Spine
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Human nucleus pulposus cells were cultured in alginate beads and activated with IL-1 beta or TNF-alpha, with and without inhibition of p38 mitogen activated protein kinase (p38 MAPK) activity. Cell production of factors modulating the anabolic/catabolic balance of the disc was determined. ⋯ Inhibition of p38 MAPK in cytokine-activated disc cells blunts production of factors associated with inflammation, pain, and disc matrix catabolism. The data support further analysis of these effects on the anabolic/catabolic balance of nucleus pulposus cells and suggest that molecular techniques blocking this signal could provide a therapeutic approach to slow the course of intervertebral disc degeneration.
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A retrospective study. ⋯ The line Tr, (runs perpendicular to the line which passes the bilateral transverse processes) had the greatest correlation to the rotation of a vertebra. On the other hand, the line Sp (defined as the midline of the spinous process) was not sufficient for predicting rotation of a vertebra and can be disregarded during the intraoperative analysis and screw placement.
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Randomized Controlled Trial
A prospective, randomized, double-blind study of the efficacy of postoperative continuous local anesthetic infusion at the iliac crest bone graft site after posterior spinal arthrodesis: a minimum of 4-year follow-up.
Parallel design, prospective, double-blinded, randomized, controlled trial composed of 2 independent groups treated with a continuous infusion catheter (saline vs. Marcain) placed into the iliac crest bone graft site (ICBG). ⋯ Continuous infusion of 0.5% Marcain at the ICBG harvest site significantly reduced chronic dysesthesias. Overall satisfaction with the procedure, number of painful days per month, and VAS scores were significantly better in the treatment group at 4 years. No long-term complications were attributed to either the ICBG site or the catheter-infusion system. The use of continuous local anesthetic infusion at the iliac crest may help in alleviating graft-related pain beyond the perioperative phase.
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Review Case Reports
Three-column ligamentous extension injury of the thoracic spine: a case report and review of the literature.
This is a report of a patient with a rare unstable 3-column ligamentous injury of the thoracic spine. ⋯ A high index of suspicion is necessary to identify such extremely unstable injury despite its relative benign clinical and radiologic presentation.