摘要:

Study Design.A case of cervical cord compression in an elderly lady with Hurler’s syndrome is reported.Objective.To report the occurrence of cervical cord compression in a 56-year-old patient of Hurler’s syndrome, making her the oldest patient with Hurler’s. The case report also highlights the appropriate management that could be given to this group of difficult patients.Summary of Background Data.The literature on Hurler’s syndrome is reviewed in terms of long-term survival and surgical management of spinal compression. No report in the literature describes cervical spine decompression in Hurler’s syndrome in a patient this old.Methods.Clinical and radiologic features of Hurler’s induced cervical cord compression are described. Pathologic changes of Hurler’s myleopathy are also reported.Results.The patient underwent cervical spine decompression and tolerated the procedure well. The patient was able to mobilize free of the wheel chair and showed significant neurologic recovery.Conclusion.The case report highlights the success of surgery in Hurler’s induced cervical cord compression. It also adds to the literature the oldest patient of Hurler’s syndrome to undergo any form of spinal surgery.We present here a 59-year-old lady with Hurler’s syndrome, who underwent a successful cervical spine decompression and stabilization for cervical myelopathy. At 59 years of age, she was the oldest case of Hurler’s to undergo spinal surgery. The case highlights the importance of undertaking major spinal surgeries in these difficult inherited disorders with reasonable success, as against common belief.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.This is a case report of a left common iliac artery occlusion identified as an intraoperative complication during a planned (combined anterior interbody and posterior fusion) 360° spinal fusion.Objective.The purpose of this report was to document the occurrence of this rare complication during a planned 360° fusion and to increase the awareness of this potential intraoperative vascular complication.Summary of Background Data.Several cases of left iliac artery occlusion after anterior spinal surgery have been reported, but there has been no reported case of intraoperative iliac artery occlusion identified during a planned 360° spinal fusion.Methods.The patient was a 46-year-old woman with chronic low and mid back pain and left leg pain for several years. She was a 2-pack-a-day cigarette smoker for 30 years. She was diagnosed with internal disc disruption at L3–L4 and L4–L5, unresponsive to nonoperative treatment, and was scheduled for a 360° spinal fusion. During the anterior procedure, the left iliac vessels were retracted with a Wiley retractor during the discectomy and fusion. It was noted that there was no pulse in the left common iliac artery as the anterior procedure neared completion. Intraoperative Doppler showed the left iliac artery was occluded, and a left iliac endarterectomy and thrombectomy were performed immediately.Results.A significant occlusive plaque was separated distally and transected in a smooth fashion, and fresh thrombus was also removed. The procedure was successfully accomplished without any further complication with excellent restoration of arterial blood flow to the left lower extremity. Doppler study showed good triphasic flow in the iliac artery and all its branches. Because of the arterial repair, the posterior portion of the surgery was not undertaken at that time and was performed 2 weeks later.Conclusions.Early recognition and appropriate treatment can prevent serious sequelae. Great care and observation should be given to the patients before surgery, intraoperatively, as well as after surgery.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.We report on a 69-year-old male who had severe back pain due to spontaneous symptomatic pseudoarthrosis at the T11–T12 intervertebral space with diffuse idiopathic skeletal hyperostosis.Objective.To describe a rare clinical entity and successful treatment by spinal fusion with a 4-year follow-up.Summary of Background Data.There have been a few reports of spontaneous symptomatic pseudoarthrosis of an intervertebral space associated with diffuse idiopathic skeletal hyperostosis, but there have been no reports of surgical treatment for this clinical condition.Methods.Plain radiographs of the patient, who was admitted to our hospital with severe back pain but no history of trauma, revealed manifestations of diffuse idiopathic skeletal hyperostosis and a pseudoarthrosis at the T11–T12 intervertebral space. Posterior instrumentation from T9 to L2 and anterior bone grafting at the T11–T12 intervertebral space were performed.Results.The patient has been followed for 4 years and is currently asymptomatic.Conclusions.A rare case of spontaneous symptomatic pseudoarthrosis at the T11–T12 intervertebral space with diffuse idiopathic skeletal hyperostosis was treated successfully by spinal fusion.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A case of idiopathic focal vertebral body osteonecrosis without vertebral collapse is reported.Objectives.To report a rare case of focal vertebral osteonecrosis and to clarify the features of imaging studies.Summary of Background DataThere are no previous reports describing focal vertebral body necrosis without collapse in the literature.Methods.A case report and literature review are presented.Results.Imaging studies demonstrated: 1) sclerotic change on computed tomography scan; 2) low intensity on T1, high intensity on T2 with clear margin, and no gadolinium enhancement on magnetic resonance imaging; and 3) no uptake on bone scan. Histologic examination revealed empty lacunas, fatty necrosis with vacuolar degeneration, and cell debris compatible with bone marrow necrosis.Conclusion.Vertebral body osteonecrosis must be considered a possible diagnosis of patients presenting with low intensity on T1, high intensity on T2 with clear margin, and no gadolinium enhancement on magnetic resonance imaging.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design and Objectives.In a randomized clinical trial, the effectiveness of behavioral graded activity was assessed as compared to usual care provided by physiotherapists for patients after first-time lumbar disc surgery (n = 105).Summary of Background Data.Little is known about the effectiveness of rehabilitation programs following lumbar disc surgery. Most programs focus on biomechanical aspects, whereas psychosocial factors are hardly addressed. The aim of the behavioral graded activity program, which is an operant treatment, is to alter psycho-social factors such as fear of movement and pain catastrophizing, which might subsequently lead to improved functional status and higher rates of recovery. Behavioral treatments for patients following lumbar disc surgery have not yet been assessed in a randomized clinical trial.Methods.Inclusion criteria: age between 18 and 65 years; first-time lumbar disc surgery; restrictions in normal activities of daily living. Exclusion criteria: surgical complications and confirmed and relevant underlying diseases. Outcome assessment took place at 6 and 12 months after randomization.Results.Six months after randomization, 62% of the patients had recovered following usual careversus65% of the patients following behavioral graded activity. After 12 months, 73% and 75%, respectively, had recovered. Differences between intervention groups, 3% and 2% respectively, after 6 and 12 months are not statistically significant. Furthermore, there were no differences between the two groups regarding functional status, pain, pain catastrophizing, fear of movement, range of motion, general health, social functioning or return to work. After 1 year, 4 of the behavioral graded activity cases had undergone another operationversus2 of usual care cases.Conclusion.Both fear of movement and pain catastrophizing seem to be unaffected by either treatment in these patients. It is concluded that treatment principles derived from theories within the field of chronic low back pain might not apply to these patients. After 1 year of follow-up, there were no statistically significant or clinically relevant differences between the behavioral graded activity program and usual care as provided by physiotherapists for patients following first-time lumbar disc surgery.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Lumbar vertebral segments from young and old male sand rats were assessed for quantitative determination of lumbar end plate bone mineral density.Objectives.To determine whether bone mineral density increases in the lumbar end plate with age in the male sand rat and to investigate its relationship to disc degeneration.Summary of the Background Data.Few basic science studies evaluated the end plate and disc degeneration. The sand rat provides an excellent economical model in which disc degeneration is reliable and well characterized.Methods.Bone mineral density data on cranial and caudal lumbar end plates of young (mean age 6.8 months) and old (mean age 23.3 months) male sand rats were assessed for changes related to age, lumbar position, and radiologic features.Results.Mean bone mineral density was significantly greater in end plates in older compared to younger males (P≤ 0.0018). Mean end plate bone mineral density within young animals was not significantly different in levels L5 to L7; in old animals, bone mineral density was significantly different (greater) progressing from L5 to L7 (P< 0.0001). In older animals, mean end plate bone mineral density for each disc showed a significant increase with lower lumbar sites (P= 0.0068). Mean end plate bone mineral density was significantly greater in animals with radiographic evidence of disc wedging (P= 0.006). End plate bone mineral density correlated positively with age.Conclusions.Results provide quantitative bone mineral density data on end plate sclerosis in male sand rats. Data reveal site specificities and show that in old animals, end plate bone mineral density is greater than in young animals. Mean end plate bone mineral density was significantly greater at sites with radiographic disc wedging (P= 0.006). Data support the hypothesis that end plate sclerosis may play a role in disc degeneration.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Anin vitroexperiment to determine the molecular and cellular effect of recombinant human bone morphogenetic protein-2 on cultured rat intervertebral disc cells was performed.Objectives.To determine the effect of recombinant human bone morphogenetic protein-2 on cell proliferation, production of sulfated-glycosaminoglycan, and the expression of genes specific for chondrocytes (Type II collagen, aggrecan, and Sox9) in cultured rat intervertebral disc cells.Summary of Background Data.Intervertebral disc degeneration is associated with cellular and biochemical changes, which include decreased synthesis of cartilage specific gene products such as Type II collagen and aggrecan. Although bone morphogenetic protein-2 is known to induce chondrogenesis during new bone formation, the effects on intervertebral disc cells have not been characterized.Method.Cells were isolated from the anulus fibrosus and transition zones of lumbar discs from Sprague-Dawley rats. The cells were grown in monolayer and treated with recombinant human bone morphogenetic protein-2 (0, 10, 100, 1000 ng/mL) in Dulbecco’s Modified Eagle Medium/F-12 with 1% fetal bovine serum (day 0). On days 2, 4, and 7 after recombinant human bone morphogenetic protein-2 treatment, sulfated-glycosaminoglycan content in the media was quantified using 1,9-dimethylmethylene blue staining. The results were normalized according to culture duration and cell number. On day 7, mRNA was extracted for reverse transcriptase-polymerase chain reaction and real-time polymerase chain reaction to quantitate mRNAs of Type I collagen, Type II collagen, aggrecan, Sox9, osteocalcin, and glyceraldehyde phosphate dehydrogenase. Cell number was determined with a hemocytometer.Results.Recombinant human bone morphogenetic protein-2 at 100 and 1000 ng/mL yielded a 17% and 42% increase in cell number on day 4, and a 59% and 79% on day 7, respectively. Recombinant human bone morphogenetic protein-2 at 10 ng/mL had no effect on cell number. Sulfated-glycosaminoglycan increase was greatest at day 7, increasing by 1.3-, 2.1-, and 3.6-fold with recombinant human bone morphogenetic protein-2 treatments of 10, 100, and 1000 ng/mL, respectively. Increases in mRNA levels of Type II collagen, aggrecan, Sox9, and osteocalcin were observed with recombinant human bone morphogenetic protein-2 concentrations of 100 and 1000 ng/mL on day 7 as determined by reverse transcriptase-polymerase chain reaction. No detectable increase in mRNA level of Type I collagen was observed with any levels of recombinant human bone morphogenetic protein-2. Real-time polymerase chain reaction showed the greatest effect at 1000 ng/mL recombinant human bone morphogenetic protein-2, leading to an 11.5-fold increase in aggrecan, a 4.6-fold increase in Type II collagen, a 5.3-fold increase in Sox9, and a 1.9-fold increase in osteocalcin mRNA above untreated controls at day 7.Conclusion.The results of this study show that recombinant human bone morphogenetic protein-2 enhances disc matrix production and chondrocytic phenotype of intervertebral disc cells. Recombinant human bone morphogenetic protein-2 increases cell proliferation and sulfated-glycosaminoglycan (proteoglycan) synthesis. It increases mRNA of Type II collagen, aggrecan, and Sox9 genes (chondrocyte specific genes), and osteocalcin, but not Type I collagen or glyceraldehyde phosphate dehydrogenase.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.An establishedin vivomouse model of compression-induced disc degeneration was used to investigate the effects of load on matrix catabolism.Objectives.To determine whether matrix metalloproteinase-2 expression in discs is modulated by mechanical load and to characterize the regulation of matrix metalloproteinase-2 activity.Summary of Background Data.We have previously shown that static compression of discs elicits changes in tissue architecture consistent with those seen with degeneration. Evidence in the literature demonstrates the existence of matrix metalloproteinases in both healthy and pathologic discs and suggests that mechanical load may influence matrix metalloproteinase expression and activity.Methods.Static compression was applied to mouse coccygeal discsin vivofor 1, 4, or 7 days, with adjacent discs serving as sham control. An activity assay was used to measure concentrations of active and total matrix metalloproteinase-2, and changes in matrix metalloproteinase-2 gene expression relative to &bgr;-actin were assessed by reverse transcriptase-polymerase chain reaction.Results.Although no change was seen relative to sham after 1 day of load, the proportion of total matrix metalloproteinase-2 that was active increased after 4 days. This elevation was sustained through 7 days of compression, with no significant differences in total matrix metalloproteinase-2 concentrations among discs throughout the range of time points examined. Semiquantitative reverse transcriptase-polymerase chain reaction demonstrated no significant changes in matrix metalloproteinase-2 gene expression at 1 day or 4 days.Conclusions.In this model, regulation of matrix metalloproteinase-2 activity occurs primarily through enhanced molecular activation of the proenzyme rather than through elevated gene expression or translation. Our results suggest that matrix metalloproteinase-2 may have a role in load-induced changes in disc architecture.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.This work was performed to investigate the role of vitamin K (VK) in the pathogenesis of ossification of posterior longitudinal ligament (OPLL), by analyzing the biochemical markers of the blood samples of OPLL patients and responses of ligament cells derived from OPLL lesion to VK2.Objectives.The pathogenesis of OPLL, classified as a form of diffuse idiopathic skeletal hyperostosis, is still unclear. In this study, we investigated the role of menaquinone (VK2) in patients with OPLL (OPLL patients) and the effects of VK2 on ligament cells isolated from OPLL lesion.Methods.Serum levels of intact osteocalcin, glu-osteocalcin, MK-4, -7 (VK2 variants) and other minerals in spot blood samples were measured in 24 OPLL patients and in 24 age-matched control patients (non-OPLL patients). The cultured cells isolated from an OPLL patient were treated with MK-4. Alkaline phosphatase (Al-p) activity and osteocalcin release were measured after 2 weeks of culture.Results.In the clinical study, the serum MK-4 in male OPLL patients was significantly higher than that in male non-OPLL patients. However, among female patients, the difference was not significant. Although the serum osteocalcin in females was significantly higher than that in males, there was no significant difference between the OPLL and non-OPLL groups. Inin vitrostudy, MK-4 did not increase Al-p activity in the ligament cells isolated from nonossified region of OPLL patient. Osteoblastic activity of the cultured cells was not stimulated by MK-4.Conclusion.From these results and previous reports, we propose the possibility of the impediment in VK2 metabolism in OPLL patients. The results also implicate the gender tendency in OPLL, because the difference of serum level of MK-4 in OPLL patients was significant only in male.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Anin vitrobiomechanical study using a thoracolumbar corpectomy model to compare load sharing capabilities and stiffnesses of six different anterior instrumentation systems (three rod styles and three plate styles) for stabilizing the thoracic and lumbar spine.Objectives.To evaluate the axial load sharing capabilities of the instrumentation in a thoracolumbar corpectomy model and to measure the bending stiffness of the anterior instrumentation systems for the axes of flexion–extension, lateral bending, and axial rotation with and without an anterior column graft in place.Summary of Background Data.Prior publications have analyzed biomechanical characteristics of many spinal instrumentation systems. These reports have compared anterior instrumentation systems with posterior instrumentation systems,in situfusion techniques, intervertebral spacers, structural allograft and instrumentation, and combined anterior and posterior instrumentation. Other reports have published data on the biomechanical characteristics of typical anterior and posterior spinal instrumentation systems. However, there are no published reports that specifically compare the characteristics of anterior plate-style with anterior rod-style systems, or examining load sharing capabilities.Methods.Six constructs of each of six instrumentation systems were mounted on simulated vertebral bodies. A custom four-axis spine simulator was used to apply independent flexion–extension, lateral bending, and axial rotation moments as well as axial compressive loads. Axial load sharing was measured through a range of applied axial loads from 50 N to 500 N with rotational moments maintained at 0 Nm. The bending stiffness of each construct was calculated in response to ±5.0 Nm moments about each axis of rotation with a 50 N compressive axial load with a full-length corpectomy graft in place, simulating reconstruction of the anterior column, and with no graft in place, simulating catastrophic graft failure. Statistical significance was determined using an analysis of variance and Fisher PLSDpost hoctest with an alpha ≤ 0.05.Results.Load sharing results ranged from 63% to 89%. There was an inverse relationship between load sharing and stiffness. No correlation was found between load sharing and implant style (rodvs.plate). With the graft in place, stiffness result varied by instrumentation system rather than by plate/rod style. Without the graft, the stiffness of the constructs decreased approximately one-third in flexion–extension, two-thirds in lateral bending, and one-fifth in axial rotation, underlying the importance of the graft in overall construct stiffness.Conclusions.For both load sharing and stiffness, there is more influence from the design of the instrumentation system, than whether it is a plate or rod style system. The graft contributed to overall construct stiffness, particularly in lateral bending.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID