A novel PLIF PEEK interbody cage with an impactionless insertion technology: A case series with a mid-term follow up of three years.

BACKGROUND: Spinal fusion surgery has become one of the most common spinal procedures during the recent years. Searching for an optimum structural stability of the vertebral interspace, surgical implants which can be inserted via a posterior lumbar interbody fusion (PLIF) approach have been enhanced recently. OBJECTIVE: Evaluation of safety and efficacy of a novel PLIF polyetheretherketone (PEEK) interbody cage (TWIST) with an impactionless insertion technique. METHODS: Surgical outcome in 15 patients treated with the new system were observed preoperatively, one and three years after surgery using the Oswestry Disability Index (ODI), a Visual Analogue Scale (VAS) for pain and radiological outcome analysis of fusion success. RESULTS: Fifteen patients (7 female, 8 male) were included in the test series. After three years ODI and VAS were significantly improved. The pain intensity was reduced by more than 75% after one year and after 3 years, pain intensity was about 60% below the initial situation. The Oswestry values (ODI) improved significantly in all patients after 3 years. The fusion evaluation showed a fusion success in 87% of the patients. CONCLUSION: The clinical and radiological results of this first series give a positive standing and important information on the efficacy and safety over 3 years. The follow-up checks with imaging techniques showed that the fusions were very successful and functional outcome as well as pain reduction were increased.

Increased MACC1 levels in tissues and blood identify colon adenoma patients at high risk.

BACKGROUND: Colorectal cancer is a preventable disease if caught at early stages. This disease is highly aggressive and has a higher incidence in African Americans. Several biomarkers and mutations of aggressive tumor behavior have been defined such as metastasis-associated in colon cancer 1 (MACC1) that was associated with metastasis in colorectal cancer patients. Here, we aim to assess colon tissue MACC1 protein and circulating MACC1 transcripts in colon preneoplastic and neoplastic African American patients. METHODS: Patients' tissue samples (n = 143) have been arranged on three tissue microarrays for normal (n = 26), adenoma (n = 68) and cancer (n = 49) samples. Immunohistochemistry was used to detect MACC1 expression. Blood samples (n = 93) from normal (n = 45), hyperplastic (n = 15) and tubular adenoma (n = 33) patients were used to assess MACC1 transcripts using qRT-PCR. Distribution of continuous variables was tested between different diagnoses with Kruskal-Wallis test. Categorical variables were tested by Chi square test. We assessed the prognostic ability of IHC staining by calculating area under receiver operating characteristics curve (ROC) for adenoma and cancer separately. Differences between groups in terms of MACC1 transcript levels in plasma were calculated by using non-parametric (exact) Wilcoxon-Mann-Whitney tests. We performed all calculations with SPSS, version 21. RESULTS: In patient tissues, there was a statistically significant difference in MACC1 expression in normal vs. adenoma samples (p = 0.004) and normal vs. cancer samples (p < 0.001). There was however no major difference in MACC1 expression between adenoma vs. cancer cases or tubular adenomas vs tubulovillous adenomas. The area under the curve for both normal vs. adenoma and normal vs. cancer cases were 70 and 67 %, respectively. MACC1 expression was not correlated to age, gender or anatomical sample location. In patient plasma, MACC1 transcripts in adenoma patients were significantly higher than in plasma from normal patients (p = 0.014). However, the difference between normal and hyperplastic plasma MACC1 transcripts was not statistically significant. CONCLUSION: Metastasis-associated in colon cancer 1 is expressed at early stages of colorectal oncogenesis within the affected colonic tissue in this patient cohort. The plasma transcripts can be used to stratify African American patients at risk for potential malignant colonic lesions.

Influence of smoking on spinal fusion after spondylodesis surgery: A comparative clinical study.

BACKGROUND: Smoking is a risk factor in the process of bone healing after lumbar spondylodesis, often associated with complications that occur intraoperatively or during follow-up periods. OBJECTIVE: To assess if smokers yield worse results concerning lumbar interbody fusion than non-smokers in a clinical comparative setting. METHODS: Spondylodesis outcomes in 50 patients, 34 non-smokers (mean 58 years; (range 29-81) and 16 smokers (mean 47 years; range 29-75) were compared preoperatively and one year after spondylodesis surgery using Oswestry-Disability-Index (ODI), visual analogue scale (VAS) and radiological outcome analysis of fusion-success. RESULTS: Smokers showed a comparable ODI-improvement (p = 0.9343) and pain reduction to non-smokers (p = 0.5451). The intake of opioids was only reduced in non-smokers one year after surgery. Fusion success was significantly better in non-smokers (p = 0.01). CONCLUSIONS: The results indicate that smoking adversely effects spinal fusion. Particularly re-operations caused by pseudarthrosis occur at a higher rate in smokers than in non-smokers.