Factors that influence the results of indirect decompression employing oblique lumbar interbody fusion.

BACKGROUND: Indirect decompression is one of the potential benefits of anterior reconstruction in patients with spinal stenosis. On the other hand, the reported rate of revision surgery after indirect decompression highlights the necessity of working out prediction models for the radiographic results of indirect decompression with assessing their clinical relevance. AIM: To assess factors that influence radiographic and clinical results of the indirect decompression in patients with stenosis of the lumbar spine. METHODS: This study is a single-center cross-sectional evaluation of 80 consecutive patients (17 males and 63 females) with lumbar spinal stenosis combined with the instability of the lumbar spinal segment. Patients underwent single level or bisegmental spinal instrumentation employing oblique lumbar interbody fusion (OLIF) with percutaneous pedicle screw fixation. Radiographic results of the indirect decompression were assessed using computerized tomography, while MacNab scale was used to assess clinical results. RESULTS: After indirect decompression employing anterior reconstruction using OLIF, the statistically significant increase in the disc space height, vertebral canal square, right and left lateral canal depth were detected (Р < 0.0001). The median (M) relative vertebral canal square increase came to М = 24.5% with 25%-75% quartile border (16.3%; 33.3%) if indirect decompression was achieved by restoration of the segment height. In patients with the reduction of the upper vertebrae slip, the median of the relative increase in vertebral canal square accounted for 49.5% with 25%-75% quartile border (2.35; 99.75). Six out of 80 patients (7.5%) presented with unsatisfactory results because of residual nerve root compression. The critical values for lateral recess depth and vertebral canal square that were associated with indirect decompression failure were 3 mm and 80 mm2 respectively. CONCLUSION: Indirect decompression employing anterior reconstruction is achieved by the increase in disc height along the posterior boarder and reduction of the slipped vertebrae in patients with degenerative spondylolisthesis. Vertebral canal square below 80 mm2 and lateral recess depth less than 3 mm are associated with indirect decompression failures that require direct microsurgical decompression.

Functionalization of Osteoplastic Material with Human Placental Growth Factor and Assessment of Biocompatibility of the Resulting Material In Vitro.

This article provides the results of a study of the interaction of placental growth factor with adipose-derived stem cells (ASCs) of various origins, as well as the possibility of generating osteoplastic material based on xenogeneic matrix functionalization with human placental growth factor (PLGF). It is demonstrated that the greatest release of this factor from the functionalized material into the medium occurs during the first 3 h of contact with the model medium, but then the levels of the factor being released fall sharply, although release did continue throughout the 7 days of observation. The modified material was not cytotoxic, and its surface provided good cell adhesion. During 3 days of cultivation, the ASCs proliferated and migrated more actively on the surfaces of the modified material than on the surfaces of the control material. This study can serve as the basis for the development of original methods to functionalize such osteoplastic material by increasing PLGF immobilization by creating stronger bonds in order to regulate both factor dosage and the dynamics of the factor release into the environment. Further studies in experimental animals should facilitate assessment of the effectiveness of the functionalized materials. Such studies will be useful in the development of osteoplastic materials with new properties resulting from the inclusion of growth factors and in research on their biological activity.

Biological Characteristics of Polyurethane-Based Bone-Replacement Materials.

A study is presented on four polymers of the polyurethane family, obtained using a two-stage process. The first composition is the basic polymer; the others differ from it by the presence of a variety of fillers, introduced to provide radiopacity. The fillers used were 15% bismuth oxide (Composition 2), 15% tantalum pentoxide (Composition 3), or 15% zirconium oxide (Composition 4). Using a test culture of human fibroblasts enabled the level of cytotoxicity of the compositions to be determined by MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay, along with variations in the characteristics of the cells resulting from their culture directly on the specimens. The condition of cells on the surfaces of the specimens was assessed using fluorescence microscopy. It was shown that introducing 15% bismuth, tantalum, or zinc compounds as fillers produced a range of effects on the biological characteristics of the compositions. With the different fillers, the levels of toxicity differed and the cells' proliferative activity or adhesion was affected. However, in general, all the studied compositions may be considered cytocompatible in respect of their biological characteristics and are promising for further development as bases for bone-substituting materials. The results obtained also open up prospects for further investigations of polyurethane compounds.