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 alignment at the cervical spine has been considered a determinant of degeneration at the adjacent disc, but this issue in cervical disc replacement surgery is poorly explored and discussed in this patient population. The aim of this systematic review is to compare anterior cervical fusion and total disc replacement (TDR) in terms of preservation of the overall cervical alignment and complications. ⋯ Even though cervical disc arthroplasty leads to similar outcomes compared to arthrodesis in the middle term follow-up, no evidence of superiority of cervical TDR is available up to date. We understand that the overall cervical alignment after TDR tends towards the loss of lordosis, but only longer follow-up can determine its influence on the clinical results.
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To evaluate the results of a novel rigid-dynamic stabilization technique in lumbar degenerative segment diseases (DSD), expressly pointing out the preservation of postoperative lumbar lordosis (LL). ⋯ When properly selected, this technique leads to good results. A proper LL should be achieved after any hybrid stabilization to preserve the segment above the fusion.
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The potential of stem cell niches (SCNs) in the intervertebral disc (IVD) region, which may be of great significance in the regeneration process, was recently proposed. To the best of our knowledge, no previous in vitro study has examined the characteristics of stem cells derived from the potential SCN of IVD (ISN). Therefore, increasing knowledge on ISN-derived stem cells (ISN-SCs) may provide a greater understanding of IVD degeneration and regeneration processes. We aimed to demonstrate the existence of ISN-SCs and to compare their characteristics with bone marrow mesenchymal stem cells (BMSCs) in vitro. ⋯ To the best of our knowledge, this is the first in vitro study aimed towards determining the existence and characteristics of ISN-SCs, which belong to the MSC family and with greater osteogenic and chondrogenic abilities than BMSCs according to our data. This finding may be of great significance for additional studies that investigate the migration of ISN-SCs into the IVD, and may provide a new perspective on different biological approaches for IVD self-regeneration.
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Spinal cord back shift has been considered the desired end point of posterior decompression procedures for cervical spondylotic myelopathy (CSM). However, the association with postoperative outcomes has not been definitively demonstrated. The aim of this review is to obtain an overview of the current knowledge on the spinal back shift after posterior decompression to clarify the main controversial aspects and provide recommendations for further studies on the subject. ⋯ There is a need for a consensus on the best way to measure the spinal cord back shift. The action of multiple factors on spinal cord back shift can explain the difference in the results collected from the studies. We recommend further studies to clarify the behavior of the spinal cord after posterior decompression and its clinical meaning.
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Randomized Controlled Trial
Trabecular metal spacers as standalone or with pedicle screw augmentation, in posterior lumbar interbody fusion: a prospective, randomized controlled trial.
This prospective randomized comparative trial compared radiological and clinical outcome of Trabecular Metal™ (TM) spacers in PLIF, used as standalone (SA) devices, to TM spacers in PLIF with pedicle screw fixation (PF), in patients with single-level degenerative disc disease (DDD). ⋯ In this study, TM spacers were found to provide a solid construct at more than 6-year follow-up after PLIF for DDD both with and without additional pedicle fixation. The clinical, but also radiological results were not significantly different between both cohorts. Future studies focusing on the differences of SA and PF at L4/5 level should be powered to study differences in post-surgery stability at the long term.