Autoimmunity in intervertebral disc herniation: from bench to bedside.

By London Spine

Autoimmunity in intervertebral disc herniation: from bench to bedside.

Expert Opin Ther Targets. 2013 Aug 30;

Authors: Di Martino A, Merlini L, Faldini C

Abstract
Introduction: The cause of low back pain and the pathophysiology of lumbar pain and sciatica have recently been reconsidered basing on current knowledge on cellular and molecular mediators of inflammation. Several cytokines have been considered as potential therapeutic targets to contrast sciatica in patients with disc herniation, and supportive studies suggest a leading role of TNF-α in this contest: therefore, clinical trials have tested TNF-α inhibitors in the clinical setting of the patient with radicular pain secondary to an herniated disc. Areas covered: The current review deals with the autoimmune theory of disc herniation and its role in determining radiculopathy and neuropathic pain. It also reports the recent evidences that led to the introduction of anti-TNF-α drugs into the clinical setting as a biological therapy for radiculopathy and disc herniation. Expert opinion: Targeting the TNF-α pathway has demonstrated controversial effects in the tested study population and available results only report a short-term follow-up. More confirmatory studies in terms of long-term clinical results, complications, more effective route of administration and cost-effective analysis are required to establish the real role of this biological therapy in the treatment of patients with disc herniation and neuropathy.

PMID: 23991673 [PubMed – as supplied by publisher]

The Efficacy of Lumbar Hybrid Stabilization Using the DIAM™ to Delay Adjacent Segment Degeneration: An Intervention Comparison Study With a Minimum Two-Year Follow-up.

By London Spine
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The Efficacy of Lumbar Hybrid Stabilization Using the DIAM™ to Delay Adjacent Segment Degeneration: An Intervention Comparison Study With a Minimum Two-Year Follow-up.

Neurosurgery. 2013 Mar 5;

Authors: Lee CH, Hyun SJ, Kim KJ, Jahng TA, Yoon SH, Kim HJ

Abstract
BACKGROUND:: Although posterior lumbar interbody fusion (PLIF) has a successful fusion rate, the long-term outcome of PLIF is occasionally below expectations because of adjacent segment degeneration (ASD). OBJECTIVE:: To evaluate the ability of hybrid stabilization using DIAM (Device for Interspinous Assisted Motion) to delay ASD. METHODS:: An intervention comparison study of 75 patients (hybrid, 25; PLIF, 50) was performed. The indications for hybrid stabilization were facet joint degeneration, Pfirrmann grade II-III, and stenosis at the rostral adjacent segment. The PLIF group consisted of patients matched for age, gender, and fusion. The hybrid stabilization procedure included traditional PLIF and DIAM installation at a superior adjacent segment. The outcomes were analyzed using linear mixed model analysis. Conditional logistic regression was performed to calculate the odds ratio for the association of surgical methods. RESULTS:: The hybrid group (24%) revealed fewer ASDs than the PLIF group (48%). Among ASDs, spondylolisthesis occurred more frequently in the PLIF group than the hybrid group. Hybrid surgery was significantly associated with ASD; the odds ratio for hybrid surgery was 0.28 when compared to PLIF. Foraminal height of the PLIF group decreased more than the hybrid group (P=.01). Segmental mobility showed a greater increase in the PLIF group than the hybrid group (P=.04). However, the clinical outcomes did not show significant differences between the groups. CONCLUSION:: Hybrid stabilization using DIAM and pedicle screws can be used for patients with facet degeneration at adjacent segments but should be further investigated.

PMID: 23467248 [PubMed – as supplied by publisher]

Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis.

By Kamruz Zaman
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Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis.

Acta Psychiatr Scand. 2016 May;133(5):341-51

Authors: Solmi M, Veronese N, Correll CU, Favaro A, Santonastaso P, Caregaro L, Vancampfort D, Luchini C, De Hert M, Stubbs B

Abstract
OBJECTIVE: To provide meta-analytical evidence of bone mineral density (BMD), fractures, and osteoporosis rates in eating disorders (ED) vs. healthy controls (HCs).
METHOD: Three independent authors searched major electronic databases from inception till August 2015 for cross-sectional studies reporting BMD in people with ED (anorexia nervosa, (AN); bulimia nervosa, (BN); eating disorders not otherwise specified, (EDNOS)) vs. HCs. Standardized mean differences (SMDs) ±95% and confidence intervals (CIs) were calculated for BMD, and odds ratios (ORs) for osteopenia, osteoporosis, and fractures.
RESULTS: Overall, 57 studies were eligible, including 21 607 participants (ED = 6485, HCs = 15 122). Compared to HC, AN subjects had significantly lower BMD values at lumbar spine (SMD = -1.51, 95% CI = -1.75, -1.27, studies = 42), total hip (SMD = -1.56, 95%CI = -1.84, -1.28, studies = 23), intertrochanteric region (SMD = -1.80, 95%CI = -2.46, -1.14, studies = 7), trochanteric region (SMD = -1.05, 95%CI = -1.44, -0.66, studies = 7), and femoral neck (SMD = -0.98, 95%CI = -1.12, -0.77, studies = 20). Reduced BMD was moderated by ED illness duration and amenorrhea (P < 0.05). AN was associated with an increased likelihood of osteoporosis (OR = 12.59, 95%CI = 3.30-47.9, P < 0.001, studies = 4) and fractures (OR = 1.84, 95% CI = 1.17-2.89, I(2) = 56, studies = 6). No difference in BMD was found between BN and EDNOS vs. HC.
CONCLUSION: People with AN have reduced BMD, increased odds of osteoporosis and risk of fractures. Proactive monitoring and interventions are required to ameliorate bone loss in AN.

PMID: 26763350 [PubMed – indexed for MEDLINE]

Clinical and Radiological Improvement Following Ozone Disc Nucleolysis: A Case Report. – PubMed

By London Spine

[ad_1] The results of traditional open surgery for herniated intervertebral disc are often limited by complications and failed back surgery syndrome (FBSS). Over the past few decades, a considerable amount of research has been done in the field of minimally invasive procedures as a treatment option for herniated intervertebral disc disease. Ozone disc nucleolysis is one such…