Endoscopic and morphological features of chronic gastritis in patients with lumbar spine osteochondrosis.

OBJECTIVE: Aim: of the study is to determine the endoscopic and morphological features of chronic gastritis (CG) in patients with lumbar spinal OC. PATIENTS AND METHODS: Materials and Methods: 102 patients with lumbar spine OC and CG were examined. The patients were diagnosed with Helicobacter pylori (HP) infection, according to which the patients were divided into two groups: the first group included 92 HP-positive patients, the second group consisted of 10 HP-negative patients. RESULTS: Results: Among HP infected patients with lumbar spine OC, erosive gastropathy was most often diagnosed (in 40 (43.5%) of the examined), as well as erosive-papular and erosive-hemorrhagic gastropathy (in 14 (15.2%) and in 16 (17, 4 %) of patients, respectively), while erythematous gastropathy was more often diagnosed among HP-negative patients (in 7 (70.0 %) cases, respectively). CONCLUSION: Conclusions: 1. 90.2% of patients with lumbar spine OC and CG have been diagnosed with HP infection. 2. Endoscopically, the lesion of the stomach MM in patients with lumbar spine OC corresponds mainly to erosive and erosive-hemorrhagic forms of gastropathy. 3. During histological examination of stomach MM, mainly 2nd and 3rd degrees of inflammation were established, especially in patients with erosive, erosive-papular and erosive-hemorrhagic forms of gastropathy.

Novel Ex Vivo Human Osteochondral Explant Model of Knee and Spine Osteoarthritis Enables Assessment of Inflammatory and Drug Treatment Responses.

Osteoarthritis of the knee and spine is highly prevalent in modern society, yet a disease-modifying pharmacological treatment remains an unmet clinical need. A major challenge for drug development includes selection of appropriate preclinical models that accurately reflect clinical phenotypes of human disease. The aim of this study was to establish an ex vivo explant model of human knee and spine osteoarthritis that enables assessment of osteochondral tissue responses to inflammation and drug treatment. Equal-sized osteochondral fragments from knee and facet joints (both n = 6) were subjected to explant culture for 7 days in the presence of a toll-like receptor 4 (TLR4) agonist and an inhibitor of transforming growth factor-beta (TGF-β) receptor type I signaling. Markers of inflammation, interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1), but not bone metabolism (pro-collagen-I) were significantly increased by treatment with TLR4 agonist. Targeting of TGF-β signaling resulted in a strong reduction of pro-collagen-I and significantly decreased IL-6 levels. MCP-1 secretion was increased, revealing a regulatory feedback mechanism between TGF-β and MCP-1 in joint tissues. These findings demonstrate proof-of-concept and feasibility of explant culture of human osteochondral specimens as a preclinical disease model, which might aid in definition and validation of disease-modifying drug targets.

[Peculiarities of clinical and psychophysiological status of elderly patients with osteochondrosis.]

We conducted a study of 220 patients in polyclinic № 91 in St. Petersburg. It was revealed that elderly patients with osteochondrosis are characterized by a high prevalence and severity of osteochondrosis against the background of metabolic disorders in the structures of the spine. At the same time, the actual condition of the spine does not always determine the severity of the pain syndrome. The effect of osteochondrosis on the development of comorbid pathology has been clarified. The ways of correction of the clinical and psychophysiological status of elderly patients with osteochondrosis such as appointment of Cytoflavin, behavioral therapy and biofeed back therapy are suggested.

Morphological changes in the human cervical intervertebral disc post trauma: response to fracture-type and degeneration grade over time.

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.

Basic aspects in MR imaging of degenerative lumbar disk disease.

Degenerative disease may lead to spinal canal stenosis and long-lasting pain. It is among the leading cause of disability that may affect the ability to work. It has become more common in an increasingly aging population. MRI is the most comprehensive imaging modality and provides detailed morphologic information. A standardized terminology facilitates communication with referring physicians. Yet imaging findings need careful interpretation in conjunction with the results of clinical tests and symptoms to truly help guide therapeutic decision making. This review summarizes aspects of normal anatomy of the intervertebral disk, pathologic mechanisms, terminology, and examples of the imaging spectrum of disk degeneration and herniation.

[Certain aspects of combined vibration training for the treatment of neurological manifestations of osteochondrosis in the lumbar spine region].

The physical rehabilitation of the patients presenting with neurological manifestations of osteochondrosis in the lumbar spine region remains a challenging problem due to the high prevalence of this condition. Vibration training in the form of graduated vibration impacts was shownto induce muscular stimulation, activate metabolic processes by promoting microcirculation, stimulate operation of the complex proprioceptive apparatus with a rise in the energy level of the gamma-system, and lead to the development of long-term post-activation alterations in the muscular fibers. These observations give reason to consider vibration therapy as a most promising method for the combined treatment of a variety of diseases affecting human subjects. We have developed a set of exercises for the vibration platform training consisting of three main parts (preparative, basic, and concluding components).

[Thermoesthesia-and-algesthesia status in the dermatomes of cauda equina roots in patients with lumbar spine osteochondrosis].

Thermoesthesia-and-algesthesia disorders have been registered in the dermatomes of cauda equina roots of patients with lumbar spine osteochondrosis in all the cases. Negative changes in the sensitivity of this type are manifested themselves as follows: 1) 2-8-degree increases of thresholds; 2) 3-6-degree decreases of thresholds; 3) absence of thermal sense. In the presence of reflex syndromes (lumbalgia and lumbar ischialgia) the disorders in L4, L5, S1 dermatomes have been determined to the greatest degree. Thermoesthesia-and-algesthesia disorders are more pronounced in patients with the radicular syndrome than in those with the reflex syndromes. The most improvement ofthermoesthesia-and-algesthesia values is observed in L5 dermatome of patients with lumbalgia and lumbar ischialgia after complex conservative therapy. The treatment performed does not result in significant thermoesthesia-and-algesthesia improvement for the limb with radiculopathy events and in the dermatome of the root compressed in patients with the radicular syndrome. Positive changes in contralateral limb are more pronounced.

[Problems of pelvic girdle asymmetry in patients with spinal osteochondrosis and remedial gymnastics].

This paper deals with the problems of pelvic girdle asymmetry in patients with spinal osteochondrosis. Effectiveness of medicamentous and rehabilitative treatment of such patients is compromised by destructive changes in the vertebrae. Analysis of locomotor disturbances and their dynamics under effect of remedial gymnastics prescribed on an individual basis showed that the main factor limiting success of osteochondrosis therapy is muscular disbalance in the pelvic girdle. This dictates the necessity to start prevention or treatment of the disease and rehabilitation of the patients from the correction of muscular asymmetry. The muscular corset should be formed so as to ensure dynamic equilibrium of muscular tone (between antagonist muscles) bearing in mind that disbalance in the tone of flexor and extensor muscles (both homo- and contralateral ones) contributes to recurring pain syndrome and further aggravates pelvic asymmetry. Its correction in due time constitutes a major condition for the prevention of diseases affecting not only joints of the lower extremities but also lumbar spine especially in patients subject to intense occupational and sports exertion.

Thoracic juxtafacet cyst (JFC) as a rare cause of myelopathy--an additional reference to support the instability theory.

Several causes for the development of a juxtafacet cyst (JFC) of the spine have been discussed, with a focus on instability with overload of the facet joints. In the thoracic spine, JFC is a very rare space-occupying lesion, which can lead to spinal canal stenosis with pain, myelopathic signs and neurological deficits. We report a case of a 70-year-old woman who had a posterolateral fusion of L2 to S1 and, six weeks later a L1 compression fracture. In the following period a thoracolumbar kyphosis has developed. Fourteen months after the fusion procedure a left-sided JFC T11/12 was identified on MRI and CT scans which led to myelopathic symptoms. This was not seen on former MRI scans. After surgical removal of the JFC the myelopathic symptoms were clearly reduced and the woman became pain free. This case report gives a strong support to the hypothesis that spinal instability can lead to overload of the facet joints and result in JFC.

Anterior C1-2 osteochondroma presenting with dysphagia and sleep apnea.

Spinal osteochondromas are rare, benign tumors of the bone. These tumors can manifest as solitary lesions or as part of a hereditary syndrome. Most spinal osteochondromas occur in the posterior cervical spine and can cause myelopathy or radiculopathy. Osteochondromas of the anterior cervical spine that cause respiratory or swallowing symptoms are rare. We present the unique case of a solitary osteochondroma of the anterior C1 vertebral arch causing obstructive sleep apnea and dysphagia in a 16-year-old female. The patient underwent resection of the tumor via a left anterior transcervical approach to the spine. The patient's symptoms resolved completely after surgery. To our knowledge, this is the first case of a sporadic osteochondroma arising from the anterior arch of the C1 vertebra causing dysphagia and obstructive apnea in a pediatric patient.