Spinal metastasis of differentiated thyroid cancer can have a favorable prognosis if radical surgery is performed. We encountered a case of spinal metastasis involving three anterior vertebral bodies at the posterior element fusion level and successfully achieved adequate stability by radical surgery involving only the anterior elements. A 67-year-old woman who had numbness and muscle weakness in the lower limbs caused by metastatic spinal tumor at the posterior element fusion level of L1–L3 vertebrae was treated with radical surgery of only the anterior element to gain stability. Similar situations may occur in cases involving other malignant tumor metastases or spinal primary tumors. If such a case occurs, this method could be useful in preventing metastasis to the posterior element.
Prospective consecutive series.To evaluate the post-traumatic disc degeneration and range of motion 10 years after short-segment fixation without fusion for thoracolumbar burst fractures with neurological deficit.Early clinical results of short-segment fixation without fusion for thoracolumbar burst fractures were satisfactory. However, the long-term results have not been reported, and post-traumatic disc degeneration and preservation of thoracolumbar motion have not been elucidated.Twelve patients who had thoracolumbar burst fractures and associated incomplete neurological deficit, operatively treated within 4 days of admission and had their implants removed within 1 year, were prospectively followed for at least 10 years. Following indirect reduction and pedicle screw fixation, transpedicular intracorporeal hydroxyapatite grafting to the fractured vertebrae was performed.Sagittal alignment was improved from a mean preoperative kyphosis of 17° to -2° (lordosis) by operation, but was found to have slightly deteriorated to 2° at the final follow-up observation. With respect to back pain, 8 patients did not report back pain. Three reported occasional minimal pain, and 1 reported moderate pain. None reported severe pain or needed daily dosages of analgesics.Regarding disc degeneration, the shape of the disc adjacent to the fractured vertebra had not changed from the preoperative to the 10-year postoperative magnetic resonance image (MRI). Although signal intensity of the disc had decreased by 1 grade from the preoperative to the 2-year postoperative MRI, the intensity had not changed from the 2-year postoperative MRI to the 10-year postoperative MRI. At the 10-year follow-up, flexion-extension radiographs revealed that a mean range of motion at the disc adjacent to the fractured vertebra was 12º (range; 5-19).This unprecedented 10-year follow-up study demonstrated that posterior indirect reduction, transpedicular hydroxyapatite grafting, and pedicle screw fixation does not require fusion to a segment, thereby preserves thoracolumbar motion without resulting in post-traumatic disc degeneration.4.
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
The knowledge how scoliosis affects the respiratory function is important for the treatment of scoliosis. This study investigates the effect of scoliosis to respiratory function using the developed simulation model of scoliosis based on individual CT/MR images. Individual model of scoliotic rib cage is formulated by FEM software (Ansys, ver6.1), to simulate the activity of the exterior and interior inter-costal muscles relating the respiratory motion .The calculation procedure of the volume change of rib-cage under respiratory motion using nodal coordinates and nodal displacements was shown. The rib-cage volume change in respiration of scoliotic subject became considerably less than that of healthy. The investigation of respiratory function relating to rib-cage volume change of scoliotic subject gives a suggestion for the treatment.
