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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Magnetic resonance imaging (MRI) can reveal a range of degenerative findings and anatomical abnormalities; however, the clinical importance of these remains uncertain and controversial. We aimed to investigate if the presence of MRI findings identifies patients with low back pain (LBP) or sciatica who respond better to particular interventions. ⋯ Although individual trials suggested that some MRI findings might be effect modifiers for specific interventions, none of these interactions were investigated in more than a single trial. High quality, adequately powered trials investigating MRI findings as effect modifiers are essential to determine the clinical importance of MRI findings in LBP and sciatica (PROSPERO: CRD42013006571).
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Spinal instability of the lumbar spine causes various clinical symptoms. Among them, spinal instability is thought to contribute to low back pain, but the pathophysiological mechanisms are controversial. Although experimental animal models of spinal instability have been reported, it is unknown whether these models produce pain and whether spinal instability affects walking ability. We used the CatWalk system to investigate whether lumbar facetectomy causes gait abnormalities and low back pain. ⋯ These results suggest that spinal instability and/or intervertebral disc degeneration induce gait abnormalities and low back pain. This experimental model may be useful for elucidating the mechanisms underlying clinical symptoms, such as low back pain, in patients with spinal instability.
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Fresh-frozen intervertebral disc transplantation was determined to be an effective treatment for degenerative disc diseases in rhesus monkeys and in humans. Further research in improving different aspects of disc allografts transplantation is needed and will be investigated in large animal models. This study reports the detailed surgical technique of intervertebral disc transplantation without internal fixation and the important notes to ensure success in goats. ⋯ Lumbar intervertebral disc transplantation without internal fixation can be successfully performed in goats.
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Post-traumatic disc degeneration (DD) is currently investigated with models not fully matching the clinical condition, in particular post-traumatic loading of the disc is not considered. Therefore, the aim was to establish an in vitro burst fracture model that more closely mimics the in vivo situation by including post-traumatic physiological loading and to investigate DD under these conditions. ⋯ An in vitro burst fracture model with physiological post-traumatic loading was established. Under these conditions, burst spinal segments undergo strong and persistent degenerative changes.
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While much evidence suggests that adjacent segment degeneration is merely a manifestation of the natural degenerative process unrelated to any spine fusion, a significant body of literature supports the notion that it is a process due in part to the altered biomechanics adjacent to fused spine segments. The purpose of this study was to review and critically analyze the published literature that investigated the in vivo kinematics of the adjacent segments and entire lumbar spine in patients receiving spinal fusion or motion-preserving devices. ⋯ There appears to be no overall kinematic changes at the rostral or caudal levels adjacent to a fusion, but some patients (~20-30%) develop excessive kinematic changes (i.e., instability) at the rostral adjacent level. The overall lumbar ROM after fusion appears to decrease after a spinal fusion.