Biomechanical Effect of C5 /C6 Intervertebral Reconstructive Height on Adjacent Segments in Anterior Cervical Discectomy and Fusion - A Finite Element Analysis.

OBJECTIVE: To investigate the biomechanical effect of different intervertebral reconstructive heights on adjacent segments following C5 /C6 anterior cervical discectomy and fusion (ACDF) through finite element analysis. METHODS: A finite element model of intact C4 -C7 segments was developed and validated for the present study. Five additional C4 -C7 postoperative models were constructed with 100%, 125%, 150%, 175%, and 200% of the benchmark height of C5 /C6 on the basis of the intact model. The changes in intradiscal pressure (IDP) and range of motion (ROM) of adjacent segments before and after reconstruction of C5 /C6 were analyzed. RESULTS: For the upper adjacent segment (C4 /C5 ), the IDPs under the different loading conditions all increased after reconstruction. The maximum IDPs were 0.387, 0.489, 0.491, and 0.472 MPa under flexion, extension, axial rotation, and lateral bending, respectively, observed at the reconstructive height of 200%. The minimum IDPs were observed at 150% reconstructive height under all loading conditions except extension, and were 57, 86 and 81% of the maximum IDPs under flexion, axial rotation, and lateral bending, respectively. The minimum IDP under extension occurred when the reconstructive height is 125% of the benchmark height. For the lower adjacent segment (C6 /C7 ), the IDPs of postoperative models under all loading conditions also increased compared to the preoperative model. The maximum IDPs after reconstruction under flexion, extension, axial rotation, and lateral bending were 0.402, 0.411, 0.461, and 0.497 MPa, respectively, when the height of the reconstruction was 200% of the benchmark. The minimum IDPs were observed after a reconstruction at 150% of the benchmark, and were 59%, 85%, 82%, and 81% of the maximum IDPs under flexion, extension, axial rotation, and lateral bending loading conditions. CONCLUSIONS: The reconstructive height is an important factor affecting the IDP and the ROM of adjacent segments after ACDF. To delay the adjacent segment disease, an intervertebral reconstructive height of 150% is an appropriate height in C5 /C6 ACDF.

Proteomics of Uterosacral Ligament Connective Tissue from Women with and without Pelvic Organ Prolapse.

PURPOSE: Damage to the uterosacral ligaments is an important contributor to uterine and vaginal prolapse. The aim of this study is to identify differentially expressed proteins (DEPs) in the uterosacral ligaments of women with and without pelvic organ prolapse (POP) and analyze their relationships to cellular mechanisms involved in the pathogenesis of POP. EXPERIMENTAL DESIGN: Uterosacral ligament connective tissue from four patients with POP and four control women undergo iTRAQ analysis followed by ingenuity pathway analysis (IPA) of DEPs. DEPs are validated using Western blot analysis. RESULTS: A total of 1789 unique protein sequences are identified in the uterosacral ligament connective tissues. The expression levels of 88 proteins are significantly different between prolapse and control groups (≥1.2-fold, p < 0.05). IPA demonstrates the association of 14 DEPs with "Connective Tissue Function." Among them, fibromodulin, collagen alpha-1 (XIV) chain, calponin-1, tenascin, and galectin-1 appear most likely to play a role in the etiology of POP. CONCLUSIONS AND CLINICAL RELEVANCE: At least six proteins not previously associated with the pathogenesis of POP with biologic functions that suggest a plausible relationship to the disorder are identified. These results may be helpful for furthering the understanding of the pathophysiological mechanisms of POP.