Klineberg E, Bui T, Schlenk R
… +1 more, Lieberman I
Evid Based Spine Care J
· 2014 Apr · PMID 24715874
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Study Design Case report and review of the literature. Objective A retro-odontoid mass is a rare cause of cervical compression and myelopathy. The differential diagnosis includes the following: metastatic disease, primar...Study Design Case report and review of the literature. Objective A retro-odontoid mass is a rare cause of cervical compression and myelopathy. The differential diagnosis includes the following: metastatic disease, primary tumor, collagen disorder, or inflammatory disease. Calcium pyrophosphate dihydrate (CPPD) deposition has been referred to as "crowned dens syndrome" when there are periodontoideal calcifications. There are only a few reported cases where CPPD presents as a cystic retro-odontoid mass in the atlanto-dens interval. In previous descriptions of surgical intervention, transoral resection of the mass is associated with significant morbidity and usually requires stabilization. The objective of this article is to report a case of an unusual presentation of CPPD disease of C1/C2, where we used a novel, minimally invasive surgical technique for decompression without fusion. Patients and Methods An 83-year-old female patient presented with progressive cervical myelopathy over a 3-month period. Computed tomography and magnetic resonance imaging demonstrated a cystic odontoid mass with a separate retro-odontoid compressive mass. A novel, minimally invasive transoral aspiration was performed. Histologic confirmation of CPPD was obtained. Results Postop imaging showed satisfactory decompression, which was maintained at the 6-month follow-up. This correlated with clinical improvement postop and 6-month follow-up. Conclusion CPPD in the atlanto-dens interval may present as a cystic retro-odontoideal mass and should be included in the differential. We used a transoral minimally invasive approach to aspirate the cyst. This novel technique avoided the need for a stabilization procedure or morbid transoral resection and provided excellent results immediately and at 6 months.
Evid Based Spine Care J
· 2014 Apr · PMID 24715873
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Study Design Case report. Objective Amyoplasia-type arthrogryposis is a rare congenital disease that presents as multiple contractures involving various areas of the body. To the authors' knowledge, there have been no re...Study Design Case report. Objective Amyoplasia-type arthrogryposis is a rare congenital disease that presents as multiple contractures involving various areas of the body. To the authors' knowledge, there have been no reports of adults with amyoplasia in the current literature. We report a case of an adult patient with cervical stenosis in the setting of amyoplasia. Patients and Methods A 48-year-old patient with amyoplasia and over 30 previous orthopedic reconstructive surgeries presented with neck pain radiating down his left shoulder and into the fingers, dysesthesia in his fingertips, and left-sided periauricular headache. A diagnosis of central spinal canal stenosis and bilateral foraminal stenosis at C3-C7 with radiculopathy was made based on computed tomography scans. Because of a prior right-side sternocleidomastoid muscle transfer, a left-side C3-C4, C5-C7 anterior cervical discectomy and fusion procedure was performed. Results The patient experienced significant improvement in symptoms that was transient. Symptoms returned to preoperative values after 1 year, despite significant and persistent improvement in stenosis. Conclusions Both amyoplasia and cervical stenosis can manifest in neurologic symptoms. Distinguishing the causing pathology can be challenging. The radiographic improvement of cervical stenosis in a patient with amyoplasia is not always associated with long-standing pain relief.
Jegapragasan M, Calniquer A, Hwang WD
… +2 more, Nguyen QT, Child Z
Evid Based Spine Care J
· 2014 Apr · PMID 24715872
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Study Design Case report. Objective The objective of this study is to report the occurrence of tophaceous gout in the lumbar spine. Methods Using a case report to illustrate the key points of gout in the spine, we provid...Study Design Case report. Objective The objective of this study is to report the occurrence of tophaceous gout in the lumbar spine. Methods Using a case report to illustrate the key points of gout in the spine, we provide a brief review of gout in the literature as it relates to its orthopedic and spinal manifestations as well as guidelines for management. Results This case report details the occurrence of a large and clinically significant finding of tophaceous gout in the lumbar spine in a 24-year-old man with a known history of gout and a 3-year history of progressive back pain. Conclusion A high index of suspicion can assist in diagnosis of patients presenting with back pain or neurologic findings with a history of gout. A previous history of gout (especially the presence of tophi), hyperuricemia, and the radiological characteristics presented here should aid the clinician in making the diagnosis of spinal gout. Early diagnosis has the potential to prevent the need for surgical intervention.
Legg J, Davies E, Raich AL
… +2 more, Dettori JR, Sherry N
Evid Based Spine Care J
· 2014 Apr · PMID 24715871
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STUDY RATIONALE: Cerebral palsy (CP) is a group of nonprogressive syndromes of posture and motor impairment associated with lesions of the immature brain. Spastic quadriplegia is the most severe form with a high incidenc...STUDY RATIONALE: Cerebral palsy (CP) is a group of nonprogressive syndromes of posture and motor impairment associated with lesions of the immature brain. Spastic quadriplegia is the most severe form with a high incidence of scoliosis, back pain, respiratory compromise, pelvic obliquity, and poor sitting balance. Surgical stabilization of the spine is an effective technique for correcting deformity and restoring sitting posture. The decision to operate in this group of patients is challenging. OBJECTIVES: The aim of this study is to determine the benefits of surgical correction of scoliosis in children with spastic quadriplegia, the adverse effects of this treatment, and what preoperative factors affect patient outcome after surgical correction. MATERIALS AND METHODS: A systematic review was undertaken to identify studies describing benefits and adverse effects of surgery in spastic quadriplegia. Factors affecting patient outcome following surgical correction of scoliosis were assessed. Studies involving adults and nonspastic quadriplegia were excluded. RESULTS: A total of 10 case series and 1 prospective and 3 retrospective cohort studies met inclusion criteria. There was significant variation in the overall risk of complications (range, 10.9-70.9%), mortality (range, 2.8-19%), respiratory/pulmonary complications (range, 26.9-57.1%), and infection (range, 2.5-56.8%). Factors associated with a worse outcome were a significant degree of thoracic kyphosis, days in the intensive care unit, and poor nutritional status. CONCLUSION: Caregivers report a high degree of satisfaction with scoliosis surgery for children with spastic quadriplegia. There is limited evidence of preoperative factors that can predict patient outcome after scoliosis. There is a need for well-designed prospective studies of scoliosis surgery in spastic quadriplegia.
Barbagallo GM, Albanese V, Raich AL
… +3 more, Dettori JR, Sherry N, Balsano M
Evid Based Spine Care J
· 2014 Apr · PMID 24715870
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STUDY DESIGN: Systematic review. STUDY RATIONALE: The surgical treatment of adult degenerative lumbar conditions remains controversial. Conventional techniques include posterior lumbar interbody fusion (PLIF) or transfor...STUDY DESIGN: Systematic review. STUDY RATIONALE: The surgical treatment of adult degenerative lumbar conditions remains controversial. Conventional techniques include posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF). A new direct approach known as lumbar lateral interbody fusion (LLIF), or extreme lateral interbody fusion (XLIF(®)) or direct lateral interbody fusion (DLIF), has been introduced. Objectives The objective of this article is to determine the comparative effectiveness and safety of LLIF, at one or more levels with or without instrumentation, versus PLIF or TLIF surgery in adults with lumbar degenerative conditions, and to determine which preoperative factors affect patient outcomes following LLIF surgery. MATERIALS AND METHODS: A systematic review of the literature was performed using PubMed and bibliographies of key articles. Articles were reviewed by two independent reviewers based on predetermined inclusion and exclusion criteria. Each article was evaluated using a predefined quality rating scheme. RESULTS: The search yielded 258 citations and the following met our inclusion criteria: three retrospective cohort studies (all using historical cohorts) (class of evidence [CoE] III) examining the comparative effectiveness and safety of LLIF/XLIF(®)/DLIF versus PLIF or TLIF surgery, and one prospective cohort study (CoE II) and two retrospective cohort studies (CoE III) assessing factors affecting patient outcome following LLIF. Patients in the LLIF group experienced less estimated blood loss and a lower mortality risk compared with the PLIF group. The number of levels treated and the preoperative diagnosis were significant predictors of perioperative or early complications in two studies. CONCLUSION: There is insufficient evidence of the comparative effectiveness of LLIF versus PLIF/TLIF surgery. There is low-quality evidence suggesting that LLIF surgery results in fewer complications or reoperations than PLIF/TLIF surgery. And there is insufficient evidence that any preoperative factors exist that predict patient outcome after LLIF surgery.
Molinari R, Bessette M, Raich AL
… +2 more, Dettori JR, Molinari C
Evid Based Spine Care J
· 2014 Apr · PMID 24715869
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STUDY DESIGN: Systematic review. STUDY RATIONALE: The purpose of this review is to further define the published literature with respect to vertebral artery (VA) anomaly and injury in patients with degenerative cervical s...STUDY DESIGN: Systematic review. STUDY RATIONALE: The purpose of this review is to further define the published literature with respect to vertebral artery (VA) anomaly and injury in patients with degenerative cervical spinal conditions. OBJECTIVES: In adult patients with cervical spine or degenerative cervical spine disorders receiving cervical spine surgery, what is the incidence of VA injury, and among resulting VA injuries, which treatments result in a successful outcome and what percent are successfully repaired? MATERIALS AND METHODS: A systematic review of pertinent articles published up to April 2013. Studies involving traumatic onset, fracture, infection, deformity or congenital abnormality, instability, inflammatory spinal diseases, or neoplasms were excluded. Two independent reviewers assessed the level of evidence quality using the Grades of Recommendation Assessment, Development and Evaluation criteria; disagreements were resolved by consensus. RESULTS: From a total of 72 possible citations, the following met our inclusion criteria and formed the basis for this report. Incidence of VA injuries ranged from 0.20 to 1.96%. None of the studies reported using preoperative imaging to identify anomalous or tortuous VA. Primary repair and ligation were the most effective in treating VA injuries. CONCLUSION: The incidence of VA injuries in degenerative cervical spinal surgery might be as high as 1.96% and is likely underreported. Direct surgical repair is the most effective treatment option. The most important preventative technique for VA injuries is preoperative magnetic resonance imaging or computed tomography angiographic imaging to detect VA anomalies. The overall strength of evidence for the conclusions is low.
Tran M, Wadhwa R, Ziewacz J
… +2 more, Mummaneni P, Chou D
Evid Based Spine Care J
· 2014 Apr · PMID 24715868
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Study Design Retrospective analysis. Clinical Question Is there a difference between the screw-rod construct (SRC) procedure without wiring and the SRC procedure with wiring with respect to fusion, implant failure, reope...Study Design Retrospective analysis. Clinical Question Is there a difference between the screw-rod construct (SRC) procedure without wiring and the SRC procedure with wiring with respect to fusion, implant failure, reoperation, donor-site morbidity, and complication rates? Patients and Methods We performed a retrospective analysis of 26 patients who underwent C1-2 fixation between 2004 and 2012 (SRC with wiring and structural bone graft, 13 patients; SRC with autograft but without wiring, 13 patients). Fusion was assessed using dynamic X-rays in all patients and computed tomographic scans in selected cases. Pseudoarthrosis was confirmed during reoperation. Results The mean follow-up time was 2 years and 5 months for the SRC without wiring group and 2 years and 1 month for the SRC with wiring group. Patients with less than 1-year follow-up time were excluded. The fusion rate, implant failure rate, and reoperation rates for the SRC without wiring group were 92, 8, and 8%, respectively. The fusion, implant failure, and reoperation rates for the SRC with wiring group were 100, 0, and 0%, respectively. There were no donor-site morbidities or complications in either group (both 0%). There were no differences in parameters we examined between the two groups (p > 0.05 for each rate, Fisher exact test). Conclusions The results suggest that supplementing the SRC procedure with wiring may increase fusion rate, but this difference is not statistically significant. Although the sample size was small, there was not a significant discrepancy in outcomes between the two groups at an average follow-up of 2 years. [Table: see text].
Weber MH, Hong CH, Schairer WW
… +2 more, Takemoto S, Hu SS
Evid Based Spine Care J
· 2014 Apr · PMID 24715867
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Study Design Retrospective cross-sectional study. Clinical Question What is the prevalence of cervical spondylosis (CS) and thoracolumbar (TL) spinal deformity in an administrative database during a 4-year study period?...Study Design Retrospective cross-sectional study. Clinical Question What is the prevalence of cervical spondylosis (CS) and thoracolumbar (TL) spinal deformity in an administrative database during a 4-year study period? Is the prevalence of CS or TL deformity higher in patients who have the other spine diagnosis compared with the overall study population? Are patients with both diagnoses more likely to have undergone spine surgery? Patients and Methods An administrative claims database containing 53 million patients with either Medicare (2005-2008) or private payer (2007-2010) insurance was used to identify patients with diagnoses of CS and/or TL deformity. Disease prevalence between groups was compared using a χ (2) test and reported using prevalence ratios (PR). Results The prevalence of CS was higher in patients with TL deformity than without TL deformity, for both Medicare (PR = 2.81) and private payer (PR = 1.79). Similarly, the prevalence of TL deformity was higher in patients with CS than without CS for both Medicare (PR = 3.19) and private payer (PR = 2.05). Patients with both diagnoses were more likely to have undergone both cervical (Medicare, PR = 1.44; private payer, PR = 2.03) and TL (Medicare, PR = 1.68; private payer, PR = 1.74) spine fusion. All comparisons were significant with p < 0.0001. Conclusions Patients with either CS or TL deformity had a higher prevalence of the other spinal diagnosis compared with the overall disease prevalence in the study population. Patients with both diagnoses had a higher prevalence of having spine surgery compared with patients with only one diagnosis. More studies to identify a causal mechanism for this relationship are warranted.
Smith MW, Annis P, Lawrence BD
… +2 more, Daubs MD, Brodke DS
Evid Based Spine Care J
· 2013 Oct · PMID 24436718
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Study Type Retrospective review. Introduction Sagittal imbalance has been associated with lower health-related quality of life outcomes, and restoration of imbalance is associated with improved outcomes.123 The long cons...Study Type Retrospective review. Introduction Sagittal imbalance has been associated with lower health-related quality of life outcomes, and restoration of imbalance is associated with improved outcomes.123 The long constructs used in adult spinal deformity have potential consequences such as proximal junctional kyphosis (PJK). Clinically, the development of PJK may not be as important as failure of the construct or vertebrae at the proximal end. As PJK does not lead to worse clinical outcomes,45 we define the term early proximal junctional failure (EPJF) as fracture, implant failure, or myelopathy due to stenosis at the upper instrumental vertebra (UIV) or UIV + 1 within 6 months of surgery. Objective The purpose of this study is to report the incidence of EPJF in patients who are sagittally imbalanced preoperatively and to identify risk factors postoperatively that correlate with EPJF using commonly reported sagittal balance parameters. Methods We reviewed 197 patients with preoperative sagittal imbalance by at least one of the following: sagittal vertical axis more than 5 cm, global sagittal alignment more than 45 degrees, pelvic incidence-lumbar lordosis more than 10 degrees, or spine-sacral angle less than 120 degrees. Radiographic measurements also included proximal junctional angle, thoracic kyphosis, lumbar lordosis, pelvic parameters, and sagittal balance parameters/formulas, as well as UIV angle, UIV spinosacral angle, and UIV plumb line to assess as potential risk factors. EPJF incidence was calculated postoperatively for each of the accepted sagittal balance parameters/formulas. Results EPJF was observed in 49 of 197 patients (25%) with preoperative sagittal imbalance and was more common in fusions with UIV in the lower thoracic spine (TS) (35%) than in those with UIV in the upper TS (10%) or lumbar (25%) (p = 0.007). Of the 49 EPJF patients, 16 patients (33%) required revision surgery within the first year, for an overall early revision rate of 8%. The incidence of EPJF was no different in patients with or without postoperative sagittal balance. No parameter/formula was more sensitive than another in predicting EPJF. Conclusions The incidence of EPJF (25%) is greater in this sagittally imbalanced group than previously reported for adult deformity patients, occurring most often when the UIV is in the lower TS. Sagittal balance correction was not correlated with change in incidence of EPJF. Despite the high incidence, the early revision rate within the first year is low.
Evid Based Spine Care J
· 2013 Oct · PMID 24436717
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Study Type Retrospective cohort. Introduction The treatment of rare neoplastic conditions is challenging, especially because studies providing high levels of evidence are often lacking. Such is the case with primary tumo...Study Type Retrospective cohort. Introduction The treatment of rare neoplastic conditions is challenging, especially because studies providing high levels of evidence are often lacking. Such is the case with primary tumors of the spine (PTS), which have a low incidence, are pathologically heterogeneous, and have diverse treatment approaches.1 Despite these difficulties, appropriate evidence-based care of these complex patients is imperative. Failure to follow validated oncologic principles may lead to unnecessary mortality and profound morbidity. Objective With the aim of offering patients the most appropriate treatment based on the best available evidence, a novel scientific model was developed and employed. This article outlines this model, which has not only provided significant evidence guiding treatment of this rare condition, but we believe is readily transferrable to other similarly rare conditions. Methods A four-stage approach was employed. (1) Planning: Data from large volume centers were reviewed together with results from a feasibility questionnaire to provide insight into epidemiology, patient volumes, tumor pathology, treatment modalities, and outcomes. (2) Recruitment: Centers with sufficient volume and valid data were enrolled and provided with the necessary infrastructure. This included study coordinators and a secure, Web-based database (REDCap, Vanderbilt University, Nashville, Tennessee, United States) to capture international data from six modules comprising: demographic, clinical, diagnostic, therapeutic, local recurrence, perioperative morbidity fields, and a cross-sectional survey to update survival information. The AOSpine Knowledge Forum Tumor designed these modules and provided funding. Each center received institutional ethics approval. (3) Retrospective stage: Prospectively collected data from all recruited centers were reviewed and analyzed retrospectively. (4) Prospective stage: Following interim analysis, prospective data collection has been implemented. In addition, a PTS bio-bank network has been created to link clinical data with tumor pathology and molecular analysis. Results It took 18 months to implement stages 1 to 3 of this model and stage 4 is ongoing. A total of 1,495 tumor cases were captured and diagnosed as one of the 18 primary spine tumor subtypes listed (Fig. 1). The most prevalent diagnosis was chordoma (n = 344, 23%). There were 674 females and 821 males with a mean age of 43 ± 19 years at the time of surgery. Surgical treatment was performed between 1981 and 2012. The survival at 5 and 10 years postsurgery was 71.9 and 53.3%, respectively, with a median survival of 13 years postsurgery (Fig. 2). Conclusions To date, this is the largest international collection of PTS. This novel scientific model has not only aggregated a large amount of PTS data, but has also established an international collaborative network of spine oncology centers. The access to large volumes of clinical and bio-bank data will generate further research to guide and enhance the clinical management of PTS. This novel scientific model could be of similar tremendous value if applied to other rare neoplastic conditions.
Norton RP, Bianco K, Lafage V
… +2 more, Schwab FJ, International Spine Study Group Foundation
Evid Based Spine Care J
· 2013 Oct · PMID 24436716
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Study Type Retrospective review of a prospectively collected multicenter database. Introduction Three-column resection osteotomies (3CO), including pedicle subtraction osteotomies and vertebral column resections are perf...Study Type Retrospective review of a prospectively collected multicenter database. Introduction Three-column resection osteotomies (3CO), including pedicle subtraction osteotomies and vertebral column resections are performed for correction of sagittal deformity; however, they have high rates of reported complications. This study examined the incidence and intercenter variability of major intraoperative complications (IOC), postoperative complications (POC), and overall complications (IOC + POC) up to 6 weeks postoperation. Objective The aim of the study is to examine the incidence and intercenter variability of major complications associated with 3CO. Patients and Methods A retrospective review of patients with 3CO from eight different sites was performed. The incidence and types of complications were determined for the study population (N = 423). The analysis compared patients with one (n = 391) and two (n = 32) osteotomies, as well as patients with a thoracic osteotomy (ThO) (n = 72) versus a lumbosacral osteotomy (LSO) (n = 319) of the spine. Subsequent analysis was performed to compare sites with low-osteotomy volumes (< 50 patients) to sites with large osteotomy volumes (more than 50 patients). Major blood loss (MBL) was defined as more than 4L. Results Of the 423 patients, the incidence of major IOC, POC, and overall complications was 28, 45, and 58%, respectively (Table 1). The most common major IOC was MBL (24%) and the most common POC was unplanned return to the operating room (OR) (19%). Other IOC included cord deficit (2.6%), pneumothorax (1.5%), large vessel injury (1.7%), nerve root injury (1.4%), and cardiac arrest (0.2%). Other POC included motor deficit (12.1%), deep infection (7.6%), acute respiratory distress/failure (4.7%), deep venous thrombosis (3.1%), pulmonary embolism (2.8%), arrhythmia (1.2%), reintubation and sepsis (0.7%), cauda equine syndrome, myocardial infarction, visual deficit, stroke (0.5%), and death (0.2%). Patients with one 3CO had significantly less POC (43 vs. 69%, p < 0.01) and overall complications (57 vs. 75%, p < 0.01) than patients with two 3CO (Fig. 1). IOC, MBL, and return to the OR were not significantly different between groups. Patients with ThO had significantly more POC (66 vs. 39%, p < 0.01) and overall complications (76 vs. 53%, p < 0.001) than patients with LSO. Patients with LSO had more MBL (25 vs. 14%, p = 0.04). Patients with ThO had more unplanned return to OR (41 vs. 14%, p < 0.001) (Fig. 2). The incidence of IOC was greater for the low-volume sites than high-volume sites (46 vs. 23%, p < 0.001). Low-volume sites had a higher frequency of patients with MBL than high-volume sites (45 vs. 18%, p < 0.001) (Fig. 3). Patients who experienced MBL had a significantly longer operating time (p < 0.001) and a higher risk of developing other IOC, POC, and overall complications (OR = 2.18, 1.51, 1.63, respectively) than patients who did not experience substantial blood loss. Conclusions The overall incidence of complications was 58% following 3CO surgery. There was significant variation in incidence of complications depending on the number, location, and experience of performing osteotomies. Risks for developing complications included having two osteotomies, ThO, surgery at a low-volume center, and blood loss more than 4 L. With a better understanding of 3CO complications and risk factors, physicians may be more informed in the decision-making process of sagittal plane deformity correction.
Mehrkens A, Karim MZ, Kim S
… +3 more, Hilario R, Fehlings MG, Erwin WM
Evid Based Spine Care J
· 2013 Oct · PMID 24436715
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Introduction Effective therapies that may stop or even reverse disc degeneration remain elusive. A minimally invasive method through which nucleus pulposus (NP) cell viability could be achieved would revolutionize the tr...Introduction Effective therapies that may stop or even reverse disc degeneration remain elusive. A minimally invasive method through which nucleus pulposus (NP) cell viability could be achieved would revolutionize the treatment of degenerative disc disease (DDD). With the presented work, we have investigated if nonchondrodystrophic (NCD) canine intervertebral disc (IVD)-derived notochordal cell conditioned medium (NCCM) and chondrodystrophic (CD) canine IVD-derived conditioned medium (CDCM) are able to protect murine and human NP cells from apoptosis. Materials and Methods We developed NCCM and CDCM from hypoxic culture of freshly isolated NPs from NCD and CD canines, respectively. We obtained murine NP cells from nine different C57BL/6 mice and human NP cells from four patients who underwent surgery for discectomy. The cells were cultured with ADMEM/F-12 (control media), NCCM, or CDCM under hypoxic conditions (3.5% O2) and treated with IL-1β + FasL or Etoposide. All media were supplemented with 2% fetal bovine serum. We then determined the expression of specific apoptotic pathways in the murine and human NP cells by recording activated caspase-8, caspase-9, and caspase-3/7 activity. Results In the murine NP cells, NCCM inhibits IL-1β + FasL- and Etoposide-mediated apoptosis via suppression of activated caspase-9 and caspase-3/7, CDCM demonstrated an inhibitory effect on IL-1β + FasL-mediated apoptosis via caspase-3/7 (Fig. 1A). In the human NP cells, NCCM inhibits Etoposide- mediated apoptosis via suppression of activated caspase-8, caspase-9, and mainly caspase-3/7. CDCM demonstrated an inhibitory effect on Etoposide-mediated apoptosis via suppression of activated caspase-8, caspase-9, and mainly caspase-3/7, though not as effective as NCCM (Fig. 1B). Conclusion IL-1β + FasL are known key molecules in the progression of DDD. Here, we demonstrate that soluble factors secreted by the NCD IVD NP strongly protect murine NP cells not only from IL-1β + FasL but also from Etoposide-induced apoptosis via suppression of activated caspase-9 and caspase-3/7. In the human samples, addition of IL-1β + FasL did not increase cell death. Because the human cell samples were obtained from herniated discs that are probably already undergoing a degenerative process, it is likely that there was already some degree of activation by the endogenously secreted prodegenerative factors such as IL-1β + FasL. It may be that the NP cells, once they have reached a pivotal point of the degenerative cascade, no longer respond to exogenously applied IL-1β + FasL in contrast to the otherwise "healthy" discs obtained from the mice. Interestingly, the rescue effect of NCCM in the etoposide-treated cells (murine and human) suggests that NCCM is capable of influencing the signaling pathways known to be relevant to etoposide-induced cell death. A better understanding and harnessing of the restorative powers of the notochordal cell could lead to novel cellular and molecular strategies for the treatment of DDD.
Potter MQ, Lawrence BD, Kinikini DV
… +1 more, Brodke DS
Evid Based Spine Care J
· 2013 Oct · PMID 24436714
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Study Design Case report and review of the literature. Objective The objective of the article is to report the case of a 20-year-old patient with a threatened aortic injury from pedicle screw instrumentation successfull...Study Design Case report and review of the literature. Objective The objective of the article is to report the case of a 20-year-old patient with a threatened aortic injury from pedicle screw instrumentation successfully managed without aortic grafting. Methods The patient's clinical course is retrospectively reviewed. The offending hardware was removed after gaining endovascular control of the aorta. Results Intraoperative aortography was normal and no graft was placed. The patient remains asymptomatic at 2 years after surgery. Conclusions Hardware impinging on the aorta can safely be removed by gaining endovascular control of the aorta. In the setting of normal intraoperative aortography in a young patient, we recommend against further intervention to avoid the known morbidity of aortic grafting.