Spine
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Review of the most recent advances in the development of poro-elastic analytical models that include physiologic parameters used for understanding lumbar disc degeneration due to repetitive loading. ⋯ A number of different approaches have been used to address the issue of disc degeneration. Poro-elastic finite element model including strain-dependent permeability and osmotic pressure is the most popular analytical tool currently available that can be used to understand how cyclic loading affects the biomechanical characteristics of a degenerated lumbar disc. However, it is important to note that a complete understanding of the behavior of the intervertebral disc will ultimately be arrived using a combination of analytical models, such as the models presented here, in addition to in vitro and in vivo experimental methods.
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A review of the literature on disc nutrition. ⋯ Loss of nutrient supply can lead to cell death, loss of matrix production, and increase in matrix degradation and hence to disc degeneration.
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The occurrence of anular tears and general disc degeneration of the lumbar spine was studied in relation to the lifetime frequency of back pain. ⋯ Anular degeneration of the lumbar discs appear earlier and are more clearly related to back pain than previously thought, most probably due to the better sensitivity of the BaSO4 discography method to detect tears.
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An in vivo serial magnetic resonance imaging study of diffusion characteristics in human lumbar discs over 24 hours in healthy volunteers and patients with low back pain. ⋯ Serial postcontrast magnetic resonance imaging studies offer a reliable method of assessing the diffusion of the discs and the functional status of the endplate cartilage. Endplate cartilage damage increases with age and produces considerable changes in diffusion. The present study has described reliable signs by which these damages can be identified in vivo. Aging and degeneration have been shown to be two separate processes by documenting clear-cut differences in diffusion. The present data encourage use of diffusion studies as a noninvasive method to assess the physiologic status of the disc and endplate and to study the effect of drugs, smoking, mechanical loading, exercises, etc. on the physiology of the disc.
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Case Reports
Fenestration of vertebral artery at the craniovertebral junction in Down syndrome: a case report.
Case report of a Down syndrome patient with right vertebral artery fenestration and abnormalities of the craniovertebral junction. ⋯ Before corrective surgery of craniovertebral junction anomalies in patients with Down syndrome, the possibility of vertebral artery anomalies associated with abnormal craniovertebral junction anatomy should be considered. With preoperative 3-dimensional computed tomography angiography, we can precisely identify the anomalous vertebral artery and modify the surgical approach to reduce the possible risk of intraoperative vertebral artery injury in advance.