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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Degenerative disc disease (DDD) is still a poorly understood phenomenon because of the lack of availability of precise definition of healthy, ageing and degenerated discs. Decreased nutrition is the final common pathway for DDD and the status of the endplate (EP) plays a crucial role in controlling the extent of diffusion, which is the only source of nutrition. The vascular channels in the subchondral plate have muscarinic receptors but the possibility of enhancing diffusion pharmacologically by dilation of these vessels has not been probed. ⋯ An EP damage score has been devised which had a good correlation to DDD and discs with a score of six and above can be considered 'at risk' for severe DDD. New data on disc diffusion patterns were obtained which may help to differentiate healthy, ageing and degenerated discs in in-vivo conditions. This is also the first study to document an increase in diffusion of human lumbar discs by oral nimodipine and poses interesting possibility of pharmacological enhancement of lumbar disc nutrition.
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Comparative Study
Short fusion versus long fusion for degenerative lumbar scoliosis.
The extent of fusion for degenerative lumbar scoliosis has not yet been determined. The purpose of this study was to compare the results of short fusion versus long fusion for degenerative lumbar scoliosis. Fifty patients (mean age 65.5 +/- 5.1 years) undergoing decompression and fusion with pedicle screw instrumentation were evaluated. ⋯ For patients with severe Cobb angle and rotatory subluxation, long fusion should be carried out to minimize adjacent segment disease. For patients who have severe sagittal imbalance, spinal osteotomy is an alternative technique to be considered. As long fusion is likely to increase early perioperative complications, great care should be taken for high-risk patients to avoid complications.
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The aim of this work was to develop a low-cost automated system to measure the three-dimensional shape of the back in patients with scoliosis. The resulting system uses structured light to illuminate a patient's back from an angle while a digital photograph is taken. The height of the surface is calculated using Fourier transform profilometry with an accuracy of +/-1 mm. ⋯ Accurate surface topography can help the clinician to measure spinal deformity at baseline and monitor changes over time. It can help the patients and their families to assess deformity. Above all it reduces the dependence on serial radiography and reduces radiation exposure when monitoring spinal deformity.
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Review
The myth of lumbar instability: the importance of abnormal loading as a cause of low back pain.
Spinal fusion became what has been termed the "gold standard" for the treatment of mechanical low back pain, yet there was no scientific basis for this. Operations of fusion for low back pain were initially done at the beginning of the last century for back pain thought to be related to congenital abnormalities or for past spinal infection. The recognition of the disc as a cause of sciatica, commonly associated with back pain, and the recognition that a degenerate disc led to abnormal movement suggested the concept that this abnormal movement was the cause of pain, and this abnormal movement came to be called "instability". ⋯ The failure of pedicle screws and cage fusion to improve the clinical results of fusion despite near 100% fusion success, and the introduction of "flexible stabilization" and artificial discs, which demonstrated that despite the often unpredictable movement permitted by of these devices, clinical success was similar to fusion, directed attention to the other role of the disc, that of load transfer, which these devices also affected. Abnormal load transfer was already known to be critical in other joints in the body and had led to the use of osteotomy to realign joints. The relevance of load transfer to the future design of spinal implants used in the treatment of low back pain is discussed, and some finite element studies are reported demonstrating the likely effect of abnormal loading beneath an incompletely incorporated plate of an artificial disc, perhaps explaining in part the somewhat disappointing clinical results to date of the implantation of artificial discs.
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Measurement of human posture and movement is an important area of research in the bioengineering and rehabilitation fields. Various attempts have been initiated for different clinical application goals, such as diagnosis of pathological posture and movements, assessment of pre- and post-treatment efficacy and comparison of different treatment protocols. Image-based methods for measurements of human posture and movements have been developed, such as the radiography, photogrammetry, optoelectric technique and video analysis. ⋯ The posture information of five subjects was recorded at 30 s intervals during daily activity over a period of 3 days and 2 h a day. The preliminary results demonstrated that the subjects could improve their posture when feedback signals were provided. The posture monitoring system could be used for the purpose of posture monitoring during daily activity.