bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Glucose-Induced Oxidative Stress Accelerates Premature Stress-Induced Senescence of Young Intervertebral Disc Cells
Authors: Park Jong-Beom , Park Eun-Young 
Published: May 2015

Introduction Diabetes mellitus (DM) is a major health problem worldwide. Approximately 10% of all DM cases are type 1 (Juvenile onset) and the prevalence of type 1 DM among the under 20s continuously rise. DM is known to be an important etiologic factor for premature disc degeneration. Previous studies have reported higher incidence of degenerative disc diseases in patients with DM, relatively young age, than in the patients without DM. A glucose-mediated increase of oxidative stress is a major causative factor for the development of diseases associated with DM through senescence. However, little is known about relationship among DM, mitochondrial damage, oxidative stress, senescence of young intervertebral disc cells, and disc degeneration. The aim of this study was to investigate the effect of high glucose on mitochondrial damage, oxidative stress, senescence of nucleus pulposus (NP) cells, and disc degeneration. Material and Methods Young nucleus pulposus (NP) and annulus fibrosus (AF) cells were isolated from 4-week-old rats, cultured and placed in either 10% FBS (normal control) or 10% FBS plus two high glucose concentrations (0.1 and 0.2 M) (experimental conditions) for 1 and 3 days. We identified and quantified the mitochondrial damage (mitochondrial transmembrane potential) and reactive oxygen species (ROS) for 1 and 3 days. We also identified and quantified the occurrence of senescence and telomerase activity. Finally, we determined the expressions of proteins related to replicative senescence (p53–p21) and stress-induced senescence (p16–pRB) pathways. Results Two high glucoses enhanced the disruption of mitochondrial transmembrane potential (mitochondrial damage) in young NP and AF cells for 1 and 3 days compared with normal control. Two high glucoses increased the occurrence of senescence of young NP and AF cells in a dose- and time-dependent manner. Telomerase activity declined in a dose- and time-dependent manner. Both high glucoses increased the expression of p16 and pRB proteins in young NP and AF cells for 1 and 3 days. However, compared to normal control, the expressions of p53 and p21 proteins were decreased in young NP and AF cells treated with both high glucoses for 1 and 3 days. Conclusion The current study demonstrated that high glucose-induced oxidative stress accelerates premature stress-induced senescence of young NP and AF cells in a dose- and time-dependent manner rather than replicative stress. This may result in dysfunction of young NP and AF cells, leading to accelerated premature disc degeneration. Therefore, the prevention of excessive generation of oxidative stress by strict blood glucose control is important to prevent or to delay premature disc degeneration in young patients with DM.
Surgical Treatment of Thoracolumbar Fractures with Osteosynthesis
Authors: Nemirovsky Carlos Eduardo , Nirino Carlos Mariano 
Published: May 2015

Introduction The aim of this study is to describe the results obtained in 44 patients, all between 20 and 65 years, operated between 2011 and 2013 with the diagnosis of thoracic and lumbar vertebral fractures posttraumatic, treated in our department. In all cases, we used the same technique, which consists of fixing two levels above and two levels below the fractured vertebrae including it in the osteosynthesis system getting full or partial reduction of the fracture. After the fracture consolidation, we proceeded to the removal of the implant between 6 to 9 months after surgery. The indication was always surgical treatment with temporary fixation without arthrodesis. After the removal of the osteosynthesis material, all patients recovered the capacity of flexo-extension of the thoracolumbar spine. The patients returned to their previous levels of daily life and sport. It took them 35 days on an average to return to work and from 6 to 9 months to their sports activities. Patients were followed for 1 year after surgery. Patients and Methods A total of 44 patients were evaluated, 34 men and 10 women. The complaint was for posttraumatic back or low back pain by falls from their own height standing or sitting, in the 72% of cases, with no more than 48 hours of evolution that did not get better with rest and got worse with mobilization. The rest of the cases were traffic accidents. All patients were studied by MRI and X-rays. All fractures were treated by the same surgeon within the first 72 hours of making the diagnosis. Fractures were divided as follows: D9 (1 case), D10 (7 cases), D11 (6 cases), D12 (11 cases), L1 (10 cases), L2 (7 cases), L3 (1 case) and L4 (1 case). Overall, 83% of cases were type A fractures according to the AO classification, and the remaining 17% were type B, which were associated with rupture of the posterior wall and invasion of the spinal canal. Only two fractures had neurological and motor compromise C, according to Frenkel classification. The rest of the fractures had Frenkel E. Results All patients returned to their usual physical activities, even those who played sports with the exception of the two Frenkel C. As postoperative complications, patients had scar hygromas that were cured with puncture and compressive bandage. Everyone referred complete or partial improvement of their symptoms. Only in one case, we had a postoperative complication which was the rupture of one of the lower transpedicular screws of the system at 3 months; after the removal of the implant at 6 months, the pain disappeared without complications. Conclusion This method, temporary fixation without arthrodesis of five levels, is usually used in our department to treat thoracolumbar fractures. Patients had no postoperative complications except one patient who presented a ruptured of a transpedicular screw but no reoperation was needed. In all cases, there was a complete remission of symptoms and return to normal activity.
Posterior Percutaneous Transpedicular Stabilization and Chrome-Densitometry 3D TC Evaluation at Month 12: Our Experience in Unstable Thoracolumbar Vertebral Fractures
Authors: Vanni Daniele , Sirabella Francesco Saverio , Guelfi Matteo , Pantalone Andrea , Sparvieri Antonio , Galzio Renato , Salini Vincenzo , Magliani Vincenzo 
Published: May 2015

Introduction The concepts of “tissue-sparing surgery” and “mini-invasiveness” are gradually involving the surgical approach to spine pathologies, both traumatic and degenerative. Patients and Methods The aim of the study is to evaluate the fracture healing model in case of unstable thoracolumbar vertebral fractures surgical treatment, treated by posterior percutaneous transpedicular stabilization (PPTS). Since March 2011, 89 patients with this fracture pattern, without neurologic involvement (according to ASIA classification) were enrolled in the study. Patients were randomly divided into two homogeneous samples. PPTS (with rods and screws) and standard posterior open approach were performed in patients of groups A (46 patients) and B (43 patients, control), respectively. A clinical and radiographical follow-up was performed respectively at months 1, 3, 6, 12 (according to visual analog scale [VAS] and Oswestry Disability Index [ODI]) and at months 1, 6, 12 (dynamic radiographic studies in the last two times). Segmental kyphosis and wedge-shaped deformity amount of the involved vertebral bodies, were measured pre- and postsurgery. At month 12, a CT scan with 3D reconstruction and analysis of chrome-densitometry was obtained. The data were analyzed by mean of the Kaplan–Meier curve (results yielding p < 0.05 were considered statistically significant). Results Clinically, in group A, we have observed a progressive and more rapid VAS and ODI scores improvement. Vertebral body collapse or kyphosis progression was not observed. There were no “fixation failure” and no patient underwent revision surgery. The 3D reconstructions and the chrome-densitometry evaluation at month 12 showed a more homogeneous and organized trabecular architecture recovery in group A (vs. group B). The PPTS acts as an “angular stability” fixation system; it allows a “biological” healing process (according to Wolf law), producing better clinical and radiographical results. Conclusion Unstable thoracolumbar fractures PPTS is an effective alternative to the classic open standard treatment. The advantage of mini-invasive spine surgery and “biological” healing process explain these better results and faster recovery times. This technique represents a safe and effective treatment, in terms of clinical and radiographical findings.
Custom Made (PMMA) Intervertebral Spacer in TLIF Preliminary Results of a Prospective Randomized Trial
Authors: Ronai Marton 
Published: May 2015

Introduction The use of bone cement in orthopedic surgery has been quite current for many years. In spine surgery, it has been used first for replacing defects after corpectomy. Then, vertebroplasty and kyphoplasty got used worldwide. Sporadically, some surgeons used cement to refill the intervertebral space after discectomy, combined with dorsal stabilization and fusion. Most recently in our institution, we started to perform routinely percutaneous cement discoplasty, for elderly patients. We also use PMMA as a spacer in TLIF. In a previous retrospective analysis, we reviewed results with this kind of surgeries. The aim of this study was to validate the use of custom-made PMMA spacer in TLIF with a high level of evidence in a randomized, prospective study. Patients and Methods In our study, we planned to collect 100 consecutive patients to whom we perform one level TLIF in the lumbar spine. The patients are randomized in three groups by the GraphPad QuickCalcs software. Group A is standard TLIF with PEEK spacer positioned in the anterior part of the intervertebral space. Group B is standard TLIF with PMMA spacer placed in the anterior part of the intervertebral space. Group C is standard TLIF with PMMA spacer positioned in the posterior part of the intervertebral space. Patients between the age of 18 and 65 years were included. Patients with a high-grade spondylolisthesis, metabolic bone disease, spinal infection, cancer, and severe scoliosis (Cobb over 30 degrees) were excluded. We evaluate the clinical results with standard questioners. Radiological evaluation focuses on bony fusion, loosening of any instrument implanted (PMMA spacer or screws), osteolysis around the cement, subsidence, changes in segmental, and overall lordosis according to the position of the spacer. Results Until today, 40 patients have a minimum of 1-year follow-up. We present these early results. On CT scan 6 months after surgery, we could observe completed fusion in 78.5% of the operated segments. The fusion rate was higher in the PMMA spacer groups (B + C), but the difference is not significant. We found six subsidence (15%), from four was in the PEEK spacer group (A) meaning, that the subsidence rate was significantly higher in this group. We found radiolucent zone around the implant (loosening) in only two cases (5%), one in the group A and one in group B. The overall clinical result was very good in 61%, good in 28%, and poor in 11% of the cases without significant difference between the groups. Conclusion With this preliminary results, we can estimate that the use of custom-made PMMA spacer in TLIF even in younger population provides good results noninferior to preformed PEEK spacer, and it even has some following advantages on preformed cages: (1) It fits better to irregularity of the end plates than preformed spacers, which can correlate with the difference in subsidence rate. (2) It requires smaller annular window to implant.
Functional Outcome of Anterior Decompression and Cage in Caries Spine: A Study of 850 Cases in Ghurki Hospital
Authors: Aziz Amer 
Published: May 2015

Introduction Tuberculosis is the leading cause of death in third world countries, from a single infectious disease. It paralyses the society when it affects the spine because of its resultant neurological deficit in the form of quadriplegia, paraplegia, loss of bladder and bowel control, bed sores, and continuous financial burden on family and whole society. Early spinal decompression and stabilization with standalone cage have dramatic results in terms of improvement in neurology, relief of pain, and correction of deformity. The objective of the study is to determine outcome of anterior decompression and stabilization with locally made standalone cage and bone graft in caries spine in terms of improvement of neurology, relief of pain, and improvement of kyphotic angle. Patients and Methods It is a prospective case series study including 850 cases who were treated at GTTH from 2003 to 2010. After preoperative assessment of pain, neurology, and measurement of angle of deformity, all patients were treated with anterior decompression and then stabilization was achieved with bone graft and standalone locally made cage. After surgery, patients were followed at 6 weeks, 3 months, 6 months, and 1 year to assess neurology, relief of pain, and kyphotic angle. Results Neurology improved in 92% of patients, pain relieved in 95% of cases, and there was mean correction of 18 degrees in kyphotic angle at the end of 1-year follow-up. Conclusion Early diagnosis and early intervention give excellent results. After anterior decompression, stabilization with cage and bone graft results in significant improvement of neurology, relief of pain, and correction of kyphotic deformity. There is no need for added instrumentation.
Role of Single Stage Posterior Pedicle Screw Fixation and Transpedicular Decompression with Chemotherapy, in Treatment of Thoracic, Thoracolumbar, and Lumbar Spinal Tuberculosis
Authors: Das Kalidutta 
Published: May 2015

Introduction Tuberculosis of spine being an anterior disease, anterior decompression, and fixation has been long considered as the gold standard. Recently, the posterior approach surgery has gained popularity, based on the principle of adequate debridement and stable fixation with much lower complication rates. This retrospective study aims at evaluating the role of a posterior stabilization with transpedicular posterior alone decompression for tuberculosis of spine. Patients and Methods A total of 55 patients surgically treated with posterior pedicle screw fixation and transpedicular decompression along with chemotherapy for tuberculosis of spine between January 2009 and May 2013 and had a minimum of 12 months' follow-up were included in the study. Their functional outcome (VAS score), neurological outcome (ASIA grading) and radiological outcome (X-ray and MRI) were assessed. Patients with kyphotic angle > 30 degrees, more than three contiguous discal involvement and multifocal lesions were excluded from the study. Results Mean age of patients was 47.2 years. Thoracic spine was involved in 29, thoracolumbar in 16, and lumbar in 10 patients. Mean follow-up was of 23.2 months. Most common indication for surgery was instability pain. VAS score improved from an average of 9.2 to 2.4 in postoperative period and 3.2 at follow-up. Neurological improvement was seen in all patients with neurological deficits preoperatively. Mean kyphosis angle was 20.6 ± 4.8 degrees and was corrected postoperatively to 7.4 ± 3.2 degrees (> 50%). At the latest follow-up, there was a mean loss of correction of 3.1 degrees resulting in 6.1 degrees of final correction. Bony fusion was achieved in 73% patients with no patient having any clinical signs of pseudoarthrosis. Conclusion Posterior stabilization and transpedicular decompression have shown an improvement in the functional outcome and the neurological status in most of the patients without the need of an anterior decompression and fusion. Good maintenance of spinal alignment and fusion along with resolution of the inflammatory process on MRI can be satisfactorily attained through posterior stabilization and transpedicular decompression when accompanied by chemotherapy. However, further follow-up is necessary to monitor for possible disease recurrence or implant failure.
May Latent Bacterial Infection Provoke Degenerative Disc Disease?
Authors: Velnar Tomaz , Gradisnik Lidija , Bunc Gorazd , Vorsic Matjaz , Ravnik Janez 
Published: May 2015

Introduction As a chronic condition, the degenerative disc disease is a significant health problem. Several factors, such as genetics, mechanical stress, inflammatory and biochemical changes, vascular aspects, as well as infection may initiate degenerative processes, most commonly affecting the nucleus pulposus. It has been proposed that disc degeneration might be initiated by possible long-lasting low-grade infection. Materials and Methods The aim of the study was to assess the incidence of bacterial infection in the lumbar intervertebral disc specimens obtained from patients with disc herniation. In a prospective study, 62 patients were included (49% women and 51% men, average age 56 years, range 22–83 years). No experience of previous invasive spinal diagnostic procedures was reported. Disc specimens from levels L1 to S1 were collected during discectomies and microbiologically tested on blood, thioglycolate, and nutrient agars. MRI and CT were used as diagnostic methods and comparison of microbiological results to clinical signs and imaging was done. Results In included patients, affected discs were removed. All microbiological cultures of disc specimens remained sterile after 1 week. Clinically, no signs of discitis were observed. The absence of an acute infection was confirmed by routine laboratory tests. Although clinical signs corresponded well to the MRI and CT imaging results, no connection with microbiological tests was found. Conclusion The exact pathobiology of degenerative disc disease is unknown. According to some studies, intradiscal bacteria may initiate a low-grade infection, playing a role in intervertebral disc degeneration. Our observations do not support this fact. Microbiological samples remained sterile in all patients, meaning that intervertebral disc is a sterile environment and bacterial infection is unlikely the cause of degeneration. Positive disc cultures in other studies may have resulted from specimen contamination after disc removal. However, the hypothesis of disc infection cannot completely be excluded because of slow growing and special growth conditions requiring bacteria that were not tested in our study. The potential role of low-grade bacterial infection contributing to the pathogenesis of degenerative disc disease thus remains uncertain. The genesis of disc degeneration might originate in the immune system and repeated episodes of injury and reparation that could culminate to progressive tissue damage.
Arthrodesis with Pedicle Screw Fixation in Thoracolumbar Infectious Discitis
Authors: Tejeda Martin 
Published: May 2015

Introduction Primary infection of spine disc is a pathology that we see more frequently, mainly because of the decompensated diabetes mellitus, and whose treatment is with antibiotics and limited physical activity for a long time. Objective Describe the outcome of surgical treatment of surgical debridement, culture/biopsy, and fusion with pedicle fixation in the same surgical procedure in a group of patients with intractable and/or clinical/radiographic instability with infectious discitis of thoracolumbar spine pain, trying to improve pain and functional limitation time. Patients and Methods A group of 15 adult patients from January 2010 to December 2013 with infectious discitis, detected with laboratory tests, imaging (X-ray, CT, and MRI) with a history of diabetes mellitus with thoracolumbar pain with various treatment regimens were studied with visual analog scale of 7 to 10/10, limited functional scale (Oswestry 70–80%), severe limitation of travel (within 100 m), to surgical debridement + culture/biopsy + pedicle fixation was performed and a clinical/radiographical follow-up of 6 months to 3 years. Results A significant decrease in pain intensity (60% of the initial pain intensity in the visual analog scale) was found, achieving a progressive improvement in functional scale in a period of time average of 6 to 8 months without detecting recurrence of infection, nor have major complications or deaths registered in monitoring patients with clinical and radiographical stability during the follow-up. Conclusion In this study, the results encourage aggressive treatment with instrumentation to improve intractable cases of pain and/or instability to shorten the period of immobility and inactivity of patients.
Reliability Analysis of the AOSpine thoracolumbar Spine Injury Classification System by a Worldwide Group of Naive Spinal Surgeons
Authors: Kepler Christopher , Vaccaro Alexander , Koerner John , Dvorak Marcel , Kandziora Frank , Rajasekaran Shanmuganathan , Aarabi Bizhan , Vialle Luiz , Fehlings Michael , Schroeder Gregory , Reinhold Maximilian , Audigé Laurent , Schnake Klaus , Bellabarba Carlo , Oner Cumhur 
Published: May 2015

Introduction The AOSpine Thoracolumbar Spine Injury Classification System was recently published and combines elements of both the Magerl system and the Thoracolumbar Injury Classification System (TLICS); however, the worldwide applicability has yet to be established. Material and Methods A previously described classification system of thoracolumbar injuries which consists of a morphologic classification of the fracture, a grading system for the neurologic status and relevant patient-specific modifiers was applied to 25 cases by 100 spinal surgeons from across the world twice independently, in grading sessions 1 month apart. The results were analyzed for classification reliability using the Kappa coefficient (κ). Results The overall Kappa coefficient for all cases was 0.56 which represents moderate reliability. Kappa values describing interobserver agreement were 0.80 for type A injuries, 0.68 for type B injuries, and 0.72 for type C injuries, all representing substantial reliability. The lowest level of agreement for specific subtypes was for fracture subtype A4 (Kappa = 0.19). Intraobserver analysis demonstrated overall average Kappa statistic for subtype grading of 0.68 also representing substantial reproducibility. Conclusion In a worldwide sample of spinal surgeons without previous exposure to the recently described AOSpine Thoracolumbar Spine Injury Classification System, we demonstrated moderate interobserver and substantial intraobserver reliability. These results suggest that most spine surgeons can reliably apply this system to spine trauma patients as or more reliably than previously described systems.