When is the Optimal Time Point for Predicting the 1-Year Follow-up Outcome of Selective Nerve Root Block for Cervical Radiculopathy?

STUDY DESIGN: Retrospective study. OBJECTIVES: In the current study, we aimed to (1) evaluate the early and late therapeutic effects of selective nerve root block (SNRB) for cervical radiculopathy, and (2) to determine the optimal time point for predicting the long-term effectiveness of cervical SNRB. SUMMARY OF LITERATURE REVIEW: Although SNRB is an important option for cervical radiculopathy, various studies of cervical SNRB have failed to specify its efficacy, especially long-term effectiveness. MATERIALS AND METHODS: We retrospectively enrolled 35 patients with cervical radiculopathy who were regularly followed-up for at least 1 year after SNRB. Clinical outcomes were evaluated using a visual analogue scale (VAS) for pain intensity and the modified Kim's method for patient satisfaction at regular follow-up intervals. In the correlation analysis, stepwise multiple linear regression was used to identify selected and unselected factors. RESULTS: The average VAS score decreased over time (p<0.05); the values just before the injection and at 1 week, 3 weeks, and 1 year of follow-up were 6.11, 3.29, 2.89, and 1.37, respectively. In the stepwise multiple regression analysis, the 1-week VAS score was related to the initial VAS score, the 3-week VAS score was related to the 1-week VAS score, and the last VAS score was related to the 3-week VAS score and symptom duration before the injection. The degree of satisfaction at the 1-year follow-up point was significantly associated with the 3-week VAS score (p=0.011). CONCLUSIONS: The current study showed that pain intensity at the 3-week time point after cervical SNRB might be the optimal time point for predicting long-term effectiveness.

When is the Optimal Time Point for Predicting the 1-Year Follow-up Outcome of Selective Nerve Root Block for Cervical Radiculopathy?

OBJECTIVES@#In the current study, we aimed to (1) evaluate the early and late therapeutic effects of selective nerve root block (SNRB) for cervical radiculopathy, and (2) to determine the optimal time point for predicting the long-term effectiveness of cervical SNRB.SUMMARY OF LITERATURE REVIEW: Although SNRB is an important option for cervical radiculopathy, various studies of cervical SNRB have failed to specify its efficacy, especially long-term effectiveness.@*MATERIALS AND METHODS@#We retrospectively enrolled 35 patients with cervical radiculopathy who were regularly followed-up for at least 1 year after SNRB. Clinical outcomes were evaluated using a visual analogue scale (VAS) for pain intensity and the modified Kim's method for patient satisfaction at regular follow-up intervals. In the correlation analysis, stepwise multiple linear regression was used to identify selected and unselected factors.@*RESULTS@#The average VAS score decreased over time (p<0.05); the values just before the injection and at 1 week, 3 weeks, and 1 year of follow-up were 6.11, 3.29, 2.89, and 1.37, respectively. In the stepwise multiple regression analysis, the 1-week VAS score was related to the initial VAS score, the 3-week VAS score was related to the 1-week VAS score, and the last VAS score was related to the 3-week VAS score and symptom duration before the injection. The degree of satisfaction at the 1-year follow-up point was significantly associated with the 3-week VAS score (p=0.011).@*CONCLUSIONS@#The current study showed that pain intensity at the 3-week time point after cervical SNRB might be the optimal time point for predicting long-term effectiveness.

A Sternum-Disk Distance Method to Identify the Skin Level for Approaching a Surgical Segment without Fluoroscopy Guidance during Anterior Cervical Discectomy And Fusion

STUDY DESIGN: A retrospective review of prospectively collected data. PURPOSE: To introduce the sternum-disk distance (SDD) method for approaching the exact surgical level without C-arm guidance during anterior cervical discectomy and fusion (ACDF) surgery and to evaluate its accuracy and reliability. OVERVIEW OF LITERATURE: Although spine surgeons have tried to optimize methods for identifying the skin level for accessing the operative disk level without C-arm guidance during ACDF, success has rarely been reported. METHODS: In total, 103 patients who underwent single-level ACDF surgery with the SDD method were enrolled. The primary outcome measure was the accuracy of the SDD method. The secondary outcome measures were the mean SDD value at each cervical level from the cranial margin of the sternum in the neutral and extension positions of the cervical spine and the inter- and intra-observer reliability of the SDD outcome determined using repeated measurements by three orthopedic spine surgeons. RESULTS: The SDD accuracy (primary outcome measure) was indicated in 99% of the patients (102/103). The mean SDD values in the neutral-position magnetic resonance imaging (MRI) were 108.8 mm at C3–C4, 85.3 mm at C4–C5, 64.4 mm at C5–C6, 44.3 mm at C6–C7, and 24.1 mm at C7–T1; and those in the extension-position MRI were 112.9 mm at C3–C4, 88.7 mm at C4–C5, 67.3 mm at C5–C6, 46.5 mm at C6–C7, and 24.3 mm at C7–T1. The Cohen kappa coefficient value for intra-observer reliability was 0.88 (excellent reliability), and the Fleiss kappa coefficient value for inter-observer reliability as reported by three surgeons was 0.89 (excellent reliability). CONCLUSIONS: Based on the results of the present study, we recommend performing ACDF surgery using the SDD method to determine the skin level for approaching the surgical cervical segment without fluoroscopic guidance.

The Efficacy of Vitamin C on Postoperative Outcomes after Posterior Lumbar Interbody Fusion: A Randomized, Placebo-Controlled Trial

BACKGROUND: Vitamin C has critical features relavant to postoperative pain management and functional improvement; however, no study has yet evaluated the effectiveness of vitamin C on improving the surgical outcomes for spine pathologies. Thus, this study aimed to explore the impact of vitamin C on postoperative outcomes after single-level posterior lumbar interbody fusion (PLIF) for lumbar spinal stenosis in prospectively randomized design. We conducted a 1-year prospective, randomized, placebo-controlled, double-blind study to evaluate the impact of vitamin C on the postoperative outcomes after PLIF surgery. METHODS: A total of 123 eligible patients were randomly assigned to either group A (62 patients with vitamin C) or group B (61 patients with placebo). Patient follow-up was continued for at least 1 year after surgery. The primary outcome measure was pain intensity in the lower back using a visual analogue scale. The secondary outcome measures were: (1) the clinical outcome assessed using the Oswestry Disability Index (ODI); (2) the fusion rate assessed using dynamic radiographs and computed tomography scans; and (3) complications. RESULTS: Pain intensity in the lower back was significantly improved in both groups compared with preoperative pain intensity, but no significant difference was observed between the 2 groups over the follow-up period. The ODI score of group A at the third postoperative month was significantly higher than the score of group B. After the sixth postoperative month, the ODI score of group A was slightly higher than the score of group B; however, this difference was not significant. The fusion rates at 1 year after surgery and the complication rates were not significantly different between the 2 groups. CONCLUSIONS: Postoperative pain intensity, the primary outcome measure, was not significantly different at 1 year after surgery between the 2 groups. However, vitamin C may be associated with improving functional status after PLIF surgery, especially during the first 3 postoperative months.

Usefulness of K-Point Injection for the Nonspecific Neck Pain in So-Called K-Point Syndrome

BACKGROUND: Shoichi Kokubun introduced his successful experience with local anesthetic injection at the occipital insertion of the sternocleidomastoid muscle in K-point syndrome. The purpose of this study was to evaluate the short-term and long-term effectiveness of K-point injection and investigate factors affecting treatment results. METHODS: K-point injection was performed in 58 patients with K-point syndrome at Yeungnam University Medical Center. The syndrome was associated with cervical whiplash injury in 10 patients and was of nonspecific origin in the rest. One milliliter of 2% lidocaine mixed with 1 milliliter of dexamethasone was injected in 50 patients and 2 milliliters of 1% lidocaine alone in the rest. Initially, the severity of local tenderness at the K-point and other tender points was examined and the degree of immediate pain relief effect was assessed within 1 hour after injection. Early effect within 1 month after the injection and current effect were evaluated in 27 patients using a modified Kim's questionnaire with regard to the duration of improvement, degree of improvement in pain and daily living activities, and satisfaction. RESULTS: Of the total 58 patients, 44 (75.8%) apparently had immediate pain relief after K-point injection. The only factor associated with successful immediate pain relief was the whiplash injury associated with traffic accident (TA). The early pain control effect was associated with the immediate effect. The current effect was associated with the early effect alone. Satisfaction with the K-point injection was related to early successful pain relief. CONCLUSIONS: K-point injection would be useful for early pain relief in nonspecific neck pain syndrome so called K-point syndrome, but not for current pain relief. Especially, it was very effective for early pain control in the whiplash injury associated with TA.

Significance of Coronal Proset Magnetic Resonance Imaging to Detect Hidden Zone of the Mid-Zone Stenosis in the Lumbar Spine and Morphometric Analysis of the Mid-Zone Stenosis

STUDY DESIGN: Retrospective exploratory imaging study. PURPOSE: To investigate the significance of the coronal magnetic resonance imaging (MRI) using Proset technique to detect the hidden zone in patients with mid-zone stenosis by comparing with conventional axial and sagittal MRI and to explore the morphologic characteristic patterns of the mid-zone stenosis. OVERVIEW OF LITERATURE: Despite advancements in diagnostic modalities such as computed tomography and MRI, stenotic lesions under the pedicle and pars interarticularis, also called the mid-zone, are still difficult to definitely detect with the conventional axial and sagittal MRI due to its inherited anatomical peculiarity. METHODS: Of 180 patients scheduled to undergo selective nerve root block, 20 patients with mid-zone stenosis were analyzed using MRI. Characteristic group patterns were also explored morphologically by comparing MRI views of each group after verifying statistical differences between them. Hierarchical cluster analysis was performed to classify morphological characteristic groups based on three-dimensional radiologic grade for stenosis at all three zones. RESULTS: At the mid-zone, the stenosis of grade 2 or more was found in 14 cases in the coronal image,13 cases in the sagittal image, and 9 cases in the axial image (p<0.05). Especially, mid-zone stenosis was not detected in six of 20 cases at the axial images. At the entrance and exit-zone, coronal image was also associated with more accurate detection of hidden zone compared to other views such as axial and sagittal images. After repeated statistical verification, the morphological patterns of hidden zone were classified into 5 groups: 6 cases in group I; 1 case in group II; 4 cases in group III; 7 cases in group IV; and 2 cases in group V. CONCLUSIONS: Coronal MRI using the Proset technique more accurately detected hidden zone of the mid-zone stenosis compared to conventional axial and sagittal images.

Usefulness of the ProSet MRI for Diagnosis of the Extraforaminal Disc Herniation

STUDY DESIGN: This is a retrospective study. OBJECTIVES: The purpose of this study is to confirm the clinical usefulness of utilizing ProSet imaging for checking the nerve root compression and swelling in extraforaminal disc herniation. SUMMARY OF LITERATURE REVIEW: Diagnosing extraforaminal disc herniations can be neglected with using a conventional MRI. MATERIALS AND METHODS: A retrospective analysis was performed on 25 patients, who underwent both conventional & Principles of the selective excitation technique (ProSet) MR imaging for the evaluation of extraforaminal disc herniation, from April 2008 to October 2010. Radiographic analysis was based on the notion that the degree of nerve root compression and swelling was decided by Pfirrmann's classification. RESULTS: Severe compression in the ProSet 3D rendering image was observed in 21 subjects, as compared with 8 subjects in the conventional axial image. Especially, nothing was ever detected in the conventional sagittal image. Severe compression in the ProSet 3D rendering image was observed in 4 subjects, while their nerve root compression was not clear in the conventional axial image. Severe compression and severe swelling in the ProSet 3D & coronal image was observed in 15 subjects, while their nerve root compression was none or not clear in the conventional sagittal image. The swelling degree of the ProSet coronal image turned out bigger than the swelling degree of conventional axial image, and the signal intensity change was also obvious. CONCLUSIONS: ProSet imaging is regarded useful to investigate the symptom triggering nerves, because ProSet image not only observes better nerve root compression, but also identifies the swelling degree more easily than that of the conventional magnetic resonance imaging (MRI).

Individual Variation in Growth Factor Concentrations in Platelet-rich Plasma and Its Influence on Human Mesenchymal Stem Cells / 대한진단검사의학회지

BACKGROUND: The objective of this study was to explore whether individual variations in the concentration of growth factors (GFs) influence the biologic effects of platelet-rich plasma (PRP) on human mesenchymal stem cells (HMSCs). METHODS: The concentrations of 7 representative GFs in activated PRP (aPRP) were measured using ELISA. The effects of PRP on the proliferation and alkaline phosphatase (ALP) activity of HMSCs were examined using several concentrations of aPRP from 3 donors; the relationships between the GF levels and these biologic effects were then evaluated using 10% aPRP from 5 subgroups derived from 39 total donors. HMSCs were cultured in DMEM with the addition of aPRP for 4 or 12 days; then, DNA content and ALP activity were measured. RESULTS: The quantity of DNA increased significantly at a 10% concentration of aPRP, but the ALP activity was suppressed at this concentration of aPRP. The GF concentrations varied among donors, and 5 subgroups of characteristic GF release patterns were identified via cluster analysis. DNA levels differed significantly between groups and tended to be higher in groups with higher concentrations of transforming growth factor-beta1 (TGF-beta1) and platelet-derived growth factors (PDGFs). DNA quantity was positively correlated with TGF-beta1 concentration, and was negatively correlated with donor age. ALP activity was negatively correlated with PDGF-BB concentration. CONCLUSIONS: The varying GF concentrations may result in different biologic effects; thus, individual differences in GF levels should be considered for reliable interpretation of the biologic functions and standardized application of PRP.

A Treatment Guideline for Neuropathic Pain

STUDY DESIGN: A review of literature including definition, diagnosis and treatment of neuropathic pain. OBJECTIVES: To review and discuss the treatment guideline for neuropathic pain. SUMMARY OF LITERATURE REVIEW: Neuropathic pains are characterized by partial or complete somatosensory change caused by various disorders affecting central and peripheral nervous system, and are especially problematic because of their severity, chronicity and resistance to simple analgesics. MATERIALS AND METHODS: Review of literature. RESULTS: Tricyclic antidepressants and the anticonvulsants gabapentin and pregablin were recommended as first-line treatments for neuropathic pain. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in selected clinical circumstances. Other medications such as dual reuptake inhibitors of both serotonin and norepinephrine would be used in severe cases. More invasive interventions (e.g., spinal cord stimulation) may sometimes be helpful. CONCLUSIONS: Treatment must be individualized for each patient and aggressive, combinatory pharmacotherapy and multidisciplinary approach are recommended for the treatment of neuropathic pain.

Radiologic Characteristics of Vertebral Artery Injury in the Cervical Spine Fracture

STUDY DESIGN: A retrospective study. OBJECTIVES: This study was performed by probing vertebral artery injuries and their radiologic characteristics in cervical spine fractures, and analyzing MRI findings of vascular injuries. SUMMARY OF LITERATURE REVIEW: Vertebral artery injuries are found relatively often in cervical spine fractures. MATERIALS AND METHODS: We evaluated 57 cases of cervical spine fractures that occurred beginning in June 2011 and ending in February 2003. The characteristics of each fracture were evaluated using conventional radiographs, CT, and MRI. The presence of a vertebral artery injury was based on the absence of signal void in multilevel transverse foramens. RESULTS: Twelve out of the 57 cases (21.1%) were found to have unilateral vertebral artery injuries. Clinically, impairment in cerebral circulation was not found. We found no statistical correlation between the signal change in the spinal cord and in the vertebral artery injury (P=0.424). We noted fractures of transverse processes in 7 cases, 6 of which showed vertebral artery injuries. Thus, the transverse process facture was associated with t vertebral artery injury (P=0.000). There seemed to be no relationship between the vertebral artery injury and each of following: fracture level (P=0.416), fracture type (P=0.723) and severity of soft tissue injury (P=0.195). CONCLUSIONS: Unilateral vertebral artery injuries were frequently found in the cervical spine fractures. And of all radiographic factors associated with vertebral artery injury, only the presence of transverse process fracture was statistically significant. Absence of signal void at multi-section MR images is considered to be a useful guide to commence additional vascular evaluation.

Metformin Inhibits Isoproterenol-induced Cardiac Hypertrophy in Mice

The present study examined whether metformin treatment prevents isoporterenol-induced cardiac hypertrophy in mice. Chronic subcutaneous infusion of isoproterenol (15 mg/kg/24 h) for 1 week using an osmotic minipump induced cardiac hypertrophy measured by the heart-to-body weight ratio and left ventricular posterior wall thickness. Cardiac hypertrophy was accompanied with increased interleukin-6 (IL-6), transforming growth factor (TGF)-beta, atrial natriuretic peptide (ANP), collagen I and III, and matrix metallopeptidase 2 (MMP-2). Coinfusion of metformin (150 mg/kg/24 h) with isoproterenol partially inhibited cardiac hypertrophy that was followed by reduced IL-6, TGF-beta, ANP, collagen I and III, and MMP-2. Chronic subcutaneous infusion of metformin did not increase AMP-activated protein kinase (AMPK) activity in heart, although acute intraperitoneal injection of metformin (10 mg/kg) increased AMPK activity. Isoproterenol increased nitrotyrosine levels and mRNA expression of antioxidant enzyme glutathione peroxidase and metformin treatment normalized these changes. These results suggest that metformin inhibits cardiac hypertrophy through attenuating oxidative stress.

Predictability of Magerl & McCormack's Load Sharing Classification on the Metal Failure after Pedicle Screw Fixation in the Thoracolumbar Spine Fracture / 대한척추외과학회지

STUDY DESIGN: A retrograde study of metal failures at thoracolumbar spinal fractures fixed using pedicle screws. OBJECTIVES: The predictability and usefulness of the McCormack's classifications for metal failures was compared with Magerl's classifications. SUMMARY OF LITERATURE REVIEW: The load sharing classification was introduced to predict metal failure after short-segmental pedicle screw fixation by McCormack. However, its reliability is uncertain. MATERIALS AND METHODS: From July 2000 to July 2003, this study examined the plain radiographs and CT images of 31 out of 46 patients who underwent posterior stabilization using pedicle screws for thoracolumbar fractures and could be followed up at least 1 year. Fractures were classified utilizing Denis's, Magerl's, and McCormack's systems. RESULTS: As a result of analysis of relation between metal failure and classification system by Magerl or McCormack, there was no significant difference in its distribution. There was no correlation between the fixation range and metal failures in type C3 fractures, but there was a correlation between short fixation and metal failures in rotational burst fractures in short fixation. CONCLUSIONS: In order to prevent metal failures after fixing thoracolumbar spinal fractures by pedicle screws, the stability should be evaluated using Magerl's classification and McCormack's total score. In addition, in cases of type C3 fractures according to the Magerl's classification, reconstructions should be carried out with a long segment fixation or anterior supporting bone grafts, particularly when McCormack's total score is greater than 7.

Effect of Bone Marrow Cell Collection Techniques and Donor Site Locations on In-Vitro Growth of Bone Forming Cells

PURPOSE: This study evaluated the influence of bone marrow cell collection techniques and donor site locations on the in-vitro growth of bone-forming cells. METHODS: Sixty six samples of bone marrow cell collections (BMCC) or bone marrow aspirates (BMA) from 15 patients were obtained. Thirty eight samples for culture were composed of 23 BMA from 7 tibial condyles and 16 ilia, with the other 15 BMCC from the contralateral ilia. The other 28 samples were used for the analysis of alkaline phosphatase activities. After counting total cell number, mesenchymal stem cells (MSC) obtained from samples were incubated for 14 days. Alkaline phosphatase staining was used to count the number of stained colonies to show osteogenic differentiation. RESULTS: The average MSC counts of BMA from tibial condyles and ilia were 1.42x10(6) and 7.35x10(6) respectively, with 4.80x10(6) from ilial BMCC (p=0.010). MSC cultures could not be produced from tibial condyles in all 7 samples. However, 9 of 15 BMCC samples and 9 of 16 ilial BMA samples were successfully cultured (p=0.018). The average of cell counts in the successful cultures was 7.92x10(6), whereas that in the failed cultures was 2.85x10(6) (p=0.000). Multiple regression analysis showed that colony count was associated with the patient's age and total cell numbers, but not with collection methods such as BMCC or BMA (p=0.000, R=0.648, beta; age=-0.405, cell number=0.356). The discriminating formula indicated that more than 5.25x10(6) cells were needed for successful culture. CONCLUSIONS: For successful cultures in vitro and for grafts, the total number of collected bone forming cells is more important than donor sites or collection methods. For young patients, grafting of bone-marrow-derived osteoprogenitor cells is promising.

Antifibrotic Effect of BMP-7 in the Peritoneum and the Mechanism / 대한신장학회잡지

PURPOSE: Bone morphogenic protein (BMP)-7, a member of TGF-beta1 superfamily, is an endogenous antifibrotic protein highly expressed in normal kidney. It is not known, however, whether human peritoneal mesothelial cells (HPMC) express BMP-7 or if BMP-7 protects against peritoneal fibrosis and by what mechanism. We examined the effect of BMP-7 overexpression in TGF-beta1-induced epithelial-mesenchymal transition (EMT) of HPMC and in TGF-beta1 signaling in HPMC to elucidate the mechanisms of antifibrotic effect of BMP-7. METHODS: Growth arrested and synchronized HPMC were stimulated with 2 ng/mL of TGF-beta1 to induce EMT. HPMC were transiently transfected with adenovirus-mediated human BMP-7 (AdBMP-7) or with GFP (AdGFP). EMT was defined as downregulation of E-cadherin and upregulation of alpha-smooth muscle actin (SMA). RESULTS: HPMC constitutively expressed BMP-7 mRNA and protein. BMP-7 mRNA and protein expression were significantly inhibited by 50 mM D-glucose, 2x diluted commercial peritoneal dialysis solution, and 2 ng/ml of TGF-beta1. Transfection of AdBMP-7 resulted in 2.5-fold increase in BMP-7 mRNA expression in HPMC. TGF-beta1 significantly decreased E-cadherin and increased alpha-SMA expression in GFP transfected cells. BMP-7 overexpression effectively reversed TGF-beta1-induced E-cadherin and alpha-SMA expression and significantly suppressed TGF-beta1-induced phosphorylation of Smad2/3, ERK1/2, JNK, and p38 MAPK in HPMC as compared to GFP transfected cells. CONCLUSION: BMP-7 is an endogenous antifibrotic protein and downregulation of BMP-7 in HPMC by high glucose, PD solution, and TGF-beta1 may permit the development of peritoneal fibrosis during long-term PD. Our data demonstrate that BMP-7 overexpression reverses TGF-beta1-induced EMT of HPMC and consequent peritoneal fibrosis possibly through inhibition of Smad2/3 and MAPK phosphorylation.

Morphologic Feasibility of Pedicle Screw Insertion in Korean / 대한정형외과학회잡지

PURPOSE: This study examined the morphological characteristics of the thoracic and lumbar vertebrae of normal Koreans and the factors causing breakage of the pedicular wall by measuring the thoracolumbar vertebrae relative to the pedicle screw insertion. MATERIALS AND METHODS: The effect of the pedicle screw shape on the pedicle wall integrity of 56 normal Koreans was examined by performing a computer simulation of the inserting pedicle screws into the pedicle wall by superimposing the graphical images of the screws onto the CT scan images. RESULTS: Because the inner pedicle diameters of the most thoracic vertebrae from T4 to T10 were <5 mm, most pedicles of the thoracic vertebrae were expected to be broken after inserting the 5 mm-diameter cylindrical screws. The pedicles of the thoracic and lumbar vertebrae were classified into 6 groups by performing the cluster analysis using morphometric parameters. Group 1 was labeled "relatively narrow". Group 2 "moderate". Group 3 "wide and angular". Group 4 "severly narrow and short", Group 5 "long", and group 6 "relatively wide and angular". The simulation showed the pedicles of groups 1 and 4 to be too narrow for the 5 mm-diameter cylindrical screws to preserve the pedicular wall integrity. CONCLUSION: The pedicles of the vertebra of Koreans are similar in size to those of Caucasians. Personal morphological characteristics of the pedicles as well as their sizes and levels of the vertebrae are believed to be the significant factors that can cause the breakage of the pedicular wall.

An Epidemiologic Study of Low Back Pain of Women Working at a General Hospital / 영남의대학술지

BACKGROUND: The aim of this study was to confirm the risk factors for low back pain and injury to improve the prevention and treatment of lower back pain. MATERIALS AND METHODS: An epidemiologic study of low back pain and injury was performed with questionnaires distributed to 471 women working at Yeungnam university hospital. The differences in low back pain and injuries among various hospital departments were analyzed by a one-way analysis of variance (ANOVA), and the relevant factors included in the questionnaire were determined by a factor analysis. RESULTS: The frequency of low back pain in women in the department of diet and in the maintenance department was higher than among the other departments. The frequency of low back pain was mainly related to the frequency of psychosomatic symptoms. In addition, the low back pain was partially related to the frequency of psychosomatic symptoms and partially related to the frequency of pushing during the workday. The degree of disability from low back pain was increased by lifting and hard physical work and was related to the frequency of psychosomatic symptoms and the degree of work dissatisfaction. The frequency of low back injury was increased by increased standing time during work and hard physical work. The frequency of low back injury was related to advancing age and in part to psychosomatic symptoms. CONCLUSION: Lower back pain and its associated complications are related to psychosomatic factors and type of work. Lower back injury is related to physiological factors such as age. For the prevention and treatment of lower back pain, a multidisciplinary approach is required.

Pain Drawing in the Assessment of Nerve Root Compression in the Degenerative Spondylosis / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To explore the pattern of pain distribution in HNP and spinal stenosis with or without degenerative spondylolisthesis (DS), and to evaluate the diagnostic value of pain drawings in predicting the presence of a painful nerve root. SUMMARY OF LITERATURE REVIEW: The usefulness of pain drawing as a tool to predict the presence of painful nerve root compression is unclear. MATERIALS AND METHODS: Fifty-seven patients (27 HNP, 21 pure spinal stenosis, and 9 spinal stenosis with DS) with leg pain were recruited. The presence of painful nerve root compression was judged based on MRI and clinical findings. Each grid of the pain drawing is assigned an area code, and discriminant analysis was performed to explore indications of painful nerve root. Diagnostic values were evaluated by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: Pain distribution was characterized by a dermatomal pattern in HNP and variable in the spinal stenosis group. Paresthesia on the sole was extracted as a discriminant factor indicating painful compression of the S1 nerve root. In HNP, the sensitivity, specificity, PPV, and NPV of this factor were 62%, 100%, 100%, and 74% respectively. In the spinal stenosis group, they were 80%, 56%, 27%, and 93%, respectively. CONCLUSIONS: The pain drawing can help assess painful nerve root compression as well as confirm the pattern of pain distribution.

Degenerative Instability of the Lumbar Spine / 대한척추외과학회지

Degenerative instability is difficult to define, diagnose, and treat. Diagnosis and treatment of degenerative instability are based on the biomechanical stability of the functional spinal unit as well as on the pathologic diagnosis of the disease. Recent advancements in biomechanical studies on the functional spinal unit and radiological diagnostic methods have introduced new diagnostic criteria. In this review, biomechanical stability of the functional spinal unit, changes in stability associated with degeneration and diagnosis, and treatment of degenerative instability are discussed.

Osteogenesis of Recombinant BMP-7 Adenovirus-transduced Human Dermal Fibroblasts in Collagen Sponge / 대한해부학회지

As a preceding study to apply recombinant BMP-7 gene to the human, we investigated bone formation in immunodeficient mice by using tissue engineering and gene transplatation. Human dermal fibroblasts were transduced with AdBMP-7 and cultured with type I collagen solution to form collagen sponge. The collagen sponge containing AdBMP-7 transduced fibroblasts was transplanted into hypodermis of the mice and osteogenesis in the spongy was investigated by histochemical, electronmicroscopic, and radiologic methods at 1, 2, 4, 6, and 8 weeks. At one week after transplantation, there were fluent cells infiltration around the collagen sponge and capsular structure was formed with fibers arranged in concentric circles. New vessel formation was observed in the capsule and subcapsular area of the sponge, but there were nucleus condensation and obscure cell boundary in the cells of the central region. Lacuna containing eosinophilic structures were observed in the capsular structure at two weeks. This structures were enlarged with time and were confirmed to be bone tissue by showing positive reaction for Von Kossa stain. Cartilaginous structure was not observed in light microscopic level, but a few chondroblasts were observed in pericapsular area in electron microscopic observation. After 6 weeks, radiopaque shadows were observed at the region of transplantation. Cortical bone was formed in periphery of the sponge while marrow like structure was observed in central region; some trabecula bone, adipocytes, and well developed vessels. The percentage of bone formation in transplanted sponge at 1, 2, 4, 6, and 8 weeks were 0, 63, 88, 100, and 100% (n = 8), respectively. From these results, bone formation by BMP-7 transduced human dermal fibroblasts using collagen sponge scaffolds in immunodeficient mouse shows another potential way of human gene transplantation using recombinant BMP-7 adenovirus.

Osteoinduction Using Recombinant Bone Morphogenetic Protein-7 Gene / 대한정형외과학회잡지

PURPOSE: The aim of this study was to develop recombinant human Bone Morphogenetic Protein-7 (BMP7)-stable cells and recombinant human BMP7 adenoviruses (AdBMP7) for osteoinduction and osteoregeneration in musculoskeletal diseases. MATERIALS AND METHODS: The human BMP7 cDNA was amplified from a human osteosarcoma cell line, U2OS using a reverse transcription-polymerase chain reaction and cloned into a eukaryotic expression vector. The BMP7-stable HEK293 cells (HEK293/BMP7) were prepared by transfecting the recombinant BMP7 plasmid vector. The recombinant human BMP7 adenovirus (AdBMP7) was constructed using the AdEasy vector system. The BMP7 expression levels in HEK293/BMP7 and AdBMP7 were measured by activity staining for alkaline phosphatase in mouse C2C12 promyoblast cells. The BMP7-stable HEK293 cells, AdBMP7 itself, or AdBMP7-transduced human fibroblasts were injected into the subcutaneous tissues and the calf muscles of immunocompromised mice. The amount of ectopic bone formation was evaluated by radiographic and histological analyses. RESULTS: Ectopic bone formation was observed after injecting the BMP7-stable HEK293 cells with either the AdBMP7 itself or AdBMP7-transduced human fibroblasts into the subcutaneous tissues and calf muscles of immunocompromised mice. CONCLUSION: These results showed that HEK293/BMP7 cells and AdBMP7 have a significant potential for bone formation and the regeneration of various bone diseases.