The spine journal : official journal of the North American Spine Society
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Case Reports
Anterior retropharyngeal approach to C1 for percutaneous vertebroplasty under C-arm fluoroscopy.
Percutaneous vertebroplasty (PVP) has proven to be a valuable palliative treatment option for patients with medically refractory painful osteolytic metastases of the spine. Percutaneous vertebroplasty of the atlas has been reported in only seven articles and has been performed with different techniques and approaches. ⋯ When the transoral approach is unsuitable or contraindicated, the anterior retropharyngeal approach could be an efficacious alternative in selected patients with C1 metastasis, providing adequate filling of bone cement and significant pain relief. Based on our preliminary exploration, only assisted by C-arm fluoroscopy, this approach is feasible to achieve PVP in C1 under local anesthesia and intravenous analgesia. Nevertheless, when considering the substantial potential risks, this technically challenging procedure should be performed by experienced operators.
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There has been concern expressed about research ethics with respect to not fully reporting data collected during clinical studies. One site available for all clinical trials is ClinicalTrials.gov. The original purpose of this site was to facilitate patients seeking a trial for the treatment of their particular condition. The internationally available site offers general information about the study, sponsor name, principal investigator, patient selection criteria, enrollment goal, study design, outcome measures, participating centers, initiation date, date posted, date completed, and other pertinent data. The site can be used to identify studies conducted for a particular condition or intervention. ⋯ Although the 38.9% publication rate for spine-related studies found in this study appears low, it is in line with other studies reporting a 22.8% publication rate for arthroplasty trials and 43.2% for orthopedic trauma trials. In addition to ClinicalTrials.gov Web site fulfilling its original goal of providing patients information about clinical studies, it can also provide a means of tracking publication of prospective studies, changes to protocols, matching publication content to posted study design, and others and raise queries concerning the reasons for not publishing what appear to be well-designed studies. The posting of spine studies before initiation can increase transparency and ability to evaluate clinical trials in spine.
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Dynamic changes in the spinal cord cross-sectional area due to cervical ossification of the posterior longitudinal ligament (C-OPLL) are unknown, but dynamic multidetector-row computed tomography (MDCT) may be a useful tool. ⋯ Dynamic MDCT was useful for evaluating dynamic changes in the spinal cord. At the most stenotic level, the spinal cord became narrower during extension at all disc levels. In the kyphosis group and K-line (-) group, it became narrower during flexion. Cervical flexion may induce greater spinal cord compression in patients with kyphosis and K-line (-).
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Comment
Anterior cervical discectomy and fusion surgery for cervical radiculopathy: is time of essence?
Burneikiene S, Nelson EL, Mason A, Rajpal S, Villavicencio AT. The duration of symptoms and clinical outcomes in patients undergoing anterior cervical discectomy and fusion for degenerative disc disease and radiculopathy. Spine J 2015;15:427-32 (in this issue).
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Intervertebral disc (IVD) degeneration, a major cause of low back pain, is considered to be induced by daily mechanical loading. Mechanical stress is widely known to affect cell survival and extracellular matrix metabolism in many cell types. Although the involvement of integrin α5β1 transmembrane mechanoreceptor in IVD degeneration has been reported, the precise function of integrin α5β1 remains obscure. ⋯ The dynamic loading organ culture system simulated cellular responses to mechanical loading of the IVD. Our results suggest that IVD cells recognize the mechanical stress through RGD integrins, particularly the α5β1 subtype that is highly expressed in NP and AF cells. Further experiments using this system will provide information about pathomechanisms of IVD degeneration through the mechanotransduction pathways.