European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Lesions of the intervertebral disc accompanying vertebral fractures are the subject of controversy and discussion regarding the extent and manner of surgical intervention. The question of when to perform disc resection and intervertebral fusion, in particular, has not been answered satisfactorily. In order to evaluate short- and medium-term lesions of the discoligamentous complex associated with thoracolumbar burst fractures, magnetic resonance images made after stabilisation and again after implant removal were compared. ⋯ No disruption of the fibrous ring or of the posterior longitudinal ligament was observed, nor was there any prolapse of intervertebral discs. When the intervertebral disk is intact and has normal morphology and a normal T2-weighted MRI signal, resection or fusion of the fracture adjacent discs appears unjustified. In our opinion, the results do not support the possibility of predicting degradation in those discs that showed an altered T2-weighted signal after the first operation.
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It is commonly believed that slight flexion/extension of the head will reverse the cervical lordosis. The goal of the present study was to determine whether slight head extension could result in a cervical kyphosis changing into a lordosis. Forty consecutive volunteer subjects with a cervical kyphosis and with flexion in their resting head position had a neutral lateral cervical radiograph followed immediately by a lateral cervical view taken in an extended head position to level the bite line. ⋯ Out of 40 subjects, only one subject, who was in the significant head extension group and had only a minor segmental kyphosis, changed from kyphosis to lordosis. The results show that slight extension of the head does not change a reversed cervical curve into a cervical lordosis as measured on lateral cervical radiographs. Only small extension angle changes (mean sum = 4.8 degrees) in the upper cervical segments (C2-C4) occur in head extension of 14 degrees or less.
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Transforming growth factor beta (TGF-beta) is a potent inducer of angiogenesis and fibrogenesis. There is presently little information about the pathophysiological function of TGF-beta in herniated disc tissue. In order to analyze the cellular role and activation of TGF-beta after disc herniation we immunostained frozen material from 38 disc herniation operations and from eight macroscopically normal discs from organ donors. ⋯ For all three antibodies, a statistically significantly (Mann-Whitney test, P = 0.0001) higher number of disc cells showed immunopositivity in the herniated discs. The increase in TGF-beta receptor immunopositivity suggested induction of TGF-beta receptors in herniated discs. Our results support an active regulatory role for TGF-beta in disc cell metabolism.