Intervertebral Disc Nucleus Repair: Hype or Hope?

Chronic back pain is a common disability, which is often accredited to intervertebral disc degeneration. Gold standard interventions such as spinal fusion, which are mainly designed to mechanically seal the defect, frequently fail to restore the native biomechanics. Moreover, artificial implants have limited success as a repair strategy, as they do not alter the underlying disease and fail to promote tissue integration and subsequent native biomechanics.

Exogenous Delivery of Link N mRNA into Chondrocytes and MSCs-The Potential Role in Increasing Anabolic Response.

Musculoskeletal disorders, such as osteoarthritis and intervertebral disc degeneration are causes of morbidity, which concomitantly burdens the health and social care systems worldwide, with massive costs. Link N peptide has recently been described as a novel anabolic stimulator for intervertebral disc repair. In this study, we analyzed the influence on anabolic response, by delivering synthetic Link N encoding mRNA into primary human chondrocytes and mesenchymal stromal cells (SCP1 cells), Furthermore, both cell types were seeded on knitted titanium scaffolds, and the influence of Link N peptide mRNA for possible tissue engineering applications was investigated.

How does a novel knitted titanium nucleus prosthesis change the kinematics of a cervical spine segment? A biomechanical cadaveric study.

Background: Total disc replacement is a possible treatment alternative for patients with degenerative disc disease, especially in the cervical spine. The aim is to restore the physiological flexibility and biomechanical behavior. A new approach based on these requirements is the novel nucleus prosthesis made of knitted titanium wires.

Characterisation of porous knitted titanium for replacement of intervertebral disc nucleus pulposus.

Effective restoration of human intervertebral disc degeneration is challenged by numerous limitations of the currently available spinal fusion and arthroplasty treatment strategies. Consequently, use of artificial biomaterial implant is gaining attention as a potential therapeutic strategy. Our study is aimed at investigating and characterizing a novel knitted titanium (Ti6Al4V) implant for the replacement of nucleus pulposus to treat early stages of chronic intervertebral disc degeneration.

Imaging Cell Viability on Non-transparent Scaffolds - Using the Example of a Novel Knitted Titanium Implant.

Intervertebral disc degeneration and disc herniation is one of the major causes of lower back pain. Depletion of extracellular matrix, culminating in nucleus pulposus (NP) extrusion leads to intervertebral disc destruction. Currently available surgical treatments reduce the pain but do not restore the mechanical functionality of the spine.

Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury.

Background: The study aim was to investigate potential influences on human nerves and pelvic organs through early implantation of bilateral sacral nerve modulators (SNMs) in complete spinal cord injury (SCI) patients during the acute bladder-areflexia phase.

Methods: Ten patients with neurologically-confirmed complete spinal cord lesions (SCLs) were provided with bilateral SNMs during the phase of atonic-detrusor muscle. Modulation was achieved by two electrodes implanted into each S(3)-foramen.

A multicenter, double-blind, randomized, parallel group study comparing polyvinyl chloride and polyvinyl chloride-free catheter materials.

Purpose: In this study we compared a polyvinyl chloride catheter with a new polyvinyl chloride-free catheter with the same hydrophilic coating, and determined whether patient perception of ease and comfort of clean intermittent catheterization was independent of the catheter material.

Materials And Methods: This investigation was designed as a randomized, double-blind, parallel group, multicenter study. Eligible patients were experienced users of clean intermittent catheterization with a polyvinyl chloride catheter for a minimum of 1 month before randomization.

[Pharyngo-vertebral fistula with transspinous course to the neck skin due to a cervical spondylodesis - case report and review of the literature].

Background: Pharyngo-vertebral fistulas - especially with delayed diagnosis - are a rare but grave reported complication in cervical spine surgery.

Patients And Methods: We present a patient, sent postoperatively from Italy after cervical spine surgery to our department. The patient has developed a pharyngo-vertebral fistula with transspinous course to the dorsal neck skin due to infected spondylodesis.

Immune depression syndrome following human spinal cord injury (SCI): a pilot study.

Experimental spinal cord injury (SCI) has been identified to trigger a systemic, neurogenic immune depression syndrome. Here, we have analyzed fluctuations of immune cell populations following human SCI by FACS analysis. In humans, a rapid and drastic decrease of CD14+ monocytes (<50% of control level), CD3+ T-lymphocytes (<20%, P<0.

Cortical processing of residual ano-rectal sensation in patients with spinal cord injury: an fMRI study.

Eleven paraplegic patients with complete traumatic spinal cord injuries (SCI) [according to American Spinal Injury Association (ASIA) criteria] at different levels (Th3-L3) were investigated during non-painful stimulation of the distal rectum and anal canal, using event related functional magnetic resonance imaging. Although a complete lesion was clinically diagnosed in all, four of them experienced reproducible sensations during anal and/or rectal stimulation. In six patients, individual data analysis revealed significant activation in the right secondary somatosensory cortex SII, the posterior cingular gyrus, the prefrontal cortex, and the left posterior cerebellar lobe during either anal or rectal stimulation or both.

Biomechanical behavior of a new nucleus prosthesis made of knitted titanium filaments.

Background: One of the greatest challenges in the development of a nucleus prosthesis is to minimize the risk of implant expulsion. At the same time, the physiological flexibility, compressive behavior, and height of the disc should be restored. In this biomechanical in vitro study we investigated the ability of a new nucleus prosthesis made of knitted titanium filaments to meet these challenges.

Experimental strategies to promote spinal cord regeneration--an integrative perspective.

Detailed pathophysiological findings of secondary damage phenomena after spinal cord injury (SCI) as well as the identification of inhibitory and neurotrophic proteins have yielded a plethora of experimental therapeutic approaches. Main targets are (i) to minimize secondary damage progression (neuroprotection), (ii) to foster axon conduction (neurorestoration) and (iii) to supply a permissive environment to promote axonal sprouting (neuroregenerative therapies). Pre-clinical studies have raised hope in functional recovery through the antagonism of growth inhibitors, application of growth factors, cell transplantation, and vaccination strategies.

[CT-based assessment score after ventral spondylodesis for thoracolumbar spine fracture].

Background: Dorsoventral stabilization is a common procedure to treat thoracolumbar spine fractures. Especially in respect of the evaluation of alternative procedures to autogenous bone graft, a standardized evaluation score for ventral spondylodesis is necessary.

Patients And Methods: In a group of 44 patients a follow-up CT scan was evaluated with a standardized scoring system by four different independent evaluators (a trauma surgeon, an orthopedic surgeon, and two radiologists).

[Development of the spine after traumatic spinal cord injury in children and adolescents].

In the 1970s, there was growing concern about the risk of secondary deformations of the spine as these seemed to endanger the otherwise improving prognosis for the life of paraplegic subjects, especially of paralyzed children and adolescents. According to the literature, the level and extent of the spinal cord injury and the age at the time of injury are determinants of the development of scoliosis, hyperlordosis or global kyphosis. Correction of the deformity by brace orthosis is not indicated except for children.

[Acupuncture treatment of low back pain].

Objectives: This prospective, non-controlled pilot-study examines the potential benefit of acupuncture in patients with low back pain and radicular symptoms.

Methods: 60 patients with low back pain and lumbar disc herniation diagnosed by magnetic resonance imaging or computed tomography were treated by acupuncture. Pain intensity was assessed before and after treatment on a 100 mm visual analogue scale.

[Complication rate following trochanteric osteotomy in total hip endoprosthesis. A retrospective study with failure analysis].

In total hip arthroplasty extended approach, simplified luxation and improved exposure are the major advantages of trochanteric osteotomy. The main complication of the iatrogenic fracture is the nonunion which has occurred in about 20% of our patients (61 operations, 80% revision procedures). The rate of nonunion decreases using an optimized technique of reattachment, in particular; sufficient thickness of wires and placing of K-wires in the trochanter minor region.

[Satisfaction following automated percutaneous lumbar discectomy as a function of clinical parameters].

182 patients assessed their condition after automated percutaneous lumbar discectomy (APLD). The analysis of descriptive data parameters++ provides new guidelines for the indication of this minimally invasive procedure: persistent leg pain despite conservative treatment, lumbar disc prolapse in one segment, minimal monological pathology, This ideal constellation implies a restriction of the common guidelines. Under these premises 50% of the patients will be satisfied.

[Arthrolysis and arthroplasty of the elbow joint. A comparison of surgical results between children and adults].

Because of stiffness of the elbow joint until 1988 146 operations have been done in 132 patients on the Department of Orthopaedic Surgery in Heidelberg. 55 procedures have been done in children and adolescents younger than 16 years, 91 times in adults. In both groups posttraumatic stiffness and stiffness of other origin have been treated.

[Transient hip joint inflammation (coxitis fugax)].

The transient coxitis is the most common hip disease in the childhood. Etiology is unknown. Questioning the history you will often find an infection in the neck, nose, ear area.

[Postoperative infections and wound healing disorders in patients with infantile cerebral palsy].

As part of a retrospective study including 569 patients with ICP and a group of 405 controls, the risk of postoperative wound healing disorders and wound infections was investigated in surgically treated children with cerebral palsy. The higher rate of wound healing disorders in ICP patients could not be attributed to factors such as excessively long duration of operation, secondary interventions, or a high number of interventions per operation. Rather, the causes of the increased risk of infection have to be seen in connection with the symptoms of ICP itself, such as immunological weakness, increased tendency to sweat, reduced circulation in the affected extremity and disturbances of sensitivity and perception.

[Diagnosis of coxitis fugax, the most frequent hip disease in childhood].

After a review of the history, clinical features, laboratory findings, imaging techniques and the treatment of coxitis fugax, the authors inform about 131 own cases. In this disease of the hip joint, which is most commonly encountered in childhood, differential diagnosis is of the utmost importance. In the present study, the initial diagnosis had to be changed in eleven cases affected with this condition, which is also referred to as "observation hip".

[Grice's method of subtalar arthrodesis--long term results of 63 operations].

Deformities of the back foot should be operated after failed conservative treatment. In this article long time results of 36 patients are demonstrated, which are operated on with extraarticular blocking (Grice-OP) of the lower ankle. Most patients are suffering of cerebral palsy.

[Ultrasound follow-up of bone lengthening osteotomy].

We report about the possibilities of sonography with regard to postoperative control of limb-lengthening. During the phase of distraction we can show the amount of lengthening with a 5 or 3.5 MHZ linear transducer.

[Symphysis injury--clinical and ultrasound follow-up].

We report about the sonography as a non-invasive method for diagnosis and control of a postpartal injury of the symphysis.