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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Diagnostic methods and biomarkers of early disc degeneration are needed as emerging treatment technologies develop (e.g., nucleus replacement, total disc arthroplasty, cell therapy, growth factor therapy) to serve as an alternative to lumbar spine fusion in treatment of low back pain. We have recently demonstrated in cadaveric human discs an MR imaging and analysis technique, spin-lock T(1rho)-weighted MRI, which may provide a quantitative, objective, and non-invasive assessment of disc degeneration. The goal of the present study was to assess the feasibility of using T(1rho) MRI in vivo to detect intervertebral disc degeneration. ⋯ The T(1rho) relaxation correlated significantly with disc degeneration (r=-0.51, P<0.01) and the values were consistent with our previous cadaveric study, in which we demonstrated correlation between T(1rho) and proteoglycan content. The technique allows for spatial measurements on a continuous rather than an integer-based scale, minimizes the potential for observer bias, has a greater dynamic range than T(2)-weighted imaging, and can be implemented on a 1.5 T clinical scanner without significant hardware modifications. Thus, there is a strong potential to use T(1rho) in vivo as a non-invasive biomarker of proteoglycan loss and early disc degeneration.
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The idea of a tissue engineered nucleus implant is to seed cells in a three-dimensional collagen matrix. This matrix may serve as a scaffold for a tissue engineered nucleus implant. The aim of this study was to investigate whether implantation of the collagen matrix into a spinal segment after nucleotomy is able to restore disc height and flexibility. ⋯ The results of this study directly reflect the efficacy of vital nucleus replacement to restore disc height and to provide stability to intervertebral discs. However, from a biomechanical point of view, the challenge is to employ an appropriate annulus fibrosus sealing method, which is capable to keep the nucleus implant in place over a long-time period. Securing the nucleus implant inside the disc is one of the most important biomechanical prerequisites if such a tissue engineered implant shall have a chance for clinical application.
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Randomized Controlled Trial
Results of complete hemivertebra excision followed by circumferential fusion and anterior or posterior instrumentation in patients with type-IA formation defect.
To evaluate the results of surgical treatment in patients with unlocked full-segmented hemivertebra treated by excision. Twenty-six patients with a mean age of 12.4+/-1.7 years were included in the study. The mean duration of follow-up was 47.8+/-21.9 months. ⋯ Circumferential fusion could be achieved in all cases. No neurological complication developed, the only complication was delayed wound healing. In view of these data, it is concluded that these techniques can be safely used for this patient group at low thoracic, thoracolumbar, and lumbar levels of vertebral column with high correction rates.
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This study was designed to assess the inter-observer reliability and intra-observer reproducibility of standard radiographic evaluation of 150 thoraco-lumbar fractures using the AO-classification. The influence of clinical information on agreement levels was also evaluated. Six observers (two junior and four senior residents) evaluated the radiographic images. ⋯ The overall inter-observer agreement was rated as fair (0.291) in the first session and moderate (0.403) in the second. Intra-observer values ranged from slight (0.181) to moderate (0.488). The increased level of agreement in the second session was attributed to the value of additional clinical information, the learning curve of the junior residents and the simplicity of the classification.
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Smith and Nephew (Endoscopy division, Andover, MA, USA) have estimated that 60,000 Intra-Discal Electrothermal Therapy (IDET) procedures have been performed world wide up to June 2005. Despite the large number of procedures performed, a critical appraisal of the evidence of efficacy of IDET has not appeared in the literature. This paper reviews the current evidence of clinical efficacy for IDET obtained via a systematic review of the literature. ⋯ The advantage for IDET patients amounted to 1.3 points on the VAS and seven points on the ODI. The second study randomised 57 subjects (38 to IDET, 19 to Sham) and showed no benefit from IDET over placebo. The evidence for efficacy of IDET remains weak and has not passed the standard of scientific proof.