Abstract. Objectives. There is still controversy in the literature over whether Cervical Foraminotomy or Anterior Cervical discectomy and fusion (ACDF) is best for treating cervical Radiculopathy. Numerous studies have focused on the respective complication rates of these procedures and outcome measures with a lack of due consideration to preoperative MRI findings. Proximal foraminal stenosis can theoretically be accessed via either approach. We aimed to investigate whether patient reported outcome measures (PROMs) favoured one approach over the other in patients with proximal foraminal stenosis. Methods. A single centre retrospective review of patients undergoing either ACDF or Cervical foraminotomy over the period 2012 to 2022. VAS, Neck disability index (NDI), EQ5DL and Patient Satisfaction on a Five Point Likert scale were obtained. Patients who had both an ACDF and a Foraminotomy were excluded. Axial MRI images were analysed and the location of the worst clinically relevant disc herniation stratified as follows: Central (1), Paracentral (2) and Foraminal (3). Correlations and average PROMs were analysed in SPSS. Results. PROMs scores were available for 33 ACDF patients and 37 Foraminotomy patients. Average surgery time in ACDF group was 167 minutes while Foraminotomy 142 minutes. Average Length of hospital stay was 6.24 days in the Foraminotomy group and 3.54 days in the ACDF group. 18 patients were excluded due to having both surgeries (2 of which developed CSF leaks postoperatively). Of the included patients there were no postoperative complications. 13 patients in the ACDF had Central or Paracentral stenosis in addition to proximal Foraminal stenosis, 3 patients in the Foraminotomy group had some significant Paracentral herniation just before the Proximal foramen. The majority of patients in both groups had pure proximal Foraminal stenosis (N= 17 (ACDF), 20 (Foraminotomy). The results showed no significant difference in PROMs between patients who received an ACDF or a Foraminotomy for Proximal foraminal stenosis (EQ5DL, NDI, and satisfaction, P= 0.268, 0.253 and 0.327). There was no correlation between location of the stenosis and PROM scores in either group. Conclusions. Our data suggest that Proximal foraminal stenosis can be effectively addressed by either an anterior ACDF or a Foraminotomy with no difference in complication rates. Foraminotomy has the benefit of no implant cost but longer hospital stay. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

The multimodal management of canal stenosis is increasing, and inhibitors of central sensitization are playing a crucial role in central sensitization processes. Pregabalin and gabapentin are antiepileptic drugs that reduce presynaptic excitability. The objective of this study was to investigate whether the use of pregabalin and gabapentin is effective in the symptomatic management of canal stenosis. A literature search was conducted in four databases. The inclusion criteria were studies that compared pregabalin or gabapentin with a control group in lumbar canal stenosis. Randomized clinical trials and a comparative retrospective cohort study were included. The main clinical endpoints were VAS/NRS, ODI, and RDQ (Roland Morris Disability Questionnaire) at 2, 4, 8 weeks, and 3 months, adverse events, and walking distance were also collected. Data were combined using Review Manager 5.4 software. Six studies and 392 patients were included. The mean age was 60.25. No significant differences were observed in VAS at 2, 4, and 8 weeks: (MD: 0.23; 95% CI: −0.63-1.09), (MD: −0.04; 95% CI: −0.64 to −0.57), and (MD: −0.6; 95% CI: −1.22 to 0.02). Significant differences were observed in favor of pregabalin with respect to VAS at three months: (MD: −2.97; 95% CI: −3.43 to −2.51). No significant differences were observed in ODI (MD: −3.47; 95% CI: −7.15 to −0.21). Adverse events were significantly higher in the pregabalin/gabapentin group (OR 5.88, 95%CI 1.28-27.05). Walking distance and RDQ could not be compared, although the results were controversial. Gabapentinoids have not been shown to be superior to other drugs used in the treatment of LSS or to placebo. However, they have shown a higher incidence of adverse effects, improved results in VAS at 3 months, and a slight improvement in ambulation at 4 months in combination with NSAIDs compared to NSAIDs in monotherapy

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. Limited physical activity (PA) is one indication for orthopaedic intervention and restoration of PA a treatment goal. However, the objective assessment of PA is not routinely performed and in particular the effect of spinal pathology on PA is hardly known. It is the purpose of this study using wearable accelerometers to measure if, by how much and in what manner spinal stenosis affects PA compared to age-matched healthy controls. Patients & Methods. Nine patients (m/f= 5/4, avg. age: 67.4 ±7.7 years, avg. BMI: 29.2 ±3.5) diagnosed with spinal stenosis but without decompressive surgery or other musculoskeletal complaints were measured. These patients were compared to 28 age-matched healthy controls (m/f= 17/11, avg. age: 67.4 ±7.6 years, avg. BMI: 25.3±2.9). PA was measured using a wearable accelerometer (GCDC X8M-3) worn during waking hours on the lateral side of the right leg for 4 consecutive days. Data was analyzed using previously validated activity classification algorithms in MATLAB to identify the type, duration and event counts of postures or PA like standing, sitting, walking or cycling. In addition, VAS pain and OSWESTRY scores were taken. Groups were compared using the t-test or Mann-Whitney U-test where applicable. Correlations between PA and clinical scores were tested using Pearson”s r. Results. Spinal stenosis patients showed much lower PA than healthy controls regarding all parameters like e.g. daily step count (2946 vs 8039, −63%, p<0.01) or the relative daily time-on-feet (%) (8.6% vs 28.3%, −70%, p<0.01) which is matched with increased sitting durations (80.3% vs 58.8%, p<0.01). Also qualitative parameters such as walking cadence was reduced in stenosis patients (83.7 vs 97.8 steps/min). With stenosis no patient ever walked >1000 steps without interruption. Also the number of walking bouts between 250–1000 steps was 4.5 times lower than in healthy controls (p<0.01). When the relative distribution of walking bout length was calculated, it became visible that stenosis patients showed more short walking bouts of 10–50 steps (p<0.05). There were no strong and significant correlations between the clinical scores and PA parameters. Discussion & Conclusions. Spinal stenosis greatly reduced physical activity to levels below WHO guidelines (e.g. <5000 steps= sedentary lifestyle) where the risk for general health (overall mortality), cardiovascular or endocrinological health is significantly increased. Activity levels are lower than reported for end-stage hip or knee osteoarthritis. Therefore, spinal stenosis patients should not only receive pain medication, but be made aware of their limited PA and its detrimental health effects, participate in activation programs, or be considered for surgical intervention. The absence of long walking bouts and the relatively more frequent short walking bouts seem indicative of intermittent claudication as typical in spinal stenosis

The periclavicular space is a conduit for the brachial plexus and subclavian-axillary vascular system. Changes in its shape/form generated by alteration in the anatomy of its bounding structures, e.g. clavicle malunion, cause distortion of the containing structures, particularly during arm motion, leading to syndromes of thoracic outlet stenosis etc., or alterations of scapular posture with potential reduction in shoulder function. Aim of this study was developing an in vitro methodology for systematic and repeatable measurements of the clinically poorly characterized periclavicular space during arm motion using CT-imaging and computer-aided 3D-methodologies. A radiolucent frame, mountable to the CT-table, was constructed to fix an upper torso in an upright position with the shoulder joint lying in the isocentre. The centrally osteotomized humerus is fixed to a semi-circular bracket mounted centrally at the end of the frame. All arm movements (ante-/retroversion, abduction/elevation, in-/external rotation) can be set and scanned in a defined and reproducible manner. Clavicle fractures healed in malposition can be simulated by osteotomy and fixation using a titanium/carbon external fixator. During image processing the first rib served as fixed reference in space. Clavicle, scapula and humerus were registered, segmented, and triangulated. The different positions were displayed as superimposed surface meshes and measurements performed automatically. Initial results of an intact shoulder girdle demonstrated that different arm positions including ante-/retroversion and abduction/elevation resulted solely in a transverse movement of the clavicle along/parallel to the first rib maintaining the periclavicular space. A radiolucent frame enabling systematic and reproducible CT scanning of upper torsos in various arm movements was developed and utilized to characterize the effect on the 3D volume of the periclavicular space. Initial results demonstrated exclusively transverse movement of the clavicle along/parallel to the first rib maintaining the periclavicular space during arm positions within a physiological range of motion

To determine the clinical efficacy of vitamin-D supplementation on pain intensity and functional disability in patients with chronic lower back pain. This prospective cohort study was conducted from 20th March 2017 to 19th March 2019. The inclusion criteria were patients of CLBP aged between 15 to 55 years. Exclusion criteria included all the patients with Disc prolapse, Spinal stenosis, Any signs of neurological involvement, Metabolic bone disease (Hypo- or Hyperparathyroidism) and Chronic kidney disease/Chronic liver disease. Patients were supplemented with 50,000 IU of oral vitamin-D3 every week for 8 weeks (induction phase) and 50,000 IU of oral vitamin-D3 once monthly for 6 months (maintenance phase). Efficacy parameters included pain intensity and functional disability measured by VAS and modified Oswestry disability questionnaire (MODQ) scores at baseline, 2, 3 and 6 months post-supplementation. Vitamin-D3 levels were measured at baseline,2,3 and 6 months. A total of 600 patients were included in the study. The mean age of patients was 44.2 ± 11.92 years. There were 337 (56.2%) male patients while 263 (43.8%) female patients. Baseline mean vitamin-D levels were 13.32 ± 6.10 ng/mL and increased to 37.18 ± 11.72 post supplementation (P < 0.0001). There was a significant decrease in the pain score after 2nd, 3rd& 6th months (61.7 ± 4.8, 45.2 ± 4.6 & 36.9 ± 7.9, respectively) than 81.2 ± 2.4 before supplementation (P < 0.001). The modified Oswestry disability score also showed significant improvement after 2nd, 3rd & 6th months (35.5, 30.2 & 25.8, respectively) as compared to baseline 46.4 (P < 0.001). About 418 (69.7%) patients attained normal levels after 6 months. Vitamin-D supplementation in chronic lower back pain patients may lead to improvement in pain intensity and functional ability

Summary Statement. Tandem stenosis is a prevalent condition in an Asian population with the narrowest cervical canal diameters and risk factors include advanced age and increased levels of lumbar canal stenosis. Introduction. Tandem spinal stenosis (TSS) is defined as patient with concomitant spinal canal stenosis found in both cervical (C) and lumbar (L) spinal region. Few studies have reported the incidence of TSS is ranged from 5–25%, but these are all noncomparative, small cohort studies. To the best of author knowledge this is the 1st study aims to compare the prevalence of TSS and its risk factors of development in a large multiracial Asian population. Methods. A retrospective review of all mid-sagittal T2MRI whole spine image was carried out at a University hospital in year 2007. Patients with spinal tumour, fracture and congenital stenosis were excluded. Spinal stenosis was defined as canal diameter of ≤10mm, measured from the posterior cervical vertebral/disc wall to anterior surface of the corresponding lamina. Patients were divided into 4 groups, no stenosis(NS), lumbar stenosis only(LS), cervical stenosis only(CS) and TSS. Patients’ demographics, race, co-morbidities and lumbar radiological report data were examined. Potential risk factors for the development of TSS were analyzed using SPSS software. Results. 926 (479 male, 447 female) patients with average age 50 (20–96) yrs were studied. Cervical canal diameters (mm) in TSS patients were the narrowest among the 4groups with C2/3 disc: 11.6, C3/4: 9.7, C4/5: 9.4, C5/6: 8.9, C6/7: 10.0 and C7T1: 11.4mm. The incidence of TSS was 26.2%. The prevalence of TSS in Chinese was 30.7%, Indian 12.5%, Malay 22.5%. The TSS prevalence in patients with 1 level lumbar canal stenosis was 12.5%, 2 levels lumbar stenosis was 6.4% and 3 levels was 4.1%. Multivariate analysis showed patients aged between 40–59 yrs (p=0.000, Exp(B):5.8, 95%CI 2.8–12.0), aged > 60yrs (p=0.000, Exp(B): 10.5, 95%CI 4.8–22.9), Chinese race (p=0.008, Exp(B): 2.5, 95%CI 1.3–4.9), patients with 1 level lumbar stenosis (p=0.000, Exp(B): 63.3, 95%CI 29.2–137.3), 2 levels lumbar stenosis (p=0.000, Exp(B): 67.7, 95%CI 29.4–155.7) and 3 levels lumbar stenosis (p=0.000, Exp(B): 106.6, 95%CI 43.6–260.5) are statistical significant risk factors for TSS development. Conclusion. The incidence of TSS was 26.2%. TSS patients have the narrowest cervical canal measurements among the studied groups. The prevalence of TSS in Chinese is the highest (30.7%). Patients advancing in age or have increased levels of lumbar canal stenosis are at risk of developing TSS

Study Purpose. To examine the presence of radicular pain and its relationship to the degree of lumbar nerve root compression in patients with a degenerative lumbar spine condition about to undergo surgery for either lumbar disc prolapse or lumbar canal stenosis. Background. The pathophysiology underlying radicular pain is not completely understood but it is thought that nerve root compression is a key factor and from a surgical perspective, decompressing the nerve root is considered to be the key therapeutic step. However, despite often severe root compression in patients with lumbar stenosis, radicular pain is not a typical feature. Methods. Thirty-nine pre-surgical patients with either lumbar disc prolapse or lumbar canal stenosis were studied using the Standardised Evaluation of Pain (StEP), a clinical assessment tool known to predict with a high degree of sensitivity and specificity the presence or absence of lumbar radicular pain. A nerve root compression score was given from lumbar MRI for each patient by a neuroradiologist blinded to the patients history. Results. The StEP assessment tool was able to distinguish the presence or absence of radicular pain with high sensitivity and specificity. This correlated well with the pre-operative diagnosis of disc prolapse or canal stenosis. The relationship between radicular pain and nerve root compression was less clear and will be discussed. Conclusion. This study confirms StEP as a useful bedside tool for identifying the presence of radicular pain in patients with a degenerative lumbar spine condition. Nerve root compression per se does not necessarily produce radicular pain. Conflicts of Interest. None. Source of Funding. None. This study has not been published or presented at a previous meeting

Summary Statement. Bilaretal epiphysiodesis of he neurocentral cartilages causes shortening of the sagittal length of the pedicles and a subsequent spinal stenosis at the operated segments, resembling that found in patients with achrondroplasia. Introduction. The introduction of pedicle screws in the immature spine may have implications for the growth of the vertebra. The effect of blocking the growth of neurocentral cartilage (NC) is not yet fully defined. Block hypothetically leads to a bilateral symmetrical alteration of the vertebral growth. Using an experimental animal model, our goal is to analyze if a bilateral epiphysiodesis of the NC using pedicle screws is able to induce narrowing of the spinal canal in the thoracolumbar spine. Experimental animals and Methods. A total of 24 domestic pigs were operated on by bilateral blocking of the NC using pedicle screws. The animals were divided into 4 groups depending on the level of blockage: A, low thoracic levels; B, thoracolumbar transitional hinge; C, upper lumbar spine; and D, blocking of the caudal lumbar level below L5 segment. Different morphological, morphometric and standard radiological parameters were analyzed at the thoracic and lumbar vertebrae of the animals. The deviation from the physiological parameters was established by comparing all parameters obtained in the NC-blocked animals with those acquired in 14 pigs without NC blocking. These animals were considered as the control group. Results. None of the animals that underwent NC epiphysiodesis showed asymmetrical spinal growth inducing deformities in the coronal plane. There was neither rotation nor wedging of the vertebral bodies. Whatever the level involved, NC epiphysiodesis caused shortening of the sagittal length of the pedicles and a subsequent decreasing of the antero-posterior diameter of the spinal canal. These features resulted in a frank spinal stenosis at the operated levels. However, the transverse diameter of the spinal canal was conserved in the coronal plane. In the sagittal plane, blocking of the neurocentral cartilage conditioned a lumbar hyperlordosis with compensatory kyphosis of the upper level to the operated vertebra. Conclusions. Symmetrical growth arresting of neurocentral cartilages induces a narrow spinal canal by decreasing the sagittal diameter similar to that observed in patients with achondroplasia. The most affected structure was the development of the vertebral pedicles

Introduction. Augmentation of spinal fusion using bone grafts is largely mediated by the osteoinductive potential of mesenchymal stem cells (MSC) that reside in cancellous bone. Iliac crest (IC) is a common autograft, but its use presents an increased risk for donor-site pain, morbidity and infection. Degenerative facet joints (FJ) harvested during facetectomy might servce as alternative local grafts. In this study, we conducted an intra-individual comparison of the osteogenic potential of MSC from both sources. Methods. IC and degenerative FJ were harvested from 8 consecutive patients undergoing transforaminal lumbar interbody fusion surgery for spinal stenosis. MSC were isolated by collagenase digestion, selected by plastic adherence and minimally expanded for downstream assays. Clonogenic and osteogenic potential was evaluated by colony formation assays in control and osteogenic culture medium. Osteogenic properties, including alkaline phosphatase (ALP) induction, matrix mineralization and type I collagen mRNA and protein expression were characterized using quantitative histochemical staining and reverse transcription PCR. Spontaneous adipogenesis was analysed by adipocyte enumeration and gene expression analysis of adipogenic markers. Results. Average colony-forming efficiency in osteogenic medium was equal between IC (38±12%) and FJ (36±11%). Osteogenic potential at the clonal level was 55±26 and 68±17% for IC and FJ MSC, respectively. Clonogenic and osteogenic potential were significantly negatively associated with donor age. Osteogenic differentiation led to significant induction of ALP activity in IC (6-fold) and FJ (8-fold) MSC. Matrix mineralization quantified by Alizarin red staining was increased by osteogenic differentiation, yet similar between both MSC sources. Protein expression of type I collagen was enhanced during osteogenesis and significantly greater in IC MSC. Correspondingly, COL1A2 mRNA expression was higher in osteogenically differentiated MSC from IC. Adipocyte numbers showed significant differences between IC (63±60) and FJ (18±15) MSC under osteogenic conditions. Negative (GREM1) and positive (FABP4) adipogenic markers were not differentially expressed between sources. Conclusion. MSC from IC and degenerative FJ largely display similar clonogenic and osteogenic properties in vitro. Differences at the molecular level are not likely to impair the osteoinductive capacity of FJ MSC. Facetectomy samples are viable bone autografts for intervertebral spinal fusion

Introduction. Facet joint osteoarthritis (FJOA) is a prominent clinical hallmark of degenerative spine disorders. During disease progression, cartilage and subchondral bone tissues undergo increased turnover and remodeling. The structural changes to the subchondral tissue of FJOA have not been studied thus far. In this study, we performed a micro computed tomography (µCT) study of the subchondral cortical plate (SCP) and trabecular bone (STB) in FJOA and determined osteoarthritis-specific alterations. Methods. Twenty-four patients (11 male, 13 female, median age 65) scheduled for decompression and stabilization surgery for degenerative spinal stenosis were included in this study. FJOA specimens were harvested during surgery and analyzed by µCT. Bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp) and trabecular number (Tb.N) were evaluated using CT Analyser. Lumbar facet joints without chondropathy from cadaveric specimens (9 male, 6 female, median age 57) served as healthy controls. Age-, gender- and disease-specific effects were identified by ANOVA (p<0.05) and significant differences confirmed by Bonferroni's post-test. Association between age and structural parameters was determined using correlation analysis. Results. Cortical and trabecular bone structural parameters of FJOA were similar between males and females. Compared to healthy controls, FJOA specimens demonstrated significantly greater trabecular Tb.N (1.97±0.11 vs 1.24±0.04 mm-1) and decrease of Tb.Sp (0.44±0.03 vs 0.69±0.03 mm). Conversely, subchondral cortical plate thickness (0.62±0.08 vs 1.60±0.08 mm) and porosity (22.9±1.9 vs 31.5±2.1%) were significantly less compared to healthy specimens. Tb.Th was equal between patients and controls. Age was positively correlated with Tb.N (r=0.48, p=0.02) and negatively correlated with Tb.Sp (r=−0.44, p=0.03) and cortical plate thickness (r=−0.52, p=0.04) in FJOA. Cortical and trabecular bone parameters did not associate in healthy and osteoarthritic facet joints. Conclusion. FJOA bone remodeling is characterized by thinning of the SCP and an increase in the number of subchondral trabeculae. Remodeling of cortical and trabecular bone might occur in an uncoupled fashion. Targeting elevated subchondral bone remodeling might slow progression of lumbar FJOA

Clinical investigations show that the cervical spine presents wide inter-individual variability, where its motion patterns and load sharing strongly depend on the anatomy. The magnitude and scope of cervical diseases, including disc degeneration, stenosis, and spondylolisthesis, constitute serious health and socioeconomic challenges that continue to increase along with the world”s growing aging population. Although complex exact finite element (FE) modeling is feasible and reliable for biomechanical studies, its clinical application has been limited as it is time-consuming and constrained to the input geometry, typically based on one or few subjects. The objective of this study was twofold: first to develop a validated parametric subject-specific FE model that automatically updates the geometry of the lower cervical spine based on different individuals; and second to investigate the motion patterns and biomechanics associated with typical cervical spine diseases. Six healthy volunteers participated in this study upon informed consent. 26 parameters were identified and measured for each vertebra in the lower cervical spine from Lateral and AP radiographs in neutral, flexion and extension viewpoints in the standing position. The lower cervical FE model was developed including the typical vertebrae (C3-C7), intervertebral discs, facet joints, and ligaments using ANSYS (PA, USA). In order to validate the FE model, the bottom surface of C7 was fixed, and a 73.6N preload together with a 1.8 N.m pure moment were input into the model in both flexion and extension. The results were compared to experimental studies from literature. Disc degeneration disease (DDD) was used as an example, where the geometry of C5-C6 disc was changed in the model to simulate 3 different grades of disc degeneration (mimicking grades 1 to 3), and the resulting biomechanical responses were evaluated. The average ranges of motion (ROM) were found to be 4.84 (±0.73) degrees and 5.36 (±0.68) degrees for flexion and extension for C5-C6 functional unit, respectively, in alignment with literature. The total ROM of the model with disc generation grades 2 and 3 was found to have decreased significantly as compared to the intact model. In contrast, the axial stresses on the degenerated discs were significantly higher than the intact discs for all 3 degeneration grades. Our preliminary results show that this novel validated subject-specific FE model provides a potential valuable tool for noninvasive time and cost effective analyses of cervical spine biomechanical (kinematic and kinetic) changes associated with various diseases. The model also provides an opportunity for clinicians to use quantitative data towards subject-specific informed therapy and surgical planning. Ongoing and future work includes expanding the studied population to investigate individuals with different cervical spine afflictions

Purpose and background. Whether to order an MRI scan or not for patients with low back and leg pain (LBP). Resources are limited. Waiting for diagnostic imaging impacts time to treatment and may be critical to the “18 week target”. We have looked into devising a system in which we can ordered MRI scans for patients with LBP pre-clinical assessment based on questionnaire and accessing their referral letter. Methods and results. 49 patient's referrals were looked into (randomly picked). 23 had a questionnaire filled by either themselves or their GPs. the rests had MRI scans ordered based on their referral letters. MRI scans were requested pre-clinical assessment for patients with symptoms spreading beyond their knees and willing to consider interventional treatments (injections or operations). We considered MRI positive if the report mentioned stenosis or disc prolapse causing nerve root or cauda compression. 7 out of the 23 fitted the criteria for MRI. 6 (85%) of them had positive results. 26 of the GP referrals letters had MRI out of those 16 (61%) had positive results. In total out of 33 MRI, 22 (66.7%) were positive. Conclusion. Our study showed that pre-clinic MRI scanning for patients with LBP is an effective method to find surgically treatable pathology. Using the questionnaire was more advantageous than the referral letter in order to identify patients who would benefit from pre-clinic MRI scanning. With the small numbers this is not statistically significant. We propose that rather than a blanket scanning, it would be reasonable to scan patients based on their referral letter. No Conflict of interest. No funding obtained. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting

Introduction. Recently various type of spinal instrumentation was applied, and they are essential in modern spinal fusion surgery. Whereas several authors reported increased possibility of complication and degeneration on adjacent segment. We tried PLIF without instrumentation with box type intervertebral cages. Method. Forty-one cases of degenerative lumbar diseases were treated by PLIF with carbon cages without spinal instrumentation. There were 17 males and 24 females, and age averaged 71.4 years. Thirty-two cases were degenerative spondylolisthesis, five were spinal stenosis, and four were disc herniation. Single PLIF was performed on forty cases, and double segment in one, with additional decompression on other segment in twenty. Bilateral facet joint were preserved to avoid lateral instability. Two pieces of cage were inserted with local bone graft. Post-op. follow-up period were 12 to 24 months, 15 months on average. Result. JOA score (29 pts on full mark) averaged 12.7 pts before the operation and was 25.4 pts at the F/U. Recovery ratio averaged 77.9%. Clinical result was excellent in 27 with more than 75% of R/R. One case showed symptomatic non-union, and additional instrumentation was applied after one year. Thirty-three cases (80%) showed solid bone union after one year, and eight cases were classified as non-union. Whereas early cage migration with vertebral collapse was seen on fourteen, and union with collapse was seen in eight. These conditions showed less clinical outcome. Conclusion. Stand alone PLIF resulted in good clinical results with box type cages. Stand alone PLIF is less invasive method and minimize chance of complication. Conflicts of interest. None. Sources of funding. None

Objectives

Degenerative disc disease (DDD) and osteoarthritis (OA) are relatively frequent causes of disability amongst the elderly; they constitute serious socioeconomic costs and significantly impair quality of life. Previous studies to date have found that aggrecan variable number of tandem repeats (VNTR) contributes both to DDD and OA. However, current data are not consistent across studies. The purpose of this study was to evaluate systematically the relationship between aggrecan VNTR, and DDD and/or OA.

Objectives

Interleukin 18 (IL-18) is a regulatory cytokine that degrades the disc matrix. Bone morphogenetic protein-2 (BMP-2) stimulates synthesis of the disc extracellular matrix. However, the combined effects of BMP-2 and IL-18 on human intervertebral disc degeneration have not previously been reported. The aim of this study was to investigate the effects of the anabolic cytokine BMP-2 and the catabolic cytokine IL-18 on human nucleus pulposus (NP) and annulus fibrosus (AF) cells and, therefore, to identify potential therapeutic and clinical benefits of recombinant human (rh)BMP-2 in intervertebral disc degeneration.

A rat model of lumbar root constriction with an additional sympathectomy in some animals was used to assess whether the sympathetic nerves influenced radicular pain. Behavioural tests were undertaken before and after the operation.

On the 28th post-operative day, both dorsal root ganglia and the spinal roots of L4 and L5 were removed, frozen and sectioned on a cryostat (8 μm to 10 μm). Immunostaining was then performed with antibodies to tyrosine hydroxylase (TH) according to the Avidin Biotin Complex method. In order to quantify the presence of sympathetic nerve fibres, we counted TH-immunoreactive fibres in the dorsal root ganglia using a light microscope equipped with a micrometer graticule (10 x 10 squares, 500 mm x 500 mm). We counted the squares of the graticule which contained TH-immunoreactive fibres for each of five randomly-selected sections of the dorsal root ganglia.

The root constriction group showed mechanical allodynia and thermal hyperalgesia. In this group, TH-immunoreactive fibres were abundant in the ipsilateral dorsal root ganglia at L5 and L4 compared with the opposite side. In the sympathectomy group, mechanical hypersensitivity was attenuated significantly.

We consider that the sympathetic nervous system plays an important role in the generation of radicular pain.