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Sample records for acute thoracolumbar intervertebral

  1. CLINICAL AND MAGNETIC RESONANCE IMAGING CHARACTERISTICS OF THORACOLUMBAR INTERVERTEBRAL DISK EXTRUSIONS AND PROTRUSIONS IN LARGE BREED DOGS.

    Gomes, Sergio A; Volk, Holger A; Packer, Rowena Ma; Kenny, Patrick J; Beltran, Elsa; De Decker, Steven

    2016-07-01

    Treatment recommendations differ for dogs with intervertebral disk extrusion vs. intervertebral disk protrusion. The aim of this retrospective, cross-sectional study was to determine whether clinical and magnetic resonance imaging (MRI) variables could be used to predict a diagnosis of thoracolumbar intervertebral disk extrusion or protrusion in dogs. Dogs were included if they were large breed dogs, had an MRI study of the thoracolumbar or lumbar vertebral column, had undergone spinal surgery, and had the type of intervertebral disk herniation (intervertebral disk extrusion or protrusion) clearly stated in surgical reports. A veterinary neurologist unaware of surgical findings reviewed MRI studies and recorded number, location, degree of degeneration and morphology of intervertebral disks, presence of nuclear clefts, disk space narrowing, extent, localization and lateralization of herniated disk material, degree of spinal cord compression, intraparenchymal intensity changes, spondylosis deformans, spinal cord swelling, spinal cord atrophy, vertebral endplate changes, and presence of extradural hemorrhage. Ninety-five dogs were included in the sample. Multivariable statistical models indicated that longer duration of clinical signs (P = 0.01), midline instead of lateralized disk herniation (P = 0.007), and partial instead of complete disk degeneration (P = 0.01) were associated with a diagnosis of intervertebral disk protrusion. The presence of a single intervertebral herniation (P = 0.023) and dispersed intervertebral disk material not confined to the disk space (P = 0.06) made a diagnosis of intervertebral disk extrusion more likely. Findings from this study identified one clinical and four MRI variables that could potentially facilitate differentiating intervertebral disk extrusions from protrusions in dogs. PMID:27038182

  2. Pedicle screw fixation combined with intervertebral bone grafting for the treatment of thoracolumbar fracture: a report of 24 cases

    Chuan-lin DU

    2014-01-01

    Full Text Available Objective To explore the clinical effect of pedicle screw fixation combined with intervertebral bone grafting for the treatment of thoracolumbar fractures. Methods The clinical data of 24 cases of unstable and/or bursting thoracolumbar fractures treated with pedicle screw fixation and intervertebral bone grafting from July 2007 to July 2010 were analyzed retrospectively. The 24 patients (18 males and 6 females were aged from 24 to 61 years (mean 31.5 years, in whom 8 with fracture of T12, 9 of L1, 5 of L2, and 2 of L3 vertebral fracture. According to Denis classification, in 8 patients it was compression fracture, and in 16 patients it was burst fracture. According to American Spinal Injury Association (ASIA criteria, 2 patients were classified as grade C, 2 as grade D and 20 as grade E. All of the 24 patients received pedicle screw fixation combined with intervertebral bone grafting to reduce and fix the thoracolumbar fractures using pedicle screw-rod system, and 4 of them received posterior decompression. Results Twenty-two patients were followed-up from 12 to 24 months (mean 18 months. No obvious loss of vertebral height or posterior protuberance was found. There was no evidence of screw loosening or breakage, neither overdistraction of intervertebral space among 22 patients. The Cobb angle was corrected from 15-44 degrees (32.3±7.6 degrees, preoperatively to 0-9.6 degrees (6.6±2.4 degrees as observed at the time of last follow-up. Conclusion Pedicle screw fixation combined with intervertebral bone grafting could reconstruct the mechanical structure of anterior and middle spinal columns, obtain effective intervertebral height and bone union, and long-term spine stability. DOI: 10.11855/j.issn.0577-7402.2013.12.11

  3. Massive hematothorax after thoracic spinal manipulation for acute thoracolumbar pain

    Johannes Struewer

    2013-07-01

    Full Text Available Spinal manipulation usually represents a widely used and effective method for physicians in order to relieve acute patient pain and muscular dysbalance. Although life-threatening complications (e.g. pneumothorax, vertebral artery dissection, stroke after manual treatment are reported with regard to actual medical literature millions of patients undergo manual treatment to manage thoracolumbar pain each year. The authors present the case of a 17 year old male patient with a life-threatening hematothorax after thoracic high velocity spinal manipulation for acute thoracolumbar pain. The patient required emergency chest tube thoracostomy and afterwards thoracoscopic haemostasis for an intercostal venous lesion. A massive hematothorax after spinal manipulation represents an extremely rare but life-threatening complication. Physicians are encouraged to promote the benefits of manual/chiropratic therapy on the one hand but on the other hand are obliged to educate about potential serious dangers and adverse events.

  4. Early recurrence of thoracolumbar intervertebral disc extrusion after surgical decompression: a report of three cases

    Jäderlund Karin H

    2010-02-01

    Full Text Available Abstract Thoracolumbar disc extrusions were diagnosed in three chondrodystrophic dogs with paraparesis of up to three days duration. All cases were managed by hemilaminectomy and removal of extruded disc material. In one dog, fenestration of the herniated disc space was also performed. Initially neurological function improved or was unchanged, but from two to ten days postoperatively clinical signs of deterioration became apparent. In all the dogs, recurrence of disc extrusion at the same location as the initial extrusion was diagnosed by computer tomography and at a second surgery abundant disc material was found at the hemilaminectomy site between the dura and an implanted graft of autogenous fat.

  5. [Acute rupture of lumbar intervertebral disc caused by violent manipulation].

    Li, J S

    1989-08-01

    Five cases of acute rupture of lumbar intervertebral disc caused by violent manipulation are reported. After protrusion of the lumbar intervertebral disc were treated by violent manipulation, the lumbo-leg pain were severe suddenly. The operations found that the annulus fibrosus had ruptured and the nerve root or cauda equina was constricted by the nucleus pulposus which had entered into the spinal canal. It must be emphasized that their is in danger of more damaging intervertebral disc degenerated by violent manipulation, then the adhesion of the nerve root will occur gradually. We don't suggest to make violent manipulation for the patient with the nerve root injured. We have acquired good results in treating protrusion of lumbar intervertebral disc by combined therapy and they are introduced in this article. PMID:2620603

  6. Value of multidetector spiral CT in diagnosis of acute thoracolumbar spinal fracture and fracture-dislocation

    龚静山; 徐坚民

    2004-01-01

    Objective:To investigate the diagnostic value of multidetector spiral CT (MSCT) in acute thoracolumbar spinal fracture and fracture-dislocation.Methods: CT imaging files of 152 consecutive traumatic patients with thoracolumbar fractures were retrospectively reviewed. MSCT scannings were performed with a collimation of 3-5 mm and a pitch of 5.5. The postprocessing included sagittal and coronal multiplannar reconstruction, and 3-D reconstruction.Result: There were 88 cases of compression fracture, 54 cases of burst fracture and 10 cases of fracasdislocation. Transverse images of MSCT could visualize all fractures directly and determine whether spinal canal was intact. Postprocessing image was helpful in depicting the displacement of fragment and orientation of dislocation.Conclusions: MSCT plays an important role in diagnosis and management of acute thoracolumbar spinal fracture and fracture-dislocation.

  7. Surgical Decompression in Dogs with Thoracolumbar Intervertebral Disc Disease and Loss of Deep Pain Perception: A Retrospective Study of 46 Cases

    Puerto David A

    2005-06-01

    Full Text Available The case details and outcome after surgical decompression of 46 dogs with thoracolumbar intervertebral disc disease with loss of deep pain perception prior to surgery were reviewed. Nineteen dogs (41.3% recovered with a median follow-up period of 12.5 months. Recovery was defined as an ambulatory paraparesis, or better, with urinary and fecal continence. There was a better outcome in dogs with loss of deep pain for less than 24 hours prior to surgery (19/41; 46.3% recovered than in dogs without deep pain perception for more than 24 hours (0/5; 0% recovered. Dogs with deep pain perception present at two weeks postoperatively had significantly higher success rate (8/12; 66.7% recovered than dogs without deep pain perception at this time period (1/10; 10.0% recovered. The return of deep pain perception by two weeks postoperatively can be a useful positive prognostic indicator.

  8. How long and low can you go? Effect of conformation on the risk of thoracolumbar intervertebral disc extrusion in domestic dogs.

    Packer, Rowena M A; Hendricks, Anke; Volk, Holger A; Shihab, Nadia K; Burn, Charlotte C

    2013-01-01

    Intervertebral disc extrusion (IVDE) is a common neurological disorder in certain dog breeds, resulting in spinal cord compression and injury that can cause pain and neurological deficits. Most disc extrusions are reported in chondrodystrophic breeds (e.g. Dachshunds, Basset Hounds, Pekingese), where selection for 'long and low' morphologies is linked with intervertebral discs abnormalities that predispose dogs to IVDE. The aim of this study was to quantify the relationship between relative thoracolumbar vertebral column length and IVDE risk in diverse breeds. A 14 month cross-sectional study of dogs entering a UK small animal referral hospital for diverse disorders including IVDE was carried out. Dogs were measured on breed-defining morphometrics, including back length (BL) and height at the withers (HW). Of 700 dogs recruited from this referral population, measured and clinically examined, 79 were diagnosed with thoracolumbar IVDE following diagnostic imaging ± surgery. The BL:HW ratio was positively associated with IVDE risk, indicating that relatively longer dogs were at increased risk, e.g. the probability of IVDE was 0.30 for Miniature Dachshunds when BL:HW ratio equalled 1.1, compared to 0.68 when BL:HW ratio equalled 1.5. Additionally, both being overweight and skeletally smaller significantly increased IVDE risk. Therefore, selection for longer backs and miniaturisation should be discouraged in high-risk breeds to reduce IVDE risk. In higher risk individuals, maintaining a lean body shape is particularly important to reduce the risk of IVDE. Results are reported as probabilities to aid decision-making regarding breed standards and screening programmes reflecting the degree of risk acceptable to stakeholders. PMID:23894518

  9. TCM Treatment for 50 Cases of Acute Protrusion of the Lumbar Intervertebral Disc

    梁述元

    2001-01-01

    @@ From January 1998 to August 2000, the author has treated 50 cases of acute protrusion of the lumbar intervertebral disc by Chinese herbs, massotherapy, and functional exercise with satisfactory therapeutic results reported in the following.

  10. An expert consensus on the evaluation and treatment of acute thoracolumbar spine and spinal cord injury in China

    Zhicheng Zhang; Fang Li; Tiansheng Sun

    2013-01-01

    This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab-lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview (one item);pre-hospital care (one item);evalu-ation and diagnosis (13 items);treatment (23 items); prevention and treatment of major complica-tions (12 items);and rehabilitation (four items). This is the first time that Chinese experts have pub-lished a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the recommenda-tion among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with “1” corre-sponding to neutrality and“5”representing maximum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After al of the votes were col ected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom-mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thoracol-umbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treat-ment strategy for acute thoracolumbar spine and spinal cord injury in China.

  11. Acute mechanical injury of the human intervertebral disc: link to degeneration and pain

    B Alkhatib

    2014-09-01

    Full Text Available Excessive mechanical loading or acute trauma to intervertebral discs (IVDs is thought to contribute to degeneration and pain. However, the exact mechanisms by which mechanical injury initiates and promotes degeneration remain unclear. This study investigates biochemical changes and extracellular matrix disruption in whole-organ human IVD cultures following acute mechanical injury. Isolated healthy human IVDs were rapidly compressed by 5 % (non-injured or 30 % (injured of disc height. 30 % strain consistently cracked cartilage endplates, confirming disc trauma. Three days post-loading, conditioned media were assessed for proteoglycan content and released cytokines. Tissue extracts were assessed for proteoglycan content and for aggrecan integrity. Conditioned media were applied to PC12 cells to evaluate if factors inducing neurite growth were released. Compared to controls, IVD injury caused significant cell death. Injury also caused significantly reduced tissue proteoglycan content with a reciprocal increase of proteoglycan content in culture media. Increased aggrecan fragmentation was observed in injured tissue due to increased matrix metalloproteinase and aggrecanase activity. Injured-IVD conditioned media contained significantly elevated interleukin (IL-5, IL-6, IL-7, IL-8, MCP-2, GROα, and MIG, and ELISA analysis showed significantly increased nerve growth factor levels compared to non-injured media. Injured-disc media caused significant neurite sprouting in PC12 cells compared to non-injured media. Acute mechanical injury of human IVDs ex vivo initiates release of factors and enzyme activity associated with degeneration and back pain. This work provides direct evidence linking acute trauma, inflammatory factors, neo-innervation and potential degeneration and discogenic pain in vivo.

  12. Vertebral and inter-vertebral screw fixation for treating thoracolumbar compression fracture:a long-term follow-up of spinal stability%经伤椎和跨伤椎螺钉置入固定胸腰椎压缩性骨折:脊柱稳定性长期随访

    谢申; 祝少博

    2016-01-01

    BACKGROUND: Posterior pedicle screw fixation is a common method for treatment of thoracolumbar compression fractures. The fixation method contains long-segment fixation, short-segment fixation and vertebral fixation. Clinical effects of vertebral fixation and inter-vertebral short-segment fixation for treating thoracolumbar fractures remain unclear. OBJECTIVE: To compare the stability of posterior vertebral fixation and inter-vertebral pedicle screw fixation for treating thoracolumbar compression fractures. METHODS: Clinical data of 46 patients with thoracolumbar compression fractures were retrospectively analyzed. According to the fixation methods, they were divided into the vertebral fixation group (n=21) and inter-vertebral fixation group (n=25). The operation time, intraoperative bleeding, intraoperative blood transfusion, the time of lying in bed, vertebral Cobb angle, anterior vertebral height and visual analog scores were evaluated for a long time. RESULTS AND CONCLUSION: (1) During repair, in both groups, operation time, intraoperative bleeding and intraoperative blood transfusion were better in the inter-vertebral fixation group than in the vertebral fixation group (P < 0.05-0.01). The time of lying in bed was better in the vertebral fixation group than in inter-vertebral fixation group (P < 0.01). (2) No significant difference in Cobb angle and anterior vertebral height was detected before and after treatment and during repair in both groups, but final fol ow-up and fol ow-up loss were better in the vertebral fixation group than in inter-vertebral fixation group (P < 0.05-0.01). (3) No significant difference in visual analog scores was detected before and after treatment in both groups. Visual analog scores were better in the vertebral fixation group than in the inter-vertebral fixation group (P <0.01). (4) These results suggested that the two fixation methods obtained satisfactory repair effects in long-term fol ow-up. The dominance in maintaining the

  13. Treatment of acute thoracolumbar burst fractures with kyphoplasty and short pedicle screw fixation: Transpedicular intracorporeal grafting with calcium phosphate: A prospective study

    Korovessis Panagiotis

    2007-01-01

    Full Text Available Background: In the surgical treatment of thoracolumbar fractures, the major problem after posterior correction and transpedicular instrumentation is failure to support the anterior spinal column, leading to loss of correction and instrumentation failure with associated complaints. We conducted this prospective study to evaluate the outcome of the treatment of acute thoracolumbar burst fractures by transpedicular balloon kyphoplasty, grafting with calcium phosphate cement and short pedicle screw fixation plus fusion. Materials and Methods : Twenty-three consecutive patients of thoracolumbar (T 9 to L 4 burst fracture with or without neurologic deficit with an average age of 43 years, were included in this prospective study. Twenty-one from the 23 patients had single burst fracture while the remaining two patients had a burst fracture and additionally an adjacent A1-type fracture. On admission six (26% out of 23 patients had neurological deficit (five incomplete, one complete. Bilateral transpedicular balloon kyphoplasty with liquid calcium phosphate to reduce segmental kyphosis and restore vertebral body height and short (three vertebrae pedicle screw instrumentation with posterolateral fusion was performed. Gardner kyphosis angle, anterior and posterior vertebral body height ratio and spinal canal encroachment were calculated pre- to postoperatively. Results : All 23 patients were operated within two days after admission and were followed for at least 12 months after index surgery. Operating time and blood loss averaged 45 min and 60 cc respectively. The five patients with incomplete neurological lesions improved by at least one ASIA grade, while no neurological deterioration was observed in any case. The VAS and SF-36 (Role physical and Bodily pain domains were significantly improved postoperatively. Overall sagittal alignment was improved from an average preoperative 16° to one degree kyphosis at final follow-up observation. The anterior

  14. CT in diagnosis of thoracolumbar region diseases

    The lumbalgia caused by affected thoracolumbar transition (Th11-L2) imitates the clinical symptomatic of disc lesions in the lower lumbar segments. The syndrome is presented by a pain projected in the area of the three branchings of the spinal nerves, coming from thoracolumbar segments. The aim of this study is to determine the pathological processes, causing the clinical symptoms of this syndrome, using computer tomography. 51 patients are studied with clinically proved thoracolumbar transition syndrome: 14 men and 37 women. CT slices of 96 vertebral segments are made. Two patient are scanned at Th11-Th12 and L1-L2. Only Th12-L1 scans are made on 10 patients and 42 are made on two neighbouring segments (41 of them on Th11-Th12 and Th12-L1 and one on Th11-L1 and L1-L2). An asymmetry (facet tropism) has been found at 59 levels, 21 if them are with spondiloarthrosis. Spondiloarthrosis has been found in 24 segments - 21 of them with osteochondrosis, one with disc prolapse, and 2 with disc protrusion. It is also found osteoporotic changes osteolysis in multiple myeloma, metastasis etc. During the 3 level examination no evidence for either of the mentioned changes is obtained. The CT slices of two neighbouring segments showed an unexpected change from thoracic to lumbar type of the intervertebral joints in 34 patients. The results from this study support the hypothesis about joints origin of the clinical symptoms of the thoracolumbar transition and demonstrate the importance of the computer tomography as a diagnostic method in this disease

  15. A comparative study of spinal bone SPECT versus X-ray radiograph, CT or MRI in patients with an acute compression fracture of a thoracolumbar vertebral body

    We retrospectively studied the spinal bone single photon emission computed tomography (SPECT) images of 84 consecutive patients (27 men, 57 women mean age, 71.3 years age range, 52-89 years) with acute non-traumatic collapse of a vertebra in the thoracolumbar spine. Of the 84 patients, 59 (70.2%) had a history of malignancy. Twelve patients (14.3%) had a vertebral metastasis and 72 (85.7%) had an osteoporosis in the vertebra. There were no clear differences between the vertebral body uptake patterns in the group with metastasis and the group with osteoporosis alone, although a horseshoe pattern tended to occur in the patients with a osteoporotic lesion (25% vs. 42%). Increased pedicle uptake was seen in 20 patients (23.8%, 20/84), 9 of whom (75.0%, 9/12) had a vertebral metastasis and 11 (15.3%, 11/72) did not (p<0.001). A pedicle sign or invasion on radiographs and/or CT images was seen in all 9 patients with metastatic disease patients (100%) but not in any of the 11 patients with osteoporosis. When pedicle uptake on SPECT images and the pedicle sign or invasion were used to diagnose bone metastasis in these 84 patients, sensitivity, specificity city, positive predictive value, negative predictive value were 75.0% (9/12), 84.7% (61/72), 45.0% (9/20), and 95.3% (61/64), respectively. Radiograph and CT remain to be important studies to diagnosis acute non-traumatic collapse of a vertebra, although a spinal SPECT study provides some additional information. (author)

  16. Endoscopic treatment of spinal trauma at the thoracolumbar junction

    Beisse Rudolf

    2007-01-01

    Full Text Available Attempts of treating unstable fractures of the thoracolumbar junction by posterior reduction and fixation alone often result in a significant loss of correction, especially in lesions where a severe destruction of the vertebral body and the intervertebral disc is present. The conventional open approaches like classic thoraco-phreno-lumbotomy produces additional iatrogenic trauma at the lateral chest and abdominal wall which not rarely lead to intercostal neuralgia, as well as post-thoracotomy syndromes. The endoscopic trans-diaphragmatic approach described below opens up the whole thoracolumbar junction to a minimally invasive procedure allowing one to perform all the procedures needed for a full reconstruction of the anterior column of the spine like corpectomy, decompression, vertebral body replacement and anterior plating. The key to address also the subdia-phragmal and retroperitoneal section of the thoracolumbar junction is a partial detachment of the diaphragm which runs along the attachment at the spine and the ribs. The technique was published first in 1998 and has been used now in 650 endoscopic procedures at the thoracolumbar junction out of a total of more than 1300 thoracoscopic operations of the spine in the BG Unfallklinik Murnau, Germany since 1996.

  17. The Comparison of Effective between Acupuncture and Bee Venom Acupuncture on the Treatment of Acute Lumbar Herniation of Intervertebral Disc

    Chang So-Young

    2006-06-01

    Full Text Available Objective : Herniation of Intervertebral Disc(HIVD is the most common disease causing low back pain. Acupuncture and Bee Venom Acupuncture has been used for treatment of HIVD. This study is to investigate the effective of Bee Venom Acupuncture for HIVD. Methods : We researched 18 patients who were diagnosed by CT and MRI as having HIVD, and treated them Acupuncture only or Acupuncture and Bee Venom Acupuncture. We compared the VAS and ROM angle of two groups. Results & Conclusions : 1. In admission date, no significant improvement between Acupuncture group and Bee Venom Acupuncture group 2. In variation of flexion and extension, Bee Venom Acupuncture group shows statistically significant improvement 3. In VAS, Bee Venom Acupuncture group shows statistically significant improvement for 1 week and discharge day

  18. Pediculectomy for the treatment of thoracolumbar disk disease

    Leonardo Martins Leal

    2011-06-01

    Full Text Available Thoracolumbar disk disease is a condition associated with spinal cord compression that leads to the extrusion of the nucleus pulposus of an intervertebral disk. It can cause mild pain to very severe symptoms including complete paralysis of the pelvic limbs. The treatment for this disease depends on the location and severity of the compression. The objective of this study was to use pediculectomy surgery technique, for spinal decompression, on a seven-year-old female dog that was a mixed breed, suffered from pelvic limb paresis, and was diagnosed with dorsolateral thoracolumbar disk disease. A disk fenestration was also performed in the area to prevent the recurrence of the symtoms. The pediculectomy technique involves creating a slot in the lateral area of the vertebras to preserve the articular facets. Thirty days after the surgery the patient was walking normally. The pediculectomy technique is a good surgical option because it promotes decompression, and extruded material can be removed, which leads to less instability decreases the chance of vertebral dislocation and allows disk fenestration to be performed during the same surgical period. Pediculectomy was effective in the treatment of this patient.

  19. MRI and discography in traumatic intervertebral disc lesions

    Ghanem, Nadir; Uhl, Markus; Elgeti, Florian; Pache, Gregor; Kotter, Elmar; Langer, Mathias [University Hospital Freiburg, Departments of Diagnostic Radiology, Freiburg (Germany); Mueller, Christoph; Markmiller, Max [University Hospital Freiburg, Traumatology, Freiburg (Germany)

    2006-11-15

    In this study we evaluated magnetic resonance imaging (MRI) in trauma patients for assessing traumatised adjacent discs of fractured vertebrae before dorsoventral stabilisation. In a prospective study, MRI of 54 discs was performed with a 1.5-T MRI unit. The preoperative MRI with sagittal T1-W-SE and T2-W-TSE was compared to intraoperative discography, which was carried out on both intervertebral discs adjacent to the fractured vertebrae. Signal alterations, morphological changes in the adjacent discs, fractured vertebrae and associated ligament injuries were evaluated. In 47/54 (87%) of the intervertebral discs, the results of both imaging findings were concordant. The discs adjoining vertebral fractures were normal in 18 cases. Regarding the positive concordant imaging findings, MRI and discography revealed traumatised adjacent cranial and caudal discs in 22 discs. In 7 cases, only the cranial adjacent disc was affected. Moreover, 17 cases of intradiscal bleeding, 13 intraosseous herniations into the fractured vertebrae and 20 anuluar tears were visualised in MRI. Associated ligament injuries were detected in 18 cases. Findings were discordant in eight discs. In six discs, MRI was abnormal, demonstrating signal alterations suggestive of positive imaging findings, whereas discography demonstrated no disc injury. MRI failed to detect disc injury in two discs, whereas discography was positive, showing an irregular intradiscal contrast media distribution. MRI, as a non-invasive method for assessing fractures of the thoraco-lumbar spine, may detect traumatised adjacent intervertebral discs. MRI is superior to intraoperative discography. The performance of MRI of the thoraco-lumbar spine is recommended before dorsoventral stabilisation in trauma patients, as it can reveal additional preoperative information such as fractures, disc and associated ligament injuries. (orig.)

  20. MRI and discography in traumatic intervertebral disc lesions

    In this study we evaluated magnetic resonance imaging (MRI) in trauma patients for assessing traumatised adjacent discs of fractured vertebrae before dorsoventral stabilisation. In a prospective study, MRI of 54 discs was performed with a 1.5-T MRI unit. The preoperative MRI with sagittal T1-W-SE and T2-W-TSE was compared to intraoperative discography, which was carried out on both intervertebral discs adjacent to the fractured vertebrae. Signal alterations, morphological changes in the adjacent discs, fractured vertebrae and associated ligament injuries were evaluated. In 47/54 (87%) of the intervertebral discs, the results of both imaging findings were concordant. The discs adjoining vertebral fractures were normal in 18 cases. Regarding the positive concordant imaging findings, MRI and discography revealed traumatised adjacent cranial and caudal discs in 22 discs. In 7 cases, only the cranial adjacent disc was affected. Moreover, 17 cases of intradiscal bleeding, 13 intraosseous herniations into the fractured vertebrae and 20 anuluar tears were visualised in MRI. Associated ligament injuries were detected in 18 cases. Findings were discordant in eight discs. In six discs, MRI was abnormal, demonstrating signal alterations suggestive of positive imaging findings, whereas discography demonstrated no disc injury. MRI failed to detect disc injury in two discs, whereas discography was positive, showing an irregular intradiscal contrast media distribution. MRI, as a non-invasive method for assessing fractures of the thoraco-lumbar spine, may detect traumatised adjacent intervertebral discs. MRI is superior to intraoperative discography. The performance of MRI of the thoraco-lumbar spine is recommended before dorsoventral stabilisation in trauma patients, as it can reveal additional preoperative information such as fractures, disc and associated ligament injuries. (orig.)

  1. Management of thoracolumbar spine trauma An overview

    S Rajasekaran

    2015-01-01

    Full Text Available Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Controversies exist regarding the appropriate radiological investigations, the indications for surgical management and the timing, approach and type of surgery. This review provides an overview of the epidemiology, biomechanical principles, radiological and clinical evaluation, classification and management principles. Literature review of all relevant articles published in PubMed covering thoracolumbar spine fractures with or without neurologic deficit was performed. The search terms used were thoracolumbar, thoracic, lumbar, fracture, trauma and management. All relevant articles and abstracts covering thoracolumbar spine fractures with and without neurologic deficit were reviewed. Biomechanically the thoracolumbar spine is predisposed to a higher incidence of spinal injuries. Computed tomography provides adequate bony detail for assessing spinal stability while magnetic resonance imaging shows injuries to soft tissues (posterior ligamentous complex [PLC] and neurological structures. Different classification systems exist and the most recent is the AO spine knowledge forum classification of thoracolumbar trauma. Treatment includes both nonoperative and operative methods and selected based on the degree of bony injury, neurological involvement, presence of associated injuries and the integrity of the PLC. Significant advances in imaging have helped in the better understanding of thoracolumbar fractures, including information on canal morphology and injury to soft tissue structures. The ideal classification that is simple, comprehensive and guides management is still elusive. Involvement of three columns, progressive neurological deficit, significant kyphosis and canal compromise with neurological deficit are accepted indications for surgical stabilization through anterior, posterior or combined approaches.

  2. Monosegmental fixation for the treatment of fractures of the thoracolumbar spine

    Defino Helton

    2007-01-01

    Full Text Available Background : A short vertebral arthrodesis has been one of the objectives of the surgical treatment of fractures of the thoracolumbar spine. We present here clinical, functional and radiographic outcome obtained after monosegmental fixation (single posterior or combined anterior and posterior of specific types of unstable thoracolumbar fractures. Materials and Methods : Twenty four patients with fractures of the thoracolumbar spine submitted to monosegmental surgical treatment (Group I - 18 single posterior monosegmental fixations and Group II - 6 combined anterior and posterior fixations were retrospectively evaluated according to clinical, radiographic and functional parameters. The indication for surgery was instability or neurological deficit. All the procedures were indicated and performed by the senior surgeon (Helton LA Defino. Results : The patients from group I were followed-up from 2 to 12 years (mean: 6.65±2.96. The clinical, functional and radiographic results show that a single posterior monosegmental fixation is adequate and a satisfactory procedure to be used in specific types of thoracolumbar spine fractures, The patients from group II were followed-up from 9 to 15 years (mean: 13 ± 2,09 years. On group II the results of clinical evaluation showed moderate indices of residual pain and of satisfaction with the final result. The values obtained by functional evaluation showed that 66.6% of the patients were unable to return to their previous job and presented a moderate disability index (Oswestry = 16.6 and a significant reduction of quality of life based on the SF-36 questionnaire. Radiographic evaluation showed increased kyphosis of the fixed vertebral segment during the late postoperative period, accompanied by a reduction of the height of the intervertebral disk. Conclusion : It is possible to stabilize the fractures which have an anterior good load-bearing capacity by a standalone posterior monosegmental fixation. However

  3. Intervertebral bone graft and posterior pedicle screw in treatment of serious thoracolumbar vertebral burst fractures%伤椎内植骨成形联合后路植骨椎弓根螺钉复位固定治疗重度胸腰椎爆裂性骨折

    丁建忠; 罗建; 胡广; 徐为刚; 臧峰

    2014-01-01

    Objective To evaluate the clinical effect of serious thoracolumbar vertebral burst fractures treated by transpedicular bone graft and posterior fixation with pedicle screws system and posterolateral bone graft. Methods A total of 36 patients with serious thoracolumbar burst fractures from Oct 2007 to May 2013 were treated by transpedicular bone graft with au_tologous and allogeneic bone chips combined with posterior fixation with pedicle screws system and posterolateral bone graft. For osteoporosis patients,bone cement was applied to reinforce screw fixation. The clinical outcome and imaging examination results before surgery,at the 3rd,6th,12th month after surgery and at the last follow up were studied. The condition of the bone graft and posterior cervical fusion was evaluated. The canalis vertebralis stenosis ,the Cobb′s angle and vertebral compression ratio were measured. The lumbago degree and neural functional recovery were assessed. Results All the patients were followed up to 3 years and 2 months in average(ranged from 13 months to 5 years). The canalis vertebralis stenosis,the Cobb′s angle and vertebral compression ratio[(3.4±1.2)%,(5.2±3.1)°,(4.4±3.1)%] were all significantly improved immediately after surgery with statistically significant difference(P0.05). CT and X ray results showed the stable bone graft,no"shell"phenomenon,no vertebral body height lost,and an average healing time of 3.5 months. The average healing time for posterior cervical fusion was 5.0 months , and pseudarthrosis formation was not observed. Fixation failure did not occur in any of the studied cases. Nerve injuries were all improved to a certain degree after surgery. Conclusion Transpedicular bone graft combined with posterior fixation with pedicle screws system and posterolateral bone graft can solve the problem of bone defect of anterior and middle column in serious thora_columbar burst fractures,and in addition,it can reinforce the fusion and fixation between the

  4. Less invasive surgical treatment of traumatic thoracolumbar fractures

    Verlaan, J.J.

    2004-01-01

    Less invasive surgical treatment of traumatic thoracolumbar fractures. In this thesis various strategies were employed to evaluate the posibilities of reducing the invasiveness of the surgical treatment of traumatic thoracolumbar fractures. A systematic review of the literature suggested that adequ

  5. IMAGING DIAGNOSIS OF THORACOLUMBAR BURST FRACTURES

    Li-yang Dai

    2004-01-01

    Objective To review imaging use in the diagnosis ofthoracolumbar burst fractures and to determine the diagnostic value of different imaging methods.Methods One hundred and fourteen patients with 120 thoracolumbar burst fractures were retrospectively reviewed. Plain radiographs were available in all cases; CT scans and MRI were obtained in 96 and 74 cases, respectively.Results A total of 27 burst fractures were misdiagnosed as other types of fractures on radiographs alone, and accounted for 22.5% of all fractures. The results indicated that plain radiographs often fail to delineate the pathological features of thoracolumbar burst fractures, leading to delay in diagnosis.Conclusion In regard to thoracolumbar injury diagnosis, burst fractures should be differentiated from compression fractures. CT should be routinely indicated and MRI examination, when necessary, may be simultaneously considered.

  6. The height of the osteotomy and the correction of the kyphotic angle in thoracolumbar kyphosis

    HAO Chou-kuan; LI Wei-shi; CHEN Zhong-qiang

    2008-01-01

    Background This study investigated the relationship between the height of osteotomy and the correction of the kyphotic angle during posterior closing wedge osteotmy with instrumentation and the spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach in thoracolumbar kyphosis, and using this relationship as the basis of the preoperative design.Methods From April 1996 to June 2007, 30 thoracolumbar kyphosis patients with complete medical records and clear X-ray photograms have undergone operation. Of these 30 cases, 16 cases underwent posterior closing wedge osteotmywith instrumentation while the height of the osteotomy and the correction of the angle have been measured; 14 casesunderwent spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posteriorapproach while the height of the osteotomy, the height and the place of the cage and the correction of the angle were also measured. A simple geometrical model was simulated to calculate the relationship between the height of the osteotomy and the correction of the angle and these results are finally compared with the data coming from the actual measuring by the Wilcoxon statistic method.Results The distribution of data from the 16 cases by posterior closing wedge osteotomy with instrumentation was as such: 9 male and 7 female, the mean age was 49.2 years (range 38-70), the kyphosis improved from an average of 30° (range 15°-45°) preoperatively to 4° (range -26°-30°) postoperatively, the kyphosis was corrected on average 2.5° per 1 mm in the height of the osteotomy. The results from the simple geometrical model were that the mean of the correction of the angle per 1 mm was 2.2°. As a result, there was no significant difference (P >0.05) when comparing the measurement collected with the result simulated from the geometric model. The distribution of data from the 14 cases by spinal osteotomy with cage

  7. TREATMENT OF UNSTABLE THORACOLUMBAR FRACTURES IN PEDIATRIC PATIENTS

    Roberto Chapa Sosa

    2015-09-01

    Full Text Available Objective:To analyze the characteristics of unstable thoracolumbar fractures in the pediatric population.Methods:A retrospective cross-sectional study was conducted with pediatric patients (0 to 15 years who presented with unstable thoracolumbar fracture with or without neurological damage. Twenty-four operated patients were analyzed: 13 male and 11 female.Results:Falls from height are the most common cause, being the thoracolumbar junction the anatomical site most frequently injured.Conclusion:The thoracolumbar fractures are rare in the pediatric population, as well as post-surgical instrumentation structural deformities.

  8. Review of 31 cases of anterior thoracolumbar fixation with the anterior thoracolumbar locking plate system.

    Wilson, J A; Bowen, S; Branch, C L; Meredith, J W

    1999-07-15

    Anterior fixation devices for the thoracolumbar spine have gained wide acceptance as viable alternatives to long-segment posterior fixation in cases of thoracolumbar spine trauma. This review was undertaken to evaluate the safety and efficacy of the Synthes anterior thoracolumbar locking plate (ATLP) system. Over a 3-year period, 31 patients with unstable traumatic fractures of the thoracolumbar spine underwent corpectomy, placement of a structural bone graft, and anterior fixation in which the Synthes ATLP system was used. Long-term follow-up data were obtained in 29 patients. Two patients were lost to follow up, one at 4 months and the other at 1 year. In the remaining patients, the average length of follow up was 20 months. In all patients radiographic evidence of solid bone fusion was demonstrated on follow-up plain x-ray films, and there were no signs or symptoms of pseudarthrosis. No patient suffered neurological deterioration as a result of surgery, and there was relatively little morbidity associated with this plating system. To date, none of the patients in this study has developed any delayed complications related to the fixation device. In one patient, who had sustained a severe flexion injury, loosening of the anterior fixation device occurred, and the patient developed progressive kyphosis, which required a posterior stabilization procedure. These results appear slightly better than those obtained in published studies in which other anterior plating systems were used, indicating that this system is safe and effective in the treatment of unstable fractures of the thoracolumbar spine. PMID:16918232

  9. Evaluation on vertebral endplate injury and adjacent intervertebral disk injury of patients with osteoporotic vertebral compression fractures by MRI and its clinical significance

    Objective: To investigate the relationship between vertebral endplate injury and adjacent intervertebral disk injury of patients with acute or sub-acute osteoporotic vertebral compression fractures (OVC-F) by MRI, and to provide basis for diagnosis of OVCF. Methods: The clinical data of a total of 66 patients with OVCF underwent vertebroplasty (76 fracture of vertebral bodies) were selected. The vertebral endplate injury and adjacent intervertebral disk injury of OVCF patients were detected by MRI. Results: There were 57 vertebral endplate injury in 76 fracture vertebral bodies (75% ). There were only 27 vertebral bodies with vertebral endplate injury in 57 fracture vertebral bodies with endplate injury (47% ), and 22 vertebral with superior and inferior vertebral endplate injury (39% ), and 8 vertebral bodies with inferior vertebral endplate injury (14% ). There were 48 vertebral bodies with intervertebral disc injury in 76 fracture vertebral bodies (63% ). There were 22 intervertebral disc injury located above the fracture of the lumbar spine in 48 vertebral bodies with intervertebral disc injury (45% ), and 19 fracture vertebral bodies with upper and lower intervertebral disc injury (40% ), and 7 intervertebral injuries located below the fracture of the lumbar spine (15% ). Conclusion: Vertebral endplate injury is frequently associated with the adjacent intervertebral disk injury. The clinical diagnosis and treatment should be emphasized in the fracture vertebral endplate damage and adjacent intervertebral disc injury. (authors)

  10. Ultrasound Evaluation of the Combined Effects of Thoracolumbar Fascia Injury and Movement Restriction in a Porcine Model

    Bishop, James H.; James R Fox; Maple, Rhonda; Loretan, Caitlin; Badger, Gary J.; Henry, Sharon M.; Vizzard, Margaret A.; Langevin, Helene M.

    2016-01-01

    The persistence of back pain following acute back “sprains” is a serious public health problem with poorly understood pathophysiology. The recent finding that human subjects with chronic low back pain (LBP) have increased thickness and decreased mobility of the thoracolumbar fascia measured with ultrasound suggest that the fasciae of the back may be involved in LBP pathophysiology. This study used a porcine model to test the hypothesis that similar ultrasound findings can be produced experime...

  11. Qualitative and quantitative assessment of collagen and elastin in annulus fibrosus of the physiologic and scoliotic intervertebral discs.

    Kobielarz, Magdalena; Szotek, Sylwia; Głowacki, Maciej; Dawidowicz, Joanna; Pezowicz, Celina

    2016-09-01

    The biophysical properties of the annulus fibrosus of the intervertebral disc are determined by collagen and elastin fibres. The progression of scoliosis is accompanied by a number of pathological changes concerning these structural proteins. This is a major cause of dysfunction of the intervertebral disc. The object of the study were annulus fibrosus samples excised from intervertebral discs of healthy subjects and patients treated surgically for scoliosis in the thoracolumbar or lumbar spine. The research material was subjected to structural analysis by light microscopy and quantitative analysis of the content of collagen types I, II, III and IV as well as elastin by immunoenzymatic test (ELISA). A statistical analysis was conducted to assess the impact of the sampling site (Mann-Whitney test, α=0.05) and scoliosis (Wilcoxon matched pairs test, α=0.05) on the obtained results. The microscopic studies conducted on scoliotic annulus fibrosus showed a significant architectural distortion of collagen and elastin fibres. Quantitative biochemical assays demonstrated region-dependent distribution of only collagen types I and II in the case of healthy intervertebral discs whereas in the case of scoliotic discs region-dependent distribution concerned all examined proteins of the extracellular matrix. Comparison of scoliotic and healthy annulus fibrosus revealed a significant decrease in the content of collagen type I and elastin as well as a slight increase in the proportion of collagen types III and IV. The content of collagen type II did not differ significantly between both groups. The observed anomalies are a manifestation of degenerative changes affecting annulus fibrosus of the intervertebral disc in patients suffering from scoliosis. PMID:27177214

  12. Timing of operation and early treatment strategy for thoracolumbar spine fractures with a-cute spinal cord injury%胸腰椎骨折合并脊髓损伤手术时机及早期治疗策略

    封亚平; 封雨; 唐少锋; 谢佳芯; 艾卫兵

    2015-01-01

    Objective To investigate the efficacy and safety of internal fixation surgery with screws through intact pedicle of fractured vertebral arch and internal and external spinal cord decompression in the treatment of thoracolumbar spine fractures with acute spinal cord injury (SCI).Methods Of 1562 patients with thoracolumbar spine fractures ,there were 1316 cases with fractured verte-bras.Internal fixation was performed with screws through intact pedicle of fractured and its upper and lower vertebras arches .A total of 2632 screws were fixed .An early internal and external spinal cord decompression was done to 287 patients who were estimated as class A by using ASIA score .All the patients were reexamined at 2 weeks ,6 months and 12 months after surgery .The fractured vertebras height,lateral dislocation,Cobb’s angle on sagittal plane,vertebral canal volume,healing condition,neural functional recovery and rate of internal fixation failure were observed .Results All the patients were followed up after surgery .The heights of the fractured vertebras were improved to 93.6%of the normal value .The Cobb’s angles on sagittal plane were restored to 3.1°.There were 4 cases with broken screw and 5 cases with broken rod after 12 months of surgery while no screw loosening or extraction was observed .The 287 patients with class A were recovered to different extent after 12 months of surgery ,in which 113 cases were class A ,74 cases class B ,68 cases class C,26 cases class D and 6 cases class E.Meanwhile,the 287 patients were scored as class Ⅰ according to Kunming Locomotor Scale (KLS).After surgery,KLS for these cases were improved including 6 cases with class Ⅱ,11 cases with class Ⅲ,62 cases with classⅣ,67 cases with class Ⅴ,84 cases with class Ⅵ,37 cases with class Ⅶ,9 cases with class Ⅷ,5 cases with class Ⅸand 6 cases with class Ⅹ.The 1225 patients with incomplete SCI also achieved 1 to 2 grade of improvement in KLS .Among all cases ,no neurological ag

  13. Requirements for an artificial intervertebral disc

    Eijkelkamp, MF; van Donkelaar, CC; Veldhuizen, AG; van Horn, [No Value; Huyghe, JM; Verkerke, GJ

    2001-01-01

    Intervertebral disc degeneration is an important social and economic problem. Presently available artificial intervertebral discs (AIDs) are insufficient and the main surgical intervention is still spinal fusion. The objective of the present study is to present a list of requirements for the develop

  14. Magnetic resonance imaging of intervertebral disc degeneration

    Maeda, Hiroshi; Noguchi, Masao (Kitakyushu City Yahata Hospital, Fukuoka (Japan)); Kira, Hideaki; Fujiki, Hiroshi; Shimokawa, Isao; Hinoue, Kaichi

    1993-02-01

    The aim of this study was to correlate the degree of lumbar intervertebral disc degeneration with findings of magnetic resonance imaging (MRI). Seventeen autopsied (from 7 patients) and 21 surgical (from 20 patients) intervertebral discs were used as specimens for histopathological examination. In addition, 21 intervertebral discs were examined on T2-weighted images. Histopathological findings from both autopsied and surgical specimens were well correlated with MRI findings. In particular, T2-weighted images reflected increased collagen fibers and rupture within the fibrous ring accurately. However, when severely degenerated intervertebral discs and hernia protruding the posterior longitudinal ligament existed, histological findings were not concordant well with T2-weighted images. Morphological appearances of autopsy specimens, divided into four on T2-weighted images, were well consistent with histological degeneration. This morphological classification, as shown on T2-weighted images, could also be used in the evaluation of intervertebral disc degeneration. (N.K.).

  15. Magnetic resonance imaging of intervertebral disc degeneration

    The aim of this study was to correlate the degree of lumbar intervertebral disc degeneration with findings of magnetic resonance imaging (MRI). Seventeen autopsied (from 7 patients) and 21 surgical (from 20 patients) intervertebral discs were used as specimens for histopathological examination. In addition, 21 intervertebral discs were examined on T2-weighted images. Histopathological findings from both autopsied and surgical specimens were well correlated with MRI findings. In particular, T2-weighted images reflected increased collagen fibers and rupture within the fibrous ring accurately. However, when severely degenerated intervertebral discs and hernia protruding the posterior longitudinal ligament existed, histological findings were not concordant well with T2-weighted images. Morphological appearances of autopsy specimens, divided into four on T2-weighted images, were well consistent with histological degeneration. This morphological classification, as shown on T2-weighted images, could also be used in the evaluation of intervertebral disc degeneration. (N.K.)

  16. Evaluation of apoptotic cell death in normal and chondrodystrophic canine intervertebral discs

    Marie Klauser

    2012-02-01

    Full Text Available Disc degeneration occurs commonly in dogs. A variety of factors is thought to contribute an inappropriate disc matrix that isolate cells in the disc and lead to apoptosis. Disc herniation with radiculopathy and discogenic pain are the results of the degenerative process. The objective of this prospective study was to determine the extent of apoptosis in intact and herniated intervertebral discs of chondrodystrophic dogs and non-chondrodystrophic dogs. In addition, the nucleus pulposus (NP was histologically compared between non-chondrodystrophic and chondrodystrophic dogs. Thoracolumbar intervertebral discs and parts of the extruded nucleus pulposus were harvested from 45 dogs. Samples were subsequently stained with haematoxylin-eosin and processed to detect cleaved caspase-3 and poly(ADP-ribose polymerase. A significant greater degree of apoptosis was observed in herniated NPs of chondrodystrophic dogs compared to non- chondrodystrophic dogs with poly (ADP-ribose polymerase and cleaved caspase- 3 detection. Within the group of chondrodystrophic dogs, dogs with an intact disc and younger than 6 years showed a significant lower incidence of apoptosis in the NP compared to the herniated NP of chondrodystrophic dogs. The extent of apoptosis in the annulus fibrosus was not different between the intact disc from chondrodystrophic and non- chondrodystrophic dogs. An age-related increase of apoptotic cells in NP and annulus fibrosus was found in the intact non-herniated intervertebral discs. Histologically, absence of notochordal cells and occurrence of chondroid metaplasia were observed in the nucleus pulposus of chondrodystrophic dogs. As a result, we found that apoptosis plays a role in disc degeneration in chondrodystrophic dogs.

  17. Pseudoenhancement of intervertebral disc herniation

    Araki, Y.; Ootani, M.; Furukawa, T.; Tsukaguchi, I. (Dept. of Radiology, Osaka Rosai Hospital (Japan)); Mitomo, M. (Dept. of Radiology, Osaka Univ. Medical School (Japan))

    1992-08-01

    Two patients with intervertebral disc herniation appeared to demonstrate abnormally diffuse and intense enhancement of the disc after intravenous administration of gadolinium-DTPA for MRI. Surgery disclosed a dilated epidural venous plexus in one and vascular granulation tissue in the other, associated with the herniated disc material. The mechanism of this 'pseudoenhancement' of the disc appears to be a partial volume effect of disc material and the adjacent veins or granulation tissue. Pseudoenhancement of a herniated disc should be included in the differential diagnosis of a diffusely enhancing epidural mass. (orig.).

  18. Thoracolumbar fracture with listhesis - an uncommon manifestation of child abuse

    Levin, Terry L.; Blitman, Netta M. [Department of Radiology, Montefiore Medical Center, 111 E. 210th Street, Bronx, New York, NY 10467-2490 (United States); Berdon, Walter E. [Department of Radiology, Babies Hospital, New York Presbyterian Hospital, New York (United States); Cassell, Ian [Department of Radiology, Phoenix Children' s Hospital, Phoenix, AZ (United States)

    2003-05-01

    Thoracolumbar fracture with listhesis (FL) is an uncommon manifestation of child abuse (increasingly known as nonaccidental trauma), with only six prior reports in the literature. This article seeks to call attention to FL of the thoracolumbar spine in abused children and infants. We reviewed plain films, CT and MR images in seven new cases of FL of the thoracolumbar spine in abused children ages 6 months to 7 years, two of whom became paraplegic from their injuries. Findings varied from subtle listhesis of one vertebra on another to frank vertebral dislocation, most commonly at L1/2. Paravertebral calcification was present in all but one case. In two children, thoracolumbar FL was the only radiographic sign of abuse. Radiographic findings of FL of the thoracolumbar spine may be subtle and may be erroneously interpreted as due to a congenital or neoplastic cause. While other signs of child abuse should be sought, spinal injury may be the sole sign of abuse. Recognition of this entity is important to pursue the diagnosis of abuse. (orig.)

  19. Thoracolumbar fracture with listhesis - an uncommon manifestation of child abuse

    Thoracolumbar fracture with listhesis (FL) is an uncommon manifestation of child abuse (increasingly known as nonaccidental trauma), with only six prior reports in the literature. This article seeks to call attention to FL of the thoracolumbar spine in abused children and infants. We reviewed plain films, CT and MR images in seven new cases of FL of the thoracolumbar spine in abused children ages 6 months to 7 years, two of whom became paraplegic from their injuries. Findings varied from subtle listhesis of one vertebra on another to frank vertebral dislocation, most commonly at L1/2. Paravertebral calcification was present in all but one case. In two children, thoracolumbar FL was the only radiographic sign of abuse. Radiographic findings of FL of the thoracolumbar spine may be subtle and may be erroneously interpreted as due to a congenital or neoplastic cause. While other signs of child abuse should be sought, spinal injury may be the sole sign of abuse. Recognition of this entity is important to pursue the diagnosis of abuse. (orig.)

  20. Influence of degenerative changes of intervertebral disc

    Wang, Yi; Chen, Hai-Bin; Zhang, Ling; ZHANG Li-ying; Liu, Jing-cheng; WANG Zheng-guo

    2012-01-01

    【Abstract】Objective: To investigate the material properties of normal and degenerated intervertebral discs (IVDs) and examine the effect of degenerative changes on IVD pathology. Methods: A computer-based online search was under-taken to identify English articles about material properties of IVDs published from January 1950 to 2011 in PubMed database. The retrieved keywords included material properties, intervertebral disc and degeneration. Based on the principle...

  1. HISTOMORPHOLOGICAL STUDY OF THORACOLUMBAR FASCIA IN PATIENTS WITH LUMBOSACRAL DISCOPATHY

    Z BEHDADIPOOR

    2000-03-01

    Full Text Available Introduction. Thoracolumbar fascia has neural ends in normal positions. It has sensory role and by inhibitory and or excitatory reflexes helps to protect vertebral column. In this research, it has been studied neural ends in thoracolumbar fascia in 42 cases. Our aim was to compare the presence of neural ends in normal individuals and those with lumbosacral discopathy. Methods. The samples were taken from one centimeter of midline at the level of L4-L5 vertebrae, since in this region the posterior layer of thoracolumbar fascia is thicker. Seven of the cases were normal and 35 were patients with lumbosacral discopathy. The samples were processed and serial sections were prepared. Six hundred and thirty sections from the serial sections were selected and 90 percent of these were stained with H&E and the rest of them were stained with Bielschowsky method. The sections were studied by light microscopy. Findings. Unlike the normal individuals, nerve corpuscles were not seen in none of our patients with lumbosacraldiscopathy.UsingBielschowsky,nerveendingswerepresentin normal individuals but they were not visible in patients with discopathy. Conclusion. It is concluded that thoracolumbar fascia in patients with discopathy had insufficient neural ends. Loss of these neural ends may be cause of decreasing proprioceptive information to nervous system and can be an initiating factor to damage the bones, ligaments and muscles.

  2. Surgical treatment in thoraco-lumbar region fractures.

    Jorge Alberto Jerez Labrada

    2008-08-01

    Full Text Available Background: thoraco-lumbar fractures may affect people at any moment of their lives, especially at their most fruitful and useful stage. Its correct diagnosis and treatment may directly influence in the posterior evolution of the patients. Objectives: to evaluate the results of the surgical treatment in thoraco-lumbar region fractures. Methods: a descriptive retrospective correlational study of series cases which included 54 patients attended due to thoraco-lumbar region fractures in the University Hospital “Dr. Gustavo Aldereguía Lima” in Cienfuegos city, Cuba from January 1999 to June 2007. Age, sex, etiology of the fracture, type and level of the fractures, associated diseases, surgical techniques used for, pre and post operatory neurological damage, usage of metilprednisolone, complications and final results were the variables taken into consideration in this study. Results: most of the patients belonged to male sex under the age of 45. The totality of the cases had type IV fracture, and a great part of them had Denis type II fracture having surgical treatment. The causes of the lesions were traffic accidents, working accidents and height falls. The most useful surgical techniques were posterior decompression, instrumentation and fusion. Surgery improved the neurological damage in almost half of sick patients with this condition. Complications were minimum and rupture of the implant was predominant. Conclusion: surgical treatment in thoraco-lumbar region fractures had satisfactory results in our milieu.

  3. Spectroscopic Parameters of Lumbar Intervertebral Disc Material

    Terbetas, G.; Kozlovskaja, A.; Varanius, D.; Graziene, V.; Vaitkus, J.; Vaitkuviene, A.

    2009-06-01

    There are numerous methods of investigating intervertebral disc. Visualization methods are widely used in clinical practice. Histological, imunohistochemical and biochemical methods are more used in scientific research. We propose that a new spectroscopic investigation would be useful in determining intervertebral disc material, especially when no histological specimens are available. Purpose: to determine spectroscopic parameters of intervertebral disc material; to determine emission spectra common for all intervertebral discs; to create a background for further spectroscopic investigation where no histological specimen will be available. Material and Methods: 20 patients, 68 frozen sections of 20 μm thickness from operatively removed intervertebral disc hernia were excited by Nd:YAG microlaser STA-01-TH third harmonic 355 nm light throw 0, 1 mm fiber. Spectrophotometer OceanOptics USB2000 was used for spectra collection. Mathematical analysis of spectra was performed by ORIGIN multiple Gaussian peaks analysis. Results: In each specimen of disc hernia were found distinct maximal spectral peaks of 4 types supporting the histological evaluation of mixture content of the hernia. Fluorescence in the spectral regions 370-700 nm was detected in the disc hernias. The main spectral component was at 494 nm and the contribution of the components with the peak wavelength values at 388 nm, 412 nm and 435±5 nm were varying in the different groups of samples. In comparison to average spectrum of all cases, there are 4 groups of different spectral signatures in the region 400-500 nm in the patient groups, supporting a clinical data on different clinical features of the patients. Discussion and Conclusion: besides the classical open discectomy, new minimally invasive techniques of treating intervertebral disc emerge (PLDD). Intervertebral disc in these techniques is assessed by needle, no histological specimen is taken. Spectroscopic investigation via fiber optics through the

  4. Angiogenesis in the degeneration of the lumbar intervertebral disc

    David, Gh; Ciurea, AV; Iencean, SM; Mohan, A.

    2010-01-01

    The goal of the study is to show the histological and biochemical changes that indicate the angiogenesis of the intervertebral disc in lumbar intervertebral disc hernia and the existence of epidemiological correlations between these changes and the risk factors of lumbar intervertebral disc hernia, as well as the patient's quality of life (QOL). We have studied 50 patients aged between 18 and 73 years old, who have undergone lumbar intervertebral disc hernia surgery, making fibroblast growth ...

  5. 胸腰结合段侧面血管的影像解剖学研究%The Imaging Research for Thoracolumbar Spine Lateral Vascular Anatomy

    欧阳志和; 欧阳厚淦

    2011-01-01

    Purpose To provide the anatomic basis of imaging for the segmental vessels of the thoracolumbar spine side and measure the distance between two adjacent segmental arteries in the three-dimensional images. Materials and Methods After conducting angiography for 30cases of normal adults through the ulnar vein, carring out thoracolumbar CT scans. In the image observation: The course and adjacent relationship of the segmental vessels. Measuring range: the distance between the the upper and lower segmental arteries of the middle line of spine side. Results We could observe the course and the adjacent relationship of thoracolumbar spine lateral vascular. That between the upper and lower segmental vessels consists a relatively non-vascular nerve safe zone where the intervertebral space locates. And we surveyed the related datas. Conclusion Three-dimensional reconstruction of CT images can effectively observe the course and adjacent relationship of the thoracolumbar spinal lateral segmental artery, and can accurately measure the safe zone.%目的:为脊柱胸腰结合段侧面的节段血管走行、'变异及毗邻关系提供影像学解剖基础.资料和方法:对32例正常成人经肘静脉造影后行脊柱胸腰段CT扫描,在图像上观察节段动脉的走行特点并在脊柱侧面正中线上对上、下位节段动脉之间的距离进行测量.结果:在影像三维图像上可观察脊柱胸腰段侧面,节段动脉较为恒定地存在并走行于相应椎体侧面中央浅沟内.上、下位节段动脉间构成了一个相对无血管、神经的安全区,椎间隙恰好位于该安全区中部.并且测量了相关数据,左右两侧比较无显著性差异(P>0.05).结论:CT三维重建图像能有效观察脊柱胸腰结合段侧面节段动脉的走行及毗邻关系,并能准确测量出安全区.

  6. Proteomic signature of the murine intervertebral disc.

    Matthew R McCann

    Full Text Available Low back pain is the most common musculoskeletal problem and the single most common cause of disability, often attributed to degeneration of the intervertebral disc. Lack of effective treatment is directly related to our limited understanding of the pathways responsible for maintaining disc health. While transcriptional analysis has permitted initial insights into the biology of the intervertebral disc, complete proteomic characterization is required. We therefore employed liquid chromatography electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS protein/peptide separation and mass spectrometric analyses to characterize the protein content of intervertebral discs from skeletally mature wild-type mice. A total of 1360 proteins were identified and categorized using PANTHER. Identified proteins were primarily intracellular/plasma membrane (35%, organelle (30%, macromolecular complex (10%, extracellular region (9%. Molecular function categorization resulted in three distinct categories: catalytic activity (33%, binding (molecule interactions (29%, and structural activity (13%. To validate our list, we confirmed the presence of 14 of 20 previously identified IVD-associated markers, including matrix proteins, transcriptional regulators, and secreted proteins. Immunohistochemical analysis confirmed distinct localization patterns of select protein with the intervertebral disc. Characterization of the protein composition of healthy intervertebral disc tissue is an important first step in identifying cellular processes and pathways disrupted during aging or disease progression.

  7. Combination use of ozone and collagenase for the treatment of prolapsed lumbar intervertebral disc herniation

    Objective: To assess the therapeutic effect of combination use of ozone and collagenase for the treatment of prolapsed lumbar intervertebral disc herniation. Methods: Combination use of ozone intra-disc ablation and collagenase extra-disc dissolution was employed to treat acute lumbar intervertebral disc protrusion. A total of 41 patients (50 diseased intervertebral discs) were enrolled in this study. The clinical results were analyzed and the therapeutic efficacy was evaluated. Results: Combination use of ozone ablation together with collagenase dissolution was carried out in 41 patients. According to Macnab criterion, the therapeutic efficacy was evaluated. The excellent effectiveness was achieved in 85.3% of patients. Follow-up CT scanning and MRI were performed 12 months after the treatment. Both preoperative and postoperative AB value and R value were determined and compared with each other. The postoperative AB value and R value were 36% and 43% of the preoperative ones, respectively. The reduction was very obvious. Conclusion: The combination use of ozone and collagenase has reliable effectiveness in the treatment of prolapsed lumbar intervertebral disc herniation. Collagenase has proteolytic effect on the fiber ring, while ozone possesses oxidation effect on the nucleus pulposus. A combination use of the two has definite curative effect. (authors)

  8. The prevalence of thoracolumbar kyphosis in achondroplasia: a systematic review

    Engberts, Alexander C.; Jacobs, Wilco C. H.; Castelijns, Sanne J. A. M.; Castelein, Rene M; Vleggeert-Lankamp, Carmen L.A.

    2011-01-01

    Purpose Thoracolumbar kyphosis (TLK) is described as a common presentation in children with achondroplasia. However, the prevalence and development of TLK are ill-defined, as well as its clinical implications. The goal of this study was to assess the existing evidence on the prevalence and development of TLK from the literature. Methods A systematic literature review was performed in PubMed, EMBASE, and Thomson Reuters (ISI) Web of Knowledge. Articles were selected and evaluated with the Newc...

  9. Thoracolumbar burst fracture: what the radiologist should know

    Jacob Junior, Charbel; Batista, Priscila Rossi de; Machado, Igor Cardoso; Rezende, Rodrigo, E-mail: grupodecoluna@santacasavitoria.org [Santa Casa de Misericordia de Vitoria, Vitoria, ES (Brazil); Barbosa, Diogo Miranda; Vieira, Dimitri Mori [Centro de Diagnostico por Imagem, Vitoria, ES (Brazil)

    2012-03-15

    Thoracolumbar burst fractures are defined as those fractures involving compromise of the anterior, middle and posterior vertebral columns. The treatment for such vertebral fractures still remains undefined, raising questions about the best form of intervention in these cases. Because of these doubts, imaging methods play a key role in the preoperative workup. However, several tests and measurements are performed by spine surgeons before deciding on the best approach to be adopted, with no standardization and neither consensus. The present review was aimed at standardizing and describing the main techniques and radiological findings on the basis of instability criteria adopted by surgeons in the assessment of thoracolumbar burst fractures, namely extent of height loss of the anterior wall of the fractured vertebra, level of spinal canal compromise by bone fragments and degree of widening of interspinous and interpedicular distance. It is the authors' opinion that the standardization of the main measurements in the evaluation of thoracolumbar burst fractures by radiological methods will provide the information required for a better interpretation of tests results and consequently aiding in the decision making about the most appropriate treatment. (author)

  10. Interobserver evaluation of TLICS system to treat thoracolumbar fractures

    Bernardo José Moreira Chaves

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the interobserver agreement regarding the TLICS Classification (Thoracolumbar Injury Classification and Severity Score. Furthermore, evaluate the reliability, analyzing the correlation between the treatment indicated by TLICS system (surgical or conservative and the treatment indicated by each evaluator surgeon.METHODS: Imaging tests and clinical data of 22 patients with thoracolumbar fractures were analyzed by eight spine surgeons, and two main analyzes were performed: the first compared the interobserver agreement related to TLICS and the second compared the agreement between the treatment indicated by TLICS classification (surgical or conservative and treatment indicated by each surgeon - based on his personal experience and the preferred classification.RESULTS: Using the parameters of Landis and Koch for interpretation of Kappa value, the interobserver agreement of TLICS classification was considered moderate in our study (K=0.6. The agreement between the indications of treatment (surgical or conservative dictated by the classification and the indication of each surgeon was considered excellent, with kappa value of 0.89.CONCLUSION: We believe that the classification is a good tool for the evaluation and the treatment indication in thoracolumbar fractures.

  11. Clinical manifestations and significance of post-traumatic thoracolumbar syringomyelia

    邱勇; 朱泽章; 吕锦瑜; 王斌; 李卫国; 朱丽华

    2004-01-01

    Objective: To analyze the pathogenic mechanism and the clinical significance of post-traumatic thoracolumbar syringomyelia through reviewing the clinical manifestations. Methods: The data of 15 patients (14 males and 1 female, aged from 28 to 56 years, with an average of 36 years) with post-traumatic syringomyelia treated in our hospital from December 1997 to February 2002 were studied retrospectively. Two patients suffered from T11 fractures, 7 from T12 fractures and 6 from L1 fractures. There were 12 patients with burst fractures and 3 with fracture dislocations. Anterior decompression, bone graft, bone fusion and internal fixation were made on 6 patients, posterior decompression, bone graft, bone fusion and internal fixation on 1 patient, and non-surgical treatment on 8 patients. Results: Syringomyelia of the patients was diagnosed accurately with magnetic resonance imaging at 0.5-4 years after the original thoracolumbar fracture. The cavern was round in 6 cases, elliptic in 6 cases, and irregular in 3 cases. The patients also suffered from pain (80%), myodynamia attenuation in lower extremities (66.7%), aggravated spasm (46.7%), sensation loss or hypesthesia (46.7%), decreased coordinate function of lower extremities (20%) and autonomic nerve symptom (6.7%).Conclusions: Post-traumatic thoracolumbar syringomyelia should be suspected if the patient has new neurological symptoms, such as myodynamia attenuation in lower extremities, after the neural function becomes stable for certain time.

  12. Minimal Invasive Circumferential Management of Thoracolumbar Spine Fractures

    S. Pesenti

    2015-01-01

    Full Text Available Introduction. While thoracolumbar fractures are common lesions, no strong consensus is available at the moment. Objectives. The aim of this study was to evaluate the results of a minimal invasive strategy using percutaneous instrumentation and anterior approach in the management of thoracolumbar unstable fractures. Methods. 39 patients were included in this retrospective study. Radiologic evaluation was based on vertebral and regional kyphosis, vertebral body height restoration, and fusion rate. Clinical evaluation was based on Visual Analogic Score (VAS. All evaluations were done preoperatively and at 1-year follow-up. Results. Both vertebral and regional kyphoses were significantly improved on postoperative evaluation (13° and 7° versus −1° and −9°  P<0.05, resp. as well as vertebral body height (0.92 versus 1.16, P<0.05. At 1-year follow-up, mean loss of correction was 1°. A solid fusion was visible in all the cases, and mean VAS was significantly reduced form 8/10 preoperatively to 1/10 at the last follow-up. Conclusion. Management of thoracolumbar fractures using percutaneous osteosynthesis and minimal invasive anterior approach (telescopic vertebral body prosthesis is a valuable strategy. Results of this strategy offer satisfactory and stable results in time.

  13. Radiologic abnormalities of the thoraco-lumbar spine in athletes

    A radiologic study of the thoraco-lumbar spine was performed in 143 (117 male and 26 female) athletes (wrestlers, gymnasts, soccer players and tennis players), aged 14 to 25 years and 30 male nonathletes, aged 19 to 25 years. Film interpretation was made after mixing the films from all groups and without knowledge of the individual's identity. Various types of radiologic abnormalities occured in both athletes and non-athletes but were more common among athletes, especially male-gymnasts and wrestlers. Abnormalities of the vertebral ring apophysis occurred exclusively in athletes. Combinations of different types of abnormalities were most common in male gymnasts and wrestlers. (orig.)

  14. Analysis of rabbit intervertebral disc physiology based on water metabolism. II. Changes in normal intervertebral discs under axial vibratory load

    Metabolic changes induced by axial vibratory load to the spine were investigated based on water metabolism in normal intervertebral discs of rabbits with or without pentobarbital anesthesia. Tritiated water concentration in the intervertebral discs of unanesthetized rabbits was reduced remarkably by axial vibration for 30 minutes using the vibration machine developed for this study. Repeated vibratory load for 18 and 42 hours duration showed the recovery of 3H2O concentration of the intervertebral disc without anesthesia. Computer simulation suggested a reduction of blood flow surrounding the intervertebral disc following the vibration stress. However, no reduction of the 3H2O concentration in the intervertebral disc was noted under anesthesia. Emotional stress cannot be excluded as a factor in water metabolism in the intervertebral disc

  15. Inflammation in intervertebral disc degeneration and regeneration

    Molinos, Maria; Almeida, Catarina R.; Caldeira, Joana; Cunha, Carla; Gonçalves, Raquel M.; Barbosa, Mário A.

    2015-01-01

    Intervertebral disc (IVD) degeneration is one of the major causes of low back pain, a problem with a heavy economic burden, which has been increasing in prevalence as populations age. Deeper knowledge of the complex spatial and temporal orchestration of cellular interactions and extracellular matrix remodelling is critical to improve current IVD therapies, which have so far proved unsatisfactory. Inflammation has been correlated with degenerative disc disease but its role in discogenic pain a...

  16. Tissue Engineering for Intervertebral Disk Degeneration

    Leung, VYL; Chan, D; Chan, BP; Cheung, KMC; Tam, V

    2011-01-01

    Many challenges confront intervertebral disk engineering owing to complexity and the presence of extraordinary stresses. Rebuilding a disk of native function could be useful for removal of the symptoms and correction of altered spine kinematics. Improvement in understanding of disk properties and techniques for disk engineering brings promise to the fabrication of a functional motion segment for the treatment of disk degeneration. Increasing sophistication of techniques available in biomedica...

  17. Stem cells sources for intervertebral disc regeneration.

    Vadalà, Gianluca; Russo, Fabrizio; Ambrosio, Luca; Loppini, Mattia; Denaro, Vincenzo

    2016-05-26

    Intervertebral disc regeneration field is rapidly growing since disc disorders represent a major health problem in industrialized countries with very few possible treatments. Indeed, current available therapies are symptomatic, and surgical procedures consist in disc removal and spinal fusion, which is not immune to regardable concerns about possible comorbidities, cost-effectiveness, secondary risks and long-lasting outcomes. This review paper aims to share recent advances in stem cell therapy for the treatment of intervertebral disc degeneration. In literature the potential use of different adult stem cells for intervertebral disc regeneration has already been reported. Bone marrow mesenchymal stromal/stem cells, adipose tissue derived stem cells, synovial stem cells, muscle-derived stem cells, olfactory neural stem cells, induced pluripotent stem cells, hematopoietic stem cells, disc stem cells, and embryonic stem cells have been studied for this purpose either in vitro or in vivo. Moreover, several engineered carriers (e.g., hydrogels), characterized by full biocompatibility and prompt biodegradation, have been designed and combined with different stem cell types in order to optimize the local and controlled delivery of cellular substrates in situ. The paper overviews the literature discussing the current status of our knowledge of the different stem cells types used as a cell-based therapy for disc regeneration. PMID:27247704

  18. Biomechanical Analysis of Pedicle Screw Fixation for Thoracolumbar Burst Fractures.

    McDonnell, Matthew; Shah, Kalpit N; Paller, David J; Thakur, Nikhil A; Koruprolu, Sarath; Palumbo, Mark A; Daniels, Alan H

    2016-05-01

    Treatment of unstable thoracolumbar burst fractures remains controversial. Long-segment pedicle screw constructs may be stiffer and impart greater forces on adjacent segments compared with short-segment constructs, which may affect clinical performance and long-term out come. The purpose of this study was to biomechanically evaluate long-segment posterior pedicle screw fixation (LSPF) vs short-segment posterior pedicle screw fixation (SSPF) for unstable burst fractures. Six unembalmed human thoracolumbar spine specimens (T10-L4) were used. Following intact testing, a simulated L1 burst fracture was created and sequentially stabilized using 5.5-mm titanium polyaxial pedicle screws and rods for 4 different constructs: SSPF (1 level above and below), SSPF+L1 (pedicle screw at fractured level), LSPF (2 levels above and below), and LSPF+L1 (pedicle screw at fractured level). Each fixation construct was tested in flexion-extension, lateral bending, and axial rotation; range of motion was also recorded. Two-way repeated-measures analysis of variance was performed to identify differences between treatment groups and functional noninstrumented spine. Short-segment posterior pedicle screw fixation did not achieve stability seen in an intact spine (P.1). Long-segment posterior pedicle screw fixation constructs were not associated with increased adjacent segment motion. Al though the sample size of 6 specimens was small, this study may help guide clinical decisions regarding burst fracture stabilization. [Orthopedics. 2016; 39(3):e514-e518.]. PMID:27135451

  19. Surgical Treatment for Giant Cell Tumor of the Thoracolumbar Spine

    Shih-Chieh Yang

    2006-02-01

    Full Text Available Background: Giant cell tumor (GCT of the bone has historically been regarded as anextremely unpredictable bone tumor. The anatomical characteristics of spinalGCT still present challenges to surgeons. Controversy remains regarding theproper treatment of patients with grade III tumors.Methods: Eleven patients with grade III GCT of the thoracolumbar spine were treatedbetween 1992 and 2002 at a medical center by the authors. Three patientswere initially treated at other institutions. Adjuvant radiotherapy wasemployed for local recurrence in these three patients. The other eight patientswere initially treated with marginal excision. The site, size, and extent ofeach lesion dictated the surgical approach.Results: Five patients had tumor recurrence. One patient, who received radiotherapy,had local relapse with malignant transformation and finally died due to disease-related complications. One patient had a recurrent tumor with multiplemetastases throughout the lung. Neurological status, measured using theAmerican Spinal Injury Association scale, of one patient was worse afterundergoing the procedure than preoperatively and three patients showedimprovement. The other seven patients were classified as with the samegrade postoperatively.Conclusion: Wide excision of GCT of the thoracolumbar spine is difficult and there is arisk of neurological deficit and spinal instability. Meticulous marginal excisionwith associated reconstruction may obtain good local control and preservefunctional spine. Early detection of recurrent GCT during intensive follow-up can allow for treatment using en bloc excision which has achievedfavorable prognoses.

  20. MR Imaging of Supraspinous Ligament Injury in the Thoracolumbar Spine

    We wanted to evaluate the MRI features and their diagnostic accuracy for SSL injury in the thoracolumbar spine. From December 2003 to June 2006, among 42 surgically treated patients with spinal fracture, the 35 patients who underwent MRI and who were surgically evaluated for SSL injury were included in this study. The sagittal MR images were evaluated for the presence of SSL injury and its level, location and distraction gap, the level and compression ratio of the fractured body, and the presence of ISL or yellow ligament injury and posterior osseous fracture. The sensitivity, specificity and accuracy of MRI were calculated. The distraction gap of the SSL and the compression ratio of the fractured body or posterior osseous fracture were statistically analyzed. Thirty-one among the 33 patients with surgically confirmed SSL injury were diagnosed on MRI. SSL injury was mostly seen at the thoracolumbar junction and near the upper spinous process. The mean distraction gap was 4.3 mm. The level of the fractured body was most commonly in the lower vertebra of the injured SSL level and the mean compression ratio was 21.8%. Combined SSL, ISL and yellow ligament injury were mostly seen. The sensitivity, specificity and accuracy were 93.9%, 50% and 91.4%, respectively. There was a statistically significant difference of the distraction gap of the injured SSL depending on the presence of posterior osseous fracture. MRI is an accurate modality for evaluating SSL injury and the associated findings

  1. Four year experience with the AO Anterior Thoracolumbar Locking Plate.

    Thalgott, J S; Kabins, M B; Timlin, M; Fritts, K; Giuffre, J M

    1997-05-01

    For decades spinal surgeons have attempted to design simple, single stage anterior internal fixation systems for the thoracic and lumbar spine. Early devices presented both biomechanical and technical problems. The AO Anterior Thoracolumbar Locking Plate (ATLP) was designed to solve some of the problems encountered with early anterior instrumentation. The ATLP system is constructed in Commercially Pure titanium. It is a low profile device indicated for use for unstable burst fractures in the anterior column; metastatic tumor management; and degenerative diseases of the thoracolumbar spine between levels T10 and L5. Implantation of the device involves direct anterior decompression with sagittal reduction and corpectomy. This is followed by grafting reconstruction, and plate fixation. This device has been implanted in 25 patients with an average follow-up of 38 months. There were five (5) broken screws in three (3) patients, and no broken plates. Implant related postoperative complications included two misplaced screws. Preliminary results indicate that the ATLP system seems to be a safe, low profile, MRI/CT compatible device that provides definitive single stage fixation of the anterior spinal column. PMID:9160452

  2. A method for quantitative measurement of lumbar intervertebral disc structures

    Tunset, Andreas; Kjær, Per; Samir Chreiteh, Shadi;

    2013-01-01

    There is a shortage of agreement studies relevant for measuring changes over time in lumbar intervertebral disc structures. The objectives of this study were: 1) to develop a method for measurement of intervertebral disc height, anterior and posterior disc material and dural sac diameter using MR...

  3. The significance of removing ruptured intervertebral discs for interbody fusion in treating thoracic or lumbar type B and C spinal injuries through a one-stage posterior approach.

    Qian-Shi Zhang

    Full Text Available OBJECTIVES: To identify the negative effect on treatment results of reserving damaged intervertebral discs when treating type B and type C spinal fracture-dislocations through a one-stage posterior approach. METHODS: This is a retrospective review of 53 consecutive patients who were treated in our spine surgery center from January 2005 to May 2012 due to severe thoracolumbar spinal fracture-dislocation. The patients in Group A (24 patients underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression. In Group B (29 patients, the patients underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression evacuating of the ruptured disc and inserting of a bone graft into the evacuated disc space for interbody fusion. The mean time between injury and operation was 4.1 days (range 2-15 days. The clinical, radiologic and complication outcomes were analyzed retrospectively. RESULTS: Periodic follow-ups were carried out until an affirmative union or treatment failure took place. A progressive kyphosis angle larger than 10°, loss of disc height, pseudoarthrosis, recurrence of dislocation or subluxation, or instrument failure before fusion were considered treatment failures. Treatment failures were detected in 13 cases in Group A (failure rate was 54.2%. In Group B, there were 28 cases in which definitive bone fusion was demonstrated on CT scans, and CT scans of the other cases demonstrated undefined pseudoarthrosis without hardware failure. There were statistically significant differences between the two groups (p0.05 Fisher's exact test. CONCLUSION: Intervertebral disc damage is a common characteristic in type B and C spinal fracture-dislocation injuries. The damaged intervertebral disc should be removed and substituted with a bone graft because reserving the damaged disc in situ increases the risk of treatment failure.

  4. Long-term functional results after short-segment pedicle fixation of thoracolumbar fractures

    Mølmer, Michael; Gehrchen, Poul Martin; Dahl, Benny

    2013-01-01

    A retrospective study to assess the health-related quality of life in patients undergoing posterior fixation of thoracolumbar fractures, and to compare the outcome with norm scores and HRQL in patients undergoing surgical treatment for degenerative conditions of the spine.......A retrospective study to assess the health-related quality of life in patients undergoing posterior fixation of thoracolumbar fractures, and to compare the outcome with norm scores and HRQL in patients undergoing surgical treatment for degenerative conditions of the spine....

  5. Stem cell horizons in intervertebral disc degeneration

    Joseph Ciacci

    2009-01-01

    Full Text Available Joseph Ciacci1, Allen Ho1,2, Christopher P Ames3, Rahul Jandial41Division of Neurosurgery, University of California, San Diego, La Jolla, California, USA; 2Del E Webb Neurosciences, Aging and Stem Cell Research Center, The Burnham Institute for Medical Research, La Jolla, California, USA; 3Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; 4Division of Neurosurgery, Department of Surgery, City of Hope Cancer Center, Duarte, CA, USAAbstract: Intervertebral disc degeneration remains a pervasive and intractable disease arising from a combination of aging and stress on the back and spine. The growing field of regenerative medicine brings the promise of stem cells in the treatment of disc disease. Scientists and physicians hope to employ stem cells not only to stop, but also reverse degeneration. However, there are many important outstanding issues, including the hostile avascular, apoptotic physiological environment of the intervertebral disc, and the difficulty of obtaining mesenchymal stem cells, and directing them towards chondrocytic differentiation and integration within the nucleus pulposus of the disc. Given the recent advances in minimally invasive spine surgery, and developing body of work on stem cell manipulation and transplantation, stem cells are uniquely poised to bring about large-scale improvements in treatment and outcomes for degenerative disc disease. In this review we will first discuss the cellular and molecular factors influencing degeneration, and then examine the efficacy and difficulties of stem cell transplantation.Keywords: intervertebral disc degeneration, stem cells, disc disease, mesenchymal stem cells, stem cell transplantation

  6. Influence of degenerative changes of intervertebral disc

    WANG Yi

    2012-04-01

    Full Text Available 【Abstract】Objective: To investigate the material properties of normal and degenerated intervertebral discs (IVDs and examine the effect of degenerative changes on IVD pathology. Methods: A computer-based online search was under-taken to identify English articles about material properties of IVDs published from January 1950 to 2011 in PubMed database. The retrieved keywords included material properties, intervertebral disc and degeneration. Based on the principles of reliability, advancement and efficiency, the obtained data were primarily examined, and the original source was retrieved to read the full-text. Repetitive articles were excluded. The data of material properties of normal and degenerated IVDs were summarized and analyzed by meta-analysis. Results: The data of Young's modulus, Poisson's ratio, shear modulus, hydraulic permeability and intradiscal pres-sure of normal and degenerated IVDs were obtained. Com-pared with normal IVDs, the Young's modulus and shear modulus of annulus fibrosus and nucleus pulposus were higher in degenerated IVDs, the Poisson's ratio was lower while the hydraulic permeability and intradiscal pressure were higher. Besides, the degeneration-related alterations in IVDs had an influence both on itself and other spinal structures, leading to diseases such as bulging disc, discogenic pain and spinal stenosis. Meanwhile, the heavy mechanical loading and injury indicated important pathways to IVD degeneration. Conclusions: To a certain extent, the degenerative changes of IVD influence its material properties. And the degeneration-related alterations of composition can cause structural failure of IVDs, leading to injuries and diseases. Key words: Intervertebral disc; Mechanical phenomena; Degeneration; Elastic modulus; Permeability; Pathology

  7. Cells and Biomaterials for Intervertebral Disc Regeneration

    Grad, Sibylle

    2010-01-01

    Disorders related to the intervertebral disc (IVD) are common causes of morbidity and of severe life quality deterioration. IVD degeneration, although in many cases asymptomatic, is often the origin of painful neck and back diseases. In Western societies IVD related pain and disability account for enormous health care costs as a result of work absenteeism and thus lost production, disability benefits, medical and insurance expenses. Although only a small percentage of patients with disc disorders finally will undergo surgery, spinal surgery has been one of the fastest growing disciplines in th

  8. Thoracolumbar disc disease in dogs: medical and surgical treatment

    Guardado, Carolina Mendonça

    2008-01-01

    Dissertação de Mestrado Integrado em Medicina Veterinária As Hérnias discais toracolombares são uma patologia frequentemente diagnosticada em cães e uma das mais frequentes causas de perda de qualidade de vida de um animal. Consistem na extrusão (Hansen tipo I) ou protusão (Hansen tipo II) de material de disco intervertebral, que provoca uma compressão medular com diversos graus de intensidade e que causa sintomatologia neurológica ao nível dos membros posteriores. Esta pode...

  9. Reduced thoracolumbar fascia shear strain in human chronic low back pain

    Konofagou Elisa E

    2011-09-01

    Full Text Available Abstract Background The role played by the thoracolumbar fascia in chronic low back pain (LBP is poorly understood. The thoracolumbar fascia is composed of dense connective tissue layers separated by layers of loose connective tissue that normally allow the dense layers to glide past one another during trunk motion. The goal of this study was to quantify shear plane motion within the thoracolumbar fascia using ultrasound elasticity imaging in human subjects with and without chronic low back pain (LBP. Methods We tested 121 human subjects, 50 without LBP and 71 with LBP of greater than 12 months duration. In each subject, an ultrasound cine-recording was acquired on the right and left sides of the back during passive trunk flexion using a motorized articulated table with the hinge point of the table at L4-5 and the ultrasound probe located longitudinally 2 cm lateral to the midline at the level of the L2-3 interspace. Tissue displacement within the thoracolumbar fascia was calculated using cross correlation techniques and shear strain was derived from this displacement data. Additional measures included standard range of motion and physical performance evaluations as well as ultrasound measurement of perimuscular connective tissue thickness and echogenicity. Results Thoracolumbar fascia shear strain was reduced in the LBP group compared with the No-LBP group (56.4% ± 3.1% vs. 70.2% ± 3.6% respectively, p Conclusion Thoracolumbar fascia shear strain was ~20% lower in human subjects with chronic low back pain. This reduction of shear plane motion may be due to abnormal trunk movement patterns and/or intrinsic connective tissue pathology. There appears to be some sex-related differences in thoracolumbar fascia shear strain that may also play a role in altered connective tissue function.

  10. Análisis de las Causas de Hernia de Disco Intervertebral Analysis of the Causes of Intervertebral Disk Hernia

    R.O Ferracutti; A Czerniecki; J Paloto; Molinari, N.

    2004-01-01

    El objetivo de este trabajo es comprobar la hipótesis de que la hernia de disco intervertebral, se produce por fatiga del material y no por compresión simple. Se han sometido probetas constituidas por columnas lumbares ovinas frescas a pruebas de fatiga por compresión. Los ensayos mostraron que las muestras sometidas a cargas de aplicación única, ceden en el hueso y sometidas a ensayos de fatiga, ceden en el disco intervertebral. Se concluye que la hernia de disco intervertebral es producto d...

  11. Axial T2* mapping in intervertebral discs: a new technique for assessment of intervertebral disc degeneration

    Hoppe, Sven; Quirbach, Sebastian; Krause, Fabian G.; Benneker, Lorin M. [Inselspital, Berne University Hospital, Department of Orthopaedic Surgery, Berne (Switzerland); Mamisch, Tallal C. [Inselspital, Berne University Hospital, Department of Radiology, Berne (Switzerland); Werlen, Stefan [Clinic Sonnenhof, Department of Radiology, Berne (Switzerland)

    2012-09-15

    To demonstrate the potential benefits of biochemical axial T2* mapping of intervertebral discs (IVDs) regarding the detection and grading of early stages of degenerative disc disease using 1.5-Tesla magnetic resonance imaging (MRI) in a clinical setting. Ninety-three patients suffering from lumbar spine problems were examined using standard MRI protocols including an axial T2* mapping protocol. All discs were classified morphologically and grouped as ''healthy'' or ''abnormal''. Differences between groups were analysed regarding to the specific T2* pattern at different regions of interest (ROIs). Healthy intervertebral discs revealed a distinct cross-sectional T2* value profile: T2* values were significantly lower in the annulus fibrosus compared with the nucleus pulposus (P = 0.01). In abnormal IVDs, T2* values were significantly lower, especially towards the centre of the disc representing the expected decreased water content of the nucleus (P = 0.01). In herniated discs, ROIs within the nucleus pulposus and ROIs covering the annulus fibrosus showed decreased T2* values. Axial T2* mapping is effective to detect early stages of degenerative disc disease. There is a potential benefit of axial T2* mapping as a diagnostic tool, allowing the quantitative assessment of intervertebral disc degeneration. circle Axial T2* mapping effective in detecting early degenerative disc disease. (orig.)

  12. Axial T2* mapping in intervertebral discs: a new technique for assessment of intervertebral disc degeneration

    To demonstrate the potential benefits of biochemical axial T2* mapping of intervertebral discs (IVDs) regarding the detection and grading of early stages of degenerative disc disease using 1.5-Tesla magnetic resonance imaging (MRI) in a clinical setting. Ninety-three patients suffering from lumbar spine problems were examined using standard MRI protocols including an axial T2* mapping protocol. All discs were classified morphologically and grouped as ''healthy'' or ''abnormal''. Differences between groups were analysed regarding to the specific T2* pattern at different regions of interest (ROIs). Healthy intervertebral discs revealed a distinct cross-sectional T2* value profile: T2* values were significantly lower in the annulus fibrosus compared with the nucleus pulposus (P = 0.01). In abnormal IVDs, T2* values were significantly lower, especially towards the centre of the disc representing the expected decreased water content of the nucleus (P = 0.01). In herniated discs, ROIs within the nucleus pulposus and ROIs covering the annulus fibrosus showed decreased T2* values. Axial T2* mapping is effective to detect early stages of degenerative disc disease. There is a potential benefit of axial T2* mapping as a diagnostic tool, allowing the quantitative assessment of intervertebral disc degeneration. circle Axial T2* mapping effective in detecting early degenerative disc disease. (orig.)

  13. Short segmental pedicle screw fixation combined with percutaneous vertebroplasty in treatment of nonadjacent thoracolumbar fractures

    HE Qing-yi; XU Jian-zhong

    2009-01-01

    To evaluate the short-term outcomes of short segmental pedicle screw fixation combined with per-cutaneous vertebroplasty in treatment of nonadjacent tho-racolumbar fractures. Methods: Twenty patients who suffered from nonadja-cent thoracolumbar fractures were treated by short segmental pedicle screw fixation for burst fracture and by percutane-ous vertebroplasty for compression fracture. X-rays, CT and MRI scans were conducted using the same protocol before and after surgery and during follow-up. Pre- and post-operative American Spinal Injury Association (ASIA) grades, fusion of fracture sites, visual analog scale (VAS) of back pain, and Oswestry disability index (ODI) were accessed. Results: All patients were followed up for an average period of 12 months. The sagittal profile of the thoracolum-bar spine was restored satisfactorily. No patient had neuro-logic deterioration after surgery, and 9 patients with incom-plete lesions improved postoperatively by at least one ASIA grade. The fusion rate was 100%. The average VAS of back pain was 7.6 preoperatively and 3.2 postoperatively. The average ODI was 72.5 preoperatively and 35.5 postoperatively. Conclusions: Short segmental pedicle screw fixation combined with percutaneous vertebroplasty in treatment of nonadjacent thoracolumbar fractures exhibits such advan-tages as preserving functional segment units, reliable fixation, good neurologic recovery and early mobilization and, therefore, is suitable for treating nonadjacent thora-columbar fractures.

  14. MANAGEMENT OF UNSTABLE THORACOLUMBAR FRACTURES BY POSTERIOR INSTRUMENTATION WITH TRANSPEDICULAR PEDICLE SCREWS AND CONNECTING RODS

    Jayaram

    2015-09-01

    Full Text Available OBJECTIVE: To evaluate the use of pedicle screw and rod fixation in post - traumatic unstable thoracolumbar Spine fractures. METHODS: Thirty six patients with posttraumatic instability of thoracolumbar were included in the study. Thoracolumbar injury severity scoring was used to assess spinal instability. All patients underwent open reduction and internal fixation by posterior approach. Pedicles were localized using detailed anatomical landmarks and intraoperative imaging. The neurological status of the patients was assessed using ASIA grading and any other complications were noted up to 6 months. RESULTS: There were 36 patients with unstable thoracolumbar junction injuries who were managed with pedicle screws and rods. M ales were more affected (M: F ratio was 8: 1. AO type A was the commonest. The most common level was L1. None of the patients deteriorated after surgery. 27 patients with incomplete cord injury showed at least one frankel grade improvement. 8 patients with complete cord injury showed no improvement. The mean kyphotic angle by Cobb’s method was 20.8° on admission, 4.6° post operatively and 6.1° at latest follow - up . Average anterior vertebral body height at the time of admission was 52%, post op was 85% and at final follow up was 80%. T here was 1 case of malpositiong of screw and 5 patients developed bed sores. CONCLUSION: Pedicle screw fixation is a useful choice for thoracolumbar junction injuries for achieving reduction and stability, without affecting extra motion segments.

  15. Análisis de las Causas de Hernia de Disco Intervertebral Analysis of the Causes of Intervertebral Disk Hernia

    R.O Ferracutti

    2004-01-01

    Full Text Available El objetivo de este trabajo es comprobar la hipótesis de que la hernia de disco intervertebral, se produce por fatiga del material y no por compresión simple. Se han sometido probetas constituidas por columnas lumbares ovinas frescas a pruebas de fatiga por compresión. Los ensayos mostraron que las muestras sometidas a cargas de aplicación única, ceden en el hueso y sometidas a ensayos de fatiga, ceden en el disco intervertebral. Se concluye que la hernia de disco intervertebral es producto de esfuerzos repetidos en compresión axial y un traumatismo único no resulta en una hernia de disco.The objective of this work is to prove the hypothesis that intervertebral disk hernia is produced by fatigue of the material and not by simple compression. Pieces of fresh ovine lumbar columns were submitted to compression tests. The experiments showed that when the samples are submitted to charges of single application, fail in the bone and when are submitted to fatigue tests, they fail in the intervertebral disk. It is concluded that the intervertebral disk hernia is produced by repetitive charges as axial compression and that a single traumatism does not generate a disk hernia.

  16. Imaging evaluation of traumatic thoracolumbar spine injuries: Radiological review.

    Gamanagatti, Shivanand; Rathinam, Deepak; Rangarajan, Krithika; Kumar, Atin; Farooque, Kamran; Sharma, Vijay

    2015-09-28

    Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen (AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types (A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient's neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score (TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management. PMID:26435776

  17. Imaging evaluation of traumatic thoracolumbar spine injuries: Radiological review

    Shivanand; Gamanagatti; Deepak; Rathinam; Krithika; Rangarajan; Atin; Kumar; Kamran; Farooque; Vijay; Sharma

    2015-01-01

    Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen(AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types(A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient’s neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score(TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management.

  18. Formative mechanism of intracanal fracture fragments in thoracolumbar burst fractures: a finite element study

    ZENG Zhi-li; ZHU Rui; LI Shan-zhu; YU Yan; WANG Jian-jie; JIA Yong-wei; CHEN Bo

    2013-01-01

    Background Thoracolumbar burst fracture is a common clinical injury,and the fracture mechanism is still controversial.The aim of this research was to study the formation of intracanal fracture fragments in thoracolumbar burst fractures and to provide information for the prevention of thoracolumbar bursts fractures and reduction of damage to the nervous system.Methods A nonlinear three-dimensional finite element model of T11-L3 segments was established,and the injury processes of thoracolumbar bursts were simulated.The intact finite element model and the finite element model after the superior articular were impacted by 100 J of energy in different directions.The distribution and variation of stress in the superior posterior region of the L1 vertebral body were analyzed.Abaqus 6.9 explicit dynamic solver was used as finite element software in calculations.Results A three-dimensional nonlinear finite element model of the thoracolumbar spine was created.In the intact model,stress was concentrated in the superior posterior region of the L1 vertebral body.The stress peak was a maximum for the extension impact load and a minimum for the flexion impact load.The stress peak and contact force in the facet joint had close correlation with time.The stress peak disappeared after excision of the superior articular process.Conclusions The three-dimensional nonlinear finite element model was suitable for dynamic analysis.The contact force in the facet joint,which can be transferred to the superior posterior vertebral body,may explain the spinal canal fragment in thoracolumbar burst fractures.

  19. Biomechanics of Thoracolumbar Burst and Chance-Type Fractures during Fall from Height

    Ivancic, Paul C.

    2014-01-01

    Study Design In vitro biomechanical study. Objective To investigate the biomechanics of thoracolumbar burst and Chance-type fractures during fall from height. Methods Our model consisted of a three-vertebra human thoracolumbar specimen (n = 4) stabilized with muscle force replication and mounted within an impact dummy. Each specimen was subjected to a single fall from an average height of 2.1 m with average velocity at impact of 6.4 m/s. Biomechanical responses were determined using impact lo...

  20. Vertebral stabilisation and selective decompression for the management of triple thoracolumbar disc protrusions.

    McKee, W M; Downes, C J

    2008-10-01

    Triple adjacent thoracolumbar disc protrusions causing moderate to severe spinal cord compression were diagnosed by magnetic resonance imaging in two German shepherd dogs with marked paraparesis and pelvic limb ataxia. Both cases were managed by selective hemilaminectomy, partial annulectomy and bilateral quadruple vertebral body stabilisation using novel canine locking fixation plates (SOP). The stabilisation of multiple vertebrae in the thoracolumbar spine was possible because the plates could be contoured with six degrees of freedom. Spinal pain resolved and neurological function improved in both dogs. Screw breakage was evident in one dog five months following surgery. PMID:18631222

  1. Features of intervertebral disc degeneration in rat's aging process

    Yin-gang ZHANG; Zheng-ming SUN; Jiang-tao LIU; Shi-jie WANG; Feng-ling REN; Xiong GUO

    2009-01-01

    Objective: The age-related change is important part of degenerative disc disease. However, no appropriate animal model or objective evaluation index is available. This study aimed to investigate the features of intervertebral disc degeneration in aging process of rats. Methods: 22-month-old Sprague-Dawley (SD) rats were used as spontaneously occurring intervertebral disc degeneration models and 6-month-old rats as young controls. Expression of collagen types Ⅱ and Ⅹ was measured by immunohistochemistry. Degenerations of intervertebral discs were scored according to Miyamoto's method. Numbers and areas of afferent vascular buds were measured. The thicknesses of non-calcified and calcified layers were measured and statistically analyzed.Results: There were less collagen type Ⅱ expression and more collagen type Ⅹ expression in the calcified layer of the cartilage endplates and nucleus pulposus in the rats of the aged group than in the young control. There were fewer and smaller afferent vascular buds in the rats of the aged group than in the young control group. The ratio of the non-calcified to the calcified layers in the rats of the aged group significantly decreased, compared with that of the young control group (P<0.01). Conclusion: Rats can spontaneously establish intervertebral disc age-related degeneration. The expression of collagen types Ⅱ and Ⅹ, numbers and areas of afferent vascular buds, the ratio of the non-calcified to the calcified layers, and water and glycosaminoglycan contents in the nucleus pulposus are sensitive indexes of intervertebral disc degeneration.

  2. [Covering of a thoraco-lumbar defect by omentoplasty].

    Le Fourn, B; Loirat, Y; Sartre, J Y; Lejeune, F; Pannier, M

    1997-02-01

    With a case of thoraco-lumbar defect, the authors discuss about different procedures to cover it. In this place, the better procedure is certainly the latissimus dorsi flap, in all combinations. The indication for omentoplasty at this spinal site should not be performed by first intention but by exclusion of other procedures, as in the case considered by the authors. It was a 37-year-old man, paraplegic from the age of 16, with a deep chronic spinal wound, secondary to sepsis of a posterior segmental fixations. A staphylococcus aureus infection which developed as a surgical complication was initially treated with antibiotics and surgical cleaning procedures without removing instrumentation. However, the infection remained active and the material was finally removed. Spinal immobilisation was strengthened by external fixation. The area was cleared of all suspect material, including bone graft, leaving a wide back-wound open to the spine. Spontaneous healing was first attempted, but the size and the chronicity of the wound led us to use pedicled greater omentum to close the defect. The omentum was pedicled on the right gastroepiploic vessels and transferred to the back wound through the posterior abdominal wall muscles, next to the right kidney. This procedure allows rapid healing. In association with suitable antibiotics, it has prevented any recurrent infection after 18 months of follow-up. It was no feasible to cover the wound with a latissimus dorsi flap, considering the importance of this muscle in the movements of a paraplegic and considering the initial impossibility of removing the external fixation. PMID:9768139

  3. Correlation of clinical, radiographic, and surgical localization of intervertebral disc extrusion in small-breed dogs: a prospective study of 50 cases

    Objective-To compare prospectively clinical, radiographic, and surgical findings of intervertebral disc extrusion (IDE) localization in small-breed dogs and to determine the best means of lesion localization for the purpose of hemilaminectomy. Study Design-Clinical, radiographic, and surgical findings of small-breed dogs with thoracolumbar IDE were prospectively compared for agreement on lesion localization. Sample Population-50 small-breed dogs with IDE treated at the three participating veterinary hospitals were included in the study if no other confounding diseases were identified and if the owner gave permission for diagnostic tests and surgery. Methods-Clinical and surgical findings were recorded by the surgeon assigned to the case. Radiographic studies were evaluated independently by two radiologists blinded as to the clinical and surgical findings. K values and 95% confidence intervals were calculated for agreement on lesion localization by clinical, radiographic, and surgical means and for agreement between radiologists. Results-K values for agreement of lesion localization were as follows: clinical versus surgical, 0.595; radiologist A versus radiologist B, 0.81; radiologist A versus surgical findings, 0.60; radiologist B versus surgical findings, 0.71. Both radiologists interpretation of IDE localization agreed with surgical localization in 60% of cases. Conclusions-Clinical lateralization of IDE was found to be the least reliable factor of those studied for determining on which side the hemilaminectomy should be performed. Results of this study differ from those of previous studies examining the reliability of myelography to localize the site of IDE accurately. The results of this study further suggest that surgery may not be an absolute standard for determination of the localization of IDE in small-breed dogs. Clinical Relevance-Intervertebral disc extrusion in small-breed dogs frequently results in bilateral distribution of extruded material. Computed

  4. Radiological outcome of transpedicular screws fixation in the management of thoracolumbar spine injury

    Traumatic fracture of the spine is a serious neurosurgical condition that has serious impact on the patient's quality of life. Thoracolumbar junction is the most common site of spinal injuries. The aims of management of thoracolumbar spinal fractures are to restore vertebral column stability, and to obtain spinal canal decompression. This ultimately leads to early mobilization of the patients. This study was conducted to compare preoperative and post-operative vertebral height, kyphotic angle and sagittal index in patients treated with pedicle screws and rods in thoracolumbar spine fractures. Methods: This cross-sectional study was conducted in the department of Neurosurgery, Hayatabad Medical Complex, Peshawar from 1st February 2010 to 31st July 2011. A total 161 patients with unstable thoracolumber spine fracture were included in this study. In these patients fixation was done through transpedicle screws with rods. Anteroposterior and lateral views X-rays of thoraco-lumbar spine were done pre and post operatively. Results: Out of 161 patients, 109 (67.7%) were males and 52 (32.3%) females. The age of patients ranged from 20 to 70 years (mean 42.2 years) with 71 (44.1%) in the age range of 31-40 years. Preoperative average vertebral height was 9.4194 mm while postoperative average was 19.642 mm. The mean kyphosis was 23.06 degree preoperatively. Immediately after surgery the average correction of kyphosis was 9.45 degree. The pre-operative average sagittal index was 19.38 degree, which was reduced to an average 5.41 degree post operatively. Conclusions: Transpedicular fixation for unstable thoraco-lumbar spinal fractures achieves a stable fracture segment with improvement of vertebral height, kyphotic angle and sagittal index. Hence, preventing the secondary spinal deformities. (author)

  5. Improving the fixation of an artificial intervertebral disc

    Eijkelkamp, MF; Hayen, J; Veldhuizen, AG; Van Horn, [No Value; Verkerke, GJ

    2002-01-01

    The fixation of an artificial intervertebral disc has been studied especially with respect to the dimensions, the convexity of the endplates and the size of the fixation elements. From literature and cadaveric vertebrae, the dimensions and shape of the lumbar vertebral endplates were determined and

  6. Acupuncture Treatment of 32 Cases of Lumbar Intervertebral Disc Protusion

    CHEN Feng; WANG Si-you

    2003-01-01

    Yaoyangguan ( GV 3 ), Shiqizhui ( Ex-B 8) and Yanglingquan (GB 34) were selected as main points and a three-part needle insertion technique was used to treat 32 cases of lumbar intervertebral disc protrusion. The curative rate was 96.9%. Deep puncture is the key to the treatment.

  7. Magnetic resonance imaging of diseased cervical and lumbar intervertebral discs

    Magnetic resonance images (MRI) of diseased cervical and lumbar intervertebral discs involving both intrinsic and extrinsic cord lesions were examined using either a 0.15 T resistive or a 0.5 T superconductive magnetic imaging system. The vertebrae, intervertebral discs, and spinal cord were delineated on spin-echo (SE) images with a long repetition time (TR) and a short echo time (proton density-weighted image). Protrusion of degenerated intervertebral discs into the spinal canal was clearly demonstrated not only on sagittal but also on parasagittal and transverse views. The location of protruded discs and compression of the spinal cord, caudal sac, and nerve roots were well visualized three-dimensionally. Pathological features of intervertebral discs were well appreciated on T2-weighted images with long TR and SE pulse sequences. Degeneration of intervertebral discs resulted in decreased signal intensity in cases of lumbar disc involvement. For suspected myelomalacia, the intrinsic cord lesion resulting from traumatic disc protrusion appeared as focal low signal intensity on T1-weithed images and as somewhat high intensity on T2 weighted images. The inversion recovery sequence with median inversion time displayed an inferior image of low contrast and was judged uninformative in comparison to SE imags. The findings showed MRI to be an essential diagnostic technique for spinal cord disorders. It clearly pinpoints the anatomic structures of the spine and the features of disc degeneration. Both extrinsic and intrinsic cord abnormalities can be identified with MRI. The selection of proper pulse sequences is required for the differentiation of the object of interest. (Namekawa, K)

  8. Magnetic resonance imaging of diseased cervical and lumbar intervertebral discs

    Kadoya, Satoru; Nakamura, Tsutomu; Takarada, Akira; Yamamoto, Itaru; Sato, Shuji.

    1989-02-01

    Magnetic resonance images (MRI) of diseased cervical and lumbar intervertebral discs involving both intrinsic and extrinsic cord lesions were examined using either a 0.15 T resistive or a 0.5 T superconductive magnetic imaging system. The vertebrae, intervertebral discs, and spinal cord were delineated on spin-echo (SE) images with a long repetition time (TR) and a short echo time (proton density-weighted image). Protrusion of degenerated intervertebral discs into the spinal canal was clearly demonstrated not only on sagittal but also on parasagittal and transverse views. The location of protruded discs and compression of the spinal cord, caudal sac, and nerve roots were well visualized three-dimensionally. Pathological features of intervertebral discs were well appreciated on T/sub 2/-weighted images with long TR and SE pulse sequences. Degeneration of intervertebral discs resulted in decreased signal intensity in cases of lumbar disc involvement. For suspected myelomalacia, the intrinsic cord lesion resulting from traumatic disc protrusion appeared as focal low signal intensity on T/sub 1/-weithed images and as somewhat high intensity on T/sub 2/ weighted images. The inversion recovery sequence with median inversion time displayed an inferior image of low contrast and was judged uninformative in comparison to SE imags. The findings showed MRI to be an essential diagnostic technique for spinal cord disorders. It clearly pinpoints the anatomic structures of the spine and the features of disc degeneration. Both extrinsic and intrinsic cord abnormalities can be identified with MRI. The selection of proper pulse sequences is required for the differentiation of the object of interest. (Namekawa, K).

  9. Ozone therapy for t he complex prolapse of lumbar intervertebral disc: a clinical observation

    Objective: To evaluate the therapeutic outcome of ozone injection therapy for the treatment of complex prolapse of lumbar intervertebral disc, which is accompanied with spinal stenosis due to hypertrophy of ligamentum flavum, degeneration of intervertebral facet joints, intervertebral hyperosteogeny and degeneration, lumbar muscle strain and negative pressure in intervertebral discs. Methods: Seventy patients with simple intervertebral disc prolapse (simple group) and 70 patients with complex intervertebral disc prolapse (complex group) were selected for the study. The complex intervertebral disc prolapse included negative pressure in intervertebral disc (n=11), recurrence after resection of nucleus polposus of intervertebral disc (n=5), spinal stenosis (n=10), degeneration of intervertebral facet joints and interver-tebral hyperosteogeny (n=30), stenosis of lateral recess (n=4) and lumbar muscle strain (n=10). All patients were treated with ozone injection under the CT guidance. A total of 2-3 ml ozone with the concentration of 40-50 μg / ml was injected into the intervertebral disk and a total of 5-8 ml ozone with the concentration of 30-40 μg / ml was injected into the paraspinal space. Infiltration injection into the pain spots with 20 ml ozone was carried out in patients with lumbar muscle strain. Results: A comparison of the therapeutic outcomes between simple group and complex group was made. Immediate relief from clinical symptoms was obtained in 80% of all treated patients. The effective rate one week after the procedure was 95%, which became 96% at 3-6 months after the treatment. Conclusion: Correct clinical diagnosis, skilled and accurate manipulation during the surgery and reasonable use of ozone injection in the treatment of soft tissue injury, etc. can markedly improve the therapeutic effect for complex lumbar intervertebral disc prolase. (authors)

  10. TREATMENT OF THORACOLUMBAR BURST FRACTURES FIXED WITH INTERMEDIATE PINS BY THE POSTERIOR APPROACH

    Henrique Motizuki

    2015-09-01

    Full Text Available Objective:Radiographic evaluation of patients with thoracolumbar burst fractures treated with unconvencional transpedicular fixation, which includes additional fixation of the fractured vertebra associated with transverse connector - Crosslink clamp.Methods:Retrospective study evaluating a total of 68 patients operated at the Hospital do Trabalhador de Curitiba, Orthopedics Service, of which 15 were eligible for the study. All patients were treated with posterior pedicle fixation and intermediate screw. The assessment by the Cobb angle method was performed on preoperative, immediate postoperative and one year after surgery radiographs.Results:It was observed an average reduction of kyphosis of 8.3o (77%, with a loss of 1.34o in late postoperative compared to the immediate postoperative period.Conclusion:The method of fixation of burst-type fractures of the thoracolumbar spine by the posterior approach with intermediate screw was effective in maintaining the reduction achieved in the immediate postoperative period and after one year of evolution.

  11. MR imaging in the assessment of the thoracolumbar spine in elite male gymnasts

    Gymnasts training on elite level from childhood to adulthood might do serious damage to the motion segments in the thoracolumbar spine. This paper reports on twenty-five elite gymnasts (age range, 18-29 years) investigated with 0.5-T MR imaging and compared with 17 aged-matched normal males. A significantly higher number of changes in configuration of the vertebrae, apophyseal changes, end plate nodes, degenerated disks, and disk bulging in the thoracolumbar spine were found among the gymnasts. The number of degenerated disks among the gymnasts were comparable to that found at the age group of 65. Disk degeneration and change of configuration of the vertebrae were also found to correlate significantly with symptoms of back pain

  12. Bilateral transtibial amputation with concomitant thoracolumbar vertebral collapse in a Sichuan earthquake survivor

    Lau Herman; Law Sheung-Wai; Yu Joseph; Wong Caroline; Chan Cavor

    2010-01-01

    Abstract The devastating earthquake in Sichuan, China on 12 May 2008 left thousands of survivors requiring medical care and intensive rehabilitation. In view of this great demand, the Chinese Speaking Orthopaedic Society established the "Stand Tall" project to provide voluntary services to aid amputee victims in achieving total rehabilitation and social integration. This case report highlights the multidisciplinary rehabilitation of a girl who suffered thoracolumbar vertebral collapse and und...

  13. Incidence of Vascular Complications Arising from Anterior Spinal Surgery in the Thoraco-Lumbar Spine

    Klezl, Zdenek; Swamy, Girish Nanjunda; Vyskocil, Thomas; Kryl, Jan; Stulik, Jan

    2014-01-01

    Study Design Modern biomaterials and instrumentation have popularised surgery of the thoraco-lumbar spine through an anterior route. The advantage of anterior surgery is that it allows for a direct decompression of the compromised spinal canal. However, the potential for devastating long-term sequelae as a result of complications is high. Purpose The aim of this study was to give a general overview and identify the incidence of vascular complications. Overview of Literature There is limited l...

  14. Sextant percutaneous pedicle screw fixation for correcting single-segment thoracolumbar fractures

    Ming Jiang-hua; Zheng Hui-feng; Zhao Qi; Chen Qing; Wang Gang

    2014-01-01

    BACKGROUND:Though the effects of conservative or traditional open reduction and internal fixation in the treatment of thoracolumbar fractures are reliable and satisfactory for most cases, two methods also have shortages. Minimal-invasive percutaneous pedicle screw system provides a new available method. OBJECTIVE:To investigate the clinical effect of Sextant percutaneous pedicle screw system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or traditional open internal fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics of Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. RESULTS AND CONCLUSION:Except two patients in traditional open internal fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. Operative time, intraoperative blood loss, postoperative drainage amount and hospital day were better in percutaneous pedicle screw fixation group than in the traditional open internal fixation group (P0.05). The results show that percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, obeying indication strictly is very important for clinical application.

  15. Spinal Nerve Root Swelling Mimicking Intervertebral Disc Herniation in Magnetic Resonance Imaging -A Case Report-

    Kim, Yu Yil; Lee, Jun Hak; Kwon, Young Eun; Gim, Tae Jun

    2010-01-01

    A herniated intervertebral disc is the most common type of soft tissue mass lesion within the lumbar spinal canal. Magnetic resonance imaging (MRI) is a useful tool for the assessment of patients with lower back pain and radiating pain, especially intervertebral disc herniation. MRI findings of intervertebral disc herniation are typical. However, from time to time, despite an apparently classic history and typical MRI findings suggestive of disc herniation, surgical exploration fails to revea...

  16. Insertion of PCB to treat traumatic cervical intervertebral disc herniation

    马远征; 隰建成; 陈兴; 关长勇; 全长彬

    2002-01-01

    Objective: To evaluate the clinical effect of PCB (a new anterior cervical instrumental system combining an intradiscal cage with an integrated plate) in treating traumatic cervical intervertebral disc herniation. Methods: Anterior decompression and PCB internal fixation were used in 22 patients with traumatic cervical intervertebral disc herniation. They were followed up from 3 to 16 months and analyzed by symptom and image data. Among them, 16 patients underwent fixation at one level and 6 patients at two levels. Results: This technique did not cause intraoperative complications. After surgery no screw backout or device failure was found. Based on the JOA grade, 20 patients improved clinically and 2 gently because of serious cervical stenosis. The general excellent rate was 90.9%. Conclusions: PCB internal fixation is stable. Morbidity of donor and acceptor sites is less. No collars are needed after surgery.

  17. Insertion of PCBto treat traumatic cervical intervertebral disc herniation

    马远征; 陈兴; 等

    2002-01-01

    Objective:To evaluate the clinical effect of PCB(a new anterior cervical instrumental system combining an intradiscal cage with an integrated plate)in treating taunatic cervical intervertebral disc herniation.Methods:Anterior decompression and PCB internal fixation were used in 22patients with traumatic cervical intervertebral disc herniation.They were followed up from3to16months and analyzed by symptom and imape data.Among them,16 patients underwent fixation at one level and 6patients at two levels.Results:This technique did not cause intraoperative complications.After surgery on screw backout or device failure was found.Based on the JOAgrade,20 patients improved clinically and 2gently because of serious cervical stenosis.The general excellent rate was90.9%.Conclusions:PCB internal fixation is stable.Morbidity of donor and acceptor sites is less.No collars are needed after surgery.

  18. Comprehensive Treatment of Prolapse of Lumbar Intervertebral Disc

    CHENG Xiao; KUAI Le

    2004-01-01

    To search for the best method in treating prolapse of lumbar intervertebral disc, the cases of prolapse of lumbar intervertebral disc were treated by Tuina plus acupuncture. The cure rate was high, the course of treatment was short and the effect was satisfactory. Tuina can relax muscles and tendons,promote the blood circulation, acupuncture can warm the meridians to disperse cold pathogen, promote the blood circulation to remove blood stasis, and the combination of these two treatments can enhance the therapeutic effect.%为探讨治疗腰椎间盘突出症的最佳方法,对腰椎盘突出症采用推拿配合针灸来治疗.本法治愈率高,疗程短,效果满意.推拿能舒经活血,针灸能温经散寒,活血散瘀,两者配合,提高疗效.

  19. Degenerated human intervertebral discs contain autoantibodies against extracellular matrix proteins

    S Capossela; P Schläfli; Bertolo, A; T Janner; BM Stadler; T Pötzel; Baur, M; JV Stoyanov

    2014-01-01

    Degeneration of intervertebral discs (IVDs) is associated with back pain and elevated levels of inflammatory cells. It has been hypothesised that discogenic pain is a direct result of vascular and neural ingrowth along annulus fissures, which may expose the avascular nucleus pulposus (NP) to the systemic circulation and induce an autoimmune reaction. In this study, we confirmed our previous observation of antibodies in human degenerated and post-traumatic IVDs cultured in vitro. We hypothesis...

  20. Bovine explant model of degeneration of the intervertebral disc

    Sivan Sarit; Menage Janis; Roberts Sally; Urban Jill PG

    2008-01-01

    Abstract Background Many new treatments for degeneration of the intervertebral disc are being developed which can be delivered through a needle. These require testing in model systems before being used in human patients. Unfortunately, because of differences in anatomy, there are no ideal animal models of disc degeneration. Bovine explant model systems have many advantages but it is not possible to inject any significant volume into an intact disc. Therefore we have attempted to mimic disc de...

  1. Lumbar intervertebral disc degeneration and related factors in Korean firefighters

    Jang, Tae-Won; Ahn, Yeon-Soon; Byun, Junsu; Lee, Jong-In; Kim, Kun-Hyung; KIM, YOUNGKI; Song, Han-Soo; Lee, Chul-Gab; Kwon, Young-Jun; Yoon, Jin-Ha; Jeong, Kyoungsook

    2016-01-01

    Objectives The job of firefighting can cause lumbar burden and low back pain. This study aimed to identify the association between age and lumbar intervertebral disc degeneration and whether the association differs between field and administrative (non-field) firefighters. Methods Subjects were selected using a stratified random sampling method. Firefighters were stratified by geographic area, gender, age and type of job. First, 25 fire stations were randomly sampled considering regional dist...

  2. Lumbar intervertebral disc allografting in a goat model

    Hung, Y; Xiao, J; Luk, K.; Leung, V.; Lu, W.

    2012-01-01

    Preliminary study in humans indicated that whole fresh-frozen intervertebral disc (IVD) transplantation may be an effective treatment for disc degenerative diseases, but signs of degenerative change in the allograft were noted after the transplantation. The underlying mechanisms are not fully understood and remain a series of ongoing research in large animal model. Because of the ethically and economically accessible issues as well as anatomical similarity with human disc, the goats were used...

  3. A Ganglion Cyst in the Second Lumbar Intervertebral Foramen

    Kim, Sang Woo; Choi, Joon Hyuk; Kim, Min Su; Chang, Chul Hoon

    2011-01-01

    Ganglion cysts usually arise from the tendon sheaths and tissues around the joints. It is usually associated with degenerative arthritic changes in older people. Ganglion cyst in the spine is rare and there is no previous report on case that located in the intervertebral foramen and compressed dorsal root ganglion associated severe radiculopathy. A 29-year-old woman presented with severe left thigh pain and dysesthesia for a month. Magnetic resonance imaging revealed a dumbbell like mass in t...

  4. The effect of posture on diffusion into lumbar intervertebral discs.

    Adams, M.A.; Hutton, W. C.

    1986-01-01

    The diffusion of small solutes into the intervertebral discs of cadaveric lumbar motion segments was measured using a radioactive tracer technique. The motion segments were wedged and loaded to simulate erect posture and flexed sitting postures. The results show that erect posture favours diffusion into the anterior half of the disc compared to the posterior half. Flexed posture, by deforming the annulus fibrosus, reverses this imbalance.

  5. New treatment strategies for canine intervertebral disc degeneration

    Smolders, L.A.

    2013-01-01

    Degeneration of the intervertebral disc (IVD) is a common problem in dogs and humans. IVD degeneration can lead to herniation of the IVD with subsequent compression of neural structures and various clinical signs, including back pain. Current treatment of IVD disease is conservative or surgical. However, these therapies do not restore health or functionality to the IVD and may lead to spinal instability and recurrence of clinical signs. Therefore, the aim of this thesis was to investigate the...

  6. Notochord Cells in Intervertebral Disc Development and Degeneration

    Matthew R. McCann

    2016-01-01

    Full Text Available The intervertebral disc is a complex structure responsible for flexibility, multi-axial motion, and load transmission throughout the spine. Importantly, degeneration of the intervertebral disc is thought to be an initiating factor for back pain. Due to a lack of understanding of the pathways that govern disc degeneration, there are currently no disease-modifying treatments to delay or prevent degenerative disc disease. This review presents an overview of our current understanding of the developmental processes that regulate intervertebral disc formation, with particular emphasis on the role of the notochord and notochord-derived cells in disc homeostasis and how their loss can result in degeneration. We then describe the role of small animal models in understanding the development of the disc and their use to interrogate disc degeneration and associated pathologies. Finally, we highlight essential development pathways that are associated with disc degeneration and/or implicated in the reparative response of the tissue that might serve as targets for future therapeutic approaches.

  7. Gene expression profile analysis of human intervertebral disc degeneration

    Chen, Kai; Wu, Dajiang; Zhu, Xiaodong; Ni, Haijian; Wei, Xianzhao; Mao, Ningfang; Xie, Yang; Niu, Yunfei; Li, Ming

    2013-01-01

    In this study, we used microarray analysis to investigate the biogenesis and progression of intervertebral disc degeneration. The gene expression profiles of 37 disc tissue samples obtained from patients with herniated discs and degenerative disc disease collected by the National Cancer Institute Cooperative Tissue Network were analyzed. Differentially expressed genes between more and less degenerated discs were identified by significant analysis of microarray. A total of 555 genes were significantly overexpressed in more degenerated discs with a false discovery rate of < 3%. Functional annotation showed that these genes were significantly associated with membrane-bound vesicles, calcium ion binding and extracellular matrix. Protein-protein interaction analysis showed that these genes, including previously reported genes such as fibronectin, COL2A1 and β-catenin, may play key roles in disc degeneration. Unsupervised clustering indicated that the widely used morphology-based Thompson grading system was only marginally associated with the molecular classification of intervertebral disc degeneration. These findings indicate that detailed, systematic gene analysis may be a useful way of studying the biology of intervertebral disc degeneration. PMID:24130454

  8. Gene expression profile analysis of human intervertebral disc degeneration

    Kai Chen

    2013-01-01

    Full Text Available In this study, we used microarray analysis to investigate the biogenesis and progression of intervertebral disc degeneration. The gene expression profiles of 37 disc tissue samples obtained from patients with herniated discs and degenerative disc disease collected by the National Cancer Institute Cooperative Tissue Network were analyzed. Differentially expressed genes between more and less degenerated discs were identified by significant analysis of microarray. A total of 555 genes were significantly overexpressed in more degenerated discs with a false discovery rate of < 3%. Functional annotation showed that these genes were significantly associated with membrane-bound vesicles, calcium ion binding and extracellular matrix. Protein-protein interaction analysis showed that these genes, including previously reported genes such as fibronectin, COL2A1 and f-catenin, may play key roles in disc degeneration. Unsupervised clustering indicated that the widely used morphology-based Thompson grading system was only marginally associated with the molecular classification of intervertebral disc degeneration. These findings indicate that detailed, systematic gene analysis may be a useful way of studying the biology of intervertebral disc degeneration.

  9. MRI evaluation of spontaneous intervertebral disc degeneration in the alpaca cervical spine.

    Stolworthy, Dean K; Bowden, Anton E; Roeder, Beverly L; Robinson, Todd F; Holland, Jacob G; Christensen, S Loyd; Beatty, Amanda M; Bridgewater, Laura C; Eggett, Dennis L; Wendel, John D; Stieger-Vanegas, Susanne M; Taylor, Meredith D

    2015-12-01

    Animal models have historically provided an appropriate benchmark for understanding human pathology, treatment, and healing, but few animals are known to naturally develop intervertebral disc degeneration. The study of degenerative disc disease and its treatment would greatly benefit from a more comprehensive, and comparable animal model. Alpacas have recently been presented as a potential large animal model of intervertebral disc degeneration due to similarities in spinal posture, disc size, biomechanical flexibility, and natural disc pathology. This research further investigated alpacas by determining the prevalence of intervertebral disc degeneration among an aging alpaca population. Twenty healthy female alpacas comprised two age subgroups (5 young: 2-6 years; and 15 older: 10+ years) and were rated according to the Pfirrmann-grade for degeneration of the cervical intervertebral discs. Incidence rates of degeneration showed strong correlations with age and spinal level: younger alpacas were nearly immune to developing disc degeneration, and in older animals, disc degeneration had an increased incidence rate and severity at lower cervical levels. Advanced disc degeneration was present in at least one of the cervical intervertebral discs of 47% of the older alpacas, and it was most common at the two lowest cervical intervertebral discs. The prevalence of intervertebral disc degeneration encourages further investigation and application of the lower cervical spine of alpacas and similar camelids as a large animal model of intervertebral disc degeneration. PMID:26135031

  10. Treatment of Protrusion of the Lumbar Intervertebral Disc by TCM Massage

    龙亚军

    2002-01-01

    @@ Protrusion of the lumbar intervertebral disc is a common disorder frequently encountered in clinic. With TCM massage and the maneuver of manual reduction, we have treated 82 cases of protrusion of the lumbar intervertebral disc, with satisfactory therapeutic results reported in the following.

  11. Target radiofrequency combined with collagenase chemonucleolysis in the treatment of lumbar intervertebral disc herniation

    Zhang, Daying; Yong ZHANG; Wang, Zhijian; Zhang, Xuexue; Sheng, Mulan

    2015-01-01

    Both target radiofrequency thermocoagulation and collagenase chemonucleolysis are effective micro-invasive therapy means for lumbar intervertebral disc herniation. In order to analyze the clinical effects of target radiofrequency thermocoagulation combined with collagenase chemonucleolysis on lumbar intervertebral disc herniation, the contents of hydroxyproline and glycosaminoglycan were measured and the histological changes of nucleus pulposus was detected in the vitro experiments. Radiofreq...

  12. Geometry of the Intervertebral Volume and Vertebral Endplates of the Human Spine

    van der Houwen, E. B.; Baron, P.; Veldhuizen, A. G.; Burgerhof, J. G. M.; van Ooijen, P. M. A.; Verkerke, G. J.

    2010-01-01

    Replacement of a degenerated vertebral disc with an artificial intervertebral disc (AID) is currently possible, but poses problems, mainly in the force distribution through the vertebral column. Data on the intervertebral disc space geometry will provide a better fit of the prosthesis to the vertebr

  13. The morphometric analysis of the intervertebral foramen and the spinal nerve root in the cervical spine

    The purpose of this study was to clarify the onset of cervical myelopathy and cervical spondylotic radiculopathy as well as what influence the anatomy of the cervical spine and cervical nerves have on their onset and occurrence of various types of disease state. We conducted imaging and morphological measurements on specimens of cervical spine of Japanese people, focusing attention on the running of intervertebral foramen and dorsal nerve rootlets of the cervical spine. The subjects were cervical spine specimens from 12 cadavers (7 males and 5 females, age at the time of death ranged from 48 to 93 years with a mean of 71 years) obtained at Showa University School of Dentistry in 2005 and 2006. Specimens were prepared by removing the atlas through the 1st thoracic vertebra from the cadavers, then resecting the soft tissue such as muscles to expose the cervical spine in whole circumference. The removed cervical spine specimens, from 1st to 7th cervical spines, were imaged by volume scan of radiographic helical CT at 0.6 mm spatial resolution, and their images were stored as Digital Imaging and Communications in Medicine (DICOM) data. Image measurement on the vertebral body, vertebral foramen, and intervertebral foramen was conducted based on DICOM data. Furthermore, macroscopic observation and measurement were conducted on the dorsal nerve rootlets of cervical spine specimens. The image measurement of cervical spine specimens showed that the intervertebral foramen at C5/6 was the narrowest, followed by C3/4, C4/5, C6/7, and C2/3, respecting. With regard to angles in the frontal section and horizontal section of the groove for the spinal nerve, there was no significant difference in the angle between the right and the left. In the frontal section, the angle was about 63deg at C3, about 57deg at C4, about 52deg at C5, and about 55deg at C6, showing a significantly acute angle at C5, while in the horizontal section, it was about 54deg at C3, about 59deg at C4, about 63

  14. Radiological diagnosis of chronic spinal cord compressive lesion at thoraco-lumbar junction

    Radiological findings in five cases with chronic spinal cord compressive lesion at thoraco-lumbar junction were reported. Three cases had spondylosis and two cases had ossification of yellow ligament (OYL). The levels of the lesions were T12/L1 in three cases and T11/12 in two cases. Two out of three spondylotic patients had also OYL at the same level. The five cases consisted of three men and two women. The ages ranged from 42 to 60 years old with a mean age of 53 years old. Neurologically, every patient showed flaccid paresis and sensory disturbance of the legs. Two cases had sensory disturbance of stocking type. The intervals from the onset of the symptoms to the final diagnosis were 6 months, 7 years, 8 years, 11 years and 12 years. Myelography showed anterior spinal cord compression by bony spur in spondylotic patients, and posterior compression by OYL in other cases. Myelography in flexion posture disclosed the cord compression by bony spur more clearly in two out of three spondylotic patients. Delayed CT-myelography showed intramedullary filling of contrast material in two cases, which indicated degenerative change or microcavitation due to long term compression of the spinal cord. MRI was taken in three spondylotic patients and could directly show compression of the spinal cord. Difficulty in detecting abnormality at thoraco-lumbar junction on plain roentgenogram, and similarity of the symptoms to peripheral nerve disease often lead to a delay in diagnosis. The significance of dynamic myelography and delayed CT-myelography when dealing with such a lesion was discussed here. MRI is also a useful method for diagnosing a compressive lesion at the thoraco-lumbar junction. (author)

  15. Decision-making in burst fractures of the thoracolumbar and lumbar spine

    Heary Robert

    2007-01-01

    Full Text Available The most common site of injury to the spine is the thoracolumbar junction which is the mechanical transition junction between the rigid thoracic and the more flexible lumbar spine. The lumbar spine is another site which is more prone to injury. Absence of stabilizing articulations with the ribs, lordotic posture and more sagitally oriented facet joints are the most obvious explanations. Burst fractures of the spine account for 14% of all spinal injuries. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. Disagreement also exists regarding the choice of the surgical approach. A large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery. Selecting an appropriate surgical option requires an in-depth understanding of the different methods of decompression, stabilization and/or fusion. Anterior surgery has the advantage of the greatest degree of canal decompression and offers the benefit of limiting the number of motion segments fused. These advantages come at the added cost of increased time for the surgery and the related morbidity of the surgical approach. Posterior surgery enjoys the advantage of being more familiar to the operating surgeons and can be an effective approach. However, the limitations of this approach include inadequate decompression, recurrence of the deformity and implant failure. Though many of the principles are the same, the treatment of low lumbar burst fractures requires some additional consideration due to the difficulty of approaching this region anteriorly. Avoiding complications of these surgeries are another important aspect and can be achieved by following an algorithmic approach to patient assessment, proper radiological examination and precision in decision-making regarding

  16. In Vivo Mouse Intervertebral Disc Degeneration Model Based on a New Histological Classification

    Ohnishi, Takashi; Sudo, Hideki; Iwasaki, Koji; Tsujimoto, Takeru; Ito, Yoichi M.; Iwasaki, Norimasa

    2016-01-01

    Although human intervertebral disc degeneration can lead to several spinal diseases, its pathogenesis remains unclear. This study aimed to create a new histological classification applicable to an in vivo mouse intervertebral disc degeneration model induced by needle puncture. One hundred six mice were operated and the L4/5 intervertebral disc was punctured with a 35- or 33-gauge needle. Micro-computed tomography scanning was performed, and the punctured region was confirmed. Evaluation was performed by using magnetic resonance imaging and histology by employing our classification scoring system. Our histological classification scores correlated well with the findings of magnetic resonance imaging and could detect degenerative progression, irrespective of the punctured region. However, the magnetic resonance imaging analysis revealed that there was no significant degenerative intervertebral disc change between the ventrally punctured and non-punctured control groups. To induce significant degeneration in the lumbar intervertebral discs, the central or dorsal region should be punctured instead of the ventral region. PMID:27482708

  17. Expression and significance of VEGF and p53 in degenerate intervertebral disc tissue

    Xiao-Yu Lu; Xiao-Hong Ding; Li-Jun Zhong; Hong Xia; Xiao-Dong Chen; Hai Huang

    2013-01-01

    Objective: To investigate the mechanism of expression and significance of vascular endothelial growth factor (VEGF) and p53 in degenerate intervertebral disc tissue. Methods: Pathological sections collected from 156 patients with lumbar disc herniation after surgery were tested by immunohistochemistry method, for evaluation of the expression of VEGF and p53 in degenerate intervertebral disc tissue. Results: 98 cases (62.8%) with vascular infiltration phenomenon are found, and positive rates of VEGF and p53 in degenerate intervertebral disc tissue are 73.42%(116/156) and 58.97% (92/156); co-expression rate is 53.2%(83/156); the expression rates of VEFG and p53 are significantly higher in the tissue with blood vessel infiltration than in the tissue without infiltration; there is a close relationship of VEGF with p53. Conclusions: VEGF and p53 gene synergetic express in degenerate intervertebral disc tissue, working together in neovascularization and infiltration, and accelerating intervertebral disc tissue degeneration.

  18. Development and Validation of a Musculoskeletal Model of the Fully Articulated Thoracolumbar Spine and Rib Cage.

    Bruno, Alexander G; Bouxsein, Mary L; Anderson, Dennis E

    2015-08-01

    We developed and validated a fully articulated model of the thoracolumbar spine in opensim that includes the individual vertebrae, ribs, and sternum. To ensure trunk muscles in the model accurately represent muscles in vivo, we used a novel approach to adjust muscle cross-sectional area (CSA) and position using computed tomography (CT) scans of the trunk sampled from a community-based cohort. Model predictions of vertebral compressive loading and trunk muscle tension were highly correlated to previous in vivo measures of intradiscal pressure (IDP), vertebral loading from telemeterized implants and trunk muscle myoelectric activity recorded by electromyography (EMG). PMID:25901907

  19. KumaFix fixation for thoracolumbar burst fractures: a prospective study on selective consecutive patients

    Yan Liang; Guo Hua; Xu Zhengwei; Liu Tuanjiang; Wang Xiaodong; He Baorong; Hao Dingjun

    2014-01-01

    Background Short-segment U-shaped pedicle screw fixation has been widely used to treat thoracolumbar burst fracture.Some studies have reported the disadvantages of traditional U-shaped pedicle screw,which included a relatively high rate of adjacent segment degeneration and screw failure,including screw pullout and breakage.The purpose of this study was to assess the efficacy of open reduction and fixation using KumaFix fixation system in treatment of thoracolumbar burst fractures.Methods From June 2011 to June 2012,45 consecutive patients with thoracolumbar burst fractures were enrolled.They were randomly assigned to treatment with KumaFix (the treatment group,n=23) or traditional U-shaped pedicle screw (the control group,n=22).The patients were followed up postoperatively and were assessed with regard to radiologic and clinical outcomes.Radiologic outcomes were assessed mainly on the basis of Cobb angle and vertebral wedge angle.Clinical outcomes were evaluated mainly with use of Visual Analog Scale (VAS) for pain and the Oswestry Disability Index (ODI) Questionnaire.Results All patients were followed up from 9 to 22 months.There were no significant differences between the two groups with regard to preoperative indices.The operation time in the treatment group was significantly lower than that in the control group.Preoperative Cobb angles and vertebral wedge angles in two groups were significantly decreased after surgery,and these have been well maintained at the last follow-up with mild correction losses.The results of clinical outcome showed lower VAS and ODI scores in two groups compared with those preoperative,and the treatment group had greater improvement on the ODI compared with the control group at the last follow-up.Conclusions Compared with traditional U-shaped pedicle screw,KumaFix fixation system can achieve gradual,controlled reduction,provide enough space for bone implantation,and avoid acceleration of adjacent segment degeneration.It is an effective

  20. CT-guided intradiscal ozone injection combined with intervertebral facet joint steroid injection for lumbar disk herniation accompanied with intervertebral arthritis

    Objective: To compare the clinical effectiveness of ozone (O3) nucleus pulposus ablation only with that of O3 nucleus pulposus ablation combined with intervertebral facet joint injection of compound Betamethasome in treating lumbar disk herniation accompanied with intervertebral facet arthritis. Methods: Eighty patients with lumbar disk herniation and intervertebral facet arthritis were equally and randomly divided into two groups. Under CT guidance, O3 nucleus pulposus ablation was performed in patients of group A(n=40), while O3 nucleus pulposus ablation combined with intervertebral facet joint injection of compound Betamethasome (0.5-1 ml) was carried out in patients of group B(n=40). Using double blind method the therapeutic effectiveness was evaluated before and 1 week,3,6-months after the procedure by an Oswestry Low Back Pain Disability Questionnaire. Results: One week after the procedure the effective rate of group A and group B was 65% and 82.5% respectively. Three and six months after the treatment, the effective rate was 75% and 70% respectively for group A, while it was 90% and 92.5% respectively for group B. The difference between two groups was significant (P 3 combined with intervertebral facet joint injection of compound Betamethasome is an effective and safe treatment for lumbar disk herniation accompanied with intervertebral facet arthritis.It is worth popularizing this technique in clinical practice. (authors)

  1. Decision making in the management of canine intervertebral disc disease

    Intervertebral disc disease is a frequent disorder of dogs; it is only rarely a cause of clinical signs in cats. Most clinicians are familiar with the diagnosis of the condition, but there may be some confusion about the most appropriate methods of treatment. While there is some controversy regarding certain regimens, particularly involving unconventional methods, there is a large amount of data in the veterinary literature concerning the disease. This article draws on this data to present guidelines which can be used in selecting the most appropriate method of treatment for individual patients

  2. ELECTROACUPUNCTURE TREATMENT OF 176 CASES OF LUMBAR INTERVERTEBRAL DISC PROTRUSION

    LI Lanmin

    2002-01-01

    In the present paper, 176 cases of lumbar intervertebral disc protrusion are treated with electroacupuncture (EA) and topical heat irradiation. Local tender-point is used as the main acupoint, combined with Tunzhong, Tiaoyue, Weizhong (BL 40) and Yanglingquan (GB 34). The treatment is conducted once daily, with 15 sessions being a therapeutic course. Following treatment, of 176 cases, 46 (26. 1%) are cured, 90 (51. 1%) have prominent improvement, 35 (19.8%) have amelioration and 5 (2.8%) have no apparent changes, with a total effective rate of 97.0%.

  3. ELECTROACUPUNCTURE TREATMENT OF 176 CASES OF LUMBAR INTERVERTEBRAL DISC PROTRUSION

    2002-01-01

    In the present paper,176 cases of lumbar intervertebral disc protusion are treated with electroacupuncture(EA) and topical heat irradiation.Local tender-point is used as the main acupoint ,combined with Tunzhong,Tiaoyue,Weizhong(BL40)and Yanglingquan(GB34).The treatment is conducted once daily,with 15 sessions being a therapeutic course,Following treatment,of 176 cases,46(26.1%) are cured.90(51.1%)have prominent improvement ,35(19.8%)have amelioration and 5(2.8%) have no apparent changes,with a total effective rate of 97.0%.

  4. Treatment of Protrusion of Cervical Intervertebral Disc by Tuina

    YE Jian-guo

    2004-01-01

    Twenty-five cases of protrusion of cervical intervertebral disc were treated by the manipulations of rolling, pressing, pushing with one-finger, traction, obliquely pulling, grasping of five channels, sweeping, etc. The result showed that 10 cases were cured, 14 cases got marked effectiveness and 1 case was improved.%采用滚、按、一指禅、拔伸、斜扳、拿五经、扫散法等手法,治疗颈椎间盘突出症患者25例,结果治愈10例,显效14例,好转1例.

  5. Transplantation of gene-modified nucleus pulposus cells reverses rabbit intervertebral disc degeneration

    LIU Yong; LI Jian-min; HU You-gu

    2011-01-01

    Background Intervertebral disc degeneration is the main cause of low back pain. The purpose of this study was to explore potential methods for reversing the degeneration of lumbar intervertebral discs by transplantation of gene-modified nucleus pulposus cells into rabbit degenerative lumbar intervertebral discs after transfecting rabbit nucleus pulposus cells with adeno-associated virus 2 (AAV2)-mediated connective tissue growth factor (CTGF) and tissue inhibitor of metalloproteinases 1 (TIMP1) genes in vitro.Methods Computer tomography (CT)-guided percutaneous annulus fibrosus injury was performed to build degenerative lumbar intervertebral disc models in 60 New Zealand white rabbits. rAAV2-CTGF-IRES-TIMP1-transfected rabbit nucleus pulposus cells were transplanted into degenerative lumbar intervertebral discs (transplantation group),phosphate-buffered saline (PBS) was injected into degenerative lumbar intervertebral discs (degeneration control group)and normal lumbar intervertebral discs served as a blank control group. After 6, 10 and 14 weeks, the disc height index (DHI) and signal intensity in intervertebral discs were observed by X-ray and magnetic resonance imaging (MRI) analysis.The expression of CTGF and TIMP1 in nucleus pulposus tissue was determined by Western blotting analysis, the synthesis efficiency of proteoglycan was determined by a 35S-sulfate incorporation assay, and the mRNA expression of type Ⅱ collagen and proteoglycan was detected by RT-PCR.Results MRI confirmed that degenerative intervertebral discs appeared two weeks after percutaneous puncture.Transgenic nucleus pulposus cell transplantation could retard the rapid deterioration of the DHI. MRI indicated that degenerative intervertebral discs were relieved in the transplantation group compared with the degeneration control group. The expression of collagen Ⅱ mRNA and proteoglycan mRNA was significantly higher in the transplantation group and the blank control group compared with the

  6. Depression of the Thoracolumbar Posterior Vertebral Body on the Estimation of Cement Leakage in Vertebroplasty and Kyphoplasty Operations

    Hao Chen

    2015-01-01

    Conclusions: Depression of the thoracolumbar posterior vertebral body may be informative for the estimation of cement location on C-arm images. To reduce type-B leakage, DCPW should be made longer than DBCV on C-arm images for safety during PVP or PKP.

  7. Combined Anterior-Posterior Surgery Versus Posterior Surgery for Thoracolumbar Burst Fractures: A Systematic Review of the Literature

    P.P. Oprel (Pim); W.E. Tuinebreijer (Wim); P. Patka (Peter); D. den Hartog (Dennis)

    2010-01-01

    textabstractAbstract: Study Design: A systematic quantitative review of the literature. Objective: To compare combined anterior-posterior surgery versus posterior surgery for thoracolumbar fractures in order to identify better treatments. Summary of Background Data: Axial load of the anterior and mi

  8. Accuracy of ultrasound-guided injections of thoracolumbar articular process joints in horses

    Fuglbjerg, Vibeke; Nielsen, J.V.; Thomsen, Preben Dybdahl;

    2010-01-01

    Reasons for performing study: Arthrosis of the articular process joints (APJs) in the caudal thoracolumbar region of horses may cause back pain and subsequent reduced performance or lameness. Ultrasound-guided injections of the APJs of the equine back have been described only briefly in the liter......Reasons for performing study: Arthrosis of the articular process joints (APJs) in the caudal thoracolumbar region of horses may cause back pain and subsequent reduced performance or lameness. Ultrasound-guided injections of the APJs of the equine back have been described only briefly...... unrelated to back problems. The backs were subsequently dissected to verify the location of the injectate in relation to the APJs. Results: Twenty-seven percent of the injections were found to be intra-articular and a total of 77% found to be within 2 mm of the joint capsule including the intra......-articular deposits. Application of a medial approach and 18 gauge needle were significantly associated with an intra-articulr injection or deposition close to the joint capsule. Operator, APJ (location) and back number (chronological) did not significantly affect the accuracy of injection. Conclusions and potential...

  9. Can MRI Findings Help to Predict Neurological Recovery in Paraplegics With Thoracolumbar Fracture?

    Lee, Joonchul; Koh, Seong-Eun; Jung, Heeyoune; Lee, Hye Yeon

    2015-01-01

    Objective To evaluate the usefulness of various magnetic resonance imaging (MRI) findings in the prognosis of neurological recovery in paraplegics with thoracolumbar fracture using association analysis with clinical outcomes and electrodiagnostic features. Methods This retrospective study involved 30 patients treated for paraplegia following thoracolumbar fracture. On axial and sagittal T2-weighted MRI scans, nerve root sedimentation sign, root aggregation sign, and signal intensity changes in the conus medullaris were independently assessed by two raters. A positive sedimentation sign was defined as the absence of nerve root sedimentation. The root aggregation sign was defined as the presence of root aggregation in at least one axial MRI scan. Clinical outcomes including the American Spinal Injury Association impairment scale, ambulatory capacity, and electrodiagnostic features were used for association analysis. Results Inter-rater reliability of the nerve root sedimentation sign and the root aggregation sign were κ=0.67 (p=0.001) and κ=0.78 (prehabilitation program (χ2=4.854, p=0.028). The presence of the root aggregation sign was associated with reduced compound muscle action potential amplitude of common peroneal and tibial nerves in nerve conduction studies (χ2=5.026, p=0.025). Conclusion A positive sedimentation sign was significantly associated with recovery of ambulatory capacity and not indicative of persistent paralysis. The root aggregation sign suggested the existence of significant cauda equina injuries. PMID:26798606

  10. Technical considerations in transforaminal endoscopic spine surgery at the thoracolumbar junction: report of 3 cases.

    Telfeian, Albert E; Jasper, Gabriele P; Oyelese, Adetokunbo A; Gokaslan, Ziya L

    2016-02-01

    OBJECTIVE In this study the authors describe the technical considerations and feasibility of transforaminal discectomy and foraminoplasty for the treatment of lumbar radiculopathy in patients who have herniated discs at the thoracolumbar junction. METHODS After institutional review board approval, charts from 3 consecutive patients with lumbar radiculopathy and T12-L1 herniated discs who underwent endoscopic procedures between 2006 and 2014 were reviewed. RESULTS Consecutive cases (n = 1316) were reviewed to determine the incidence and success of surgery performed at the T12-L1 level. Only 3 patients (0.23%) treated with endoscopic surgery for their herniated discs had T12-L1 herniated discs; the rest were lumbar or lumbosacral herniations. For patients with T12-L1 disc herniations, the average preoperative visual analog scale score was 8.3 (indicated in the questionnaire as describing severe and constant pain). The average 1-year postoperative visual analog scale score was 1.7 (indicated in the questionnaire as mild and intermittent pain). CONCLUSIONS Transforaminal endoscopic discectomy and foraminotomy can be used as a safe yet minimally invasive technique for the treatment of lumbar radiculopathy in the setting of a thoracolumbar disc herniation. PMID:26828890

  11. Treatment of Protrusion of the Lumbar Intervertebral Disc by Massotherapy

    程斌

    2001-01-01

    @@Clinically, there is a higher incidence of protrusion of the lumbar intervertebral disc. It can cause a terrible pain. The author has treated 66 cases by massotherapy, who were confirmatively diagnosed as having protrusion of the lumbar intervertebral disc by X-ray film and computer-aided tomography, with satisfactory results as reported in the following. Clinical Data Among the 66 cases in this series, 49 were male and 17 female, ranging in age from 26 to 59 years, averaging 36.2 years. All the patients had got lumbago and unilateral ischialgia, with the left side affected in 37 cases and the right side in 29 cases. The leg pain radiating to lateral malleolus was found in 28 cases, to dorsum of the foot in 24 cases, and to the toes in 14 cases. Intermittent claudication was present in 22 cases, numbness of the affected foot in 16 cases, pain exacerbated when coughing in 35 cases, scoliosis in 21 cases, and positive Lasegue's sign in 48 cases.

  12. Mechanisms for mechanical damage in the intervertebral disc annulus fibrosus.

    Iatridis, J C James C; ap Gwynn, Iolo

    2004-08-01

    Intervertebral disc degeneration results in disorganization of the laminate structure of the annulus that may arise from mechanical microfailure. Failure mechanisms in the annulus were investigated using composite lamination theory and other analyses to calculate stresses in annulus layers, interlaminar shear stress, and the region of stress concentration around a fiber break. Scanning electron microscopy (SEM) was used to evaluate failure patterns in the annulus and evaluate novel structural features of the disc tissue. Stress concentrations in the annulus due to an isolated fiber break were localized to approximately 5 microm away from the break, and only considered a likely cause of annulus fibrosus failure (i.e., radial tears in the annulus) under extreme loading conditions or when collagen damage occurs over a relatively large region. Interlaminar shear stresses were calculated to be relatively large, to increase with layer thickness (as reported with degeneration), and were considered to be associated with propagation of circumferential tears in the annulus. SEM analysis of intervertebral disc annulus fibrosus tissue demonstrated a clear laminate structure, delamination, matrix cracking, and fiber failure. Novel structural features noted with SEM also included the presence of small tubules that appear to run along the length of collagen fibers in the annulus and a distinct collagenous structure representative of a pericellular matrix in the nucleus region. PMID:15212921

  13. Mechanical Characterization of the Human Lumbar Intervertebral Disc Subjected to Impact Loading Conditions

    Jamison, David, IV

    Low back pain is a large and costly problem in the United States. Several working populations, such as miners, construction workers, forklift operators, and military personnel, have an increased risk and prevalence of low back pain compared to the general population. This is due to exposure to repeated, transient impact shocks, particularly while operating vehicles or other machinery. These shocks typically do not cause acute injury, but rather lead to pain and injury over time. The major focus in low back pain is often the intervertebral disc, due to its role as the major primary load-bearing component along the spinal column. The formation of a reliable standard for human lumbar disc exposure to repeated transient shock could potentially reduce injury risk for these working populations. The objective of this project, therefore, is to characterize the mechanical response of the lumbar intervertebral disc subjected to sub-traumatic impact loading conditions using both cadaveric and computational models, and to investigate the possible implications of this type of loading environment for low back pain. Axial, compressive impact loading events on Naval high speed boats were simulated in the laboratory and applied to human cadaveric specimen. Disc stiffness was higher and hysteresis was lower than quasi-static loading conditions. This indicates a shift in mechanical response when the disc is under impact loads and this behavior could be contributing to long-term back pain. Interstitial fluid loss and disc height changes were shown to affect disc impact mechanics in a creep study. Neutral zone increased, while energy dissipation and low-strain region stiffness decreased. This suggests that the disc has greater clinical instability during impact loading with progressive creep and fluid loss, indicating that time of day should be considered for working populations subjected to impact loads. A finite element model was developed and validated against cadaver specimen

  14. 80 CASES OF PROLAPSE OF LUMBAR INTERVERTEBRAL DISC TREATED BY ROUND-SHARP NEEDLE

    ZHANG Yu-he

    2005-01-01

    Objective: To observe the therapeutic effect of round-sharp needle for prolapse of lumbar intervertebral disc. Methods: A total of 80 cases of lumbar intervertebral disc prolapse were treated by puncturing Qihaishu (气海俞 BL 24), Guanyuanshu (关元俞 BL 26), etc., with round-sharp needle, once every week, continuously for 4 sessions. Results: After the treatment, of the 80 cases, 56 (70 %) were cured, 16 (20%) improved,and 8 (10)%) failed, with an effective rate of 90%. Conclusion: Round-sharp needle works well in the treatment of prolapse of lumbar intervertebral disc.

  15. Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system: an analysis of 38 cases

    Wang, Hong-Wei; Li, Chang-Qing; Zhou, Yue; Zhang, Zheng-Feng; Wang, Jian; Chu, Tong-Wei

    2010-01-01

    To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non- randomized case-control study.

  16. Biomechanical evaluation of vertebroplasty using calcium sulfate cement for thoracolumbar burst fractures

    WU Xiao-tao; JIANG Xing-jie; ZHANG Shao-dong; YANG Hui-lin

    2007-01-01

    Objective: To evaluate the biomechanical performance of vertebroplasty using calcium sulfate cement for thoracolumbar burst fractures.Methods: Sixteen bovine thoracolumbar spines (T11-L1 ) were divided into 4 groups (A, B, C and D). After burst-fracture model was created, 12 vertebral bodies in Groups A, B and C were augmented with calcium sulfate cement (CSC), calcium phosphate cement (CPC) and polymethylmethacrylate ( PMMA ) bone cement,respectively. Each anterior vertebral body height was measured with a caliper at 4 time points: intact conditions(HInt), post-fracture (HFr), post-reduction (HRe) and post-vertebroplasty (HVP). The filling volume of 3 different bone cements was also measured. Each vertebral body was compressed at 0.5 mm/s using a hinged plating system on a materials testing machine to 50% of the postvertebroplasty height to determine strength and stiffness.Difference was checked using t test or One-way ANOVA.Results: The average strike energy was 66. 2 J.Vertebroplasty with different cements could sustain vertebral height. The average filling volume of bone cement in 3 groups was 4.35 ml (CSC), 3.72 ml (CPC) and 3.95 ml (PMMA), respectively, and there was no statistically significant difference among them ( P >0.05).Vertebroplasty with PMMA completely restored strength(116%) and stiffness (105%). CSC or CPC partly recovered vertebral strength and stiffness. However,greater strength restoration was got with CSC ( 1 659 N) as compared with CPC (1 011N, P<0.01 ). Regarding stiffness, differences between CSC (140 N/mm ±40 N/mm)and the other two bone cements ( CPC :148 N/mm ±33 N/mm,PMMA:236 N/mm ±97 N/mm) were not significant (P>0.05).Conclusions: For a burst-fracture of calf spine, useof CSC for vertebroplasty yields similar vertebral stiffnessas compared with PMMA or CPC. Although augmentationwith CSC partly obtains the normal strength, thistreatment still can be applied in thoracolumbar burstfractures with other instrumental devices in

  17. Comparison of three different surgical approaches for treatment of thoracolumbar burst fracture

    WU Han; WANG Chun-xin; GU Chang-yue; ZHANG Zi-yan; TONG Shen; YAN Hua-dong; WANG Jin-cheng

    2013-01-01

    Objective:The main treatment method used for thoracolumbar fractures is open reduction and internal fixation.Commonly there are three surgical approaches:anterior,posterior and paraspinal.We attempt to compare the three approaches based on our clinical data analysis.Methods:A group of 94 patients with Denis type A or B thoracolumbar burst fracture between March 2008 and September 2010 were recruited in this study.These patients were treated by anterior-,posterior-or paraspinal-approach reduction with or without decompression.The fracture was fixed with titanium mesh and Z-plate via anterior approach (24 patients),screw and rod system via posterior approach (38 patients) or paraspinal approach (32 patients).Clinical evaluations included operation duration,blood loss,incision length,preoperative and postoperative Oswestry disability index (ODI).Results:The average operation duration (94.1 min±13.7min),blood loss (86.7 ml±20.0 ml),length of incision (9.3mm± 0.7 mm) and postoperative ODI (6±0.5) were significandy lower (P<0.05) in paraspinal approach group than in traditional posterior approach group (operation duration 94.1 min±13.7 min,blood loss 143.3 ml±28.3 ml,length of incision 15.4 cm±2.1 cm and ODI 12±0.7) and anterior approach group (operation duration 176.3 min±20.7 min,blood loss 255.1 m1±38.4 ml,length of incision 18.6 cm±2.4 cm and OD113±2.4).There was not statistical difference in terms of Cobb angle on radiographs among the three approaches.Conclusion:The anterior approach surgery is convenient for resection of the vertebrae and reconstruction of vertebral height,but it is more complicated and traumatic.Hence it is mostly used for severe Denis type B fracture.The posterior approach is commonly applied to most thoracolumbar fractures and has fewer complications compared with the anterior approach,but it has some shortcomings as well.The paraspinal approach has great advantages compared with the other two approaches.It is in accordance with

  18. Hybrid cadaveric/surrogate model of thoracolumbar spine injury due to simulated fall from height.

    Ivancic, Paul C

    2013-10-01

    A fall from high height can cause thoracolumbar spine fracture with retropulsion of endplate fragments into the canal leading to neurological deficit. Our objectives were to develop a hybrid cadaveric/surrogate model for producing thoracolumbar spine injury during simulated fall from height, evaluate the feasibility and performance of the model, and compare injuries with those observed clinically. Our model consisted of a 3-vertebra human lumbar specimen (L3-L4-L5) stabilized with muscle force replication and mounted within an impact dummy. The model was subjected to a fall from height of 2.2 m with impact velocity of 6.6 m/s. Kinetic and kinematic time-history responses were determined using spinal and pelvis load cell data and analyses of high-speed video. Injuries to the L4 vertebra were evaluated by fluoroscopy, radiography, and detailed anatomical dissection. Peak compression forces during the fall from height occurred at 7 ms and reached 44.7 kN at the ground, 9.1 kN at the pelvis, and 4.5 kN at the spine. Pelvis acceleration peaks reached 209.9 g at 8 ms for vertical and 62.8 g at 12 ms for rearward. Tensile load peaks were then observed (spine: 657.0 N at 47 ms; pelvis: 569.4 N at 61 ms). T1/pelvis peak flexion of 68.3° occurred at 38 ms as the upper torso translated forward while the pelvis translated rearward. Complete axial burst fracture of the L4 vertebra was observed including endplate comminution, retropulsion of bony fragments into the canal, loss of vertebral body height, and increased interpedicular distance due to fractures anterior to the pedicles and a vertical split fracture of the left lamina. Our dynamic injury model closely replicated the biomechanics of real-life fall from height and produced realistic, clinically relevant burst fracture of the lumbar spine. Our model may be used for further study of thoracolumbar spine injury mechanisms and injury prevention strategies. PMID:23792617

  19. Comparison of three different surgical approaches for treatment of thoracolumbar burst fracture

    WU Han

    2013-02-01

    Full Text Available 【Abstract】Objective: The main treatment method used for thoracolumbar fractures is open reduction and in-ternal fixation. Commonly there are three surgical approaches: anterior, posterior and paraspinal. We attempt to compare the three approaches based on our clinical data analysis. Methods: A group of 94 patients with Denis type A or B thoracolumbar burst fracture between March 2008 and September 2010 were recruited in this study. These patients were treated by anterior-, posterior- or paraspinal-approach reduction with or without decompression. The fracture was fixed with titanium mesh and Z-plate via anterior approach (24 patients, screw and rod system via posterior approach (38 patients or paraspinal approach (32 patients. Clinical evaluations included operation duration, blood loss, inci-sion length, preoperative and postoperative Oswestry dis-ability index (ODI. Results: The average operation duration (94.1 min±13.7 min, blood loss (86.7 ml±20.0 ml, length of incision (9.3 mm± 0.7 mm and postoperative ODI (6±0.5 were signifi-cantly lower (P<0.05 in paraspinal approach group than in traditional posterior approach group (operation duration 94.1 min±13.7 min, blood loss 143.3 ml±28.3 ml, length of incision 15.4 cm±2.1 cm and ODI 12±0.7 and anterior approach group (operation duration 176.3 min±20.7 min, blood loss 255.1 ml±38.4 ml, length of incision 18.6 cm±2.4 cm and ODI 13±2.4. There was not statistical difference in terms of Cobb angle on radiographs among the three approaches. Conclusion: The anterior approach surgery is conve-nient for resection of the vertebrae and reconstruction of vertebral height, but it is more complicated and traumatic. Hence it is mostly used for severe Denis type B fracture. The posterior approach is commonly applied to most thora-columbar fractures and has fewer complications compared with the anterior approach, but it has some shortcomings as well. The paraspinal approach has great advantages

  20. A new brace treatment similar for adolescent scoliosis and kyphosis based on restoration of thoracolumbar lordosis. Radiological and subjective clinical results after at least one year of treatment

    van Loon Piet JM

    2012-10-01

    Full Text Available Abstract Study design A prospective treatment study with a new brace was conducted Objective. To evaluate radiological and subjective clinical results after one year conservative brace treatment with pressure onto lordosis at the thoracolumbar joint in children with scoliosis and kyphosis. Summary of background data Conservative brace treatment of adolescent scoliosis is not proven to be effective in terms of lasting correction. Conservative treatment in kyphotic deformities may lead to satisfactory correction. None of the brace or casting techniques is based on sagittal forces only applied at the thoracolumbar spine (TLI= thoracolumbar lordotic intervention. Previously we showed in patients with scoliosis after forced lordosis at the thoracolumbar spine a radiological instantaneous reduction in both coronal curves of double major scoliosis. Methods A consecutive series of 91 children with adolescent scoliosis and kyphosis were treated with a modified symmetric 30 degrees Boston brace to ensure only forced lordosis at the thoracolumbar spine. Scoliosis was defined with a Cobb angle of at least one of the curves [greater than or equal to] 25 degrees and kyphosis with or without a curve Results Before treatment start ‘in brace’ radiographs showed a strong reduction of the Cobb angles in different curves in kyphosis and scoliosis groups (sagittal n = 5 all p Conclusion Conservative treatment using thoracolumbar lordotic intervention in scoliotic and kyphotic deformities in adolescence demonstrates a marked improvement after one year also in clinical and postural criteria. An effect not obtained with current brace techniques.

  1. TCM Treatment for Protrusion of Lumbar Intervertebral Disc——A Report of 100 Cases

    Li Xiang; Li Xulin; Hou Fengmei; Jia Guoqing

    2006-01-01

    @@ Since the year of 2003,100 cases of protrusion of lumbar intervertebral disc (PLID) have been treated in our department by using Chinese drugs combined with massotherapy, with quite good therapeutic results reported as follows.

  2. Protective Effect of Ligustrazine on Lumbar Intervertebral Disc Degeneration of Rats Induced by Prolonged Upright Posture

    Qian-Qian Liang

    2014-01-01

    Full Text Available Most chronic low back pain is the result of degeneration of the lumbar intervertebral disc. Ligustrazine, an alkaloid from Chuanxiong, reportedly is able to relieve pain, suppress inflammation, and treat osteoarthritis and it has the protective effect on cartilage and chondrocytes. Therefore, we asked whether ligustrazine could reduce intervertebral disc degeneration. To determine the effect of ligustrazine on disc degeneration, we applied a rat model. The intervertebral disc degeneration of the rats was induced by prolonged upright posture. We found that pretreatment with ligustrazine for 1 month recovered the structural distortion of the degenerative disc; inhibited the expression of type X collagen, matrix metalloproteinase (MMP-13, and MMP3; upregulated type II collagen; and decreased IL-1β, cyclooxygenase (COX-2, and inducible nitric oxide synthase (iNOS expression. In conclusion, ligustrazine is a promising agent for treating lumbar intervertebral disc degeneration disease.

  3. Radiation diagnosis of sequestrated intervertebral disk hernias of the lumbar spine

    The work is based on complex examination of 137 patients with sequestered intervertebral disk hernias of the lumbosacral spine with the use of an x-ray method, helical computed tomography, magnetic resonance imaging.

  4. Effect of osteoporosis and intervertebral disc degeneration on endplate cartilage injury in rats

    Lei Wang; Wei Cui; Jean Pierre Kalala; Tom Van Hoof; Bao-Ge Liu

    2014-01-01

    Objective:To investigate the effect of osteoporosis and intervertebral disc degeneration on the endplate cartilage injury in rats.Methods:A total of48 femaleSpragueDawley rats(3 months) were randomly divided intoGroupsA,B,C andD with12 rats in each group.Osteoporosis and intervertebral disc degeneration composite model, simple degeneration model and simple osteoporosis model were prepared inGroupsA,B andC respectively.After modeling, four rats of each group at12th,18th and24th week were sacrificed.Intervertebral height of cervical vertebra C6/C7 was measured.Micro-CT was used to image the endplate of cephalic and caudal cartilage atC6/C7 intervertebral disc.Abraded area rate ofC6 caudal andC7 cephalic cartilage endplate was calculated, and thenC6/C7 intervertebral disc was routinely embedded and sectioned, stained with safraninO to observe histological changes microscopically.Results:At12,18 and 24 weeks, intervertebral disc height ofC6/C7 were(0.58±0.09) mm,(0.53±0.04) mm and(0.04±0.06) mm inGroupA rats,(0.55±0.05) mm,(0.52±0.07) mm and(0.07±0.05) mm inGroupB rats.At24th week, intervertebral disc height ofGroupA rats was significantly lower than that ofGroupB rats (P0.05).At12 and18 weeks, the abraded rate ofC6 caudal andC7 cephalic cartilage endplate inGroupA rats were significantly higher than that inGroupsB,C andD rats(P0.05).Microscopic observation ofCT showed that ventral defects inC6 caudal orC7 cephalic cartilage endplate inGroupsA andB appeared after12 weeks of modeling;obvious cracks were found in front of theC6 andC7 vertebral body, and cartilage defect shown the trend of "repairing" at18 and24 weeks after modeling.Conclusions:Intervertebral disc degeneration and osteoporosis can cause damage to the cartilage endplate.Co-existence of these two factors can induce more serious damage to the endplate, which has possitive correlation with intervertebral disc degeneration.Osteoporosis plays a certain role in intervertebral disc degeneration process, and

  5. Future perspectives of cell-based therapy for intervertebral disc disease

    Sakai, Daisuke

    2008-01-01

    Intervertebral disc degeneration is a primary cause of low back pain and has a high societal cost. Research on cell-based therapies for intervertebral disc disease is emerging, along with the interest in biological therapy to treat disc disease without reducing the mobility of the spinal motion segment. Results from animal models have shown promising results under limited conditions; however, future studies are needed to optimise efficacy, methodology, and safety. To advance research on cell-...

  6. A Review of Animal Models of Intervertebral Disc Degeneration: Pathophysiology, Regeneration, and Translation to the Clinic

    Chris Daly; Peter Ghosh; Graham Jenkin; David Oehme; Tony Goldschlager

    2016-01-01

    Lower back pain is the leading cause of disability worldwide. Discogenic pain secondary to intervertebral disc degeneration is a significant cause of low back pain. Disc degeneration is a complex multifactorial process. Animal models are essential to furthering understanding of the degenerative process and testing potential therapies. The adult human lumbar intervertebral disc is characterized by the loss of notochordal cells, relatively large size, essentially avascular nature, and exposure ...

  7. Spontaneous fusion across the apex of severe thoracolumbar Scheuermann′s kyphosis: A surgical consideration

    Tsirikos Athanasios

    2010-01-01

    Full Text Available Considerable debate exists regarding the pathogenesis, natural history and treatment of Scheuermann′s kyphosis. Surgical correction is indicated in the presence of severe kyphosis which carries the risk of neurological complications, persistent back pain and significant cosmetic deformity. This can be achieved through a posterior-only or an anteroposterior approach. Spontaneous fusion in association with Scheuermann′s kyphosis has not been previously described. This is an important consideration if surgical correction of the kyphosis is planned. Two patients with severe thoracolumbar Scheuermann′s kyphosis who developed spontaneous posterior and anteroposterior fusion across the apex of the deformity are presented. The surgical treatment and final outcome is discussed.

  8. Simultaneously anterior decompression and posterior instrumentation by extrapleural retroperitoneal approach in thoracolumbar lesions

    Jain Anil

    2010-01-01

    Full Text Available Background: Anterior decompression with posterior instrumentation when indicated in thoracolumbar spinal lesions if performed simultaneously in single-stage expedites rehabilitation and recovery. Transthoracic, transdiaphragmatic approach to access the thoracolumbar junction is associated with significant morbidity, as it violates thoracic cavity; requires cutting of diaphragm and a separate approach, for posterior instrumentation. We evaluated the clinical outcome morbidity and feasibility of extrapleural retroperitoneal approach to perform anterior decompression and posterior instrumentation simultaneously by single "T" incision outcome in thoracolumbar spinal trauma and tuberculosis. Patients and Methods: Forty-eight cases of tubercular spine (n = 25 and fracture of the spine (n = 23 were included in the study of which 29 were male and 19 female. The mean age of patients was 29.1 years. All patients underwent single-stage anterior decompression, fusion, and posterior instrumentation (except two old traumatic cases via extrapleural retroperitoneal approach by single "T" incision. Tuberculosis cases were operated in lateral position as they were stabilized with Hartshill instrumentation. For traumatic spine initially posterior pedicle screw fixation was performed in prone position and then turned to right lateral position for anterior decompression by same incision and approach. They were evaluated for blood loss, duration of surgery, superficial and deep infection of incision site, flap necrosis, correction of the kyphotic deformity, and restoration of anterior and posterior vertebral body height. Results: In traumatic spine group the mean duration of surgery was 269 minutes (range 215-315 minutes including the change over time from prone to lateral position. The mean intraoperative blood loss was 918 ml (range 550-1100 ml. The preoperative mean ASIA motor, pin prick and light touch score improved from 63.3 to 74.4, 86 to 94.4 and 86 to 96 at

  9. Autophagy: A double-edged sword in intervertebral disk degeneration.

    Zhang, Shu-Jun; Yang, Wei; Wang, Cheng; He, Wen-Si; Deng, Hai-Yang; Yan, Yi-Guo; Zhang, Jian; Xiang, Yong-Xiao; Wang, Wen-Jun

    2016-06-01

    Autophagy is a homeostatic mechanism through which intracellular damaged organelles and proteins are degraded and recycled in response to increased metabolic demands or stresses. Although primarily cytoprotective, dysfunction of autophagy is often associated with many degenerative diseases, including intervertebral disc (IVD) degeneration (IDD). As a main contributing factor to low back pain, IDD is the pathological basis for various debilitating spinal diseases. Either higher or lower levels of autophagy are observed in degenerative IVD cells. Despite the precise role of autophagy in disc degeneration that is still controversial, with difference from protection to aggravation, targeting autophagy has shown promise for mitigating disc degeneration. In the current review, we summarize the changes of autophagy in degenerative IVD cells and mainly discuss the relationship between autophagy and IDD. With continued efforts, modulation of the autophagic process could be a potential and attractive therapeutic strategy for degenerative disc disease. PMID:27018178

  10. Molecular mechanisms of cell death in intervertebral disc degeneration (Review).

    Zhang, Fan; Zhao, Xueling; Shen, Hongxing; Zhang, Caiguo

    2016-06-01

    Intervertebral discs (IVDs) are complex structures that consist of three parts, namely, nucleus pulposus, annulus fibrosus and cartilage endplates. With aging, IVDs gradually degenerate as a consequence of many factors, such as microenvironment changes and cell death. Human clinical trial and animal model studies have documented that cell death, particularly apoptosis and autophagy, significantly contribute to IVD degeneration. The mechanisms underlying this phenomenon include the activation of apoptotic pathways and the regulation of autophagy in response to nutrient deprivation and multiple stresses. In this review, we briefly summarize recent progress in understanding the function and regulation of apoptosis and autophagy signaling pathways. In particular, we focus on studies that reveal the functional mechanisms of these pathways in IVD degeneration. PMID:27121482

  11. Correlation of outcome measures with epidemiological factors in thoracolumbar spinal trauma

    Upendra Bidre

    2007-01-01

    Full Text Available Background : The epidemiological data of a given population on spinal trauma in India is lacking. The present study was undertaken to evaluate the profile of patients with thoracolumbar fractures in a tertiary care hospital in an urban setup. Materials and Methods : Four hundred forty patients with thoracolumbar spinal injuries admitted from January 1990 to May 2000 to the All India Institute of Medical Sciences were included in the analysis. Both retrospective data retrieval and prospective data evaluation of patients were done from January 1998 to May 2000. Epidemiological factors like age, sex and type of injury, mode of transport, time of reporting and number of transfers before admission were recorded. Frankel′s grading was used to assess neurological status. Functional assessment of all patients was done using the FIM™ instrument (Functional Independence Measure. Average follow-up was 33 months (24-41 months. Results : Of the 440 patients, females comprised 17.95% (n=79, while 82.04% (n=361 were males. As many as 40.9% (n=180 of them were in the third decade. Fall from height remained the most common cause 52.3% (n=230. Two hundred sixty (59.1% patients reported within 48 hours. Thirty-two (7.27% patients had single transfer, and all 32 showed complete independence for mobility at final follow-up. 100 of 260 (38.5% patients reporting within 48 hours developed pressure sores, while 114 of 142 (80.28% patients reporting after 5 days developed pressure sores. Conclusion : The present study highlights the magnitude of the problems of our trauma-care and transport system and the difference an effective system can make in the care of spinal injury patients. There is an urgent need for epidemiological data on a larger scale to emphasize the need for a better trauma-care system and pave way for adaptation of well-established trauma-care systems from developed countries.

  12. Biomechanics of Thoracolumbar Burst and Chance-Type Fractures during Fall from Height

    Ivancic, Paul C.

    2014-01-01

    Study Design In vitro biomechanical study. Objective To investigate the biomechanics of thoracolumbar burst and Chance-type fractures during fall from height. Methods Our model consisted of a three-vertebra human thoracolumbar specimen (n = 4) stabilized with muscle force replication and mounted within an impact dummy. Each specimen was subjected to a single fall from an average height of 2.1 m with average velocity at impact of 6.4 m/s. Biomechanical responses were determined using impact load data combined with high-speed movie analyses. Injuries to the middle vertebra of each spinal segment were evaluated using imaging and dissection. Results Average peak compressive forces occurred within 10 milliseconds of impact and reached 40.3 kN at the ground, 7.1 kN at the lower vertebra, and 3.6 kN at the upper vertebra. Subsequently, average peak flexion (55.0 degrees) and tensile forces (0.7 kN upper vertebra, 0.3 kN lower vertebra) occurred between 43.0 and 60.0 milliseconds. The middle vertebra of all specimens sustained pedicle and endplate fractures with comminution, bursting, and reduced height of its vertebral body. Chance-type fractures were observed consisting of a horizontal split fracture through the laminae and pedicles extending anteriorly through the vertebral body. Conclusions We hypothesize that the compression fractures of the pedicles and vertebral body together with burst fracture occurred at the time of peak spinal compression, 10 milliseconds. Subsequently, the onset of Chance-type fracture occurred at 20 milliseconds through the already fractured and weakened pedicles and vertebral body due to flexion-distraction and a forward shifting spinal axis of rotation. PMID:25083357

  13. Creating reproducible thoracolumbar burst fractures in human specimens: an in vitro experiment.

    Oberkircher, Ludwig; Schmuck, Maya; Bergmann, Martin; Lechler, Philipp; Ruchholtz, Steffen; Krüger, Antonio

    2016-04-01

    OBJECT The treatment of traumatic burst fractures unaccompanied by neurological impairment remains controversial and ranges from conservative management to 360° fusion. Because of the heterogeneity of fracture types, classification systems, and treatment options, comparative biomechanical studies might help to improve our knowledge. The aim of the current study was to create a standardized fracture model to investigate burst fractures in a multisegmental setting. METHODS A total of 28 thoracolumbar fresh-frozen human cadaveric spines were used. The spines were dissected into segments (T11-L3). The T-11 and L-3 vertebral bodies were embedded in Technovit 3040 (cold-curing resin for surface testing and impressions). To simulate high energy, a metallic drop tower was designed. Stress risers were used to ensure comparable fractures. CT scans were acquired before and after fracture. All fractures were classified using the AO/OTA classification. RESULTS The preparation and embedding of the spine segments worked well. No repositioning or second embedding of the specimen, even after fracture, was required. It was possible to create single burst fractures at the L-1 level in all 28 spine segments. Among the 28 fractures there were 16 incomplete burst fractures (Type A3.1), 8 burst-split fractures (Type A3.2), and 4 complete burst fractures (Type A3.3). The differences before and after fracture for stiffness and for anterior, posterior, and central heights were all significant (p < 0.05). CONCLUSIONS The ability to create reproducible burst fractures of a single vertebral body in a thoracolumbar spine segment may serve as a basis for future biomechanical studies that will provide better understanding of mechanical properties or fixation techniques. PMID:26682598

  14. Heparanase isoform expression and extracellular matrix remodeling in intervertebral disc degenerative disease

    Luciano Miller Reis Rodrigues

    2011-01-01

    Full Text Available OBJECTIVE: To determine the molecules involved in extracellular matrix remodeling and to identify and quantify heparanase isoforms present in herniated and degenerative discs. INTRODUCTION: Heparanase is an endo-beta-glucuronidase that specifically acts upon the heparan sulfate chains of proteoglycans. However, heparanase expression in degenerative intervertebral discs has not yet been evaluated. Notably, previous studies demonstrated a correlation between changes in the heparan sulfate proteoglycan pattern and the degenerative process associated with intervertebral discs. METHODS: Twenty-nine samples of intervertebral degenerative discs, 23 samples of herniated discs and 12 samples of non-degenerative discs were analyzed. The expression of both heparanase isoforms (heparanase-1 and heparanase-2 was evaluated using immunohistochemistry and real-time RT-PCR analysis. RESULTS: Heparanase-1 and heparanase-2 expression levels were significantly higher in the herniated and degenerative discs in comparison to the control tissues, suggesting a possible role of these proteins in the intervertebral degenerative process. CONCLUSION: The overexpression of heparanase isoforms in the degenerative intervertebral discs and the herniated discs suggests a potential role of both proteins in the mediation of inflammatory processes and in extracellular matrix remodeling. The heparanase-2 isoform may be involved in normal metabolic processes, as evidenced by its higher expression in the control intervertebral discs relative to the expression of heparanase-1.

  15. Comparison of anthropometric method and medical image method in the lumbar intervertebral disc size

    Kim, Jong Soon; Kim, Chang Soo [College of Health Sciences, Catholic University of Pusan, Busan (Korea, Republic of)

    2007-06-15

    The purpose of this study was to examine the indirect estimation of the lumbar intervertebral disc size by two anthropometric methods (Colombini's method and Turk and Celan's method), in order to compare these indirect methods with the direct analysis by computed tomography (CT). The wrist, elbow, knee and ankle joint (right side) diameters were measured in 52 normal volunteers and intervertebral disc sizes were measured in 50 normal subjects by CT. Then the intervertebral disc sizes were calculated using two anthropometric formula. The data were analysed with ANOVA to differentiation between indirect and direct estimation of the lumbar intervertebral disc sizes. This study shows that male subjects have significantly larger L4-5 and L5-S1 intervertebral disc sizes than female subjects. In addition, disc sizes calculated by Colombini's formula were significantly larger than Turk and Celan's formula but were was no significant differences in the compared Turk and Celan's estimation with CT values. The indirect estimation of the intervertebral disc size by Turk and Celan's formula can be considered as a clinically useful method. However, further study should be conducted to compare anthropometric values according to age.

  16. "Free-hand" technique for thoracolumbar pedicle screw instrumentation: Critical appraisal of current "State-of-Art"

    Mattei Tobias

    2009-01-01

    Full Text Available Pedicle screws are widely used for instrumentation of the thoracolumbar spine. The anatomic studies performed in the last two decades, detailing the complex morphometry and three-dimensional anatomy of the thoracolumbar pedicles, have enabled the emergence of the so-called "free-hand" technique of pedicle screw placement based exclusively on anatomical parameters. However, in the thoracic spine, the benefits of pedicle screws have been tempered by its potential risks, such as, spinal canal violation, pedicle fracture, nerve root compression, and vascular lesions. Furthermore, the narrow and inconsistent shape of the thoracic pedicles, especially in spinal deformity, makes their placement technically challenging. In this article, the authors make a critical appraisal of current "state-of-art" of "free-hand" technique of pedicle instrumentation, analyzing its anatomical basis, surgical technique, present indications and limitations as well as the role of adjuvant image-guided and neurophysiological monitoring methods.

  17. Clinical observation of umbilical cord mesenchymal stem cell transplantation in treatment for sequelae of thoracolumbar spinal cord injury

    Cheng, Hongbin; Liu, Xuebin; Hua, Rongrong; Dai, Guanghui; Wang, Xiaodong; Gao, Jianhua; An, Yihua

    2014-01-01

    Background Umbilical cord mesenchymal stem cells (UCMSCs) have a considerable advantage and potential in treating for central nervous system diseases and have become a novel alternative treatment for spinal cord injury. This study aims to compare the neurological function outcome of stem cell transplantation, rehabilitation therapy, and self-healing for sequelae of spinal cord injury. Methods Thirty-four cases of thoracolumbar spinal cord injury were randomly divided into three groups: the st...

  18. The Effects of Glucocorticoid and Voluntary Exercise Treatment on the Development of Thoracolumbar Kyphosis in Dystrophin-Deficient Mice

    Brereton, Daniel; Plochocki, Jeffrey; An, Daniel; Costas, Jeffrey; Simons, Erin

    2012-01-01

    The development of spinal curvature deformities is a hallmark of muscular dystrophy. While glucocorticoid treatment has been shown to prolong muscle function in dystrophic mice, its effects on the development of dystrophinopathic spinal deformation are poorly understood. In this study, we test the effects of glucocorticoid treatment on the onset of thoracolumbar kyphosis in the dystrophin-deficient mdx mouse using voluntary running exercise to exacerbate muscle fibrosis. We measure the kyphot...

  19. Magnetic resonance imaging study determining cord level and occupancy at thoracolumbar junction in achondroplasia – A prospective study

    Modi, Hitesh N; Seung-Woo Suh; Jae-Young Hong; Jae-Hyuk Yang

    2011-01-01

    Background: Thoracolumbar (TL) stenosis in achondroplasia is frequently reported, and becomes symptomatic in adulthood. Hence we conducted a prospective study to determine cord level and occupancy at TL junction in symptomatic or asymptomatic achondroplasis patients in comparision to normal population by magnetic resonance imaging (MRI). Materials and Methods: Cord level with its occupancy rate and TL kyphosis were measured on MRI and standing radiogram, respectively. We prospectively stu...

  20. Comparison of therapeutic effects of anterior decompression and posterior decompression on thoracolumbar spine fracture complicated with spinal nerve injury

    Cui, Hongxun; Guo, Jiayi; Lei YANG; Guo, Yanxing; Guo, Malong

    2015-01-01

    Objective: To compare the clinical therapeutic effects of anterior decompression and posterior decompression on thoracolumbar spine fracture (TSF) complicated with spinal nerve injury (SNI). Methods: A total of 120 patients with TSF and SNI were selected and divided into a treatment group and a control group that were then treated by anterior decompression and posterior decompression respectively. The preoperative and postoperative motor scores, tactile scores, heights of injured vertebral bo...

  1. Postoperative Disc Wedging in Adolescent Idiopathic Thoracolumbar/Lumbar Scoliosis: a Comparison of Anterior and Posterior Approaches

    Bin Yu; Yi-peng Wang; Gui-xing Qiu; Jian-guo Zhang; Jian-xiong Shen; Yu Zhao; Shu-gang Li; Qi-yi Li

    2010-01-01

    Objective To evaluate the different influences of anterior and posterior correction and fusion ap-proaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis.Methods The retrospective study was conducted with the medical records and radiographs of ado-lescent idiopathic thoracolumbar/lumbar scoliosis patients that underwent anterior (group A) or posterior (group B) correction and fusion surgery from December 1998 to May 2008. The correction of the main curve and changes of the disc wedging were analyzed.Results Fifty-three patients were included, 26 in group A and 27 in group B. The mean coronal Cobb angles of the main curve in group A and group B were significantly corrected after surgery (P0.05). The difference between disc wedging at final follow-up and that after surgery was significant in group A (P0.05). Between the two groups, group A had larger disc angles after operation and at final follow-up (P<0.05), and a greater loss of disc angle (P<0.05).Conclusion For adolescent idiopathic thoracolumbar/lumbar scoliosis, posterior approach using all pedicle screws might produce a better result in terms of disc wedging compared with anterior approach.

  2. Magnetic resonance imaging of lumbar intervertebral discs in elderly patients with minor trauma

    Purpose: Vertebral body fractures due to minor trauma, which commonly occur in the elderly, are a frequently encountered clinical problem. We utilized MRI in patients with acute back pain following minor injury to ensure the earliest possible diagnosis. Lumbar discs adjacent to fractured vertebral bodies were evaluated, using magnetic resonance imaging (MRI), to elucidate how often these discs were injured and how the injured discs were depicted by MRI. Materials and methods: We retrospectively reviewed MR images of 74 discs from 37 elderly patients (>65-year-old) with a single level vertebral fracture (fracture group). Patients with multiple-level fractures, burst fractures and/or major trauma, such as that resulting from a traffic accident, were excluded from this study. We also reviewed MR images of 190 discs from 27 elderly patients diagnosed with lumbar stenosis, who had no previous history of vertebral body fractures (stenosis group). Results: In the fracture group, 23% (17/74) of T1-weighted images exhibited a high-intensity area in the disc, whereas only 3% (5/190) exhibited a high-intensity area in the stenosis group. In some cases, in the T2-weighted images we also found a high-intensity zone in discs that showed low- or iso-intensity. This phenomenon was more frequently observed in the fracture group (47%: 35/74) than in the stenosis group. Conclusion: The present study indicates that, in elderly patients, intervertebral discs adjacent to vertebral fractures resulting from minor trauma are often injured. Because hemorrhage is the most likely cause of a high-intensity T1-weighted image, the results indicate that hemorrhage can be induced in a disc adjacent to a vertebral body fractured by even minor trauma.

  3. Magnetic resonance imaging of lumbar intervertebral discs in elderly patients with minor trauma

    Afzal, Suhail [Orthopaedic Spine Surgeon, Spine Clinic, Srinagar, Kashmir (India)], E-mail: drsuhaila@yahoo.com; Akbar, Saleem [Nehru Hospital, Rose Belle (Mauritius)

    2009-05-15

    Purpose: Vertebral body fractures due to minor trauma, which commonly occur in the elderly, are a frequently encountered clinical problem. We utilized MRI in patients with acute back pain following minor injury to ensure the earliest possible diagnosis. Lumbar discs adjacent to fractured vertebral bodies were evaluated, using magnetic resonance imaging (MRI), to elucidate how often these discs were injured and how the injured discs were depicted by MRI. Materials and methods: We retrospectively reviewed MR images of 74 discs from 37 elderly patients (>65-year-old) with a single level vertebral fracture (fracture group). Patients with multiple-level fractures, burst fractures and/or major trauma, such as that resulting from a traffic accident, were excluded from this study. We also reviewed MR images of 190 discs from 27 elderly patients diagnosed with lumbar stenosis, who had no previous history of vertebral body fractures (stenosis group). Results: In the fracture group, 23% (17/74) of T1-weighted images exhibited a high-intensity area in the disc, whereas only 3% (5/190) exhibited a high-intensity area in the stenosis group. In some cases, in the T2-weighted images we also found a high-intensity zone in discs that showed low- or iso-intensity. This phenomenon was more frequently observed in the fracture group (47%: 35/74) than in the stenosis group. Conclusion: The present study indicates that, in elderly patients, intervertebral discs adjacent to vertebral fractures resulting from minor trauma are often injured. Because hemorrhage is the most likely cause of a high-intensity T1-weighted image, the results indicate that hemorrhage can be induced in a disc adjacent to a vertebral body fractured by even minor trauma.

  4. CT-guided percutaneous drainage within intervertebral space for pyogenic spondylodiscitis with psoas abscess

    Matsumoto, Tomohiro; Morishita, Hiroyuki; Lida, Shigeharu; Asai, Shunsuke; Masui, Koji; Sato, Osamu (Department of Diagnostic Radiology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto (Japan)), Email: t-matsu@koto.kpu-m.ac.jp; Yamagami, Takuji; Nishimura, Tsunehiko (Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto (Japan)); Yamazoe, Shoichi (Department of Orthopedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto (Japan))

    2012-02-15

    Background. Reports on CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis with a secondary psoas abscess are limited. Purpose. To evaluate CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis and a secondary psoas abscess in which the two sites appear to communicate. Material and Methods. Eight patients with pyogenic spondylodiscitis and a secondary psoas abscess showing communication with the intradiscal abscess underwent CT-guided percutaneous drainage within the intervertebral space. The clinical outcome was retrospectively assessed. Results. An 8-French pigtail catheter within the intervertebral space was successfully placed in all patients. Seven patients responded well to this treatment. The one remaining patient who had developed septic shock before the procedure died on the following day. The mean duration of drainage was 32 days (13-70 days). Only one patient with persistent back pain underwent surgery for stabilization of the spine after the improvement of inflammation. Among seven patients responding well, long-term follow-up (91-801 days, mean 292 days) was conducted in six patients excluding one patient who died of asphyxiation due to aspiration unrelated to the procedure within 30 days after the procedure. In these six patients, no recurrence of either pyogenic spondylodiscitis or the psoas abscess was noted. Conclusion. CT-guided percutaneous drainage within the intervertebral space can be effective for patients with pyogenic spondylodiscitis and a secondary psoas abscess if the psoas abscess communicates with the intradiscal abscess

  5. Analysis of Gene Expression Pattern of Lumbar Intervertebral Disc Degeneration in Human

    HU Ming; MA Yuan-zheng; FENG Hui-cheng; CHEN Xing; CHAI Xiao-jun; PENG Wei; LI Hong-wei

    2006-01-01

    Objective To investigate the gene expression changes in normal and degeneration lumbar intervertebral disc in humans, providing information for clinical. Methods The PCR products of 4096 human genes were spotted onto a kind of chemical-material-coated-glass slides. The total RNAs were isolated from the tissues. Both the mRNAs from the degeneration and normal lumbar intervertebral disc in humans were reversely transcribed to the cDNAs, which used as the hybridization probes with the incorporations of fluorescent dUTP. The mixed probes were then hybridized to the cDNA microarray. After high-stringent washing, the cDNA microarray was scanned for the fluorescent signals and analyzed with computer image analysis. Results Among the 4096 targets,there were 706 genes whose expression levels differed between the degeneration and normal lumbar intervertebral disc in all cases,comprising 298 up-regulated and 358 down-regulated ones. Conclusion DNA microarray technology is an effective technique in screening for differently expressed genes between the degeneration and normal lumbar intervertebral disc. Cell apoptosis plays an important role in the process of lumbar intervertebral disc degeneration.

  6. Neuroanatomic and pathophysiologic aspects of intervertebral disc disease in the dog.

    Thacher, C

    1989-01-01

    A sound understanding of anatomy and the pathophysiology of disease is important in all branches of medicine, but nowhere is it more critical to success than in the medical and surgical management of intervertebral disc disease. Due to the remote location and unforgiving nature of the spinal cord, the veterinary surgeon must possess an intimate working knowledge of the surgical anatomy of the vertebrae, ligaments and joints of the spine, intervertebral discs, spinal cord, and spinal nerves. In addition, proper localization of spinal cord lesions during the neurological evaluation requires awareness of the functional neuroanatomy of the upper and lower motor motor neurons, the sensory systems and tracts, and the reflex arcs. Knowledge of the pathophysiology the intervertebral disc degeneration and the response of the spinal cord to disc extrusions are also important in the overall understanding of the disease and enhances proper decision making for its management. This chapter reviews the portions of the gross and functional neuroanatomy and the pathophysiology of the intervertebral disc and the spinal cord that are pertinent to the dog with intervertebral disc disease. Emphasis is placed on concepts that are critical for the veterinary surgeon who is involved in the surgical management of the disc patient. PMID:2520119

  7. Avaliação dos resultados clínicos após cirurgia descompressiva em cães com doença de disco intervertebral Evaluation of clinical results of decompressive surgery in dogs with degenerative disk disease

    M.V.B. Arias

    2007-12-01

    Full Text Available Avaliaram-se os resultados clínicos após realização de cirurgia descompressiva em 45 cães com doença do disco intervertebral cervical ou toracolombar. Após a cirurgia, 35 cães (77,8% recuperaram-se totalmente, oito (17,8% parcialmente e dois (4,4% não apresentaram alteração do quadro inicial. Em oito cães com paraplegia e perda da sensibilidade dolorosa profunda houve completa melhora do quadro clínico, com recuperação total em 62,5% dos casos. Em quatro cães com tetraparesia, a cirurgia foi eficaz. A cirurgia descompressiva (slot cervical e hemilaminectomia toracolombar, com a retirada do material do disco do interior do canal vertebral, foi uma forma efetiva de gerar melhora do quadro funcional.Clinical results after decompressive surgery were evaluated in 45 dogs with cervical or thoracolumbar intervertebral disk disease. After surgery, 35 dogs recovered totally, eight (17.8% partially, and two (4.4% did not present any change in clinical findings. Eight dogs with paraplegy and loss of deep pain perception showed improvement, with total recovering in 62.5% of cases. Surgery was effective in four dogs with tetraparesy. Decompressive surgery (cervical slot or hemilaminectomy, with removal of disk material from inside the vertebral canal, was an effective form to produce functional improvement in dogs with this disease.

  8. A diffusion and T2 relaxation MRI study of the ovine lumbar intervertebral disc under compression in vitro

    Drew, Simon C.; Silva, Pujitha; Crozier, Stuart; Pearcy, Mark J.

    2004-08-01

    The ovine lumbar intervertebral disc is a useful model for the human lumbar disc. We present preliminary estimates of diffusion coefficients and T2 relaxation times in a pilot MRI study of the ovine lumbar intervertebral disc during uniaxial compression in vitro, and identify factors that hamper the ability to accurately monitor the temporal evolution of the effective diffusion tensor at high spatial resolution.

  9. Substructuring and poroelastic modelling of the intervertebral disc.

    Swider, P; Pédrono, A; Ambard, D; Accadbled, F; Sales de Gauzy, J

    2010-05-01

    We proposed a substructure technique to predict the time-dependant response of biological tissue within the framework of a finite element resolution. Theoretical considerations in poroelasticity preceded the calculation of the sub-structured poroelastic matrix. The transient response was obtained using an exponential fitting method. We computed the creep response of an MRI 3D reconstructed L(5)-S(1) intervertebral disc of a scoliotic spine. The FE model was reduced from 10,000 degrees of freedom for the full 3D disc to only 40 degrees of freedom for the sub-structured model defined by 10 nodes attached to junction nodes located on both lower and upper surfaces of the disc. Comparisons of displacement fields were made between the full poroelastic FE model and the sub-structured model in three different loading conditions: compression, offset compression and torsion. Discrepancies in displacement were lower than 10% for the first time steps when time-dependant events were significant. The substructuring technique provided an exact solution in quasi-static behavior after pressure relaxation. Couplings between vertical and transversal displacements predicted by the reference FE model were well stored by the sub-structured model despite the drastic reduction of degrees of freedom. Finally, we demonstrated that substructuring was very efficient to reduce the size of numerical models while respecting the time-dependant behavior of the structure. This result highlighted the potential interest of substructure techniques in large-scale models of musculoskeletal structures. PMID:20170917

  10. Calcified cervical intervertebral disc in children: radiological findings

    Nucleus pulposus calcification in children (CCIDC) is relatively rare but well known clinical syndrome, usually localized at the level of cervical spine. More than hundred and fifty cases have been reported in the literature with an increasing number of new reports in the last decade. The disease entity has been attributed to trauma, inflammation , or increased hydrostatic pressure with the disc, but the exact etiology still remains uncertain. The prognosis of disc calcification in children is good. As a rule pain resolves and there is a spontaneous resorption. Although the benign nature of the disease has been emphasized by many authors, herniation of the calcified nucleus pulposus through ruptured annulus fibrosus may occasionally occur. This rare but potentially serious complication with radiological signs of extradural space occupying lesion rises the question of eventual operative therapy. In several cases which have been reported in literature remission of symptoms occurred with conservative treatment. Radiological investigations are important for the diagnosis, evaluation of extent and follow-up of the disease. Radiography, computed tomography (CT) and magnetic resonance imaging (MRI) may be used. The first radiologic examination is standard radiography of the cervical spine. An addition of oblique views suggested before introduction of CT for better presentation of eventual protrusion (extrusion) of calcified discs material into the region of the intervertebral foramen (nerve root comprehension). Since frequently multilevel disc calcifications have been reported some authors suggest standard radiography of the whole spine. Radiography clearly demonstrates nucleus pulposus calcifications, which are round, oval flattened or fragmented. Radiographic appearances are to some extent reminiscent of discographic findings in normal or degenerated disc. Affected disc spaces may be slightly expanded indicating possibility of increased intradiscal pressure. Some of the

  11. Degenerated human intervertebral discs contain autoantibodies against extracellular matrix proteins

    S Capossela

    2014-04-01

    Full Text Available Degeneration of intervertebral discs (IVDs is associated with back pain and elevated levels of inflammatory cells. It has been hypothesised that discogenic pain is a direct result of vascular and neural ingrowth along annulus fissures, which may expose the avascular nucleus pulposus (NP to the systemic circulation and induce an autoimmune reaction. In this study, we confirmed our previous observation of antibodies in human degenerated and post-traumatic IVDs cultured in vitro. We hypothesised that the presence of antibodies was due to an autoimmune reaction against specific proteins of the disc. Furthermore we identified antigens which possibly trigger an autoimmune response in degenerative disc diseases. We demonstrated that degenerated and post-traumatic IVDs contain IgG antibodies against typical extracellular proteins of the disc, particularly proteins of the NP. We identified IgGs against collagen type II and aggrecan, confirming an autoimmune reaction against the normally immune privileged NP. We also found specific IgGs against collagens types I and V, but not against collagen type III. In conclusion, this study confirmed the association between disc degeneration and autoimmunity, and may open the avenue for future studies on developing prognostic, diagnostic and therapy-monitoring markers for degenerative disc diseases.

  12. Minimally invasive photopolymerization in intervertebral disc tissue cavities

    Schmocker, Andreas M.; Khoushabi, Azadeh; Gantenbein-Ritter, Benjamin; Chan, Samantha; Bonél, Harald Marcel; Bourban, Pierre-Etienne; Mânson, Jan Anders; Schizas, Constantin; Pioletti, Dominique; Moser, Christophe

    2014-03-01

    Photopolymerized hydrogels are commonly used for a broad range of biomedical applications. As long as the polymer volume is accessible, gels can easily be hardened using light illumination. However, in clinics, especially for minimally invasive surgery, it becomes highly challenging to control photopolymerization. The ratios between polymerizationvolume and radiating-surface-area are several orders of magnitude higher than for ex-vivo settings. Also tissue scattering occurs and influences the reaction. We developed a Monte Carlo model for photopolymerization, which takes into account the solid/liquid phase changes, moving solid/liquid-boundaries and refraction on these boundaries as well as tissue scattering in arbitrarily designable tissue cavities. The model provides a tool to tailor both the light probe and the scattering/absorption properties of the photopolymer for applications such as medical implants or tissue replacements. Based on the simulations, we have previously shown that by adding scattering additives to the liquid monomer, the photopolymerized volume was considerably increased. In this study, we have used bovine intervertebral disc cavities, as a model for spinal degeneration, to study photopolymerization in-vitro. The cavity is created by enzyme digestion. Using a custom designed probe, hydrogels were injected and photopolymerized. Magnetic resonance imaging (MRI) and visual inspection tools were employed to investigate the successful photopolymerization outcomes. The results provide insights for the development of novel endoscopic light-scattering polymerization probes paving the way for a new generation of implantable hydrogels.

  13. Experimental chemonucleolysis with chymopapain in canine intervertebral disks

    The present study describes the radiological and histological changes in the canine intervertebral disk after the experimental injection of chymopapain as the chemical reagent, and determines the appropriate dose of the enzyme for treatment of herniated disks. By radiography, narrowing of the disk space was observed within 2 weeks after the injection of chymopapain, and recovered to 74.1% in the 0.1 mg group, 61.1% in the 1.0 mg group and 71.7% in the 10.0 mg group at 12 weeks. The disk space recovery showed a tendency to delay with aging. Microscopically, proteoglycan positive matrix appeared and the nuclear space was reduced in each disk at 2 weeks after chymopapain injection. The nucleus pulposus contained an irregularly-defined mass consisting of clusters of degenerated notochordal cells surrounded by proliferated chondrocytes and collagen matrix. In each disk at 12 weeks after chymopapain injection, the center of the nucleus pulposus was replaced by fibrocartilage tissue. In the disk into which 10.0 mg chymopapain was injected, the nuclear space filled with dense fibrocartilage tissue without a regenerated matrix component and narrowing of the disk were maintained. It is suggested that canine chemonucleolysis with 10.0 mg of chymopapain reduces the interdiskal pressure. This treatment may therefore relieve the signs and symptoms of herniation of the nucleus pulposus, and may effect chemical disk decompression

  14. Bovine explant model of degeneration of the intervertebral disc

    Sivan Sarit

    2008-02-01

    Full Text Available Abstract Background Many new treatments for degeneration of the intervertebral disc are being developed which can be delivered through a needle. These require testing in model systems before being used in human patients. Unfortunately, because of differences in anatomy, there are no ideal animal models of disc degeneration. Bovine explant model systems have many advantages but it is not possible to inject any significant volume into an intact disc. Therefore we have attempted to mimic disc degeneration in an explant bovine model via enzymatic digestion. Methods Bovine coccygeal discs were incubated with different concentrations of the proteolytic enzymes, trypsin and papain, and maintained in culture for up to 3 weeks. A radio-opaque solution was injected to visualise cavities generated. Degenerative features were monitored histologically and biochemically (water and glycosaminoglycan content, via dimethylmethylene blue. Results and Conclusion The central region of both papain and trypsin treated discs was macro- and microscopically fragmented, with severe loss of metachromasia. The integrity of the surrounding tissue was mostly in tact with cells in the outer annulus appearing viable. Biochemical analysis demonstrated greatly reduced glycosaminoglycan content in these compared to untreated discs. We have shown that bovine coccygeal discs, treated with proteolytic enzymes can provide a useful in vitro model system for developing and testing potential new treatments of disc degeneration, such as injectable implants or biological therapies.

  15. Mesenchymal stem cell tracking in the intervertebral disc

    Charles Handley; Tony Goldschlager; David Oehme; Peter Ghosh; Graham Jenkin

    2015-01-01

    Low back pain is a common clinical problem, whichleads to significant social, economic and public healthcosts. Intervertebral disc (IVD) degeneration is acceptedas a common cause of low back pain. Initially, thisis characterized by a loss of proteoglycans from thenucleus pulposus resulting in loss of tissue hydrationand hydrostatic pressure. Conservative management,including analgesia and physiotherapy often fails andsurgical treatment, such as spinal fusion, is required. Stemcells offer an exciting possible regenerative approachto IVD disease. Preclinical research has demonstratedpromising biochemical, histological and radiological resultsin restoring degenerate IVDs. Cell tracking provides anopportunity to develop an in-depth understanding ofstem cell survival, differentiation and migration, enablingoptimization of stem cell treatment. Magnetic ResonanceImaging (MRI) is a non-invasive, non-ionizing imagingmodality with high spatial resolution, ideally suited for stemcell tracking. Furthermore, novel MRI sequences have thepotential to quantitatively assess IVD disease, providingan improved method to review response to biologicaltreatment. Superparamagnetic iron oxide nanoparticleshave been extensively researched for the purpose of celltracking. These particles are biocompatible, non-toxicand act as excellent MRI contrast agents. This review willexplore recent advances and issues in stem cell trackingand molecular imaging in relation to the IVD.

  16. The canine intervertebral disk. 2. Degenerative changes: nonchondrodystrophoid versus chondrodystrophoid disks

    In the second of a two-part article on the canine intervertebral disk, the morphological changes which occur within the disk during aging and degeneration are described. Degeneration of the intervertebral disk appears to be a self-perpetuating process as a consequence of disruption to the annulus fibrous, cellular remodeling, altered biomechanical loading, and nutritional deficiencies. In the nonchondrodystrophoid disk, premature acceleration of the aging process can occur following traumatic disruption to the annulus fibrous. This degeneration usually occurs in isolated disks along the length of the vertebral column, By contrast, disk degeneration in the chondrodystrophoid breeds occurs simultaneously in all disks along the vertebral column and usually is well advanced by two years of age, Ultrastructural differences between the intervertebral disk of the nonchondrodystrophoid dog and that of the chondrodystrophoid dog may explain the rapidity and severity of degenerative changes in the latter breeds

  17. Treatment of 116 Cases of Cervical Intervertebral Disc Protrusion by Tuina

    WANG Guang-zong; XIAO Yuan-chun

    2007-01-01

    Objective: To observe the clinical efficacy of uplifting massage therapy in the treatment of cervical intervertebral disc protrusion and study the effectiveness of this massage therapy for cervical intervertebral disc protrusion. Methods: 116 subjects were randomized into two groups: treatment group in which 60 cases were treated by uplifting massage therapy and conventional massage, and control group in which 56 cases were treated by simple conventional massage. Results: After 1-2 courses of treatment, the total effective rate was 95.0% in treatment group and 80.4% in control group; the former rate was higher than the latter one(P<0.05).Conclusion: The uplifting massage therapy combined with conventional massage has better effects than simple conventional massage in the treatment of cervical intervertebral disc protrusion.

  18. Genome-Wide Association Study in Dachshund: Identification of a Major Locus Affecting Intervertebral Disc Calcification

    Mogensen, Mette Sloth; Karlskov-Mortensen, Peter; Proschowsky, Helle Friis;

    2011-01-01

    Intervertebral disc calcification and herniation commonly affects Dachshund where the predisposition is caused by an early onset degenerative process resulting in disc calcification. A continuous spectrum of disc degeneration is seen within and among clog breeds, suggesting a multifactorial...... etiology. The number of calcified discs at 2 years of age determined by a radiographic evaluation is a good indicator of the severity of disc degeneration and thus serves as a measure for the risk of developing intervertebral disc herniation. The aim of the study was to identify genetic variants associated...... with intervertebral disc calcification in Dachshund through a genome-wide association (GWA) study. Based on thorough radiographic examinations, 48 cases with >= 6 disc calcifications or surgically treated for disc herniation and 46 controls with 0-1 disc calcifications were identified. GWA using the...

  19. Design Concepts of Polycarbonate-Based Intervertebral Lumbar Cages: Finite Element Analysis and Compression Testing.

    Figueroa-Cavazos, J Obedt; Flores-Villalba, Eduardo; Diaz-Elizondo, José A; Martínez-Romero, Oscar; Rodríguez, Ciro A; Siller, Héctor R

    2016-01-01

    This work explores the viability of 3D printed intervertebral lumbar cages based on biocompatible polycarbonate (PC-ISO® material). Several design concepts are proposed for the generation of patient-specific intervertebral lumbar cages. The 3D printed material achieved compressive yield strength of 55 MPa under a specific combination of manufacturing parameters. The literature recommends a reference load of 4,000 N for design of intervertebral lumbar cages. Under compression testing conditions, the proposed design concepts withstand between 7,500 and 10,000 N of load before showing yielding. Although some stress concentration regions were found during analysis, the overall viability of the proposed design concepts was validated. PMID:27578960

  20. Intervention of CT Localization plus TCM Therapy on Prolapse of Lumbar Intervertebral Disc

    LUO Zhi-hong; SHEN Wei-na

    2003-01-01

    Purpose To observe the curative effect of interventional therapy by CT localization combined traditional Chinese medicine on prolapse of lumbar intervertebral disc. Method The inpatients of lumbar intervertebral disc prolapse were randomly divided into treatmentgroup and control group. Interventional therapy by CT localization combined TCM was used in the treatment group while in the control group TCM therapy was taken only. The treatment lasted for 10 days in both groups. Results The curative effect was 94.3% in the treatment group while 76.8% in the control one (P < 0.05), which had statistical meaning. Conclusion Interventional therapy by CT localization combined TCM on prolapse of lumbar intervertebral disc had better effect and shorter treatment course.

  1. On the modeling of the intervertebral joint in multibody models for the spine

    Christophy, Miguel, E-mail: christophy@gmail.com [University of California at Berkeley, Department of Mechanical Engineering (United States); Curtin, Maurice, E-mail: moecurtin@gmail.com [University College Dublin, School of Electrical, Electronic and Communications Engineering (Ireland); Faruk Senan, Nur Adila, E-mail: adilapapaya@gmail.com [University of California at Berkeley, Department of Mechanical Engineering (United States); Lotz, Jeffrey C., E-mail: lotzj@orthosurg.ucsf.edu [University of California at San Francisco, Department of Orthopaedic Surgery (United States); O’Reilly, Oliver M., E-mail: oreilly@berkeley.edu [University of California at Berkeley, Department of Mechanical Engineering (United States)

    2013-12-15

    The need to develop feasible computational musculoskeletal models of the spine has led to the development of several multibody models. Central features in these works are models for the ligaments, muscles, and intervertebral joint. The purpose of the present paper is to show how experimental measurements of joint stiffnesses can be properly incorporated using a bushing element. The required refinements to existing bushing force functions in musculoskeletal software platforms are discussed and further implemented using a SpineBushing element specific to the intervertebral joint. Four simple lumbar spine models are then used to illustrate the accompanying improvements. Electronic supplemental material for this article includes a complementary review of formulations of stiffness matrices for the intervertebral joint.

  2. On the modeling of the intervertebral joint in multibody models for the spine

    The need to develop feasible computational musculoskeletal models of the spine has led to the development of several multibody models. Central features in these works are models for the ligaments, muscles, and intervertebral joint. The purpose of the present paper is to show how experimental measurements of joint stiffnesses can be properly incorporated using a bushing element. The required refinements to existing bushing force functions in musculoskeletal software platforms are discussed and further implemented using a SpineBushing element specific to the intervertebral joint. Four simple lumbar spine models are then used to illustrate the accompanying improvements. Electronic supplemental material for this article includes a complementary review of formulations of stiffness matrices for the intervertebral joint

  3. Percutaneous kyphoplasty combined with the posterior screw-rod system in treatment of osteoporotic thoracolumbar fractures

    Jiang Wu

    2013-01-01

    Materials and Methods: Twenty six patients (65 years of age or older with the single spine fractures included in study. The preoperative bone mineral density was measured by dual-energy X-ray. The PKP was done in all the cases. Decompression was done if neurological symptoms were present. Results: The results demonstrated osteoporosis with BMD T value ≤ −2.5; injured posterior vertebral body (3 cases had shown the whole damage accompanied by neurological symptoms through X-ray or CT. After 2 days, the remaining patients of back pain symptoms were relieved or disappeared except for three cases of patients with decompression incision. VAS score and Cobb angle changed from preoperative 8.23 ± 0.17 and 28.7 ± 0.33° respectively to postoperative 3.77 ± 0.44 and 3.8 ± 0.2° respectively. Conclusion: Treatment of rupture of the posterior vertebral osteoporotic thoracolumbar fractures by means of kyphoplasty combined with posterior screw-rod system is a safe, effective procedure.

  4. Gradual Height Decrease of Augmented Vertebrae after Vertebroplasty at the Thoracolumbar Junction

    Oh, Han San; Kim, Hyun Gon; Park, Kwan Ho

    2016-01-01

    Objective Vertebroplasty is an effective treatment for vertebral compression fracture, but may progress gradual vertebral height decrease in spite of vertebroplasty. Gradual vertebral height decrease also may induce aggravation of kyphotic change without severe pain. The purpose of this study was to evaluate risk factors for gradual vertebral height decrease in the absence of recurrent severe back pain. Methods A retrospective analysis was performed on 44 patients who were diagnosed with a first osteoporotic compression fracture at a single level at the thoracolumbar junction. All patients were taken vertebroplasty. Possible risk factors for gradual vertebral height decrease, such as sex, age, bone mineral density, body mass index, level of compression fracture, volume of injected cement, cement leakage into disc space, and air clefts within fractured vertebrae, were analyzed. Results Gradual vertebral height decrease of augmented vertebrae occurred commonly when more than 4 cc of injected cement was used, and when air clefts within fractured vertebrae were seen on admission. In addition, the sagittal Cobb angle more commonly increased during the follow-up period in such cases. Conclusion Injection of more than 4 cc of cement during vertebroplasty and air cleft within fractured vertebrae on admission induced gradual vertebral height decrease in augmented vertebrae. Thus, longer follow-up will be needed in such cases, even when patients do not complain of recurrent severe back pain.

  5. Treatment of Thoracolumbar Spinal Infections through Anterolateral Approaches Using Expandable Titanium Mesh Cage for Spine Reconstruction

    Tarantino Roberto

    2012-01-01

    Full Text Available Pyogenic vertebral osteomyelitis (PVO is still a rare pathology. However, its incidence is on the rise. This is due to an increasing population with predisposing factors. Also, the availability of more effective diagnostic tools has brought it increasingly to the surgeon’s attention. In this study the patients were treated in the Neurosurgery Division of the Department of Neurological Sciences and Psychiatry of the Sapienza University of Rome, between 2001 and 2009. They had thoracolumbar pyogenic spondylitis. This study was undertaken in order to identify the correct diagnostic and therapeutic treatment needed in such cases. From the cases studied here, it is evident that spinal infections can be extremely insidious and that diagnosis tends to be reached late. Surgery, along with the antibiotic treatment, allows for eradication of the causes of the pathology by the reclamation of the affected region. Surgery is also fundamental in helping to recover vital functions and in restoring as much as possible the correct curvature of the rachises. The use of an anterolateral approach is dictated by the necessity of obtaining 360° stability as well as by the need to clear away extensive infections, which are not always reachable using a posterior approach.

  6. Burst fracture of the thoracolumbar spine: correlation between kyphosis and clinical result of the treatment

    Rodrigo Arnold Tisot

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the correlation between kyphosis due to burst fractures of thoracic and lumbar spine and clinical outcome in patients undergoing conservative or surgical treatment.METHODS: A retrospective, cross-sectional study was conducted with 29 patients with thoracolumbar burst fractures treated by the Spine Group in a trauma reference hospital between the years 2002 and 2011. Patients were followed-up as outpatients for a minimum of 24 months. All cases were clinically evaluated by Oswestry and SF-36 quality of life questionnaires and the visual analogue scale (VAS of pain. They were also evaluated by X-ray examinations and CT scans of the lumbosacral spine at the time of hospitalization and subsequently as outpatients by Cobb method for measuring the degree of kyphosis.RESULTS: There was no statistically significant correlation between the degree of initial kyphosis and clinical outcome measured by VAS and by most of the SF-36 domains in both patients treated conservatively and the surgically treated. The Oswestry questionnaire showed benefits for patients who received conservative treatment (p=0.047 compared to those surgically treated (p=0.335. The analysis of difference between initial and final kyphosis and final kyphosis alone in relation to clinical outcome showed no statistical correlation in any of the scores used.CONCLUSION: The clinical outcome of treatment of the thoracic and lumbar burst fractures was not influenced by a greater or lesser degree of initial or residual kyphosis, regardless of the type of treatment.

  7. Lumbar intervertebral disc puncture under C-arm fluoroscopy: a new rat model of lumbar intervertebral disc degeneration.

    Li, Dapeng; Yang, Huilin; Huang, Yonghui; Wu, Yan; Sun, Taicun; Li, Xuefeng

    2014-01-01

    To establish a minimally invasive rat model of lumbar intervertebral disc degeneration (IDD) to better understand the pathophysiology of the human condition. The annulus fibrosus of lumbar level 4-5 (L4-5) and L5-6 discs were punctured by 27-gauge needles using the posterior approach under C-arm fluoroscopic guidance. Magnetic resonance imaging (MRI), histological examination by hematoxylin and eosin (H&E) staining, and reverse transcription polymerase chain reaction (RT-PCR) were performed at baseline and 2, 4, and 8 weeks after disc puncture surgery to determine the degree of degeneration. All sixty discs (thirty rats) were punctured successfully. Only two of thirty rats subjected to the procedure exhibited immediate neurological symptoms. The MRI results indicated a gradual increase in Pfirrmann grade from 4 to 8 weeks post-surgery (PCol2), and Sox9 mRNAs, which encode disc components, decreased gradually post-surgery. In contrast, mRNA expression of type I collagen (Col1), an indicator of fibrosis, increased (P<0.05). The procedure of annular puncture using a 27-gauge needle under C-arm fluoroscopic guidance had a high success rate. Histological, MRI, and RT-PCR results revealed that the rat model of disc degeneration is a progressive pathological process that is similar to human IDD. PMID:24770648

  8. A method for quantifying intervertebral disc signal intensity on T2-weighted imaging

    Nagashima, Masaki [Dept. of Orthopaedic Surgery, Keio Univ. School of Medicine, Tokyo (Japan); Dept. of Orthopaedic Surgery, Kitasato Univ. Kitasato Inst. Hospital, Tokyo (Japan); Abe, Hitoshi [Dept. of Orthopaedic Surgery, Kitasato Univ. Kitasato Inst. Hospital, Tokyo (Japan)], E-mail: hit-abe@insti.kitasato-u.ac.jp; Amaya, Kenji [Graduate School of Information Science and Engineering, Tokyo Inst. of Technology, Tokyo (Japan); Matsumoto, Hideo [Inst. for Integrated Sports Medicine, Keio Univ. School of Medicine, Tokyo (Japan); Yanaihara, Hisashi [Dept. of Diagnostic Radiology, Kitasato Univ. Kitasato Inst. Hospital, Tokyo (Japan); Nishiwaki, Yuji [Dept. of Environmental and Occupational Health, Toho Univ. School of Medicine, Tokyo (Japan); Toyama, Yoshiaki; Matsumoto, Morio [Dept. of Orthopaedic Surgery, Keio Univ. School of Medicine, Tokyo (Japan)

    2012-11-15

    Background Quantification of intervertebral disc degeneration based on intensity of the nucleus pulposus in magnetic resonance imaging (MRI) often uses the mean intensity of the region of interest (ROI) within the nucleus pulposus. However, the location and size of ROI have varied in different reports, and none of the reported methods can be considered fully objective. Purpose To develop a more objective method of establishing ROIs for quantitative evaluation of signal intensity in the nucleus pulposus using T2-weighted MRI. Material and Methods A 1.5-T scanner was used to obtain T2-weighted mid-sagittal images. A total of 288 intervertebral discs from 48 patients (25 men, 23 women) were analyzed. Mean age was 47.4 years (range, 17-69 years). All discs were classified into five grades according to Pfirrmann et al. Discs in grades I and II were defined as bright discs, and discs in grades IV and V were defined as dark discs. Eight candidate methods of ROI determination were devised. The method offering the highest degree of discrimination between bright and dark discs was investigated among these eight methods. Results The method with the greatest degree of discrimination was as follows. The quadrangle formed by anterior and posterior edges of the upper and lower end plates in contact with the intervertebral disc to be measured was defined as the intervertebral area. A shape similar to the intervertebral area but with one-quarter the area was drawn. The geometrical center of the shape was matched to the center of intensity, and this shape was then used as the ROI. Satisfactory validity and reproducibility were obtained using this method. Conclusion The present method offers adequate discrimination and could be useful for longitudinal tracking of intervertebral disc degeneration with sufficient reproducibility.

  9. A method for quantifying intervertebral disc signal intensity on T2-weighted imaging

    Background Quantification of intervertebral disc degeneration based on intensity of the nucleus pulposus in magnetic resonance imaging (MRI) often uses the mean intensity of the region of interest (ROI) within the nucleus pulposus. However, the location and size of ROI have varied in different reports, and none of the reported methods can be considered fully objective. Purpose To develop a more objective method of establishing ROIs for quantitative evaluation of signal intensity in the nucleus pulposus using T2-weighted MRI. Material and Methods A 1.5-T scanner was used to obtain T2-weighted mid-sagittal images. A total of 288 intervertebral discs from 48 patients (25 men, 23 women) were analyzed. Mean age was 47.4 years (range, 17-69 years). All discs were classified into five grades according to Pfirrmann et al. Discs in grades I and II were defined as bright discs, and discs in grades IV and V were defined as dark discs. Eight candidate methods of ROI determination were devised. The method offering the highest degree of discrimination between bright and dark discs was investigated among these eight methods. Results The method with the greatest degree of discrimination was as follows. The quadrangle formed by anterior and posterior edges of the upper and lower end plates in contact with the intervertebral disc to be measured was defined as the intervertebral area. A shape similar to the intervertebral area but with one-quarter the area was drawn. The geometrical center of the shape was matched to the center of intensity, and this shape was then used as the ROI. Satisfactory validity and reproducibility were obtained using this method. Conclusion The present method offers adequate discrimination and could be useful for longitudinal tracking of intervertebral disc degeneration with sufficient reproducibility

  10. Determination of the intervertebral disc space from CT images of the lumbar spine

    Korez, Robert; Å tern, Darko; Likar, Boštjan; Pernuš, Franjo; Vrtovec, Tomaž

    2014-03-01

    Degenerative changes of the intervertebral disc are among the most common causes of low back pain, where for individuals with significant symptoms surgery may be needed. One of the interventions is the total disc replacement surgery, where the degenerated disc is replaced by an artificial implant. For designing implants with good bone contact and continuous force distribution, the morphology of the intervertebral disc space and vertebral body endplates is of considerable importance. In this study we propose a method for the determination of the intervertebral disc space from three-dimensional (3D) computed tomography (CT) images of the lumbar spine. The first step of the proposed method is the construction of a model of vertebral bodies in the lumbar spine. For this purpose, a chain of five elliptical cylinders is initialized in the 3D image and then deformed to resemble vertebral bodies by introducing 25 shape parameters. The parameters are obtained by aligning the chain to the vertebral bodies in the CT image according to image intensity and appearance information. The determination of the intervertebral disc space is finally achieved by finding the planes that fit the endplates of the obtained parametric 3D models, and placing points in the space between the planes of adjacent vertebrae that enable surface reconstruction of the intervertebral disc space. The morphometric analysis of images from 20 subjects yielded 11:3 +/- 2:6, 12:1 +/- 2:4, 12:8 +/- 2:0 and 12:9 +/- 2:7 cm3 in terms of L1-L2, L2-L3, L3-L4 and L4-L5 intervertebral disc space volume, respectively.

  11. Computerized tomography of the lumbar vertebral column after intervertebral disk operation. Pt. 1

    Schindler, G.; Klott, K.

    1984-01-01

    Problems after intervertebral disk operations are to be expected in about 25-40% of the patients operated. Progressive degnerative alterations at the disks, the vertebrae and the intervertebral joints entail chronic mechanical pain resulting from the sensitive innervation of the structures mentioned, or lead in severe cases to the alteration of the epidural space respectively the spinal nerves with corresponding peripheral neurological symptoms. As post-surgical complications spondylodiscitis, spondylitis, haematomae, liquor fistulae, and split-off bone fragments can be the cause of complaints, for which computerized tomography is a better diagnostical method than myelography.

  12. The effectiveness of percutaneous laser disc decompression for the prolapsed lumbar intervertebral disc

    Mu, Ming Wei; Liu, Wei; Feng, Wei; Ma, Nan

    2009-07-01

    Objective: to investigate the role of associated factors in the effectiveness of laser treatment for prolapsed lumber intervertebral disc. Method: 302 prolapsed lumber intervertebral discs in 212 patients were treated with percutaneous laser disc decompression (PLDD). Patients were followed up by 12month, the associated factors which affecting the effectiveness of treatment, ie age, duration of illness were analyzed. Results: Punctual Success rate was 100%. After 12 month's follow up, 86% successful outcomes were obtained, in which 93% successful outcomes were obtained in patients less than 50 years old, 92% successful outcomes was obtained in the patients whose duration of illness less than 1 year.

  13. Treatment of 30 Cases of Prolapse of Lumbar Intervertebral Disc by Electroacupuncture plus Tuina

    JIANG Gui-mei; JIA Chao; WU Xue-fei

    2003-01-01

    Purpose: To observe the clinical therapeutic effect of electro acupuncture plus Tuina on treating prolapse of lumbar intervertebral disc. Methods: Electro -acupuncture at Jiaji(Ex-B 2) acupoints plus reduction manipulations were used to treat 30 cases of prolapse of lumbar intervertebral disc. Results: After 2 courses of treatment, among the 30 cases, 8 cases were cured and 22cases got improvements, and the effective rate was 100%.Conclusion: Electroacupuncture plus reduction manipula -tions had a satisfactory effect on treating this disease;and it can significantly improve the clinical symptoms of the patients.

  14. Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

    Percutaneous treatments are used in the therapy of small- to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques and consist of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines are written to be used in quality improvement programs for assessing fluoroscopy- and/or computed tomography-guided percutaneous intervertebral disc ablative techniques.

  15. Effect of intervertebral disc disease on scoliosis in the lumbar spine

    Wojcik Gustaw

    2014-09-01

    Full Text Available Lumbar intervertebral discopathy is a common clinical problem and a significant cause of low back pain. Usually it is associated with overload and damage to the intervertebral disc, which directly relates to the instability of the motion segment. Renal normal anatomy between tissues within the spinal canal is a cause of the reflex curvature of the spine, the goal is to increase the volume of the spinal channel and reduce the compression of the nerve tissue. Knee-jerk reaction to pain is an non physiological change of the setting of the spine in the frontal plane.

  16. Clinical and radiological outcomes of conservative treatment after stable post-traumatic thoracolumbar fractures in elderly: Is it really best option for all elderly patients?

    Deniz Cankaya

    2015-12-01

    Conclusion: Although there is wide acceptance of conservative treatment of post-traumatic stable thoracolumbar fracture with intact PCL according to the Thoracolumbar Injury Classification and Severity Score (TLICS, elderly female patients with a post-traumatic compression fracture in the junctional region are at great risk of conservative treatment failure. These patients should be well-informed about the possible complications and poor results of conservative treatment, and surgical treatment should be considered in selective cases with the informed consent of the patients.

  17. Biomechanical analysis of the camelid cervical intervertebral disc

    Dean K. Stolworthy

    2015-01-01

    Full Text Available Chronic low back pain (LBP is a prevalent global problem, which is often correlated with degenerative disc disease. The development and use of good, relevant animal models of the spine may improve treatment options for this condition. While no animal model is capable of reproducing the exact biology, anatomy, and biomechanics of the human spine, the quality of a particular animal model increases with the number of shared characteristics that are relevant to the human condition. The purpose of this study was to investigate the camelid (specifically, alpaca and llama cervical spine as a model of the human lumbar spine. Cervical spines were obtained from four alpacas and four llamas and individual segments were used for segmental flexibility/biomechanics and/or morphology/anatomy studies. Qualitative and quantitative data were compared for the alpaca and llama cervical spines, and human lumbar specimens in addition to other published large animal data. Results indicate that a camelid cervical intervertebral disc (IVD closely approximates the human lumbar disc with regard to size, spinal posture, and biomechanical flexibility. Specifically, compared with the human lumbar disc, the alpaca and llama cervical disc size are approximately 62%, 83%, and 75% with regard to area, depth, and width, respectively, and the disc flexibility is approximately 133%, 173%, and 254%, with regard to range of motion (ROM in axial-rotation, flexion-extension, and lateral-bending, respectively. These results, combined with the clinical report of disc degeneration in the llama lower cervical spine, suggest that the camelid cervical spine is potentially well suited for use as an animal model in biomechanical studies of the human lumbar spine.

  18. Spreading epidural hematoma and deep subcutaneous edema: indirect MRI signs of posterior ligamentous complex injury in thoracolumbar burst fractures

    Kim, Na Ra [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Konkuk University School of Medicine, Department of Radiology, Seoul (Korea); Hong, Sung Hwan [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Seoul National University Hospital, Department of Radiology, Seoul (Korea); Choi, Ja-Young; Myung, Jae Sung [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Chang, Bong-Soon [Seoul National University College of Medicine, Department of Orthopedic Surgery, Seoul (Korea); Lee, Joon Woo; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seoul (Korea); Moon, Sung Gyu [Konkuk University School of Medicine, Department of Radiology, Seoul (Korea)

    2010-08-15

    The purpose of this study was to evaluate the diagnostic value of a spreading epidural hematoma (SEH) and deep subcutaneous edema (DSE) as indirect signs of posterior ligamentous complex (PLC) injuries on MR imaging of thoracolumbar burst fractures. We retrospectively reviewed spinal MR images of 43 patients with thoracolumbar burst fractures: 17 patients with PLC injuries (study group) and 26 without PLC injuries (control group). An SEH was defined as a hemorrhagic infiltration into the anterior or posterior epidural space that spread along more than three vertebrae including the level of the fracture. A DSE was regarded as a fluid-like signal lesion in the deep subcutaneous layer of the back, and its epicenter was at the burst fracture level. The frequency of the SEH/DSE in the two groups was analyzed. In addition, the association between each sign and the degree of vertebral collapse, the severity of central canal compromise, and surgical decisions were analyzed. Magnetic resonance images showed an SEH in 20 out of 43 patients (46%) and a DSE in 17 (40%). The SEH and DSE were more commonly seen in the study group with PLC injuries (SEH, 15 out of 17 patients, 80%; DSE, 16 out of 17 patients, 94%) than in the control group without PLC injuries (SEH, 5 out of 26, 19%; DSE, 1 out of 26, 4%) (P <0.0001). The SEH and DSE were significantly associated with surgical management decisions (17 out of 20 patients with SEH, 85%, vs 8 out of the 23 without SEH, 35%, P =0.002; 15 out of 17 with DSE, 88%, vs 10 out of 26 without DSE, 38%, P =0.002). The SEH and DSE did not correlate with the degree of vertebral collapse or the severity of central canal compromise. The SEH and DSE may be useful secondary MR signs of posterior ligamentous complex injury in thoracolumbar burst fractures. (orig.)

  19. Short Segment Fixation Versus Short Segment Fixation With Pedicle Screws at the Fracture Level for Thoracolumbar Burst Fracture

    Anghel S

    2014-04-01

    Full Text Available Objective: The most prevailing surgical procedure in the treatment of thoracolumbar burst fractures, Short Segment Fixation (SSF, is often followed by loss of correction or hardware failure which may be significant enough to require another surgical intervention. In order to take advantage of its benefits but to avoid or diminish the risk and impact of associated drawbacks, some other alternatives have been lately developed among which we refer to short segment fixation with intermediate screws (SSF+IS. This article provides a comparative picture over the effectiveness of the two above-mentioned surgical treatments, focusing on their potential to prevent the loss of correction.

  20. Clinical study on the application of minimally invasive percutaneous pedicle screw fixation in single segment thoracolumbar fracture without neurological symptoms

    Jin-ping LIU

    2016-04-01

    Full Text Available Objective To discuss the clinical effects of minimally invasive percutaneous pedicle screw fixation in the treatment of single segment thoracolumbar fracture without neurological symptoms.  Methods From June 2012 to October 2014, 38 neurologically intact patients with thoracolumbar fracture underwent surgeries, including open pedicle screw fixation in 16 cases and percutaneous pedicle screw fixation in 22 cases. The incision length, operation time, intraoperative blood loss, postoperative drainage and postoperative complication were recorded and compared between 2 groups. Thoracolumbar orthophoric, lateral and flexion-extension X-ray was used to measure sagittal Cobb angle and height of injured anterior vertebral body before and after operation. Modified Macnab evaluation was used to assess the curative effects 3 months after operation. Results The success rate of operations in 38 patients was 100%. There were a total of 114 vertebral bodies fused and 228 pedicle screws implanted. Patients in the percutaneous pedicle screw group had smaller incision length [(10.55 ± 1.23 cm vs (18.50 ± 2.50 cm, P = 0.000], less intraoperative blood loss [(32.55 ± 7.22 ml vs (320.50 ± 15.48 ml, P = 0.000], shorter hospital stay [(6.55 ± 1.50 d vs (13.50 ± 2.52 d, P = 0.000], and without postoperative drainage. The follow-up after operation ranged from 3 to 6 months, with the average time of (4.65 ± 1.24 months. Cobb angle was reduced (P = 0.000 and height of injured anterior vertebral body were improved signifcantly (P = 0.000 3 months after surgery in both groups. The total effective rate was 14/16 in open surgery group, and 86.36% (19/22 in percutaneous pedicle screw group, however, the difference between 2 groups was not significant (P = 1.000. Conclusions Minimally invasive percutaneous pedicle screw fixation is a surgical method with less iatrogenic injury, less intraoperative blood loss and quick recovery for patients with thoracolumbar fracture

  1. Does a herniated nucleus pulposus contribute significantly to a decrease in height of the intervertebral disc? Quantitative volumetrich MRI

    Holodny, A.I.; Kisza, P.S.; Contractor, S.; Liu, W.C. [Department of Radiology, UMDNJ-New Jersey Medical School, University Hospital C-320, 150 Bergen Street, Newark, NJ 07103-2714 (United States)

    2000-06-01

    A lumbar intervertebral disc with a herniated nucleus pulposus (HNP) often exhibits a decrease in the height of the intervertebral space. Our purpose was to ascertain whether the loss of volume of an HNP is sufficient to cause a perceptible decrease in the height of the intervertebral space. MRI of 44 patients with 51 HNPs were reviewed. The volumes of the herniated material and of the intervertebral discs were calculated for every level from L 1-2 to L 5-S 1. The average volume of the HNP was 503{+-}301 mm{sup 3}. The average volumes of all 220 intervertebral discs and of the 127 normal-appearing discs were 14442{+-}4200 mm{sup 3} and 17476{+-}2885 mm{sup 3} respectively. The average volume of the HNP represented 3.5% of the parent disc. An average HNP caused a decrease in intervertebral space height of 0.35 mm (0.56 pixels). Therefore, the loss of the volume of the HNP does not cause a significant decrease in the intervertebral space height. The average calculated decrease in the disc height is less than that reported in normal diurnal variation. (orig.)

  2. MANAGEMENT OF UNSTABLE THORACOLUMBAR SPINAL INJURIES BY POSTERIOR INSTRUMENTATION: A PROSPECTIVE STUDY

    Shivanaik

    2014-10-01

    Full Text Available BACKGROUND AND OBJECTIVES: Spinal trauma is one of the grave injuries that cause infinite morbidity and disability resulting from high energy trauma. 30-60% of all spinal injuries are concentrated in the thoracic and lumbar spine and 15-20% is associated with neurological injury. The neurological improvement is independent of treatment modality, lately consensus evolving around the world for stabilization of spine with instrumentation allowing early mobilization, prevention and limitation of neurological injury as well as restoration of spinal stability. A number of fixation systems have been advocated. The use of pedicular screws and rod system allows adequate 3 dimensional control of each motion segment and allows rigid fixation. Acceptable results have been reported in majority of patients treated with pedicle screw and rod system with good neurological recovery. The aim of the study was to access the commonest mode, level, type of fracture, efficacy of pedicle screw and rod system and the radiological, neurological and functional out come in order to recreate a stable pain free spinal column. METHODS: This study is a prospective clinical study of unstable thoracolumbar spinal injuries by posterior instrumentation (pedicular screw and rod fixation in thoracic, lumbar, and thoracolumbar spinal fractures. In all, a total of 21 cases were evaluated and assessed during the period from 1st June 2008 to 30th September 2010. The study was conducted in the Department of Orthopaedics, Vijayanagara Institute of Medical sciences, Bellary. Patient selection was according to the inclusion and exclusion criteria and was surgically treated with pedicle screw and rod system. RESULTS: In our series there were 20(94.75% males and 1(5.25% female patient with an average age of 28.3 years 17(82.1% cases due to fall from height, 4(17.9% cases following road traffic accident.16(76.1% cases were of AO Type A, 3 (14.2% of AO Type B, 2(9.52% of AO type C fractures

  3. Dose-Volume Effects in Rat Thoracolumbar Spinal Cord: The Effects of Nonuniform Dose Distribution

    Purpose: To investigate dose-volume effects in rat spinal cord irradiated with nonuniform dose distributions and to assess regional differences in radiosensitivity. Methods and Materials: A total of 106 rats divided into three groups were irradiated with 192Ir γ-rays at a high dose rate. The groups were irradiated with one, two, or six catheters distributed around the thoracolumbar spinal cord to create different dose distributions. After irradiation, the animals were tested for motor function for 9 months. The response was defined as motor dysfunction and WM or nerve root necrosis. Dose-response data were analyzed with a probit analysis as function of the dose level at a percentage of the volume (D%) and with different normal tissue complication probability models. Additionally, the histologic responses of the individual dose voxels were analyzed after registration with the histologic sections. Results: The probit analysis at D24 (24% of the volume) gave the best fit results. In addition, the Lyman Kutcher Burman model and the relative seriality model showed acceptable fits, with volume parameters of 0.17 and 0.53, respectively. The histology-based analysis revealed a lower radiosensitivity for the dorsal (50% isoeffective dose [ED50] = 32.3) and lateral WM (ED50 = 33.7 Gy) compared with the dorsal (ED50 = 25.9 Gy) and ventral nerve roots (ED50 = 24.1 Gy). Conclusions: For this nonuniform irradiation, the spinal cord did not show typical serial behavior. No migration terms were needed for an acceptable fit of the dose-response curves. A higher radiosensitivity for the lumbar nerve roots than for the thoracic WM was found

  4. Evaluation the results of surgical management of traumatic paraplegia in traumatic thoracolumbar fractures

    Subarna Misra

    2016-06-01

    Full Text Available Background: Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Aim of this study was to evaluate the results of surgical management of traumatic paraplegia, complete or incomplete as classified by Frankel scoring. Methods: A prospective study was conducted in patients attending outdoor and emergency department of Orthopedics of a tertiary care teaching institute in Kolkata, West Bengal with traumatic paraplegia involving the dorsolumbar spine. The important objectives are the time for recovery of various functions like sensory, motor and bowel and bladder function, comparison between early and late decompression, results of posterolateral fusion and time taken for solid bony fusion after operation. Total 46 cases were selected within a minimum of 6-month post-operative follow-up of which 4 cases lost in follow-up. Data collected from patient records included age, sex, time from injury to hospitalization, initial neurological status as per Frankel Score, MRI findings, surgery performed, postoperative course and neurological status at the time of discharge and latest follow up. Patients lost to follow up were not studied for outcome analysis. Results: When decompression done within 1st week in incomplete paraplegia, 80% of the patients showed return of grade 3 power. In complete paraplegia cases, 11% of the patients had return of power up to grade 3 when decompression done within 1 week, where no cases showed return of grade 3 power when decompression done after 2nd or 3rd week. Conclusions: After recovery from spinal shock, the earlier the surgical compression done, the better the neurological and bowel/bladder function recovery both in complete and incomplete paraplegic cases. Reduction is better and easy and less time consuming in early decompression than in late. Motor recovery can continue for over 6 months after decompression. [Int J Res Med Sci 2016; 4(6.000: 2262-2270

  5. MORPHOMETRIC AND MORPHOLOGICAL STUDY OF ARTICULAR FACETS OF THE THORACOLUMBAR VERTEBRAL COLUMN IN NORTH INDIAN POPULATION

    Rimpi Gupta

    2015-09-01

    Full Text Available Background: The articular processes of thoracolumbar vertebral column play an important role in weight transmission and determining the range and direction of movements between any two vertebrae. Size of these facets has been correlated with the magnitude of stress imposed on them. Purpose of study: The present study has been conducted on the articular processes of 510 vertebrae (thoracic: 360; lumbar:150 with the aim to provide high quality data sets for constructing the models of spine to study mechanics of spinal instrumentation. The length , width and the distance between the right & left superior & inferior articular processes have been measured with the vernier callipers. The presence/ absence of mamillary tubercle has been observed in the present study. Results: The length of thoracic SAFs was almost same at all levels whereas that of the lumbar SAFs increased gradually from L1-L5. However the width showed a variable trend. In case of thoracic IAFs both these parameters showed a variable trend. Whereas in lumbar region, these increased gradually from L1-L5. The distance between two inferior articular processes was more than that between two superior articular processes at almost all levels except T1-T3 & L1-L4 where reverse was true. The mamillary tubercle/process was altogether absent from T-1 to T-8. From T-9 to T-11, the number of vertebral column showing mamillary tubercle increased from 4-19. However at T-12, it was seen in 29 Vertebral columns. In lumbar region, it was well developed in all vertebrae and termed as mamillary process. Conclusion: The measurements obtained by present study reveals the importance of articular facets in understanding basic spinal mechanics and its application with respect to weight transmission.

  6. Posterior short-segment fixation using ligamentotaxis for the thoracolumbar vertebral body fractures. Multicenter study

    Described are the operative technique for the thoracolumbar vertebral body fractures and their imaging evaluation by X-radiography and CT. The radiological technique of surgery involves the one level above-one level below screw fixation at the injured vertebra, taxis of kyphotic abnormality with screws and distraction with a rod, and ligamentotaxis after fulfillment of hydroxyl-apatite block in the formed hole at the pedicle of arch. Subjects are 74 patients (M 45/F 29; 14-78 years old; fracture at T11-12, 7 cases, L1-5, 67; A1 fracture 9 cases, A2, 8, A3, 55, and C1, 2) (not including the fragility fracture) of 5 hospitals, of whose 40 cases are followed up for 9-24 months after operation. Operation with Universal Spine System (Synthes) is conducted 1-31 days post injury. Following parameters are obtained in images before (at injury) and immediately after or after operation: Vertebral kyphotic angles, and heights of injured bone anterior/posterior (a/p) for calculation of wedge-shaped deformation rate (WDR) are measured in the lateral radiograph; and minimal diameters of a/p injured vertebral canal for canal constrictive rate, in CT. The mean kyphotic angle is found to be 8.5 deg at injury and 0.2 deg immediately after surgery, and WDR, 33.3% and 12.9%: significant corrections found. The canal constriction 57% at injury is significantly improved to 39% after operation. From aspect of calculated AIC (Akaike Information Criteria) on WDR, the operation is considered to have to be done within 7 disease days in average. (K.T.)

  7. Experimental model of intervertebral disc degeneration by needle puncture in Wistar rats

    A.C. Issy

    Full Text Available Animal models of intervertebral disc degeneration play an important role in clarifying the physiopathological mechanisms and testing novel therapeutic strategies. The objective of the present study is to describe a simple animal model of disc degeneration involving Wistar rats to be used for research studies. Disc degeneration was confirmed and classified by radiography, magnetic resonance and histological evaluation. Adult male Wistar rats were anesthetized and submitted to percutaneous disc puncture with a 20-gauge needle on levels 6-7 and 8-9 of the coccygeal vertebrae. The needle was inserted into the discs guided by fluoroscopy and its tip was positioned crossing the nucleus pulposus up to the contralateral annulus fibrosus, rotated 360° twice, and held for 30 s. To grade the severity of intervertebral disc degeneration, we measured the intervertebral disc height from radiographic images 7 and 30 days after the injury, and the signal intensity T2-weighted magnetic resonance imaging. Histological analysis was performed with hematoxylin-eosin and collagen fiber orientation using picrosirius red staining and polarized light microscopy. Imaging and histological score analyses revealed significant disc degeneration both 7 and 30 days after the lesion, without deaths or systemic complications. Interobserver histological evaluation showed significant agreement. There was a significant positive correlation between histological score and intervertebral disc height 7 and 30 days after the lesion. We conclude that the tail disc puncture method using Wistar rats is a simple, cost-effective and reproducible model for inducing disc degeneration.

  8. Treatment of the degenerated intervertebral disc; closure, repair and regeneration of the annulus fibrosus

    Sharifi, Shahriar; Bulstra, Sjoerd K.; Grijpma, Dirk W.; Kuijer, Roel

    2015-01-01

    Degeneration of the intervertebral disc (IVD) and disc herniation are two causes of low back pain. The aetiology of these disorders is unknown, but tissue weakening, which primarily occurs due to inherited genetic factors, ageing, nutritional compromise and loading history, is the basic factor causi

  9. Experimental model of intervertebral disc degeneration by needle puncture in Wistar rats

    Issy, A.C.; Castania, V.; Castania, M. [Departamento de Morfologia, Fisiologia e Patologia Básica, Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Salmon, C.E.G. [Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Nogueira-Barbosa, M.H. [Divisão de Radiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Bel, E. Del [Departamento de Morfologia, Fisiologia e Patologia Básica, Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Defino, H.L.A. [Departamento de Biomecânica, Medicina e Reabilitação do Sistema Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil)

    2013-03-15

    Animal models of intervertebral disc degeneration play an important role in clarifying the physiopathological mechanisms and testing novel therapeutic strategies. The objective of the present study is to describe a simple animal model of disc degeneration involving Wistar rats to be used for research studies. Disc degeneration was confirmed and classified by radiography, magnetic resonance and histological evaluation. Adult male Wistar rats were anesthetized and submitted to percutaneous disc puncture with a 20-gauge needle on levels 6-7 and 8-9 of the coccygeal vertebrae. The needle was inserted into the discs guided by fluoroscopy and its tip was positioned crossing the nucleus pulposus up to the contralateral annulus fibrosus, rotated 360° twice, and held for 30 s. To grade the severity of intervertebral disc degeneration, we measured the intervertebral disc height from radiographic images 7 and 30 days after the injury, and the signal intensity T2-weighted magnetic resonance imaging. Histological analysis was performed with hematoxylin-eosin and collagen fiber orientation using picrosirius red staining and polarized light microscopy. Imaging and histological score analyses revealed significant disc degeneration both 7 and 30 days after the lesion, without deaths or systemic complications. Interobserver histological evaluation showed significant agreement. There was a significant positive correlation between histological score and intervertebral disc height 7 and 30 days after the lesion. We conclude that the tail disc puncture method using Wistar rats is a simple, cost-effective and reproducible model for inducing disc degeneration.

  10. Experimental model of intervertebral disc degeneration by needle puncture in Wistar rats

    Animal models of intervertebral disc degeneration play an important role in clarifying the physiopathological mechanisms and testing novel therapeutic strategies. The objective of the present study is to describe a simple animal model of disc degeneration involving Wistar rats to be used for research studies. Disc degeneration was confirmed and classified by radiography, magnetic resonance and histological evaluation. Adult male Wistar rats were anesthetized and submitted to percutaneous disc puncture with a 20-gauge needle on levels 6-7 and 8-9 of the coccygeal vertebrae. The needle was inserted into the discs guided by fluoroscopy and its tip was positioned crossing the nucleus pulposus up to the contralateral annulus fibrosus, rotated 360° twice, and held for 30 s. To grade the severity of intervertebral disc degeneration, we measured the intervertebral disc height from radiographic images 7 and 30 days after the injury, and the signal intensity T2-weighted magnetic resonance imaging. Histological analysis was performed with hematoxylin-eosin and collagen fiber orientation using picrosirius red staining and polarized light microscopy. Imaging and histological score analyses revealed significant disc degeneration both 7 and 30 days after the lesion, without deaths or systemic complications. Interobserver histological evaluation showed significant agreement. There was a significant positive correlation between histological score and intervertebral disc height 7 and 30 days after the lesion. We conclude that the tail disc puncture method using Wistar rats is a simple, cost-effective and reproducible model for inducing disc degeneration

  11. Experimental model of intervertebral disc degeneration by needle puncture in Wistar rats

    A.C. Issy

    2013-03-01

    Full Text Available Animal models of intervertebral disc degeneration play an important role in clarifying the physiopathological mechanisms and testing novel therapeutic strategies. The objective of the present study is to describe a simple animal model of disc degeneration involving Wistar rats to be used for research studies. Disc degeneration was confirmed and classified by radiography, magnetic resonance and histological evaluation. Adult male Wistar rats were anesthetized and submitted to percutaneous disc puncture with a 20-gauge needle on levels 6-7 and 8-9 of the coccygeal vertebrae. The needle was inserted into the discs guided by fluoroscopy and its tip was positioned crossing the nucleus pulposus up to the contralateral annulus fibrosus, rotated 360° twice, and held for 30 s. To grade the severity of intervertebral disc degeneration, we measured the intervertebral disc height from radiographic images 7 and 30 days after the injury, and the signal intensity T2-weighted magnetic resonance imaging. Histological analysis was performed with hematoxylin-eosin and collagen fiber orientation using picrosirius red staining and polarized light microscopy. Imaging and histological score analyses revealed significant disc degeneration both 7 and 30 days after the lesion, without deaths or systemic complications. Interobserver histological evaluation showed significant agreement. There was a significant positive correlation between histological score and intervertebral disc height 7 and 30 days after the lesion. We conclude that the tail disc puncture method using Wistar rats is a simple, cost-effective and reproducible model for inducing disc degeneration.

  12. Epidural fat distribution patterns in patients with lumbar intervertebral disc protrusion

    Yang Zhizhou; Zhu Xiaodong; Li Ming

    2009-01-01

    Objective: To investigate epidural fat distribution patterns in patients with lumbar intervertebral disc protrusion. Methods: Medical records were selected randomly from 30 patients whose diagnoses were consistent with the inclusion criteria of the study. Thickness of bilateral fat, the longest length of posterior fat, thickness of bilateral yellow ligament and thehernial distance of lumbar discs were measured by MRI at L3/L4, L4/L5 and LS/S 1 levels. According to clinical symptoms of lumbar intervertebral disc protrusion, the patients were divided into two groups at all space levels. All data were analyzed by statistical software. Results: The longest length of posterior epidural fat at the symptomatic levels was shorter than that at the non-symptomatic levels in each disc space. The symptomatic levels had no effect on the whole thickness of the lateral fat and lateral yellow ligaments. Conclusion: Epidural fat distribution in patients with lumbar intervertebral disc protrusion is different from that in normal adults. It is affected by the hernial distance of lumbar discs. The diagnostic criteria for spinal epidural lipomatosis in normal adults may therefore prove to be inappropriate for patients with lumbar intervertebral disc protrusion.

  13. Intervertebral disc (IVD): Structure, degeneration, repair and regeneration

    Whatley, Benjamin R.; Wen Xuejun, E-mail: xjwen@clemson.edu

    2012-02-01

    Low back pain affects a large portion of the population, resulting in high care costs for therapy and treatment. One primary cause of low back pain is the degeneration of the intervertebral disc (IVD) resulting in the compression of the spinal nerves and adjacent vertebrae. Exact causes of degeneration are unknown, but it is thought that natural aging, and both biological and genetic factors may play a significant role in the degenerative process. Conventional methods to alleviate low back pain include spinal fusion and artificial disc replacement. Traditional treatments through spinal fusion may eliminate pain yet do not restore disc function and lead to further degeneration of adjacent levels by altering disc biomechanics and natural kinematics. Recently, artificial IVD replacements have started to gain interest, with two IVD implants currently approved in the United States. Although these implants facilitate the preservation of motions and disc space height, they are unable to sustain compressive forces due to their lack of elasticity. In addition, the implants may produce wear debris that can cause osteolysis and other deleterious effects. As an alternative to these conventional approaches, tissue engineered IVD constructs offer the advantage of biointegration while preserving the essential attributes of natural motion and disc space restoration. There is a great need for the development of tissue engineered scaffolds that simulate the natural 3D morphology and microenvironment of the targeted tissue. Scaffolds should facilitate biological transport to satisfy nutrition and waste removal requirements within the IVD. The discrete tissue architectures of the nucleus pulposus (NP) and annulus fibrosus (AF) have posed great challenges to IVD tissue engineering. Current attempts have not been able to satisfy the biological functions and/or mechanical properties of native tissue. Therefore, these current scaffolds are far from satisfactory. This review highlights the

  14. Adolescent prolapsed lumbar intervertebral disc: Management strategies and outcome

    Pragyan Sarma

    2016-01-01

    Full Text Available Objective: Lumbar intervertebral disc herniation (LIVDH is rare in children and adolescents when compared to adults. In literature, children generally constitute around 0.5–3% of surgically treated LIVDH. Though much rarer, they are less likely to respond to conservative treatment than adults. In this study, we analyze our experience in the management of adolescent LIVDH (ALIVDH (age group 12–18 years including the demographic, clinico-radiological features; surgical management strategies and outcome. Materials and Methods: This retrospective analysis constituted all patients between 12 and 18 years, who underwent surgery for LIVDH at our institute over a period of 15 years from January 1999 to June 2014. The records of these patients were retrieved, and demographic features, clinical picture, radiological features, operative findings, and postoperative events were evaluated. Follow-up data were obtained either through direct clinical evaluation or mailed self-report questionnaire and telephone conversations. The long-term outcome was analyzed by using standardized and condition specific outcome scales in addition to routine clinical follow-up evaluation. The long-term outcome was analyzed by using the short form-36 (SF-36.Results: There were a total of 32 patients (26 males, eight females with an average age of 15.64 years. Trauma was a significant etiological factor 57.14% (n = 16/28. Vertebral anomalies were present in 35.7% (n = 10/28 cases. Majority had a neurological deficit at presentation (n = 20/28. The most commonly involved level was the L4–L5 level (n = 18/128 in this series. Multiple level disc degeneration was present in eight patients (28.6%. Immediate postoperative relief was achieved in all but one patient. At long-term follow-up twenty patients were pain-free (71.4%. At follow-up, the physical functioning scale of SF-36 was significantly lower in patients with gross motor deficit prior to surgery. Conclusions: Early

  15. CT findings of lumbar intervertebral discs: I. normal anatomy

    The cross-sectional anatomy of the intervertebral disc and spinal canal can be studied in detail by computed tomography (CT) which is not invasive and is much simpler than conventional myelography. The shape of the normal disc and distribution of epidural fat pad varied at each disc level and CT findings of the normal disc and spinal canal are essential in diagnosis of herniation or bulging. However, there has been no previous publications providing us with the detailed criteria of normal disc and neural canal cross-sectional anatomy. The present study has been carried out to investigate CT anatomy of the normal distribution of the epidural fat at each lumbar disc level to set up a baseline by which one will be able to judge disc herniation or bulging. The materials consisted of 30 adult volunteers. They were sampled randomly from the individual undergoing a CT study for the reasons other than spinal disease and having no symptoms or signs of the lumbar spinal disease. CT scans were performed with a Siemens Somatom 2 Scanner. Technical factors involved were: Tube voltage 125 kVp, exposure time 10 seconds, 460 mAS, 256 x 256 matrix, and pixel size 0.4 mm. Contiguous 2-mm thick slice of each disc were obtained parallel to the disc plane at 3-mm interval for 5 lumbar disc. The results are follows: 1. The shape of the posterior disc margins at L1-2, L2-3, and L3-4 levels were concave anteriorly in over 90% of the cases compared with the disc margins at L4-5 and L5-S1 where were convex or flat in over 85%. 2. None of the convex disc showed focal nodular protrusion nor were more convex than anterior margin of the disc. 3. The lower lumbar levels, the greater the visibility of the epidural fat pad. The visibility of the epidural fat pad in both lateral recesses was 81.5% at the L4-5 level and 100% at the L5-S1 level. There was no single case in which epidural fat pad was visable in only on side. 4. The visibility of the epidural fat just behind the disc was only 18.5% at

  16. Intervertebral disc (IVD): Structure, degeneration, repair and regeneration

    Low back pain affects a large portion of the population, resulting in high care costs for therapy and treatment. One primary cause of low back pain is the degeneration of the intervertebral disc (IVD) resulting in the compression of the spinal nerves and adjacent vertebrae. Exact causes of degeneration are unknown, but it is thought that natural aging, and both biological and genetic factors may play a significant role in the degenerative process. Conventional methods to alleviate low back pain include spinal fusion and artificial disc replacement. Traditional treatments through spinal fusion may eliminate pain yet do not restore disc function and lead to further degeneration of adjacent levels by altering disc biomechanics and natural kinematics. Recently, artificial IVD replacements have started to gain interest, with two IVD implants currently approved in the United States. Although these implants facilitate the preservation of motions and disc space height, they are unable to sustain compressive forces due to their lack of elasticity. In addition, the implants may produce wear debris that can cause osteolysis and other deleterious effects. As an alternative to these conventional approaches, tissue engineered IVD constructs offer the advantage of biointegration while preserving the essential attributes of natural motion and disc space restoration. There is a great need for the development of tissue engineered scaffolds that simulate the natural 3D morphology and microenvironment of the targeted tissue. Scaffolds should facilitate biological transport to satisfy nutrition and waste removal requirements within the IVD. The discrete tissue architectures of the nucleus pulposus (NP) and annulus fibrosus (AF) have posed great challenges to IVD tissue engineering. Current attempts have not been able to satisfy the biological functions and/or mechanical properties of native tissue. Therefore, these current scaffolds are far from satisfactory. This review highlights the

  17. Investigation of intervertebral disc degeneration using multivariate FTIR spectroscopic imaging.

    Mader, Kerstin T; Peeters, Mirte; Detiger, Suzanne E L; Helder, Marco N; Smit, Theo H; Le Maitre, Christine L; Sammon, Chris

    2016-06-23

    Traditionally tissue samples are analysed using protein or enzyme specific stains on serial sections to build up a picture of the distribution of components contained within them. In this study we investigated the potential of multivariate curve resolution-alternating least squares (MCR-ALS) to deconvolute 2nd derivative spectra of Fourier transform infrared (FTIR) microscopic images measured in transflectance mode of goat and human paraffin embedded intervertebral disc (IVD) tissue sections, to see if this methodology can provide analogous information to that provided by immunohistochemical stains and bioassays but from a single section. MCR-ALS analysis of non-degenerate and enzymatically in vivo degenerated goat IVDs reveals five matrix components displaying distribution maps matching histological stains for collagen, elastin and proteoglycan (PG), as well as immunohistochemical stains for collagen type I and II. Interestingly, two components exhibiting characteristic spectral and distribution profiles of proteoglycans were found, and relative component/tissue maps of these components (labelled PG1 and PG2) showed distinct distributions in non-degenerate versus mildly degenerate goat samples. MCR-ALS analysis of human IVD sections resulted in comparable spectral profiles to those observed in the goat samples, highlighting the inter species transferability of the presented methodology. Multivariate FTIR image analysis of a set of 43 goat IVD sections allowed the extraction of semi-quantitative information from component/tissue gradients taken across the IVD width of collagen type I, collagen type II, PG1 and PG2. Regional component/tissue parameters were calculated and significant correlations were found between histological grades of degeneration and PG parameters (PG1: p = 0.0003, PG2: p < 0.0001); glycosaminoglycan (GAG) content and PGs (PG1: p = 0.0055, PG2: p = 0.0001); and MRI T2* measurements and PGs (PG1: p = 0.0021, PG2: p < 0.0001). Additionally

  18. Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system: an analysis of 38 cases

    WANG Hong-wei

    2010-06-01

    Full Text Available To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non- randomized case-control study.

  19. An animal model to create intervertebral disc degeneration characterized by radiography and molecular biology

    Zhengming Sun; Miao Liu; Yingang Zhang

    2008-01-01

    Objectives: To develop a rabbit model of intervertebral disc degeneration that more exactly simulates the pathological changes of human intervertebral disc degeneration. Methods: Twelve New Zealand white rabbits were utilized to establish three different disc injury models according to the following protocol; group A: anulus punctures were done with a 18-gauge needle at L2-L3 and L5-L6; Group B: intradiscal injection of interleukin-l IL-lβ with a 23-gauge needle at L3-L4; and Group C: intradiscal injection of phosphate buffer saline(PBS) with a 23-gange needle at L4-L5. The L1-L2 level was used as a control. Rabbits were killed after 24 weeks. The intervertebral disc height was measured by lateral plain radiographs. After the radiographic measurements were obtained, the intervertebral discs were removed and analyzed for DNA, sulfated glycosaminoglycan(s-GAG) and water contents of nucleus puiposus. Results: The intervertebral disc height, s-GAG, and water contents in anulus needle punctures were significantly decreased in Group A, but the DNA content in the nucleus pulposus was significantly increased when compared to the control. The significant decrease of disc height and water contents were demonstrated, only the s-GAG and DNA contents did not show a significant difference in Group B when compared to the control. The significant decrease of disc height, s-GAG, water, and DNA contents did not show in Group C when compared to the control. Conclusion: The 18-gauge puncture models produced the most consistent disc degeneration in the rabbit lumbar spine.

  20. Epithelioid hemangioendothelioma and multiple thoraco-lumbar lateral meningoceles: two rare pathological entities in a patient with NF-1

    Epithelioid hemangioendothelioma (EHE) is a rare vascular soft-tissue tumour of intermediate malignancy. Neurofibromatosis type I (NF-1) is a genetic syndrome associated with soft tissue sarcoma and higher risk of developing neoplasia. Lateral meningoceles are uncommon entities, being mostly associated with NF-1. We report a case of a 31-year-old woman, with NF-1 and past history of right thalamic/peduncular astrocytoma WHO grade II, admitted to the Neurosurgery Department in December 2003 due to severe low back pain, irradiating to the left leg without a radicular pattern. Thoraco-lumbar magnetic resonance imaging (MRI) showed a large left posterior paravertebral expansive lesion, bilateral and multiple thoraco-lumbar lateral meningoceles and dural ectasias with scalloping of the vertebral bodies. Biopsy of the paravertebral mass lesion disclosed EHE. We present this case because of the novel association between NF-1 and EHE, and the unusual aggressiveness of the neoplasia. Additionally, we highlight the co-existence of bilateral and multiple lateral meningoceles. (orig.)

  1. Epithelioid hemangioendothelioma and multiple thoraco-lumbar lateral meningoceles: two rare pathological entities in a patient with NF-1

    Reis, C.; Carneiro, E.; Fonseca, J.; Salgado, A. [Hospital S. Joao, Departments of Neuroradiology, Porto (Portugal); Pereira, P.; Vaz, R. [Hospital S. Joao, Department of Neurosurgery, Porto (Portugal); Pinto, R. [Hospital S. Joao, Department of Orthopaedics, Porto (Portugal); Capelinha, A.F.; Lopes, J.M. [Hospital S. Joao, Department of Pathology, Porto (Portugal)

    2005-02-01

    Epithelioid hemangioendothelioma (EHE) is a rare vascular soft-tissue tumour of intermediate malignancy. Neurofibromatosis type I (NF-1) is a genetic syndrome associated with soft tissue sarcoma and higher risk of developing neoplasia. Lateral meningoceles are uncommon entities, being mostly associated with NF-1. We report a case of a 31-year-old woman, with NF-1 and past history of right thalamic/peduncular astrocytoma WHO grade II, admitted to the Neurosurgery Department in December 2003 due to severe low back pain, irradiating to the left leg without a radicular pattern. Thoraco-lumbar magnetic resonance imaging (MRI) showed a large left posterior paravertebral expansive lesion, bilateral and multiple thoraco-lumbar lateral meningoceles and dural ectasias with scalloping of the vertebral bodies. Biopsy of the paravertebral mass lesion disclosed EHE. We present this case because of the novel association between NF-1 and EHE, and the unusual aggressiveness of the neoplasia. Additionally, we highlight the co-existence of bilateral and multiple lateral meningoceles. (orig.)

  2. The development of a posterior dynamic stabilisation implant indicated for thoraco-lumbar disc degeneration / Christopher Daniel (Chris) Parker

    Parker, Christopher Daniel

    2013-01-01

    Posterior lumbar spinal dynamic stabilisation devices are intended to relieve the pain of spinal segments while prolonging the lifespan of adjacent intervertebral discs. This study focuses on the design of such a device, one that has the correct stiffness to stabilise the spinal segment by the correct amount. An initial literature survey covers contemporary topics related to the lumbar spine. Included topics are lumbar anatomy and kinematics, pathology of degenerative disc dise...

  3. Acute Splenic Sequestration Crisis in a 70-Year-Old Patient With Hemoglobin SC Disease.

    Squiers, John J; Edwards, Anthony G; Parra, Alberto; Hofmann, Sandra L

    2016-01-01

    A 70-year-old African American female with a past medical history significant for chronic bilateral shoulder pain and reported sickle cell trait presented with acute-onset bilateral thoracolumbar pain radiating to her left arm. Two days after admission, Hematology was consulted for severely worsening microcytic anemia and thrombocytopenia. Examination of the patient's peripheral blood smear from admission revealed no cell sickling, spherocytes, or schistocytes. Some targeting was noted. A Coombs test was negative. The patient was eventually transferred to the medical intensive care unit in respiratory distress. Hemoglobin electrophoresis confirmed a diagnosis of hemoglobin SC disease. A diagnosis of acute splenic sequestration crisis complicated by acute chest syndrome was crystallized, and red blood cell exchange transfusion was performed. Further research is necessary to fully elucidate the pathophysiology behind acute splenic sequestration crisis, and the role of splenectomy to treat hemoglobin SC disease patients should be better defined. PMID:27047980

  4. Rabbit model of intervertebral disc degeneration by external compression device characterized by X-ray, MRI, histology, and cell viability

    Ismail Ismail; Hee H. Tak; James C. Goh; Wang S. Chang; Wong H. Kit

    2006-01-01

    Appropriate experimental animal models, which mimic the degenerative process occurring in human intervertebral disc (IVD) breakdown and can be used for new treatment studies such as tissue engineering or disc distraction are lacking. We studied the external compression device that used by Kroeber et al to create intervertebral disc degeneration in rabbit model characterized by X-ray, MRI, Histology, and Cell Viability. Ten NZW rabbit were randomly assigned to one of five groups. Intervertebra...

  5. A diffusion and T{sub 2} relaxation MRI study of the ovine lumbar intervertebral disc under compression in vitro

    Drew, Simon C [Centre for Magnetic Resonance, University of Queensland, Brisbane, 4072 (Australia); Silva, Pujitha [Centre for Magnetic Resonance, University of Queensland, Brisbane, 4072 (Australia); Crozier, Stuart [School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, 4072 (Australia); Pearcy, Mark J [School of Mechanical, Manufacturing and Medical Engineering, Queensland University of Technology, Brisbane, 4001 (Australia)

    2004-08-21

    The ovine lumbar intervertebral disc is a useful model for the human lumbar disc. We present preliminary estimates of diffusion coefficients and T{sub 2} relaxation times in a pilot MRI study of the ovine lumbar intervertebral disc during uniaxial compression in vitro, and identify factors that hamper the ability to accurately monitor the temporal evolution of the effective diffusion tensor at high spatial resolution.

  6. Subcutaneous fluid collection: An imaging marker for treatment response of infectious thoracolumbar spondylodiscitis

    Kakigi, Takahide, E-mail: tkakigi@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 (Japan); Okada, Tomohisa, E-mail: tomokada@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 (Japan); Sakai, Osamu, E-mail: osamu.sakai@bmc.org [Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA 02118 (United States); Iwamoto, Yoshitaka, E-mail: iwacame@hotmail.co.jp [Department of General Internal Medicine, Rakuwakai Otowa Hospital, 2 Otowachoinji-cho, Yamashina-ku, Kyoto 607-8062 (Japan); Kubo, Soichi, E-mail: kubo-s@mbox.kyoto-inet.or.jp [Department of Radiology, Rakuwakai Otowa Hospital, 2 Otowachoinji-cho, Yamashina-ku, Kyoto 607-8062 (Japan); Yamamoto, Akira, E-mail: yakira@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 (Japan); Togashi, Kaori, E-mail: nmdioffice@kuhp.kyoto-ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 (Japan)

    2015-07-15

    Highlights: • No imaging marker for treatment response of spondylodiscitis (SD) has been proposed. • Volume changes of subcutaneous fluid collection (SFC) had significant correlation with changes of C-reactive protein (CRP). • SFC can be used as an imaging marker for treatment response of SD on magnetic resonance imaging (MRI). - Abstract: Purpose: To evaluate prevalence of subcutaneous fluid collection (SFC) in infectious thoracolumbar spondylodiscitis (SD) compared with control patients and to investigate correlation between volume changes of SFC and treatment response of SD. Materials and methods: This retrospective study was approved by our institutional review board. From April 2011 to March 2012, 49 patients (24 SD and 25 non-SD patients) were enrolled. Prevalence of SFC was evaluated respectively for SD and non-SD patients using magnetic resonance imaging (MRI) on the sagittal short tau inversion recovery (STIR) imaging or fat-saturated T2-weighted imaging (T2WI), and compared. In SD patients with SFC, correlation was investigated between SFC volume on the 1st MRI and initial clinical status. The same analysis was conducted also for SFC volume changes from the 1st to 2nd or last MRI. Results: SFC was found in 20 patients with SD (83.3%) and 3 non-SD patients (12%) with significant difference (p < .001). In 20 SD patients with SFC, 17 patients had follow-up MRI. For the 1st MRI, no significant correlation was found between volume of SFC and initial status of patients, including body weight, body mass index (BMI), white blood cell (WBC), and erythrocyte sedimentation rate (ESR). However, significant positive correlations were found between changes of C-reactive protein (CRP) and SFC volume from the 1st to 2nd as well as from the 1st to the last MRI (each p < .05). Conclusion: SD patients had significantly higher prevalence of SFC than non-SD patients. Volume changes of SFC had significant correlation with changes of CRP, which can be used as an imaging

  7. A paired study of bone mineral density between the patients of type 2 diabetes mellitus and herniation of intervertebral disc

    Objective: To observe the changes of bone mineral density (BMD)'s changing in different parts of body and the relation with diagnosis of osteoporosis in patients with type 2 diabetes mellitus or herniation of intervertebral disc. Methods: There are 41 patients in each group of DM or herniation of intervertebral disc, who were paired by the factors of sex, age etc. BMD of whole body, arms, legs and lumbar spines were measured by dual energy X-ray absorptiometry (DEXA). Results: The whole body BMD in group of DM was significantly higher than in group of herniation of intervertebral disc (P<0.01). BMD of arms and legs in DM patients (esp. legs) was more significantly decreased than in group of herniation of intervertebral disc (P<0.05). Lumbar BMD in group of DM was higher than in group of herniation of intervertebral disc (P<0.01). Conclusion: It may be a characteristic of the osteoporosis in DM that BMD reduced mainly in extremity. Contrast to osteoporosis by herniation of intervertebral disc, it maybe mainly caused by central bone. It shows that it is necessary to make different rules for different diseases on diagnosis of osteoporosis

  8. Detailed analysis of the clinical effects of cell therapy for thoracolumbar spinal cord injury: an original study

    Sharma A

    2013-07-01

    Full Text Available Alok Sharma,1 Nandini Gokulchandran,1 Hemangi Sane,2 Prerna Badhe,1 Pooja Kulkarni,2 Mamta Lohia,3 Anjana Nagrajan,3 Nancy Thomas3 1Department of Medical Services and Clinical Research, 2Department of Research and Development, 3Department of Neurorehabilitation, NeuroGen Brain and Spine Institute, Surana Sethia Hospital and Research Centre, Chembur, Mumbai, India Background: Cell therapy is amongst the most promising treatment strategies in spinal cord injury (SCI because it focuses on repair. There are many published animal studies and a few human trials showing remarkable results with various cell types. The level of SCI determines whether paraplegia or quadriplegia is present, and greatly influences recovery. The purpose of this study was to determine the significance of the clinical effects and long-term safety of intrathecal administration of autologous bone marrow-derived mononuclear cells, along with changes in functional independence and quality of life in patients with thoracolumbar SCI. Methods: We undertook a retrospective analysis of a clinical study in which a nonrandomized sample of 110 patients with thoracolumbar SCI underwent autologous bone marrow-derived mononuclear cell transplantation intrathecally and subsequent neurorehabilitation, with a mean follow-up of 2 years ± 1 month. Changes on any parameters were recorded at follow-up. The data were analyzed using the Wilcoxon's signed-rank test and McNemar's test. Functional Independence Measure and American Spinal Injury Association (ASIA scores were recorded, and a detailed neurological assessment was performed. Results: Overall improvement was seen in 91% of patients, including reduction in spasticity, partial sensory recovery, and improvement in trunk control, postural hypotension, bladder management, mobility, activities of daily living, and functional independence. A significant association of these symptomatic improvements with the cell therapy intervention was established

  9. A Review of Animal Models of Intervertebral Disc Degeneration: Pathophysiology, Regeneration, and Translation to the Clinic

    Ghosh, Peter

    2016-01-01

    Lower back pain is the leading cause of disability worldwide. Discogenic pain secondary to intervertebral disc degeneration is a significant cause of low back pain. Disc degeneration is a complex multifactorial process. Animal models are essential to furthering understanding of the degenerative process and testing potential therapies. The adult human lumbar intervertebral disc is characterized by the loss of notochordal cells, relatively large size, essentially avascular nature, and exposure to biomechanical stresses influenced by bipedalism. Animal models are compared with regard to the above characteristics. Numerous methods of inducing disc degeneration are reported. Broadly these can be considered under the categories of spontaneous degeneration, mechanical and structural models. The purpose of such animal models is to further our understanding and, ultimately, improve treatment of disc degeneration. The role of animal models of disc degeneration in translational research leading to clinical trials of novel cellular therapies is explored. PMID:27314030

  10. Quantification of the association between intervertebral disk calcification and disk herniation in Dachshunds

    Jensen, Vibeke Frøkjær; Beck, S.; Christensen, K.A.;

    2008-01-01

    predictor of clinical disk herniation (odds ratio per calcified disk, 1.42; 95% confidence interval, 1.19 to 1.81). Number of calcified disks in the full vertebral column was a better predictor than number of calcified disks between vertebrae T10 and L3. Numbers of calcified disks at >= 8 years of age and......Objective-To quantify the association between intervertebral disk calcification and disk herniation in Dachshunds. Design-Longitudinal study. Animals-61 Dachshunds that had been radiographically screened for calcification of intervertebral disks at 2 years of age in other studies. Thirty-seven of....... Information on occurrence of disk herniation between 2 and 8 years of age was obtained from owners via questionnaire. Associations between numbers of calcified disks and disk herniation were analyzed via maximum likelihood logistic regression. Results-Disk calcification at 2 years of age was a significant...

  11. Intervertebral disc calcification in children: Case description and review of relevant literature

    Intervertebral disc calcification is a rare condition in children; in most cases, it is asymptomatic and therefore not diagnosed. In our study, we present a case of idiopathic intervertebral disc calcification within the cervical segment, at the level of C2/C3 and C4/C5 vertebrae in a 5-year-old girl with torticollis. Basic neurological examination supplemented by X-ray examination was performed, showing calcification within the cervical segment at the level of C2/C3 and C4/C5 vertebrae. In order to complement the diagnostics, a CT scan of the cervical spine was performed; the scan confirmed the diagnosis and revealed additional calcification of the anterior longitudinal ligament at the level of C4/C5 vertebrae

  12. A Review of Animal Models of Intervertebral Disc Degeneration: Pathophysiology, Regeneration, and Translation to the Clinic

    Chris Daly

    2016-01-01

    Full Text Available Lower back pain is the leading cause of disability worldwide. Discogenic pain secondary to intervertebral disc degeneration is a significant cause of low back pain. Disc degeneration is a complex multifactorial process. Animal models are essential to furthering understanding of the degenerative process and testing potential therapies. The adult human lumbar intervertebral disc is characterized by the loss of notochordal cells, relatively large size, essentially avascular nature, and exposure to biomechanical stresses influenced by bipedalism. Animal models are compared with regard to the above characteristics. Numerous methods of inducing disc degeneration are reported. Broadly these can be considered under the categories of spontaneous degeneration, mechanical and structural models. The purpose of such animal models is to further our understanding and, ultimately, improve treatment of disc degeneration. The role of animal models of disc degeneration in translational research leading to clinical trials of novel cellular therapies is explored.

  13. Functional probe for annulus fibrosus-targeted intervertebral disc degeneration imaging.

    Kim, Hye-Yeong; Mcclincy, Michael; Vo, Nam V; Sowa, Gwendolyn A; Kang, James D; Bai, Mingfeng

    2013-10-01

    Intervertebral disc degeneration (IDD) is closely associated with low back pain. Typically nonsurgical treatment of IDD is the most effective when detected early. As such, establishing reliable imaging methods for the early diagnosis of disc degeneration is critical. The cellular and tissue localization of a facile functional fluorescent probe, HYK52, that labels disc annulus fibrosus is reported. HYK52 was synthesized with high yield and purity via a two-step chemical reaction. Rabbit disc cell studies and ex vivo tissue staining images indicated intracellular localization and intervertebral disc (IVD) tissue binding of HYK52 with negligible cytotoxicity. Moreover, HYK52 is purposefully designed with a functional terminal carboxyl group to allow for coupling with various signaling molecules for multimodal imaging applications. These results suggest that this IVD-targeted probe may have great potential in early diagnosis of IDD. PMID:23839314

  14. Contrast myelography in the diagnosis of posterior hernias of lumbar intervertebral disks

    Based on the analysis of the results of 297 contrast myelographies (MG) by means of water soluble agents made in patients with posterior hernias of lumbar intervertebral disks (PHLID), the authors define the potentialities of this technique in the diagnosis of PHLID. Additionally, two oblique X-ray films have been included into the exicting filming routine, which may detect all specific features of intervertebral disk damage at MG. The authors make additions into the wellknown myelographic symptomatology of PHLID, by outlining the abnormal anterior configuration of a contrast column at the level of a diseased disk in PHLID at the foraminal site. The findings suggest that contrast MG with nonionic water-soluble agents is a rather effective technique in the diagnosis of PHLID

  15. Calcification of intervertebral discs in the Dachshund: An estimation of heritability

    The heritability of calcified intervertebral discs in the dachshund was estimated using data gathered from a radiographic study. Radiographs of the vertebral columns of 274 clinically normal, 12 to 18 months old dachshunds, were examined. The dogs were offspring from 75 different sires, representing the same number of half sib groups. There were 2 to 14 offspring in each half-sib group. The number of full sib groups was 81. Calcified intervertebral discs were identified in 20.4% of the dogs. An analysis of variance that used the data as a continuous and as an either/or-variable estimated the heritability of calcified discs to be 0.22 and 0.15 respectively. A genetic factor was found to be essential for the occurrence of calcified discs in a dog while a common environmental factor presumably resulting from non-genetic causes was significant in determining the number of discs to undergo calcification in affected dogs

  16. A Review of Animal Models of Intervertebral Disc Degeneration: Pathophysiology, Regeneration, and Translation to the Clinic.

    Daly, Chris; Ghosh, Peter; Jenkin, Graham; Oehme, David; Goldschlager, Tony

    2016-01-01

    Lower back pain is the leading cause of disability worldwide. Discogenic pain secondary to intervertebral disc degeneration is a significant cause of low back pain. Disc degeneration is a complex multifactorial process. Animal models are essential to furthering understanding of the degenerative process and testing potential therapies. The adult human lumbar intervertebral disc is characterized by the loss of notochordal cells, relatively large size, essentially avascular nature, and exposure to biomechanical stresses influenced by bipedalism. Animal models are compared with regard to the above characteristics. Numerous methods of inducing disc degeneration are reported. Broadly these can be considered under the categories of spontaneous degeneration, mechanical and structural models. The purpose of such animal models is to further our understanding and, ultimately, improve treatment of disc degeneration. The role of animal models of disc degeneration in translational research leading to clinical trials of novel cellular therapies is explored. PMID:27314030

  17. 胸腰椎骨折治疗的研究进展(综述)%Research progress of the treatment of thoracolumbar fracture

    李圣

    2015-01-01

    胸腰椎骨折是指发生于胸11至腰1之间的脊柱骨折,由于其为胸腰椎移行区,为生物应力的集中点,所以易于发生损伤,而胸腰椎骨折的治疗目标是让患者存活,避免更进一步的神经损害,通过重建脊柱序列获得脊柱的稳定性并通过早期的活动及康复,从而使患者尽快恢复正常工作.胸腰椎骨折因其固有的解剖特点,在诊断、治疗等方面有其特殊性,且因其发生率较高,为临床工作经常遇到的疾病,为了更好的指导临床工作,现就胸腰椎骨折治疗的研究进展做一综述.%The thoracolumbar fracture are the spine fractures occurring at the T11 to the L1 level.Because it's the transition region of thoracolumbar spine and the focus of the biological stress,it is easy to damage.The goal of treatment of the thoracolumbar fracture is keeping patients alive,protecting from the further neural damage,obtaining the stability by constructing anatomical alignment of spinal columns and returning patients to workplace through early mobilization and rehabilitation.Because of its inherent anatomical features,the diagnosis and the treatment of thoracolumbar fracture are special,and there is a high morbidity of thoracolumbar fracture,which we are frequently encountering in the clinical work.To guide the clinical work better,we will take a review about the research progress of the treatment of thoracolumbar fracture.

  18. Physical Therapy for Intervertebral Disk Disease : A Practical Guide to Diagnosis and Treatment

    Broetz, D; Weller, M.

    2016-01-01

    Patients with pain emanating from their spines represent some of the most frequent and challenging cases for physical therapists. Here is a comprehensive and practical introduction to the management of back pain and restricted spinal function caused by intervertebral disk damage. The authors provide evidence-based, clinically oriented strategies for the diagnosis and therapeutic treatment of disk injury in the lumbar, thoracic, and cervical spinal regions. The text gives an overview of resear...

  19. Mechanisms of Intervertebral Disk Degeneration/Injury and Pain: A Review

    Ito, Keita; Creemers, Laura

    2013-01-01

    Degeneration of the intervertebral disk and its treatments are currently intensely investigated topics. Back pain is a condition whose chronic and debilitating nature combined with its prevalence make it a major health issue of substantial socioeconomic importance. Although researchers, and even sometimes clinicians, focus on the degenerated disk as the problem, to most patients, pain is the factor that limits their function and impacts their well-being. The purpose of this review is to delin...

  20. Pulsed Electromagnetic Field Stimulates Cellular Proliferation in Human Intervertebral Disc Cells

    Lee, Hwan-Mo; Kwon, Un-Hye; Kim, Hyang; Kim, Ho-Joong; Kim, Boram; Park, Jin-Oh; Moon, Eun-Soo; Moon, Seong-Hwan

    2010-01-01

    Purpose The purpose of this study is to investigate the mechanism of cellular proliferation of electromagnetic field (EMF) on human intervertebral disc (IVD) cells. Materials and Methods Human IVD cells were cultured three-dimensionally in alginate beads. EMF was exposed to IVD cells with 650Ω, 1.8 millitesla magnetic flux density, 60 Hz sinusoidal wave. Cultures were divided into a control and EMF group. Cytotoxicity, DNA synthesis and proteoglycan synthesis were measured by MTT assay, [3H]-...

  1. Minimizing cryopreservation-induced loss of disc cell activity for storage of whole intervertebral discs

    SCW Chan; SKL Lam; VYL Leung; Chan, D.; KDK Luk; KMC Cheung

    2010-01-01

    Severe intervertebral disc (IVD) degeneration often requires disc excision and spinal fusion, which leads to loss of spinal segment mobility. Implantation of an allograft disc or tissue engineered disc construct emerges as an alternative to artificial disc replacement for preserving the motion of the degenerated level. Establishment of a bank of cadaveric or engineered cryopreserved discs enables size matching, and facilitates clinical management. However, there is a lack of understanding of ...

  2. Besonderheiten eines Bandscheibenvorfalles bei Spondylolisthese [ = Characteristics of an intervertebral disk herniation in spondylolisthesis

    Grifka, Joachim; J. Möller

    1991-01-01

    Treatment of intervertebral disc herniation associated with spondylolisthesis is not different from common procedures concerning indication for surgery and surgical technique as far as sciatica is not related to retrolisthetic soft tissue or the posterior edge of the vertebral body. In a case of a disc herniation L5/S1 and an olisthesis grade I with radicular pain L5 a microdiscectomy of the prolapse and parts of the retrolisthetic soft tissue was performed. An immediate reintervention was ne...

  3. Painful, degenerating intervertebral discs up-regulate neurite sprouting and CGRP through nociceptive factors

    Krock, Emerson; Rosenzweig, Derek H.; Chabot-Doré, Anne-Julie; Jarzem, Peter; Weber, Michael H.; Ouellet, Jean A; Stone, Laura S.; Haglund, Lisbet

    2014-01-01

    Intervertebral disc degeneration (IVD) can result in chronic low back pain, a common cause of morbidity and disability. Inflammation has been associated with IVD degeneration, however the relationship between inflammatory factors and chronic low back pain remains unclear. Furthermore, increased levels of nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF) are both associated with inflammation and chronic low back pain, but whether degenerating discs release sufficient conce...

  4. Organ Culture Bioreactors – Platforms to Study Human Intervertebral Disc Degeneration and Regenerative Therapy

    Gantenbein, Benjamin; Illien-Jünger, Svenja; Chan, Samantha CW; Walser, Jochen; Haglund, Lisbet; Ferguson, Stephen J; Iatridis, James C.; Grad, Sibylle

    2015-01-01

    In recent decades the application of bioreactors has revolutionized the concept of culturing tissues and organs that require mechanical loading. In intervertebral disc (IVD) research, collaborative efforts of biomedical engineering, biology and mechatronics have led to the innovation of new loading devices that can maintain viable IVD organ explants from large animals and human cadavers in precisely defined nutritional and mechanical environments over extended culture periods. Particularly in...

  5. Transdural epidurography in the diagnosis of lesions of the lumbar intervertebral disks

    The anterior epidural space adjoining directly the posterior parts of the vertebral bodies, was examined with 8-12% solution of verografin in 140 patients with lumbar osteochodrosis. Of them 110 had been previously operated on. The use of low-concentration water-soluble iodine contrast agents makes it possible to avoid the stimulation of the epidural structures. X-ray appearance which is typical of protrusion and hernia of the intervertebral disks is described

  6. Relation between operative findings and magnetic resonance imaging of lumbar intervertebral herniation

    We studied the relation between operative findings and magnetic resonance imaging of lumbar intervertebral disc herniation in 124 subjects. The accuracy rate was 63% for rupture of the posterior longitudinal ligament. Operative findings indicated extrusion in most cases of hernia shifted to the cranial side in MRI. Central type herniated mass revealed by transverse MRI was found to be located in the subligamentous space in operative findings. (author)

  7. Transdural epidurography in the diagnosis of lesions of the lumbar intervertebral disks

    Matvienko, V.I.; Serikov, Yu.G.; Syuremov, M.N. (Rostovskij-na-Donu Meditsinskij Inst. (USSR))

    The anterior epidural space adjoining directly the posterior parts of the vertebral bodies, was examined with 8-12% solution of verografin in 140 patients with lumbar osteochodrosis. Of them 110 had been previously operated on. The use of low-concentration water-soluble iodine contrast agents makes it possible to avoid the stimulation of the epidural structures. X-ray appearance which is typical of protrusion and hernia of the intervertebral disks is described.

  8. Intradiscal injection of simvastatin retards progression of intervertebral disc degeneration induced by stab injury

    Zhang, Huina; Lin WANG; Park, Jun Beom; Park, Paul; Yang, Victor C.; Hollister, Scott J.; La Marca, Frank; Lin, Chia-Ying

    2009-01-01

    Introduction Earlier work indicates that the cholesterol-lowering drug, simvastatin, is anabolic to chondrogenic expression of rat intervertebral disc (IVD) cells, which suggests a potential role for simvastatin in IVD regeneration. In this study, we expand on our earlier work to test the effectiveness of simvastatin on disc degeneration utilizing a rat tail disc degeneration model. Methods 30 rats that underwent 21 G needle-puncture at rat tail discs were injected with simvastatin-loaded pol...

  9. Elastic fibers in the anulus fibrosus of the dog intervertebral disc.

    Johnson, E F; Caldwell, R W; Berryman, H E; Miller, A; Chetty, K

    1984-01-01

    A light microscopic investigation of the anulus fibrosus in cervical intervertebral discs of the dog was conducted to ascertain the arrangement and distribution of elastic fibers. Elastic fibers were observed in all lamellae of the anulus fibrosus. However, collagenous fibers were the predominant type of connective tissue fiber, and elastic fibers were randomly dispersed among them. Intralamellar (collagenous and elastic) fibers were vertically and obliquely oriented in both superficial and deep lamellae of the anulus fibrosus. All intralamellar fibers were densely and regularly arranged in superficial lamellae, but they were more loosely organized in deep lamellae. A narrow border of interlamellar, elastic fibers was observed between broader, contiguous lamellae in the superficial zone of the anulus fibrosus. Interlamellar elastic fibers wer vertically and obliquely arranged in superficial lamellae; however, they were radially oriented in deep lamellae. The deepest lamella of the anulus fibrosus consisted of a loose, three-dimensional network of intermeshing collagenous and elastic fibers. These observations suggest that elastic fibers are integral components of the articular and shock absorption mechanisms of the anulus fibrosus, and the cervical intervertebral disc of the dog is a suitable model for experimental investigation of the role of elastic fibers in intervertebral disc herniation. PMID:6720244

  10. Magnetic resonance imaging for each type of herniated cervical intervertebral disc

    Kim, Ham Gyum [Ansan 1 College, Ansan (Korea, Republic of)

    2000-04-15

    The classification of herniated intervertebral cervical disc types are clinically important, as treatment methods would be slightly different according to the specific type of the herniated disc. 423 patients who suffered from herniated intervertebral cervical discs were tested with Magnetic Resonance Imaging (MRI), to distinguish the type of the herniated discs. The following are the results: The age of the patients tested ranged from 16 to 75 years old and the mean age of the patients was 41.4 years of age. There were twice as many male patients with a ratio of 288: 135 men to women. 101 patients suffered from single herniated discs while 322 patients suffered from multi-herniated discs. Of single herniated disc injuries. 52 patients had protruded discs (52%) while 25 patients had extruded discs (25%). 21 Patients (21%) had herniated intervertebral discs between C{sub 4} {approx} C{sub 5} and 51 patients (50%) and had the same injury between C{sub 5} and C{sub 6}. Of multi-herniated disc injuries. 140 patients had protruded discs (44%). while 45 patients had extruded discs (14%). 54 patients had both protruded and extruded discs (17%). 36 patients (11%). herniated discs C{sub 3} {approx} C{sub 6}: 69 patients (21%). herniated discs C{sub 3} {approx} C{sub 7}: 47 patients (15%) herniated discs C{sub 4} {approx} C{sub 6} and 67 patients (20%) herniated discs C{sub 5} {approx} C{sub 7}.

  11. Follow-up radiographs of the cervical spine after anterior fusion with titanium intervertebral disc

    Purpose: We examined the postoperative changes of the cervical spine after treatment of cervical nerve root compression with anterior cervical discectomy and fusion with a new titanium intervertebral disc. Patients and Methods: 37 patients were examined prior to, as well as 4 days, 6 weeks, and 7 months after surgery. Lateral view X-rays and functional imaging were used to evaluate posture and mobility of the cervical spine, the position of the implants, and the reactions of adjacent bone structures. Results: Implantation of the titanium disc led to post-operative distraction of the intervertebral space and slight lordosis. Within the first 6 months a slight loss of distraction and re-kyphosis due to impression of the implants into the vertebral end-plates were found in all patients. We noted partial infractions into the vertebral end-plates in 10/42 segments and slight mobility of the implants in 14/42 segments. Both groups of patients showed reactive spondylosis and local symptoms due to loosening of the implants. The pain subsided after onset of bone bridging and stable fixation of the loosened discs. Conclusions: The titanium intervertebral disc provides initial distraction of the fusioned segments with partial recurrence of kyphosis during the subsequent course. Loosening of the implants with local symptoms can be evaluated with follow-up X-rays and functional imaging. (orig.)

  12. Interrater reliability of identifying indicators of posterior ligamentous complex disruption when plain films are indeterminate in thoracolumbar injuries

    The Spine Trauma Study Group (STSG) has proposed a novel thoracolumbar injury classification system and score (TLICS) in an attempt to define traumatic spinal injuries and direct appropriate management schemes objectively. The TLICS assigns specific point values based on three variables to generate a final severity score that guides potential treatment options. Within this algorithm, significant emphasis has been placed on posterior ligamentous complex (PLC) integrity. The purpose of this study was to determine the interrater reliability of indicators surgeons use when assessing PLC disruption on imaging studies, including computed tomography (CT) and magnetic resonance imaging (MRI). Orthopedic surgeons and neurosurgeons retrospectively reviewed a series of thoracolumbar injury case studies. Thirteen case studies, including images, were distributed to STSG members for individual, independent evaluation of the following three criteria: diastasis of the facet joints on CT; posterior edema-like signal in the region of PLC components on sagittal T2-weighted fat saturation (FAT SAT) MRI; and disrupted PLC components on sagittal T1-weighted MRI. Interrater agreement on the presence or absence of each of the three criteria in each of the 13 cases was assessed. Absolute interrater percent agreement on diastasis of the facet joints on CT and posterior edema-like signal in the region of PLC components on sagittal T2-weighted FAT SAT MRI was similar (agreement 70.5%). Interrater agreement on disrupted PLC components on sagittal T1-weighted MRI was 48.9%. Facet joint diastasis on CT was the most reliable indicator of PLC disruption as assessed by both Cohen's kappa (κ=0.395) and intraclass correlation coefficient (ICC 0.430). The interrater reliability of assessing diastasis of the facet joints on CT had fair to moderate agreement. The reliability of assessing the posterior edema-like signal in the region of PLC components was lower but also fair, whereas the reliability of

  13. Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall.

    Rozen, W M; Tran, T M N; Ashton, M W; Barrington, M J; Ivanusic, J J; Taylor, G I

    2008-05-01

    Previous descriptions of the thoracolumbar spinal nerves innervating the anterior abdominal wall have been inconsistent. With modern surgical and anesthetic techniques that involve or may damage these nerves, an improved understanding of the precise course and variability of this anatomy has become increasingly important. The course of the nerves of the anterior abdominal is described based on a thorough cadaveric study and review of the literature. Twenty human cadaveric hemi-abdominal walls were dissected to map the course of the nerves of the anterior abdominal wall. Dissection included a comprehensive tracing of nerves and their branches from their origins in five specimens. The branching pattern and course of all nerves identified were described. All thoracolumbar nerves that innervate the anterior abdominal wall were found to travel as multiple mixed segmental nerves, which branch and communicate widely within the transversus abdominis plane (TAP). This communication may occur at multiple locations, including large branch communications anterolaterally (intercostal plexus), and in plexuses that run with the deep circumflex iliac artery (DCIA) (TAP plexus) and the deep inferior epigastric artery (DIEA) (rectus sheath plexus). Rectus abdominis muscle is innervated by segments T6-L1, with a constant branch from L1. The umbilicus is always innervated by a branch of T10. As such, identification or damage to individual nerves in the TAP or within rectus sheath is unlikely to involve single segmental nerves. An understanding of this anatomy may contribute to explaining clinical outcomes and preventing complications, following TAP blocks for anesthesia and DIEA perforator flaps for breast reconstruction. PMID:18428988

  14. Transcript levels of major interleukins in relation to the clinicopathological profile of patients with tuberculous intervertebral discs and healthy controls.

    Chong Liu

    Full Text Available The purpose of the present study was to simultaneously examine the transcript levels of a large number of interleukins (ILs; IL-9, IL-10, IL-12, IL-13, IL-16, IL-17, IL-18, IL-26, and IL-27 and investigate their correlation with the clinicopathological profiles of patients with tuberculous intervertebral discs.Clinical data were collected from 150 patients participating in the study from January 2013 to December 2013. mRNA expression levels in 70 tuberculous, 70 herniated, and 10 control intervertebral disc specimens were determined by real-time polymerase chain reaction.IL-10, IL-16, IL-17, IL-18, and IL-27 displayed stronger expression in tuberculous spinal disc tissue than in normal intervertebral disc tissue (P<0.05. Our results illustrated multiple correlations among IL-10, IL-16, IL-17, IL-18, and IL-27 mRNA expression in tuberculous samples. Smoking habits were found to have a positive correlation with IL-17 transcript levels and a negative correlation with IL-10 transcript levels (P<0.05. Pain intensity, symptom duration, C-reactive protein levels, and the erythrocyte sedimentation rate exhibited multiple correlations with the transcript levels of several ILs (P<0.05.The experimental data imply a double-sided effect on the activity of ILs in tuberculous spinal intervertebral discs, suggesting that they may be involved in intervertebral discs destruction. Our findings also suggest that smoking may affect the intervertebral discs destruction process of spinal tuberculosis. However, further studies are necessary to elucidate the exact role of ILs in the intervertebral discs destruction process of spinal tuberculosis.

  15. Percutaneous medical ozone injection under low-dose CT guidance for the treatment of lumbar intervertebral disc protrusion

    Objective: To evaluate the therapeutic effect of percutaneous medical ozone injection in treating lumbar intervertebral disc protrusion under low-dose CT scanning guidance. Methods: Under low-dose CT scanning guidance, percutaneous injection of different concentrations of medical ozone was carried out in 156 patients with lumbar intervertebral disc protrusion. The puncturing was performed through the latero-posterior route or medical route of vertebral facets, which was followed by the injection of medical ozone into, or around, the intervertebral disk. Results: Of the total 156 patients, excellent and good result at one week after the treatment was obtained in 59 and 63 respectively, with an effective rate of 78.2%. One month after the procedure, the excellent and good result was achieved in 63 and 64 respectively, with an effective rate of 81.4%. Three months after the injection the total effective rate was 86%. The effective rate for disc bulging, protrusion and prolapse was 97.4% (37/38), 90.2% (101/112) and 3/6, respectively. The effective rate in the group that kept ozone within the intervertebral disk and in the group that did not keep ozone within the intervertebral disk was 92.0% (46/50) and 87.3% (69/79) respectively. The effective rate in the group with complete annulus fibrous and in the group with ruptured annulus fibrous was 92.2% (119/129) and 81.5% (22/27) respectively. Conclusion: For the treatment of lumbar intervertebral disc protrusion percutaneous medical ozone injection under low-dose CT scanning guidance carries reliable therapeutic efficacy. Having the advantages of high safety, less invasiveness, precisely locating ability, simple manipulation and lower radiation exposure dose, this technique is an ideal treatment for lumbar intervertebral disc protrusion. (authors)

  16. Circumspinal decompression through a single posterior incision to treat thoracolumbar disc herniation

    QI Qiang; SUN Chui-guo; CHEN Zhong-qiang; LIU Ning; GUO Zhao-qing; SHI Ze-feng; LIU Zhong-jun; LIU Xiao-guang; LI Wei-shi; ZENG Yan

    2011-01-01

    Background Various surgical approaches have been successfully used in the treatment of thoracolumbar disc herniation (TLDH).Although the anterior transthoracic approach has a reputation for better visualization than the posterolateral and lateral approaches,it involves the manipulation of the thoracic and pulmonary structures.Thus,this approach is technically demanding and prone to compromising the respiratory system.An ideal approach would involve adequate visualization and be accomplished through the posterior midline approach that is familiar to spine surgeons.The objective of this retrospective preliminary clinical study was to introduce a new surgical procedure,circumspinal decompression through a single posterior incision,for the treatment of TLDH (T10/11-L1/2) and to evaluate the surgical outcome of this procedure by comparing it to the conventional anterior transthoracic approach.Methods In this study,15 patients (10 males,5 females; mean age 51 years) with symptomatic TLDH underwent the circumspinal decompression through a single posterior incision procedure between January 2008 and December 2009.Altogether,17 herniated discs were excised,with 2 discs at T10/11,4 discs at T11/12,5 discs at T12/L1 and 6 discs at L1/2.Of these patients,13 were followed up with a mean follow-up period of 23.5 months.Clinical outcomes,including operative time,blood loss,perioperative complications,postoperative time of hospitalization,neurologic status improvement,back pain and correction of local kyphosis,were investigated by comparing these data with the results from patients who underwent the anterior transthoracic approach for TLDH during the same period.The patients' neurologic status was evaluated by a modified Japanese Orthopedic Association (JOA) scoring system of 11 points.Neurologic status improvement after the surgery was assessed by calculating the recovery rate,which was equal to the (postoperative JOA score-preoperative JOA score)/(11-preoperative JOA score)x100

  17. Initial study of the degeneration of lumbar intervertebral discs by magnetic resonance diffusion tensor imaging

    Objective: To evaluate the earlier changes of degeneration discs in vivo using magnetic resonance diffusion tensor imaging (DTI). Methods: From September 2010 to March 2011,88 consecutive outpatients [age 16-63 years, mean age (37 ± 13) years] were enrolled in this study. The excluded criteria were as follows: spinal deformity, spinal tumors and post-operation of spine. The mean diffusion (MD) and fractional anisotropy (FA) values on DTI images of 428 intervertebral discs which without susceptibility artifacts were measured. Fiber track (FT) images of annulus of intervertebral discs were analyzed. MD and FA were also measured on FT. The quartile and median were used to record the non-normal distribution dates. The Chi-square test statistic was applied by SPSS11.0 software package. Results: Annulus fibrosis type had closely related to the Pfirrmann grading. Three types were divided based on FT charts of degenerated intervertebral disc. Intact type was noted in 135 discs, Pfirrmann Ⅱ level has a high percentage (92 discs, 68.15%) in this type; Scrambled type was noted in 195 discs, Pfirrmann Ⅲ and Ⅳ level were accounted for 63.07% (123 discs); Conglomerate type was noted in 98 discs, the Pfirrmann Ⅳ and Ⅴ level were accounted for 83.68% (82 discs) (Mantel-Haenszel test, χ2=183.90, P <0.01). Different annulus types had different MD and FA values. The median (range) of FA of complete, messy and clumps type fibrous ring were 0.32 (0.29-4.35), 0.35 (0.33-0.38), 0.54 (0.46-0.62). The corresponding median(range)of MD were 12.40 (11.50-13.20)×10-10, 11.10(9.92-12.00) × 10-10, 6.30 (5.03-7.72) × 10-10 mm2/s. Scrambled annulus fibers had lower MD values and higher FA values,which had significant difference (χ2=219.74, 243.88, P<0.01). Conclusions: DTI is a non-invasive method to assess intervertebral disc structural changes in vivo. MD and FA values are helpful to evaluate the intervertebral disc degeneration. (authors)

  18. TREATMENT OF 247 CASES OF PROLAPSE OF LUMBAR INTERVERTEBRAL DISC WITH COMPREHENSIVE PLUM-BLOSSOM MAGNETIC NEEDLE THERAPY

    张保平; 周日清; 周登芳

    2004-01-01

    Objective: To observe the therapeutic effect of comprehensive plum-blossom magnetic needle therapy on prolapse of lumbar intervertebral disc. Methods: 247 cases of prolapse of lumbar intervertebral disc were treated first with manual treatment and then with plum-blossom magnetic needle therapy and effect-increasing pad therapy at specified points and reactive points. Results: After treatment for 2 therapeutic courses,153 cases were cured accounting for 61.94%, 71 cases were markedly effective accounting for 28.75%, 22 cases were improved accounting for8.91% and the rest one failed,accounting for 0.45%. Conclusion: The comprehensive plum-blossom magnetic needle therapy has a better therapeutic effect on prolapse of lumbar intervertebral disc.

  19. Comparison of Therapeutic Effects Between Acupuncture plus Sacral Injection and Simple Acupuncture for Lumbar Intervertebral Disc Herniation

    YAN Jie-ying; XU Yao

    2007-01-01

    To compare the therapeutic effects between acupuncture plus sacral injection and simple acupuncture for intervertebral disc hemia.Methods:The patients with lumbar intervertebral disc hernia at the age of 30-45 years old were divided into No.1-80 upon their visiting order,with odd number as Group A and even number as Group B.Group A was treated by acupuncture plus sacral injection,and Group B was treated by simple acupuncture.Results:The clinical effective rate was higher in Group A than in Group B,with significant difference (P<0.05).Conclusion:Acupuncture plus sacral injection had the better therapeutic effect than simple acupuncture in treating lumbar intervertebral disc hernia.

  20. Doença do disco intervertebral em trabalhadores da perfuração de petróleo Intervertebral disk disease among oil drilling workers

    Rita de Cássia Pereira Fernandes

    2000-09-01

    Full Text Available Estudo transversal em 1.026 trabalhadores em distrito de perfuração de petróleo do Nordeste brasileiro mostrou prevalência global de doença do disco intervertebral lombar de 5%, variando de 1,8% (atividades sem manuseio de carga, 4,5% (manuseio ocasional até 7,2% (manuseio habitual. Tal prevalência foi de 11,4% em operadores de sonda de perfuração de petróleo com mais de 40 anos de idade e de 10,5% naqueles com mais de 15 anos de empresa. A razão de prevalência (R.P. à associação entre trabalho em operação de sonda e doença do disco foi 2,3 (I.C. 95%: 1,3, 4,0. Para minimizar o efeito sobrevivência do trabalhador sadio foram usadas informações retrospectivas acerca da exposição. A informação referente à ocupação atual em lugar do histórico ocupacional resultaria em RP subestimada de 1,1 (I.C. 95%: 0,6, 1,9. A regressão logística ratificou os achados da análise tabular. Não houve confundimento nem interação. O incremento da indústria de petróleo no país e as alterações na gestão e contratação da força de trabalho implicam mudanças no gerenciamento de risco e controle de saúde, além de pronta intervenção ergonômica para controle da doença.A cross-sectional study among 1,026 oil drilling workers in Northeast Brazil found a prevalence rate of 5% for intervertebral disk disease, varying from 1.8% (activities without heavy lifting and 4.5% (occasional lifting to 7.2% (routine lifting. Disease prevalence was 10.5% among drilling workers with more than 15 years in the industry and 11.3% among those over 40 years of age. Prevalence ratio (PR for the association between working in oil drilling operations and intervertebral disk disease was 2.3 (95% CI: 1.3-4.0. Retrospective information about exposure was collected to minimize the healthy worker survival effect. Using information on current occupation instead of occupational life history would cause an underestimated PR of 1.1 (95% CI: 0.6-1.9. Logistic

  1. Doença do disco intervertebral em trabalhadores da perfuração de petróleo Intervertebral disk disease among oil drilling workers

    Rita de Cássia Pereira Fernandes; Fernando Martins Carvalho

    2000-01-01

    Estudo transversal em 1.026 trabalhadores em distrito de perfuração de petróleo do Nordeste brasileiro mostrou prevalência global de doença do disco intervertebral lombar de 5%, variando de 1,8% (atividades sem manuseio de carga), 4,5% (manuseio ocasional) até 7,2% (manuseio habitual). Tal prevalência foi de 11,4% em operadores de sonda de perfuração de petróleo com mais de 40 anos de idade e de 10,5% naqueles com mais de 15 anos de empresa. A razão de prevalência (R.P.) à associação entre tr...

  2. Treatment of lumbar intervertebral disc prolapse with X-ray guided Nd: YAG laser interposing percutaneous laser disc decompression

    Objective: To discuss the percutaneous laser disc decompression (PLDD) therapy by adopting the Nd: YAG Laser CL-50 Device under X-ray monitor supervision. Methods: A total of 378 cases were included in this study. There was 198 males and 180 females, the age ranged from 19 to 76 years, with the average of 43.9 years, and the course of diseases from 1 month to 16 years. 17 cases of lumbar intervertebral disc prolapse were diagnosed between L2 and L3, 35 cases between L3 and L4, 140 cases between L4 and L5, and 116 cases between L5 and S1. 60 cases with two intervertebral disc prolapses at the same time, and 10 cases with three intervertebral disc prolapses at the same time. A total of 458 intervertebral-disc operations were conducted with PLDD. All the cases selected had been examined by CT or MRI, and their clinical symptoms and physical signs were in compliance with the diagnosis standards for prolapse of lumbar intervertebral disc. Results: After PLDD operation, 268 cases were cured within 1 month with a cure rate of 70.90%; 259 cases were cured in 3 months with a cure rate of 68.52%, 260 cases were cured in 6 months with a cure rate of 68.25%. Stable results were found with curing satisfaction rate, effective rate and failure rate. Conclusion: X-ray guided PLDD therapy is an ideal non-operative therapy for curing lumbar intervertebral disc prolapse with micro-trauma, little pain, quick recovery and good effect. PLDD has achieved encouraging effects both in its recent clinical outcome and long term effect as well. (authors)

  3. Refinement of elastic, poroelastic, and osmotic tissue properties of intervertebral disks to analyze behavior in compression.

    Stokes, Ian A F; Laible, Jeffrey P; Gardner-Morse, Mack G; Costi, John J; Iatridis, James C

    2011-01-01

    Intervertebral disks support compressive forces because of their elastic stiffness as well as the fluid pressures resulting from poroelasticity and the osmotic (swelling) effects. Analytical methods can quantify the relative contributions, but only if correct material properties are used. To identify appropriate tissue properties, an experimental study and finite element analytical simulation of poroelastic and osmotic behavior of intervertebral disks were combined to refine published values of disk and endplate properties to optimize model fit to experimental data. Experimentally, nine human intervertebral disks with adjacent hemi-vertebrae were immersed sequentially in saline baths having concentrations of 0.015, 0.15, and 1.5 M and the loss of compressive force at constant height (force relaxation) was recorded over several hours after equilibration to a 300-N compressive force. Amplitude and time constant terms in exponential force-time curve-fits for experimental and finite element analytical simulations were compared. These experiments and finite element analyses provided data dependent on poroelastic and osmotic properties of the disk tissues. The sensitivities of the model to alterations in tissue material properties were used to obtain refined values of five key material parameters. The relaxation of the force in the three bath concentrations was exponential in form, expressed as mean compressive force loss of 48.7, 55.0, and 140 N, respectively, with time constants of 1.73, 2.78, and 3.40 h. This behavior was analytically well represented by a model having poroelastic and osmotic tissue properties with published tissue properties adjusted by multiplying factors between 0.55 and 2.6. Force relaxation and time constants from the analytical simulations were most sensitive to values of fixed charge density and endplate porosity. PMID:20711754

  4. A role for TNFα in intervertebral disc degeneration: A non-recoverable catabolic shift

    Highlights: ► TNFα induced catabolic changes similar to human intervertebral disc degeneration. ► The metabolic shift induced by TNFα was sustained following removal. ► TNFα induced changes suggestive of cell senescence without affecting cell viability. ► Interventions are required to stimulate anabolism and increase cell proliferation. -- Abstract: This study examines the effect of TNFα on whole bovine intervertebral discs in organ culture and its association with changes characteristic of intervertebral disc degeneration (IDD) in order to inform future treatments to mitigate the chronic inflammatory state commonly found with painful IDD. Pro-inflammatory cytokines such as TNFα contribute to disc pathology and are implicated in the catabolic phenotype associated with painful IDD. Whole bovine discs were cultured to examine cellular (anabolic/catabolic gene expression, cell viability and senescence using β-galactosidase) and structural (histology and aggrecan degradation) changes in response to TNFα treatment. Control or TNFα cultures were assessed at 7 and 21 days; the 21 day group also included a recovery group with 7 days TNFα followed by 14 days in basal media. TNFα induced catabolic and anti-anabolic shifts in the nucleus pulposus (NP) and annulus fibrosus (AF) at 7 days and this persisted until 21 days however cell viability was not affected. Data indicates that TNFα increased aggrecan degradation products and suggests increased β-galactosidase staining at 21 days without any recovery. TNFα treatment of whole bovine discs for 7 days induced changes similar to the degeneration processes that occur in human IDD: aggrecan degradation, increased catabolism, pro-inflammatory cytokines and nerve growth factor expression. TNFα significantly reduced anabolism in cultured IVDs and a possible mechanism may be associated with cell senescence. Results therefore suggest that successful treatments must promote anabolism and cell proliferation in

  5. Nerve Growth Factor Is Regulated by Toll-Like Receptor 2 in Human Intervertebral Discs.

    Krock, Emerson; Currie, J Brooke; Weber, Michael H; Ouellet, Jean A; Stone, Laura S; Rosenzweig, Derek H; Haglund, Lisbet

    2016-02-12

    Nerve growth factor (NGF) contributes to the development of chronic pain associated with degenerative connective tissue pathologies, such as intervertebral disc degeneration and osteoarthritis. However, surprisingly little is known about the regulation of NGF in these conditions. Toll-like receptors (TLR) are pattern recognition receptors classically associated with innate immunity but more recently were found to be activated by endogenous alarmins such as fragmented extracellular matrix proteins found in degenerating discs or cartilage. In this study we investigated if TLR activation regulates NGF and which signaling mechanisms control this response in intervertebral discs. TLR2 agonists, TLR4 agonists, or IL-1β (control) treatment increased NGF, brain-derived neurotrophic factor (BDNF), and IL-1β gene expression in human disc cells isolated from healthy, pain-free organ donors. However, only TLR2 activation or IL-1β treatment increased NGF protein secretion. TLR2 activation increased p38, ERK1/2, and p65 activity and increased p65 translocation to the cell nucleus. JNK activity was not affected by TLR2 activation. Inhibition of NF-κB, and to a lesser extent p38, but not ERK1/2 activity, blocked TLR2-driven NGF up-regulation at both the transcript and protein levels. These results provide a novel mechanism of NGF regulation in the intervertebral disc and potentially other pathogenic connective tissues. TLR2 and NF-κB signaling are known to increase cytokines and proteases, which accelerate matrix degradation. Therefore, TLR2 or NF-κB inhibition may both attenuate chronic pain and slow the degenerative progress in vivo. PMID:26668319

  6. Ho:YAG laser: intervertebral disk cell interaction using three-dimensional cell culture system

    Sato, Masato; Ishihara, Miya; Arai, Tsunenori; Asazuma, Takashi; Kikuchi, Toshiyuki; Kikuchi, Makoto; Fujikawa, Kyosuke

    2000-06-01

    The purpose of this study is to evaluate the influence on the intervertebral disc cells after laser irradiation using three- dimensional culture system and to clarify the optimum Ho:YAG laser irradiation condition on percutaneous laser disc decompression (PLDD) for lumbar disc herniation. Since the Ho:YAG laser ablation is characterized by water-vapor bubble dynamics, not only thermal effect but also acoustic effect on cell metabolism might occur in the intervertebral disc. We studied the disc cell reaction from the metabolic point of view to investigate photothermal and photoacoustic effects on three-dimensional cultured disc cell. Intervertebral discs were obtained from female 30 Japanese white rabbits weighing about 1 kg. A pulsed Ho:YAG laser (wavelength: 2.1 micrometer, pulse width: about 200 microseconds) was delivered through a 200 micrometer-core diameter single silica glass fiber. We used the Ho:YAG laser irradiation fluence ranging from 60 to approximately 800 J/cm2 at the fiber end. To investigate acoustic effect, the acoustic transducer constructed with polyvinylidene fluoride (PVdF) film and acoustic absorber was used to detect the stress wave. Thermocouple and thermography were used to investigate thermal effect. Concerning damage of plasma membrane and ability of matrix synthesis, thermal effect might mainly affect cell reaction in total energy of 54 J (closed to practically used condition), but in 27 J, acoustic effect might contribute to it. We found that total energy was key parameter among the optimum condition, so that temperature and/or stress wave may influence Ho:YAG laser-disc cell interactions.

  7. CT and MRI Determination of Intermuscular Space within Lumbar Paraspinal Muscles at Different Intervertebral Disc Levels.

    Xuefei Deng

    Full Text Available Recognition of the intermuscular spaces within lumbar paraspinal muscles is critically important for using the paramedian muscle-splitting approach to the lumbar spine. As such, it is important to determine the intermuscular spaces within the lumbar paraspinal muscles by utilizing modern medical imaging such as computed tomography (CT and magnetic resonance imaging (MRI.A total of 30 adult cadavers were studied by sectional anatomic dissection, and 60 patients were examined using CT (16 slices, 3-mm thickness, 3-mm intersection gap, n = 30 and MRI (3.0T, T2-WI, 5-mm thickness, 1-mm intersection gap, n = 30. The distances between the midline and the superficial points of the intermuscular spaces at different intervertebral disc levels were measured.Based on study of our cadavers, the mean distances from the midline to the intermuscular space between multifidus and longissimus, from intervertebral disc levels L1-L2 to L5-S1, were 0.9, 1.1, 1.7, 3.0, and 3.5 cm, respectively. Compared with the upper levels (L1-L3, the superficial location at the lower level (L4-S1 is more laterally to the midline (P<0.05. The intermuscular space between sacrospinalis and quadratus lumborum, and that between longissimus and iliocostalis did not exist at L4-S1. The intermuscular spaces in patients also varied at different levels of the lumbar spine showing a low discontinuous density in CT and a high signal in MRI. There were no significant differences between the observations in cadavers and those made using CT and MRI.The intermuscular spaces within the paraspinal muscles vary at different intervertebral disc levels. Preoperative CT and MRI can facilitate selection of the muscle-splitting approach to the lumbar spine. This paper demonstrates the efficacy of medical imaging techniques in surgical planning.

  8. Precision of spinal radiographs as a screening test for intervertebral disc calcification in Dachshunds.

    Rosenblatt, Alana J; Hill, Peter B; Davies, Sarah E; Webster, Natalie S; Lappalainen, Anu K; Bottema, Cynthia D K; Caraguel, Charles G B

    2015-11-01

    Among dog breeds, the Dachshund has the highest lifetime incidence of intervertebral disc disease (IVDD). Intervertebral disc (IVD) calcification is an indicator of severe degeneration that predisposes to disc herniation. IVDD is heritable in Dachshunds, and in some countries, breeding candidates are screened to reduce IVDD occurrence by selecting dogs according to their score of radiographically detectable intervertebral disc calcification (RDIDC) and excluding dogs with ≥5 RDIDCs from breeding. This study evaluated the precision of scoring spinal radiographs for IVD calcification and subsequent classification of Dachshund dogs for breeding based on their RDIDC score. Digital radiographs of the spine were obtained in 19 clinically healthy, young adult Dachshunds, and scored for RDIDC independently by five scorers with varying levels of experience, three times each. Within scorer (repeatability) and between scorer (reproducibility) variability was estimated both at the individual IVD level and at the whole dog level for breeding classification purposes. At the IVD level, some degree of scorer effect was supported by the pairwise repeatability (92.3%; 95% CI: 88.8-94.7%) being marginally higher than the reproducibility (89.2%; 95% CI: 85.7-91.8%). Scorer-specific patterns confirmed the presence of scorer subjectivity. Repeatability significantly increased with scorer experience but the reproducibility did not. RDIDC scoring repeatability and reproducibility substantially decreased at the cervicothoracic spine region, likely due to anatomical superimpositions. At the dog level, a breeding classification could be repeated by the same scorer for 83.6% (95% CI: 73.8-90.2%) of the dogs, and was reproduced between two scorers for 80.2% (95% CI: 66.6-89.1%) of the dogs. The repeatability of breeding classification also seemed to increase with scorer experience but not the reproducibility. Overall, RDIDC scoring revealed some degree of inconsistency explained by scorer

  9. The Changes in the Expression of NF-KB in a Degenerative Human Intervertebral Disc model.

    Sun, Zhongyi; Yin, Zhanmin; Liu, Chao; Tian, Jiwei

    2015-05-01

    We aim at determining the changes in the expression of NF-kB signaling pathway in degenerative intervertebral discs. We collected normal and degenerated intervertebral discs tissues. The normal and degenerated cells were cultivated and their histopathology and immunofluoresence studies were used to observe the position of NF-kB p65 in the cell. We also treated the nucleus pulposus cells with inflammatory factors and inhibitors. Western blot was used to analyze the expression of different proteins. Real time fluorescence-based quantitative PCR was used for observation of NF-kB regulation of change in gene expression. Immunofluorescence showed that in the non-degenerative group the p65 was found in the cytoplasm of the nucleus pulposus cell while in the degenerated cell group the p65 protein was found in the nucleus of the cell. The expression of p65 increased with increase in the degree of degenerative change of the nucleus pulposus cell. RT-PCR showed that the expression of matrix metalloproteinases, aggrecanases and IL-6 was higher in the degenerative group. The amount of aggrecan and type II collagen was significantly decreased in the degenerative group. IL-1β was able to upregulate the activation of NF-kB and the expression of MMP-13 and ADAMTS-4 was also significantly increased. The effect of these proteins can be inhibited by the NF-kB inhibitor, BAY11-7082. The activation of the NK-kB signaling pathway in a degenerative intervertebral disc is gradually increased, regulating the over-expression of matrix-degrading enzymes. It plays an important role in the degradation of extracellular matrix. PMID:25433723

  10. LASER BIOLOGY AND MEDICINE: Effect of repetitive laser pulses on the electrical conductivity of intervertebral disc tissue

    Omel'chenko, A. I.; Sobol', E. N.

    2009-03-01

    The thermomechanical effect of 1.56-μm fibre laser pulses on intervertebral disc cartilage has been studied using ac conductivity measurements with coaxial electrodes integrated with an optical fibre for laser radiation delivery to the tissue. The observed time dependences of tissue conductivity can be interpreted in terms of hydraulic effects and thermomechanical changes in tissue structure. The laserinduced changes in the electrical parameters of the tissue are shown to correlate with the structural changes, which were visualised using shadowgraph imaging. Local ac conductivity measurements in the bulk of tissue can be used to develop a diagnostic/monitoring system for laser regeneration of intervertebral discs.

  11. [Research advances of three-dimension printing technology in vertebrae and intervertebral disc tissue engineering].

    Zechuan, Yang; Chunde, L I; Haolin, Sun

    2016-03-25

    Three-dimensional (3D) printing technology is characterized by "inside-out" stack manufacturing. Compared with conventional technologies, 3D printing has the advantage of personalization and precision. Therefore, the shape and internal structure of the scaffolds made by 3D printing technology are highly biomimetic. Besides, 3D bioprinting can precisely deposit the biomaterials, seeding cells and cytokines at the same time, which is a breakthrough in printing technique and material science. With the development of 3D printing, it will make great contributions to the reconstruction of vertebrae and intervertebral disc in the future. PMID:27273987

  12. Clinical Experience on Treatment of Lumbar Intervertebral Disc Protrusion by Traditional Manual Techniques plus Electric Acupuncture

    LIANG Hao-wen; WU Fang; YANG Wan-zhang; ZHANG Min; HUANG Guo-qi

    2007-01-01

    52 cases of the patients with L4-S1 intervertebral disc protrusion were first treated by traditional Tuina manual techniques, including the rolling method, pressing method,oblique-plucking method and shaking method, and then treated by electric acupuncture on Shenshu (BL 23), Yaoyangguan (GV 3), Dachangshu (BL 25), Xiaochangshu (BL 27),Mingmen (GV 4) and Shangliao (BL 31). After 7-28 sessions of the treatments, the results showed cure in 40 cases, remarkable effect in 8 cases, effect in 3 cases, failure in 1 case, and the total effective rate in 98.1%.

  13. Rheological and biological properties of a hydrogel support for cells intended for intervertebral disc repair

    Benz Karin

    2012-04-01

    Full Text Available Abstract Background Cell-based approaches towards restoration of prolapsed or degenerated intervertebral discs are hampered by a lack of measures for safe administration and placement of cell suspensions within a treated disc. In order to overcome these risks, a serum albumin-based hydrogel has been developed that polymerizes after injection and anchors the administered cell suspension within the tissue. Methods A hydrogel composed of chemically activated albumin crosslinked by polyethylene glycol spacers was produced. The visco-elastic gel properties were determined by rheological measurement. Human intervertebral disc cells were cultured in vitro and in vivo in the hydrogel and their phenotype was tested by reverse-transcriptase polymerase chain reaction. Matrix production and deposition was monitored by immuno-histology and by biochemical analysis of collagen and glycosaminoglycan deposition. Species specific in situ hybridization was performed to discriminate between cells of human and murine origin in xenotransplants. Results The reproducibility of the gel formation process could be demonstrated. The visco-elastic properties were not influenced by storage of gel components. In vitro and in vivo (subcutaneous implants in mice evidence is presented for cellular differentiation and matrix deposition within the hydrogel for human intervertebral disc cells even for donor cells that have been expanded in primary monolayer culture, stored in liquid nitrogen and re-activated in secondary monolayer culture. Upon injection into the animals, gels formed spheres that lasted for the duration of the experiments (14 days. The expression of cartilage- and disc-specific mRNAs was maintained in hydrogels in vitro and in vivo, demonstrating the maintenance of a stable specific cellular phenotype, compared to monolayer cells. Significantly higher levels of hyaluronan synthase isozymes-2 and -3 mRNA suggest cell functionalities towards those needed for the

  14. Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study

    Branney, Jonathan; Breen, Alan C

    2014-01-01

    Background Spinal manipulation for nonspecific neck pain is thought to work in part by improving inter-vertebral range of motion (IV-RoM), but it is difficult to measure this or determine whether it is related to clinical outcomes. Objectives This study undertook to determine whether cervical spine flexion and extension IV-RoM increases after a course of spinal manipulation, to explore relationships between any IV-RoM increases and clinical outcomes and to compare palpation with objective mea...

  15. The Intervertebral Joint as a Stiffness Matrix: Theory, Practice, and Application

    Faruk Senan, Nur Adila

    2011-01-01

    The relationship between the motion of a pair of vertebras and the ensuing loads exerted by the intervertebral joint have been studied extensively. In the realm of small and quasi-static motion, this relationship is approximately linear and can be modeled using a 6 × 6 stiffness matrix. Efforts to determine the elements of these stiffness matrices as well as to apply them in models of the joint have been underway since this joint model was first proposed in the early 1970s. Meanwhile, a ...

  16. Microstructure-based fiber optic pressure sensor for measurements in lumbar intervertebral discs

    Hoejer, Svante; Krantz, Martin; Ekstroem, Lars; Kaigle, Allison; Holm, Sten

    1999-01-01

    A fiberoptic system with a microstructure sensor element was used for measuring lumbar intervertebral disc pressure in a porcine model. The fiberoptic pressure sensor was inserted in the disc using a guiding needle. A reference sensor was also introduced into the same area of an adjacent disc. The fiberoptic sensor detected pressures from 0.7-8 bar in the disc. Dynamic measurements were carried out at frequencies between 2 and 10 Hz. No phase lag was observed between the applied force and the measured pressures. Sensitivity, dynamic response and available pressure range are all important design characteristics for which this fiberoptic sensor has a competitive edge.

  17. Diagnosis of hernia of lumbar intervertebral disk. Potentials and limits of MR imaging

    CT and myelography are acknowledged techniques for the detection and diagnosis of hernia of intervertebral disk. After the development and successful testing of special surface coils, MR imaging is a serious competitor of the two methods, offering advantages such as absence of ionizing radiation, or any other hazard, possibility of making tomograms in various planes, the sagittal plane being preferably used. Spatial resolution of CT and MRI is about equal, but the contrast resolution of MRI is far better. The contribution in hand is the first communication of results of a comparative study. (orig.)

  18. Diagnosis of hernia of lumbar intervertebral disk. Potentials and limits of MR imaging

    Beyer, H.K.; Uhlenbrock, D.; Steiner, G.

    1986-04-01

    CT and myelography are acknowledged techniques for the detection and diagnosis of hernia of intervertebral disk. After the development and successful testing of special surface coils, MR imaging is a serious competitor of the two methods, offering advantages such as absence of ionizing radiation, or any other hazard, possibility of making tomograms in various planes, the sagittal plane being preferably used. Spatial resolution of CT and MRI is about equal, but the contrast resolution of MRI is far better. The contribution in hand is the first communication of results of a comparative study.

  19. Acute Bronchitis

    ... of bronchitis: acute and chronic. Most cases of acute bronchitis get better within several days. But your cough ... that cause colds and the flu often cause acute bronchitis. These viruses spread through the air when people ...

  20. Ablation of intervertebral discs in dogs using a MicroJet-assisted dye-enhanced injection device coupled with the diode laser

    Bartels, Kenneth E.; Henry, George A.; Dickey, D. Thomas; Stair, Ernest L.; Powell, Ronald; Schafer, Steven A.; Nordquist, Robert E.; Frederickson, Christopher J.; Hayes, Donald J.; Wallace, David B.

    1998-07-01

    Use of holmium laser energy for vaporization/coagulation of the nucleus pulposus in canine intervertebral discs has been previously reported and is currently being applied clinically in veterinary medicine. The procedure was originally developed in the canine model and intended for potential human use. Since the pulsed (15 Hz) holmium laser energy exerts photomechanical and photothermal effects, the potential for extrusion of additional disc material to the detriment of the patient is possible using the procedure developed for the dog. To reduce this potential complication, use of diode laser (805 nm - CW mode) energy, coupled with indocyanine green (ICG) as a selective laser energy absorber, was formulated as a possible alternative. Delivery of the ICG and diode laser energy was through a MicroJet device that could dispense dye interactively between individual laser 'shots.' Results have shown that it is possible to selectively ablate nucleus pulposus in the canine model using the device described. Acute observations (gross and histopathologic) illustrate that accurate placement of the spinal needle before introduction of the MicroJet device is critically dependent on the expertise of the interventional radiologist. In addition, the success of the overall technique depends on consistent delivery of both ICG and diode laser energy. Minimizing tissue carbonization on the tip of the MicroJet device is also of crucial importance for effective application of the technique in clinical veterinary medicine.

  1. Thoracolumbar Tuberculosis: Implications for Appropriate Management based on Disease Location and Proposal of a Novel Scoring System

    Shahryar Noordin

    2011-01-01

    Full Text Available Objective: To identify factors indicating disease severity in patients with thoracolumbar tuberculosis requiring surgical intervention.Design: Medical charts of patients who underwent surgery for thoracic and lumbar spinal tuberculosis from 1990-2005 were reviewed. Patients with different levels of disease were compared in terms of neurological deficits, duration of symptoms, previous antituberculous therapy, nutritional status and associated co-morbids.Results: Ninety-three patients aged 7-77 years (mean age 40 years were included. Thoracic spine was involved in 80% of operated patients, and lumbar spine in 20%. Severe neurological impairment (Frankel A to C was present in 68% of patients with thoracic disease, as compared to 5% with lumbar disease (p<0.05. Postoperatively, complete neurological recovery occurred in 65% with thoracic versus 100% with lumbar disease (p<0.05. Based on the disease location and pertinent elements in clinical history, physical signs, radiographic and biochemical features, a scoring system was developed.Conclusion: In endemic areas with limited resources, strategies for cost-effective care are needed. By objectively outlining the treatment approach, the judicious use of surgery offers hope for enormous cost savings in countries endemic for tuberculosis, averting complications from disease progression

  2. Effective modulus of the human intervertebral disc and its effect on vertebral bone stress.

    Yang, Haisheng; Jekir, Michael G; Davis, Maxwell W; Keaveny, Tony M

    2016-05-01

    The mechanism of vertebral wedge fractures remains unclear and may relate to typical variations in the mechanical behavior of the intervertebral disc. To gain insight, we tested 16 individual whole discs (between levels T8 and L5) from nine cadavers (mean±SD: 66±16 years), loaded in compression at different rates (0.05-20.0% strain/s), to measure a homogenized "effective" linear elastic modulus of the entire disc. The measured effective modulus, and average disc height, were then input and varied parametrically in micro-CT-based finite element models (60-μm element size, up to 80 million elements each) of six T9 human vertebrae that were virtually loaded to 3° of moderate forward-flexion via a homogenized disc. Across all specimens and loading rates, the measured effective modulus of the disc ranged from 5.8 to 42.7MPa and was significantly higher for higher rates of loading (pvertebral bone stresses increased but their spatial distribution was largely unchanged: most of the highest stresses occurred in the central trabecular bone and endplates, and not anteriorly. Taken together with the literature, our findings suggest that the effective modulus of the human intervertebral disc should rarely exceed 100MPa and that typical variations in disc effective modulus (and less so, height) minimally influence the spatial distribution but can appreciably influence the magnitude of stress within the vertebral body. PMID:26949100

  3. Calcification of intervertebral discs in the dachshund: a radiographic study of 327 young dogs

    The vertebral columns of 327 clinically normal, 12 to 18 months old dachshunds, were x-rayed. This sample represented 16.1% of all dachshunds registered with the Norwegian Kennel Club in the period 1986-1988. Calcified intervertebral discs were identified in 79 (24.2%) of the dogs and the number of calcified discs in each individual varied from 1 to 11 with a mean of 2.3. Calcified discs were estimated to occur in 23.5% of Norwegian dachshunds. The occurrence of calcified discs in standard-sized dachshunds was higher in the wirehaired variety (27.1%) than in the smoothcoated (16.4%) or longhaired (9.1%) varieties. However, within the longhaired variety the occurrence was higher in dwarfs and kaninchens (36.0%) than in standard-sized dachshunds (9.1%). Calcification was identified in all cervical, thoracic and lumbar intervertebral discs other than T1-2, and was found to be most frequent in the caudal thoracic vertebral column

  4. Paraspinal muscle activation in accordance with mechanoreceptors in the intervertebral discs.

    Kim, Young Eun; Choi, Hae Won

    2013-02-01

    Paraspinal muscle forces were derived computationally based on the hypothesis that the intervertebral disc has a transducer function and the muscle is activated according to a sensor-driving control mechanism. A three-dimensional finite element model of the musculoskeletal system, which consisted of a detailed whole lumbar spine, pelvis, simplified trunk model, and muscles, was developed and combined with an optimization technique to calculate muscle forces in isometric forward flexed and erect standing postures. Minimization of deviations in the nucleus pressure and averaged tensile stress in the annulus fibers at five discs was used for muscle force calculations. The results indicated that all the muscles were properly activated to maintain posture and stabilize the lumbar spine. The nucleus pressure difference was decreased during the iterative calculations and its resulting value at the L4/L5 level was consistent with in vivo measurements. Muscle activation produced vertebra motion, which resulted in a relatively uniform stress distribution in the intervertebral discs. This can minimize the risk of injury at a specific level and increase the ability of the spine to sustain a load. PMID:23513985

  5. Biomechanical Analysis Of The Intervertebral Disc Implant Using The Finite Element Method

    Kajzer W.

    2015-09-01

    Full Text Available Dysfunctions of the vertebral column belong to a group of civilisation diseases and they affect approximately 80% of population. The underlying cause is modern (sedentary lifestyle, low locomotive activity of people and frequent motor vehicle and sports accidents. Despite civilisation’s progress, no injury prophylactics or prevention of dysfunctions of the vertebral column have been introduced. The key element influencing function of the vertebral column is the intervertebral disc. It enables multidimensional movements and constitutes a basic connective element between the joints of the vertebral column. It also enables performing basic daily activities. Acting as a “damper”, it cushions vibrations and transmits loads between the vertebrae. One of the diseases affecting the intervertebral disc is discopathy. This is the most common degenerative disease, which can be treated by both conservative and surgical treatment. After removal of the damaged disc, it can be replaced by an adequate implant, which will assume its function. The implant will be expected to restore the vertebral column motor function, as well as to eliminate the pain resulting from compression of the spine caused by the damaged disc.

  6. Cervical spine degenerative changes (narrowed intervertebral disc spaces and osteophytes) in coal miners

    A series of 685 x-rays films of the cervical spine obtained in coal miners was analyzed to explore the occurrence of narrowed disc spaces and osteophytes in this occupational group, and to examine the association of x-rays changes with age, duration of employment, and duration of occupational exposure to hand-arm vibration. All data were extracted from individual medical files of coal miners examined for suspected hand-arm vibration-related disorders in 1989-1999 at the Occupational Medicine Center in Katowice. The narrowed intervertebral disc spaces were found in 188 coal miners (26.9%) and osteophytes in 332 coal miners (47.5%). The occurrence of degenerative changes in coal miners was similar to that observed in a small group of 68 blue-collar workers (no exposure to hand-arm vibration) employed in the coal industry. Univariate comparisons showed that intervertebral disc spaces and osteophytes were more frequent among older subjects and among subjects with longer duration of employment. The results of logistic regression analysis confirmed statistically significant effect of age, but not of other factors included in the model. When both x-ray changes were grouped together (a combined dependent variable) age remained the only statistically significant explanatory variable. The findings do not support the view that the examined degenerative changes in cervical spine are more prevalent in coal miners and depend on duration of physical work or local exposure to hand-arm vibration in this occupational group. (author)

  7. Cordycepin inhibits LPS-induced inflammatory and matrix degradation in the intervertebral disc.

    Li, Yan; Li, Kang; Mao, Lu; Han, Xiuguo; Zhang, Kai; Zhao, Changqing; Zhao, Jie

    2016-01-01

    Cordycepin is a component of the extract obtained from Cordyceps militaris and has many biological activities, including anti-cancer, anti-metastatic and anti-inflammatory effects. Intervertebral disc degeneration (IDD) is a degenerative disease that is closely related to the inflammation of nucleus pulposus (NP) cells. The effect of cordycepin on NP cells in relation to inflammation and degeneration has not yet been studied. In our study, we used a rat NP cell culture and an intervertebral disc (IVD) organ culture model to examine the inhibitory effects of cordycepin on lipopolysaccharide (LPS)-induced gene expression and the production of matrix degradation enzymes (MMP-3, MMP-13, ADAMTS-4, and ADAMTS-5) and oxidative stress-associated factors (nitric oxide and PGE2). We found a protective effect of cordycepin on NP cells and IVDs against LPS-induced matrix degradation and macrophage infiltration. In addition, western blot and luciferase assay results demonstrated that pretreatment with cordycepin significantly suppressed the LPS-induced activation of the NF-κB pathway. Taken together, the results of our research suggest that cordycepin could exert anti-inflammatory and anti-degenerative effects on NP cells and IVDs by inhibiting the activation of the NF-κB pathway. Therefore, cordycepin may be a potential treatment for IDD in the future. PMID:27190710

  8. Calcification of intervertebral discs in the dachshund: a radiographic study of 21 stud-dogs

    The vertebral columns of 21 clinically normal, 4.9 to 13.2 year old dachshunds were x-rayed. This sample represented 55.3% of all male dachshunds with 20 or more offspring registered with the Norwegian Kennel Club in the period 1985-1989. Calcified intervertebral discs were identified in 9 (42.9%) of the stud-dogs, and the number of calcified discs in each individual varied from 2 to 5 with a mean of 3.7. The frequency of stud-dogs with 1 or more calcified discs was compared with the corresponding frequency in a material of 327 one-year-old dachshunds. In this comparison, the relative risk was estimated with 95% confidence bounds. When the different composition of size and coat varieties in the 2 materials was not considered, the relative risk of calcified discs was found to be 1.77 (0.99-3.2) times higher in stud-dogs than in young dogs. When the different composition of varieties in the 2 materials was considered, the relative risk was found to be 1.9 (1.1-3.4) times higher in stud-dogs than in young dogs. The results of the present study strongly suggest that an increase in the frequency of dachshunds with 1 or more calcified intervertebral discs occurs after 1 year of age

  9. Treatment of 89 Cases of Lumbar Intervertebral Disc Herniation with Acupuncture

    吴广伟; 杨湘宇

    2006-01-01

    采用以针刺为主、辅以腰部牵引和按摩等方法对89例腰椎间盘突出症患者进行综合治疗.经4个疗程的治疗,治愈65例,显效12例,有效7例,无效3例.采用以针刺为主的综合治疗腰椎间盘脱出症,能明显提高治疗效果,值得临床推广应用.%Eighty-nine cases of lumbar intervertebral disc herniation were mainly dealt with acupuncture method, supplementing with traction and Tuina at lumbar region. After 4 courses of treatment, 65 cases were cured, 12 cases got marked effects, 7 some effects, and 3 no effect. This integrated treatment had good effects on lumbar intervertebral disc herniation, and are worthy of being applied widely in clinic.

  10. CLINICAL OBSERVATION ON LUMBAR INTERVERTEBRAL DISC HERNIATION TREATED BY TRACTION COMBINED WITH ACUPUNCTURE

    何涛; 何岚

    2004-01-01

    Objective: To observe the therapeutic effect of traction combined with acupuncture on lumbar intervertebral disc herniation (LIDH).Methods:Eighty-three patients diagnosed as LIDH were randomly divided into treatment group (n=42)and control group (n=41).In the treatment group, besides lumbar traction, electroacupuncture at Jiaji (EX-B 2, L3~5), Shenshu (BL 23), Qihai (CV 6), Mingmen (GV 4), Huantiao (GB 30), Chengshan (BL 57) and Yanglingquan (GB 34) was added.In the control group, only lumbar traction was applied.Results: In treatment group, the cure plus markedly effective rate was 80.95% with a total effective rate of 92.86%, while in control group, it was 39.02% with a total effective rate of 80.48%.The therapeutic effect in the treatment group was obviously better than that in the control group (P<0.001).Conclusion: Lumbar traction plus EA can effectively alleviate or even eliminate clinical symptoms and signs of lumbar intervertebral disc herniation.

  11. Characteristics of stem cells derived from the degenerated human intervertebral disc cartilage endplate.

    Lan-Tao Liu

    Full Text Available 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. 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. Lastly, 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. 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. 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.

  12. Cordycepin inhibits LPS-induced inflammatory and matrix degradation in the intervertebral disc

    Mao, Lu; Han, Xiuguo; Zhang, Kai; Zhao, Changqing

    2016-01-01

    Cordycepin is a component of the extract obtained from Cordyceps militaris and has many biological activities, including anti-cancer, anti-metastatic and anti-inflammatory effects. Intervertebral disc degeneration (IDD) is a degenerative disease that is closely related to the inflammation of nucleus pulposus (NP) cells. The effect of cordycepin on NP cells in relation to inflammation and degeneration has not yet been studied. In our study, we used a rat NP cell culture and an intervertebral disc (IVD) organ culture model to examine the inhibitory effects of cordycepin on lipopolysaccharide (LPS)-induced gene expression and the production of matrix degradation enzymes (MMP-3, MMP-13, ADAMTS-4, and ADAMTS-5) and oxidative stress-associated factors (nitric oxide and PGE2). We found a protective effect of cordycepin on NP cells and IVDs against LPS-induced matrix degradation and macrophage infiltration. In addition, western blot and luciferase assay results demonstrated that pretreatment with cordycepin significantly suppressed the LPS-induced activation of the NF-κB pathway. Taken together, the results of our research suggest that cordycepin could exert anti-inflammatory and anti-degenerative effects on NP cells and IVDs by inhibiting the activation of the NF-κB pathway. Therefore, cordycepin may be a potential treatment for IDD in the future. PMID:27190710

  13. The Natural Polyphenol Epigallocatechin Gallate Protects Intervertebral Disc Cells from Oxidative Stress

    Krupkova, Olga; Handa, Junichi; Hlavna, Marian; Klasen, Juergen; Ospelt, Caroline; Ferguson, Stephen John; Wuertz-Kozak, Karin

    2016-01-01

    Oxidative stress-related phenotypic changes and a decline in the number of viable cells are crucial contributors to intervertebral disc degeneration. The polyphenol epigallocatechin 3-gallate (EGCG) can interfere with painful disc degeneration by reducing inflammation, catabolism, and pain. In this study, we hypothesized that EGCG furthermore protects against senescence and/or cell death, induced by oxidative stress. Sublethal and lethal oxidative stress were induced in primary human intervertebral disc cells with H2O2 (total n = 36). Under sublethal conditions, the effects of EGCG on p53-p21 activation, proliferative capacity, and accumulation of senescence-associated β-galactosidase were tested. Further, the effects of EGCG on mitochondria depolarization and cell viability were analyzed in lethal oxidative stress. The inhibitor LY249002 was applied to investigate the PI3K/Akt pathway. EGCG inhibited accumulation of senescence-associated β-galactosidase but did not affect the loss of proliferative capacity, suggesting that EGCG did not fully neutralize exogenous radicals. Furthermore, EGCG increased the survival of IVD cells in lethal oxidative stress via activation of prosurvival PI3K/Akt and protection of mitochondria. We demonstrated that EGCG not only inhibits inflammation but also can enhance the survival of disc cells in oxidative stress, which makes it a suitable candidate for the development of novel therapies targeting disc degeneration. PMID:27119009

  14. INNERVATION OF SENSORY NERVE TERMINALS IN RAT LUMBAR INTERVERTEBRAL DISC AND POSTERIOR LONGITUDINAL LIGAMENT

    2002-01-01

    Objective:To investigate the distribution of sensory nerve terminals in the lumbar intervertebral disc and posterior longitudinal ligament(PLL)in an animal model.Methods:Immunohistochemical method was used to visualize nerve terminals with antibodies of substanceP(SP) and calcitonin gene-related peptide(CGRP),and to characterize sensory nerve terminals on sections from lumbar intervertebral disc and posterior longitudinal ligament(PLL) of the sprague Dawley rate.Results :The immunostaining revealed an extensive distribution of SP and CGRP immunoreactive nerve filbers in the surface and most superficial portions of all annulus fibrosus and PLL.Most immunoreactions were observed in ventral and lateral regions of the annulus fibrosus,Morphologically,both thin varicose nerve fibers and tiny punctate nerve terminals could be observed.Conclusion:This study demonstrates an extensive distribution of SP and CGRP immunoreactive nerve fibers throughout the PLL and the peripheral annulus fibrosus and provides an illustration of this distribution.This finding supports a role for the disc as a source of low back pain and provides the neuroanatomic foundation of the disc-genic pain.

  15. Photobiomodulation on human annulus fibrosus cells during the intervertebral disk degeneration: extracellular matrix-modifying enzymes.

    Hwang, Min Ho; Kim, Kyoung Soo; Yoo, Chang Min; Shin, Jae Hee; Nam, Hyo Geun; Jeong, Jin Su; Kim, Joo Han; Lee, Kwang Ho; Choi, Hyuk

    2016-05-01

    Destruction of extracellular matrix (ECM) leads to degeneration of the intervertebral disk (IVD), which is a major contributor to many spine disorders. IVD degeneration is induced by pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β), which are secreted by immune cells, including macrophages and neutrophils. The cytokines modulate ECM-modifying enzymes such as matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in human annulus fibrosus (AF) cells. The resulting imbalance in catabolic and anabolic enzymes can cause generalized back, neck, and low back pain (LBP). Photobiomodulation (PBM) is known to regulate inflammatory responses and wound healing. The aim of this study was to mimic the degenerative IVD microenvironment, and to investigate the effect of a variety of PBM conditions (wavelength: 635, 525, and 470 nm; energy density: 16, 32, and 64 J/cm(2)) on the production of ECM-modifying-enzymes by AF cells under degenerative conditions induced by macrophage-conditioned medium (MCM), which contains pro-inflammatory cytokines such as TNF-α and IL-β secreted by macrophage during the development of intervertebral disk inflammation. We showed that the MCM-stimulated AF cells express imbalanced ratios of TIMPs (TIMP-1 and TIMP-2) and MMPs (MMP-1 and MMP-3). PBM selectively modulated the production of ECM-modifying enzymes in AF cells. These results suggest that PBM can be a therapeutic tool for degenerative IVD disorders. PMID:26987527

  16. Loading-Induced Heat-Shock Response in Bovine Intervertebral Disc Organ Culture.

    Chooi, Wai Hon; Chan, Samantha Chun Wai; Gantenbein, Benjamin; Chan, Barbara Pui

    2016-01-01

    Mechanical loading has been shown to affect cell viability and matrix maintenance in the intervertebral disc (IVD) but there is no investigation on how cells survive mechanical stress and whether the IVD cells perceive mechanical loading as stress and respond by expression of heat shock proteins. This study investigates the stress response in the IVD in response to compressive loading. Bovine caudal disc organ culture was used to study the effect of physiological range static loading and dynamic loading. Cell activity, gene expression and immunofluorescence staining were used to analyze the cell response. Cell activity and cytoskeleton of the cells did not change significantly after loading. In gene expression analysis, significant up-regulation of heat shock protein-70 (HSP70) was observed in nucleus pulposus after two hours of loading. However, the expression of the matrix remodeling genes did not change significantly after loading. Similarly, expressions of stress response and matrix remodeling genes changed with application and removal of the dynamic loading. The results suggest that stress response was induced by physiological range loading without significantly changing cell activity and upregulating matrix remodeling. This study provides direct evidence on loading induced stress response in IVD cells and contributes to our understanding in the mechanoregulation of intervertebral disc cells. PMID:27580124

  17. Lentivirus-mediated TGF-β3, CTGF and TIMP1 gene transduction as a gene therapy for intervertebral disc degeneration in an in vivo rabbit model

    LIU, YONG; YU, TAO; MA, XUE-XIAO; XIANG, HONG-FEI; HU, YOU-GU; CHEN, BO-HUA

    2016-01-01

    The present study examined the effects of transforming growth factor (TGF)-β3, connective tissue growth factor (CTGF) and tissue inhibitor of metalloproteinase 1 (TIMP1) gene transduction, using a lentiviral vector, on rabbit intervertebral disc degeneration in vivo, with the intention of investigating their potential use in gene therapy. A model of lumbar intervertebral disc degeneration was created by needle puncture into the annulus fibrosus of 15 New Zealand white rabbits. Empty lentivirus or recombinant lentiviral plasmid lenti-TGFβ3-P2A-CTGF-T2A-TIMP1 was injected into degenerative lumbar intervertebral discs (representing the control and experimental groups, respectively), whilst untreated degenerative lumbar intervertebral discs served as the puncture group. After 16 and 20 weeks, magnetic resonance imaging (MRI) was conducted and the changes in intensity on micrographs of degenerative intervertebral discs were measured. The mRNA levels of aggrecan and type II collagen in nucleus pulposus tissue were determined by reverse transcription-polymerase chain reaction, and protein expression levels of type II collagen and aggrecan were determined by western blot analysis. MRI results indicated that intervertebral disc degeneration was ameliorated in the experimental group when compared with the control and the puncture group. Furthermore, the expression levels of type II collagen and aggrecan in the puncture and control groups were significantly lower than in the experimental group (P<0.05). In conclusion, lenti-TGFβ3-P2A-CTGF-T2A-TIMP1 co-transduction can promote synthesis of aggrecan and type II collagen in degenerative intervertebral discs, thereby delaying intervertebral disc degeneration. These results indicate the potential of gene therapy in treatment of intervertebral disc degeneration. PMID:27073456

  18. Three-dimensional movements of the pelvis and the lumbar intervertebral joints in walking and trotting dogs.

    Wachs, K; Fischer, M S; Schilling, N

    2016-04-01

    Current knowledge of the physiological range of motion (ROM) in the canine axial system during locomotion is relatively limited. This is particularly problematic because dogs with back-related dysfunction frequently present for routine consultations. To collect detailed kinematic information and describe the three-dimensional motions of the pelvis and the lumbar spine (i.e. intervertebral joints S1/L7-L2/L1), we recorded ventro-dorsal and latero-lateral X-ray videos of three walking and trotting dogs and reconstructed their pelvic and intervertebral motions using X-ray reconstruction of moving morphology and scientific rotoscoping. Pelvic roll displayed a monophasic motion pattern and the largest ROM with on average 13° and 11° during walking and trotting, respectively. Pelvic yaw had the smallest ROM with on average 5° (walk) and 6° (trot). A biphasic pattern was observed for pelvic pitch with a mean ROM of 8°. At both gaits, the greatest intervertebral motions occurred either in S1/L7 or L7/L6. The intervertebral motions were mono- or biphasic in the horizontal and the transverse body planes and biphasic in the sagittal plane. Cranial to L6/5, the ROM tended to decrease from 3° to trotting. PMID:26831181

  19. Methodical aspects of ultrasonic research of cervical intervertebral disk and spiral canal children of the advanced school age

    Held ultrasound intervertebral discs (MPD), the spinal canal (PC) with the level of C2-C3 to C7-TH1 67 healthy children in the age groups 13-15 and 16-18 years. In the sagittal and axial projections defined sizes MPD PC dural spaces, radicular channels. Studied echo structure nucleus pulposus, the contours of the fibrous ring

  20. High incidence of persistence of sacral and coccygeal intervertebral discs in South Indians – a cadaveric study

    Satheesha Nayak, B; Ashwini Aithal, P; Kumar, Naveen; George, Bincy M; Deepthinath, R; Shetty, Surekha D

    2016-01-01

    The sacrum, by virtue of its anatomic location plays a key role in providing stability and strength to the pelvis. Presence of intervertebral discs in sacrum and coccyx is rare. Knowledge of its variations is of utmost importance to surgeons and radiologists. The current study focused on the presence of intervertebral discs between the sacral and coccygeal vertebrae in south Indian cadaveric pelvises. We observed 56 adult pelvises of which, 34 (61%) pelvises showed the presence of intervertebral discs between the sacral vertebrae and between the coccygeal vertebrae, while 22 (39%) pelvises did not have the intervertebral discs either in the sacrum or the coccyx. We also found that most of the specimens had discs between S1 and S2 vertebrae (39%), followed by, between S4 and S5 (18%), between S2–S3 (14%) and least being between S3–S4 (13%). In the coccyx it was found that 7% of pelvises had disc between Co1-Co2, 4% of them had between Co2-Co3 and 4% had between Co3-Co4. Knowledge regarding such anatomic variations in the sacro-coccygeal region is important to note because they require alterations in various instrumentation procedures involving the sacrum. PMID:27385838

  1. Collagen turnover in normal and degenerate human intervertebral discs as determined by the racemization of aspartic acid

    Sivan, S.-S.; Wachtel, E.; Tsitron, E.; Sakkee, N.; Ham, F. van der; Groot, J.de; Roberts, S.; Maroudas, A.

    2008-01-01

    Knowledge of rates of protein turnover is important for a quantitative understanding of tissue synthesis and catabolism. In this work, we have used the racemization of aspartic acid as a marker for the turnover of collagen obtained from healthy and pathological human intervertebral disc matrices. We

  2. A Combined Treatment of Scalp Acupuncture and Traction in 108 Cases of Prolapse of the Lumbar Intervertebral Disc

    2007-01-01

    @@ Prolapse of the lumbar intervertebral disc is a syndrome commonly seen in clinic. The main manifestation is pain in the lumbar region radiating to the lower limbs. In the treatment of this disease, the author has employed traction together with scalp needling, and obtained quite good therapeutic effects. A report follows.

  3. 椎体成形术治疗胸腰椎骨折的临床效果观察%Clinical Effect of Vertebroplasty Treatment of Thoracolumbar Fractures

    方德归

    2012-01-01

      Objective Explored the clinical effect of vertebroplasty treatment of thoracolumbar fractures. Methods Selected our hospital 88 patients with thoracolumbar fracture, randomly divided into observation group in 44 cases, control group in 44 cases, compared two groups patients’ clinical effects. Results After vertebroplasty treatment, the observation group’s excellent rate was 90.91%, and the control group after traditional conservative treatment, the excellent rate was 54.55%, the clinical effect of observation group was better than control group. Conclusion Vertebroplasty in the treatment of thoracolumbar fractures had exact clinical effect, worthy for clinical use.%  目的探讨椎体成形术治疗胸腰椎骨折的临床效果.方法选取本院收治的88例胸腰椎骨折患者,随机将这些患者分成观察组44例,对照组44例,比较两组患者治疗后的临床效果.结果观察组经椎体成形术治疗,效果优良率为90.91%,对照组经传统保守治疗,效果优良率为54.55%,观察组临床效果明显优于对照组.结论椎体成形术在治疗胸腰椎骨折方面具有确切的临床效果,值得临床推广使用.

  4. Smallness kerf pedicle screw internal fixation cure thoracolumbar fracture%小切口椎弓根钉棒内固定治疗胸腰椎骨折

    胡红耘

    2009-01-01

    Objective Smallness kerr rout of retreat pedicle screw posting restoration fixing cure thoracolum-bar fracture. Methods Versus 12 example thoracolumbar fracture adopt smallness keff micro-wound rout of retreat pedicle screw posting restoration fixing technology. Results 12 example fracture patient follow-up survey 8 loaf months to 2 year, average long dozen month, fracture restoration satisfaction, pedicle screw position all right, without height lost, without looseness,lapse sever natl. Conclusion Thoracolumbar fracture met pedicle screw push off resto-ration internal fixation, reestablish physiologic protrusion, operation kerf smallness, esthetic appearance, hemorrhage fewness wound reaction smallness, in favor of skill post-recovery.%目的 探讨椎弓根钉棒置入复位固定治疗胸腰椎骨折的手术入路方法.方法 对12例胸腰椎骨折的病例采用小切口微创后路椎弓根钉棒置入复位固定技术.结果 12例骨折患者随访8个月至2年,平均13个月,骨折复位满意,椎弓根钉棒位置良好,无高度丢失、无松动、失效、断钉.结论 胸腰椎骨折可选择后路小切口术式行椎弓根钉棒撑开复位内固定,重建生理前突,手术切口小、美观、出血少、创伤反应小,有利于术后恢复.

  5. First performance evaluation of software for automatic segmentation, labeling and reformation of anatomical aligned axial images of the thoracolumbar spine at CT

    Highlights: •Automatic segmentation and labeling of the thoracolumbar spine. •Automatically generated double-angulated and aligned axial images of spine segments. •High grade of accurateness for the symmetric depiction of anatomical structures. •Time-saving and may improve workflow in daily practice. -- Abstract: Objectives: To evaluate software for automatic segmentation, labeling and reformation of anatomical aligned axial images of the thoracolumbar spine on CT in terms of accuracy, potential for time savings and workflow improvement. Material and methods: 77 patients (28 women, 49 men, mean age 65.3 ± 14.4 years) with known or suspected spinal disorders (degenerative spine disease n = 32; disc herniation n = 36; traumatic vertebral fractures n = 9) underwent 64-slice MDCT with thin-slab reconstruction. Time for automatic labeling of the thoracolumbar spine and reconstruction of double-angulated axial images of the pathological vertebrae was compared with manually performed reconstruction of anatomical aligned axial images. Reformatted images of both reconstruction methods were assessed by two observers regarding accuracy of symmetric depiction of anatomical structures. Results: In 33 cases double-angulated axial images were created in 1 vertebra, in 28 cases in 2 vertebrae and in 16 cases in 3 vertebrae. Correct automatic labeling was achieved in 72 of 77 patients (93.5%). Errors could be manually corrected in 4 cases. Automatic labeling required 1 min in average. In cases where anatomical aligned axial images of 1 vertebra were created, reconstructions made by hand were significantly faster (p < 0.05). Automatic reconstruction was time-saving in cases of 2 and more vertebrae (p < 0.05). Both reconstruction methods revealed good image quality with excellent inter-observer agreement. Conclusion: The evaluated software for automatic labeling and anatomically aligned, double-angulated axial image reconstruction of the thoracolumbar spine on CT is time

  6. First performance evaluation of software for automatic segmentation, labeling and reformation of anatomical aligned axial images of the thoracolumbar spine at CT

    Scholtz, Jan-Erik, E-mail: janerikscholtz@gmail.com; Wichmann, Julian L.; Kaup, Moritz; Fischer, Sebastian; Kerl, J. Matthias; Lehnert, Thomas; Vogl, Thomas J.; Bauer, Ralf W.

    2015-03-15

    Highlights: •Automatic segmentation and labeling of the thoracolumbar spine. •Automatically generated double-angulated and aligned axial images of spine segments. •High grade of accurateness for the symmetric depiction of anatomical structures. •Time-saving and may improve workflow in daily practice. -- Abstract: Objectives: To evaluate software for automatic segmentation, labeling and reformation of anatomical aligned axial images of the thoracolumbar spine on CT in terms of accuracy, potential for time savings and workflow improvement. Material and methods: 77 patients (28 women, 49 men, mean age 65.3 ± 14.4 years) with known or suspected spinal disorders (degenerative spine disease n = 32; disc herniation n = 36; traumatic vertebral fractures n = 9) underwent 64-slice MDCT with thin-slab reconstruction. Time for automatic labeling of the thoracolumbar spine and reconstruction of double-angulated axial images of the pathological vertebrae was compared with manually performed reconstruction of anatomical aligned axial images. Reformatted images of both reconstruction methods were assessed by two observers regarding accuracy of symmetric depiction of anatomical structures. Results: In 33 cases double-angulated axial images were created in 1 vertebra, in 28 cases in 2 vertebrae and in 16 cases in 3 vertebrae. Correct automatic labeling was achieved in 72 of 77 patients (93.5%). Errors could be manually corrected in 4 cases. Automatic labeling required 1 min in average. In cases where anatomical aligned axial images of 1 vertebra were created, reconstructions made by hand were significantly faster (p < 0.05). Automatic reconstruction was time-saving in cases of 2 and more vertebrae (p < 0.05). Both reconstruction methods revealed good image quality with excellent inter-observer agreement. Conclusion: The evaluated software for automatic labeling and anatomically aligned, double-angulated axial image reconstruction of the thoracolumbar spine on CT is time

  7. Topical vancomycine and bacterial culture from intervertebral herniated disc prevent postoperative osteodiscitis

    Adam1 Danil

    2014-12-01

    Full Text Available Osteodiscitis represents a serious complication of lumbar disc herniation operations. The treatment of osteodiscitis is controversial and expensive to society. It extends over a period of several months from diagnosis. Reducing postoperative osteodiscitis by using simple measures may limit patient's suffering and reduce costs. The purpose of this study is to evaluate the early diagnosis of bacterial infections of the intervertebral disc by isolating germs located in the herniated disc fragment and topical Vancomycine powder application, along with the conventional anti-infective therapy. Medical files of patients who were operated on for lumbar disc herniations during 01.01.2013 - 30.06.2014 were reviewed. The diagnosis of lumbar disc herniation was established based on the clinical evaluation, confirmed by MRI results. The surgical intervention was performed by mini-open approach: fenestration and foraminotomy completed with removal of the herniated disc fragment and disc remnants from the intervertebral space. A group of 162 patients (group A received conventional therapy for prevention of post-operative infections with 2 doses of cephalosporin. In the second group of 137 patients (group B, after the removal of the herniated disc fragments, 1g of Vancomycine powder was topically applied and the disc fragments were bacteriologically analyzed. They received the conventional treatment of preventing post-operative infections with cephalosprin - 2 doses. The two groups of patients were similar in terms of demographic characteristics: age, sex, operative level. Out of the 162 patients of group A, one patient developed postoperative osteodiscitis and was treated for 3 months with antibiotics. Regarding patients in group B, in four cases Staphylococcus was isolated from the disc fragments. Postoperative treatment for these patients with prolonged antibiotic therapy over the standard period avoided the developement of the clinical picture of

  8. Depression of the Thoracolumbar Posterior Vertebral Body on the Estimation of Cement Leakage in Vertebroplasty and Kyphoplasty Operations

    Hao Chen; Pu Jia; Li Bao; Fei Feng; He Yang; Jin-Jun Li; Hai Tang

    2015-01-01

    Background: The cross-section ofthoracolumbar vertebral body is kidney-shaped with depressed posterior boundary.The anterior wall of the vertebral canal is separated from the posterior wall of the vertebral body on the lateral X-ray image.This study was designed to determine the sagittal distance between the anterior border of the vertebral canal and the posterior border of the vertebral body (DBCV) and to analyze the potential role of DBCV in the estimation of cement leakage during percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP).Methods: We retrospectively recruited 233 patients who had osteoporotic vertebral compression fractures and were treated with PVP or PKP.Computed tomography images ofT1 l-L2 normal vertebrae were measured to obtain DBCV.The distance from cement to the posterior wall of the vertebral body (DCPW) of thoracolumbar vertebrae was measured from C-ann images.The selected vertebrae were divided into two groups according to DCPW, with the fracture levels, fracture grades and leakage rates of the two groups compared.A relative operating characteristic (ROC) curve was applied to determine whether the DCPW difference can be used to estimate the degree of cement leakage.The data were processed by statistical software SPSS version 21.0 using independent sample t-test and Chi-square tests.Results: The maximum DBCV was 6.40 mm and the average DBCV was 3.74 ± 0.95 mm.DBCV appeared to be longer in males than in females, but the difference was not statistically significant.The average DCPW of type-B leakage vertebrae (2.59 ± 1.20 mm) was shorter than that of other vertebrae (7.83 ± 2.38 mm, P < 0.001).The leakage rate of group DCPW ≤6.40 mm was lower than that of group DCPW >6.40 mm for type-C and type-S, but much higher for type-B.ROC curve revealed that DCPW only has a predictive value for type-B leakage (area under the curve: 0.98, 95% confidence interval: 0.954.99, P < 0.001), and when the cut-offvalue was 4.05 mm, the

  9. The Retrospective Analysis of Posterior Short-Segment Pedicle Instrumentation without Fusion for Thoracolumbar Burst Fracture with Neurological Deficit

    Zhouming Deng

    2014-01-01

    Full Text Available This study aims to investigate the efficacy of posterior short-segment pedicle instrumentation without fusion in curing thoracolumbar burst fracture. All of the 53 patients were treated with short-segment pedicle instrumentation and laminectomy without fusion, and the restoration of retropulsed bone fragments was conducted by a novel custom-designed repositor (RRBF. The mean operation time and blood loss during surgery were analyzed; the radiological index and neurological status were compared before and after the operation. The mean operation time was 93 min (range: 62–110 min and the mean intraoperative blood loss was 452 mL in all cases. The average canal encroachment was 50.04% and 10.92% prior to the surgery and at last followup, respectively (P<0.01. The preoperative kyphotic angle was 17.2 degree (±6.87 degrees, whereas it decreased to 8.42 degree (±4.99 degrees at last followup (P<0.01. Besides, the mean vertebral body height increased from 40.15% (±9.40% before surgery to 72.34% (±12.32% at last followup (P<0.01. 45 patients showed 1-2 grades improvement in Frankel’s scale at last followup. This technique allows for satisfactory canal clearance and restoration of vertebral body height and kyphotic angle, and it may promote the recovery of neurological function. However, further research is still necessary to confirm the efficacy of this treatment.

  10. Acute Pancreatitis and Pregnancy

    ... Acute Pancreatitis > Acute Pancreatitis and Pregnancy test Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is ... of acute pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for ...

  11. 胸腰段椎间盘突出症与休门病%Thoracolumbar disc herniation and Scheuermann's disease

    石泽锋; 陈仲强; 刘宁; 齐强

    2011-01-01

    目的 探讨胸腰段椎间盘突出症(thoracolumbardisc herniation,TLDH)和休门病的内在联系以及休门病在TLDH发病中的作用.方法 2006年6月至2010年6月,以45例因TLDH(T10-11~L2-3)手术的患者作为研究组(TLDH组),及同期手术的低位(L3-4~L5S1)腰椎间盘突出症(1umbardisc herniation,LDH)患者中随机抽取45例作为对照组(LDH组).通过复习其CT、MRI和X线片,对比两组合并休门病和各种影像学休门样改变的比例,并比较两组的胸腰段后凸角度.进一步在TLDH组内部分别对比存在各种休门样改变的节段和无休门样改变节段合并椎间盘突出的比例.结果 TLDH组97.8%(44/45)的患者均合并休门病,LDH组仅为26.7%(12/45;x2=48.403,P=0.000).TLDH组出现各种休门样改变的比例均高于LDH组,分别为许莫结节66.7%(30/45)和15.6%(7/45;x2=24.278,P=0.000),终板不规则88.9%(40/45)和15.6%(7/45;x2=48.496,P=0.000),椎体后缘离断75.6%(34/45)和13.3%(6/45;x2=35.280,P=0.000),相邻椎体楔形变93.3%(42/45)和0%(x2=78.750,P=0.000).TLDH组患者平均胸腰段后凸角15.8°±6.9°,LDH组为4.8°±4.0°(t=7.703,P<0.001).TLDH组内,存在许莫结节(32.8%,39/119;x2=9.276,P=0.002),终板不规则(50.0%,55/110;x2=22.255,P=0.000),椎体后缘离断(100%,40/40;x2=69.421,P=0.000)和椎体楔形变(39.5%,58/147;x2=14.631,P=0.000)的节段发生椎间盘突出的比例均高于无休门样改变的节段(9.1%,4/44).结论 胸腰段椎间盘突出症与休门病关系密切,前者可能是后者的一种表现.许莫结节、终板不规则、椎体楔形变,尤其是椎体后缘离断,与椎间盘突出的发生有关.%Objective To explore the relationship between thoracolumbar disc herniation (TLDH) and Scheuermann1's disease (SD),as well as the role of SD in the etiology of TLDH.Methods From June 2006 to June 2010,45 patients with TLDH (T10-11-L2-3) underwent surgery in our department.Forty-five patients with lower lumbar disc herniation (LDH,L3-4-L5S1

  12. MRI analysis of the ISOBAR TTL internal fixation system for the dynamic fixation of intervertebral discs: a comparison with rigid internal fixation

    Gao, Jun; Zhao, Weihua; Zhang, Xi; Nong, Luming; Zhou, Dong; Lv, Zhengxiang; Sheng, Yonghua; Wu, Xingbiao

    2014-01-01

    Objectives Using magnetic resonance imaging (MRI), we analyzed the efficacy of the posterior approach lumbar ISOBAR TTL internal fixation system for the dynamic fixation of intervertebral discs, with particular emphasis on its effects on degenerative intervertebral disc disease. Methods We retrospectively compared the MRIs of 54 patients who had previously undergone either rigid internal fixation of the lumbar spine or ISOBAR TTL dynamic fixation for the treatment of lumbar spondylolisthesis....

  13. Effect of glycosaminoglycan polysulphate on the human intervertebral discs based on stature measurements.

    Videman, T; Leskinen, T; Stalhammar, H; Riihimaki, H; Takala, E P; Viikari-Juntura, E; Forsskahl, B

    1994-05-01

    Glycosaminoglycan polysulphate has been shown to protect against loss of glycosaminoglycans in experimental osteoarthritis and has been used in humans to achieve the same result. It was assumed that if glycosaminoglycan polysulphate generally affects human connective tissues its use would increase or maintain intervertebral disc height by preventing water loss. Stature was measured during a resting-loading-resting period of 1.5 h. Four baseline measurements were taken of six subjects during a 4-week period. Thereafter each subject was given glycosaminoglycan polysulphate for 3 weeks and stature was measured once a week until a stable condition was reached; no less than three measurements were obtained. No effect of glycosaminoglycan polysulphate on the stature could, however, be seen in the mean values for all six subjects. PMID:23916184

  14. Conservative therapy for lumbar intervertebral disc hernia. Intradiscal compressive injection and MRI findings

    Yoshida, Tohru; Nanba, Hiromichi; Kasai, Tsutomu; Ohta, Susumu [Yoshida Orthopaedic Hospital, Toyota, Aichi (Japan)

    1996-01-01

    To herniating intervertebral discs, 3-20 ml physiological saline was pressurized and injected. To avoid excessive force, the injection pressure was set at less than 3 kg/cm{sup 2}. Between January 1993 and December 1994, 380 cases were studied (286 men and 94 women with a mean age of 45.5 years). After the compressive injection there were 259 (68.2%) effective cases in which symptoms were relieved and 121 ineffective cases (31.8%). The proportion of effective cases was higher in women than in men and in older than in younger patients. After intradiscal pressurized injection, the effective cases were investigated with MRI and a tendency to relatively early shrinkage of herniated mass was noted. (author).

  15. Development of a method for quantitative measures of lumbar intervertebral disc structures

    Tunset, Andreas; Kjær, Per; Chreiteh, Shadi Samir;

    2013-01-01

    applicable description of quantitative methods for measuring lumbar disc herniations and related structures on sagittal MRIs. The objectives of this study were: 1) to develop methods for quantitative measures of intervertebral discs, lumbar disc herniations and dural sac/spinal canal using MRIs, 2) to......Background: Detailed information about the development of disc morphology over time could provide valuable knowledge about disc health when compared with clinical measures such as pain and activity limitation. However, a review of the available literature did not reveal any detailed and directly...... evaluate the agreement of these methods, and 3) to identify factors in the measurement procedures that may compromise agreement. Methods: In this intra- and inter-rater agreement study, lumbar quantitative measurements were performed on magnetic resonance images from 32 participants from a study cohort...

  16. Experimental and clinical studies on dynamic circulation of intervertebral discs by radiation clearance method

    Few studies on the mechanism of dynamic circulation in intervertebral discs are reported. The purpose of this study is to clarify the dynamic mechanism of circulation in the lumbar intervertebra discs with radioisotope clearance, experimentally and clinically. Rabbits were used as experimental animals and were divided into two groups, normal and artificially injured. I131-sodium was injected into them and the clearance was followed. Injected I131-sodium was cleared in the order of; 1) discs with injured annulus fibrosus, 2) discs with injection of α-chymotrypsin, 3) discs with injuries in the border between vertebral body and annulus fibrosus, 4) and normal discs. Human degenerated discs were also used for this study. In the clinical cases, I131-sodium was cleared faster in the degenerated discs than in the normal. The pathway for I131-sodium to be cleared is supposed to be extravascular and interstitial spaces in the disc. (author)

  17. Contrast myelography in the diagnosis of hernal protrusion of intervertebral disks in lumbar osteochondrosis

    The paper is concerned with the results of a radiopaque study of the vertebral canal in 701 patients with lumbar osteochondrosis (pneumomyelography was performed in 280, positive myelography with water soluble contrast substances in 421 patients). Myelography using Amipaque, a water soluble contrast substance, is a highly informative method of diagnosis of protrusion of disks. Amipaque is more physiological and sparing as compared to the air and emulsive contrast agents. The combination of myelography with functional X-ray investigations, and tomography permits the detection in most of the cases of protrusion of intervertebral disks. This combination is also used to determine the side of lateral hernias for a less traumatic surgical access. Diagnostic accuracy in positive myelography was 96.5%, in negative myelography 89.13%

  18. Conservative therapy for lumbar intervertebral disc hernia. Intradiscal compressive injection and MRI findings

    To herniating intervertebral discs, 3-20 ml physiological saline was pressurized and injected. To avoid excessive force, the injection pressure was set at less than 3 kg/cm2. Between January 1993 and December 1994, 380 cases were studied (286 men and 94 women with a mean age of 45.5 years). After the compressive injection there were 259 (68.2%) effective cases in which symptoms were relieved and 121 ineffective cases (31.8%). The proportion of effective cases was higher in women than in men and in older than in younger patients. After intradiscal pressurized injection, the effective cases were investigated with MRI and a tendency to relatively early shrinkage of herniated mass was noted. (author)

  19. Discoscopic Findings of High Signal Intensity Zones on Magnetic Resonance Imaging of Lumbar Intervertebral Discs

    Kosuke Sugiura

    2014-01-01

    Full Text Available A 32-year-old man underwent radiofrequency thermal annuloplasty (TA with percutaneous endoscopic discectomy (PED under local anesthesia for chronic low back pain. His diagnosis was discogenic pain with a high signal intensity zone (HIZ in the posterior corner of the L4-5 disc. Flexion pain was sporadic, and steroid injection was given twice for severe pain. After the third episode of strong pain, PED and TA were conducted. The discoscope was inserted into the posterior annulus and revealed a migrated white nucleus pulposus which was stained blue. Then, after moving the discoscope to the site of the HIZ, a migrated slightly red nucleus pulposus was found, suggesting inflammation and/or new vessels penetrating the mass. After removing the fragment, the HIZ site was ablated by TA. To our knowledge, this is the first report of the discoscopic findings of HIZ of the lumbar intervertebral disc.

  20. Nutrition of the intervertebral disc: effect of fluid flow on solute transport

    Adult dogs were injected intravenously with 35S-sulphate, and moderately exercised for one to six hours to measure isotope concentrations and profiles throughout the intervertebral discs. The isotope profiles were also observed in control animals that had been under anesthesia between injections and death. In both sets of animals, the profiles were in agreement with those expected for isotope transport by diffusion. This agreement indicates that fluid pumping during movement has an insignificant effect on transport of nutrients into the disc. Small solutes, e.g., O2, glucose, and sulphate, are transported into the disc chiefly by diffusion. However, calculations show that because of their low diffusivities, pumping may increase the rate of transport of large solutes into the disc, as it does in articular cartilage

  1. Hydrogel-Based Platforms for the Regeneration of Osteochondral Tissue and Intervertebral Disc

    Luigi Ambrosio

    2012-09-01

    Full Text Available Hydrogels currently represent a powerful solution to promote the regeneration of soft and hard tissues. Primarily, they assure efficient bio-molecular interactions with cells, also regulating their basic functions, guiding the spatially and temporally complex multi-cellular processes of tissue formation, and ultimately facilitating the restoration of structure and function of damaged or dysfunctional tissues. In order to overcome basic drawbacks of traditional synthesized hydrogels, many recent strategies have been implemented to realize multi-component hydrogels based on natural and/or synthetic materials with tailored chemistries and different degradation kinetics. Here, a critical review of main strategies has been proposed based on the use of hydrogels-based devices for the regeneration of complex tissues, i.e., osteo-chondral tissues and intervertebral disc.

  2. Acute Sciatic Neuritis following Lumbar Laminectomy

    Foad Elahi

    2014-01-01

    Full Text Available It is commonly accepted that the common cause of acute/chronic pain in the distribution of the lumbosacral nerve roots is the herniation of a lumbar intervertebral disc, unless proven otherwise. The surgical treatment of lumbar disc herniation is successful in radicular pain and prevents or limits neurological damage in the majority of patients. Recurrence of sciatica after a successful disc surgery can be due to many possible etiologies. In the clinical setting we believe that the term sciatica might be associated with inflammation. We report a case of acute sciatic neuritis presented with significant persistent pain shortly after a successful disc surgery. The patient is a 59-year-old female with complaint of newly onset sciatica after complete pain resolution following a successful lumbar laminectomy for acute disc extrusion. In order to manage the patient’s newly onset pain, the patient had multiple pain management visits which provided minimum relief. Persistent sciatica and consistent physical examination findings urged us to perform a pelvic MRI to visualize suspected pathology, which revealed right side sciatic neuritis. She responded to the electrical neuromodulation. Review of the literature on sciatic neuritis shows this is the first case report of sciatic neuritis subsequent to lumbar laminectomy.

  3. In-vivo T2-relaxation times of asymptomatic cervical intervertebral discs

    Limited research exists on T2-mapping techniques for cervical intervertebral discs and its potential clinical utility. The objective of this research was to investigate the in-vivo T2-relaxation times of cervical discs, including C2-C3 through C7-T1. Ten asymptomatic subjects were imaged using a 3.0 T MR scanner and a sagittal multi-slice multi-echo sequence. Using the mid-sagittal image, intervertebral discs were divided into five regions-of-interest (ROIs), centered along the mid-line of the disc. Average T2 relaxation time values were calculated for each ROI using a mono-exponential fit. Differences in T2 values between disc levels and across ROIs of the same disc were examined. For a given ROI, the results showed a trend of increasing relaxation times moving down the spinal column, particularly in the middle regions (ROIs 2, 3 and 4). The C6-C7 and C7-T1 discs had significantly greater T2 values compared to superior discs (discs between C2 and C6). The results also showed spatial homogeneity of T2 values in the C3-C4, C4-C5, and C5-C6 discs, while C2-C3, C6-C7, and C7-T1 showed significant differences between ROIs. The findings indicate there may be inherent differences in T2-relaxation time properties between different cervical discs. Clinical evaluations utilizing T2-mapping techniques in the cervical spine may need to be level-dependent. (orig.)

  4. In-vivo T2-relaxation times of asymptomatic cervical intervertebral discs

    Driscoll, Sean J.; Mao, Haiqing; Li, Guoan [Massachusetts General Hospital/Harvard Medical School, Bioengineering Laboratory, Department of Orthopaedic Surgery, Boston, MA (United States); Zhong, Weiye [Massachusetts General Hospital/Harvard Medical School, Bioengineering Laboratory, Department of Orthopaedic Surgery, Boston, MA (United States); Second Xiangya Hospital and Central South University, Department of Spinal Surgery, Changsha, Hunan (China); Torriani, Martin [Massachusetts General Hospital/Harvard Medical School, Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Wood, Kirkham B.; Cha, Thomas D. [Massachusetts General Hospital/Harvard Medical School, Spine Service, Department of Orthopaedic Surgery, Boston, MA (United States)

    2016-03-15

    Limited research exists on T2-mapping techniques for cervical intervertebral discs and its potential clinical utility. The objective of this research was to investigate the in-vivo T2-relaxation times of cervical discs, including C2-C3 through C7-T1. Ten asymptomatic subjects were imaged using a 3.0 T MR scanner and a sagittal multi-slice multi-echo sequence. Using the mid-sagittal image, intervertebral discs were divided into five regions-of-interest (ROIs), centered along the mid-line of the disc. Average T2 relaxation time values were calculated for each ROI using a mono-exponential fit. Differences in T2 values between disc levels and across ROIs of the same disc were examined. For a given ROI, the results showed a trend of increasing relaxation times moving down the spinal column, particularly in the middle regions (ROIs 2, 3 and 4). The C6-C7 and C7-T1 discs had significantly greater T2 values compared to superior discs (discs between C2 and C6). The results also showed spatial homogeneity of T2 values in the C3-C4, C4-C5, and C5-C6 discs, while C2-C3, C6-C7, and C7-T1 showed significant differences between ROIs. The findings indicate there may be inherent differences in T2-relaxation time properties between different cervical discs. Clinical evaluations utilizing T2-mapping techniques in the cervical spine may need to be level-dependent. (orig.)

  5. Chondroitin sulphate sulphation motif expression in the ontogeny of the intervertebral disc

    AJ Hayes

    2011-01-01

    Full Text Available Chondroitin sulphate chains on cell and extracellular matrix proteoglycans play important regulatory roles in developing systems. Specific, developmentally regulated, sulphation motifs within the chondroitin glycosaminoglycan structure may help bind, sequester or present bioactive signalling molecules to cells thus modulating their behaviour. Using monoclonal antibodies 3B3(-, 4C3, 6C3 and 7D4, we have mapped the distribution of different chondroitin sulphation epitopes in a rat intervertebral disc developmental series. The sulphation epitopes had complex, dynamic and specific distributions in the disc and vertebral tissues during their differentiation, growth and ageing. At embryonic day [E]15, prior to disc differentiation, 4C3 and 7D4 occurred within the cellular disc condensations whilst 6C3 was present in the notochordal sheath. At E17, post disc differentiation, 4C3 and 7D4 occurred within the nucleus pulposus, inner annulus and vertebral bodies; 3B3(- in the nucleus, inner annulus, annulus/vertebral body interface and perichondrium; and 6C3, ventrally, within the perichondrium. At E19, 3B3(-, 4C3 and 7D4 became further restricted to the nucleus, inner annulus, annulus/vertebral body interface and perichondrium. Prior to birth, all four epitopes occurred within the inner annulus and nucleus, with 6C3 and 7D4 also occurring within the future end-plate. Postnatal expression of the sulphation epitopes was more widespread in the disc and also within the growth plate. At 4 months, the epitopes were associated with chondrocyte clusters within the nucleus; and at 24 months, with annular lesions. Overall, our data suggests that differential sulphation of chondroitin correlates with significant events in development, growth and aging of the rat intervertebral disc.

  6. Chondroitin sulphate sulphation motif expression in the ontogeny of the intervertebral disc.

    Hayes, A J; Hughes, C E; Ralphs, J R; Caterson, B

    2011-01-01

    Chondroitin sulphate chains on cell and extracellular matrix proteoglycans play important regulatory roles in developing systems. Specific, developmentally regulated, sulphation motifs within the chondroitin glycosaminoglycan structure may help bind, sequester or present bioactive signalling molecules to cells thus modulating their behaviour. Using monoclonal antibodies 3B3(-), 4C3, 6C3 and 7D4, we have mapped the distribution of different chondroitin sulphation epitopes in a rat intervertebral disc developmental series. The sulphation epitopes had complex, dynamic and specific distributions in the disc and vertebral tissues during their differentiation, growth and ageing. At embryonic day [E]15, prior to disc differentiation, 4C3 and 7D4 occurred within the cellular disc condensations whilst 6C3 was present in the notochordal sheath. At E17, post disc differentiation, 4C3 and 7D4 occurred within the nucleus pulposus, inner annulus and vertebral bodies; 3B3(-) in the nucleus, inner annulus, annulus/vertebral body interface and perichondrium; and 6C3, ventrally, within the perichondrium. At E19, 3B3(-), 4C3 and 7D4 became further restricted to the nucleus, inner annulus, annulus/vertebral body interface and perichondrium. Prior to birth, all four epitopes occurred within the inner annulus and nucleus, with 6C3 and 7D4 also occurring within the future end-plate. Postnatal expression of the sulphation epitopes was more widespread in the disc and also within the growth plate. At 4 months, the epitopes were associated with chondrocyte clusters within the nucleus; and at 24 months, with annular lesions. Overall, our data suggests that differential sulphation of chondroitin correlates with significant events in development, growth and aging of the rat intervertebral disc. PMID:21213210

  7. Comparative study of the clinical effect and safety of anterior surgical approach and posterior surgical approach in the treatment of thoracolumbar spinal fracture

    Dengfeng Zhang

    2015-01-01

    Full Text Available The clinical effect and safety of the anterior surgical approach and posterior surgical approach in the treatment of thoracolumbar spinal fracture was compared. Retrospective analyses of clinical data for 91 patients observed from March 2010 to September 2014 were made. The pre-operation and post-operation comparisons between two sets of Cobb’s angle, affected vertebra height, Frankel’s classification of spinal nerves, motion functions, and tactile functions showed statistically significant differences (P<0.05. After having the operation, the Cobb’s angle and affected vertebra height of the patient in the anterior approach group were both significantly higher than that of patients in the posterior approach group (P<0.05. The bone graft fusion rate of the patients in the anterior approach group 3 months after operation was higher than that of patients in the control group while the status of complications was worse than that of patients in the posterior approach group, both with a remarkable difference (P<0.05. Both the anterior surgical approach and posterior surgical approach have good clinical outcome for spinal fractures but they all have their respective adaption diseases. The key in the treatment of thoracolumbar spinal fractures lies in choosing proper operative approach.

  8. Bronchitis - acute

    ... sharing features on this page, please enable JavaScript. Acute bronchitis is swelling and inflammation in the main passages ... present only for a short time. Causes When acute bronchitis occurs, it almost always comes after having a ...

  9. Bronchitis - acute

    Acute bronchitis is swelling and inflammation in the main passages that carry air to the lungs. The swelling narrows ... makes it harder to breathe. Another symptom of bronchitis is a cough. Acute means the symptoms have ...

  10. Acute Bronchitis

    Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It ... chest tightness. There are two main types of bronchitis: acute and chronic. Most cases of acute bronchitis ...

  11. CLINICAL COMPARISION OF THE TREATMENT OF CERVICAL PROLAPSE OF INTERVERTEBRAL DISC BY USING CAGE OR TITANIUM PLATE

    Yang Pei; Wang Kunzheng; Gong Fuliang; Wang Chunsheng; Shi Zhibin

    2006-01-01

    Objective To compare the clinical effects of treating cervical prolapse of intervertebral disc by using Solis cage, titanium cage and autogenous iliac crest graft (AICG) combined with titanium plate. Methods 64 cases of cervical prolapse of intervertebral disc were analyzed retrospectively. All the patients were followed up for about one year. Group A is composed of 20 patients (30 intervertebral spaces) treated with microdiscectomy and Solis cage fusion;group B is composed of 21 patients(22 intervertebral spaces) treated with titanium cage and group C is involved of 23patients(28 intervertebral spaces) which were dealt with AICG combined with titanium plate. The differences in the to-tal X ray exposure time, time working on iliac bone, incidence of complications, fusion rate, incidence of JOA score recovery rate more than 50 % and rehabilitation time of the three groups are analyzed. Results All indexes from group A and B were more satisfactory than those from group C (P<0. 05). The statistic analysis results of the incidence of complications of cervical part, rehabilitation time in group A are 5.0± 1.8, 5.1 ± 1.2; and that is 14.3±2.6, 7.5 ± 1.6and 26.1±6.2, 8.6±2.3 in group B and group C respectively. There is significant difference between group A and group B on the incidence of complications of cervical part and rehabilitation time (P<0.05). Results of the incidence of JOA score recovery rate > 50 % in group A(95.8 ± 3.2) was more satisfactory than that in group B(93.6 ± 2.9),while there was no statistical difference between group A and group B (P>0.05). Conclusion The Solis cage is better in treating the cervical prolapse of intervertebral disc than other ways. Also, it makes the operation easier, rehabilitation time shorter, and it causes fewer complications.

  12. Acute pancreatitis

    Bo-Guang Fan; Åke Andrén-Sandberg

    2010-01-01

    Background : Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims : The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods : We reviewed the English-language literature (Medline) addressing pancreatitis. Results : Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingest...

  13. Acute pancreatitis

    Bo-Guang Fan; Åke Andrén-Sandberg

    2010-01-01

    Background: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods: We reviewed the English-language literature (Medline) addressing pancreatitis. Results: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion....

  14. Early curative effect of transpedicular screw fixation in treatment of thoracolumbar fracture combined with posterior ligamentous complex injuries%经椎弓根钉内固定治疗合并后方韧带复合体损伤胸腰椎骨折早期疗效观察

    曹贵君; 孟纯阳; 张卫红; 孔祥清; 高峰; 吴同申; 陈国武

    2015-01-01

    .According to the degree of fracture displacement and types of ligament injury,posterolateral bone grafting or intervertebral fusion at the level of injury was conducted.Vertebral height restoration,Cobb' s angle and American Spinal Injury Association (ASIA) score were reviewed preoperatively,at postoperative 3 days and at the last follow-up.Results All the patients were operated on smoothly.There were no complications during operation.All the patients were followed up for 5-51 months (mean,26.5 months).Fracture reductions were satisfied with the closure of vertebral posterior element.Mean anterior vertebral height and Cobb' s angle improved by 20.6% and 10.60°respectively after operation (P <0.01).Eight patients with neurological dysfunction showed some recovery after operation with the mean sensory score improved by 20.7% (P < 0.05) and mean motor function score improved by 30.9% (P < 0.0l).All bone grafts were healed,without pain,loosening or breakage in the fixation system.Conclusions Posterior pedicular screw fixation attains good short-term outcome for thoracolumbar flexion-distraction fracture combined with posterior ligamentous complex injuries.The surgery provides satisfactory reduction and instant spinal three-column stability for the unstable spine fracture.Sufficient bone graft is the guarantee to permanent stability.

  15. Fatores genéticos e ambientais envolvidos na degeneração do disco intervertebral Genetic and environmental factors involved on intervertebral disc degeneration

    Francine Teresa Brioni Nunes

    2007-01-01

    Full Text Available A etiologia da degeneração do disco intervertebral (DDI ainda não está totalmente esclarecida. O gene do receptor da vitamina D (VDR tem sido apontado como um dos possíveis envolvidos no surgimento das discopatias. Por outro lado, este estudo relaciona pela primeira vez, a participação dos genes das glutatião transferases M1 e T1 (GSTT1 e GSTM1, responsáveis pela inativação dos componentes do cigarro, na DDI. Foi extraído DNA de leucócitos de 66 pacientes e 88 controles, pareados por gênero e idade. O polimorfismo VDR-FokI foi amplificado por reação em cadeia da polimerase (PCR seguido de restrição com a enzima FokI. Os polimorfismos das GSTT1/M1 foram determinados por meio da PCR multiplex. A história familial e a gravidade da doença se destacaram nos pacientes portadores do alelo f do gene VDR-FokI (P=0,000 e 0,0012, respectivamente. A idade de surgimento da doença mostrou-se precoce nos indivíduos com genótipo _/f (média de 26 anos. Foi encontrada associação do polimorfismo FokI com a degeneração precoce e gravidade da DDI, sendo que o hábito de fumar também interferiu nesse processo, independente da presença ou não do genótipo favorável para GSTT1/M1.The etiology of intervertebral disc degeneration (IDD has not been fully clarified yet. Vitamin D receptor’s gene (VDR has been suggested as one of the potential entities involved in disc pathologies onset. On the other hand, this study correlates, for the first time, glutathione transferases M1 and T1 genes (GSTT1 and GSTM1 participation, which are responsible for cigarette components’ inactivation, in IDD. DNA was extracted from leukocytes of 66 patients and 88 controls, paired by gender and age. The VDR-Fokl polymorphism was amplified by polymerase chain reaction (PCR followed by restriction with Fokl enzyme. GSTT1/M1 polymorphisms were determined by means of PCR multiplex. Family history and disease severity were highlighted in patients carrying the f

  16. Acute pancreatitis

    Bo-Guang Fan

    2010-05-01

    Full Text Available Background: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods: We reviewed the English-language literature (Medline addressing pancreatitis. Results: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions: Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  17. Acute pancreatitis

    Bo-Guang Fan

    2010-01-01

    Full Text Available Background : Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims : The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods : We reviewed the English-language literature (Medline addressing pancreatitis. Results : Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions : Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  18. A computational study of intervertebral disc degeneration in relation to changes in regional tissue composition and disc nutrition

    Ruiz Wills, Carlos

    2015-01-01

    Up to 85% of the world population suffers from low back pain, a clinical condition often related to the intervertebral disc (IVD) degeneration (DD). Altered disc cell nutrition affects cell viability and can generate catabolic cascades that degrade the extracellular matrix (ECM). Also, a major degenerative biochemical change in the disc is the proteoglycan (PG) loss, which affects the osmotic pressure and hydration that is critical for cell nutrition. However, the relationship between biochem...

  19. Brain-derived neurotrophic factor and its receptor in the human and the sand rat intervertebral disc

    Gruber, Helen E.; Ingram, Jane A; Hoelscher, Gretchen; Zinchenko, Natalia; Norton, H. James; Hanley, Edward N

    2008-01-01

    Introduction Brain-derived neurotrophic factor (BDNF) was first identified in the intervertebral disc (IVD) when its molecular upregulation was observed in sections of nucleus pulposus cultured under conditions of increased osmolarity. BDNF is now known to be involved in a number of biologic functions, including regulation of differentiation/survival of sensory neurons, regulation of nociceptive function and central pain modulation, and modulation of inflammatory pain hypersensitivity. In add...

  20. Automated determination of the centers of vertebral bodies and intervertebral discs in CT and MR lumbar spine images

    Štern, Darko; Vrtovec, Tomaž; Pernuš, Franjo; Likar, Boštjan

    2010-03-01

    The knowledge of the location of the centers of vertebral bodies and intervertebral discs is valuable for the analysis of the spine. Existing methods for the detection and segmentation of vertebrae in images acquired by computed tomography (CT) and magnetic resonance (MR) imaging are usually applicable only to a specific image modality and require prior knowledge of the location of vertebrae, usually obtained by manual identification or statistical modeling. We propose a completely automated framework for the detection of the centers of vertebral bodies and intervertebral discs in CT and MR images. The image intensity and gradient magnitude profiles are first extracted in each image along the already obtained spinal centerline and therefore contain a repeating pattern representing the vertebral bodies and intervertebral discs. Based on the period of the repeating pattern and by using a function that approximates the shape of the vertebral body, a model of the vertebral body is generated. The centers of vertebral bodies and intervertebral discs are detected by measuring the similarity between the generated model and the extracted profiles. The method was evaluated on 29 CT and 13 MR images of lumbar spine with varying number of vertebrae. The overall mean distance between the obtained and the ground truth centers was 2.8 +/- 1.9 mm, and no considerable differences were detected between the results for CT, T1-weighted MR or T2-weighted MR images, or among different vertebrae. The proposed method may therefore be valuable for initializing the techniques for the detection and segmentation of vertebrae.

  1. 2002 SSE Award Competition in Basic Science: Expression of major matrix metalloproteinases is associated with intervertebral disc degradation and resorption

    Weiler, C.; Nerlich, A.; Zipperer, J.; Bachmeier, B.; Boos, N

    2002-01-01

    During the process of degeneration, the intervertebral disc (IVD) shows a progressive and significant reduction in height due to tissue resorption. Intradiscal clefts and tears are major hallmarks of disc degeneration. Matrix-degrading enzymes such as matrix metalloproteinases (MMPs) are assumed to play a pivotal role in disc tissue degradation and resorption. The objective of this study was therefore to investigate the potential role of MMPs in extracellular matrix degradation leading to dis...

  2. Tissue-engineered intervertebral discs produce new matrix, maintain disc height, and restore biomechanical function to the rodent spine

    Bowles, Robby D.; Gebhard, Harry H.; Härtl, Roger; Bonassar, Lawrence J.

    2011-01-01

    Lower back and neck pain are leading physical conditions for which patients see their doctors in the United States. The organ commonly implicated in this condition is the intervertebral disc (IVD), which frequently herniates, ruptures, or tears, often causing pain and limiting spinal mobility. To date, approaches for replacement of diseased IVD have been confined to purely mechanical devices designed to either eliminate or enable flexibility of the diseased motion segment. Here we present the...

  3. The relationship between low pH in intervertebral discs and low back pain: a systematic review

    Liang, Cheng-zhen; Li, Hao; Tao, Yi-qing; Zhou, Xiao-peng; Yang, Zi-ru; Li, Fang-cai; Chen, Qi-xin

    2012-01-01

    Introduction To systematically review the relationship between low pH in intervertebral discs and low back pain. Material and methods Electronic database (PubMed, ISI Web of Science, Cochrane Library, CINAHL, AMED, and China National Knowledge Infrastructure) searches and hand searching of conference proceedings were conducted. Two authors independently evaluated the methodological quality and abstracted relevant data according to standard criteria. Then the experimental methods and samples e...

  4. Biomechanical effect of altered lumbar lordosis on intervertebral lumbar joints during the golf swing: a simulation study.

    Bae, Tae Soo; Cho, Woong; Kim, Kwon Hee; Chae, Soo Won

    2014-11-01

    Although the lumbar spine region is the most common site of injury in golfers, little research has been done on intervertebral loads in relation to the anatomical-morphological differences in the region. This study aimed to examine the biomechanical effects of anatomical-morphological differences in the lumbar lordosis on the lumbar spinal joints during a golf swing. The golf swing motions of ten professional golfers were analyzed. Using a subject-specific 3D musculoskeletal system model, inverse dynamic analyses were performed to compare the intervertebral load, the load on the lumbar spine, and the load in each swing phase. In the intervertebral load, the value was the highest at the L5-S1 and gradually decreased toward the T12. In each lumbar spine model, the load value was the greatest on the kypholordosis (KPL) followed by normal lordosis (NRL), hypolordosis (HPL), and excessive lordosis (EXL) before the impact phase. However, results after the follow-through (FT) phase were shown in reverse order. Finally, the load in each swing phase was greatest during the FT phase in all the lumbar spine models. The findings can be utilized in the training and rehabilitation of golfers to help reduce the risk of injury by considering individual anatomical-morphological characteristics. PMID:25162173

  5. Intra- and inter-observer reliability of MRI examination of intervertebral disc abnormalities in patients with cervical myelopathy

    Braga-Baiak, Andresa [Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC (United States); Post-graduation Program, Department of Radiology, University of Sao Paulo (Brazil); Shah, Anand [Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC (United States); Pietrobon, Ricardo [Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC (United States); Department of Surgery, Duke University Medical Center, Durham, NC (United States); Braga, Larissa [Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC (United States); University of Nebraska Medical Center, Lincoln NE (United States); Neto, Arnolfo Carvalho [Clinica DAPI, Curitiba (Brazil); Section of Diagnostic Radiology, Department of Internal Medicine, Universidade Federal do Parana (Brazil); Cook, Chad [Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC (United States); Division of Physical Therapy, Duke University Medical Center, Durham, NC (United States)], E-mail: chad.cook@duke.edu

    2008-01-15

    Purpose: Intervertebral cervical disc herniation (CDH) is a relatively common disorder that can coexist with degenerative changes to worsen cervicogenic myelopathy. Despite the frequent disc abnormalities found in asymptomatic populations, magnetic resonance imaging (MRI) is considered excellent at detecting cervical spine myelopathy (CSM) associated with disc abnormality. The objective of this study was to investigate the intra- and inter-observer reliability of MRI detection of CSM in subjects who also had co-existing intervertebral disc abnormalities. Materials and methods: Seven experienced radiologists reviewed twice the MRI of 10 patients with clinically and/or imaging determined myelopathy. MRI assessment was performed individually, with and without operational guidelines. A Fleiss Kappa statistic was used to evaluate the intra- and inter-observer agreement. Results: The study found high intra-observer percent agreement but relatively low Kappa values on selected variables. Inter-observer reliability was also low and neither observation was improved with operational guidelines. We believe that those low values may be associated with the base rate problem of Kappa. Conclusion: In conclusion, this study demonstrated high intra-observer percent agreement in MR examination for intervertebral disc abnormalities in patients with underlying cervical myelopathy, but differing levels of intra- and inter-observer Kappa agreement among seven radiologists.

  6. Posterior Decompression, Lumber Interbody Fusion and Internal Fixation in the Treatment of Upper Lumbar Intervertebral Disc Herniation

    DONG Zhan

    2014-12-01

    Full Text Available Objective: To assess the clinical outcomes of posterior decompression, interbody fusion and internal fixationfor the treatment of the upper lumbar intervertebral disc herniation. Methods: Twelve patients with the upper lumbar intervertebral disc herniation were treated by posterior decompression, interbosy fusion and internal fixation. The time of the operation, the amount of bleeding and the clinical efficacy were evaluated. Results: The time of operation was (143±36 min and the amount of bleeding during operation was (331.5±47.9 mL. There was no spinal cord and injuries, nerve injury, epidural damage and leakage of cerebrospinal fluid. All patients were followed up for 10~19 months with the average being 12.6 months. The functional scoring of Japanese Orthopedic Association (JOA before the operation was (11.4±3.3 scores and final score after follow-up was (22.9±3.1 scores and there were statistical difference (P<0.01. Lumber interbody fusion of all patients completed successfully and the good rate after the operation was 91.7%. Conclusion: Posterior decompression, interbody fusion and internal fixation for the treatment of the upper lumbar intervertebral disc herniation was characterized by full exposure, safety and significant efficacy.

  7. An experimental model for chronic compression of dorsal root ganglion produced by intervertebral foramen stenosis in the rat.

    Hu, S J; Xing, J L

    1998-07-01

    Under anesthesia and sterile surgery, a small stainless steel rod (4 mm in length and 0.5-0.8 mm in diameter) was inserted into the L5 intervertebral foramen in the rat, developing intervertebral foramen stenosis and hence producing a chronic steady compression of the dorsal root ganglion (DRG). The hind paw on the injured side exhibited a significant reduction in the latency of foot withdrawal to noxious heat and manifested a persistent heat hyperalgesia 5-35 days after surgery. Injection of 1% carrageenan into the intervertebral foramen, presumably causing inflammation of the DRG, also produced hyperalgesia to heat on the hind paw of the injured side 5-21 days after surgery. Extracellular electrophysiological recordings from myelinated dorsal root fibers were performed in vivo. Spontaneous activity was present in 21.5% of the fibers recorded from DRG neurons injured with chronic compression in contrast to 1.98% from uninjured DRG neurons. The pattern of spontaneous activity was periodic and bursting in 75.3% of the spontaneously active fibers. These neurons had a greatly enhanced sensitivity to mechanical stimulation of the injured DRG and a prolonged after discharge. In response to TEA, topically applied to the DRG, excitatory responses were evoked in the injured, but not the uninjured, DRG neurons. Application of this experimental model may further our understanding of the neural mechanisms by which chronic compression of DRG induces low back pain and sciatica. PMID:9755014

  8. Quantitative in vivo MRI evaluation of lumbar facet joints and intervertebral discs using axial T2 mapping

    Stelzeneder, David; Messner, Alina; Scheurecker, Georg; Goed, Sabine; Friedrich, Klaus M.; Trattnig, Siegfried [Medical University of Vienna, Department of Radiology, MR Centre-High Field MR, Vienna (Austria); Vlychou, Marianna [Medical University of Vienna, Department of Radiology, MR Centre-High Field MR, Vienna (Austria); University Hospital of Larissa, Department of Radiology, Larissa (Greece); Welsch, Goetz H. [Medical University of Vienna, Department of Radiology, MR Centre-High Field MR, Vienna (Austria); University of Erlangen, Department of Trauma Surgery, Erlangen (Germany); Pieber, Karin; Pflueger, Verena [Medical University of Vienna, Department of Physical Medicine and Rehabilitation, Vienna (Austria)

    2011-11-15

    To assess the feasibility of T2 mapping of lumbar facet joints and intervertebral discs in a single imaging slab and to compare the findings with morphological grading. Sixty lumbar spine segments from 10 low back pain patients and 5 healthy volunteers were examined by axial T2 mapping and morphological MRI at 3.0 Tesla. Regions of interest were drawn on a single slice for the facet joints and the intervertebral discs (nucleus pulposus, anterior and posterior annulus fibrosus). The Weishaupt grading was used for facet joints and the Pfirrmann score was used for morphological disc grading (''normal'' vs. ''abnormal'' discs). The inter-rater agreement was excellent for the facet joint T2 evaluation (r = 0.85), but poor for the morphological Weishaupt grading (kappa = 0.15). The preliminary results show similar facet joint T2 values in segments with normal and abnormal Pfirrmann scores. There was no difference in mean T2 values between facet joints in different Weishaupt grading groups. Facet joint T2 values showed a weak correlation with T2 values of the posterior annulus (r = 0.32) This study demonstrates the feasibility of a combined T2 mapping approach for the facet joints and intervertebral discs using a single axial slab. (orig.)

  9. Automated detection of spinal centrelines, vertebral bodies and intervertebral discs in CT and MR images of lumbar spine

    Štern, Darko; Likar, Boštjan; Pernuš, Franjo; Vrtovec, Tomaž

    2010-01-01

    We propose a completely automated algorithm for the detection of the spinal centreline and the centres of vertebral bodies and intervertebral discs in images acquired by computed tomography (CT) and magnetic resonance (MR) imaging. The developed methods are based on the analysis of the geometry of spinal structures and the characteristics of CT and MR images and were evaluated on 29 CT and 13 MR images of lumbar spine. The overall mean distance between the obtained and the ground truth spinal centrelines and centres of vertebral bodies and intervertebral discs were 1.8 ± 1.1 mm and 2.8 ± 1.9 mm, respectively, and no considerable differences were detected among the results for CT, T1-weighted MR and T2-weighted MR images. The knowledge of the location of the spinal centreline and the centres of vertebral bodies and intervertebral discs is valuable for the analysis of the spine. The proposed method may therefore be used to initialize the techniques for labelling and segmentation of vertebrae.

  10. The imbalance between TIMP3 and matrix-degrading enzymes plays an important role in intervertebral disc degeneration.

    Li, Yan; Li, Kang; Han, Xiuguo; Mao, Chuanyuan; Zhang, Kai; Zhao, Tengfei; Zhao, Jie

    2016-01-15

    It is well-known that one of the most important features of intervertebral disc degeneration (IDD) is the extracellular matrix (ECM) degradation. Collagen and aggrecan are major components of ECM; the degradation of ECM in intervertebral discs (IVDs) is closely related to the activities of collagenase and aggrecanase. TIMP-3 is the most efficient inhibitor of aggrecanase in IVD. However, only few studies focus on the potential relationship between TIMP-3 and IDD. In our study, we found TIMP-3 gene expression was decreased after stimulating with LPS in rat nucleus pulposus (NP) cells. Then we used a lentivirus vector to reconstruct rat NP cells which high expressed TIMP-3 gene (LV-TIMP3). The upregulation of MMPs and ADAMTSs induced by LPS was significantly inhibited in LV-TIMP3 cells. After overexpression of TIMP-3, the aggrecan breakdown caused by LPS was also reduced in both monolayer culture and three-dimension culture model. To further study the relation between TIMP-3 and IDD, we collected human NP tissue samples of different degenerative degrees. Real-time PCR and immunohistochemical staining showed that the expression of TIMP-3 was negatively correlated with the degree of intervertebral disc degeneration, while MMP-1 and ADAMTS-4 were markedly increased in degenerative IVD. Taken together, our results suggest that the imbalance between aggrecanase and TIMP-3 may play an important role in the pathogenesis of IDD and therefore be a potential therapeutic target for treating IDD. PMID:26686417

  11. Multicenter retrospective evaluation of the validity of the Thoracolumbar Injury Classification and Severity Score system in children.

    Sellin, Jonathan N; Steele, William J; Simpson, Lauren; Huff, Wei X; Lane, Brandon C; Chern, Joshua J; Fulkerson, Daniel H; Sayama, Christina M; Jea, Andrew

    2016-08-01

    OBJECTIVE The Thoracolumbar Injury Classification and Severity Score (TLICS) system was developed to streamline injury assessment and guide surgical decision making. To the best of the authors' knowledge, external validation in the pediatric age group has not been undertaken prior to this report. METHODS This study evaluated the use of the TLICS in a large retrospective series of children and adolescents treated at 4 pediatric medical centers (Texas Children's Hospital, Children's Healthcare of Atlanta, Riley Children's Hospital, and Doernbecher Children's Hospital). A total of 147 patients treated for traumatic thoracic or lumbar spine trauma between February 1, 2002, and September 1, 2015, were included in this study. Clinical and radiographic data were evaluated. Injuries were classified using American Spinal Injury Association (ASIA) status, Denis classification, and TLICS. RESULTS A total of 102 patients (69%) were treated conservatively, and 45 patients (31%) were treated surgically. All patients but one in the conservative group were classified as ASIA E. In this group, 86/102 patients (84%) had Denis type compression injuries. The TLICS in the conservative group ranged from 1 to 10 (mean 1.6). Overall, 93% of patients matched TLICS conservative treatment recommendations (score ≤ 3). No patients crossed over to the surgical group in delayed fashion. In the surgical group, 26/45 (58%) were ASIA E, whereas 19/45 (42%) had neurological deficits (ASIA A, B, C, or D). One of 45 (2%) patients was classified with Denis type compression injuries; 25/45 (56%) were classified with Denis type burst injuries; 14/45 (31%) were classified with Denis type seat belt injuries; and 5/45 (11%) were classified with Denis type fracture-dislocation injuries. The TLICS ranged from 2 to 10 (mean 6.4). Eighty-two percent of patients matched TLICS surgical treatment recommendations (score ≥ 5). No patients crossed over to the conservative management group. Eight patients (8

  12. Interleukin-1 inhibits Sox9 and collagen type Ⅱ expression via nuclear factor-κB in the cultured human intervertebral disc cells

    YU Zhan-ge; XU Ning; WANG Wen-bo; PAN Shang-ha; LI Ke-shen; LIU Jia-kun

    2009-01-01

    Background The most significant biological change in intervertebral disc degeneration is the decrease of chondrocyte specific gene and protein expression of Sox9 and collagen type Ⅱ. Interleukin-1 (IL-1) is not expressed in the normal intervertebral disc tissue but increases in the degenerated intervertebral disc tissue. This suggests that IL-1 may play a role in regulation of the expression of Sox9 and collagen type Ⅱ.Methods Human intervertebral disc cells were isolated and cultured. Sox9 and collagen type Ⅱ expression during treatment with IL-1, with or without the nuclear factor-κB (NF-κB) activity inhibitor curcumin, were detected by using reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting, and the activity of the NF-κB signaling pathway was detected by the electrophoretic mobility shift assay (EMSA).Results IL-1 lowered the mRNA level and protein expression of Sox9 and collagen type Ⅱ in the cultured intervertebral disc cells in a dose dependent manner (P 0.05). IL-1 at concentrations of 0.1 ng/ml, 1 ng/ml and 10 ng/ml could stimulate the activity of NF-κB in the intervertebral disc cells in a dose dependent manner (P <0.05) that was inhibited by curcumin.Conclusions We demonstrated the previously unknown function of IL-1 in inhibiting Sox9 and collagen type II via NF-κB in the intervertebral disc cells. This inhibition can be attenuated by curcumin, which is an effective NF-κB activity inhibitor.

  13. Comparison between two types of"Scheuermann disease-like people": thoracolumbar disc herniation patients and healthy volunteers with radiological signs of Scheuermann's disease

    Guo Xinhu; Chen Zhongqiang; Liu Ning; Guo Zhaoqing; Qi Qiang; Li Weishi; Zeng Yan

    2014-01-01

    Background Scheuermann's disease (SD) is a spinal disorder and includes both a classic form and an atypical form.Interestingly,its existence among the general population as well as the disc disease patients is common.One of our previous studies showed that about 18% of the hospital staff members meet the SD criteria.On the other hand,another study has demonstrated that 95.2% of the symptomatic thoracolumbar disc herniation (STLDH) patients meet the SD criteria,which suggests that STLDH is very likely a special form of SD.The purpose of this study was to discriminate the factors contributing to the development of STLDH by comparing STLDH patients with the healthy SD-like hospital staff members.Methods This is a retrospective study including 33 STLDH patients who met the SD criteria and 30 SD-like hospital staff members.The STLDH group was chosen from a group of patients who underwent surgery after a diagnosis of STLDH (T10/11-L1/2) at our hospital between June 2007 and June 2010.SD-like hospital staff members were chosen from a database created in 2007,which contained a lumbar MR and low back pain (LBP) questionnaire of 188 hospital staff members.The demographic and radiologic characteristics were compared between groups.Results There was no statistical difference in sex,age,and height between the two groups.The STLDH patients had higher body weight,boby mass index,and thoracolumbar kyphotic angle than SD-like hospital staff members.In addition,STLDH patients had more levels of Schmorl's nodes (3.5±1.7 vs.2.0±1.9,t=3.364,P=0.001) and irregular endplateson (4.0±1.9 vs.2.7±1.9,t=2.667,P=0.010) compared to the SD-like hospital staff members.Conclusions Higher body weight,higher body mass index,larger thoracolumbar kyphosis,and more Schmorl's nodes and irregular endplates on MR may be associated with the development of STLDH in "SD-like people."

  14. Feasibility of minimally-invasive fiber-based evaluation of chondrodystrophoid canine intervertebral discs by light absorption and scattering spectroscopy

    Jiang, Yuanyuan; McKeirnan, Kelci; Piao, Daqing; Bartels, Kenneth E.

    2011-03-01

    Extrusion or protrusion of an intervertebral disc is a common, frequently debilitating, painful, and sometimes fatal neurologic disease in the chondrodystrophic dog (dachshund, Pekingese, etc.). A similar condition of intervertebral disc degeneration with extrusion/protrusion is also a relatively common neurologic condition in human patients. Degeneration of the relatively avascular chondrodystrophoid intervertebral disc is associated with loss of water content, increased collagen, and deposits of calcified mineral in the nucleus pulposus. Current diagnostic methods have many limitations for providing accurate information regarding disc composition in situ prior to surgical intervention. Disc composition (i.e., mineralization), can influence the type of treatment regime and potentially prognosis and recurrence rates. The objective of this study is to investigate the feasibility of using a fiber-needle spectroscopy sensor to analyze the changes of tissue compositions involved in the chondrodystrophoid condition of the canine intervertebral disc. The nucleous pulposus, in which the metaplastic process / degeneration develops, is approximately 2mm thick and 5mm in diameter in the dachshund-sized dog. It lies in the center of the disc, surrounded by the annulus fibrosis and is enclosed by cartilaginous vertebral endplates cranially and caudally. This "shallow-and-small-slab" geometry limits the configuration of a fiber probe to sense the disc tissue volume without interference from the vertebrae. A single-fiber sensor is inserted into a 20 gauge myelographic spinal needle for insertion into the disc in situ and connected via a bifurcated fiber to the light source and a spectrometer. A tungsten light source and a 940nm light-emitting-diode are combined for spectral illumination covering VIS/NIR with expected improved sensitivity to water. Analysis of the reflectance spectra is expected to provide information of scattering and absorption compositions of tissue in

  15. Initial presentation of CNS-restricted acute lymphoblastic B cell leukaemia as peripheral polyneuropathy.

    Piovezani Ramos, Guilherme; Villasboas Bisneto, Jose C; Chen, Dong; Pardanani, Animesh

    2016-01-01

    We report a case of a 58-year-old woman who presented with a 1-month course of progressive lower and upper extremity weakness in addition to binocular diplopia. Diagnostic lumbar puncture revealed atypical lymphoid cells with 28% blasts. Immunophenotype was consistent with B cell acute lymphoblastic leukaemia (B-ALL). Further work up showed no systemic involvement but extensive thoracolumbar-sacral leptomeningeal disease. The patient was treated with several courses of intrathecal and systemic chemotherapy followed by craniospinal irradiation for consolidation. There was initial steady improvement in neurological symptoms and leptomeningeal disease, the latter being ascertained through radiological studies and cerebrospinal fluid examination. After 10 months of response, the patient relapsed with central nervous system (CNS) and systemic disease. B-ALL is a rare precursor lymphoid neoplasm that generally presents with systemic disease. While CNS involvement is not uncommon, isolated involvement of this compartment without systemic disease is exceedingly rare. PMID:27095809

  16. Fibromyalgia and arachnoiditis presented as an acute spinal disorder

    Zamzuri Idris

    2014-01-01

    Full Text Available Background: Adhesive arachnoiditis is a chronic, insidious condition that causes debilitating intractable pain and a range of other neurological problems. Its pathophysiology is not well understood. This manuscript discusses its presentations, which can mimic an acute spinal disorder, its hypothetical pathophysiology, treatment, and its relationship with fibromyalgia. Case Description: The authors present a case of a 47-year-old female who presented with clinical features mimicking an acute spinal disorder but later found to have an adhesive arachnoiditis. She was admitted following a trauma with complaints of back pain and paraplegia. On examination, there was marked tenderness over thoracolumbar spine with lower limbs upper motor neuron weakness. An urgent magnetic resonance imaging (MRI of the spine revealed multiple lesions at her thoracic and lumbar spinal canals, which did not compress the spinal cord. Therefore, conservative management was initiated. Despite on regular therapies, her back and body pain worsened and little improvement in her limbs power was noted. Laminectomy was pursued and found to have spinal cord arachnoiditis. Subsequently, she was operated by other team members for multiple pelvic masses, which later proved to be benign. After gathering all the clinical information obtained at surgery and after taking detailed history inclusive of cognitive functions, diagnosis of an adhesive arachnoiditis syndrome was made. Currently, she is managed by neuropsychologist and pain specialist. Conclusion: This case report highlights the importance of knowing an adhesive arachnoiditis syndrome - a rarely discussed pathology by the neurosurgeon, which discloses a significant relationship between immune and nervous systems.

  17. 胸腰段脊柱骨折的手术治疗研究%The research of surgical treatment of thoracolumbar spine fractures

    陈孔宁; 刘成招; 王春

    2014-01-01

    Objective To investigate the clinical efficacy of surgical posterior thoracolumbar spine fractures. Methods 80cases of thoracolumbar spine fracture patients in our hospital from February in 2011 to October in 2013 were seleted for the study. They were treated with posterior surgery, and the clinical efficacy of the patients was observed. Results All of the patients were cured of 51 cases (63.75%), 23 cases (28.75%) were effective, and total effective rate was 92.50%. After posterior surgery, tactile scores was(74.8±14.8) and sports scores was (72.1±24.8) which were excellent than treated before. There was a significant difference between them(P <0.05). Conclusion The implementation of thoracolumbar spine fractures in patients with posterior surgery can significantly improve the clinical treatment of patients with efficiency, and improve clinical symptoms of patients, moreover, posterior surgery can lower incidence of postoperative complications. It's an effective way to treat thoracolumbar spine fractures.%目的:探讨后路手术治疗胸腰段脊柱骨折的临床疗效。方法选取2011年2月~2013年10月我院接收的80例胸腰段脊柱骨折患者为研究对象,所有患者均实施后路手术治疗,观察患者手术治疗的临床疗效。结果80例患者经后路手术治疗后,显效51例(63.75%),有效23例(28.75%),总有效率为92.50%;治疗后患者手术后嗅觉评分为(74.8±14.8),运动评分为(72.1±24.8),均明显高于手术前,手术前后比较存在显著性差异(P<0.05)。结论对胸腰段脊柱骨折患者实施后路手术治疗可显著提高患者的临床治疗有效率,改善患者的临床症状,且术后并发症发生率较低,临床疗效显著,是治疗胸腰段脊柱骨折的有效方法。

  18. Surgical treatment in thoraco-lumbar region fractures. Tratamiento quirúrgico de las fracturas de columna en la región toracolumbar

    Yoan Manuel Quiñones González

    2008-06-01

    Full Text Available Background: thoraco-lumbar fractures may affect people at any moment of their lives, especially at their most fruitful and useful stage. Its correct diagnosis and treatment may directly influence in the posterior evolution of the patients. Objectives: to evaluate the results of the surgical treatment in thoraco-lumbar region fractures. Methods: a descriptive retrospective correlational study of series cases which included 54 patients attended due to thoraco-lumbar region fractures in the University Hospital “Dr. Gustavo Aldereguía Lima” in Cienfuegos city, Cuba from January 1999 to June 2007. Age, sex, etiology of the fracture, type and level of the fractures, associated diseases, surgical techniques used for, pre and post operatory neurological damage, usage of metilprednisolone, complications and final results were the variables taken into consideration in this study. Results: most of the patients belonged to male sex under the age of 45. The totality of the cases had type IV fracture, and a great part of them had Denis type II fracture having surgical treatment. The causes of the lesions were traffic accidents, working accidents and height falls. The most useful surgical techniques were posterior decompression, instrumentation and fusion. Surgery improved the neurological damage in almost half of sick patients with this condition. Complications were minimum and rupture of the implant was predominant. Conclusion: surgical treatment in thoraco-lumbar region fractures had satisfactory results in our milieu.
    Fundamento: Las fracturas de columna vertebral pueden afectar a las personas en cualquier momento de su vida, especialmente en la etapa más útil y fructífera. Su correcto diagnóstico y tratamiento influyen directamente en la posterior evolución de los pacientes. Objetivo: Evaluar los resultados del

  19. Shock Absorbing Function Study on Denucleated Intervertebral Disc with or without Hydrogel Injection through Static and Dynamic Biomechanical Tests In Vitro

    Zhiyu Zhou

    2014-01-01

    Full Text Available Hydrogel injection has been recently proposed as a novel therapy for disc degenerative diseases, with the potential to restore the spine motion and the intervertebral disc height. However, it remains unknown whether the new technique could also maintain the shock absorbing property of the treated intervertebral disc. In this study, 18 porcine lumbar bone-disc-bone specimens were collected and randomly divided into three groups: the normal with intact intervertebral discs, the mimic for the injection of disulfide cross-linked hyaluronan hydrogels following discectomy, and the control disc with discectomy only. In the static compression test, specimens in the mimic group exhibited displacements similar to those in the normal discs, whereas the control group showed a significantly larger displacement range in the first two steps (P<0.05. With the frequency increasing, all specimens generally displayed an increasing storage modulus, decreasing loss modulus, and tanδ. At any frequency point, the control group exhibited the largest value in all the three parameters among three groups while the normal group was the lowest, with the mimic group being mostly close to the normal group. Therefore, the hydrogel injection into the intervertebral discs greatly restored their shock absorbing function, suggesting that the technique could serve as an effective approach to maintaining biomechanical properties of the degenerative intervertebral disc.

  20. Anterior approach on protrusion of intervertebral disc and early rehabilitation training after operation%颈椎间盘突出症的前路手术与术后早期康复训练

    方军; 高克海; 李华壮; 褚俊良

    2002-01-01

    Backgroud: The main causes of protrusion of cervical intervertebral disc are degenerations such as osteophymas on degenerated protruded intervertebral disc and vertebral body anterior to vertebral canal. Decompression via cervical anterior approach and fusion of implanted bone are effective methods. And it is very important for surgical effect and functional restoration to make sufficient preoperative preparation and consummate postoperative rehabilitation.

  1. Training for motor function after removal of nucleus pulposus in protrusion of lumbar intervertebral discs%腰椎间盘突出症髓核摘除术后运动功能训练

    王媛

    2003-01-01

    @@ INTRODUCIION Protrusion of lumbar intervertebral discs is a kind of disease causedby protrusion of nucleus pulposus to vertebral canal due to degen-eration and rupture of lumbar intervertebral discs and stimulationand compression on neighboring nerve roots. Therapeutic effects afteroperation has a direct relationship with postoperative rehabilitationnursing.

  2. Pericellular colocalisation and interactive properties of type VI collagen and perlecan in the intervertebral disc.

    Hayes, A J; Shu, C C; Lord, M S; Little, C B; Whitelock, J M; Melrose, J

    2016-01-01

    The aim of this study was to immunolocalise type VI collagen and perlecan and determine their interactive properties in the intervertebral disc (IVD). Confocal laser scanning microscopy co-localised perlecan with type VI collagen as pericellular components of IVD cells and translamellar cross-bridges in ovine and murine IVDs. These cross-bridges were significantly less abundant in the heparin sulphate deficient Hspg2 exon 3 null mouse IVD than in wild type. This association of type VI collagen with elastic components provides clues as to its roles in conveying elastic recoil properties to annular tissues. Perlecan and type VI collagen were highly interactive in plasmon resonance studies. Pericellular colocalisation of perlecan and type VI collagen provides matrix stabilisation and cell-matrix communication which allows IVD cells to perceive and respond to perturbations in their biomechanical microenvironment. Perlecan, at the cell surface, provides an adhesive interface between the cell and its surrounding extracellular matrix. Elastic microfibrillar structures regulate tensional connective tissue development and function. The 2010 Global Burden of Disease study examined 291 disorders and identified disc degeneration and associated low back pain as the leading global musculoskeletal disorder emphasising its massive socioeconomic impact and the need for more effective treatment strategies. A greater understanding of how the IVD achieves its unique biomechanical functional properties is of great importance in the development of such therapeutic measures. PMID:27377666

  3. Experimental observation of human bone marrow mesenchymal stem cell transplantation into rabbit intervertebral discs

    Tao, Hao; Lin, Yazhou; Zhang, Guoqing; Gu, Rui; Chen, Bohua

    2016-01-01

    Allogeneic bone marrow mesenchymal stem cell (BMSC) transplantation has been investigated worldwide. However, few reports have addressed the survival status of human BMSCs in the intervertebral discs (IVDs) in vivo following transplantation. The current study aimed to observe the survival status of human BMSCs in rabbit IVDs. The IVDs of 15 New Zealand white rabbits were divided into three groups: Punctured blank control group (L1-2); punctured physiological saline control group (L2-3); and punctured human BMSCs transfected with green fluorescent protein (GFP) group (L3-4, L4-5 and L5-6). One, 2, 4, 6 and 8 weeks after transplantation the IVDs were removed and a fluorescence microscope was used to observe the density of GFP-positive human BMSCs. The results indicated that in the sections of specimens removed at 1, 2, 4, 6 and 8 weeks post-transplantation, no GFP-positive cells were observed in the control groups, whereas GFP-positive cells were apparent in the nucleus pulposus at all periods in the GFP-labeled human BMSCs group, and the cell density at 6 and 8 weeks was significantly less than that at 1, 2 and 4 weeks post-transplantation (P<0.001). Thus, it was identified that human BMSCs were able to survive in the rabbit IVDs for 8 weeks.

  4. Simulating the sensitivity of cell nutritive environment to composition changes within the intervertebral disc

    Wills, C. Ruiz; Malandrino, A.; van Rijsbergen, MM.; Lacroix, D.; Ito, K.; Noailly, J.

    2016-05-01

    Altered nutrition in the intervertebral disc affects cell viability and can generate catabolic cascades contributing to extracellular matrix (ECM) degradation. Such degradation is expected to affect couplings between disc mechanics and nutrition, contributing to accelerate degenerative processes. However, the relation of ECM changes to major biophysical events within the loaded disc remains unclear. A L4-L5 disc finite element model including the nucleus (NP), annulus (AF) and endplates was used and coupled to a transport-cell viability model. Solute concentrations and cell viability were evaluated along the mid-sagittal plane path. A design of experiment (DOE) was performed. DOE parameters corresponded to AF and NP biochemical tissue measurements in discs with different degeneration grades. Cell viability was not affected by any parameter combinations defined. Nonetheless, the initial water content was the parameter that affected the most the solute contents, especially glucose. Calculations showed that altered NP composition could negatively affect AF cell nutrition. Results suggested that AF and NP tissue degeneration are not critical to nutrition-related cell viability at early-stage of disc degeneration. However, small ECM degenerative changes may alter significantly disc nutrition under mechanical loads. Coupling disc mechano-transport simulations and enzyme expression studies could allow identifying spatiotemporal sequences related to tissue catabolism.

  5. Effect of intervertebral disc degeneration on disc cell viability: a numerical investigation.

    Galbusera, Fabio; Mietsch, Antje; Schmidt, Hendrik; Wilke, Hans-Joachim; Neidlinger-Wilke, Cornelia

    2013-01-01

    Degeneration of the intervertebral disc may be initiated and supported by impairment of the nutrition processes of the disc cells. The effects of degenerative changes on cell nutrition are, however, only partially understood. In this work, a finite volume model was used to investigate the effect of endplate calcification, water loss, reduction of disc height and cyclic mechanical loading on the sustainability of the disc cell population. Oxygen, lactate and glucose diffusion, production and consumption were modelled with non-linear coupled partial differential equations. Oxygen and glucose consumption and lactate production were expressed as a function of local oxygen concentration, pH and cell density. The cell viability criteria were based on local glucose concentration and pH. Considering a disc with normal water content, cell death was initiated in the centre of the nucleus for oxygen, glucose, and lactate diffusivities in the cartilaginous endplate below 20% of the physiological values. The initial cell population could not be sustained even in the non-calcified endplates when a reduction of diffusion inside the disc due to water loss was modelled. Alterations in the disc shape such as height loss, which shortens the transport route between the nutrient sources and the cells, and cyclic mechanical loads, could enhance cell nutrition processes. PMID:21970697

  6. Cell-seeded polyurethane-fibrin structures – A possible system for intervertebral disc regeneration

    C Mauth

    2009-10-01

    Full Text Available Nowadays, intervertebral disc (IVD degeneration is one of the principal causes of low back pain involving high expense within the health care system. The long-term goal is the development of a medical treatment modality focused on a more biological regeneration of the inner nucleus pulposus (NP. Hence, interest in the endoscopic implantation of an injectable material took center stage in the recent past. We report on the development of a novel polyurethane (PU scaffold as a mechanically stable carrier system for the reimplantation of expanded autologous IVD-derived cells (disc cells to stimulate regenerative processes and restore the chondrocyte-like tissue within the NP. Primary human disc cells were seeded into newly developed PU spheroids which were subsequently encapsulated in fibrin hydrogel. The study aims to analyze adhesion properties, proliferation capacity and phenotypic characterization of these cells. Polymerase chain reaction was carried out to detect the expression of genes specifically expressed by native IVD cells. Biochemical analyses showed an increased DNA content, and a progressive enhancement of total collagen and glycosaminoglycans (GAG was observed during cell culture. The results suggest the synthesis of an appropriate extracellular matrix as well as a stable mRNA expression of chondrogenic and/or NP specific markers. In conclusion, the data presented indicate an alternative medical approach to current treatment options of degenerated IVD tissue.

  7. Localized strain measurements of the intervertebral disc annulus during biaxial tensile testing.

    Karakolis, Thomas; Callaghan, Jack P

    2015-01-01

    Both inter-lamellar and intra-lamellar failures of the annulus have been described as potential modes of disc herniation. Attempts to characterize initial lamellar failure of the annulus have involved tensile testing of small tissue samples. The purpose of this study was to evaluate a method of measuring local surface strains through image analysis of a tensile test conducted on an isolated sample of annular tissue in order to enhance future studies of intervertebral disc failure. An annulus tissue sample was biaxial strained to 10%. High-resolution images captured the tissue surface throughout testing. Three test conditions were evaluated: submerged, non-submerged and marker. Surface strains were calculated for the two non-marker conditions based on motion of virtual tracking points. Tracking algorithm parameters (grid resolution and template size) were varied to determine the effect on estimated strains. Accuracy of point tracking was assessed through a comparison of the non-marker conditions to a condition involving markers placed on tissue surface. Grid resolution had a larger effect on local strain than template size. Average local strain error ranged from 3% to 9.25% and 0.1% to 2.0%, for the non-submerged and submerged conditions, respectively. Local strain estimation has a relatively high potential for error. Submerging the tissue provided superior strain estimates. PMID:25145810

  8. Painful, degenerating intervertebral discs up-regulate neurite sprouting and CGRP through nociceptive factors

    Krock, Emerson; Rosenzweig, Derek H; Chabot-Doré, Anne-Julie; Jarzem, Peter; Weber, Michael H; Ouellet, Jean A; Stone, Laura S; Haglund, Lisbet

    2014-01-01

    Intervertebral disc degeneration (IVD) can result in chronic low back pain, a common cause of morbidity and disability. Inflammation has been associated with IVD degeneration, however the relationship between inflammatory factors and chronic low back pain remains unclear. Furthermore, increased levels of nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF) are both associated with inflammation and chronic low back pain, but whether degenerating discs release sufficient concentrations of factors that induce nociceptor plasticity remains unclear. Degenerating IVDs from low back pain patients and healthy, painless IVDs from human organ donors were cultured ex vivo. Inflammatory and nociceptive factors released by IVDs into culture media were quantified by enzyme-linked immunosorbent assays and protein arrays. The ability of factors released to induce neurite growth and nociceptive neuropeptide production was investigated. Degenerating discs release increased levels of tumour necrosis factor-α, interleukin-1β, NGF and BDNF. Factors released by degenerating IVDs increased neurite growth and calcitonin gene-related peptide expression, both of which were blocked by anti-NGF treatment. Furthermore, protein arrays found increased levels of 20 inflammatory factors, many of which have nociceptive effects. Our results demonstrate that degenerating and painful human IVDs release increased levels of NGF, inflammatory and nociceptive factors ex vivo that induce neuronal plasticity and may actively diffuse to induce neo-innervation and pain in vivo. PMID:24650225

  9. Anisotropic Multishell Analytical Modeling of an Intervertebral Disk Subjected to Axial Compression.

    Demers, Sébastien; Nadeau, Sylvie; Bouzid, Abdel-Hakim

    2016-04-01

    Studies on intervertebral disk (IVD) response to various loads and postures are essential to understand disk's mechanical functions and to suggest preventive and corrective actions in the workplace. The experimental and finite-element (FE) approaches are well-suited for these studies, but validating their findings is difficult, partly due to the lack of alternative methods. Analytical modeling could allow methodological triangulation and help validation of FE models. This paper presents an analytical method based on thin-shell, beam-on-elastic-foundation and composite materials theories to evaluate the stresses in the anulus fibrosus (AF) of an axisymmetric disk composed of multiple thin lamellae. Large deformations of the soft tissues are accounted for using an iterative method and the anisotropic material properties are derived from a published biaxial experiment. The results are compared to those obtained by FE modeling. The results demonstrate the capability of the analytical model to evaluate the stresses at any location of the simplified AF. It also demonstrates that anisotropy reduces stresses in the lamellae. This novel model is a preliminary step in developing valuable analytical models of IVDs, and represents a distinctive groundwork that is able to sustain future refinements. This paper suggests important features that may be included to improve model realism. PMID:26833355

  10. Postoperative changes of herniated intervertebral disc: Normal and discitis MR findings

    Lim, Seung Jae; Ryu, Kyung Nam; Choi, Woo Suk; Yoon, Yup; Kim, Ki Tack [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1994-08-15

    To describe normal postoperative MR findings and MR findings of postoperative discitis in patients who underwent operation due to herniated intervertebral disc. We retrospectively reviewed normal postoperative MR findings and MR findings of discitis in 30 patients(21-61 yrs) (13 cases diagnosed as discitis and 17 cases as normal) who previously underwent laminectomy and discectomy, or bony fusion. We analyzed signal intensity of end plate and disc, end plate destruction,and enhancement of end plate and disc on T1- and T2-weighted images(WI) of 1.5 T MRI. Among 14 out 17 patients with no evidence of discitis, 7 patients showed high signal of the posterior portion of disc on T1- and T2-WI and 11 patients revealed enhancement at the same sites. In all 13 patients suspected of having discitis, end plate and disc showed low signal on T1-WI, high signal on T2-WI, heterogeneous enhancement,and irregular destruction of end plate. Meanwhile, 3 cases with no evidence of postoperative discitis clinically who underwent bony fusion showed similar findings to those of the above 13 patients, except for homogeneous enhancement of end plate and vertebral body. The MR findings of postoperative discitis were low signal on T1-WI, high signal on T2-WI, and heterogeneous enhancement of and plate and disc, and destruction of end plate.

  11. Laser radiation at various wavelengths for decompression of intervertebral disk. Experimental observations on human autopsy specimens.

    Choy, D S; Altman, P A; Case, R B; Trokel, S L

    1991-06-01

    The interaction of laser radiation with the nucleus pulposus from autopsy specimens of human intervertebral disks was evaluated at different wavelengths (193 nm, 488 nm & 514 nm, 1064 nm, 1318 nm, 2150 nm, 2940 nm, and 10600 nm). A significant correlation of linear least squares fit of the mass ablated as a function of incident energy was found for all lasers used except the Excimer at 193 nm. The 2940-nm Erbium:YAG laser was most efficient in terms of mass of disk ablated per joule in the limited lower range where this wavelength was observed. At higher energy levels, the CO2 laser in the pulsed mode was most efficient. However, the Nd:YAG 1064-nm and 1318-nm lasers are currently best suited for percutaneous laser disk decompression because of the availability of usable waveguides. Carbonization of tissue with the more penetrating Nd:YAG 1064-nm laser increases the efficiency of tissue ablation and makes it comparable to the Nd:YAG 1318-nm laser. PMID:1904334

  12. INNERVATION OF SENSORY NERVE TERMINALS IN RAT LUMBAR INTERVERTEBRAL DISC AND POSTERIOR LONGITUDINAL LIGAMENT

    韩学哲; 王民; 刘淼; 赵昌松

    2002-01-01

    Objective To investigate the distribution of sen sory nerve terminals in the lumbar intervertebral disc and posterior longitudina l ligament (PLL) in an animal model. Methods Immunohistochemical method was used to visualize nerve terminals with antibodies of substance P(SP) and calcitonin gene-related pepti de(CGRP), and to characterize sensory nerve terminals on sections from lumbar in tervertebral disc and posterior longitudinal ligament(PLL) of the Sprague Dawley rats.Results The immunostaining revealed an extensive distribution o f SP and CGRP immunoreactive nerve fibers in the surface and most superficial po rtions of all annulus fibrosus and PLL. Most immunoreactions were observed in ve ntral and lateral regions of the annulus fibrosus. Morphologically, both thin va ricose nerve fibers and tiny punctate nerve terminals could be observed. Conclusion This study demonstrates an extensive distribution o f SP and CGRP immunoreactive nerve fibers throughout the PLL and the peripheral annulus fibrosus and provides an illustration of this distribution. This finding supports a role for the disc as a source of low back pain and provides the neur oanatomic foundation of the disc-genic pain.

  13. Characterization of slow-gelling alginate hydrogels for intervertebral disc tissue-engineering applications.

    Growney Kalaf, Emily A; Flores, Reynaldo; Bledsoe, J Gary; Sell, Scott A

    2016-06-01

    Reversal of intervertebral disc degeneration can have a potentially monumental effect on spinal health. As such, the goal of this research is to create an injectable, cellularized alginate-based nucleus pulposus that will restore disc function; with the primary goal of creating an alginate gel with tailorable rates of gelation to improve functionality over standard CaCl2 crosslinking techniques. Gelation characteristics of 1% sodium alginate were analyzed over various molar concentrations of a 1:2 ratio of CaCO3:glucono-δ-lactone (GDL), with 10% CaCl2 as the control crosslinker. Alginate construct characterization for all concentrations was performed via ultimate and cyclic compressive testing over a 28day degradation period in PBS. Dehydration, swell testing, and albumin release kinetics were determined, and cytotoxicity and cell homogeneity tests showed promise for cellularization strategies. Overall, the 30 and 60mM GDL alginate concentrations presented the most viable option for use in further studies, with a gelation time between 10 and 30min, low hysteresis over control, low percent change in thickness and weight under both PBS degradation and swelling conditions, and stable mechanical properties over 28days in vitro. PMID:27040212

  14. A minimally invasive in-fiber Bragg grating sensor for intervertebral disc pressure measurements

    We present an in-fiber Bragg grating (FBG) based intervertebral disc (IVD) pressure sensor that has pressure sensitivity seven times greater than that of a bare fiber, and a major diameter and sensing area of only 400 µm and 0.03 mm2, respectively. This is the only optical, the smallest and the most mechanically compliant disc pressure sensor reported in the literature. This is also an improvement over other FBG pressure sensors that achieve increased sensitivity through mechanical amplification schemes, usually resulting in major diameters and sensing lengths of many millimeters. Sensor sensitivity is predicted using numerical models, and the predicted sensitivity is verified through experimental calibrations. The sensor is validated by conducting IVD pressure measurements in porcine discs and comparing the FBG measurements to those obtained using the current standard sensor for IVD pressure. The predicted sensitivity of the FBG sensor matched with that measured experimentally. IVD pressure measurements showed excellent repeatability and agreement with those obtained from the standard sensor. Unlike the current larger sensors, the FBG sensor could be used in discs with small disc height (i.e. cervical or degenerated discs). Therefore, there is potential to conduct new measurements that could lead to new understanding of the biomechanics

  15. Risk factors for diskospondylitis in dogs after spinal decompression surgery for intervertebral disk herniation.

    Canal, Sara; Contiero, Barbara; Balducci, Federica; Calò, Pietro; Bernardini, Marco

    2016-06-15

    OBJECTIVE To determine the incidence of and risk factors for development of postoperative diskospondylitis (POD) in dogs that underwent spinal decompression surgery for intervertebral disk herniation (IVDH). DESIGN Retrospective single cohort study. ANIMALS 372 dogs that underwent spinal decompression surgery for IVDH between January 2007 and January 2011. PROCEDURES Medical records of dogs were retrospectively reviewed. Data regarding signalment, type and anatomic site of IVDH, severity of neurologic signs, type of surgery, duration of anesthesia, esophageal temperature during surgery, and use of corticosteroid drugs were analyzed for associations with POD. RESULTS POD developed in 8 of 372 (2.2%) dogs. Univariate analysis revealed that German Shepherd Dogs had 9.8 times the odds of POD, compared with the odds for other breeds. In addition, dogs > 8.8 years of age, weighing > 20 kg (44 lb), or having disk protrusions were at higher risk of developing POD than were other dogs. The only factor that retained a significant association with POD after controlling for other factors in multivariate analysis was body weight > 20 kg. CONCLUSIONS AND CLINICAL RELEVANCE Factors identified in this study may be useful for prediction of POD, an apparently uncommon outcome, in dogs undergoing spinal decompression surgery for IVDH. Dogs at higher risk than others, particularly those weighing > 20 kg, should be monitored carefully in the immediate postoperative period, and signs of worsening neurologic condition after initial improvement should be promptly investigated. PMID:27270060

  16. In-situ photopolymerized and monitored implants: successful application to an intervertebral disc replacement

    Schmocker, Andreas M.; Khoushabi, Azadeh; Bourban, Pierre-Etienne; Schizas, Constantin; Pioletti, Dominique; Moser, Christophe

    2016-02-01

    Photopolymerization is a common method to harden materials initially in a liquid state. A surgeon can directly trigger the solidification of a dental implant or a bone or tissue filler by using ultra-violet light. Traditionally, photopolymerization has been used mainly in dentistry. Over the last decade advances in material development including a wide range of biocompatible gel- and cement-systems open up a new avenue for in-situ photopolymerization. We designed a miniaturized light probe where a photoactive material can be 1) mixed, pressurized and injected 2) photopolymerized or photoactivated and 3) monitored during the chemical reaction. The device enables surgeries to be conducted through a hole smaller than 500 μm in diameter. Using a combination of Raman and fluorescence spectroscopy, the current state of the photopolymerization was inferred and monitored in real time within an in-vitro tissue model. It was also possible to determine roughly the position of the probe within the tissue cavity by analysing the fluorescence signal. Using the technique hydrogels were successfully implanted into a bovine intervertebral disc model. Mechanical tests could not obstruct the functionality of the implant. Finally, the device was also used for other application such as the implantation of a hydrogel into an aneurysm tissue cavity which will be presented at the conference.

  17. Histochemical and magnetic resonance imaging study of degenerative diseases in human intervertebral discs

    The aim of this study was to compare degenerative changes by means of histochemical study (with nicotinamide adenine dinucleotide phosphate diaphorase - NADPH-d) and magnetic resonance imaging (MRI) findings of degenerated human intervertebral disc (IVD). We used surgical specimens from patients undergoing surgical treatment in the lumbar region and fresh cadaveric lumbar spines for histochemical study and MRI examination of patients with low back pain. The rate of IVD degeneration depends on age, weight, abnormal mechanical load, genetics, trauma, inflammation and others. All structures from IVD (nucleus pulposus, annulus fibrosus, cartilage end plate) and the vertebral body were assessed. The histochemical study showed an increase in the intensity of NADPH-d reaction in the cells, parallel to the increase in the degree of IVD degeneration. Degenerative diseases of IVD showed different MRI findings related to the decrease in the water content of IVD, protrusion, extrusion, stenosis of vertebral canal, osteochondrosis, osteophits of the vertebral body, ossification and hypertrophy of longitudinal ligaments, Modic I and II changes and compression of the dural sac. The correlation between the histochemical results and MRI findings depended basically on aging

  18. Running Exercise Alleviates Pain and Promotes Cell Proliferation in a Rat Model of Intervertebral Disc Degeneration

    Shuo Luan

    2015-01-01

    Full Text Available Chronic low back pain accompanied by intervertebral disk degeneration is a common musculoskeletal disorder. Physical exercise, which is clinically recommended by international guidelines, has proven to be effective for degenerative disc disease (DDD patients. However, the mechanism underlying the analgesic effects of physical exercise on DDD remains largely unclear. The results of the present study showed that mechanical withdrawal thresholds of bilateral hindpaw were significantly decreased beginning on day three after intradiscal complete Freund’s adjuvant (CFA injection and daily running exercise remarkably reduced allodynia in the CFA exercise group beginning at day 28 compared to the spontaneous recovery group (controls. The hindpaw withdrawal thresholds of the exercise group returned nearly to baseline at the end of experiment, but severe pain persisted in the control group. Histological examinations performed on day 70 revealed that running exercise restored the degenerative discs and increased the cell densities of the annulus fibrosus (AF and nucleus pulposus (NP. Furthermore, immunofluorescence labeling revealed significantly higher numbers of 5-bromo-2-deoxyuridine (BrdU-positive cells in the exercise group on days 28, 42, 56 and 70, which indicated more rapid proliferation compared to the control at the corresponding time points. Taken together, these results suggest that running exercise might alleviate the mechanical allodynia induced by intradiscal CFA injection via disc repair and cell proliferation, which provides new evidence for future clinical use.

  19. The distribution of calcific deposits in intervertebral discs of the lumbosacral spine.

    Feinberg, J; Boachie-Adjei, O; Bullough, P G; Boskey, A L

    1990-05-01

    The incidence of intervertebral disc calcifications (IVDCs) was examined in 52 lumbosacral spines obtained sequentially at autopsy. The presence of calcific deposits was detected by fine-grain roentgenograms. The nature of these deposits was determined by wide-angle x-ray diffraction, and histologic observations were made. A high prevalence of IVDC, 18 spines of 52, some with multiple deposits, was noted. Calcium pyrophosphate dihydrate (CPPD) deposits were found in 3% of the spines and accounted for 29% of the 42 deposits analyzed. The CPPD deposits occurred at multiple disc levels (an average of four per spine), were diffuse, and involved a major portion of the disc (nucleus pulposus, annulus fibrosus, and endplate) but were not generally associated with histologic disc degeneration. Hydroxyapatite (HA) deposits occurred in 12% of the spines, most often in the nucleus pulposus and endplate. The HA deposits appeared as small punctate radiodensities. Roentgenographic evidence of degenerative changes, i.e., disc space narrowing, endplate disruption, desiccation, and osteophyte formation, were present in all but one of the spines containing HA deposits. An additional 19% of the spines had deposits that could not be characterized by x-ray diffraction but were very similar in roentgenographic appearance to HA deposits. No conclusions could be drawn on the relationship between the presence of HA or CPPD and collagen or hexosamine content. PMID:2157573

  20. A large volume of visceral adipose tissue leads to severe acute pancreatitis

    Obesity plays an important role in acute pancreatitis. Assuming that the volume of visceral adipose tissue (VAT) directly influences the severity of acute pancreatitis, we investigated the relationship between VAT and acute pancreatitis. Data were collected consecutively from 124 patients who were diagnosed with acute pancreatitis. Body mass index (BMI) was calculated from the database. Computed tomography was performed in all patients, and VAT, subcutaneous adipose tissue (SAT), and waist circumference (WC) were measured at the level of the intervertebral disk between L2 and L3. Atlanta criteria were adopted to define severe acute pancreatitis. Clinical courses were investigated, and the Ranson and acute physiology and chronic health evaluation II (APACHE II) scores were calculated for all patients. Forty-eight patients had severe acute pancreatitis (38.7%), and 76 were mild cases. BMI, VAT, SAT, and WC were correlated with the severity of acute pancreatitis in a univariate analysis, but only VAT had a strong correlation with severe acute pancreatitis in the multivariate analysis. In a trend analysis, not only severity but also the presence of pseudocysts (local complication) and prognostic factors (Ranson and APACHE II scores) were significantly related to VAT volume. In particular, the presence of a pancreatic pseudocyst was strongly related to VAT volume (p<0.001). In acute pancreatitis, peripancreatic VAT has a stronger correlation with severe acute pancreatitis than BMI or WC. VAT volume is strongly correlated with the formation of a pseudocyst and with systemic inflammatory response syndrome in patients with acute pancreatitis and high VAT volume may lead to severe acute pancreatitis. (author)

  1. Influence of duration of clinical signs on surgical treatment results of 16 dogs with intervertebral disc disease (IVDD

    Wrzosek Marcin

    2014-06-01

    Full Text Available The purpose of this study was to evaluate the outcome of surgical treatment in 16 dogs, depending on the animal’s age, body weight, deep pain perception, and time from the onset of neurological symptoms to the consultation with a veterinary neurologist and successive surgery. Sixteen dogs diagnosed with cervical (n = 11 or thoracolumbar (n = 5 disc extrusions underwent spinal surgeries (eleven ventral slots and five hemilaminectomies. The success rate of surgical treatment was 64.3% in dogs with preserved nociception. No association between the animal’s age or body weight and the result of surgical treatment was found. A successful surgical outcome was more likely when the symptom-to-surgery time was shorter.

  2. Signal intensity loss of the intervertebral discs in the cervical spine of young patients on fluid sensitive sequences

    Bruin, F. de; Horst, S. ter; Bloem, J.L.; Reijnierse, M. [Leiden University Medical Center, Department of Radiology, C2-S, Albinusdreef 2, PO box 9600, Leiden (Netherlands); Berg, R. van den; Hooge, M. de; Gaalen, F. van; Heijde, D. van der [Leiden University Medical Center, Department of Rheumatology, Leiden (Netherlands); Fagerli, K.M. [Diakonhjemmet Hospital, Department of Rheumatology, Oslo (Norway); Landewe, R. [Amsterdam Medical Center, Department of Rheumatology, Amsterdam (Netherlands); Oosterhout, M. van [Groene Hartziekenhuis, Department of Rheumatology, Gouda (Netherlands)

    2016-03-15

    To evaluate the signal intensity (SI) of the intervertebral discs of the cervical spine on magnetic resonance (MR) fluid sensitive sequences, and correlate this to secondary signs of degeneration on MR and radiographs as well as to age. A total of 265 patients aged ≥16 with back pain (≥3-months, <2-year, onset <45-years) from the SPondyloArthritis Caught Early (SPACE) cohort were included. Sagittal 1.5 T MR images and lateral radiographs of the cervical spine were independently evaluated by two readers for: SI of the intervertebral discs using a grading system based of Pfirrmann (grade 1 normal/bright SI; 2 inhomogeneous/bright SI; 3 inhomogeneous/mildly decreased SI; 4 inhomogeneous/markedly decreased SI; 5 signal void), disc herniation and Modic changes (MRI) and disc space narrowing, osteophytes and sclerosis (radiograph). Readers were blinded for clinical information. Descriptive statistics were used for characteristics and prevalence of findings, and regression analysis was used for age and grades. Of 265 patients (36 % male, mean age 30), 221 (83 %) patients had 1 to 6 discs (median 4) with decreased SI. Of 1,590 discs, 737 (46 %) were grade 1; 711 (45 %) grade 2; 133 (8 %) grade 3; 8 (1 %) grade 4 and 1 (0 %) grade 5. Secondary signs of degeneration were rare and seen predominantly in C5-C7 and appear to be related to signal loss grade 3 and 4. Low signal intensity of intervertebral discs in absence of secondary degenerative signs in the cervical spine on fluid sensitive MR images might be pre-existing and part of the natural course. (orig.)

  3. Construction of recombinant baculovirus Ac-CMV-hSox9 for gene therapy of intervertebral disc degeneration

    LIU Xiao-yun; YANG Shu-hua; LIANG Chang-yong; SONG Jian-hua; LI Kang-hua; CHEN Xin-wen

    2007-01-01

    Objective: To construct the recombinant baculovirus Ac-cytomegalovirus (CMV)-hSox9 for gene therapy of intervertebral disc degeneration. Methods: Bac-to-Bac system was used for the construction of baculovirus Ac-CMV-hSox9. The cDNA of hSox9 was first cloned into a plasmid vector under the control of CMV promotor to generate the donor plasmid pFastBacDul-green fluorescene protein (GFP)-CMV (pFGC)-hSox9.The resultant plasmid was transformed into DH10Bac cells and then the transformation mixture was spread on Luria-Bertani (LB) agarose culture medium containing isopropyl-β-D-thiogalactoside (IPTG), X-gal, gentamicin, kanamycin and tetracycline.The white colonies were selected and cultured for amplification, and the hSox9Bacmid DNA was extracted. After verification, recombinant baculovirus Ac-CMV-hSox9 was obtained through transfecting Sf 21 cells.The expression of hSox9 gene in the intervertebral disc cells in rabbits was determined by Western blotting and immunohistochemical staining.Results: Polymerase chain reaction (PCR) confirmed the presence of hSox9 gene in the recombinant baculovirus and the Sf 21 cells transfected by the baculovirus showed the expression of fluorescence protein.Western blotting and immunohistochemical staining analysis indicated that exogenous hSox9 gene was expressed in the disc cells.Conclusions: The successful construction of the recombinant baculovirus Ac-CMV-hSox9 and the confirmation of the target gene expression provides a novel expression vector system for basic research and clinical treatment of intervertebral degenerative disc disease.

  4. Crocin exerts anti-inflammatory and anti-catabolic effects on rat intervertebral discs by suppressing the activation of JNK

    Li, Kang; Li, Yan; MA, ZHENJIANG; Zhao, Jie

    2015-01-01

    As intervertebral disc (IVD) degeneration has been proven to contribute to low back pain (LBP), drug treatment aiming at attenuating IVD degeneration may prove to be benefiical. Crocin, a bioactive component of saffron, has been found to exert anti-inflammatory effects on cartilage. In the present study, the anti-inflammatory and anti-catabolic effects of crocin on rat IVDs were analyzed in vitro and ex vivo. Nucleus pulposus (NP) cells were isolated from the lumbar IVDs of Sprague-Dawley rat...

  5. Genetic Polymorphisms of Interleukin-1 Alpha and the Vitamin D Receptor in Mexican Mestizo Patients with Intervertebral Disc Degeneration

    Cervin Serrano, Salvador; González Villareal, Dalia; Aguilar-Medina, Maribel; Romero-Navarro, Jose Guillermo; Romero Quintana, Jose Geovanni; Arámbula Meraz, Eliakym; Osuna Ramírez, Ignacio; Picos-Cárdenas, Veronica; Granados, Julio; Estrada-García, Iris; Sánchez-Schmitz, Guzman; Ramos-Payán, Rosalío

    2014-01-01

    Intervertebral disc degeneration (IDD) is the most common diagnosis in patients with back pain, a leading cause of musculoskeletal disability worldwide. Several conditions, such as occupational activities, gender, age, and obesity, have been associated with IDD. However, the development of this disease has strong genetic determinants. In this study, we explore the possible association between rs1800587 (c.-949C>T) of interleukin-1 alpha (IL1A) and rs2228570 (c.2T>V) and rs731236 (c.1056T>C) o...

  6. Double and zero quantum filtered 2H NMR analysis of D2O in intervertebral disc tissue

    Ooms, Kristopher J.; Vega, Alexander J.; Polenova, Tatyana; Cannella, Marco; Marcolongo, Michele

    2015-09-01

    The analysis of double and zero quantum filtered 2H NMR spectra obtained from D2O perfused in the nucleus pulposus of human intervertebral disc tissue samples is reported. Fitting the spectra with a three-site model allows for residual quadrupolar couplings and T2 relaxation times to be measured. The analysis reveals changes in both the couplings and relaxation times as the tissue begins to show signs of degradation. The full analysis demonstrates that information about tissue hydration, water collagen interactions, and sample heterogeneity can be obtained and used to better understand the biochemical differences between healthy and degraded tissue.

  7. A combined numerical and experimental technique for estimation of the forces and moments in the lumbar intervertebral disc

    Wang, Shaobai; Park, Won Man; Gadikota, Hemanth R.; Miao, Jun; Kim, Yoon Hyuk; Wood, Kirkham B.; Li, Guoan

    2012-01-01

    Evaluation of the loads on the lumbar intervertebral discs is critically important since it is closely related to spine biomechanics, pathology and prosthesis design. Non-invasive estimation of the loads in the discs remains a challenge. In this study we proposed a new technique to estimate in-vivo loads in the IVD using a subject-specific finite element model of the disc and the kinematics of the disc endplates as input boundary conditions. The technique was validated by comparing the forces...

  8. Acute pancreatitis

    ... page: //medlineplus.gov/ency/article/000287.htm Acute pancreatitis To use the sharing features on this page, ... fatty foods after the attack has improved. Outlook (Prognosis) Most cases go away in a week. However, ...

  9. Acute Pericarditis

    ... Sugar Control Helps Fight Diabetic Eye Disease Are 'Workaholics' Prone to OCD, Anxiety? ALL NEWS > Resources First ... cancer, or heart surgery, the fluid is blood. Causes Acute pericarditis usually results from infection or other ...

  10. Acute dyspnea

    Radiodiagnosis is applied to determine the causes of acute dyspnea. Acute dyspnea is shown to aggravate the course of pulmonary diseases (bronchial asthma, obstructive bronchitis, pulmonary edema, throboembolism of pulmonary arteries etc) and cardiovascular diseases (desiseas of myocardium). The main tasks of radiodiagnosis are to determine volume and state of the lungs, localization and type of pulmonary injuries, to verify heart disease and to reveal concomitant complications

  11. Bronchitis (acute)

    Wark, Peter

    2008-01-01

    Acute bronchitis, with transient inflammation of the trachea and major bronchi, affects over 40/1000 adults a year in the UK. The causes are usually considered to be infective, but only around half of people have identifiable pathogens.The role of smoking or environmental tobacco smoke inhalation in predisposing to acute bronchitis is unclear.A third of people may have longer-term symptoms or recurrence.

  12. C-Fos regulation by the MAPK and PKC pathways in intervertebral disc cells.

    Katsuya Yokoyama

    Full Text Available BACKGROUND: The gene encoding c-fos is an important factor in the pathogenesis of joint disease in patients with osteoarthritis. However, it is unknown whether the signal mechanism of c-fos acts in intervertebral disc (IVD cells. We investigated whether c-fos is activated in relation to mitogen-activated protein kinases (MAPKs and the protein kinase C (PKC pathway in nucleus pulposus (NP cells. METHODOLOGY/RESULTS: Reverse transcription-polymerase chain reaction and western blotting analyses were used to measure the expression of c-fos in rat IVD cells. Transfections were performed to determine the effects of c-fos on target gene activity. The effect of c-fos protein expression was examined in transfection experiments and in a 3- (4,5-dimethylthiazol-2-yl -2,5-diphenyltetrazolium bromide cell viability assay. Phorbol 12-myristate 13-acetate (PMA, the most commonly used phorbol ester, binds to and activates protein kinase C (PKC, causing a wide range of effects in cells and tissues. PMA induced the expression of c-fos gene transcription and protein expression, and led to activation of the MAPK pathways in NP cells. The c-fos promoter was suppressed completely in the presence of the MAPK inhibitor PD98059, an inhibitor of the MEK/ERK kinase cascade, but not in the presence of SKF86002, SB202190, or SP600125. The effects of the PKC pathway on the transcriptional activity of the c-fos were evaluated. PKCγ and PKCδ suppressed the promoter activity of c-fos. Treatment with c-fos inhibited aggrecan and Col2 promoter activities and the expression of these genes in NP cells. CONCLUSIONS: This study demonstrated, for the first time, that the MAPK and PKC pathways had opposing effects on the regulation of c-fos in NP cells. Thus, the expression of c-fos can be suppressed in the extracellular matrix of NP cells.

  13. An injectable hydrogel incorporating mesenchymal precursor cells and pentosan polysulphate for intervertebral disc regeneration.

    Frith, Jessica E; Cameron, Andrew R; Menzies, Donna J; Ghosh, Peter; Whitehead, Darryl L; Gronthos, Stan; Zannettino, Andrew C W; Cooper-White, Justin J

    2013-12-01

    Intervertebral disc (IVD) degeneration is one of the leading causes of lower back pain and a major health problem worldwide. Current surgical treatments include excision or immobilisation, with neither approach resulting in the repair of the degenerative disc. As such, a tissue engineering-based approach in which stem cells, coupled with an advanced delivery system, could overcome this deficiency and lead to a therapy that encourages functional fibrocartilage generation in the IVD. In this study, we have developed an injectable hydrogel system based on enzymatically-crosslinked polyethylene glycol and hyaluronic acid. We examined the effects of adding pentosan polysulphate (PPS), a synthetic glycosaminoglycan-like factor that has previously been shown (in vitro and in vivo) to this gel system in order to induce chondrogenesis in mesenchymal precursor cells (MPCs) when added as a soluble factor, even in the absence of additional growth factors such as TGF-β. We show that both the gelation rate and mechanical strength of the resulting hydrogels can be tuned in order to optimise the conditions required to produce gels with the desired combination of properties for an IVD scaffold. Human immunoselected STRO-1+ MPCs were then incorporated into the hydrogels. They were shown to retain good viability after both the initial formation of the gel and for longer-term culture periods in vitro. Furthermore, MPC/hydrogel composites formed cartilage-like tissue which was significantly enhanced by the incorporation of PPS into the hydrogels, particularly with respect to the deposition of type-II-collagen. Finally, using a wild-type rat subcutaneous implantation model, we examined the extent of any immune reaction and confirmed that this matrix is well tolerated by the host. Together these data provide evidence that such a system has significant potential as both a delivery vehicle for MPCs and as a matrix for fibrocartilage tissue engineering applications. PMID:24050877

  14. Fabrication of a biomimetic elastic intervertebral disk scaffold using additive manufacturing

    Whatley, Benjamin R; Kuo, Jonathan; Shuai, Cijun; Wen Xuejun [Clemson-MUSC Bioengineering Program, Department of Bioengineering, Clemson University, Charleston, SC 29425 (United States); Damon, Brooke J, E-mail: xjwen@clemson.edu, E-mail: xuejun@musc.edu [Department of Cell Biology and Anatomy, Medical University of South Carolina, Charleston, SC 29425 (United States)

    2011-03-24

    A custom-designed three-dimensional additive manufacturing device was developed to fabricate scaffolds for intervertebral disk (IVD) regeneration. This technique integrated a computer with a device capable of 3D movement allowing for precise motion and control over the polymer scaffold resolution. IVD scaffold structures were designed using computer-aided design to resemble the natural IVD structure. Degradable polyurethane (PU) was used as an elastic scaffold construct to mimic the elastic nature of the native IVD tissue and was deposited at a controlled rate using ultra-fine micropipettes connected to a syringe pump. The elastic PU was extruded directly onto a collecting substrate placed on a freezing stage. The three-dimensional movement of the computer-controlled device combined with the freezing stage enabled precise control of polymer deposition using extrusion. The addition of the freezing stage increased the polymer solution viscosity and hardened the polymer solution as it was extruded out of the micropipette tip. This technique created scaffolds with excellent control over macro- and micro-structure to influence cell behavior, specifically for cell adhesion, proliferation, and alignment. Concentric lamellae were printed at a high resolution to mimic the native shape and structure of the IVD. Seeded cells aligned along the concentric lamellae and acquired cell morphology similar to native tissue in the outer portion of the IVD. The fabricated scaffolds exhibited elastic behavior during compressive and shear testing, proving that the scaffolds could support loads with proper fatigue resistance without permanent deformation. Additionally, the mechanical properties of the scaffolds were comparable to those of native IVD tissue.

  15. OZONE NUCLEOLYSIS IN LUMBAR INTERVERTEBRAL DISC HERNIATION: NON - RANDOMIZED PROSPECTIVE ANALYSIS

    Vivekananda S

    2015-05-01

    Full Text Available STUDY DESI GN: Non - randomized, prospective analysis of 68 patients of lumbar disc herniation treated with ozone nucleolysis. OBJECTIVE: To assess the patients with lumbar disc herniation treated with intradiscal ozone, pre and post ozone nucleolysis, for pain using Visual Analog Scale (VAS functional & disability score using Japanese Orthopedic Association (JOA Clinical Symptom Score. SUMMARY OF BACKGROUN D DATA: Ozone therapy for disc herniation is becoming popu lar because of its minimal invasive, lesser recurrences and remarkably fewer side effects. Successful outcomes of ozone therapy have been reported from various European & Indian centers. METHODS: A series of 68 patients were treated with ozone therapy for lumbar disc herniation from January 2009 to January 2012. The procedure is done under C - arm guidance under local anesthesia by “Single sitting double injection technique”. All patients were assessed using VAS for radiation pain & back pain, Clinical Symptom Score of the Japanese Orthopaedic Association (JOA for a Patient with Lumbar Disc Herniation, pre op and post op, on day one, after a week, two weeks, first month, third months, sixth month one year second year. Were classified them as Good, Moder ate & Poor outcome. RESULTS: Out of 68 patients 89.7% (61/68 patients had good outcome, 7.35% (5/68 patients had moderate outcome, 2.95% (2/68 had poor outcome. Intra - op in 1 patient where ozone spread in Para spinal muscles but had no postoperative pro blem.4 patients had mild nausea, 2 had mild headache & No infection. CONCLUSIONS: Ozone nucleolysis is a new, minimally invasive procedure done under local anesthesia & has shown effective results in the treatment of contained intervertebral disc herniatio n with no side effects.

  16. Fabrication of a biomimetic elastic intervertebral disk scaffold using additive manufacturing

    A custom-designed three-dimensional additive manufacturing device was developed to fabricate scaffolds for intervertebral disk (IVD) regeneration. This technique integrated a computer with a device capable of 3D movement allowing for precise motion and control over the polymer scaffold resolution. IVD scaffold structures were designed using computer-aided design to resemble the natural IVD structure. Degradable polyurethane (PU) was used as an elastic scaffold construct to mimic the elastic nature of the native IVD tissue and was deposited at a controlled rate using ultra-fine micropipettes connected to a syringe pump. The elastic PU was extruded directly onto a collecting substrate placed on a freezing stage. The three-dimensional movement of the computer-controlled device combined with the freezing stage enabled precise control of polymer deposition using extrusion. The addition of the freezing stage increased the polymer solution viscosity and hardened the polymer solution as it was extruded out of the micropipette tip. This technique created scaffolds with excellent control over macro- and micro-structure to influence cell behavior, specifically for cell adhesion, proliferation, and alignment. Concentric lamellae were printed at a high resolution to mimic the native shape and structure of the IVD. Seeded cells aligned along the concentric lamellae and acquired cell morphology similar to native tissue in the outer portion of the IVD. The fabricated scaffolds exhibited elastic behavior during compressive and shear testing, proving that the scaffolds could support loads with proper fatigue resistance without permanent deformation. Additionally, the mechanical properties of the scaffolds were comparable to those of native IVD tissue.

  17. Cell therapy for intervertebral disc repair: advancing cell therapy from bench to clinics

    LM Benneker

    2014-05-01

    Full Text Available Intervertebral disc (IVD degeneration is a major cause of pain and disability; yet therapeutic options are limited and treatment often remains unsatisfactory. In recent years, research activities have intensified in tissue engineering and regenerative medicine, and pre-clinical studies have demonstrated encouraging results. Nonetheless, the translation of new biological therapies into clinical practice faces substantial barriers. During the symposium "Where Science meets Clinics", sponsored by the AO Foundation and held in Davos, Switzerland, from September 5-7, 2013, hurdles for translation were outlined, and ways to overcome them were discussed. With respect to cell therapy for IVD repair, it is obvious that regenerative treatment is indicated at early stages of disc degeneration, before structural changes have occurred. It is envisaged that in the near future, screening techniques and non-invasive imaging methods will be available to detect early degenerative changes. The promises of cell therapy include a sustained effect on matrix synthesis, inflammation control, and prevention of angio- and neuro-genesis. Discogenic pain, originating from "black discs" or annular injury, prevention of adjacent segment disease, and prevention of post-discectomy syndrome were identified as prospective indications for cell therapy. Before such therapy can safely and effectively be introduced into clinics, the identification of the patient population and proper standardisation of diagnostic parameters and outcome measurements are indispensable. Furthermore, open questions regarding the optimal cell type and delivery method need to be resolved in order to overcome the safety concerns implied with certain procedures. Finally, appropriate large animal models and well-designed clinical studies will be required, particularly addressing safety aspects.

  18. Aging affects response to cyclic tensile stretch: paradigm for intervertebral disc degeneration

    H Cho

    2011-09-01

    Full Text Available Much evidence supports a fundamental role for mechanical forces in modulating differentiation, homeostasis, and remodelling of musculoskeletal cells. Little is known, however, regarding mechanobiology and gene expression of intervertebral disc (IVD cells from older individuals. To characterise the effect of mechanical stimulation on cells from older discs, an in vitro study of IVD cells harvested from different aged pigs was conducted to measure extracellular matrix (ECM gene expression in response to cyclic tensile stress (CTS. Gene expression of annulus fibrosus (AF cells from IVDs of mature and older pigs was quantified for the predominant ECM genes; type I collagen, type II collagen and aggrecan, and matrix metalloproteinase 1 (MMP-1, a collagenase that degrades fibrillar collagens.AF cells cultured on flexible-bottom plates were stretched 10 % at 0.5 Hz frequency. After 24 h, gene expression was assayed using reverse transcriptase polymerase chain reaction (RT-PCR. Basal mRNA levels without stretching for type II collagen and aggrecan were lower in older annular cells whereas MMP-1 levels were higher compared to mature cells. Following CTS, an adaptive response was elicited in annular cells from both age groups. ECM protein genes were upregulated, whereas MMP-1 was downregulated. The magnitude of response was significantly greater in older cells as compared to mature cells. These data suggest that the cells from the AF of older animals manifest lower basal levels of mRNA for type II collagen and aggrecan and higher levels of MMP-1 possibly due to decreased tensile stress experienced in vivo and is not the result of reduced capacity for response.

  19. MR monitoring of minimally invasive delivery of mesenchymal stem cells into the porcine intervertebral disc.

    Monika Barczewska

    Full Text Available PURPOSE: Bone marrow stem cell therapy is a new, attractive therapeutic approach for treatment of intervertebral disc (IVD degeneration; however, leakage and backflow of transplanted cells into the structures surrounding the disc may lead to the formation of undesirable osteophytes. The purpose of this study was to develop a technique for minimally invasive and accurate delivery of stem cells. METHODS: Porcine mesenchymal stem cells (MSCs were labeled with superparamagnetic iron oxide nanoparticles (SPIO, Molday ION rhodamine and first injected into the explanted swine lumbar IVD, followed by ex vivo 3T MRI. After having determined sufficient sensitivity, IVD degeneration was then induced in swine (n=3 by laser-evaporation. 3 x 10(6 SPIO-labeled cells embedded within hydrogel were injected in 2 doses using a transcutaneous cannula and an epidural anesthesia catheter. T2-weighted MR images were obtained at 3T before and immediately after cell infusion. Two weeks after injection, histological examination was performed for detection of transplanted cells. RESULTS: MSCs were efficiently labeled with Molday ION rhodamine. Cells could be readily detected in the injected vertebral tissue explants as distinct hypointensities with sufficient sensitivity. MR monitoring indicated that the MSCs were successfully delivered into the IVD in vivo, which was confirmed by iron-positive Prussian Blue staining of the tissue within the IVD. CONCLUSION: We have developed a technique for non-invasive monitoring of minimally invasive stem delivery into the IVD at 3T. By using a large animal model mimicking the anatomy of IVD in humans, the present results indicate that this procedure may be clinically feasible.

  20. Dynamic loading, matrix maintenance and cell injection therapy of human intervertebral discs cultured in a bioreactor.

    Rosenzweig, D H; Gawri, R; Moir, J; Beckman, L; Eglin, D; Steffen, T; Roughley, P J; Ouellet, J A; Haglund, L

    2016-01-01

    Low back pain originating from intervertebral disc (IVD) degeneration affects the quality of life for millions of people, and it is a major contributor to global healthcare costs. Long-term culture of intact IVDs is necessary to develop ex vivo models of human IVD degeneration and repair, where the relationship between mechanobiology, disc matrix composition and metabolism can be better understood. A bioreactor was developed that facilitates culture of intact human IVDs in a controlled, dynamically loaded environment. Tissue integrity and cell viability was evaluated under 3 different loading conditions: low 0.1-0.3, medium 0.1-0.3 and high 0.1-1.2 MPa. Cell viability was maintained > 80 % throughout the disc at low and medium loads, whereas it dropped to approximately 70 % (NP) and 50 % (AF) under high loads. Although cell viability was affected at high loads, there was no evidence of sGAG loss, changes in newly synthesised collagen type II or chondroadherin fragmentation. Sulphated GAG content remained at a stable level of approximately 50 µg sGAG/mg tissue in all loading protocols. To evaluate the feasibility of tissue repair strategies with cell supplementation, human NP cells were transplanted into discs within a thermoreversible hyaluronan hydrogel. The discs were loaded under medium loads, and the injected cells remained largely localised to the NP region. This study demonstrates the feasibility of culturing human IVDs for 14 days under cyclic dynamic loading conditions. The system allows the determination a safe range-of-loading and presents a platform to evaluate cell therapies and help to elucidate the effect of load following cell-based therapies. PMID:26728497

  1. Intervertebral reaction force prediction using an enhanced assembly of OpenSim models.

    Senteler, Marco; Weisse, Bernhard; Rothenfluh, Dominique A; Snedeker, Jess G

    2016-01-01

    OpenSim offers a valuable approach to investigating otherwise difficult to assess yet important biomechanical parameters such as joint reaction forces. Although the range of available models in the public repository is continually increasing, there currently exists no OpenSim model for the computation of intervertebral joint reactions during flexion and lifting tasks. The current work combines and improves elements of existing models to develop an enhanced model of the upper body and lumbar spine. Models of the upper body with extremities, neck and head were combined with an improved version of a lumbar spine from the model repository. Translational motion was enabled for each lumbar vertebrae with six controllable degrees of freedom. Motion segment stiffness was implemented at lumbar levels and mass properties were assigned throughout the model. Moreover, body coordinate frames of the spine were modified to allow straightforward variation of sagittal alignment and to simplify interpretation of results. Evaluation of model predictions for level L1-L2, L3-L4 and L4-L5 in various postures of forward flexion and moderate lifting (8 kg) revealed an agreement within 10% to experimental studies and model-based computational analyses. However, in an extended posture or during lifting of heavier loads (20 kg), computed joint reactions differed substantially from reported in vivo measures using instrumented implants. We conclude that agreement between the model and available experimental data was good in view of limitations of both the model and the validation datasets. The presented model is useful in that it permits computation of realistic lumbar spine joint reaction forces during flexion and moderate lifting tasks. The model and corresponding documentation are now available in the online OpenSim repository. PMID:26031341

  2. MR imaging of lumbar herniated intervertebral disc and spinal stenosis: Correlation with CT

    Lee, Won Jae; Park, Kil Sun; Chang, Kee Hyun; Han, Moon Hee; Kim, Hyun Jip; Han, Man Chung; Kim, Chu Wan [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1989-12-15

    MR imagings obtained in 40 patients with surgically proven lumbar herniated intervertebral disc (HIVD) and/or spinal stenosis were retrospectively analysed and compared with CT scans, in order to evaluate the MR findings of HIVD and spinal stenosis, and to assess the diagnostic accuracy of MR. The MR imaging was performed on a 2.0 T superconducting unit, using multislice spin echo (SE) and gradient echo (GE) techniques. The results were as follows: 1. The texture of vertebral body with spinal stenosis had the tendency to be more heterogeneous than that with HIVD. 2. The signal intensity of the diseased disc was isointense relative to normal disc in 81 % (60/74) and the remainder (19%) was hypointense on both T1 weighted SE and GE images. There was no significant difference in signal intensity among HIVD, HIVD combined with spinal stenosis and spinal stenosis groups, but there was the tendency of lower signal intensity of the diseased disc in patients with severe degenerative change of spine in both T1 weighted SE imaged and GE image. 3. The diagnostic accuracy of MR was 92%, which was similar to that of CT. 4. T1 weighted SE image appears superior to GE image in evaluation of most of the structural differentiation, but as for differentiating between lumina and ligamentum flavum, and for the vacuum phenomenon, GE image seems to be better than T1 weighted SE image. In conclusion, MR appears to be better than CT as a initial imaging modality in evaluation of the patients with suspected lumbar spinal stenosis or HIVD because MR has the capability of demonstrating rupture of anulus fibrosus in sagittal plane.

  3. Outcome of single level intervertebral disc prolapse treated with interlaminar lumbar discectomy by fenestration

    Ramanagouda Biradar

    2016-04-01

    Full Text Available Background: Low back pain due to lumbar disc prolapse is the major cause of morbidity throughout the world affecting mainly young adults. Different surgical techniques for lumbar discectomy are in vogue with the aim of least possible damage to other structures while dealing with the prolapsed disc. This short term prospective study was done to assess the functional outcome interlaminar fenestration discectomy. Materials and Methods: Thirty six patients with clinical symptoms and signs of single level prolapsed lumbar intervertebral disc having radiological correlation by MRI study were subjected to disc excision by interlaminar fenestration. Outcomes were measured using the visual analogue scale (VAS for back and leg pain, Roland-Morris score (RM improvement and modified Macnab criteria at 3 months, 6 months and 2 years. All quantitative data were summarised using mean and standard deviation, and qualitative data using proportions. Results: Mean (SD VAS for lower back ache and leg pain at 3 months, 6 months, and 2 years shows improvement in the overall low back pain and leg pain in patients studied. The maximum improvement in radicular pain is seen within six months after surgery and from then on not much improvement were noted. According to modified Macnab criteria outcome was good in 69.4%, fair in 22.2%, and poor in 8.3% of patients treated by fenestration surgery. Conclusion: Interlaminar lumbar discectomy by fenestration method without extensive laminectomy is effective and reliable surgical technique for treating properly selected patients with herniated lumbar disc at L4-L5 and L5-S1 levels. The results are comparable to microdiscectomy, and this may be due to the close similarity of the two procedures.

  4. Segmental Quantitative MR Imaging analysis of diurnal variation of water content in the lumbar intervertebral discs

    Zhu, Ting Ting; Ai, Tao; Zhang, Wei; Li, Tao; Li, Xiao Ming [Dept. of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan (China)

    2015-02-15

    To investigate the changes in water content in the lumbar intervertebral discs by quantitative T2 MR imaging in the morning after bed rest and evening after a diurnal load. Twenty healthy volunteers were separately examined in the morning after bed rest and in the evening after finishing daily work. T2-mapping images were obtained and analyzed. An equally-sized rectangular region of interest (ROI) was manually placed in both, the anterior and the posterior annulus fibrosus (AF), in the outermost 20% of the disc. Three ROIs were placed in the space defined as the nucleus pulposus (NP). Repeated-measures analysis of variance and paired 2-tailed t tests were used for statistical analysis, with p < 0.05 as significantly different. T2 values significantly decreased from morning to evening, in the NP (anterior NP = -13.9 ms; central NP = -17.0 ms; posterior NP = -13.3 ms; all p < 0.001). Meanwhile T2 values significantly increased in the anterior AF (+2.9 ms; p = 0.025) and the posterior AF (+5.9 ms; p < 0.001). T2 values in the posterior AF showed the largest degree of variation among the 5 ROIs, but there was no statistical significance (p = 0.414). Discs with initially low T2 values in the center NP showed a smaller degree of variation in the anterior NP and in the central NP, than in discs with initially high T2 values in the center NP (10.0% vs. 16.1%, p = 0.037; 6.4% vs. 16.1%, p = 0.006, respectively). Segmental quantitative T2 MRI provides valuable insights into physiological aspects of normal discs.

  5. Texture-based quantification of lumbar intervertebral disc degeneration from conventional T2-weighted MRI

    Michopoulou, Sofia; Speller, Robert; Todd-Pokropek, Andrew (Dept. of Medical Physics and Bioengineering, University College London (United Kingdom)), e-mail: s.michopoulou@ucl.ac.uk; Costaridou, Lena (Dept. of Medical Physics, School of Medicine, Univ. of Patras (Greece)); Vlychou, Marianna (Dept. of Radiology, Univ. Hospital of Larissa, Univ. of Thessaly (Greece))

    2011-02-15

    Background: Disc degeneration quantification is important for monitoring the effects of new therapeutic methods, such as cell and growth factor therapy. Magnetic resonance (MR) image texture reflects biochemical and structural tissue properties and has been used for differentiating between normal and pathological status in a variety of medical applications. Purpose: To investigate the suitability of textural descriptors for the quantification of intervertebral disc degeneration using conventional T2-weighted magnetic resonance images of the lumbar spine. Material and Methods:: A 3 Tesla scanner was used, and conventional T2- weighted MR images were obtained, and a total of 255 lumbar discs were analyzed. An atlas-based method was used for segmenting the disc regions from the images. A set of first and second order statistics describing texture of each region were calculated. The validity and reliability of these descriptors for disc degeneration severity quantification was tested through their correlation with patient age and qualitative clinical grading of degeneration severity. Texture quantification results were compared to a widely accepted method for disc degeneration quantification based on the measurement of disc's mean signal intensity. Results: Out of the set of texture descriptors tested, two descriptors quantifying image intensity inhomogeneity, i.e. the grey level standard deviation and co-occurrence derived sum of squares displayed the strongest association to patient age and clinical grading of disc degeneration severity (P < 0.001). This is attributed to these inhomogeneity descriptors' capability to capture the progressive loss of nucleus-annulus distinction in the degenerative progress. Statistical analysis indicates that these descriptors can effectively separate between early stages of degeneration. Quantitative measurements are highly repeatable (intraclass correlation >0.98). Conclusion: Inhomogeneity descriptors could be a valuable

  6. Improvement of gagCEST imaging in the human lumbar intervertebral disc by motion correction

    To investigate whether motion correction improves glycosaminoglycan chemical exchange saturation transfer imaging (gagCEST imaging) of intervertebral discs (IVDs). Magnetic resonance gagCEST imaging of 12 volunteers was obtained in lumbar IVDs at 3 T using a prototype pulse sequence. The data were motion-corrected using a prototype diffeomorphism-based motion compensation technique. For both the data with and that without motion correction (datac, datauc), CEST evaluation was performed using the magnetisation transfer ratio asymmetry (MTRasym) as a means of quantifying CEST effects. MTRasym and the signal-to-noise ratio (SNR) of the MTRasym map in the nucleus pulposus (NP) were compared for datac and datauc. A visual grading analysis was performed by a radiologist in order to subjectively quantify the quality of the MTRasym analysis (score 1: best quality, score 5: worst quality). Furthermore, a landmark analysis was performed in order to objectively quantify the motion between CEST images using the mean landmark distance dmean. MTRasym and SNR were significantly higher for the motion-corrected data than for the uncorrected CEST data (MTRasym(datac) = 3.77 % ± 0.95 %, MTRasym(datauc) = 3.41 % ± 1.54 %, p value = 0.001; SNR(datac) = 3.88 ± 2.04, SNR(datauc) = 2.77 ± 1.55, p value c (maximum score = 2) compared with datauc (maximum score = 5). The landmark analysis demonstrated the superiority of the motion-corrected data (dmean(datac) =0.08 mm ±0.09 mm, dmean(datauc) = 0.36 mm ±0.09 mm, p value = 0.001). Our study showed significant improvements in the ability to quantify CEST imaging in IVDs after the application of motion correction compared with uncorrected datasets. (orig.)

  7. A Structurally and Functionally Biomimetic Biphasic Scaffold for Intervertebral Disc Tissue Engineering.

    Andrew Tsz Hang Choy

    Full Text Available Tissue engineering offers high hopes for the treatment of intervertebral disc (IVD degeneration. Whereas scaffolds of the disc nucleus and annulus have been extensively studied, a truly biomimetic and mechanically functional biphasic scaffold using naturally occurring extracellular matrix is yet to be developed. Here, a biphasic scaffold was fabricated with collagen and glycosaminoglycans (GAGs, two of the most abundant extracellular matrix components in the IVD. Following fabrication, the scaffold was characterized and benchmarked against native disc. The biphasic scaffold was composed of a collagen-GAG co-precipitate making up the nucleus pulposus-like core, and this was encapsulated in multiple lamellae of photochemically crosslinked collagen membranes comprising the annulus fibrosus-like lamellae. On mechanical testing, the height of our engineered disc recovered by ~82-89% in an annulus-independent manner, when compared with the 99% recovery exhibited by native disc. The annulus-independent nature of disc height recovery suggests that the fluid replacement function of the engineered nucleus pulposus core might mimic this hitherto unique feature of native disc. Biphasic scaffolds comprised of 10 annulus fibrosus-like lamellae had the best overall mechanical performance among the various designs owing to their similarity to native disc in most aspects, including elastic compliance during creep and recovery, and viscous compliance during recovery. However, the dynamic mechanical performance (including dynamic stiffness and damping factor of all the biphasic scaffolds was similar to that of the native discs. This study contributes to the rationalized design and development of a biomimetic and mechanically viable biphasic scaffold for IVD tissue engineering.

  8. Aquaporin 3 protects against lumbar intervertebral disc degeneration via the Wnt/β-catenin pathway.

    Xie, Huanxin; Jing, Yongbin; Xia, Jingjun; Wang, Xintao; You, Changcheng; Yan, Jinglong

    2016-03-01

    Previous studies have demonstrated that the expression of aquaporin 3 (AQP3), a water channel which promotes glycerol permeability and water transport across cell membranes, is reduced in degenerative lumbar intervertebral disc (IVD) tissues. However, the role of AQP3 in the pathogenesis of IVD degeneration has not recieved much scholarly attention. The objective of the present study was to investigate the effect of AQP3 on cell proliferation and extracellular matrix (ECM) degradation in human nucleus pulposus cells (hNPCs) using gain-of-function and loss-of-function experiments, and to determine whether Wnt/β-catenin signaling is involved in the effect of AQP3 on IVD degeneration. hNPCs were transfected with the AQP3-pcDNA3.1 plasmid or AQP3 siRNA to overexpress or suppress AQP3. An MTT assay was performed to determine cell proliferation, and we found that AQP3 promoted hNPC proliferation. The expression of aggrecan, a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)4 and ADAMTS5 was detected using western blot analysis, to examine the effect of AQP3 on ECM degradation in hNPCs. The results revealed that AQP3 inhibited ECM degradation in hNPCs. In addition, we found that Wnt/β-catenin signaling was suppressed by AQP3. However, the effect of AQP3 on hNPC proliferation and ECM degradation was reversed by treatment with lithium chloride, a known activator of Wnt/β‑catenin signaling. In conclusion, using in vitro and in vivo tests, we have reported for the first time, to the best of our knowledge, that AQP3 exerts protective effects against IVD degeneration, and these are effected, at least partially, through the inhibition of Wnt/β-catenin signaling. PMID:26820815

  9. Pre-operative digital design for osteotomy and intra-operative navigation for treatment of secondary thoracolumbar kyphosis following surgery of thoracolumbar fracture%术前数字化截骨设计及术中导航辅助技术矫正胸腰段骨折术后继发角状后凸畸形

    樊勇; 吴子祥; 杨红军; 漆伟; 雷伟; 裴彦军; 裴国献; 桑宏勋

    2015-01-01

    Objective To evaluate the efficacy of pre-operative digital design for osteotomy and intra-operative navigation for treatment of secondary thoracolumbar kyphosis following surgery of thoracolumbar fracture.Methods Thirty-four patients with secondary thoracolumbar kyphosis following surgery of thoracolumbar fracture were treated with pedicle subtraction osteotomy (PSO) from January 2008 to April 2013.They were 18 men and 16 women,from 17 to 44 years of age (average,26.5 years).Of them,11 received traditional posterior osteotomy (unassisted group) and 23 received preoperative design with Mimics software and intraoperative navigation (assisted group).The 2 groups were compared in terms of operation time,blood loss,local deformity correction rate,cobb angle,visual analogue scale (VAS),and Oswestry disability index (ODI).Results The assisted group bad significantly shorter operation time,less blood loss and a higher deformity correction rate than the unassisted group (P < 0.05).All patients were followed up for a mean duration of 38 months (from 6 to 51 months).In all patients,the preoperative cobb angle,VAS and ODI scores were significantly improved at postoperation and the last follow-up (P < 0.05).At the last follow-up,the cobb angle,VAS and ODI scores in the assisted group were significantly better than in the unassisted group (P < 0.05).In all the patients,rigid fusion of the spinal vertebrae fixated was achieved,no implant failure occurred,the secondary thoracolumbar kyphosis was obviously corrected,and back pain disappeared.Conclusion The pre-operative digital design for osteotomy and intra-operative navigation improve the safety of PSO,therapeutic outcomes and local deformity correction for treatment of secondaU thoracolumbar kyphosis following surgery of thoracolumbar fracture.%目的 探讨联合应用术前数字化截骨设计和术中导航技术辅助矫正胸腰段骨折术后继发角状后凸畸形的有效性. 方法 2008年1至201 3年4月对34

  10. Anatomy of thoracolumbar spinal cord anterior operation and its clinical application%胸腰段脊椎前路手术解剖与临床应用

    曾志远; 黄杰聪; 陈小青; 蔡雅谷; 卢天祥

    2014-01-01

    Objective To Study the clinical effect of the thoracolumbar Anterior Operation (T10-L3) approach anatomy guidance anterior corpectomy decompression bone internal fixation. Methods Based on the anatomy, study of the thoracolumbar spine (T12-L3) of 10 (male 6, female 4) adult cadaveric specimens, and 30 cases of patients with spinal cord compression mainly from anterior thoracolumbar burst fracture from 2010 January to 2013 October were given scattered thoracolumbar anterior decompression bone grafting and internal fixation. Among them, 21 cases were male, 9 cases were female; age was 20-65 years old, average age was 38.5 years old. Adopted the right lateral, left approach, resection of the left eleventh rib, subtotal resection body bone graft and internal fixation of T12, or L1, L2 vertebral, in which 5 cases of T12,12 cases of L1 , 13 cases of L2, all cases were given short segment fixation separated by a vertebral body, the bleeding complications during operation time and the postoperative follow-up were comparative analyzed, bone graft fusion condition was observation. Results The average operation time was (1.8±1.3) h, the average amount of bleeding during operation was800mL(400-2100mL) , 5 cases of patients got the thoracic and abdominal injury during operation, 3 cases of thoracic drainage after operation, no damage and visceral organs of major vascular injury, and no spinal cord injury aggravated cases. The time of follow-up was 6-46 months, average time was 20 months. All cases got satisfactory reduction, there were no loss of reduction during the follow-up period, fixed position was good, no loosening or fracture, both achieved bony fusion in 5 months, the fusion rate was 100%. Conclusion For the thoracolumbar(T12-L2) vertebral burst fractures, spinal cord compression mainly from anterior spinal anterior approach, familiar with local anatomy, master the techniques of using anterior, anterior approach for subtotal resection of vertebral body bone graft and

  11. Longitudinal Comparison of Enzyme- and Laser-Treated Intervertebral Disc by MRI, X-Ray, and Histological Analyses Reveals Discrepancies in the Progression of Disc Degeneration: A Rabbit Study

    Colombier, Pauline; Lesoeur, Julie; Youl, Samy; Madec, Stéphane; Gauthier, Olivier; Hamel, Olivier; Guicheux, Jérôme; Clouet, Johann

    2016-01-01

    Regenerative medicine is considered an attractive prospect for the treatment of intervertebral disc (IVD) degeneration. To assess the efficacy of the regenerative approach, animal models of IVD degeneration are needed. Among these animal models, chemonucleolysis based on the enzymatic degradation of the Nucleus Pulposus (NP) is often used, but this technique remains far from the natural physiopathological process of IVD degeneration. Recently, we developed an innovative animal model of IVD degeneration based on the use of a laser beam. In the present study, this laser model was compared with the chemonucleolysis model in a longitudinal study in rabbits. The effects of the treatments were studied by MRI (T2-weighted signal intensity (T2wsi)), radiography (IVD height index), and histology (NP area and Boos' scoring). The results showed that both treatments induced a degeneration of the IVD with a decrease in IVD height and T2wsi as well as NP area and an increase in Boos' scoring. The enzyme treatment leads to a rapid and acute process of IVD degeneration. Conversely, laser radiation induced more progressive and less pronounced degeneration. It can be concluded that laser treatment provides an instrumental in vivo model of slowly evolving IVD degenerative disease that can be of preclinical relevance for assessing new prophylactic biological treatments of disc degeneration. PMID:27247937

  12. Fijación posterior monosegmentaria en fracturas de la columna toracolumbar Fixação posterior monossegmentar nas fraturas da coluna toracolombar Posterior monosegmental fixation in thoracolumbar spine fractures

    José Fleiderman Valenzuela

    2011-01-01

    return to work. RESULTS: 4 patients (14% presented radiological treatment failure. 3 suffered acute complications, and had 2 delayed complications. 92.8% of the patients returned to their jobs, with a mean postoperative time out of work of 3.4 months. no statistically significant differences were detected among the different evaluated variables evaluated and the levels of treatment failure. CONCLUSION: Posterior monosegmental fixation has good results in the treatment of thoracolumbar fractures. In our series we had good clinical results in 93% and radiological results in 86% of the patients. We did not find any variable that could be correlated with treatment failure, although the cases considered failures according to the radiological exams had a major preoperative kyphosis and a greater postoperative kyphosis correction than those who did not.

  13. The Analysis on Complications of Anterior Surgery for 28 Cases of Thoracolumbar Spine Burst Fracture%胸腰椎爆裂骨折28例前路手术并发症分析

    张广平; 舒钧

    2011-01-01

    Objective To choose the right surgical treatment of thoracolumbar burst fracture, reduce complications and get the best spinal cord rehabiltion and spinal stability. Methods 28 cases of thoracolumbar burst fractures were selected in this study. preoperative X-ray examination, CT examination, and plain CT scanning were performed before anterior sugery for thoracolumbar spine. X-ray examination and CT examination were performed to observe the fixed and decompression effects 1, 2, 3, 6 months and 1 year after surgery.Results There was 1 case of the selected patients with retroperitoneal chylous fluid leak, 1 case of incisional hernia, and 1 case of pneumothorax. After active treatment, all patients were cured. Conclusions The incidence of complications of anterior sugery for thoracolumbar spine are related with the familiarity to the anatomy of thoracolumbar spine, the surgical operation skills, and experiences of the operators. Timely and effective symptomatic treatment can reduce the damage of complications to the patients.%目的 正确选择胸腰椎爆裂骨折手术治疗方法,减少并发症,以获得最佳脊髓神经恢复和脊柱稳定性.方法 胸腰椎爆裂骨折前路手术28例,术前X、CT摄片,部分行MRI平扫;术后分别1月、2月、6月、1 a摄片及部分CT检查,观察固定和减压效果.结果 1例出现乳糜液漏,1例切口疝,1例气胸.经过积极治疗,全部治愈.结论 胸腰段前路手术并发症的发生大多数和术者对该段解剖熟知程度、手术技巧和经验有关,而在发生时及时有效的进行对症治疗可将其危害降到最低.

  14. Acute myelogenous leukemia (AML) - children

    Acute myelogenous leukemia - children; AML; Acute myeloid leukemia - children; Acute granulocytic leukemia - children; Acute myeloblastic leukemia - children; Acute non-lymphocytic leukemia (ANLL) - children

  15. Calcification of the intervertebral discs and curvature of the radius and ulna: A radiographic survey of Finnish miniature dachshunds

    The vertebral column of 124 randomly selected miniature dachshunds, representing 4.5% of the population registered by the Finnish Kennel Club during the years 1988 to 1996, were radiographed. The front legs were also radiographed in order to evaluate the curvature of the radius and ulna. Calcified discs were found in 75.9% of the longhaired miniature dachshunds and in 86.7% of the wirehaired ones. The occurrence of signs associated with IDD was 16.5% in longhaired and 15.6% in wirehaired miniature dachshunds. The occurrence of signs of IDD in dogs with calcified discs was 20.0% and 17.9% in longhaired and wirehaired miniature dachshunds, respectively. In dogs without calcifications only one dog showed signs of IDD. The curvature of the radius and the ulna did not differ between the dogs with signs of IDD and the healthy ones, or between the dogs with and without intervertebral calcifications. Our results indicate that radiographic eradication based on the presence of intervertebral calcifications is not suitable for breeding purposes for the Finnish miniature dachshund population because the percentage of dogs without calcifications is small

  16. A forward dynamics simulation of human lumbar spine flexion predicting the load sharing of intervertebral discs, ligaments, and muscles.

    Rupp, T K; Ehlers, W; Karajan, N; Günther, M; Schmitt, S

    2015-10-01

    Determining the internal dynamics of the human spine's biological structure is one essential step that allows enhanced understanding of spinal degeneration processes. The unavailability of internal load figures in other methods highlights the importance of the forward dynamics approach as the most powerful approach to examine the internal degeneration of spinal structures. Consequently, a forward dynamics full-body model of the human body with a detailed lumbar spine is introduced. The aim was to determine the internal dynamics and the contribution of different spinal structures to loading. The multi-body model consists of the lower extremities, two feet, shanks and thighs, the pelvis, five lumbar vertebrae, and a lumped upper body including the head and both arms. All segments are modelled as rigid bodies. 202 muscles (legs, back, abdomen) are included as Hill-type elements. 58 nonlinear force elements are included to represent all spinal ligaments. The lumbar intervertebral discs were modelled nonlinearly. As results, internal kinematics, muscle forces, and internal loads for each biological structure are presented. A comparison between the nonlinear (new, enhanced modelling approach) and linear (standard modelling approach, bushing) modelling approaches of the intervertebral disc is presented. The model is available to all researchers as ready-to-use C/C++ code within our in-house multi-body simulation code demoa with all relevant binaries included. PMID:25653134

  17. The presence and absence of lymphatic vessels in the adult human intervertebral disc: relation to disc pathology

    Although the normal adult human intervertebral disc is considered to be avascular, vascularised cellular fibrous tissue can be found in pathological conditions involving the disc such as disc herniation. Whether lymphatics vessels form a component of this reparative tissue is not known as the presence or absence of lymphatics in herniated and normal disc tissue is not known. We examined spinal tissues and discectomy specimens for the presence of lymphatics. The examination used immunohistochemistry to identify the specific lymphatic endothelial cell markers, podoplanin and LYVE1. Lymphatic vessels were not found in the nucleus pulposus or annulus fibrosus of intact, non-herniated lumbar and thoracic discs but were present in the surrounding ligaments. Ingrowth of fibrous tissue was seen in 73% of herniated disc specimens of which 36% contained LYVE1+/podoplanin + lymphatic vessels. Lymphatic vessels were not seen in the sacrum and coccyx or biopsies of four sacrococcygeal chordomas, but they were noted in surrounding extra-osseous fat and fibrous tissue at the edge of the infiltrating tumour. Our findings indicate that lymphatic vessels are not present in the normal adult intervertebral disc but that, when there is extrusion of disc material into surrounding soft tissue, there is ingrowth of reparative fibrous tissue containing lymphatic vessels. Our findings also indicate that chordoma, a tumour of notochordal origin, spreads to regional lymph nodes via lymphatics in para-spinal soft tissues. (orig.)

  18. The study of migration of bone mesenchymal stem cells transplanted in intervertebral discs of rabbits and expression of exogenous gene

    Jintang Wang; Hong Zhang; Yingang Zhang; Xiaowei Zhang; Meng Li

    2006-01-01

    Objective: To explore the survival and migration of bone mesenchymal stem cells transplantated in intervertebral disc of rabbits and expression of the exogenic genes. Methods: Thirty-two rabbits were used, A randomized block design was used and discs in the same rabbit were one block,the lumbar discs from L2-3 to L5-6 were randomly divided into blank group, saline group, cell transplantation group Ⅰ and cell transplantation group Ⅱ. The fluorescence microscopy was used to determine the fluorescence of the maker protein GFP and DNA-PCR was used to analyze the copies of DNA of neomycin-resistant gene at 1, 3, 6, months after transplantation. Results: There was fluorescence in cell transplantation group Ⅰ and Ⅱ and none in blank group, saline group at 1, 3, 6 months after transplantation. In cell transplantation groups,the fluorescent distribution was more scatter with time, but no significant difference between cell groups Ⅰ and Ⅱ. The test of neomycin resistant gene expressed in cell transplantation group Ⅰ and Ⅱ and quantitative analysis showed that there was no significant difference between the cell groups Ⅰ and Ⅱ (P>0.05). Conclusion: The transplanted bone mesenchymal stem cells can survive, migrate and the transfer genes can express efficiently, it suggests that the BMSC therapy may be effective to prevent and treat intervertebral disc degeneration.

  19. The presence and absence of lymphatic vessels in the adult human intervertebral disc: relation to disc pathology

    Kliskey, Karolina; Williams, Kelly; Yu, J.; Urban, Jill; Athanasou, Nick [University of Oxford, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Science, Oxford (United Kingdom); Jackson, David [Weatherall Institute of Molecular Medicine, Human Immunology Unit, Oxford (United Kingdom)

    2009-12-15

    Although the normal adult human intervertebral disc is considered to be avascular, vascularised cellular fibrous tissue can be found in pathological conditions involving the disc such as disc herniation. Whether lymphatics vessels form a component of this reparative tissue is not known as the presence or absence of lymphatics in herniated and normal disc tissue is not known. We examined spinal tissues and discectomy specimens for the presence of lymphatics. The examination used immunohistochemistry to identify the specific lymphatic endothelial cell markers, podoplanin and LYVE1. Lymphatic vessels were not found in the nucleus pulposus or annulus fibrosus of intact, non-herniated lumbar and thoracic discs but were present in the surrounding ligaments. Ingrowth of fibrous tissue was seen in 73% of herniated disc specimens of which 36% contained LYVE1+/podoplanin + lymphatic vessels. Lymphatic vessels were not seen in the sacrum and coccyx or biopsies of four sacrococcygeal chordomas, but they were noted in surrounding extra-osseous fat and fibrous tissue at the edge of the infiltrating tumour. Our findings indicate that lymphatic vessels are not present in the normal adult intervertebral disc but that, when there is extrusion of disc material into surrounding soft tissue, there is ingrowth of reparative fibrous tissue containing lymphatic vessels. Our findings also indicate that chordoma, a tumour of notochordal origin, spreads to regional lymph nodes via lymphatics in para-spinal soft tissues. (orig.)

  20. Rabbit model of intervertebral disc degeneration by external compression device characterized by X-ray, MRI, histology, and cell viability

    Ismail Ismail

    2006-12-01

    Full Text Available Appropriate experimental animal models, which mimic the degenerative process occurring in human intervertebral disc (IVD breakdown and can be used for new treatment studies such as tissue engineering or disc distraction are lacking. We studied the external compression device that used by Kroeber et al to create intervertebral disc degeneration in rabbit model characterized by X-ray, MRI, Histology, and Cell Viability. Ten NZW rabbit were randomly assigned to one of five groups. Intervertebral disc VL4-L5 are compressed using an external loading device, 1.9 MPa. First group rabbit are loaded for 14 days, second loaded for 28 days, thirth group are loaded for 14 days, and unloaded for 14 days, fourth group loaded for 28 days and unloaded for 28 days. The fifth group, rabbits underwent a sham operation. Additional, rabbits were used as sample for cell viability study. In disc height : sample in group one have biggest decreasing of disc height, that is 23.9 unit. In MRI assessment, the worst grade is grade 3. In histological score, the worst group is group three (58.69, and the best is group 4 (45.69. Group one have the largest dead cell, that are 403.5, and the smallest is group four (124.75. Trypan blue staining showed that group four have better viable cell (91.1 compare than group three (86.4. The study conclude disc degeneration can be created by external axial loading for 14 days in rabbit intervertebral disc. Duration of 28 days unloading gave better result for cells to recover. (Med J Indones 2006; 15:199-207  Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Keywords: Rabbit model –intervertebral disc degeneration- external compression device-X-ray, MRI, Histology, and Cell viabilty /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso

  1. Acute camptocormia induced by olanzapine: a case report

    Boyer Stéphane

    2010-06-01

    Full Text Available Abstract Introduction Camptocormia refers to an abnormal posture with flexion of the thoraco-lumbar spine which increases during walking and resolves in supine position. This symptom is an increasingly recognized feature of parkinsonian and dystonic disorders, but may also be caused by neuromuscular diseases. There is recent evidence that both central and peripheral mechanisms may be involved in the pathogenesis of camptocormia. We report a case of acute onset of camptocormia, a rare side effect induced by olanzapine, a second-generation atypical anti-psychotic drug with fewer extra-pyramidal side-effects, increasingly used as first line therapy for schizophrenia, delusional disorders and bipolar disorder. Case presentation A 73-year-old Caucasian woman with no history of neuromuscular disorder, treated for chronic delusional disorder for the last ten years, received two injections of long-acting haloperidol. She was then referred for fatigue. Physical examination showed a frank parkinsonism without other abnormalities. Routine laboratory tests showed normal results, notably concerning creatine kinase level. Fatigue was attributed to haloperidol which was substituted for olanzapine. Our patient left the hospital after five days without complaint. She was admitted again three days later with acute back pain. Examination showed camptocormia and tenderness in paraspinal muscles. Creatine kinase level was elevated (2986 UI/L. Magnetic resonance imaging showed necrosis and edema in paraspinal muscles. Olanzapine was discontinued. Pain resolved quickly and muscle enzymes were normalized within ten days. Risperidone was later introduced without significant side-effect. The camptocormic posture had disappeared when the patient was seen as an out-patient one year later. Conclusions Camptocormia is a heterogeneous syndrome of various causes. We believe that our case illustrates the need to search for paraspinal muscle damage, including drug

  2. Causes and clinical significance of intervertebral disk flavus ligamentum space in lumbar stenosis (a comparative study of CT non-contrast and CT-myelography of 83 cases)

    Objective: To compare the imaging findings of CT non-contrast (CTNOC) and CT-myelography (CTM) in lumbar intervertebral disk, the authors proposed a new concept of intervertebral disk-flavum ligamentum space (DFLS), analyzed the causes of stenosis in lumbar DFLS and evaluated its diagnostic value in compressed lumbar radiculopathy. Methods: The images of CTNOC and CTM of 83 cases were retrospectively analyzed, and the shapes of L3-S1 disk, the width of flavum ligament at each side, the degree of prominence interior of the joint process superior at each side, and the sagittal diameter of the dural sac in L3-S1 were recorded. The relation of these restrictions and parameters to DFLS stenosis and the compressed lumbar nerve roots shown in CTNOC and CTM were analyzed. Results: The herniation of intervertebral disk were found in 138 level with the diameter of the corresponding dural sac 5 mm; 67 joint process superior prominent interior > 2 mm; 157 of 83 cases of mean width DFLS 3.8 mm. Conclusion: The DFLS≤5 mm can be diagnosed as stenosis. The main causes of stenosis are the herniation of intervertebral disk, flavum ligament thicker; and joint process superior prominent interior. It can be used as a valuable criterion in diagnosing lumbar nerve root compression in CT study

  3. 腰椎间盘突出症术后康复治疗%Postoperative rehabilitation treatment of patients with prolapse of lumbar intervertebral disc

    2001-01-01

    @@ Background:Now,transcutaneous lumbar removal of vertebral disc,a kind of effective treatments for prolapse of lumbar intervertebral disc is widely used in clinic .Postoperative rehabilitation training has been recepted in clinic. Objective:In order to strengthen stability of spine,oppression and stimulation for nerve root were removed. Unit:General Hospital of Shenyang Military Region.

  4. Treatment of Prolapse of Lumbar Intervertebral Disc by Tuina Massotherapy Combined with Oral Administration of Buyang Huanwu Tang——A Report of 75 Cases

    Du Deli; Wang Xinzhong

    2007-01-01

    @@ Prolapse of lumbar intervertebral disc is a commonly encountered disease. From Feb. 2003 - Feb. 2005, a series of 75 cases had been treated by Tuina massotherapy combined with oral administration of Buyang Huanwu Tang (补阳还五汤 Decoction for Invigorating Yang and Recuperation), with satisfactory therapeutic results reported as follows.

  5. Combined expression of CTGF and tissue inhibitor of metalloprotease-1 promotes synthesis of proteoglycan and collagen type Ⅱ in rhesus monkey lumbar intervertebral disc cells in vitro

    LIU Yong; KONG Jie; CHEN Bo-hua; HU You-gu

    2010-01-01

    Background Low back pain has emerged as a widespread disease often caused by intervertebral disc degeneration.This study aimed to establish an in vitro cell culture model of rhesus monkey lumbar intervertebral discs and to investigate the effect of combined connective tissue growth factor (CTGF) and tissue inhibitor of metalloprotease-1(TIMP-1) expression mediated by adeno-associated virus (AAV) on collagen type Ⅱ and proteoglycan levels.The purpose of these investigations was to explore potential methods for relieving the degeneration of lumbar intervertebral disc cells.Methods Rhesus monkey lumbar intervertebral disc nucleus pulposus cells (NPCs) were isolated by enzyme digestion,cultured, and transduced with rAAV2-CTGF-IRES-TIMP-1, rAAV2-CTGF, or rAAV2-TIMP-1 at a multiplicity of infection (MOl) of 106.The expression of collagen type Ⅱ and proteoglycan was measured using RT-PCR and Western blotting.The synthetic rate of proteoglycan was measured using 35S incorporation.Results Rhesus monkey lumbar intervertebral disc NPCs were transduced with rAAV2-CTGF-IRES-TIMP-1,rAAV2-CTGF, and rAAV2-TIMP-1 and the transduced genes were expressed and detected.Compared to the control,CTGF promoted the synthesis of collagen type Ⅱ and proteoglycan.TIMP-1 showed an enhancing effect on the expression of proteoglycan but no effect on collagen type Ⅱ.Expression of both genes in rhesus monkey lumbar intervertebral disc NPCs significantly enhances the synthesis of proteoglycan and collagen type Ⅱ.Conclusions Single gene transduction of CTGF or TIMP-1 can enhanced synthesis of proteoglycan.CTGF expression can also enhance collagen type Ⅱ protein synthesis.Combined transduction of both CTGF and TIMP1 can significantly promote the expression of proteoglycan and collagen type Ⅱ to levels greater than transduction of a single gene alone.Our study provides a good basis for multi-gene therapy to treat lumbar intervertebral disc degeneration.

  6. Improvement of gagCEST imaging in the human lumbar intervertebral disc by motion correction

    Mueller-Lutz, Anja; Schleich, Christoph; Topgoez, Melike; Pentang, Gael; Antoch, Gerald; Wittsack, Hans-Joerg; Miese, Falk [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf (Germany); Schmitt, Benjamin [Siemens Ltd. Australia, Healthcare Sector, Macquarie Park, NSW (Australia)

    2014-10-23

    To investigate whether motion correction improves glycosaminoglycan chemical exchange saturation transfer imaging (gagCEST imaging) of intervertebral discs (IVDs). Magnetic resonance gagCEST imaging of 12 volunteers was obtained in lumbar IVDs at 3 T using a prototype pulse sequence. The data were motion-corrected using a prototype diffeomorphism-based motion compensation technique. For both the data with and that without motion correction (data{sub c}, data{sub uc}), CEST evaluation was performed using the magnetisation transfer ratio asymmetry (MTR{sub asym}) as a means of quantifying CEST effects. MTR{sub asym} and the signal-to-noise ratio (SNR) of the MTR{sub asym} map in the nucleus pulposus (NP) were compared for data{sub c} and data{sub uc}. A visual grading analysis was performed by a radiologist in order to subjectively quantify the quality of the MTR{sub asym} analysis (score 1: best quality, score 5: worst quality). Furthermore, a landmark analysis was performed in order to objectively quantify the motion between CEST images using the mean landmark distance d{sub mean}. MTR{sub asym} and SNR were significantly higher for the motion-corrected data than for the uncorrected CEST data (MTR{sub asym}(data{sub c}) = 3.77 % ± 0.95 %, MTR{sub asym}(data{sub uc}) = 3.41 % ± 1.54 %, p value = 0.001; SNR(data{sub c}) = 3.88 ± 2.04, SNR(data{sub uc}) = 2.77 ± 1.55, p value < 0.001, number of IVDs = 48). The visual grading analysis revealed a higher reliability for data{sub c} (maximum score = 2) compared with data{sub uc} (maximum score = 5). The landmark analysis demonstrated the superiority of the motion-corrected data (d{sub mean}(data{sub c}) =0.08 mm ±0.09 mm, d{sub mean}(data{sub uc}) = 0.36 mm ±0.09 mm, p value = 0.001). Our study showed significant improvements in the ability to quantify CEST imaging in IVDs after the application of motion correction compared with uncorrected datasets. (orig.)

  7. Calibration of hyperelastic material properties of the human lumbar intervertebral disc under fast dynamic compressive loads.

    Wagnac, Eric; Arnoux, Pierre-Jean; Garo, Anaïs; El-Rich, Marwan; Aubin, Carl-Eric

    2011-10-01

    Under fast dynamic loading conditions (e.g. high-energy impact), the load rate dependency of the intervertebral disc (IVD) material properties may play a crucial role in the biomechanics of spinal trauma. However, most finite element models (FEM) of dynamic spinal trauma uses material properties derived from quasi-static experiments, thus neglecting this load rate dependency. The aim of this study was to identify hyperelastic material properties that ensure a more biofidelic simulation of the IVD under a fast dynamic compressive load. A hyperelastic material law based on a first-order Mooney-Rivlin formulation was implemented in a detailed FEM of a L2-L3 functional spinal unit (FSU) to represent the mechanical behavior of the IVD. Bony structures were modeled using an elasto-plastic Johnson-Cook material law that simulates bone fracture while ligaments were governed by a viscoelastic material law. To mimic experimental studies performed in fast dynamic compression, a compressive loading velocity of 1 m/s was applied to the superior half of L2, while the inferior half of L3 was fixed. An exploratory technique was used to simulate dynamic compression of the FSU using 34 sets of hyperelastic material constants randomly selected using an optimal Latin hypercube algorithm and a set of material constants derived from quasi-static experiments. Selection or rejection of the sets of material constants was based on compressive stiffness and failure parameters criteria measured experimentally. The two simulations performed with calibrated hyperelastic constants resulted in nonlinear load-displacement curves with compressive stiffness (7335 and 7079 N/mm), load (12,488 and 12,473 N), displacement (1.95 and 2.09 mm) and energy at failure (13.5 and 14.7 J) in agreement with experimental results (6551 ± 2017 N/mm, 12,411 ± 829 N, 2.1 ± 0.2 mm and 13.0 ± 1.5 J respectively). The fracture pattern and location also agreed with experimental results. The simulation performed with

  8. Inaccurate level of intervertebral space estimated by palpation: The ultrasonic revelation

    Parate, LH; Manjunath, B; Tejesh, CA; Pujari, V

    2016-01-01

    Background: Spinal cord injury resulting from spinal anesthesia is a rare, but an alarming scenario. The most likely cause is believed to be misjudged level of intervertebral space (IVS). We evaluated the accuracy of palpation method to locate IVS with the ultrasonography. Materials and Methods: A total of 109 patients undergoing spinal anesthesia were included in this observational, double-blind study. First anesthesiologist was asked to mark IVS using palpation method. It was followed by ultrasonographic assessment by another anesthesiologist who was unaware of the level estimated for the mark. We evaluated the accuracy of palpation method in sitting and lateral position as well as the impact of the anesthesiologist's experience (Trainee/Consultant). Statistical Analysis Used: Association between the gender, anthropometric parameters, type of anesthesiologists assessing the IVS, and the level of agreement were identified using Chi-square test. The agreement between palpation method and ultrasound assessment of IVS was analyzed using kappa statistic. P < 0.05 was defined as statistical significance. Results: The IVS located by palpation method was in agreement with ultrasound location in 37.14% of the patients. There were no statistically significant differences found in terms of demographic data (sex, age, height, weight, or body mass index [BMI]) between agreement and disagreement group. The rate of errors was found to be significantly higher (P = 0.01) among the trainees (74.51%) than the consultants (51.86%). The rate of errors was not different between the sitting and lateral position. The frequency of errors was more common in cephalad direction (53.31.5%) compared to caudal direction (9.52%). The misidentified spaces were as high as three spaces above the intended space while in caudal direction it differed by only one space. Conclusion: The accuracy of palpation method controlled by ultrasound is 37.14% and differs by 1-3 IVS in cephalad direction (53

  9. Autologous nucleus pulposus transplantation to lumbar 5 dorsal root ganglion after epineurium discission in rats: a modified model of non-compressive lumbar herniated intervertebral disc

    ZHANG Jin-jun; SONG Wu; LUO Wen-ying; WEI Ming; SUN Lai-bao; ZOU Xue-nong; LIAO Wei-ming

    2011-01-01

    Background Nucleus pulposus of intervertebral discs has proinflammatory characteristics that play a key role in neuropathic pain in lumbar herniated intervertebral disc. One of the most commonly used animal models (the traditional model) of non-compressive lumbar hemiated intervertebral disc is created by L4-L5 hemilaminectomy and the application of autologous nucleus pulposus to cover the left L4 and L5 nerve roots in rats. However, such procedures have the disadvantages of excessive trauma and low success rate. We proposed a modified model of non-compressive lumbar herniated intervertebral disc in which only the left L5 dorsal root ganglion is exposed and transplanted with autologous nucleus pulposus following incision of epineurium. We aimed to compare the modified model with the traditional one with regard to trauma and success rate.Methods Thirty Sprague-Dawley male rats were randomized into three groups: sham operation group (n=6). traditional group (n=12), and modified group (n=12). The amount of blood loss and operative time for each group were analyzed. The paw withdrawal threshold of the left hind limb to mechanical stimuli and paw withdrawal latency to heat stimuli were examined from the day before surgery to day 35 after surgery.Results Compared with the traditional group, the modified group had shorter operative time, smaller amount of blood loss, and higher success rate (91.7% versus 58.3%, P <0.05). There was no decrease in paw withdrawal latency in any group. The sham operation group had no decrease in postoperative paw withdrawal threshold, whereas the modified and traditional groups had significant reduction in paw withdrawal threshold after surgery (mechanical hyperalgesia).Conclusions Transplantation of nucleus pulposus onto the L5 dorsal root ganglion following incision of epineurium in rats established an improved animal model of non-compressive lumbar herniated intervertebral disc with less trauma and more stable pain ethology.

  10. Subacute post-traumatic ascending myelopathy (SPAM: Two cases of SPAM following surgical treatment of thoracolumbar fractures

    Kamran Farooque

    2014-01-01

    Full Text Available To report two cases of traumatic paraplegia who developed Sub-acute Post-Traumatic Ascending Myelopathy (SPAM following surgical decompression.We hereby report two cases (both 35yr old male with traumatic paraplegia that developed ascending weakness at 3rd and 5th Post-Op day respectively following surgical decompression. Both the patients experienced remarkable improvement in Neurology after treatment with steroids. The authors conclude by emphasizing on minimum cord handling during surgical decompression of the spinal cord to avoid this potentially life threatening complication.

  11. Effect of comprehensive rehabilitative treatment on prolapse of lumbar intervertebral disc in 120 cases%综合康复治疗腰椎间盘出症120例疗效分析

    梁君

    2002-01-01

    Background:Lumbar spine connects thorax and pelvis,its physiological structure and kinetics confer susceptibility to injury and degeneration.Prolapse of lumbar intervertebral disc often coexist with other diseases or is secondary to them.

  12. Effect of comprehensive rehabilitation treatment on protrusion of lumbar intervertebral disc%综合康复疗法对腰椎间盘突出症的作用

    陈淑娥

    2003-01-01

    @@ BACKGROUND:Conservative therapy is very important in treatment of lumbar protrusion of lumbar intervertebral disc and symptoms can be alleviated or disappear in most patients by physical therapy,traction and other comprehensive methods.

  13. Prótese para substituição total de disco intervertebral: desenvolvimento de modelo computacional e análise por elementos finitos Prótese de reemplazo total del disco intervertebral: modelo de desarrollo computacional y análisis de elementos finitos Prosthesis for total intervertebral disc replacement: computacional model development and finite element analysis

    Tiago Nunes Campello

    2009-03-01

    Full Text Available INTRODUÇÃO: a idéia de um disco intervertebral artificial não é nova. O campo de estudos sobre próteses para artroplastia de coluna desenvolve-se ao passo que novas tecnologias na área de materiais e engenharia médica são desenvolvidas ou introduzidas para o surgimento de novos projetos. OBJETIVO: estabelecer metodologia de desenvolvimento de produto em um projeto de prótese para substituição total de disco intervertebral pela utilização de ferramentas computacionais de engenharia. MÉTODOS: a metodologia de desenvolvimento de prótese para substituição total de disco iniciou-se com a definição do seu modelo virtual, seguida pela a análise mecânica virtual por elementos finitos. RESULTADOS: a prótese de disco foi concebida com três componentes, sendo eles o flange superior, o flange inferior e o núcleo. Aplicando o critério de von Mises para solução da análise virtual, verificou-se que o núcleo da prótese é o componente mais solicitado durante compressão axial e compressão/cisalhamento. CONCLUSÃO: este estudo demonstra a viabilidade do desenvolvimento de um projeto para fabricação de prótese para substituição total de disco intervertebral, por meio de metodologia computacional já consagrada em projetos mecânicos de engenharia, principalmente, nos ramos automotivo e aeronáutico.INTRODUCCIÓN: la idea de un disco intervertebral artificial no es nueva. Los estudios de la columna vertebral artroplastia prótesis están en desarrollo, mientras las nuevas tecnologías en el ámbito de la ingeniería y los materiales médicos son desarr llados o introducidos a la aparición de nuevos proyectos. OBJETIVO: establecer una metodología para el desarrollo de producto en un proyecto de prótesis para reemplazo total del disco intervertebral, a través del uso de herramientas de ingeniería computacional. MÉTODOS: la metodología de desarrollo de prótesis para reemplazo total del disco se inició con la definici

  14. CLINICAL OBSERVATION ON TREATMENT OF 80 CASES OF PROLAPSE OF LUMBAR INTERVERTEBRAL DISC BY COMBINATION OF ACUPUNCTURE AND MEDICINE

    RUAN Yongdui; ZHOU Weixiong; ZHENG Zhi; HE Xuewu

    2002-01-01

    150 cases of prolapse of lumbar intervetebral disc were randomly divided into treatment and control groups. 80 cases in treatment group were treated with combination of acupuncture, oral administration of Chinese medicinal herbs, traction, point-injection and intravenous drip of energy dehydration mixture; 70 cases in control group were managed by combination of acupuncture, oral administration of herbal medicines, traction, acupoint-injection (without energy dehydration mixture). The results showed that the curative rate and the total effective rate of the treatment group were 91.25 % and 98.75% separately, while those of the control group 62.86 % and 92.86 % respectively. Comparison of the curative rate between the 2 groups showed a remarkable significance ( P < 0.01 ). The observation demonstrated that combined treatment of prolapse of lumbar intervertebral disc with traditional Chinese and Western medicine is an effective approach.

  15. Strain distribution in the intervertebral disc under unconfined compression and tension load by the optimized digital image correlation technique.

    Liu, Qing; Wang, Tai-Yong; Yang, Xiu-Ping; Li, Kun; Gao, Li-Lan; Zhang, Chun-Qiu; Guo, Yue-Hong

    2014-04-01

    The unconfined compression and tension experiments of the intervertebral disc were conducted by applying an optimized digital image correlation technique, and the internal strain distribution was analysed for the disc. It was found that the axial strain values of different positions increased obviously with the increase in loads, while inner annulus fibrosus and posterior annulus fibrosus experienced higher axial strains than the outer annulus fibrosus and anterior annulus fibrosus. Deep annulus fibrosus exhibited higher compressive and tensile axial strains than superficial annulus fibrosus for the anterior region, while there was an opposite result for the posterior region. It was noted that all samples demonstrated a nonlinear stress-strain profile in the process of deforming, and an elastic region was shown once the sample was deformed beyond its toe region. PMID:24718863

  16. Acute pancreatitis

    Al Mofleh Ibrahim

    1997-01-01

    Full Text Available The past few years have witnessed a tremendous progress in our knowledge regarding the pathogenesis, diagnosis, prognostic evaluation and classification of acute pancreatitis. The role of ischemia, lysosomal enzymes, oxygen free radicals, polymorphnuclear cells-byproducts and inflammatory mediators in the pathogenesis of pancreatic necrosis and multiple organ failure has been emphasized. Furthermore, the recent knowledge about agents infecting pancreatic necrosis, routes of infection, bacteriological examination of fine needle aspirate and appropriate antibiotics have changed the concept of acute pancreatitis. New diagnostic tests such as rapid urinary trypsinogen-2 test and inflammatory mediators including polymorphnuclear elastase, C-reactive protein and interleukin-6 contribute to early diagnosis, prognostic evaluation and initiation of an appropriate therapy.

  17. Via de acesso para exposição ampla da coluna toracolombar anterior (T10 -L5 Extensive anterior approach to the thoracolumbar spine (T10 -L5

    Roberto Augusto Caffaro

    1998-08-01

    Full Text Available Os autores descrevem técnica de via de acesso para exposição ampla da coluna toracolombar anterior (T10 -L5 a que foi submetida uma série de cem pacientes com indicação cirúrgica para correção de diversas doenças da coluna. A partir das estruturas envolvidas, são analisados e comentados os tempos operatórios pertinentes bem como as complicações transoperatórias e pós-operatórias decorrentes da técnica. Sugere-se que a técnica de acesso proposta seja utilizada quando adequada à doença a cuja correção se destina, independente da área de comprometimento clinicamente objetivada.The authors describe a technique for extensive anterior approach to the thoracolumbar spine (T10 -L5, to which 100 patients with surgical indication for correcting orthopedic anomalies were submitted. The anatomical structures involved in surgical procedures are analyzed and discussed. Results have shown that this extensive anterior approach to the thoracolumbar spine a allows the aimed approach in 100% for the cases, making easier the arthopedic management necessary to the correction of the spine deformity to be treated; b makes possible to avoid transoperative complications from the knowledge of anatomical structures exposed in the surgical field, except for the sympathetic trunk, in which lesion can occur in 70% of cases; and c presents a low rate (2% of post operative complications. It is suggested that this technique for extensive anterior approach to the thoracolumbar spine should be used, independently of the extension of the clinically diagnosed affected area.

  18. MRI interrReader and intra-reader reliabilities for assessing injury morphology and posterior ligamentous complex integrity of the spine according to the thoracolumbar injury classification system and severity score

    Lee, Guen Young; Lee, Joon Woo; Choi, Seung Woo; Lim, Hyun Jin; Sun, Hye Young; Kang, Yu Suhn; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Chai, Jee Won; Kim, Su Jin [Dept. of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of)

    2015-08-15

    To evaluate spine magnetic resonance imaging (MRI) inter-reader and intra-reader reliabilities using the thoracolumbar injury classification system and severity score (TLICS) and to analyze the effects of reader experience on reliability and the possible reasons for discordant interpretations. Six radiologists (two senior, two junior radiologists, and two residents) independently scored 100 MRI examinations of thoracolumbar spine injuries to assess injury morphology and posterior ligamentous complex (PLC) integrity according to the TLICS. Inter-reader and intra-reader agreements were determined and analyzed according to the number of years of radiologist experience. Inter-reader agreement between the six readers was moderate (k = 0.538 for the first and 0.537 for the second review) for injury morphology and fair to moderate (k = 0.440 for the first and 0.389 for the second review) for PLC integrity. No significant difference in inter-reader agreement was observed according to the number of years of radiologist experience. Intra-reader agreements showed a wide range (k = 0.538-0.822 for injury morphology and 0.423-0.616 for PLC integrity). Agreement was achieved in 44 for the first and 45 for the second review about injury morphology, as well as in 41 for the first and 38 for the second review of PLC integrity. A positive correlation was detected between injury morphology score and PLC integrity. The reliability of MRI for assessing thoracolumbar spinal injuries according to the TLICS was moderate for injury morphology and fair to moderate for PLC integrity, which may not be influenced by radiologist' experience.

  19. Poroelastic behaviour of the degenerating human intervertebral disc: a ten-day study in a loaded disc culture system

    KS Emanuel

    2015-06-01

    Full Text Available The intervertebral disc (IVD allows flexibility to the vertebral column, and transfers the predominant axial loads during daily activities. Its axial biomechanical behaviour is poroelastic, due to the water-binding and releasing capacity of the nucleus pulposus. Degeneration of the intervertebral disc presumably affects both the instantaneous elastic response to the load on the IVD and the subsequent interstitial flow of fluid. This study aims to quantify the poroelastic behaviour of the IVD and its change with degeneration, as defined by the magnetic resonance imaging-based Pfirrmann Score (PS. For a period of ten days, 36 human lumbar IVDs were loaded with a simulated physiological axial loading regime, while deformation was monitored. The IVDs responded to the loads with instantaneous elastic and slow poroelastic axial deformation. Several mechanical parameters changed throughout the first five days of the experiment, until the IVDs settled into a dynamic equilibrium. In this equilibrium, degeneration was significantly related to a decrease in disc height loss during the daytime high load phase (ρ = -0.49, and to a decrease in the rate of this deformation during the final half hour of each day (ρ = -0.53. These properties were related to the nucleus glycosaminoglycan/hydroxyproline (GAG/HYP ratio, rather than GAG content alone, indicating that remodelling of the extracellular matrix reduces poroelastic properties of the IVD. This implies that the degenerated discs have a reduced capacity to bind water and/or a reduced resistance against fluid flow. The resulting loss in hydrostatic pressure may further change cell behaviour in the nucleus pulposus.

  20. Evaluation of different laser wavelengths on ablation lesion and residual thermal injury in intervertebral discs of the lumbar spine.

    Plapler, Hélio; Mancini, Marília W; Sella, Valéria R G; Bomfim, Fernando R C

    2016-04-01

    Laser discectomy or nucleotomy is an increasingly important method for less invasive procedures of column, but the ideal kind of laser is still not established. As the wavelength is an important parameter for water absorption, this study was performed to investigate the action of the laser emission in the near infrared (808 to 1908 nm) region in the context of surgical procedures for percutaneous intervertebral disc decompression (nucleotomy). Forty intervertebral discs from pigs lumbar spines were irradiated with laser (λ = 808, 980, 1470 and 1908 nm), 1-s on/off time cycles, for 120 cycles and 10 W of power (808, 980, and 1470 nm) or 240 cycles and 5 W of power (1908 nm), with total power of 1200 J, and subjected to microscopic evaluation through hematoxylin-eosin (HE) staining in order to measure the ablation lesions and the residual thermal injury. Ten other discs were not irradiated and worked as controls. The ablation lesions were measured (in mm) at 1.08 ± 1.25, 1.70 ± 0.63, 2.23 ± 1.02, 1.37 ± 0.39, and 0.94 ± 0.41 (median ± SD) for the control, 808, 980, 1470, and 1908 nm groups, respectively. The difference between 1908 nm and all the other groups was statistically significant (p < 0.05). The residual thermal injury was less evident in 1908 nm laser and sharper in 980 nm laser wavelengths. The laser at a wavelength of 1908 nm was considered the most efficient for the vaporization of the nucleus pulposus, followed by the laser wavelengths of 1470, 808, and 980 nm, and proved to be useful for laser nucleotomy procedure. PMID:26796705

  1. The non-aggregated aggrecan in the human intervertebral disc can arise by a non-proteolytic mechanism

    PJ Roughley

    2014-09-01

    Full Text Available Analysis of both the aggregated and non-aggregated fractions of aggrecan isolated from adult human intervertebral disc using immunoblotting with antibodies specific for the different domains constituting the aggrecan core protein or atomic force microscopy revealed that many components contained the G1 domain. However, little of the disc aggrecan was able to reform aggregates with hyaluronan, as determined by gel filtration chromatography, suggesting that the G1 domains had been rendered non-functional. Since previous studies have shown that disc aggrecan undergoes non-enzymatic glycation with age, the functional effect of such modification was investigated in vitro using bovine aggrecan isolated from young animals. Incubation of monomeric aggrecan with ribose to induce glycation rendered it unable to form complexes with hyaluronan stable to agarose gel electrophoresis or gel filtration chromatography. Similarly, extended treatment of intact proteoglycan aggregate with ribose resulted in destabilisation of the complex with separation of the aggrecan from the hyaluronan. Although it is clear that proteolysis occurs in the intervertebral disc and gives rise to some non-aggregating molecules, a different mechanism is required to explain the presence of many non-aggregating molecules bearing the G1 domain. The products of non-enzymatic glycation of the globular domains of aggrecan would account for this phenomenon and explain why some of the non-aggregating molecules are still large proteoglycans. While such molecules may be retained in the nucleus pulposus, they may be able to diffuse within it, reducing the ability of the tissue to resist compression under asymmetric loading such as bending and ultimately contributing to disc degeneration.

  2. Design and fabrication of 3D-printed anatomically shaped lumbar cage for intervertebral disc (IVD) degeneration treatment.

    Serra, T; Capelli, C; Toumpaniari, R; Orriss, I R; Leong, J J H; Dalgarno, K; Kalaskar, D M

    2016-01-01

    Spinal fusion is the gold standard surgical procedure for degenerative spinal conditions when conservative therapies have been unsuccessful in rehabilitation of patients. Novel strategies are required to improve biocompatibility and osseointegration of traditionally used materials for lumbar cages. Furthermore, new design and technologies are needed to bridge the gap due to the shortage of optimal implant sizes to fill the intervertebral disc defect. Within this context, additive manufacturing technology presents an excellent opportunity to fabricate ergonomic shape medical implants. The goal of this study is to design and manufacture a 3D-printed lumbar cage for lumbar interbody fusion. Optimisations of the proposed implant design and its printing parameters were achieved via in silico analysis. The final construct was characterised via scanning electron microscopy, contact angle, x-ray micro computed tomography (μCT), atomic force microscopy, and compressive test. Preliminary in vitro cell culture tests such as morphological assessment and metabolic activities were performed to access biocompatibility of 3D-printed constructs. Results of in silico analysis provided a useful platform to test preliminary cage design and to find an optimal value of filling density for 3D printing process. Surface characterisation confirmed a uniform coating of nHAp with nanoscale topography. Mechanical evaluation showed mechanical properties of final cage design similar to that of trabecular bone. Preliminary cell culture results showed promising results in terms of cell growth and activity confirming biocompatibility of constructs. Thus for the first time, design optimisation based on computational and experimental analysis combined with the 3D-printing technique for intervertebral fusion cage has been reported in a single study. 3D-printing is a promising technique for medical applications and this study paves the way for future development of customised implants in spinal

  3. Biochemical imaging of cervical intervertebral discs with glycosaminoglycan chemical exchange saturation transfer magnetic resonance imaging: feasibility and initial results

    Schleich, Christoph; Mueller-Lutz, Anja; Zimmermann, Lisa; Boos, Johannes; Wittsack, Hans-Joerg; Antoch, Gerald; Miese, Falk [Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf (Germany); Schmitt, Benjamin [Siemens Ltd. Australia, Healthcare Sector, Macquarie Park, NSW (Australia)

    2016-01-15

    To evaluate glycosaminoglycan chemical exchange saturation transfer (gagCEST) imaging at 3T in the assessment of the GAG content of cervical IVDs in healthy volunteers. Forty-two cervical intervertebral discs of seven healthy volunteers (four females, three males; mean age: 21.4 ± 1.4 years; range: 19-24 years) were examined at a 3T MRI scanner in this prospective study. The MRI protocol comprised standard morphological, sagittal T2 weighted (T2w) images to assess the magnetic resonance imaging (MRI) based grading system for cervical intervertebral disc degeneration (IVD) and biochemical imaging with gagCEST to calculate a region-of-interest analysis of nucleus pulposus (NP) and annulus fibrosus (AF). GagCEST of cervical IVDs was technically successful at 3T with significant higher gagCEST values in NP compared to AF (1.17 % ± 1.03 % vs. 0.79 % ± 1.75 %; p = 0.005). We found topological differences of gagCEST values of the cervical spine with significant higher gagCEST effects in lower IVDs (r = 1; p = 0). We could demonstrate a significant, negative correlation between gagCEST values and cervical disc degeneration of NP (r = -0.360; p = 0.019). Non-degenerated IVDs had significantly higher gagCEST effects compared to degenerated IVDs in NP (1.76 % ± 0.92 % vs. 0.52 % ± 1.17 %; p < 0.001). Biochemical imaging of cervical IVDs is feasible at 3T. GagCEST analysis demonstrated a topological GAG distribution of the cervical spine. The depletion of GAG in the NP with increasing level of morphological degeneration can be assessed using gagCEST imaging. (orig.)

  4. 2D segmentation of intervertebral discs and its degree of degeneration from T2-weighted magnetic resonance images

    Castro-Mateos, Isaac; Pozo, José Maria; Lazary, Aron; Frangi, Alejandro F.

    2014-03-01

    Low back pain (LBP) is a disorder suffered by a large population around the world. A key factor causing this illness is Intervertebral Disc (IVD) degeneration, whose early diagnosis could help in preventing this widespread condition. Clinicians base their diagnosis on visual inspection of 2D slices of Magnetic Resonance (MR) images, which is subject to large interobserver variability. In this work, an automatic classification method is presented, which provides the Pfirrmann degree of degeneration from a mid-sagittal MR slice. The proposed method utilizes Active Contour Models, with a new geometrical energy, to achieve an initial segmentation, which is further improved using fuzzy C-means. Then, IVDs are classified according to their degree of degeneration. This classification is attained by employing Adaboost on five specific features: the mean and the variance of the probability map of the nucleus using two different approaches and the eccentricity of the fitting ellipse to the contour of the IVD. The classification method was evaluated using a cohort of 150 intervertebral discs assessed by three experts, resulting in a mean specificity (93%) and sensitivity (83%) similar to the one provided by every expert with respect to the most voted value. The segmentation accuracy was evaluated using the Dice Similarity Index (DSI) and Root Mean Square Error (RMSE) of the point-to-contour distance. The mean DSI ± 2 standard deviation was 91:7% ±5:6%, the mean RMSE was 0:82mm and the 95 percentile was 1:36mm. These results were found accurate when compared to the state-of-the-art.

  5. 椎间盘镜手术治疗腰椎间盘突出症124例临床观察%Intervertebral disc surgery treated on 124 cases with lumbar disc herniation

    李再学; 谢文伟; 冉雪莲; 姚汉刚; 苏厂尧

    2016-01-01

    Objective:To investigate the clinical effect of intervertebral disc surgery in the treatment of lumbar intervertebral disc herniation.Methods:124 cases o lumbar intervertebral disc herniation were selected.They were treated with intervertebral disc surgery.Results:They were followed up from 6~12 months,with an average of 8.4 months.The excellent and good rate was 98.6%. Conclusion: effect of intervertebral disc surgery in the treatment of lumbar intervertebral disc herniation is significant.%目的:探讨椎间盘镜手术治疗腰椎间盘突出症的临床效果。方法:选取124例腰椎间盘突出症患者,均实施了椎间盘镜间盘髓核摘除术。结果:本组124例,随访6~12个月,平均8.4个月,优良率98.6%。结论:椎间盘镜手术治疗腰椎间盘突出症效果显著。

  6. Intervertebral anticollision constraints improve out-of-plane translation accuracy of a single-plane fluoroscopy-to-CT registration method for measuring spinal motion

    Lin, Cheng-Chung; Tsai, Tsung-Yuan; Hsu, Shih-Jung [Institute of Biomedical Engineering, National Taiwan University, Taiwan 10051 (China); Lu, Tung-Wu [Institute of Biomedical Engineering, National Taiwan University, Taiwan 10051, Republic of China and Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taiwan 10617 (China); Shih, Ting-Fang [Department of Medical Imaging, National Taiwan University, Taiwan 10051 (China); Wang, Ting-Ming [Department of Orthopaedic Surgery, National Taiwan University Hospital, Taiwan 10051 (China)

    2013-03-15

    Purpose: The study aimed to propose a new single-plane fluoroscopy-to-CT registration method integrated with intervertebral anticollision constraints for measuring three-dimensional (3D) intervertebral kinematics of the spine; and to evaluate the performance of the method without anticollision and with three variations of the anticollision constraints via an in vitro experiment. Methods: The proposed fluoroscopy-to-CT registration approach, called the weighted edge-matching with anticollision (WEMAC) method, was based on the integration of geometrical anticollision constraints for adjacent vertebrae and the weighted edge-matching score (WEMS) method that matched the digitally reconstructed radiographs of the CT models of the vertebrae and the measured single-plane fluoroscopy images. Three variations of the anticollision constraints, namely, T-DOF, R-DOF, and A-DOF methods, were proposed. An in vitro experiment using four porcine cervical spines in different postures was performed to evaluate the performance of the WEMS and the WEMAC methods. Results: The WEMS method gave high precision and small bias in all components for both vertebral pose and intervertebral pose measurements, except for relatively large errors for the out-of-plane translation component. The WEMAC method successfully reduced the out-of-plane translation errors for intervertebral kinematic measurements while keeping the measurement accuracies for the other five degrees of freedom (DOF) more or less unaltered. The means (standard deviations) of the out-of-plane translational errors were less than -0.5 (0.6) and -0.3 (0.8) mm for the T-DOF method and the R-DOF method, respectively. Conclusions: The proposed single-plane fluoroscopy-to-CT registration method reduced the out-of-plane translation errors for intervertebral kinematic measurements while keeping the measurement accuracies for the other five DOF more or less unaltered. With the submillimeter and subdegree accuracy, the WEMAC method was

  7. Intervertebral disc degeneration and bone density in degenerative lumbar scoliosis: a comparative study between patients with degenerative lumbar scoliosis and patients with lumbar stenosis

    DING Wen-yuan; YANG Da-long; CAO Lai-zhen; SUN Ya-peng; ZHANG Wei; XU Jia-xin; ZHANG Ying-ze; SHEN Yong

    2011-01-01

    Background Degenerative lumbar scoliosis is common in older patients.Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis.A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed.The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study.Methods From January 2001 to August 2010,96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls.Cobb angle,height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides,the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group.The height of L2/L3,L3/L4,L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group.The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups.The bone density of lumbar vertebrae was measured with dual-energy X-ray.Results In scoliosis group,the intervertebral disc height on the convex side was greater than the height on the concave side (P <0.001 ).The vertebral body height on the convex side was greater than the height on the concave side (P=0.016).There was a significant difference between the scoliosis group and the control group (P=0.003),and between T-value and the rate of osteoporosis between the two groups (both P <0.001).Results were verified using multiple linear regression analysis.Conclusions Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces.There is a positive correlation between the angle of scoliosis and

  8. Intervertebral anticollision constraints improve out-of-plane translation accuracy of a single-plane fluoroscopy-to-CT registration method for measuring spinal motion

    Purpose: The study aimed to propose a new single-plane fluoroscopy-to-CT registration method integrated with intervertebral anticollision constraints for measuring three-dimensional (3D) intervertebral kinematics of the spine; and to evaluate the performance of the method without anticollision and with three variations of the anticollision constraints via an in vitro experiment. Methods: The proposed fluoroscopy-to-CT registration approach, called the weighted edge-matching with anticollision (WEMAC) method, was based on the integration of geometrical anticollision constraints for adjacent vertebrae and the weighted edge-matching score (WEMS) method that matched the digitally reconstructed radiographs of the CT models of the vertebrae and the measured single-plane fluoroscopy images. Three variations of the anticollision constraints, namely, T-DOF, R-DOF, and A-DOF methods, were proposed. An in vitro experiment using four porcine cervical spines in different postures was performed to evaluate the performance of the WEMS and the WEMAC methods. Results: The WEMS method gave high precision and small bias in all components for both vertebral pose and intervertebral pose measurements, except for relatively large errors for the out-of-plane translation component. The WEMAC method successfully reduced the out-of-plane translation errors for intervertebral kinematic measurements while keeping the measurement accuracies for the other five degrees of freedom (DOF) more or less unaltered. The means (standard deviations) of the out-of-plane translational errors were less than −0.5 (0.6) and −0.3 (0.8) mm for the T-DOF method and the R-DOF method, respectively. Conclusions: The proposed single-plane fluoroscopy-to-CT registration method reduced the out-of-plane translation errors for intervertebral kinematic measurements while keeping the measurement accuracies for the other five DOF more or less unaltered. With the submillimeter and subdegree accuracy, the WEMAC method was

  9. Braden评分法在预防胸腰椎骨折并发压疮患者中的应用%Application of Braden scoring method in the prevention of bedsore in the patients with thoracolumbar fractures

    张敏

    2012-01-01

    Objective: To explore the effect of nursing intervention in the light of Braden scoring method in the prevention of bedsore in patients with thoracolumbar fractures . Methods: 138 patients with thoracolumbar fractures were randomly divided into a control group ( n= 65) and an experimental group (n =73) in order of admission. The conventional grading nursing method was implemented in the control group and Braden scoring method was used to predict the potential risk of bedsore in the patients with thoracolumbar fractures in the exper -imental group, and then the grading nursing care was given to the patients according to the scores of potential risk . Results: Bedsore occurred in one patient in the experimental group and 6 patients in the control group ,the difference was statistically significant between the two groups (P <0.05). Conclusion:The early warning nursing intervention by following Braden scoring method can effectively reduce the incidence of bedsore in the patients with thoracolumbar fractures .%目的:探讨Braden评分法护理干预对预防胸腰椎骨折患者压疮发生的疗效.方法:将138例胸腰椎骨折患者按入院先后顺序随机分为对照组65例和实验组73例,对照组采用传统分级护理方法护理,实验组应用Braden评分法预测胸腰椎骨折卧床患者压疮发生的潜在危险度,根据分值进行分级护理.结果:实验组发生压疮1例,对照组发生压疮6例,两组比较差异有统计学意义(P<0.05).结论:采用Braden评分法预警干预护理能有效降低胸腰椎骨折卧床患者压疮的发生率.

  10. 不同术式治疗腰椎管肿瘤合并腰椎间盘突出患者疼痛的疗效观察%Curative effects observation of different therapies to treat patients' pains of lumbar spine tube tumor combined with prolapse of lumbar intervertebral disc

    2001-01-01

    @@Background: There was seldom report on lumbar spine tube tumor combined with prolapse of lumbar intervertebral disc. In clinical treatment doctors are usually satisfied by the discovery of prolapse of lumbar intervertebral disc, and neglect the existence of tumor. The main symptoms are lumbago, and its obviously when patients rest at night. Objective: To explore curative effects of different therapies to treat patients' pains of lumbar spine tube tumor combined with prolapse of lumbar intervertebral disc. Unit: People Hospital of Taizhou City.

  11. Towards an Intelligent Intervertebral Disc Prosthesis for the Assessment of Spinal Loading

    Pancholi, M.

    2010-01-01

    Low back pain is an economic and social burden to society. Low back pain is considered to be a chronic problem when the causes are due degenerative disc diseases and damaged vertebrae. The main causes for degenerative disc are extremely complex and still not well understood, although in their majority are strongly related to the acute and frequent mechanical loading on the spine. Knowledge that might shed more light on such pathologies is the availability of in vivo human spinal disc loading ...

  12. Comparing Single Versus Double Screw-Rod Anterior Instrumentation for Treating Thoracolumbar Burst Fractures with Incomplete Neurological Deficit: A Prospective, Randomized Controlled Trial.

    Yu, Yu; Wang, Juan; Shao, Gaohai; Wang, Qunbo; Li, Bo

    2016-01-01

    BACKGROUND Following a thoracolumbar burst fracture (TCBF), anterior screw-rods apply pressure upon the graft site. However, there is limited evidence comparing single screw-rod anterior instrumentation (SSRAI) to double screw-rod anterior instrumentation (DSRAI) for TCBFs. Our objective was to compare SSRAI versus DSRAI for TCBFs with incomplete neurological deficit. MATERIAL AND METHODS A total of 51 participants with T11-L2 TCBFs (AO classification: A3) were randomly assigned to receive SSRAI or DSRAI. Key preoperative, perioperative, and postoperative data were collected. Statistical analysis was conducted to determine the independent factors associated with inferior clinical outcomes, as well as the comparative efficacy of SSRAI and DSRAI. RESULTS There were no significant differences in the key demographic and clinical characteristics between the two groups (all p>0.05). Smoking status was significantly associated with inferior three-month and six-month Denis pain scores (Wald statistic=4.246, p=0.039). Both SSRAI and DSRAI were significantly effective in improving three-month and six-month postoperative degree of kyphosis, three-month and six-month postoperative ASIA impairment scale scores, three-month and six-month postoperative Denis pain score, and three-month and six-month postoperative Denis work score (all p0.05), DSRAI displayed significantly longer operating times, as well as significantly larger operative blood losses (both p<0.001). CONCLUSIONS SSRAI may be preferable over DSRAI for TCBFs with incomplete neurological deficit due to its lower operating time and amount of operative blood loss. PMID:27197020

  13. 胸腰椎单纯性屈曲性压缩性骨折的护理%explore the treatment and care of thoracolumbar vertebral fracture

    陈帆; 魏清; 蒋礼

    2013-01-01

    Objective:To explore the treatment and care of thoracolumbar vertebral fracture, body movement and the complications of the lower. Methods: A retrospective analysis was made on the clinical data of 47 cases of compression fractures of thoracic and lumbar spine simple sex from October, 1996 to August, 2012 in our hospital. Results: Through the careful treatment, decubitus care and prevention and treatment of complications, 47 patients of this group all got better;through the follow-up visits from half a year to 16 years, 47 patients of this group all recovered. Conclusion:Through the close observation of vital signs, limb function exercise and lumbar muscle exercise, 47 patients of this group have smoothly recovered.%  目的:探讨胸腰椎骨折治疗和护理,肢体运动,降低并发症。方法:回顾分析我院1996年10月~2012年8月47例胸腰椎单纯性屈曲性压缩性骨折的临床资料。结果:本组47例病经精心治疗、及卧姿护理,防治并发症均好转,经随访半年~16年47例均痊愈。结论:经密切观察生命体征,肢体功能运动及腰椎肌锻炼,均能顺利康复。

  14. Acute abdomen

    Acute abdomen may be connected with the injury of one of the internal organs, injury of large blood vessels, with the spreading of pains from some other area. It may also be a manifestation of systemic disease or poisoning. The main purposes of radiodiagnosis are: determination of the cause of clinical syndrome; determination of the localization and spreading of pathological changes in abdominal organs; finding out the character of complications. If the data of the ordinary roentgenological investiagtion and isn't complete, the computer tomography of abdominal and pelvic cavities is needed

  15. The influence of MatrigelTM or growth factor reduced MatrigelTMo n human intervertebral disc cell growth and proliferation

    Desai, B.J.; Gruber, H E; Hanley Jr., E.N.

    1999-01-01

    MatrigelTM (reconstituted basement membrane extract) is a potent inducer of cell growth and differentiation in vitro. This study examined phenotypic variation and proliferative responses of human annular intervertebral disc cells in vitro in MatrigelTM and Growth Factor Reduced MatrigelTM (GFR-MatrigelTM). Cells from age- and gender-matched control subjects and patients with degenerative disc disease were grown either on the surface of, or suspended within, eit...

  16. The effect of gamma irradiation on the biological properties of intervertebral disc allografts: in vitro and in vivo studies in a beagle model

    Ding, Yu; Ruan, Dike; Luk, Keith D. K.; He, Qing; Wang, Chaofeng

    2014-01-01

    Study Design An animal experiment about intervertebral disc allograft. Objective To explore the feasibility to decellularize disc allografts treated by 6°Co Gamma Irradiation, and simultaneously, to assess the possibility to make use of the decellularized natural disc scaffold for disc degeneration biotherapy. Summary of Background Data Studies of both animal and human disc allograft transplantation indicated that the disc allograft may serve as a scaffold to undertake the physiological respo...

  17. [Acute myocarditis].

    Combes, Alain

    2013-05-01

    Myocarditis is defined as inflammation of the myocardium accompanied by myocellular necrosis. Acute myocarditis must be considered in patients who present with recent onset of cardiac failure or arrhythmia. Fulminant myocarditis is a distinct entity characterized by sudden onset of severe congestive heart failure or cardiogenic shock, usually following a flu-like illness, parvovirus B19, human herpesvirus 6, coxsackievirus and adenovirus being the most frequently viruses responsible for the disease. Treatment of myocarditis remains largely supportive, since immunosuppression has not been proven to be beneficial for acute lymphocytic myocarditis. Trials of antiviral therapies, or immunostimulants such as interferons, suggest a potential therapeutic role but require further investigation. Lastly, early recognition of patients rapidly progressing to refractory cardiac failure and their immediate transfer to a medical-surgical center experienced in mechanical circulatory support is warranted. In this setting, ECMO should be the first-line mechanical assistance. For highly unstable patients, a Mobile Cardiac Assistance Unit, that rapidly travels to primary care hospitals with a portable ECMO system and hooks it up before refractory multiorgan failure takes hold, is the preferred option. PMID:23789482

  18. Expression and localization of estrogen receptor-β in annulus cells of the human intervertebral disc and the mitogenic effect of 17-β-estradiol in vitro

    Leslie Kelly

    2002-01-01

    Full Text Available Abstract Background Recent evidence suggests that estrogens exert effects in different tissues throughout the body, and that the estrogen receptor β (ERβ may be important for the action of estrogen (17-β-estradiol on the skeleton. The cellular localization of ERβ in the human intervertebral disc, however, has not yet been explored. Methods Human disc tissue and cultured human disc cells were used for immunocytochemical localization of ERβ. mRNA was isolated from cultured human disc cells, and RT-PCR amplification of ERβ was employed to document molecular expression of this receptor. Cultured human disc cells were tested to determine if 17-β-estradiol stimulated cell proliferation. Results In this report data are presented which provide evidence for ERβ gene expression in human intervertebral disc cells in vivo and in vitro. Culture of annulus cells in the presence of 10-7 M 17-β-estradiol significantly increased cell proliferation. Conclusions These data provide new insight into the biology of cells in the annulus of the intervertebral disc.

  19. Narrowing of lumbar spinal canal predicts chronic low back pain more accurately than intervertebral disc degeneration: a magnetic resonance imaging study in young Finnish male conscripts.

    Visuri, Tuomo; Ulaska, Jaana; Eskelin, Marja; Pulkkinen, Pekka

    2005-11-01

    The objective of this magnetic resonance imaging study was to evaluate the role of degenerative changes, developmental spinal stenosis, and compression of spinal nerve roots in chronic low back (CLBP) and radicular pain in Finnish conscripts. The degree of degeneration, protrusion, and herniation of the intervertebral discs and stenosis of the nerve root canals was evaluated, and the midsagittal diameter and cross-sectional area of the lumbar vertebrae canal were measured in 108 conscripts with CLBP and 90 asymptomatic controls. The midsagittal diameters at L1-L4 levels were significantly smaller in the patients with CLBP than in the controls. Moreover, degeneration of the L4/5 disc and protrusion or herniation of the L5/S1 disc and stenosis of the nerve root canals at level L5/S1 were more frequent among the CLBP patients. Multifactorial analysis of the magnetic resonance imaging findings provided a total explanatory rate of only 33%. Narrowing of the vertebral canal in the anteroposterior direction was more likely to produce CLBP and radiating pain than intervertebral disc degeneration or narrowing of the intervertebral nerve root canals. PMID:16450819

  20. RECURRENT SEASONAL ACUTE PSYCHOSIS

    Agarwal, Vivek

    1999-01-01

    Acute psychoses have been reported to occur more frequently in summer. This is a report of seasonal recurrence of acute psychosis in a patient. This case report emphasizes towards the biological etiology of acute psychoses.

  1. Acute cerebellar ataxia

    Cerebellar ataxia; Ataxia - acute cerebellar; Cerebellitis; Post-varicella acute cerebellar ataxia; PVACA ... Acute cerebellar ataxia in children, especially younger than age 3, may occur several weeks after an illness caused by a virus. ...

  2. Para-muscular and trans-muscular approaches to the lumbar inter-vertebral foramen: an anatomical comparison Acessos paramuscular e transmuscular ao forame intervertebral lombar: comparação anatômica

    Arthur Werner Poetscher

    2005-03-01

    Full Text Available Foraminal and extra-foraminal disc herniations comprise up to 11.7% of all lumbar disc herniations. Facetectomy, which had been the classic approach, is now recognized as cause of pain and instability after surgery. Otherwise, posterior lateral approaches through a trans-muscular or a para-muscular technique offer no significant damage to key structures for spinal stability. The surgical anatomy of these approaches has already been described, but they were not compared. In order to quantify the angle of vision towards the intervertebral foramen offered by each technique, 12 fresh cadavers were dissected and studied regarding these approaches. The angle presented by trans-muscular approach was wider in all studied lumbar levels. Surgery through the trans-muscular approach is performed with a better working angle, requiring a smaller resection of surrounding tissues. Therefore, minor surgical trauma can be expected. Our measurements support previously published data that point the trans-muscular approach as the best surgical option.As hérnias de disco lombares apresentam-se como foraminais ou extra-foraminais em até 11,7% dos casos. Seu tratamento cirúrgico através de facetectomias pode causar dor e instabilidade, o que não ocorre com a utilização de acessos cirúrgicos posteriores laterais ao canal central, quer seja por via transmuscular ou paramuscular. Nosso objetivo foi comparar o ângulo de trabalho relativo ao forame intervertebral permitido por cada via e avaliar possíveis implicações cirúrgicas. Dissecções e medidas realizadas em doze cadáveres frescos demonstraram que este ângulo é maior na via transmuscular em todos os níveis lombares estudados. Dado que um ângulo mais favorável permite uma ressecção menor das estruturas envolvidas para que se estabeleça o campo de trabalho, a cirurgia por meio da via transmuscular permitirá, então, um trauma cirúrgico menor. Nossos resultados corroboram publicações pr

  3. Biomechanical properties of monosegmental pedicle screw fixation via the fractured thoracolumbar vertebrae%经胸腰段伤椎单节段椎弓根螺钉固定后的生物力学特性

    刘上楼; 徐军; 倪卓民; 张云庆; 周枫; 姜雪峰

    2013-01-01

    背景:临床常采用经伤椎椎弓根螺钉内固定治疗胸腰椎骨折,研究已证实经伤椎双侧椎弓根螺钉固定后脊柱稳定性加强,但也有研究认为经伤椎单节段椎弓根螺钉固定足以增加脊柱的稳定性,但此结论缺乏生物力学结果支持。  目的:观察胸腰段椎体骨折经伤椎单节段固定的相关生物力学特性。  方法:取扬州大学医学院解剖教研室提供8具中国人新鲜胸腰段标本(T11-L3),锯条横断2/3椎体,制成完整胸腰段椎体实验标本,将8具标本等分成跨伤椎固定组和单节段经伤椎固定组,分别在跨伤椎临近椎体四钉固定和临近椎体四钉固定+经伤椎单侧椎弓根固定。  结果与结论:胸腰段椎体骨折后经跨伤椎固定与经单节段伤椎固定的载荷-应变关系相差12%、载荷-位移关系相差11%、强度相差18%、轴向刚度相差11%、扭转力相差11%及拔出力相差1.8%,两组差异有显著性意义(P OBJECTIVE:To evaluate the biomechanical properties of monosegmental pedicle screws fixation via fractured vertebrae for thoracolumbar fracture. METHODS:Eight cadavers’ thoracolumbar specimens (T11-L3) were provided by the Department of Anatomy, Yangzhou University School of Medicine. Saw was used to transect 2/3 of the vertebrae in order to make complete experimental thoracolumbar specimens. Eight specimens were divided into two group;beyond-fractured vertebrae fixation group and monosegmental fixation via fracture vertebrae group. The specimens in the two groups were treated with adjacent vertebral four screw fixation beyond fractured vertebrae and adjacent vertebral four screw fixation+monosegmental pedicle screw fixation via fractured vertebrae respectively. RESULTS AND CONCLUSION:After thoracolumbar fracture, the differences between beyond fractured vertebrae fixation and monosegmental pedicle screw fixation via fractured vertebrae were as fol ows

  4. Acute Myopericarditis Mimicking Acute Myocardial Infarction

    Seval İzdeş; Neriman Defne Altıntaş; Gülin Karaaslan; Recep Uygun; Abdulkadir But

    2011-01-01

    Acute coronary syndromes among young adults are relatively low when compared with older population in the intensive care unit. Electrocardiographic abnormalities mimicking acute coronary syndromes may be caused by non-coronary syndromes and the differential diagnosis requires a detailed evaluation. We are reporting a case of myopericarditis presenting with acute ST elevation and elevated cardiac enzymes simulating acute coronary syndrome. In this case report, the literature is reviewed to dis...

  5. Early diagnosis and treatment of acute or subacute spinal epidural hematoma

    YU Hang-ping; FAN Shun-wu; YANG Hui-lin; TANG Tian-si; ZHOU Feng; ZHAO Xing

    2007-01-01

    Background Despite low morbidity, acute or subacute spinal epidural hematoma may develop quickly with a high tendency to paralysis. The delay of diagnosis and therapy often leads to serious consequences. In this study we evaluated the effects of a series of methods for the diagnosis and treatment of the hematoma in 11 patients seen in our hospital.Methods Of the 11 patients (8 males and 3 females), 2 had the hematoma involving cervical segments, 2 cervico-thoracic, 4 thoracic, 1 thoraco-lumbar, and 2 lumbar. Three patients had quadriplegia, including one with central cord syndrome; another had Brown-Sequard's syndrome; and the other seven had paraplegia. Five patients were diagnosed at our hospitals within 3-48 hours afterappearance of symptoms, and 6 patients were transferred from community hospitals within 21-106 hours after development of symptoms. Key dermal points, key muscles and the rectal sphincter were determined according to the American Spinal Injury Society Impairment Scales as scale A in two patients,B in 5 and C in 4. Emergency MRI in each patient confirmed that the dura mater was compressed in the spinal canal, with equal intensity or hyperintensity on T1 weighted image and mixed hyperintensity on T2 weighted image. Preventive and curative measures were taken preoperatively and emergency operation was performed in all patients. Open laminoplasty was done at the cervical and cervico-thoracic segments, laminectomy at the thoracic segments, laminectomy with pedicle screw fixation at the thoraco-lumbar and lumbar segments involving multiple levels, and double-sided laminectomy with the integrity of articular processes at the lumbar segments involving only a single level. During the operation, special attention was given to hematoma evacuation, hemostasis and drainage tube placement.Results Neither uncontrollable hemorrhage nor postoperative complications occurred. All patients were followed up for 1-6 years. A marked difference was noted between

  6. Microscale Material Properties of Bone and the Mineralized Tissues of the Intervertebral Disc-Vertebral Body Interface

    Paietta, Rachel C.

    The objective of this dissertation is to understand the influences of material structure on the properties, function and failure of biological connective tissues. Biological interfaces are becoming an increasingly studied system within mechanics and tissue engineering as a model for attaching dissimilar materials. The elastic modulus of bone (≈ 20 GPa) and cartilage (≈ 0.1-1 MPa) differ over orders of magnitude, which should intuitively create high stress concentrations and failure at the interface. Yet, these natural interface systems rarely fail in vivo, and the mechanism by which loads are transferred between tissues has not yet been established. Tissue quality is one major contributor to the mechanical behavior of bone and cartilage, and is defined by properties such as collagen orientation, mineral volume fraction, porosity and tissue geometry. These properties have yet to be established at the bone-cartilage interface in the spine, and the lack of quantitative data on material microstructure and behavior limits treatments and tissue engineering construct design. In this dissertation, second harmonic generation imaging, quantitative backscattered scanning electron imaging and nanoindentation are combined to characterize micrometer scale tissue quality and modulus in both bone and calcified cartilage. These techniques are utilized to: 1) determine the hierarchical micrometer to millimeter scale properties of lamellar bone, 2) quantify changes throughout development and aging at the human intervertebral disc-vertebral body junction, and 3) explore compressive fractures at this interface. This work is the first to provide quantitative data on the mineral volume fraction, collagen orientation and modulus from the same, undecalcified sections of tissue to corroborate tissue structure and mineralization and describe quantitative parameters of the interface. The principal findings from this work indicate that the underlying matrix, or collagen, organization in

  7. Biomechanics of artificial intervertebral disk and nucleus prosthesis%人工椎间盘及髓核假体的生物力学

    李玉成; 邢星; 孙文才

    2012-01-01

    BACKGROUND: Whether total intervertebral disk or nucleus prosthesis accorded with anatomical characteristics and biomechanics of human intervertebral disk was a focus of recent studies.OBJECTIVE: To summarize the types and biomechanical characteristics of artificial intervertebral disk and nucleus prosthesis. METHODS: The first author retrieved Wanfang Database, China National Knowledge Infrastructure and PubMed Database for literatures published from 1989 to 2011. The key words were “intervertebral diac, nucleus pulposus, artificial prosthesis, biomechanics". Articles regarding types and biomechanical characteristics of artificial intervertebral disk and nucleus prosthesis were included, and repetitive studies were excluded. Totally 72 articles were retrieved. In accordance with inclusion and exclusion criteria, 26 articles were included.RESULTS AND CONCLUSION: At present, materials for artificial intervertebral disk included cobalt-chromium alloy, titanium alloy, stainless steel, ceramics and ultrahigh molecular weight polyethylene. Bryan prosthesis was widely used in clinic. In vitro study, three dimensional finite element analysis and clinical study have confirmed good biomechanical characteristics and high success replacement rate. Artificial nucleus pulposus prosthesis contained prefabricated type and in situ polymerization type. It could obtain small surgery injury, and was a focus of recent studies. However, it is difficult to reach biomechanical function of human nucleus pulposus. To discover novel materials and to design individual prosthesis are future development directions.%背景:全椎间盘或髓核假体是否符合人的椎间盘的解剖特点、生物力学是目前关注的焦点.目的:综述目前存在的人工椎间盘及髓核假体的类型及其生物力学特征.方法:由第一作者用计算机检索万方数据库、中国期刊全文数据库和PubMed数据库,检索时间:1989/2011,检索词分别为"椎间盘、髓核、人工假体、生物力学"和"intervertebral

  8. Osteoporotic compression fracture of the thoracolumbar spine and sacral insufficiency fracture: incidence and analysis of the relationship according to the clinical factors

    Kong, Jeong Hwa; Park, Ji Sun; Ryu, Kyung Nam [Kyunghee University Hospital, Seoul (Korea, Republic of)

    2006-11-15

    To evaluate the incidence of sacral insufficiency fracture in osteoporotic patient with compression fracture of the thoracolumbar (T-L) spine on magnetic resonance image (MRI), and to analyze the correlation of variable clinical factors and the incidence of sacral insufficiency fracture. We retrospectively reviewed 160 patients (27 men, 133 women; age range of 50 to 89 years) who underwent spinal MRI and had compression fracture of the T-L spine. Compression fractures due to trauma or tumor were excluded. We evaluated the incidence of sacral insufficiency fracture according to the patients' age, sex, number of compression fractures, and the existence of bone marrow edema pattern of compression fracture. During the same period, we evaluated the incidence of spinal compression fracture in the patients of pelvic insufficiency fracture. Out of the 160 patients who had compression fracture in the T-L spine, 17 (10.6%) had insufficiency fracture of the sacrum. Compression fracture occurred almost 5 times more frequently in women (27:133), but the incidence of sacral insufficiency fracture was 2/27 for men (7.4%) and 15/133 for women (11.3%), with no statistically significant difference ({rho} = 0.80). According to age, the ratio of insufficiency fracture to compression fracture was 0% (0/23) in the 50's, 10.6% (7/66) in the 60's, 12.5% (7/56) in the 70's, and 20.0% (3/15) in the 80's. In respect of single and multiple compression fracture, the incidence of sacral insufficiency fracture was 8/65 for men (12.3%) and 9/95 for women (9.5%), showing no significant difference ({rho} = 0.37). In the patients with and without compression fracture with bone marrow edema, insufficiency fracture occurred in 5/76 (6.6%) and 12/84 (14.3%), respectively. On the other hand, of the 67 patients who had pelvic insufficiency fracture, 27 (40.3%) also had spinal compression fracture. About 10% of the patients with osteoporotic compression fracture in the T/L spine

  9. Type II collagen-hyaluronan hydrogel – a step towards a scaffold for intervertebral disc tissue engineering

    L Calderon

    2010-09-01

    Full Text Available Intervertebral disc regeneration strategies based on stem cell differentiation in combination with the design of functional scaffolds is an attractive approach towards repairing/regenerating the nucleus pulposus. The specific aim of this study was to optimise a composite hydrogel composed of type II collagen and hyaluronic acid (HA as a carrier for mesenchymal stem cells. Hydrogel stabilisation was achieved by means of 1-ethyl-3(3-dimethyl aminopropyl carbodiimide (EDC and N-hydroxysuccinimide (NHS cross-linking. Optimal hydrogel properties were determined by investigating different concentrations of EDC (8mM, 24mM and 48mM. Stable hydrogels were obtained independent of the concentration of carbodiimide used. The hydrogels cross-linked by the lowest concentration of EDC (8mM demonstrated high swelling properties. Additionally, improved proliferation of seeded rat mesenchymal stem cells (rMSCs and hydrogel stability levels in culture were observed with this 8mM cross-linked hydrogel. Results from this study indicate that EDC/NHS (8mM cross-linked type II collagen/HA hydrogel was capable of supporting viability of rMSCs, and furthermore their differentiation into a chondrogenic lineage. Further investigations should be conducted to determine its potential as scaffold for nucleus pulposus regeneration/repair.

  10. BMP7 enhances the effect of BMSCs on extracellular matrix remodeling in a rabbit model of intervertebral disc degeneration.

    Xu, Jun; E, Xiao-Qiang; Wang, Nan-Xiang; Wang, Mo-Nan; Xie, Huan-Xin; Cao, Yan-Hui; Sun, Li-Hua; Tian, Jun; Chen, Hua-Jiang; Yan, Jing-Long

    2016-05-01

    Intervertebral discs (IVDs) provide stability and flexibility to the spinal column; however, IVDs, and in particular the nucleus pulposus (NP), undergo a degenerative process characterized by changes in the disc extracellular matrix (ECM), decreased cell viability, and reduced synthesis of proteoglycan and type II collagen. Here, we investigated the efficacy and feasibility of stem cell therapy using bone marrow mesenchymal stem cells (BMSCs) over-expressing bone morphogenetic protein 7 (BMP7) to promote ECM remodeling of degenerated IVDs. Lentivirus-mediated BMP7 over-expression induced differentiation of BMSCs into an NP phenotype, as indicated by expression of the NP markers collagen type II, aggrecan, SOX9 and keratins 8 and 19, increased the content of glycosaminoglycan, and up-regulated β-1,3-glucuronosyl transferase 1, a regulator of chondroitin sulfate synthesis in NP cells. These effects were suppressed by Smad1 silencing, indicating that the effect of BMP7 on ECM remodeling was mediated by the Smad pathway. In vivo analysis in a rabbit model of disc degeneration showed that implantation of BMSCs over-expressing BMP7 promoted cell differentiation and proliferation in the NP, as well as their own survival, and these effects were mediated by the Smad pathway. The results of the present study indicate the beneficial effects of BMP7 on restoring ECM homeostasis in NP cells, and suggest potential strategies for improving cell therapy for the treatment of disc diseases. PMID:26929154

  11. Ultrastructure of Intervertebral Disc and Vertebra-Disc Junctions Zones as a Link in Etiopathogenesis of Idiopathic Scoliosis

    Evalina L. Burger

    2014-01-01

    Full Text Available Background Context. There is no general accepted theory on the etiology of idiopathic scoliosis (IS. An important role of the vertebrae endplate physes (VEPh and intervertebral discs (IVD in spinal curve progression is acknowledged, but ultrastructural mechanisms are not well understood. Purpose. To analyze the current literature on ultrastructural characteristics of VEPh and IVD in the context of IS etiology. Study Design/Setting. A literature review. Results. There is strong evidence for multifactorial etiology of IS. Early wedging of vertebra bodies is likely due to laterally directed appositional bone growth at the concave side, caused by a combination of increased cell proliferation at the vertebrae endplate and altered mechanical properties of the outer annulus fibrosus of the adjacent IVD. Genetic defects in bending proteins necessary for IVD lamellar organization underlie altered mechanical properties. Asymmetrical ligaments, muscular stretch, and spine instability may also play roles in curve formation. Conclusions. Development of a reliable, cost effective method for identifying patients at high risk for curve progression is needed and could lead to a paradigm shift in treatment options. Unnecessary anxiety, bracing, and radiation could potentially be minimized and high risk patient could receive surgery earlier, rendering better outcomes with fewer fused segments needed to mitigate curve progression.

  12. Biomechanical effect of vertebroplasty on the adjacent intervertebral levels using a three-dimensional finite element analysis

    LU Sheng; XU Yong-qing; ZHANG Mei-chao; TANG Xun; WANG Yue-li; ZHONG Shi-zheng

    2007-01-01

    Objective: To investigate the biomechanical effect of different volume,distribution and leakage to adjacent disc of bone cement on the adjacent vertebral body by three-dimensional osteoporosis finite element model of lumbar.Methods: L4-L5 motion segment data of the cadaver of an old man who had no abnormal findings on roentgenograms were obtained from computed tomography (CT) scans. Three-dimensional model of L4-L5 was established with Mimics software, and finite element model of L4-L5 functional spinal unit (FSU) was established by Ansys 7.0 software. The effect of different loading conditions and distribution of bone cement after vertebroplasty on the adjacent vertebral body was investigated.Results: This study presented a validated finite element model of L4-L5 FSU with a simulated vertebroplasty augmentation to predict stresses and strains of adjacent untreated vertebral bodies. The findings from this FSU study suggested the endplate and disc stress of the adjacent vertebral body was not influenced by filling volume of bone cement but unipedicle injection and leakage to the disc of bone cement could concentrate the stress of adjacent endplate.Conclusions: Asymmetric distributions and leakage of cement into intervertebral disc can improve the stress of endplate in adjacent vertebral body. These results suggest that optimal biomechanical configuration should have symmetric placement and avoid leakage of cement in operation.

  13. Geometrical aspects of patient-specific modelling of the intervertebral disc: collagen fibre orientation and residual stress distribution.

    Marini, Giacomo; Studer, Harald; Huber, Gerd; Püschel, Klaus; Ferguson, Stephen J

    2016-06-01

    Patient-specific modelling of the spine is a powerful tool to explore the prevention and the treatment of injuries and pathologies. Albeit several methods have been proposed for the discretization of the bony structures, the efficient representation of the intervertebral disc anisotropy remains a challenge, especially with complex geometries. Furthermore, the swelling of the disc's nucleus pulposus is normally added to the model after geometry definition, at the cost of changes of the material properties and an unrealistic description of the prestressed state. The aim of this study was to develop techniques, which preserve the patient-specific geometry of the disc and allow the representation of the system anisotropy and residual stresses, independent of the system discretization. Depending on the modelling features, the developed approaches resulted in a response of patient-specific models that was in good agreement with the physiological response observed in corresponding experiments. The proposed methods represent a first step towards the development of patient-specific models of the disc which respect both the geometry and the mechanical properties of the specific disc. PMID:26243011

  14. Best Paper NASS 2013: Link-N can stimulate proteoglycan synthesis in the degenerated human intervertebral discs

    R Gawri

    2013-09-01

    Full Text Available Intervertebral disc (IVD degeneration is the most common cause of back pain. Presently there is no medical treatment, leaving surgery as the only offered option. Here we evaluate the potential of Link-N to promote extracellular matrix regeneration in human IVDs. Human disc cells cultured in alginate and intact human discs were exposed to a combination of Link-N and 35SO4 in the presence or absence of interleukin (IL-1, and the effect on proteoglycan synthesis was evaluated. In addition, message levels of aggrecan, matrix metalloproteinase (MMP-3, MMP-13, a Disintegrin And Metalloproteinase with Thrombospondin Motifs (ADAMTS-4 and ADAMTS-5 were evaluated in alginate cultures. Human disc cells responded in a dose dependent manner with maximal proteoglycan synthesis at 1 µg/mL Link-N. Link-N treatment also induced proteoglycan synthesis in intact human discs, and a prolonged effect was found up to one week after Link-N treatment. Message levels of proteinases were decreased by Link-N in the presence of IL-1. Thus, Link-N can promote proteoglycan synthesis and deplete proteinase expression in adult human discs. Link-N could therefore be a promising candidate for biologically-induced disc repair, and could provide an alternative to surgical intervention for early stage disc degeneration.

  15. Genetic Polymorphisms of Interleukin-1 Alpha and the Vitamin D Receptor in Mexican Mestizo Patients with Intervertebral Disc Degeneration

    Salvador Cervin Serrano

    2014-01-01

    Full Text Available Intervertebral disc degeneration (IDD is the most common diagnosis in patients with back pain, a leading cause of musculoskeletal disability worldwide. Several conditions, such as occupational activities, gender, age, and obesity, have been associated with IDD. However, the development of this disease has strong genetic determinants. In this study, we explore the possible association between rs1800587 (c.-949C>T of interleukin-1 alpha (IL1A and rs2228570 (c.2T>V and rs731236 (c.1056T>C of vitamin D receptor (VDR gene polymorphisms and the development of IDD in northwestern Mexican Mestizo population. Gene polymorphisms were analyzed by polymerase chain reaction followed by restriction fragment length polymorphism, in two groups matched by age and gender: patients with symptomatic lumbar IDD n=100 and subjects with normal lumbar-spine MRI-scans n=100. Distribution of the mutated alleles in patients and controls was 27.0% versus 28.0% P=0.455 for T of rs1800587 (IL1A; 53.0% versus 58.0% P=0.183 for V of rs2228570 (VDR; and 18.0% versus 21.0% P=0.262 for C of rs731236 (VDR. Our results showed no association between the studied polymorphisms and IDD in this population. This is the first report on the contribution of gene polymorphisms on IDD in a Mexican population.

  16. Porous titanium-nickel for intervertebral fusion in a sheep model: part 2. Surface analysis and nickel release assessment.

    Assad, M; Chernyshov, A V; Jarzem, P; Leroux, M A; Coillard, C; Charette, S; Rivard, C H

    2003-02-15

    Porous titanium-nickel (PTN) devices represent an alternative to traditional cage implants. PTN materials possess an interconnecting network of pores with capillarity properties that may promote bone ingrowth, long-term fixation, and intervertebral fusion without the need for bone grafting. However, their considerable surface area and nickel content may elicit concerns over sensitization potential. Therefore, PTN surface corrosion and nickel release resistance must be carefully studied. To evaluate this possibility, a PTN interbody fusion device (IFD) was compared to a conventional nonporous cage made of TiAlV, a well-known biocompatible biomaterial, in a sheep model. PTN and TiAlV IFDs were inserted at two non-contiguous lumbar sites for 3, 6, and 12 months postsurgery. Their surface was then evaluated by scanning electron microscopy (SEM) combined with backscattered electron analysis (BSE). No evidence of surface corrosion was observed either pre- or postimplantation, regardless of device type. Dosage of nickel ions was also performed with the use of inductively coupled plasma-mass spectrometry (ICP-MS). Blood nickel levels were observed to be within acceptable levels at all postinstrumentation times. Nickel content in PTN-adjacent tissue, as well as in detoxification and remote organs, was equivalent both in PTN-treated and control sheep. Therefore, porous titanium-nickel demonstrated resistance to both in vivo surface corrosion and nickel ion release and compared very well with a conventional titanium implant in the course of a 12-month sheep study. PMID:12516086

  17. Lumbar intervertebral disc abnormalities: comparison of quantitative T2 mapping with conventional MR at 3.0 T

    Trattnig, Siegfried [Medical University of Vienna, Department of Radiology, MR Centre-Highfield MR, Vienna (Austria); Ludwig Boltzmann Institute for Clinical and Experimental Traumatology, Austrian Cluster for Tissue Regeneration, Vienna (Austria); Stelzeneder, David; Goed, Sabine; Reissegger, Michael [Medical University of Vienna, Department of Radiology, MR Centre-Highfield MR, Vienna (Austria); Mamisch, Tallal C. [Inselspital Berne, Orthopedic Surgery Department, Berne (Switzerland); Paternostro-Sluga, Tatjana [Medical University of Vienna, Department of Physical Medicine and Rehabilitation, Vienna (Austria); Weber, Michael [Medical University of Vienna, Department of Radiology, Vienna (Austria); Szomolanyi, Pavol [Medical University of Vienna, Department of Radiology, MR Centre-Highfield MR, Vienna (Austria); Slovak Academy of Sciences, Department of Imaging Methods, Institute of Measurement Science, Bratislava (Slovakia); Welsch, Goetz H. [Medical University of Vienna, Department of Radiology, MR Centre-Highfield MR, Vienna (Austria); University Hospital of Erlangen, Department of Trauma Surgery, Erlangen (Germany)

    2010-11-15

    To assess the relationship of morphologically defined lumbar disc abnormalities with quantitative T2 mapping. Fifty-three patients, mean age 39 years, with low back pain were examined by MRI at 3 T (sagittal T1-fast spin echo (FSE), three-plane T2-FSE for morphological MRI, multi-echo spin echo for T2 mapping). All discs were classified morphologically. Regions of interest (ROIs) for the annulus were drawn. The space in between was defined as the nucleus pulposus (NP). To evaluate differences between the classified groups, univariate ANOVA with post hoc Games-Howell and paired two-tailed t tests were used. In 265 discs we found 39 focal herniations, 10 annular tears, 123 bulging discs and 103 ''normal discs''. T2 values of the NP between discs with annular tear and all other groups were statistically significantly different (all p {<=} 0.01). Discs with annular tears showed markedly lower NP T2 values than discs without. The difference in NP T2 values between discs with focal herniation and normal discs (p = 0.005) was statistically significant. There was no difference in NP T2 values between bulging and herniated discs (p = 0.11) Quantitative T2 mapping of the nucleus pulposus of the intervertebral disc in the lumbar spine at 3 T reveals significant differences in discs with herniation and annular tears compared with discs without these abnormalities. (orig.)

  18. Acute abdomen

    The book first presents the anatomy and physiology of the abdomen and continues with chapters discussing clinical and laboratory aspects and a suitable order of diagnostic examinations with reference to the acute processes, explaining the diagnostic tools: ultrasonography, radiography including angiography and CT, tapping techniques and endoscopy together with their basic principles, examination techniques, and diagnosis. One chapter presents a complete survey of the processes involving the entire abdomen - as e.g. peritonitis, ileus, abdominal trauma, intraperitoneal hemorrage. This chapter profoundly discusses the diagnostics and therapies including emergency measures and surgery. Problems requiring consultation among varous specialists, in internal medicine, gynecology, urology, or pediatrics, are discussed in great detail. Information for the anesthetist is given for cases of emergency. More than one third of the book is devoted to organ-specific information, dicussing the pathogenesis, diagnostics, and therapy of the oesophagus, stomach, large and small intestine, bile ducts, pankreas, liver, spleen, and the abdominal vessels and the abdominal wall. (orig.) With 153 figs., 90 tabs

  19. Acute pancreatitis

    A prospective study was performed on the relationship of CT findings to the clinical course of 148 patients with acute pancreatitis. The type of pancreatic inflammation seen on CT was classified into six categories based on an overall assessment of size, contour and density of the gland, and peripancreatic abnormalities. The majority (94%) of patients in whom CT showed mild pancreatic changes (grades A, B and C) had two or less positive clinical indicaters of severe pancreatitis (Ranson's signs). In contrast, 92% of patients in whom CT showed more severe changes of pancreatitis (grades D, E or F) had three or more positive signs. The nine patients who died with pancreatitis-related complications were in grades D, E or F. We wish to draw attention to a CT appearance which we have called 'fat islets' (low density intrapancreatic or peripancreatic areas, the contents of which approach fat in attenuation values); there was a strong correlation between this appearance and subsequent infection. (author). 24 refs.; 7 figs.; 4 tabs

  20. 经伤椎椎弓根椎体内植骨治疗胸腰椎爆裂性骨折临床观察%Clinical Observation of Blowout Fracture Within the Vertebral Pedicle Bone Graft for Thoracolumbar

    陈煜东

    2015-01-01

    Objective To observe the pedicle bone graft for thoracolumbar burst fracture treatment. Methods 65 cases of thoracolumbar fracture patients were chosen from May 2011 to October 2012 in our hospital, they were given by pedicle bone graft treatment, surgery to vertebral CT taken as the center piece and X ray, fracture healing state, vertebral height and Cobb angle changes to improve the situation. Results The patients were followed up 0.5~3 years, the excellent was 87.69%in this group, all patients were low back pain, no fracture fixation, failure, loosening and other complications. Conclusion The administration of thoracolumbar burst fracture patients by internal pedicle bone graft treatment, helps promote healing, strengthen before vertebral column stability, reduce long-term complications.%目的:观察经伤椎椎弓根椎体内植骨对胸腰椎爆裂性骨折的治疗效果。方法选择2011年5月~2012年10月我院收治的65例胸腰椎爆裂性骨折患者,均给予经伤椎椎弓根椎体内植骨治疗,术后以伤椎为中心拍摄CT片及X线片,观察骨折愈合状态、伤椎高度变化及Cobb角改善情况。结果术后随访0.5~3年,本组优良率为87.69%,所有患者均未出现腰背疼痛,无内固定断裂、失效、松动等并发症。结论给予胸腰椎爆裂性骨折患者经伤椎椎弓根椎体内植骨治疗,有助于促进骨折愈合,加强伤椎前中柱稳定性,减少远期并发症发生。

  1. Constipation acupuncture in the treatment of thoracolumbar fractures after abdominal distension constipation curative effect observation%便秘灸治疗胸腰椎骨折后腹胀便秘的疗效观察

    任春霞

    2016-01-01

    目的:观察便秘灸治疗胸腰椎骨折患者腹胀、便秘的疗效。方法:将102例胸腰椎骨折后腹胀便秘的患者随机分成两组,观察组用便秘灸贴敷脐部,对照组给予腹部按摩、热敷、口服缓泻剂等方法。观察两组患者肛门排气、排便、腹胀消除的情况及观察两组病人副作用发生情况。结果:观察组总有效率96.15%,对照组74%。副作用发生情况:观察组9.16%,对照组36%。结论:便秘灸治疗胸腰椎骨折患者腹胀便秘效果优于按摩、热敷、口服缓泻剂等方法。两组比较,差异有统计学意义(P<0.01)。%Objective To observe the constipation main treatment of thoracolumbar fractures in patients with abdominal distension and constipation curative effect.Methods 102 cases of thoracolumbar fractures after abdominal distension constipation patients were randomly divided into two groups, observation group with constipation main navel, the control group given abdominal massage and hot compress, oral sugar-refining, etc. Observe two groups of patients with anal exhaust, defecation, abdominal distension, eliminate.Results Observation group total effectiveness 96.15%, control group 74%.Conclusion Abdominal distension of constipation in patients with constipation acupuncture treatment thoracolumbar fractures is better than massage and hot compress, oral sugar-refining, etc. Comparison of similar between the two groups was statistically significant (P<0.01).

  2. Application of intermediate screw technology on thoracolumbar fractures%经伤椎椎弓根置钉技术在胸腰段骨折中的应用

    吕豪珍; 林红; 张绍昆; 闫明; 刘理迪

    2012-01-01

    BACKGROUND: For thoracolumbar fractures, there are a lot of fixed ways, however, at present intermediate screws in shortsegment pedicular fixation is minimal damage, cost less, and fixed tightly.OBJECTIVE: To systemic illustrate the technology of intermediate screw and clinical application effect.METHODS: A computer-based online search was performed on PuMed database and CNKI database with key words of"Intermediate screws, pedicular screw fixation, thoracolumbar fracture" in English and Chinese from January 1983 to June 2011.Repeated literatures were eliminated.RESULTS AND CONCLUSION: A total of 48 articles were included to review. Biological mechanics experimental and clinicalapplication result indicates that intermediate screws in short segment pedicular fixation can instantly reset vertebral fracture,restore vertebral body height, and compared with the traditional short segments of the posterior fixation, intermediate screws inshort segment pedicular fixation can effectively reduce the incidence of complications of internal fixation loose or screw breakage,vertebral height lost again.%背景:对于胸腰椎骨折,有很多固定方式,但目前经伤椎后路短节段内固定是损伤最小、费用较少,且固定牢固的固定方式.目的:系统阐述伤椎置钉技术的发展及其临床应用效果.方法:应用计算机检索1983-01/2011-06 PubMed数据库、中国知网数据库中相关文章,中文检索词为"伤椎置钉,椎弓根螺钉内固定,胸腰段骨折",英文检索词为"intermediate screws,pedicular screw fixation,thoracolumbar fracture".排除重复文献.结果与结论:共纳入48篇文献进行综述.目前,生物力学实验及临床应用结果证明,经伤椎短节段椎弓根螺钉内固定能即时复位骨折椎体,恢复椎体高度,且同传统的后路短节段内固定相比,能有效地降低内固定松动或短钉、伤椎高度再次丢失等并发症的发生率.

  3. Confidence HIGH VISCOSITY BONE CEMENT SYSTEM AND POSTURAL REDUCTION IN TREATING ACUTE SEVERE OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES%Confidence高黏度骨水泥椎体成形系统结合体位复位治疗急性重度骨质疏松性椎体压缩骨折

    李波; 王群波; 余雨; 杜维; 邵高海

    2011-01-01

    目的 探讨应用Confidence高黏度骨水泥椎体成形系统结合体位复位治疗急性重度骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床效果.方法 回顾分析2004年6月-2009年6月采用Confidence高黏度骨水泥及其椎体成形系统结合体位复何治疗34例急性重度OVCF患者的临床资料.男14例,女20例;年龄62~88岁,平均72.6岁.均为单椎体骨折.损伤节段:T114例,T1210例,L115例,L24例,L31例.骨密度测定T值均≤-2.5,提示骨质疏松.伤后至入院时间2~72 h.术前先对压缩椎体行腰椎过伸位复位7~14 d,术中采用单侧穿刺,经椎弓根入路,每个椎体注射骨水泥2~6 mL,平均3.2 mL.结果 术中3例(8.8%)椎体出现不同程度骨水泥渗漏,其中2例椎体渗漏全椎间隙,1例椎体渗漏至椎旁软组织;均无临床症状,末行处理.患者均无肺栓塞、感染和神经损伤等并发症发生.34例均获随访,随访时间12~38个月,平均18.5个月.术后31例术前疼痛症状完全缓解,3例部分缓解;未见伤椎再骨折、骨与骨水泥界面松动及相邻椎体骨折发生.术后3 d及未次随访时伤椎前中柱椎体高度、后凸Cobb角及疼痛视觉模拟评分(VAS)均较术前显著改善(P0.05).结论 Confidence高黏度骨水泥椎体成形系统具有瞬间高黏度、可注射时间长、定向可控注射等优点,降低了骨水泥渗漏风险,术前结合体何复位治疗急性重度OVCF疗效较好.%Objective To evaluate the effectiveness of Confidence high viscosity bone cement system and postural reduction in treating acute severe osteoporotic vertebral compression fracture (OVCF).Methods Between June 2004 and June 2009, 34 patients with acute severe OVCF were treated with Confidence high viscosity bone cement system and postural reduction.There were 14 males and 20 females with an average age of 72.6 years (range, 62-88 years).All patients had single thoracolumbar fracture, including 4

  4. 无痛护理模式用于椎间盘突出症术后疼痛的疗效观察%Painless nursing mode used in intervertebral disc herniation curative effect observation of postoperative pain

    廖化敏

    2013-01-01

    Objective: Discusses different patterns of nursing intervention, leading to use analgesic drugs on intervertebral disc hemiation in patients with pain after the operation effect.Methods:Choose to hold bachelor degree of 90 cases of intervertebral disc hemiation surgery patients, randomly divided into A, B, C three groups, A group with normal care + serious pain medicine analgesia, group B with normal care + psychological intervention and health education + serious pain medicine analgesia, the group C painless nursing mode, namely the routine nursing + psychological intervention and health education + advance using drugs analgesia. Observe and record three groups of patients postoperative pain relief degree. Result:Painless nursing mode pain level best, 3 sets of data analysis showed that the difference was statistically significant (P < 0.05). Conclusion: Painless nursing mode on the intervertebral disc disease can significantly reduce postoperative pain, is worth popularizing use.

  5. Doença do disco intervertebral cervical em cães: 28 casos (2003-2008 Cervical intervertebral disk disease in dogs: 28 cases (2003-2008

    Giancarlo Santini

    2010-08-01

    Full Text Available O objetivo deste estudo foi identificar cães com doença do disco intervertebral (DDIV cervical atendidos no Hospital Veterinário Universitário (HVU da Universidade Federal de Santa Maria (UFSM entre janeiro de 2003 e outubro de 2008 e obter informações a respeito de raça, sexo, idade, sinais neurológicos, resposta ao tratamento cirúrgico, complicações, tempo de recuperação funcional após a cirurgia e ocorrência de recidiva. Hiperestesia cervical foi observada em todos os cães (n=28. Quanto ao grau de disfunção neurológica foram verificados: grau I (8/28[28,5%], grau II (3/28 [10,7%], grau III (5/28[17,8%] e grau V (12/2 [42,8%]. A duração dos sinais neurológicos antes da cirurgia em sete cães (25% permaneceu por até 15 dias, em 14 cães (50% entre 15 e 30 dias e nos outros sete cães (25% por mais de 30 dias. A recuperação satisfatória e sem recidiva foi observada em todos os cães submetidos ao tratamento cirúrgico e que sobreviveram (n=21. Pode-se concluir que a DDIV cervical em nossa rotina acomete principalmente cães adultos, machos, de raças condrodistróficas e não condrodistróficas, incluindo as de grande porte; a hiperestesia cervical é a principal manifestação clínica; a técnica de fenda ventral promove recuperação funcional satisfatória e sem recidiva; as principais complicações trans-operatórias são a hemorragia do plexo venoso, a bradicardia e a hipotensão; e a duração dos sinais clínicos não interfere no tempo de recuperação pós-operatória dos cães.The aim of this study was to evaluate the medical records of dogs with cervical intervertebral disk disease (IDD, submitted to surgical treatment at the Hospital Veterinário Universitário of Universidade Federal de Santa Maria (HVU-UFSM, between January 2003 and October 2008. The animal data included breed, sex, age, neurological signs and their durations, response to surgical treatment, complications, time for functional recovery

  6. Acute chylous peritonitis due to acute pancreatitis

    2012-01-01

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of “chyle” occurs rapidly, the patient may present with signs of peritonitis. Preoperative...

  7. Improved Lateral Anterior Surgical Approaches in Thoracolumbar Burst Fractures%改进的侧前方手术径路在胸腰椎爆裂性骨折中的应用

    曹众; 米光明; 熊俭

    2013-01-01

      目的针对胸腰椎爆裂性骨折行改进侧前方手术径路的治疗效果进行研讨。方法对我院在2010年3月至2011年11月所收治的36例胸腰椎爆裂性骨折患者采取随机分配的方式分为治疗组与对照组,治疗组行改进的侧前方手术径路治疗,对照组行传统的胸腹膜外入路治疗,比较两组患者术中出血量、手术时间、最终治疗效果。对患者骨折情况进行随访3~12个月。结果36例患者手术均取得成功,治疗组在手术过程中出血量、总出血量、手术时间均少于对照组,两组患者数据对比具有明显差异(P<0.05)。随访两组患者术后均未出现感染、无截瘫加重、无植骨块塌陷等情况出现。结论对胸腰椎爆裂性骨折患者行改进的侧前方手术路径治疗方法能够减少术中出血量、总出血量,减短手术时间,最大限度保证脊柱稳定性,降低脊髓损伤的发生概率,保证治疗效果,是治疗胸腰椎爆裂性骨折疗效较好的治疗方法。%Objective To discuss the surgical approach improved side in front of thoracolumbar burst fracture line treatment effect. Methods 36 cases admitted to our hospital in March 2010-November thoracolumbar burst fracture patients were randomly divided into a treatment group and the control group, the treatment of lateral anterior surgical approach in the treatment group line improvements, the control group underwent traditional film outside the thoracoabdominal approach for treatment, the two groups were compared blood loss, operative time, the final treatment effect. Results 36 patients with surgery were successful, the treatment group in the amount of bleeding during surgery, the total amount of bleeding, surgery time was less than that of the control group, the two groups of patients with the comparison of the data with a significant difference (P<0.05). None of the follow-up postoperative infection, paraplegia heavier, graft

  8. 经皮可扩张椎体支柱块置入术治疗胸腰椎压缩骨折%Percutaneous intravertebral expandable pillar implanting for treatment of thoracolumbar vertebral compression fractures

    黄智慧; 丁亮华; 胡新宇; 包欣南; 张乃东; 凌为其

    2012-01-01

    目的 探讨经皮可扩张椎体支柱块(IVEP)置入并植骨治疗胸腰椎压缩性骨折的手术技巧和短期疗效.方法 自2009年1月~2011年2月采用经皮穿刺经双侧椎弓根IVEP置入术治疗胸腰椎压缩性骨折42例(44椎),共置入支柱块88枚.结果 术后疼痛显著缓解,VAS评分及ODI评分均较术前明显降低.平均手术时间(38.8±5.3)min/椎.术后椎体高度平均恢复至正常椎体高度的(89.6±6.5)%,术后Cobb角明显变小.至末次随访,骨折愈合良好,无复位丢失和支柱块移位.结论 经皮可扩张IVEP置入并植骨治疗胸腰椎压缩性骨折的短期疗效满意,具有创伤小、手术操作简便、并发症少、并且可保留脊柱生理活动度的优点,是治疗该类骨折较为理想的选择.%Objective To study the operation techniques and therapeutic outcomes of percutaneous intravertebral expandable pillar (IVEP) implanting for treatment of thoracolumbar vertebral compression fractures. Methods Between January 2009 and February 2012, forty-two patients with thoracolumbar vertebral compression fractures were treated by percutaneously IVEP implanting and bone grafting through bilateral pedicle. Results Forty-four vertebral bodies were treated in forty-two patients. All patients successfully underwent the surgery without open-surgery or changing internal fixation. The average operation tune was (38.8?.3)min per vertebral body (range, 25~45 min). Pain was prominently relieved the next day after operation. The VAS was (8.2?.2) before operation and (2.3?.1) twenty-four hours after operation. The ODI was (53.2?3.4)% before operation and (24.9?4.7)%. The preoperative loss of vertebral height was 36% and it was reduced to 10% postoperatively. The average Cobb's angle was 23?preoperatively and 8?postoperatively. In an average follow up of 13.7 months (range 6-20 months), there were no loss of reduction and dislocation of IVEP. Conclusion These forty-two cases demonstrate that the IVEP

  9. Analysis and treatment of surgical complications after percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis

    Guang HAN

    2016-04-01

    Full Text Available Objective To analyze the causes of surgical complications after treatment of lumbar disc herniation (LDH and lumbar intervertebral foraminal stenosis by percutaneous transforaminal endoscopic discectomy (PTED.  Methods From December 2009 to December 2014, 286 patients with LDH (N = 201 and lumbar intervertebral foraminal stenosis (N = 85 were confirmed by X-ray, CT or MRI and treated by PTED in our hospital. Visual Analogue Scale (VAS was used to evaluate the degree of pain in each paitent before and after operation. The curative effect was evaluated by Macnab score. Surgical complications were recorded to find out the causes and methods to prevent them.  Results All cases were followed up for 3 months, and the VAS score decreased significantly compared with preoperation [1.00 (0.00, 1.05 vs 8.50 (7.75, 9.25; Z = 2.825, P = 0.050]. According to Macnab score, the rate of excellent and good functional recovery was 95.45% (273/286. Procedure-related complications included nerve injury in 8 cases (2.80%, hemorrhage at the operation site and hematoma formation around nerve root in 6 cases (2.10%, rupture of dural sac in one case (0.35%, muscle cramps in 3 cases (1.05%, surgical infection in one case (0.35%, postoperative recurrence in 4 cases (1.40%. All patients with complications were cured after symptomatic treatment. Conclusions The overall effect of percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis is satisfactory, which has a low incidence rate of postoperative complications. Some tips can effectively reduce the rate of surgical complications such as preoperative evaluation, precise performance, careful hemostasis, shortening the operation time and postoperatively symptomatic treatment, etc. DOI: 10.3969/j.issn.1672-6731.2016.04.007

  10. Artificial cervical vertebra and intervertebral complex replacement through the anterior approach in animal model: a biomechanical and in vivo evaluation of a successful goat model.

    Jie Qin

    Full Text Available This was an in vitro and in vivo study to develop a novel artificial cervical vertebra and intervertebral complex (ACVC joint in a goat model to provide a new method for treating degenerative disc disease in the cervical spine. The objectives of this study were to test the safety, validity, and effectiveness of ACVC by goat model and to provide preclinical data for a clinical trial in humans in future. We designed the ACVC based on the radiological and anatomical data on goat and human cervical spines, established an animal model by implanting the ACVC into goat cervical spines in vitro prior to in vivo implantation through the anterior approach, and evaluated clinical, radiological, biomechanical parameters after implantation. The X-ray radiological data revealed similarities between goat and human intervertebral angles at the levels of C2-3, C3-4, and C4-5, and between goat and human lordosis angles at the levels of C3-4 and C4-5. In the in vivo implantation, the goats successfully endured the entire experimental procedure and recovered well after the surgery. The radiological results showed that there was no dislocation of the ACVC and that the ACVC successfully restored the intervertebral disc height after the surgery. The biomechanical data showed that there was no significant difference in range of motion (ROM or neural zone (NZ between the control group and the ACVC group in flexion-extension and lateral bending before or after the fatigue test. The ROM and NZ of the ACVC group were greater than those of the control group for rotation. In conclusion, the goat provides an excellent animal model for the biomechanical study of the cervical spine. The ACVC is able to provide instant stability after surgery and to preserve normal motion in the cervical spine.

  11. Fratura toracolombar explosão: confiabilidade do método de guerra na análise tomográfica Thoracolumbar burst fracture: reliability of the guerra's method on tomographic analysis

    Osmar Avanzi

    2009-01-01

    Full Text Available OBJETIVOS: Avaliar as características do fragmento retropulsado nas fraturas explosão da coluna toracolombar, de acordo com dois examinadores independentes no plano sagital da TAC e correlacionar estes achados com a presença de déficit neurológico. MATERIAL E MÉTODOS: Coleta retrospectiva de dados de prontuário e TC em 138 pacientes com fratura toracolombar do tipo explosão internados no nosso serviço entre 1983 e 2004. RESULTADOS: Observamos correlação significante entre dois examinadores independentes (pOBJECTIVES: The objective of the current study was to evaluate the correlation between neurological deficits and the characteristics of retropulsed fragment into the spinal canal in patients with thoracolumbar burst fractures. MATERIAL AND METHODS: From 1983 to 2004, 135 patients with thoracolumbar burst fractures according to Denis' criteria were evaluated at a tertiary teaching institution by two different observers. CT-Scans of the fractured spine were analyzed in order to assess the narrowing of the spinal canal. Neurological deficit was evaluated by using the Franke's classification. RESULTS: A significant correlation was found between two independent observers (P<0.05. The observed characteristics of the retropulsed fragment into the spinal canal were: triangular form, rotation dislocation with average of 20 degrees and cranial dislocation with average of eight millimeters. There was no statistical correlation between neurological deficits and the characteristics of retropulsed fragment of the spinal canal. CONCLUSION: There was no statistical correlation between neurological deficits and the characteristics of retropulsed fragment of the spinal canal.

  12. 胸腰椎多节段脊柱骨折手术治疗的临床疗效分析%Analysis Clinical Curative Effect on Thoracolumbar Spinal Fracture Surgery

    王雯筠

    2015-01-01

    Objective Analysis clinical curative effect on thoracolumbar spinal fracture surgery. Methods Adopt operation treatment for 75 cases with thoracolumbar multi segmental spinal, observation patients with fracture reduction and Frankel classification postoperative. Results All the patients were followed up, no internal fixation loosen, broken rods, screw breakage condition. Patients with vertebral height from preoperative 22.75%~75.41%to 80.54%~99.21%to postoperative recovery. Conclusion In thoracic and lumbar spine were treated with multi section treat according to the speciifc situation of patients with fracture of spinal column sequence, returned to normal, complete reconstruction of spinal stability.%目的:对胸腰椎多节段脊柱骨折手术治疗的临床疗效进行分析。方法对75例胸腰椎多节段脊柱患者对其进行手术治疗,术后观察患者骨折复位情况及Frankel分级情况。结果对患者进行随访,随访时患者均未出现内固定松动、断棒、断钉情况。患者椎体高度由术前22.75%~75.41%,恢复至术后80.54%~99.21%。结论在对胸腰椎多节段脊柱骨折患者进行治疗时应根据患者具体情况进行治疗,从而使患者脊柱序列恢复正常,完成重建脊柱稳定的目的。

  13. The value of 18F-fluoride PET/CT in the assessment of screw loosening in patients after intervertebral fusion stabilization

    We evaluated 18F-fluoride PET/CT for the diagnosis of screw loosening after intervertebral fusion stabilization and compared the results with those from functional radiography. A group of 59 patients with pain in the region of previous intervertebral fusion stabilization and suspicion of implant instability due to screw loosening were investigated with 18F-fluoride PET/CT and functional radiography, 30.1 ± 3.4 and 29.3 ± 3.2 months, respectively, after surgery. The criterion for loosening was increased focal uptake surrounding the screw entry point and shaft. SUVmax and SUVmean were measured in a region of interest (ROI) drawn around each screw (334 screws analysed). The final diagnosis was established by surgical exploration in 27 patients and clinical follow-up after intervertebral fusion stabilization in 32 patients. Of the 59 patients, 20 were proven positive for implant failure due to screw loosening and 39 were confirmed negative. The sensitivity, specificity and accuracy of 18F-fluoride PET/CT were 75 %, 97.4 % and 89.8 % in the patient-based analysis, and 45.6 %, 100 % and 80 % in the screw-based analysis, respectively. The positive and negative predictive values were 93.8 % and 100 % in the patient-based analysis, and 88.4 and 76 % in the screw-based analysis, respectively. CT signs in PET/CT allowed screw breakage to be detected in three patients. SUVmax, SUVmean and SUVmax/SUVmean ratios in screw ROIs and respective values in reference regions were all found to be significantly different between screws positive for loosening (58 screws) and screws negative for loosening (276 screws). The ratio between SUVmax in screw ROIs and the values in reference regions was the most significant parameter for distinguishing screws positive and screws negative for loosening. 18F-Fluoride PET/CT imaging is useful for the diagnosis of screw loosening in patients with persistent symptoms after intervertebral fusion stabilization. (orig.)

  14. The value of {sup 18}F-fluoride PET/CT in the assessment of screw loosening in patients after intervertebral fusion stabilization

    Seifen, Tanja; Rodrigues, Margarida; Rettenbacher, Lukas; Holzmannhofer, Johannes; Pirich, Christian [Paracelsus Medical University Salzburg, Department of Nuclear Medicine and Endocrinology, Salzburg (Austria); Piotrowski, Wolfgang [Paracelsus Medical University Salzburg, Department of Neurosurgery, Salzburg (Austria); Mc Coy, Mark [Paracelsus Medical University Salzburg, Division of Neuroradiology, Salzburg (Austria)

    2014-09-16

    We evaluated {sup 18}F-fluoride PET/CT for the diagnosis of screw loosening after intervertebral fusion stabilization and compared the results with those from functional radiography. A group of 59 patients with pain in the region of previous intervertebral fusion stabilization and suspicion of implant instability due to screw loosening were investigated with {sup 18}F-fluoride PET/CT and functional radiography, 30.1 ± 3.4 and 29.3 ± 3.2 months, respectively, after surgery. The criterion for loosening was increased focal uptake surrounding the screw entry point and shaft. SUV{sub max} and SUV{sub mean} were measured in a region of interest (ROI) drawn around each screw (334 screws analysed). The final diagnosis was established by surgical exploration in 27 patients and clinical follow-up after intervertebral fusion stabilization in 32 patients. Of the 59 patients, 20 were proven positive for implant failure due to screw loosening and 39 were confirmed negative. The sensitivity, specificity and accuracy of {sup 18}F-fluoride PET/CT were 75 %, 97.4 % and 89.8 % in the patient-based analysis, and 45.6 %, 100 % and 80 % in the screw-based analysis, respectively. The positive and negative predictive values were 93.8 % and 100 % in the patient-based analysis, and 88.4 and 76 % in the screw-based analysis, respectively. CT signs in PET/CT allowed screw breakage to be detected in three patients. SUV{sub max}, SUV{sub mean} and SUV{sub max}/SUV{sub mean} ratios in screw ROIs and respective values in reference regions were all found to be significantly different between screws positive for loosening (58 screws) and screws negative for loosening (276 screws). The ratio between SUV{sub max} in screw ROIs and the values in reference regions was the most significant parameter for distinguishing screws positive and screws negative for loosening. {sup 18}F-Fluoride PET/CT imaging is useful for the diagnosis of screw loosening in patients with persistent symptoms after

  15. Activation of TonEBP by Calcium Controls β1,3-Glucuronosyltransferase-I Expression, a Key Regulator of Glycosaminoglycan Synthesis in Cells of the Intervertebral Disc*

    Hiyama, Akihiko; Gajghate, Sachin; Sakai, Daisuke; Mochida, Joji; Shapiro, Irving M.; Risbud, Makarand V.

    2009-01-01

    The goal of this investigation was to study the expression and regulation of β1,3-Glucuronosyltransferase-I (GlcAT-I), a key enzyme regulating GAG synthesis in cells of the intervertebral disc. There was a robust expression of GlcAT-I in the nucleus pulposus in vivo. Treatment with the calcium ionophore ionomycin resulted in increased GlcAT-I expression, whereas GlcAT-I promoter constructs lacking TonE site or a mutant TonE were unresponsive to the ionophore. Experimen...

  16. Calcification of intervertebral discs in the dachshund: a radiographic study of 115 dogs at 1 and 5 years of age

    The vertebral columns of 115 dachshunds were x-rayed at 1 and 5 years of age. This sample represented 5.7% of all dachshunds registered with the Norwegian Kennel Club in the period 1986-1988. All dogs were clinically normal at the commencement of the study. At 1 year of age calcified intervertebral discs were identified in 34 (29.6%) of the dogs and the number of calcified discs in each individual varied from 1 to 7 with a mean of 2.7. At 5 years of age calcified discs were identified in 66 (57.4%) of the dogs and the number of calcified discs in each individual varied from 1 to 11 with a mean of 3.2. Of all dogs in which calcified discs were identified at 1 year of age, 33 (97.1%) were found to have calcified discs also at 5 years of age. Of 92 calcified discs identified in the dogs at 1 year of age, 29 (31.5%) were not calcified 4 years later. Of 211 calcified discs identified in the dogs at 5 years of age, 148 (70.1%) were not calcified 4 years before. From 1 to 5 years of age, signs of spinal disease were registered in 12 (35.3%) of the dogs in which calcified discs were identified at 1 year of age, and in 7 (8.6%) of the dogs in which calcified discs were not identified at 1 year of age. Of all dogs in which one or more calcified discs had disappeared during the study-period, signs of spinal disease were registered in 9 (75.0%)

  17. Material property discontinuities in intervertebral disc porohyperelastic finite element models generate numerical instabilities due to volumetric strain variations.

    Ruiz, C; Noailly, J; Lacroix, D

    2013-10-01

    Numerical studies of the intervertebral disc (IVD) are important to better understand the load transfer and the mechanobiological processes within the disc. Among the relevant calculations, fluid-related outputs are critical to describe and explore accurately the tissue properties. Porohyperelastic finite element models of IVD can describe accurately the disc behaviour at the organ level and allow the inclusion of fluid effects. However, results may be affected by numerical instabilities when fast load rates are applied. We hypothesized that such instabilities would appear preferentially at material discontinuities such as the annulus-nucleus boundary and should be considered when testing mesh convergence. A L4-L5 IVD model including the nucleus, annulus and cartilage endplates were tested under pure rotational loads, with different levels of mesh refinement. The effect of load relaxation and swelling were also studied. Simulations indicated that fluid velocity oscillations appeared due to numerical instability of the pore pressure spatial derivative at material discontinuities. Applying local refinement only was not enough to eliminate these oscillations. In fact, mesh refinements had to be local, material-dependent, and supplemented by the creation of a material transition zone, including interpolated material properties. Results also indicated that oscillations vanished along load relaxation, and faster attenuation occurred with the incorporation of the osmotic pressure. We concluded that material discontinuities are a major cause of instability for poromechanical calculations in multi-tissue models when load velocities are simulated. A strategy was presented to address these instabilities and recommendations on the use of IVD porohyperelastic models were given. PMID:23796430

  18. Stem Cell Therapies for Intervertebral Disc Degeneration: Immune Privilege Reinforcement by Fas/FasL Regulating Machinery.

    Ma, Chi-Jiao; Liu, Xu; Che, Lu; Liu, Zhi-Heng; Samartzis, Dino; Wang, Hai-Qiang

    2015-01-01

    As a main contributing factor to low back pain, intervertebral disc degeneration (IDD) is the fundamental basis for various debilitating spinal diseases. The pros and cons of current treatment modalities necessitate biological treatment strategies targeting for reversing or altering the degeneration process in terms of molecules or genes. The advances in stem cell research facilitate the studies aiming for possible clinical application of stem cell therapies for IDD. Human NP cells are versatile with cell morphology full of variety, capable of synthesizing extracellular matrix components, engulfing substances by autophagy and phagocytosis, mitochondrial vacuolization indicating dysfunction, expressing Fas and FasL as significant omens of immune privileged sites. Human discs belong to immune privilege organs with functional FasL expression, which can interact with invasive immune cells by Fas-FasL regulatory machinery. IDD is characterized by decreased expression level of FasL with dysfunctional FasL, which in turn unbalances the interaction between NP cells and immune cells. Certain modulation factors might play a role in the process, such as miR-155. Accumulating evidence indicates that Fas-FasL network expresses in a variety of stem cells. Given the expression of functional FasL and insensitive Fas in stem cells (we term as FasL privilege), transplantation of stem cells into the disc may regenerate the degenerative disc by not only differentiating into NP-like cells, increasing extracellular matrix, but also reinforce immune privilege via interaction with immune cells by Fas-FasL network. PMID:25381758

  19. Structural analysis of the intervertebral discs adjacent to an interbody fusion using multibody dynamics and finite element cosimulation

    Monteiro, Nuno Miguel Barroso, E-mail: nuno.barroso.monteiro@gmail.com; Silva, Miguel Pedro Tavares da, E-mail: MiguelSilva@ist.utl.pt; Folgado, Joao Orlando Marques Gameiro, E-mail: jfolgado@dem.ist.utl.pt [Technical University of Lisbon, IDMEC/IST-Instituto Superior Tecnico (Portugal); Melancia, Joao Pedro Levy, E-mail: levymelancia@netcabo.pt [University of Lisbon, FML-Faculdade de Medicina de Lisboa (Portugal)

    2011-02-15

    This work describes a methodology for the dynamic and structural analysis of complex (bio)mechanical systems that joins both multibody dynamics and finite element domains, in a synergetic way, through a cosimulation procedure that takes benefit of the advantages of each numerical formulation. To accomplish this goal, a cosimulation module is developed based on the gluing algorithm X-X, which is the key element responsible for the management of the information flux between the two software packages (each using its own mathematical formulation and code). The X-X algorithm uses for each cosimulated structure multiple pairs of reference points whose kinematics are solved by the multibody module and prescribed, as initial data, to the finite element counterpart. The finite element module, by its turn, solves the structural problem imposed by the prescribed kinematics, calculates the resulting generalized loads applied over the reference points and return these loads back to the multibody module that uses them to solve the dynamic problem and to calculate new reference kinematics to prescribe to the finite element module in the next time step. The proposed method is applied to study the cervical spine dynamics in a pathologic situation in which an intersomatic fusion is simulated to confirm its potential advantages. Taking into account the proposed simulation scenario, a cervical spine multibody model that includes the rigid vertebrae, the facet joints' and spinous processes' contacts, ligaments and the finite element models of the intervertebral discs, and their surrogates is developed. The proposed model is simulated for extension in a forward dynamics perspective.

  20. Pamidronate Down-regulates Tumor Necrosis Factor-alpha Induced Matrix Metalloproteinases Expression in Human Intervertebral Disc Cells

    Kang, Young-Mi; Hong, Seong-Hwan; Yang, Jae-Ho; Oh, Jin-Cheol; Park, Jin-Oh; Lee, Byung Ho; Lee, Sang-Yoon; Kim, Hak-Sun; Lee, Hwan-Mo

    2016-01-01

    Background N-containing bisphosphonates (BPs), such as pamidronate and risedronate, can inhibit osteoclastic function and reduce osteoclast number by inducing apoptotic cell death in osteoclasts. The aim of this study is to demonstrate the effect of pamidronate, second generation nitrogen-containing BPs and to elucidate matrix metallo-proteinases (MMPs) mRNA expression under serum starvation and/or tumor necrosis factor alpha (TNF-α) stimulation on metabolism of intervertebral disc (IVD) cells in vitro. Methods Firstly, to test the effect of pamidronate on IVD cells in vitro, various concentrations (10-12, 10-10, 10-8, and 10-6 M) of pamidronate were administered to IVD cells. Then DNA and proteoglycan synthesis were measured and messenger RNA (mRNA) expressions of type I collagen, type II collagen, and aggrecan were analyzed. Secondly, to elucidate the expression of MMPs mRNA in human IVD cells under the lower serum status, IVD cells were cultivated in full serum or 1% serum. Thirdly, to elucidate the expression of MMPs mRNA in IVD cells under the stimulation of 1% serum and TNF-α (10 ng/mL) In this study, IVD cells were cultivated in three dimensional alginate bead. Results Under the lower serum culture, IVD cells in alginate beads showed upregulation of MMP 2, 3, 9, 13 mRNA. The cells in lower serum and TNF-α also demonstrated upregulation of MMP-2, 3, 9, and 13 mRNA. The cells with various doses of pamidronate and lower serum and TNF-α were reveled partial down-regulation of MMPs. Conclusions Pamidronate, N-containing second generation BPs, was safe in metabolism of IVD in vitro maintaining chondrogenic phenotype and matrix synthesis, and down-regulated TNF-α induced MMPs expression.