The body of literature supports fusion surgery as a viable treatment option for reducing pain and improving function in patients with chronic LBP refractory to nonsurgical care when a diagnosis of disc degeneration can be made.

We were able to establish a predominant diagnosis in 94% of our patients. Foraminal stenosis remains the leading cause of FBSS, but painful discs are also common. Recurrent disc herniation is seen less often than in the past, and there is increased recognition of neuropathic pain. Knowledge of the potential causes of FBSS leads to a more efficient and cost-effective evaluation of these patients.

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Circumferential lumbar fusion is a useful procedure for a patient with difficult reconstructive disease. There is a very high fusion rate. Overall, 62% of patients are satisfied with the result, especially those with a diagnosis of pseudarthrosis or spondylolisthesis with stenosis. Patients who are working before surgery and patients who are not injured workers also tended to progress well.

Both the 360 degrees and 270 degrees fusions significantly reduce pain and improve function, and there are no significant clinical differences between them. However, there were shorter operating times, less blood loss, lower costs, and less utilization of health care resources associated with the 270 degrees fusions.

Study Design An in vitro study examining factors produced by human mesenchymal stem cells (MSCs) on spine implant materials. Objective The aim of this study was to examine if the inflammatory microenvironment generated by cells on titanium-aluminum-vanadium (Ti-alloy, TiAlV) surfaces is affected by surface microtexture and if it differs from that generated on poly(ether ether ketone) (PEEK). Summary of Background Data Histologically, implants fabricated from PEEK have a fibrous connective tissue surface interface whereas Ti-alloy implants demonstrate close approximation with surrounding bone. Ti-alloy surfaces with complex micron/submicron scale roughness promote osteoblastic differentiation and foster a specific cellular environment that favors bone formation while PEEK favors fibrous tissue formation. Methods Human MSCs were cultured on tissue culture polystyrene (TCPS), PEEK, smooth TiAlV, or macro/micro/nano-textured rough TiAlV (mmnTiAlV) disks. Osteoblastic differentiation and secreted inflammatory interleukins were assessed after seven days. Fold changes in mRNAs for inflammation, necrosis, DNA damage, or apoptosis with respect to TCPS were measured by low-density PCR array. Data were analyzed by ANOVA followed by Student’s t-test with post hoc analysis. Results Cells on PEEK up-regulated mRNAs for chemokine ligand-2 (CCL2), interleukin (IL) 1β, IL6, IL8, and tumor necrosis factor (TNF). Cells grown on the mmnTiAlV had an 8-fold reduction in mRNAs for toll-like receptor-4. Cells grown on mmnTiAlV had reduced levels of pro-inflammatory interleukins. Cells on PEEK had higher mRNAs for factors strongly associated with cell death/apoptosis, while cells on mmnTiAlV exhibited reduced cytokine factor levels. All results were significant (p<0.05). Conclusions These results suggest that fibrous tissue around PEEK implants may be due to several factors: reduced osteoblastic differentiation of progenitor cells and production of an inflammatory environment that favors cell death via apoptosis and necrosis. Ti alloy surfaces with complex macro/micro/nano-scale roughness promote osteoblastic differentiation and foster a specific cellular environment that favors bone formation.

In a patient presenting with neurogenic symptoms after lumbar surgery, a meticulous workup is required to elucidate the source of these symptoms. Surgical indications are similar to those for primary lumbar spinal surgery and include a well-defined anatomic source of neural compression that is amenable to a surgical solution.