The spine journal : official journal of the North American Spine Society
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1H magnetic resonance imaging (MRI) of the spine can rule out common causes of low back pain (LBP), such as disc protrusions or nerve root compression; however, no significant causal relation exists between morphology and the extent of symptoms. Functional MRI techniques, such as 23Na, may provide additional information, allowing indirect assessment of vertebral glycosaminoglycan concentrations, decreases in which are associated with early degenerative changes. ⋯ The results underline the feasibility and robustness of 23Na-MRI of human IVDs and affirm, in a large cohort, decreases in 23Na IVD content seen with disc degeneration.
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Prognosis of minor lumbar curve correction after selective thoracic fusion in idiopathic scoliosis is well defined. However, the prognosis of minor thoracic curve after isolated anterior fusion of the major lumbar curve has not been well described. ⋯ Selective anterior fusion of the major thoracolumbar/lumbar curve was an effective method for the treatment of Lenke Type 5C curves. Minor thoracic curves did not progress after selective fusion of thoracolumbar/lumbar curves in minimum 2-year follow-up.
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Although giant cell tumors (GCTs) are histologically benign, they may become locally aggressive bone tumors. As these lesions tend to respond poorly to radio- and chemotherapy, currently the standard surgical paradigm for the treatment of spinal GCTs involves en bloc surgical resection. Denosumab is a newly developed monoclonal antibody designed to inhibit the receptor activator of nuclear factor kappa-B ligand (RANKL) which has already been demonstrated to induce marked radiographic responses on GCTs of the appendicular skeleton. Nevertheless, the role of denosumab in the treatment algorithm of GCTs of the spine has not yet been defined. ⋯ This is the first report of sustained long-term complete clinical and radiographic regression of a GCT of the spine after treatment with the new RANKL antibody denosumab. Although future long-term follow-up studies are still necessary to establish important key points regarding the best therapeutic protocol with such a new drug (such as the optimal time frame to keep the patient under treatment), denosumab promises to bring major changes to the current therapeutic paradigm for GCTs of the spine, which, up to now, has strongly relied on en bloc surgical resection.
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The existing evidence suggests that, although older spinal cord injury (SCI) patients experience a similar degree of neurologic recovery to younger patients, older patients experience diminished functional outcomes at follow-up. However, all studies have assumed that the impact of age on functional outcome is the same across the spectrum of injury severity. ⋯ Overall, advanced age is associated with worse functional outcome after SCI; however, this effect varies across the spectrum of injury severity. These results will help to facilitate enhanced clinical communication as well as potentially aid in the development of customized treatment and rehabilitation protocols.
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Neuromuscular scoliosis could develop at a young age and progress beyond skeletal maturity. An early spinal fusion arrests growth of the spine and thorax, risking the development of secondary thoracic insufficiency syndrome. Vertical expandable prosthetic titanium rib (VEPTR) is a fusionless technique aiming at correction of the deformity with preservation of growth potential. ⋯ Early results of VEPTR for neuromuscular scoliosis are encouraging. Follow-up till skeletal maturity will best determine future indications.