The spine journal : official journal of the North American Spine Society
-
The intervertebral disc plays a major functional role in the spinal column, providing jointed flexibility and force transmission. The end plate acts as an important structural transition between the hard vertebral tissues and the compliant disc tissues and is therefore a region of potentially high stress concentration. The effectiveness of anchorage of the tough annulus fibers in the end plate will have a major influence on the overall strength of the motion segment. Failure of the end plate region is known to be associated with disc herniation. ⋯ Given both the limited thickness of the end plate and the intrinsic strength of the interface bond between bundle and end plate matrix, the branched morphology is consistent with a mechanism of optimal shear stress transfer wherein a greater strength of annular fiber anchorage can be achieved over a relatively short insertion distance.
-
Low back pain is prevalent in the United States. At the present time, no large longitudinal study is available characterizing the incidence of this condition in the US population or identifying potential risk factors for its development. ⋯ Age, sex, and race are significant risk factors for the development of low back pain necessitating treatment in an emergency department.
-
Intervertebral disc degeneration (IDD) is a common cause of back pain. Patients who fail conservative management may face the morbidity of surgery. Alternative treatment modalities could have a significant impact on disease progression and patients' quality of life. ⋯ Treatment of punctured rabbit intervertebral discs with AAV2-BMP2 or AAV2-TIMP1 helps delay degenerative changes, as seen on MRI, histologic sampling, serum biochemical analysis, and biomechanical testing. Although data from animal models should be extrapolated to the human condition with caution, this study supports the potential use of gene therapy for the treatment of IDD.
-
The most common surgical treatment of symptomatic degenerative lumbar spondylolisthesis (DLS) is decompression and instrumented fusion. However, contemporary, midline-sparing, microdecompressive techniques have shown good results for selected patients with stable Grade 1 DLS. Growing concerns over the rising cost and rates of spinal fusion warrant both clinical and economic comparative effectiveness research in this common spinal diagnosis. ⋯ For a select subgroup of patients with DLS (leg-dominant pain with a stable Grade 1 spondylolisthesis), decompression without fusion is significantly more cost effective than instrumented fusion and provides an opportunity for increased service delivery and/or cost savings for this growing population.