Thoracoscopic treatment for single level symptomatic thoracic disc herniation: a prospective followed cohort study in a group of 167 consecutive cases.

PROBLEM: Thoracic disc disease with radicular pain and myelopathic symptoms can have serious neurological sequelae. The authors present a relevant treatment option. METHODS: Data of patients with single level symptomatic thoracic disc herniation treated with thoracoscopic microdiscectomy were prospectively collected over a period of 10 years. Data collection included the preoperative status and the follow-up status was 6, 12 and 24 months after surgery for every patient. RESULTS: A total of 167 single level thorascoscopic discectomies without previous surgery on the level of the procedure were included in this study. The average preoperative duration of pain symptoms was 14.3 months, myelopathic symptoms were present for an average of 16.7 months before surgery. After the procedure pain scores measured with visual analog scale (VAS) decreased by 4.4 points and the muscle strength improved by a mean of 4.6 points (American Spinal Injury Association ASIA motor score). After 2 years, 79% of the patients reported a excellent or good outcome for pain and 80% of the patients reported a excellent or good outcome for motor function. The overall complication rate was 15.6%. CONCLUSIONS: Thoracoscopic microdiscectomy for single level symptomatic disc herniation is a highly effective and reliable technique, it can be performed safely with low complication rate.

Senescence in cells in aseptic loosening after total hip replacement.

Particle-induced osteolysis is a major cause of aseptic loosening after total joint replacement. The purpose of the current study was to evaluate cellular senescence of macrophages and giant cells in patients with aseptic hip loosening by determination of SA-ß-Gal (SA-ß-galactosidase), a reliable and frequently used indicator of cellular senescence. The level of senescence in capsule and interface membranes was significantly higher in patients with aseptic loosening in comparison to specimens from patients without aseptic loosening. Using Spearman's rank correlation, we found that the expression of SA-ß-Gal in giant cells (p=0.002) and macrophages (p=0.050) in the interface membranes correlates significantly with the degree of polyethylene debris. We speculate that the induction of DNA damage by wear particles is responsible for premature senescence. Consequently, we conclude that the form of senescence observed in this study is a "stress-induced senescence".

Grading of degenerative disk disease and functional impairment: imaging versus patho-anatomical findings.

Degenerative instability affecting the functional spinal unit is discussed as a cause of symptoms. The value of imaging signs for assessing the resulting functional impairment is still unclear. To determine the relationship between slight degrees of degeneration and function, we performed a biomechanical study with 18 multisegmental (L2-S2) human lumbar cadaveric specimens. The multidirectional spinal deformation was measured during the continuous application of pure moments of flexion/extension, bilateral bending and rotation in a spine tester. The three flexibility parameters neutral zone, range of motion and neutral zone ratio were evaluated. Different grading systems were used: (1) antero-posterior and lateral radiographs (degenerative disk disease) (2) oblique radiographs (facet joint degeneration) (3) macroscopic and (4) microscopic evaluation. The most reliable correlation was between the grading of microscopic findings and the flexibility parameters; the imaging evaluation was not as informative.