Age-related changes in the spinal column result in a degenerative cascade known as spondylosis.
Low back pain as a result of degenerative disc disease imparts a large socioeconomic impact on the health care system. Traditional concepts for treatment of lumbar disc degeneration have aimed at symptomatic relief by limiting motion in the lumbar spine, but novel treatment strategies involving stem cells, growth factors, and gene therapy have the theoretical potential to prevent, slow, or even reverse disc degeneration. Understanding the pathophysiological basis of disc degeneration is essential for the development of treatment strategies that target the underlying mechanisms of disc degeneration rather than the downstream symptom of pain. Such strategies ideally aim to induce disc regeneration or to replace the degenerated disc. However, at present, treatment options for degenerative disc disease remain suboptimal, and development and outcomes of novel treatment options currently have to be considered unpredictable.
Insulin-like growth factor-1 (IGF-1) promotes myocyte proliferation and can reverse cardiac abnormalities when it is administered in the early fetal stage. Supplementation of a mouse embryonic stem cell (ESC) suspension with IGF-1 might enhance cellular engraftment and host organ-specific differentiation after injection in the area of acute myocardial injury. In the study reported here, we sought to enhance the restorative effect of ESCs in the injured heart by adding IGF-1 to the injected cell population. Green fluorescent protein (GFP)-labeled sv129 ESCs (2.5 ✕ 10 5 ) were injected into the ischemic area after left anterior descending (LAD) artery ligation in BalbC mice. Recombinant mouse IGF-1 (25 ng) was added to the cell suspension prior to the injection (n = 5).
Spondylotic degeneration in the cervical spine may result in static and/or dynamic spinal cord compression that can lead to the associated signs and symptoms of myelopathy. Clinical examination combined with appropriate imaging studies help to confirm the diagnosis. Classic natural history and basic science studies suggest a pernicious course of demyelination and neurologic decline in a large subset of patients. The characterization of disease severity and progression in patients with cervical spondylotic myelopathy has improved in recent years with imaging and data from prospective and multicenter studies. Additionally, advances in surgical techniques, implants, and imaging modalities have improved the identification of surgical candidates with cervical spondylotic myelopathy and associated treatment strategies. Surgical treatment, via an anterior, posterior, or a combined approach, is primarily intended to arrest neurologic progression, although it can improve function in many patients. Alignment and the characteristics and location of spinal cord compression help determine the ideal surgical approach. Distinct complications associated with each technique may be mitigated by appropriate patient selection and should be discussed preoperatively to ensure informed decision making.
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