摘要:

Study DesignImmunohistologic staining of human intervertebral discs collected at the time of surgery (100 intervertebral discs from 80 patients) and 10 discs collected from 7 cadavers within 12 hours of death was performed using antimatrix metalloproteinase-3 monoclonal antibody and antitissue inhibitor of metalloproteinase-1 monoclonal antibody.ObjectivesTo examine the relationship between matrix destruction and staining for matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1 in intervertebral disc degeneration.Summary of Background DataMatrix metalloproteinase-3, which decomposes aggregating proteoglycans, has attracted research attention as a substance contributing to matrix destruction in the articular cartilage and intervertebral disc. However, except for a fewin vitrostudies, the relationship between matrix destruction of the intervertebral disc and matrix metalloproteinase-3 has been little studied.MethodsImmunohistologic staining was performed to examine the relationship between matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1 in the intervertebral disc, and the relationship of these two agents to magnetic resonance imaging, radiographic, and surgical findings.ResultsThose cases testing positive for matrix metalloproteinase-3 and negative for tissue inhibitor of metalloproteinase-1 accounted for most of the surgical specimens. The matrix metalloproteinase-3-positive cell ratio was significantly correlated with the magnetic resonance imaging grade of intervertebral disc degeneration, and the matrix metalloproteinase-3-positive cell ratio observed in prolapsed lumbar intervertebral discs was significantly higher than that in nonprolapsed discs. In cervical intervertebral discs, the matrix metalloproteinase-3-positive cell ratio and staining of cartilaginous endplate were correlated with the size of osteophyte formation.ConclusionsThese findings suggested that intervertebral disc degeneration is caused by disturbance in the equilibrium of matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1, and that matrix metalloproteinase-3 contributes to degeneration of the cartilaginous endplate.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThe current report describes a study in beagles in which the effects of intradiscal injection of three doses of chymopapain were evaluated with respect to the reduction of disc width and reconstitution of the nucleus pulposus.ObjectivesTo establish an intradiscal dose of chymopapain that would achieve optimal reduction in disc height followed by maximum reconstitution of the nucleus pulposus.Summary of Background DataEarlier reports of the efficacy of high and low doses of chymopapain for chemonucleolysis have provided conflicting data, and a scientific basis for an appropriate dose is lacking.MethodsFour mature, female beagles were subjected to chemonucleolysis using three doses of chymopapain as Chymodiactin (31, 63 and 125 picokatals/disc) injected into the L2-L3, L1-L2, and L3-L4 discs. Disc widths were monitored radiographically over 32 weeks. Proteoglycans were radiolabeled by intravenous injection with Na235SO4(1 mCi/kg) 24 hours before sacrifice, and their specific activities (disintegrations per minute/mg proteoglycan), hydrodynamic size, and ability to aggregate determined.ResultsSixty-three picokatals of Chymodiactin produced optimal disc reconstitution after chemonucleolysis. A reduction in disc height of approximately 35% was evident within 1 month and this slowly returned to approximately 90% of the preinjection value after 32 weeks. The nucleus pulposus contained approximately 75% of the proteoglycan content of control tissues, and most of these formed aggregates with hyaluronan. Disc collagen levels remained relatively unaffected by treatment.ConclusionsThis study demonstrates that an effective reduction in disc width compatible with later reconstitution of the nucleus pulposus can be achieved experimentally with an appropriate dose of chymopapain. These data clearly indicate that an optimal dose of chymopapain for chemonucleolysis in humans needs to be established.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignCranial and spinal dura from nine Sprague Dawley male rats were examined immunocytochemically for the presence of nerve fibers and mast cells and for innervation. The posterior longitudinal ligament and peridural membrane were also examined for these elements.ObjectiveTo examine the pattern of sensory innervation and the presence of mast cells in rat spinal dura.Summary of Background DataThe cranial dura is richly innervated and has a robust population of mast cells, which have been implicated in the pathogenesis of vascular headache. Moskowitz's explanation for vascular headache focused on the dura mater and neurogenic inflammation. Essential to his model are dural trigeminovascular fibers and mast cells. Previous studies provide contradictory and inconclusive results regarding spinal dural innervation.MethodsImmunocytochemical techniques using antibodies to calcitonin gene-related peptide and substance P were used to identify sensory nerve fibers and antibodies to serotonin were used to identify mast cells. Specimens dissected included dura of the cranial vault in continuity with the dorsal cervical dura, dura of the skull base in continuity with the ventral cervical dura, lumbar dura, and posterior longitudinal ligament from the cervical and lumbar regions.ResultsA rich neural network and an abundant mast cell population were identified in the supratentorial and infratentorial cranial dura, both dorsally and ventrally. A paucity of nerve fibers and mast cells was observed in the cervical and lumbar dura; in contrast, these elements were prominent in the posterior longitudinal ligament and peridural membrane.ConclusionsSpinal dura does not have a rich innervation of calcitonin gene-related peptide- and substance P-positive nerve fibers or a robust population of mast cells. The spinal dura may serve as a protective covering. Unlike the cranial dura, it may not be implicated in the pathogenesis of pain. Additional studies on primate and human spinal dura are warranted to corroborate findings that the spinal dura may be relatively insensitive.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignA rabbit model for lumbar intertransverse process spine arthrodesis was utilized, with blind evaluation of the control and experimental animals.ObjectivesTo establish an animal model for motion-induced nonunion of lumbar intertransverse process spine arthrodesis and to determine if there was an early time period during which excessive motion at the arthrodesis site was deleterious to fusion.Summary of Background DataMost previously reported animal models for nonunion of lumbar spine arthrodesis do not use intertransverse process fusion and do not allow variable control of the nonunion-inducing factor.MethodsForty-two adult New Zealand white rabbits underwent posterolateral intertransverse process spine arthrodesis with autogenous iliac crest graft. Rabbits in the experimental group (n = 23) underwent a lifting protocol to produce motion at the arthrodesis site; those in the control group (n = 12) remained undisturbed in their cages. Arthrodeses were assessed radiographically and manually to determine if fusion had occurred.ResultsLifted rabbits exhibited a 13% fusion rate compared to a 50% fusion rate in controls. Rabbits lifted during only the first 2 postoperative weeks exhibited a fusion rate that was significantly less (P= 0.03) than that of controls.ConclusionsA small animal model for motion-induced nonunion of lumbar intertransverse process spine arthrodesis has been established. With respect to excessive motion as a promoter of nonunion in spine arthrodeses, the early postoperative time period appears critical.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignA comparative study was performed in patients with cervical radiculomyelopathy due to soft disc herniation to compare surgical results of laminoplasty with anterior discectomy and arthrodesis.ObjectivesTo determine whether posterior decompression without discectomy can be selected for cervical myelopathy due to cervical soft disc herniation.Summary of Background DataAnterior cervical discectomy and arthrodesis has had acceptable surgical results, but a significant number of complications have been reported, especially those related to bone grafting.MethodsSixteen patients who received expansive laminoplasty and 17 patients who received anterior arthrodesis were studied. The mean value of the anteroposterior diameter of the spinal canal was 12.4 mm in the former and 12.9 mm in the latter. The mean follow-up was 3.1 years in the laminoplasty group, and 8.8 years in the anterior arthrodesis group. There was no statistical difference between the two groups in prognostic factors believed to affect surgical results. Neurologic results were evaluated with postoperative scores and recovery rates by methods previously described, and assessed by the Japanese Orthopaedic Association scoring system.ResultsThe difference between the two groups in the recovery rate and final Japanese Orthopaedic Association score was not statistically significant. Surgical complications were more frequent in the anterior arthrodesis group than in the laminoplasty group. Additional surgeries were performed in three cases (18%) in the anterior arthrodesis group: posterior wiring for delayed union and kyphotic deformity in two cases, and laminoplasty for deterioration of myelopathy in one case. Regression of herniated cervical disc after laminoplasty was confirmed by computed tomography or magnetic resonance imaging in six of eight cases (75%).ConclusionsWhen the incidence of complications and the possibility of regression of herniated disc are taken into consideration, expansive laminoplasty can be selected for radiculomyelopathy due to cervical disc herniation.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThis study analyzed the use of the one piece cervical device (OPCD) surgically inserted to treat atlanto-axial or subaxial subluxation. Operative results, techniques, and the enhanced correction mechanism were studied.ObjectivesThe results were correlated to provide a rationale for posterior cervical spinal fusion.Summary of Background DataWiring techniques were generally performed for posterior fusion. Recently, the Luque rod has been used on the cervical spine.MethodsOne hundred eighty-seven patients were analyzed clinically and radiologically. The operative techniques were detailed and the corrective mechanism explained through biomechanical considerations.ResultsThe patients were followed from 2 to 13 years. The results were 94% satisfactory. No poor or worsening cases were encountered.ConclusionsSatisfactory operative results showed that the OPCD is safe, convenient, and reliable. It can be used in all areas of the cervical spine. The primary reason for these benefits is the enhanced correction mechanism of the OPCD.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignBiomechanical parameters affecting the strength of screw-to-bone fixations of ventral cervical spondylodeses were determined.ObjectivesThe rate of implant loosening with ventral cervical spondylodeses is high. Types of failure and how they can be avoided are presented.Summary of Background DataThe number of sound studies on corresponding thoraco-lumbar spinal implants is large. However, no comparative study has been published thus far covering the strength of screw-to-bone fixation in the cervical region.MethodsHuman cervical vertebrae were obtained at autopsy. Their bone mineral density related to calcium-hydroxyapatite was determined by single energy quantitative computed tomography scan. Standard cancellous screws with a diameter of 3.5 mm and 4.5 mm “rescue” screws were screwed down to failure into 43 single vertebral bodies. The applied torque T and the resultant axial force Faxat the “washer's” position were measured simultaneously by a specially designed electronic testing machine.ResultsA strong correlation among Fax, T, and bone mineral density was found (0.4636 < r < 0.7545). Application of standard screws reveals that Faxand T linearly respond to the effective thread length, whether the posterior vertebral cortex is engaged or not (pairedttest:P< 0.05, n = 38). When “rescue” screws are used and the posterior vertebral cortex is included, a significantly higher torque T must be applied to achieve the same revolution. Surprisingly, the resulting force Faxhardly alters. If under similar circumstances the posterior vertebral cortex is not included in the construct, Faxis significantly lower (pairedttest:P< 0.05, n = 32). A stable fixation of 3.5 mm screws cannot be achieved if bone mineral density remains below 150 mg/ml.ConclusionsThus, determining bone mineral density before surgery by quantitative computed tomography is recommended to ensure a proper selection of screw type and thereby increase the success of surgical fixation.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID