The Relationship Between Inflammatory Processes and Apoptosis in Lumbar Disc Degeneration.

OBJECTIVE: Degenerative Disc Disease (DDD) is a common health problem in the population. There are recent studies focusing on relationship between DDD and immunological factors. However, there is still a lack of data on the role of apoptosis in DDD pathophysiology. Therefore, we aimed to investigate the relationship between Modic-type changes and the apoptosis in DDD. MATERIALS AND METHODS: Ninety adult male patients who presented with low back and/or radicular pain and were operated on due to lumbar disc herniation were included. Three groups were formed based on Modic type degeneration observed on magnetic resonance imaging. Specific parameters involved in the intrinsic and extrinsic pathways of apoptosis were assessed in excised disc materials using the enzyme-linked immunosorbent assay method. RESULTS: All three groups formed according to Modic degeneration types were homogenous in all variances. Cytochrome-C was significantly decreased only in the Modic type-3 group, whereas Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand Receptor-1, B-Cell Lymphoma-2 (Bcl-2) Homologous Antagonist Killer-1, Direct Inhibitor of Apoptosis-Binding Protein with Low Pi, and Bcl-2 Associated X Apoptosis Regulator levels were significantly different in both Modic type-2 and -3 groups. However, BH3 interacting domain death agonist and Bcl-2 levels were similar across all groups. CONCLUSIONS: In conclusion, this study suggests that Direct Inhibitor of Apoptosis-Binding Protein with Low Pi, cytochrome - c, Bcl-2 Associated X Apoptosis Regulator, Bcl-2 Homologous Antagonist Killer-1, and Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand Receptor-1proteins play important roles in the development and progression of DDD and are correlated with Modic types. Further studies are needed to explore the potential therapeutic role of inhibiting these apoptotic proteins in DDD.

Posterior-only approach in patients with poor general condition and spinal metastatic vertebral fracture / Corpectomía con abordaje solo posterior en pacientes con mal estado general y fractura vertebral metastásica espinal

Purpose The surgical treatment of spinal metastases is mostly palliative in nature and focuses on improving the quality of life of patients. The posterior transpedicular surgical approach provides circumferential 360° decompression, allows reconstruction and stabilisation to be achieved in a single session and can be performed using an open, mini-open or minimally invasive approach. We present and discuss the surgical techniques and outcomes for patients with single-level metastatic spinal disease and in poor general condition who underwent surgery via the posterior-only transpedicular corpectomy approach and reconstruction with expandable corpectomy cages. Methods Patients with a single level thoracolumbar metastatic disease (T3-L5) and a Karnofsky score of ≤70, who underwent a complete posterior transpedicular corpectomy with expandable cage reconstruction of the anterior spinal column were retrospectively reviewed. Patients’ demographics, SINS, modified Tokuhashi scores as well as preoperative and postoperative ASIA scale, Karnofsky scores, VAS scores and vertebral height/Cobb angle values were analysed. Results A total of 44 patients (24 M/20 F) (mean age 53.25±21.26 years) met the inclusion criteria. The modified Tokuhashi scores were as follows: score 0–8, 5 (11.4%) patients; score 9–11, 14 (31.8%) patients; and score 12–15, 25 (56.8%) patients. There were significant improvements in the postoperative VAS scores (mean 7.7–2.9), Karnofsky scores (mean 63.3–79.6) as well as the Cobb angles (18.6–12.8°) and vertebral height (AU)

Propósito El tratamiento quirúrgico de las metástasis espinales es principalmente de naturaleza paliativa y se enfoca en mejorar la calidad de vida de los pacientes. El abordaje quirúrgico transpedicular posterior proporciona una descompresión circunferencial de 360°, permite lograr la reconstrucción y estabilización en una sola sesión y se puede realizar mediante un abordaje abierto, miniabierto o mínimamente invasivo. Presentamos y discutimos las técnicas quirúrgicas y los resultados para pacientes con enfermedad espinal metastásica de un solo nivel, y en mal estado general, que se sometieron a cirugía mediante el abordaje de corpectomía transpedicular solo posterior y reconstrucción con jaulas de corpectomía expandibles. Métodos Se revisaron retrospectivamente pacientes con una enfermedad metastásica toracolumbar de un solo nivel (T3-L5) y una puntuación de Karnofsky≤70, que se sometieron a una corpectomía transpedicular posterior completa con reconstrucción de la columna anterior con jaula expandible. Se analizaron los datos demográficos de los pacientes, SINS, las puntuaciones de Tokuhashi modificadas, así como la escala ASIA preoperatoria y posoperatoria, las puntuaciones de Karnofsky, las puntuaciones VAS y los valores de altura vertebral/ángulo de Cobb. Resultados Un total de 44 pacientes (24 M/20 F) (edad media 53,25±21,26 años) cumplieron los criterios de inclusión. Las puntuaciones de Tokuhashi modificadas fueron las siguientes: puntuación de 0 a 8, 5 (11,4%) pacientes; puntuación 9-11, 14 (31,8%) pacientes; y puntuación 12-15, 25 (56,8%) pacientes. Hubo mejoras significativas en las puntuaciones VAS postoperatorias (media de 7,7 a 2,9), las puntuaciones de Karnofsky (media de 63,3 a 79,6), así como los ángulos de Cobb (18,6° a 12,8°) y la altura vertebral. Treinta y cinco pacientes mostraron una función neurológica mejorada en al menos un grado ASIA, mientras que 9 no mostraron mejoría durante el período postoperatorio (AU)