Cervical fusion for treatment of degenerative conditions: development of appropriate use criteria.

Background Context: High quality evidence is difficult to generate, leaving substantial knowledge gaps in the treatment of spinal conditions. Appropriate use criteria (AUC) are a means of determining appropriate recommendations when high quality evidence is lacking.

Purpose: Define appropriate use criteria (AUC) of cervical fusion for treatment of degenerative conditions of the cervical spine.

Effect of BMP-2 Adherent to Resorbable Sutures on Cartilage Repair: A Rat Model of Xyphoid Process.

Meniscal tears are often seen in orthopedic practice. The current strategy for meniscal repair has only had limited success with a relatively high incidence of re-operative rate. This study evaluates the therapeutic effects of Bone morphogenetic protein-2 (BMP-2) soaked sutures for cartilage repair, using a rat model of xyphoid healing.

Prevention and management of osteoporosis and osteoporotic fractures in persons with a spinal cord injury or disorder: A systematic scoping review.

The primary objective was to review the literature regarding methodologies to assess fracture risk, to prevent and treat osteoporosis and to manage osteoporotic fractures in SCI/D. Scoping review. Human adult subjects with a SCI/D.

Morphology and Clinical Relevance of Vertebral Endplate Changes Following Limited Lumbar Discectomy With or Without Bone-anchored Annular Closure.

Study Design: Post hoc analysis of a randomized controlled trial.

Objective: To characterize the morphology and clinical relevance of vertebral endplate changes (VEPC) following limited lumbar discectomy with or without implantation of a bone-anchored annular closure device (ACD).

Summary Of Background Data: Implantation of an ACD following limited lumbar discectomy has shown promise in reducing the risk of recurrent herniation in patients with large annular defects.

Differentiation of nerve-derived adult pluripotent stem cells into osteoblastic and endothelial cells.

Background Context: Stem cell-involved tissue engineering has gained dramatic attention as a therapeutic strategy for tissue regeneration including bone repair. However, the currently available possibilities to use embryonic stem cells and induced pluripotent stem cells (iPCs) face potential ethical issues, as well as risks of malignant transformation and immune rejection. Recently identified peripheral nerve-derived adult pluripotent stem cells (NEDAPS) that quickly proliferate after exposure to bone morphogenetic protein-2 (BMP-2) or nerve trauma and exhibit many embryonic stem cell characteristics may provide an attractive source cells for a variety of regenerative therapies.

Quiescent pluripotent stem cells reside within murine peripheral nerves that can be stimulated to proliferate by recombinant human bone morphogenic protein 2 or by nerve trauma.

Background: The clinical use of recombinant human bone morphogenic protein 2 (rhBMP-2, Infuse) has been associated with nerve-related complications including new-onset sciatica, and retrograde ejaculation.

Purpose: To better understand the interaction of rhBMP-2 and peripheral nerves with the intent of making procedures safer.

Study Design/setting: Using a mouse model to examine the direct effect of diluted rhBMP-2 (Infuse) on murine sciatic nerves.

Ablation of the basivertebral nerve for treatment of back pain: a clinical study.

Background Content: Lumbar axial back pain arising from degenerative disc disease continues to be a challenging clinical problem whether treated with nonsurgical management, local injection, or motion segment stabilization and fusion.

Purpose: The purpose of this study was to determine the efficacy of intraosseous basivertebral nerve (BVN) ablation for the treatment of chronic lumbar back pain in a clinical setting.

Study Design: Patients meeting predefined inclusion or exclusion criteria were enrolled in a study using radiofrequency energy to ablate the BVN within the vertebral bodies adjacent to the diagnosed level.

Therapeutic effects of naringin on degenerative human nucleus pulposus cells for discogenic low back pain.

Background: Over half the population of the world will suffer from moderate or severe low back pain (LBP) during their life span. Studies have shown that naringin, a major flavonoid in grapefruit and an active compound extracted from a Chinese herbal medicine (Rhizoma Drynariae) possesses many pharmacological effects.

Purpose: The aim of this study was to evaluate the influence of naringin on the growth of degenerative human nucleus pulposus (NP) cells, and its repair effects on protein and gene expressions of the cells.

Biomechanical evaluation of CIBOR spine interbody fusion device.

Background: The CIBOR PEEK spinal interbody fusion device is an anterior lumbar interbody fusion construct with a hollow center designed to accommodate an osteoinductive carbon foam insert to promote bony ingrowth to induce fusion where rigid stabilization is needed.

Methods: Three different sizes of the device were investigated. Part-I: implants were tested under axial compression and rotation using polyurethane foam blocks.

Management of Pediatric Supracondylar Humerus Fractures With Vascular Injury.

The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) document Management of Pediatric Supracondylar Humerus Fractures With Vascular Injury. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC clinical patient scenarios were derived from patient indications that generally accompany a pediatric supracondylar humerus fracture with vascular injury, as well as from current evidence-based clinical practice guidelines and supporting literature.

Gene therapy for spinal fusion using an insect vector.

Fu T-S, Chang Y-H, Wong C-B, Wang I-C, Tsai T-T, Lai P-L, et al. Mesenchymal stem cells expressingbaculovirus-engineered BMP-2 and VEGF enhance posterolateral spine fusion in a rabbit model. Spine J 2015;15(9):2036-44.

Management of Pediatric Supracondylar Humerus Fractures.

The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria (AUC) on the Management of Pediatric Supracondylar Humerus Fractures (PSHF). Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The PSHF AUC clinical patient scenarios were derived from patient indications that generally accompany a PSHF as well as from current evidence-based clinical practice guidelines and supporting literature.

Effect of vertebroplasty on the compressive strength of vertebral bodies.

Background Context: Percutaneous vertebroplasty has been used successfully for many years in the treatment of painful compressive vertebral fractures due to osteoporosis.

Purpose: To compare the effect of vertebroplasty on the compressive strength of unfractured vertebral bodies.

Study Design: Biomechanical study on cadaveric thoracic vertebrae.

Mortality after lower extremity fractures in men with spinal cord injury.

In the United States, there are over 200,000 men with spinal cord injuries (SCIs) who are at risk for lower limb fractures. The risk of mortality after fractures in SCI is unknown. This was a population-based, cohort study of all male veterans (mean age 54.

Quantitative imaging of murine osteoarthritic cartilage by phase-contrast micro-computed tomography.

Objective: The mouse is an optimal model organism in which gene-environment interactions can be used to study the pathogenesis of osteoarthritis (OA). The gold standard for arthritis research in mice is based on histopathology and immunohistochemistry, which are labor-intensive, prone to sampling bias and technical variability, and limited in throughput. The aim of this study was to develop a new technique that assesses mouse cartilage by integrating quantitative volumetric imaging techniques.

Histologic identification of brown adipose and peripheral nerve involvement in human atherosclerotic vessels.

The disease mechanisms and histology of plaque development associated with atherosclerosis remain incredibly complex and not entirely understood. Recent investigations have emphasized the importance of inflammation in atherosclerosis. Several studies have also indicated heterotopic or extraskeletal bone formation in atherosclerotic vessels.

Prospective randomized phase II Trial of accelerated reepithelialization of superficial second-degree burn wounds using extracorporeal shock wave therapy.

Background: As extracorporeal shock wave therapy (ESWT) can enhance healing of skin graft donor sites, this study focused on shock wave effects in burn wounds.

Methods: A predefined cohort of 50 patients (6 with incomplete data or lost to follow-up) with acute second-degree burns from a larger study of 100 patients were randomly assigned between December 2006 and December 2007 to receive standard therapy (burn wound debridement/topical antiseptic therapy) with (n = 22) or without (n = 22) defocused ESWT (100 impulses/cm at 0.1 mJ/mm) applied once to the study burn, after debridement.

Toward the establishment of optimal computed tomographic parameters for the assessment of lumbar spinal fusion.

Background Context: The accurate detection of the extent of bony fusion after attempted lumbar arthrodesis is important given that subsequent efforts-such as decisions regarding need for continued external bracing, use of enhancing modalities (electrical stimulation and pulsed ultrasound), recommended activity levels, return to employment, early surgical intervention, and others-may be needed to reduce the risk of late failure, especially in light of the fact that late revisions for failed fusions often result in poor outcomes and significant costs. Thin-cut computed tomography (CT) has emerged as the study of choice for this purpose.

Purpose: To delineate the optimal CT parameters for determining fusion versus pseudarthosis after attempted lumbar fusion.

Cell-based gene therapy for repair of critical size defects in the rat fibula.

More than a decade has passed since the first experiments using adenovirus-transduced cells expressing bone morphogenetic protein 2 were performed for the synthesis of bone. Since this time, the field of bone gene therapy has tackled many issues surrounding safety and efficacy of this type of strategy. We present studies examining the parameters of the timing of bone healing, and remodeling when heterotopic ossification (HO) is used for bone fracture repair using an adenovirus gene therapy approach.

An injectable method for noninvasive spine fusion.

Background Context: Bone morphogenetic proteins (BMPs) induce bone formation but are difficult to localize, and subsequent diffusion from the site of interest and short half-life reduce the efficacy of the protein. Currently, spine fusion requires stripping, decortications of the transverse processes, and an autograft harvest procedure. Even in combination with BMPs, clinical spinal fusion has a high failure rate, presumably because of difficulties in localizing sufficient levels of BMP.

Assessing mechanical integrity of spinal fusion by in situ endochondral osteoinduction in the murine model.

Background: Historically, radiographs, micro-computed tomography (micro-CT) exams, palpation and histology have been used to assess fusions in a mouse spine. The objective of this study was to develop a faster, cheaper, reproducible test to directly quantify the mechanical integrity of spinal fusions in mice.

Methods: Fusions were induced in ten mice spine using a previously described technique of in situ endochondral ossification, harvested with soft tissue, and cast in radiolucent alginate material for handling.