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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Comparative Study Clinical Trial
Intimate relationship between instability and degenerative signs at L4/5 segment examined by flexion-extension radiography.
Relationship between lumbar disc degeneration and segmental instability has remained controversial. Using instability factors that found close relations with symptoms in flexion-extension radiographic study, their relationship with degenerative findings was examined. More than (≥) 3 mm slip in neutral position (SN), ≥3 mm translation (ST), and ≥10° angulation (SA) at L4/5 segment were defined as instability factors and were applied on 447 patients who had low back and/or leg pain and satisfied inclusion criteria for accurate measurements. ⋯ Disc height was the most important in the examined parameters and showed an intimate relationship with age and instability factors. Although the etiology is still unknown, clinical common knowledge, that a diminution of disc height with progressive degeneration had a close relation with anterior vertebral slippage, was firstly confirmed. This study allows comprehensive understanding of segmental instability and is useful for considering surgical indications.
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Comparative Study
Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae.
Percutaneous kyphoplasty (PKP) has been used to treat osteoporotic vertebral compression fractures for over 10 years; however, clinically speaking it is still controversial as to whether the use of unipedicular PKP or bipedicular PKP is best. Our study aimed to compare the different effects of unipedicular PKP and bipedicular PKP on the stiffness of compression fractured vertebral bodies (VBs), as well as to assess how cement distribution affect the bilateral biomechanical balance of the VBs. During this study, 30 thoracic VBs were compressed, creating vertebral compression fracture models; then they were augmented by unipedicular (group A and B) PKP and bipedicular (group C) PKP. ⋯ Bipedicular PKP creates stiffness uniformly across both sides of the vertebrae, while unipedicular PKP, creates a biomechanical balance depending on the distribution of cement. If bone cement is augmented only on one side, the stiffness of non-augmented side will be significantly lower than the augmented side, which might lead to an imbalance of stress on the VB. However, when cement augmentation crosses the midline, stiffness of both sides increase comparatively and biomechanical balance is thus achieved.
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Comparative Study
Comparison of inpatient treatment costs after balloon kyphoplasty and non-surgical treatment of vertebral body compression fractures.
We performed an analysis of following costs after primary conservative or operative treatment with balloon kyphoplasty (BKP) in osteoporotic vertebral fractures. Patients with primary osteoporotic vertebral fractures treated with BKP or conservatively from discharge year 2002-2005 were retrospectively assessed regarding the following hospital treatment in any hospital in Austria from 2002 to 2006. A statistical record linkage between the hospital data and the mortality registry of Statistic Austria was performed. ⋯ The number of readmissions was 1.62 times higher (P = 0.039), the length of stay 1.09 times higher (P = 0.046) in the conservative group. No difference in the DRG scores were found (P = 0.11). In conclusion, patients with osteoporotic vertebral fractures showed in the following years after BKP fewer hospital readmissions and shorter hospital stays but no difference in DRG scores in comparison to conservatively treated patients.
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Vertebral compression fractures represent a frequent pathology among elderly population, with potentially devastating consequences. More than 20 years have passed since percutaneous vertebroplasty was initially used in the treatment of angiomas, representing nowadays a widely used treatment for osteoporotic vertebral fractures. The authors present a retrospective review of 59 consecutive patients (in total 94 fractured levels) that underwent polymethylmethacrylate percutaneous vertebroplasty for vertebral compression fractures due to senile or secondary osteoporosis. ⋯ In conclusion, percutaneous vertebroplasty is an effective and safe procedure for treating vertebral compression fractures in the elderly. It provides immediate pain relief and allows early mobilization, thus avoiding potentially severe complications related to persistent back pain and prolonged bed rest. When performed by experienced surgeon complication rate is low, representing a safe procedure, able to provide a satisfactory outcome.
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Various mechanical stresses in vivo induce disc cell apoptosis and intervertebral disc (IVD) degeneration, but the underlying molecular mechanism is not fully known. The aim of this study was to investigate the role of endoplasmic reticulum stress in cyclic stretch-induced apoptosis of rat annulus fibrosus (AF) cells. Flexercell Tension Plus system was used to apply cyclic stretch to rat annulus fibrosus cells at a frequency of 0.5 Hz with 20% elongation for 12, 24, 36, or 48 h. ⋯ In addition, specific inhibitor of caspase-12 (Z-ATAD-FMK) and caspase-9 (Z-LEHD-FMK) partly suppressed cyclic stretch-induced AF cell apoptosis and the anti-apoptotic effects of the caspase inhibitors were additive. Our data suggest that endoplasmic reticulum stress, likely mediated by NO, contributes to the AF cell apoptosis induced by cyclic stretch in addition to the mitochondrial pathway. These findings could be helpful to understand the mechanism of disc cell apoptosis, the root cause of IVD degeneration.