Description

European Spine Journal is a publication founded in response to the increasing trend toward specialization in spinal surgery. The Journal is devoted to spine surgery and all related disciplines including functional and surgical anatomy of the spine biomechanics and pathophysiology diagnostic procedures and neurology. The aim of European Spine Journal is to support the further development of highly innovative European spine surgery and to provide an integrated and balanced view of diagnostic research and treatment procedures that will enhance effective collaboration among specialists worldwide.

Publisher details

Springer Verlag

Publications in this journal

• Comparison of the aorta impingement risks between thoracolumbar/lumbar curves with different convexities in adolescent idiopathic scoliosis: a computed tomography study

  Authors: Jun Qiao

  European Spine Journal.

• anterior approach

  Authors: Talamonti

  European Spine Journal.

• comparison of radiographic findings

  Authors: seok woo kim

  European Spine Journal.

• Bone graft substitutes in anterior cervical discectomy and fusion

  Authors: Anthony M T Chau, Ralph J Mobbs

  European Spine Journal. 18(4):449-464.

  Anterior cervical discectomy with fusion is a common surgical procedure for patients suffering pain and/ or neurological deficits and unresponsive to conservative management. For decades, autologousAnterior cervical discectomy with fusion is a common surgical procedure for patients suffering pain and/ or neurological deficits and unresponsive to conservative management. For decades, autologous bone grafted from the iliac crest has been used as a substrate for cervical arthrodesis. However patient dissatisfaction with donor site morbidity has led to the search for alternative techniques. We present a literature review examining the progress of available grafting options as assessed in human clinical trials, considering allograft-based, synthetic, factor- and cell-based technologies.

• Spine surgeons: spine industry.

  Authors: Steven R Garfin

  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. 17(6):785-90; discussion 791-3.

• Pregabalin as a neuroprotector after spinal cord injury in rats.

  Authors: Kee-Yong Ha, Young-Hoon Kim, Kee-Won Rhyu, Soon-Eok Kwon

  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. 17(6):864-72.

  The over-expression of excitotoxic neurotransmitter, such as glutamate, is an important mechanism of secondary injury after spinal cord injury. The authors examined the neuroprotective effect ofThe over-expression of excitotoxic neurotransmitter, such as glutamate, is an important mechanism of secondary injury after spinal cord injury. The authors examined the neuroprotective effect of pregabalin (GP) which is known as to reduce glutamate secretion, in a rat model of spinal cord injury. Thirty-two male Sprague-Dawley rats were randomly allocated to four groups; the control group (contusion injury only), the methylprednisolone treated group, the minocycline treated group and the GP treated group. Spinal cord injury was produced by contusion using the New York University impactor (25 g-cm, at the 9th-10th thoracic). Functional evaluations were done using the inclined plane test and a motor rating scale. Anti-apoptotic and anti-inflammatory effects were evaluated by in situ nick-end labeling staining technique (TUNEL) and immunofluorescence staining of cord tissues obtained at 7 days post-injury. Pregabalin treated animals showed significantly better functional recovery, and anti-apoptotic and anti-inflammatory effects. Mean numbers of TUNEL positive cells in the respective groups were 63.5 +/- 7.4, 53.6 +/- 4.0, 44.2 +/- 3.9 and 36.5 +/- 3.6. Double staining (TUNEL and anti-CC1) for oligodendrocyte apoptosis, was used to calculate oligodendrocyte apoptotic indexes (AI), using the following formula AI = (No. of doubly stained cells/No. of anti-CC1 positive cells) x 100. Mean group AIs were 88.6, 46.7, 82.1 and 70.3%, respectively. Mean numbers of activated microglia (anti-OX-42 positive cells) in high power fields were 29.8 +/- 3.9, 22.7 +/- 4.1, 21.0 +/- 3.9 and 17.8 +/- 4.3, respectively. This experiment demonstrates that GP can act as a neuroprotector after SCI in rats, and its anti-apoptotic and anti-inflammatory effects are related to its neuroprotective effect. Further studies are needed to unveil the specific mechanism involved at the receptor level.

• Intramedullary hemangioblastomas: timing of surgery, microsurgical technique and follow-up in 23 patients.

  Authors: A Boström, F J Hans, P C Reinacher, T Krings, U Bürgel, J M Gilsbach, M H T Reinges

  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. 17(6):882-6.

  Hemangioblastomas are highly vascularised tumors of the central nervous system and account for 1.5-2.5% of all spinal cord tumors. Because of the rarity of these tumors, surgical experience is oftenHemangioblastomas are highly vascularised tumors of the central nervous system and account for 1.5-2.5% of all spinal cord tumors. Because of the rarity of these tumors, surgical experience is often limited and, therefore, treatment and indications for timing of surgery are discussed controversial. The authors reviewed their data of 23 consecutive patients with respect to timing of surgery, microsurgical technique, and follow-up. Clinical records of 23 consecutive patients with intramedullary hemangioblastomas who underwent first surgery in our department between 1990 and 2005 were reviewed. In three cases the tumors were localised at the craniocervical junction; four patients had a single tumor in the cervical spine, six patients multiple tumors in the cervical and thoracic spine, eight patients in the thoracic spine only, one patient in the conus region, and one patient had multiple tumors located in the thoracic and lumbar spine. In eight patients, a von-Hippel-Lindau disease (VHL) was associated. The neurological follow-up was evaluated according to the classification of McCormick. Operation was recommended to every symptomatic patient as early as possible. In asymptomatic patients with a sporadic tumor surgery was discussed for diagnostic purposes at any time. In VHL patients, surgery was recommended if tumor growth was observed on MRI in the next practicable time. All tumors were diagnosed by magnetic resonance imaging and in all cases but one a DSA was performed. All patients were treated microsurgically through a posterior approach. The tumors in the spinal cord were removed microsurgically through a partial hemilaminectomy (n = 1), a hemilaminectomy (n = 15), or laminectomy (n = 4) and at the craniocervical junction (n = 3) through a suboccipital craniotomy. During follow-up after 6 months, 18 patients remained neurologically stable (17 in McCormick grade I and 1 in McCormick grade II) and 5 patients recovered to a better status (3 from grade III to II, 2 from grade II to I). There was one complication with a CSF fistula and one recurrence/incomplete removal. Following the above-mentioned principles of microsurgical removal of intramedullary hemangioblastomas, operation is possible with a low procedure-related morbidity and can be recommended especially in VHL patients with progressive symptoms or tumor growth during follow-up. Patients without VHL most frequently require hemangioblastoma resection for diagnostic purposes and/or because symptoms prompted an imaging work-up that lead to the discovery of the tumor.

• Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques.

  Authors: Raymond Pollock, Ilhan Alcelik, Chandra Bhatia, Graham Chuter, Kiran Lingutla, Chakravarty Budithi, Manoj Krishna

  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. 17(6):845-52.

  We have studied the occurrence of donor site morbidity, cosmesis and overall satisfaction with graft procedure in 76 patients who had undergone iliac crest bone harvesting for anterior cervicalWe have studied the occurrence of donor site morbidity, cosmesis and overall satisfaction with graft procedure in 76 patients who had undergone iliac crest bone harvesting for anterior cervical discectomy and fusion (ACDF). Totally 24 patients underwent an open procedure and 52 a minimally invasive trephine harvesting method. Although our study demonstrated substantial donor site pain and its effect on ambulation in both groups, this was of limited duration. Two patients, one in each group, suffered long-term pain that was eventually resolved. Totally 8.3% of patients in the open group suffered minor complications and 11.5% in the trephine group. There were two cases of meralgia parasthetica. There were no major complications in either group. There was no statistically significant difference in morbidity between the open and trephine groups. There was a trend towards significance (P = 0.076) for pain at the donor site, with less pain reported by patients who underwent the trephine procedure for harvesting.

• Relations between surgeons and industry: the time of clarification has come.

  Authors: M Aebi, R Gunzburg, F Pellisé, M Szpalski

  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. 17(6):783-4.

• High glucose promotes collagen synthesis by cultured cells from rat cervical posterior longitudinal ligament via transforming growth factor-beta1.

  Authors: Hai Li, Da Liu, Chang-Qing Zhao, Lei-Sheng Jiang, Li-Yang Dai

  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. 17(6):873-81.

  Non-insulin-dependent diabetes is known as a risk factor of ossification of posterior longitudinal ligament, but the mechanism has not been well understood. We hypothesized that hyperglycemia, as aNon-insulin-dependent diabetes is known as a risk factor of ossification of posterior longitudinal ligament, but the mechanism has not been well understood. We hypothesized that hyperglycemia, as a typical characteristic of diabetes, is closely associated with ligament hypertrophy in ossification of posterior longitudinal ligament. In this in vitro study, we investigated the effect of high glucose on collagen synthesis and transforming growth factor-beta1 (TGF-beta1) production using cells isolated from rat cervical posterior longitudinal ligament. The cells were subjected to high D-glucose concentration (25 mM) media for 4 days. Notable increases were observed in gene expression and protein synthesis of collagen types I, III in the cells. The increase was inhibited in the presence of anti-TGF-beta1 antibodies. Production of TGF-beta1 by the cells was also increased significantly by high glucose concentration. Exogenous application of TGF-beta1 was confirmed to increase collagen synthesis of the cells. These data suggested that high glucose could promote collagen synthesis in the posterior longitudinal ligament mainly via endogenous TGF-beta1, resulting in hypertrophy of the ligament.

• Comparison of open versus percutaneous pedicle screw insertion in a sheep model.

  Authors: W Lehmann, A Ushmaev, A Ruecker, J Nuechtern, L Grossterlinden, P G Begemann, T Baeumer, J M Rueger, D Briem

  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. 17(6):857-63.

  Minimally invasive surgery has become more and more important for the treatment of traumatic spine fractures. Besides, some clinical studies, objective data regarding the possible lower damage to theMinimally invasive surgery has become more and more important for the treatment of traumatic spine fractures. Besides, some clinical studies, objective data regarding the possible lower damage to the surrounding tissue of the spine is still missing. Here we report a sheep model where we compared a percutaneous versus an open approach for dorsal instrumentation with pedicle screws to the spine. Twelve skeletally mature sheep underwent bilateral pedicle screw fixation at the L4-L6 level. Forty-eight pedicle screws were bilaterally inserted into the pedicles and connected with rods using either an open dorsal standard or a percutaneous approach. Operation time, blood flow, compartment pressure, radiation time, loss of blood, laboratory findings and EMG were evaluated to objectify possible advantages for the percutaneous operation technique. Loss of blood and the distribution of CK-MM as a marker for muscle damage were significantly lower in the percutaneous group. However, radiation time was significantly longer in the percutaneous group. Other parameters like compartment pressure, blood flow and also measurement of the EMG at different time points did not reveal significant differences. Based on the results we found in the present study, percutaneous screw insertion can bring moderate advantages but it should be noted that essential functional deficits to the muscle could not be detected.

• Comments about "European guidelines for the diagnosis and treatment of pelvic girdle pain".

  Authors: Margareta Nordin

  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. 17(6):820-1.

• Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review.

  Authors: Efstathios J Boviatsis, Lampis C Staurinou, Andreas T Kouyialis, Maria M. Gavra, Pantelis C. Stavrinou, Marios Themistokleous, Panayiotis Selviaridis, Damianos E Sakas

  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. 17(6):831-7.

  This study is designed based on the retrospective analysis of patients treated in the Neurosurgical Department of two major hospitals and review of the literature. The aim of this study is toThis study is designed based on the retrospective analysis of patients treated in the Neurosurgical Department of two major hospitals and review of the literature. The aim of this study is to evaluate the efficacy of surgery and address controversial issues in the treatment of symptomatic lumbar intraspinal synovial cysts. Spinal juxtafacet cysts (synovial and ganglion cysts) are a rare cause of low back and radicular leg pain. Although the relevant reports in the international literature are increasing, the controversy about conservative versus surgical treatment and the need for concomitant fusion still exists. Data from seven patients (age range 58-69 years, mean age 61 years) with low back and radicular leg pain due to a lumbar facet joint cyst were retrospectively analyzed. Demographic data, cyst level, presence of concomitant local pathology, treatment and results of treatment were recorded. A follow-up of at least 6 months (range 6-48 months) was conducted and results were noted. All patients had back pain, while five also experienced unilateral radicular leg pain and one had bilateral leg pain. One patient had neurogenic claudication. MRI identified the cyst and highlighted underlying pathology in all cases. All patients underwent surgical cyst excision. No fusion was performed. Post-operatively, all patients showed a total resolution of symptoms with sustained benefit at final evaluation. Review of the literature revealed a trend towards surgery, as this is correlated to a more favorable outcome compared with conservative treatment. Fusion should be performed on a case-by-case basis only. Surgery is a safe and effective treatment choice in this increasingly appearing ailment. A prospective, randomized trial should clarify issues under debate.

• Lumbar fusion outcomes in patients with rheumatoid arthritis.

  Authors: Charles H Crawford, Leah Y Carreon, Mladen Djurasovic, Steven D Glassman

  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. 17(6):822-5.

  Although outcomes after cervical fusion in rheumatoid arthritis (RA) patients are widely published, outcomes of lumbar fusion in RA patients has not been reported. Nineteen patients with RA,Although outcomes after cervical fusion in rheumatoid arthritis (RA) patients are widely published, outcomes of lumbar fusion in RA patients has not been reported. Nineteen patients with RA, identified using ICD-9 and CPT codes, who underwent instrumented posterolateral lumbar fusion were matched for age, gender, smoking status, date, and level of surgery to a contemporaneous non-RA group. Medical records and radiographs were reviewed by the primary author who had no role in the treatment of these patients. The average age was 64 years in the RA group and 65 years in the non-RA group. The male to female ratio was 2:17 and 1:18, respectively. There were three smokers and two diabetics in each group. An average of 1.5 levels was fused in each group. Average follow-up was 24 and 27 months, respectively. In the RA group, 15 patients were taking DMARDs with 7 of those also taking oral steroids; 4 patients were taking NSAIDs only. There were seven complications (37%) in the RA group versus four (21%) in the non-RA group; wound infections in three patients (16%) in the RA group versus one (5%) in the non-RA group; and non-union in two patients (11%) in the RA group versus three (16%) in the non-RA group. Clinical outcomes were similar between the two groups with 74% of patients achieving good to excellent results in the RA group compared to 63% in the non-RA group (p = 0.692). Surgeons and their RA patients who undergo an instrumented lumbar fusion can expect a slightly higher complication rate than patients without RA which may be related to osteopenia and immunosuppression.

• European guidelines for the diagnosis and treatment of pelvic girdle pain.

  Authors: Andry Vleeming, Hanne B. Albert, Hans Christian Ostgaard, Bengt Sturesson, Britt Stuge

  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. 17(6):794-819.

  A guideline on pelvic girdle pain (PGP) was developed by "Working Group 4" within the framework of the COST ACTION B13 "Low back pain: guidelines for its management", issued by the EuropeanA guideline on pelvic girdle pain (PGP) was developed by "Working Group 4" within the framework of the COST ACTION B13 "Low back pain: guidelines for its management", issued by the European Commission, Research Directorate-General, Department of Policy, Coordination and Strategy. To ensure an evidence-based approach, three subgroups were formed to explore: (a) basic information, (b) diagnostics and epidemiology, and (c) therapeutical interventions. The progress of the subgroups was discussed at each meeting and the final report is based on group consensus. A grading system was used to denote the strength of the evidence, based on the AHCPR Guidelines (1994) and levels of evidence recommended in the method guidelines of the Cochrane Back Review group. It is concluded that PGP is a specific form of low back pain (LBP) that can occur separately or in conjunction with LBP. PGP generally arises in relation to pregnancy, trauma, arthritis and/or osteoarthritis. Uniform definitions are proposed for PGP as well as for joint stability. The point prevalence of pregnant women suffering from PGP is about 20%. Risk factors for developing PGP during pregnancy are most probably a history of previous LBP, and previous trauma to the pelvis. There is agreement that non risk factors are: contraceptive pills, time interval since last pregnancy, height, weight, smoking, and most probably age. PGP can be diagnosed by pain provocation tests (P4/thigh thrust, Patrick's Faber, Gaenslen's test, and modified Trendelenburg's test) and pain palpation tests (long dorsal ligament test and palpation of the symphysis). As a functional test, the active straight leg raise (ASLR) test is recommended. Mobility (palpation) tests, X-rays, CT, scintigraphy, diagnostic injections and diagnostic external pelvic fixation are not recommended. MRI may be used to exclude ankylosing spondylitis and in the case of positive red flags. The recommended treatment includes adequate information and reassurance of the patient, individualized exercises for pregnant women and an individualized multifactorial treatment program for other patients. We recommend medication (excluding pregnant women), if necessary, for pain relief. Recommendations are made for future research on PGP.

• A neurosurgical view of anatomical evaluation of anterior C1-C2 for safer transoral odontoidectomy.

  Authors: Kagan Tun, Erkan Kaptanoglu, Berker Cemil, S. Tuna Karahan, Ali Firat Esmer, Alaiddin Elhan

  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. 17(6):853-6.

  An anatomical study for evaluation of anterior C1-C2. To provide essential anatomic data for safer transoral odontoidectomy. The surface dimensions of the atlas vertebra and the transoral approachAn anatomical study for evaluation of anterior C1-C2. To provide essential anatomic data for safer transoral odontoidectomy. The surface dimensions of the atlas vertebra and the transoral approach for odontoidectomy have been described in detail. Anterior arcus of C1 must be drilled out to reach odontoid process for transoral odontoidectomy. The thickness of anterior ring of C1 has not been studied before. Sixty, dried adult atlas and 60 axis vertebrae and ten cadaveric craniocervical specimens were measured for the following: (1) bony drilling depth (BDD), the distance from the anterior wall of anterior ring of C1 to anterior wall of odontoid; (2) minimum drilling diameter (MDD), distance of minimum C1 anterior ring removal for odontoid resection on horizontal plane; (3) maximum bony drilling diameter (MBDD), distance of maximum C1 anterior ring removal for odontoid resection on horizontal plane. Lateral border of this diameter is limited by medial borders of the lateral mass; (4) the widest odontoid diameters (WOD) on coronal sections were measured. On 60 atlas and axis vertebrae, the BDD was 7.0 +/- 1.2 mm on dry bones, the distance between the medial borders of the lateral mass (MBDD) was 16.1 +/- 1.5 mm, and the WOD on coronal sections (WOD) was 9.8 +/- 0.8 mm. On cadavers, the distance between the two edges of C1 anterior ring removal for odontoid resection (MDD) was 10.8 +/- 1.1 mm and the WOD on coronal sections (WOD) was 10.1 +/- 1.4 mm. An odontoid surgery through transoral approach is safe and feasible. A quantitative understanding of the anterior anatomy of C-1 and C-2 is necessary when considering transoral odontoid resection. In this study the authors define safe zones for anterior atlas and axis.

• Quality of sleep in patients with chronic low back pain: a case-control study.

  Authors: M Marty, S Rozenberg, B Duplan, P Thomas, B Duquesnoy, F Allaert

  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. 17(6):839-44.

  Animal experiments and studies in humans clearly show that the relation between pain (acute and chronic) and sleep quality is two-way: sleep disorders can increase pain, which in turn may cause sleepAnimal experiments and studies in humans clearly show that the relation between pain (acute and chronic) and sleep quality is two-way: sleep disorders can increase pain, which in turn may cause sleep disorders. Sleep disorders and chronic low back pain are frequent health problems and it is unsurprising that the two can co-exist. This study was conducted to evaluate if sleep disorders and chronic pain associated are more frequently than one would expect. The objective of the study was to compare sleep quality in a population of patients with chronic low back pain and a control population. Sleep quality was assessed in 101 patients with chronic low back pain (CLBP) and in 97 sex- and age-matched healthy control subjects using the Pittsburgh Sleep Quality Index [PSQI; score from 0 (no disorder) to 21]. The French version of the Dallas Pain Questionnaire (DPQ) was used to assess the impact of low back pain on patients' quality of life. This impact was taken as nil in the healthy controls. The patients with CLBP and the controls were comparable in age, sex, and height, but mean bodyweight was higher in the CLBP group (70.3 +/- 14.5 vs. 61.8 +/- 11.4 kg; P < 0.05). The patients with CLBP were also more frequently on sick leave than the controls (32.3%; n = 31 vs. 0.0% n = 0; P < 0.001). Coffee, tea, and cola intakes were comparable in the two groups. Patients with CLBP had statistically higher scores in all items of the PSQI than the healthy controls. The mean PSQI was 4.7 +/- 3.2 for the healthy controls and 10.9 +/- 7.9 for the patients with CLBP (P < 0.0001). Sleep disorders were greater when the impact of CLBP on daily life (the four aspects of the DPQ) was greater [P < 0.0001]). The sleep of the patients with CLBP was significantly altered compared with that of the healthy controls, in proportion to the impact of low back pain on daily life. Our findings do not indicate whether sleep disorders are a cause or a consequence of CLBP.

• Relationship between the morphology of the atlanto-occipital joint and the radiographic results in patients with atlanto-axial subluxation due to rheumatoid arthritis.

  Authors: Haku Iizuka, Yasunori Sorimachi, Tsuyoshi Ara, Masahiro Nishinome, Takashi Nakajima, Yoichi Iizuka, Kenji Takagishi

  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. 17(6):826-30.

  The upper cervical spine is a common focus of destruction from rheumatoid arthritis (RA). Atlanto-axial subluxation (AAS) presents with marked frequency among patients with instability. However,The upper cervical spine is a common focus of destruction from rheumatoid arthritis (RA). Atlanto-axial subluxation (AAS) presents with marked frequency among patients with instability. However, there are occasional patients who show no motion between the occipital bone and atlas on a dynamic cervical radiograph in AAS patients. This study investigated the morphology of the atlanto-occipital joint (AOJ) in AAS patients due to RA using computed tomography, and examined the relationship between its morphology and other radiographic results. Twenty-six consecutive patients with AAS due to RA treated by surgery were reviewed. The subjects included 18 females and 8 males. The average patient age was 59.3 years. The mean duration of RA was 14.3 years. In all the patients, the AOJ was morphologically evaluated using sagittal reconstruction view on computed tomography before surgery. Moreover, the ADI value was investigated at the neutral and maximal flexion position, and atlanto-axial angle (AAA) at the neutral position in preoperative lateral cervical radiographs. The morphology of the AOJ on a CT sagittal reconstruction view was classified into three types as follows: a normal type which showed a maintenance of the joint space, a narrow type which showed a disappearance of the joint space and a fused type which showed the fusion of the AOJ. The pre-operative CT sagittal reconstruction image of the AOJ demonstrated a normal type bilaterally in six cases (Group A). In 15 cases (Group B), CT image demonstrated narrowing on at least one side of the AOJ. In five cases (Group C), CT images demonstrated fusion on at least one side of the AOJ. The average ADI value at the flexion position was 10.7 mm in Group A, 11.7 mm in Group B, and 12.6 mm in Group C. There was no significant difference among those groups. The average ADI value at the neutral position before surgery was 2.8 mm in Group A, 5.9 mm in Group B, and 10.4 mm in Group C. There was no significant difference between Group A and B (P > 0.105), and Groups B and C (P > 0.032), however, there was a significant difference between Groups A and C (P < 0.004). The average AAA value was 25.3 degrees in Group A, 19.3 degrees in Group B and 3.4 degrees in Group C. There was no significant difference between Groups A and B (P > 0.230), however, there was a significant difference between Groups A and C (P < 0.002), and Groups B and C (P < 0.007). This study showed that fusion or ankylosis of the AOJ induced an enlargement of the ADI and anterior inclination of the atlas in the neutral position, despite the fact that normal findings of AOJ showed a slight displacement of the atlas to axis in RA patients showing AAS involvement. This morphology may progress to SAS and VS due to AOJ after atlanto-axial arthrodesis.

• Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients.

  Authors: Martin A Sutter, Andreas Eggspuehler, Dieter Grob, Francois Porchet, Dezsö Jeszenszky, Jiri Dvorak

  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. 16 Suppl 2:S221-8.

  A prospective study on 409 patients who received multimodel intraoperative monitoring (MIOM) during lumbosacral surgical procedures between March 2000 and December 2005 was carried out. The objectiveA prospective study on 409 patients who received multimodel intraoperative monitoring (MIOM) during lumbosacral surgical procedures between March 2000 and December 2005 was carried out. The objective of this study was to determine the sensitivity and specificity of MIOM techniques used to monitor conus medullaris, cauda equina and nerve root function during lumbosacral decompression surgery. MIOM has increasingly become important to monitor ascending and descending pathways, giving immediate feedback information regarding any neurological deficit during the decompression and stabilisation procedure in the lumbosacral region. Intraoperative spinal- and cortical-evoked potentials, combined with continuous EMG- and motor-evoked potentials of the muscles, were evaluated and compared with postoperative clinical neurological changes. A total of 409 consecutive patients with lumbosacral spinal stenosis with or without instability were monitored by MIOM during the entire surgical procedure. A total of 388 patients presented true-negative findings while two patients presented false negative and 1 patient false-positive findings. Eighteen patients presented true-positive findings where neurological deficit after the operation was intraoperatively predicted. Of the 18 true-positive findings, 12 patients recovered completely; however, 6 patients recovered only partially. The sensitivity of MIOM applied during decompression and fusion surgery of the lumbosacral region was calculated as 90%, and the specificity was calculated as 99.7%. On the basis of the results of this study, MIOM is an effective method of monitoring the conus medullaris, cauda equina and nerve root function during surgery at the lumbosacral junctions and might reduce postoperative surgical-related complications and therefore improve the long-term results.

• Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment, a comment.

  Authors: I Aprile, A E Ruggeri, F Savi Scarponi, S Illiano, M Foschini, G Vergili, G Frasca, L Padua

  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. 16(11):1962-3; author reply 1964.

• PDGF, bFGF and IGF-I stimulate the proliferation of intervertebral disc cells in vitro via the activation of the ERK and Akt signaling pathways.

  Authors: Harris Pratsinis, Dimitris Kletsas

  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. 16(11):1858-66.

  Intervertebral disc (IVD) degeneration is frequently characterized by increased cell proliferation, probably as a tissue regenerative response. Although many growth factors and their receptors haveIntervertebral disc (IVD) degeneration is frequently characterized by increased cell proliferation, probably as a tissue regenerative response. Although many growth factors and their receptors have been shown to be expressed normally in the disc, and generally to be over-expressed during degeneration, not all of them have been thoroughly studied concerning their effects on IVD cell proliferation. In the present report, three potent mitogens, platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF) and insulin-like growth factor-I (IGF-I) are examined regarding their capacity to induce proliferation in vitro of bovine coccygeal nucleus pulposus (NP) and annulus fibrosus (AF) cells, as well as to activate major intracellular signal transduction pathways. PDGF, bFGF and IGF-I were found to induce DNA synthesis in quiescent IVD cells in a dose-dependent manner. Maximum stimulation was induced by PDGF, while stimulation by all three factors simultaneously exceeded only slightly that caused by PDGF alone. All three growth factors were shown to phosphorylate immediately extracellular-signal regulated kinases (ERKs), while the stimulation by bFGF especially resulted in sustained ERK phosphorylation. Furthermore, all three growth factors induced phosphorylation of Akt in both Thr308 and Ser473 residues immediately after stimulation, although bFGF-induced phosphorylation was much weaker than that provoked by PDGF and IGF-I. In addition, the MEK inhibitor PD98059 and the PI 3-K inhibitor wortmannin were shown to block growth factor-induced ERK- and Akt-phosphorylation, respectively, in IVD cells. Inhibition of the MEK/ERK or the PI 3-K/Akt pathways provoked a significant decline of the proliferative effects of PDGF, bFGF or IGF-I on IVD cell cultures, while the simultaneous inhibition of both signaling pathways abolished completely the mitogenicity of these growth factors. The above effects of the three growth factors were reproduced similarly in both NP and AF cell cultures. Overall, the above results indicate that PDGF, bFGF and IGF-I stimulate the proliferation of IVD cells via the ERK and Akt signaling pathways.

• Association between the -1306C/T polymorphism of matrix metalloproteinase-2 gene and lumbar disc disease in Chinese young adults.

  Authors: D M Dong, M Yao, B Liu, C Y Sun, Y Q Jiang, Y S Wang

  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. 16(11):1958-61.

  Matrix metalloproteinase-2 (MMP-2) has been shown to play a pivotal role in the pathophysiology of lumbar disc disease (LDD). Increased expression and activity of MMP-2 has been documented inMatrix metalloproteinase-2 (MMP-2) has been shown to play a pivotal role in the pathophysiology of lumbar disc disease (LDD). Increased expression and activity of MMP-2 has been documented in degenerative discs. The polymorphism -1306C/T in the promoter region of MMP-2 gene was reported to influence gene transcription and expression. The objective of this study was therefore to investigate the possible association of MMP-2 -1306C/T polymorphism with the occurrence and the clinical characteristics of LDD. MMP-2 genotypes were determined by polymerase chain reaction (PCR) and direct DNA sequencing in a case-control study involving 162 younger patients with LDD and 318 age- and sex-matched healthy adults. The results showed that the frequency of MMP-2 -1306CC genotype was significantly higher in LDD patients when compared with controls. Subjects with the CC genotype had nearly threefold increased risk for LDD (odds ratio 3.08; 95% confidence interval 1.84-5.16) compared with subjects carrying at least one variant T allele. Furthermore, this genotype was found to correlate with more severe grades of disc degeneration observed on magnetic resonance imaging scan. These findings suggest that MMP-2 -1306C/T polymorphism may be a genetic risk factor related to LDD susceptibility in the young adult population.

• Current opinions and recommendations on multimodal intraoperative monitoring during spine surgeries.

  Authors: Martin Sutter, Vedran Deletis, Jiri Dvorak, Andreas Eggspuehler, Dieter Grob, David Macdonald, Alfred Mueller, Francesco Sala, Tetsuya Tamaki

  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. 16 Suppl 2:S232-7.

• Biological and mechanical consequences of transient intervertebral disc bending.

  Authors: Charles Court, Jennie R Chin, Ellen Liebenberg, Olivier K Colliou, Jeffrey C Lotz

  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. 16(11):1899-906.

  Degenerative mechanisms for the intervertebral disc are unclear, particularly those associated with cumulative trauma. This research focuses on how mechanical loading at levels below those known toDegenerative mechanisms for the intervertebral disc are unclear, particularly those associated with cumulative trauma. This research focuses on how mechanical loading at levels below those known to cause acute trauma can lead to cellular injury. Mouse-tail discs were subjected to static bending for 1 week, then allowed to recover unloaded for 3 weeks and 3 months. Discs were analyzed using histology, in situ hybridization (collagen and aggrecan gene expression), TUNEL assay for apoptotic cell death, and biomechanics. The bent discs demonstrated loss of annular cellularity on the concave (compressed) side, while the nucleus and convex annulus appeared normal. Chondrocyte-like cells were apparent within the inner, concave annulus on the recovered discs, with evidence of proliferation at the annulus/endplate interface. However, annular architecture and biomechanical properties for the recovered discs were not different from controls, suggesting that restoration of physiologic tissue stress prevents the inner annular degradation noted in previous compression-induced degeneration models. These data demonstrate that cellular injury can be induced by transient compressive stress, and that recellularization is slow in this avascular tissue. Taken together, this suggests that cellular damage accumulation may be an important injury mechanism that is distinct from acute mechanical failure.

• Low thoracic and lumbar burst fractures: radiographic and functional outcomes.

  Authors: Helton L A Defino, Fabiano R T Canto

  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. 16(11):1934-43.

  Twenty patients with thoracolumbar burst fractures (type A3 in the classification of Magerl et al.) were studied prospectively for the evaluation of clinical, radiographic and functional results. TheTwenty patients with thoracolumbar burst fractures (type A3 in the classification of Magerl et al.) were studied prospectively for the evaluation of clinical, radiographic and functional results. The patients were submitted to surgical treatment by posterior arthrodesis, posterior fixation and autologous transpedicular graft. The patients were followed up for 2 years after surgery and assessed on the basis of clinical (pain, neurologic deficit, postoperative infection), radiographic (load sharing classification, Farcy s sagittal index of the fractured segment, relation between traumatic vertebral body height and the adjacent vertebrae (compression percentage), height of the intervertebral disk proximal and distal to the fractured vertebra, rupture or loosening of the implants) and functional (return to work, SF-36) criteria. Two patients presented a marked loss of correction and required the placement of an anterior support graft. Pain assessment revealed that eight patients (44%) had no pain; four (22%) had occasional pain, three (17%) moderate pain, and three (17%) severe pain. According to the classification of Frankel et al., 17 patients persisted as Frankel E and one patient presented improvement of one degree, becoming Frankel D. The mean value of Farcy s sagittal index of the injured vertebral segment was 20.67 degrees +/- 6.15 degrees (range 8 degrees -32 degrees ) during the preoperative period, 11.22 degrees +/- 8.09 degrees (range -5 degrees to 21 degrees ) during the immediate postoperative period, and 14.22 degrees +/- 7.37 degrees (range 3 degrees -25 degrees ) at late evaluation. There was a statistically significant difference between the immediate postoperative values and the preoperative and late postoperative values. The compression percentage of the fractured vertebral body ranged from 9.1 to 60 (mean 28.81 +/- 11.51) during the preoperative period, from 0 to 60 (mean: 15.59 +/- 14.49) during the immediate postoperative period, and from 8 to 60 (mean: 25.9 +/- 13.02) at late evaluation. There was a statistically significant difference between the preoperative and postoperative values and between the postoperative and late postoperative values. The height of the proximal intervertebral disk ranged from 6 to 14 mm (mean 8.44 +/- 2.66) during the preoperative period, from 6 to 15 mm (mean 10 +/- 2.30) during the immediate postoperative period, and from 0 to 11 mm (mean 7.22 +/- 2.55) during the late postoperative period. A significant difference was observed between the immediate postoperative values and the preoperative and late postoperative values. The height of the intervertebral disk distal to the fractured vertebra ranged from 7 to 16 mm (mean 9.94 +/- 2.64) during the preoperative period, from 5 to 18 mm (mean 11.61 +/- 3.29) during the immediate postoperative period, and from 2 to 14 mm (mean 9.72 +/- 3.17) during the late postoperative period. There was a significant difference between the immediate postoperative values and the preoperative and late postoperative values. Except for the height of the intervertebral disk proximal to the fractured vertebra, no correlation was detected between the clinical, functional and radiologic results. The results observed in the present study indicate that other, still incompletely defined parameters influence the functional result of thoracolumbar burst fractures.

Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.