Inducing Angiogenesis in the Nucleus Pulposus.

Bone morphogenetic protein (BMP) gene delivery to Lewis rat lumbar intervertebral discs (IVDs) drives bone formation anterior and external to the IVD, suggesting the IVD is inhospitable to osteogenesis. This study was designed to determine if IVD destruction with a proteoglycanase, and/or generating an IVD blood supply by gene delivery of an angiogenic growth factor, could render the IVD permissive to intra-discal BMP-driven osteogenesis and fusion. Surgical intra-discal delivery of naïve or gene-programmed cells (BMP2/BMP7 co-expressing or VEGF expressing) +/- purified chondroitinase-ABC (chABC) in all permutations was performed between lumbar 4/5 and L5/6 vertebrae, and radiographic, histology, and biomechanics endpoints were collected.

Intravenous Ketorolac Substantially Reduces Opioid Use and Length of Stay After Lumbar Fusion: A Randomized Controlled Trial.

Study Design: A randomized, double-blinded, placebo-controlled trial.

Objective: To examine the effect of intravenous ketorolac (IV-K) on hospital opioid use compared with IV-placebo (IV-P) and IV acetaminophen (IV-A).

Summary Of Background Data: Controlling postoperative pain while minimizing opioid use after lumbar spinal fusion is an important area of study.

Lumbar spine intervertebral disc gene delivery of BMPs induces anterior spine fusion in lewis rats.

Minimally invasive techniques and biological autograft alternatives such as the bone morphogenetic proteins (BMPs) can reduce morbidity associated with spinal fusions. This study was a proof-of-concept for gene-therapy-mediated anterior spine fusion that could be adapted to percutaneous technique for clinical use. Isogeneic bone marrow stromal cells genetically programmed to express b-galactosidase (LACZ, a marker gene), BMP2, BMP7, a mixture of BMP2 and BMP7 infected cells (homodimers, HM), or BMP2/7 heterodimers (HT) were implanted into the discs between lumbar vertebrae 4 and 5 (L4/5) and L5/6 of male Lewis rats.

Minimal Clinically Important Difference and Substantial Clinical Benefit Using PROMIS CAT in Cervical Spine Surgery.

Study Design: This was a prospective cohort study.

Objective: The objective of this study was to establish minimal clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds for Patient-Reported Outcomes Measurement Information System (PROMIS) in cervical spine pathology.

Summary Of Background Data: PROMIS enables improved psychometric properties with reduced questionnaire burden through computer adaptive testing.

Unplanned Reoperations Affect Long-Term Outcomes in Adult Spinal Deformity Patients Undergoing Long Fusions to the Sacrum.

Study Design: Retrospective clinical cohort study.

Objective: To compare the long-term complications and outcomes scores of primary and revision surgeries for adult spinal deformity of patients treated with long fusions to the sacrum.

Summary Of Background Data: Long fusions in patients with adult spinal deformity are fraught with complications and the need for reoperation that can significantly impact patient health-related quality of life.

Lumbar spine intervertebral disc gene delivery: a pilot study in lewis rats.

Background: Basic research toward understanding and treating disc pathology in the spine has utilized numerous animal models, with delivery of small molecules, purified factors, and genes of interest. To date, gene delivery to the rat lumbar spine has only been described utilizing genetically programmed cells in a matrix which has required partial disc excision, and expected limitation of treatment diffusion into the disc.

Purpose: This study was designed to develop and describe a surgical technique for lumbar spine exposure and disc space preparation, and use of a matrix-free method for gene delivery.

Preoperative templating before spinal fusion using a fluoroscopic multiplanar imaging system is as accurate as CT scan and uses substantially less radiation.

Background: Many surgeons utilize preoperative multiplanar imaging for surgical planning before fusion surgery using pedicle screw instrumentation. Computed tomographic (CT) scan is often used but limited by non-weight-bearing images and high-ionizing radiation. The purpose of this study was to compare pedicle length and width measurements using a multiplanar fluoroscopic imaging system and CT with gross measurements to validate the accuracy of multiplanar fluoroscopic imaging and compare relative radiation exposure between techniques.

Comparison of a fluoroscopic 3-dimensional imaging system and conventional CT in detection of pars fractures in the cadaveric lumbar spine.

Study Design: Cadaveric Study.

Objective: To compare a fluoroscopic imaging system with computed tomography (CT) and radiographs in detection of spondylolysis and radiation exposure in a cadaver model.

Summary Of Background Data: Lumbar spondylolysis is defined as a defect or fracture of the pars interarticularis and occurs with or without anterior spondylolisthesis.

Long-term magnetic resonance imaging follow-up demonstrates minimal transitional level lumbar disc degeneration after posterior spine fusion for adolescent idiopathic scoliosis.

Study Design: Retrospective cohort study.

Objective: To describe long-term clinical and imaging results focusing on the uninstrumented lumbar spine after posterior spinal fusion for adolescent idiopathic scoliosis.

Summary Of Background Data: Although previous studies found rates of low back pain after long fusion for adolescent idiopathic scoliosis which are comparable to rates found in the general population, many surgeons believe that the long lever arm associated with the fusion mass will result in increased stress at uninstrumented caudal intervertebral discs and accelerated degenerative changes.

The effect of sacral decortication on lumbosacral fixation in a calf spine model.

Study Design: Animal cadaveric biomechanical study.

Objective: We hypothesized that increasing bony destabilization of a bovine cadaveric sacrum by anterior pedicle screw penetration and bilateral alar decortication would decrease the amount of load necessary for failure of the construct and result in failure through the decortication sites.

Summary Of Background Data: Fusion to the sacrum has become commonly used for treatment of neuromuscular scoliosis and fusions in osteoporotic patients.

Surgical treatment for atlantooccipital osteoarthritis: a case report of two patients.

Background/purpose: Although rarely discussed in the literature and difficult to evaluate on plain radiographs, atlantooccipital osteoarthritis can be a source of persistent suboccipital pain. Our objective in this report is to describe two cases with atlantooccipital (O-C1) osteoarthritis treated with posterior occipitocervical fusion.

Methods And Results: Two patients presented with unilateral suboccipital pain, which was refractory to conservative treatment.

Pulmonary embolism in spine surgery: a comparison of combined anterior/posterior approach versus posterior approach surgery.

Study Design: retrospective review.

Objective: to determine if Anterior/Posterior Combined approach spine surgery is associated with an increased risk of pulmonary embolism (PE) compared to Posterior Only approach surgery.

Summary Of Background Data: combined anterior/posterior approach spine surgery is associated with a significantly increased risk for PE.

Stromal derived factor-1 regulates bone morphogenetic protein 2-induced osteogenic differentiation of primary mesenchymal stem cells.

Stromal derived factor-1 (SDF-1) is a chemokine signaling molecule that binds to its transmembrane receptor CXC chemokine receptor-4 (CXCR4). While we previously detected that SDF-1 was co-required with bone morphogenetic protein 2 (BMP2) for differentiating mesenchymal C2C12 cells into osteoblastic cells, it is unknown whether SDF-1 is similarly involved in the osteogenic differentiation of mesenchymal stem cells (MSCs). Therefore, here we examined the role of SDF-1 signaling during BMP2-induced osteogenic differentiation of primary MSCs that were derived from human and mouse bone marrow.

Mesh cage reconstruction with autologous cancellous graft in anterior cervical discectomy and fusion.

Study Design: Retrospective case series.

Objective: To present the technique and results of anterior cervical discectomy and fusion (ACDF) by using mesh cage reconstruction with autologous cancellous bone graft.

Background: Since the initial ACDF description by Bailey and Badgley, a variety of grafting techniques have been proposed.

Thromboembolic disease after combined anterior/posterior reconstruction for adult spinal deformity: a prospective cohort study using magnetic resonance venography.

Study Design: Thromboembolic disease (TED) after anterior/posterior spinal reconstructions was prospectively evaluated in 66 consecutive patients.

Objective: Determine the incidence of TED after anterior/posterior spinal reconstruction.

Summary Of Background Data: Few studies have examined the rate of TED after potentially high-risk combined anterior/posterior reconstructions.

A novel regulatory role for stromal-derived factor-1 signaling in bone morphogenic protein-2 osteogenic differentiation of mesenchymal C2C12 cells.

Stromal-derived factor 1 (SDF-1) is a chemokine with important functions in development and postnatal tissue homeostasis. SDF-1 signaling via the G-protein-coupled receptor CXCR4 regulates the recruitment of stem and precursor cells to support tissue-specific repair or regeneration. In this study we examined the contribution of SDF-1 signaling to osteogenic differentiation of mesenchymal C2C12 cells induced by bone morphogenic protein 2 (BMP2).

A novel source of cancellous autograft for ACDF surgery: the manubrium.

There are a variety of techniques and biologic options when performing interbody fusion during an anterior cervical discectomy and fusion (ACDF). Autologous graft provides high rates of fusion; however, complications associated with donor site morbidity from the iliac crest have prompted some surgeons to use alternative graft material. Ten patients (8 men, 2 women) with cervical radiculopathy underwent single-level ACDF with plate fixation, titanium mesh cage, and cancellous autograft from the manubrium.

Comprehensive analysis of cantilever, translational, and modular corrective techniques in adults with scoliosis treated with surgery to the sacropelvis.

Background: The treatment of adults with scoliosis has been the source of debate over the last several decades. Pain associated with curve progression and decompensation is the most common presenting scenario and surgical management is often indicated. Correction of these deformities may involve long segment fusions to the sacrum and pelvis.

Noggin regulation of bone morphogenetic protein (BMP) 2/7 heterodimer activity in vitro.

Bone morphogenic proteins (BMPs) are growth factors important for skeletal development and bone growth. Noggin, one of the soluble BMP antagonists, regulates the action of BMPs on mesenchymal precursor cells, partially through a feedback type of inhibition. In this study, we constructed a novel BMP2/7 'fusion gene' that encodes both BMP2 and BMP7 genes in tandem by a linker.

The treatment of large (>70 degrees) thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis: when is anterior release indicated?

Study Design: Retrospective clinical study from 2 centers.

Objective: To analyze the efficacy of posterior instrumentation and arthrodesis for thoracic idiopathic scoliosis curves more than 70 degrees.

Summary Of Background Information: The increasing use of thoracoscopic techniques in deformity surgery has led several investigators to advocate anterior release followed by posterior instrumentation when treating "stiff" thoracic curves 60 degrees-70 degrees.

Not all spondylolisthesis grading instruments are reliable.

Spondylolisthesis is the slippage of one vertebral body on an adjacent level, and occurs commonly at the lumbosacral junction in children. Many radiographic measurement instruments have been described to predict progression and need for intervention. We evaluated the reliability of eight common grading instruments.

Combined bone morphogenetic protein-2 and -7 gene transfer enhances osteoblastic differentiation and spine fusion in a rodent model.

Unlabelled: To enhance the osteogenic activity of BMP, combination BMP2 and BMP7 gene transfer was performed. This approach led to a significant increase in osteoblastic differentiation of mesenchymal precursors compared with single BMP gene transfer in vitro. When tested in 78 rats, combination gene transfer enhanced mechanically stable spine fusion and bone formation rate versus single BMP gene transfer.

Scheuermann kyphosis: safe and effective surgical treatment using multisegmental instrumentation.

Study Design: A retrospective review was conducted on 23 consecutive patients who underwent surgical correction of Scheuermann kyphosis using modern multisegmental instrumentation.

Objective: To evaluate Scheuermann kyphosis correction and complication rates.

Summary Of Background Data: The surgical treatment of Scheuermann kyphosis remains a topic of debate.

Enhancement of spine fusion using combined gene therapy and tissue engineering BMP-7-expressing bone marrow cells and allograft bone.

Study Design: Prospective study to assess the enhancement of spine fusion using a tissue engineering construct consisting of bone marrow cells genetically modified by adenovirus (Ad) vector-encoding bone morphogenetic protein-7 (BMP-7) seeded onto an allograft scaffold in a rat model.

Objectives: To evaluate Ad transgene expression at the fusion site and the effect of AdBMP-7-treatment on fusion rates, mechanical stability, microscopic anatomy, and bone formation rates.

Summary Of Background Data: Nonunion is a major complication of spine fusion.