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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A retrospective analysis of insurance data was made of 600 individuals claiming compensation for whiplash following motor vehicle accidents. Three hundred randomly selected claimants who had settled their injury claims within 9 months of the accident were compared with 300 who had settled more than 24 months after the accident. We compared the two groups to identify possible risk factors for prolonged recovery, for which settlement time greater than 24 months was a marker. ⋯ Late settlement may be the direct effect of legal intervention, independent of the severity of the injury. Whilst the financial benefit to the claimant of consulting a solicitor is apparent, the benefit of prolonged disability is not. It may be to the advantage of both insurers and claimants if those likely to proceed to late settlement could be recognised early and their claims settled expeditiously.
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We studied the distribution of fibronectin (a marker for "active" reparative connective tissue processes) and TGF-beta1 (a cytokine controlling the connective tissue metabolism) in intervertebral disc tissue from individuals of different age and various histomorphological evidence for tissue degeneration. The protein deposition was determined by immunohistochemistry on 30 complete cross-sections of lumbar spine obtained at autopsy (0-86 years) and 12 surgically removed disc samples. The mRNA expression was detected by non-radioactive in situ hybridization in the surgical material. ⋯ These cells also synthesize TGF-beta1, as shown by protein and mRNA expression. Since it is known that TGF-beta1 induces matrix alterations (by auto and paracrine stimulation of matrix synthesis), these observations suggest that the recently described disturbance of the matrix during disc degeneration may be induced by TGF-beta. This may offer new approaches to interfere with disc matrix alterations.
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This study aimed to investigate the long-term clinical results of the apatite wollastonite-containing glass ceramic (AWGC) iliac spacer and to discuss its efficacy in reconstruction of the bone graft donor site at the iliac crest. Thirty-one patients were studied for more than 10 years. All patients underwent anterior spinal fusion using autogenous tricortical iliac bone graft. ⋯ There was no abnormal silicon concentration in blood examinations. AWGC iliac spacer appears to be useful in the reconstruction of harvested iliac crest. New bone formation occurs, reducing the defect size.
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Inflammation and irritation of the nerve roots has been indicated as an important factor in the pain associated with symptomatic disc herniations. Tumour necrosis factor alpha (TNFalpha) is now believed to be involved in this pathway. TNFalpha causes connective tissue cells in culture to synthesise a glycoprotein, TNFalpha-stimulated gene-6 (TSG-6). ⋯ IalphaI immunostaining was frequently widespread throughout the disc but there was little in the cartilage endplate. It has been proposed that these molecules have widespread effects, including extracellular matrix stabilisation, down-regulation of the protease network and reduction of inflammation. Hence, the occurrence of TSG-6 and IalphaI in disc tissue could have implications in the aetiopathogenesis and future therapeutics of intervertebral disc disease.
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The objective of this cohort study--conducted at a regional trauma unit in southern Ontario, Canada--was to review the imaging history of open-section, iliac-wing bone graft donor sites in lumbar fusion patients. Intervention entailed review of available X-ray and CT scan images for all patients undergoing lumbar fusion with iliac autograft in the senior author's practice over a 4-year period. Outcome was radiographic confirmation of the absence of bony reconstitution at the iliac harvest site. ⋯ Only minimal marginal sclerosis to suggest attempted remodeling was observed. We conclude that iliac-wing bone graft donor sites do not remodel. Given that iliac harvesting is known to increase strain in the pelvis, and that lumbosacral stabilization increases stress in the pelvis, permanent deficiency of iliac bone stock at donor harvest site may be a factor in both primary donor site pain and the observed high frequency of this problem in lumbosacral fusion patients.