Spine
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Retrospective national database analysis. ⋯ Our results demonstrated an overall incidence of 6.7 cardiac complications per 1000 lumbar spine surgical procedures from 2002 to 2009. Patients undergoing lumbar fusion were more likely to experience cardiac events than lumbar decompression patients. Cardiac events tend to occur in patients with noted risk factors and result in increased hospitalizations, costs, and mortality. On the basis of these findings, we think that patients with specified risk factors should be monitored closely and medically optimized in the perioperative period.
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We measured the expression and responses of Toll-Like Receptor 4 (TLR4) activation in the intervertebral disc (IVD) in vitro and in vivo. We hypothesize that stimulation of the IVD with the TLR4 ligand lipopolysaccharide (LPS) results in upregulation of a coordinated set of proinflammatory mediators and inhibition of matrix expression, both consistent with a molecular profile of degeneration. ⋯ This study provides the first evidence that IVD cells express TLR4 and are responsive to TLR4 activation by upregulating a coordinated set of inflammatory cytokines. This study suggests that intradiscal injection of LPS offers a model for triggering inflammation of the IVD, demonstrating that inflammatory insults alone may potentially trigger degenerative changes of the IVD.
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Comparative Study
Comparison of lumbopelvic rhythm and flexion-relaxation response between 2 different low back pain subtypes.
A cross-sectional study to compare the kinematics and muscle activities during trunk flexion and return task in people with and without low back pain (LBP). ⋯ These results show that the lumbopelvic rhythms are different among healthy subjects and patients assigned to 2 specific LBP subgroups. These results provide information on the FR response of the erector spinae muscle.
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A retrospective review of a consecutive population of patients treated with radiofrequency-targeted vertebral augmentation (RF-TVA) for malignant vertebral compression fractures (VCFs). ⋯ We report optimum safety and efficacy results in the treatment of malignant VCFs with a novel RF-TVA technique in which controlled delivery of an ultrahigh viscosity PMMA is used for fracture stabilization. The deposition of PMMA with RF-TVA is predictable and uniform, and can be performed without the PMMA handling constraints that may be encountered with vertebroplasty and balloon kyphoplasty. The safety and efficacy we report with RF-TVA achieved equivalency with other methods of treatment for VCF stabilization.
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Randomized Controlled Trial Multicenter Study Comparative Study
A prospective, randomized, controlled clinical investigation comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion. 2-year results from the US FDA IDE clinical trial.
Prospective, multicenter, randomized Food and Drug Administration approved investigational device exemption clinical trial. ⋯ The treatment of symptomatic single-level cervical spondylosis with PCM achieves clinical outcomes that are at least equivalent to ACDF while maintaining motion. At 2 years, patients with PCM had lower NDI scores, statistically lower rate of prolonged dysphagia, greater patient satisfaction, and superior overall success.