Introduction. The influence of lumbar and lumbosacral fusion on adjacent moving segments has been the subject of a number of studies, which have shown the origin and progress of degenerative changes and instability brought about by alterations of kinematics and elasticity of the fused segment. Back pains which emerge later in the postoperative period may be the consequence of degeneration and instability in the adjacent segment to the said fusion. The fusion shifts the centre of rotation to the level adjacent to the fusion, which increases the pressure and pull on both the disk and joints. It can be supposed that the pull and attendant pains are in direct proportion to the rigidity of the spondylodesis that is more pronounced after anterior intersomatic fusion and less so after posterior. The development of hyperlordosis or kyphosis in the lumbar region is also a risk factor for adjacent segment failure. Material and methods. The authors performed a retrospective analysis on a group of 91 patients with spondylolisthesis who had undergone PLIF technique with transpedicular fixation surgery and PLF. A total of 10 (11%) of 91 patients developed symptomatic next segment desease at a previously asymptomatic level. Date were obtained in patients with next – segment failure based on X-rays studies, neurological assessment and sequential follow-up examinations. The aforementioned patients had a mean age of 42.8 years and the mean follow up period was 8.7 years after surgery. 7 cases were isthmic, 2 degenerative and 1 dysplastic spondylolisthesis. Fusion in every case entailed the use of autologinous bone grafts, and with the PLIF technique cages, in 3 cases, dowels, in 6 cases, and autofibula in 1 case were used. The mean follow-up period between original surgery and next-segment failure was 3.8 years. Results. In ten cases from the group there was evidence of instability or degeneration, instability in 3 cases (all above fusion) and degeneration in 7 cases (4 above and 3 below fusion) respectively. All patients with instability in cranial adjacent segment underwent successfully additional surgery by using 360° fusion with instrumentation (ALIF). Discussion. In X-rays conducted prior to surgery, signs of hypermobility were present in the cranial adjacent segment in one case. This hypermobility affected the rigidity of the fusion in the caudal segment, which accelerated the progress of instability and caused further surgery to be necessary. The cause of instability could also be overloading of the spine, damage to the stability of ligament and bone structures sustained during the operation, or a combination of the above

Study design: Prospective clinical and radiologic study. Objective: The purpose of this study was to investigate the risk factors for adjacent segment degeneration after posterior lumbar interbody fusion (PLIF). Summary of Background data: Although several authors have reported the adjacent segment degeneration after lumbar or lumosacral fusion, there is no consensus regarding the risk factors for adjacent segment degeneration. Methods: Sixty-five patients were studied after PLIF after a minimum follow up time of 6 years. Plain and flexion/ extension radiographs and MRI scans were obtained and compared to preoperative and postoperative. Progression of segment degeneration was defined as a condition in which the distinction between nucleus and annulus is lost, and the disc space is collapsed according to the grading system (Grade 1–5) described by Pfirrmann et al evaluated with T2 weighted MRI scans. Patients were divided into three groups: Group 1 with no radiological progression of disc degeneration, Group 2 with radiological progression of disc degeneration, and Group 3 with radiological progression of disc degeneration and clinical deterioration. Risk factors for progression of adjacent disc degeneration as lumbar lordosis, lordosis at the fused segment, facet sagittalization, and pre-existing disc degeneration were evaluated. The images were evaluated by two independent radiologists. Results: Fifteen patients (23%) showed no radiological progression of disc degeneration on MRI scans and were classified into Group 1. Forty patients (62%) developed some cranial or caudal deterioration of the adjacent segment without clinical deterioration and were classified into Group 2. Ten patients (15%) required reoperation for neurological and clinical deterioration caused by cranial or caudal degeneration of the adjacent disc (Group 3). No statistically significant differences were found in lumbar lordosis, lordosis at the fused segment, facet sagittalization between each group. Patients in Group 3 showed on preoperative MRI already moderate to severe alteration of the adjacent disc (mean Grade 4) compared to Group 1 (mean Grade 2) and 2 (mean Grade 2,5) (p< 0.01). Conclusion: After PLIF disc degeneration appear homogeneously at several levels cranial and caudal to fusion over the years in most of the patients (79%). Only pre-existing degeneration of the adjacent cranial and caudal segment is a potential risk factor for clinical deterioration caused by disc collapse

Introduction Adjacent segment disease with radiculopathy and neurologic deficit adjacent to a non-mobile spinal segment is the ideal application for cervical arthroplasty. Not only are the stresses and loads increased but unfortunately the previously fused segment is further compromised by being fixed in a kyphotic position. Methods This is a prospective study of 40 PCM prostheses inserted in thirty patients with 50 adjacent segments previously fused or rendered immobile—ten cases were performed as bi-level implantations. The inclusion and exclusion criteria were otherwise identical to the normal FDA prospective IDE criteria with all patients presenting with radiculopathy and a corresponding neurologic deficit confirmed by an MRI compressive lesion. Results The mean preoperative cervical lordosis was 2.65 degrees (−32 to 25), mean postoperative lordosis 12.3 degrees (−17 to 30), and the mean improvement was 9.4 degrees of cervical lordosis (range (−15 to 23). EBL = 0 to 100 cc with no patients requiring blood transfusions, Length of surgery = mean 104 minutes (60 to 150) and the length of hospital stay = mean 1.17 days (0 to 3 days). The clinical follow-up was greater than 2 years. All patients were neurologically intact at follow up with a mean improvement of NDI = 50 % and mean improvement in VAS = 58.3 %.The range of flexion and extension motion at the level of the prosthesis was a mean of 8.9 degrees (range 4 to 20 degrees). Discussion Naturally, the adjacent segment application of a cervical disc replacement is a challenging clinical environment for cervical arthroplasty – by definition every case had prior surgery. Not only is the cervical spine position often compromised by being in excessive kyphosis, but seventeen of the 50 previously fused levels had prior cervical instrumentation. 5 patients had previous cervical cages, 2 had cage-plates, 5 patients had previous anterior cervical plates, one had a prior arthroplasty device with HO, and 4 patients had PMMA which required revision. Despite the complicated nature of the presenting pathology, the Porous Coated Motion Cervical prosthesis successfully restored some element of cervical lordosis, and restored stability to the cervical segments. An added potential bonus is the preserved 9.4 degrees of flexion – extension mobility. The PCM appeared to work well in these revision cases. This is the world’s largest study to date investigating prospectively the value of cervical arthroplasty in adjacent segment disease

With the increase in the elderly population, there is a dramatic increase in the number of spinal fusions. Spinal fusion is usually performed in cases of primary instability. However it is also performed to prevent iatrogenic instability created during surgical treatment of spinal stenosis in most cases. In literature, up to 75% of adjacent segment disease (ASD) can be seen according to the follow-up time. 1. Although ASD manifests itself with pathologies such as instability, foraminal stenosis, disc herniation or central stenosis. 1,2. There are several reports in the literature regarding lumbar percutaneous transforaminal endoscopic interventions for lumbar foraminal stenosis or disc herniations. However, to the best our knowledge, there is no report about the treatment of central stenosis in ASD. In this study, we aimed to investigate the short-term results of unilateral biportal endoscopic decompressive laminotomy (UBEDL) technique in ASD cases with symptomatic central or lateral recess stenosis. The number of patients participating in the prospective study was 8. The mean follow-up was 6.9 (ranged 6 to 11) months. The mean age of the patients was 68 (5m, 3F). The development of ASD time after fusion was 30.6 months(ranged 19 to 42). Mean fused segments were 3 (ranged 2 to 8). Preoperative instability was present in 2 of the patients which was proven by dynamic lumbar x-rays. Preoperative mean VAS-back score was 7.8, VAS Leg score was 5.6. The preoperative mean JOA (Japanese Orthopaedic Association) score was 11.25. At 6th month follow-up, the mean VAS back score of the patients was 1, and the VAS leg score was 0.5. This improvement was statistically significant (p = 0.11 and 0.016, respectively). The mean JOA score at the 6th month was 22.6 and it was also statistically significant comparing preoperative JOA score(p = 0.011). The preoperative mean dural sac area measured in MR was 0.50 cm2, and it was measured as 2.1 cm. 2. at po 6 months.(p = 0.012). There was no progress in any patient's instability during follow-up. In orthopedic surgery, when implant related problems develop in any region of body (pseudoarthrosis, infection, adjacent fracture, etc.), it is generally treated by using more implants in its final operation. This approach is also widely used in spinal surgery. 3. However, it carries more risk in terms of devoloping ASD, infection or another complications. In the literature, endoscopic procedures have almost always been used in the treatment of ventral pathologies which constitute only 10%. In ASD, disease devolops as characterized by wide facet joint arthrosis and hypertrophied ligamentum flavum in the cranial segment and it is mostly presented both lateral recess and santal stenosis symptoms (39%). In this study, we found that UBEDL provides successful results in the treatment of patients without no more muscle and ligament damage in ASD cases with spinal stenosis. One of the most important advantages of UBE is its ability to access both ventral and dorsal pathologies by minimally invasive endoscopic aproach. I think endoscopic decompression also plays an important role in the absence of additional instability at postoperatively in patients. UBE which has already been described in the literature given successful results in most of the spinal degenerative diseases besides it can also be used in the treatment of ASD. Studies with longer follow-up and higher patient numbers will provide more accurate results

INTRODUCTION. The elimination of motion and disc stress produced by spinal fusion may have potential consequences beyond the index level overloading the spinal motion segments and leading to the appearance of degenerative changes. So the “topping-off” technique is a new concept instructing dynamic fixation such as interspinous process device (IPD) for the purpose of avoiding adjacent segment disease (ASD) proximal to the fusion construct. MATERIALS AND METHODS. The study simulated spinal fusion in L4-L5, fusion combined DIAM in L3-L4. The ROM and maximum von Miss stresses were analyzed in flexion, extension, lateral bending, and torsion in response to hybrid method, compared to intact modeland fusion model. RESULTS. The investigation revealed that decreased ROM, intradiscal stress in implanted level but a considerable increase in stresses at more upper level (L2-L3) during flexion and extension in hybrid model, comparing with the fusion model. CONCLUSIONS. The raise of intradiscal pressure at the adjacent segment to a rigid fusion segment can be reduced when the rigid construct is augmented with an interspinous process device. However, the burden of stress over total spinal segments was still the same, the stress and ROM were just shift to supraadjacent levels

Introduction: ACDF involves cancellation of the diseased spinal motion segment, the neighboring spinal segments take the burden of excessive compensatory spinal movements and strain resulting in early degeneration. Adjacent segment degeneration with new, symptomatic radiculopathy occurs after ACDF in 2–3% of patients per year on cumulative basis. An estimated 15% of patients ultimately require a secondary procedure at an adjacent level. An alternative to fusion is total disc arthroplasty (TDA). The key advantage of this promising technology is restoration and maintenance of normal physiological motion rather than elimination of motion. We describe 4 patients with a serious complication observed following implantation of the Bryan disc prosthesis in our cohort of 48 patients. Material and Results:. Patient #1: 43 M, with neck pain & left brachalgia, with left C6 dermatome signs, with MRI findings of C5/6 disc prolapse with left C6 root impingement, undergoing C5/6 Bryan TDA in April 2004, with treatment recommendation of C3/4 and C6/7 Bryan TDA in January 2006. Patient #2: 47 M, with worsening gait over 2 years with right brachalgia, with findings of progressive cervical myelopathy with right C5 radiculopathy, with MRI findings of severe C5/6 disc degeneration with spinal cord compression, undergoing C5/6 Bryan TDA in January 2003, with MRI FU findings after 16/12 with new left C6/7 disc prolapse and left C6 radiculopathy, with treatment recommendation of C6/7 Bryan TDA, on waiting list. Patient #3: 45 F, 6 years of neck pain with right brachialgia, with right C5 dermatome signs, with MRI findings of C5/6 central disc herniation with cord compression, undergoing C5/6 Bryan TDA in December 2000, with FU MRI showing after 5 years and 7/12 (67/12) new C6/7 canal narrowing with right C6 radiculopathy, and treatment recommendation of C6/7 Bryan TDA. Patient #4: 38 M, worsening gait over 5 years and exam findings of progressive cervical myelopathy, with MRI findings of severe C5/6 disc degeneration with spinal cord compression, undergoing C5/6 Bryan TDA in August 2003, with FU MRI showing after 3 years new C4/5 disc prolapse with C5 radiculopathy, followed by treatment recommendation of C4/5 Bryan TDA. Discussion & Conclusions: Bryan TDR did not prevent the development of accelerated ASD. Evidence from in vivo X ray studies suggested that the range of motion across the operated levels did not match the physiological ROM. Despite the MRI images preoperatively, it is difficult to exclude the natural progression of degeneration as a reason for ASD

Introduction: We report a series of 10 cases from a cohort of 421 Dynesys procedures in which evidence of Accelerated Adjacent Disc Disease (AASDD). Spinal fusion for degenerative disc disease is known to have inconsistent outcomes. One concern is the possibility of AASDD as a result of the altered kinematics. The Dynamic Neutralisation System (Dynesys) appears to offer an advantage in that it restricts, rather than abolishes movement at the treated segment, and should thereby reduce the problem of AASDD, In the event of failure, it can in addition be removed, returning the spine to the former status quo. Various biomechanical studies confirmed flexibility of Dynesys. Method: Ten patients developed new and symptomatic disc disease within segments adjacent to Dynesys. The average age of patients was 49 year with range between 36–70 years. Average post Dynesys to secondary surgery for ASD was 24.7 months. Previous discography and MRI in all cases had shown no evidence of disc disease within these adjacent segements prior to Dynesys. All patients were evaluated preoperatively using Oswestry Disability Index, SF 36 and Visual Analogue Scores together with plain x ray imaging, MRI scanning and discography. Of this cohort Dynesys was indicated to treat single disc level in 7 and two levels in 3. Results: Incidence of AASDD associated with Dynesys was 2.1%. Further surgical intervention included:. Extension of Dynesys10. Dynesys combined with MIF2. Dynesys combined with PLIF2. There was no caudal ASD in our cohort. Discussion & Conclusions: Dyensys did not prevent the development of accelerated ASD. Evidence from Aylott cadaver studies suggests that Dynesys instrumentation alters the Kinematics of the adjacent segment and increases the excursion. It is unclear whether the small number of AASDD reported here is other than the natural progression of degenerative change. 95.7 cases did not progress

Purpose: Adjacent Segment Degeneration (ASD) can occur after spinal fusion. Disc degeneration, spinal stenosis, deformity, spondylolisthesis and fracture are observed. The incidence is unknown and its occurrance difficult to predict. Further major surgery is required to correct the clinical problem that exists although not all cases of ASD are symptomatic. The primary purpose of this study was to identify the incidence of ASD after multilevel(> /=3) thoracolumbar fusions for degenerative disorders. Risk factors for ASD were to be determined. Methods: Over 400 spinal fusions of 3 levels or greater, minimum 5 year follow-up were assessed for ASD. Radiographic data were available from a prospective data bank. The radiological incidence of ASD was distinguished from those that were clinically significant as determined by Oswestry, back and leg pain scores. |Personal and telephone interviews were conducted along with most recent plain xrays. Data was analyzed (ANOVA) from a single surgeon’s practice. Radiographic assessment was performed by the author with radiologist’s opinions available. Results: The incidence of ASD after extended spinal fusions overall was 20%. Clinically significant ASD requiring further surgery was 12%. The incidence varied according to location of the fusion, number of levels, age and preexisting disc degeneration and or deformity at the end vertebrae. Overall it was difficult to predict risk factors but trends were noted. Long fusions(greater than or equal to 3 levels) has a significantly high risk of ASD by 5 yrs after the index operation. Conclusions: The incidence of ASD by 5 years post spine fusion of 3 or more levels is 20% in over 400 cases.12% of these index cases needed further surgery. ASD is a clinically significant entity that deserves study to aid in its prevention

Purpose: Adjacent Segment Degeneration (ASD) can occur after spinal fusion, disc degeneration, spinal stenosis, deformity, spondylolisthesis and fracture. The incidence is unknown and its occurence difficult to predict. Further major surgery is required to correct the clinical problem that exists although not all cases of ASD are symptomatic. The primary purpose of this study was to identify the incidence of ASD after multilevel (> /= 3 level) thoracolumbar fusions for degenerative disorders at a minimum 5 year followup. Risk factors for ASD were to be determined. Method: 405 spinal fusions of three levels or greater, performed between 1988 and 2001, minimum five year followup were assessed for ASD. Radiographic data was available from a prospective data bank. The radiological incidence of ASD was distinguished from those that were clinically significant as determined by Oswestry Disability Index, back and leg pain visual analog scales. Results: The incidence of ASD after extended spinal fusions overall was 28%, based on radiological evaluation. There was an 18% incidence of clinically significant ASD. 10% of the entire group required surgery to address ASD. The incidence varied according to the location of the fusion, number of levels, age and pre-existing disc degeneration and/or deformity at the end vertebrae. Overall it was difficult to predict risk factors but trends were noted. Long fusion (> /= 3 levels) have a significantly high risk of ASD by five years after the index operation. Adjacent level degenerative disc disease and spinal stenosis were the most common type of ASD. Conclusion: The incidence of ASD by five years post spine fusion of three or more levels is 28% in over 405 cases. 10% of these cases needed further surgery. ASD is a clinically significant entity that deserves further study to aid in its prevention

Spondylolysis can be associated with severe back or leg pain requiring surgical management.

Fusion is the most often performed procedure since disk degeneration is frequently present. In a limited number of cases, when there is no disk disease or only limited dehydration, isthmic reconstruction may be considered, saving mobility and avoiding adjacent level stress.

We review 30 patients submitted to L4 or L5 posterior arch reconstruction and 60 patients submitted to a one level (L4L5 or L5S1) posterior or interbody fusion.

Through Prolo scores, SF36 and Oswestry questionnaires, the every day, professional and sports functional and satisfaction rates are evaluated.

Present data fail to show better functional results in the isthmic reconstruction group. However, even longer follow up will be necessary in these groups of young adults with a great life expectancy to show potentially less degenerative deterioration in adjacent levels. Meanwhile, isthmic reconstruction proved to be an effective technique, comparable to fusion in patients with no associated disk disease, with no need for further surgery and minimal complications.

Objective: To document the incidence of adjacent superior segment facet joint violation following transpedicular instrumentation in the lumbar spine as it has been postulated that this can lead to long term deterioration There has been no study so far determining this incidence. Design: Patients undergoing lumbar fusion were prospectively evaluated with a CT scan and plain radiographs six months following surgery. These were blindly and independantly evaluated by a consultant radiologist and a research fellow. Subjects: 106 patients (212 top level facet screws) between 1996 and 1999 were evaluated. All patients had their screws and instrumentation inserted through a Wiltse muscle splitting approach and a lateral entry point in the pedicle so as to reduce the risk of facetal impingement. . 1. Outcome Measures: Kappa co-efficient and chi-squared analysis. Results: The Kappa co-efficient for the CT scan and plain radiographs were 0.88 and 0.39 respectively. On the CT scan both observers noted facet joint impingement in just over 20% of the screws and just over 30% of the patients. The impingement was independent of the level and diagnosis (p> 0.05) and it occurred with uniform incidence in each of the year. Conclusion: This study raises the theoretical possibility of long term deterioration in the clinical results following the use of transpedicular instrumentaion

Background. It has become increasingly important to conduct studies assessing clinical outcomes, reoperation rates, and revision rates to better define the indications and efficacy of lumbar spinal procedures and its association with symptomatic adjacent segment degeneration (sASD). Adjacent segment degeneration (ASD) is defined as the radiographic change in the intervertebral discs adjacent to the surgically treated spinal level. SASD represents adjacent segment degeneration which causes pain or numbness due to post-operative spinal instability or nerve compression at the same level. The most common reason for early reoperation and late operation is sASD, therefore is in our best interest to understand the causes of ASD and make steps to limit the occurrence. Method. A comprehensive literature search was performed selecting Randomized controlled trials (RCTs) and retrospective or prospective studies published up to December 2023. Meta-analysis was performed on 38 studies that met the inclusion criteria and included data of clinical outcomes of patients who had degenerative disc disease, disc herniation, radiculopathy, and spondylolisthesis and underwent lumbar fusion or motion-preservation device surgery; and reported on the prevalence of ASD, sASD, reoperation rate, visual analogue score (VAS), and Oswestry disability index (ODI) improvement. Results. When compared to fusion surgery, a significant reduction of ASD, sASD and reoperation was observed in the cohort of patients that underwent motion-preserving surgery. Conclusion. Dynamic fusion constructs are treatment options that may help to prevent sASD. Conflicts of interest. This research was funded by Paradigm Spine. Sources of funding. Paradigm Spine

Introduction. The biomechanical behavior of lumbar spine instrumentation is critical in understanding its efficacy and durability in clinical practice. In this study, we aim to compare the biomechanics of the lumbar spine instrumented with single-level posterior rod and screw systems employing two distinct screw designs: paddle screw versus conventional screw system. Method. A fully cadaveric-validated 3D ligamentous model of the lumbopelvic spine served as the foundation for our comparative biomechanical analysis. 1. To simulate instrumentation, the intact spine was modified at the L4L5 level, employing either paddle screws or standard pedicle screws (SPS). The implants were composed of Ti-6AL-4V. Fixation at the S1 ensured consistency across loading scenarios. Loading conditions included a 400-N compressive load combined with a 10 N.m pure bending moment at the level of L1, replicating physiological motions of flexion-extension, lateral bending and axial rotation. We extracted data across various scenarios, focusing on the segmental range of motion at both implanted and adjacent levels. Result. In the flexion of L4L5, the applied force ranged from -29.2 to 29.3 N in the paddle screw, while it ranged from -25 to 25 N in the PS system. Similarly, the extension of L4L5 ranged from -3.1 to 2.6 N in the paddle and ranged from -4.5 to 3.9 N in the SPS system. In terms of stress distributions on the screw, stress concentrations decreased in several cases in the paddle design compared to the SPS systems. Top of Form. Conclusion. The paddle screw enhanced the range of motion overall in both the upper adjacent segment (L3L4) and the lower adjacent segment (L5S1) compared to the conventional SPS system. The stability of the aimed segment was increased by 33% on average with the paddle screw compared to conventional PS. Increasing the stability of the host segment decreases the possibility of non-union and the rate of fusion failure . 2.

Introduction. The degeneration of the adjacent segment in lumbar spine with spondylodesis is well known, though the exact incidence and the mechanism is not clear. Several implants with semi rigid or dynamic behavior are available to reduce the biomechanical loads and to prevent an adjacent segment disease (ASD). Randomized controlled trials are not published. We investigated the biomechanical influence of dynamic and semi rigid implants on the adjacent segment in cadaver lumbar spine with monosegmental fusion (MF). Materials and Methods. 14 fresh cadaver lumbar spines were prepared; capsules and ligaments were kept intact. Pure rotanional moments of ±7.5 Nm were applied with a Zwick 1456 universal testing machine without preload in lateral bending and flexion/extension. The intradiscal pressure (IDP) and the range of motion (ROM) were measured in the segments L2/3 and L3/4 in following situations: in the native spine, monosegmental fusion L4/5 (MF), MF with dynamic rod to L3/4 (Dynabolt), MF with interspinous implant L3/4 (Coflex), and semi rigid fusion with PEEK rod (CD Horizon Legacy) L3-L5. Results. Under flexion load all implants reduced the IDP of segment L2/L3, whereas the IDP in the segment L3/4 was increased using interspinous implants in comparison to the other groups. The IDP was reduced in extension in both segments for all semi rigid or dynamic implants. Compared under extension to the native spine the MF had no influence on the IDP of the adjacent disc. The rod instrumentation (Dynabolt, PEEK rod) lead to a decreased IDP in lateral bending tests. The ROM in L3 was reduced in all groups compared to the native spine. The dynamic and semi rigid stabilization in the segment L3/4 limited the ROM more than the MF. Discussion. The MF reduced the ROM in all directions, whereas the IDP of the adjacent segment remained unaffected. The support of the adjacent segment by semi rigid and dynamic implants decreased the IDP of both segments in extension mainly. This fact is an agreement with other studies. Compared to our data, no significant effect on the adjacent levels was observed. Interestingly, in our study, the IDP of the adjacent segment is unaffected by MF. The biomechanical influence in the view of an ASD could be comprehended, but is not completely clear. The fact of persistent IDP in the adjacent segment suggests that MF has a lower effect on the adjacent segment degeneration as presumed. Biomechanical studies with human cadaver lumbar spines are limited and depend on age and degenerative situation. The effect on supporting implants on adjacent segment disease in lumbar spine surgery has to be investigated in clinical long term studies

Anterior cervical discectomy and fusion for radiculopathy and myelopathy has the complication of the development of adjacent segment degeneration. Furthermore, reoperations may be required to treat complications of fusion, such as non-union, graft collapse, or expulsion. Cervical disc arthroplasty lays claim to preserving cervical motion and reducing the risks of adjacent segment disease in the treatment of cervical radiculopathy. We performed a prospective study in order to evaluate the radiological and clinical outcomes of cervical disc arthroplasty for single or two level disc disease with associated radiculopathy. Our study included a total of 26 patients. Each patient had cervical radiculopathy from nerve root compression due to degenerative disc disease at one or two levels. Diagnosis was made preoperatively on clinical examination and by means of MRI scanning. Each patient also had preoperative flexion and extension cervical spine x-rays in order to assess pre-operative range of neck movement. The outcomes of surgery were assessed prospectively. Range of motion at final follow-up was measured by flexion and extension view x-rays of the cervical spine. Clinical outcome was assessed by means of VAS scores for pain, SF12 for mental and physical health and the neck disability index (NDI). All complications were recorded. 14 of the patients had a follow-up for two years and the remaining 12 patients had a follow-up for one year. A Discovery disc arthoplasty by Scient'X was the implant used in all patients. A standard anterior cervical approach was used to achieve decompression and for the implantation of the prosthesis. On follow-up all patients had either maintenance or an improvement in the range of movement. There was no evidence of progression of degeneration in the segments adjacent to the arthroplasty prosthesis. Improvements in SF12, VAS, and NDI scores were seen from preoperative levels in 25 of the 26 patients. Complications included one patient with a horse voice post-operatively and one patient with minimal improvement of radicular symptoms. Post-operative MRI scanning demonstrated adequate decompression with this procedure and showed no evidence of progression of adjacent segment disease. There were no cases of implant subsidence or dislocations. We have found cervical disc arthroplasty to produce good clinical outcomes when used for single or two level cervical radiculopathy whilst maintaining neck motion with an acceptable complication rate. A longer follow-up is needed to further assess the risk of development of adjacent segment disease but we did not discover the development of adjacent segment disease in our study with a follow-up of upto 2 years

The biomechanical effects on facet joints after posterior fusion remain unclear and seem to be responsible for accelerated degeneration. The following biomechanical study was performed to investigate the effects on the pressure and mobility of neighbouring unfused segments after double level T12-L2 posterior stabilization. The experimental study was performed on eighteen fresh, human, cadaveric thoracolumbal spine specimens. The specimens were cleaned and dissected from muscles and fat with care to preserve bone-ligament units intact. In a specially constructed testing machine the data of the segmental pressure and mobility of adjacent segments above and below the fusion were measured before and after double level T12-L2 posterior stabilization with an internal fixator (Universal Spine System) in flexion, extension, lateral bending, and rotation. For measuring the mobility a motion tracker (3Space Fastrak) and for direct evaluation of the pressure a quartz miniature force transducer was used. Also the bone mineral density of the specimens were measured and showed normal values. In flexion and extension Range of Motion (ROM) of the segment above the double level T12-L2 posterior fusion was significantly increased (p< 0,05). In the adjacent segment below the fusion there was no significant increased mobility after fusion for each moment was applied. The pressure did not show any significant difference, but after posterior fusion in flexion and extension the pressure below the posterior fusion (L2/L3) was decreased and above the fusion (T11/T12) increased. There is evidence that the adjacent segment above a double-level T12-L2 posterior fusion becomes more mobile and leads possibly to an accelerated degeneration in the facet joints due to increased stress at this point. Also the posterior fusion seems to change the load distribution in the facets of adjacent segments. These results could be responsible for symptoms like low back pain after spinal surgery

The World Health Organisation (WHO) has included low back pain in its list of twelve priority diseases. Notably, Degenerative disc disease (DDD) presents a large, unmet medical need which results in a disabling loss of mechanical function. Today, no efficient therapy is available. Chronic cases often receive surgery, which may lead to biomechanical problems and accelerated degeneration of adjacent segments. Our consortium partners have developed and studied mesenchymal stem cell-based, regenerative therapies trials. In previous phase 2 trial, patients exhibited rapid and progressive improvement of functional and pain indexes after 1 year with no significant side effects. To develop the world's first rigorously proven, effective treatment of DDD, EUROSPINE aims to assess, via a multicentre, randomized, controlled, phase 2b clinical trial including 112 patients with DDD, the efficacy of an allogenic intervertebral mesenchymal stem cell (MSC)-based therapy. This innovative therapy aims to rapidly and sustainably (at least 24 months) reduce pain and disability. In addition, the consortium aims to provide new knowledge on immune response & safety associated with allogeneic BM-MSC intradiscal injection. This simple procedure would be cost-effective, minimally invasive, and standardised. At the end of the RESPINE trial, we aim to propose a broadly available and clinically applicable treatment for DDD, marketed by European SMEs

Osteoarthritis (OA) is a painful and disabling chronic condition that constitutes a major challenge to health care worldwide. There is currently no cure for OA and the analgesic pharmaceuticals available do not offer adequate and sustained pain relief, often being associated with significant undesirable side effects. Another disease associated with degenerating joints is Intervertebral disc degeneration (IVDD) which is a leading cause of chronic back pain and loss of function. It is characterized by the loss of extracellular matrix, specifically proteoglycan and collagen, tissue dehydration, fissure development and loss of disc height, inflammation, endplate sclerosis, cell death and hyperinnervation of nociceptive nerve fibers. The adult human IVD seems incapable of intrinsic repair and there are currently no proven treatments to prevent, stop or even retard disc degeneration. Fusion is currently the most common surgical treatment of symptomatic disc disease. However, radiographic follow-up studies have revealed that many patients develop adjacent segment disc degeneration due to altered spine biomechanics. The development of safe and efficacious disease modifying OA drugs (DMOADs) that treat pain and inflammation in joints will improve our ability to control the disease. I addition, a biologic treatment of IVDD is desirable. This presentation will provide an overview of recent advances and future prospects of a multimodal biologic treatment of OA, and IVDD. We will focus on Link N, a naturally occurring peptide representing the N terminal region of link protein and the first 1–8 residues of Link N (short Link N, sLN) responsible for the biologic therapy in question

Multiple myeloma (MM) is a chronic, malignant B-cell disorder, with a less than 50% 5-year survival rate [1]. This disease is responsible for vertebral compression fractures (VCFs) in 34 to 64% of diagnosed patients [1], and at least 80% of MM patients experience pathological fractures [3]. Even though reduced DXA-derived bone mineral density (BMD) has been observed in MM patients with vertebral fractures [4], the current quantitative standard method is insufficient in MM due to the osteo-destructive bone changes. Finite-element (FE) analysis is a computational and non-destructive modeling and testing approach to determine bone strength using 3D bone models from CT images. Thus, this study aimed to assess the differences in FE-predicted critical fracture load in MM patients with and without VCFs in the thoracic and lumbar segments of the spine. Multi-detector CT (MDCT) images of two radiologically assessed MM patients (1 with VCFs and 1 without VCFs) were used to generate three-dimensional (3D) models of the whole spine. For each subject, the thoracic segments, 1 to 12 (T1-T12) and lumbar segments, 1 to 5 (L1-L5) were segmented and meshed. Heterogeneous, non-linear anisotropic material properties were applied by discretizing each vertebral segment into 10 distinct sets of materials. A compressive load was simulated by constraining the surface nodes on the inferior endplate in all directions, and a displacement load was applied on the surface nods on the superior endplate [2]. This analysis was performed using ABAQUS version 6.10 (Hibbitt, Karlsson, and Sorensen, Inc., Pawtucket, RI, USA). The MM subject with VCFs had originally experienced fractures in the T4, T5, T12, L1, and L5 segments whereas the MM subject without VCFs experienced none. The former displayed large and abrupt differences in fracture loads between adjacent vertebrae segments, unlike the latter, which exhibited progressive differences instead (no abrupt changes between adjacent vertebrae segments observed). Results from this preliminary study suggest that segments at high risk of fracture are collectively involved in an unstable network, which place the vertebral segments with high values of fracture loads (peaks) as well as the adjacent segments at risk of VCF. For instance, the high fracture load at T11 places T10, T11 and T12 at risk of fracture. Accordingly, T12 has already fractured, and T10 and T11 remain at risk. The relative changes between adjacent vertebrae segments that indicate instability (extremely high fracture load values) enables ease of identification of segments at high fracture risk. Clinicians would be able to work with pre-emptive treatment strategies in future as they can focus on more targeted therapy options at the high-risk vertebrae segments [3]