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Liu Y, Xue M, Han Y, Li Y, Xiao B, Wang W, Yu J, Ye X. Exosomes from M2c macrophages alleviate intervertebral disc degeneration by promoting synthesis of the extracellular matrix via MiR-124/CILP/TGF-β. Bioeng Transl Med 2023; 8:e10500. [PMID: 38023721 PMCID: PMC10658595 DOI: 10.1002/btm2.10500] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 01/16/2023] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
Immuno-inflammation is highly associated with anabolic and catabolic dysregulation of the extracellular matrix (ECM) in the nucleus pulposus (NP), which dramatically propels intervertebral disc degeneration (IVDD). With the characteristics of tissue remodeling and regeneration, M2c macrophages have attracted great attention in research on immune modulation that rebuilds degenerated tissues. Therefore, we first demonstrated the facilitating effects of M2c macrophages on ECM anabolism of the NP in vitro. We subsequently found that exosomes from M2c macrophages (M2c-Exoss) mediated their metabolic rebalancing effects on the ECM. To determine whether M2c-Exoss served as positive agents protecting the ECM in IVDD, we constructed an M2c-Exos-loaded hyaluronic acid hydrogel (M2c-Exos@HA hydrogel) and implanted it into the degenerated caudal disc of rats. The results of MRI and histological staining indicated that the M2c-Exos@HA hydrogel alleviated IVDD in vivo in the long term. To elucidate the underlying molecular mechanism, we performed 4D label-free proteomics to screen dysregulated proteins in NPs treated with M2c-Exoss. Cartilage intermediate layer protein (CILP) was the key protein responsible for the rebalancing effects of M2c-Exoss on ECM metabolism in the NP. With prediction and verification using luciferase assays and rescue experiments, miR-124-3p was identified as the upstream regulator in M2c-Exoss that regulated CILP and consequently enhanced the activity of the TGF-β/smad3 pathway. In conclusion, we demonstrated ameliorating effects of M2c-Exoss on the imbalance of ECM metabolism in IVDD via the miR-124/CILP/TGF-β regulatory axis, which provides a promising theoretical basis for the application of M2c macrophages and their exosomes in the treatment of IVDD.
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Affiliation(s)
- Yi Liu
- Department of OrthopaedicsSecond Affiliated Hospital of Naval Medical UniversityShanghaiPeople's Republic of China
- Department of OrthopedicsTongren Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Mintao Xue
- Department of OrthopaedicsSecond Affiliated Hospital of Naval Medical UniversityShanghaiPeople's Republic of China
| | - Yaguang Han
- Department of OrthopaedicsSecond Affiliated Hospital of Naval Medical UniversityShanghaiPeople's Republic of China
| | - Yucai Li
- Department of OrthopedicsTongren Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Bing Xiao
- Department of OrthopaedicsSecond Affiliated Hospital of Naval Medical UniversityShanghaiPeople's Republic of China
| | - Weiheng Wang
- Department of OrthopaedicsSecond Affiliated Hospital of Naval Medical UniversityShanghaiPeople's Republic of China
| | - Jiangming Yu
- Department of OrthopedicsTongren Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Xiaojian Ye
- Department of OrthopedicsTongren Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
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Torga T, Suutre S, Kisand K, Aunapuu M, Arend A. Expression of CILP-2 and DDR2 and ultrastructural changes in the articular cartilage of patients with knee osteoarthritis undergoing total knee arthroplasty: a pilot morphological study. Med Mol Morphol 2023; 56:46-57. [PMID: 36370214 DOI: 10.1007/s00795-022-00339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
The aim of the study was to correlate the immunohistochemical expression of cartilage intermediate layer protein 2 (CILP-2) and discoidin domain receptor 2 (DDR2), and the ultrastructural changes in the cartilage with the degree of articular cartilage damage in osteoarthritis (OA) patients. Cartilage samples were obtained from twenty patients aged from 46 to 68 years undergoing total knee arthroplasty. In each patient, medial and lateral tibial plateau samples were analysed applying OARSI histopathology grading. Positive correlation was noted between the extent of CILP-2 staining intensity and OARSI grades. Abundant staining for CILP-2 was found in the superficial and middle layers and in the pericellular matrix (PCM) of the deep zone. Transmission electron microscopy studies demonstrated strong damage of chondrocytes, the organelles were often diminished or focally aggregated. As a characteristic finding, PCM was frequently expanded, which may reflect a pathogenic step in OA progression. In conclusion, CILP-2 may potentially be a relevant marker of OA progression as its expression correlated better with cartilage damage than the known marker of articular cartilage damage, DDR2.
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Affiliation(s)
- Taavi Torga
- Department of Anatomy, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
| | - Siim Suutre
- Department of Anatomy, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Kalle Kisand
- Department of Internal Medicine, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia
| | - Marina Aunapuu
- Department of Anatomy, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Andres Arend
- Department of Anatomy, University of Tartu, Ravila 19, 50411, Tartu, Estonia
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Liu J, Chen Y, Shan X, Wang H. Association between CILP and IL-1α polymorphisms and phenotype-dependent intervertebral disc degeneration susceptibility: A meta-analysis. Front Genet 2022; 13:1005393. [PMID: 36276953 PMCID: PMC9582649 DOI: 10.3389/fgene.2022.1005393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The relationship between CILP (1184T>C) and IL-1α(+889C/T) polymorphisms and intervertebral disc degeneration (IDD) have been explored in several studies but the results were conflicting. The aim of the study was to evaluate and synthesize the currently available data on the association between CILP (1184T>C) and IL-1α(+889C/T) polymorphisms and susceptibility of phenotype-dependent radiologic IDD (RIDD) and symptomatic intervertebral disk herniation (SIDH). Methods: A computerized literature search was in PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure database, and Web of Science. The pooled results were presented as odds ratios (ORs) with 95% confidence intervals (CIs). Moreover, the false-positive report probability (FPRP) test and trial sequential analysis (TSA) were applied to estimate the significant results. Results: Our evidence demonstrated that IL-1α(+889C/T) was significant associated with RIDD (allele model: OR = 1.34, 95%CI 1.03-1.74, p = 0.029) and SIDH (allele model: OR = 1.28, 95% CI 1.03-1.60, p = 0.028). However, the results were not noteworthy under the FPRP test and TSA analysis. Additionally, CILP (1184T>C) polymorphism was significantly associated with RIDD with adequate evidence (allele model: OR = 1.27, 95% CI 1.09-1.48, p = 0.002) instead of SIDH. Conclusion: The current meta-analysis illustrated firm evidence that CILP (1184T>C) polymorphism was significantly associated with the susceptibility of RIDD. However, the significant associations between IL-1α(+889C/T) and RIDD and SIDH were less credible. Thus, more multi-center studies with diverse populations were required to verify the results.
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Affiliation(s)
- Jiachen Liu
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunxia Chen
- Department of Endocrinology, Cangzhou People’s Hospital, Cangzhou, China
| | - Xiuqi Shan
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Huan Wang
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
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Behnamian S, Esposito U, Holland G, Alshehab G, Dobre AM, Pirooznia M, Brimacombe CS, Elhaik E. Temporal population structure, a genetic dating method for ancient Eurasian genomes from the past 10,000 years. CELL REPORTS METHODS 2022; 2:100270. [PMID: 36046618 PMCID: PMC9421539 DOI: 10.1016/j.crmeth.2022.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 06/17/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022]
Abstract
Radiocarbon dating is the gold standard in archeology to estimate the age of skeletons, a key to studying their origins. Many published ancient genomes lack reliable and direct dates, which results in obscure and contradictory reports. We developed the temporal population structure (TPS), a DNA-based dating method for genomes ranging from the Late Mesolithic to today, and applied it to 3,591 ancient and 1,307 modern Eurasians. TPS predictions aligned with the known dates and correctly accounted for kin relationships. TPS dating of poorly dated Eurasian samples resolved conflicting reports in the literature, as illustrated by one test case. We also demonstrated how TPS improved the ability to study phenotypic traits over time. TPS can be used when radiocarbon dating is unfeasible or uncertain or to develop alternative hypotheses for samples younger than 10,000 years ago, a limitation that may be resolved over time as ancient data accumulate.
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Affiliation(s)
- Sara Behnamian
- Department of Biology, Lund University, 22362 Lund, Sweden
| | - Umberto Esposito
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield S10 2TN, UK
| | - Grace Holland
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield S10 2TN, UK
| | - Ghadeer Alshehab
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield S1 3JD, UK
| | - Ann M. Dobre
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield S10 2TN, UK
| | - Mehdi Pirooznia
- National Heart, Lung, and Blood Institute (NHLBI), Bethesda, MD 20892, USA
| | - Conrad S. Brimacombe
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield S10 2TN, UK
- Department of Anthropology and Archaeology, University of Bristol, Bristol BS8 1TH, UK
| | - Eran Elhaik
- Department of Biology, Lund University, 22362 Lund, Sweden
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Li S, Liu J, Chen L. MiR-330-5p inhibits intervertebral disk degeneration via targeting CILP. J Orthop Surg Res 2021; 16:440. [PMID: 34233701 PMCID: PMC8261929 DOI: 10.1186/s13018-021-02582-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/25/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Intervertebral disk degeneration (IDD) is caused by nucleus pulposus (NP) degeneration and extracellular matrix (ECM) remodeling and cartilage intermediate layer protein (CILP) expression has been confirmed to be increased in IDD. This study is mainly conducted to clarify the mechanism of CILP in the NP cell degeneration and ECM remodeling in IDD. METHODS CILP expression in the degenerated NP tissues and cells is quantified by quantitative real-time PCR and western blot. CILP function is assessed by cell cycle assay, 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and flow cytometry, β-galactosidase staining, and the detection of ECM-related molecules aggrecan, collagen type I, collagen type II, MMP-3, and MMP-9 expression is accomplished by qRT-PCR. The potential mechanism is authenticated by dual-luciferase reporter gene assay. RESULTS CILP was increased in the degenerated NP tissues and cells, and the knockdown of CILP promoted the NP cell cycle, increased cell activity, and repressed cell apoptosis and repressed cell senescence and ECM production. Moreover, miR-330-5p targeted the CILP 3'-untranslated region, and miR-330-5p negatively regulated CILP expression. Moreover, the overexpression of miR-330-5p repressed NP cell degeneration and ECM remodeling to relieve IDD by downregulating CILP. CONCLUSION MiR-330-5p represses NP cell degeneration and ECM remodeling to ameliorate IDD by downregulating CILP.
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Affiliation(s)
- Shangzhi Li
- Department of Orthopaedics, Tianjin Hospital, Tianjin, 300211, People's Republic of China
| | - Jinwei Liu
- Department of Orthopaedics, Tianjin Hospital, Tianjin, 300211, People's Republic of China
| | - Liang Chen
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, People's Republic of China.
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Fiani B, Covarrubias C, Jarrah R. Genetic Predictors of Early-Onset Spinal Intervertebral Disc Degeneration: Part Two of Two. Cureus 2021; 13:e15183. [PMID: 34178504 PMCID: PMC8221650 DOI: 10.7759/cureus.15183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Understanding genetic indicators is a fundamental aspect to characterizing the pathophysiology of chronic diseases such as intervertebral disc degeneration (IVDD). In our previous spinal genetics review, we characterized some more common genetic influencers in the context of IVDD. In this second part of our two-part comprehensive spinal genetics review, we characterize the more infrequently studied genes that have pathophysiological relevance. In doing so, we aim to expand upon the current gene-library for IVDD. The genes of interest include: asporin, cartilage intermediate layer protein, insulin-like growth factor 1 receptor, matrix metallopeptidase 9, and thrombospondin 2. Findings show that these genetic indicators have trends and polymorphisms that may have causal associations with the manifestation of IVDD. However, there is a narrow selection of studies that use genetic indicators to describe correlations to the severity and longevity of the pathology. Nevertheless, with the continued identification of risk genes involved with IVDD, the possibilities for refined models of gene therapies can be established for future treatment trials.
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Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Claudia Covarrubias
- School of Medicine, Universidad Anáhuac Querétaro, Santiago de Querétaro, MEX
| | - Ryan Jarrah
- College of Arts and Sciences, University of Michigan-Flint, Flint, USA
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Liu L, He J, Liu C, Yang M, Fu J, Yi J, Ai X, Liu M, Zhuang Y, Zhang Y, Huang B, Li C, Zhou Y, Feng C. Cartilage intermediate layer protein affects the progression of intervertebral disc degeneration by regulating the extracellular microenvironment (Review). Int J Mol Med 2021; 47:475-484. [PMID: 33416131 PMCID: PMC7797476 DOI: 10.3892/ijmm.2020.4832] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/27/2020] [Indexed: 12/25/2022] Open
Abstract
Intervertebral disc degeneration (IDD), which is caused by multiple factors, affects the health of individuals and contributes to low back pain. The pathology of IDD is complicated, and changes in the extracellular microenvironment play an important role in promoting the process of degeneration. Cartilage intermediate layer protein (CILP) is a matrix protein that resides in the middle of human articular cartilage and is involved in numerous diseases that affect cartilage. However, there is no detailed review of the relationship between CILP and degenerative disc disease. Growing evidence has revealed the presence of CILP in the extracellular microenvironment of intervertebral discs (IVDs) and has suggested that there is a gradual increase in CILP in degenerative discs. Specifically, CILP plays an important role in regulating the metabolism of the extracellular matrix (ECM), an important component of the extracellular microenvironment. CILP can combine with transforming growth factor‑β or insulin‑like growth factor‑1 to regulate the ECM synthesis of IVDs and influence the balance of ECM metabolism, which leads to changes in the extracellular microenvironment to promote the process of IDD. It may be possible to show the correlation of CILP with IDD and to target CILP to interfere with IDD. For this purpose, in the present study, the current knowledge on CILP was summarized and a detailed description of CILP in discs was provided.
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Affiliation(s)
- Libangxi Liu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University
| | - Jinyue He
- Department of Orthopedics, Xi'nan Hospital, Army Medical University, Chongqing 400037
| | - Chang Liu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University
| | - Minghui Yang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University
| | - Jiawei Fu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University
| | - Jiarong Yi
- Department of Orthopedics, Xinqiao Hospital, Army Medical University
| | - Xuezheng Ai
- Department of Orthopedics, Xinqiao Hospital, Army Medical University
| | - Miao Liu
- Department of Orthopedics, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Yong Zhuang
- Department of Orthopedics, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University
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He J, Feng C, Sun J, Lu K, Chu T, Zhou Y, Pan Y. Cartilage intermediate layer protein is regulated by mechanical stress and affects extracellular matrix synthesis. Mol Med Rep 2018; 17:6130-6137. [PMID: 29436660 DOI: 10.3892/mmr.2018.8588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 07/17/2017] [Indexed: 11/06/2022] Open
Abstract
Lumbar disc disease (LDD) is common in aged populations, and it is primarily caused by intervertebral disc degeneration (IDD). Cartilage intermediate layer protein (CILP), which is specifically expressed in intervertebral discs (IVDs), is suspected to be associated with IDD. However, it remains unclear whether CILP contributes to IDD in humans. Furthermore, the regulation of CILP in human IVDs is poorly understood, especially by mechanical stimuli, which are regarded as primary factors promoting IDD. To address these issues, the present study collected nucleus pulposus (NP) cells from patients undergoing lumbar spinal surgery for degenerative disc disease (DDD). Subsequently, CILP expression was measured in human NP cells in response to mechanical stimuli, including cyclic compressive stress and cyclic tensile strain (CTS), by reverse transcription‑quantitative polymerase chain reaction and western blotting. Aggrecan and collagen II, which are the main components of the extracellular matrix (ECM) and traditional degenerative markers for IDD, were detected following the treatment with CILP small interfering (si)RNA or recombinant human CILP (rhCILP) at various concentrations to determine whether CILP contributes to IDD by negatively regulating expression of the ECM. The results revealed that CILP expression in loaded NP cells was significantly increased compared with that in non‑loaded cells under compressive loading, and that it was markedly decreased in cells under tensile loading, in contrast with the expression of aggrecan and collagen II in response to the same stimuli. Furthermore, CILP siRNA effectively inhibited CILP expression and significantly increased the expression of aggrecan and collagen II. In addition, treatment of NP cells with a high concentration of rhCILP resulted in significantly decreased expression of aggrecan and collagen II. In conclusion, these results demonstrated for the first time, to the best of our knowledge, that in human NP cells, CILP is regulated by mechanical stress and that its expression affects ECM synthesis. Therefore, CILP represents a promising therapeutic target for preventing loss of the matrix during IDD as a novel treatment strategy.
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Affiliation(s)
- Jinyue He
- Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Chencheng Feng
- Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Jing Sun
- Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Kang Lu
- Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Tongwei Chu
- Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Yue Zhou
- Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Yong Pan
- Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
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Efficacy of Platelet-Rich Plasma in Retarding Intervertebral Disc Degeneration: A Meta-Analysis of Animal Studies. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7919201. [PMID: 28752097 PMCID: PMC5511641 DOI: 10.1155/2017/7919201] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/24/2017] [Accepted: 04/11/2017] [Indexed: 01/04/2023]
Abstract
Objectives Several animal studies have demonstrated the positive effects of platelet-rich plasma (PRP) on disc degeneration retardation. The present meta-analysis was to verify the efficacy of PRP in retarding disc degeneration in animal. Methods Relevant studies were identified and evaluated according to our inclusion and exclusion criteria. The standardized mean difference (SMD) and related 95% confidence interval (95% CI) were estimated to assess PRP efficiency. Results In total, eleven studies were included in this meta-analysis. Significant differences were found in the PRP treatment group, which showed increased disc height (SMD = 2.66, 95% CI: 1.86, 3.47, p = 0.000), increased MRI T2 signal intensity (SMD = −3.29, 95% CI: −4.44, −2.13, p = 0.000), and decreased histological degeneration grade (SMD = −4.28, 95% CI: −5.26, −3.30, p = 0.000). However, no significant increase in collagen II expression was found (SMD = 25389.74, 95% CI: −27585.72, 78365.21, p = 0.348). Apart from the subgroup analysis of the disc height based on animal species (pig) and disc degeneration model (chymopapain induction), other subgroup analysis based on animal species (rabbit and rat), study design, disc degeneration model, and follow-up period demonstrated that PRP treatment can significantly restore disc height and increase MRI T2 signal intensity. Conclusions PRP treatment is potentially effective in restoring disc height of rodent rabbit and rat, reducing histological degeneration grade, and increasing MRI T2 image signal. PRP injection may be promising therapy for retarding disc degeneration.
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Campbell RJ, Mobbs RJ, Phan K. Evidence update-association between CILP and degeneration of the intervertebral disc: a meta-analysis. JOURNAL OF SPINE SURGERY 2016; 2:242-243. [PMID: 27757442 DOI: 10.21037/jss.2016.07.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Ryan J Campbell
- The NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Ralph J Mobbs
- The NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Kevin Phan
- The NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
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