Poroelastic behaviour of the degenerating human intervertebral disc: a ten-day study in a loaded disc culture system.

By London Spine
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Poroelastic behaviour of the degenerating human intervertebral disc: a ten-day study in a loaded disc culture system.

Eur Cell Mater. 2015;29:330-341

Authors: Emanuel KS, Vergroesen PA, Peeters M, Holewijn RM, Kingma I, Smit TH

Abstract
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.

PMID: 26091731 [PubMed – as supplied by publisher]

Validity of PROMIS(®) Physical Function Measures in Diverse Clinical Samples.

By London Spine
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Validity of PROMIS(®) Physical Function Measures in Diverse Clinical Samples.

J Clin Epidemiol. 2016 Mar 9;

Authors: Schalet BD, Hays RD, Jensen SE, Beaumont JL, Fries JF, Cella D

Abstract
OBJECTIVE: To evaluate the validity of the PROMIS(®) Physical Function measures using longitudinal data collected in six chronic health conditions.
STUDY DESIGN AND SETTING: Individuals with rheumatoid arthritis (RA), major depressive disorder (MDD), back pain, chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and cancer completed the PROMIS Physical Function computerized adaptive test (CAT) or fixed-length short form (SF) at baseline and at the end of clinically-relevant follow-up intervals. Anchor items were also administered to assess change in physical function and general health. Linear mixed effects models and standardized response means were estimated at baseline and follow-up.
RESULTS: 1415 individuals participated (COPD n = 121; CHF n = 57; back pain n = 218; MDD n = 196, RA n = 521; cancer n = 302). The PROMIS Physical Function scores improved significantly for treatment of CHF and back pain patients, but not for patients with MDD or COPD. Most of the patient subsamples that reported improvement or worsening on the anchors showed a corresponding positive or negative change in PROMIS Physical Function.
CONCLUSION: This study provides evidence that the PROMIS Physical Function measures are sensitive to change in intervention studies where physical function is expected to change and able to distinguish among different clinical samples. The results inform the estimation of meaningful change, enabling comparative effectiveness research.

PMID: 26970039 [PubMed – as supplied by publisher]

Safety and Efficacy Study of an Ozone Laser Combined Therapy Using Puncture Needle in the Treatment of Patients With Cervical Spondylosis. – PubMed

By London Spine

[ad_1] STUDY DESIGN AND METHODS: Fifty-eight patients with cervical spondylosis (CS) were treated with patented technology of ozone laser combined therapy using puncture needle between August 2008 and February 2010. Visual Analogue Scale (VAS) score changes before and 6 months after surgery and MacNab score criteria 6 months after surgery were analyzed. BACKGROUND AND OBJECTIVE:…

Anterior cervical discectomy and fusion surgery versus total disc replacement: A comparative study with minimum of 10-year follow-up.

By London Spine
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Anterior cervical discectomy and fusion surgery versus total disc replacement: A comparative study with minimum of 10-year follow-up.

Sci Rep. 2017 Nov 27;7(1):16443

Authors: Yang SD, Zhu YB, Yan SZ, Di J, Yang DL, Ding WY

Abstract
Based on long-term follow-ups, this study was designed to investigate the incidence and risk factors for postoperative adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) or total disc replacement (TDR) in treating cervical degenerative diseases. Between January 2000 and December 2005, 108 cases undergoing ACDF and 78 undergoing TDR, were enrolled into this study. All medical records were retrospectively collected. Every patient was followed up at least 10 years. Outcome assessment included visual analogue scale (VAS) score, Neck Disability Index (NDI) score, Japanese Orthopaedic Association (JOA) score, and radiographic parameters. Consequently, thirty-eight (35.2%) of 108 cases suffered from ASD in ACDF group, and 26 (33.3%) of 78 cases in TDR group. There was no statistical difference between the two groups regarding ASD incidence, VAS/NDI/JOA score, recovery rate. Logistic regression analysis showed that age (OR = 2.86, 95% CI, 1.58-4.14) and preoperative segmental lordosis (OR = 1.90, 95% CI, 1.05-3.20) were risk factors associated with increased odds of ASD regardless of surgical procedures. On the other hand, preoperative overall lordosis (OR = 0.54, 95% CI, 0.26-0.82) was most likely protective. In conclusion, advanced age and preoperative segmental lordosis were identified as risk factors for postoperative ASD, while preoperative overall lordosis proves to be a protective factor.

PMID: 29180636 [PubMed – in process]

Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases.

By London Spine

Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases.

J Neurosurg Spine. 2015 Jun 26;:1-7

Authors: Sukkarieh HG, Hitchon PW, Awe O, Noeller J

Abstract
OBJECT The authors sought to determine patient-related outcomes after minimally invasive surgical (MIS) lumbar intra-spinal synovial cyst excision via a tubular working channel and a contralateral facet-sparing approach. METHODS All the patients with a symptomatic lumbar intraspinal synovial cyst who underwent surgery at the University of Iowa Hospitals and Clinics with an MIS excision via a contralateral approach were treated between July 2010 and August 2014. There was a total of 13 cases. Each patient was evaluated with preoperative neurological examinations, lumbar spine radiography, MRI, and visual analog scale (VAS) scores. The patients were evaluated postoperatively with neurological examinations and VAS and Macnab scores. The primary outcomes were improvement in VAS and Macnab scores. Secondary outcomes were average blood loss, hospital stay duration, and operative times. RESULTS There were 5 males and 8 females. The mean age was 66 years, and the mean body mass index was 28.5 kg/m(2). Sixty-nine percent (9 of 13) of the cysts were at L4-5. Most patients had low-back pain and radicular pain, and one-third of them had Grade 1 spondylolisthesis. The mean (± SD) follow-up duration was 20.8 ± 16.9 months. The mean Macnab score was 3.4 ± 1.0, and the VAS score decreased from 7.8 preoperatively to 2.9 postoperatively. The mean operative time was 123 ± 30 minutes, with a mean estimated blood loss of 44 ± 29 ml. Hospital stay averaged 1.5 ± 0.7 days. There were no complications noted in this series. CONCLUSIONS The MIS excision of lumbar intraspinal synovial cysts via a contralateral approach offers excellent exposure to the cyst and spares the facet joint at the involved level, thus minimizing risk of instability, blood loss, operative time, and hospital stay. Prospective randomized trials with longer follow-up times and larger cohorts are needed to conclusively determine the superiority of the contralateral MIS approach over others, including open or ipsilateral minimally invasive surgery.

PMID: 26115025 [PubMed – as supplied by publisher]

A comparison between blind and nerve stimulation guided obturator nerve block in transurethral resection of bladder tumor.

By London Spine
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A comparison between blind and nerve stimulation guided obturator nerve block in transurethral resection of bladder tumor.

J Endourol. 2012 Oct;26(10):1319-22

Authors: Khorrami M, Hadi M, Javid A, Izadpahani MH, Mohammadi Sichani M, Zargham M, Alizadeh F

Abstract
PURPOSE: To compare blind and nerve stimulation guided transurethral obturator nerve block (ONB) in transurethral resection of bladder tumor (TURBT) to prevent obturator reflex.
PATIENTS AND METHODS: One hundred and twelve patients with lateral bladder wall tumors and at high risk for general anesthesia were categorized randomly in three groups. In the first group (34 patients), after spinal analgesia was administered, the exact site of the obturator nerve was determined by nerve stimulation and 15 mL of lidocaine HCl 2% was injected around the nerve. In the second group (31 patients), we determined the obturator nerve using nerve stimulation (like the first group), then 20 mL of saline was injected. In the third group (47 patients), the obturator nerve was determined based on anatomic landmarks and blocked subsequently. Leg jerking was reported and compared in the three groups.
RESULTS: The median ages in the three groups were 55.4, 59.4, 57.8 years in the first, second, and third groups, respectively. Male/female ratios were 79.5% in the first, 80.7% in the second, and 80.9% in the third group (P=0.986). Leg jerking was reported in 5.8%, 34%, and 6.3% of patients in the first, second, and third groups, respectively (P=0.0001). ONB took 6.7 minutes in the first, 6.1 minutes in the second, and 5.2 minutes in the third group, on average. There was no report of adverse effects of lidocaine HCl in this study.
CONCLUSION: Transvesical ONB is a safe and effective method of ONB before TURBT. This method is feasible by urologists and promising even without nerve stimulation and only by anatomic landmarks.

PMID: 22658168 [PubMed – indexed for MEDLINE]