Spine
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We measured the expression and responses of Toll-Like Receptor 4 (TLR4) activation in the intervertebral disc (IVD) in vitro and in vivo. We hypothesize that stimulation of the IVD with the TLR4 ligand lipopolysaccharide (LPS) results in upregulation of a coordinated set of proinflammatory mediators and inhibition of matrix expression, both consistent with a molecular profile of degeneration. ⋯ This study provides the first evidence that IVD cells express TLR4 and are responsive to TLR4 activation by upregulating a coordinated set of inflammatory cytokines. This study suggests that intradiscal injection of LPS offers a model for triggering inflammation of the IVD, demonstrating that inflammatory insults alone may potentially trigger degenerative changes of the IVD.
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Experimental study. ⋯ The high-dose parecoxib-soaked absorbable gelatin sponge can prevent peridural fibrosis without complications. The low-dose parecoxib and cellulose membrane provided no significant benefit vis-à-vis prevention of peridural fibrosis, as adduced from the lack of any statistically significant difference between the test and control rats.
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A single-center, retrospective study of 39 consecutive patients with Lenke 5 adolescent idiopathic scoliosis (AIS), all operated by a single surgeon using identical surgical technique and type of instrumentation (pedicle screws). ⋯ Without curve flexibility taken into consideration, implant density is positively correlated with thoracolumbar or lumbar coronal Cobb curve correction. No significant correlation is found between screw density and correction index, if the effect of the flexibility was eliminated. There was no association between implant density and magnitude of sagittal curve correction before and after surgery.
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Retrospective database analysis. ⋯ Our study found that "off-label" use of BMP as an adjunct to cervical fusions was associated with increased rates of dysphagia in ACFs and increased costs for all cervical fusions. Our study does not measure long-term outcomes after discharge; however, the impact of increased inhospital costs, length of stay, and incidence of dysphagia with utilization of BMP should be considered prior to its use in cervical fusions.
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Randomized Controlled Trial Multicenter Study Comparative Study
A prospective, randomized, controlled clinical investigation comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion. 2-year results from the US FDA IDE clinical trial.
Prospective, multicenter, randomized Food and Drug Administration approved investigational device exemption clinical trial. ⋯ The treatment of symptomatic single-level cervical spondylosis with PCM achieves clinical outcomes that are at least equivalent to ACDF while maintaining motion. At 2 years, patients with PCM had lower NDI scores, statistically lower rate of prolonged dysphagia, greater patient satisfaction, and superior overall success.