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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Meta Analysis
Meta-analysis of the effects of genetic polymorphisms on intervertebral disc degeneration.
Chronic low back pain is a significant public health issue. Both its direct and indirect cost represents tens of billions of US dollars. Although chronic low back pain can be the result of many factors, the predominant cause is disc degeneration. Recent studies have shown genetic involvement in up to 74% of cases. This study aimed to evaluate genetic risk factors of disc degeneration by performing a systematic analysis of association studies. The objective is to provide a guide for practice by assessing the clinical relevance of current information. ⋯ The results highlight the lack of methodological rigor in most of the studies. The absence of international clinical and radiological classification of early disc degeneration, limits the homogeneity of studies. Understanding which populations are predisposed to this significant public health problem may change our approach to diagnostic and therapeutic methods. This work opens up enormous opportunities to provide a genetic solution and consider new diagnostic and therapeutic means to this public health problem.
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Multicenter Study
Surgical treatment of thoraco-lumbar kyphosis (TLK) associated with low pelvic incidence.
Thoraco-lumbar kyphosis (TLK) is poorly described in the literature and its surgical treatment remains equivocal for patients with low pelvic incidence. The aim of the study was to identify which surgical correction would yield the best functional results as measured by the Oswestry score. ⋯ It seems that keeping the physiological morphology is the treatment of choice. For patients with degenerative scoliosis, reducing the kyphosis could work. We do not recommend to increase the lordosis and obtain a type 3 morphology with an anteverted pelvis because of the risk of PJK and poor functional results.
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Since its introduction BMP has been utilized in populations with higher rates of malunion, such as adult spinal deformity (ASD) patients. Contradictory conclusions exist in spinal literature regarding the safety and efficacy of the use of BMP in this setting. Previous studies, however, did not distinguish deformity cases from spondylolisthesis or stenosis. The purpose of this study is to evaluate the safety and efficacy of BMP use in spinal fusion surgery for ASD. ⋯ The current literature shows BMP to be a safe and effective grafting technique in the treatment of ASD. Spine surgeons may currently be using sub-optimal doses of BMP. The benefit of increasing the rate of fusion must be weighed against the increased risk of radiculitis and neurologic complications in this patient population.
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Chronic low back pain has been associated with intervertebral disc (IVD) degeneration, which is characterized by the accumulation of extracellular matrix (ECM)-degrading proteases and inflammatory molecules in the degenerate tissue. IVD degeneration could be the outcome of natural organismal ageing and/or of the exposure of the disc to cumulative stressful environmental stimuli and is accompanied by an increased population of senescent cells in the tissue. On the other hand, senescent cells are known to secrete proteolytic enzymes and inflammatory molecules, which can contribute to ECM catabolism. The aim of this study was to investigate the transcriptional profile of selected metalloproteinases (MMPs) and inflammatory mediators in human nucleus pulposus IVD cells that became senescent using three different approaches: serial subculturing, exposure to ionizing radiation and p16INK4a overexpression. ⋯ Data described here suggest that senescent cells may have similar functions in IVD homeostasis, irrespective of the origin of senescence induction.