The spine journal : official journal of the North American Spine Society
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Comparative Study
Human lumbar facet joint capsule strains: II. Alteration of strains subsequent to anterior interbody fixation.
In cases of low back pain associated with biomechanical lumbar instability, anterior interbody fixation can be used as a surgical treatment, but its affect on facet joint capsule strains is unknown. ⋯ Restriction of a vertebral motion segment using a single ATLP increased adjacent capsular strains, which if suprathreshold for capsule nociceptors, could play a role in low back pain.
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Somatosensory evoked potentials (SSEPs) monitor global spinal cord function, and the interpretation of motor loss is based on inferred rather than direct measurements. Therefore, SSEPs may not be useful for identifying motor function deficits caused by anterior spinal column injury or nerve root injury during decompression or placement of instrumentation. For these reasons, adjunctive methods for monitoring may be especially useful during cervical spine surgery. ⋯ The results illustrate the potential utility of intraoperative SSEPs and the tceMEPs for detection of changes in spinal cord function related to patient positioning and hemodynamic effects during anterior cervical fusion.
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Discectomy is a surgical technique commonly used to treat bulging or herniated discs causing nerve root compression. Clinical data suggest discectomy may also help patients with contained discs and no clear neural compromise. However, the mechanisms of clinical efficacy are uncertain, and consequently bases for treatment optimization are limited. ⋯ Our results demonstrate that percutaneous plasma discectomy alters the expression of inflammatory cytokines in degenerated discs, leading to a decrease in IL-1 and an increase in IL-8. Whereas both IL-1 and IL-8 have hyperalgesic properties, IL-1 is likely to be a more important pathophysiologic factor in painful disc disorders than IL-8. Therefore, the alteration in cytokine expression that we observed is consistent with this effect as a mechanism of pain relief after discectomy. In addition, given that IL-1 is catabolic in injured tissue and IL-8 is anabolic, our results suggest that a percutaneous plasma discectomy may be capable of initiating a repair response in the disc.
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A substantial cause of neurological disability in spinal cord injury is oligodendrocyte death leading to demyelination and axonal degeneration. Rescuing oligodendrocytes and preserving myelin is expected to result in significant improvement in functional outcome after spinal cord injury. Although previous investigators have used cellular transplantation of xenografted pluripotent embryonic stem cells and observed improved functional outcome, these transplants have required steroid administration and only a minority of these cells develop into oligodendrocytes. ⋯ These findings suggest that the transplantation of oligodendrocyte precursors may improve axonal conduction and spinal cord function in the injured spinal cord. The benefits seem more pronounced with the addition of Shh, and the addition of Shh alone results in the proliferation of an endogenous population of neural precursor cells.
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Randomized Controlled Trial Clinical Trial
A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain.
Intradiscal electrothermal therapy (IDET) is a treatment for discogenic low back pain the efficacy of which has not been rigorously tested. ⋯ Nonspecific factors associated with the procedure account for a proportion of the apparent efficacy of IDET, but its efficacy cannot be attributed wholly to a placebo effect. The results of this trial cannot be generalized to patients who do not fit the strict inclusion criteria of this study, but IDET appears to provide worthwhile relief in a small proportion of strictly defined patients undergoing this treatment for intractable low back pain.