Intervertebral disc (IVD) degeneration is responsible for severe clinical symptoms including chronic back pain. Galectins are a family of carbohydrate-binding proteins, some of which can induce functional disease markers in IVD cells and other musculoskeletal diseases. Galectins −4 and −8 were shown to trigger disease-promoting activity in chondrocytes but their effects on IVD cells have not been investigated yet. This study elucidates the role of galectin-4 and −8 in IVD degeneration.

Immunohistochemical evidence for the presence of galectin-4 and −8 in the IVD was comparatively provided in specimens of 36 patients with spondylochondrosis, spondylolisthesis, or spinal deformity. Confocal microscopy revealed co-localization of galectin-4 and −8 in chondrocyte clusters of degenerated cartilage. The immunohistochemical presence of galectin-4 correlated with histopathological and clinical degeneration scores of patients, whereas galectin-8 did not show significant correlations. The specimens were separated into annulus fibrosus (AF), nucleus pulposus (NP) and endplate, which was confirmed histologically. Separate cell cultures of AF and NP (n=20) were established and characterized using cell type-specific markers. Potential binding sites for galectins including sialylated N-glycans and LacdiNAc structures were determined in AF and NP cells using LC/ESI-MS-MS. To assess galectin functions, cell cultures were treated with recombinant galectin-4 or −8, in comparison to IL-1β, and analyzed using RT-qPCR and In-cell Western blot. In vitro, both galectins triggered the induction of functional disease markers (CXCL8 and MMP3) on mRNA level and activated the nuclear factor-kB pathway. NP cells were significantly more responsive to galectin-8 and Il-1β than AF cells. Phosphorylation of p-65 was time-dependently induced by both galectins in both cell types to a comparable extent.

Taken together, this study provides evidence for a functional role of glycobiological processes in IVD degeneration and highlights galectin-4 and −8 as regulators of pro-inflammatory and degrative processes in AF and NP cells.

Background: Postoperative thromboses are among the most feared complications in orthopedic surgery, possibly causing life-threatening conditions in otherwise highly successful procedures such as total joint replacement. Body weight is an important risk factor for thromboses and is being used in algorithms to determine dosages in prophylaxis. However, weight patterns among orthopedic populations have changed considerably since the introduction of these algorithms, essentially shifting towards obesity. This study asks whether present-day obese patients are essential under-dosed and would benefit from higher than usual dosages of bemiparin sodium in the prophylaxis of postoperative thrombosis.

Patients and Methods: To ensure sufficient power a sample of 750 patients, allocated into two cohorts receiving either 3,500 IU or 5,00o IU bemiparin sodium were followed postoperatively for 6 weeks and blindly assessed for clinically symptomatic thrombotic events. Differences in rates of thrombotic events were modeled using mulitvariate Poisson regression including potential confounders severity of immobilisation, gender, exact weight, and age as covariates. A p-value of 5% was considered significant.

Results: Information on 723 patients for a total of 66.8 person-years was analysed per intention-to-treat. The adjusted incidence rate ratio was 0.35 (95%CI: 0.03 to 2.91). Thus there was not evidence for a difference in rates between groups. There was, however, a borderline significant association between rates and body weight, suggesting a potential benefit of higher dosages in even heavier patients. There were no complications due to higher dosages of bemiparin sodium.

Conclusion: We did not see a significant reduction of incidence rates of thromboses with higher dosages of bemiparin in this population. However, there was some evidence that higher dosages might prove beneficial as populations further gain weight.

Autologous chondrocyte transplantation is technically feasible and biologically relevant to repairing disc damage and retarding disc degeneration in animal models. Prospective clinical trials with open discectomy, cultivation of disc cells and transplantation by a minimally invasive procedure are ongoing (co.don chondro-transplant DISC).

We used the decompressor (Stryker) for percutaneous lumbar discectomy to harvest disc cells for cultivation. A cannula was placed in the degenerated disc. The 1,5mm decompressor was introduced through the cannula. 0,5–1,5 millilitres of disc material was aspirated. In the laboratory the material was cultured using the patients serum. The cells were expandable. The capacity of the cells to produce matrix molecules was proven in vitro.

The percutaneous discectomy of contained discs with signes of early degeneration, the expansion and the transplantation of autologous chondrocytes to the disc might be a possibility of repairing disc damage and retarding disc degeneration.

Aim: Life quality is decreased due to pain and the consequences of kyphosis after osteoporotic vertebral fractures. Injections of bone cement (PMMA) are known to stabilise fractured vertebral bodies avoiding major surgeries. The balloon kyphoplasty was introduced for reduction of the local kyphosis. We wanted to observe the range of time in which a correction of the deformity might be possible. Methods: A needle is introduced via a transpedicular or extrapedicular approach into the vertebral body. Then a balloon is inserted and inßated to elevate the endplates and to decrease the local kyphosis. After removal of the balloon PMMA is þlled into the cavity for stabilisation. We performed this procedure in 64 vertebral bodies in 40 patients. Results: The method was mainly used in deformities of vertebral bodies after stable fracture of the endplates due to osteoporosis but also in non-unions within the vertebral bodies. In these cases no signs of ongoing bone remodelling were found within the horizontal fracture gaps in the magnetic resonance imaging despite of the long lasting history of pain. In functional x-rays the instability within the vertebral body was observed. Only the dorsal wall of the vertebral body and the spinal canal had been proven to be intact. A distinct decrease in pain and disability was found in the patients during the time of follow up. The vertebral bodies showed a partial restoration of height and reduction of the local kyphosis even after a period of 3months. The non-unions were stabilised. However the fracture rate of adjacent segments was twice compared to other segments. Conclusion: We conclude that the balloon kyphoplasty is a save procedure in the hand of spine surgeons and sufþcient to reduce pain and improve the mechanical properties of the spine.

Aim: Stabilisation of vertebral bodies by injection of bone cement after osteoporotic fracture is well known for reduction of pain. During the last years the balloon kyphoplasty was introduced for reduction of kyphosis and increase of vertebral height. We investigated the used of this method in vertebral bodies even months after osteoporotic fractures with delayed ossification or unstable non-unions within the vertebral bodies. Methods: These fractures had a median age of 17 weeks. In the magnetic resonance imaging no signs of ongoing bone remodelling were found within the horizontal fracture gaps. In functional x-rays the instability within the vertebral body was proven. During surgery the needle was introduced via a transpedicular or extrapedicular approach and passed straight through the gap of the non-union. In very flat bones this procedure can be more tricky. The balloon was inserted and inflated to decrease the local kyphosis. After removal of the balloon bone cement (PMMA) was filled into the hole to fixate the fragments and stabilize the vertebral body. Results: The Patients had a distinct decrease in pain by preventing the movements within the vertebral body. Life quality measured with the Oswestry disability questionnaire showed a distinct and long lasting increase. Conclusion: In selected cases the balloon kyphoplasty is sufficient to reduce and stabilize vertebral bodies despite of a long period after the fracture.