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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Quantification of thermal thresholds is a useful method to assess and follow up the function of afferent small A-delta and C-fibres in patients with nerve dysfunctions. The object of this study was to estimate thermal test-retest repeatability in 19 patients with unilateral sciatica (14 L5 and 5 S1) in affected and non-affected dermatomes on the symptomatic (S) and non-symptomatic (NS) sides. Detection thresholds were measured at six sites, two within each of the L4, L5 and S1 dermatomes. ⋯ The sensitivity was better on the foot than the lateral calf (5 of 14 vs 1 of 14 abnormal thresholds) in the subgroup with L5 sciatica. We conclude that dermatomal thermotesting has acceptable repeatability, particularly at proximal lower extremity sites. The test may be useful in longitudinal investigations of patients with sciatica, e.g. in treatment follow-up studies.
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Comparative Study
Comparison of BMP-2 and combined IGF-I/TGF-ss1 application in a sheep cervical spine fusion model.
Growth factors have proven to promote spine fusion. However, no comparative evaluation of growth factors in spinal fusion has yet been performed. The purpose of this study was to compare the efficacy and safety of combined IGF-I and TGF-ss1 application with BMP-2 application and autologous cancellous bone graft at an early time point in a sheep cervical spine fusion model. ⋯ In comparison to the autologous cancellous bone graft group, both growth factors (BMP-2 and combined IGF-I and TGF-ss1) significantly improved the biomechanical results of interbody fusion. No systemic side effects were observed for either growth factor. On the basis of these preliminary results, it would appear that combined IGF-I/TGF-ss1 application yields equivalent results to BMP-2 application at an early time point in anterior sheep cervical spine fusion.
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Lower back pain and disc degeneration negatively affect quality of life and impose an enormous financial burden. An extensive body of scientific work has evolved that characterizes the disc, demonstrating spinal anatomy and morphology that contribute to risk and likely promote failure. ⋯ One intervening approach to breaking this sequence has been to repopulate the anatomy with autologous disc chondrocytes--cells capable of restoring the matrix and retaining the mechanical balance by which the disc functions. This strategy has been implemented both in patients and in animal models, and early results, although preliminary, support the premise as a positive approach.
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A first-generation implant for non-rigid stabilization of lumbar segments was developed in 1986. It included a titanium interspinous blocker and an artificial ligament made of dacron. Following an initial observational study in 1988 and a prospective controlled study from 1988 to 1993, more than 300 patients have been treated for degenerative lesions with this type of implant with clinical and mechanical follow-up. ⋯ Non-rigid fixation clearly appears to be a useful technique in the management of initial forms of degenerative intervertebral lumbar disc disease. This method should rapidly assume a specific role along with total disc prostheses in the new step-wise surgical strategy to obviate definitive fusion of degenerative intervertebral segments. At present, the Wallis system is recommended for lumbar disc disease in the following indications: (i) discectomy for massive herniated disc leading to substantial loss of disc material, (ii) a second discectomy for recurrence of herniated disc, (iii) discectomy for herniation of a transitional disc with sacralization of L5, (iv) degenerative disc disease at a level adjacent to a previous fusion, and (v) isolated Modic I lesion leading to chronic low-back pain.
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Multicenter Study Clinical Trial
The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system.
Various forms of lumbar instability require a surgical stabilization. As an alternative to fusion, a mobile, dynamic stabilization restricting segmental motion would be advantageous in various indications, allowing greater physiological function and reducing the inherent disadvantages of rigid instrumentation and fusion. The dynamic neutralization system for the spine (Dynesys) is a pedicle screw system for mobile stabilization, consisting of titanium alloy screws connected by an elastic synthetic compound, controlling motion in any plane (non-fusion system). ⋯ Long-term screw fixation is dependent on correct screw dimension and proper screw positioning. The natural course of polysegmental disease in some cases necessitates further surgery as the disease progresses. Dynamic neutralization proved to be a safe and effective alternative in the treatment of unstable lumbar conditions.