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Güdü BO, Aydın AL, Mercan NE, Dilbaz S, Çırak M, Öktenoğlu T, Özer AF. Anatomical Parameters of Percutaneous, Minimally Invasive, Direct Intralaminar Pars Screw Fixation of Spondylolysis. World Neurosurg 2024; 188:e567-e572. [PMID: 38825312 DOI: 10.1016/j.wneu.2024.05.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 05/26/2024] [Accepted: 05/26/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE To investigate the anatomical parameters of the ideal screw trajectory for percutaneous intralaminar screw fixation of a pars defect in lumbar spondylolysis using computed tomography scans. METHODS Using advanced radiological software, the ideal intralaminar screw trajectory was determined. The anatomical parameters of this trajectory were analyzed using a total of 80 single-level lumbar tomography scans in patients with spondylolysis at the lumbar 4 vertebrae and lumbar 5 vertebrae levels. The ideal intralaminar screw trajectory started from the inferolateral edge of the lamina and was between the intralaminar region, pars defect, and defective pars neck and pedicle. Along this trajectory, the skin-lamina distance, intralaminar screw length, isthmic lamina length and width, defective pars neck width, lateral entry distance of the screw to the center of the spinous process, and sagittal and coronal screw application angles were analyzed. RESULTS When comparing the lumbar 4 vertebrae and lumbar 5 vertebrae parameters, the mean skin-to-lamina distances were 11-9 cm (P = 0.000), intralaminar screw lengths 3.5-3.6 cm (P = 0.067), isthmic lamina lengths 2-2 cm (P = 0.698), mid-lamina widths 1-1 cm (P = 0.941), defective pars neck widths 1-1 cm (P = 0.674), screw lateral entry distances according to the spinous process 1-1.5 cm (P = 0.000), sagittal screw angles 45°-45° (P = 0.870), and coronal screw angles 10°-20° (P = 0.000), respectively. There were no differences based on age and gender (P < 0.05). CONCLUSIONS Percutaneous intralaminar rigid screw fixation of a pars defect in spondylolysis provides minimally invasive, low-profile instrumentation. In spondylolysis, a screw length of 3-4 cm and a screw diameter of 4-5 mm may be sufficient for pars fixation with intralaminar screws.
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Affiliation(s)
- Burhan Oral Güdü
- Department of Neurosurgery, Medipol University Sefakoy Hospital, Istanbul, Turkey.
| | - Ahmet Levent Aydın
- Department of Neurosurgery, Medicana Healthy Group Hospital, Istanbul, Turkey
| | - Necip Engin Mercan
- Department of Neurosurgery, Avrasya Healthy Group Hospital, Istanbul, Turkey
| | - Suna Dilbaz
- Department of Neurosurgery, Kanuni Sultan Suuleyman Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Musa Çırak
- Department of Neurosurgery, University of Health Sciences, Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Tunç Öktenoğlu
- Department of Neurosurgery, Koc University School of Medicine, American Hospital, Neurosurgery Department, Istanbul, Turkey
| | - Ali Fahir Özer
- Department of Neurosurgery, Koc University School of Medicine, American Hospital, Neurosurgery Department, Istanbul, Turkey
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Chepurin D, Chamoli U, Diwan AD. Bony Stress and Its Association With Intervertebral Disc Degeneration in the Lumbar Spine: A Systematic Review of Clinical and Basic Science Studies. Global Spine J 2022; 12:964-979. [PMID: 34018442 PMCID: PMC9344512 DOI: 10.1177/21925682211008837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Translational review encompassing basic science and clinical evidence. OBJECTIVES Multiple components of the lumbar spine interact during its normal and pathological function. Bony stress in the lumbar spine is recognized as a factor in the development of pars interarticularis defect and stress fractures, but its relationship with intervertebral disc (IVD) degeneration is not well understood. Therefore, we conducted a systematic review to examine the relationship between bony stress and IVD degeneration. METHODS Online databases Scopus, PubMed and MEDLINE via OVID were searched for relevant studies published between January 1980-February 2020, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two authors independently analyzed the data, noting characteristics and biases in various studies. RESULTS Thirty-two articles were included in the review: 8 clinical studies, 9 finite element modeling studies, 3 in-vivo biomechanical testing studies, and 12 in-vitro biomechanical testing studies. Of the 32 articles, 19 supported, 4 rejected and 9 made no conclusion on the hypothesis that there is a positive associative relationship between IVD degeneration and bony stress. However, sufficient evidence was not available to confirm or reject a causal relationship. CONCLUSIONS Most studies suggest that the prevalence of IVD degeneration increases in the presence of bony stress; whether a causal relationship exists is unclear. The literature recommends early diagnosis and clinical suspicion of IVD degeneration and bony stress. Longitudinal studies are required to explore causal relationships between IVD degeneration and bony stress.
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Affiliation(s)
- Daniel Chepurin
- Department of Orthopaedic Surgery,
Spine Service, St. George & Sutherland Clinical School, University of New South
Wales Australia, Kogarah, Sydney, New South Wales, Australia,Department of Medicine, Faculty of Medicine Nursing & Health
Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Uphar Chamoli
- Department of Orthopaedic Surgery,
Spine Service, St. George & Sutherland Clinical School, University of New South
Wales Australia, Kogarah, Sydney, New South Wales, Australia,School of Biomedical Engineering,
Faculty of Engineering & Information Technology, University of Technology
Sydney, Ultimo, Sydney, New South Wales, Australia,Uphar Chamoli, Spine Service, L5, Suite 16,
St. George Private Hospital, Kogarah, NSW 2217, Australia.
| | - Ashish D. Diwan
- Department of Orthopaedic Surgery,
Spine Service, St. George & Sutherland Clinical School, University of New South
Wales Australia, Kogarah, Sydney, New South Wales, Australia
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Zhang W, Wang H, Yuan Z, Chu G, Sun H, Yu Z, Liang H, Liu T, Zhou F, Li B. Moderate mechanical stimulation rescues degenerative annulus fibrosus by suppressing caveolin-1 mediated pro-inflammatory signaling pathway. Int J Biol Sci 2021; 17:1395-1412. [PMID: 33867854 PMCID: PMC8040478 DOI: 10.7150/ijbs.57774] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/22/2021] [Indexed: 12/29/2022] Open
Abstract
Mechanical loading can induce or antagonize the extracellular matrix (ECM) synthesis, proliferation, migration, and inflammatory responses of annulus fibrosus cells (AFCs), depending on the loading mode and level. Caveolin-1 (Cav1), the core protein of caveolae, plays an important role in cellular mechanotransduction and inflammatory responses. In the present study, we presented that AFCs demonstrated different behaviors when subjected to cyclic tensile strain (CTS) for 24 h at a magnitude of 0%, 2%, 5% and 12%, respectively. It was found that 5% CTS had positive effects on cell proliferation, migration and anabolism, while 12% CTS had the opposite effects. Besides, cells exposed to interleukin-1β stimulus exhibited an increase expression in inflammatory genes, and the expression of these genes decreased after exposure to moderate mechanical loading with 5% CTS. In addition, 5% CTS decreased the level of Cav1 and integrin β1 and exhibited anti-inflammatory effects. Moreover, the expression of integrin β1 and p-p65 increased in AFCs transfected with Cav1 plasmids. In vivo results revealed that moderate mechanical stimulation could recover the water content and morphology of the discs. In conclusion, moderate mechanical stimulation restrained Cav1-mediated signaling pathway and exhibited anti-inflammatory effects on AFCs. Together with in vivo results, this study expounds the underlying molecular mechanisms on the effect of moderate mechanical stimulation on intervertebral discs (IVDs) and may provide a new therapeutic strategy for the treatment of IVD degeneration.
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Affiliation(s)
- Weidong Zhang
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Huan Wang
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Zhangqin Yuan
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Genglei Chu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Heng Sun
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Zilin Yu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Huan Liang
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Tao Liu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Feng Zhou
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Bin Li
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China.,China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, Zhejiang, China
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Fu F, Bao R, Yao S, Zhou C, Luo H, Zhang Z, Zhang H, Li Y, Yan S, Yu H, Du W, Yang Y, Jin H, Tong P, Sun ZT, Yue M, Chen D, Wu C, Ruan H. Aberrant spinal mechanical loading stress triggers intervertebral disc degeneration by inducing pyroptosis and nerve ingrowth. Sci Rep 2021; 11:772. [PMID: 33437038 PMCID: PMC7804398 DOI: 10.1038/s41598-020-80756-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023] Open
Abstract
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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Affiliation(s)
- Fangda Fu
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.,The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China
| | - Ronghua Bao
- Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology, Hangzhou, 311400, Zhejiang, China
| | - Sai Yao
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.,The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China
| | - Chengcong Zhou
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.,The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China
| | - Huan Luo
- Department of Pharmacy, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Zhiguo Zhang
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.,The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China
| | - Huihao Zhang
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.,The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China
| | - Yan Li
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China
| | - Shuxin Yan
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China
| | - Huan Yu
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.,Research Center for Human Tissues and Organs Degeneration, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.,The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China
| | - Weibin Du
- Research Institute of Orthopedics, the Affiliated JiangNan Hospital of Zhejiang Chinese Medical University, Hangzhou, 311200, Zhejiang, China
| | - Yanping Yang
- Longhua Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Hongting Jin
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Peijian Tong
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Zhi-Tao Sun
- Department of Orthopedics, Shenzhen Traditional Chinese Hospital, Guangzhou University of Chinese Medicine, Shenzhen, 518055, China
| | - Ming Yue
- Department of Physiology, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Di Chen
- Research Center for Human Tissues and Organs Degeneration, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Chengliang Wu
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.
| | - Hongfeng Ruan
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China. .,Longhua Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
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