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1

Puncture of a Disc and Application of Nucleus Pulposus Induces Disc Herniation-Like Changes and Osteophytes. An Experimental Study in Rats  

PubMed Central

It has been observed that puncture of a lumbar disc may induce formation of a nodule on the surface of the disc and osteophytes. It is not known if this is based on the presence of a foreign tissue or specifically by the presence of nucleus pulposus or on the disc injury. In this study these mechanisms were separated by comparing disc puncture with application of nucleus pulposus without disc injury, with superficial disc injury without nucleus pulposus and with application of fat. Fifty rats underwent facetectomy of the left L4-5 facet. Ten additional rats were used as donor rats. The rats were exposed to disc puncture (n=10), application of homologous nucleus pulposus (n=10), application of homologous fat tissue (n=10), superficial disc injury (n=10) and ten rats served as control. After 3 weeks the rats were examined macroscopically regarding presence of disc nodules and osteophytes. A limited histological analysis was performed to obtain a microscopic overview of any observed changes. In rats with application of fat, superficial disc injury and in sham controls there were almost no changes observed. However, in rats with disc puncture and applied nucleus pulposus there were clear disc nodules and osteophytes noted. Microscopically the nodules comprised granulation tissue and the osteophytes cortical bone. In conclusion, the data indicate that the presence of nucleus pulposus is more likely to be responsible for the formation of disc nodules and osteophytes than disc injury or the presence of a foreign tissue. This may provide new insights in the mechanisms regarding the formation of disc herniations and osteophytes.

Olmarker, Kjell

2011-01-01

2

Minimally invasive removal of a recurrent lumbar herniated nucleus pulposus by the small incised microendoscopic discectomy interlaminar approach.  

PubMed

In this report, we introduce two cases of recurrent herniated nucleus pulposus (HNP) at L5-S1 that were successfully removed using the small incised microendoscopic discectomy (sMED) technique, proposed by Dezawa and Sairyo in 2011. sMED was performed via the interlaminar approach with a percutaneous endoscope. The patients had previously underdone microendoscopic discectomy for HNP. For the recurrent HNP, the sMED interlaminar approach was selected because the HNP occurred at the level of L5-S1; the percutaneous endoscopic transforaminal approach was not possible for anatomical reasons. To perform sMED via the interlaminar approach, we employed new, specially made devices to enable us to use this technique. In conclusion, sMED is the most minimally invasive approach available for HNP, and its limitations have been gradually eliminated with the introduction specially made devices. In the near future, percutaneous endoscopic surgery could be the gold standard for minimally invasive disc surgery. PMID:22776341

Koga, S; Sairyo, K; Shibuya, I; Kanamori, Y; Kosugi, T; Matsumoto, H; Kitagawa, Y; Sumita, T; Dezawa, A

2012-02-01

3

Minimally invasive and simultaneous removal of herniated intracanal and extracanal lumbar nucleus pulposus with a percutaneous spinal endoscope.  

PubMed

Herniated nucleus pulposus (HNP) in the lumbar spine is usually found in the neural canal (in the intracanal space) and occasionally in the extracanal space, where it is known as a lateral HNP. HNP is rarely found simultaneously in both spaces. However, we experienced such a case in a 48-year-old man who presented with right leg pain and lower back pain that had lasted for more than a year. MRI revealed HNP in both the right intracanal and extracanal spaces at L2-L3. A transforaminal approach was used to complete a percutaneous endoscopic discectomy. An 8-mm incision was made with the patient under local anesthesia, and the percutaneous endoscope was inserted at the affected disc space. First, the HNP fragments in the intracanal space were removed, and then the cannula and endoscope were extracted to the extracanal space where the extracanal fragments were removed. Two hours after the surgery, the patient stood and walked. Right leg pain and lower back pain had disappeared. Unlike other techniques such as Love's procedure and the microendoscopic discectomy technique, the use of a transforaminal approach with the percutaneous endoscopic technique enables the HNP fragments in the intracanal and extracanal spaces to be removed at the same time with a single approach. PMID:23095297

Kitagawa, Yasuhiro; Sairyo, Koichi; Shibuya, Isao; Kitahama, Yoshihiro; Kanamori, Yasuo; Koga, Soichi; Matsumoto, Hironori; Sumita, Takayuki; Yamada, Atsuhisa; Dezawa, Akira

2012-11-01

4

A prospective randomized, double-blind, controlled clinical trial comparing epidural butorphanol plus corticosteroid with corticosteroid alone for sciatica due to herniated nucleus pulposus  

PubMed Central

Objective: To compare the efficacy of up to 3 epidural butorphanol plus corticosteroid with corticosteroid alone for sciatica due to herniated nucleus pulposus. Materials and Methods: In a randomized, double-blind controlled clinical trial, we administered up to 3 epidural injections of either 80 mg (2 mL) of methylprednisolone acetate and 1 mg (1 mL) of butorphanol diluted with 7 mL of isotonic saline or 80 mg (2 mL) of methylprednisolone acetate diluted with 8 mL of isotonic saline by a lumbar interlaminar approach under fluoroscopic guidance to 120 patients (60 patients in each group) with sciatica due to a herniated nucleus pulposus lasting for 4 weeks to 1 year. All patients had scores higher than 30 mm on visual analog scale (VAS). Information on the use of paracetamol, intensity of pain on a VAS ranging from 0 (no pain) to 100 mm (worst pain possible), Schober's test (cm), Straight Leg Raising test, neurologic examination assessing sensory deficits, motor deficits and reflex changes, and Oswestry Low Back Pain Disability Questionnaire were evaluated at 3 weeks, 6 weeks, and 3 months after the first injection. Results: There were no significant differences between the 2 groups with regard to baseline characteristics, withdrawals, and complication rate. Three weeks, 6 weeks, and 3 months after the first injection, all the outcome measures in the butorphanol plus corticosteroid group were significantly different from that of the corticosteroid group. Conclusions: Epidural butorphanol plus corticosteroid injections, as compared with corticosteroid alone injections, offered marked improvement in pain, reflex, motor and sensory deficits, and functional status and reduced the need for analgesics. Level of Evidence: Therapeutic Level I.

Maity, Abhijan; Mondal, Bikash Chandra; Saha, Debasish; Roy, Debasish Sinha

2012-01-01

5

Identification of novel nucleus pulposus markers  

PubMed Central

Mesenchymal stem-cell based therapies have been proposed as novel treatments for intervertebral disc degeneration, a prevalent and disabling condition associated with back pain. The development of these treatment strategies, however, has been hindered by the incomplete understanding of the human nucleus pulposus phenotype and by an inaccurate interpretation and translation of animal to human research. This review summarises recent work characterising the nucleus pulposus phenotype in different animal models and in humans and integrates their findings with the anatomical and physiological differences between these species. Understanding this phenotype is paramount to guarantee that implanted cells restore the native functions of the intervertebral disc. Cite this article: Bone Joint Res 2013;2:169–78.

Rodrigues-Pinto, R.; Richardson, S. M.; Hoyland, J. A.

2013-01-01

6

Nucleus pulposus tissue engineering: a brief review  

Microsoft Academic Search

Symptomatic intervertebral disc degeneration is associated with several spinal diseases, which cause losses of life quality\\u000a and money. Tissue engineering provides a promising approach to recover the functionality of the degenerative intervertebral\\u000a disc. Most studies are directed toward nucleus pulposus (NP) tissue engineering because disc degeneration is believed to originate\\u000a in NP region, and considerable progress has been made in

Xinlin Yang; Xudong Li

2009-01-01

7

Hypoxic Regulation of Nucleus Pulposus Cell Survival  

PubMed Central

This minireview examines the role of hypoxia, and hypoxia inducible factors (HIF-1 and HIF-2), in regulating the metabolism, function, and fate of cells of the nucleus pulposus in the intervertebral disk. We focus on the mechanisms by which both these hypoxia-sensitive transcription factors influence energy metabolism, radical dismutation, and expression of survival proteins. In addition, we discuss how cells of the nucleus respond to a number of hypoxia-sensitive proteins, including galectin-3, Akt, and VEGF. Where applicable, these discussions are extended to include the impact of these molecules and hypoxia on degenerating resident cells in the intervertebral niche. Finally, because the notch signaling pathway is responsive to hypoxia, we speculate that in the intervertebral niche, notch proteins participate in the regulation of disk precursor cell proliferation and differentiation. We predict that knowledge of each of these interactive proteins within the disk niche could be used to enhance renewal and promote differentiation and function of cells of the nucleus pulposus.

Risbud, Makarand V.; Schipani, Ernestina; Shapiro, Irving M.

2010-01-01

8

Transcriptional profiling of the nucleus pulposus: say yes to notochord  

PubMed Central

This editorial addresses the debate concerning the origin of adult nucleus pulposus cells in the light of profiling studies by Minogue and colleagues. In their report of several marker genes that distinguish nucleus pulposus cells from other related cell types, the authors provide novel insights into the notochordal nature of the former. Together with recently published work, their work lends support to the view that all cells present within the nucleus pulposus are derived from the notochord. Hence, the choice of an animal model for disc research should be based on considerations other than the cell loss and replacement by non-notochordal cells.

2010-01-01

9

Nucleus pulposus tissue engineering: a brief review.  

PubMed

Symptomatic intervertebral disc degeneration is associated with several spinal diseases, which cause losses of life quality and money. Tissue engineering provides a promising approach to recover the functionality of the degenerative intervertebral disc. Most studies are directed toward nucleus pulposus (NP) tissue engineering because disc degeneration is believed to originate in NP region, and considerable progress has been made in the past decade. Before this important technique is utilized for clinical treatment of disc degeneration, many challenges need to address including in all three principal components of tissue engineering, i.e., seed cells, signals and biomaterial scaffolds. This article briefly gives certain aspects of state of the art in this field, as well as pays a little more attention to our work published in the past 5 years, on growth and differentiation factor-5 (GDF-5), adipose-derived stem cells (ADSCs) and heparin functionalization of scaffold. We suggest that combinatorial application of ADSCs, GDF-5, heparin functionalization and injectable hydrogels will be advantageous in NP tissue engineering. PMID:19603198

Yang, Xinlin; Li, Xudong

2009-11-01

10

Effects of hypoxias and scaffold architecture on rabbit mesenchymal stem cell differentiation towards a nucleus pulposus-like phenotype  

Microsoft Academic Search

Nucleus pulposus grafts are needed for patients requiring replacement of their degenerated intervertebral discs. Bone marrow-derived mesenchymal stem cells (MSCs) are a potential autologous stem cell source for the nucleus pulposus regeneration. One of the key issues of constructing functional nucleus pulposus using MSCs, however, is to differentiate MSCs into nucleus pulposus phenotype in vitro and to maintain their phenotypic stability

Ganjun Feng; Xiaobing Jin; Jiang Hu; Haiyun Ma; Melanie J. Gupte; Hao Liu; Peter X. Ma

2011-01-01

11

An injectable vehicle for nucleus pulposus cell-based therapy  

Microsoft Academic Search

An injectable hydrogel, acting as a reservoir for cell delivery and mimicking the native environment, offers promise for nucleus pulposus (NP) repair and regeneration. Herein, the potential of a stabilised type II collagen hydrogel using poly(ethylene glycol) ether tetrasuccinimidyl glutarate (4S-StarPEG) cross-linker, enriched with hyaluronic acid (HA) was investigated. The optimally stabilised type II collagen hydrogel was determined by assessing

Estelle C. Collin; Sibylle Grad; Dimitrios I. Zeugolis; Claire S. Vinatier; Johann R. Clouet; Jérôme J. Guicheux; Pierre Weiss; Mauro Alini; Abhay S. Pandit

2011-01-01

12

In vitro Measurement of Nucleus Pulposus Swelling Pressure: A New Technique for Studies of Spinal Adaptation to Gravity.  

National Technical Information Service (NTIS)

Swelling of the intervertebral disc nucleus pulposus is altered by posture and gravity. We have designed and tested a new osmometer for in vitro determination of nucleus pulposus swelling pressure. The functional principle of the osmometer involves compre...

A. R. Hargens M. G. Glover M. M. Mahmood S. Gott S. R. Garfin

1992-01-01

13

Development and characterization of novel hydrogels for nucleus pulposus replacement  

NASA Astrophysics Data System (ADS)

Hydrogels have been proposed as candidates for nucleus pulposus replacement due to their similarity in mechanical behavior to the native tissue when subjected to transient or static loading; however, given the viscoelastic nature of soft biological tissues, the lack of dynamic testing is a significant inadequacy in the studies performed to date. Our goal was to identify hydrogel systems whose viscoelastic behavior, particularly under dynamic torsional shear, mimicked that of the native tissue. Hydrogels were formed via photopolymerization of glycidyl methacrylate and 1,2-epoxy-5-hexene modified poly(vinyl alcohol) and were allowed to equilibrate in Hank's solution prior to analysis. The viscoelastic behavior of all prepared materials was compared with that of sheep nucleus pulposi. Complex shear moduli and phase shift angles were determined from dynamic frequency sweeps in torsional shear. Resistance towards hydrolysis was assessed by evaluation of the viscoelastic behavior of hydrogels submerged in Hank's solution for progressively longer periods of time. For glycidyl methacrylate-PVA hydrogels the viscoelastic parameters could be modulated by varying the molecular weight of PVA and the concentration of polymer prior to photopolymerization. The mechanical behavior of 1,2-epoxy-5-hexene-PVA hydrogels could be regulated in a similar manner by altering the type and percentage of monomer used to induce polymerization. The phase shift angles of all hydrogels were lower than those of the nucleus pulposi; however, the complex shear moduli of both synthetic systems spanned the values observed for the natural system. Over the time frame of the experiment, no change in moduli was observed following submersion in Hank's solution. This study represents the first attempt to successfully mimic the viscoelastic nature of the nucleus pulposus exhibited under dynamic torsional loading with that of materials intended for use in tissue replacement.

Bader, Rebecca Ann

14

Inflammatory Cytokines Induce NOTCH Signaling in Nucleus Pulposus Cells  

PubMed Central

The objective of the study was to investigate how inflammatory cytokines, IL-1?, and TNF-? control NOTCH signaling activity in nucleus pulposus (NP) cells. An increase in expression of selective NOTCH receptors (NOTCH1 and -2), ligand (JAGGED2), and target genes (HES1, HEY1, and HEY2) was observed in NP cells following cytokine treatment. A concomitant increase in NOTCH signaling as evidenced by induction in activity of target gene HES1 and HEY1 promoters and reporter 12xCSL was seen. Moreover, treatment increased activity of a 2-kb NOTCH2 promoter. Treatment of cells with NF-?B and MAPK inhibitors abolished the inductive effect of cytokines on NOTCH2 promoter and its expression. Gain and loss-of-function studies confirmed the inductive effect of p65 on NOTCH2 promoter activity. In contrast, p50 blocked the cytokine induction of promoter activity. Supporting promoter studies, lentiviral delivery of sh-p65, and sh-IKK? significantly decreased cytokine dependent change in NOTCH2 expression. Interestingly, MAPK signaling showed an isoform-specific control of NOTCH2 promoter; p38?/?2/?, ERK1, and ERK2 contributed to cytokine dependent induction, whereas p38? played no role. Analysis of human NP tissues showed that NOTCH1 and -2 and HEY2 expression correlated with each other. Moreover, expression of NOTCH2 and IL-1? as well as the number of cells immunopositive for NOTCH2 significantly increased in histologically degenerate discs compared with non-degenerate discs. Taken together, these results explain the observed dysregulated expression of NOTCH genes in degenerative disc disease. Thus, controlling IL-1? and TNF-? activities during disc disease may restore NOTCH signaling and nucleus pulposus cell function.

Wang, Hua; Tian, Ye; Wang, Jianru; Phillips, Kate L. E.; Binch, Abbie L. A.; Dunn, Sara; Cross, Alison; Chiverton, Neil; Zheng, Zhaomin; Shapiro, Irving M.; Le Maitre, Christine L.; Risbud, Makarand V.

2013-01-01

15

Nucleus pulposus-induced nerve root injury: effects of diclofenac and ketoprofen  

Microsoft Academic Search

Main problem. Nucleus pulposus and\\/or chronic compression can induce spinal nerve root injury. Inflammation has been proposed as having major importance in the pathophysiologic mechanisms involved in the induction of such injuries. Corticosteroids, potent anti-inflammatory drugs, have been demonstrated to reduce nucleus pulposus-induced spinal nerve root injury. The aim of the present study was to assess the effects of two

M. Cornefjord; K. Olmarker; K. Otani; B. Rydevik

2002-01-01

16

Leptin activates RhoA/ROCK pathway to induce cytoskeleton remodeling in nucleus pulposus cells.  

PubMed

Hyperleptinemia is implicated in obesity-associated lumbar disc degeneration. Nevertheless, the effect of leptin on the intracellular signaling of nucleus pulposus cells is not clear. The current study sought to delineate the possible involvement of the RhoA/ROCK pathway in leptin-mediated cytoskeleton reorganization in nucleus pulposus cells. Nucleus pulposus cells isolated from scoliosis patients were treated with 10 ng/mL of leptin. Fluorescent resonance energy transfer analysis was used to determine the activation of RhoA signaling in nucleus pulposus cells. The protein expression of LIMK1 and cofilin-2 were analyzed by western blot analysis. F-actin cytoskeletal reorganization was assessed by rhodamine-conjugated phalloidin immunoprecipitation. Leptin induced F-actin reorganization and stress fiber formation in nucleus pulposus cells, accompanied by localized RhoA activation and phosphorylation of LIMK1 and cofilin. The RhoA inhibitor C3 exoenzyme or the ROCK inhibitor Y-27632 potently attenuated the effects of leptin on F-actin reorganization and stress fiber formation. Both inhibitors also prevented leptin-induced phosphorylation of LIMK1 and cofilin-2. Our study demonstrated that leptin activated the RhoA/ROCK/LIMK/cofilin-2 cascade to induce cytoskeleton reorganization in nucleus pulposus cells. These findings may provide novel insights into the pathogenic mechanism of obesity-associated lumbar disc degeneration. PMID:24441571

Li, Zheng; Liang, Jinqian; Wu, William Ka Kei; Yu, Xin; Yu, Jun; Weng, Xisheng; Shen, Jianxiong

2014-01-01

17

TGF? Controls CCN3 Expression in Nucleus Pulposus Cells of the Intervertebral Disc  

PubMed Central

Objective To investigate TGF? regulation of CCN3 expression in cells of the nucleus pulposus. Methods Real Time RT-PCR and Western blot analysis was used to measure CCN3 expression in the nucleus pulposus. Transfections were used to measure the effect of Smad3, MAPKs and AP1 on TGF? mediated CCN3 promoter activity. Lentiviral knock down of Smad3 was performed to asses the role of Smad3 in CCN3 expression. Results CCN3 was expressed in embryonic and adult intervertebral discs. TGF? decreased CCN3 expression and suppressed its promoter activity in nucleus pulposus cells. DN-Smad3, Smad3-siRNA or DN-AP1 had little effect on TGF? suppression of CCN3 promoter activity. However, p38 and ERK inhibitors blocked suppression of CCN3 by TGF?, suggesting involvement of these signaling pathways in the regulation. Interestingly, overexpression of Smad3, in absence of TGF? increased CCN3 promoter activity. We validated the role of Smad3 in controlling CCN3 expression in Smad3 null mice and in nucleus pulposus cells transduced with lentiviral shSmad3. In terms of function, treatment with rCCN3 showed a dose dependent decrease in proliferation of nucleus pulposus cells. Moreover, CCN3 treated cells shows a decrease in aggrecan, versican, CCN2 as well as collagen type I expression. Conclusion The opposing effect of TGF? on CCN2 and CCN3 expression and suppression of CCN2 by CCN3 in nucleus pulposus cells furthers the paradigm that these CCN proteins form an interacting triad, possibly important in maintaining extracellular matrix homeostasis and cell number.

Tran, Cassie M.; Smith, Harvey E.; Symes, Aviva; Rittie, Laure; Perbal, Bernard; Shapiro, Irving M.; Risbud, Makarand V.

2011-01-01

18

The effects of oxygen tension and antiaging factor Klotho on Wnt signaling in nucleus pulposus cells  

PubMed Central

Introduction The goals of this study were to examine the oxemic regulation of Wnt signaling to explore whether Wnt signaling accelerates the age-related degeneration of nucleus pulposus cells, and if so, to define the mechanism underlying this effect. We investigated the expression of Klotho, a newly identified antiaging gene, and whether its regulation is attributable to the suppression of Wnt signaling. Methods Rat nucleus pulposus cells were cultured under normoxic (21% O2) or hypoxic (2% O2) conditions, and the expression and promoter activity of Wnt signaling and Klotho were evaluated. The effect of Klotho protein was examined with transfection experiments, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, senescence-associated ?-galactosidase staining, and cell-cycle analysis. To determine the methylation status of the Klotho promoter region, bisulfite genomic sequencing analysis was performed. Its relation with the activation of Wnt signaling was assessed. We also examined whether the expression of Klotho could block the effects of pathological Wnt expression in nucleus pulposus cells. Results Nucleus pulposus cells exhibited increased ?-catenin mRNA and protein under the hypoxic condition. Klotho protein was expressed in vivo, and protein and messenger RNA expression decreased under the hypoxic condition. Klotho treatment decreased cell proliferation and induced the quiescence of nucleus pulposus cells. In addition, Klotho treatment inhibited expression of ?-catenin gene and protein compared with untreated control cells. Conclusions These data indicate that Wnt signaling and Klotho form a negative-feedback loop in nucleus pulposus cells. These results suggest that the expression of Klotho is regulated by the balance between upregulation and downregulation of Wnt signaling.

2012-01-01

19

In vitro measurement of nucleus pulposus swelling pressure: A new technique for studies of spinal adaptation to gravity  

NASA Technical Reports Server (NTRS)

Swelling of the intervertebral disc nucleus pulposus is altered by posture and gravity. We have designed and tested a new osmometer for in vitro determination of nucleus pulposus swelling pressure. The functional principle of the osmometer involves compressing a sample of nucleus pulposus with nitrogen gas until saline pressure gradients across a 0.45 microns Millipore filter are eliminated. Swelling pressure of both pooled dog and pooled pig lumbar disc nucleus pulposus were measured on the new osmometer and compared to swelling pressures determined using the equilibrium dialysis technique. The osmometer measured swelling pressures comparable to those obtained by the dialysis technique. This osmometer provides a rapid, direct, and accurate measurement of swelling pressure of the nucleus pulposus.

Hargens, A. R.; Glover, M. G.; Mahmood, M. M.; Gott, S.; Garfin, S. R.; Ballard, R.; Murthy, G.; Brown, M. D.

1992-01-01

20

Inflammation Induces Irreversible Biophysical Changes in Isolated Nucleus Pulposus Cells  

PubMed Central

Intervertebral disc degeneration is accompanied by elevated levels of inflammatory cytokines that have been implicated in disease etiology and matrix degradation. While the effects of inflammatory stimulation on disc cell metabolism have been well-studied, their effects on cell biophysical properties have not been investigated. The hypothesis of this study is that inflammatory stimulation alters the biomechanical properties of isolated disc cells and volume responses to step osmotic loading. Cells from the nucleus pulposus (NP) of bovine discs were isolated and treated with either lipopolysaccharide (LPS), an inflammatory ligand, or with the recombinant cytokine TNF-? for 24 hours. We measured cellular volume regulation responses to osmotic loading either immediately after stimulation or after a 1 week recovery period from the inflammatory stimuli. Cells from each group were tested under step osmotic loading and the transient volume-response was captured via time-lapse microscopy. Volume-responses were analyzed using mixture theory framework to investigate two biomechanical properties of the cell, the intracellular water content and the hydraulic permeability. Intracellular water content did not vary between treatment groups, but hydraulic permeability increased significantly with inflammatory treatment. In the 1 week recovery group, hydraulic permeability remained elevated relative to the untreated recovery control. Cell radius was also significantly increased both after 24 hours of treatment and after 1 week recovery. A significant linear correlation was observed between hydraulic permeability and cell radius in untreated cells at 24 hours and at 1-week recovery, though not in the inflammatory stimulated groups at either time point. This loss of correlation between cell size and hydraulic permeability suggests that regulation of volume change is disrupted irreversibly due to inflammatory stimulation. Inflammatory treated cells exhibited altered F-actin cytoskeleton expression relative to untreated cells. We also found a significant decrease in the expression of aquaporin-1, the predominant water channel in disc NP cells, with inflammatory stimulation. To our knowledge, this is the first study providing evidence that inflammatory stimulation directly alters the mechanobiology of NP cells. The cellular biophysical changes observed in this study are coincident with documented changes in the extracellular matrix induced by inflammation, and may be important in disease etiology.

Maidhof, Robert; Jacobsen, Timothy; Papatheodorou, Angelos; Chahine, Nadeen O.

2014-01-01

21

Current Developments in Tissue Engineering of Nucleus Pulposus for the Treatment of Intervertebral Disc Degeneration  

Microsoft Academic Search

The main cause for back pain is considered to be the degenerative changes in the intervertebral disc (IVD). Some evidence indicates that IVD degeneration originates from the nucleus pulposus (NP). The IVD does not possess self repair capacity. Current treatment options range from pain management to invasive procedures. The science of disc cell transplantation is still in its infancy. Advancement

Immanuel M. Sebastine; David J. Williams

2007-01-01

22

Morphologic characteristics of processes of nucleus pulposus cells in adult human intervertebral disc  

NASA Astrophysics Data System (ADS)

To explore morphologic characterizatics of cellular processes from adult human nucleus pulposus cells, the nucleus pulposus of adult human intervertebral disc were obtained from 8 patients (Thompson's grade I~II) and then the tissues specimens were carried out by frozen section and electron microscopic section as well as cell isolation and cultured, processes of nucleus pulposus cells were examined using light microscopy, laser scanning confocal microscopy and transmission electron microscopy. When examined at both the confocal and electron microscope level, all the cells possessed the processes and adjacent nucleus pulposus cells processes possessed a gap junction. But elongated and round cells can be examined when NP cells were monolayer cultured. The rate of elongated cells to round cells is 2.3 to 1. The elongated cells protrude along with the long axis of cell body without second processes. Dendritic processes of round cells protrude to all directions from the cell body with multiple-level processes. Processes are one of the morphologic characteristics of intervertebral disc cells which are different from articular cartilage chondrocytes. The research on processes functions will be helpful to understand pathomechanism of intervertebral disc degradation and open a new approach for cytobiology treatment of the intervertebral disc diseases.

Liu, Xiaoyun; Wu, Xinghuo; Hui, Liu; Xu, Weihua; Liu, Xianze; Yang, Shuhua

2008-12-01

23

The potential of chitosan-based gels containing intervertebral disc cells for nucleus pulposus supplementation  

Microsoft Academic Search

The suitability of chitosan-based hydrogels as scaffolds for the encapsulation of intervertebral disc (IVD) cells and the accumulation of a functional extracellular matrix mimicking that of the nucleus pulposus (NP) was investigated. The specific hypothesis under study was that the cationic chitosan would form an ideal environment in which large quantities of newly synthesized anionic proteoglycan could be entrapped. Indeed,

Peter Roughleya; Caroline Hoemannb; Eric DesRosiersc; Fackson Mwaled; John Antonioud; Mauro Alinie

24

MiR-27a Regulates Apoptosis in Nucleus Pulposus Cells by Targeting PI3K  

PubMed Central

The precise role of apoptosis in the pathogenesis of intervertebral disc degeneration (IDD) remains to be elucidated. We analyzed degenerative nucleus pulposus (NP) cells and found that the expression of miR-27a was increased. The overexpression of miR-27a was further verified using real-time RT-PCR. Bioinformatics target prediction identified phosphoinositide-3 kinases (PI3K) as putative targets of miR-27a. Furthermore, miR-27a inhibited PI3K expression by directly targeting their 3’-UTRs, and this inhibition was abolished by mutation of the miR-27a binding sites. Various cellular processes including cell growth, proliferation, migration and adhesion are regulated by activation of the PI3K/AKT signaling pathway, and nucleus pulposus cells are known to strongly express the phosphorylated survival protein AKT. Our results identify PI3K as a novel target of miR-27a. Upregulation of miR-27a thus targets PI3K, initiating apoptosis of nucleus pulposus cells. This present study revealed that downregulated miR-27a might develop a novel intervention for IDD treatment through the prevention of apoptosis in Nucleus pulposus Cells.

Chen, Huajiang; Yuan, Wen; Wang, Jianxi; Tang, Xianye

2013-01-01

25

miR-21 promotes human nucleus pulposus cell proliferation through PTEN/AKT signaling.  

PubMed

The precise role of nucleus pulposus cell proliferation in the pathogenesis of intervertebral disc degeneration remains to be elucidated. Recent findings have revealed that microRNAs, a class of small noncoding RNAs, may regulate cell proliferation in many pathological conditions. Here, we showed that miR-21 was significantly upregulated in degenerative nucleus pulposus tissues when compared with nucleus pulposus tissues that were isolated from patients with idiopathic scoliosis and that miR-10b levels were associated with disc degeneration grade. Moreover, bioinformatics target prediction identified PTEN as a putative target of miR-21. miR-21 inhibited PTEN expression by directly targeting the 3'UTR, and this inhibition was abolished through miR-21 binding site mutations. miR-21 overexpression stimulated cell proliferation and AKT signaling pathway activation, which led to cyclin D1 translation. Additionally, the increase in proliferation and cyclin D1 expression induced by miR-21 overexpression was almost completely blocked by Ly294002, an AKT inhibitor. Taken together, aberrant miR-21 upregulation in intervertebral disc degeneration could target PTEN, which would contribute to abnormal nucleus pulposus cell proliferation through derepressing the Akt pathway. Our study also underscores the potential of miR-21 and the PTEN/Akt pathway as novel therapeutic targets in intervertebral disc degeneration. PMID:24603539

Liu, Hongzhe; Huang, Xiangwang; Liu, Xiangyang; Xiao, Sheng; Zhang, Yi; Xiang, Tiecheng; Shen, Xiongjie; Wang, Guoping; Sheng, Bin

2014-01-01

26

Determination and comparison of specifics of nucleus pulposus cells of human intervertebral disc in alginate and chitosan-gelatin scaffolds  

PubMed Central

Introduction: Low back pain is a major economical and social problem nowadays. Intervertebral disc herniation and central degeneration of disc are two major reasons of low back pain that occur because of structural impairment of disc. The intervertebral disc contains three parts as follows : Annulus fibrosus, transitional region, and nucleus pulposus, which forms the central nucleus of the disc. The reduction of cell count and extracellular matrix, especially in nucleus pulposus, causes disc degeneration. Different scaffolds (natural and synthetic) have been used for tissue repairing and regeneration of the intervertebral disc in tissue engineering. Most scaffolds have biodegradable and biocompatible characteristics and also prepare a fine condition for proliferation and migration of cells. In this study, proliferation of NP cells of human intervertebral disc compromised in Chitosan-gelatin scaffold with alginate scaffold was studied. Materials and Methods: NP cells derived from nucleus pulposus by collagenase enzymatic hydrolysis. They were derived from patients who undergoing open surgery for discectomy in the Isfahan Alzahra hospital. Chitosan was blended with gelatin and glutaraldehyde was used for cross linking the two polymers. Then, alginate scaffold was prepared. Cellular suspension with 1 × 105 transferred to each scaffold and cultured for 21 days. Cell viability and proliferation investigated by trypan blue and (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Scanning electron microscope (SEM) was used to assert the porosity and to survey structure of scaffold. Results: MTT assay dem1onstrated that cell viability of third day had significant difference in contrast by first day in both scaffolds. Accordingly, there was a significant decreased in cellular viability from day 3 to 21. Results of the cell count showed a punctual elevation cell numbers for alginate scaffold but there was no similar result for chitosan–gelatin scaffold. Conclusion: Alginate scaffold prepared a better condition for proliferation of NP cells in comparison with chitosan–gelatin scaffold. Results of this study suggest that alginate scaffold could be useful in in vivo studies and treatment.

Renani, Hamid Bahramian; Ghorbani, Masood; Beni, Batool Hashemibeni; Karimi, Z; Mirhosseini, MM; Zarkesh, H; Kabiri, A

2012-01-01

27

Phenotypic characteristics of the nucleus pulposus: expression of hypoxia inducing factor-1, glucose transporter-1 and MMP-2.  

PubMed

Attempts to study the biology of the nucleus pulposus have been limited in scope due to the low rates of cell proliferation, difficulties in maintaining viable disc cells in culture and the absence of a clearly defined phenotype. The major objective of this communication is to construct a phenotypic signature for cells of the nucleus pulposus that is based on the hypothesis that in response to restriction on oxygen and nutrient flux, there is expression of HIF-1, GLUT-1 and MMP-2. Nucleus pulposus, as well as annulus fibrosus and cartilage of the vertebral end plates, was collected from rat spinal units. Western blot analysis and immunohistochemistry clearly showed that there was a significant level of expression of the HIF-1 beta isoform in the nucleus pulposus; HIF-1 beta was present at lower levels in cells of the annulus and the end plate. In contrast to HIF-1 beta, HIF-1 alpha was expressed only in the nucleus pulposus. This isoform was absent from both the cartilage end plate and annulus. We detected HIF-1 alpha immunohistochemically in the nucleus pulposus; however, the staining was light and diffuse. Cells of the nucleus pulposus expressed GLUT-1; in contrast, when probed by Western blot analysis the annulus and cartilage were negative for this protein. Western blot analysis also showed that in the nucleus pulposus the level of MMP-2 was high when compared to the adjacent tissues. We suggest that the differential expression of the two HIF isoforms, and GLUT-1 and MMP-2, provides a phenotypic signature that permits cells of the nucleus pulposus to be distinguished from neighboring tissues. Moreover, the presence of these isoforms provides evidence that cells of the disc respond to hypoxia and nutrient stress by upregulating stress-responsive genes. PMID:12107433

Rajpurohit, Ramesh; Risbud, Makarand V; Ducheyne, Paul; Vresilovic, Edward J; Shapiro, Irving M

2002-06-01

28

Determination of the strain-dependent hydraulic permeability of the compressed bovine nucleus pulposus  

Microsoft Academic Search

The hydraulic permeability, k, of the nucleus pulposus (NP) is crucial, both in withstanding compressive stress and for convective transport of nutrients within the disc. Permeability has previously been determined using biphasic mathematical models, but has not been found by direct permeation experiments, which is the objective of this study. Bovine coccygeal nucleus samples (n=64), ?10mm and thickness 683±49?m (mean±S.D.)

Paul Heneghan; Philip E. Riches

2008-01-01

29

Differentiation of mesenchymal stem cells towards a nucleus pulposus-like phenotype utilizing simulated microgravity In vitro  

Microsoft Academic Search

Summary  Mesenchymal stem cells (MSCs) were induced into a nucleus pulposus-like phenotype utilizing simulated microgravity in vitro in order to establish a new cell-based tissue engineering treatment for intervertebral disc degeneration. For induction of\\u000a a nucleus pulposus-like phenotype, MSCs were cultured in simulated microgravity in a chemically defined medium supplemented\\u000a with 0 (experimental group) and 10 ng\\/mL (positive control group) of

Wei Luo; Wei Xiong; Min Qiu; Yongwei Lv; Yong Li; Feng Li

2011-01-01

30

Exhaustion of nucleus pulposus progenitor cells with ageing and degeneration of the intervertebral disc  

PubMed Central

Despite the high prevalence of intervertebral disc disease, little is known about changes in intervertebral disc cells and their regenerative potential with ageing and intervertebral disc degeneration. Here we identify populations of progenitor cells that are Tie2 positive (Tie2+) and disialoganglioside 2 positive (GD2+), in the nucleus pulposus from mice and humans. These cells form spheroid colonies that express type II collagen and aggrecan. They are clonally multipotent and differentiated into mesenchymal lineages and induced reorganization of nucleus pulposus tissue when transplanted into non-obese diabetic/severe combined immunodeficient mice. The frequency of Tie2+ cells in tissues from patients decreases markedly with age and degeneration of the intervertebral disc, suggesting exhaustion of their capacity for regeneration. However, progenitor cells (Tie2+GD2+) can be induced from their precursor cells (Tie2+GD2?) under simple culture conditions. Moreover, angiopoietin-1, a ligand of Tie2, is crucial for the survival of nucleus pulposus cells. Our results offer insights for regenerative therapy and a new diagnostic standard.

Sakai, Daisuke; Nakamura, Yoshihiko; Nakai, Tomoko; Mishima, Taishi; Kato, Shunichi; Grad, Sibylle; Alini, Mauro; Risbud, Makarand V.; Chan, Danny; Cheah, Kathryn S.E.; Yamamura, Ken-ichi; Masuda, Koichi; Okano, Hideyuki; Ando, Kiyoshi; Mochida, Joji

2012-01-01

31

Difference in Energy Metabolism of Annulus Fibrosus and Nucleus Pulposus Cells of the Intervertebral Disc  

PubMed Central

Low back pain is associated with intervertebral disc degeneration. One of the main signs of degeneration is the inability to maintain extracellular matrix integrity. Extracellular matrix synthesis is closely related to production of adenosine triphosphate (i.e. energy) of the cells. The intervertebral disc is composed of two major anatomical regions: annulus fibrosus and nucleus pulposus, which are structurally and compositionally different, indicating that their cellular metabolisms may also be distinct. The objective of this study was to investigate energy metabolism of annulus fibrosus and nucleus pulposus cells with and without dynamic compression, and examine differences between the two cell types. Porcine annulus and nucleus tissues were harvested and enzymatically digested. Cells were isolated and embedded into agarose constructs. Dynamically loaded samples were subjected to a sinusoidal displacement at 2 Hz and 15% strain for 4 h. Energy metabolism of cells was analyzed by measuring adenosine triphosphate content and release, glucose consumption, and lactate/nitric oxide production. A comparison of those measurements between annulus and nucleus cells was conducted. Annulus and nucleus cells exhibited different metabolic pathways. Nucleus cells had higher adenosine triphosphate content with and without dynamic loading, while annulus cells had higher lactate production and glucose consumption. Compression increased adenosine triphosphate release from both cell types and increased energy production of annulus cells. Dynamic loading affected energy metabolism of intervertebral disc cells, with the effect being greater in annulus cells.

Salvatierra, Jessica Czamanski; Yuan, Tai Yi; Fernando, Hanan; Castillo, Andre; Gu, Wei Yong; Cheung, Herman S.; Huant, C.-Y. Charles

2011-01-01

32

Percutaneous Disc Decompression with Nucleoplasty-Volumetry of the Nucleus Pulposus Using Ultrahigh-Field MRI  

PubMed Central

Purpose To evaluate changes in nucleus pulposus volume as a potential parameter for the effects of disc decompression. Methods Fifty-two discs (T8 to L1) were extracted from 26 pigs and separated into thoracic (T8 to T11) and thoracolumbar discs (T12 to L1). The discs were imaged using 7.1 Tesla ultrahigh-field magnetic resonance imaging (MRI) with acquisition of axial T2-weighted turbo spin-echo sequences for determination of baseline and postinterventional nucleus pulposus volumes. Volumes were calculated using OsiriX® (http://www.osirix-viewer.com). After randomization, one group was treated with nucleoplasty, while the placebo group was treated with an identical procedure but without coblation current. The readers analyzing the MR images were blinded to the kind of procedure performed. Baseline and postinterventional volumes were compared between the nucleoplasty and placebo group. Results Average preinterventional nucleus volume was 0.799 (SD: 0.212) ml. Postinterventional volume reduction in the nucleoplasty group was significant at 0.052 (SD: 0.035) ml or 6.30% (p<0.0001) (thoracic discs) and 0.082 (SD: 0.042) ml or 7.25% (p?=?0.0078) (thoracolumbar discs). Nucleoplasty achieved volume reductions of 0.114 (SD: 0.054) ml or 14.72% (thoracic) and 0.093 (SD: 0.081) ml or 11.61% (thoracolumbar) compared with the placebo group. Conclusions Nucleoplasty significantly reduces thoracic and thoracolumbar nucleus pulposus volumes in porcine discs.

Kasch, Richard; Mensel, Birger; Schmidt, Florian; Drescher, Wolf; Pfuhl, Ralf; Ruetten, Sebastian; Merk, Harry R.; Kayser, Ralph

2012-01-01

33

Hydrodynamic stimulation and long term cultivation of nucleus pulposus cells: a new bioreactor system to induce extracellular matrix synthesis by nucleus pulposus cells dependent on intermittent hydrostatic pressure.  

PubMed

A novel bioreactor system was constructed to induce extracellular matrix (ECM) synthesis by intervertebral disc (ID) cells due to intermittent hydrostatic pressure. The developed system is completely sterilizable and reusable. It is viable for cultivation, immobilization, and stimulation of various other cell types and tissues especially for cartilage. The custom made lid allows long-run cultivation through semi-continuous operation. Manual interferences and therefore the risk of contamination are reduced. Sampling, medium changing and addition of supplements are easily performed from the connected conditioning vessel, which could be placed in an incubator. For the present investigations nucleus pulposus cells from pigs were taken and immobilized in agarose to obtain three-dimensional cell matrix constructs which were subjected to intermittent hydrostatic pressure. Afterwards the construct was biochemically examined. The proven constituents of ECM were found to be released in dependence of the magnitude and profile of the applied pressure. PMID:15636054

Gokorsch, S; Nehring, D; Grottke, C; Czermak, P

2004-11-01

34

Mechanical Compression and Nucleus Pulposus Application on Dorsal Root Ganglia Differentially Modify Evoked Neuronal Activity in the Thalamus  

PubMed Central

Abstract A combination of mechanical compression caused by a protruding disc and leakage of nucleus pulposus (NP) from the disc core is presumed to contribute to intervertebral disc hernia-related pain. Experimental models of disc hernia including both components have resulted in changes in neuronal activity at the level of the dorsal root ganglion (DRG) and spinal cord, but changes within the brain have been less well studied. However, acute application of NP to a DRG without mechanical compression rapidly increases neuronal activity in the thalamus, a major brain relay nucleus processing information from sensory pathways including ascending nociceptive tracts. The combination of mechanical compression and NP might therefore result in further increases in central neuronal activity. Using an experimental disc herniation rat model including both mechanical compression and NP the present study aimed to investigate changes in neuronal activity in the contralateral thalamic ventral posterior lateral nucleus in vivo. Measurements were obtained while electrically stimulating the ipsilateral sciatic nerve at A? fiber intensities. The L4 DRG was subjected to light mechanical compression and NP exposure, and acute changes in evoked thalamic responses were recorded for up to 40?min. In order to compare effects in naïve animals with effects following a longer period of NP exposure, animals that were either disc-punctured or sham-operated 24?h previously were also included. In all animals, light mechanical compression of the DRG depressed the number of evoked neuronal responses. Prior NP exposure resulted in less potent changes following mechanical compression (80% of baseline) than that observed in naïve animals (50%). During the subsequent NP application, the number of evoked responses compared to baseline increased in pre-exposed animals (to 87%) as well as in naïve animals (72%) in which the removal of the mechanical compression resulted in a further increase (106%). The contribution of acute DRG compression and disc material leakage to changes in transmission in central neuronal networks is likely to be complex and to involve both short-term and long-term effects. Since a light mechanical compression may reduce transmission in nociceptive pathways, it is possible that the presence or absence of NP is crucial for pain development in the acute phase of disc herniation.

Nilsson, Elin; Brisby, Helena; Rask, Katarina

2013-01-01

35

Noninvasive Quantification of Human Nucleus Pulposus Pressure with Use of T1?-Weighted Magnetic Resonance Imaging  

PubMed Central

Background: Early diagnosis is a challenge in the treatment of degenerative disc disease. A noninvasive biomarker detecting functional mechanics of the disc is needed. T1?-weighted imaging, a spin-lock magnetic resonance imaging technique, has shown promise for meeting this need in in vivo studies demonstrating the clinical feasibility of evaluating both intervertebral discs and articular cartilage. The objectives of the present study were (1) to quantitatively determine the relationship between T1? relaxation time and measures of nucleus pulposus mechanics, and (2) to evaluate whether the quantitative relationship of T1? relaxation time with the degenerative grade and glycosaminoglycan content extend to more severe degeneration. It was hypothesized that the isometric swelling pressure and compressive modulus would be directly correlated with the T1? relaxation time and the apparent permeability would be inversely correlated with the T1? relaxation time. Methods: Eight cadaver human lumbar spines were imaged to measure T1? relaxation times. The nucleus pulposus tissue from the L1 disc through the S1 disc was tested in confined compression to determine the swelling pressure, compressive modulus, and permeability. The glycosaminoglycan and water contents were measured in adjacent tissue. Linear regression analyses were performed to examine the correlation between the T1? relaxation time and the other measured variables. Mechanical properties and biochemical content were evaluated for differences associated with degeneration. Results: A positive linear correlation was observed between the T1? relaxation time on the images of the nucleus pulposus and the swelling pressure (r = 0.59), glycosaminoglycan content per dry weight (r = 0.69), glycosaminoglycan per wet weight (r = 0.49), and water content (r = 0.53). No significant correlations were observed between the T1? relaxation time and the modulus or permeability. Similarly, the T1? relaxation time, swelling pressure, glycosaminoglycan content per dry weight, and water content were significantly altered with degeneration, whereas the modulus and permeability were not. Conclusions: T1?-weighted magnetic resonance imaging has a strong potential as a quantitative biomarker of the mechanical function of the nucleus pulposus and of disc degeneration. Clinical Relevance: Several in vivo studies have previously demonstrated the clinical feasibility of using T1?-weighted imaging to evaluate both intervertebral discs and articular cartilage. Its application for the diagnosis of disc degeneration looks promising.

Nguyen, An M.; Johannessen, Wade; Yoder, Jonathon H.; Wheaton, Andrew J.; Vresilovic, Edward J.; Borthakur, Arijitt; Elliott, Dawn M.

2008-01-01

36

Injectable thermoreversible hyaluronan-based hydrogels for nucleus pulposus cell encapsulation  

Microsoft Academic Search

Introduction  Thermoreversible hydrogels have potential in spine research as they provide easy injectability and mild gelling mechanism\\u000a (by physical cross-link). The purpose of this study was to assess the potential of thermoreversible hyaluronan-based hydrogels\\u000a (HA-pNIPAM) (pNIPAM Mn = 10, 20, 35 × 103 g mol?1) as nucleus pulposus cells (NPC) carrier. \\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  Cytocompatibility (WST-1 assay), viability (trypan blue), morphology (toluidine blue), sulphated glycosaminoglycan synthesis\\u000a (DMMB assay)

Marianna Peroglio; Sibylle Grad; Derek Mortisen; Christoph Martin Sprecher; Svenja Illien-Jünger; Mauro Alini; David Eglin

37

Hypoxic regulation of nucleus pulposus cell survival: from niche to notch.  

PubMed

This minireview examines the role of hypoxia, and hypoxia inducible factors (HIF-1 and HIF-2), in regulating the metabolism, function, and fate of cells of the nucleus pulposus in the intervertebral disk. We focus on the mechanisms by which both these hypoxia-sensitive transcription factors influence energy metabolism, radical dismutation, and expression of survival proteins. In addition, we discuss how cells of the nucleus respond to a number of hypoxia-sensitive proteins, including galectin-3, Akt, and VEGF. Where applicable, these discussions are extended to include the impact of these molecules and hypoxia on degenerating resident cells in the intervertebral niche. Finally, because the notch signaling pathway is responsive to hypoxia, we speculate that in the intervertebral niche, notch proteins participate in the regulation of disk precursor cell proliferation and differentiation. We predict that knowledge of each of these interactive proteins within the disk niche could be used to enhance renewal and promote differentiation and function of cells of the nucleus pulposus. PMID:20133815

Risbud, Makarand V; Schipani, Ernestina; Shapiro, Irving M

2010-04-01

38

Injectable oxidized hyaluronic acid/adipic acid dihydrazide hydrogel for nucleus pulposus regeneration.  

PubMed

Injectable hydrogel allows irregular surgical defects to be completely filled, lessens the risk of implant migration, and minimizes surgical defects due to the solution-gel state transformation. Here, we first propose a method for preparing oxidized hyaluronic acid/adipic acid dihydrazide (oxi-HA/ADH) injectable hydrogel by chemical cross-linking under physiological conditions. Fourier transform infrared spectrometry and trinitrobenzene sulfonate assay were used to confirm the oxidation of hyaluronic acid. Rheological properties were measured to evaluate the working ability of the hydrogel for further clinical application. The oxi-HA/ADH in situ forming hydrogel can transform from liquid form into a gel-like matrix within 3-8 min, depending on the operational temperature. Furthermore, hydrogel degradation and cell assessment is also a concern for clinical application. Injectable oxi-HA/ADH8 hydrogel can maintain its gel-like state for at least 5 weeks with a degradation percentage of 40%. Importantly, oxi-HA/ADH8 hydrogel can assist in nucleus pulposus cell synthesis of type II collagen and aggrecan mRNA gene expression according to the results of real-time PCR analysis, and shows good biocompatibility based on cell viability and cytotoxicity assays. Based on the results of the current study, oxi-HA/ADH hydrogel may possess several advantages for future application in nucleus pulposus regeneration. PMID:20193782

Su, Wen-Yu; Chen, Yu-Chun; Lin, Feng-Huei

2010-08-01

39

The potential of chitosan-based gels containing intervertebral disc cells for nucleus pulposus supplementation.  

PubMed

The suitability of chitosan-based hydrogels as scaffolds for the encapsulation of intervertebral disc (IVD) cells and the accumulation of a functional extracellular matrix mimicking that of the nucleus pulposus (NP) was investigated. The specific hypothesis under study was that the cationic chitosan would form an ideal environment in which large quantities of newly synthesized anionic proteoglycan could be entrapped. Indeed, all the formulations of cell-seeded chitosan hydrogels, studied under in vitro culture conditions, showed that the majority of proteoglycan produced by encapsulated NP cells was retained within the gel rather than released into the culture medium. This was not always the case when annulus fibrosus cells were encapsulated, as unlike the nucleus cells the annulus cells often did not survive when cultured in chitosan. The results support the concept that chitosan may be a suitable scaffold for cell-based supplementation to help restore the function of the NP during the early stages of IVD degeneration. PMID:16125220

Roughley, Peter; Hoemann, Caroline; DesRosiers, Eric; Mwale, Fackson; Antoniou, John; Alini, Mauro

2006-01-01

40

TNF-? and IL-1? Dependent Induction of CCL3 Expression by Nucleus Pulposus Cells Promotes Macrophage Migration through CCR1  

PubMed Central

Objective To investigate TNF-? and IL-1? regulation of CCL3 expression in nucleus pulposus (NP) cells and in macrophage migration. Methods qRT-PCR and immunohistochemistry were used to measure CCL3 expression in NP cells. Transfections were used to determine the role of NF-?B, C/EBP-? and MAPK on cytokine mediated CCL3 promoter activity. Effect of NP-conditioned medium on macrophage migration was measured using a transwell system. Results An increase in CCL3 expression and promoter activity was observed in NP cells after TNF-? or IL-1? treatment. Treatment of cells with NF-?B and MAPK inhibitors abolished the effect of the cytokines on CCL3 expression. The inductive effect of p65 and C/EBP-? on CCL3 promoter was confirmed through gain- and loss-of-function studies. Noteworthy, co-transfection of p50 completely blocked cytokine and p65 dependent induction. In contrast, c-Rel and RelB had little effect on promoter activity. Lentiviral transduction with Sh-p65 and Sh-Ikk? significantly decreased TNF-? dependent increase in CCL3 expression. Analysis of degenerate human NP tissues showed that CCL3, but not CCL4 expression correlated positively with the grade of tissue degeneration. Importantly, treatment of macrophages with conditioned medium of NP cells treated with TNF-? or IL-1? promoted their migration; pretreatment of macrophages with antagonist to CCR1, primary receptor for CCL3 and CCL4, blocked cytokine mediated migration. Conclusions By controlling the activation of MAPK, NF-?B and C/EBP? signaling, TNF-? and IL-1? modulate the expression of CCL3 in NP cells. The CCL3-CCR1 axis may play an important role in promoting macrophage infiltration in degenerate, herniated discs.

Wang, Jianru; Tian, Ye; Phillips, Kate L.E.; Chiverton, Neil; Haddock, Gail; Bunning, Rowena A.; Cross, Alison K.; Shapiro, Irving M.; LeMaitre, Christine L.; Risbud, Makarand V.

2012-01-01

41

HIF-1? AND HIF-2? DEGRADATION IS DIFFERENTIALLY REGULATED IN NUCLEUS PULPOSUS CELLS OF THE INTERVERTEBRAL DISC  

PubMed Central

Studies of many cell types show that level of HIF-1? and HIF-2? is primarily controlled by oxygen-dependent proteasomal degradation, catalyzed by HIF prolyl-hydroxylases (PHDs). However, in hypoxic niche of the intervertebral disc, the mechanism of HIF-? turnover in nucleus pulposus cells is not yet known. We show that in nucleus pulposus cells HIF-1? and HIF-2? degradation was mediated through 26S proteasome irrespective of oxygen tension. Noteworthy, HIF-2? degradation through 26S proteasome was more pronounced in hypoxia. Surprisingly, treatment with DMOG, a PHD inhibitor, shows accumulation of only HIF-1? and induction in activity of its target genes but not of HIF-2?. Loss and gain of function analyses using lentiviral knockdown of PHDs and overexpression of individual PHDs show that in nucleus pulposus cells only PHD2 played a limited role in HIF-1? degradation, again HIF-2? degradation was unaffected. We also demonstrate that the treatment with inhibitors of lysosomal proteolysis results in a strong accumulation of HIF-1? and to a much smaller extent of HIF-2? levels. It is thus evident that in addition to PHD2 catalyzed degradation, HIF-1? turnover in nucleus pulposus cells is primarily regulated by oxygen-independent pathways. Importantly, our data clearly suggests that proteasomal degradation of HIF-2? is not mediated by classical oxygen dependent PHD pathway. These results for the first time provide a rationale for the normoxic stabilization as well as the maintenance of steady state levels of HIF-1? and HIF-2? in nucleus pulposus cells.

Fujita, Nobuyuki; Chiba, Kazuhiro; Shapiro, Irving M.; Risbud, Makarand V.

2011-01-01

42

HIF Regulation of ANK Expression in Nucleus Pulposus Cells: Possible Implications in Controlling Dystrophic Mineralization in the Intervertebral Disc  

PubMed Central

Objective Since nucleus pulposus cells reside in hypoxia, we determined if expression of ANK, a pyrophosphate transporter, is regulated by the HIF proteins. Methods Quantitative RT-PCR and Western blot were used to measure ANK expression in nucleus pulposus cells. Transfections were performed to determine the effect of HIF-1/-2 on ANK promoter activity. Results ANK was expressed in embryonic and mature rat disc. Oxygen dependent changes in ANK expression in nucleus pulposus cells were minimal. However, silencing of HIF-1? and HIF-2? resulted in increased ANK expression and upregulation of promoter activity. HIF mediated suppression of ANK was validated by measuring promoter activity in HIF-1? null embryonic fibroblasts. Compared with wild type cells, in hypoxia, there was induction of promoter activity in the null cells. We overexpressed HIF-1? and HIF-2? in nucleus pulposus cells and noted a significant suppression in ANK promoter activity. Since the ANK promoter contains two hypoxia response elements (HRE), we performed site-directed mutagenesis and measured promoter activity. We found that HIF-1 can bind to either of the HRE and suppress promoter activity. In contrast, HIF-2 was required to bind to both HRE to suppress activity. Finally, analysis of human nucleus pulposus tissue showed that while ANK was expressed in normal tissue, there was increased expression of ANK along with alkaline phosphatase in the degenerate state. Conclusion Both HIF-1 and HIF-2 serve as negative regulators of ANK expression in the disc. We propose that baseline ANK expression in the disc serves to prevent mineral formation under physiological conditions.

Skubutyte, Renata; Markova, Dessislava; Freeman, Theresa A.; Anderson, D. Greg; Dion, Arnold S.; Williams, Charlene J.; Shapiro, Irving M.; Risbud, Makarand V.

2011-01-01

43

Biomechanical Conditioning Enhanced Matrix Synthesis in Nucleus Pulposus Cells Cultured in Agarose Constructs with TGF?  

PubMed Central

Biomechanical signals play an important role in normal disc metabolism and pathology. For instance, nucleus pulposus (NP) cells will regulate metabolic activities and maintain a balance between the anabolic and catabolic cascades. The former involves factors such as transforming growth factor-? (TGF?) and mechanical stimuli, both of which are known to regulate matrix production through autocrine and paracrine mechanisms. The present study examined the combined effect of TGF? and mechanical loading on anabolic activities in NP cells cultured in agarose constructs. Stimulation with TGF? and dynamic compression reduced nitrite release and increased matrix synthesis and gene expression of aggrecan and collagen type II. The findings from this work has the potential for developing regenerative treatment strategies which could either slow down or stop the degenerative process and/or promote healing mechanisms in the intervertebral disc.

Tilwani, Reshma K.; Bader, Dan L.; Chowdhury, Tina T.

2012-01-01

44

Adult acute calcific discitis confined to the nucleus pulposus in the cervical spine: case report.  

PubMed

Acute calcific discitis is a rare condition in the pediatric population and has been reported in only 2 instances in the adult population. This report describes a case of acute calcific discitis that uniquely presented in the adult cervical spine. A 22-year-old woman presented with the chief complaint of sudden-onset neck pain. Nonsurgical management, including nonsteroidal antiinflammatory drugs, provided moderate symptom relief. Radiography revealed nucleus pulposus calcification at the C2-3 level. Contrast-enhanced MRI did not reveal any additional abnormalities. Further nonsurgical management, including physical therapy and nonsteroidal antiinflammatory drugs, led to complete symptom relief within 6 months. Follow-up imaging demonstrated that the calcification had nearly resolved. Acute calcific discitis should be managed conservatively; the prognosis for a complete recovery is excellent. The pathophysiology of the disorder is yet to be elucidated, and the disorder is not exclusive to the pediatric population. PMID:23746089

Azizaddini, Shahrzad; Arefanian, Saeed; Redjal, Navid; Walcott, Brian P; Mollahoseini, Reza

2013-08-01

45

Decreased swelling pressure of rat nucleus pulposus associated with simulated weightlessness  

NASA Technical Reports Server (NTRS)

Data are presented on the effects of actual and simulated weightlessness on the swelling pressure of nucleus pulposus in rats exposed to 12.5 days of flight aboard Cosmos 1887 or to seven days of tail suspension, respectively. The flight-exposed rats were adapted to normal gravity for over 50 hrs prior to sacrifice and tissue harvesting. In the experiments with flight-exposed rats, swelling pressures were 690, 675, and 622 mm Hg for flight rats, synchronous controls, and vivarium controls, respectively. In experiments with simulated weightlessness, swelling pressures were 295, 610, and 527 mm Hg for tail-suspended rats, cage controls, and vivarium controls, respectively, suggesting that fluid moves into the disc during seven days of simulated weightlessness.

Hargens, Alan R.; Mahmood, Mubashar

1989-01-01

46

Reduced Nucleus Pulposus Glycosaminoglycan Content Alters Intervertebral Disc Dynamic Viscoelastic Mechanics  

PubMed Central

The intervertebral disc functions over a range of dynamic loading regimes including axial loads applied across a spectrum of frequencies at varying compressive loads. Biochemical changes occurring in early degeneration, including reduced nucleus pulposus glycosaminoglycan content, may alter disc mechanical behavior and thus may contribute to the progression of degeneration. The objective of this study was to determine disc dynamic viscoelastic properties under several equilibrium loads and loading frequencies, and further, to determine how reduced nucleus glycosaminglycan content alters dynamic mechanics. We hypothesized (1) that dynamic stiffness would be elevated with increasing equilibrium load and increasing frequency, (2) that the disc would behave more elastically at higher frequencies, and finally, (3) that dynamic stiffness would be reduced at low equilibrium loads under all frequencies due to nucleus glycosaminoglycan loss. We mechanically tested control and chondroitinase-ABC injected rat lumbar motion segments at several equilibrium loads using oscillatory loading at frequencies ranging from 0.05 to 5 Hz. The rat lumbar disc behaved non-linearly with higher dynamic stiffness at elevated compressive loads irrespective of frequency. Phase angle was not affected by equilibrium load, although it decreased as frequency was increased. Reduced glycosaminoglycan decreased dynamic stiffness at low loads but not at high equilibrium loads and led to increased phase angle at all loads and frequencies. The findings of this study demonstrate the effect of equilibrium load and loading frequencies on dynamic disc mechanics and indicate possible mechanical mechanisms through which disc degeneration can progress.

Boxberger, John I.; Orlansky, Amy S.; Sen, Sounok; Elliott, Dawn M.

2009-01-01

47

Combination of Two Cytokine Inhibitors Reduces Nucleus Pulposus-Induced Nerve Injury More Than Using Each Inhibitor Separately  

PubMed Central

Although recent experimental studies indicate that disc-derived cytokines, as for instance TNF, seems to be intimately involved in the pathophysiology of sciatica and low back pain, the clinical studies performed do not provide conclusive data on TNF-inhibition as a useful complement for treatment of such conditions to existing modalities. Based on the fact that TNF is merely one component in a complex network it was assumed that the combination of a TNF-inhibitor and an IL-1?-inhibitor could potentiate the effects in a pig model on nucleus pulposus-induced nerve conduction velocity reduction. The data indicated that combination of two cytokine inhibitors seems to be more efficient in reducing the nucleus pulposus-induced effects on nerve conduction velocity than using each inhibitor separately. This may be considered if future clinical trials for the treatment of sciatica and low back pain using just a single inhibitor may continue to demonstrate inconclusive data.

Olmarker, Kjell

2011-01-01

48

Determination of the strain-dependent hydraulic permeability of the compressed bovine nucleus pulposus.  

PubMed

The hydraulic permeability, k, of the nucleus pulposus (NP) is crucial, both in withstanding compressive stress and for convective transport of nutrients within the disc. Permeability has previously been determined using biphasic mathematical models, but has not been found by direct permeation experiments, which is the objective of this study. Bovine coccygeal nucleus samples (n=64), phi10mm and thickness 683+/-49microm (mean+/-S.D.) were compressed axially to one of lambda=1.0, 0.9, 0.8, 0.7, 0.6, 0.5, 0.4 or 0.3, where lambda is the stretch ratio. Ringer's solution was permeated through the sample, with an o-ring ensuring axial flow. During stress equilibrium, k was determined and fitted to four permeability-strain equations. Permeability decreased exponentially with compression, and was best described by Values of k were comparable to those arising from mathematical models, lending confidence to permeability being determined from such models. PMID:18164714

Heneghan, Paul; Riches, Philip E

2008-01-01

49

Osmolarity and Intracellular Calcium Regulate Aquaporin2 Expression Through TonEBP in Nucleus Pulposus Cells of the Intervertebral Disc  

PubMed Central

The goal of this study was to examine the expression and regulation of aquaporin2 (AQP2), a tonicity-sensitive water channel in nucleus pulposus cells of the intervertebral disc. We found that AQP2 protein was expressed in vivo in both rat and human discs. We determined whether AQP2 promoter expression was regulated by osmolarity in a tonicity enhancer binding protein (TonEBP)-dependent manner. When TonEBP was suppressed under hypertonic conditions or overexpressed under isotonic conditions, AQP2 promoter activity was correspondingly inhibited or induced. The role of TonEBP in controlling AQP2 expression was confirmed using mouse embryonic fibroblasts (MEFs) derived from TonEBP-null mice. We studied whether calcium in addition to osmolarity played a role in regulation of AQP2 in nucleus pulposus cells. We also determined whether both TonEBP and calcineurin–nuclear factor of activated T cells (NFAT) signaling contributed to ionomycin, a calcium ionophore, mediated induction of AQP2. Co-transfection of AQP2 reporter with calcineurin (CnA/B) and/or NFAT1–4 vectors suggested that this pathway did not control AQP2 promoter activity in nucleus pulposus cells. These findings were also validated using MEFs from TonEBP, fibroblasts from CnA?- and CnA?-null mice, and mutant TonE reporter constructs. Results of these studies suggest that, in nucleus pulposus cells, osmotic pressure and calcium modulate AQP2 expression through TonEBP and are independent of the calcineurin–NFAT pathway. Because calcium flux reflects a change in applied stress, the possibility exists that NFAT5/TonEBP modulate not just water balance in the disc but also accommodate applied biomechanical forces.

Gajghate, Sachin; Hiyama, Akihiko; Shah, Monica; Sakai, Daisuke; Anderson, D. Greg; Shapiro, Irving M.; Risbud, Makarand V.

2009-01-01

50

BiDirectional Exchange of Membrane Components Occurs during Co-Culture of Mesenchymal Stem Cells and Nucleus Pulposus Cells  

Microsoft Academic Search

Mesenchymal stem cell (MSC)-based therapies have been proposed as novel treatments for intervertebral disc (IVD) degeneration. We have previously demonstrated that when MSCs are co-cultured with nucleus pulposus (NP) cells with direct cell-cell contact, they differentiate along the NP lineage and simultaneously stimulate the degenerate NP cell population to regain a normal (non-degenerate) phenotype, an effect which requires cell-cell communication.

Sandra Strassburg; Nigel W. Hodson; Patrick I. Hill; Stephen M. Richardson; Judith A. Hoyland

2012-01-01

51

Increase of Sodium Channels (Nav 1.8 and Nav 1.9) in Rat Dorsal Root Ganglion Neurons Exposed to Autologous Nucleus Pulposus  

PubMed Central

Purpose: It has been assumed that nucleus pulposus-induced activation of the dorsal root ganglion (DRG) may be related to an activation of sodium channels in the DRG neurons. In this study we assessed the expression of Nav 1.8 and Nav 1.9 following disc puncture. Method: Thirty female Sprague-Dawley rats were used. The L4/L5 disc was punctured by a needle (n=12) and compared to a sham group without disc puncture (n=12) and a naive group (n=6). At day 1 and 7, sections of the left L4 DRG were immunostained with anti-Nav 1.8 and Nav 1.9 antibodies. Result: At day 1 after surgery, both Nav 1.8-IR neurons and Nav 1.9-IR neurons were significantly increased in the disc puncture group compared to the sham and naive groups (p<0.05), but not at day 7. Conclusion: The findings in the present study demonstrate a neuronal mechanism that may be of importance in the pathophysiology of sciatic pain in disc herniation.

Watanabe, Kazuyuki; Larsson, Karin; Rydevik, Bjorn; Konno, Shin-ichi; Nordborg, Claes; Olmarker, Kjell

2014-01-01

52

Interactions of environmental conditions and mechanical loads have influence on matrix turnover by nucleus pulposus cells.  

PubMed

Disc degeneration is associated with several changes in the physicochemical environment of intervertebral disc cells. Nucleus pulposus (NP) cells in the center of degenerated discs are exposed to decreased glucose supply, osmolarity, pH, and oxygen levels. To understand the complexity of these interactions on a cellular level, we designed standardized experiments in which we compared responses to these environmental factors under normal levels with those seen under two different degrees of disc degeneration. We hypothesized that these changes in environmental stimuli influence gene expression of matrix proteins and matrix degrading enzymes and alter their responses to cyclic hydrostatic pressure (HP). Our results suggest that a simulation of degenerative conditions influences the degradation of disc matrix through impairing matrix formation and accelerating matrix resorption via up- or down-regulation of the respective target genes. The greatest effects were seen for decreases in glucose concentration and pH. Low oxygen had little influence. HP had little direct effect but appeared to counteract matrix degradation by reducing or inverting some of the adverse effects of other stimuli. For ongoing in vitro studies, interactions between mechanical stimuli and factors in the physicochemical environment should not be ignored as these could markedly influence results. PMID:21674606

Neidlinger-Wilke, Cornelia; Mietsch, Antje; Rinkler, Christina; Wilke, Hans-Joachim; Ignatius, Anita; Urban, Jill

2012-01-01

53

Regenerating Nucleus Pulposus of the Intervertebral Disc Using Biodegradable Nanofibrous Polymer Scaffolds  

PubMed Central

Low back pain is a leading health problem in the United States, which is most often resulted from nucleus pulposus (NP) degeneration. To date, the replacement of degenerated NP relies entirely on mechanical devices. However, a biological NP replacement implant is more desirable. Here, we report the regeneration of NP tissue using a biodegradable nanofibrous (NF) scaffold. Rabbit NP cells were seeded on the NF scaffolds to regenerate NP-like tissue both in vitro and in a subcutaneous implantation model. The NP cells on the NF scaffolds proliferated faster than those on control solid-walled (SW) scaffolds in vitro. Significantly more extracellular matrix (ECM) production (glycosaminoglycan and type II collagen) was found on the NF scaffolds than on the control SW scaffolds. The constructs were then implanted in the caudal spine of athymic rats for up to 12 weeks. The tissue-engineered NP could survive, produce functional ECM, remain in place, and maintain the disc height, which is similar to the native NP tissue.

Feng, Ganjun; Zhang, Zhanpeng; Jin, Xiaobing; Hu, Jiang; Gupte, Melanie J.; Holzwarth, Jeremy M.

2012-01-01

54

Modulating Notochordal Differentiation of Human Induced Pluripotent Stem Cells Using Natural Nucleus Pulposus Tissue Matrix  

PubMed Central

Human induced pluripotent stem cells (hiPSCs) can differentiate into notochordal cell (NC)-like cells when cultured in the presence of natural porcine nucleus pulposus (NP) tissue matrix. The method promises massive production of high-quality, functional cells to treat degenerative intervertebral discs (IVDs). Based on our previous work, we further examined the effect of cell-NP matrix contact and culture medium on the differentiation, and further assessed the functional differentiation ability of the generated NC-like. The study showed that direct contact between hiPSCs and NP matrix can promote the differentiation yield, whilst both the contact and non-contact cultures can generate functional NC-like cells. The generated NC-like cells are highly homogenous regarding the expression of notochordal marker genes. A culture medium containing a cocktail of growth factors (FGF, EGF, VEGF and IGF-1) also supported the notochordal differentiation in the presence of NP matrix. The NC-like cells showed excellent functional differentiation ability to generate NP-like tissue which was rich in aggrecan and collagen type II; and particularly, the proteoglycan to collagen content ratio was as high as 12.5–17.5 which represents a phenotype close to NP rather than hyaline cartilage. Collectively, the present study confirmed the effectiveness and flexibility of using natural NP tissue matrix to direct notochordal differentiation of hiPSCs, and the potential of using the generated NC-like cells for treating IVD degeneration.

Liu, Yongxing; Rahaman, Mohamed N.; Bal, B. Sonny

2014-01-01

55

Histologic findings of disc, end plate and neural elements after coblation of nucleus pulposus: an experimental nucleoplasty study  

Microsoft Academic Search

Background contextPartial removal of the nucleus has been shown to decompress herniated discs, relieving pressure on nerve roots and, in some cases, offering relief from disc pain. The nucleoplasty technique builds on earlier surgical approaches that helped validate the strategy of intranuclear tissue removal. Nucleoplasty, a new minimally invasive procedure using patented coblation technology, combines coagulation and ablation for partial

Yung C Chen; Sang-Heon Lee; Yamil Saenz; Norman L Lehman

2003-01-01

56

Regulation of CCN2/CTGF Expression in the Nucleus Pulposus of the Intervertebral Disc: Role of Smad and AP1 Signaling  

PubMed Central

Objective To investigate TGF? regulation of CTGF expression in cells of the nucleus pulposus. Methods Real Time RT-PCR and Western blot analysis was used to measure CTGF expression in the nucleus pulposus. Transfections were used to measure the effect of Smad2/3/7 and AP1on TGF? mediated CTGF promoter activity. Results CTGF expression was lower in the neonatal disc compared with the skeletally mature rat disc. An increase in CTGF expression and promoter activity was observed in nucleus pulposus cells after TGF? treatment. Deletion analysis indicated that promoter constructs lacking smad and AP1 motifs were unresponsive to treatment. Analysis showed that full-length Smad3 and the Smad3-MH2 domain alone increased CTGF activity. Further evidence of Smad3 and AP1 involvement was seen when DN-Smad3, SiRNA-Smad3, smad7 and DN-AP1 suppressed TGF? mediated activation of the CTGF promoter. When either Smad3 or AP1 sites were mutated, CTGF promoter induction by TGF? was suppressed. We also observed a decrease in expression of CTGF in discs of Smad3 null mice compared to the wild type. Analysis of human nucleus pulposus indicated a trend of increasing CTGF and TGF? expression in the degenerate state. Conclusion TGF?, through Smad3 and AP1, serves as a positive regulator of CTGF expression in the nucleus pulposus. We propose that CTGF is a part of the limited reparative response of the degenerate disc.

Tran, Cassie M.; Markova, Dessislava; Smith, Harvey E.; Susarla, Bala; Ponnappan, Ravi Kumar; Anderson, D Greg; Symes, Aviva; Shapiro, Irving M.; Risbud, Makarand V.

2011-01-01

57

Pain Behavior Changes Following Disc Puncture Relate to Nucleus Pulposus Rather than to the Disc Injury Per Se: An Experimental Study in Rats  

PubMed Central

It has previously been demonstrated that disc puncture in the rat induced changes in grooming and wet dog shakes, two behavioral changes that may be linked to discomfort and neuropathic pain. In this study the aim was to separate the effects of disc injury and the epidural presence of nucleus pulposus. Following anesthesia, the L4-5 disc was exposed using a dorsal approach. Ten rats received a superficial disc injury without nucleus pulposus leakage and ten rats received nucleus pulposus from a donor rat without disc injury. In ten animals the L4-5 disc was punctured using a ventral approach, with 10 corresponding controls. Spontaneous behavior was assessed after surgery. The data was matched to historical control of dorsal sham surgery and disc puncture. The study showed that the effects of nucleus pulposus were more pronounced than the effects induced by the disc injury. Ventral disc puncture did not induce any behavioral changes different from sham exposure. In conclusion, the data from the study indicate that behavioral changes induced by disc puncture are more likely to relate to the epidural presence of nucleus pulposus than the disc injury per se.

Nilsson, Elin; Nakamae, Toshio; Olmarker, Kjell

2011-01-01

58

Influence of preoperative nucleus pulposus status and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry  

PubMed Central

Background Currently, herniated nucleus pulposus (HNP) with radiculopathy and other preconditions are regarded as relative or absolute contraindications for lumbar total disc replacement (TDR). In Switzerland it is left to the surgeon's discretion when to operate. The present study is based on the dataset of SWISSspine, a governmentally mandated health technology assessment registry. We hypothesized that preoperative nucleus pulposus status and presence or absence of radiculopathy has an influence on clinical outcomes in patients treated with mono-segmental lumbar TDR. Methods Between March 2005 and April 2009, 416 patients underwent mono-segmental lumbar TDR, which was documented in a prospective observational multicenter mode. The data collection consisted of perioperative and follow-up data (physician based) and clinical outcomes (NASS, EQ-5D). Patients were divided into four groups according to their preoperative status: 1) group degenerative disc disease ("DDD"): 160 patients without HNP and no radiculopathy, classic precondition for TDR; 2) group "HNP-No radiculopathy": 68 patients with HNP but without radiculopathy; 3) group "Stenosis": 73 patients without HNP but with radiculopathy, and 4) group "HNP-Radiculopathy": 132 patients with HNP and radiculopathy. The groups were compared regarding preoperative patient characteristics and pre- and postoperative VAS and EQ-5D scores using general linear modeling. Results Demographics in all four groups were comparable. Regarding the improvement of quality of life (EQ-5D) there were no differences across the four groups. For the two main groups DDD and HNP-Radiculopathy no differences were found in the adjusted postoperative back- and leg pain alleviation levels, in the stenosis group back- and leg pain relief were lower. Conclusions Despite higher preoperative leg pain levels, outcomes in lumbar TDR patients with HNP and radiculopathy were similar to outcomes in patients with the classic indication; this because patients with higher preoperative leg pain levels benefit from a relatively greater leg pain alleviation. The group with absence of HNP but presence of radiculopathy showed considerably less benefits from the operation, which is probably related to ongoing degenerative processes of the posterior segmental structures. This observational multicenter study suggests that the diagnoses HNP and radiculopathy, combined or alone, may not have to be considered as absolute or relative contraindications for mono-segmental lumbar TDR anymore, whereas patients without HNP but with radiculopathy seem to be suboptimal candidates for the procedure.

2011-01-01

59

Nanofibrillated cellulose composite hydrogel for the replacement of the nucleus pulposus.  

PubMed

The swelling and compressive mechanical behavior as well as the morphology and biocompatibility of composite hydrogels based on Tween® 20 trimethacrylate (T3), N-vinyl-2-pyrrolidone (NVP) and nanofibrillated cellulose (NFC) were assessed in the present study. The chemical structure of T3 was verified by Fourier transform infrared spectroscopy and proton nuclear magnetic resonance, and the degree of substitution was found to be around 3. Swelling ratios of neat hydrogels composed of different concentrations of T3 and NVP were found to range from 1.5 to 5.7 with decreasing concentration of T3. Various concentrations of cellulose nanofibrils (0.2-1.6wt.%) were then used to produce composite hydrogels that showed lower swelling ratios than neat ones for a given T3 concentration. Neat and composite hydrogels exhibited a typical nonlinear response under compression. All composite hydrogels showed an increase in elastic modulus compared to neat hydrogel of about 3- to 8-fold, reaching 18kPa at 0% strain and 62kPa at 20% strain for the hydrogel with the highest NFC content. All hydrogels presented a porous and homogeneous structure, with interconnected pore cells of around 100nm in diameter. The hydrogels are biocompatible. The results of this study demonstrate that composite hydrogels reinforced with NFC may be viable as nucleus pulposus implants due to their adequate swelling ratio, which may restore the annulus fibrosus loading, and their increased mechanical properties, which could possibly restore the height of the intervertebral discs. PMID:21651996

Borges, Ana C; Eyholzer, Christian; Duc, Fabien; Bourban, Pierre-Etienne; Tingaut, Philippe; Zimmermann, Tanja; Pioletti, Dominique P; Månson, Jan-Anders E

2011-09-01

60

Changes in the molecular phenotype of nucleus pulposus cells with intervertebral disc aging.  

PubMed

Intervertebral disc (IVD) disorder and age-related degeneration are believed to contribute to low back pain. Cell-based therapies represent a promising strategy to treat disc degeneration; however, the cellular and molecular characteristics of disc cells during IVD maturation and aging still remain poorly defined. This study investigated novel molecular markers and their age-related changes in the rat IVD. Affymetrix cDNA microarray analysis was conducted to identify a new set of genes characterizing immature nucleus pulposus (NP) cells. Among these markers, select neuronal-related proteins (Basp1, Ncdn and Nrp-1), transcriptional factor (Brachyury T), and cell surface receptors (CD24, CD90, CD155 and CD221) were confirmed by real-time PCR and immunohistochemical (IHC) staining for differential expression between IVD tissue regions and among various ages (1, 12 and 21 months). NP cells generally possessed higher levels of mRNA or protein expression for all aforementioned markers, with the exception of CD90 in anulus fibrosus (AF) cells. In addition, CD protein (CD24 and CD90) and Brachyury (T) expression in immature disc cells were also confirmed via flow cytometry. Similar to IHC staining, results revealed a higher percentage of immature NP cells expressing CD24 and Brachyury, while higher percentage of immature AF cells was stained positively for CD90. Altogether, this study identifies that tissue-specific gene expression and age-related differential expression of the above markers do exist in immature and aged disc cells. These age-related phenotype changes provide a new insight for a molecular profile that may be used to characterize NP cells for developing cell-based regenerative therapy for IVD regeneration. PMID:23284858

Tang, Xinyan; Jing, Liufang; Chen, Jun

2012-01-01

61

Severity of spinal cord dysfunction and pain associated with hydrated nucleus pulposus extrusion in dogs.  

PubMed

Objective: To identify the severity of neurological deficits, presence of signs of cervical pain, and the site of intervertebral disc space extrusion in 21 dogs diagnosed via magnetic resonance imaging (MRI) with a hydrated nucleus pulposus extrusion (HNPE) and compare those findings to dogs with other compressive cervical myelopathies. Methods: Medical records and MRI findings were reviewed in dogs that were presented to two veterinary hospitals between 2006 and 2012 and subsequently diagnosed by MRI to have a HNPE (n = 21) or other compressive cervical myelopathies originating from the intervertebral disc (n = 174). Information obtained included signalment, severity of neurological deficits, presence of signs of neck pain, and site of HNPE. The severity of clinical neurological spinal cord dysfunction was determined for each dog in both groups using the Frankel scoring system (0-4). The MRI were reviewed for confirmation of diagnosis and site of HNPE. An ANOVA was used to compare age between groups and a Mann-Whitney test for pairwise comparisons of the Frankel score between groups. Values of p <0.05 were considered statistically significant. Results: Significantly more severe Frankel scores and less severe signs of cervical pain detected on palpation were observed in dogs with a HNPE as compared to dogs with other compressive myelopathies. The sites of HNPE were C3-C4 (8/21), C4-C5 (12/21), and C5-C6 (1/21). Clinical significance: Dogs affected with HNPE have more severe clinical neurological deficits and less severe signs of cervical pain as compared to dogs with other compressive cervical myelopathies. PMID:24992451

Hamilton, T; Glass, E; Drobatz, K; Agnello, K A

2014-07-21

62

Nucleus pulposus deformation in response to lumbar spine lateral flexion: an in vivo MRI investigation  

PubMed Central

Whilst there are numerous studies examining aspects of sagittal plane motion in the lumbar spine, few consider coronal plane range of motion and there are no in vivo reports of nucleus pulposus (NP) displacement in lateral flexion. This study quantified in vivo NP deformation in response to side flexion in healthy volunteers. Concomitant lateral flexion and axial rotation range were also examined to evaluate the direction and extent of NP deformation. Axial T2- and coronal T1-weighted magnetic resonance images (MRI) were obtained from 21 subjects (mean age, 24.8 years) from L1 to S1 in the neutral and left laterally flexed position. Images were evaluated for intersegmental ranges of lateral flexion and axial rotation. A novel methodology derived linear pixel samples across the width of the disc from T2 images, from which the magnitude and direction of displacement of the NP was determined. This profiling technique represented the relative hydration pattern within the disc. The NP was displaced away from the direction of lateral flexion in 95/105 discs (p < 0.001). The extent of NP displacement was associated strongly with lateral flexion at L2–3 (p < 0.01). The greatest range of lateral flexion occurred at L2–3, L3–4 and L4–5. Small intersegmental ranges of axial rotation occurred at all levels, but were not associated with NP displacement. The direction of NP deformation was highly predictable in laterally flexed healthy lumbar spines; however, the magnitude of displacement was not consistent with the degree of intersegmental lateral flexion or rotation.

Takasaki, Hiroshi; Singer, Kevin P.

2010-01-01

63

PKC? signalling activates ERK1/2, and regulates aggrecan, ADAMTS5, and miR377 gene expression in human nucleus pulposus cells.  

PubMed

The protein kinase C (PKC) signaling, a major regulator of chondrocytic differentiation, has been also implicated in pathological extracellular matrix remodeling, and here we investigate the mechanism of PKC?-dependent regulation of the chondrocytic phenotype in human nucleus pulposus (NP) cells derived from herniated disks. NP cells from each donor were successfully propagated for 25+ culture passages, with remarkable tolerance to repeated freeze-and-thaw cycles throughout long-term culturing. More specifically, after an initial downregulation of COL2A1, a stable chondrocytic phenotype was attested by the levels of mRNA expression for aggrecan, biglycan, fibromodulin, and lumican, while higher expression of SOX-trio and Patched-1 witnessed further differentiation potential. NP cells in culture also exhibited a stable molecular profile of PKC isoforms: throughout patient samples and passages, mRNAs for PKC ?, ?, ?, ?, ?, ?, and µ were steadily detected, whereas ?, ?, and ? were not. Focusing on the signalling of PKC?, an isoform that may confer protection against degeneration, we found that activation with the PKC?-specific activator small peptide ??RACK led sequentially to a prolonged activation of ERK1/2, increased abundance of the early gene products ATF, CREB1, and Fos with concurrent silencing of transcription for Ki67, and increases in mRNA expression for aggrecan. More importantly, ??RACK induced upregulation of hsa-miR-377 expression, coupled to decreases in ADAMTS5 and cleaved aggrecan. Therefore, PKC? activation in late passage NP cells may represent a molecular basis for aggrecan availability, as part of an PKC?/ERK/CREB/AP-1-dependent transcriptional program that includes upregulation of both chondrogenic genes and microRNAs. Moreover, this pathway should be considered as a target for understanding the molecular mechanism of IVD degeneration and for therapeutic restoration of degenerated disks. PMID:24312401

Tsirimonaki, Emmanouella; Fedonidis, Constantinos; Pneumaticos, Spiros G; Tragas, Adamantios A; Michalopoulos, Ioannis; Mangoura, Dimitra

2013-01-01

64

Differential expression of extracellular-signal-regulated kinase 5 (ERK5) in normal and degenerated human nucleus pulposus tissues and cells.  

PubMed

Extracellular-signal-regulated kinase 5 (ERK5) is a member of the mitogen-activated protein kinase (MAPK) family and regulates a wide variety of cellular processes such as proliferation, differentiation, necrosis, apoptosis and degeneration. However, the expression of ERK5 and its role in degenerated human nucleus pulposus (NP) is hitherto unknown. In this study, we observed the differential expression of ERK5 in normal and degenerated human nucleus pulposus tissues by using immunohistochemical staining and Western blot. Treatment of NP cells with Pro-inflammatory cytokine, TNF-? decreased ERK5 gene expression as well as NP marker gene expression; including the type II collagen and aggrecan. Suppression of ERK5 gene expression in NP cells by ERK5 siRNA resulted in decreased gene expression of type II collagen and aggrecan. Furthermore, inhibition of ERK5 activation by BIX02188 (5?M) decreased the gene expression of type II collagen and aggrecan in NP cells. Our results document the expression of ERK5 in degenerated nucleus pulposus tissues, and suggest a potential involvement of ERK5 in human degenerated nucleus pulposus. PMID:24857985

Liang, Weiguo; Fang, Dejian; Ye, Dongping; Zou, Longqiang; Shen, Yan; Dai, Libing; Xu, Jiake

2014-07-11

65

TonEBP and HIF Coordinate Hsp70 Expression in Hypoxic Nucleus Pulposus Cells: Role of Hsp70 in HIF-1? Degradation  

PubMed Central

The objective of our study was to examine the regulation of hypoxic expression of Hsp70 in nucleus pulposus cells and to determine if Hsp70 promoted HIF-1? degradation. Rat nucleus pulposus cells were maintained in culture in either 21% or 1% oxygen. To determine the regulation of Hsp70 expression by Tonicity enhancer binding protein (TonEBP) and HIF-1/2, loss- and gain-of-function experiments and mutational analysis of Hsp70 promoter were performed. Hypoxia increased Hsp70 expression in nucleus pulposus cells. Noteworthy, hypoxia increased TonEBP transactivation and mutation of TonE motifs blocked hypoxic induction of Hsp70 promoter. In contrast, mutation of HRE motifs coupled with loss of function experiments suggested that HIF-1 and HIF-2 suppressed Hsp70 promoter activity and transcription. Interestingly, HIF-? interferes with TonEBP function and suppresses inductive effect of TonEBP on Hsp70 promoter. In terms of Hsp70 function, when treated with Hsp70 transcriptional inhibitor, KNK437, there was an increase in HIF-1? protein stability and transcriptional activity. Likewise, when Hsp70 was overexpressed, the stability of HIF-1? and its transcriptional activity decreased. Hsp70 interacted with HIF-1? under hypoxic conditions and evidenced increased binding when treated with MG132, a proteasomal inhibitor. These results suggest that Hsp70 may promote HIF-1? degradation through proteasomal pathway in nucleus pulposus cells. In hypoxic and hyperosmolar nucleus pulposus cells, Hsp70, TonEBP and HIFs form a regulatory loop. We propose that the positive regulation by TonEBP and negative regulation of Hsp70 by HIF-1 and HIF-2 may serve to maintain Hsp70 levels in these cells, whereas Hsp70 may function in controlling HIF-1? homeostasis.

Gogate, Shilpa S.; Fujita, Nobuyuki; Skubutyte, Renata; Shapiro, Irving M; Risbud, Makarand V.

2012-01-01

66

PI3K/AKT Regulates Aggrecan Gene Expression by Modulating Sox9 Expression and Activity in Nucleus Pulposus Cells of the Intervertebral Disc  

PubMed Central

The goal of the investigation was to test the hypothesis that the PI3K/AKT signaling pathway regulates the expression of the major extracellular matrix component of the intervertebral disc, aggrecan, in nucleus pulposus cells. Primary rat nucleus pulposus cells were treated with PI3K inhibitor to measure changes in gene and protein expression. In addition, cells were transfected with various luciferase reporter plasmids to investigate mechanisms of regulation of aggrecan gene expression. We found that treatment of nucleus pulposus cells with a PI3K inhibitor, LY294002 resulted in decreased expression of aggrecan and a reduction in deposition of sulfated glycosaminoglycans. Moreover, pharmacological suppression or co-expression of dominant negative (DN)-PI3K or DN-AKT resulted in downregulation of aggrecan promoter activity. Expression of constitutively active (CA)-PI3K significantly induced aggrecan promoter activity. We observed that PI3K maintained Sox9 gene expression and activity: inhibition of PI3K/AKT resulted in decreased Sox9 expression, lowered promoter activity and mediated a reduction in Sox9 transcriptional activity. PI3K effects were independent of phosphorylation status of C-terminus transactivation domain (TAD) of Sox9. Finally, we noted that in nucleus pulposus cells, PI3K signaling controlled transactivation of p300 (p300-TAD activity), an important transcriptional coactivator of Sox9. Results of these studies demonstrate for the first time that PI3K/AKT signaling controls aggrecan gene expression, in part by modulating Sox9 expression and activity in cells of the nucleus pulposus.

Cheng, Chin-Chang; Uchiyama, Yoshiyasu; Hiyama, Akihiko; Gajghate, Sachin; Shapiro, Irving M.; Risbud, Makarand V.

2009-01-01

67

Osthole, a herbal compound, alleviates nucleus pulposus-evoked nociceptive responses through the suppression of overexpression of acid-sensing ion channel 3 (ASIC3) in rat dorsal root ganglion  

PubMed Central

Summary Background Osthole (Ost), a natural coumarin derivative, has been shown to inhibit many pro-inflammatory mediators and block voltage-gated Na+ channels. During inflammation, acidosis is an important pain inducer which activates nociceptors by gating depolarizing cationic channels, such as acid-sensing ion channel 3 (ASIC3). The aim of this study was to examine the effects of Ost on nucleus pulposus-evoked nociceptive responses and ASIC3 over-expression in the rat dorsal root ganglion, and to investigate the possible mechanism. Material/Methods Radicular pain was generated with application of nucleus pulposus (NP) to nerve root. Mechanical allodynia was evaluated using von Frey filaments with logarithmically incremental rigidity to calculate the 50% probability thresholds for mechanical paw withdrawal. ASIC3 protein expression in dorsal root ganglions (DRGs) was assessed with Western blot and immunohistochemistry. Membrane potential (MP) shift of DRG neurons induced by ASIC3-sensitive acid (pH6.5) was determined by DiBAC4 (3) fluorescence intensity (F.I.). Results The NP-evoked mechanical hyperalgesia model showed allodynia for 3 weeks, and ASIC3 expression was up-regulated in DRG neurons, reaching peak on Day 7. Epidural administration of Ost induced a remarkable and prolonged antinociceptive effect, accompanied by an inhibition of over-expressed ASIC3 protein and of abnormal shift of MP. Amiloride (Ami), an antagonist of ASIC3, strengthened the antinociceptive effect of Ost. Conclusions Up-regulation of ASIC3 expression may be associated with NP-evoked mechanical hyperalgesia. A single epidural injection of Ost decreased ASIC3 expression in DGR neurons and the pain in the NP-evoked mechanical hyperalgesia model. Osthole may be of great benefit for preventing chronic pain status often seen in lumbar disc herniation (LDH).

He, Qiu-Lan; Chen, Yuling; Qin, Jian; Mo, Sui-Lin; Wei, Ming; Zhang, Jin-Jun; Li, Mei-Na; Zou, Xue-Nong; Zhou, Shu-Feng; Chen, Xiao-Wu; Sun, Lai-Bao

2012-01-01

68

The avian intervertebral disc arises from rostral sclerotome and lacks a nucleus pulposus: Implications for evolution of the vertebrate disc  

PubMed Central

Deterioration of the intervertebral discs is an unfortunate consequence of aging. The intervertebral disc in mammals is composed of three parts: a jelly-like center called the nucleus pulposus, the cartilaginous annulus fibrosus and anterior and posterior endplates that attach the discs to vertebrae. In order to understand the origin of the disc, we have investigated the intervertebral region of chickens. Surprisingly, our comparison of mouse and chicken discs revealed that chicken discs lack nuclei pulposi. In addition, the notochord, which in mice forms nuclei pulposi, was found to persist as a rod-like structure and express Shh throughout chicken embryogenesis. Our fate mapping data indicates that cells originating from the rostral half of each somite are responsible for forming the avian disc while cells in the caudal region of each somite form vertebrae. A histological analysis of mammalian and non-mammalian organisms suggests that nuclei pulposi are only present in mammals.

Bruggeman, Bradley J.; Maier, Jennifer A.; Mohiuddin, Yasmin S.; Powers, Rae; Lo, YinTing; Guimaraes-Camboa, Nuno; Evans, Sylvia M.; Harfe, Brian D.

2012-01-01

69

Butterfly vertebra with lumbar intervertebral disc herniation.  

PubMed

A butterfly vertebra is a rare congenital anomaly that is usually asymptomatic. The authors, however, describe a novel case involving a butterfly vertebra overlapping with disc herniation that presented as radiculopathy. A butterfly vertebra is characterized by a symmetrical fusion defect resulting in a sagittal cleft vertebra. Only a few cases of butterfly vertebrae have been reported as incidental findings. This spinal anomaly may be associated with other congenital conditions such as Pfeiffer, Crouzon, Jarcho-Levin, and Alagille syndromes. Moreover, there is no previous report of a case associated with symptomatic disc herniation from the sagittal cleft. The authors excised the herniated disc fragment. They performed intraoperative discography after exposure of the corresponding intervertebral space via a conventional interlaminar approach. Histological examination of a tissue specimen showed scattered chondrocytes in the myxohyaline stroma, which indicated the nucleus pulposus. PMID:21819182

Cho, Hyung-Lea; Kim, Jin-Sung; Paeng, Sung Suk; Lee, Sang-Ho

2011-11-01

70

SMAD3 Functions as a Transcriptional Repressor of Acid-Sensing Ion Channel 3 (ASIC3) in Nucleus Pulposus Cells of the Intervertebral Disc  

PubMed Central

The goal of this investigation was to study the regulation of acid-sensing ion channel (ASIC)3 expression by TGF? in the nucleus pulposus cells of the intervertebral disc. Analysis of human nucleus pulposus tissue indicated decreased ASIC3 and elevated TGF? expression in the degenerate state. In a parallel study, treatment of nucleus pulposus cells with TGF? resulted in decreased expression of ASIC3 mRNA and protein. Suppression of ASIC3 promoter activity was evident when the nucleus pulposus cells were treated with TGF? or co-transfected with the constitutively active ALK5 or a smad3 construct. On the other hand, co-transfection of dominant negative smad3 or smad7 restored ASIC3 promoter activity. We validated the role of smad3 in controlling ASIC3 expression using cells derived from smad3-null mice. ASIC3 promoter activity in the null cells was 2- to 3-fold higher than the wildtype cells. Moreover, expression of smad3 in null cells decreased ASIC3 promoter activity by almost 50%. Further studies using deletion constructs and trichostatin A treatment showed that the full-length smad3 was necessary, and the suppression involved recruitment of histone deacetylase to the promoter. To determine the mechanism, we evaluated the rat ASIC3 promoter sequence and noted the presence of two smad interacting CAGA box motifs. Gel-shift and supershift analysis indicated that smad3 protein was bound to this motif. Chromatin immunoprecipitation analysis confirmed that smad3 bound both the CAGA elements. Results of these studies clearly show that TGF? is highly expressed in the degenerate disc and through smad3 serves as a negative regulator of ASIC3 expression.

Uchiyama, Yoshiyasu; Guttapalli, Asha; Gajghate, Sachin; Mochida, Joji; Shapiro, Irving M; Risbud, Makarand V

2008-01-01

71

[Coblation of nucleus pulposus in treatment of military men's lumbar disc protrusions].  

PubMed

Mini-invasive surgery is used more often for the treatment of spinal disc herniations today. Coblation is one of such contemporary methods. The aim of our investigation was to evaluate results of percutaneous disc nucleoplasty using coblation. 35 patients with disc protrusions diagnosed by MRI underwent operations using this method. We used Visual Analogue Pain Scale, took into account time of painless sitting, standing and walking position, and also patients' satisfaction to assess the immediate results of treatment and short-time outcomes. It was noted the better immediate results in group of operated patients in comparison with the non-operated group. It was obvious either on the table or the day after operation. There were 84 and 93% of good results in 3 months and in 1 year after operation, respectively. Coblation is definitely modern and effective way to treat disc protrusions with different types, sizes, and may be used in lumbar spine wherever. PMID:22888698

Manukovski?, V A; Badalov, V I; Tiulikov, K V; Korostelev, K E

2012-06-01

72

Variations in gene and protein expression in canine chondrodystrophic nucleus pulposus cells following long-term three-dimensional culture.  

PubMed

Intervertebral disc (IVD) degeneration greatly affects quality of life. The nucleus pulposus (NP) of chondrodystrophic dog breeds (CDBs) is similar to the human NP, because the cells disappear with age and are replaced by fibrochondrocyte-like cells. However, because IVD develops as early as within the first year of life, we used canines as a model to investigate in vitro the mechanisms underlying IVD degeneration. Specifically, we evaluated the potential of a three-dimensional (3D) culture of healthy NP as an in vitro model system to investigate the mechanisms of IVD degeneration. Agarose hydrogels were populated with healthy NP cells from beagles after performing magnetic resonance imaging, and mRNA expression profiles and pericellular extracellular matrix (ECM) protein distribution were determined. After 25 days of 3D culture, there was a tendency for redifferentiation into the native NP phenotype, and mRNA levels of Col2A1, COMP, and CK18 were not significantly different from those of freshly isolated cells. Our findings suggest that long-term 3D culture promoted chondrodystrophic NP redifferentiation through reconstruction of the pericellular microenvironment. Further, lipopolysaccharide (LPS) induced expression of TNF-?, MMP3, MMP13, VEGF, and PGES mRNA in the 3D cultures, creating a molecular milieu that mimics that of degenerated NP. These results suggest that this in vitro model represents a reliable and cost-effective tool for evaluating new therapies for disc degeneration. PMID:23658803

Iwata, Munetaka; Ochi, Hiroki; Asou, Yoshinori; Haro, Hirotaka; Aikawa, Takeshi; Harada, Yasuji; Nezu, Yoshinori; Yogo, Takuya; Tagawa, Masahiro; Hara, Yasushi

2013-01-01

73

Variations in Gene and Protein Expression in Canine Chondrodystrophic Nucleus Pulposus Cells following Long-Term Three-Dimensional Culture  

PubMed Central

Intervertebral disc (IVD) degeneration greatly affects quality of life. The nucleus pulposus (NP) of chondrodystrophic dog breeds (CDBs) is similar to the human NP, because the cells disappear with age and are replaced by fibrochondrocyte-like cells. However, because IVD develops as early as within the first year of life, we used canines as a model to investigate in vitro the mechanisms underlying IVD degeneration. Specifically, we evaluated the potential of a three-dimensional (3D) culture of healthy NP as an in vitro model system to investigate the mechanisms of IVD degeneration. Agarose hydrogels were populated with healthy NP cells from beagles after performing magnetic resonance imaging, and mRNA expression profiles and pericellular extracellular matrix (ECM) protein distribution were determined. After 25 days of 3D culture, there was a tendency for redifferentiation into the native NP phenotype, and mRNA levels of Col2A1, COMP, and CK18 were not significantly different from those of freshly isolated cells. Our findings suggest that long-term 3D culture promoted chondrodystrophic NP redifferentiation through reconstruction of the pericellular microenvironment. Further, lipopolysaccharide (LPS) induced expression of TNF-?, MMP3, MMP13, VEGF, and PGES mRNA in the 3D cultures, creating a molecular milieu that mimics that of degenerated NP. These results suggest that this in vitro model represents a reliable and cost-effective tool for evaluating new therapies for disc degeneration.

Iwata, Munetaka; Ochi, Hiroki; Asou, Yoshinori; Haro, Hirotaka; Aikawa, Takeshi; Harada, Yasuji; Nezu, Yoshinori; Yogo, Takuya; Tagawa, Masahiro; Hara, Yasushi

2013-01-01

74

Reconstruction of an In Vitro Niche for the Transition from Intervertebral Disc Development to Nucleus Pulposus Regeneration  

PubMed Central

The nucleus pulposus (NP) plays a prominent role in both the onset and progression of intervertebral disc degeneration. While autologous repair strategies have demonstrated some success, their in vitro culture system is outdated and insufficient for maintaining optimally functioning cells through the required extensive passaging. Consequently, the final population of cells may be unsuitable for the overwhelming task of repairing tissue in vivo and could result in subpar clinical outcomes. Recent work has identified synovium-derived stem cells (SDSCs) as a potentially important new candidate. This population of precursors can promote matrix regeneration and additionally restore the balance of catabolic and anabolic metabolism of surrounding cells. Another promising application is their ability to produce an extracellular matrix in vitro that can be modified via decellularization to produce a tissue-specific substrate for efficient cell expansion, while retaining chondrogenic potential. When combined with hypoxia, soluble factors, and other environmental regulators, the resultant complex microenvironment will more closely resemble the in vivo niche, which further improves the cell capacity, even after extensive passaging. In this review, the adaptive mechanisms NP cells utilize in vivo are considered for insight into what factors are important for constructing a tissue-specific in vitro niche. Evidence for the use of SDSCs for NP regeneration is also discussed. Many aspects of NP behavior are still unknown, which could lead to future work yielding key information on producing sufficient numbers of a high-quality NP-specific population that is able to regenerate deteriorated NP in vivo.

Shoukry, Mark; Li, Jingting

2013-01-01

75

In situ forming hydrogels composed of oxidized high molecular weight hyaluronic acid and gelatin for nucleus pulposus regeneration.  

PubMed

Encapsulation of nucleus pulposus (NP) cells within in situ forming hydrogels is a novel biological treatment for early stage intervertebral disc degeneration. The procedure aims to prolong the life of the degenerating discs and to regenerate damaged tissue. In this study we developed an injectable oxidized hyaluronic acid-gelatin-adipic acid dihydrazide (oxi-HAG-ADH) hydrogel. High molecular weight (1900 kDa) hyaluronic acid was crosslinked with various concentrations of gelatin to synthesize the hydrogels and their viscoelastic properties were analyzed. Interactions between the hydrogels, NP cells, and the extracellular matrix (ECM) were also evaluated, as were the effects of the hydrogels on NP cell gene expression. The hydrogels possess several clinical advantages, including sterilizability, low viscosity for injection, and ease of use. The viscoelastic properties of the hydrogels were similar to native tissue, as reflected in the complex shear modulus (?11-14 kPa for hydrogels, 11.3 kPa for native NP). Cultured NP cells not only attached to the hydrogels but also survived, proliferated, and maintained their round morphology. Importantly, we found that hydrogels increased NP cell expression of several crucial ECM-related genes, such as COL2A1, AGN, SOX-9, and HIF-1A. PMID:23041783

Chen, Yu-Chun; Su, Wen-Yu; Yang, Shu-Hua; Gefen, Amit; Lin, Feng-Huei

2013-02-01

76

Shh Signaling from the Nucleus Pulposus Is Required for the Postnatal Growth and Differentiation of the Mouse Intervertebral Disc  

PubMed Central

Intervertebral discs (IVD) are essential components of the vertebral column. They maintain separation, and provide shock absorbing buffers, between adjacent vertebrae, while also allowing movements between them. Each IVD consists of a central semi-liquid nucleus pulposus (NP) surrounded by a multi-layered fibrocartilagenous annulus fibrosus (AF). Although the IVDs grow and differentiate after birth along with the vertebral column, little is known about the mechanism of this. Understanding the signals that control normal IVD growth and differentiation would also provide potential therapies for degenerative disc disease, which is the major cause of lower back pain and affects a large proportion of the population. In this work, we show that during postnatal growth of the mouse, Sonic hedgehog (Shh) signaling from the NP cells controls many aspects of growth and differentiation of both the NP cells themselves and of the surrounding AF, and that it acts, at least partly, by regulating other signaling pathways in the NP and AF. Recent studies have shown that the NP cells arise from the embryonic notochord, which acts as a major signaling center in the embryo. This work shows that this notochord-derived tissue continues to carry out a major signaling function in the postnatal body and that the IVDs are signaling centers, in addition to their already known functions in the mechanics of vertebral column function.

Dahia, Chitra Lekha; Mahoney, Eric; Wylie, Christopher

2012-01-01

77

Synthesis and characterization of injectable bioadhesive hydrogels for nucleus pulposus replacement and repair of the damaged intervertebral disc.  

PubMed

Bioadhesive polymers are natural or synthetic materials that can be used for soft tissue repair. The aim of this investigation was to develop an injectable, bioadhesive hydrogel with the potential to serve as a synthetic replacement for the nucleus pulposus of the intervertebral disc or as an annulus closure material. Branched copolymers of poly(N-isopropylacrylamide) (PNIPAAm) and poly(ethylene glycol) (PEG) were blended with poly(ethylene imine) (PEI). This three component injectable system can form a precipitated gel at physiological temperature due to the phase transition of PNIPAAm. The injection of glutaraldehyde into the gel core will adhere the implant to the surrounding tissues. (1)H NMR results indicated the successful physical incorporation of PEI into the PNIPAAm-PEG network by blending. In addition, the covalent crosslinking between the amine functionalities on the PEI and the aldehyde functionalities on the glutaraldehyde was verified using FTIR difference spectroscopy. Mechanical characterization of these blends showed a significant increase (p < 0.05) in compressive modulus following glutaraldehyde injection. The in vitro bioadhesive force studies with porcine skin showed a significant increase (p < 0.05) in the mean maximum force of detachment for PNIPAAm-PEG/PEI gels when glutaraldehyde was injected into the gel core. The results of this study indicate that the reactivity between amines and aldehyde functionalities can be exploited to impart bioadhesive properties to PNIPAAm-PEG/PEI copolymers. PMID:20225214

Vernengo, J; Fussell, G W; Smith, N G; Lowman, A M

2010-05-01

78

Brain herniation  

MedlinePLUS

... herniation; Uncal herniation; Subfalcine herniation; Tonsillar herniation; Herniation - brain ... Brain herniation occurs when something inside the skull produces pressure that moves brain tissues. This is most ...

79

Hypoxia-inducible Factor (HIF)-1? and CCN2 Form a Regulatory Circuit in Hypoxic Nucleus Pulposus Cells  

PubMed Central

The objective of the study was to investigate if hypoxia-inducible factor (HIF)-1? and connective tissue growth factor (CCN2) form a regulatory network in hypoxic nucleus pulposus (NP) cells. A decrease in CCN2 expression and proximal promoter activity was observed in NP cells after hypoxic culture. Analysis of both human and mouse CCN2 promoters using the JASPAR core database revealed the presence of putative hypoxia response elements. Transfection experiments showed that both promoter activities and CCN2 expression decreases in hypoxia in a HIF-1?-dependent fashion. Interestingly, deletion analysis and mutation of the hypoxia responsive elements individually or in combination resulted in no change in promoter activity in response to hypoxia or in response to HIF-1?, suggesting an indirect mode of regulation. Notably, silencing of endogenous CCN2 increased HIF-1? levels and its target gene expression, suggesting a role for CCN2 in controlling basal HIF-1? levels. On the other hand, treatment of cells with rCCN2 resulted in a decrease in the ability of HIF-1? transactivating domain to recruit co-activators and diminished target gene expression. Last, knockdown of CCN2 in NP cells results in a significant decrease in GAG synthesis and expression of AGGRECAN and COLLAGEN II. Immunohistochemical staining of intervertebral discs of Ccn2 null embryos shows a decrease in aggrecan. These findings reveal a negative feedback loop between CCN2 and HIF-1? in NP cells and demonstrate a role for CCN2 in maintaining matrix homeostasis in this tissue.

Tran, Cassie M.; Fujita, Nobuyuki; Huang, Bau-Lin; Ong, Jessica R.; Lyons, Karen M.; Shapiro, Irving M.; Risbud, Makarand V.

2013-01-01

80

Expression of Laminin Isoforms, Receptors and Binding Proteins Unique to Nucleus Pulposus Cells of Immature Intervertebral Disc  

PubMed Central

Intervertebral disc (IVD) disorders are believed to be related to aging-related cell loss and phenotypic changes, as well as biochemical and structural changes in the extracellular matrix of the nucleus pulposus (NP) region. Previously, we found that the laminin ?1 chain was more highly expressed in immature NP porcine tissues, in parallel with the expression pattern for a laminin receptor, integrin ?6 subunit, as compared to adjacent anulus fibrosus region; suggesting that cell-matrix interactions may be unique to the immature NP. However, the identity of laminin isoforms specific to immature or mature NP tissues, their associated receptors and functional significance are still poorly understood. In this study, we evaluated the zonal-specific expression of the laminin chains, receptors (i.e. integrins) and other binding proteins in immature tissue and isolated cells of rat, porcine and human intervertebral disc, towards the goal of revealing features of cellular environment and cell-matrix interactions in the immature NP. Results from both immuno-histochemical staining and flow cytometry analysis found that NP cells expressed higher levels of the laminin ?5 chain, laminin receptors (integrin ?3, ?6, ?4 subunit and CD239) and related binding proteins (CD151), as compared to cells from adjacent anulus fibrosus. These differences suggest that laminin interactions with NP cells are distinct from that of the anulus fibrosus, and that laminins may be important contributors to region-specific IVD biology. The revealed laminin isoforms, their receptors and related binding proteins may be used as distinguishing features of these immature NP cells in the intervertebral disc.

Chen, Jun; Jing, Liufang; Gilchrist, Christopher L; Richardson, William J; Fitch, Robert D; Setton, Lori A

2010-01-01

81

Differentiation of Mouse Induced Pluripotent Stem Cells (iPSCs) into Nucleus Pulposus-Like Cells In Vitro  

PubMed Central

A large percentage of the population may be expected to experience painful symptoms or disability associated with intervertebral disc (IVD) degeneration – a condition characterized by diminished integrity of tissue components. Great interest exists in the use of autologous or allogeneic cells delivered to the degenerated IVD to promote matrix regeneration. Induced pluripotent stem cells (iPSCs), derived from a patient’s own somatic cells, have demonstrated their capacity to differentiate into various cell types although their potential to differentiate into an IVD cell has not yet been demonstrated. The overall objective of this study was to assess the possibility of generating iPSC-derived nucleus pulposus (NP) cells in a mouse model, a cell population that is entirely derived from notochord. This study employed magnetic activated cell sorting (MACS) to isolate a CD24+ iPSC subpopulation. Notochordal cell-related gene expression was analyzed in this CD24+ cell fraction via real time RT-PCR. CD24+ iPSCs were then cultured in a laminin-rich culture system for up to 28 days, and the mouse NP phenotype was assessed by immunostaining. This study also focused on producing a more conducive environment for NP differentiation of mouse iPSCs with addition of low oxygen tension and notochordal cell conditioned medium (NCCM) to the culture platform. iPSCs were evaluated for an ability to adopt an NP-like phenotype through a combination of immunostaining and biochemical assays. Results demonstrated that a CD24+ fraction of mouse iPSCs could be retrieved and differentiated into a population that could synthesize matrix components similar to that in native NP. Likewise, the addition of a hypoxic environment and NCCM induced a similar phenotypic result. In conclusion, this study suggests that mouse iPSCs have the potential to differentiate into NP-like cells and suggests the possibility that they may be used as a novel cell source for cellular therapy in the IVD.

Chen, Jun; Lee, Esther J.; Jing, Liufang; Christoforou, Nicolas; Leong, Kam W.; Setton, Lori A.

2013-01-01

82

Injectable hydrogels with high fixed charge density and swelling pressure for nucleus pulposus repair: biomimetic glycosaminoglycan analogues.  

PubMed

The load-bearing biomechanical role of the intervertebral disc is governed by the composition and organization of its major macromolecular components, collagen and aggrecan. The major function of aggrecan is to maintain tissue hydration, and hence disc height, under the high loads imposed by muscle activity and body weight. Key to this role is the high negative fixed charge of its glycosaminoglycan side chains, which impart a high osmotic pressure to the tissue, thus regulating and maintaining tissue hydration and hence disc height under load. In degenerate discs, aggrecan degrades and is lost from the disc, particularly centrally from the nucleus pulposus. This loss of fixed charge results in reduced hydration and loss of disc height; such changes are closely associated with low back pain. The present authors developed biomimetic glycosaminoglycan analogues based on sulphonate-containing polymers. These biomimetics are deliverable via injection into the disc where they polymerize in situ, forming a non-degradable, nuclear "implant" aimed at restoring disc height to degenerate discs, thereby relieving back pain. In vitro, these glycosaminoglycan analogues possess appropriate fixed charge density, hydration and osmotic responsiveness, thereby displaying the capacity to restore disc height and function. Preliminary biomechanical tests using a degenerate explant model showed that the implant adapts to the space into which it is injected and restores stiffness. These hydrogels mimic the role taken by glycosaminoglycans in vivo and, unlike other hydrogels, provide an intrinsic swelling pressure, which can maintain disc hydration and height under the high and variable compressive loads encountered in vivo. PMID:24270091

Sivan, S S; Roberts, S; Urban, J P G; Menage, J; Bramhill, J; Campbell, D; Franklin, V J; Lydon, F; Merkher, Y; Maroudas, A; Tighe, B J

2014-03-01

83

Expression of Prolyl Hydroxylases (PHDs) Is Selectively Controlled by HIF-1 and HIF-2 Proteins in Nucleus Pulposus Cells of the Intervertebral Disc  

PubMed Central

Adaptive response to hypoxia in nucleus pulposus cells of the intervertebral disc is regulated by the hypoxia-inducible factors, HIF-1? and HIF-2?. Moreover, oxygen-dependent turnover of HIF-1? in these cells is controlled by the prolyl-4-hydroxylase domain (PHD) family of proteins. Whether HIF homologues control expression of PHDs and whether PHDs control hypoxia-inducible factor (HIF) turnover and/or activity under hypoxia is not known. Here, we show that in nucleus pulposus cells, hypoxia robustly induces PHD3 expression and, to a lesser extent, of PHD2 and PHD1. Reporter analysis shows that the hypoxic induction of the PHD2 promoter is HIF-1? dependent, whereas PHD3 promoter/enhancer activity is dependent on both HIF-1? and HIF-2?. Lentiviral delivery of HIF-1?, ShHIF-1?, and ShHIF-1? confirmed these observations. Noteworthy, HIF-1? maintains basal expression of PHD1 in hypoxia at the posttranscriptional level. Finally, loss of function studies using lentiviral transduction of ShPHDs clearly shows that even at 1% O2, PHD2 selectively degrades HIF-1?. In contrast, in hypoxia, PHD3 enhances HIF-1? transcriptional activity without affecting protein levels. To correlate these observations with disc disease, a condition characterized by tissue vascularization, we analyzed human tissues. Increased PHD1 mRNA expression but decreased PHD2 and PHD3 expression is observed in degenerate tissues. Interestingly, the hypoxic responsiveness of all the PHDs is maintained in isolated nucleus pulposus cells regardless of the disease state. We propose that PHD2 and PHD3 can be used as a biomarker of tissue oxygenation in the disc and that, as such, it may have important clinical implications.

Fujita, Nobuyuki; Markova, Dessislava; Anderson, D. Greg; Chiba, Kazuhiro; Toyama, Yoshiaki; Shapiro, Irving M.; Risbud, Makarand V.

2012-01-01

84

Treatment of Lumbar Intervertebral Disc Herniation Using C-Arm Fluoroscopy Guided Target Percutaneous Laser Disc Decompression  

PubMed Central

Abstract Objective: To evaluate the safety and therapeutic efficacy of target percutaneous laser disc decompression (T-PLDD) for the treatment of lumbar disc herniation. Background data: PLDD using the Nd:YAG laser has been regarded as an effective alternative treatment for disc herniation. However, all the previous studies were concentrated on vaporizing the nucleus pulposus in the intervertebral space. We hypothesize that insertion of the needle into the extruded part of the nucleus pulposus will decrease its volume and provide superior clinical effects compared to therapies that decrease the volume of the intradiscal nucleus pulposus. Materials and methods: A total of 25 patients suffering from posterolateral extruded but nonsequestered lumbar intervertebral disc herniation were treated with T-PLDD. After treatment, the patients were followed up and the therapeutic effect was assessed at 1, 3, 6, and 12 months using the modified MacNab criteria. Results: The success rate was 80.0% (18 of 25), 88.0% (22 of 25), 92.0% (23 of 25), and 92.0% (23 of 25) at 1, 3, 6, and 12 months respectively. No serious complications occurred in any of the patients. Furthermore, we did not observe any neurological sequelae. Conclusions: T-PLDD can significantly decrease pain and improve function of patients who have extruded but nonsequestered lumbar intervertebral disc herniation.

Zhao, Xu-Li; Xu, Yong-Guang; Zhao, Xue-Jun; Song, Wen-Ge; Zheng, Hong

2012-01-01

85

An injectable nucleus replacement as an adjunct to microdiscectomy: 2 year follow-up in a pilot clinical study  

Microsoft Academic Search

Literature indicates that loss of disc tissue from herniation and\\/or surgery can accelerate degeneration of the disc. The\\u000a associated loss of disc height may correspond with recurrent back and\\/or leg pain. A novel hydrogel has been developed to\\u000a replace lost nucleus pulposus and potentially restore normal disc biomechanics following herniation and surgery. A single-center,\\u000a non-randomized, prospective feasibility study was undertaken

Ulrich Berlemann; Othmar Schwarzenbach

2009-01-01

86

Notochordal cells protect nucleus pulposus cells from degradation and apoptosis: implications for the mechanisms of intervertebral disc degeneration  

PubMed Central

Introduction The relative resistance of non-chondrodystrophic (NCD) canines to degenerative disc disease (DDD) may be due to a combination of anabolic and anti-catabolic factors secreted by notochordal cells within the intervertebral disc (IVD) nucleus pulposus (NP). Factors known to induce DDD include interleukin-1 beta (IL-1ß) and/or Fas-Ligand (Fas-L). Therefore we evaluated the ability of notochordal cell conditioned medium (NCCM) to protect NP cells from IL-1ß and IL-1ß +FasL-mediated cell death and degeneration. Methods We cultured bovine NP cells with IL-1ß or IL-1ß+FasL under hypoxic serum-free conditions (3.5% O2) and treated the cells with either serum-free NCCM or basal medium (Advanced DMEM/F-12). We used flow cytometry to evaluate cell death and real-time (RT-)PCR to determine the gene expression of aggrecan, collagen 2, and link protein, mediators of matrix degradation ADAMTS-4 and MMP3, the matrix protection molecule TIMP1, the cluster of differentiation (CD)44 receptor, the inflammatory cytokine IL-6 and Ank. We then determined the expression of specific apoptotic pathways in bovine NP cells by characterizing the expression of activated caspases-3, -8 and -9 in the presence of IL-1ß+FasL when cultured with NCCM, conditioned medium obtained using bovine NP cells (BCCM), and basal medium all supplemented with 2% FBS. Results NCCM inhibits bovine NP cell death and apoptosis via suppression of activated caspase-9 and caspase-3/7. Furthermore, NCCM protects NP cells from the degradative effects of IL-1ß and IL-1ß+Fas-L by up-regulating the expression of anabolic/matrix protective genes (aggrecan, collagen type 2, CD44, link protein and TIMP-1) and down-regulating matrix degrading genes such as MMP-3. Expression of ADAMTS-4, which encodes a protein for aggrecan remodeling, is increased. NCCM also protects against IL-1+FasL-mediated down-regulation of Ank expression. Furthermore, NP cells treated with NCCM in the presence of IL-1ß+Fas-L down-regulate the expression of IL-6 by almost 50%. BCCM does not mediate cell death/apoptosis in target bovine NP cells. Conclusions Notochordal cell-secreted factors suppress NP cell death by inhibition of activated caspase-9 and -3/7 activity and by up-regulating genes contributing anabolic activity and matrix protection of the IVD NP. Harnessing the restorative powers of the notochordal cell could lead to novel cellular and molecular strategies in the treatment of DDD.

2011-01-01

87

FasL on human nucleus pulposus cells prevents angiogenesis in the disc by inducing Fas-mediated apoptosis of vascular endothelial cells  

PubMed Central

The intervertebral disc is the largest avascular organ in the human body. However, with the progress of intervertebral disc degeneration (IDD), the disc tends to be vascularized increasingly via angiogenesis. It is well established that both human nucleus pulposus (NP) cells and vascular endothelial cells express FasL and Fas. However, the issue remains open as to whether there are certain active mechanisms preventing angiogenesis in the disc via the FasL-Fas machinery. Here, we established a co-culture system of human NP cells and vascular endothelial (HMEC-1) cells. We found that normal NP cells were more capable of inducing apoptosis in HMEC-1 cells (14.2±3.4%) than degenerate NP cells (6.7±1.9%), p<0.05. By up-regulating the FasL expression in degenerate NP cells, we found that FasL played an essential role in the mediation of HMEC-1 cell apoptosis with the activation of downstream FADD and caspase-3. Furthermore, we found an increased Fas expression in HMEC-1 cells following co-cultured with NP cells, which might be closely linked with FasL produced by NP cells and enhance their interaction. Collectively, this is the first study showing FasL-Fas network might plays an important role in the molecular mechanisms of angiogenesis avoidance of human disc. Consequently, our findings might shed light on the pathogenesis in human IDD and provide a novel target for the treatment strategies for IDD.

Sun, Zhen; Wan, Zhong-Yuan; Guo, Yun-Shan; Wang, Hai-Qiang; Luo, Zhuo-Jing

2013-01-01

88

Leptin Induces Cyclin D1 Expression and Proliferation of Human Nucleus Pulposus Cells via JAK/STAT, PI3K/Akt and MEK/ERK Pathways  

PubMed Central

Increasing evidence suggests that obesity and aberrant proliferation of nucleus pulposus (NP) cells are associated with intervertebral disc degeneration. Leptin, a hormone with increased circulating level in obesity, has been shown to stimulate cell proliferation in a tissue-dependent manner. Nevertheless, the effect of leptin on the proliferation of human NP cells has not yet been demonstrated. Here, we show that leptin induced the proliferation of primary cultured human NP cells, which expressed the leptin receptors OBRa and OBRb. Induction of NP cell proliferation was confirmed by CCK8 assay and immunocytochemistry and Real-time PCR for PCNA and Ki-67. Mechanistically, leptin induced the phosphorylation of STAT3, Akt and ERK1/2 accompanied by the upregulation of cyclin D1. Pharmacological inhibition of JAK/STAT3, PI3K/Akt or MEK/ERK signaling by AG490, Wortmannin or U0126, respectively, reduced leptin-induced cyclin D1 expression and NP cell proliferation. These experiments also revealed an intricate crosstalk among these signaling pathways in mediating the action of leptin. Taken together, we show that leptin induces human NP cell cyclin D1 expression and proliferation via activation of JAK/STAT3, PI3K/Akt or MEK/ERK signaling. Our findings may provide a novel molecular mechanism that explains the association between obesity and intervertebral disc degeneration.

Li, Zheng; Shen, Jianxiong; Wu, William Ka Kei; Yu, Xin; Liang, Jinqian; Qiu, Guixing; Liu, Jiaming

2012-01-01

89

Cervical radiculopathy caused by neural foraminal migration of a herniated calcified intervertebral disk in childhood: a case report.  

PubMed

Childhood intervertebral disk calcification is a rare clinical entity. Although its clinical course is usually benign, nerve root irritation or spinal cord compression can occasionally occur. We present the clinical and radiologic findings of a 9-year-old boy with cervical radiculopathy due to a herniated calcified intervertebral disk, which developed suddenly after swimming for 1 hour. Radiologic findings indicated that a calcified nucleus pulposus at the C6-7 level herniated into the spinal canal and migrated far into the right C6-7 neural foramen. Surgical management was performed 8 weeks after the onset of symptoms, because the initial presenting symptoms persisted despite conservative treatment. In children, calcified intervertebral disks can cause cervical radiculopathy that requires surgical management when they herniate and migrate far into the neural foramen. PMID:16271574

Park, Sung Min; Kim, Eun-Sang; Sung, Duk Hyun

2005-11-01

90

Changes in disc herniation after CT-guided Percutaneous Laser Disc Decompression (PLDD): MR findings  

NASA Astrophysics Data System (ADS)

The aim of Percutaneous Laser Disc Decompression (PLDD) is to vaporize a small portion of the nucleus pulposus. Clinical efficacy of this technique is largely proven. However, time-evolution of intervertebral disc and its hernia after PLDD is not known. This study analyses changes in disc herniation and its native intervertebral disc at a mean follow-up of 7.5 months after PLDD in asymptomatic patients. Main observations at MRI are appearance of a high signal on T2WI in the hernia in 59%, shrinking of the hernia in 66% and overall stability of disc height.

Brat, Hugues G.; Bouziane, Tarik; Lambert, Jean; Divano, Luisa

2004-09-01

91

Spontaneous regression of herniated lumbar discs.  

PubMed

The spontaneous regression of a lumbar herniated disc is a common occurrence. Studies using imaging techniques as well as immunohistologic analyses have attempted to explain the mechanism for regression. However, the exact mechanism remains elusive. Understanding the process by which herniated discs disappear in the absence of surgery may better guide treatment. Recent case reports, radiographic and immunohistologic studies show that the extent of extrusion of the nucleus pulposus is related to a higher likelihood of regression. To our knowledge, Patient 3 is the first report of spontaneous regression occurring within 2 months. This occurrence was discovered intraoperatively. We present three illustrative patients. Patient 1, a 53-year-old man, presented with a large L2-L3 disc herniation. His 2 year follow-up MRI revealed a complete regression of the extruded fragment. Patient 2, a 58-year-old man, presented with an L3-L4 disc herniation with cephalad migration of a free fragment. MRI 9 months later showed no free fragment but progression of a disc bulge. Intraoperative exploration during the L3-L4 microdiscectomy confirmed the absence of the free fragment. Patient 3, a 58-year-old woman, presented with a large L2-L3 disc extrusion with cephalad migration. An imaging study performed 2 months after the initial study revealed an absence of the free fragment. Our case reports demonstrate the temporal variance in disc regression. While the time course and extent of regression vary widely, the rapid time in which regression can occur should caution surgeons contemplating discectomy based on an MRI performed a significant period prior to surgery. PMID:24316264

Kim, Eric S; Oladunjoye, Azeem O; Li, Jay A; Kim, Kee D

2014-06-01

92

Inflammatory Cytokines Associated with Degenerative Disc Disease Control Aggrecanase-1 (ADAMTS-4) Expression in Nucleus Pulposus Cells through MAPK and NF-?B  

PubMed Central

We investigated TNF-? and IL-1? regulation of ADAMTS-4 expression in nucleus pulposus (NP) cells and its role in aggrecan degradation. Real-time quantitative RT-PCR, Western blotting, and transient transfections with rat NP cells and lentiviral silencing with human NP cells were performed to determine the roles of MAPK and NF-?B in cytokine-mediated ADAMTS-4 expression and function. ADAMTS4 expression and promoter activity increased in NP cells after TNF-? and IL-1? treatment. Treatment of cells with MAPK and NF-?B inhibitors abolished the inductive effect of the cytokines on ADAMTS4 mRNA and protein expression. Although ERK1, p38?, p38?2, and p38? were involved in induction, ERK2 and p38? played no role in TNF-?–dependent promoter activity. The inductive effect of p65 on ADAMTS4 promoter was confirmed through gain and loss-of-function studies. Cotransfection of p50 completely blocked p65-mediated induction. Lentiviral transduction with shRNA plasmids shp65, shp52, shIKK-?, and shIKK-? significantly decreased TNF-?–dependent increase in ADAMTS-4 and -5 levels and aggrecan degradation. Silencing of either ADAMTS-4 or -5 resulted in reduction in TNF-?–dependent aggrecan degradation in NP cells. By controlling activation of MAPK and NF-?B signaling, TNF-? and IL-1? modulate expression of ADAMTS-4 in NP cells. To our knowledge, this is the first study to show nonredundant contribution of both ADAMTS-4 and ADAMTS-5 to aggrecan degradation in human NP cells in vitro.

Tian, Ye; Yuan, Wen; Fujita, Nobuyuki; Wang, Jianru; Wang, Hua; Shapiro, Irving M.; Risbud, Makarand V.

2014-01-01

93

Hypoxic Regulation of ?1,3 Glucuronosyl Transferase-I (GlcAT-I) Expression in Nucleus Pulposus Cells of The Intervertebral Disc: Role of HIF Proteins  

PubMed Central

Objective The goal of the investigation was to study if hypoxia and HIF proteins regulate expression of GlcAT-I, a key enzyme in GAG synthesis in nucleus pulposus (NP) cells. Methods QRT-PCR and Western blot were used to measure GlcAT-I expression. Transfections were performed to determine the effect of HIF-1/-2 on GlcAT-I promoter activity. Results In hypoxia there was an increase in GlcAT-I expression; a significant increase in promoter activity was seen in both NP and N1511 chondrocytes. We investigated if HIF controlled GlcAT-I expression. Suppression of HIF-1? and HIF-2? induced GlcAT-I promoter activity and expression only in NP cells. While, GlcAT-I promoter activity was suppressed by co-expression of both CA-HIF-1? and CA-HIF-2? only in NP cells suggesting a cell type specific regulation. Site directed mutagenesis and deletion constructs were used to further confirm the suppressive role of HIFs on GlcAT-I promoter function in NP cells. Although it was evident that interaction of HIF with HRE results in suppression of basal promoter activity, it was not necessary for transcriptional suppression. This result suggested both a direct and an indirect mode of regulation possibly through recruitment of a HIF-dependent repressor. Finally we show that hypoxic expression of GlcAT-I was also partially dependent on MAPK signaling. Conclusions Results of these studies demonstrate that hypoxia regulates GlcAT-I expression through a signaling network comprising both an activator and suppressor molecules and that this regulation is unique to NP cells.

Gogate, Shilpa S.; Nasser, Rena; Shapiro, Irving M.; Risbud, Makarand V.

2011-01-01

94

In vitro characterization of a stem-cell-seeded triple-interpenetrating-network hydrogel for functional regeneration of the nucleus pulposus.  

PubMed

Intervertebral disc degeneration is implicated as a major cause of low-back pain. There is a pressing need for new regenerative therapies for disc degeneration that restore native tissue structure and mechanical function. To that end we investigated the therapeutic potential of an injectable, triple-interpenetrating-network hydrogel comprised of dextran, chitosan, and teleostean, for functional regeneration of the nucleus pulposus (NP) of the intervertebral disc in a series of biomechanical, cytotoxicity, and tissue engineering studies. Biomechanical properties were evaluated as a function of gelation time, with the hydrogel reaching ?90% of steady-state aggregate modulus within 10?h. Hydrogel mechanical properties evaluated in confined and unconfined compression were comparable to native human NP properties. To confirm containment within the disc under physiological loading, toluidine-blue-labeled hydrogel was injected into human cadaveric spine segments after creation of a nucleotomy defect, and the segments were subjected to 10,000 cycles of loading. Gross analysis demonstrated no implant extrusion, and further, that the hydrogel interdigitated well with native NP. Constructs were next surface-seeded with NP cells and cultured for 14 days, confirming lack of hydrogel cytotoxicity, with the hydrogel maintaining NP cell viability and promoting proliferation. Next, to evaluate the potential of the hydrogel to support cell-mediated matrix production, constructs were seeded with mesenchymal stem cells (MSCs) and cultured under prochondrogenic conditions for up to 42 days. Importantly, the hydrogel maintained MSC viability and promoted proliferation, as evidenced by increasing DNA content with culture duration. MSCs differentiated along a chondrogenic lineage, evidenced by upregulation of aggrecan and collagen II mRNA, and increased GAG and collagen content, and mechanical properties with increasing culture duration. Collectively, these results establish the therapeutic potential of this novel hydrogel for functional regeneration of the NP. Future work will confirm the ability of this hydrogel to normalize the mechanical stability of cadaveric human motion segments, and advance the material toward human translation using preclinical large-animal models. PMID:24410394

Smith, Lachlan J; Gorth, Deborah J; Showalter, Brent L; Chiaro, Joseph A; Beattie, Elizabeth E; Elliott, Dawn M; Mauck, Robert L; Chen, Weiliam; Malhotra, Neil R

2014-07-01

95

Three-dimensional hypoxic culture of human mesenchymal stem cells encapsulated in a photocurable, biodegradable polymer hydrogel: A potential injectable cellular product for nucleus pulposus regeneration.  

PubMed

Nucleus pulposus (NP) tissue damage can induce detrimental mechanical stresses and strains on the intervertebral disc, leading to disc degeneration. This study demonstrates the potential of a novel, photo-curable, injectable, synthetic polymer hydrogel (pHEMA-co-APMA grafted with polyamidoamine (PAA)) to encapsulate and differentiate human mesenchymal stem cells (hMSC) towards a NP phenotype under hypoxic conditions which could be used to restore NP tissue function and mechanical properties. Encapsulated hMSC cultured in media (hMSC and chondrogenic) displayed good cell viability up to day 14. The genotoxicity effects of ultraviolet (UV) on hMSC activity confirmed the acceptability of 2.5min of UV light exposure to cells. Cytotoxicity investigations revealed that hMSC cultured in media containing p(HEMA-co-APMA) grafted with PAA degradation product (10% and 20%v/v concentration) for 14days significantly decreased the initial hMSC adhesion ability and proliferation rate from 24hrs to day 14. Successful differentiation of encapsulated hMSC within hydrogels towards chondrogenesis was observed with elevated expression levels of aggrecan and collagen II when cultured in chondrogenic media under hypoxic conditions, in comparison with culture in hMSC media for 14days. Characterization of the mechanical properties revealed a significant decrease in stiffness and modulus values of cellular hydrogels in comparison with acellular hydrogels at both day 7 and day 14. These results demonstrate the potential use of an in vivo photo-curable injectable, synthetic hydrogel with encapsulated hMSC for application in the repair and regeneration of NP tissue. PMID:24793656

Kumar, Deepak; Gerges, Irini; Tamplenizza, Margherita; Lenardi, Cristina; Forsyth, Nicholas R; Liu, Yang

2014-08-01

96

Smad3 Controls ?-1,3-Glucuronosyltransferase 1 Expression in Rat Nucleus Pulposus Cells: Implications of Dysregulated Expression in Disc Disease  

PubMed Central

Objective To study the regulation of expression of ?-1,3-glucuronosyltransferase 1 (GlcAT-1), an important regulator of glycosaminoglycan (GAG) synthesis, by Smad3 in nucleus pulposus (NP) cells. Methods GlcAT-1 expression was examined in rat NP and anulus fibrosus (AF) cells treated with transforming growth factor ? (TGF?). The effects of Smad signaling and Smad suppression on GlcAT-1 were examined in rat NP cells. GlcAT-1 expression was analyzed in the discs of Smad3-null mice and in degenerated human NP tissue. Results TGF? increased the expression of GlcAT-1 in rat NP but not rat AF cells. Suppression of GlcAT-1 promoter activity was evident with dominant-negative ALK-5 (DN-ALK-5). Cotransfection with Smad3 strongly induced promoter activity independent of TGF?. Bioinformatics analysis indicated the presence of several Smad binding sites in the promoter; deletion analysis showed that the region between ?274 and ?123 bp was required for Smad3 response. DN-Smad3, Smad 3 small interfering RNA, and Smad7 strongly suppressed basal as well as TGF?-induced promoter activity. Induction of promoter activity by Smad3 was significantly blocked by DN-Smad3; Smad7 had a very small effect. Lentiviral transduction of NP cells with short hairpin RNA Smad3 resulted in a decrease in GlcAT-1 expression and accumulation of GAG. Compared to wild-type mice, significantly lower expression of GlcAT-1 was seen in the discs of Smad3-null mice. Analysis of degenerated human NP tissue specimens showed no positive correlation between GlcAT-1 and TGF? expression. Moreover, isolated cells from degenerated human tissue showed a lack of induction of GlcAT-1 expression following TGF? treatment, suggesting an altered response. Conclusion Our findings demonstrate that in healthy NP cells, the TGF?–Smad3 axis serves as a regulator of GlcAT-1 expression. However, an altered responsiveness to TGF? during disc degeneration may compromise GAG synthesis.

Wu, Qianghua; Wang, Jianru; Skubutyte, Renata; Kepler, Christopher K.; Huang, Zonggui; Anderson, D. Greg; Shapiro, Irving M.; Risbud, Makarand V.

2013-01-01

97

Co?culture of human nucleus pulposus cells with multipotent mesenchymal stromal cells from human bone marrow reveals formation of tunnelling nanotubes.  

PubMed

Degeneration of the intervertebral disc (IVD) is the main cause of age-related damage of spinal tissues. Using multipotent mesenchymal stromal cells (MSCs) regenerative medicine intends to restore the IVD components of annulus fibrosus (AF) and nucleus pulposus (NP). In the present study NP cells (NPCs) and MSCs obtained from adolescent patients suffering from scoliosis were used. IVDs and vertebrae were obtained during surgery and subsequently processed in order to establish cultures of NPCs and MSCs. The two cell types were co-cultured in 1-µm pore size insert system (indirect co-culture) or on one surface (direct co-culture). Prior to co-culture in these systems one of the cell types was stained by lipophilic fluorescent dye DiD (red). The results demonstrated that regardless of the cell type, the flow of DiD from stained to non-stained cells was more efficient in the direct co-culture in comparison with the insert system. Moreover, in the direct system the DiD flow was more efficient from MSCs towards NPCs compared with that in the opposite direction. These data indicated that the membrane interchange between the two cell types was asymmetric. To discriminate the subpopulation of cells that underwent membrane interchange, cells were double stained with DiD and DiO (green). In the first part of the experiment NPCs were stained by DiO and MSCs by DiD. In the second, NPCs were stained by DiD and MSCs by DiO. The cells were co-cultured in the direct system for 8 days and subsequently analyzed by flow cytometry and confocal microscopy. This analysis revealed that >50% of cells were stained by the DiO and DiD dyes. NPCs and MSCs formed structures similar to tunnelling nanotubes (TnT). In conclusion, the formation of TnT-like structures is able to promote, phenotypic changes during the direct co-culture of NPCs with MSCs. PMID:24271232

Lehmann, Tomasz P; Filipiak, Krystyna; Juzwa, Wojciech; Sujka-Kordowska, Patrycja; Jagodzi?ski, Pawe? P; Zabel, Maciej; G?owacki, Jakub; Misterska, Ewa; Walczak, Micha?; G?owacki, Maciej

2014-02-01

98

Growth differentiation factor 6 and transforming growth factor-beta differentially mediate mesenchymal stem cell differentiation, composition, and micromechanical properties of nucleus pulposus constructs  

PubMed Central

Introduction Currently, there is huge research focus on the development of novel cell-based regeneration and tissue-engineering therapies for the treatment of intervertebral disc degeneration and the associated back pain. Both bone marrow-derived (BM) mesenchymal stem cells (MSCs) and adipose-derived MSCs (AD-MSCs) are proposed as suitable cells for such therapies. However, currently no consensus exists as to the optimum growth factor needed to drive differentiation to a nucleus pulposus (NP)-like phenotype. The aim of this study was to investigate the effect of growth differentiation factor-6 (GDF6), compared with other transforming growth factor (TGF) superfamily members, on discogenic differentiation of MSCs, the matrix composition, and micromechanics of engineered NP tissue constructs. Methods Patient-matched human AD-MSCs and BM-MSCs were seeded into type I collagen hydrogels and cultured in differentiating media supplemented with TGF-?3, GDF5, or GDF6. After 14 days, quantitative polymerase chain reaction analysis of chondrogenic and novel NP marker genes and sulfated glycosaminoglycan (sGAG) content of the construct and media components were measured. Additionally, construct micromechanics were analyzed by using scanning acoustic microscopy (SAM). Results GDF6 stimulation of BM-MSCs and AD-MSCs resulted in a significant increase in expression of novel NP marker genes, a higher aggrecan-to-type II collagen gene expression ratio, and higher sGAG production compared with TGF-? or GDF5 stimulation. These effects were greater in AD-MSCs than in BM-MSCs. Furthermore, the acoustic-wave speed measured by using SAM, and therefore tissue stiffness, was lowest in GDF6-stiumlated AD-MSC constructs. Conclusions The data suggest that GDF6 stimulation of AD-MSCs induces differentiation to an NP-like phenotype and results in a more proteoglycan-rich matrix. Micromechanical analysis shows that the GDF6-treated AD-MSCs have a less-stiff matrix composition, suggesting that the growth factor is inducing a matrix that is more akin to the native NP-like tissue. Thus, this cell and growth-factor combination may be the ideal choice for cell-based intervertebral disc (IVD)-regeneration therapies.

2014-01-01

99

The Association of the Activation-Inducible Tumor Necrosis Factor Receptor and Ligand with Lumbar Disc Herniation  

PubMed Central

Purpose Herniated nucleus pulposus fragments are recognized by the immune system as a foreign-body, which results in an autoimmune reaction. Human activation-inducible tumor necrosis factor receptor (AITR) and its ligand, AITRL, are important costimulatory molecules in the pathogenesis of autoimmune diseases. Despite the importance of these costimulatory molecules in autoimmune disease, their role in the autoimmune reaction to herniated disc fragments has yet to be explored. The purpose of the present study is to investigate whether the overexpression of AITR and AITRL might be associated with lumbar disc herniation. Materials and Methods The study population consisted of 20 symptomatic lumbar disc herniation patients. Ten macroscopically normal control discs were obtained from patients with spinal fractures managed with anterior procedures that involved a discectomy. Peripheral blood samples from both the study patients and controls were collected. The expression levels of AITR and AITRL were investigated by flow cytometric analysis, confocal laser scanning microscopy, immunohistochemistry and by reverse transcriptase-polymerase chain reaction (RT-PCR). The soluble AITR and AITRL serum levels were measured by an enzyme-linked immunosorbent assay. Results Flow cytometric analysis revealed significantly higher levels of both AITR and AITRL in the lumbar disc herniation patients than in the controls. The AITRL expression levels were also increased in patients with lumbar disc herniation, shown by using confocal laser scanning microscopy, immunohistochemistry and RT-PCR. Finally, soluble AITR and AITRL were elevated in the patients with lumbar disc herniations. Conclusion The AITR and AITRL are increased in both the herniated disc tissue and the peripheral blood of patients with lumbar disc herniation.

Lee, Hwan-Mo; Hahn, Soo-Bong; Moon, Seong-Hwan; Kim, Yung-Tae; Lee, Choon-Sung; Jung, Hyo-Won; Kwon, Byoung-Se; Riew, K. Daniel

2007-01-01

100

Single-level calcified cervical disk herniation in a 13-year-old girl.  

PubMed

This article describes a case of a 13-year-old girl with single-level calcified cervical disk herniation. The patient was treated conservatively for a symptomatic intervertebral calcification that caused neurological compression, and the data were reviewed retrospectively. Previous reports have shown that the natural history of the disease is self-limiting with a benign course and an excellent prognosis. However, on rare occasions when the calcified nucleus pulposus herniates into the spinal canal and compresses the spinal cord or its roots, neurological abnormalities can occur, such as radiculopathy and myelopathy. This also raises the question of whether operative therapy will eventually be necessary. In the current case, conservative treatment was applied. Plain radiographs are usually sufficient to determine the presence and extent of a calcified cervical disk, and computed tomography or magnetic resonance imaging can detect an associated disk herniation. Conservative treatment with antalgics, muscle relaxants, neurotrophic drugs, and a cervical collar were applied. The patient was completely free of symptoms 3 weeks after the initial treatment. Magnetic resonance imaging indicated complete vertebral canal clearance at final follow-up. Cervical intervertebral disk calcification and herniation is a rare disorder in children with an obscure etiology but a good prognosis. Conservative therapy produces satisfactory results, even if clinical symptoms due to nerve root or spinal cord compression are present. Surgical treatments are only suitable in rare cases with severe progressive radicular pain or neurological deficit. PMID:22868626

Li, Min; Rong, Weiping; Pan, Xianming; Yu, Lin

2012-08-01

101

BMP-2 and TGF-? Stimulate Expression of ?1,3-Glucuronosyl Transferase 1 (GlcAT-1) in Nucleus Pulposus Cells Through AP1, TonEBP, and Sp1: Role of MAPKs  

PubMed Central

The goal of the study was to investigate bone morphogenetic protein 2 (BMP-2) and transforming growth factor ? (TGF-?) control of the expression of ?1,3-glucuronosyl transferase 1 (GlcAT-1), an important regulator of chondroitin sulfate synthesis in cells of the nucleus pulposus. Treatment with both growth factors resulted in induction of GlcAT-1 expression and promoter activity. Deletion analysis indicated that promoter constructs lacking AP1 and TonE sites were unresponsive to growth factor treatment. Experiments using dominant-negative proteins showed that these transcription factors along with Sp1 were required for induction of GlcAT-1 promoter activity. Moreover, when either AP1 or TonE binding sites were mutated, induction was suppressed. Both BMP-2 and TGF-? increased c-Jun and TonEBP expression and phosphorylation of transactivation domains. We investigated the role of the mitogen-activated protein kinase (MAPK) signaling pathway following growth factor treatment; a robust and transient activation of ERK1/2, p38, and JNK was noted. Treatment with MAPK inhibitors blocked BMP-2- and TGF-?-induced AP1 reporter function, GlcAT-1 expression, and GAG accumulation. We found that DN-ERK1 but not DN-ERK2 resulted in suppression of growth factor–mediated induction of GlcAT-1 promoter activity; we also showed that p38? was important in GlcAT-1 activation. Results of these studies demonstrate that BMP-2 and TGF-? regulate GlcAT-1 expression in nucleus pulposus cells through a signaling network comprising MAPK, AP1, Sp1, and TonEBP. It is concluded that by controlling both GAG and aggrecan synthesis, these growth factors positively influence disk cell function. © 2010 American Society for Bone and Mineral Research.

Hiyama, Akihiko; Gogate, Shilpa S; Gajghate, Sachin; Mochida, Joji; Shapiro, Irving M; Risbud, Makarand V

2010-01-01

102

Prolyl Hydroxylase 3 (PHD3) Modulates Catabolic Effects of Tumor Necrosis Factor-? (TNF-?) on Cells of the Nucleus Pulposus through Co-activation of Nuclear Factor ?B (NF-?B)/p65 Signaling*  

PubMed Central

Recent studies suggest a differential role of prolyl hydroxylase (PHD) isoforms in controlling hypoxia-inducible factor (HIF)-? degradation and activity in nucleus pulposus (NP) cells. However, the regulation and function of PHDs under inflammatory conditions that characterize disc disease are not yet known. Here, we show that in NP cells, TNF-? and IL-1? induce PHD3 expression through NF-?B. Lentiviral delivery of Sh-p65 and Sh-IKK? confirms that cytokine-mediated PHD3 expression is NF-?B-dependent. It is noteworthy that although both cytokines induce HIF activity, mechanistic studies using Sh-HIF-1? and PHD3 promoter/enhancer constructs harboring well characterized hypoxia response element (HRE) show lack of HIF involvement in cytokine-mediated PHD3 expression. Loss-of-function studies clearly indicate that PHD3 serves as a co-activator of NF-?B signaling activity in NP cells; PHD3 interacts with, and co-localizes with, p65. We observed that when PHD3 is silenced, there is a significant decrease in TNF-?-induced expression of catabolic markers that include ADAMTS5, syndecan4, MMP13, and COX2, and at the same time, there is restoration of aggrecan and collagen type II expression. It is noteworthy that hydroxylase function of PHDs is not required for mediating cytokine-dependent gene expression. These findings show that by enhancing the activity of inflammatory cytokines, PHD3 may serve a critical role in degenerative disc disease.

Fujita, Nobuyuki; Gogate, Shilpa S.; Chiba, Kazuhiro; Toyama, Yoshiaki; Shapiro, Irving M.; Risbud, Makarand V.

2012-01-01

103

Fluoroscopy Assisted Minimally Invasive Transplantation of Allogenic Mesenchymal Stromal Cells Embedded in HyStem Reduces the Progression of Nucleus Pulposus Degeneration in the Damaged Interverbal Disc: A Preliminary Study in Rabbits  

PubMed Central

This study was conducted to develop a technique for minimally invasive and accurate delivery of stem cells to augment nucleus pulposus (NP) in damaged intervertebral discs (IVD). IVD damage was created in noncontiguous discs at L4-L5 level; rabbits (N = 12) were randomly divided into three groups: group I treated with MSCs in HyStem hydrogel, group II treated with HyStem alone, and group III received no intervention. MSCs and hydrogel were administered to the damaged disc under guidance of fluoroscopy. Augmentation of NP was assessed through histological and MRI T2 mapping of the NP after eight weeks of transplantation. T2 weighted signal intensity was higher in group I than in groups II and III (P < 0.05). Disc height index showed maximum disc height in group I compared to groups II and III. Histological score of the degenerative index was significantly (P < 0.05) lower in group I (8.6 ± 1.8) than that in groups II (11.6 ± 2.3) and III (18.0 ± 5.7). Immunohistochemistry staining for collagen type II and aggrecan staining were higher in group I as compared to other groups. Our results demonstrate that the minimally invasive administration of MSCs in hyaluronan hydrogel (HyStem) augments the repair of NP in damaged IVD.

Puvanan, Karunanithi; Murali, Malliga Raman; Balaji Raghavendran, Hanumantha Rao; Shani, Samuel; Abdullah, Basri Johan Jeet; Amir Abbas, Azlina; Mohamed, Jamal Azmi; Kamarul, Tunku

2014-01-01

104

The use of a novel injectable hydrogel nucleus pulposus replacement in restoring the mechanical properties of cyclically fatigued porcine intervertebral discs.  

PubMed

Repeated flexion and extension of an intervertebral disc has been shown to affect the angular stiffness of spinal motion segments and is a barometer of the mechanical integrity of the disc. A degenerated disc that loses height causes higher levels of stress on the annulus and facet joints which may increase its level of degeneration; restoring disc height may therefore help to slow this degenerative cascade. Previous research has indicated that nucleus implants have the potential to improve the mechanical characteristics of a disc and an implant that is custom-fit to the intervertebral disc yields the best results with respect to decreasing annular degeneration. Two groups of porcine spinal motion segments were exposed to repeated flexion and extension. One group was then injected with a novel hydrogel while the other group was used as a control. Both groups were then exposed to another round of cyclic flexion and extension to examine the effect that the hydrogel had on restoring the original mechanics to the motion segments. Angular stiffness was restored to the group which received the hydrogel injection in addition to a significant improvement in specimen height. No significant changes were seen in the group which did not receive an injection. It would appear that use of the novel injectable hydrogel is able to restore angular stiffness to cyclically fatigued spinal motion segments. It is also important to note that continued repetition of the event causing specimen fatigue after performing hydrogel injection will result in an eventual return to the same fatigued state. PMID:23699716

Balkovec, Christian; Vernengo, Jennifer; McGill, Stuart M

2013-06-01

105

A Functional Polymorphism in COL11A1, Which Encodes the ?1 Chain of Type XI Collagen, Is Associated with Susceptibility to Lumbar Disc Herniation  

PubMed Central

Lumbar disc herniation (LDH), degeneration and herniation of the nucleus pulposus of the intervertebral disc (IVD) of the lumbar spine, is one of the most common musculoskeletal diseases. Its etiology and pathogenesis, however, remain unclear. Type XI collagen is important for cartilage collagen formation and for organization of the extracellular matrix. We identified an association between one of the type XI collagen genes, COL11A1, and LDH in Japanese populations. COL11A1, which encodes the ?1 chain of type XI collagen, was highly expressed in IVD, but its expression was decreased in the IVD of patients with LDH. The expression level was inversely correlated with the severity of disc degeneration. A single-nucleotide polymorphism (c.4603C?T [rs1676486]) had the most significant association with LDH (P=3.3×10-6), and the transcript containing the disease-associated allele was decreased because of its decreased stability. These observations indicate that type XI collagen is critical for IVD metabolism and that its decrease is related to LDH.

Mio, Futoshi; Chiba, Kazuhiro; Hirose, Yuichiro; Kawaguchi, Yoshiharu; Mikami, Yasuo; Oya, Takeshi; Mori, Masaki; Kamata, Michihiro; Matsumoto, Morio; Ozaki, Kouichi; Tanaka, Toshihiro; Takahashi, Atsushi; Kubo, Toshikazu; Kimura, Tomoatsu; Toyama, Yoshiaki; Ikegawa, Shiro

2007-01-01

106

The Combined Use of a Posterior Dynamic Transpedicular Stabilization System and a Prosthetic Disc Nucleus Device in Treating Lumbar Degenerative Disc Disease With Disc Herniations  

Microsoft Academic Search

BackgroundProsthetic replacement of spinal discs is emerging as a treatment option for degenerative disc disease. Posterior dynamic transpedicular stabilization (PDTS) and prosthetic disc nucleus (PDN) devices have been used sporadically in spinal surgery.

Mehdi Sasani; Ahmet Levent Aydin; Tunc Oktenoglu; Murat Cosar; Yaprak Ataker; Tuncay Kaner; Ali Fahir Ozer

2008-01-01

107

Acute postoperative cardiac herniation.  

PubMed

Acute herniation of the heart is an uncommon complication in patients undergoing pneumonectomy with associated pericardial resection. We report the case of a postoperative cardiac herniation after a right extrapleural pneumonectomy following neoadjuvant chemotherapy for malignant pleural mesothelioma. After surgery the patient was completely asymptomatic, but a postoperative chest X-ray revealed unexpected massive dextrocardia. The patient was immediately brought back to the operating room: a cardiac herniation was found to be caused by a partial dehiscence of the pericardial prosthesis suture. The defect was repaired without consequences. PMID:20940166

Kawamukai, Kenji; Antonacci, Filippo; Di Saverio, Salomone; Boaron, Maurizio

2011-01-01

108

Herniated Cervical Disc  

MedlinePLUS

... are sometimes prescribed for more severe arm and neck pain because of their very powerful anti-inflammatory effect. ... caused by a herniated cervical disc. However, some neck pain may persist. Most patients respond well to discectomy; ...

109

Lumbar Disc Herniation in Adolescence  

Microsoft Academic Search

Lumbar disc herniation very rarely occurs in adolescence. The aim of this study was to assess the radiological, clinical and surgical features and case outcomes for adolescents with lumbar disc herniation, and to compare with adult cases. The cases of 17 adolescents (7 girls and 10 boys, age range 13–17 years) who were surgically treated for lumbar disc herniation in

Serdar Ozgen; Deniz Konya; O. Zafer Toktas; Adnan Dagcinar; M. Memet Ozek

2007-01-01

110

Can Prevention of a Reherniation Be Investigated? Establishment of a Herniation Model and Experiments With an Anular Closure Device  

PubMed Central

Study Design. Biomechanical in vitro study. Objective. To establish a reliable in vitro herniation model with human cadaver spines that enables evaluation of anular closure devices. Summary of Background Data. Biomechanically, it is desirable to close anulus defects after disc herniation to preserve as much nucleus as possible. Multiple anular closure options exist to prevent reherniation. A reliable test procedure is needed to evaluate the efficacy and reliability of these implants. Methods. Two groups of human lumbar segments (n = 6 per group) were tested under cyclic loading until herniation occurred or 100,000 load cycles were applied. One group contained moderate/severe degenerated discs. A second group had mild degenerated discs. Intradiscal pressure was measured in the intact state to confirm disc quality. If herniation occurred, the extruded material was reinserted into the disc and the anulus defect was treated with the Barricaid anular closure device (Intrinsic Therapeutics, Inc., Woburn, MA). Disc height and 3-dimensional flexibility of the specimens in the intact, defect, and implanted states were measured under pure moments in each principal motion plane. Afterwards, provocation of reherniation was attempted with additional 100,000 load cycles. Results. Likelihood of herniation was strongly linked to disc degeneration and supported by the magnitude of intradiscal pressure. In moderate/severe degenerated discs, only 1 herniation was created. In mild degenerated discs, herniations were reliably created in all specimens. Using this worst-case model, herniation caused a significant reduction of disc height, which was nearly restored with the implant. In no case was reherniation or implant migration visible after 100,000 load cycles after Barricaid implantation. Conclusion. We established a human herniation model that reliably produced nucleus extrusion during cyclic loading by selecting specimens with low disc degeneration. The Barricaid seems to prevent nucleus from reherniating. The reliability of this method suggests the opportunity to investigate other anulus closure devices and nucleus replacement techniques critically.

Wilke, Hans-Joachim; Ressel, Lena; Heuer, Frank; Graf, Nicolas; Rath, Stefan

2013-01-01

111

Radicular interdural lumbar disc herniation.  

PubMed

Intraradicular lumbar disc herniation is a rare complication of disc disease that is generally diagnosed only during surgery. The mechanism for herniated disc penetration into the intradural space is not known with certainty, but adhesion between the radicular dura and the posterior longitudinal ligament was suggested as the most important condition. The authors report the first case of an intraradicular lumbar disc herniation without subdural penetration; the disc hernia was lodged between the two radicular dura layers. The patient, a 34-year-old soldier, was admitted with a 12-month history of low back pain and episodic left sciatica. Neurologic examination showed a positive straight leg raising test on the left side without sensory, motor or sphincter disturbances. Spinal CT scan and MRI exploration revealed a left posterolateral osteophyte formation at the L5-S1 level with an irregular large disc herniation, which migrated superiorly. An intradural extension was suspected. A left L5 hemilaminectomy and S1 foraminotomy were performed. The exploration revealed a large fragment of disc material located between the inner and outer layers of the left S1 radicular dura. The mass was extirpated without cerebrospinal fluid outflow. The postoperative course was uneventful. Radicular interdural lumbar disc herniation should be suspected when a swollen, hard and immobile nerve root is present intraoperatively. PMID:19888608

Akhaddar, Ali; Boulahroud, Omar; Elasri, Abad; Elmostarchid, Brahim; Boucetta, Mohammed

2010-07-01

112

Spontaneous transdural spinal cord herniation.  

PubMed

A 42-year-old man with a history of benign incidental dorsal trauma 5 years earlier presented with progressive weakness of the right leg for 2 years. Clinical examination revealed decreased left-sided pain, temperature, and light touch sensation below the level of T2, right leg weakness, normal proprioception, and increased deep tendon reflexes in the right leg, in absence of bladder dysfunction. Spinal MRI showed herniation of the ventral spinal cord to the left at level T1 (figure). A diagnosis of transdural spinal cord herniation (TSCH) was made. TSCH is a rare cause of progressive myelopathy. TSCH is reported after spinal trauma or herniated disc surgery.(1) Spontaneous cases are also described.(2) Patients usually present with a Brown-Séquard-like syndrome or progressive paraparesis. PMID:24711533

Castelnovo, Giovanni; Hladky, Jean Pierre; Renard, Dimitri

2014-04-01

113

Chronic herniation of the hindbrain  

PubMed Central

Herniation of the hindbrain occurs when the lowest parts of the cerebellum and sometimes part of the medulla are moved downwards through the foramen magnum, a pressure difference acting across the foramen magnum moulding the tissues into a plug. It is suggested that the clinical course in both adults and babies with spina bifida may be explained by the hindbrain hernia acting as a valve. The term 'Chiari Type I deformity' is commonly used for an abnormality in which the tonsils and lowermost parts of the cerebellar hemispheres are prolapsed through a normal foramen magnum. Acute herniation may occur as a result of space-occupying lesions. Chronic herniation may be morphologically identical although it tends to be more severe. Sometimes it will produce few symptoms which often may be delayed so that the original causative lesion may not be apparent. Causes include bone softening, tumour, or previous meningitis. Birth injury is probably the commonest cause of the deformity, which presents clinically in adults. In infants with severe forms of spina bifida a hindbrain herniation is present. This abnormality may be called 'Chiari Type II deformity' or Arnold—Chiari deformity and is an intra-uterine abnormality in which the fourth ventricle and medulla are grotesquely herniated before they are properly developed and the foramen magnum is enlarged. The commonest clinical presentation of Chiari Type I deformity is syringomyelia, which is usually not diagnosed until adult life. Other presentations include syringobulbia, headache, oscillopsia, attacks of giddiness, lower cranial nerve palsies, and ataxia. Particularly characteristic are cough headache and cough syncope. Syringomyelia and syringobulbia in particular may be irreversible by the time they are diagnosed. Nevertheless, surgical decompression may be successful in relieving symptoms of headache, cough syncope, and long-tract compression; most cases of syringomyelia show some improvement and in others progression of the disease is arrested. Operative techniques for hindbrain herniation are discussed. Chiari Type II deformity is probably responsible for the progression of hydrocephalus after birth in the majority of babies with spina bifida. Measurement of pressure in the cerebrospinal fluid above and below the foramen magnum shows that intermittent pressure difference is commonly present at times of neurological deterioration. Surgical decompression of the hernia in adults allows correction of the valvular effect, which may be monitored by pressure measurements. In babies the associated hydrocephalus is usually so gross that it requires separate treatment, but pressure monitoring may be of value in assessing the state of the disease. ImagesFig. 1Fig. 2Fig. 3Fig. 4

Williams, Bernard

1981-01-01

114

Intraradicular disc herniations in the lumbar spine and a new classification of intradural disc herniations  

Microsoft Academic Search

Study design: A case report of intraradicular disc herniation. Intraradicular disc herniation is a special type of intradural disc hernations. In this report, we present the tenth case of intraradicular lumbar disc herniation and suggest a new classification for intradural disc herniations.Case Report: A 32-year-old male was admitted to hospital having experienced pain in the lower back and right leg

M Mut; M Berker; S Palao?lu

2001-01-01

115

[Traumatic recurrence of idiopathic spinal cord herniation].  

PubMed

Idiopathic spinal cord herniation is a rare cause of thoracic myelopathy and its recurrence is even more infrequent. Cord herniation is through an anterior dural defect in thoracic spine with unknown causes. Symptomatic cases must be surgically treated to reduce the hernia and seal the defect to prevent recurrences. We report a patient presenting a Brown-Séquard syndrome secondary to a D5 spinal cord herniation treated successfully and its posterior traumatic recurrence. PMID:23453309

Lorente-Muñoz, Asís; Cortés-Franco, Severiano; Moles-Herbera, Jesús; Casado-Pellejero, Juan; Rivero-Celada, David; Alberdi-Viñas, Juan

2013-01-01

116

Thoracic disc herniation: a diagnostic challenge  

Microsoft Academic Search

An unusual case of lower thoracic disc herniation combined with shoulder pain is presented in this case report, A literature search showed that shoulder pain associated with a lower thoracic disc herniation has not yet been reported. An acromioplasty for chronic impingement syndrome was performed to relieve the patient's shoulder symptoms. An unsatisfactory outcome plus a progressive but incomplete paraplegia,

Axel Wilke; Udo Wolf; Peter Lageard; Peter Griss

2000-01-01

117

A patient with thoracic intradural disc herniation  

Microsoft Academic Search

Intradural disc herniation is a rare disease that occurs most commonly in the lumbar region, while fewer than 5% occur in the thoracic and cervical regions. We report a patient with thoracic intradural disc herniation at T12–L1 who presented with radiculopathy and motor weakness. The preoperative MRI did not demonstrate an intradural lesion, and it was identified intraoperatively by inspection

Robert G. Whitmore; Brian J. Williams; Bradley C. Lega; Matthew R. Sanborn; Paul Marcotte

118

Minimally invasive treatment of thoracic disc herniations.  

PubMed

In the past, treatment of thoracic disc herniations has not been seen as a minimally invasive procedure. This article evaluates the progression of minimally invasive techniques for the treatment of thoracic disc herniations. Discussion of the advantages and disadvantages of the approaches is noted so that surgeons may consider them while incorporating these techniques in their practice. PMID:24703446

Snyder, Laura A; Smith, Zachary A; Dahdaleh, Nader S; Fessler, Richard G

2014-04-01

119

Risk factors of recurrent lumbar disk herniation  

PubMed Central

Background: Recurrent lumbar disc herniation (LDH) is a common cause of poor outcomes after lumbar discectomy surgery. Studies focused on risk factors of true recurrent disk herniation at the same level and side, are few. The aim of current study is to evaluate risk factors of recurrent disc herniation in Iranian population. Materials and Methods: We retrospectively reviewed 40 patients with recurrent disc herniation and 120 patients without recurrence to evaluate possible risk factors for herniation recurrence. A clinically significant recurrent herniation was defined as a disc herniation causing leg pain with radiographic (MRI) evidence of disc material at the same side and level of the index surgery causing impingement, compression, or deviation of nerve tissue. A series of patients without recurrence was used for comparison to identify possible risk factors for recurrent LDH. Results: There was significant difference between groups with and without LDH in sex (P = 0.003), smoking habit (P = 0.004), height (P = 0.04), weight (P = 0.006) and occupational characteristic (P < 0.001). By putting these differences in logistic regression analysis, it showed that gender (male), taller height, heavy works and being smoker could predict lumbar disc herniation recurrence. Conclusion: Considering sex, smoking and heavy works as predictors of recurrent LDH, surgeons should advice their patients to limit hard work and put away smoking especially in tall and male ones to prevent LDH recurrence.

Shimia, Mohammad; Babaei-Ghazani, Arash; Sadat, Bina Eftekhar; Habibi, Behnaz; Habibzadeh, Afshin

2013-01-01

120

Transdiaphragmatic Intercostal Herniation following Blunt Trauma.  

PubMed

Intercostal herniation is very rarely and sporadically reported in the literature. Intercostal hernia can occur following blunt trauma and may be associated with rib fractures. We present a case of a patient who presented with rib fractures, diaphragmatic rupture, and intrathoracic herniation of abdominal contents with subsequent herniation of both lung and abdominal contents through an intercostal defect. The patient was successfully treated with primary surgical repair of the diaphragm and intercostal hernia. The presentation, pathophysiology, and management of this rare clinical entity are discussed. PMID:23198242

Sarkar, Debkumar; Warta, Melissa; Solomon, Jason

2012-01-01

121

Spontaneous cervical intradural disc herniation.  

PubMed

Cervical intradural disc herniation (IDH) is a rare condition with very few case reports in the literature. We report a 64-year-old man who presented with sudden onset neck pain and rapidly progressing weakness in the left upper and lower limb. There was no history of trauma. MRI of the cervical spine showed a C6-C7 disc prolapse, for which he underwent a C6-C7 discectomy and fusion with bone graft through an anterior cervical approach. To our knowledge, all patients with a cervical IDH reported in the literature have a traumatic etiology. To the best of our knowledge, we report the first patient with a spontaneous cervical IDH. PMID:24210799

Warade, Abhijit G; Misra, Basant K

2014-05-01

122

Disc degeneration after disc herniation: are we accelerating the process?  

PubMed

Study design: ?Systematic review. Study rationale: ?Disc degeneration is a common process starting early in life. Often disc herniation is an early step in disc degeneration, which may cause pain or stenosis. How quickly this subsequent disc degeneration occurs following a disc herniation and subsequent surgical treatment and whether certain spinal procedures increase the rate of degeneration remain unclear. Objectives: ?To investigate the risk of subsequent radiographic disc degeneration following discectomy, discography, and conservative care in patients with a first-time diagnosed herniated nucleus pulpous (HNP) and to ascertain whether this risk in these defined groups changes over time. Methods: ?A systematic review of pertinent articles published up to June 2012. Key articles were searched to identify studies evaluating the risk of subsequent radiographic disc degeneration following treatment for HNP. Studies that included patients undergoing secondary surgery for disc herniation or that did not use a validated classification system to measure the severity of disc degeneration were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results: ?From a total of 147 possible citations, three cohort studies (class of evidence III) met our inclusion criteria and form the basis for this report. The risk of subsequent lumbar disc degeneration following standard discectomy was significantly greater compared with both microdiscectomy (48.7% vs 9.1%) and asymptomatic controls (90% vs 68%) in two studies with mean follow-ups of 5.5 and 25.3 years, respectively. Following conservative care for first-time HNP in the third study, the risk of progression of lumbar disc degeneration was 47.6% over the first 2 years of follow-up and 95.2% over the next 6 years of follow-up. In the same study, the risk of lumbar disc degeneration was shown to increase incrementally over the course of the 8-year follow-up, with all patients showing signs of degeneration at final examination. Conclusion: ?Standard discectomy in first-time lumbar HNP may increase the risk of subsequent same-level lumbar disc degeneration compared with microdiscectomy as seen in one low-quality study. However, disc degeneration is likely a natural, temporal consequence following HNP, as demonstrated in a second low-quality study. The overall strength of evidence for the conclusions is very low. PMID:23526910

Schroeder, Josh E; Dettori, Joseph R; Brodt, Erika D; Kaplan, Leon

2012-11-01

123

Disc degeneration after disc herniation: are we accelerating the process?  

PubMed Central

Study design:?Systematic review. Study rationale:?Disc degeneration is a common process starting early in life. Often disc herniation is an early step in disc degeneration, which may cause pain or stenosis. How quickly this subsequent disc degeneration occurs following a disc herniation and subsequent surgical treatment and whether certain spinal procedures increase the rate of degeneration remain unclear. Objectives:?To investigate the risk of subsequent radiographic disc degeneration following discectomy, discography, and conservative care in patients with a first-time diagnosed herniated nucleus pulpous (HNP) and to ascertain whether this risk in these defined groups changes over time. Methods:?A systematic review of pertinent articles published up to June 2012. Key articles were searched to identify studies evaluating the risk of subsequent radiographic disc degeneration following treatment for HNP. Studies that included patients undergoing secondary surgery for disc herniation or that did not use a validated classification system to measure the severity of disc degeneration were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results:?From a total of 147 possible citations, three cohort studies (class of evidence III) met our inclusion criteria and form the basis for this report. The risk of subsequent lumbar disc degeneration following standard discectomy was significantly greater compared with both microdiscectomy (48.7% vs 9.1%) and asymptomatic controls (90% vs 68%) in two studies with mean follow-ups of 5.5 and 25.3 years, respectively. Following conservative care for first-time HNP in the third study, the risk of progression of lumbar disc degeneration was 47.6% over the first 2 years of follow-up and 95.2% over the next 6 years of follow-up. In the same study, the risk of lumbar disc degeneration was shown to increase incrementally over the course of the 8-year follow-up, with all patients showing signs of degeneration at final examination. Conclusion:?Standard discectomy in first-time lumbar HNP may increase the risk of subsequent same-level lumbar disc degeneration compared with microdiscectomy as seen in one low-quality study. However, disc degeneration is likely a natural, temporal consequence following HNP, as demonstrated in a second low-quality study. The overall strength of evidence for the conclusions is very low.

Schroeder, Josh E.; Dettori, Joseph R.; Brodt, Erika D.; Kaplan, Leon

2012-01-01

124

Expression of the JAK/STAT3/SOCS3 signaling pathway in herniated lumbar discs.  

PubMed

The inflammatory cytokine interleukin-6 (IL-6) plays an important role in causing symptoms of lumbar disk herniation. The present study clarifies the expression of the signaling pathway of IL-6 in herniated discs. Homogenates prepared from lumbar herniated discs from 10 patients were assessed. The expression of janus kinase 1 (JAK1), signal transducer and activator of transcription 3 (STAT3), phosphorylated (p)-STAT3 at Tyr(705), suppressor of cytokine signaling 3 (SOCS3) and actin was examined by Western blot analysis. The expression of JAK1, STAT3, and p-STAT3 at Tyr(705) was also examined by immunostaining. JAK1, STAT3, p-STAT3 at Tyr(705) and SOCS3 were detected in almost all cases. Immunoreactivity against JAK1 and STAT3 was observed mainly in chondrocytes, whereas immunoreactivity against p-STAT3 at Tyr(705) was observed in the nuclei of chondrocytes. The JAK/STAT signaling pathway might be activated by IL-6 and transmit messages from the cell surface to the nucleus, and the pathway is negatively regulated by SOCS3. These JAK1, STAT3 and SOCS3 molecules might tightly regulate and play a role in the degeneration of chondrocytes within herniated discs. PMID:24686183

Osuka, Koji; Usuda, Nobuteru; Aoyama, Masahiro; Yamahata, Hitoshi; Takeuchi, Mikinobu; Yasuda, Muneyoshi; Takayasu, Masakazu

2014-05-21

125

Nucleus-nucleus potentials  

SciTech Connect

The significance of a nucleus-nucleus potential is discussed. Information about such potentials obtained from scattering experiments is reviewed, including recent examples of so-called rainbow scattering that probe the potential at smaller distances. The evidence for interactions involving the nuclear spins is summarized, and their possible origin in couplings to non-elastic channels. Various models of the potentials are discussed.

Satchler, G.R.

1983-01-01

126

[Idiopathic spinal cord herniation: a rare condition].  

PubMed

Idiopathic spinal cord hernia, in which the reason that spinal cord protrudes through a defect in the dura mater is unknown, is a rare cause of progressive myelopathy. The most common clinical presentation is Brown-Séquard syndrome. Spinal cord herniation is a reversible cause of myelopathy: surgery to correct the defect in the dura mater has a high rate of functional recovery. Thus, early imaging detection is crucial. Magnetic resonance imaging is the technique of choice for the diagnosis. We present two cases of idiopathic spinal cord herniation and show the imaging findings that make it possible to recognize and diagnose this condition. PMID:20382404

Salvador Álvarez, E; Jiménez De La Peña, M; Herraiz Hidalgo, L; Pardo Moreno, J

2010-01-01

127

Toward a clinical lumbar CAD: herniation diagnosis  

Microsoft Academic Search

Purpose  A CAD system for lumbar disc degeneration and herniation based on clinical MR images can aid diagnostic decision-making provided\\u000a the method is robust, efficient, and accurate.\\u000a \\u000a \\u000a \\u000a \\u000a Material and methods  A Bayesian-based classifier with a Gibbs distribution was designed and implemented for diagnosing lumbar disc herniation.\\u000a Each disc is segmented with a gradient vector flow active contour model (GVF-snake) to extract shape

Raja’ S. Alomari; Jason J. Corso; Vipin Chaudhary; Gurmeet Dhillon

2011-01-01

128

Sudden death following delayed traumatic diaphragmatic herniation.  

PubMed

Blunt force trauma to the chest can often result in diaphragmatic tears. These tears can go months without being discovered, until a secondary injury or circumstance causes an organ to herniate through the diaphragm. Special care should be taken at autopsy to determine the mechanism of injury of any tears in the diaphragm as this may influence the cause and manner of death. We present a case of a 28-year-old man who suffered multiple injuries in a motor vehicle collision. Six months later he presented with a left diaphragmatic tear and gastric fundal herniation, and died eventually. PMID:20683321

Yates, Adam M; Fulcher, James W; Ward, Michael E

2011-03-01

129

Lumbar disc nucleoplasty using coblation technology: clinical outcome  

Microsoft Academic Search

Background and purposeAlthough the standard treatment for lumbar disc herniation is lumbar microdiscectomy, nucleoplasty offers a new technique with encouraging results in well selected cases. Nucleoplasty is a minimally invasive technique that manages intradiscal herniation through energy based removal of part of the nucleus pulposus. The purpose of this study was to assess the safety and clinical outcome of the

Alaa Azzazi; Sherif AlMekawi; Mostafa Zein

2010-01-01

130

Curing kinetics and mechanical properties of a composite hydrogel for the replacement of the nucleus pulposus  

Microsoft Academic Search

A polymer material system has been developed to propose an injectable, UV and insitu curable hydrogel with properties similar to the native nucleuspulposus of intervertebral disc. Neat hydrogels based on Tween® 20 trimethacrylates (T3) and N-vinyl-2-pyrrolidone (NVP) and composite hydrogels of same composition reinforced by nano-fibrillated cellulose were synthesized with different T3 concentrations and their curing kinetics was investigated by

A. C. Borges; P.-E. Bourban; D. P. Pioletti; J.-A. E. Månson

2010-01-01

131

Nanofibrillated cellulose composite hydrogel for the replacement of the nucleus pulposus  

Microsoft Academic Search

The swelling and compressive mechanical behavior as well as the morphology and biocompatibility of composite hydrogels based on Tween® 20 trimethacrylate (T3), N-vinyl-2-pyrrolidone (NVP) and nanofibrillated cellulose (NFC) were assessed in the present study. The chemical structure of T3 was verified by Fourier transform infrared spectroscopy and proton nuclear magnetic resonance, and the degree of substitution was found to be

Ana C. Borges; Christian Eyholzer; Fabien Duc; Pierre-Etienne Bourban; Philippe Tingaut; Tanja Zimmermann; Dominique P. Pioletti; Jan-Anders E. Månson

2011-01-01

132

Injectable oxidized hyaluronic acid\\/adipic acid dihydrazide hydrogel for nucleus pulposus regeneration  

Microsoft Academic Search

Injectable hydrogel allows irregular surgical defects to be completely filled, lessens the risk of implant migration, and minimizes surgical defects due to the solution–gel state transformation. Here, we first propose a method for preparing oxidized hyaluronic acid\\/adipic acid dihydrazide (oxi-HA\\/ADH) injectable hydrogel by chemical cross-linking under physiological conditions. Fourier transform infrared spectrometry and trinitrobenzene sulfonate assay were used to confirm

Wen-Yu Su; Yu-Chun Chen; Feng-Huei Lin

2010-01-01

133

Isolated trans-hiatal colonic herniation.  

PubMed

Isolated herniation of the colon through congenital or traumatic diaphragmatic defects are well documented. However, trans-hiatal herniation of the colon in the absence of an intrathoracic stomach has been reported only once. A 67-year-old man presented with intragastric abdominal pain and a chest x-ray film documenting a posterior mediastinal air-fluid level. Computed tomography showed gastrointestinal contents within the thorax. The findings on an upper gastrointestinal film with small bowel follow-through were normal. Finally, a barium enema identified transverse colon within the thoracic cavity. At laparoscopy, the entire transverse colon was reduced with the hernia sac. The crural defect was repaired, and a Toupet fundoplication was performed. A gastropexy was also added. The patient was discharged on postoperative day 2 able to tolerate a regular diet, and he has been asymptomatic for 5 months. This defect most likely represents a congenital deformity of the diaphragm with intact posterior gastric attachments, including the posterior phrenoesophageal ligament. An intact gastric mesentery enabled isolated colonic herniation with retention of the stomach its normal anatomic position. An antireflux procedure was performed in addition to the crural repair because of the circumferential dissection of the esophagus. This article is the second report of an isolated trans-hiatal herniation of the colon and the first report of laparoscopic repair of this entity. PMID:12737724

Felsher, Joshua; Brodsky, Jason; Brody, Fred

2003-04-01

134

Upward transtentorial herniation: seven cases and a literature review.  

PubMed

Seven cases of upward transtentorial herniation occurred. In each patient, coma with reactive, miotic pupils, asymmetrical or absent caloric responses, and decerebrate posture indicated brain-stem compression. In this setting, the development of unequal, then midposition, fixed pupils signaled midbrain failure from upward herniation. Vertebral angiography showed upward displacement of the superior cerebellar arteries. Results of autopsy confirmed the existence of grooving of the vermis by the tentorial margins and, in one case, of anterior displacement and distortion of the midbrain. In five of 45 reported cases of upward herniation, the conditions were diagnosed antemortem. Instances of cerebellar hematoma and tumor predominated. In at least seven patients, performance of ventriculography may have precipitated herniation. Clinical details were provided in only nine patients and did not separate upward herniation from brain-stem compression. Cerebellar ischemic infarct found in one of our patients is a rarely reported cause of upward herniation. PMID:485890

Cuneo, R A; Caronna, J J; Pitts, L; Townsend, J; Winestock, D P

1979-10-01

135

Risk Factors for Recurrent Lumbar Disc Herniations  

PubMed Central

The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future.

2014-01-01

136

Intercostal lung herniation - The role of imaging  

PubMed Central

Extrathoracic lung hernias can be congenital or acquired. Acquired hernias may be classified by etiology into traumatic, spontaneous, and pathologic. We present a case of a 40-year-old male with a history of bronchial asthma and a blunt chest trauma who presented complaining of sharp chest pain of acute onset that began after five consecutive days of vigorous coughing. Upon physical examination a well-demarcated deformity overlying the third intercostal space of the left upper anterior hemithorax was revealed. Thoracic CT scan showed that a portion of the anterior bronchopulmonary segment of the left upper lobe had herniated through a chest wall defect. The role of imaging, especially chest computed tomography with multiplanar image reconstructions and maximum (MIP) and minimum intensity projection (MinIP) reformats can clearly confirm the presence of the herniated lung, the hernial sac, the hernial orifice in the chest wall, and exclude possible complications such as lung tissue strangulation.

Detorakis, Efstathios E.; Androulidakis, Emmanuel

2014-01-01

137

Spinal cord dysfunction from lumbar disk herniation.  

PubMed

Two patients with a herniated disk respectively at the level of the L4-L5 and of the L5-S1 intervertebral spaces presented with pyramidal signs, bladder paralysis and radicular impairment. The symptoms subsided immediately following surgical removal of the prolapsed disk. The role of transient ischemia in the lower segments of the spinal cord as possible cause of this uncommon clinical picture is discussed, and the pertinent literature is reviewed. PMID:2618830

Pau, A; Cossu, M; Turtas, S; Zirattu, G

1989-12-01

138

Transitional Cell Carcinoma within a Portion of Inguinally Herniated Bladder  

PubMed Central

Bladder herniation within the inguinal canal is a relatively uncommon finding. We report an even less-common occurrence of transitional cell carcinoma located within a portion of inguinally herniated bladder. Fewer than 20 reports exist in the literature describing this scenario.

Uhlman, Matthew A.; Bockholt, Nathan A.; Gupta, Amit

2013-01-01

139

Transdural Spinal Cord Herniation: Imaging and Clinical Spectra  

Microsoft Academic Search

PURPOSE: Transdural herniation of the spinal cord is a rarely reported clinical entity, and many of the existing reports were published before the advent of MR imaging. We describe five current cases and compare them with findings in 25 cases reported in the literature to delineate the clinical and imaging spectra of transdural spinal cord herniation. METHODS: MR imaging, CT

Michael R. Watters; John C. Stears; Anne G. Osborn; Gary E. Turner; Bradford S. Burton; Kevin Lillehei; William T. C. Yuh

1998-01-01

140

Intradural disc herniations pathogenesis, clinical picture, diagnosis and treatment  

Microsoft Academic Search

Summary The relatively rare occurrence and uncertainty about pathogenesis of intradurally displaced disc herniations stimulated an anatomico-pathological study into intradural disc herniations. The relation between the ventral dura and posterior longitudinal ligament in the cervical, thoracic, lumbar and sacral regions were examined macroscopically and microscopically, and ventral and dorsal durai thickness was compared in 20 adult autopsies on patients who

A. Yildizhan; A. Pa?ao?lu; T. Okten; N. Ekinci; K. Aycan; Ö. Aral

1991-01-01

141

Brain code and coma recovery: aggressive management of cerebral herniation.  

PubMed

Cerebral herniation occurs due to lateral or vertical shifts in brain tissue as a complication of an intra- or extra-axial nervous system pathology. Midline shift of midline brain structures has been independently associated with poor outcome in a variety of neurologic injuries. Herniation may present as a subacute phenomenon constituting mild and progressive alteration of consciousness or as a hyperacute scenario wherein there is rapid decompensation of intracranial compliance. If left uncontrolled, cerebral herniation will lead to destruction of arousal mechanisms and result in a comatose state. A protocol-based approach for the management of herniation has the potential to minimize or reverse these shifts and in conjunction with clinical examination, radiologic data and neuromonitoring techniques offer the option of preventing a second catastrophe. In this article, the authors discuss the mechanisms that lead to coma in brain-herniating patients and the treatment choices that have been successfully used in this patient population. PMID:23888397

Kalanuria, Atul A; Geocadin, Romergryko G; Püttgen, Hans A

2013-04-01

142

Cerebellar Herniation in Syringomyelia: Relation between Tonsillar Herniation and the Dimensions of the Syrinx and the Remaining Spinal Cord  

Microsoft Academic Search

The dimensions of the syrinx, the remaining spinal cord and the degree of cerebellar herniation were analyzed by one- and two-dimensional MRI studies in 22 patients with syringomyelia. A deep and\\/or broad cyst tends to be a long one. The dimensions of the syrinx and the spinal cord have an inverse relationship. The degree of cerebellar herniation is not related

Harald Masur; Christoph Oberwittler; Georg Reuther; Petra Heyen

1995-01-01

143

Risk factors for recurrent lumbar disc herniations.  

PubMed

The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future. PMID:24761206

Shin, Byung-Joon

2014-04-01

144

Automatic stepping in the pontomedullary stage of central herniation.  

PubMed

Both spontaneous and reflexive movements may occur during the final stages of herniation and following brain death. We describe spontaneous, rhythmic (0.2 to 0.5 Hz), alternating flexion of the hip, knee, and ankle in two patients during the pontomedullary phase of central herniation following a massive hemispheric infarct. Automatic stepping is likely a spinal automatism generated within the spinal locomotion center and regulated by both ascending and descending brainstem tracts. Clinicians and family members of neurologically devastated patients should be aware that this and other movements can occur during the late stages of central herniation preceding and following brain death. PMID:7746419

Hanna, J P; Frank, J I

1995-05-01

145

The Nucleus  

NSDL National Science Digital Library

The Nucleus is the ComPADRE collection developed to help physics and astronomy students become engaged in the field. The Nucleus includes discussion forums, learning resources, and information about research, scholarship, and outreach opportunities. This collection is managed by the Society of Physics Students (SPS) and coordinates with the activities of the SPS.

2010-06-30

146

Percutaneous diskectomy for lumbar disk herniation. A preliminary report.  

PubMed

Percutaneous diskectomy is a new method for reducing lumbar disk herniation. This procedure is simple, safe, and only semiinvasive since it causes no direct damage to the dura or nerve roots. This technique employs a nucleotome (blunt-tipped, suction-cutting probe) with a rotating electric shaver (3 mm in diameter) that was specially developed for this procedure. It was applied to 117 patients with lumbar disk herniation whose sciatica had not been relieved by conservative treatments. The results of the technique were considered effective in 94 patients (80.3%). The improvements were even more marked in patients with protrusion or prolapse type herniation. Reviewed with postoperative examinations using magnetic resonance imaging (MRI), excision of the herniated disk, resulting in decompression of the nerve root, may be correlated with the relief of symptoms. PMID:8425341

Sakou, T; Masuda, A

1993-01-01

147

Outcomes of cervical and lumbar disk herniations in Major League Baseball pitchers.  

PubMed

The effects of disk herniations on the career and performance outcomes of Major League Baseball (MLB) pitchers are unknown. The purpose of this study is to determine the outcomes after a cervical or lumbar disk herniation for MLB pitchers. Forty MLB pitchers from 1984 to 2009 with a cervical disk herniation or lumbar disk herniation were identified using a previously established protocol. Cervical disk herniation was identified in 11 pitchers, 8 of which were treated operatively. The majority of pitchers with cervical disk herniation (8/11) returned to play at an average of 11.6 months. Lumbar disk herniation was identified in 29 pitchers, 20 of which were treated operatively. All pitchers with lumbar disk herniation (29/29) returned to play at an average of 7.3 months after diagnosis. PMID:21800814

Roberts, David W; Roc, Gilbert J; Hsu, Wellington K

2011-08-01

148

Imaging findings in dogs with caudal intervertebral disc herniation.  

PubMed

The radiographic and magnetic resonance imaging (MRI) findings for four dogs with herniation of the Cd1-Cd2 intervertebral disc are described. All dogs were 7 years of age at the time of presentation, with one neutered male and three neutered females. Breeds included one Beagle, one Bassett hound, and two large, mixed breed dogs. All dogs had tail pain on manipulation, two had pain during defecation, and two maintained an abnormal tail position. Three dogs had radiographs in which mineralization within the disc space was apparent. Two of these dogs also had mineralization within the vertebral canal. Three dogs underwent MRI, which was characterized by varying degrees of disc herniation and nerve root compression at Cd1-Cd2. Mobility may be a factor predisposing to disc herniation in the cranial aspect of the caudal spine. We documented that caudal disc herniation does occur occasionally in dogs and that radiography and MRI may be used to identify this disease. Caudal intervertebral disc herniation should be considered as a differential for dogs with caudal vertebral pain, pain with tail manipulation, pain during defecation, or abnormal tail carriage. PMID:21689201

Lawson, Caitlin M; Reichle, Jean K; McKlveen, Tori; Smith, Mary O

2011-01-01

149

Herniation of the cervical disk in plastic surgeons.  

PubMed

Herniations of the cervical disk in plastic surgeons are far more common in practice than the paucity of reported cases would indicate. A likely explanation may be the peculiar, nonergonomic positions that plastic surgeons must hold during surgery while wearing a headlight and loupes. From January 2003 to December 2006, at Tri-Service General Hospital, Taiwan, 4 plastic surgeons experienced herniations of the cervical disk. Magnetic resonance imaging study indicated there was disk herniation or bulging with spinal cord impingement. Two plastic surgeons received cervical diskectomy, corpectomy with strut reconstruction using titanium cages. These 2 surgeons were symptom-free 2 years after their operations. The other 2 plastic surgeons were under conservative physical therapy with persistent symptoms. The clinical evidence indicated that cervical disk herniation is an occupational hazard in plastic surgeons. To prevent prolonged hyperflexion and twisting of the neck, we proposed wearing a cervical brace during surgery for the plastic surgeons at Tri-Service-General Hospital since January 2008. No more plastic surgeons have experienced herniation of the cervical disk since then. The results indicated that wearing a cervical brace may be an effective measure to protect plastic surgeons from cervical disk disease. PMID:23154341

Tzeng, Yuan-Sheng; Chen, Shyi-Gen; Chen, Tim-Mo

2012-12-01

150

5-Millimeter Trocar-Site Bowel Herniation Following Laparoscopic Surgery  

PubMed Central

Background and Objectives: This is a case report of a 5-mm trocar-site large bowel herniation following laparoscopic tubal sterilization. During laparoscopic sterilization, the 5-mm port site was closed initially. Large bowel herniation was recognized at the end of the case and managed immediately by laparoscopically reducing the hernia and closing the port site without any short- or long-term complications. Trocar-site bowel hernia is a rare complication after laparoscopic surgery. It is usually associated with trocar size >10mm. We describe a case of bowel herniation through a 5-mm trocar site, which was managed after laparoscopic surgery. Case Report: A 36-year-old multigravid patient underwent a laparoscopic tubal fulguration. Two 5-mm ports were used for the procedure. At the end of the procedure, the lateral trocar site was found to have fat protrusion that looked like appendices epiploicae. A laparoscopic camera was reintroduced into the abdominal cavity that showed a large bowel herniation through the 5-mm lateral port site. The hernia was reduced laparoscopically, and the fascial defect was repaired. Conclusion: Bowel herniation can occur through a 5-mm port. All port sites should be closed to avoid such complications.

Chung, Maurice; Horrigan, Terrence; Manahan, Kelly; Geisler, John P.

2012-01-01

151

Relationship between physical work load and lumbar disc herniation.  

PubMed

Lumbar disc herniation (LDH) is a disabling problem. This retrospective case control study was done to evaluate the possible relevance of physical work load with Lumbar Disc Herniation. We have performed this study in the Spinal Surgery Unit of Department of Orthopaedic Surgery at BSMMU, Dhaka from July 2007 to June 2010 where 200 cases with Lumbar Disc Herniation and 200 control subjects matched by age, gender and area of residence were taken and analyzed. Chi-square test was computed for sex, area of residence, type of physical work and effort at work, whereas Odds ratio was computed for physical work load, stress at work and daily working period. The highest odds ratio (OR) was with the physical work load (OR: 03.48, CI: 01.84-06.59), hard work (OR: 03.14, CI: 01.74-05.65) and working period of >8 hours (OR: 01.34, CI: 0.75-02.38). Odds ratio for heavy load carrying at work was 03.48 and less job satisfaction or stress at work was 02.45. There was a statistically significant positive association between cumulative exposure of physical work load and lumbar disc herniation indicating an increased occurrence of herniation in heavy physical work load and occupation requiring harder efforts. PMID:23982545

Ahsan, M K; Matin, T; Ali, M I; Ali, M Y; Awwal, M A; Sakeb, N

2013-07-01

152

Cervical lung lobe herniation in dogs identified by fluoroscopy  

PubMed Central

This study aimed to determine the frequency of cervical lung lobe herniation (CLLH) in dogs evaluated fluoroscopically and to identify associated characteristics. Reports of diagnostic procedures and patient summaries from 2008 to 2010 were reviewed retrospectively. Signalment, body weight, duration of cough, presence of heart murmur and airway collapse, and radiographic findings were compared between dogs with and without CLLH. Of the 121 dogs that were examined, CLLH occurred in 85 (70%). The extra-thoracic trachea kinked during herniation in 33 (39%) dogs with CLLH. Collapse of the intra-thoracic trachea (assessed fluoroscopically or bronchoscopically) and collapse of major bronchi (assessed fluoroscopically) were strongly associated with CLLH. Although redundant dorsal tracheal membrane on radiographs was associated with CLLH, extra-thoracic tracheal collapse, assessed fluoroscopically or bronchoscopically, was not. No other associations were found. Cervical lung lobe herniation was present in most dogs evaluated during cough and was associated with intra-thoracic large airway collapse, but not duration of cough.

Nafe, Laura A.; Robertson, Ian D.; Hawkins, Eleanor C.

2013-01-01

153

Nontraumatic Acute Paraplegia Associated With Cervical Disk Herniation  

PubMed Central

Background: Acute paraplegia is a true emergency. It is often the result of trauma but is rarely reported in association with cervical disk herniation in patients without antecedent injury. Methods: Case report. Findings: This 75-year-old man presented with acute paraplegia due to severe compression of the spinal cord by herniation of the C4-C5 cervical disk. He underwent emergency diskectomy and anterior fusion. Postoperatively, his neurologic functions improved gradually. Conclusions: Cervical disk herniation should be considered in the differential diagnosis of nontraumatic acute paraplegia. Pre-existing narrowed canal is an important predisposing factor and excessive neck movements are believed to be triggering factors. Immediate early decompressive surgery is recommended to avoid irreversible progression of neurologic deficit.

Liu, Chao; Huang, Yue; Cai, Hong-Xin; Fan, Shun-Wu

2010-01-01

154

Cervical disc herniation producing acute brown-sequard syndrome.  

PubMed

Brown-Sequard syndrome may be the result of penetrating injury to the spine, but many other etiologies have been described. This syndrome is most commonly seen with spinal trauma and extramedullary spinal neoplasm. A herniated cervical disc has been rarely reported as a cause of this syndrome. We present a case of a 28-year-old male patient diagnosed as large C3-C4 disc herniation with spinal cord compression. He presented with left hemiparesis and diminished sensation to pain and temperature in the right side below the C4 dermatome. Microdiscectomy and anterior cervical fusion with carbon fiber cage containing a core of granulated coralline hydroxyapatite was performed. After the surgery, rapid improvement of the neurologic deficits was noticed. We present a case of cervical disc herniation producing acute Brown-Sequard syndrome with review of pertinent literature. PMID:19516953

Kim, Jong-Tae; Bong, Ho-Jin; Chung, Dong-Sup; Park, Young-Sup

2009-05-01

155

Childhood intervertebral disc calcification  

Microsoft Academic Search

Two cases of intervertebral disc calcification in children are reported. A 13-year-old boy presented with right subscapular pain radiating into the axilla with radiographic demonstration of multiple calcified intervertebral discs and a herniated fragment of calcified nucleus pulposus at T2–3. His condition improved with conservative therapy, and follow-up radiographic evaluation revealed resolution of the herniated calcified disc material. A second

B. Theo Mellion; John P. Laurent; William C. Watters

1993-01-01

156

Traumatic lumbar visceral herniation in a young woman?  

PubMed Central

INTRODUCTION Lumbar herniation is uncommon, with traumatic etiology being rare. Traumatic lumbar hernias are usually caused by seatbelt injury in motor vehicle accidents. It is exceedingly uncommon to see lumbar hernias in an unrestrained passenger of a motor vehicle accident. PRESENTATION OF CASE We present a case of a traumatic inferior lumbar hernia in a young woman who was an unrestrained driver of a vehicle involved in a high-speed collision, with multiple rollover and ejection. CT scans of the abdomen and pelvis suggested soft tissue injury involving muscles in the left lower posterior flank with traumatic herniation of the colon and small bowel. Emergent midline abdominal laparotomy confirmed herniation in the left lower quadrant. After abdominal closure, in the prone position, an extensive laceration over the left flank also confirmed herniation. Due to its dirty nature, the wound was irrigated, lavaged and covered with wound vacuum-assisted closure placement. The decision was made in favor of delayed elective hernia repair. DISCUSSION Lumbar hernias are usually caused by sudden force to the abdomen, leading to increased intra-abdominal pressure. This pressure combined with areas of weakness in the superior and/or inferior triangle lead to herniation. Uncommonly, the contents of lumbar hernias can strangulate or incarcerate leading to bowel obstruction. This can often be prevented by detection with CT and laparotomy. CONCLUSION Lumbar herniation of traumatic etiology is rare. Early detection with CT and/or exploratory laparotomy is important to avoid increases in size of the defect and bowel strangulation and incarceration.

Woolbert, Ashley; Calasanz, Emily R.; Nazim, Muhammad

2013-01-01

157

Syndrome of transtentorial herniation: is vertical displacement necessary?  

PubMed Central

MRI from a comatose patient with a massive acute subdural haematoma showed most of the features of transtentorial herniation described in the classic pathology literature. In addition to encroachment on the perimesencephalic cisterns, infarction in the anterior and posterior cerebral artery territories, ischaemic change in the lower diencephalon, and ventricular enlargement were visualised. Despite the clinical syndrome and these secondary changes due to compression, there was only approximately 2 mm of downward displacement of the upper brainstem compared with 13 mm horizontal displacement. Although tissue shifts adjacent to the tentorial aperture cause brainstem and vascular compression, these changes may occur with minimal downward herniation. Images

Ropper, A H

1993-01-01

158

Chronic Tonsillar Herniation and Crouzon’s Syndrome  

Microsoft Academic Search

Patients born with craniofacial syndromes such as Crouzon’s syndrome will often develop hydrocephalus after their initial craniofacial reconstructive procedures. We have treated 10 patients with Crouzon’s syndrome; 5 patients required a shunting procedure after cranial remodeling. Each of these 5 shunted patients later demonstrated chronic tonsillar herniation on magnetic resonance imaging studies. One of these patients exhibited signs of pseudotumor

Paul M. Francis; Stephen Beals; Harold L. Rekate; Hal W. Pittman; Kim Manwaring; Jacque Reiff

1992-01-01

159

Back extensor muscle fatigue in patients with lumbar disc herniation  

Microsoft Academic Search

We investigated back muscle fatigue and endurance in patients with lumbar disc herniation before and after surgery, and established the degree of association between perceived fatigue and objectively measured fatigue. Additionally, the relationships between muscle fatigue and endurance time on the one hand, and activity, participation, self-efficacy and health on the other, were investigated to clarify the grades of association

Åsa Dedering; Karin Harms-Ringdahl; Gunnar Nèmeth

2006-01-01

160

Risk factors for developing brain herniation during diabetic ketoacidosis  

Microsoft Academic Search

The charts were reviewed of children admitted in diabetic ketoacidosis (DKA) to one hospital within 12 years. The frequency of brain herniation after admission was nine of 153 children admitted for one or more episodes of DKA. The severity of acidosis and hypercapnea were the most reliable risk factors. None of the children who maintained a blood pH greater than

C. Patrick Mahoney; Brien W Vlcek; Michael DelAguila

1999-01-01

161

Spontaneous regression of sequestrated lumbar disc herniations: Literature review.  

PubMed

Lumbar disc herniations (LDH) may regress with conservative management; however, this phenomenon is poorly understood for the sequestrated subtype of LDH. We present one of the first comprehensive literature reviews specifically addressing the spontaneous regression of sequestrated intervertebral discs. We reviewed all publications with lumbar disc herniations, sequestrated subtype. Our results were then narrowed to patients who experienced spontaneous regression of the sequestration. Based on our literature review of 53 cases, patients with sequestrated lumbar disc herniations experienced symptomatic resolution in a mean of 1.33±1.34 months and radiographic resolution in 9.27±13.32 months. Symptomatic patients with sequestrated discs present similarly to those with other types of lumbar disc herniations. Sequestrations may have the highest likelihood to radiographically regress in the shortest time frame in comparison to the remaining subtypes of LDH. The most likely mechanism for regression is an inflammatory response elicited against the free fragment. Patients with disc sequestrations may be managed conservatively, in the absence of intractable pain, inability to walk, weakness or symptoms suggestive of cauda equina syndrome. PMID:24630494

Macki, Mohamed; Hernandez-Hermann, Marta; Bydon, Mohamad; Gokaslan, Aaron; McGovern, Kelly; Bydon, Ali

2014-05-01

162

Thoracic venous congestion caused by thoracic disc herniation  

PubMed Central

We present what is to our knowledge the first reported case of thoracic disc herniation leading to venous congestive myelopathy (VCM), which was clinically and radiographically suggestive of Foix–Alajouanine syndrome (angiodysgenetic necrotizing myelopathy). In addition, we review current concepts in evaluating the etiology of VCM and discuss indications for surgery.

Roger, Eric P; Chamczuk, Andrea J; Hagan, Marygrace C

2013-01-01

163

Recovery of motor deficits after microdiscectomy for lumbar disc herniation  

Microsoft Academic Search

e have studied, prospectively, 116 patients with motor deficits associated with herniation of a lumbar disc who underwent microdiscectomy. They were studied during the first six months and at a mean of 6.4 years after surgery. Before operation, muscle weakness was mild (grade 4) in 67% of patients, severe (grade 3) in 21% and very severe (grade 2 or 1)

F. Postacchini; G. Giannicola; G. Cinotti

2002-01-01

164

Automatic diagnosis of lumbar disc herniation with shape and appearance features from MRI  

NASA Astrophysics Data System (ADS)

Intervertebral disc herniation is a major reason for lower back pain (LBP), which is the second most common neurological ailment in the United States. Automation of herniated disc diagnosis reduces the large burden on radiologists who have to diagnose hundreds of cases each day using clinical MRI. We present a method for automatic diagnosis of lumbar disc herniation using appearance and shape features. We jointly use the intensity signal for modeling the appearance of herniated disc and the active shape model for modeling the shape of herniated disc. We utilize a Gibbs distribution for classification of discs using appearance and shape features. We use 33 clinical MRI cases of the lumbar area for training and testing both appearance and shape models. We achieve over 91% accuracy in detection of herniation in a cross-validation experiment with specificity of 91% and sensitivity of 94%.

Alomari, Raja's.; Corso, Jason J.; Chaudhary, Vipin; Dhillon, Gurmeet

2010-03-01

165

Brain herniations into the dural venous sinuses or calvarium: MRI of a recently recognized entity.  

PubMed

Brain herniations into dural venous sinuses (DVS) are rare findings recently described and their etiology and clinical significance are controversial. We describe five patients with brain herniations into the DVS or calvarium identified on MRI, and discuss their imaging findings, possible causes, and relationship to the patient's symptoms. All patients were examined with MRI including high resolution pre- and post-contrast T1- and T2-weighted sequences. With respect to brain herniations we documented their locations, signal intensities in different sequences, and size. We then reviewed clinical records in an attempt to establish if any symptoms were related to the presence of these herniations. Three males and two females were examined (age range, 11-68 years). Three patients had unilateral temporal lobe herniations into transverse sinuses, one had a cerebellar herniation into the skull, and one had bilateral temporal lobe herniations into the transverse sinuses as well as a cerebellar herniation into the sigmoid sinus. In all, the herniated brain and surrounding cerebrospinal fluid (CSF) had normal signal intensity on all MRI sequences. When correlated with clinical symptoms, brain herniations were thought to be incidental and asymptomatic in three patients and two patients had histories of headaches. Brain herniations with surrounding CSF into the DVS/skull should be considered potential sources of filling defects in the DVS. We believe that they are probably incidental findings that may be more common than previously recognized and should be not confused with the more common arachnoid granulations, clots, or tumors. Two patients had headaches, but their relation to the presence of herniated brain was uncertain. PMID:24571834

Battal, Bilal; Castillo, Mauricio

2014-02-01

166

Redundant Nerve Roots of Cauda Equina Mimicking Intradural Disc Herniation: A Case Report  

PubMed Central

Redundant Nerve Roots (RNRs) is an uncommon clinical condition characterized by a tortuous, serpentine, large and elongated nerve root of the cauda equina. To our knowledge, most cases of RNRs are associated with lumbar stenosis, and RNRs associated with lumbar disc herniation has not been reported until now. Here we present a rare case of unusual RNRs associated with lumbar disc herniation mimicking intradural disc herniation.

Yang, Sang Mi; Park, Hyung Ki; Cho, Sung Jin

2013-01-01

167

Chronic uncal herniation secondary to posterior fossa shunting: case report and literature review  

Microsoft Academic Search

Introduction  Chronic herniation syndromes other than tonsillar herniation are not well-recognized. Transtentorial uncal herniation in its\\u000a chronic form has been reported in only few case reports (Horowitz et al., J Neuroimaging 12:78–79, 2002; Naidich et al., Radiology 158:431–434, 1986; Ng and Valiante, J Clin Neurosci 16:944, 2009; Ng and Valiante, J Clin Neurosci 16:984, 2009). We hereby illustrate a case with

Suhas Udayakumaran; Liat Ben Sira; Shlomi Constantini

2010-01-01

168

Cervical disc herniation manifesting as a Brown-Sequard syndrome  

PubMed Central

Brown-Sequard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm. The clinical picture reflects hemisection of the spinal cord. We report a rare case of Brown-Sequard syndrome caused by a large cervical herniated disc. A 63-year-old man presented with progressive right hemiparesis and disruption of pain and temperature sensation on the left side of the body. Magnetic resonance imaging showed large C3-C4 disc herniation compressing the spinal cord at that level, with severe canal stenosis from C4 through C7. Decompressive cervical laminoplasty was performed. After surgery, complete sensory function was restored and a marked improvement in motor power was obtained.

Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Kuroiwa, Toshihiko

2012-01-01

169

Cervical disc herniation manifesting as a Brown-Sequard syndrome.  

PubMed

Brown-Sequard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm. The clinical picture reflects hemisection of the spinal cord. We report a rare case of Brown-Sequard syndrome caused by a large cervical herniated disc. A 63-year-old man presented with progressive right hemiparesis and disruption of pain and temperature sensation on the left side of the body. Magnetic resonance imaging showed large C3-C4 disc herniation compressing the spinal cord at that level, with severe canal stenosis from C4 through C7. Decompressive cervical laminoplasty was performed. After surgery, complete sensory function was restored and a marked improvement in motor power was obtained. PMID:22865973

Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Kuroiwa, Toshihiko

2012-05-01

170

Foraminal disc herniation Th9-Th10 mimicking abdominal pain  

Microsoft Academic Search

Thoracic disc herniations (TDH) requiring surgery are rare. They usually present with pain and\\/or myelopathy. Only 6% are wide lateral, either intraforaminal or extraforaminal. A 52-year-old patient presented with chronic mid-thoracic pain, radiating along the left 9th and 10th ribs. After nephrologic and pancreatic diseases had been exclud - ed, a CT-scan showed a far-lateral calcified TDH in the left

Patrick FRANSEN; Frédéric COLLIGNON; Bernard VAN DEN HEULE

2008-01-01

171

Skull malformation and cerebellar herniation in captive African lions.  

PubMed

Thickening of the cranial vault with a resulting cerebellar herniation is described in a series of litters of lion cubs, all with the same parents, one of whom was also very mildly affected. This animal, when mated to his daughter, also produced affected cubs. The aetiology of the condition is discussed and it is considered that vitamin A deficiency may have been less important than has been suggested by other authors. PMID:847879

Baker, J R; Lyon, D G

1977-02-01

172

Lumbar Intervertebral Disc Herniation Following Experimental Intradiscal Pressure Increase  

Microsoft Academic Search

Summary  ?An experimental biomechanical model of overload and rupture of the annulus fibrosus (AF) and lumbar disc herniation was achieved\\u000a by increasing intradiscal pressure while keeping disc height constant in 69 motion segments at the L4–L5 level excised from\\u000a cadaveric spines. The experiments were made on 53 specimens in neutral posture and on 16 specimens in flexion posture.\\u000a \\u000a ?The values found

2000-01-01

173

Herniation through the foramen of Morgagni: early diagnosis and treatment  

Microsoft Academic Search

The majority of congenital diaphragmatic hernias (CDH) occur through the foramen of Bochdalek; herniation through the foramen\\u000a of Morgagni (MH) is rare. Fifteen children (12 males and 3 females) with congenital MH (7 right, 3 left, 5 bilateral) were\\u000a treated over a period of 15 years, comprising 11% of a total of 135 children with different types of CDH. The

Ahmed H. Al-Salem; Akhter Nawaz; Hilal Matta; Alic Jacobsz

2002-01-01

174

Brown-Sequard syndrome revealing intradural thoracic disc herniation.  

PubMed

Brown-Sequard syndrome (BSS) is a rare form of severe myelopathy characterised by a clinical picture reflecting hemisection of the spinal cord. This syndrome is mostly due to a penetrating injury to the spine but many other non-traumatic causes have been described. Intradural thoracic disc herniation (TDH) is one of the rare aetiologies of this syndrome. Despite progress in imaging techniques, diagnosis and treatment remain difficult. We retrospectively reviewed one of the largest reported series of six patients with BSS revealing intradural TDH between 2003 and 2007. There was a marked female predominance and the mean age was 44 years. Before surgery, half of the patients had a severe neurological deficit. The mean duration of symptoms until surgery was 8.5 months (range 0.5-24 months). Spine magnetic resonance imaging (MRI) or spine computer tomography scan showed calcified TDH between T5-T6 and T9-T10. The intradural location of the thoracic herniation was strongly suspected from the clinical data. All the patients underwent posterolateral transpedicular surgery with an operative microscope to open the dura mater. The intradural location of the herniation was overlooked in one case and the patient underwent a second procedure. The dura mater was carefully closed. Two patients' condition worsened immediately after the surgery before slowly improving. All the other patients improved their neurological status immediately after the surgery and at 12 months follow-up. BSS with TDH on the spine MRI scan may be a warning symptom of the intradural location of the herniated disc. In such cases, spine surgeons are advised to use an operative magnification and to open the dura mater to avoid missing this potentially curable cause of severe myelopathy. PMID:20589517

Diabira, S; Henaux, P-L; Riffaud, L; Hamlat, A; Brassier, G; Morandi, X

2011-01-01

175

Acute renal failure caused by bilateral ureteral herniation through the sciatic foramen.  

PubMed

Ureteral herniation is rare. Only a few cases of bilateral ureterosciatic herniation have been reported. We report the case of a 74-year-old woman with flank pain and acute renal failure. The initial ultrasound scan showed bilateral hydronephrosis. Follow-up computed tomography imaging demonstrated sciatic herniation of both ureters, causing bilateral hydronephrosis and hydroureter. The patient underwent bilateral retrograde ureterography and ureteral stent placement, with improvement in renal function to normal limits. Observation after stent removal demonstrated recurrent sciatic herniation of both ureters. Definitive surgical correction was performed by way of laparoscopic bilateral ureterolysis and sciatic notch hernia repair using mesh. PMID:23602799

Whyburn, James J; Alizadeh, Ahmadreza

2013-06-01

176

Progressive cerebellar tonsillar herniation with recurrent divergence insufficiency esotropia.  

PubMed

The Chiari malformations are characterized by herniation of posterior fossa contents through the foramen magnum. Chiari I malformation is currently defined as ectopia of the cerebellar tonsils more than 5 mm below the foramen magnum. Extension of the cerebellar tonsils up to 3 mm may be found in the normal population. Although Chiari malformations are congenital, symptoms often do not manifest until the third and fourth decades of life, or even later. Patients usually present with headache, lower cranial nerve palsies, downbeat nystagmus, ataxia, or dissociated anesthesia of the trunk and extremities. Definitive diagnosis is made by magnetic resonance imaging (MRI), which shows the compressed tonsils extending through the foramen magnum into the cervical subarachnoid space. One of the rare presenting signs of Chiari I malformations is acquired esotropia with a divergence insufficiency pattern. We report such a case in which the initial neuroimaging showed tonsillar herniation, but of insufficient magnitude to meet diagnostic criteria for Chiari I malformation. When the strabismus recurred after initially successful eye muscle surgery, follow-up scan showed progressive tonsillar herniation. PMID:15226735

Pokharel, Dipesh; Siatkowski, R Michael

2004-06-01

177

Tethered thoracic cord resulting from spinal cord herniation.  

PubMed

Tethered cord syndrome (TCS) usually involves tethering of the lower cord at the conus medullaris from dural abnormalities, but may occur after spinal cord herniation. A tethered thoracic spinal cord is rare. We present an unusual case of a 30-year-old woman with a history of myelopathy presumed to be secondary to T6 cord compression resulting from T6-T8 arachnoid cyst. She continued to deteriorate after partial excision of the cyst. Repeat magnetic resonance imaging suggested recurrence of the presumed arachnoid cyst with cord compression and showed tethering at T6-T8. Surgical exploration revealed myelocele with cord herniation through the anterior thoracic dura. Pathologic diagnosis showed neural tissue with gliosis. After physical therapy treatments, the patient had increased lower extremity strength, ambulated with a cane, and regained some bladder control. Progressive myelopathy may represent tethering of the cord resulting from cord herniation. Early recognition of TCS, even in patients with minimal neurologic deficits, could prevent progressive disability. PMID:9161375

Henry, A; Tunkel, R; Arbit, E; Ku, A; Lachmann, E

1997-05-01

178

Recurrent wound dehiscence and small bowel herniation following Caesarean section in a woman with hidradenitis suppurativa  

PubMed Central

Caesarean wound dehiscence that is severe enough to result in bowel herniation is exceptionally rare. This case describes a woman who experienced wound dehiscence following each of her two Caesarean sections, with bowel herniation present in the second case. The contribution of her comorbid hidradenitis suppurativa will be discussed.

Fernando, Magage; Schultz, Meleesa J.

2014-01-01

179

Recurrent wound dehiscence and small bowel herniation following Caesarean section in a woman with hidradenitis suppurativa.  

PubMed

Caesarean wound dehiscence that is severe enough to result in bowel herniation is exceptionally rare. This case describes a woman who experienced wound dehiscence following each of her two Caesarean sections, with bowel herniation present in the second case. The contribution of her comorbid hidradenitis suppurativa will be discussed. PMID:24876503

Fernando, Magage; Schultz, Meleesa J

2014-01-01

180

Intermittent cervical traction for cervical radiculopathy caused by large-volume herniated disks  

Microsoft Academic Search

Objective: To describe the use of intermittent cervical traction in managing 4 patients with cervical radiculopathy and large-volume herniated disks. Clinical Features: Four patients had neck pain radiating to the arm. The clinical examination was typical in all cases for radiculopathy of cervical origin. Magnetic resonance imaging (MRI) of the cervical spine revealed large-volume herniated disks in all patients. Intervention

Constantine Constantoyannis; Demetres Konstantinou; Harry Kourtopoulos; Nicolas Papadakis

2002-01-01

181

Focal bone tracer uptake associated with a herniation pit of the femoral neck  

Microsoft Academic Search

The herniation pit of the femoral neck is a common radiographic lesion whose pathogenesis has been described by Pitt et al and reported as negative on bone scanning. This case report demonstrates increased uptake of Tc-99m MDP in a herniation pit of the femoral neck.

CHARLES B. THOMASON; EUGENE D. SILVERMAN; RICHARD D. WALTER; ROBERT OLSHAKER

1983-01-01

182

Catabolic cytokine expression in degenerate and herniated human intervertebral discs: IL1? and TNF? expression profile  

Microsoft Academic Search

Low back pain is a common and debilitating disorder. Current evidence implicates intervertebral disc (IVD) degeneration and herniation as major causes, although the pathogenesis is poorly understood. While several cytokines have been implicated in the process of IVD degeneration and herniation, investigations have predominately focused on Interleukin 1 (IL-1) and tumor necrosis factor alpha (TNF?). However, to date no studies

Christine Lyn Le Maitre; Judith Alison Hoyland; Anthony J Freemont

2007-01-01

183

Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation  

PubMed Central

Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors’ clinic and treated by PCN. The patients’ gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 ± 10.2 years). The levels of involvement were 21 cases at C3–4, 30 cases at C4–5, 40 cases at C5–6, and 35 cases at C6–7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) ?11° or horizontal displacement (HD) ?3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P < 0.01). There were no cases of instability following the PCN procedure. There was no significant difference in stability either preoperatively or postoperatively (P > 0.05). Our findings confirm that PCN for the treatment of cervical disc herniation results in a good outcome without any tampering of the stability of the cervical spine. Hence, PCN as a procedure is safe, minimally invasive, less traumatic, requiring less time with an excellent clinical outcome. PCN should be performed for those patients who fail conservative medical management including medication, physical therapy, behavioral management, psychotherapy, and who are unwilling to undergo a more invasive technique such as spinal surgery.

Li, Jian; Zhang, Zai-Heng

2008-01-01

184

Diaphragmatic acute massive herniation after laparoscopic gastroplasty for esophagectomy.  

PubMed

Minimally invasive techniques are increasingly being used for oesophagectomy. Diaphragmatic hernia is a rare complication of gastroplasty in open surgery. One of the advantages of the laparoscopic technique, the lack of peritoneal adhesions, may lead to an increased rate of this complication. We report two cases of diaphragmatic acute massive herniation after laparoscopic gastroplasty for esophagectomy out of a series of 44 laparoscopic gastroplasties performed over 33 months. We discuss some technical aspects related to its occurrence. Prevention should include a limited crural division and fixation of the gastric tube to the diaphragmatic crura at primary surgery. PMID:16364043

Fumagalli, U; Rosati, R; Caputo, M; Bona, S; Zago, M; Lutmann, F; Peracchia, A

2006-01-01

185

Head Injury and Early Signs of Tentorial Herniation  

PubMed Central

In 100 patients intracranial exploration was done soon after severe head injury when signs of transtentorial herniation were present. A third of patients had extracerebral hematomas shown on initial burr hole examination. An additional 18 percent had parenchymal clots of clinical significance disclosed only by angiography after burr hole exploration or at autopsy. Half the patients in whom exploration was done did not have intracranial hematomas of sufficient size to warrant an operative approach. Detailed neurological examinations soon after injury and the availability of more rapid diagnostic tools may improve the accuracy of early diagnosis and allow more specific prognostication in patients with severe head injury.

Hoff, Julian T.; Spetzler, Robert; Winestock, David

1978-01-01

186

Cervical intradural disc herniation and cerebrospinal fluid leak.  

PubMed

Cervical intradural disc herniation (IDH) is a rare condition and only 25 cases of cervical have been reported. We report a 45-year-old male who presented with sudden onset right lower limb weakness after lifting heavy weight. Magnetic resonance imaging of the cervical spine showed C5/6 disc prolapse with intradural extension. The patient underwent C5/6 discectomy through anterior cervical approach. Postoperatively, the patient improved in stiffness but developed cerebrospinal fluid leak and the leak resolved with multiple lumbar punctures. PMID:21743181

Kansal, Ritesh; Mahore, Amit; Kukreja, Sanjay

2011-01-01

187

Delayed presentation of a traumatic diaphragmatic rupture with intrapericardial herniation.  

PubMed

Thoracic and abdominal blunt traumas are the major causes of diaphragmatic rupture. These ruptures may be recognized at the time of the initial trauma, but are diagnosed months or even years later during the workup for related symptoms. We present herein a patient who suffered from abdominal pain and dyspnea years after a motor vehicle accident. A chest computed tomography (CT) demonstrated diaphragmatic rupture with intrapericardial herniation of intraabdominal organs. Exploratory laparotomy confirmed the diagnosis. In this report, we describe our management of this unusual diaphragmatic rupture. PMID:21258833

Cipe, G; Genç, V; Uzun, C; Atasoy, C; Erkek, B

2012-08-01

188

Occupational risk factors for symptomatic lumbar disc herniation; a case-control study  

PubMed Central

Background: Previous studies mostly did not separate between symptomatic disc herniation combined with osteochondrosis/spondylosis of the lumbar spine and symptomatic disc herniation in radiographically normal intervertebral spaces. This may at least in part explain the differences in the observed risk patterns. Aims: To investigate the possible aetiological relevance of physical and psychosocial workload to lumbar disc herniation with and without concomitant osteochondrosis/spondylosis. Methods: A total of 267 cases with acute lumbar disc herniation (in two practices and four clinics) and 197 control subjects were studied. Data were gathered in a structured personal interview and analysed using logistic regression to control for age, region, nationality, and diseases affecting the lumbar spine. Cases without knowledge about osteochondrosis/spondylosis (n=42) were excluded from analysis. Risk factors were examined separately for those cases with (n=131) and without (n=94) radiographically diagnosed concomitant osteochondrosis or spondylosis. Results: There was a statistically significant positive association between extreme forward bending and lumbar disc herniation with, as well as without concomitant osteochondrosis/spondylosis. There was a statistically significant relation between cumulative exposure to weight lifting or carrying and lumbar disc herniation with, but not without, concomitant osteochondrosis/spondylosis. Cases with disc herniation reported time pressure at work as well as psychic strain through contact with clients more frequently than control subjects. Conclusions: Further larger studies are needed to verify the concept of distinct aetiologies of lumbar disc herniation in relatively younger persons with otherwise normal discs and of disc herniation in relatively older persons with structurally damaged discs.

Seidler, A; Bolm-Audorff, U; Siol, T; Henkel, N; Fuchs, C; Schug, H; Leheta, F; Marquardt, G; Schmitt, E; Ulrich, P; Beck, W; Missalla, A; Elsner, G

2003-01-01

189

Clinical and radiographic characteristics of upper lumbar disc herniation: ten-year microsurgical experience.  

PubMed

Upper and lower lumbar disc herniation apparently have different background, symptoms, and operative results. This retrospective study reviewed the clinical records of 403 patients (409 discs) who underwent lumbar microdiscectomy performed by different surgeons at our institute between 1999 and 2009. The 290 male (72.0%) and 113 female (28.0%) patients were aged from 19 to 77 years (mean 44 years). Demographics, symptoms, and static and dynamic radiographic and magnetic resonance images obtained at the L1-2, L2-3, L3-4, L4-5, and L5-S1 intervertebral levels were analyzed. Of the 409 herniations, 3 were at L1-2, 9 at L2-3, 21 at L3-4, 166 at L4-5, and 210 at L5-S1. The mean age at herniation at L1-2 and L2-3 levels was 55.7 years. Patients with herniation of discs at L3-4 or above were significantly older than patients who suffered herniation at L4-5 or below (p < 0.0001), and the incidence of urinary disturbance was significantly higher in patients with herniation at L1-2 and L2-3 levels (p = 0.0013). The incidence of degenerative scoliosis was significantly higher in patients with herniation at L1-2 and L2-3 than in those with herniated discs at L3-4 or below (p < 0.0001). Patients with upper lumbar disc herniation were older and manifested a higher incidence of urinary disturbance. A high incidence of degenerative scoliosis was noted in the course of prolonged degenerative processes. PMID:21701105

Iwasaki, Motoyuki; Akino, Minoru; Hida, Kazutoshi; Yano, Shunsuke; Aoyama, Takeshi; Saito, Hisatoshi; Iwasaki, Yoshinobu

2011-01-01

190

Is that lumbar disc symptomatic? Herniated lumbar disc associated with contralateral radiculopathy.  

PubMed

Herniated lumbar disc may be asymptomatic or associated with lower limb radiculopathy. Most spinal surgeons would offer surgery following a period of conservative measures if the radiological and clinical findings correlate. However, the existing dictum that lumbar radiculopathy should correlate with ipsilateral lumbar disc herniation may not be accurate as it can rarely present with contralateral sciatica. Literature regarding this phenomenon is scarce. Therefore, we report a patient with herniated lumbar disc presenting with predominantly contralateral motor weakness radiculopathy, which resolved after discectomy. PMID:24811105

Abdul Jalil, Muhammad Fahmi; Lam, Miu Fei; Wang, Yi Yuen

2014-01-01

191

A painful sneeze: spontaneous thoracic lung herniation induced by vigorous sneeze.  

PubMed

Lung herniation, defined as the protrusion of lung tissue outside the normal boundaries of thoracic cage, is an unusual event. This most commonly occurs as a consequence of thoracic trauma. Spontaneous subtypes of lung herniation are rare with only a few cases reported in medical literature. We present a 63-year-old male who presented with spontaneously herniated lung after an episode of vigorous sneezing. The possible underlying mechanisms, important physical examination and diagnostic imaging findings, and aspects of management considerations are briefly discussed. PMID:24419190

Bhardwaj, Himanshu; Bhardwaj, Bhaskar; Youness, Houssein A

2014-01-01

192

Adolescent lumbar disc herniation in a Tae Kwon Do martial artist: a case report  

PubMed Central

Lumbar disc herniations are rare in children. The etiology and clinical picture may be different in children than in adults. Conservative management is the treatment of choice. Tae Kwon Do is a Korean martial art which is notorious for its high fast kicks. Tae Kwon Do will be an official Olympic sport in the year 2000. Low back pain is occasionally reported by Tae Kwon Do athletes but there are no reported cases in the literature on disc herniation in a Tae Kwon Do athlete. A case report is presented to illustrate clinical presentation, diagnosis, radiological assessment and conservative management of lumbar disc herniation in children. ImagesFigure 1Figure 2

Kazemi, Mohsen

1999-01-01

193

Surgical vs Nonoperative Treatment for Lumbar Disk Herniation  

PubMed Central

Context For patients with lumbar disk herniation, the Spine Patient Outcomes Research Trial (SPORT) randomized trial intent-to-treat analysis showed small but not statistically significant differences in favor of diskectomy compared with usual care. However, the large numbers of patients who crossed over between assigned groups precluded any conclusions about the comparative effectiveness of operative therapy vs usual care. Objective To compare the treatment effects of diskectomy and usual care. Design, Setting, and Patients Prospective observational cohort of surgical candidates with imaging-confirmed lumbar intervertebral disk herniation who were treated at 13 spine clinics in 11 US states and who met the SPORT eligibility criteria but declined randomization between March 2000 and March 2003. Interventions Standard open diskectomy vs usual nonoperative care. Main Outcome Measures Changes from baseline in the Medical Outcomes Study Short-Form Health Survey (SF-36) bodily pain and physical function scales and the modified Oswestry Disability Index (American Academy of Orthopaedic Surgeons/MODEMS version). Results Of the 743 patients enrolled in the observational cohort, 528 patients received surgery and 191 received usual nonoperative care. At 3 months, patients who chose surgery had greater improvement in the primary outcome measures of bodily pain (mean change: surgery, 40.9 vs nonoperative care, 26.0; treatment effect, 14.8; 95% confidence interval, 10.8-18.9), physical function (mean change: surgery, 40.7 vs nonoperative care, 25.3; treatment effect, 15.4; 95% CI, 11.6-19.2), and Oswestry Disability Index (mean change: surgery, ?36.1 vs nonoperative care, ?20.9; treatment effect, ?15.2; 95% CI, ?18.5. to ?11.8). These differences narrowed somewhat at 2 years: bodily pain (mean change: surgery, 42.6 vs nonoperative care, 32.4; treatment effect, 10.2; 95% CI, 5.9-14.5), physical function (mean change: surgery, 43.9 vs nonoperavtive care 31.9; treatment effect, 12.0; 95% CI; 7.9-16.1), and Oswestry Disability Index (mean change: surgery ?37.6 vs nonoperative care ?24.2; treatment effect, ?13.4; 95% CI, ?17.0 to ?9.7). Conclusions Patients with persistent sciatica from lumbar disk herniation improved in both operated and usual care groups. Those who chose operative intervention reported greater improvements than patients who elected nonoperative care. However, nonrandomized comparisons of self-reported outcomes are subject to potential confounding and must be interpreted cautiously. Trial Registration clinicaltrials.gov Identifier: NCT00000410

Weinstein, James N.; Lurie, Jon D.; Tosteson, Tor D.; Skinner, Jonathan S.; Hanscom, Brett; Tosteson, Anna N. A.; Herkowitz, Harry; Fischgrund, Jeffrey; Cammisa, Frank P.; Albert, Todd; Deyo, Richard A.

2008-01-01

194

Percutaneous Thoracic Intervertebral Disc Nucleoplasty: Technical Notes from 3 Patients with Painful Thoracic Disc Herniations  

PubMed Central

Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic disc herniation. Two of the patients experienced more than 75% pain relief and one patient experienced more than 50% pain relief. Post-procedural pain relief was maintained up to an average of 10 months after nucleoplasty. One patient with preoperative neurological signs improved postoperatively. There were no reported complications in all three patients. In view of the reduced morbidity and shorter operating time, thoracic intervertebral disc nucleoplasty can be considered in patients with pain due to thoracic disc herniation, with no calcification of the herniated disc, and in patients who may be otherwise be unfit for conventional surgery.

Gultuna, Ismail; Riezebos, Patricia; Beems, Tjemme; Vissers, Kris C.

2011-01-01

195

Post-traumatic diaphragmatic herniation of the liver, examined by positron emission tomography: case report  

PubMed Central

We present a case of post-traumatic diaphragmatic herniation of the liver, which mimicked an intrathoracic tumor. After an automobile accident, the patient underwent thoracotomies for hemothorax and lung cancer in the right chest. Seven months later, computed tomography (CT) demonstrated a round tumor in the thorax adjacent to the right diaphragm with a higher density than the liver parenchyma. An intrathoracic tumor including a primary or metastatic lung cancer was suspected. However, positron emission tomography (PET) showed that the uptake of fluorine-18-fluorodeoxyglucose (FDG) was identical to that in the liver, and the tumor appeared to be contiguous with the liver. Thus, we suspected liver herniation. Core needle biopsy revealed liver cells without neoplastic tissue. Upon surgical exploration, herniation of the liver was found and repaired. PET was helpful in providing morphological and functional information leading to accurate diagnosis of liver herniation in this unusual case.

2011-01-01

196

Surgical vs Nonoperative Treatment for Lumbar Disk Herniation  

PubMed Central

Context Lumbar diskectomy is the most common surgical procedure performed for back and leg symptoms in US patients, but the efficacy of the procedure relative to nonoperative care remains controversial. Objective To assess the efficacy of surgery for lumbar intervertebral disk herniation. Design, Setting, and Patients The Spine Patient Outcomes Research Trial, a randomized clinical trial enrolling patients between March 2000 and November 2004 from 13 multidisciplinary spine clinics in 11 US states. Patients were 501 surgical candidates (mean age, 42 years; 42% women) with imaging-confirmed lumbar intervertebral disk herniation and persistent signs and symptoms of radiculopathy for at least 6 weeks. Interventions Standard open diskectomy vs nonoperative treatment individualized to the patient. Main Outcome Measures Primary outcomes were changes from baseline for the Medical Outcomes Study 36-item Short-Form Health Survey bodily pain and physical function scales and the modified Oswestry Disability Index (American Academy of Orthopaedic Surgeons MODEMS version) at 6 weeks, 3 months, 6 months, and 1 and 2 years from enrollment. Secondary outcomes included sciatica severity as measured by the Sciatica Bothersomeness Index, satisfaction with symptoms, self-reported improvement, and employment status. Results Adherence to assigned treatment was limited: 50% of patients assigned to surgery received surgery within 3 months of enrollment, while 30% of those assigned to nonoperative treatment received surgery in the same period. Intent-to-treat analyses demonstrated substantial improvements for all primary and secondary outcomes in both treatment groups. Between-group differences in improvements were consistently in favor of surgery for all periods but were small and not statistically significant for the primary outcomes. Conclusions Patients in both the surgery and the nonoperative treatment groups improved substantially over a 2-year period. Because of the large numbers of patients who crossed over in both directions, conclusions about the superiority or equivalence of the treatments are not warranted based on the intent-to-treat analysis. Trial Registration clinicaltrials.gov Identifier: NCT00000410

Weinstein, James N.; Tosteson, Tor D.; Lurie, Jon D.; Tosteson, Anna N. A.; Hanscom, Brett; Skinner, Jonathan S.; Abdu, William A.; Hilibrand, Alan S.; Boden, Scott D.; Deyo, Richard A.

2008-01-01

197

CT of adult lumbar disc herniations mimicking posterior apophyseal ring fractures.  

PubMed

This report concerns 35 adult patients with lumbar or sciatic pain and axial CT findings reportedly associated with posterior apophyseal ring fractures. Review of the CT images suggested two pathophysiologic categories. (1) Posterior Schmorl--A posterior intravertebral disc herniation with posterior displacement of a fractured or remodelled vertebral margin. (2) Calcified subligamentous--Reactive annular and or posterior longitudinal ligament calcification at the periphery of a herniated disc with or without remodelling and anterior displacement of the posterior vertebral margin. PMID:1749472

Gomori, J M; Floman, Y; Liebergall, M

1991-01-01

198

Cervical Disc Herniation Causing Brown-S?quard's Syndrome: A Case Report and Literature Review  

PubMed Central

Brown-Séquard's syndrome (BSS) is caused by hemisection or hemicompression of the cord leading to ipsilateral motor deficit and contralateral sensory loss. Cervical disc herniation has been reported to be a rare cause of Brown-Séquard's syndrome. We describe a rare case of multilevel cervical disc herniation presenting as BSS. The condition was confirmed by MRI scan. Cervical corpectomy, decompression, and fusion gave a satisfying result. Pertinent literature has been reviewed.

Rustagi, Tarush; Badve, Siddharth; Maniar, Hemil; Parekh, Aseem N.

2011-01-01

199

Simultaneous occurrence of herniated disc and mesothelial cyst in a 16-year-old male  

Microsoft Academic Search

The unusual, simultaneous occurrence of both a herniated disc and an intraspinal mesothelial cyst in an adolescent is reported. The patient was a 16-year-old white male who presented with sciatic pain in his left lower extremity. Myelography revealed evidence of a left L4–5 discal herniation, and a L5–S3 midline sacral lesion that proved to be a mesothelial cyst.

Nancy E. Epstein; Joseph A. Epstein; Robert Gould; Roger Hyman

1986-01-01

200

Intradural Lumbar Disc Herniation Associated With Degenerative Spine Disease and Rheumatoid Arthritis.  

PubMed

Study Design. A case report by Kara Krajewski and Jan Regelsberger.Objective. To demonstrate a case of intradural lumbar disc herniation including imaging studies, intraoperative imaging and an intraoperative video.Summary of Background Data. The first case of lumbar intradural disc herniation was reported as early as 1942; since then over 150 cases have been reported, mostly in the lumbar spine. Gadolinium-enhanced MRI is considered the gold standard for diagnosing this entity, though it is rarely peformed routinely in lumbar disc disease and diagnosis is often made intraoperatively.Methods. A 70-year-old man presented to the emergency department as a referral complaining of lower back pain, loss of sensation in the right thigh and difficulty walking. On examination, he showed uneven gait, right-sided foot drop (1/5), hypesthesias in the right inguinal area and ventral thigh and a positive straight leg raise test on the right. Anal sphincter tone was within normal limits. An MRI of the lumbar spine showed a large mediolateral herniated disc at L3/4, with caudal displacement and unclear signal changes intradurally.Results. Intraoperatively, the herniated disc was found upon opening the dural sac.Conclusion. Intradural disc herniations are a rare entity. The opening and inspection of the dural sack should be considered when the correct spinal level can be confirmed and insufficient herniated disc material can be visualized extradurally. PMID:23462573

Krajewski, K; Regelsberger, J

2013-03-01

201

Lumbar Discectomy Outcomes Vary by Herniation Level in the Spine Patient Outcomes Research Trial  

PubMed Central

Background: The Spine Patient Outcomes Research Trial showed an overall advantage for operative compared with nonoperative treatment of lumbar disc herniations. Because a recent randomized trial showed no benefit for operative treatment of a disc at the lumbosacral junction (L5-S1), we reviewed subgroups within the Spine Patient Outcomes Research Trial to assess the effect of herniation level on outcomes of operative and nonoperative care. Methods: The combined randomized and observation cohorts of the Spine Patient Outcomes Research Trial were analyzed by actual treatment received stratified by level of disc herniation. Overall, 646 L5-S1 herniations, 456 L4-L5 herniations, and eighty-eight upper lumbar (L2-L3 or L3-L4) herniations were evaluated. Primary outcome measures were the Short Form-36 bodily pain and physical functioning scales and the modified Oswestry Disability Index assessed at six weeks, three months, six months, one year, and two years. Treatment effects (the improvement in the operative group minus the improvement in the nonoperative group) were estimated with use of longitudinal regression models, adjusting for important covariates. Results: At two years, patients with upper lumbar herniations (L2-L3 or L3-L4) showed a significantly greater treatment effect from surgery than did patients with L5-S1 herniations for all outcome measures: 24.6 and 7.1, respectively, for bodily pain (p = 0.002); 23.4 and 9.9 for Short Form-36 physical functioning (p = 0.014); and ?19 and ?10.3 for Oswestry Disability Index (p = 0.033). There was a trend toward greater treatment effect for surgery at L4-L5 compared with L5-S1, but this was significant only for the Short Form-36 physical functioning subscale (p = 0.006). Differences in treatment effects between the upper lumbar levels and L4-L5 were significant for Short Form-36 bodily pain only (p = 0.018). Conclusions: The advantage of operative compared with nonoperative treatment varied by herniation level, with the smallest treatment effects at L5-S1, intermediate effects at L4-L5, and the largest effects at L2-L3 and L3-L4. This difference in effect was mainly a result of less improvement in patients with upper lumbar herniations after nonoperative treatment. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

Lurie, J.D.; Faucett, S.C.; Hanscom, B.; Tosteson, T.D.; Ball, P.A.; Abdu, W.A.; Frymoyer, J.W.; Weinstein, J.N.

2008-01-01

202

Lumbar intraspinal extradural ganglion cyst  

Microsoft Academic Search

A case is presented of an intraspinal extradural ganglion cyst at the L4–5 level. The clinical picture suggested a herniated nucleus pulposus at this level. A myelogram revealed a round lesion almost completely obstructing the flow of Pantopaque at the L4–5 level. A ganglion cyst with a haemorrhage into it and the surrounding tissue was removed, and surgery was followed

Adam Brish; Hushong M. Payan

1972-01-01

203

Hemilaminoplasty for the treatment of lumbar disc herniation.  

PubMed

The aim of this study was to evaluate the clinical outcome of the hemilaminoplasty technique for the treatment of lumbar disc herniation (LDH). Forty-three cases of single-level LDH underwent a discectomy and hemilaminoplasty procedure. The preoperative JOA score and VAS of lower back and leg pain were 10.4+/-1.3, 7.8+/-2.1, and 8.6+/-1.7, respectively. The Cobb angle of lumbar sagittal alignment was 10.1+/-2.0. Twenty-five patients who agreed to lumbar discectomy through fenestration were enrolled as the control group. The postoperative JOA score and VAS of low back and leg pain of the hemilaminoplasty group were 19.4+/-1.3, 1.4+/-0.4, and 2.1+/-0.5, respectively. The Cobb angle was 29.2+/-1.9 degrees. There was no epidural scar observed in any of the patients. The Cobb angle of the hemilaminoplasty group was higher than that of the control group (p < 0.05), while the VAS was significantly lower (p < 0.05). Hemilaminoplasty is a useful method to improve clinical outcome, prevent epidural scar, and preserve the normal alignment of lumbar spine. PMID:18636258

Xinyu, Liu; Yanping, Zheng; Jianmin, Li; Liangtai, Gong

2009-10-01

204

Lumbar herniation following extended autologous latissimus dorsi breast reconstruction  

PubMed Central

Background Reconstructive breast surgery is now recognized to be an important part of the treatment for breast cancer. Surgical reconstruction options consist of implants, autologous tissue transfer or a combination of the two. The latissimus dorsi flap is a pedicled musculocutaneous flap and is an established method of autologous breast reconstruction. Lumbar hernias are an unusual type of hernia, the majority occurring after surgery or trauma in this area. The reported incidence of a lumbar hernia subsequent to a latissimus dorsi reconstruction is very low. Case presentation We present the unusual case of lumbar herniation after an extended autologous latissimus dorsi flap for breast reconstruction following a mastectomy. The lumbar hernia was confirmed on CT scanning and the patient underwent an open mesh repair of the hernia through the previous latissimus dorsi scar. Conclusion Lumbar hernias are a rare complication that can occur following latissimus dorsi breast reconstruction. It should be considered in all patients presenting with persistent pain or swelling in the lumbar region.

2013-01-01

205

Transmastoid approach to repair meningoencephalic herniation in the middle ear.  

PubMed

Meningoencephalic herniation (MEH) in the middle ear and mastoid is a rare pathological entity with possible life-threatening complications. We treated 24 patients with a trans-mastoid approach, and the bony defect was closed by heterologous materials positioned in a multilayer fashion. The cause of the bony defect were chronic otitis media with cholesteatoma, iatrogenic, spontaneous and post-traumatic. The major presenting symptoms were meningitis, headache, conductive hearing loss, cerebrospinal fluid (CSF leak), neurologic deficit and pneumoencephalus, and stenosis of a canal wall down cavity. During follow-up, no patient developed complications due to surgery or related to the pathology, and imaging showed a stable occlusion of the bony defect. Different surgical treatments have been proposed to repair MEH, and the choice is based on the localization and size of the bony defect, preoperative auditory function and the presence of a coexisting pathology. We propose the use of collagenous membranes and bone substitutes for reconstruction of the floor of the middle fossa. PMID:23853399

Sergi, B; Passali, G C; Picciotti, P M; De Corso, E; Paludetti, G

2013-04-01

206

Thoracic disc herniation treated by video-assisted thoracoscopic surgery: case report.  

PubMed

Clinically, thoracic disc herniation occurs much less frequently than herniation in the cervical or lumbar regions, and accounts for only 0.15 to 1.8% of all intervertebral discs treated surgically. Classically, open thoracotomy is the standard procedure for thoracic disc herniation, but this type of surgery can cause prolonged postoperative wound pain that jeopardizes the mechanism of respiration and postoperative rehabilitation. We report the case of a 41-year-old woman with a symptomatic T11-T12 thoracic disc herniation and cord compression. Video-assisted thoracoscopic surgery (VATS) was performed to remove the herniated disc successfully. Intraoperatively, there was no injury to vital organs or the spinal cord. The total operating time was 3.5 hours, and the estimated blood loss was 400 ml. Postoperatively, the incisional pain was minimal, and no intercostal neuralgia was noted. At her 2-year follow-up examination, she was fully ambulatory and free of pain. This type of minimally invasive procedure is a good alternative to the classic thoracotomy and proved to be a safe and effective procedure for this patient. PMID:10074733

Lee, Y Y; Huang, T J; Liu, H P; Hsu, R W

1998-12-01

207

Thoracic Disk Herniation, a not Infrequent Cause of Chronic Abdominal Pain  

PubMed Central

This study assesses the proportion of patients presenting with nonvisceral chronic abdominal pain who have thoracic disk herniation as a possible cause. We designed a descriptive transversal study of patients attending our offices between February 2009 and October 2010, with a complaint of chronic abdominal pain of suspected abdominal wall source (positive Carnett sign). Nuclear magnetic resonance (NMR) of the spinal column was performed on all patients. When the NMR showed thoracic disk herniation the patients were treated according to their etiology. We also evaluated the symptoms in patients with thoracic disk herniation and their response to the applied treatment. Twenty-seven patients with chronic abdominal pain were evaluated. The NMR results in 18 of these 27 patients (66.66%) showed evidence of disk herniation. We report on the results of these 18 patients, emphasizing that the symptoms are florid and varied. Many patients had been previously diagnosed with irritable bowel syndrome. Thoracic disk herniation may account for chronic abdominal pain in many patients who remain undiagnosed or are diagnosed with irritable bowel syndrome. Thus, this possibility needs to be taken into account to achieve a correct diagnosis and a suitable mode of treatment.

Lara, F.J. Perez; Berges, A. Ferrer; Quesada, J. Quintero; Ramiro, J.A. Moreno; Toledo, R. Bustamante; Munoz, H. Oliva

2012-01-01

208

Three-dimensional radiological classification of lumbar disc herniation in relation to surgical outcome  

PubMed Central

Centrally located lumbar disc herniations have been reported to be of predictive value for poor post-operative clinical outcome. One hundred and fifty patients undergoing lumbar disc herniation surgery were prospectively included. Herniation-related parameters, including the grading of contours, were assessed from pre-operative computed tomography (CT) and magnetic resonance imaging (MRI) images using a new three-dimensional grading system. The radiological findings were compared with outcome parameters two years post-operatively (patient-assessed pain, function/health scores and evaluation by an independent observer). An intra- and inter-observer validation of the classification was performed in a subgroup of patients. High intra-observer and good inter-observer reliability for both CT and MRI was seen. In the study population, no relation between the distribution or size of the herniations and outcome at 2-year follow-up were found. The distribution and size of the lumbar disc herniations with the three-dimensional classification were not found to be of importance for the clinical outcome.

Lind, B.; Ronnberg, K.; Gothlin, J.; Gadeholt-Gothlin, G.; Zoega, B.; Brisby, H.

2008-01-01

209

Expression of neurotrophic factors in the dorsal root ganglion in a rat model of lumbar disc herniation  

Microsoft Academic Search

A variety of molecules released by inflammatory reactions in the dorsal root and dorsal root ganglion (DRG) may play important roles in the pathology of neuronal abnormalities in lumbar disc herniation. In order to elucidate the pathophysiological mechanisms of painful radiculopathy, secondary to lumbar disc herniation, we evaluated pain-related behavior and the change of nerve growth factor (NGF) and brain-derived

Koichi Obata; Hiroaki Tsujino; Hiroki Yamanaka; Dai Yi; Tetsuo Fukuoka; Norio Hashimoto; Kazuo Yonenobu; Hideki Yoshikawa; Koichi Noguchi

2002-01-01

210

Gangrenous small bowel obstruction secondary to congenital internal herniation: a case report.  

PubMed

Congenital internal herniation is a rare condition presenting as recurrent abdominal pain or acute intestinal obstruction. In cases in which bowel incarceration or strangulation develop, rapid progression to bowel ischemia, necrosis or perforation is inevitable. Mortality in such cases has been reported to be as high as 50%. Despite advances in imaging modalities, arriving at a pre-operative diagnosis of a congenital internal herniation remains a challenge. We report such a case where imaging was unsuccessful in determining the cause of intestinal obstruction in a 3 year old child. Congenital internal herniation may result in disastrous consequences if not addressed in a timely fashion due to its rarity. Hence a high index of clinical suspicion is needed to avoid missing this diagnosis in a child presenting with recurrent abdominal pain or acute intestinal obstruction. PMID:22582563

Tan, Y L; Alhagi, Muthu V

2012-02-01

211

Cervical disc herniation as a cause of brown-séquard syndrome.  

PubMed

The possible causes of Brown-Séquard Syndrome (BSS) have been frequently observed with spinal trauma and extramedullary spinal tumors, but the cervical disc herniation to cause BSS is rare. The authors present five cases of patients who were diagnosed with BSS resulting from cervical disc herniation, and the results of the literature in view of their distinctive symptoms and clinical outcomes. Postoperatively, the patients showed complete or almost complete recovery from their motor and sensory deficits. On the basis of our cases, it is important to diagnose it early by cervical magnetic resonance imaging, especially in the absence of the typical symptoms of cervical disc herniation or other obvious etiology of extremity numbness. Immediate surgical treatment is also essential for a favorable functional neurological recovery. PMID:20041066

Choi, Kyeong Bo; Lee, Choon Dae; Chung, Dai-Jin; Lee, Sang-Ho

2009-11-01

212

Compressive properties of fibrous repair tissue compared to nucleus and annulus.  

PubMed

The wound healing process includes filling the void between implant and tissue edges by collagenous connective repair tissue. This fibrous repair tissue may load share or stabilize implants such as spinal disc replacements. The objective of this study was the biomechanical characterization of human fibrous tissue compared to annulus fibrosus and nucleus pulposus. Human lumbar discs (10 nucleus and annulus) and 10 lumbar deep wound fibrous tissue specimens were sectioned into 12mm diameter×6mm high cylindrical samples. Confined compression testing, after 2h swelling at 0.11MPa, was performed at 5%, 10% and 15% strain over 3.5h. Unconfined dynamic testing (2-0.001Hz) was performed at 5-15% strain. Semi-quantitative histology estimated the proportion of proteoglycan to collagen. Fibrous tissue exhibited a decrease in height during the swelling period whereas annulus and nucleus tissues did not. The aggregate modulus was significantly less for fibrous tissue (p<0.002). Percent stress relaxation was greatest for the fibrous tissue and similar for annulus and nucleus. Dynamic testing found the storage modulus (E') was greater than the loss modulus (E?) for all tissues. Annulus were found to have greater E' and E? than nucleus, whereas E' and E? were similar between annulus and fibrous tissue. Fibrous tissue had the greatest increase in both moduli at greater frequencies, but had the lowest hydration and proteoglycan content. Fibrous tissue would not be a substitute for native tissue within the disc space but if adjacent to a disc prosthesis may impart some degree of intersegmental stability during acute loading activities. PMID:23643028

Freeman, Andrew L; Buttermann, Glenn R; Beaubien, Brian P; Rochefort, Willie E

2013-06-21

213

Comparison between cranial thoracic intervertebral disc herniations in German Shepherd dogs and other large breed dogs.  

PubMed

Cranial thoracic intervertebral disc herniations have been reported to be rare in dogs due to the presence of the intercapital ligament, however some studies have proposed they may not be uncommon in German Shepherd dogs. The purpose of this retrospective study was to compare cranial thoracic intervertebral disc herniations in German Shepherd dogs and other large breed dogs (control group). Medical records at the Ontario Veterinary College were searched for German Shepherd dogs and other large breed dogs that had magnetic resonance imaging studies including the T1-T9 region. For each dog and each disc space from T1-T9, three variables (compression, disc degeneration, and herniation) were recorded and graded based on review of sagittal T2-weighted images. Twenty-three German Shepherd dogs and 47 other large breed dogs met inclusion criteria. The German Shepherd dog group had higher scores than the control group for compression (P = 0.0099) and herniation (P < 0.001), but not disc degeneration (P = 0.97). In the German Shepherd dog group, intervertebral discs T2-T3 and T4-T5 had an increased risk for compression and T3-T4 had an increased risk for compression and herniation. Findings from this study indicated that German Shepherd dogs may be more likely than other large breed dogs to have spinal cord compression due to cranial thoracic disc herniations. Imaging of the cranial thoracic spine, including T2-T3, is recommended for German Shepherd dogs with T3-L3 neurological signs. PMID:23278950

Gaitero, Luis; Nykamp, Stephanie; Daniel, Rob; Monteith, Gabrielle

2013-01-01

214

Outpatient, awake, ultra-minimally invasive endoscopic treatment of lumbar disc herniations.  

PubMed

Background: Endoscopic discectomy is an ultra- minimally invasive outpatient surgical option for the treatment of lumbar herniated discs. The purpose of this study was to assess the benefit of tranforaminal versus interlaminar endoscopic discectomy in patients with single level Lumbar 5-Sacral 1(L5-S1) disc herniations and lumbar radiculopathy. Methods: After Institutional Review Board Approval, charts from 41 consecutive patients with complaints of lower back and radicular pain and an L5-S1 herniated disc who underwent an endoscopic procedure between 2007 and 2012 were reviewed. The transforaminal approach was used for patients with far lateral, foraminal, and paracentral disc herniations and the intralaminar approach was used for herniations that were more central. Results: The average pain relief 1-year postoperatively was 75.9% for the transforaminal group and 75.3% for the interlaminar group, both excellent results as defined by MacNab. The average preoperative visual analogue scale (VAS) scores were 8.2 and 8.4 for the transforaminal and interlaminar groups respectively, indicated in our questionnaire as severe and constant pain. The average 1-year postoperative VAS scores were 1.7 and 2.1, indicated in our questionnaire as mild and intermittent pain. There were no complications in the series of patients treated. Conclusions: The 1-year follow-up data presented here for transforaminal and intralaminar approaches to L5-S1 disc herniations appears to indicate that either approach can be used as determined to best suit the pathology without sacrificing the probability of postoperative pain improvement. [Full text available at http://rimed.org/rimedicaljournal-2014-06.asp, free with no login]. PMID:24905375

Jasper, Gabriele P; Francisco, Gina M; Telfeian, Albert

2014-06-01

215

Imaging dogs with suspected disc herniation: pros and cons of myelography, computed tomography, and magnetic resonance.  

PubMed

Myelography, computed tomography (CT), and magnetic resonance (MR) imaging are the diagnostic modalities currently used in the evaluation of dogs with suspected disc herniation. Where high-field MR imaging is available, it is considered the optimal modality for any myelopathy in dogs, including those with disc disease. CT myelography may be the next best option, particularly in nonchondrodystrophoid dogs. In chondrodystrophoid dogs, in which extrusion of mineralized disc material is common, plain CT will enable diagnosis in most cases. Myelography is still considered adequate for diagnosis of disc herniation when MR and CT are unavailable. PMID:21392160

Robertson, Ian; Thrall, Donald E

2011-01-01

216

Diagnosis of disc herniation based on classifiers and features generated from spine MR images  

NASA Astrophysics Data System (ADS)

In recent years the demand for an automated method for diagnosis of disc abnormalities has grown as more patients suffer from lumbar disorders and radiologists have to treat more patients reliably in a limited amount of time. In this paper, we propose and compare several classifiers that diagnose disc herniation, one of the common problems of the lumbar spine, based on lumbar MR images. Experimental results on a limited data set of 68 clinical cases with 340 lumbar discs show that our classifiers can diagnose disc herniation with 97% accuracy.

Koh, Jaehan; Chaudhary, Vipin; Dhillon, Gurmeet

2010-03-01

217

Non traumatic liver herniation due to persistent cough mimicking a pulmonary mass  

PubMed Central

Background: Non traumatic liver herniation through a diaphragmatic defect is rare. Case Report: A 44 year old woman presented with lower lobe opacity at the right lung. Chest Computed tomography (CT) demonstrated a round tumor adjacent to the right diaphragm. Percutaneous needle biopsy revealed liver tissue. A small liver herniation through a diaphragmatic defect was detected in saggital and coronal CT views but no traumatic rupture of the diaphragm or endometriosis were documented. Conclusions: The patient suffered from gastroesophageal reflux disease and increased transdiaphragmatic pressure from paroxysmal cough due to aspirations may have provoked the diaphragmatic rupture.

Pataka, A; Paspala, A; Sourla, E; Bagalas, V; Argyropoulou, P

2013-01-01

218

Giant posterior fossa arachnoid cyst causing tonsillar herniation and cervical syringomyelia.  

PubMed

Acquired cerebellar tonsillar herniation and syringomyelia associated with posterior fossa mass lesions is an exception rather than the rule. In the present article, we describe the neuroimaging findings in a case of 28-year-old female patient presented with a history of paraesthesia involving right upper limb of 8-month duration. Magnetic resonance imaging showed a giant retrocerebellar arachnoid causing tonsillar herniation with cervical syringomyelia. The findings in the present case supports that the one of the primary mechanism for the development of syringomyelia may be the obstruction to the flow of cerebrospinal fluid causing alterations in the passage of extracellular fluid in the spinal cord and leading to syringomyelia. PMID:24381458

Joshi, Vijay P; Valsangkar, Ashwin; Nivargi, Satish; Vora, Nitant; Dekhne, Anish; Agrawal, Amit

2013-01-01

219

Thoracic disk herniation manifesting as sciatica-like pain--two case reports.  

PubMed

Two patients presented with sciatica-like pain caused by thoracic disk herniation. Sciatica-like pain was the initial and major symptom in both patients, but careful neurological examination showed vague signs of upper motor neuron disturbance, and thoracic magnetic resonance (MR) imaging revealed disk herniations at the mid-thoracic level. After video-assisted thoracoscopic discectomy, the pain was completely improved. Thorough neurological examination and MR imagery of the thoracic spine, and if needed, even the cervical spine, are required if lumbar image findings do not correlate with the symptoms or physical examination. PMID:21273750

Cho, Hyung-Lea; Lee, Sang-Ho; Kim, Jin-Sung

2011-01-01

220

The Inguinal Herniation of the Ovary in the Newborn: Ultrasound and Color Doppler Ultrasound Findings  

PubMed Central

Inguinal hernias in the newborn age group are seldom encountered. In the affected female patient, the ovaries, fallopian tubes, and the intestines may settle in the hernia sac. The early diagnosis of torsion in cases in which the ovary is herniated into the inguinal canal is of utmost importance in order to give surgery the chance of reduction and correction. In this paper, a case of an ovarian herniation into the inguinal canal without the presence of torsion is being presented, and the place of US and CDUS in the differential diagnosis of the situation is being discussed.

Kaya, Omer; Esen, Kaan; Gulek, Bozkurt; Yilmaz, Cengiz; Soker, Gokhan; Onem, Onder

2014-01-01

221

Delayed presentation of traumatic diaphragmatic rupture with herniation of the left kidney and bowel loops.  

PubMed

Rupture of the diaphragm mostly occurs following major trauma. We report a case of delayed presentation of traumatic diaphragmatic hernia on the left side in a 44-year-old male who presented two weeks after a minor blunt trauma. Left kidney and intestinals coils were found to herniate through the diaphragmatic tear. This case demonstrates the importance of considering the diagnosis in all cases of blunt trauma of the trunk. It also illustrates the rare possibility of herniation of kidney through the diaphragmatic tear. PMID:23956912

Dwari, Amiya Kumar; Mandal, Abhijit; Das, Sibes Kumar; Sarkar, Sudhansu

2013-01-01

222

Delayed Presentation of Traumatic Diaphragmatic Rupture with Herniation of the Left Kidney and Bowel Loops  

PubMed Central

Rupture of the diaphragm mostly occurs following major trauma. We report a case of delayed presentation of traumatic diaphragmatic hernia on the left side in a 44-year-old male who presented two weeks after a minor blunt trauma. Left kidney and intestinals coils were found to herniate through the diaphragmatic tear. This case demonstrates the importance of considering the diagnosis in all cases of blunt trauma of the trunk. It also illustrates the rare possibility of herniation of kidney through the diaphragmatic tear.

Dwari, Amiya Kumar; Mandal, Abhijit; Sarkar, Sudhansu

2013-01-01

223

Multipoint determination of pressure-volume curves in human intervertebral discs.  

PubMed Central

To gain further insight into the biomechanics of the human intervertebral disc and to determine a potential mechanism for causation and relief of symptoms related to a herniated disc, the pressure-volume relation was determined within the nucleus pulposus. Pressure was measured continuously within the nucleus pulposus in 17 intact lumbar discs from human cadavers by means of a miniature strain gauge at the tip of a size 4 French (1.3 mm) catheter inserted into the nucleus pulposus. The volume of the nucleus pulposus was increased at the slow, continuous rate of 0.034 ml/min by the pump regulated infusion of saline coloured with methylene blue. In 12 unloaded discs, nucleus pulposus pressure rose in a linear fashion (linear r = 0.96) from an initial mean pressure of 174 (SD 81) kPa. The mean rate of pressure rise was 327 (SD 109) kPa/ml volume increase. The peak pressure measured was 550 kPa; this was slightly higher than the capability of the transducer. Similar linear relations were obtained during infusion of saline into five vertically loaded discs fixed at the deformation produced by a 9.1 kg weight. The data define the pressure-volume relation within the disc and show that the nucleus pulposus, surrounded by the relatively inelastic annulus and the solid vertebral end plates, has the properties of a tight hydraulic space in which a large pressure rise will regularly result from a small increase in volume. Presumably the opposite is also true. The data may provide a biomechanical basis for the physiological variation in symptoms related to the disc, and for any benefits obtained from interventions designed to remove disc tissue.

Ranu, H S

1993-01-01

224

The plant cell nucleus  

PubMed Central

Communication between the cytoplasm and the nucleus is a fundamental feature shared by both plant and animal cells. Cellular factors involved in the transport of macromolecules through the nuclear envelope, including nucleoporins, importins and Ran-GTP related components, are conserved among a variety of eukaryotic systems. Interestingly, mutations in these nuclear components compromise resistance signaling, illustrating the importance of nucleocytoplasmic trafficking in plant innate immunity. Indeed, spatial restriction of defense regulators by the nuclear envelope and stimulus-induced nuclear translocation constitute an important level of defense-associated gene regulation in plants. A significant number of effectors from different microbial pathogens are targeted to the plant cell nucleus. In addition, key host factors, including resistance proteins, immunity components, transcription factors and transcriptional regulators shuttle between the cytoplasm and the nucleus, and their level of nuclear accumulation determines the output of the defense response, further confirming the crucial role played by the nucleus during the interaction between plants and pathogens. Here, we discuss recent findings that situate the nucleus at the frontline of the mutual recognition between plants and invading microbes.

Deslandes, Laurent

2011-01-01

225

Partial left pericardial defect with herniation of the left atrial appendage  

Microsoft Academic Search

A case is reported of herniation of the left atrial appendage through a partial pericardial defect, probably congenital. The diagnosis was suggested by the history of chest pain and bulging of the middle segment of the left heart border on the plain chest film, without other signs. Angiography revealed a dilated left atrial appendage. An artificial left pneumothorax confirmed the

C. Pernot; J C. Hoeffel; M. Henry; R. Frisch; B. Brauer

1972-01-01

226

Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation  

PubMed Central

Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS), MacNab classification, and Oswestry disability index (ODI). At the final follow up (mean: 17 months; range: 6–41 months), patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery.

Nie, Hong-Fei; Liu, Kai-Xuan

2013-01-01

227

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?  

Microsoft Academic Search

Lumbar disc herniation (LDH) is a common cause of back and sciatic pain. When clinical treat- ment fails, surgery may be indicated in selected patients. Although surgery is effective in most cases, some of these patients may have a poor outcome. Different factors may influence these results and poor adap- tation at work is one well-known cause of treatment failure.

Daniel Benzecry Almeida; Paola Hesse Poletto; Jerônimo Buzetti Milano; André Giacomelli Leal; Ricardo Ramina

2007-01-01

228

Children Presenting with Calcified Disc Herniation: A Self-Limiting Process  

PubMed Central

We present two cases of disc herniation associated with juvenile intervertebral disc calcification, a rare, self-limiting process which typically resolves with conservative treatment. Recognition of this entity prevents unnecessary diagnostic workup and possible surgical intervention. A review of the literature for this rare entity is discussed.

Ho, Chang; Chang, Stanley; Fulkerson, Daniel; Smith, Jodi

2012-01-01

229

Retrolisthesis and lumbar disc herniation: a preoperative assessment of patient function  

Microsoft Academic Search

Background contextRetrolisthesis is relatively rare but when present has been associated with increased back pain and impaired back function. Neither the prevalence of this condition in individuals with lumbar disc herniations nor its possible relation to preoperative back pain and dysfunction has been well studied.

Michael Shen; Afshin Razi; Jon D. Lurie; Brett Hanscom; Jim Weinstein

2007-01-01

230

Laparoscopic repair of a small bowel herniation through a broad ligament defect.  

PubMed

A 44-year-old female presented with a diagnosis of intestinal obstruction from unknown origin. Laparoscopy revealed herniation of small bowel trough a defect in the left broad ligament. After reduction, the defect was corrected laparoscopically. The post operative recovery was uneventful. PMID:25013338

Buero, Agustín; Silberman, Ezequiel A; Medina, Pablo; Morra, Matias E; Bogetti, Diego J; Porto, Eduardo A

2014-07-01

231

Cervical disc herniation presenting with neck pain and contralateral symptoms: a case report  

PubMed Central

Introduction Cervical disc herniation often results in neck and arm pain in patients as a result of direct impingement of nerve roots and associated inflammatory processes. The clinical presentation usually corresponds with the side of herniation and ipsilateral symptoms predominate the clinical picture. Case presentation A 35-year-old Caucasian man presented to our facility with neck pain and left-sided upper and lower extremity pain. A magnetic resonance imaging scan revealed a right paramedian herniated disc at the C5 to C6 level. All other cervical levels were normal without central canal stenosis or neural foraminal stenosis. Results from magnetic reasonance imaging scans of the brain and lumbar spine were negative. An anterior cervical discectomy was performed at the C5 to C6 level, and an inter-body graft and plate were placed. Our patient had complete resolution of his neck and left arm pain. Conclusions Anterior discectomy and fusion of the cervical spine resulted in complete resolution of our patient’s neck and left arm symptoms and improvement of his contralateral left leg pain. Cervical disc herniation may present with contralateral symptoms that are different from the current perception of this disease.

2012-01-01

232

Influence of age on symptoms and signs in lumbar disc herniation  

Microsoft Academic Search

In a prospective and consecutive study we evaluated the prevalence of pain-related symptoms, the results of the strainght leg raising (SLR) test and neurological disturbances by age group in a total of 150 patients operated on due to lumbar disc herniation. On admission, all patients were interviewed, and pain at rest, at night and on coughing was recorded. Walking capacity

B. Jönsson; B. Strömqvist

1995-01-01

233

Myelopathy due to lumbar disc herniation in the presence of a tethered cord.  

PubMed

Study design:Single case report.Objectives:To present a case of lumbar disc herniation causing compression of a tethered cord that was successfully treated with lumbar decompression and fusion.Background:A tethered cord is a rare pathology associated with a congenital spinal malformation, spinal dysraphism. Furthermore, myelopathy due to lumbar disc herniation in the presence of a tethered cord is extremely rare.Methods:Single case report.Results:A 43-year-old male with a history of spina bifida presented to our clinic for an evaluation of a progressive spastic gait disturbance and numbness in the lower limbs. A neurological examination revealed muscle weakness and pyramidal tract signs in the lower limbs. Magnetic resonance imaging of the lumbar spine showed disc herniation at L2-3 causing compression of a low-lying cord. Surgical intervention, including herniotomy via a posterolateral approach and instrumented posterolateral fusion, was performed, and a good outcome was achieved 1 year after the surgery.Conclusion:The potential for lumbar disc herniation in the presence of a tethered cord should be taken into account in the differential diagnosis of spinal pathologies causing spastic gait disturbances. Furthermore, posterior decompression and fusion is a useful treatment option in such cases. PMID:24902642

Endo, F; Iizuka, H; Iizuka, Y; Kobayashi, R; Mieda, T; Takagishi, K

2014-06-01

234

Clinical Features and Surgical Results of Cervical Myelopathy Caused by Soft Disc Herniation  

PubMed Central

Objective There are many causes of cervical myelopathy including trauma, degenerative conditions, tumors and demyelinating disorders. However, myelopathy caused by soft disc herniation might be seen rarely than the spondylosis caused by hard disc. Here, authors retrospectively analyzed the clinical features and results of cervical myelopathy caused by soft disc herniation. Methods From March 2010 to December 2010, 134 patients with degenerative cervical spinal disease were treated with anterior cervical discectomy and interbody fusion. Among them, 21 patients with cervical myelopathy secondary to cervical soft disc herniation were analyzed. Their clinical features, preoperative and, postoperative clinical results were evaluated by Nurick Grade and Japanese Orthopaedic Association scale (JOA) retrospectively. Preoperative clinical features including duration of myelopathy, pain intensity and postoperative clinical results including improvement rate of myelopathy and radiculopathy were retrospectively analyzed by Nurick Grade and JOA scale. We also evaluated correlation between the duration of symptom, type of the disc herniation, pain intensity and clinical outcome. Results Mean age was 49.7 and male was predominant. Gait disturbance with mild to moderate pain was most common symptom in clinical features. Severe pain was shown in only 9 cases, and the other 12 cases experienced mild to moderate pain. Mean duration of myelopathy was 1.18 month. The mean JOA scores were 11.22 before surgery and 14.2 after surgery. The mean Nurick grades were 2.78 before treatment and 1.67 after treatment. Neurologic status of mild or moderate pain group on preoperative state is worse than that of severe pain group. The patients with duration of myelopathy symptom (<1 month) showed lower clinical improvement rate than the patients with myelopathy over 1 month. Patients with median type of disc herniation showed poorer neurological status than those with paramedian type of herniation in preoperative state. Conclusion Authors reviewed the clinical features and surgical outcome of the cervical myelopathy secondary to cervical soft disc herniation. We presumed that patients of more than one month of symptom duration, mild to moderate initial symptom would be related with better postoperative improvement rate.

Park, Sung Joo; Kim, Min Ki; Lee, Sung Ho; Oh, In Ho

2013-01-01

235

Clinical and Radiologic Analysis of Posterior Apophyseal Ring Separation Associated with Lumbar Disc Herniation  

PubMed Central

Objective We analyzed the clinical and radiologic features of posterior apophyseal ring separation (PARS) with lumbar disc herniation and suggest the proper management options according to the PARS characteristics. Methods We reviewed case series of patients with PARS who underwent surgery of lumbar disc herniation. Preoperative symptoms, neurologic status, Body Mass Index, preoperative and postoperative Visual Analogue Scale (VAS) and Korean-Oswestry Disability Index (K-ODI) scores, operation types were obtained. PARS size, locations, the degree of resection were assessed. Results PARS was diagnosed in 109 (7.5%) patients among 1448 patients given surgical treatment for single level lumbar disc herniation. There were 55 (50.5%) small PARS and 54 (49.5%) large PARS. Among the large PARS group, 15 (27.8%) had lower endplate PARS of upper vertebra at the level of disc herniation. Thirty-nine (72.2%) were upper endplate PARS of lower vertebra. Among the group with upper endplate PARS of lower vertebra, unresected PARS was diagnosed in 12 (30.8%) cases and resected PARS was diagnosed in 27 (69.2%) cases. VAS and K-ODI scores changes were 3.6±2.9 and 5.4±6.4 in the unresected PARS group, 5.8±2.1 and 11.3±7.1 in the resected PARS group. The group with upper endplate PARS of lower vertebra showed significant difference of VAS (p=0.01) and K-ODI (p=0.013) score changes between unresected and resected PARS groups. Conclusion The large PARS of upper endplate in lower vertebra should be removed during the surgery of lumbar disc herniation. High level or bilateral side of PARS should be widely decompressed and arthrodesis procedures are necessary if there is a possibility of secondary instability.

Bae, Jung-Sik; Rhee, Woo-Tack; Kim, Woo-Jae; Ha, Seong-Il; Lim, Jae-Hyeon

2013-01-01

236

A novel microendoscopically assisted approach for the treatment of recurrent lumbar disc herniation: transosseous discectomy surgery.  

PubMed

Background and Object?Microendoscopic discectomy (MED) is still regarded as contraindicated for the treatment of recurrent lumbar disc herniation by many surgeons. Moreover, the presence of epidural scar tissue makes surgical manipulation difficult. To successfully remove the herniated disc in such cases, an open technique with a wide exposure may be required. We devised a new minimally invasive endoscopic approach, which is using a transosseous route. This is a retrospective review of a consecutive case series to examine the operative and clinical results of this new approach. Material and Methods?Fifty-seven patients who underwent surgery for recurrent lumbar disc herniation were divided into two groups based on the operative procedure. Thirty patients underwent microendoscopic transosseous discectomy (TD) and 27 underwent MED. We graded operative results and clinical outcomes using the Japanese Orthopaedic Association (JOA) score for low-back pain before surgery and 1?year after surgery and compared the scores of the two groups. Results?No conversion to open procedure was necessary in either group. The mean TD operative time was 89.2 minutes with a mean intraoperative blood loss of 16.5 mL. Mean MED operative time was 92.0 minutes with a mean blood loss of 19.3 mL. There were two dural tears in the MED group, and one tear was combined with a fracture of the inferior articular process. No dural tears occurred in the TD group. No patients in either group had experienced re-recurrence of lumbar disc herniation at the time of the last follow-up. The JOA score improved significantly after surgery in both groups (p?herniation. Operative time, intraoperative blood loss, and clinical results compare favorably with MED. PMID:23677684

Nomura, Kazunori; Yoshida, Munehito; Kawai, Masaki; Okada, Motohiro; Nakao, Shin-Ichi

2014-05-01

237

Higgs-Boson Production in Nucleus-Nucleus Collisions.  

National Technical Information Service (NTIS)

Cross section calculations are presented for the production of intermediate-mass Higgs bosons produced in ultrarelativistic nucleus-nucleus collisions via two photon fusion. The calculations are performed in position space using Baur's method for folding ...

J. W. Norbury

1992-01-01

238

Evolution of the nucleus?  

PubMed Central

The nucleus represents a major evolutionary transition. As a consequence of separating translation from transcription many new functions arose, which likely contributed to the remarkable success of eukaryotic cells. Here we will consider what has recently emerged on the evolutionary histories of several key aspects of nuclear biology; the nuclear pore complex, the lamina, centrosomes and evidence for prokaryotic origins of relevant players.

Devos, Damien P; Graf, Ralph; Field, Mark C

2014-01-01

239

Antiproton-nucleus interaction  

SciTech Connect

Several facets of antinucleon-nucleus interactions are explored. The topics treated are: coherent interactions, production of unusual states and particles in the nuclear medium, and the creation of extreme states of matter by antimatter annihilation. It is found that temperatures of the magnitude necessary to achieve the predicted quark-gluon phase transition are obtained. 20 references.

Gibbs, W.R.

1984-01-01

240

Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations  

Microsoft Academic Search

BackgroundThe observed rate of recurrent disc herniation after limited posterior lumbar discectomy is highest in patients with posterior wide annular defects, according to the Carragee classification of type II (fragment-defect) disc hernia. Although the recurrent herniation rate is lower in both type III (fragment-contained) and type IV (no fragment-contained) patients, recurrent persistent sciatica is observed in both groups. A higher

Tuncay Kaner; Mehdi Sasani; Tunc Oktenoglu; Murat Cosar; Ali Fahir Ozer

2010-01-01

241

Antinucleon-nucleus interactions  

SciTech Connect

Recent experimental and theoretical results on anti p-nucleus interactions are reviewed. We focus on determinations of the anti p optical potential from elastic scattering, the use of (anti p, anti p') inelastic scattering to reveal aspects of the spin-isospin dependence of N anti N amplitudes, and some puzzling features of (anti p, anti n) charge exchange reactions on nuclei. 47 refs., 7 figs.

Dover, C.B.

1987-01-01

242

Math/Science Nucleus  

NSDL National Science Digital Library

Math/Science Nucleus is a non-profit organization composed of scientists, educators, and community members focused on education and research. It provides a resource center designed to develop problem solving capacity through science for the world's children. A free online reference science curriculum for elementary grades is provided including lesson plans. Additionally, online animated storybooks and slideshows guide educators in how to integrate science content into children's lives.

2004-11-28

243

Interacting gluon model for hadron-nucleus and nucleus-nucleus collisions in the central rapidity region  

SciTech Connect

The interacting gluon model developed to describe the inelasticity distribution in hadron-nucleon collisions has been generalized and applied to hadron-nucleus and nucleus-nucleus interactions. Leading particle spectra and energy distributions in hadron-nucleus and nucleus-nucleus collisions are calculated.

Fowler, G.N. (Department of Physics, University of Exeter, Exeter, United Kingdom (GB)); Navarra, F.S. (Department of Physics, University of Marburg, Marburg, Federal Republic of Germany); Plumer, M. (Department of Physics, University of Marburg, Marburg, Federal Republic of Germany Lawrence Berkeley Laboratory, Nuclear Science Division, Berkeley, California 94720); Vourdas, A. (Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool, United Kingdom); Weiner, R.M.

1989-09-01

244

Naturally occurring disk herniation in dogs: an opportunity for pre-clinical spinal cord injury research.  

PubMed

Traumatic spinal cord injuries represent a significant source of morbidity in humans. Despite decades of research using experimental models of spinal cord injury to identify candidate therapeutics, there has been only limited progress toward translating beneficial findings to human spinal cord injury. Thoracolumbar intervertebral disk herniation is a naturally occurring disease that affects dogs and results in compressive/contusive spinal cord injury. Here we discuss aspects of this disease that are analogous to human spinal cord injury, including injury mechanisms, pathology, and metrics for determining outcomes. We address both the strengths and weaknesses of conducting pre-clinical research in these dogs, and include a review of studies that have utilized these animals to assess efficacy of candidate therapeutics. Finally, we consider a two-species approach to pre-clinical data acquisition, beginning with a reproducible model of spinal cord injury in the rodent as a tool for discovery with validation in pet dogs with intervertebral disk herniation. PMID:21438715

Levine, Jonathan M; Levine, Gwendolyn J; Porter, Brian F; Topp, Kimberly; Noble-Haeusslein, Linda J

2011-04-01

245

Naturally Occurring Disk Herniation in Dogs: An Opportunity for Pre-Clinical Spinal Cord Injury Research  

PubMed Central

Abstract Traumatic spinal cord injuries represent a significant source of morbidity in humans. Despite decades of research using experimental models of spinal cord injury to identify candidate therapeutics, there has been only limited progress toward translating beneficial findings to human spinal cord injury. Thoracolumbar intervertebral disk herniation is a naturally occurring disease that affects dogs and results in compressive/contusive spinal cord injury. Here we discuss aspects of this disease that are analogous to human spinal cord injury, including injury mechanisms, pathology, and metrics for determining outcomes. We address both the strengths and weaknesses of conducting pre-clinical research in these dogs, and include a review of studies that have utilized these animals to assess efficacy of candidate therapeutics. Finally, we consider a two-species approach to pre-clinical data acquisition, beginning with a reproducible model of spinal cord injury in the rodent as a tool for discovery with validation in pet dogs with intervertebral disk herniation.

Levine, Gwendolyn J.; Porter, Brian F.; Topp, Kimberly; Noble-Haeusslein, Linda J.

2011-01-01

246

Intradural disk herniation at L1-L2: report of two cases  

PubMed Central

Context Lumbar intradural disk herniation (IDH) is a rare but serious complication of spinal disk protrusions. Although the pathogenesis of lumbar IDH is still vague, it is believed to be associated with the adhesion of the posterior longitudinal ligament with the ventral wall of the dura. Diagnosis is still difficult despite current neuroradiologic imaging techniques. Findings Two women, ages 63 and 69 years, presented with recent exacerbation of back pain. In each case, imaging studies revealed a ventral herniated disk at L1–L2. Both patients underwent surgery and in both cases a hard mass was palpated through the dura. Both patients experienced immediate postoperative relief of back pain following surgery. One patient required fusion and postoperative rehabilitation; her neurologic deficit returned to baseline. Conclusion/clinical relevance Prompt surgical intervention is indicated for IDH; disk removal allows for symptomatic relief and minimization of neurologic deficit.

Arnold, Paul M.; Wakwaya, Yosafe T.

2011-01-01

247

Third ventricle herniation into the sphenoid sinus following endoscopic transnasal transsphenoidal fenestration of Rathkes cleft cyst.  

PubMed

Rathke cleft cyst (RCC) is an uncommon albeit benign sellar lesion with an incidence rate of between 2 to 33%. RCCs are usually asymptomatic except in the large cases whit suprasellar extension. We herein describe a unique case of RCC, which presented with severe visual loss owing to massive herniation of the optic chiasm and third ventricle down into the sphenoid sinus through a small 8 x 8 mm foramen after transnasal endoscopic surgical fenestration and marsupialization of the cyst. We describe a reconstruction method via endonasal transsphenoidal approach in this case and suggest prophylactic reconstruction of the sellar floor in sellar lesions with equal or more voluminous suprasellar extensions that are susceptible to such massive herniation and secondary empty sella syndrome. PMID:24535793

Jalessi, Maryam; Sharifi, Guive; Jahanbakhshi, Amin; Parsa, Khosro; Yazdanifard, Parin

2014-01-01

248

Incarcerated Thoracic Gastric Herniation after Nephrectomy: A Report of Two Cases  

PubMed Central

Iatrogenic diaphragmatic hernias can occur after abdominal or thoracic surgery. Acute presentation of a diaphragmatic hernia varies depending on the extent and nature of the organ which has herniated. The initial diagnosis can be challenging due to the nonspecific nature of the presenting symptoms. Delay in diagnosis poses a significant risk to the patient, and a rapid deterioration can occur in the context of strangulation. We outline two cases of acute gastric herniation through a defect in the diaphragm after an open and a laparoscopic nephrectomy. Both had characteristic findings on imaging, required emergency, surgery and had a successful outcome. Both cases highlight the potential for late presentation with non-specific symptoms and the necessity for urgent surgical management where gastric perfusion is compromised.

Fitzgerald, Conall; Mc Cormack, Orla; Awan, Faisal; Elliott, Jessie; Ravi, Narayanasamy; Reynolds, John V.

2013-01-01

249

Congenital partial pericardial defect and herniated right atrial appendage: a rare anomaly.  

PubMed

A congenital partial defect of the right-sided pericardium is a rare cardiac anomaly and it represents defective formation of the pleuropericardial membrane. Patients can be asymptomatic, but they may experience chest pain, myocardial ischemia, emboli, arrhythmia, and sudden death. In this report, we present an 8-month-old boy with pericardial defect and right atrial appendage herniation. It was diagnosed by echocardiography and cardiac magnetic resonance imaging. PMID:16999699

Karakurt, Cem?it; O?uz, Deniz; Karademir, Selmin; Sungur, Metin; Ocal, Burhan

2006-10-01

250

Spontaneous intradural disc herniation with focal distension of the subarachnoid space in a dog.  

PubMed

Myelo-computed tomography of a paraparetic 14-year-old dog revealed subarachnoid distension with an intradural filling defect above the T13-L1 disc space. T12-L1 hemilaminectomy followed by durotomy allowed removal of a large piece of degenerated disc material that compressed the spinal parenchyma. Full return to function was achieved 10 days post-surgery. The distension was likely secondary to the intradural herniation, and is a rare and distinct finding. PMID:23633713

Barnoon, Itai; Chai, Orit; Srugo, Itai; Peeri, Dana; Konstantin, Lilach; Brenner, Ori; Shamir, Merav H

2012-11-01

251

A rare case of Brown-Sequard syndrome caused by cervical disc herniation: a case report  

PubMed Central

Abstract: Brown-Sequard syndrome is a rare neurological disorder characterized by ipsilateral motor paralysis caused by a lesion through corticospinal tract and contralateral loss of pain and temperature sensation due to the involvement of spinothalamic tract. Cervical disc herniation has been reported to be a rare cause of Brown-Séquard's syndrome. This paper aims to report a case of Brown-Sequard syndrome that occurred in a patient suffering from CHD. In this case, using a rapid and urgent intervention we could prevent permanent neurologic deficit in the patient. Case: A 56-year-old woman complained about a sudden paresis in her right leg lasting for 4 days. Her pain was progressively worsening until she couldn’t walk without assistance. There was no history of trauma in the neck. Neurological examinations revealed right side spastic hemi-paresis as well as loss of pain and temperature sensation below T4 dermatome in the left side. The case was diagnosed as Brown-Sequard syndrome and cervical magnetic resonance imaging scan showed a disc herniation at C5/C6 and C6/C7 levels. Surgery was performed via anterior cervical microdiscectomy and fusion. After a 2-month period of follow-up, neurological assessments showed that motor and sensory functions of the patient returned to the normal condition. Although cervical disc herniation as a cause of Brown-Sequard syndrome is relatively rare, early diagnosis accompanied by an urgent treatment can prevent neurological complications in such cases. Keywords: Brown-Sequard Syndrome, Cervical Disc Herniation, Surgery, Ipsilateral motor paralysis

Ghasemi, Amir Abbas

2012-01-01

252

Idiopathic ventral spinal cord herniation: a rare presentation of tethered cord.  

PubMed

Idiopathic ventral spinal cord herniation is a rare condition that has been increasingly reported in the last decade. The natural history and optimal management have yet to be defined. Therefore, debate exists regarding the pathogenesis and surgical management of this condition. The purpose of this review article is to further educate neurosurgeons about the surgical techniques and outcomes associated with treating this rare and often misdiagnosed condition. PMID:20593998

Shin, John H; Krishnaney, Ajit A

2010-07-01

253

Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2.  

PubMed

A 54-year-old Caucasian woman presented with a 6?week history of periscapular pain and a T1 radiculopathy associated with Horner's syndrome. MRI of her cervicothoracic spine revealed an intervertebral disc herniation at the level of T1-2. During investigation she experienced some improvement in her symptoms and a conservative approach was pursued. At 6?months her pain and radiculopathy had resolved, and there was mild residual ptosis. PMID:24903729

Spacey, Kate; Dannawi, Zaher; Khazim, R; Dannawi, Z

2014-01-01

254

Laparoscopic repair of intrathoracic liver herniation after traumatic rupture of the diaphragm.  

PubMed

Right diaphragmatic hernia after abdominal trauma is a rare injury. Most patients can be asymptomatic, and the diagnosis may be delayed for several years. The treatment of choice involves surgical repair via laparotomy. The authors treated a young patient with transdiaphragmatic herniation of the right hepatic lobe and delayed diagnosis using a laparoscopic approach and accomplished a successful complete repair. The 6-month radiologic follow-up assessment confirmed good results. PMID:21556995

Fiscon, Valentino; Portale, Giuseppe; Migliorini, Giovanni; Frigo, Flavio

2011-10-01

255

Usefulness of gadolinium in MRI evaluation of non surgically treated herniated disk.  

PubMed

PURPOSE: The rationale for the use of Gadolinium (Gd) in the MRI evaluation of non surgically treated herniated disk is based on the known presence of inflammatory granulation tissue and neoangiogenesis which plays an important role in both pain and the spontaneous resorption of the hernia. The AIM: of this study was to determine the usefulness of Gd in MRI examination for detecting the inflammatory reaction around the discal hernia. MATERIALS AND METHODS: Thirty-eight patients (mean age 45 years; range 20-70 years) with non surgically treated herniated disk were evaluated with MRI between January 2000 and July 2004. T2w-FAST-SE sagittal and T1w-SE transaxial and sagittal images were acquired before and after the administration of Gd. RESULTS: Twenty out of 22 patients with acute sciatic pain (symptoms =/< 40 days) showed significant peri-hernial enhancement which facilitated the differential diagnosis with other extradural lesions, such as synovial cysts (2/22 cases), as well as the correct definition of the extension of discal hernia in the spinal canal. In the remaining 16 with chronic sciatic pain (symptoms > 6 months) the discal hernia did not show peri-hernial enhancement. CONCLUSIONS: In MRI evaluation of the herniated disk, peri-hernial enhancement is correlated with inflammatory reaction around the hernia which is associated with acute symptoms. The absence of peri-hernial enhancement in chronic herniated disk is due to the poorly vascular fibrotic tissue. Therefore, peri-hernial enhancement facilitates the differential diagnosis in uncertain cases and represents a reliable prognostic index of response to non-surgical therapy and of the possible spontaneous resorption of discal hernia. PMID:15973229

Motta, E; Boniotti, V; Miserocchi, L; Caudana, R

2005-01-01

256

Analytic optical potentials for nucleon-nucleus nucleus-nucleus collisions involving light and medium nuclei  

NASA Technical Reports Server (NTRS)

Utilizing an optical model potential approximation to the exact nucleus-nucleus multiple-scattering series, optical potentials for nucleon-nucleus and nucleus-nucleus collisions are analytically derived. These expressions are applicable to light and medium cosmic ray nuclei as their single-particle density distributions are analytically determined, without approximation, from their actual harmonic well charge density distributions. Pauli correlation effects are included through the use of a simple Gaussian function to replace the usual expression obtained in the infinite nuclear matter approximation.

Bidasaria, H. B.; Townsend, L. W.

1982-01-01

257

Outcome of nucleoplasty in patients with radicular pain due to lumbar intervertebral disc herniation  

PubMed Central

Background: Nucleoplasty (percutaneous lumbar disc decompression) is a minimally invasive procedure that utilizes radiofrequency energy as a treatment for symptomatic lumbar disc herniation, against open microdiscectomy, which would be the mainstay treatment modality. The literature reports a favorable outcome in up to 77% of patients at 6 months. Aim: To evaluate the effectiveness of nucleoplasty in the management of discogenic radicular pain. Materials and Methods: The medical notes of 33 patients, admitted for nucleoplasty between June 2006 and September 2007, were reviewed retrospectively. All had radicular pain, and contained herniated disc as seen on magnetic resonance imaging (MRI) of lumbosacral spine. Patients were followed up at 1 and 3 months post-procedure. The outcome measures employed in this study were satisfaction with symptoms and self-reported improvement. Results: Thirty-three cases were examined (18 males and 15 females). Twenty-seven procedures were performed with no complications and six were abandoned due to anatomical reasons. There were 18 and 15 cases of disc herniation at L5/S1 and L4/5 levels, respectively. Four weeks following the procedure, 13 patients reported improvement in symptoms, and 14 remained symptomatically the same and subsequently had open microdiscectomy. Conclusion: Nucleoplasty has been shown to be a safe and minimal-access procedure. Less than half of our selected cohort of patients reported symptomatic improvement at 1-month follow-up. We no longer offer this procedure to our patients. Possible reasons are discussed.

Ogbonnaya, Sunny; Kaliaperumal, Chandrasekaran; Qassim, Abdulla; O'Sullivan, Michael

2013-01-01

258

Paraplegia caused by posture during MRI in a patient with cervical disk herniation.  

PubMed

A 48-year-old man presented with numbness in the lower left extremity of 4 months' duration. One month earlier, he presented to an orthopedic clinic and magnetic resonance imaging (MRI) revealed cervical disk herniation. Because the pain did not subside, he visited the clinic again and MRI was performed. His neck was slightly extended and fixed to the headrest of the MRI instrument. Because of the posture of his cervical spine, he suffered severe pain in the scapular region during the MRI. After 15 minutes the pain was unbearable and the MRI examination was aborted. As the patient tried to descend from the MRI table, he was unable to move his bilateral lower extremities. No muscle contraction was observed in his lower limbs. Following MRI with flexion posture of the cervical spine, he was diagnosed with paraplegia caused by cervical disk herniation. Emergency surgery consisting of anterior decompression and fusion was performed. The patient showed good neurological recovery. Three weeks postoperatively, the patient could walk without assistance and he was discharged. The extension posture of the cervical spine during MRI was considered to be the cause of acute paraplegia in this patient. Care should be taken with the posture of the cervical spine, when performing MRI in patients with cervical disk herniation. Extended posture of the cervical spine during MRI may lead to acute neurological deterioration. PMID:20806756

Kato, Yoshihiko; Nishida, Norihiro; Taguchi, Toshihiko

2010-06-01

259

Rapid progression of traumatic bifrontal contusions to transtentorial herniation: A case report  

PubMed Central

We report a case of mild to moderate traumatic brain injury in which ICP monitoring or quantitative cerebral perfusion data may have allowed earlier recognition of impending herniation, avoidance of a secondary insult, and ultimately resulted in a better outcome, even though the patient did not meet the standard guidelines of the Brain Trauma Foundation. A thirty-five year old male who presented with traumatic bifrontal contusions and GCS of fourteen and twelve hours later progressed rapidly to having dilated pupils and transtentorial/central herniation over the course of fifteen minutes. The patient was taken emergently for a bifrontal craniectomy. Post operatively he had an acute infarct in the posterolateral left temporal lobe with expected evolution of parenchymal contusions as well as infarcts in the splenium of the corpus callosum, left thalamus and medial right occipital lobe. This case signifies an exception from the guidelines submitted by the Brain Trauma Foundation for intracranial pressure monitoring in patients with severe brain injury. We also point out previous reports which state that in such a patient a more sensitive test for detection would perhaps be quantitative blood flow monitoring, and may have led to a better outcome. We recommend using intracranial pressure monitoring or blood flow measurements to trend patients with bifrontal intraparenchymal contusions and GCS greater than eight to prevent clinically undetected deterioration from transtentorial/central herniation.

Rehman, Tausif; Ali, Rushna; Tawil, Isaac; Yonas, Howard

2008-01-01

260

Rapid progression of traumatic bifrontal contusions to transtentorial herniation: A case report.  

PubMed

We report a case of mild to moderate traumatic brain injury in which ICP monitoring or quantitative cerebral perfusion data may have allowed earlier recognition of impending herniation, avoidance of a secondary insult, and ultimately resulted in a better outcome, even though the patient did not meet the standard guidelines of the Brain Trauma Foundation. A thirty-five year old male who presented with traumatic bifrontal contusions and GCS of fourteen and twelve hours later progressed rapidly to having dilated pupils and transtentorial/central herniation over the course of fifteen minutes. The patient was taken emergently for a bifrontal craniectomy. Post operatively he had an acute infarct in the posterolateral left temporal lobe with expected evolution of parenchymal contusions as well as infarcts in the splenium of the corpus callosum, left thalamus and medial right occipital lobe. This case signifies an exception from the guidelines submitted by the Brain Trauma Foundation for intracranial pressure monitoring in patients with severe brain injury.We also point out previous reports which state that in such a patient a more sensitive test for detection would perhaps be quantitative blood flow monitoring, and may have led to a better outcome. We recommend using intracranial pressure monitoring or blood flow measurements to trend patients with bifrontal intraparenchymal contusions and GCS greater than eight to prevent clinically undetected deterioration from transtentorial/central herniation. PMID:18831756

Rehman, Tausif; Ali, Rushna; Tawil, Isaac; Yonas, Howard

2008-01-01

261

Brain herniation in a patient with apparently normal intracranial pressure: a case report  

PubMed Central

Introduction Intracranial pressure monitoring is commonly implemented in patients with neurologic injury and at high risk of developing intracranial hypertension, to detect changes in intracranial pressure in a timely manner. This enables early and potentially life-saving treatment of intracranial hypertension. Case presentation An intraparenchymal pressure probe was placed in the hemisphere contralateral to a large basal ganglia hemorrhage in a 75-year-old Caucasian man who was mechanically ventilated and sedated because of depressed consciousness. Intracranial pressures were continuously recorded and never exceeded 17 mmHg. After sedation had been stopped, our patient showed clinical signs of transtentorial brain herniation, despite apparently normal intracranial pressures (less than 10 mmHg). Computed tomography revealed that the size of the intracerebral hematoma had increased together with significant unilateral brain edema and transtentorial herniation. The contralateral hemisphere where the intraparenchymal pressure probe was placed appeared normal. Our patient underwent emergency decompressive craniotomy and was tracheotomized early, but did not completely recover. Conclusions Intraparenchymal pressure probes placed in the hemisphere contralateral to an intracerebral hematoma may dramatically underestimate intracranial pressure despite apparently normal values, even in the case of transtentorial brain herniation.

2010-01-01

262

Neutrino-Nucleus Interactions  

NASA Astrophysics Data System (ADS)

The study of neutrino oscillations has necessitated a new generation of neutrino experiments that are exploring neutrino-nuclear scattering processes. We focus in particular on charged-current quasi-elastic scattering, a particularly important channel that has been extensively investigated both in the bubble-chamber era and by current experiments. Recent results have led to theoretical reexamination of this process. We review the standard picture of quasi-elastic scattering as developed in electron scattering, review and discuss experimental results, and discuss additional nuclear effects such as exchange currents and short-range correlations that may play a significant role in neutrino-nucleus scattering.

Gallagher, H.; Garvey, G.; Zeller, G. P.

2011-11-01

263

Gatekeepers of the Nucleus  

NSDL National Science Digital Library

Nuclear pore complexes (NPCs) form the site for entry and exit from the nucleus. A convergence of studies have defined the physical framework for the nuclear transport mechanism. This includes definition of the soluble transport machinery required for protein and RNA movement, x-ray structure analysis of transport factors, definitive compositional analysis of yeast NPCs, and documentation of the relative steady state arrangement of NPC components within the portal. With this information, researchers are now in the exciting position to examine the dynamic interplay between shuttling transport factors and the static pore complex.

Susan Wente (Washington University School of Medicine;Department of Cell Biology and Physiology)

2000-05-26

264

Neutrino-nucleus interactions  

SciTech Connect

The study of neutrino oscillations has necessitated a new generation of neutrino experiments that are exploring neutrino-nuclear scattering processes. We focus in particular on charged-current quasi-elastic scattering, a particularly important channel that has been extensively investigated both in the bubble-chamber era and by current experiments. Recent results have led to theoretical reexamination of this process. We review the standard picture of quasi-elastic scattering as developed in electron scattering, review and discuss experimental results, and discuss additional nuclear effects such as exchange currents and short-range correlations that may play a significant role in neutrino-nucleus scattering.

Gallagher, H.; /Tufts U.; Garvey, G.; /Los Alamos; Zeller, G.P.; /Fermilab

2011-01-01

265

Nucleus from string theory  

NASA Astrophysics Data System (ADS)

In generic holographic QCD, we find that baryons are bound to form a nucleus, and that its radius obeys the empirically-known mass-number (A) dependence r?A1/3 for large A. Our result is robust, since we use only a generic property of D-brane actions in string theory. We also show that nucleons are bound completely in a finite volume. Furthermore, employing a concrete holographic model (derived by Hashimoto, Iizuka, and Yi, describing a multibaryon system in the Sakai-Sugimoto model), the nuclear radius is evaluated as O(1)×A1/3[fm], which is consistent with experiments.

Hashimoto, Koji; Morita, Takeshi

2011-08-01

266

Higgs-boson production in nucleus-nucleus collisions  

NASA Technical Reports Server (NTRS)

Cross-section calculations are presented for the production of intermediate-mass Higgs bosons produced in ultrarelativistic nucleus-nucleus collisions via two-photon fusion. The calculations are performed in position space using Baur's method for folding together the Weizsacker-Williams virtual-photon spectra of the two colliding nuclei. It is found that two-photon fusion in nucleus-nucleus collisions is a plausible way of finding intermediate-mass Higgs bosons at the Superconducting Super Collider or the CERN Large Hadron Collider.

Norbury, J. W.; Townsend, L. W. (Principal Investigator)

1990-01-01

267

Higgs-Boson Production in Nucleus-Nucleus Collisions  

NASA Technical Reports Server (NTRS)

Cross section calculations are presented for the production of intermediate-mass Higgs bosons produced in ultrarelativistic nucleus-nucleus collisions via two photon fusion. The calculations are performed in position space using Baur's method for folding together the Weizsacker-Williams virtual-photon spectra of the two colliding nuclei. It is found that two photon fusion in nucleus-nucleus collisions is a plausible way of finding intermediate-mass Higgs bosons at the Superconducting Super Collider or the CERN Large Hadron Collider.

Norbury, John W.

1992-01-01

268

Higgs-boson production in nucleus-nucleus collisions.  

PubMed

Cross-section calculations are presented for the production of intermediate-mass Higgs bosons produced in ultrarelativistic nucleus-nucleus collisions via two-photon fusion. The calculations are performed in position space using Baur's method for folding together the Weizsacker-Williams virtual-photon spectra of the two colliding nuclei. It is found that two-photon fusion in nucleus-nucleus collisions is a plausible way of finding intermediate-mass Higgs bosons at the Superconducting Super Collider or the CERN Large Hadron Collider. PMID:10012777

Norbury, J W

1990-12-01

269

Reevaluation of predictive factors for complete recovery in dogs with nonambulatory tetraparesis secondary to cervical disk herniation.  

PubMed

The vast majority of dogs with cervical disk herniation experience cervical pain and only mild motor deficits; therefore, not much is known about the factors that predict recovery in dogs with nonambulatory tetraparesis (NAT) secondary to cervical disk herniation. In this retrospective study, we tested the hypothesis that two previously reported prognostic factors, site of disk herniation and severity of neurological deficits, are useful predictors of complete recovery. Overall, 20 (62%) of 32 dogs with cervical disk herniation-associated NAT had complete recovery. Site of disk herniation was not a significant predictor of complete recovery; dogs with high cervical lesions (C2 to C3, C3 to C4) did not have a higher likelihood of complete recovery than other dogs. Likewise, severity of neurological deficits (i.e., intact voluntary motor function versus absent voluntary motor function) was not a significant predictor of complete recovery. Using stepwise logistic regression, two significant predictors of complete recovery were identified. Small dogs (delta15 kg body weight) were six times more likely to achieve complete recovery than larger dogs. Dogs that regained the ability to walk within 96 hours after surgery were seven times more likely to completely recover than dogs not walking 96 hours after surgery. We conclude that neither the site of disk herniation nor severity of neurological deficits assists the clinician in predicting postoperative outcome in dogs with cervical disk herniation-associated NAT. Reliable preoperative predictors of complete recovery are needed to advance current diagnostic and treatment protocols to improve overall prognosis. PMID:19570897

Hillman, Robert B; Kengeri, Seema S; Waters, David J

2009-01-01

270

The crowded nucleus.  

PubMed

The principles that determine the organization of the nucleus have become clearer in recent years, largely because of new insights into polymer, colloid, and soft-matter science. Macromolecules, together with the giant linear polymers that form the chromosomes, are confined at high concentrations within the nuclear envelope and their interactions are influenced strongly by short-range depletion or entropic forces which are negligible in dilute systems, in addition to the more familiar van der Waals, electrostatic, steric, hydrogen bonding, and hydrophobic forces. The studies described in this volume are consistent with the model that this complex and concentrated mixture of macromolecules is maintained in a delicate equilibrium by quite simple although unsuspected physicochemical principles. The sensitivity of this equilibrium to perturbation may underlie the controversies about the existence of a nuclear matrix or scaffold. In this volume, we underline the importance for cell biologists of being familiar with current work in colloid, polymer, soft matter, and nanoscience. This chapter presents a brief background to the aspects of the nucleus that are considered in detail in subsequent chapters. PMID:24380591

Hancock, Ronald

2014-01-01

271

K/sup +/-nucleus interaction  

SciTech Connect

The K/sup +/-nucleus system is reviewed and comparison with data is made. The principal conclusions are that the theoretical uncertainties in relating the K/sup +/-nucleus interaction to the K/sup +/-nucleon interaction are very small and hence the positive kaon makes an excellent probe of the nucleus. It is suggested that this particle may be more sensitive to the non-nucleonic degrees of freedom (especially quarks) than classical probes.

Gibbs, W.R.

1984-11-15

272

Momentum loss in proton-nucleus and nucleus-nucleus collisions  

NASA Technical Reports Server (NTRS)

An optical model description, based on multiple scattering theory, of longitudinal momentum loss in proton-nucleus and nucleus-nucleus collisions is presented. The crucial role of the imaginary component of the nucleon-nucleon transition matrix in accounting for longitudinal momentum transfer is demonstrated. Results obtained with this model are compared with Intranuclear Cascade (INC) calculations, as well as with predictions from Vlasov-Uehling-Uhlenbeck (VUU) and quantum molecular dynamics (QMD) simulations. Comparisons are also made with experimental data where available. These indicate that the present model is adequate to account for longitudinal momentum transfer in both proton-nucleus and nucleus-nucleus collisions over a wide range of energies.

Khan, Ferdous; Townsend, Lawrence W.

1993-01-01

273

Radiographic Markers of Femoroacetabular Impingement: Correlation of Herniation Pit and Femoral Bump with a Positive Cross-Over Ratio  

PubMed Central

Introduction. The goal of this study was to research the association of femoral bumps and herniation pits with the overlap-ratio of the cross-over sign. Methods. Pelvic X-rays and CT-scans of 2925 patients with good assessment of the anterior and the posterior acetabular wall and absence of neutral pelvic tilt were enrolled in the investigation. Finally pelvic X-rays were assessed for the presence of a positive cross-over sign, and CT-scans for a femoral bump or a herniation pit. Additionally, if a positive cross-over sign was discovered, the overlap-ratio was calculated. Results. A femoral bump was found in 53.3% (n = 1559), and a herniation pit in 27.2% (n = 796) of all hips. The overlap-ratio correlated positively with the presence of a femoral bump, while a negative correlation between the overlap-ratio and the presence of a herniation pit was found. The latter was significantly more often combined with a femoral bump than without. Conclusions. We detected an increased prevalence of femoral bump with increasing overlap-ratios of the cross-over sign indicating a relation to biomechanical stress. The observed decreased prevalence of herniation pits with increasing overlap-ratios could be explained by reduced mechanical stress due to nontightened iliofemoral ligament in the presence of retroversion of the acetabulum.

Scheyerer, Max J.; Copeland, Carol E.; Stromberg, Jeffrey; Ruckstuhl, Thomas; Werner, Clement M. L.

2014-01-01

274

Actin up in the nucleus  

Microsoft Academic Search

Scepticism regarding the existence of actin in the nucleus is finally giving way to the productive investigation of its functional roles. The identification of actin in several nuclear complexes implicates it in diverse nuclear activities including transcription, chromatin remodelling and nucleocytoplasmic trafficking. A major challenge is that actin does not seem to form large filamentous structures in the nucleus and

Blaine T. Bettinger; David M. Gilbert; David C. Amberg

2004-01-01

275

[A case of transtentorial upward herniation due to cerebellar infarction manifesting upward gaze palsy as an initial sign].  

PubMed

Transtentorial upward herniation is a rare complication of cerebellar infarction and its development indicates an emergency and necessity of posterior cranial fossa decompression. A 63-year-old man with a history of myocardial infarction was admitted to the hospital complaining of sudden onset of vertigo and headache. Neurological examination revealed marked upward gaze palsy, right blepharoptosis, facial weakness, hearing loss on the left side and ataxia of the left upper and lower extremities. A few hours later, he rapidly lost consciousness and MRI revealed massive infarction in the left cerebellar hemisphere and transtentorial upward herniation. Immediate surgical decompression of the posterior cranial fossa was performed, thereafter patient gradually improved. This case suggests that upward gaze palsy is an important initial sign of transtentorial upward herniation with massive cerebellar infarction. PMID:8476670

Yamazaki, M; Hashimoto, T; Haruta, S; Yanagisawa, N

1993-02-01

276

Use of CT-guided periradicular injection for the treatment of foraminal and extraforaminal disc herniations  

PubMed Central

Study design:?Retrospective case series. Evidence level IV. Objectives:?To evaluate surgical candidates with foraminal or extraforaminal lumbar disc herniation treated with CT-guided periradicular injection (CTGPI) as a valid treatment option for avoiding surgery. Methods:?We carried out a retrospective evaluation of 46 consecutive patients with foraminal or extraforaminal disc herniation treated with CTGPI. CTGPI was performed only when radicular pain could not be controlled, or in patients who continued requiring pain medication following an acute episode and whose radicular pain precluded them from resuming their daily activities. Forty-six patients with a minimum 2-year follow-up met the inclusion criteria. There were 21 women and 25 men, with a mean age of 47 years. Results:?At 1 month after injection, 41 (89%) patients experienced a decrease in radicular pain; 3 experienced no change; and 2 had received surgical treatment. At the final follow-up visit (mean, 74 months) 6 additional patients underwent surgery while 38 (83%) did not require surgery. Pain level comparison between pre-injection and last examination showed that low back pain had decreased a mean of 5 points and radicular pain diminished a mean of 7 points. Twenty-two (58%) of the 38 nonoperated patients had no pain at all and 35 patients had resumed their normal daily activities. No complications were recorded. Conclusion:?Based on these results, we consider that the use of CTGPI is a reliable alternative before surgery for patients with foraminal or extraforaminal disc herniation without severe motor deficit but with intractable radicular pain. Final Class of evidence (CoE)-treatment Yes Study design:  RCT  Cohort  Case control  Case series • Methods  Concealed allocation (RCT)  Intention to treat (RCT)  Blinded/independent evaluation of primary outcome  F/U ?85% •  Adequate sample size • Control for confounding Overall class of evidence IV The definiton of the different classes of evidence is available on page 59.

Gruenberg, Marcelo F.; Petracchi, Matias; Valacco, Marcelo; Sola, Carlos

2011-01-01

277

Decreased risk of secondary brain herniation with intracranial pressure monitoring in patients with haemorrhagic stroke  

PubMed Central

Background Intracranial-pressure (ICP) monitoring is considered standard care for severe traumatic brain injury and is used frequently, but the efficacy of treatment based on monitoring in patients with hemorrhagic stroke has not been rigorously assessed. In this study, we investigated the clinical value of ICP monitoring in patients with hemorrhagic stroke. Methods We conducted a randomized, unblinded, controlled trial in which 90 patients with hemorrhagic stroke were randomly assigned to ICP monitoring or a control group. The primary outcome was a composite of incidence rate of hematoma enlargement and secondary brain herniation. The secondary outcome was neurological status assessed using the Glasgow Outcome Scale scores at 6 months post-onset. Characteristics of the patients at baseline and outcome measurements were also compared between the two groups. Results There was no significant between-group difference in the incidence of hematoma enlargement (control group, 38.6% vs. ICP monitoring group, 32.6%; P?>?0.05). The incidence rate of secondary brain herniation in the ICP monitoring group was significantly lower compared with the control group (10.9% vs. 20.5%, P?=?0.04). Six-month mortality was 6.5% in the ICP group and 9.1% in the control group (P?herniation in patients with hemorrhagic stroke compared with guidance directed by clinical signs and radiological indicators.

2014-01-01

278

Lower-extremity sensibility testing in patients with herniated lumbar intervertebral discs.  

PubMed

The significance of sensory changes determined by pinprick and light touch in individuals with a herniated lumbar disc has been questioned. Discrepancies may be related to the subjectiveness of the test, failure to use dermatome-specific testing sites, overlap of areas that are innervated by different nerve roots, anatomical variations, or lack of sensitivity of the testing technique. For this study, we assessed the results of sensory examinations of twenty-five patients with documented herniation of a lumbar disc. The examinations were done using Semmes-Weinstein monofilaments, vibrometry, pinprick, and light touch in the autonomous skin areas supplied by the fourth and fifth lumbar and first sacral-nerve roots. Right-left differences in Semmes-Weinstein pressure thresholds of more than fifteen milligrams per square millimeter enabled us to localize disc lesions to a specific root in 100 per cent of patients and differences in vibratory thresholds of more than 3.5 micrometers, to localize the correct level in 88 per cent. Lesser differences in thresholds did not help to identify the involved root. The mean sensory threshold on the side of the disc lesion was found to be significantly greater than that on the opposite side by both vibrometry and pressure aesthesiometry (p less than 0.005). These findings were not duplicated using light touch or pinprick testing. Even with the most sophisticated sensibility-testing techniques, correct identification of the nerve root that was compressed by a herniated lumbar disc was accurate in only 50 per cent of patients. PMID:2997232

Weise, M D; Garfin, S R; Gelberman, R H; Katz, M M; Thorne, R P

1985-10-01

279

[Nerve root compression by gas containing lumbar disc herniation--case report].  

PubMed

The radiographic appearance of gas collection in the intervertebral disc represents the so-called "vacuum phenomenon." Incidence of the vacuum phenomenon on plain radiographs is reported to be 1-20%, whereas gas-containing disc herniations are rarely observed. We present a case report involving a patient with L4/5 gas-containing disc herniation, which was demonstrated by CT and MRI scans and was also surgically documented. A 48-year-old man with no previous back trauma presented with a 14-day history of left leg pain. On neurologic examination, the straight leg raising test was positive at 60degrees. Leg muscle strength was weak on the extensor hallucis longus. Sensory disturbances and abnormalities in deep-tendon reflexes were not observed. Lumbar roentogenograms showed "vacuum phenomenon" at L2/3, L4/5 and the L5/S disc space. MRI indicated a herniated disc at L4/5 displacing the dural sac and a focal low intensity in the lesion. Administration of an epidural block relieved the patient's symptoms. Ten months later, the patient reported a gradual return of similar left leg pain. His symptoms did not respond to conservative management. Lumbar spine films indicated abnormalities identical to the original results. MRI showed an enlarged area of low intensity with compression of the left L5 nerve root. In addition to recurrent pain, discography with metrizamide injections confirmed the presence of intradiscal gas and compression of the left L5 nerve root. During surgery, a gray-bluish air mass compressing the L5 nerve root was identified. Manipulation of the mass resulted in rupture and the release of gas. The displaced nerve root immediately relaxed to its normal position. Seven months after the operation, the patient remains free of pain. PMID:19526837

Yasuoka, Hiroki; Nemoto, Osamu; Kawaguchi, Masahisa; Naitou, Satoko; Yamamoto, Kouji; Ukegawa, You

2009-06-01

280

Imaging diagnosis-CT myelography in a dog with intramedullary intervertebral disc herniation.  

PubMed

A 5-year-old Chihuahua was examined for peracute pain and paraparesis. Neuroanatomic localization was consistent with a symmetric T3-L3 myelopathy. Computed tomography (CT) of the T9-L5 vertebrae was normal. Myelography disclosed attenuation of the subarachnoid space from T11 to L1, consistent with spinal cord swelling. CT following the myelogram disclosed a focal area of intramedullary iodinated contrast medium at T13-L1. At surgery, intervertebral disc material was removed from the spinal cord. Based on the findings in this patient, intramedullary disc herniation should be considered a cause for focal intramedullary contrast medium accumulation. PMID:21388471

Kent, Marc; Holmes, Shannon; Cohen, Eli; Sakals, Sharise; Roach, Wesley; Platt, Simon; Schatzberg, Scott; Howerth, Elizabeth

2011-01-01

281

A differential diagnosis in postural headache: herniation of a giant posterior fossa arachnoid cyst.  

PubMed

The causes of postural headache are usually associated with low intracranial pressure. However, there are still rare causes of posture-related headaches that are not associated with low intracraninal pressure and caused by pathologic processes. Herein, we report a patient with giant posterior fossaarachnoid cyst herniating below the level of foramen magnum presenting with postural headache, which has not been described previously in the literature. Emergency physicians should be aware that posterior fossa arachnoid cysts should be considered one of the differential diagnoses in patients with postural headache. PMID:18272121

Lu, Kuan-Che; Chao, Chun-Chieh; Wang, Tzong-Luen; Chong, Chee-Fah; Chen, Chien-Chih

2008-02-01

282

Diaphragmatic herniation in the horse: 31 cases from 2001-2006  

PubMed Central

Diaphragmatic rent and visceral herniation in the horse is seldom diagnosed, but historically carries a poor prognosis. The objective of this study was to document the presentation and surgical management of all diaphragmatic rents as presented to 2 referral institutions over a 5-year period. A review of 31 cases demonstrated that even with advances in surgical management of abdominal and thoracic conditions, little has been done to change the prognosis for this condition. Success rate was 23% for all horses presented for colic and were ultimately diagnosed with a diaphragmatic hernia, and 46% for those cases for which surgical management was elected.

Romero, Alfredo E.; Rodgerson, Dwayne H.

2010-01-01

283

Central brain herniation secondary to fulminant acute disseminated encephalomyelitis: implications for neurosurgical management. Case report.  

PubMed

Acute disseminated encephalomyelitis (ADEM), also known as postinfectious encephalomyelitis, is an immunologically mediated demyelinating disorder affecting the central nervous system that typically occurs after infection or vaccination. The prognosis of ADEM is generally favorable. In a small subset of patients with ADEM, however, fulminant cerebral edema requiring neurosurgical intervention will develop. Few recommendations are available to help the neurosurgeon in dealing with such cases. In this report, the authors present the case of a patient with ADEM in whom central brain herniation developed secondary to medically intractable cerebral edema. The authors review the salient features of the disease and suggest a role for neurosurgeons in cases of fulminant ADEM. PMID:16961146

Sekula, Raymond F; Marchan, Edward M; Baghai, Parviz; Jannetta, Peter J; Quigley, Matthew R

2006-09-01

284

Management of post-goniopuncture iris herniation: a two-step procedure.  

PubMed

A 38-year-old male presented to the emergency room suffering acute pain in his left eye. Two months before he had been submitted to uneventful non-penetrating deep sclerectomy and one month before to YAG-laser goniopuncture. Examination showed iris herniation into the trabeculo-descemet's window. Surgical reduction was carried out through a peripheral corneal incision, and a large air bubble was injected into the anterior chamber. Four days later a wide laser peripheral iridotomy was performed. This technique can transform a non-penetrating technique into a full-trabeculectomy, without reopening the superficial flap. PMID:23740144

Martín-Moro, Julio González; Miguel, Yolanda Fernández

2014-06-01

285

Rescue microsurgery in coil herniation causing thromboembolic occlusion of parent artery  

Microsoft Academic Search

Background  Malpositioned coils can provoke abrupt occlusion of the parent vessels and\\/or neighboring branches causing stroke during coil\\u000a embolization (CE) of intracranial aneurysms. The authors describe a series of cases in which urgent surgical recanalization\\u000a of the vessels clogged with herniated or migrated coils rescued the patients.\\u000a \\u000a \\u000a \\u000a Methods  A total of six patients with aneurysms who underwent surgical management for parent artery

Yong Bae Kim; Kyu Chang Lee; Jae Whan Lee; Seung Kon Huh; Pyeong Ho Yoon; Dong Ik Kim

2009-01-01

286

The Impact of Psychiatric Comorbidity on the Return to Work in Patients Undergoing Herniated Disc Surgery  

Microsoft Academic Search

Introduction This study examines (1) return to work (RTW) and ability to work (ATW) rates, and the association with (2) psychiatric comorbidity\\u000a and (3) socio-demographic, illness-related, vocational and rehabilitation-related characteristics in herniated disc surgery\\u000a patients. Methods In this longitudinal observational study 305 consecutive patients took part in face-to-face interviews during hospital stay.\\u000a 277 patients also participated in a 3-month follow-up

Margrit Zieger; Melanie Luppa; Hans Jörg Meisel; Lutz Günther; Dirk Winkler; René Toussaint; Katarina Stengler; Matthias C. Angermeyer; Hans-Helmut König; Steffi G. Riedel-Heller

2011-01-01

287

Paraplegia after Gastrectomy in a Patient with Cervical Disc Herniation: A Case Report and Review of Literature  

PubMed Central

Paraplegia is a rare postoperative complication. We present a case of acute paraplegia after elective gastrectomy surgery because of cervical disc herniation. The 73-year-old man has the medical history of cervical spondylitis with only symptom of temporary pain in neck and shoulder. Although the patient's neck was cautiously preserved by using the Discopo, an acute paraplegia emerged at about 10 hours after the operation. Severe compression of the spinal cord by herniation of the C4-C5 cervical disc was diagnosed and emergency surgical decompression was performed immediately. Unfortunately the patient showed limited improvement in neurologic deficits even after 11 months.

Zhang, Qingfu; Jiang, Wei; Zhou, Quanhong; Wang, Guangyan; Zhao, Linlin

2014-01-01

288

Small bowel herniation through subumbilical port site following laparoscopic surgery at the time of reversal of anesthesia.  

PubMed

Incisional hernias through laparoscopic trocar sites are unusual complications of laparoscopy. Two cases of small bowel herniation at subumbilical port site occurred at the time of withdrawal of the trocar sheath at the end of the laparoscopic procedure are reported. The herniations were precipitated by the coughing movements of the patients as a result of too early reversal of the general anesthesia. Awareness of the complication, precaution at time of sheath withdrawal and a well-timed reversal of the general anesthesia are important in avoiding such a complication. PMID:10729764

Leung, T Y; Yuen, P M

2000-01-01

289

Nucleus accumbens facilitates nociception.  

PubMed

We have previously demonstrated an opioid link in nucleus accumbens (NAc) that mediates antinociception produced by a novel ascending pain modulation pathway. For example, noxious stimulation induces heterosegmental antinociception that is mediated by both mu- and delta-opioid receptors in NAc. However, spinal intrathecal administration of the mu-receptor agonist [D-Ala(2), N-Me-Phe(4),Gly(5)-ol]-enkephalin (DAMGO) also induces heterosegmental antinociception. The aim of the present study in the rat was to identify the intra-NAc opioid receptors that mediate the antinociceptive effects of spinally administered DAMGO and also to determine the effect of NAc efferent activity on nociception. Intra-NAc administration of either the mu-opioid receptor antagonist Cys(2),Tyr(3), Orn(5),Pen(7)amide (CTOP) or the delta-opioid receptor antagonist naltrindole blocked the antinociceptive effect of spinally administered DAMGO on the jaw-opening reflex (JOR). Injection of quaternary lidocaine (QX-314) attenuated the JOR, suggesting that the output of NAc is pronociceptive. In support of this, intra-NAc injection of the excitatory amino acid agonist kainate enhanced the JOR. Thus, it is possible to modulate activity in NAc to bidirectionally attenuate or enhance nociception, suggesting a potential role for NAc in setting nociceptive sensitivity. PMID:21458450

Gear, Robert W; Levine, Jon D

2011-06-01

290

Nucleus Accumbens Facilitates Nociception  

PubMed Central

We have previously demonstrated an opioid link in nucleus accumbens (NAc) that mediates antinociception produced by a novel ascending pain modulation pathway. For example, noxious stimulation induces heterosegmental antinociception that is mediated by both mu- and delta-opioid receptors in NAc. However, spinal intrathecal administration of the mu-receptor agonist [D-Ala2, N-Me-Phe4,Gly5-ol]-enkephalin (DAMGO) also induces heterosegmental antinociception. The aim of the present study in the rat was to identify the intra-NAc opioid receptors that mediate the antinociceptive effects of spinally administered DAMGO and also to determine the effect of NAc efferent activity on nociception. Intra-NAc administration of either the mu-opioid receptor antagonist Cys2,Tyr3, Orn5,Pen7amide (CTOP) or the delta-opioid receptor antagonist naltrindole blocked the antinociceptive effect of spinally administered DAMGO on the jaw-opening reflex (JOR). Injection of quaternary lidocaine (QX-314) attenuated the JOR, suggesting that the output of NAc is pronociceptive. In support of this, intra-NAc injection of the excitatory amino acid agonist kainate enhanced the JOR. Thus, it is possible to modulate activity in NAc to bidirectionally attenuate or enhance nociception, suggesting a potential role for NAc in setting nociceptive sensitivity.

Gear, Robert W.; Levine, Jon D.

2011-01-01

291

Analysis of crucial molecules involved in herniated discs and degenerative disc disease  

PubMed Central

OBJECTIVES: Herniated discs and degenerative disc disease are major health problems worldwide. However, their pathogenesis remains obscure. This study aimed to explore the molecular mechanisms of these ailments and to identify underlying therapeutic targets. MATERIAL AND METHODS: Using the GSE23130 microarray datasets downloaded from the Gene Expression Omnibus database, differentially co-expressed genes and links were identified using the differentially co-expressed gene and link method with a false discovery rate <0.25 as a significant threshold. Subsequently, the underlying molecular mechanisms of the differential co-expression of these genes were investigated using Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. In addition, the transcriptional regulatory relationship was also investigated. RESULTS: Through the analysis of the gene expression profiles of different specimens from patients with these diseases, 539 differentially co-expressed genes were identified for these ailments. The ten most significant signaling pathways involving the differentially co-expressed genes were identified by enrichment analysis. Among these pathways, apoptosis and extracellular matrix-receptor interaction pathways have been reported to be related to these diseases. A total of 62 pairs of regulatory relationships between transcription factors and their target genes were identified as critical for the pathogenesis of these diseases. CONCLUSION: The results of our study will help to identify the mechanisms responsible for herniated discs and degenerative disc disease and provides a theoretical basis for further therapeutic study.

Qu, Zhigang; Miao, Weiwei; Zhang, Qi; Wang, Zhenyu; Fu, Changfeng; Han, Jinhua; Liu, Yi

2013-01-01

292

Proteomic analysis of the cerebrospinal fluid of patients with lumbar disk herniation.  

PubMed

To better understand the pathophysiologic mechanisms underlying spinal nerve root injury induced by lumbar disk herniation (LDH), comparative proteomic analysis of cerebrospinal fluid (CSF) between patients with LDH (the experiment group) and the otherwise healthy patients who had had implants removed from healed fractures in the lower limbs (the control group) was carried out using 2-DE followed by LC-IT-MS and database searching. Image analysis of silver-stained 2-DE gels revealed that 15 protein spots showed significant differential expression between the two groups of CSF samples (p < 0.05). After searching the database we found that in CSF of LDH patients, the expression of cystatin C, apolipoprotein A-IV, vitamin D-binding protein, neurofilament triplet L protein, IgG, tetranectin, and hemoglobin were elevated. However, ProSAAS, prostagladin D2 synthase, creatine kinase B, superoxide dismutase 1 and peroxiredoxin 2 were decreased. The subsequent ELISA measured the concentration of tetranectin, vitamin D-binding protein and cystatin C and confirmed the results of proteomic analysis. These identified proteins are involved in the pathophysiological process of spinal nerve root injury caused by herniated lumbar disk. The functional implications of the alterations in the levels of these proteins are discussed in this paper. PMID:16372267

Liu, Xu-Dong; Zeng, Bing-Fang; Xu, Jian-Guang; Zhu, Hai-Bo; Xia, Qi-Chang

2006-02-01

293

Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion  

PubMed Central

Between 2001 and 2005, 43 patients (average age 54.2, range 36–68 years) with recurrent lumbar disc herniation underwent reoperation with the transforaminal lumbar interbody fusion (TLIF) technique at our unit. All cases were followed up for 24–72 months (mean 45 months) and graded using the Japanese Orthopaedic Association (JOA) score system pre- and post-operation and during the follow-up period. The leg pain of all patients was relieved significantly within one month postoperatively. The mean JOA score was improved from 9.3 before surgery to 25.0 at the final follow-up visit (P<0.0001). The average recovery rate was 86.0% (range 52–100%). General clinical outcome was excellent in 23 (53.5%) patients, good in 14 (32.6%) and fair in 6 (13.9%). The fusion rate was 100% two years postoperatively. Three patients (7%) had transient neurological deficits, which resolved completely within 3 months. There were no major complications. We, therefore, believe the TLIF technique to be an effective procedure with satisfactory clinical results for the treatment of recurrent lumbar disc herniation.

Zhao, Jie; Liu, AiGang; Yuan, Jiandong; Li, Zhonghai

2008-01-01

294

Arachnoid cyst resulting in tonsillar herniation and syringomyelia in a patient with achondroplasia. Case report.  

PubMed

Achondroplasia has been associated with varying degrees of cervicomedullary and spinal compression, although usually in the pediatric population. Large arachnoid cysts have also been found to result in tonsillar herniation and syringomyelia. The authors present the case of a patient with achondroplasia who presented with symptoms of foramen magnum compression and syringomyelia, and who was subsequently found to have a large posterior fossa arachnoid cyst. This 38-year-old woman with achondroplasia presented with an 8-month history of headache and numbness of the hands and fingers. Admission magnetic resonance (MR) imaging of the head and spine revealed a large arachnoid cyst in the posterior cranial fossa, a 6-mm tonsillar herniation consistent with an acquired Chiari malformation, and a large cervicothoracic syrinx. The patient was treated using suboccipital craniectomy, C-1 laminectomy, fenestration of the arachnoid cyst, and decompression of the acquired Chiari malformation with duraplasty. Surgical decompression resulted in improvement of the presenting symptoms, adequate decompression of crowding at the foramen magnum, and resolution of the syrinx. Although there was only partial reduction in the retrocerebellar cisternal space on follow-up MR imaging, no residual symptoms were related to this. PMID:16398464

Bauer, Andrew M; Mueller, Diane M; Oró, John J

2005-11-01

295

Differentiation of idiopathic spinal cord herniation from CSF-isointense intraspinal extramedullary lesions displacing the cord.  

PubMed

Focal spinal cord displacement can be caused by idiopathic spinal cord herniation (ISCH), in which the cord protrudes through a dural defect into the epidural space, causing cord displacement and tethering. ISCH is uncommon and often is misdiagnosed initially, which results in delayed management. ISCH can be mimicked by space-occupying cerebrospinal fluid (CSF)-isointense intraspinal extramedullary lesions, such as epidermoid cysts or teratomas, intradural arachnoid cysts, epidural hematomas or abscesses, cystic nerve sheath tumors, synovial or Tarlov cysts, meningoceles, and pseudomeningoceles. Initial computed tomography (CT) and unenhanced magnetic resonance (MR) imaging studies may depict focal cord displacement and a widened CSF space but often are not sufficient to identify the underlying cause. High-resolution thin-section MR imaging can delineate the exact location of the dural defect and the protrusion of the herniated cord through this defect into the epidural space. At imaging, unimpeded CSF pulsation artifacts seen within a widened CSF space exclude a space-occupying lesion. A filling defect seen at conventional or CT myelography can help confirm a CSF-isointense space-occupying lesion; intravenous contrast agent administration can help exclude a rim-enhancing cystic extramedullary lesion. The clinical presentation usually is nonspecific, but symptom acuity, fever, and trauma can guide the imaging evaluation and help narrow the differential diagnosis. A multimodality imaging approach is essential to differentiate ISCH from space-occupying CSF-isointense intraspinal extramedullary lesions. PMID:24617681

Haber, Marc D; Nguyen, Dustin D; Li, Shan

2014-01-01

296

Bilateral post-injection fibrosis of the gluteal region mimicking lumbar disc herniation: a case report  

PubMed Central

Tissue fibrosis is a known complication of intramuscular injections, which is especially seen in children due to vaccinations and injections. Herein we report a case of post injection gluteal fibrosis that had undergone two unsuccessful lumbar discectomies to treat the symptoms of this disease. A 45 years old male patient was consulted to our clinic from the department of neurochirurgy with complaints of bilateral hip pain. The patient was operated on for lumbar disc herniation in L4–5 level twice but his complaints had not resolved. A third operation including L4–5 instrumentation and fusion was planned. His examination revealed nodules in his both hips. His x-rays, MRI and blood tests were normal. He underwent bilateral gluteal fascia excision and his complaints resolved totally. The clinical diagnosis of post-injection fibrosis is problematic, due to the difficulty of determining the etiology. In many patients the diagnosis comes from a history of injection. Pain in the gluteal region is not a frequently described clinical feature of this condition. Many reports in the literature emphasize a contracture rather than pain. Post-injection fibrosis in the gluteal region may mimic lumbar disc herniation and a detailed physical examination is the key for correct differential diagnosis. In refractory cases not responding to conservative treatment, surgical excision of the nodules may lead to a complete clinical recovery of the patient.

Kose, Kamil Cagri; Altinel, Levent; Isikb, Cengiz; Komurcuc, Erkam; Mutlud, Serhat; Ozdemire, Mustafa

2009-01-01

297

Retrolisthesis and Lumbar Disc Herniation: A Pre-operative Assessment of Patient Function  

PubMed Central

BACKGROUND CONTEXT Retrolisthesis is relatively rare but when present has been associated with increased back pain and impaired back function. Neither the prevalence of this condition in individuals with lumbar disc herniations nor its possible relation to pre-operative back pain and dysfunction has been well studied. PURPOSE The purposes of this study were as follows: 1) to determine the prevalence of retrolisthesis (alone or in combination with other degenerative conditions) in individuals with confirmed L5 – S1 disc herniation who later underwent lumbar discectomy; 2) to determine if there is any association between retrolisthesis and degenerative changes within the same vertebral motion segment; and 3) to determine the relation between retrolisthesis (alone or in combination with other degenerative conditions) and pre-operative low back pain, physical function, and quality of life. STUDY DESIGN/SETTING Cross-sectional study. PATIENT SAMPLE A total of 125 individuals were identified for incorporation into this study. All patients had confirmed L5-S1 disc herniation on MRI and later underwent L5-S1 discectomy. All patients were enrolled in the SPORT (Spine Patient Outcomes Research Trial) study; data was obtained from the multi-institutional database comprised of SPORT patients from across the United States. OUTCOME MEASURES Retrolisthesis, Degenerative change on MRI, Modic Changes. METHODS MRI scans of the lumbar spine were assessed at spinal level L5–S1 for all 125 patients. Retrolisthesis was defined as posterior subluxation of 8% or more. Disc degeneration was defined as any loss of disc signal on T2 imaging. Modic changes were graded 1 – 3 and collectively classified as vertebral endplate degenerative changes. The presence of facet arthropathy and ligamentum flavum hypertrophy were classified jointly as posterior degenerative changes. RESULTS The overall incidence of retrolisthesis at L5-S1 in our study was 23.2%. Retrolisthesis combined with posterior degenerative changes, degenerative disc disease, or vertebral endplate changes had incidences of 4.8%, 16%, and 4.8% respectively. The prevalence of retrolisthesis did not vary by sex, age, race, smoking status, or education level when compared to individuals with normal sagittal alignment. However, individuals with retrolisthesis were more likely to be receiving worker compensation than those without retrolisthesis. Increased age was found to be associated with individuals having vertebral endplate degenerative changes (both alone and in conjunction with retrolisthesis) and degenerative disc disease. Individuals who had retrolisthesis with concomitant vertebral endplate degenerative changes were more often smokers and had no insurance. The presence of retrolisthesis was not associated with an increased incidence of having degenerative disc disease, posterior degenerative changes, or vertebral endplate changes. No statistical significance was found between the presence of retrolisthesis on the degree of patient pre-operative low back pain and physical function. Patients with degenerative disc disease were found to have increased leg pain compared to those patients without degenerative disc changes. CONCLUSIONS We found no significant relationship between retrolisthesis in patients with L5-S1 disc herniation and worse baseline pain or function. It is possible that the contribution of pain or dysfunction related to retrolisthesis was far overshadowed by the presence of symptoms due to the concomitant disc herniation. It remains to be seen whether retrolisthesis will affect outcome following discectomy in these patients.

Shen, Michael; Razi, Afshin; Lurie, Jon D.; Hanscom, Brett; Weinstein, Jim

2008-01-01

298

Balance Acupuncture: An Experimental Study on the Effectiveness of Treating Radicular Pain in a Lumbar Disc Herniation Rat Model  

Microsoft Academic Search

BackgroundLumbar disc herniation (LDH) is a common clinical disease accounting for lumbocrural pain in the majority of the patients. The incidence of LDH has risen quickly in the past years. The theory of balance acupuncture is a new method firstly established by Dr. Wang Wenyuan and further developed according to a large amount of clinical studies which have come to

Ying Wang; Hong Yuan; Danni Xu; Wang WY

2009-01-01

299

An epidemiologic study of sports and weight lifting as possible risk factors for herniated lumbar and cervical discs  

Microsoft Academic Search

The associations between participation in several spe cific sports, use of free weights, and use of weight lifting equipment and herniated lumbar or cervical inter vertebral discs were examined in a case-control epi demiologic study. Specific sports considered were baseball or softball, golf, bowling, swimming, diving, jogging, aerobics, and racquet sports. Included in the final analysis were 287 patients with

Diane J. Mundt; Jennifer L. Kelsey; Anne L. Golden; Manohar M. Panjabi; Harris Pastides; Anne T. Berg; Joseph Sklar; Timothy Hosea

1993-01-01

300

Nonmedical methods to relieve low back pain caused by lumbar disc herniation: a descriptive study in northeastern Turkey.  

PubMed

Low back pain due to the effects of lumbar disc herniation is a common complaint of patients who often subsequently seek help from medical professionals. It is also a significant health problem which is quite difficult to treat. This descriptive study was conducted to determine nonmedical methods used by patients with lumbar disc herniation to relieve low back pain; the patients' intensity of low back pain when they were admitted to the hospital was also explored. Ninety-two patients with lumbar disc herniation participated in this study, which was carried out at a university hospital in northeastern Turkey. Data were collected using a patient information form and the visual analog scale (VAS). When the patients were admitted to hospital, their mean VAS score was 6.56 ± 2.45. The study results showed that as a first choice nearly all of the patients (94.6%) with lumbar disc herniation preferred consulting with their physicians before to obtain relief for low back pain. However, in addition to seeing their physician, more than one-half of these patients (57.6%) also used nonmedical methods. The primary nonmedical methods were hot/cold compresses, wrapping various substances on the back, and herbal preparations. An increase in pain was noted by 17.0% of patients after using nonmedical methods. Findings indicated that more than two-thirds of patients experienced either no change or an increase in pain after using nonmedical methods to find relief. PMID:24882024

Cilingir, Dilek; Hintistan, Sevilay; Yigitbas, Cagla; Nural, Nesrin

2014-06-01

301

Lumbar disc herniation and cauda equina syndrome following spinal manipulative therapy: a review of six court decisions in Canada.  

PubMed

The purpose of this review is to expand practitioners' knowledge on areas of liability when treating low back pain patients. Six cases where chiropractors in Canada were sued for allegedly causing or aggravating lumbar disc herniation after spinal manipulative therapy were retrieved using the CANLII search database. The case series involves 4 men and 2 women with an average age of 37.3 years (range, 31-48 years). Trial courts' decisions were rendered between 2000 and 2011. This study highlights the following conclusions from Canadian courts: 1) informed consent is an ongoing process that cannot be entirely delegated to office personnel; 2) when the patient's history reveals risk factors for lumbar disc herniation the chiropractor has the duty to rule out disc pathology as an etiology for the symptoms presented by the patients before beginning anything but conservative palliative treatment; 3) lumbar disc herniation may be triggered by spinal manipulative therapy on vertebral segments distant from the involved herniated disc such as the thoracic spine. PMID:24485443

Boucher, Pierre; Robidoux, Sébastien

2014-02-01

302

Intrathoracic major duodenal papilla with transhiatal herniation of the pancreas and duodenum: A case report and review of the literature  

PubMed Central

Transhiatal herniation of the pancreas is an extremely rare condition. In the published literature we found only eleven cases reported in the period of 1958 to 2011. A coincidental hiatal herniation of the duodenum is described in two cases only. To our knowledge, we report the first case with a hiatal herniation of the complete duodenum and proximal pancreas presenting an intrathoracic major duodenal papilla with consecutive intrahepatic and extrahepatic cholestasis. A 72-year-old Caucasian woman was admitted to our department with a hiatal hernia grade IV for further evaluation. According to our recommendation of surgical hernia repair soon after the diagnosis of a transhiatal herniation of the proximal pancreas and entire duodenum, we had to respect the declared intention of the patient for a conservative procedure. So we were forced to wait for surgical repair within an emergency situation complicated by a myocardial infarction and reduced general condition. We discuss the therapeutic decision making process and a complete literature review of this rare entity.

Jager, Tarkan; Neureiter, Daniel; Nawara, Clemens; Dinnewitzer, Adam; Ofner, Dietmar; Lamade, Wolfram

2013-01-01

303

Macrophage tissue infiltration, clinical symptoms, and signs in patients with lumbar disc herniation. A clinicopathological study on 179 patients.  

PubMed

It is postulated that in addition to nerve-root compression, an inflammatory stimulus of the herniated lumbar disc is responsible for sciatic pain and radiculopathy. The clinical relevance of the histologically described inflammatory infiltrates is, however, not clearly defined [8, 22]. It was the aim of this study to assess the clinical relevance of inflammatory cells in herniated lumbar disc specimens. The presence of inflammatory cells was examined immunohistochemically in routinely processed resection specimens of the lumbar disc. The histological results were compared to prospectively obtained clinical data. Disc specimens of 179 patients who underwent surgery for lumbar disc herniation were studied immunohistologically. Preoperatively each patient received a visual analogue scale for classification of the pain level and general clinical data were recorded prospectively. Varying amounts of inflammatory cells could be demonstrated in the resected disc tissue. In the statistical workup no statistically significant correlation between the histological evidence of macrophage infiltrates and the pain grading scale or the clinical data could be found. In our study there is no statistically significant correlation between macrophage infiltrates in herniated lumbar disc specimen and the obtained clinical data. PMID:9932124

Rothoerl, R; Woertgen, C; Holzschuh, M; Brehme, K; Rüschoff, J; Brawanski, A

1998-01-01

304

Sensitivity of cross sections for elastic nucleus-nucleus scattering to halo nucleus density distributions  

NASA Astrophysics Data System (ADS)

In order to clear up the sensitivity of the nucleus-nucleus scattering to the nuclear matter distributions in exotic halo nuclei, we have calculated differential cross sections for elastic scattering of the 6He and 11Li nuclei on several nuclear targets at the energy of 0.8 GeV/nucleon with different assumed nuclear density distributions in 6He and 11Li.

Alkhazov, G. D.; Sarantsev, V. V.

2012-12-01

305

Transport of the influenza virus genome from nucleus to nucleus.  

PubMed

The segmented genome of an influenza virus is encapsidated into ribonucleoprotein complexes (RNPs). Unusually among RNA viruses, influenza viruses replicate in the nucleus of an infected cell, and their RNPs must therefore recruit host factors to ensure transport across a number of cellular compartments during the course of an infection. Recent studies have shed new light on many of these processes, including the regulation of nuclear export, genome packaging, mechanisms of virion assembly and viral entry and, in particular, the identification of Rab11 on recycling endosomes as a key mediator of RNP transport and genome assembly. This review uses these recent gains in understanding to describe in detail the journey of an influenza A virus RNP from its synthesis in the nucleus through to its entry into the nucleus of a new host cell. PMID:24104053

Hutchinson, Edward C; Fodor, Ervin

2013-10-01

306

Repair, regenerative and supportive therapies of the annulus fibrosus: achievements and challenges  

PubMed Central

Lumbar discectomy is a very effective therapy for neurological decompression in patients suffering from sciatica due to hernia nuclei pulposus. However, high recurrence rates and persisting post-operative low back pain in these patients require serious attention. In the past decade, tissue engineering strategies have been developed mainly targeted to the regeneration of the nucleus pulposus (NP) of the intervertebral disc. Accompanying techniques that deal with the damaged annulus fibrous are now increasingly recognised as mandatory in order to prevent re-herniation to increase the potential of NP repair and to confine NP replacement therapies. In the current review, the requirements, achievements and challenges in this quickly emerging field of research are discussed.

Bron, Johannes Leendert; Helder, Marco N.; Meisel, Hans-Jorg; Van Royen, Barend J.

2008-01-01

307

Herniated Disk  

MedlinePLUS

... lifting techniques, and controlling weight may help prevent back injury. Your health care provider may recommend a back brace to help support the spine. A brace can help prevent injuries in people who lift heavy objects at work. ...

308

Intradiscal injection of oxygen-ozone gas mixture for the treatment of cervical disc herniations.  

PubMed

For disc herniations the use of open surgical approaches is reduced since new percutaneous methods allowing shrinkage of the disc and improvement of the radicular function are gaining interest. Studies on the spontaneous disappearance of disc fragments have demonstrated autoimmune responses with a chronic inflammatory reaction. Also radicular pain has been shown to be mostly due to biochemical mechanisms. Researchers in different fields surprisingly noticed that a brief, calculated, oxidative stress by ozone administration may correct a persistent imbalance due to excessive, chronic oxidative injury. Oxygen-ozone gas injection in painful patients has a dramatic effect on clinical symptoms. On these bases the intradiscal injection of oxygen-ozone gas has been conceived. We report the treatment on a series of patients affected by cervical disc pathology, treated by intradiscal injection of oxygen-ozone gas mixture. The effects both on pain and on radicular dysfunction are impressive. The morphological effect of the treatment was also evaluated by pathological examination. PMID:15830973

Alexandre, A; Corò, L; Azuelos, A; Buric, J; Salgado, H; Murga, M; Marin, F; Giocoli, H

2005-01-01

309

Thoracic Disc Herniation of the Adjacent Segment With Acutely Progressing Myelopathy  

PubMed Central

We report a case of a 66-year-old woman with progressing myelopathy. Her history revealed instrumented fusion from T10 to S1 for degenerative lumbar kyphosis and spinal stenosis. The plain radiographs showed narrowing of the intervertebral disc space with a gas shadow and sclerotic end-plate changes at T9-T10. Magnetic resonance imaging revealed a posterolateral mass compressing the spinal cord at the T9-T10 level. The patient was treated with a discectomy through the posterior approach combined with posterior instrumentation. The patient's symptoms and myelopathy resolved completely after the discectomy and instrumented fusion. The thoracic disc herniation might have been caused by the increased motion and stress concentration at the adjacent segment.

Oh, In-Soo; Seo, Jun-Yeong; Kim, Yoon-Chung

2010-01-01

310

[Noninvasive magnetic resonance myelography in patients with lumbosacral intervertebral disk herniation].  

PubMed

For many decades X-ray myelography has remained one of the major diagnostic methods for spinal pathology. With the advent of computed tomography (CT), CT myelography using water-soluble contrast agents has been developed. Visualization of the subarachnoidal spaces of the spinal cord and dural sac without an intrathecal contrast agent has become possible with the emergence of magnetic resonance imaging (MRI). Its further development and improvement has brought to existence the new noninvasive technique MR myelography based on the suppression of a signal from the medulla and its enhancement from the cerebrospinal fluid-containing spaces. This paper compares routine X-ray myelography, CT myelography, and MR myelography used in the diagnosis of lumbosacral intervertebral disk herniation and assesses the informative value and benefits of MR myelography as a noninvasive diagnostic method for this pathology. PMID:21866824

Arutiunov, N V; Konovalov, N A; Mel'nikova-Pitskheluri, T V; Fadeeva, L M; Tissen, T P

2011-01-01

311

Dorsal Extradural Lumbar Disc Herniation Causing Cauda Equina Syndrome : A Case Report and Review of Literature  

PubMed Central

A 73-year-old male presented with a rare dorsally sequestrated lumbar disc herniation manifesting as severe radiating pain in both leg, progressively worsening weakness in both lower extremities, and urinary incontinence, suggesting cauda equina syndrome. Magnetic resonance imaging suggested the sequestrated disc fragment located in the extradural space at the L4-L5 level had surrounded and compressed the dural sac from the lateral to dorsal sides. A bilateral decompressive laminectomy was performed under an operating microscope. A large extruded disc was found to have migrated from the ventral aspect, around the thecal sac, and into the dorsal aspect, which compressed the sac to the right. After removal of the disc fragment, his sciatica was relieved and the patient felt strength of lower extremity improved.

Lee, Sang-Ho; Arbatti, Nikhil J.

2010-01-01

312

The Influence of Obesity on the Outcome of Treatment of Lumbar Disc Herniation  

PubMed Central

Background: Questions remain as to the effect that obesity has on patients managed for symptomatic lumbar disc herniation. The purpose of this study was to determine if obesity affects outcomes following the treatment of symptomatic lumbar disc herniation. Methods: An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial for the treatment of lumbar disc herniation. A comparison was made between patients with a body mass index of <30 kg/m2 (nonobese) (n = 854) and those with a body mass index of ?30 kg/m2 (obese) (n = 336). Baseline patient demographic and clinical characteristics were documented. Primary and secondary outcomes were measured at baseline and at regular follow-up time intervals up to four years. The difference in improvement from baseline between operative and nonoperative treatment was determined at each follow-up period for both groups. Results: At the time of the four-year follow-up evaluation, improvements over baseline in primary outcome measures were significantly less for obese patients as compared with nonobese patients in both the operative treatment group (Short Form-36 physical function, 37.3 compared with 47.7 points [p < 0.001], Short Form-36 bodily pain, 44.2 compared with 50.0 points [p = 0.005], and Oswestry Disability Index, ?33.7 compared with ?40.1 points [p < 0.001]) and the nonoperative treatment group (Short Form-36 physical function, 23.1 compared with 32.0 points [p < 0.001] and Oswestry Disability Index, ?21.4 compared with ?26.1 points [p < 0.001]). The one exception was that the change from baseline in terms of the Short Form-36 bodily pain score was statistically similar for obese and nonobese patients in the nonoperative treatment group (30.9 compared with 33.4 points [p = 0.39]). At the time of the four-year follow-up evaluation, when compared with nonobese patients who had been managed operatively, obese patients who had been managed operatively had significantly less improvement in the Sciatica Bothersomeness Index and the Low Back Pain Bothersomeness Index, but had no significant difference in patient satisfaction or self-rated improvement. In the present study, 77.5% of obese patients and 86.9% of nonobese patients who had been managed operatively were working a full or part-time job. No significant differences were observed in the secondary outcome measures between obese and nonobese patients who had been managed nonoperatively. The benefit of surgery over nonoperative treatment was not affected by body mass index. Conclusions: Obese patients realized less clinical benefit from both operative and nonoperative treatment of lumbar disc herniation. Surgery provided similar benefit over nonoperative treatment in obese and nonobese patients. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Rihn, Jeffrey A.; Kurd, Mark; Hilibrand, Alan S.; Lurie, Jon; Zhao, Wenyan; Albert, Todd; Weinstein, James

2013-01-01

313

Traumatic Acute Brain Herniation through the Ear in a Child: Concealed compound fracture.  

PubMed

A seven-year-old girl presented to Sultan Qaboos University Hospital, Oman, with a history of having been hit by a motor vehicle. After this, she had right-sided cerebrospinal fluid otorrhoea, and a week later, brain matter extruded through the right ear. A computed tomography scan of the brain demonstrated a tegmen fracture communicating with the external auditory canal. There was no hearing or facial nerve impairment and an otoscopic examination showed an intact tympanic membrane. She underwent a transcranial repair of the middle cranial fossa base, which revealed a wide dural and bony defect of the tegmen with herniation of the temporal lobe. Repair was made with an intradural patch of artificial dura. The rarity of this type of presentation of temporal bone fracture and its management are discussed. PMID:22912929

Kariyattil, Rajeev; Muthukuttiparambil, Unnikrishnan

2012-08-01

314

Psoas Compartment Blockade in a Laterally Herniated Disc Compressing the Psoas Muscle -A Case Report-  

PubMed Central

A psoas compartment block has been used to provide anesthesia for orthopedic surgical procedures and analgesia for post-operative pain. Currently, this block is advocated for relieving pain in the lower extremity and pelvic area resulting from various origins. We report a case of a 69-year-old male patient who had gait abnormality with posterior pelvic and hip pain, which were both aggravated by hip extension. From the magnetic resonance image, the patient was found to have a laterally herniated intervertebral disc at the L2/3 level, which compressed the right psoas muscle. This was thought to be the origin of the pain, so a psoas compartment block was performed using 0.25% chirocaine with triamcinolone 5mg, and the pain in both the pelvis and hip were relieved.

Kim, Hye Young; Park, Jin Woo; Moon, Jee Youn; Shin, Jae Hyuck; Park, Sang Hyun

2012-01-01

315

Cometary nucleus and active regions  

NASA Technical Reports Server (NTRS)

On the basis of the icy conglomerate model of cometary nuclei, various observations demonstrate the spotted nature of many or most nuclei, i.e., regions of unusual activity, either high or low. Rotation periods, spin axes and even precession of the axes are determined. The observational evidence for variations in activity over the surfaces of cometary nuclei are listed and discussed. On June 11 the comet IRAS-ARAKI-ALCOCK approached the Earth to a distance of 0.031 AU, the nearest since C/Lexell, 1770 I, providing a unique opportunity for near-nucleus observations. Preliminary analysis of these images establishes the spin axis of the nucleus, with an oblioquity to the orbit plane of approximately 50 deg, and a lag angle of sublimation approximately 35 deg from the solar meridian on the nucleus. Asymmetries of the inner coma suggests a crazy-quilt distribution of ices with differing volatility over the surface of the nucleus. The observations of Comet P/Homes 1892 III, exhibiting two 8-10 magnitude bursts, are carefully analyzed. The grazing encounter produced, besides the first great burst, an active area on the nucleus, which was rotating retrograde with a period of 16.3hr and inclination nearly 180 deg. After the first burst the total magnitude fell less than two magnitudes from November 7 to November 30 (barely naked eye) while the nuclear region remained diffuse or complex, rarely if ever showing a stellar appearance. The fading was much more rapid after the second burst. The grazing encounter distributed a volume of large chunks in the neighborhood of the nucleus, maintaining activity for weeks.

Whipple, F. L.

1984-01-01

316

SPORT: Do outcomes vary across centers for surgery for lumbar disc herniation?  

PubMed Central

Background Lumbar discectomy is the most common procedure performed in spine surgery. Different centers performing this procedure may have different outcomes. Objective To determine whether the choice of academic spine center in which surgery is performed affects outcome after lumbar discectomy. Methods Spine Patient Outcomes Research Trial (SPORT) cohort participants with a confirmed diagnosis of intervertebral disc herniation (IDH) undergoing standard first-time open discectomy were followed from baseline at 6 weeks, and 3, 6, 12 months and yearly thereafter, at 13 spine clinics in 11 US states. Patient data were retrospectively reviewed. As of August 2009, the mean (SD) follow-up among all analyzed IDH patients was 41.3 (14.6) months. The median (range) follow-up time among all analyzed IDH patients was 47.4 (1.3, 95.3) months. Enrollment began in March 2000 and ended in November 2004. Results 792 patients underwent first-time lumbar discectomy. Significant differences were found amongst centers with regard to patient age and race, and in baseline levels of disability and treatment preferences. There were no significant differences among the study centers in other patient characteristics (e.g., sex, body mass index, the prevalence of smoking, diabetes or hypertension), or disease characteristics (herniation level or type). Some short-term outcomes varied significantly among centers, including operative duration and blood loss, the incidence of durotomy and the length of hospital stay. Unadjusted reoperation rates also varied across centers. There were no differences among the various centers in incidence of nerve root injury, post-operative mortality, SF-36 scores of body pain or physical function, or Oswestry Disability Index at 4 years. Conclusions Although mean operative blood loss, risk of durotomy and length of hospital stay vary across academic centers performing lumbar discectomy, there appears to be no difference in long-term functional outcomes. The role of different reoperation rates in producing similar outcomes remains unclear.

Desai, Atman; Bekelis, Kimon; Ball, Perry A.; Lurie, Jon; Mirza, Sohail K.; Tosteson, Tor D.; Zhao, Wenyan; Weinstein, James N.

2014-01-01

317

Lumbar Disk Herniation in the Spine Patient Outcomes Research Trial (SPORT): Does Educational Attainment Impact Outcome?  

PubMed Central

Study Design Randomized trial with concurrent observational cohort. 1171 patients were divided into subgroups by educational attainment: high school or less, some college, and college degree or above. Objective To assess the influence of education level on outcomes for treatment of lumbar disk herniation. Summary of Background Data Educational attainment has been demonstrated to have an inverse relationship with pain perception, co-morbidities, and mortality. Methods The Spine Patient Outcomes Research Trial enrolled surgical candidates (imaging-confirmed disk herniation with at least 6 weeks of persistent signs and symptoms of radiculopathy) from 13 multidisciplinary spine clinics in 11 US states. Treatments were standard open diskectomy vs. non-operative treatment. Outcomes were changes from baseline for SF-36 bodily pain (BP) and physical function (PF) scales and the modified Oswestry Disability Index (ODI) at 6 weeks, 3 months, 6 months, and yearly through 4 years. Results Substantial improvement was seen in all patient cohorts. Surgical outcomes did not differ by level of education. For non-operative outcomes, however, higher levels of education were associated with significantly greater overall improvement over 4 years in BP (p=0.007), PF (p=0.001) and ODI (p=0.003). At 4 years a “dose-response” type relationship was shown for BP (high school or less 25.5; some college 31; college graduate or above 36.3; p= 0.004); results were similar for PF and ODI. The success of non-operative treatment in the more educated cohort resulted in an attenuation of the relative benefit of surgery. Conclusions Patients with higher educational attainment demonstrated significantly greater improvement with non-operative treatment while educational attainment was not associated with surgical outcomes.

Olson, Patrick R.; Lurie, Jon D.; Frymoyer, John; Walsh, Thomas; Zhao, Wenyan; Abdu, William A.; Weinstein, James N.

2011-01-01

318

Recurrence Rate after Herniotomy only versus Discectomy in Lumbar Disc Herniation  

PubMed Central

Objective Lumbar disc herniation (LDH) recurrence necessitating reoperation can pose problems following spinal surgery, with an overall reported incidence of approximately (3-13%). The purpose of this study is to identify the rate of recurrent disc herniation, to discuss the radiologic indications for herniotomy and to analyze clinical outcomes compared with conventional discectomy. Methods This study is a retrospective case control study. The authors retrospectively reviewed 114 patients who underwent herniotomy & conventional discectomy by a single surgeon for single-level LDH between June 2009 and May 2012. Herniotomy group was 57 patients and conventional discectomy group was 57 patients that were selected from 631 patients using stratified randomization. Evaluation for LDH recurrence included detailed medical chart and radiologic review and telephone interview. Postoperative VAS and the Korean version of ODI were examined one week after surgery. Clinical outcome was investigated according to Odom's criteria from three months to three years. Results Of the 114 patients for whom the authors were able to definitively assess symptomatic recurrence status, four patients (7%) experienced LDH recurrence following single-level herniotomy and three patients (5.2%) conventional discectomy. There were no differences in the VAS and Korean version of ODI between herniotomy group and conventional discectomy group. The herniotomy group had better results than the conventional discectomy group in clinical outcome from three months to three years, but the difference was not significant. Conclusion There were no significant differences in clinical outcome between herniotomy and conventional discectomy. Recurrence rates following herniotomy for LDH compare favorably with those in patients who have undergone conventional discectomy, lending further support for its effectiveness in treating herniotomy.

Park, Jong Soo; Choi, Sang Eun; Cho, Tae Koo; Kim, Sang-hyuk; Rhee, Wootack; Kim, Woo Jae; Ha, Seong Il; Jang, Il Tae

2013-01-01

319

Acridine: a versatile heterocyclic nucleus.  

PubMed

Acridine is a heterocyclic nucleus. It plays an important role in various medicines. A number of therapeutic agents are based on acridine nucleus such as quinacrine (antimalarial), acriflavine and proflavine (antiseptics), ethacridine (abortifacient), amsacrine and nitracine (anticancer), and tacrine. Acridine is obtained from high boiling fraction of coal tar. It is also obtained in nature from plant and marine sources. Acridine undergoes a number of reactions such as nucleophilic addition, electrophilic substitution, oxidation, reduction, reductive alkylation and photoalkylation. The present review article summarizes the synthesis, reaction, literature review and pharmaceutical importance of acridine. PMID:22574501

Kumar, Ramesh; Kaur, Mandeep; Kumari, Meena

2012-01-01

320

Formin' actin in the nucleus.  

PubMed

Many if not most proteins can, under certain conditions, change cellular compartments, such as, for example, shuttling from the cytoplasm to the nucleus. Thus, many proteins may exert functions in various and very different subcellular locations, depending on the signaling context. A large amount of actin regulatory proteins has been detected in the mammalian cell nucleus, although their potential roles are much debated and are just beginning to emerge. Recently, members of the formin family of actin nucleators were also reported to dynamically localize to the nuclear environment. Here we discuss our findings that specific diaphanous-related formins can promote nuclear actin assembly in a signal-dependent manner. PMID:24637338

Baarlink, Christian; Grosse, Robert

2014-01-01

321

Formin' actin in the nucleus  

PubMed Central

Many if not most proteins can, under certain conditions, change cellular compartments, such as, for example, shuttling from the cytoplasm to the nucleus. Thus, many proteins may exert functions in various and very different subcellular locations, depending on the signaling context. A large amount of actin regulatory proteins has been detected in the mammalian cell nucleus, although their potential roles are much debated and are just beginning to emerge. Recently, members of the formin family of actin nucleators were also reported to dynamically localize to the nuclear environment. Here we discuss our findings that specific diaphanous-related formins can promote nuclear actin assembly in a signal-dependent manner.

Baarlink, Christian; Grosse, Robert

2014-01-01

322

Long-Term Outcome of Patients who Underwent Percutaneous Nucleotomy for Lumbar Disc Herniation: Results after a Mean Follow-up of 5 Years  

Microsoft Academic Search

Summary   A total of 41 patients who had undergone percutaneous nucleotomy for a single level lumbar disc herniation were clinically\\u000a examined after a mean postoperative follow-up of 5 years (range 4 to 7 years). There were 14 (34%) male and 27 (66%) female\\u000a patients with a mean age of 49 years. By intra-operative discography, the herniation had been graded as

E. Kotilainen; S. Valtonen

1998-01-01

323

Low energy antiproton nucleus interactions  

SciTech Connect

We have studied antiproton quasielastic scattering on Al, Cu, and Pb for two incident momenta, 514 and 633 MeV/c. Combining these data with other existing p-bar nucleus data, we have performed a global analysis using a nonrelativistic optical potential of the Woods-Saxon form.

Sainio, M.E.; Ashford, V.; Sakitt, M.; Skelly, J.; Debbe, R.; Fickinger, W.; Marino, R.; Robinson, D.K.

1984-11-15

324

Low energy antiproton nucleus interactions  

SciTech Connect

We have studied antiproton quasielastic scattering on Al, Cu, and Pb for two incident momenta, 514 and 633 MeV/c. Combining these data with other existing anti p nucleus data, we have performed a global analysis using a nonrelativistic optical potential of the Woods-Saxon form.

Sainio, M.E.; Ashford, V.; Sakitt, M.; Skelly, J.; Debbe, R.; Fickinger, W.; Marino, R.; Robinson, D.K.

1984-05-01

325

Comet Odyssey: Comet Nucleus Orbiter  

NASA Astrophysics Data System (ADS)

Comet Odyssey is a comet nucleus orbiter mission, proposed to NASA's Discovery program in 2004. The goal of the mission is to completely characterize a cometary nucleus, both physically and compositionally, as can only be done during an extended rendezvous and not with a fast flyby. Comet Odyssey will launch in October 2009 on a Delta II 7925 and use a solar-electric powered spacecraft to effect a rendezvous with periodic comet 46P/Wirtanen in October 2013. Arrival is 96 days after perihelion at a heliocentric distance of 1.61 AU. Comet Odyssey's science payload includes narrow- and wide-angle CCD cameras, an infrared thermal imager, a gas chromatograph/mass spectrometer, an XRD/XRF dust compositional analyzer, and a dust counter and accumulation sensors. The Comet Odyssey spacecraft implementation uses a high heritage approach of flight proven and redundant hardware. The 3-engine ion propulsion subsystem is derived from that on Dawn but includes the capability for multi-engine thrusting. Comet Odyssey will approach the Wirtanen nucleus and make repeated slow flybys through the active cometary coma for a period of three months. It will then be placed in a ˜100-km radius orbit around the nucleus, with a plan to eventually orbit at 40-km altitude or less. From that altitude the narrow-angle camera will map the entire nucleus surface at 1 meter/pixel and the thermal imager will map at 19 meter/pixel. The orbital portion of the nominal mission will last 4.5 months, following the comet outward from the Sun to 3.3 AU as the comet evolves from an active to a quiescent state. En route to P/Wirtanen, the Comet Odyssey spacecraft will perform a close flyby of the 200-km diameter, G-type, main belt asteroid 19 Fortuna in January 2012 and make appropriate remote sensing observations.

Weissman, P. R.; Smythe, W. D.; Spitz, S. J.; Bernard, D. E.; Bailey, R. W.

2004-11-01

326

Unilateral pupillary mydriasis from nebulized ipratropium bromide: A false sign of brain herniation in the intensive care unit  

PubMed Central

Although there are many causes of anisocoria in the intensive care setting, the development of unilateral mydriasis in patients with intracranial hemorrhage or tumor is a neurological emergency, as it may herald the onset of uncal herniation. We describe two patients with a hemiparesis from neurosurgical disorder who subsequently developed a fixed and dilated pupil. The pupillary abnormality was caused by nebulized ipratropium bromide in both cases, and resolved when the medication was discontinued. Nebulized ipratropium may leak from the mask into ipsilateral eye and cause mydriasis in patients with facial weakness. This benign cause of anisocoria in the intensive care setting is distinguished from uncal herniation by the laterality of neurologic findings, and lack of mental status change, ptosis, and extraocular movement impairment.

Chaudhry, Priyanka; Friedman, Deborah I.; Yu, Wengui

2014-01-01

327

Surgical management of cerebellar tonsillar herniation in three patients with macrocephaly-cutis marmorata telangiectatica congenita. Report of three cases.  

PubMed

The authors report on three patients with a congenital brain overgrowth syndrome, macrocephaly-cutis marmorata telangiectatica congenita (M-CMTC), who experienced neurological sequelae associated with herniation of the cerebellar tonsils through the foramen magnum. In two of these patients, the authors document postnatal brain overgrowth that contributed to recurrent descent of the cerebellar tonsils and complicated the surgical treatment in one of the patients. The authors address the neurosurgical concerns related to this syndrome with special attention to acquired tonsillar ectopia and postulate that some patients may be at risk for progressive tonsillar herniation and consequent neurological symptoms due to cerebellar overgrowth. Ectopic cerebellar tonsils have been reported previously in cases of M-CMTC, and this phenomenon may be a secondary event associated with brain overgrowth rather than due to a congenitally small posterior fossa. PMID:17465364

Conway, Robert L; Danielpour, Moise; Graham, John M

2007-04-01

328

Analysis of relativistic nucleus-nucleus interactions in emulsion chambers  

NASA Technical Reports Server (NTRS)

The development of a computer-assisted method is reported for the determination of the angular distribution data for secondary particles produced in relativistic nucleus-nucleus collisions in emulsions. The method is applied to emulsion detectors that were placed in a constant, uniform magnetic field and exposed to beams of 60 and 200 GeV/nucleon O-16 ions at the Super Proton Synchrotron (SPS) of the European Center for Nuclear Research (CERN). Linear regression analysis is used to determine the azimuthal and polar emission angles from measured track coordinate data. The software, written in BASIC, is designed to be machine independent, and adaptable to an automated system for acquiring the track coordinates. The fitting algorithm is deterministic, and takes into account the experimental uncertainty in the measured points. Further, a procedure for using the track data to estimate the linear momenta of the charged particles observed in the detectors is included.

Mcguire, Stephen C.

1987-01-01

329

Dynamics of high-energy nucleus-nucleus collisions  

SciTech Connect

The authors use a Glauber multiple-collision model to examine the dynamics of nucleus-nucleus collisions. The model introduces a stopping law, which describes how a baryon loses energy in a baryon-baryon collision, and a particle production law, which is based on the baryon energy loss. The model gives results on the longitudinal energy loss which compare well with the recent WA80 experimental data for /sup 16/O on various targets at 60 and 200 GeV per nucleon. The stopping law that is needed to fit the experimental zero-degree spectra reveals that the degree of stopping in these high-energy nuclear collisions is high.

Wong, C.Y.; Lu, Z.D.

1988-01-01

330

Transverse Energy in nucleus-nucleus collisions: A review  

SciTech Connect

The status of Transverse Energy (E/sub T/) in relativistic nucleus-nucleus collisions at the Brookhaven AGS and the CERN SPS is reviewed. The definition of E/sub T/ and its physical significance are discussed. The basic techniques and limitations of the experimental measurements are presented. The acceptances of the major experiments to be discussed are shown, along with remarks about their idiosyncrasies. The data demonstrate that the nuclear geometry of colliding spheres primarily determines the shapes of the observed spectra. Careful account of the acceptances is crucial to comparing and interpreting results. It is concluded that nuclear stopping power is high, and that the amount of energy deposited into the interaction volume is increasing with beam energy even at SPS energies. The energy densities believed to be obtained at the SPS are close to the critical values predicted for the onset of a quark-gluon plasma. 25 refs., 8 figs.

Tincknell, M.

1988-11-15

331

Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients  

PubMed Central

A prospective randomised 2-year follow-up study on patients undergoing lumbar disc herniation surgery. The objective was to investigate the relationship between peridural scarring and clinical outcome, the scar development 6 and 24 months postoperatively by using MRI, and if ADCON-L (a bioresorbable carbohydrate polymer gel) has an effect on scar size and/or improve patients’ outcome after lumbar disc herniation surgery. The association between peridural scarring and recurrent pain after lumbar disc herniation surgery is debated. Numerous materials have been used in attempts to prevent or reduce postoperative peridural scarring; however, there are conflicting data regarding the clinical effects. The study included 119 patients whose mean age was 39 years (18–66); 51 (47%) were women. Sixty patients (56%) were perioperatively randomised to receive ADCON-L, and 48 (44%) served as controls. All patients underwent MRI at 6 and 24 months postoperatively, and an independent radiologist graded the size, location and development of the scar, by using a previously described scoring system. Pre- and 2-year postoperatively patients graded their leg pain on a visual analogue scale (VAS). At the 2-year follow-up patients rated their satisfaction with treatment (subjective outcome) and were evaluated by an independent neurologist (objective outcome), using MacNab score. There was no relationship between size or localisation of the scar and any of the clinical outcomes (VAS, subjective and objective outcome). The scar size decreased between 6 and 24 months in 49%, was unchanged in 42% and increased in 9% of the patients. Patients treated with ADCON-L did not demonstrate any adverse effects, nor did they demonstrate less scarring or better clinical outcome than control patients. No significant association between the presence of extensive peridural scar or localisation of scar formation and clinical outcome could be detected in the present study. Further, no positive or negative effects of ADCON-L used in disc herniation surgery could be seen.

Lind, B.; Zoega, B.; Gadeholt-Gothlin, G.; Halldin, K.; Gellerstedt, M.; Brisby, H.

2008-01-01

332

Evidence for a serotonin-mediated effect of cocaine causing vasoconstriction and herniated umbilici in chicken embryos.  

PubMed

Some of cocaine (COC)'s pathophysiological effects on exposed embryos likely result from its vasoconstrictive action, and serotonin2 (5-HT2) agonists such as dimethoxyiodophenylaminopropane (DOI) can mimic these effects. Infusions of COC (5 mg/kg/min) or DOI (0.5 mg/kg/min) for 15 min into chicken eggs with embryos on E15 caused a significant reduction in blood vessel diameters (14 and 30%, respectively). Pretreatment with the 5-HT2 antagonist ritanserin (RIT, 0.9 mg/kg) 18-22 h earlier blocked the effect of COC and blocked or attenuated the effect of DOI. In separate groups of chicken embryos exposed to multiple injections of low doses of COC on E18, herniated umbilici were prominent in hatchlings. A single bolus injection of the same absolute amount of COC did not cause herniated umbilici. An additional experiment replicated the induction of herniated umbilici by multiple injections of COC and demonstrated the probable involvement of 5-HT2 receptors because RIT blocked COC's ability to induce this anomaly. These data suggest that COC's vasoconstrictive effect, via 5-HT2 receptors, may play a mechanistic role in some adverse outcomes in embryos exposed to COC. PMID:9512060

Zhang, X; Schrott, L M; Sparber, S B

1998-03-01

333

Hummingbird Comet Nucleus Analysis Mission  

NASA Technical Reports Server (NTRS)

Hummingbird is a highly focused scientific mission, proposed to NASA s Discovery Program, designed to address the highest priority questions in cometary science-that of the chemical composition of the cometary nucleus. After rendezvous with the comet, Hummingbird would first methodically image and map the comet, then collect and analyze dust, ice and gases from the cometary atmosphere to enrich characterization of the comet and support landing site selection. Then, like its namesake, Hummingbird would carefully descend to a pre-selected surface site obtaining a high-resolution image, gather a surface material sample, acquire surface temperature and then immediately return to orbit for detailed chemical and elemental analyses followed by a high resolution post-sampling image of the site. Hummingbird s analytical laboratory contains instrumentation for a comprehensive molecular and elemental analysis of the cometary nucleus as well as an innovative surface sample acquisition device.

Kojiro, Daniel; Carle, Glenn C.; Lasher, Larry E.

2000-01-01

334

Doubly Magic Nucleus Hs162108270  

NASA Astrophysics Data System (ADS)

Theoretical calculations predict Hs270 (Z=108, N=162) to be a doubly magic deformed nucleus, decaying mainly by ?-particle emission. In this work, based on a rapid chemical isolation of Hs isotopes produced in the Mg26+Cm248 reaction, we observed 15 genetically linked nuclear decay chains. Four chains were attributed to the new nuclide Hs270, which decays by ?-particle emission with Q?=9.02±0.03MeV to Sg266 which undergoes spontaneous fission with a half-life of 444-148+444ms. A production cross section of about 3 pb was measured for Hs270. Thus, Hs270 is the first nucleus for which experimental nuclear decay properties have become available for comparison with theoretical predictions of the N=162 shell stability.

Dvorak, J.; Brüchle, W.; Chelnokov, M.; Dressler, R.; Düllmann, Ch. E.; Eberhardt, K.; Gorshkov, V.; Jäger, E.; Krücken, R.; Kuznetsov, A.; Nagame, Y.; Nebel, F.; Novackova, Z.; Qin, Z.; Schädel, M.; Schausten, B.; Schimpf, E.; Semchenkov, A.; Thörle, P.; Türler, A.; Wegrzecki, M.; Wierczinski, B.; Yakushev, A.; Yeremin, A.

2006-12-01

335

Magnetic Resonance Imaging Predictors of Surgical Outcome in Patients with Lumbar Intervertebral Disc Herniation  

PubMed Central

Study Design A retrospective cohort design Objective To determine if baseline MRI findings including central/foraminal stenosis, Modic change, disc morphology, facet arthropathy, disc degeneration, nerve root impingement, and thecal sac compression are associated with differential surgical treatment effect. Summary of Background Data Intervertebral Disc Herniation (IDH)remains the most common source of lumbar radiculopathy treated either with discectomy or non-operative intervention. Although MRI remains the reliable gold standard for diagnosis, uncertainty surrounds the relationship between MRI findings and treatment outcomes. Methods Three-hundred-and-seven “complete” images from patients enrolled in a previous trial were de-identified and evaluated by one of 4 independent readers. Findings were compared to outcome measures including the Oswestry Disability Index. Differences in surgery and non-operative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in ODI scores. Results The cohort was comprised of 40% females with an average age of 41.5 (±11.6), 61% of which underwent discectomy for IDH. Patients undergoing surgery with Modic type I endplate changes had worse outcomes (?26.4 versus ?39.7 for none and ?39.2 for type 2, p=0.002) and smaller treatment effect (?3.5 versus ?19.3 for none and ?15.7 for type 2, p=0.003). Those with compression >=1/3 showed the greatest improvement within the surgical group (?41.9 for >=1/3 versus ?31.6 for none and ?38.1 for <1/3,p=0.007), and the highest TE (?23 compared to ?11.7 for none and ?15.2 for <1/3, p=0.015). Furthermore, patients with minimal nerve root impingement demonstrated worse surgical outcomes(?26.5 versus ?41.1 for “displaced” and ?38.9 for “compressed”, p=0.016). Conclusion Among patients with IDH, those with thecal sac compression >=1/3 had greater surgical treatment effect than those with small disc herniations and Modic type I changes. Additionally, patients with nerve root “compression” and “displacement” benefit more from surgery than those with minimal nerve-root impingement.

Lurie, Jon D.; Moses, Rachel A.; Tosteson, Anna N. A.; Tosteson, Tor D.; Carragee, Eugene J.; Carrino, John A.; Kaiser, Jay A.; Herzog, Richard J.

2013-01-01

336

Assessing the Risk of Disc Heniation Related to Landing Impact Following Long-duration Spacecraft  

NASA Technical Reports Server (NTRS)

Previous research has shown that crewmembers returning on the Space Shuttle have an increased incidence of herniated nucleus pulposus after spaceflight. This increased risk is thought to be related to disc volume expansion due to unloading and prolonged exposure to microgravity. Although there is an increased risk of disc herniation in Space Shuttle astronauts, it is unknown if dynamic landing loads further contribute to the risk of herniation. To determine if dynamic loads increase the risk of incidence, data from crewmembers (excluding cosmonauts) returning on the Soyuz spacecraft will be compared to Space Shuttle astronauts. These data will be obtained from the Lifetime Surveillance of Astronaut Health (LSAH) Project at NASA. Severity and incidence after spaceflight will be mined from the data, and statistical analyses will be used to determine if Soyuz crewmembers have a higher incidence of disc herniation than Space Shuttle crewmembers. The results are expected to show no difference between Space Shuttle and Soyuz crewmembers, indicating that higher dynamic loads on landing and long-duration spaceflight do not significantly increase the risk of disc herniation. If no difference is shown between the two crewmember populations, then disc volume expansion due to microgravity does not significantly increase the risk of injury due to dynamic loads for deconditioned crewmembers. Any risk associated with deconditioning would be primarily due to bone structure changes and resulting bone strength changes. This study is an important first step in determining whether the spinal disc plays a role in injury due to dynamic loads.

Somers, J. T.; Newby, N..; Wells, J.

2014-01-01

337

Preoperative and postoperative evaluation of somatosensorial evoked potentials of upper extremities in cervical intervertebral disc herniation.  

PubMed

This study aims to determine the dysfunction caused by existing pathological condition in structures involved in the transfer of sensory functions of the neural system in cervical disc herniation, and to establish whether or not the level and degree of this anatomical damage can be anticipated by SEP (Somatosensorial Evoked Potentials). We compared the obtained SEP values for statistical significance using the Friedman Variation Analysis. In parameters with statistical significance, the Wilcoxon Signed Rank test was used to identify when significant improvements occurred. The study found that the statistical data of the latency of the N14 wave originating from the dorsal column nuclei of the medulla spinalis and dorsal column gray matter improved (p < 0.05) in the postoperative period compared with the preoperative values. Using the Wilcoxon Signed Rank test, we studied postoperative months separately in regard to the difference in the latency of the N14 wave, and found the statistically significant improvement to be marked particularly in months 3 and 6 postoperatively (p < 0.05). In conclusion, we suggest that SEP is a useful tool to check the functional condition of the dorsal spinal column. The benefit of the SEP utilization is the ability to determine the severity of the pathological condition preoperatively and follow the patient's functional postoperative improvement. PMID:23756968

Umur, Ahmet Sukru; Selcuki, Mehmet; Selcuki, Deniz; Temiz, Cuneyt; Akbasak, Aytac

2013-01-01

338

A review of current treatment for lumbar disc herniation in children and adolescents  

PubMed Central

Lumbar disc herniation (LDH) is a common disorder among adults with degenerated lumbar intervertebral discs. However, its occurrence in childhood and adolescence is much less frequent mostly because children and adolescents tend to have a healthier lumbar spine as compared with adults. This difference indicates that children and adolescents are far from being just little adults. Over the years, there have constantly been published studies concerning this entity where the findings suggested that pediatric LDH is, in many ways, different from that in adults. To date, the prevalence, the etiological and the diagnostic features of pediatric LDH have been fully described in the literature whereas the characteristics regarding to the treatment is yet to be reviewed in details. The aim of the present review is to provide a collective opinion on the treatment of pediatric LDH as well as its outcome. It reviewed the relevant information available in the literature and compared the results among and within various treatments. It was found that pediatric patients responded less favorably to conservative treatment as compared with adults. In addition, the outcome of surgery remained to be satisfactory for at least 10 years after the initial operation, even though it appeared to deteriorate slightly. To the best of our knowledge, this is the first literature review focusing on the treatment of pediatric LDH.

Liu, Zhongjun

2009-01-01

339

Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms.  

PubMed

Schmorl's nodes were first described by the pathologist Christian Schmorl in 1927 as a herniation of the nucleus pulposus through the cartilaginous and bony endplate into the vertebral body. Although such lesions present most commonly as incidental findings in asymptomatic patients (or in patients with back or radicular pain due to other etiology), there have been several reports emphasizing the deleterious effects of the inflammatory response and endplate changes elicited by the herniation of for such reasons, Schmorl's nodes have been occasionally implicated in the etiology of chronic axial pain as well as in pathological osteoporotic fractures. In this article, a thorough literature review about the most relevant historical studies on Schmorl's nodes previously published is performed. Furthermore, the authors provide an overview about the recent advances in basic science research on the pathophysiology of such lesions, as well as on current diagnostic and therapeutic paradigms. PMID:23955279

Mattei, Tobias A; Rehman, Azeem A

2014-01-01

340

Magnetic resonance imaging of acute symptomatic Schmorl's node formation.  

PubMed

The intraspongious herniation of intervertebral disk material into the endplate of a vertebral body was first described by Schmorl in 1927. Any process which weakens the cartilaginous endplate or the subchondral cancellous bone may predispose to the development of Schmorl's nodes. These include Scheuermann's disease, infection, metabolic disorders, neoplastic disorders, and degenerative disease. In the young individual, however, trauma may precipitate an acute focal and symptomatic endplate herniation by the well-hydrated and delineated nucleus pulposus. Magnetic resonance imaging (MRI) is the most sensitive imaging method for the detection of intervertebral disk disease and, thus, has facilitated the diagnosis of traumatic Schmorl's nodes. MRI was very helpful in diagnosing an acute, traumatic, symptomatic Schmorl's node when plain film radiographs and nuclear medicine bone scan were unremarkable. PMID:1754491

Walters, G; Coumas, J M; Akins, C M; Ragland, R L

1991-10-01

341

Linear momentum transfer in nonrelativistic nucleus-nucleus collisions  

NASA Astrophysics Data System (ADS)

The systematic behavior of linear momentum transfer from projectile to target in nonrelativistic nucleus-nucleus collisions has been studied using the results of fission-fragment angular-correlation measurements on uranium target nuclei. Data for 4He, 12C, 16O, and 20Ne projectiles have been analyzed over an energy range which extends well above the interaction barrier. The data illustrate the division of the total reaction cross section into two primary components: one associated with ~ 90 percent or greater linear momentum transfer and the other involving much smaller amounts of linear momentum transfer. The former is attributed to fusionlike collisions and the latter to peripheral collisions. The minimum between these two components corresponds to a linear momentum transfer of about 50 percent. It is observed that the ratio of fusionlike collisions to the total reaction cross section decreases regularly as a function of both increasing bombarding energy and projectile mass. From comparison of the experimental fission-fragment angular correlation functions with the predictions of complete fusion kinematics, it is shown that above 10 MeV/nucleon, the experimental definition of complete fusion is complicated by the increasing probability for large, but incomplete, linear momentum transfer collisions. Estimates of critical angular momenta derived from these data do not show any major disagreement with rotating-liquid-drop predictions. NUCLEAR REACTIONS, FISSION Studied systematics of fission-fragment angular correlation measurements from uranium target nuclei. Deduced linear momentum transfer distributions, fusionlike collision and complete fusion probabilities, and critical angular momenta.

Viola, V. E., Jr.; Back, B. B.; Wolf, K. L.; Awes, T. C.; Gelbke, C. K.; Breuer, H.

1982-07-01

342

Teacher Resources on the Nucleus  

NSDL National Science Digital Library

The Nucleus is the ComPADRE collection targeted at undergraduate students majoring in physics and astronomy. It is assumed that undergraduates majoring in physics and astronomy might follow a wide array of career paths, so the types of resources included in the collection are correspondingly broad. From its inception, the collection has had two primary goals: Providing resources that will enhance the learning experiences of undergraduates, and providing tools and resources that will facilitate the establishment of an online community of physics and astronomy undergraduates.

Donnelly, Dave

2010-01-11

343

Exceptionally bright, compact starburst nucleus  

SciTech Connect

Observations are reported of a remarkably bright (V about 13) starburst nucleus, 0833 + 652, which has been detected at radio, infrared, optical, ultraviolet, and X-ray wavelengths. Despite an observed flux at each of these wavelengths which is comparable to that of NGC 7714, often considered the 'prototypical' example of the starburst phenomenon, 0833 + 652 appears to be a previously uncataloged object. Its ease of detectability throughout the electromagnetic spectrum should make it useful for a variety of problems in the study of compact emission-line galaxies. 30 references.

Margon, B.; Anderson, S.F.; Mateo, M.; Fich, M.; Massey, P.

1988-11-01

344

Full-endoscopic interlaminar removal of chronic lumbar epidural hematoma after spinal manipulation  

PubMed Central

Background: Spinal manipulation is widely used for low back pain treatments. Complications associated with spinal manipulation are seen. Lumbar epidural hematoma (EDH) is one of the complications reported in the literature. If lumbar chronic EDH symptoms are present, which are similar to those of a herniated nucleus pulposus, surgery may be considered if medical treatment fails. Percutaneous endoscopic discectomy utilizing an interlaminar approach can be successfully applied to those with herniated nucleus pulposus. We use the same technique to remove the lumbar chronic EDH, which is the first documented report in the related literature. Methods: We present a case with chronic lumbar EDH associated with spinal manipulation. Neurologic deficits were noted on physical examination. We arranged for a full-endoscopic interlaminar approach to remove the hematoma for the patient with the rigid endoscopy (Vertebris system; Richard Wolf, Knittlingen, Germany). Results: After surgery, the patient's radiculopathy immediately began to disappear. Magnetic resonance imaging (MRI) follow-up 10 days after the surgery revealed no residual hematoma. No complications were noted during the outpatient department follow up. Conclusions: Lumbar EDH is a possible complication of spinal manipulation. Patient experiencing rapidly progressive neurologic deficit require early surgical evacuation, while conservative treatment may only be applied to those with mild symptoms. A percutaneous full-endoscopic interlaminar approach may be a viable alternative for the treatment of those with chronic EDH with progressive neurologic deficits.

Cheng, Yen-Po; Lee, Kwo-Whei; Lin, Ping-Yi; Huang, Abel Po-Hao; Cheng, Chun-Yuan; Ma, Hsin-I; Chen, Chien-Min; Hueng, Dueng-Yuan

2014-01-01

345

Comet nucleus sample return mission  

NASA Technical Reports Server (NTRS)

A comet nucleus sample return mission in terms of its relevant science objectives, candidate mission concepts, key design/technology requirements, and programmatic issues is discussed. The primary objective was to collect a sample of undisturbed comet material from beneath the surface of an active comet and to preserve its chemical and, if possible, its physical integrity and return it to Earth in a minimally altered state. The secondary objectives are to: (1) characterize the comet to a level consistent with a rendezvous mission; (2) monitor the comet dynamics through perihelion and aphelion with a long lived lander; and (3) determine the subsurface properties of the nucleus in an area local to the sampled core. A set of candidate comets is discussed. The hazards which the spacecraft would encounter in the vicinity of the comet are also discussed. The encounter strategy, the sampling hardware, the thermal control of the pristine comet material during the return to Earth, and the flight performance of various spacecraft systems and the cost estimates of such a mission are presented.

1983-01-01

346

Secretory Granule to the Nucleus  

PubMed Central

Intrinsically unstructured domains occur in one-third of all proteins and are characterized by conformational flexibility, protease sensitivity, and the occurrence of multiple phosphorylation. They provide large interfaces for diverse protein-protein interactions. Peptidylglycine ?-amidating monooxygenase (PAM), an enzyme essential for neuropeptide biosynthesis, is a secretory granule membrane protein. As one of the few proteins spanning the granule membrane, PAM is a candidate to relay information about the status of the granule pool and conditions in the granule lumen. Here, we show that the PAM cytosolic domain is unstructured. Mass spectroscopy and two-dimensional gel electrophoresis demonstrated phosphorylation at 10–12 sites in the cytosolic domain. Stimulation of exocytosis resulted in coupled phosphorylation and dephosphorylation of specific sites and in the endoproteolytic release of a soluble, proteasome-sensitive cytosolic domain fragment. Analysis of granule-rich tissues, such as pituitary and heart, showed that a similar fragment was generated endogenously and translocated to the nucleus. This multiply phosphorylated unstructured domain may act as a signaling molecule that relays information from secretory granules to both cytosol and nucleus.

Rajagopal, Chitra; Stone, Kathryn L.; Francone, Victor P.; Mains, Richard E.; Eipper, Betty A.

2009-01-01

347

Theoretical antideuteron-nucleus absorptive cross sections  

NASA Technical Reports Server (NTRS)

Antideuteron-nucleus absorptive cross sections for intermediate to high energies are calculated using an ion-ion optical model. Good agreement with experiment (within 15 percent) is obtained in this same model for (bar p)-nucleus cross sections at laboratory energies up to 15 GeV. We describe a technique for estimating antinucleus-nucleus cross sections from NN data and suggest that further cosmic ray studies to search for antideuterons and other antinuclei be undertaken.

Buck, W. W.; Norbury, J. W.; Townsend, L. W.; Wilson, J. W.

1993-01-01

348

Targeted CT-guided epidural blood patch for treatment of spontaneous intracranial hypotension due to calcified intradural thoracic disc herniation.  

PubMed

Calcified thoracic intradural disc herniations have recently been reported as a cause of spontaneous intracranial hypotension (SIH). We report successful treatment of SIH with a targeted CT-guided epidural blood patch. A 57-year-old man presented to the emergency department with a two-week history of progressively debilitating headache. CT and MRI of the brain showed findings consistent with intracranial hypotension and MRI of the spine showed findings consistent with CSF leak. Subsequent CT myelogram of the thoracic spine confirmed the presence of CSF leak and calcified disc herniations at the T6-7, T7-8 and T8-9 levels indenting the ventral dura and spinal cord. The calcified disc herniation at T6-7 had an intradural component and was therefore the most likely site of the CSF leak. Under CT fluoroscopic guidance, a 20-gauge Tuohy needle was progressively advanced into the dorsal epidural space at T6-7. After confirmation of needle tip position, approximately 18cc of the patient's own blood was sterilely removed from an arm vein and slowly re-injected into the dorsal epidural space. With satisfactory achievement of clot formation, the procedure was terminated. The patient tolerated the procedure well. The next morning, his symptoms had completely resolved and he was neurologically intact. At five-week follow up, he was symptom-free. Targeted epidural blood patch at the site of presumed CSF leak can be carried out in a safe and effective manner using CT fluoroscopic guidance and can be an effective alternative to open surgical management in selected patients. PMID:23472734

Agarwal, V; Sreedher, G; Rothfus, W E

2013-03-01

349

Return to play after conservative treatment in athletes with symptomatic lumbar disc herniation: a practice-based observational study  

PubMed Central

The purpose of the study was to confirm the short-term outcome of conservative treatment in terms of the ability to return to play and factors influencing return to play in athletes with symptomatic lumbar disc herniation. A total of 100 consecutive athletes (72 male and 28 female) who consulted our sports medicine clinic during the 16-year period between September 1993 and October 2009 because of severe low back pain and/or leg pain/numbness due to lumbar disc herniation were studied. The mean age of the subjects was 23 years. All of them were conservatively treated by being advised to discontinue their sporting activities with/without short-term medication. After the subjective symptoms had reduced by more than 80%, individual training was started in order to allow the athletes to return to play. Seventy-nine athletes (79.0%) returned to play at an average of 4.8 months (range 1–12 months) after the start of treatment and were able to sustain the activities for at least 6 months, the minimum duration of follow-up in the study. The outcome of the conservative treatment was not influenced by the intensity of the sporting activity. Multiple logistic regression analyses showed that the severity of the symptoms prior to the start of treatment was the factor influencing the ability of the athletes to return to play. The present study confirmed the satisfactory short-term outcome of conservative treatment in athletes with symptomatic lumbar disc herniation regarding return to play and revealed that subjective symptoms prior to the start of treatment appeared to be a key factor in return to play after conservative treatment.

Iwamoto, Jun; Sato, Yoshihiro; Takeda, Tsuyoshi; Matsumoto, Hideo

2011-01-01

350

Reliability of T2-weighted sagittal magnetic resonance images for determining the location of compressive disk herniation in dogs.  

PubMed

Magnetic resonance imaging is used commonly to diagnose intervertebral disk herniation in dogs. It is common to locate areas of suspected compression on sagittal T2-weighted (T2-W) images and then obtain limited transverse images in these areas to reduce the acquisition time (a step-by-step approach). Our objective was to assess the frequency of correct localization of spinal cord compression due to disk herniation using only the sagittal images. The results from isolated readings of the sagittal T2-W images alone or combined with a single-shot fast spin echo (SSFSE) slab in 118 dogs were compared with a gold standard, based on a consensual reading of all images available, including complete transverse images across the entire spinal segments under study. The sites of compression were localized correctly from the sagittal images in 89.8% of dogs. If only the most significant lesions were accounted for, the percentage increased up to 95.2%. In 54.9% of the readings with incorrect localization, the actual compressive site was immediately adjacent to the one suspected from review of the sagittal images. The frequency of correct localization was higher in the cervical region, and was increased by examination of the SSFSE slab. The most common cause of disagreement was the presence of multiple degenerate bulging disks. Based on these results we recommend obtaining transverse images across the entire segment when multiple bulging disks are present. It is also recommended to obtain transverse images across the spaces immediately adjacent to the suspected site of herniation from review of the sagittal images. PMID:21689199

Guillem Gallach, R; Suran, J; Cáceres, A V; Reetz, J A; Brown, D C; Mai, W

2011-01-01

351

Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial [ISRCTN51857546  

PubMed Central

Background Open discectomy is the standard surgical procedure in the treatment of patients with long-lasting sciatica caused by lumbar disc herniation. Minimally invasive approaches such as microendoscopic discectomy have gained attention in recent years. Reduced tissue trauma allows early ambulation, short hospital stay and quick resumption of daily activities. A comparative cost-effectiveness study has not been performed yet. We present the design of a randomised controlled trial on cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in patients with lumbar disc herniation. Methods/Design Patients (age 18–70 years) presenting with sciatica due to lumbar disc herniation lasting more than 6–8 weeks are included. Patients with disc herniation larger than 1/3 of the spinal canal diameter, or disc herniation less than 1/3 of the spinal canal diameter with concomitant lateral recess stenosis or sequestration, are eliglible for participation. Randomisation into microendoscopic discectomy or conventional unilateral transflaval discectomy will take place in the operating room after induction of anesthesia. The length of skin incision is equal in both groups. The primary outcome measure is the functional assessment of the patient, measured by the Roland Disability Questionnaire for Sciatica, at 8 weeks and 1 year after surgery. We will also evaluate several other outcome parameters, including perceived recovery, leg and back pain, incidence of re-operations, complications, serum creatine kinase, quality of life, medical consumption, absenteeism and costs. The study is a randomised prospective multi-institutional trial, in which two surgical techniques are compared in a parallel group design. Patients and research nurses are kept blinded of the allocated treatment during the follow-up period of 2 years. Discussion Currently, open discectomy is the golden standard in the surgical treatment of lumbar disc herniation. Whether microendoscopic discectomy is more cost-effective than unilateral transflaval discectomy has to be determined by this trial.

Arts, Mark P; Peul, Wilco C; Brand, Ronald; Koes, Bart W; Thomeer, Ralph TWM

2006-01-01

352

Clinical Outcomes of Percutaneous Plasma Disc Coagulation Therapy for Lumbar Herniated Disc Diseases  

PubMed Central

Objective This is prospective study of clinical outcomes of percutaneous plasma disc coagulation Therapy (PDCT) in patients with herniated lumbar disc disease (HLD) to evaluate the safety and efficacy in its clinical application and usefulness as a reliable alternative to microscopic discectomy. Methods Forty-six patients were enrolled in this study from April 2006 to June 2010. All patients had one-level HLD. Disc degeneration was graded on routine T2-weighted magnetic resonance Image (MRI) using the Pfirrmann's grading system and all index levels were grade 3 and grade 4. Indications for surgery were radiculopathy caused by disc protrusion with soft consistency. MRI was done at one month after the procedure in all patients to check post-PDCT change. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. Results This study was approved by the Institutional Review Board of our institution. The age of the study population ranged from 16 to 59 years with a mean age of 37.2 years. There were 29 males and 17 females in this study. The mean period of clinical follow-up was 21 months. The average preoperative VAS score for radiculopathy was 7.4±1.4, while the final follow-up VAS score was 1.4±0.7 (p<0.001). In MacNab's criteria, 41 patients (89.1%) had achieved favorable improvement (excellent and good) until later follow-up. There were one patient from infection and two patients who needed to convert to open discectomy. Conclusion PDCT is a safe and efficient treatment modality in a selective patient with HLD.

Kim, Sung Chul; Cho, Ki Hong

2012-01-01

353

Herniation Pits in Human Mummies: A CT Investigation in the Capuchin Catacombs of Palermo, Sicily  

PubMed Central

Herniation pits (HPs) of the femoral neck were first described in a radiological publication in 1982 as round to oval radiolucencies in the proximal superior quadrant of the femoral neck on anteroposterior radiographs of adults. In following early clinical publications, HPs were generally recognized as an incidental finding. In contrast, in current clinical literature they are mentioned in the context of femoroacetabular impingement (FAI) of the hip joint, which is known to cause osteoarthritis (OA). The significance of HPs in chronic skeletal disorders such as OA is still unclear, but they are discussed as a possible radiological indicator for FAI in a large part of clinical studies. In this paleoradiological study we examined a sample of mummies from the Capuchin Catacombs of Palermo, Sicily, by a mobile computed tomography (CT) scanner. Evaluation of the CT examinations revealed HPs in six out of 16 (37.5%) adult male mummies. The first aim of this study was to compare the characteristics of HPs shown in our mummy collection to the findings described in clinical literature. Thereby CT evaluation revealed that their osseous imaging characteristics are in accordance, consisting of round to oval subcortical lesions at the anterior femoral neck, clearly demarcated by a sclerotic margin. The second aim was to introduce HPs to the paleoradiological and paleopathological methodology as an entity that underwent a renaissance from an incidental finding to a possible radiological indicator of FAI in the clinical situation. As FAI plays an important role in the development of OA of the hip, which is a very common finding in human skeletal remains, HPs should always be considered in paleoradiological evaluation of hip joint diseases.

Panzer, Stephanie; Piombino-Mascali, Dario; Zink, Albert R.

2012-01-01

354

Does Opioid Pain Medication Use Affect the Outcome of Patients with Lumbar Disk Herniation?  

PubMed Central

Study Design Subgroup analysis of prospective, randomized cohort Objective To review the results of patients who received opioid pain medications during treatment compared to patients who did not receive opioid medications. Summary of Background Data The SPORT trial is a prospective, multicenter study of surgical treatment versus nonoperative treatment for lumbar intervertebral disk herniation (IDH). Methods The study population includes patients enrolled in SPORT for treatment of IDH in combined randomized and observational cohorts. Patients who received opioid medications at baseline (Opioid) were compared to those who did not. (No-Opioid) Results There were 520 patients in the Non-Opioid group and 542 patients in the Opioid group. Among the opioid medication group there were significantly (p<0.001) worse baseline scores in primary and secondary outcome measures. There was an increased percentage of patients in the opioid medication group with the perception of worsening symptoms and neurological deficit (p<0.001). A higher percentage of the opioid patients received surgery (p<0.001) At four years follow-up, there were no significant differences in primary or secondary outcome measures or treatment effect of surgery between opioid and non-opioid medication patients. Opioid medications were associated with increased crossover to surgical treatment (p=0.005) and decreased surgical avoidance. (p=0.01)The incidence of opioid use at four years was 16% among patients who were using opioids at baseline and 5% among patients who were not using opioids at baseline. Conclusion Patients who were treated with opioids had significantly worse baseline pain and quality of life. At final follow-up, there was no long term difference in outcome associated with opioid pain medication use. Opioid medications were not associated with surgical avoidance. The majority of patients who use opioids during the study did not continue usage at four years.

Radcliff, Kris; Freedman, Mitchell; Hilibrand, Alan; Isaac, Roman; Lurie, Jon D.; Zhao, Wenyan; Vaccaro, Alex; Albert, Todd; Weinstein, James

2013-01-01

355

Nonsurgical Treatment of Lumbar Disk Herniation: Are Outcomes Different in Older Adults?  

PubMed Central

Objectives To determine whether older adults (age?60 years) experience less improvement in disability and pain with nonsurgical treatment of lumbar disk herniation (LDH), as compared to younger adults (age<60 years). Design Prospective longitudinal comparative cohort study. Setting Outpatient specialty spine clinic Participants 133 consecutive patients with radicular pain and MR-confirmed acute LDH (89 younger adults and 44 older adults). Intervention Nonsurgical treatment tailored to the individual patient. Measurements Patient-reported disability on the Oswestry Disability Index (ODI), leg pain intensity, and back pain intensity were recorded at baseline, 1, 3, and 6 months. The primary outcome was the ODI change score at 6 months. Secondary longitudinal analyses examined rates of change over the follow-up period. Results Older adults demonstrated improvements in ODI(range 0-100) and pain intensity(range 0-10) with nonsurgical treatment that were not significantly different from those seen in younger adults at 6 month follow-up, either with or without adjustment for potential confounders. Adjusted mean improvements in older adults as compared to younger adults were 31 vs. 33 (p=0.63) for ODI, 4.5 vs. 4.5 (p=0.99) for leg pain, and 2.4 vs. 2.7 for back pain (p=0.69). A greater amount of the total improvement in leg pain and back pain in older adults was noted in the first month of follow-up, as compared to younger adults. Conclusion These preliminary findings suggest that the outcomes of LDH with nonsurgical treatment were not worse in older adults (age?60 years) as compared to younger adults (age<60 years). Future research is warranted to examine nonsurgical treatment for LDH in older adults.

Suri, Pradeep; Hunter, David J.; Jouve, Cristin; Hartigan, Carol; Limke, Janet; Pena, Enrique; Li, Ling; Luz, Jennifer; Rainville, James

2011-01-01

356

Idiopathic spinal cord herniation: Clinical review and report of three cases  

PubMed Central

Idiopathic spinal cord herniation (ISCH) is a rare condition, of unknown pathogenesis, that primarily affects the thoracic spinal cord. It is characterized by ventral displacement of the spinal cord through a dural defect. The aim of this study was to review the literature and to present a retrospective single center experience with three cases of ISCH. The literature review analyzed a total of 78 relevant publications on ISCH, which included a total of 171 patients, supplemented with 3 patients treated at our institution. Numerous case reports have demonstrated improvement in clinical outcomes after surgery; however, follow-up is predominantly short, data are incomplete, the condition is frequently misdiagnosed, and it is difficult to predict which patients will benefit from surgery. We identified 159 cases treated with surgical management. The mean symptom duration was 54 months, and the mean follow-up 33 months. The result at follow-up was improved neurological outcome in 74%, unchanged result in 18%, and worse outcome in 8%. There were 15 cases of conservative management, with mean symptom duration 52 months and mean follow-up 33 months. The neurological outcome was unchanged in 100%. ISCH is a rare condition causing progressive thoracic myelopathy, and the natural history is unknown. There is a lack of evidence-based treatment strategies, and the majority of cases are treated with surgical management at diagnosis. Management of ISCH needs to be individualized for each patient, and clinicians should be encouraged to report new cases, standardize case reports, and ensure long-term follow-up.

Summers, Johanne C.; Balasubramani, Yagnesh V.; Chan, Patrick C. H.; Rosenfeld, Jeffrey V.

2013-01-01

357

Mechanisms of cerebellar tonsil herniation in patients with Chiari malformations as guide to clinical management  

PubMed Central

Background The pathogenesis of Chiari malformations is incompletely understood. We tested the hypothesis that different etiologies have different mechanisms of cerebellar tonsil herniation (CTH), as revealed by posterior cranial fossa (PCF) morphology. Methods In 741 patients with Chiari malformation type I (CM-I) and 11 patients with Chiari malformation type II (CM-II), the size of the occipital enchondrium and volume of the PCF (PCFV) were measured on reconstructed 2D-CT and MR images of the skull. Measurements were compared with those in 80 age- and sex-matched healthy control individuals, and the results were correlated with clinical findings. Results Significant reductions of PCF size and volume were present in 388 patients with classical CM-I, 11 patients with CM-II, and five patients with CM-I and craniosynostosis. Occipital bone size and PCFV were normal in 225 patients with CM-I and occipitoatlantoaxial joint instability, 55 patients with CM-I and tethered cord syndrome (TCS), 30 patients with CM-I and intracranial mass lesions, and 28 patients with CM-I and lumboperitoneal shunts. Ten patients had miscellaneous etiologies. The size and area of the foramen magnum were significantly smaller in patients with classical CM-I and CM-I occurring with craniosynostosis and significantly larger in patients with CM-II and CM-I occurring with TCS. Conclusions Important clues concerning the pathogenesis of CTH were provided by morphometric measurements of the PCF. When these assessments were correlated with etiological factors, the following causal mechanisms were suggested: (1) cranial constriction; (2) cranial settling; (3) spinal cord tethering; (4) intracranial hypertension; and (5) intraspinal hypotension.

Nishikawa, Misao; Kula, Roger W.; Dlugacz, Yosef D.

2010-01-01

358

Transforaminal Epidural Clonidine versus Corticosteroid for Acute Lumbosacral Radiculopathy due to Intervertebral Disk Herniation  

PubMed Central

Study Design Randomized, double-blinded trial clinical trial. Objective To compare efficacies of 2 active therapies for chronic low back pain. Summary of Background Data Radicular pain may result from intervertebral disk herniation (IDH). Clonidine has demonstrated analgesic and antiinflammatory activity in animal studies of nerve injury. Extensive clinical experience supports neuraxial clonidine's safety. Methods Patients with ˜3 months of low back and leg pain due to IDH were randomized to transforaminal epidural (TFE) injection(s) of 2% lidocaine and either clonidine (200 or 400mcg) or triamcinolone (40mg). Patients received 1- 3 injections administered about 2 weeks apart. Patients, investigators and study coordinators were blinded to treatment. Primary outcome was 11-point Pain Intensity Numerical Rating Scale (PI-NRS) at 1 month. Other outcomes included Patient Global Impression of Change (PGIC), and functional measures. Results Thirty-three patients were screened and randomized. Twenty-six patients enrolled; 11 received clonidine and 15 triamcinolone. Both groups showed significant improvement in pain score at 2 weeks and 1 month compared to baseline (p< 0.05). The corticosteroid group showed additional functional improvement at 1 month relative to clonidine (p=0.022). There was no difference between groups for primary outcome. However, as target enrollment was not reached, we cannot say with confidence that the 2 treatments would be expected to result in similar short-term pain relief. Side-effects were common in both groups, but there were no serious complications. Conclusions Radicular pain due to IDH improved rapidly with TFE injection of either clonidine or triamcinolone. Corticosteroid resulted in greater functional improvement, with unclear differences in analgesia. Future studies will determine if clonidine is superior to placebo and of particular use in those at risk for corticosteroid complications.

Burgher, Abram H.; Hoelzer, Bryan C.; Schroeder, Darrell R.; Wilson, Gregory A.; Huntoon, Marc A.

2010-01-01

359

Postural control in patients with lumbar disc herniation in the early postoperative period  

PubMed Central

Chronic spinal disc disease leads to disorders in postural movement coordination. An incorrect asymmetrical movement pattern for the lower limbs loading impairs proprioception and deteriorates postural stability, particularly when the vision is occluded. The standard surgical treatment improves biomechanical conditions in the lumbar spine, reduces pain, yet does it reduce the stability deficit in the upright position? An answer to the latter question would help work out targeted therapy to improve postural stability. We hypothesized that the standard surgical treatment would improve postural stability reflected by decreased sway variability accounting for better use of proprioceptive inputs postoperatively. Thirty-nine patients with lumbar disc herniation participated in the study. Their postural sway was recorded in anterior/posterior and medial/lateral planes with their eyes open or closed (EC) before and after surgery. The variability, range, mean velocity of the recorded time series and the area of the ellipse enclosed by the statokinesiogram were used as measures of postural stability. Preoperatively, EC condition resulted in an increased variability and mean velocity of postural sway, while postoperatively it caused an increase in sway mean velocity and sway area only with no effect on sway variability and range. The comparison of the balance before and after the surgery in the EC condition showed significant decrease in all parameters. In the early postoperative period, the patients recover the ability to control their postural sway in EC within normal limits, however, at the expense of significantly increased frequency of corrective torques. It is probably a transient short-term strategy needed to compensate for the recovery phase when the normal weighting factors for all afferents are being reestablished. We propose that this transient postoperative period may be the best timing of therapeutic intervention targeted at facilitating and reinforcing the acquisition of correct motor patterns.

Chantsoulis, Marzena; Kuczynski, Michal

2009-01-01

360

Particle Production in High Energy Nucleus--Nucleus Experiments at Berkeley.  

National Technical Information Service (NTIS)

A review of high energy nucleus-nucleus experiments performed at the Berkeley Bevalac is presented. Earlier results on projectile and target fragmentation and pion production are briefly summarized. More recent results on Coulomb effects in projectile fra...

L. S. Schroeder

1976-01-01

361

Description of Antiproton-Nucleus Scattering with the Proton-Nucleus Dirac Impulse Approximation Optical Potential.  

National Technical Information Service (NTIS)

The antiproton-nucleus scattering problem is formulated as the charge-conjugated Dirac equation for proton-nucleus scattering. The Dirac impulse approximation optical potential is used to calculate within the eikonal approximation the scattering observabl...

M. S. Hussein B. V. Carlson M. P. Isidro Filho

1984-01-01

362

Reaktsii sliyaniya i ehffektivnyj yadro-yadernyj potentsial. (Fusion reactions and effective nucleus-nucleus potential).  

National Technical Information Service (NTIS)

An effective energy-dependent nucleus-nucleus potential is proposed. In quasi-classical approximation fusion cross-sections are calculated at different energies for different pairs of nuclei. The agreement of calculation and experiment for a selected nucl...

A. T. D'yachenko

1990-01-01

363

Comparison of the diagnosis of intervertebral disc herniation in dogs by CT before and after contrast enhancement of the subarachnoid space.  

PubMed

Eleven miniature dachshunds with a herniated intervertebral disc were examined by CT, first before and then after contrast enhancement of the subarachnoid space. The images were classified into three grades by three veterinarians. In four cases, lesions observed on the scans obtained after contrast enhancement had not been observed on the preliminary scans and in one case a lesion observed on the preliminary scan was not observed on the scan obtained after contrast enhancement. Hemilaminectomies were performed on the basis of the enhanced CT results, and a clinical improvement was observed in each of the dogs. Calcification was detected in all the samples of herniated intervertebral disc material. PMID:19684345

Shimizu, J; Yamada, K; Mochida, K; Kako, T; Muroya, N; Teratani, Y; Kishimoto, M; Lee, K; Iwasaki, T; Miyake, Y

2009-08-15

364

Large phillipsite crystal as ferromanganese nodule nucleus  

Microsoft Academic Search

We report here the occurrence of, to date, the largest (21 × 10 × 8 mm) phillipsite crystal forming the nucleus of a diagenetically formed ferromanganese nodule from the Central Indian Ocean Basin (CIOB). Assuming an average rate of ferromanganese nodule accretion as ~ 2 mm\\/Ma and that of phillipsite growth as ~ 0.65 mm\\/Ka, the nucleus material appears to

A. K. Ghosh; Ranadhir Mukhopadhyay

1995-01-01

365

[Discussion on the regular of acupoint selection of acupuncture and moxibustion for lumbar disc herniation during recent 10 years].  

PubMed

By taking "lumbar disc herniation", Chinese medicine", "acupuncture and moxibustion" as key words Chinese articles about acupuncture for lumbar disc herniation in recent 10 years were searched in three major Chinese databases of Wan fang database, VIP database and CNKI. Totally 546 relative articles were retrieved. After the elimination of invalid articles, 173 were included as valid articles with 49 main acupoints. The hierarchical clustering statistical method was used to analyze the possible rules among the former 20 acupoints. It turned out that there were 10 most common used acupoints on Bladder Meridian [Geshu (BL 17), Xiaochangshu (BL 27), Shenshu (BL 23), Dachangshu (BL 25), Pangguangshu (BL 28), Guanyuanshu (BL 26), Weizbong (BL 40), Zhibian (BL 54), Chengshan (BL 57), Kunlun (BL 60)], 2 on Gallbladder Meridian [Huantiao (GB 30), Yanglingquan (GB 34)], 2 on Governor Vessel [Yaoyangguan (GV 3), Shuigou (GV 26)], 2 on Stomach Meridian [Zusanli (ST 36), Juliao (ST 3)], 2 on Spleen Meridian [Sanyinjiao (SP 6), Xuehai (SP 10)], and the rest were extra points (Huatuo Jiaji) and Ashi points, so a conclusion could be drawn that the most common used acupoints were Bladder Meridian acupoints and supplemented by Gallbladder Meridian, Governor Vessel, Stomach Meridian, Spleen Meridian, extra points and Ashi points. The selected acupoints were most located on the lumbosacral region, leg and fewer located on the face, back and local part. PMID:24032212

Li, Ju-Bao; Xiong, Qi-Liang; Qu, Shang-Ke; Qi, Feng; Zhang, Lei; Wang, Qi; Bao, Ke; Li, Fan-Bing

2013-07-01

366

A finite element analysis of the influence of surgical herniation on the viscoelastic properties of the intervertebral disc.  

PubMed

The purpose of this paper was to study the influence of surgical herniation on the viscoelastic properties of the intervertebral disc. The work was broken down into two phases: experimentation and analysis. In the first step of experimentation, five specimens were excised from the L1-L2 level of young adult rhesus monkeys. The prepared specimen consisted of the intervertebral joint and the two adjacent vertebral centrums without either the posterior elements or associated soft tissue. The specimens were subjected to a constant compressive load for eight hours followed by a sixteen hour relaxation time. During all the load cycles, displacement of the specimens was measured with an LVDT. After the first compressive test, the specimens were herniated and then the compressive test repeated. In the second phase of the work, a viscoelastic axisymmetric finite element model was used to quantify the experimental data. A three parameter Kelvin solid was employed in the finite element model. The results of this paper will be used to construct a dynamic model for the vertebral column. PMID:6643516

Furlong, D R; Palazotto, A N

1983-01-01

367

Treating thoracic-disc herniations: Do we always have to go anteriorly?  

PubMed Central

Study design:?Retrospective cohort study. Objective:?To determine if there is a difference in outcome and complications in surgically managed patients with thoracic-disc herniations (TDH) undergoing a modified transfacet pedicle-sparing decompression and fusion (posteriorly) compared to those undergoing anterior transthoracic discectomies (anteriorly). Methods:?Thirty-five consecutive operatively managed TDH underwent operative management between March 2003 and November 2009. Outcomes and complications were reviewed from patient records and x-rays assessing differences between those treated posteriorly and those treated anteriorly. Results:?Twenty-four patients underwent posterior management for 35 TDH and ten patients underwent anterior management for twelve TDH. Mean age was 50 years in both groups. Body mass index (BMI) averaged 28.8 in the anterior group and 32.0 in the posterior group. Follow-up averaged 38 weeks with four patients lost to follow-up (all posterior). Major complications secondary to surgery occurred in three patients (30%) in the anterior group (pulmonary embolus, pneumonia, and wrong level surgery) and in seven patients (35%) in the posterior group (seroma, misplaced instrumentation requiring revision, recurrence requiring an additional operation, and four infections). No neurological complications occurred and all patients noted improvement from baseline. Average length of stay was 7.3 days in the anterior group and 4.2 days in the posterior group (P < .003). Final pain as assessed by visual analog scale (VAS) improved from 6.7 to 4.3 in the anterior group and 6.9 to 2.3 in the posterior group (P?=?.05). Conclusions:?Complication rates are similar between groups and are approach related. Posteriorly managed patients had greater improvement in pain and shorter length of stay. Methods evaluation and class of evidence (CoE) Methodological principle: Study design:  Randomized controlled trial  Cohort study •  Case control  Case series Statement of concealed allocation* Intent to treat* Independent or blind assessment • Complete follow-up of ?85% Adequate sample size Controlling for possible confounding Evidence class: III *Applies to randomized controlled trials only. The definition of the different classes of evidence is available on page 83.

Bransford, Richard J.; Zhang, Fangyi; Bellabarba, Carlo; Lee, Michael J.

2010-01-01

368

Relativistic nuclear optical models for nucleon--nucleus scattering  

SciTech Connect

Relativistic treatments of the nucleon-nucleus optical model potential are discussed. Results of relativistic impulse approximation calculations for proton--nucleus and anti-proton-nucleus elastic scattering are compared with experiment.

Clark, B.C.

1984-11-15

369

Coordinated Spitzer Comet Nucleus Observations  

NASA Astrophysics Data System (ADS)

We have been awarded 104.5 hours of Spitzer telescope time (Fall 2006 and Spring 2007) to make an albedo and radius survey for 100 Jupiter-family comet nuclei using the IRS PU and MIPS imaging. These nuclei have dynamical and evolutionary connections to other Solar System small bodies: TNOs, Centaurs, Trojan asteroids and extinct comet nuclei. The JFCs remain the only group that has not been studied in the mid-IR. Using Spitzer and complementary optical (ground-based) imaging proposed here, we will (1) measure the thermal emission from 100 JFC nuclei and determine their radii, (2) combine the thermal data with optical data to get geometric albedos (for a subset), (3) compare the comet albedo distribution with those of Centaurs, TNOs, Trojans and extinct comet candidates to gauge the effects of surface evolution, (4) test for correlations between cometary albedos and other properties of the nuclei (e.g. composition and dynamical age), (5) resolve the long- standing question of just how safe it is to assume an albedo for a cometary nucleus, and (6) use the radii to derive a new estimate of the size distribution of the JFC comets and verify if a truncation in the sizes is required for small nuclei. This request is for the optical imaging component for those targets best observed from the southern hemisphere.

Meech, Karen; Fernandez, Yanga; Pittichova, Jana; Harrington, David

2007-02-01

370

Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; design of a prospective randomized controlled trial  

PubMed Central

Background The usual surgical treatment of refractory sciatica caused by lumbar disc herniation, is open discectomy. Minimally invasive procedures, including percutaneous therapies under local anesthesia, are increasingly gaining attention. One of these treatments is Percutaneous Laser Disc Decompression (PLDD). This treatment can be carried out in an outpatient setting and swift recovery and return to daily routine are suggested. Thus far, no randomized trial into cost-effectiveness of PLDD versus standard surgical procedure has been performed. We present the design of a randomized controlled trial, studying the cost-effectiveness of PLDD versus conventional open discectomy in patients with sciatica from lumbar disc herniation. Methods/design The study is a randomized prospective multi-center trial, in which two treatment strategies are compared in a parallel group design. Patients (age 18–70 years) visiting the neurosurgery department of the participating hospitals, are considered for inclusion in the trial when sciatica due to lumbar disc herniation has lasted more than 8 weeks. Patients with disc herniation smaller than 1/3 of the spinal canal diameter, without concomitant lateral recess stenosis or sequestration, are eligible for participation, and are randomized into one of two treatment arms; either Percutaneous Laser Disc Decompression or conventional discectomy. The functional outcome of the patient, as assessed by the Roland Disability Questionnaire for Sciatica at 8 weeks and 1 year after treatment, is the primary outcome measure. The secondary outcome parameters are recovery as perceived by the patient, leg and back pain, incidence of re-intervention, complications, quality of life, medical consumption, absence of work and secondary costs. Discussion Open discectomy is still considered to be the golden standard in the surgical treatment of lumbar disc herniation. Whether Percutaneous Laser Disc Decompression has at least as much efficacy as the standard surgical procedure, and is more cost-effective, will be determined by this trial. Trial registration Current Controlled Trials ISRCTN25884790.

Brouwer, Patrick A; Peul, Wilco C; Brand, Ronald; Arts, Mark P; Koes, Bart W; Berg, Annette A van den; van Buchem, Mark A

2009-01-01

371

Large phillipsite crystal as ferromanganese nodule nucleus  

NASA Astrophysics Data System (ADS)

We report here the occurrence of, to date, the largest (21 × 10 × 8 mm) phillipsite crystal forming the nucleus of a diagenetically formed ferromanganese nodule from the Central Indian Ocean Basin (CIOB). Assuming an average rate of ferromanganese nodule accretion as ~ 2 mm/Ma and that of phillipsite growth as ~ 0.65 mm/Ka, the nucleus material appears to have been growing for ~4.5 5 Ma. Originally surfaced as a rock fragment from late Miocene volcanism, this nucleus was later altered to phillipsite under alkaline, silica-undersaturated, low-temperature conditions through the length of the Neogene sedimentary hiatus.

Ghosh, A. K.; Mukhopadhyay, Ranadhir

1995-03-01

372

The mediodorsal thalamic nucleus and schizophrenia  

PubMed Central

The mediodorsal nucleus of the human thalamus is in a crucial position that allows it to establish connections with diverse cerebral structures, particularly the prefrontal cortex. The present review examines existing neurobiologic studies of the brains of people with and without schizophrenia that indicate a possible involvement of the mediodorsal nucleus in this psychiatric disorder. Studies at synaptic and cellular levels of the neurobiology of the mediodorsal nucleus, together with a better anatomic understanding of this diencephalic structure owing to neuroimaging studies, should help to establish a more deep and solid pathophysiologic model of schizophrenia.

Alelu-Paz, Raul; Gimenez-Amaya, Jose Manuel

2008-01-01

373

Long-Term Outcomes of Patients with Lumbar Disc Herniation Treated with Percutaneous Discectomy: Comparative Study with Microendoscopic Discectomy  

SciTech Connect

We assessed the long-term outcomes of patients with lumbar disc herniation treated with percutaneous lumbar discectomy (PLD) or microendoscopic discectomy (MED). A retrospective study was performed in consecutive patients with lumbar disc herniation treated with PLD (n = 129) or MED (n = 101) in a single hospital from January 2000 to March 2002. All patients were followed up with MacNab criteria and self-evaluation questionnaires comprising the Oswestry Disability Index and Medical Outcomes Study 36-Item Short-Form Health Survey. Several statistical methods were used for analyses of the data, and a p value of <0.05 was considered to be statistically significant. A total of 104 patients (80.62%) with PLD and 82 patients (81.19%) with MED were eligible for analyses, with a mean follow-up period of 6.64 {+-} 0.67 years and 6.42 {+-} 0.51 years, respectively. There were no significant differences between the two groups in age, number of lesions, major symptoms and physical signs, and radiological findings. According to the MacNab criteria, 75.96% in the PLD group and 84.15% in the MED group achieved excellent or good results, respectively, this was statistically significant (p = 0.0402). With the Oswestry Disability Index questionnaires, the average scores and minimal disability, respectively, were 6.97 and 71.15% in the PLD group and 4.89 and 79.27% in the MED group. Total average scores of Medical Outcomes Study 36-Item Short-Form Health Survey were 75.88 vs. 81.86 in PLD group vs. MED group (p = 0.0582). The cost and length of hospitalization were higher or longer in MED group, a statistically significant difference (both p < 0.0001). Long-term complications were observed in two patients (2.44%) in the MED group, no such complications were observed in the PLD group. Both PLD and MED show an acceptable long-term efficacy for treatment of lumbar disc herniation. Compared with MED patients, long-term satisfaction is slightly lower in the PLD patients; complications, hospitalization duration, and costs in PLD group are also lower.

Liu Wengui [Southeast University, Department of Radiology, Zhong-Da Hospital (China); Wu Xiaotao [Southeast University, Department of Orthopedics, Zhong-Da Hospital (China); Guo Jinhe [Southeast University, Department of Radiology, Zhong-Da Hospital (China); Zhuang Suyang [Southeast University, Department of Orthopedics, Zhong-Da Hospital (China); Teng Gaojun, E-mail: gjteng@vip.sina.co [Southeast University, Department of Radiology, Zhong-Da Hospital (China)

2010-08-15

374

Comet encke: radar detection of nucleus.  

PubMed

The nucleus of the periodic comet Encke was detected in November 1980 with the Arecibo Observatory's radar system (wavelength, 12.6 centimeters). The echoes in the one sense of circular polarization received imply a radar cross section of 1.1 +/- 0.7 square kilometers. The estimated bandwidth of these echoes combined with an estimate of the rotation vector of Encke yields a radius for the nucleus of l.5(+2.3)(-1.0) kilometers. The uncertainties given are dependent primarily on the range of models considered for the comet and for the manner in which its nucleus backscatters radio waves. Should this range prove inadequate, the true value of the radius of the nucleus might lie outside the limits given. PMID:17832744

Kamoun, P G; Campbell, D B; Ostro, S J; Pettengill, G H; Shapiro, I I

1982-04-16

375

Analysis of Returned Comet Nucleus Samples.  

National Technical Information Service (NTIS)

This volume contains abstracts that have been accepted by the Program Committee for presentation at the Workshop on Analysis of Returned Comet Nucleus Samples, held in Milpitas, California, January 16-18, 1989. Conveners are Sherwood Chang (NASA Ames Rese...

S. Chang

1997-01-01

376

Dirac phenomenology and hyperon-nucleus interactions.  

National Technical Information Service (NTIS)

We discuss various aspects of hyperon-nucleus interactions in the relativistic mean field theory. First, characteristics of (Lambda), (Sigma) and (identical-to) hypernuclei, as well as multi strange baryonic objects, are investigated. The spin-orbit split...

J. Mares B. K. Jennings E. D. Cooper

1993-01-01

377

Nova near the nucleus of M31.  

NASA Astrophysics Data System (ADS)

A nova, one of the nearest to the nucleus of M31, was discovered by V. V. Shulga on September 7/8, 1992 on two photographic plates, obtained at the f/13 focus of the Maidanak Observatory (Uzbekistan) 1-m telescope. The distance of the nova from the nucleus of M31 is 11?2. The nova's brightness was B = 16m0.

Shokin, Yu. A.; Shul'Ga, V. V.

378

Multiplicity distribution in hadron-nucleus scattering  

SciTech Connect

It is argued that the multiplicity distribution in hadron-nucleus scattering should obey universal Koba-Nielsen-Olesen scaling at each impact parameter. For the whole nucleus, scaling remains approximately valid, but universality breaks down. The model predicts that as A increases, the peak of the scaled multiplicity distribution shifts towards smaller values of n/n-bar, and the normalized dispersion and skewness increase. All these properties are in agreement with data.

Kiang, D.; Ling, S.H.; Young, K.; Lam, C.S.

1985-01-01

379

Functional architecture in the cell nucleus.  

PubMed Central

The major functions of the cell nucleus, including transcription, pre-mRNA splicing and ribosome assembly, have been studied extensively by biochemical, genetic and molecular methods. An overwhelming amount of information about their molecular mechanisms is available. In stark contrast, very little is known about how these processes are integrated into the structural framework of the cell nucleus and how they are spatially and temporally co-ordinated within the three-dimensional confines of the nucleus. It is also largely unknown how nuclear architecture affects gene expression. In order to understand how genomes are organized, and how they function, the basic principles that govern nuclear architecture and function must be uncovered. Recent work combining molecular, biochemical and cell biological methods is beginning to shed light on how the nucleus functions and how genes are expressed in vivo. It has become clear that the nucleus contains distinct compartments and that many nuclear components are highly dynamic. Here we describe the major structural compartments of the cell nucleus and discuss their established and proposed functions. We summarize recent observations regarding the dynamic properties of chromatin, mRNA and nuclear proteins, and we consider the implications these findings have for the organization of nuclear processes and gene expression. Finally, we speculate that self-organization might play a substantial role in establishing and maintaining nuclear organization.

Dundr, M; Misteli, T

2001-01-01

380

Commissural Axons of the Mouse Cochlear Nucleus  

PubMed Central

The axons of commissural neurons that project from one cochlear nucleus to the other were studied after labeling with anterograde tracer. Injections were made into the dorsal subdivision of the cochlear nucleus in order to restrict labeling only to the group of commissural neurons that gave off collaterals to, or were located in, this subdivision. The number of labeled commissural axons in each injection was correlated with the number of labeled radiate multipolar neurons, suggesting radiate neurons as the predominant origin of the axons. The radiate commissural axons are thick and myelinated, and they exit the dorsal acoustic stria of the injected cochlear nucleus to cross the brainstem in the dorsal half, near the crossing position of the olivocochlear bundle. They enter the opposite cochlear nucleus via the dorsal and ventral acoustic stria and at its medial border. Reconstructions of single axons demonstrate that terminations are mostly in the core and typically within a single subdivision of the cochlear nucleus. Extents of termination range from narrow to broad along both the dorso-ventral (i.e. tonotopic) and rostro-caudal dimensions. In the electron microscope, labeled swellings form synapses that are symmetric (in that there is little postsynaptic density), a characteristic of inhibitory synapses. Our labeled axons do not appear to include excitatory commissural axons that end in edge regions of the nucleus. Radiate commissural axons could mediate the broad-band inhibition observed in responses to contralateral sound, and they may balance input from the two ears on a quick time course.

Brown, M. Christian; Drottar, Marie; Benson, Thane E.; Darrow, Keith

2012-01-01

381

Targeting the red nucleus for cerebellar tremor.  

PubMed

Deep brain stimulation of the thalamus (and especially the ventral intermediate nucleus) does not significantly improve a drug-resistant, disabling cerebellar tremor. The dentato-rubro-olivary tract (Guillain-Mollaret triangle, including the red nucleus) is a subcortical loop that is critically involved in tremor genesis. We report the case of a 48-year-old female patient presenting with generalized cerebellar tremor caused by alcohol-related cerebellar degeneration. Resistance to pharmacological treatment and the severity of the symptoms prompted us to investigate the effects of bilateral deep brain stimulation of the red nucleus. Intra-operative microrecordings of the red nucleus revealed intense, irregular, tonic background activity but no rhythmic components that were synchronous with upper limb tremor. The postural component of the cerebellar tremor disappeared during insertion of the macro-electrodes and for a few minutes after stimulation, with no changes in the intentional (kinetic) component. Stimulation per se did not reduce postural or intentional tremor and was associated with dysautonomic symptoms (the voltage threshold for which was inversed related to the stimulation frequency). Our observations suggest that the red nucleus is (1) an important centre for the genesis of cerebellar tremor and thus (2) a possible target for drug-refractory tremor. Future research must determine how neuromodulation of the red nucleus can best be implemented in patients with cerebellar degeneration. PMID:24415178

Lefranc, M; Manto, M; Merle, P; Tir, M; Montpellier, D; Constant, J-M; Le Gars, D; Macron, J-M; Krystkowiak, P

2014-06-01

382

Matrix metalloprotease-9 activity in the cerebrospinal fluid and spinal injury severity in dogs with intervertebral disc herniation.  

PubMed

We investigated whether matrix metalloproteinase (MMP)-9 expression in the cerebrospinal fluid (CSF) of dogs with intervertebral disc herniation (IVDH) is associated with the severity of neurological signs and prognosis. CSF from the cisterna magna (C-CSF) and the lumbar spine (L-CSF) of 34 dogs with IVDH was analyzed using zymography. Activity of MMP-9 in L-CSF was detected in 6 of 34 dogs with IVDH, often for more than 7 days after injury. MMP-9 activity was not detected from any of the C-CSF samples. Of the six cases that were MMP-9 positive, all four cases with grade V that had loss of deep pain were non-ambulatory 6 months after treatment. The remaining two cases with grade III and IV could recover mobility. In dogs with grade V thoracolumbar IVDH, MMP-9 expression in the CSF may indicate severe spinal cord injury with poor prognosis. PMID:20965533

Nagano, S; Kim, S H; Tokunaga, S; Arai, K; Fujiki, M; Misumi, K

2011-12-01

383

Survivorship analysis of 150 consecutive patients with DIAM(TM) implantation for surgery of lumbar spinal stenosis and disc herniation  

PubMed Central

Recently, the Device for Intervertebral Assisted Motion (DIAM™) has been introduced for surgery of degenerative lumbar disc diseases. The authors performed the current study to determine the survivorship of DIAM™ implantation for degenerative lumbar disc diseases and risk factors for reoperation. One hundred and fifty consecutive patients underwent laminectomy or discectomy with DIAM™ implantation for primary lumbar spinal stenosis or disc herniation. The characteristics of the 150 patients included the following: 84 males and 66 females; mean age at the time of surgery, 46.5 years; median value of follow-up, 23 months (range 1–48 months); 96 spinal stenosis and 54 disc herniations; and 146 one-level (115, L4–5; 31, L5–6) and 4 two-level (L4–5 and L5–6). In the current study, due to lumbosacral transitional vertebra (LSTV) L6 meant lumbarization of S1 and this had a prominent spinous process so that the DIAM™ was implanted at L5–6. Reoperations due to any reasons of the DIAM™ implantation level or adjacent levels were defined as a failure and used as the end point for determining survivorship. The cumulative reoperation rate and survival time were determined via Kaplan–Meier analysis. The log-rank test and Cox regression model were used to evaluate the effect of age, gender, diagnosis, location, and level of DIAM™ implantation on the reoperation rate. During a 4-year follow-up, seven patients (two males and five female) underwent reoperation at the DIAM™ implantation level, giving a reoperation rate of 4.7%. However, no patients underwent reoperation for adjacent level complications. The causes of reoperation were recurrent spinal stenosis (n = 3), recurrent disc herniation (n = 2), post-laminectomy spondylolisthesis (n = 1), and delayed deep wound infection (n = 1). The mean time between primary operation and reoperation was 13.4 months (range 2–29 months). Kaplan–Meier analysis predicted an 8% cumulative reoperation rate 4 years post-operatively. Survival time was predicted to be 45.6 ± 0.9 months (mean ± standard deviation). Based on the log-rank test, the reoperation rate was higher at L5–6 (p = 0.002) and two-level (p = 0.01) DIAM™ implantation compared with L4–5 and one-level DIAM™ implantation. However, gender (p = 0.16), age (p = 0.41), and diagnosis (p = 0.67) did not significantly affect the reoperation rate of DIAM™ implantation. Based on a Cox regression model, L5–6 [hazard ratio (HR), 10.3; 95% CI, 1.7–63.0; p = 0.01] and two-level (HR, 10.4; 95% CI, 1.2–90.2; p = 0.04) DIAM™ implantation were also significant variables associated with a higher reoperation rate. Survival time was significantly lower in L5–6 (47 vs. 22 months, p = 0.002) and two-level DIAM™ implantation (46 vs. 18 months, p = 0.01) compared with L4–5 and one-level DIAM™ implantation. The current results suggest that 8% of the patients who have a DIAM™ implantation for primary lumbar spinal stenosis or disc herniation are expected to undergo reoperation at the same level within 4 years after surgery. Based on the limited data set, DIAM™ implantation at L5–6 and two-level in patients with LSTV are significant risk factors for reoperation.

Sur, Yoo-Joon; Kong, Chae-Gwan

2010-01-01

384

Survivorship analysis of 150 consecutive patients with DIAM™ implantation for surgery of lumbar spinal stenosis and disc herniation.  

PubMed

Recently, the Device for Intervertebral Assisted Motion (DIAM™) has been introduced for surgery of degenerative lumbar disc diseases. The authors performed the current study to determine the survivorship of DIAM™ implantation for degenerative lumbar disc diseases and risk factors for reoperation. One hundred and fifty consecutive patients underwent laminectomy or discectomy with DIAM™ implantation for primary lumbar spinal stenosis or disc herniation. The characteristics of the 150 patients included the following: 84 males and 66 females; mean age at the time of surgery, 46.5 years; median value of follow-up, 23 months (range 1-48 months); 96 spinal stenosis and 54 disc herniations; and 146 one-level (115, L4-5; 31, L5-6) and 4 two-level (L4-5 and L5-6). In the current study, due to lumbosacral transitional vertebra (LSTV) L6 meant lumbarization of S1 and this had a prominent spinous process so that the DIAM™ was implanted at L5-6. Reoperations due to any reasons of the DIAM™ implantation level or adjacent levels were defined as a failure and used as the end point for determining survivorship. The cumulative reoperation rate and survival time were determined via Kaplan-Meier analysis. The log-rank test and Cox regression model were used to evaluate the effect of age, gender, diagnosis, location, and level of DIAM™ implantation on the reoperation rate. During a 4-year follow-up, seven patients (two males and five female) underwent reoperation at the DIAM™ implantation level, giving a reoperation rate of 4.7%. However, no patients underwent reoperation for adjacent level complications. The causes of reoperation were recurrent spinal stenosis (n = 3), recurrent disc herniation (n = 2), post-laminectomy spondylolisthesis (n = 1), and delayed deep wound infection (n = 1). The mean time between primary operation and reoperation was 13.4 months (range 2-29 months). Kaplan-Meier analysis predicted an 8% cumulative reoperation rate 4 years post-operatively. Survival time was predicted to be 45.6 ± 0.9 months (mean ± standard deviation). Based on the log-rank test, the reoperation rate was higher at L5-6 (p = 0.002) and two-level (p = 0.01) DIAM™ implantation compared with L4-5 and one-level DIAM™ implantation. However, gender (p = 0.16), age (p = 0.41), and diagnosis (p = 0.67) did not significantly affect the reoperation rate of DIAM™ implantation. Based on a Cox regression model, L5-6 [hazard ratio (HR), 10.3; 95% CI, 1.7-63.0; p = 0.01] and two-level (HR, 10.4; 95% CI, 1.2-90.2; p = 0.04) DIAM™ implantation were also significant variables associated with a higher reoperation rate. Survival time was significantly lower in L5-6 (47 vs. 22 months, p = 0.002) and two-level DIAM™ implantation (46 vs. 18 months, p = 0.01) compared with L4-5 and one-level DIAM™ implantation. The current results suggest that 8% of the patients who have a DIAM™ implantation for primary lumbar spinal stenosis or disc herniation are expected to undergo reoperation at the same level within 4 years after surgery. Based on the limited data set, DIAM™ implantation at L5-6 and two-level in patients with LSTV are significant risk factors for reoperation. PMID:20953966

Sur, Yoo-Joon; Kong, Chae-Gwan; Park, Jong-Beom

2011-02-01

385

Diplopia and visual impairment as presenting symptoms of shunt failure in association with tonsillar herniation in idiopathic intracranial hypertension.  

PubMed

Two cases of cerebellar tonsilar herniation due to shunt complications in idiopathic intracranial hypertension are reported in which both patients presented with visual symptoms. One patient had horizontal diplopia due to an acute sixth nerve palsy along with severe constriction of visual fields while the second patient had symptoms of blurred vision. Both patients required neurosurgery, one patient requiring surgery for tonsillar descent and revision of an over-draining lumbar peritoneal shunt and the second patient only requiring revision of his over-draining lumbar peritoneal shunt. Following surgery the visual signs of reduced vision, cranial nerve palsy, and visual field loss gradually resolved. Both patients had normal ocular movements and visual fields at final follow-up. PMID:23211144

Rowe, Fiona J

2012-12-01

386

Improved Cloud Condensation Nucleus Spectrometer  

NASA Technical Reports Server (NTRS)

An improved thermal-gradient cloud condensation nucleus spectrometer (CCNS) has been designed to provide several enhancements over prior thermal- gradient counters, including fast response and high-sensitivity detection covering a wide range of supersaturations. CCNSs are used in laboratory research on the relationships among aerosols, supersaturation of air, and the formation of clouds. The operational characteristics of prior counters are such that it takes long times to determine aerosol critical supersaturations. Hence, there is a need for a CCNS capable of rapid scanning through a wide range of supersaturations. The present improved CCNS satisfies this need. The improved thermal-gradient CCNS (see Figure 1) incorporates the following notable features: a) The main chamber is bounded on the top and bottom by parallel thick copper plates, which are joined by a thermally conductive vertical wall on one side and a thermally nonconductive wall on the opposite side. b) To establish a temperature gradient needed to establish a supersaturation gradient, water at two different regulated temperatures is pumped through tubes along the edges of the copper plates at the thermally-nonconductive-wall side. Figure 2 presents an example of temperature and supersaturation gradients for one combination of regulated temperatures at the thermally-nonconductive-wall edges of the copper plates. c) To enable measurement of the temperature gradient, ten thermocouples are cemented to the external surfaces of the copper plates (five on the top plate and five on the bottom plate), spaced at equal intervals along the width axis of the main chamber near the outlet end. d) Pieces of filter paper or cotton felt are cemented onto the interior surfaces of the copper plates and, prior to each experimental run, are saturated with water to establish a supersaturation field inside the main chamber. e) A flow of monodisperse aerosol and a dilution flow of humid air are introduced into the main chamber at the inlet end. The inlet assembly is designed to offer improved (relative to prior such assemblies) laminar-flow performance within the main chamber. Dry aerosols are subjected to activation and growth in the supersaturation field. f) After aerosol activation, at the outlet end of the main chamber, a polished stainless-steel probe is used to sample droplets into a laser particle counter. The probe features an improved design for efficient sampling. The counter has six channels with size bins in the range of 0.5- to 5.0-micron diameter. g) To enable efficient sampling, the probe is scanned along the width axis of the main chamber (thereby effecting scanning along the temperature gradient and thereby, further, effecting scanning along the supersaturation gradient) by means of a computer-controlled translation stage.

Leu, Ming-Taun

2010-01-01

387

Changes in the total Oswestry Index and its ten items in females and males pre- and post-surgery for lumbar disc herniation: a 1-year follow-up  

Microsoft Academic Search

To study the characteristics and changes in the total Oswestry Disability Index (ODI) and in its ten component items in female\\u000a and male patients pre- and post-surgery for lumbar disc herniation. Ninety-eight patients [mean (SD) age 43 (13), 61% males]\\u000a undergoing lumbar disc herniation surgery were selected for this clinical 12-month follow-up. Subjective disability and back\\u000a and leg pain were

Arja Häkkinen; Hannu Kautiainen; Salme Järvenpää; Marja Arkela-Kautiainen; Jari Ylinen

2007-01-01

388

Effective number of inelastically interacting nucleons in rare nucleus-nucleus production processes.  

National Technical Information Service (NTIS)

A model of nucleus-nucleus interaction using one inelastic NN-interaction is suggested for the exclusive production processes with small cross-section. A-dependence nuclear coherent and incoherent production cross-section are predicted. 20 refs.; 4 figs. ...

V. L. Korotkikh I. P. Lokhtin

1992-01-01

389

Computer program for parameterization of nucleus-nucleus electromagnetic dissociation cross sections  

NASA Technical Reports Server (NTRS)

A computer subroutine parameterization of electromagnetic dissociation cross sections for nucleus-nucleus collisions is presented that is suitable for implementation in a heavy ion transport code. The only inputs required are the projectile kinetic energy and the projectile and target charge and mass numbers.

Norbury, John W.; Townsend, Lawrence W.; Badavi, Forooz F.

1988-01-01

390

Target nucleus in relativistic nuclear collisions  

SciTech Connect

Both the fireball model and hydrodynamical model predict, in a central collision, a fast energy dissipation in the early diving stage of the projectile into the target nucleus. In the final state both models show total incident energy largely dispersed over the whole target nucleus. In a quantitative comparison with the data for the Intranuclear Cascade Calculations, however, the 90/sup 0/ double differential cross section seems to be flatter than the calculated one. If the slope is reflecting the temperature in the system then the data are having apparently a higher temperature than the cascade would predict. This report suggests and discusses a picture of the reaction mechanism where the light projectile (e.g. Ne) gets stopped very early in the large target nucleus (e.g. Au or U) forming a small fireball at approximately half the beam rapidity, which decays inside the target nucleus, heating it up and causing thee whole system to expand. The expansion cools the system and big clusters can condense out if the total energy and thus entropy in the system is not too high to prevent it. Such a qualitative picture of a reaction mechanism emerges when we consider the information obtained about relativistic nuclear collisions from measurements of the remnants of a large target nucleus struck by a smaller projectile (Ne + Au) and relate it to the complementary information from earlier measurements of fast light reaction products. (WHK)

Gutbrod, H.H.; Warwick, A.I.; Wieman, H.

1982-03-01

391

Structural dynamics of the cell nucleus  

PubMed Central

Neuronal morphology plays an essential role in signal processing in the brain. Individual neurons can undergo use-dependent changes in their shape and connectivity, which affects how intracellular processes are regulated and how signals are transferred from one cell to another in a neuronal network. Calcium is one of the most important intracellular second messengers regulating cellular morphologies and functions. In neurons, intracellular calcium levels are controlled by ion channels in the plasma membrane such as NMDA receptors (NMDARs), voltage-gated calcium channels (VGCCs) and certain ?-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) as well as by calcium exchange pathways between the cytosol and internal calcium stores including the endoplasmic reticulum and mitochondria. Synaptic activity and the subsequent opening of ligand and/or voltage-gated calcium channels can initiate cytosolic calcium transients which propagate towards the cell soma and enter the nucleus via its nuclear pore complexes (NPCs) embedded in the nuclear envelope. We recently described the discovery that in hippocampal neurons the morphology of the nucleus affects the calcium dynamics within the nucleus. Here we propose that nuclear infoldings determine whether a nucleus functions as an integrator or detector of oscillating calcium signals. We outline possible ties between nuclear mophology and transcriptional activity and discuss the importance of extending the approach to whole cell calcium signal modeling in order to understand synapse-to-nucleus communication in healthy and dysfunctional neurons.

Wiegert, Simon; Bading, Hilmar

2011-01-01

392

Clinical experience with percutaneous holmium:YAG laser discectomy in dogs  

NASA Astrophysics Data System (ADS)

Thirty-five clinical cases received laser disc ablation utilizing a uniplanar fluoroscopically guided percutaneous technique over a three year period. With the dog in right lateral recumbency, uniplanar fluoroscopy was utilized to guide the placement of 20-gauge, 2.5 inch spinal needles percutaneously through the left epaxial soft tissues into the nucleus pulposus with the dog in right lateral recumbency. The needle was advanced in increments following palpation and brief fluoroscopic observations to insure avoidance of the spinal cord and other vital structures. Entrance into the intervertebral disc was identified by a characteristic `gritty' feel of the needle passing through the annulus fibrosus. The dog was then placed in sternal recumbency, and the needles adjusted to place the tip approximately one-third of the distance into the disc. The laser fiber was then placed through the needle into the nucleus pulposus to ablate the nucleus with holmium laser energy. No detrimental side effects of this technique have been identified with the exception of one case. This single exception suggests that this procedure should not be performed on dogs with acute disc herniation. The technique appears safe given adherence to careful placement of the spinal needles and proper clinical criteria for patient selection.

Henry, George A.; Bartels, Kenneth E.; Dickey, D. Thomas

1995-05-01

393

Surgical Treatment of T1-2 Disc Herniation with T1 Radiculopathy: A Case Report with Review of the Literature  

PubMed Central

The prevalence of intervertebral disc herniation (IDH) of the thoracic spine is rare compared to the cervical or lumbar spine. In particular, IDH of the upper thoracic spine is extremely rare. We report the case of T1-2 IDH and its treatment, with a literature review. A 37-year-old male patient visited our hospital due to radiating pain at the left upper extremity and weakness of grip power. In cervical spine magnetic resonance images, T1-2 disc space showed herniated disc material and compressed T1 root was identified. Laminoforaminotomy was performed with a posterior approach. The radiating pain and weakness of grip power improved immediately after the surgery. Of patients who show radiating pain or numbness at the medial aspect of forearm, or weakness of intrinsic muscle of hand, can be suspected to have T1 radiculopathy. A detailed physical examination and a radiologic evaluation including this area should be required for the T1 radiculopathy.

Son, Eun-Seok; Park, So-Young; Kim, Ki-Tack; Kang, Chul-Hyung; Cho, Seong-Woo

2012-01-01

394

[Report of a patient with CADASIL having a novel missense mutation of the Notch 3 gene--association with alopecia and lumbar herniated disk].  

PubMed

We report a 52-year-old man with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) presenting dementia, alopecia and lumbar herniated disk. He had an episode of stroke and migraine-like headache lasting for 5 minutes. A lot of members had cerebral infarction in this family. Brain magnetic resonance imaging demonstrated, on T2-weighted images, numerous hyperintense lesions suggestive of small infarcts in the basal ganglia and diffuse hyperintense lesions in the cerebral white matter. The clinical symptoms, the family history and the MRI findings suggested the diagnosis of CADASIL. However, the patient also showed alopecia and lumbar herniated disk, both are characteristic features of cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL). The DNA analysis of the Notch 3 gene identified a novel missense mutation Cys174Phe in this patient. Our case report indicated the importance of the DNA analysis for the diagnosis of CADASIL. PMID:11481859

Yamada, H; Yasuda, T; Kotorii, S; Takahashi, K; Tabira, T; Sunada, Y

2001-01-01

395

mRNA stability in the nucleus*  

PubMed Central

Eukaryotic gene expression is controlled by different levels of biological events, such as transcription factors regulating the timing and strength of transcripts production, alteration of transcription rate by RNA processing, and mRNA stability during RNA processing and translation. RNAs, especially mRNAs, are relatively vulnerable molecules in living cells for ribonucleases (RNases). The maintenance of quality and quantity of transcripts is a key issue for many biological processes. Extensive studies draw the conclusion that the stability of RNAs is dedicated-regulated, occurring co- and post-transcriptionally, and translation-coupled as well, either in the nucleus or cytoplasm. Recently, RNA stability in the nucleus has aroused much research interest, especially the stability of newly-made transcripts. In this article, we summarize recent progresses on mRNA stability in the nucleus, especially focusing on quality control of newly-made RNA by RNA polymerase II in eukaryotes.

Liu, Han; Luo, Min; Wen, Ji-kai

2014-01-01

396

Dynamics of hadron-nucleus interactions  

SciTech Connect

Recent progress in diffraction theory shows that proton-nucleus scattering at nonforward angles is dominated by the interference of waves from two or more bright spots. Analytic formulas based on asymptotic theories of diffraction yield valuable new insights into the scattering and these formulas can be readily extended to illuminate the role of dynamical ingredients, i.e., the nucleon-nucleon amplitudes. The governing parameters of the diffraction and some direct connections between the observed cross sections and the input dynamics are reviewed. New information regarding the nucleon-nucleon parameters based on recent phase shift analyses show some systematic differences from the effective NN amplitudes which produce fits to proton-nucleus diffraction data. Recent progress in understanding the role of ..delta..-isobars in proton-nucleus dynamics is reviewed. 126 references.

Wallace, S.J.

1981-07-01

397

Correlation of serum trace elements and melatonin levels to radiological, biochemical, and histological assessment of degeneration in patients with intervertebral disc herniation  

Microsoft Academic Search

The aim of our study was to assess the blood concentrations of some trace elements and melatonin (MLT) in patients with intervertebral\\u000a disc herniation (IDH) and to investigate the interaction of histological and biochemical degeneration findings with aging.\\u000a The present study was carried out on 13 subjects (8 women and 5 men) diagnosed with IDH. They were divided into three

Mehmet Turgut; Çi?dem Yenisey; Orhan Akyüz; Yelda Öszunar; Muhan Erku?; Tuncay Biçakçi

2006-01-01

398

Relativistic theory of electron-nucleus scattering  

SciTech Connect

A consistent relativistic formalism is developed for electron-nucleus scattering. It is based on renormalizable relativistic quantum field theories of mesons and baryons (quantum hadrodynamics). The relativistic Hartree approximation describes the target using four-component Dirac wave functions. An effective, local electromagnetic current operator is constructed that reproduces electron scattering from a single nucleon. This operator is explicitly conserved in the relativistic Hartree approximation and, together with the Hatree wave functions, provides a consistent covariant formalism for electron-nucleus scattering. Applications of the formalism to elastic charge and magnetic scattering are discussed.

Serot, B.D.

1984-11-15

399

Compound Nucleus Contributions to the Optical Potential  

SciTech Connect

An ab-initio calculation of the optical potential for neutron-nucleus scattering has been performed by explicitly coupling the elastic channel to all the particle-hole (p-h) excitation states in the target. These p-h states may be regarded as doorway states through which the flux flows to more complicated configurations, and (in the end) to long-lived compound nucleus resonances. The random-phase approximation (RPA) provides the linear combinations of p-h states that include the residual interactions within the target, and we show preliminary results for elastic flux loss using both p-h and RPA descriptions of target excitations.

Thompson, I J; Dietrich, F S; Escher, J E; Dupuis, M

2008-01-28

400

Application of Percutaneous Cervical Nucleoplasty Using the Navigable Disc Decompression Device in Patient of Cervical Herniated Intervertebral Disc: A Case Report  

PubMed Central

Recent years, various percutaneous procedures including cervical nucleoplasty have been developed for disc decompressions to relieve radicular pains caused by disc herniations. We report the application of percutaneous cervical nucleoplasty (PCN) by using the navigable disc decompression device in two patients of cervical herniated intervertebral discs (HIVD). A 38-year-old female diagnosed with C4-C5 disc extrusion with bilateral C5 roots impingement received nucleoplasty twice at C4-C5 disc level. After second procedure, her pain was improved from 6-7/10 to 1-2/10 by visual analog scale (VAS). The second case, a 51-year-male was diagnosed with C6-C7 disc extrusion with right C7 roots impingement and received the procedure at C6-C7 disc level. The pain improved from 8/10 to 3-4/10 by VAS. Successfully, we decompressed cervical herniated discs in 2 HIVD patients without major complications. The PCN with the navigable device will be recommended as an alternative treatment method for cervical HIVD.

Lim, Ji-Hoon; Lee, Hye-Jin

2013-01-01

401

A Minimally Invasive Treatment for Lumbar Disc Herniation: DiscoGel® Chemonucleolysis in Patients Unresponsive to Chemonucleolysis with Oxygen-Ozone  

PubMed Central

Summary A multitude of therapies is available to treat disc herniation, ranging from conservative methods (medication and physical therapy) to minimally invasive (percutaneous) treatments and surgery. O2-O3 chemonucleolysis (O2-O3 therapy) is one of the minimally invasive treatments with the best cost/benefit ratio and lowest complication rate. Another substance recently made available exploiting the chemical properties of pure ethanol is DiscoGel®, a radiopaque gelified ethanol more viscous than absolute alcohol8,9. The present study aimed to assess the therapeutic outcome of DiscoGel® chemonucleolysis in patients with lumbar disc herniation unresponsive to O2-O3 therapy. Thirty-two patients aged between 20 and 79 years were treated by DiscoGel® chemonucleolysis between December 2008 and January 2010. The treatment was successful (improvement in pain) in 24 out of 32 patients. DiscoGel® is safe and easy to handle and there were no complications related to product diffusivity outside the treatment site. The therapeutic success rate of DiscoGel® chemonucleolysis in patients unresponsive to O2-O3 therapy was satisfactory. Among other methods used to treat lumbar disc herniation, DiscoGel® chemonucleolysis can be deemed an intermediate procedure bridging conservative medical treatments and surgery.

Stagni, S.; de Santis, F.; Cirillo, L.; Dall'Olio, M.; Princiotta, C.; Simonetti, L.; Stafa, A.; Leonardi, M.

2012-01-01

402

A minimally invasive treatment for lumbar disc herniation: DiscoGel® chemonucleolysis in patients unresponsive to chemonucleolysis with oxygen-ozone.  

PubMed

A multitude of therapies is available to treat disc herniation, ranging from conservative methods (medication and physical therapy) to minimally invasive (percutaneous) treatments and surgery. O?-O? chemonucleolysis (O?-O? therapy) is one of the minimally invasive treatments with the best cost/benefit ratio and lowest complication rate. Another substance recently made available exploiting the chemical properties of pure ethanol is DiscoGel®, a radiopaque gelified ethanol more viscous than absolute alcohol 8,9. The present study aimed to assess the therapeutic outcome of DiscoGel® chemonucleolysis in patients with lumbar disc herniation unresponsive to O?-O? therapy. Thirty-two patients aged between 20 and 79 years were treated by DiscoGel® chemonucleolysis between December 2008 and January 2010. The treatment was successful (improvement in pain) in 24 out of 32 patients. DiscoGel® is safe and easy to handle and there were no complications related to product diffusivity outside the treatment site. The therapeutic success rate of DiscoGel® chemonucleolysis in patients unresponsive to O?-O? therapy was satisfactory. Among other methods used to treat lumbar disc herniation, DiscoGel® chemonucleolysis can be deemed an intermediate procedure bridging conservative medical treatments and surgery. PMID:22440607

Stagni, S; de Santis, F; Cirillo, L; Dall'olio, M; Princiotta, C; Simonetti, L; Stafa, A; Leonardi, M

2012-03-01

403

Nucleus-Nucleus Chou-Yang Correlations with Generalized Multiplicity Distribution  

NASA Astrophysics Data System (ADS)

The Chou-Yang model has been successful in describing the forward-backward multiplicity distributions for Hadron-Hadron collisions. The model is extended to the case of Nucleus-Nucleus collisions where geometry is incorporated into the Generalized Multiplicity Distribution component. This contribution is investigated for forward-backward multiplicity measured at 130 GeV Au-Au collisions by calculating the correlation coefficient obtained with the model. Results are also produced for various oxygen-nucleus collisions. Finally the model is applied to the case of Pb-Pb collisions which can be extended to predict correlation coefficients in the TeV range.

Jasvantlal, J. K.; Dewanto, A.; Chan, A. H.; Oh, C. H.

2011-11-01

404

TWO-PHOTON PHYSICS IN NUCLEUS-NUCLEUS COLLISIONS AT RHIC.  

SciTech Connect

Ultra-relativistic heavy-ions carry strong electromagnetic and nuclear fields. Interactions between these fields in peripheral nucleus-nucleus collisions can probe many interesting physics topics. This presentation will focus on coherent two-photon and photonuclear processes at RHIC. The rates for these interactions will be high. The coherent coupling of all the protons in the nucleus enhances the equivalent photon flux by a factor Z{sup 2} up to an energy of {approx} 3 GeV. The plans for studying coherent interactions with the STAR experiment will be discussed. Experimental techniques for separating signal from background will be presented.

NYSTRAND,J.

1998-09-10