The spine journal : official journal of the North American Spine Society
-
The vanilloid receptor 1 (VR1) is expressed by the type II A-delta and C-fiber neurons, functioning as a molecular integrator for nociception. VR1 can be selectively ablated by resiniferatoxin (RTX), an ultra-potent excitotoxic agonist, when injected into sensory ganglia. ⋯ VR1-positive neurons are essential for the development of mechanical allodynia. In rats already exhibiting neuropathic pain, the VR1-positive neurons mediate the most sensitive part of mechanical allodynia. RTX injection in sensory ganglia may represent a novel treatment for neuropathic pain.
-
Previous studies documenting the osteoconductive nature of calcium sulfate (CaSO(4))-based biomaterials have been largely limited to animal models exhibiting nonosteoporotic bone biology. In addition to diminished bone mineral density (BMD) and altered bone microarchitecture, the osteoporosis phenotype is associated with a proinflammatory and pro-osteolytic state. Thus, osteoporosis may elicit an amplified bioreactivity to common orthopedic biomaterials, potentially limiting their full osteoconductive capabilities in vivo. ⋯ This study suggests that cement bioreactivity is heightened and osteoconductivity may be limited in a preclinical model of the OS. The disparity between the two resorption profiles suggests that this accelerated cement resorption is a material-dependent phenomenon. The proinflammatory and pro-osteolytic bone environment associated with the osteoporosis disease state may contribute to the accelerated resorption and altered osteoconductivity exhibited by both materials. Future study of potential biomaterials intended for use within the OS may necessitate further exploration of the relationship between biomaterial performance and osteoporosis bone biology.
-
The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing amongst available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. ⋯ Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.
-
The management of chronic low back pain (CLBP) has proven to be very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing amongst available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. ⋯ Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.