Biomechanical effects of sequential resection of the posterior ligamentous complex on intradiscal pressure and resistance to compression forces

Merter, Abdullah; Karaca, Mustafa Onur; Yazar, Tarık

doi:10.1016/j.aott.2019.08.016

Cited by 16 publications

(15 citation statements)

References 23 publications

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“…Multiple clinical investigations have showed that congenital malformations of spine (including scoliosis, kyphosis, spina bifida, spondylolysis and Klippel Feil syndrome) 35,36 , accidental back injury or ligament injury [37][38][39] , occupational exposure (such as crane and car drivers, weightlifters, etc.) [40][41][42] could induce aberrant mechanical loading of lumbar spine, and finally lead to IVDD.…”

Section: Discussionmentioning

confidence: 99%

Aberrant spinal mechanical loading stress triggers intervertebral disc degeneration by inducing pyroptosis and nerve ingrowth

Bao²,

Yao

et al. 2021

Sci Rep

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Aberrant mechanical factor is one of the etiologies of the intervertebral disc (IVD) degeneration (IVDD). However, the exact molecular mechanism of spinal mechanical loading stress-induced IVDD has yet to be elucidated due to a lack of an ideal and stable IVDD animal model. The present study aimed to establish a stable IVDD mouse model and evaluated the effect of aberrant spinal mechanical loading on the pathogenesis of IVDD. Eight-week-old male mice were treated with lumbar spine instability (LSI) surgery to induce IVDD. The progression of IVDD was evaluated by μCT and Safranin O/Fast green staining analysis. The metabolism of extracellular matrix, ingrowth of sensory nerves, pyroptosis in IVDs tissues were determined by immunohistological or real-time PCR analysis. The apoptosis of IVD cells was tested by TUNEL assay. IVDD modeling was successfully produced by LSI surgery, with substantial reductions in IVD height, BS/TV, Tb.N. and lower IVD score. LSI administration led to the histologic change of disc degeneration, disruption of the matrix metabolism, promotion of apoptosis of IVD cells and invasion of sensory nerves into annulus fibrosus, as well as induction of pyroptosis. Moreover, LSI surgery activated Wnt signaling in IVD tissues. Mechanical instability caused by LSI surgery accelerates the disc matrix degradation, nerve invasion, pyroptosis, and eventually lead to IVDD, which provided an alternative mouse IVDD model.

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Section: Discussionmentioning

confidence: 99%

Aberrant spinal mechanical loading stress triggers intervertebral disc degeneration by inducing pyroptosis and nerve ingrowth

Bao²,

Yao

et al. 2021

Sci Rep

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“…The spinous processes, interspinous ligament, and part of the posterior ligamentous complex play a role in spinal stability 29 . After spinal surgery, osseous continuity between the spinous processes and the lamina is important for maintaining the long‐term benefit 30 .…”

Section: Discussionmentioning

confidence: 99%

Full‐Endoscopic Approach Forchronic Low Back Pain from Baastrup's Disease: Interspinous Plasty

Wei

Xie

Lin

et al. 2021

Orthopaedic Surgery

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The objective was to introduce a new endoscopic technique‐interspinous plasty for low back pain from Baastrup's disease; based on clinical manifestations, imaging findings and diagnostic test, to discuss a detailed diagnostic procedure for Baastrup's disease; and to explore the mechanism of interspinous plasty in pain relief. To our knowledge, there is no report about the results of endoscopic lumbar technique for Baastrup's disease. This study described the successful full‐endoscopic surgical treatment for Baastrup's disease, providing a brand‐new therapeutic method for patients. Clinical manifestations, imaging findings, including X‐ray, computed tomography (CT) and magnetic resonance imaging, and a “positive” diagnostic test with local anesthetic were used to confirm Baastrup's disease in the three included patients. The interspinous plasty procedure, which aimed to recover a physiological gap between the adjacent spinous processes, was performed by full‐endoscopic resection of marginal osteophytes. The removal of local inflamed tissue and reducing inflammation via intraoperative saline irrigation also lead to pain relief. Clinical outcomes included visual analog scale (VAS) for low back pain and the Oswestry Disability Index (ODI). The distance between the adjacent spinous processes was measured from the preoperative and postoperative CT scan. We calculated and recorded the difference between preoperative and postoperative measurements. Technical procedures and advantages of interspinous plasty are introduced. The three patients showed improvement in terms of the postoperative VAS of low back pain (from 8 to 2, from 7 to 1 and from 8 to 2) and ODI (from 68.9% to 33.3%, from 77.8% to 28.9% and from 71.1% to 28.9%, respectively) at the 12‐month follow‐up. Compared postoperative ODI index, the ODI index increased from 26.7% to 33.3% and from 24.4% to 28.9% in two of the cases at the 12‐month follow‐up. At 1 week, CT confirmed an obvious reduction in the marginal osteophytes between the adjacent spinous processes. Compared with those on preoperative CT images, the distance between adjacent spinous processes on postoperative CT was enlarged from 1 to 4 mm, and a repeated CT scan 3 months later reconfirmed little recrudescent osteoproliferation. In selected cases, full‐endoscopic surgical treatment for chronic mechanical back pain as part of the phenomena of Baastrup's disease may be beneficial. The operations in this study were performed under local anesthesia, with satisfactory early clinical outcomes and a low incidence of complications or adverse events. This may be a feasible therapeutic method or an alternative option for patients who cannot tolerate general anesthesia surgery.

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Section: Discussionmentioning

confidence: 99%

“…Severity of PLC injury is believed to correlate with subsequent potential for instability, deformity and neurological compromise. 15,16 CT scans can be used to indirectly evaluate PLC integrity; MRI can add accuracy to the assessment. 17 The AOSpine Thoracolumbar Spine Injury Classification System has previously been found to have good inter-and intraobserver reliability and reproducibility in the adult population.…”

Section: Discussionmentioning

confidence: 99%

The reliability of the AOSpine Thoracolumbar Spine Injury Classification System in children: An international validation study

Miller

Pizones

et al. 2021

Journal of Children's Orthopaedics

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Purpose To evaluate the AOSpine Thoracolumbar Spine Injury Classification System and if it is reliable and reproducible when applied to the paediatric population globally. Methods A total of 12 paediatric orthopaedic surgeons were asked to review MRI and CT imaging of 25 paediatric patients with thoracolumbar spine traumatic injuries, in order to determine the classification of the lesions observed. The evaluators classified injuries into primary categories: A, B and C. Interobserver reliability was assessed for the initial reading by Fleiss’s kappa coefficient (kF) along with 95% confidence intervals (CI). For A and B type injuries, sub-classification was conducted including A0-A4 and B1-B2 subtypes. Interobserver reliability across subclasses was assessed using Krippendorff’s alpha (αk) along with bootstrapped 95% CIs. A second round of classification was performed one-month later. Intraobserver reproducibility was assessed for the primary classifications using Fleiss’s kappa and sub-classification reproducibility was assessed by Krippendorff’s alpha (αk) along with 95% CIs. Results In total, 25 cases were read for a total of 300 initial and 300 repeated evaluations. Adjusted interobserver reliability was almost perfect (kF = 0.74; 95% CI 0.71 to 0.78) across all observers. Sub-classification reliability was substantial (αk= 0.67; 95% CI 0.51 to 0.81), Adjusted intraobserver reproducibility was almost perfect (kF = 0.91; 95% CI 0.83 to 0.99) for both primary classifications and for sub-classifications (αk = 0.88; 95% CI 0.83 to 0.93). Conclusion The inter- and intraobserver reliability for the AOSpine Thoracolumbar Spine Injury Classification System was high amongst paediatric orthopaedic surgeons. The AOSpine Thoracolumbar Spine Injury Classification System is a promising option as a uniform fracture classification in children. Level of Evidence III

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Biomechanical effects of sequential resection of the posterior ligamentous complex on intradiscal pressure and resistance to compression forces

Cited by 16 publications

References 23 publications

Aberrant spinal mechanical loading stress triggers intervertebral disc degeneration by inducing pyroptosis and nerve ingrowth

Aberrant spinal mechanical loading stress triggers intervertebral disc degeneration by inducing pyroptosis and nerve ingrowth

Full‐Endoscopic Approach Forchronic Low Back Pain from Baastrup's Disease: Interspinous Plasty

The reliability of the AOSpine Thoracolumbar Spine Injury Classification System in children: An international validation study

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