Introduction Degeneration of the lumbar intervertebral disc is a cause of low back pain. The pathological mechanism is thought to be sensory nerve ingrowth into the inner layers of the degenerated intervertebral disc. NGF is also important for mediating inflammatory pain from intervertebral discs via the high-affinity receptor, TrkA. Recent research has also revealed that the low-affinity NGF receptor, p75 neurotrophic receptor (p75NTR), plays an important role in inflammatory pain. In most DRG neurons, innervating rat intervertebral discs were positive for two types of NGF receptors. However, the participative two types of NGF receptors have not been clarified in human degenerative discs. To evaluate the axonal growth and induction of a painful neuropeptide, CGRP, using neutralize antibody and extracted medium from human degenerative disc cells in vitro. Materials and Methods The nucleus pulposus (NP) of human intervertebral discs were harvested from patients with discogenic low back pain. Extracted medium from human degenerative intervertebral discs and rat DRGs were cultured with TrkA or p75NTR neutralize antibody. We evaluated the promotion of axonal growth and CGRP induction of DRG neurons in extracted medium from the NP using immunocytochemistry. Results The average length of growing axons in the NP and positive control group with TrkA or p75NTR neutralize antibody were significantly longer than that in the control group ( p < 0.001). The average length of growing axons in the NP group and positive control group was significantly shortened after TrkA and p75NTR neutralize antibody treatment ( p < 0.001). The percentage of CGRP-immunoreactive cells with growing axons was significantly shorter than in the NP and positive control group compared with the control groups with p75NTR neutralize antibody ( p < 0.05). The expression of CGRP in all group with TrkA neutralize antibody was not decreased. Conclusion TrkA and p75NTR were associated with the growing axons in extracted medium from the NP of human intervertebral discs. p75NTR were associated with the percentage of CGRP-immunoreactive cells with growing axons more than TrkA. These in vitro results may suggest that p75NTR is related with discogenic low back pain. Disclosure of Interest None declared References Yamauchi K, Inoue G, Koshi T, et al. Nerve growth factor of cultured medium extracted from human degenerative nucleus pulposus promotes sensory nerve growth and induces substance p in vitro. Spine 2009;34(21):2263–2269 Sugiura A, Ohtori S, Yamashita M, et al. Effect of applying p75NTR saporin to a punctured intervertebral disc on calcitonin gene-related peptide expression in rat dorsal root ganglion neurons. J Orthop Sci 2010;15(3):407–413 Fukui Y, Ohtori S, Yamashita M, et al. Low affinity NGF receptor (p75 neurotrophin receptor) inhibitory antibody reduces pain behavior and CGRP expression in DRG in the mouse sciatic nerve crush model. J Orthop Res 2010;28(3):279–283
We report a case of vertebral fracture with diffuse idiopathic skeletal hyperostosis (DISH) who underwent posterior dynamic stabilisation using mobile percutaneous pedicle screws (PPS) with 1 above-1 below and obtained good bone fusion. A 76-year-old man experienced severe low back pain after he fell backward 1 m off a stepladder during work. A 12th thoracic vertebral fracture with DISH was observed. As the fractured part was unstable due to a three-column injury, and the conservative treatment of resting was not successful, posterior dynamic stabilisation with a mobile PPS between T11–L1 was performed the 38th day after injury. Immediately after surgery, a fracture gap was observed, but 5 months later, vertebral body height was shortened by about 4 mm, and good bone fusion was observed without loosening of the screw. The mobile PPS flexibly adapts to spinal plasticity and may be useful for bone union in vertebral fractures associated with DISH.
In our experiments, both ponderal and histologic observations on the adrenal support the view that in the rat the hypophysisadrenal axis begins to function before birth. After birth, there is an hiatus of 3 days during which the function is significantly reduced.
Objective: Atopic dermatitis (AD) is one of the known risk factors for Staphylococcus aureus infection. The authors report the case of a patient with cervical spondylosis and AD who developed delayed surgical site infection after posterior cervical instrumented surgery. Patient: A 39-year-old male presented to our hospital with paralysis of the left upper extremity without any cause or prior injury. He had a history of severe AD. We performed C3-C7 posterior decompression and instrumented fusion based on the diagnosis of cervical spondylotic amyotrophy. One year after surgery, his deltoid and bicep muscle strength were fully recovered. Nevertheless, his neck pain worsened 2 years after surgery following worsening of AD. One month after that, he developed severe myelopathy and was admitted to our hospital. Radiographic findings showed that all the screws had loosened and the retropharyngeal space had expanded. Magnetic resonance imaging and computed tomography showed severe abscess formation and destruction of the C7/T1 vertebrae. Result: We diagnosed him with delayed surgical site infection. Methicillin-resistant Staphylococcus aureus was identified on abscess culture. The patient responded adequately to treatment with antibiotic therapy and two debridements and the infection subsided. Conclusion: We should consider the possibility of delayed surgical site infection when conducting instrumented spinal surgery in patients with severe AD.
Retrospective observational study.To examine fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) values of damaged nerves to discriminate between lumbar intraspinal stenosis (IS) and foraminal stenosis (FS) using diffusion tensor imaging (DTI).It is important in the selection of surgical procedure to discriminate between lumbar IS and FS, but such discrimination is difficult.There were 9 cases of IS, 7 cases of FS, and 5 healthy controls. The regions of interest were established in the lumbar intraspinal zone (Iz), nerve root (N), and extraforaminal zone (Ez). The FA and ADC values were measured on the affected and unaffected sides of the nerves. The FA ratio and the ADC ratio were calculated as the affected side/unaffected side ×100 (%).In the Ez, the FA value was significantly lower in FS than in IS (p<0.01). FA ratio was significantly lower in FS than in IS for the Ez (p<0.01). In the Iz, the ADC value was significantly higher in IS than FS (p<0.01). ADC ratio was significantly higher in FS than in IS for the N and Ez (p<0.05). For the Ez, receiver operating characteristic analysis of parameters revealed that the FA values showed a higher accuracy for the diagnosis of FS than the ADC values, and the FA value cut-off value was 0.42 (sensitivity: 85.7%, false positive: 11.1%) and the FA ratio cut-off value was 83.9% (sensitivity: 85.7%, false positive: 22.2%).The low FA value in the extraforaminal zone suggests the presence of foraminal stenosis. When the FA value and FA ratio cut-off value were established as 0.42 and 83.9%, respectively, the accuracy was high for the diagnosis of foraminal stenosis. It may be possible to use DTI parameters to help in the discrimination between IS and FS.
