European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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The aim of this study is to establish standard MRI values for the cervical spinal canal, dural tube, and spinal cord, to evaluate age-related changes in healthy subjects, and to assess the prevalence of abnormal findings in asymptomatic subjects. ⋯ Using MRI data of 1,211 asymptomatic subjects, the standard values for the cervical spinal canal, dural tube, and spinal cord for healthy members of each sex and each decade of life and the age-related changes in these parameters were established. The relatively high prevalence of abnormal MRI findings of the cervical spine in asymptomatic individuals emphasizes the dangers of predicating operative decisions on diagnostic tests without precisely correlating these findings with clinical signs and symptoms.
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We evaluated radiologic and clinical outcomes to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior corpectomy and fusion (ACCF) for multilevel cervical spondylotic myelopathy (CSM). ⋯ Both ACDF and ACCF provide satisfactory clinical outcomes and fusion rates for multilevel CSM. However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stays, less blood loss, and shorter operative times.
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Spine stabilisation exercises, in which patients are taught to preferentially activate the transversus abdominus (TrA) during "abdominal hollowing" (AH), are a popular treatment for chronic low back pain (cLBP). The present study investigated whether performance during AH differed between cLBP patients and controls to an extent that would render it useful diagnostic tool. 50 patients with cLBP (46.3 ± 12.5 years) and 50 healthy controls (43.6 ± 12.7 years) participated in this case-control study. They performed AH in hook-lying. ⋯ In conclusion, the difference in group mean values for TrA-CR was small and of uncertain clinical relevance. Moreover, TrA-CR showed a poor ability to discriminate between control and cLBP subjects on an individual basis. We conclude that the TrA-CR during abdominal hollowing does not distinguish well between patients with chronic low back pain and healthy controls.
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Case Reports
Fusionless posterior hemivertebra resection in a 2-year-old child with 16 years follow-up.
We present the case of a 2-year-old patient with congenital scoliosis due to a lumbar hemivertebra. The current gold standard treatment of such an abnormality would be hemivertebra resection and short level posterior spinal fusion. However, due to the young age of the patient, we considered that application of a fusionless solution might offer advantages in terms of retaining normal segmental motion and the potential for growth. ⋯ To our knowledge a fusionless surgical solution for the treatment of a hemivertebra has never been described before. Although this is only a single case, the good result with a long follow-up suggests the technique is worthwhile considering when planning the treatment of a lumbar hemivertebra in very young children.
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Comparative Study
Influence of different commercial scaffolds on the in vitro differentiation of human mesenchymal stem cells to nucleus pulposus-like cells.
Cell-based therapies for regeneration of the degenerated intervertebral disc (IVD) are an alternative to current surgical intervention. Mesenchymal stem cells (MSCs), in combination with a scaffold, might be ideal candidates for regenerating nucleus pulposus (NP), the pressure-distributing part of the IVD. While the use of growth factors for MSCs differentiation currently receives major attention, in this study we compare the performance of sponge-like matrixes in supporting cell differentiation into NP-like cells. ⋯ Collagen supports provide a readily available, medically approved and effective scaffold for chondrogenic differentiation in vitro, but the phenotype of differentiated MSCs is not yet completely equivalent to that of NP cells.