to “implant” the tissue regeneration scaffold. Our vision is to develop a novel, injectable biomaterial delivery system which can deliver mesenchymal stem cells (MSCs) to the degenerate nucleus pulposus (NP) to stimulate regeneration, together with inhibitors of degeneration if required and provide mechanical support to the motion segment enabling regeneration to take place. Materials and Methods Here, we investigated a novel hydrogel system, which can be maintained as a liquid ex vivo and can be injected into the IVD where body temperature triggers in situ solidification. Human MSCs were incorporated into hydrogel systems and cell viability, migration characteristics, SEM, gene expression for NP markers, and matrix production investigated to determine differentiation capacity of incorporated MSCs. Mechanical properties of hydrogel systems were determined using dynamic mechanical analysis and compared with native NP tissue. Microparticles incorporation to provide delivery of inhibitors of degeneration were also investigated. Results Viability of MSCs was maintained within hydrogel systems for the 6 weeks investigated, where they were shown to migrate through the hydrogel system, deposit matrix within and differentiate toward NP cells with a switch in matrix gene expression from collagen type I to type II, and deposition of GAGs with immunopositivity seen for aggrecan following 4 weeks in culture. DMA analysis demonstrated hydrogel systems containing 10% hyaluronic acid displayed similar mechanical properties to native NP cells. Hydrogel systems were injected via 26-gauge needles into collagenase digested bovine caudal discs, which was maintained during loading of the bovine motion segments. In addition, microparticles were successfully incorporated into hydrogel systems in the liquid state before thermal triggered solidification. Conclusion Here, we have developed a hydrogel system with the potential to deliver MSCs via minimally invasive injection using small bore needles which decreases the chance of inducing damage to the annulus fibrosus. Hydrogel systems were nontoxic, support MSC growth and differentiation, and show potential to provide mechanical support to the motion segment while regeneration takes place. Such a therapy combined with inhibition of degeneration could show great promise for early and mid-stages of degeneration. Disclosure of Interest None declared
Long-Term Results of Total Lumbar Disc Replacement: A Prospective Analysis with 5 to 10 Years Follow-Up
Authors: Siepe C. J. , Heider F. , Wiechert K. , Mehren C. , Korge A. , Mayer M. H. 
Published: May 2014

Introduction The role of fusion of lumbar motion segments for the treatment of intractable low back pain (LBP) from degenerative disc disease (DDD) remains controversially debated. Total lumbar disc replacement (TDR) has been used as an alternative in a highly selected patient cohort. However, the amount of long-term follow-up (FU) data on TDR is limited. Materials and Methods Visual analog scale (VAS), Oswestry disability index (ODI) and patient satisfaction rates were acquired within the framework of an ongoing prospective clinical trial. The patient's professional activity/employment status, complications, and reoperations were recorded. A comparison was performed between mono- and bisegmental cases. Results The initial cohort consisted of 201 patients; 181 patients were available for final FU (90.0% FU rate) after a mean FU of 7.4 years (range, 5.0-10.8 years). VAS and ODI scores revealed a highly significant improvement from baseline levels at all postoperative stages ( p < 0.0001). VAS scores demonstrated a slight (VAS 2.6-3.3) but statistically significant deterioration from 48 months onward ( p < 0.05). Patient satisfaction rates remained stable throughout the entire postoperative course, with 63.6% of patients reporting a “highly satisfactory” or a “satisfactory outcome” (22.7%), while 13.7% of patients were not satisfied. The overall complication rate was 14.4% ( n = 26/181). The incidence of revision surgeries for general and/or device related complications was 7.2% ( n = 13/181). Results for two-level TDR were significantly inferior in comparison with one-level cases and were associated with higher complication (11.9 vs. 27.6%; p = 0.03) and inferior satisfaction rates ( p < 0.003). Conclusion Despite the fact that the current data comprise the early experiences and learning curve associated with a new surgical technique, the results demonstrate satisfactory and maintained mid- to long-term clinical results after a mean FU of 7.4 years. Patient safety was proven with acceptable complication and reoperation rates. Fear of excessive late complications or reoperations following the primary TDR procedure cannot be substantiated with the present data. In carefully selected cases, TDR can be considered a viable treatment alternative to lumbar fusion for which spine communities around the world seem to have accepted mediocre clinical results as well as obvious and significant drawbacks. Disclosure of Interest None declared
Characteristics of Stem Cells Derived from the Degenerated Human Intervertebral Disc Cartilage Endplate
Authors: Huang B. , Liu L. , Li C. , Zhuang Y. , Wang J. , Zhou Y. 
Published: May 2014

Introduction Mesenchymal stem cells (MSCs) derived from adult tissues are an important candidate for cell-based therapies and regenerative medicine due to their multipotential differentiation capability. MSCs have been identified in many adult tissues but have not reported in the human intervertebral disc cartilage endplate (CEP). Materials and Methods The initial purpose of this study was to determine whether MSCs exist in the degenerated human CEP. Next, the morphology, proliferation capacity, cell cycle, cell surface epitope profile, and differentiation capacity of these CEP-derived stem cells (CESCs) were compared with bone-marrow MSCs (BM-MSCs). Finally, whether CESCs are a suitable candidate for BM-MSCs was evaluated. Isolated cells from degenerated human CEP were seeded in an agarose suspension culture system to screen the proliferative cell clusters. Cell clusters were chosen and expanded in vitro and were compared with BM-MSCs derived from the same patient. Results The morphology, proliferation rate, cell cycle, immunophenotype, and stem cell gene expression of the CESCs were similar to BM-MSCs. In addition, the CESCs could be induced into osteoblasts, adipocytes, chondrocytes, and are superior to BM-MSCs in terms of osteogenesis and chondrogenesis. This study is first to demonstrate the presence of stem cells in the human degenerated CEP. Conclusion These results may improve our understanding of intervertebral disc (IVD) pathophysiology and the degeneration process, and could provide cell candidates for cell-based regenerative medicine and tissue engineering. Disclosure of Interest None declared
Assessment of the Neurocentral Synchondrosis in Pediatric Spines and the “Developmental” Etiology of Schmorl Nodes
Authors: Luk K. , Law T. , Portia-Anthony M. , Samartzis D. 
Published: May 2014

Introduction Schmorl nodes of the thoracolumbar region have been associated with the presence and severity of disc degeneration in adults. The etiology of Schmorl nodes remains precarious; however, a unique multilevel phenotype of “kissing” nodes seems to suggest a developmental origin. The neurocentral synchondrosis (NCS) are cartilaginous growth plates near the neural arch ossification centers in a growing vertebrae that may play a direct role in the development of endplate abnormalities, such as Schmorl nodes. This study assessed the NCS in pediatric spines to raise discussion of a developmental component of Schmorl nodes. Materials and Methods A retrospective imaging study of pediatric patients at a single institute assessed over a 5-year period (age range: 0-10 years) was performed. Patients with spinal disorders (e.g., scoliosis) were excluded. A total of 102 patients (57 males and 45 females) and a total of 113 sets of MRI images were reviewed. The thoracolumbar regions (T12-S1) were evaluated. Sagittal T1- and T2-weighted images were assessed for the presence or absence of the NCS, defined as a hypointense vertical line located between the vertebral body anteriorly and the posterior arch. The presence of Schmorl nodes was also noted. Results NCS was noted in 46% of the MRIs. No statistically significant difference in the disappearance of the NCS between different age groups ( p = 0.063) or gender ( p = 0.706) was found. The NCS was noted to be completely fused at the midpoint of the vertebrae. Indentation of the vertebral endplates resembling Schmorl node at many of the rostral and caudal ends of the unfused NCS were observed (Fig. 1). Conclusion The significance of further characterizing the nature of NCS closure may lie in potential associations with failure of complete closure with endplate abnormalities, such as Schmorl nodes. Our MRI study provides a foundation that a development etiology of Schmorl nodes exists. Disclosure of Interest None declared
MiRNA-146a and Intervertebral Disc Homeostasis: In Vitro, Ex Vivo Studies
Authors: Gu S. , Li X. , Ranjan K.C. , Sampen H. J. 
Published: May 2014

Introduction Expressions of miR-146a in chondrocytes were shown controversial effect according to different studies. This study is designed to demonstrate for the first time that MiRNA-146a is involved in intervertebral disc homeostasis, and its role in anti-inflammatory effect via both in vitro and ex vivo tests. Materials and Methods NP cells isolated from bovine tails in monolayer were transfected with synthetic miR-146a, and IL-1 was administered in parallel to provoke a catabolic response, using PCR and WB to confirm its effects. Then, histologic analysis using an ex vivo organ culture model of miR-146a KO mouse was used. Results In bovine disc NP cells in vitro experiment, PCR results showed the presence of IL-1 significantly increase the expression of all the cytokines when compared with the control group. Transfection of miR-146a antagonized IL-1 mediated increase of degrading enzymes and the inflammatory related cytokines. WB results also confirmed the miR-146a effects. Ex vivo mice whole disc organ culture model showed when challenged by IL-1, the 146KO NPs showed more serious decrease of GAG and degeneration, compared with WT NPs. And the numbers of MMP-13 and Adamts5 positive cells were significantly increased in the NPs of 146-a KO mouse than the WT. Conclusion The overexpression of miR-146a of bovine NP cells showed strong anti-inflammatory effects, and we thought that miR-146a might also be involved in the process of IVD degeneration, which is closely related with inflammatory factors. The relative importance of miR-146a as compared with other miRNA or proinflammatory factors in the process of IVD degeneration, however, needs further investigations. Disclosure of Interest None declared
Epidemiology of 258 Surgically Treated Cases of Lumbar Disc Prolapse
Authors: Zahoor A. , Jayachandran R. Kumar , Ashraf S. , Unnikrishnan R. , Menon K. V. 
Published: May 2014

Introduction Low back pain (LBP) is common with a lifetime prevalence of 70% and sciatic conditions in one quarter. Most of the research related to spine surgery is focused on the methods and techniques of diagnosis, therapy and rehabilitation, but hardly anything has been published on disease prevention and avoiding the need for surgery. The purpose of this study is to examine the epidemiological characters and investigate risk factors that predispose individuals to LIVDP. Materials and Methods This is an observational, noninterventional, descriptive study of 500 surgically treated cases of lumbar disc prolapse in a tertiary spine care center over 7 years’ time. Data were collected through questionnaires, outpatient registers, X-rays, MRI scans, and operation notes. Variables studied were age, body mass index, occupation, intensity of physical labor at work, driving, smoking, level of education, socioeconomic status, recreational activities, and family history of LIVDP. Data were analyzed and depicted in the form of various charts, tables, graphs, and histograms according to their occurrence. Results In our study, 26 to 45 years is the most common age group affected with LIVDP. Males were 69.8% with progressive increase in the difference as the age increases; 54.65% patients hailed from rural population, 70.54% occupations were involved in sedentary type of work with excessive bending and twisting activities, and only 28.68% were from the heavy manual group involved in lifting and other strenuous activities. Driving was a significant factor 60.47% with dominance of two wheeler drivers by 58.97%. Trauma was an event initiating back pain in 34%. Family history of back pain or spine surgeries was not significant. There was no effect of smoking or drinking. Total 84.5% were having sedentary habits with no sporting activities. Anxiety and stress were found in 61.7% people with 38.8% having it before the surgery. Conclusion Most common age group presenting with lumbar disc prolapse is 26 to 45 years with two-thirds predominance of males. Light manual and secretarial occupations, involving sedentary type of work with excessive bending and twisting activities form the major occupational group with LIVDP. Driving is a significant association factor. However, there is no effect of smoking or positive family history. Total 84.5% of the cases have sedentary habits with no sporting activities suggesting the protective role of sports. Emotional factors such as anxiety and stress have a possible role in the etiology of lumbar disc prolapse and its severity of symptoms to require surgery. Disclosure of Interest None declared
A New Porcine Animal Model of Cervical Disc Degeneration
Authors: Lee S. E. , Jahng T. A. 
Published: May 2014

Introduction Previous in vivo animal model for disc degeneration was predominantly smaller animals. But such small discs were inappropriate to investigate the cell transplantation therapy highlighted recently. A porcine disc degeneration model in lumbar spine was introduced; however, the lumbar spine was not influenced by the gravity. Hence, the authors performed porcine animal model of disc degeneration in cervical spine. Materials and Methods Three domestic minipigs (aged, 5 months; weight, 40-50 kg) were used. After anesthesia, right transverse 5 cm-sized incision was made over the three fingers above the clavicle on the anterior neck. Similar to a standard anterior cervical approach of Smith-Robinson method, anatomic dissection was performed to expose anterior surface of the cervical spine. The partial nucleotomy by a Jamshidi bone marrow biopsy needle was performed in one intervertebral disc, and the other disc spaces served as control. Radiologic study using lateral plain radiograph (X-ray) and magnetic resonance image (MRI) was evaluated at preoperation and postoperative 4 and 8 weeks. Results Two of three minipigs were confirmed disc degeneration at C4-5 and C6-7, respectively. The disc height was reduced by 20% at nucleotomy level. And these discs with previous Pfirrmann grade I were changed to grade IV degeneration at postoperative 4 and 8 weeks. The other disc spaces were maintained previous disc height and Pfirrmann grade I condition. Conclusion This was a pilot study to introduce a new disc degeneration model with relatively large animal at cervical spine. The authors will conduct a further experiment to confirm the cervical disc degeneration and plan the cell therapy for treatment of disc degeneration. Disclosure of Interest None declared
Evaluation of the Correlation among the Expression of Inflammatory Cytokines, Degeneration of the Intervertebral Disc, and Prominent Symptoms in Degenerative Human Lumbar Intervertebral Discs
Authors: Sainoh T. , Orita S. , Yamauchi K. , Sakuma Y. , Kubota G. , Oikawa Y. , Inage K. , Sato J. , Fujimoto K. , Takahashi K. , Ohtori S. 
Published: May 2014

Introduction Low back pain (LBP) disease is reportedly associated with inflammatory cytokines such as tumor necrosis factor (TNF-α) and interleukin-6 (IL-6), as well as with nerve growth factor (NGF) that is expressed in increased amounts within degenerative intervertebral discs (IVDs). In the present study, we aimed to assess the correlation between the local expression of TNF-α, IL-6, and NGF within degenerative human lumbar IVDs and the degree of degeneration, as well as the correlation between the expression of these mediators and the prominent symptoms. Materials and Methods In total, 58 IVD samples of patients who underwent surgery for various lumbar disorders were examined. The expression level of these mediators in each sample was determined using enzyme-linked immunosorbent assay. The samples were grouped according to the degree of IVD degeneration using Pfirrmann grading on magnetic resonance imaging, and the grades were correlated with the individual expression levels. The chief complaints of the patients were then recorded and assigned to the LBP group and the leg pain group, and were compared with the individual expression levels. Results A gradual increase in TNF-α (R: 0.391) and IL-6 (R: 0.388) expression levels were observed with a progression in the degree of degeneration, but NGF (R: − 0.164) exhibited a minimal decrease in the expression level. With regard to the chief complaints, the LBP group only exhibited a significant increase in the TNF-α expression level. Conclusion We noted a trend of increasing expression levels of TNF-α and IL-6 with the progression of IVD degeneration, which indicates that these cytokines may have an important role in the degenerative process of IVD at any stage. Moreover, NGF may have an important effect during the early stage of the progression of degeneration. With regard to the symptoms, TNF-α expression was significantly greater in the LBP group. Thus, we propose that TNF-α may be significantly involved in LBP. Disclosure of Interest None declared