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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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.
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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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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 assess the cost-utility and perioperative costs of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) versus open-TLIF for degenerative lumbar pathologies. ⋯ From the limited evidence, the available data suggest a trend of significantly reduced perioperative costs, length of stay, and blood loss for minimally invasive compared with open surgical approaches for TLIF. MI-TLIF may represent an opportunity for optimal utilization and allocation of health-care resources from both a hospital and societal perspective.
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To assess the cost-utility and perioperative costs of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) versus open-TLIF for degenerative lumbar pathologies. ⋯ From the limited evidence, the available data suggest a trend of significantly reduced perioperative costs, length of stay, and blood loss for minimally invasive compared with open surgical approaches for TLIF. MI-TLIF may represent an opportunity for optimal utilization and allocation of health-care resources from both a hospital and societal perspective.