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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Dynamic contrast-enhanced MRI (DCE-MRI) was used to investigate the associations between intervertebral disc degeneration and changes in perfusion and diffusion in the disc endplates. ⋯ Increased enhancement in the endplate regions of degenerating discs might be an indication of ongoing damage in these tissues. Therefore, DCE-MRI could aid in understanding the pathophysiology of disc degeneration. Moreover, it could be used in the planning of novel treatments such as stem cell therapy.
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To evaluate the relative position between lumbar plexus and access corridor of minimally invasive lateral transpsoas lumbar approach, as well as the approach safety. ⋯ With respect to the SCPL of disc, a trajectory of guide wire or a radiographic reference landmark to place working channel, lumbar plexus lies posteriorly to it from L1-L2 to L3-L4 level and shifts anteriorly to it at L4-L5 level, while genitofemoral nerve locates anteriorly to the SCPL from L2-L3 to L4-L5 level. Neural retraction may take place during sequential dilation of access corridor especially at L4-L5 level.
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Some patients will experience post-operative back pain following lumbar discectomy, and the potential sources for that pain are poorly understood. One potential source is the vertebral endplates. The goal of this study was to document the changes that occur in lumbar endplates following discectomies, and to assess associations between endplate changes and clinical outcomes. ⋯ This study documents lesion characteristics in detail and supports that osseous defects in the endplates at the level of a lumbar discectomy may be a relatively common finding following surgery, along with disc height loss, loss of disc signal intensity, and Modic changes. The clinical significance of these imaging findings could not be conclusively determined in this study.
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Sacral chordoma is a rare low-to-intermediate grade malignant tumour. The mainstay of treatment is still surgery with en bloc and wide resection margins, which can grant the best chances of a long-term control or cure of this disease. The first aim of this paper is to collect data about survival, time to local recurrence and metastasis among patients affected by sacral chordoma and primarily treated with surgery. The second aim is to analyze the influence of level resection, tumor volume and surgical margins on local recurrence. ⋯ Solid survival at long-term follow-up can be achieved by a surgical resection performed with wide margins.
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Review
What is the preclinical evidence on platelet rich plasma and intervertebral disc degeneration?
Intervertebral disc degeneration is a common disease that usually starts from the third decade of life and it represents a significant cause of socio-economic problems. The accepted surgical treatment for disc degeneration is disc removal and vertebral fusion or, in selected cases, intervertebral disc arthroplasty. Several studies have demonstrated the ability of platelet rich plasma (PRP) to stimulate cell proliferation and extracellular matrix regeneration. However, literature results are still limited and more studies are required to clarify the role of PRP in the prevention or in the treatment of degenerative disc disease. The aim of this review is to summarize and critically analyze the current preclinical evidence about the use of PRP in intervertebral disc degeneration. ⋯ It is not possible to draw definitive evidence about the use of PRP in IVD regeneration. We advise a proper standardization of the methodological analysis in order to compare the available data and achieve definitive results. This should be the cornerstone for future clinical applications.