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Lindtner RA, Wurm A, Pirchner E, Putzer D, Arora R, Coraça-Huber DC, Schirmer M, Badzoka J, Kappacher C, Huck CW, Pallua JD. Enhancing Bone Infection Diagnosis with Raman Handheld Spectroscopy: Pathogen Discrimination and Diagnostic Potential. Int J Mol Sci 2023; 25:541. [PMID: 38203710 PMCID: PMC10778662 DOI: 10.3390/ijms25010541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Osteomyelitis is a bone disease caused by bacteria that can damage bone. Raman handheld spectroscopy has emerged as a promising diagnostic tool for detecting bone infection and can be used intraoperatively during surgical procedures. This study involved 120 bone samples from 40 patients, with 80 samples infected with either Staphylococcus aureus or Staphylococcus epidermidis. Raman handheld spectroscopy demonstrated successful differentiation between healthy and infected bone samples and between the two types of bacterial pathogens. Raman handheld spectroscopy appears to be a promising diagnostic tool in bone infection and holds the potential to overcome many of the shortcomings of traditional diagnostic procedures. Further research, however, is required to confirm its diagnostic capabilities and consider other factors, such as the limit of pathogen detection and optimal calibration standards.
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Affiliation(s)
- Richard Andreas Lindtner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
| | - Alexander Wurm
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
- Praxis Dr. Med. Univ. Alexander Wurm FA für Orthopädie und Traumatologie, Koflerweg 7, 6275 Stumm, Austria
| | - Elena Pirchner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
| | - David Putzer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
| | - Rohit Arora
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
| | - Débora Cristina Coraça-Huber
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
| | - Michael Schirmer
- Department of Internal Medicine, Clinic II, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria;
| | - Jovan Badzoka
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria; (J.B.); (C.K.); (C.W.H.)
| | - Christoph Kappacher
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria; (J.B.); (C.K.); (C.W.H.)
| | - Christian Wolfgang Huck
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria; (J.B.); (C.K.); (C.W.H.)
| | - Johannes Dominikus Pallua
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
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Woess C, Huck CW, Badzoka J, Kappacher C, Arora R, Lindtner RA, Zelger P, Schirmer M, Rabl W, Pallua J. Raman spectroscopy for postmortem interval estimation of human skeletal remains: A scoping review. J Biophotonics 2023; 16:e202300189. [PMID: 37494000 DOI: 10.1002/jbio.202300189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 07/27/2023]
Abstract
Estimating postmortem intervals (PMI) is crucial in forensic investigations, providing insights into criminal cases and determining the time of death. PMI estimation relies on expert experience and a combination of thanatological data and environmental factors but is prone to errors. The lack of reliable methods for assessing PMI in bones and soft tissues necessitates a better understanding of bone decomposition. Several research groups have shown promise in PMI estimation in skeletal remains but lack valid data for forensic cases. Current methods are costly, time-consuming, and unreliable for PMIs over 5 years. Raman spectroscopy (RS) can potentially estimate PMI by studying chemical modifications in bones and teeth correlated with burial time. This review summarizes RS applications, highlighting its potential as an innovative, nondestructive, and fast technique for PMI estimation in forensic medicine.
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Affiliation(s)
- C Woess
- Institute of Forensic Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian W Huck
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innsbruck, Austria
| | - J Badzoka
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innsbruck, Austria
| | - C Kappacher
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innsbruck, Austria
| | - R Arora
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - R A Lindtner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Zelger
- University Clinic for Hearing, Voice and Speech Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - M Schirmer
- Department of Internal Medicine, Clinic II, Medical University of Innsbruck, Innsbruck, Austria
| | - W Rabl
- Institute of Forensic Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Pallua
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
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Spicher A, Lindtner RA, Zegg MJ, Schmid R, Hoermann R, Schmoelz W. Pedicle screw augmentation in posterior constructs of the thoracolumbar spine: How many pedicle screws should be augmented? Clin Biomech (Bristol, Avon) 2023; 106:106010. [PMID: 37245280 DOI: 10.1016/j.clinbiomech.2023.106010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUNDS To evaluate the effects of different pedicle screw augmentation strategies on screw loosening and adjacent segment collapse at the proximal end of long-segment instrumentation. METHODS Eighteen osteoporotic (9 male, 9 female donors; mean age: 74.7 ± 10.9 [SD] years) thoracolumbar multi-segmental motion segments (Th11 - L1) were assigned as follows: control, one-level augmented screws (marginally), and two-level augmented screws (fully augmented) groups (3 × 6). Pedicle screw placement was performed in Th12 and L1. Cyclic loading in flexion started with 100-500 N (4 Hz) and was increased by 5 N every 500 cycles. Standardized lateral fluoroscopy images with 7.5 Nm loading were obtained periodically during loading. The global alignment angle was measured to evaluate the overall alignment and proximal junctional kyphosis. The intra-instrumental angle was used to evaluate screw fixation. FINDINGS Considering screw fixation as a failure criterion, the failure loads of the control (683 N), and marginally (858 N) and fully augmented (1050 N) constructs were significantly different (ANOVA p = 0.032).Taking the overall specimen alignment as failure criteria, failure loads of the three groups (control 933 ± 271.4 N, marginally 858 N ± 196 N, and full 933 ± 246.3 N were in the same range and did not show any significance (p = 0.825). INTERPRETATION Global failure loads were comparable among the three groups and unchanged with augmentation because the adjacent segment and not the instrumentation failed first. Augmentation of all screws showed significant improved in screw anchorage.
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Affiliation(s)
- Anna Spicher
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Austria
| | | | - Michael Josef Zegg
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Austria
| | - Rene Schmid
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Austria
| | - Romed Hoermann
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Schmoelz
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Austria.
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Ferlic PW, Hauser L, Götzen M, Lindtner RA, Fischler S, Krismer M. Correction of adolescent idiopathic scoliosis using a convex pedicle screw technique with low implant density. Bone Joint J 2021; 103-B:536-541. [PMID: 33641409 DOI: 10.1302/0301-620x.103b3.bjj-2020-0760.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this retrospective study was to compare the correction achieved using a convex pedicle screw technique and a low implant density achieved using periapical concave-sided screws and a high implant density. We hypothesized that there would be no difference in outcome between the two techniques. METHODS We retrospectively analyzed a series of 51 patients with a thoracic adolescent idiopathic scoliosis. There were 26 patients in the convex pedicle screw group who had screws implanted periapically (Group 2) and a control group of 25 patients with bilateral pedicle screws (Group 1). The patients' charts were reviewed and pre- and postoperative radiographs evaluated. Postoperative patient-reported outcome measures (PROMs) were recorded. RESULTS The number of implants (14.5 vs 17.1) and the implant density (1.5 vs 1.9) were significantly lower in Group 2 (p < 0.001). Operating time was 27 minutes shorter in Group 2 than in Group 1, with a mean of 217 minutes (SD 50.5; 120 to 346). The duration of surgery per instrumented vertebra was reduced by 19% in Group 2 (p = 0.011). No statistical difference was found in the postoperative Cobb angle, vertebral rotation, the relative correction achieved, or postoperative PROMs. CONCLUSION Despite a lower implant density and achieving correction through a convex rod, surgical correction of the Cobb angle and vertebral body rotation was similar in both groups. Periapical pedicle screws and primary correction on the concave side do not seem to be mandatory in order to achieve good surgical results in idiopathic thoracic scoliosis. The operating time was shorter in the group with lower implant density. In conclusion, the technique provided good results and has the potential to reduce complications and costs. Cite this article: Bone Joint J 2021;103-B(3):536-541.
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Affiliation(s)
- Peter W Ferlic
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria.,Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Laurenz Hauser
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Götzen
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria.,Department of Orthopaedics and Traumatology, Hospital Feldkirch, Feldkirch, Austria
| | - Richard Andreas Lindtner
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria.,Department for Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Fischler
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Krismer
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Moll CWI, Schmiedinger T, Moll MA, Seppi T, Pfaller K, Hess MW, Gutleben K, Lindtner RA, Blauth M, Krumschnabel G, Ebner HL. Extracellular matrix mimicking scaffold promotes osteogenic stem cell differentiation: A new approach in osteoporosis research. Biomed Mater Eng 2017; 28:87-103. [PMID: 28372263 DOI: 10.3233/bme-171659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Osteoporosis is a common metabolic disease, with mesenchymal stem cells discussed to play an important role in its pathomechanism. For in vitro osteoporosis studies, selection of adequate culture conditions is mandatory so as to preserve cell properties as far as possible. A suitable cell culture surface would ideally provide reproducible experimental conditions by resembling those in-vivo. OBJECTIVE Generating an improved growth surface for osteogenic differentiation of human bone marrow derived mesenchymal stem cells (hBMSCs). METHODS We modified electrospun gelatine meshes with hydroxyapatite nanopowder. The potential beneficial impact of the ensuing culture conditions were evaluated by cultivating and comparing the growth of cells from osteoporotic and non-osteoporotic donors on either hydroxyapatite-gelatine (HA) meshes, pure gelatine meshes, or 2D standard tissue culture surfaces. RESULTS After 21 days of differentiation, cells grown on pure or HA-gelatine meshes showed significantly higher mineralization levels compared to cells cultured in standard conditions. The amount of mineralization varied considerably in hBMSC cultures of individual patients but showed no significant difference between stem cells obtained from osteoporotic or non-osteoporotic donors. CONCLUSIONS Overall, these results indicate that the use of HA-gelatine meshes as growth surfaces may serve as a valuable tool for cultivation and differentiation of mesenchymal stem cells along the osteogenic lineage, facilitating future research on osteoporosis and related issues.
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Affiliation(s)
- C W I Moll
- Department of Trauma Surgery, Medical University, Anichstrasse 35, Innsbruck, Austria
| | - T Schmiedinger
- Department of Therapeutic Radiology and Oncology, Medical University, Anichstrasse 35, Innsbruck, Austria
| | - M A Moll
- Department of Vascular Surgery, Medical University, Anichstrasse 35, Innsbruck, Austria
| | - T Seppi
- Department of Therapeutic Radiology and Oncology, Medical University, Anichstrasse 35, Innsbruck, Austria
| | - K Pfaller
- Division of Histology and Embryology, Medical University, Müllerstrasse 59, Innsbruck, Austria
| | - M W Hess
- Division of Histology and Embryology, Medical University, Müllerstrasse 59, Innsbruck, Austria
| | - K Gutleben
- Division of Histology and Embryology, Medical University, Müllerstrasse 59, Innsbruck, Austria
| | - R A Lindtner
- Department of Trauma Surgery, Medical University, Anichstrasse 35, Innsbruck, Austria
| | - M Blauth
- Department of Trauma Surgery, Medical University, Anichstrasse 35, Innsbruck, Austria
| | - G Krumschnabel
- OROBOROS® INSTRUMENTS Corporation (GmbH), Schöpfstrasse 18, Innsbruck, Austria
| | - H L Ebner
- Department of Trauma Surgery, Medical University, Anichstrasse 35, Innsbruck, Austria.,MED-EL Medical Electronics (GmbH), Fürstenweg 77a, Innsbruck, Austria
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Sitte I, Klosterhuber M, Lindtner RA, Freund MC, Neururer SB, Pfaller K, Kathrein A. Morphological changes in the human cervical intervertebral disc post trauma: response to fracture-type and degeneration grade over time. Eur Spine J 2015; 25:80-95. [PMID: 26188769 DOI: 10.1007/s00586-015-4089-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 06/20/2015] [Accepted: 06/26/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE In the first 24 h post-intervertebral disc (IVD) trauma, up to 75 % cell death has been reported. In addition, burst fractures cause post-traumatic disc degeneration by elevated pro-apoptotic and pro-inflammatory gene transcription. Moreover, some patients have pre-trauma degenerative disc disease. The aim of the study was to assess histological changes and cell-death over a time period of up to 1 year caused by mechanical and structural factors. METHODS 116 anterior portions of IVDs of the cervical spine were studied histologically by light microscopy and ultrastructurally by transmission electron microscopy (TEM). The group was investigated with regard to three main parameters: fracture mechanism (compressive vs. tensile/shear loads), degeneration grade (low vs. high) and endplate fracture (with vs. without). Disc architecture (e.g. ruptures) was studied histologically. Cell morphology was examined ultrastructurally to quantify cell-death, healthy and balloon cells. According to ultrastructural observations, two time-groups (up to 6 days vs. later) were established. Statistical analyses were carried out within and between time-groups. RESULTS Histological changes were obvious in the annulus fibrosus where ruptures with haematoma were replaced by granulation tissue. Significant differences in cell-death were seen in the first few days due to different loads. In contrast to the more degenerated segments, low degenerated ones revealed significantly less cell death with time post-trauma. Interestingly, no difference was found between groups after the sixth day. Cell-death (mean 44 % for all investigated groups) remained high after day 6 post-trauma. CONCLUSION IVDs retrieved from low grade degenerated segments revealed a significant recovery, with less cell-death and a partially restored disc matrix, although cell-death remained high. Long-term clinical studies of stabilized segments arising from different fracture mechanisms are required.
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Affiliation(s)
- Ingrid Sitte
- Department of Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Miranda Klosterhuber
- Department of Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Richard Andreas Lindtner
- Department of Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | | | - Sabrina Barbara Neururer
- Department for Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Kristian Pfaller
- Division of Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anton Kathrein
- Department of Traumatology and Sports Medicine, Sankt Vinzenz Krankenhaus Zams, Zams, Austria
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Sitte I, Kathrein A, Klosterhuber M, Lindtner RA, Neururer SB, Rauch S, Kuhn V, Schmoelz W. Morphological similarities after compression trauma of bovine and human intervertebral discs: Do disc cells have a chance of surviving? J Orthop Res 2014; 32:1198-207. [PMID: 24888549 DOI: 10.1002/jor.22655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 01/21/2014] [Indexed: 02/04/2023]
Abstract
To study the behavior of bovine disc cells and changes in disc matrix following in vitro compression tests; to compare the findings to investigations on human intervertebral discs (IVD) after burst fracture of the cervical spine. Healthy IVDs (n = 21) from three bovine tails were studied at 6 and 12 h post-mortem, with 16 IVDs subjected to impact loading and five as unloaded controls. IVDs (n = 8) from patients with burst fractures were compared to the bovine compression group. Specimens were studied macroscopically, histologically, and ultrastructurally for healthy cells, balloon cells, and disc cell death (DCD). Annulus ruptures were seen in both post-trauma groups, with radial ruptures being present histologically in all loaded bovine discs. Balloon cells were found in some human IVDs and were induced in vitro in bovine loaded discs within a distinct range of absorbed energy. There was a positive correlation between DCD and absorbed energy in all compartments of bovine discs. Both species showed similar patterns of DCD in the different compartments. This study was able to show similarities between both species in cell morphologies and matrix damage. The survival of the disc after substantial compression trauma thus seems to remain highly questionable.
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Affiliation(s)
- Ingrid Sitte
- Department of Traumatology, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
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Lindtner RA, Tiaden AN, Genelin K, Ebner HL, Manzl C, Klawitter M, Sitte I, von Rechenberg B, Blauth M, Richards PJ. Osteoanabolic effect of alendronate and zoledronate on bone marrow stromal cells (BMSCs) isolated from aged female osteoporotic patients and its implications for their mode of action in the treatment of age-related bone loss. Osteoporos Int 2014; 25:1151-61. [PMID: 23974861 DOI: 10.1007/s00198-013-2494-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 08/07/2013] [Indexed: 12/22/2022]
Abstract
SUMMARY In the present study, we evaluated the potential for aminobisphosphonates to enhance the development of bone-forming osteoblasts from progenitor cells isolated from aged female osteoporotic patients. The aminobisphosphonates tested significantly enhanced osteoblast formation and thus lend further insights into their possible mode of action in the treatment of osteoporosis. INTRODUCTION The primary aim of this study was to evaluate the influence of aminobisphosphonates on the osteogenesis of human bone marrow stromal cells (hBMSCs) and mineralization of differentiating bone-forming cells isolated from osteoporotic patients. METHODS The influence of aminobisphosphonate treatment on hBMSC osteogenesis was assessed by the quantitative measurement of alkaline phosphatase (ALP) activity, in addition to quantitative reverse transcription polymerase chain reaction and Western blot analysis of known osteogenic markers. Mineralized matrix formation by hBMSC-derived osteoblasts was visualized and quantified using Alizarin red staining. RESULTS hBMSC cultures treated with osteogenic medium supplemented with zoledronate demonstrated a significant increase in Alizarin red staining after 3 weeks as compared to cells cultured in osteogenic medium alone. Similarly, cultures of differentiating hBMSCs isolated from patients receiving alendronate treatment also demonstrated an increased propensity for mineralization, even in the absence of further in vitro stimulation by zoledronate. The stimulatory effects of aminobisphosphonate treatment on hBMSC-derived osteoblast-mediated mineralization were independent of any alterations in ALP activity, although significant decreases in the expression levels of osteopontin (SPP1) were evident in hBMSCs following exposure to aminobisphosphonates. Further analysis including Western blotting and loss-of-function studies revealed osteopontin as having a negative influence on the mineralization of differentiating osteoporotic bone-forming cells. CONCLUSIONS The results presented here demonstrate for the first time that aminobisphosphonate treatment of osteoporotic hBMSCs enhances their capacity for osteoblast formation and subsequent mineral deposition, thus supporting the concept of aminobisphosphonates as having an osteoanabolic effect in osteoporosis.
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Affiliation(s)
- R A Lindtner
- Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, Innsbruck, Austria
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Schmid R, Lindtner RA, Lill M, Blauth M, Krappinger D, Kammerlander C. Combined posteroanterior fusion versus transforaminal lumbar interbody fusion (TLIF) in thoracolumbar burst fractures. Injury 2012; 43:475-9. [PMID: 22227107 DOI: 10.1016/j.injury.2011.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 10/25/2011] [Accepted: 12/10/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND The optimal treatment strategy for burst fractures of the thoracolumbar junction is discussed controversially in the literature. Whilst 360° fusion has shown to result in better radiological outcome, recent studies have failed to show its superiority concerning clinical outcome. The morbidity associated with the additional anterior approach may account for these findings. The aim of this prospective observational study was therefore to compare two different techniques for 360° fusion in thoracolumbar burst fractures using either thoracoscopy or a transforaminal approach (transforaminal lumbar interbody fusion (TLIF)) to support the anterior column. METHODS Posterior reduction and short-segmental fixation using angular stable pedicle screw systems were performed in all patients as a first step. Monocortical strut grafts were used for the anterior support in the TLIF group, whilst tricortical grafts or titanium vertebral body replacing implants of adjustable height were used in the combined posteroanterior group. At final follow-up, the radiological outcome was assessed by performing X-rays in a standing position. The clinical outcome was measured using five validated outcome scores. The morbidity associated with the approaches and the donor site was assessed as well. RESULTS There were 21 patients in the TLIF group and 14 patients in the posteroanterior group included. The postoperative loss of correction was higher in the TLIF group (4.9°±8.3° versus 3.4°±6.4°, p>0.05). There were no significant differences regarding the outcome scores between the two groups. There were no differences in terms of return to employment, leisure activities and back function either. More patients suffered from donor-site morbidity in the TLIF group, whilst the morbidity associated with the surgical approach was higher in the posteroanterior group. CONCLUSION The smaller donor-site morbidity in the posteroanterior group is counterbalanced by an additional morbidity associated with the anterior approach resulting in similar clinical outcome. Mastering both techniques will allow the spine surgeon to be more flexible in specific situations, for example, in patients with neurological deficits or severe concomitant thoracic trauma.
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Affiliation(s)
- Rene Schmid
- Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstraße 35, Innsbruck, Austria.
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