Spine
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Prospective cohort study in a tertiary care spine center. ⋯ The C-TLIF allows for creation and maintenance of sagittal lordosis while avoiding subsidence and neurologic problems with a 99% fusion rate and 97% patient satisfaction.
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Retrospective study. ⋯ Risk factors for sagittal thoracic decompensation developing were sagittal imbalance at 8 weeks postoperatively (> or = 5 cm), smaller lumbar lordosis compared with thoracic kyphosis (< 10 degrees) at 8 weeks postoperatively, preoperative sagittal imbalance (> or = 5 cm), age at surgery (older than 55 years), and associated comorbidities. Sagittal thoracic decompensation adversely affected Scoliosis Research Society 24 outcomes scores.
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A radiographic review of 78 consecutive patients with degenerative rotatory lumbar scoliosis. ⋯ In degenerative scoliotic curves, lateral translation is associated with rotation. Increased rotary olisthesis does not lead to decreased dural sac area. Anteroposterior olisthesis is inversely correlated to the dural sac anteroposterior diameter and cross-sectional area. With increased segmental Cobb angle, foraminal cross-sectional area enlarges in the convexity and does not decrease in the concavity. Presence of intervertebral rotation alone does not appear to be associated with reduced neural canal dimensions. Ligamentum flavum hypertrophy, posterior disc bulging, and bony overgrowth are more likely to contribute to stenosis irrespective of scoliosis.
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Comparative Study
Comparative effects of bone morphogenetic proteins and sox9 overexpression on extracellular matrix metabolism of bovine nucleus pulposus cells.
An in vitro biologic study of the effects of adenovirus expressing bone morphogenetic proteins (BMPs) and adenovirus expressing Sox9 on extracellular matrix metabolism by bovine nucleus pulposus cells. ⋯ To our knowledge, for the first time, we have shown the relative effectiveness of 12 different BMPs and Sox9 in stimulating proteoglycan and collagen production by nucleus pulposus cells. Adenoviruses expressing BMP-2 and 7 were the most effective in stimulating proteoglycan accumulation, while adenoviruses expressing BMP-4 and 14 were the most effective in stimulating collagen accumulation. To our knowledge, this study is the first to compare the relative effectiveness of various BMPs and Sox9 on extracellular matrix accumulation by nucleus pulposus cells, and could help to develop more efficacious approaches to the treatment of degenerating intervertebral discs.
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Randomized Controlled Trial
Effects of perioperatively administered bupivacaine and bupivacaine-methylprednisolone on pain after lumbar discectomy.
A prospective, randomized, controlled trial that compared the efficacy of different protocols of local tissue infiltration with bupivacaine or bupivacaine-methylprednisolone at the surgical site for pain relief after lumbar discectomy. ⋯ In addition, our data suggest that preemptive infiltration of the wound site with bupivacaine alone provides similar pain control to preemptive infiltration of the wound site with bupivacaine and methylprednisolone combined.