The spine journal : official journal of the North American Spine Society
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Patients with thoracic tuberculosis have been not always successfully treated by radical debridement and bone grafting with or without supplementary posterior instrumentation and fusion, although most surgeons use posterior instrumentation to support anterior strut grafts. ⋯ The authors think that the one-stage anterior autogenous rib grafts and instrumentation are safe and effective methods in the surgical management of thoracic tuberculosis.
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Mitochondrial dysfunction is recognized during cell senescence and apoptosis, two important components of human disc aging/degeneration. We hypothesize that mitochondrial dysfunction is present in the degenerating and senescent annulus cells. The objective of the present study was to analyze gene expression profiles related to mitochondrial function in vivo. ⋯ Novel data showed that significant gene expression patterns are present in the human annulus related to mitochondrial dysfunction; changes were identified in important genes involving apoptosis, eNOS and Msr expressions, and solute carrier genes. Because current research efforts are focusing on bioactive compounds for mitochondria, we suggest that future biologic cell-based therapies for annulus degeneration should also consider mitochondrial-focused therapies.
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Pedicle screws are now standard for spinal arthrodesis as they provide three-column spinal stabilization. Decreased vertebral body bone density because of aging reduces the stability of the bone-screw interface, potentially increasing screw pullout or pseudarthrosis. Modifications to standard pedicle screw designs to improve screw stabilization may help to compensate for the detrimental effects of decreased vertebral bone density. ⋯ Expandable titanium pedicle screws demonstrated improved screw pullout stability compared with standard titanium screws in osteopenic or osteoporotic bone. Further studies are warranted examining other loading methods to evaluate the stability provided by an expandable pedicle screw.
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Randomized Controlled Trial
No difference in long-term trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus cognitive intervention and exercises.
Reduced muscle strength and density observed at 1 year after lumbar fusion may deteriorate more in the long term. ⋯ Although this study did not assess the morphology of muscles likely damaged by surgery, trunk muscle strength and cross-sectional area above the surgical levels are not different between those who had lumbar fusion or cognitive intervention and exercises at 7- to 11-year follow-up.
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Comparative Study Clinical Trial
Provocative lumbar discography versus functional anesthetic discography: a comparison of the results of two different diagnostic techniques in 52 patients with chronic low back pain.
There is mounting evidence that the currently available techniques for the diagnosis of discogenic low back pain are insufficiently accurate-this may explain some of the variability in outcomes of surgery for this important clinical problem. New diagnostic methods are needed to address this diagnostic issue; improvements here may do as much to improve overall patient outcomes as improvements in surgical treatment methods. ⋯ We have presented the results of a new diagnostic technique in 52 patients with chronic low back pain presumed discogenic in origin that was designed to help differentiate between symptomatic and asymptomatic disc degeneration. The findings of the test differed from those of standard pressure-controlled PD in 46% of the cases reported on here. Further studies are needed to demonstrate the clinical utility of the test.