Fusion Of Vertebral Bodies Research Articles

Effect of preoperative feeding artery occlusion on invasive vertebral hemangioma resection

To evaluate the effectiveness and safety of preoperative feeding artery occlusion on vertebral resection of invasive vertebral hemangioma. The clinical data of 20 patients with invasive vertebral hemangioma who received posterior lumbar vertebral body resection, bone grafting, fusion and internal fixation between March 2010 and March 2017 were retrospectively analyzed. According to whether feeding artery occlusion was performed before operation, the patients were divided into group A (11 cases, tumor feeding artery occlusion before operation) and group B (9 cases, no tumor feeding artery occlusion before operation). There was no significant difference in gender, age, lesion segment, and disease duration between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, blood transfusion volume, and ambulant time after surgery, hospitalization time, and deep venous thrombosis of lower extremities were recorded and compared between the two groups. Pain improvement was evaluated by visual analogue scale (VAS) score. The operation time, intraoperative blood loss, blood transfusion volume, and ambulant time after surgery were significantly less in group A than those in group B ( P<0.05). There was no significant difference in postoperative drainage volume and hospitalization time between the two groups ( P>0.05). Five patients (3 in group A and 2 in group B) suffered from pleural tear due to intraoperative pleural adhesions. Closed thoracic drainage tubes were placed immediately after suture and extubated on 3-5 days. Both groups were followed up 1-1.5 years, with an average of 1.35 years. In group B, 1 patient died of pulmonary embolism at 7 days after operation; and 2 patients developed deep venous thrombosis of lower extremity after operation, who were treated with inferior vena cava filter and thrombolytic therapy, and recovered well after operation. The local pain of the other patients was significantly relieved after operation, and the pain disappeared at 1 month after operation. The VAS scores of the two groups at 3 days after operation were significantly improved when compared with those before operation ( P<0.05). There was no significant difference in VAS scores between the two groups before operation and at 3 days after operation ( P>0.05). Three patients (2 in group A and 1 in group B) who had neurological symptoms were significantly relieved after surgery. Bone healing was achieved in both groups at 1 year after operation. No fracture or loosening of internal fixator occurred during follow-up. Nutritional artery occlusion before vertebrectomy for invasive vertebral hemangioma can effectively reduce intraoperative blood loss, operation time, perioperative blood transfusion, and other perioperative complications.

Impaired Annulus Fibrosus Development and Vertebral Fusion Cause Severe Scoliosis in Mice with Deficiency of c-Jun NH2-Terminal Kinases 1 and 2

Mitogen-activated protein kinases, including c-Jun NH2-terminal kinase (JNK), play an important role in the development and function of a large variety of tissues. The skeletal phenotype of JNK1 and JNK2 double-knockout (dKO) mice (JNK1fl/flCol2-Cre/JNK2-/-) and control genotypes were analyzed at different embryonic and postnatal stages. JNK1/2 dKO mice displayed a severe scoliotic phenotype beginning during development that was grossly apparent around weaning age. Alcian blue staining at embryonic day 17.5 showed abnormal fusion of the posterior spinal elements. In adult mice, fusion of vertebral bodies and of spinous and transverse processes was noted by micro-computed tomography, Alcian blue/Alizarin red staining, and histology. The long bones developed normally, and histologic sections of growth plate and articular cartilage revealed no significant abnormalities. Histologic sections of the vertebral column at embryonic days 15.5 and 17.5 revealed an abnormal organization of the annulus fibrosus in the dKOs, with chondrocyte-like cells and fusion of dorsal processes. Spinal sections in 10-week-old dKO mice showed replacement of intervertebral disk structures (annulus fibrosus and nucleus pulposus) by cartilage and bone tissues, with cells staining for markers of hypertrophic chondrocytes, including collagen X and runt-related transcription factor 2. These findings demonstrate a requirement for both JNK1 and JNK2 in the normal development of the axial skeleton. Loss of JNK signaling results in abnormal endochondral bone formation and subsequent severe scoliosis.

Two-stage corrective surgery for severe rigid cervical kyphotic deformity with unilateral vertebral artery occlusion after old blunt trauma: a case report.

There are considerable risks for vertebral artery (VA) injury in case of corrective surgery for a severe and rigid cervical kyphotic deformity. This case report describes a rare case of surgical management for pre-existing traumatic rigid cervical kyphosis associated with unilateral VA occlusion. A 73-year-old male fell down and injured his neck. He was referred to our hospital 10 months after injury because his degree of head drop progressed gradually to a chin-on-chest position such that he could not look straight forward. On plain X-ray, the C2-7 angles in the neutral, flexion, and extension positions were 61°, 71°, and 50°, respectively. CT revealed a collapse of the C5 vertebral body and bone fusion between C4 and C5 in the anterior vertebrae, and unilateral VA occlusion was confirmed by angiography. Two-stage surgery was planned to correct the kyphosis. In the first stage, anterior release of the C4/5 bone-spur fusion and dissection of the intervertebral disk were performed. After release, angiography confirmed neither occlusion nor rupture of the VA. In the second stage, anterior and posterior fixation was performed at correcting position while maintaining slight kyphosis in order to avoid excessive distortion of the VA. The postoperative C2-7 kyphosis angle improved to 16° without any VA injury, and the patient could look forward easily. The degree of correction as well as risk management of VAs should be considered carefully during corrective surgery for severe and rigid cervical kyphosis, especially with unilateral VA occlusion.

Incidental findings based on anatomical location and clinical significance in CBCT scans of dental implant patients.

Several incidental findings with varying degrees of clinical significance are often found on cone beam computed tomography (CBCT) scans of the maxillofacial skeleton acquired for dental procedures. The present study analyzed CBCT scans of dental implant therapy patients to identify incidental findings and assign those findings an appropriate clinical significance. A total of 500 CBCT scans of patients were evaluated for this study. The incidental findings recorded in different anatomical regions were assigned a clinical significance score of mild, moderate, or severe. These findings were further segregated based on age and sex to evaluate specific trends for prevalence of incidental findings and their clinical significance. Out of the 298 intracranial findings, four were categorized as moderate. Out of 407 sinonasal findings, 19 were categorized as severe. Most (43%) of the airway findings were classified as mild. Among the cervical vertebrae findings the severe category included degenerative changes and vertebral-body fusion along with other degenerative changes. Most (259 [51.8%]) of the vascular findings were categorized as severe. Patients referred for dental implant treatment present with a myriad of incidental radiographic findings in the head and neck region. It is important that care providers recognize and understand these findings so appropriate care and timely intervention may be initiated.

Bone without minerals and its secondary mineralization in Atlantic salmon (Salmo salar): the recovery from phosphorus deficiency.

Calcium and phosphorus (P) are the main bone minerals, and P deficiency can cause hypomineralized bones (osteomalacia) and malformations. This study used a P-deficient salmon model to falsify three hypotheses. First, an extended period of dietary P deficiency does not cause pathologies other than osteomalacia. Second, secondary mineralization of non-mineralized bone is possible. Third, secondary mineralization can restore the bones' mineral composition and mechanical properties. For 7weeks, post-smolt Atlantic salmon (Salmo salar) received diets with regular P content (RP) or with a 50% lowered P content (LP). For additional 9weeks, RP animals continued on the regular diet (RP-RP). LP animals continued on the LP diet (LP-LP), on a regular P diet (LP-RP) or on a high P diet (LP-HP). After 16 weeks, animals in all groups maintained a non-deformed vertebral column. LP-LP animals continued bone formation albeit without mineralization. Nine weeks of RP diet largely restored the mineral content and mechanical properties of vertebral bodies. Mineralization resumed deep inside the bone and away from osteoblasts. The history of P deficiency was traceable in LP-RP and LP-HP animals as a ring of low-mineralized bone in the vertebral body endplates, but no tissue alterations occurred that foreshadow vertebral body compression or fusion. Large quantities of non-mineralized salmon bone have the capacity to re-mineralize. If 16 weeks of P deficiency as a single factor is not causal for typical vertebral body malformations, other factors remain to be identified. This example of functional bone without minerals may explain why some teleost species can afford to have an extremely low mineralized skeleton.

Effect of different inner core diameters on structural strength of cannulated pedicle screws under various lumbar spine movements

BackgroundCurrently, cannulated pedicle screws have been widely used in minimal invasive or navigation techniques. However, the stress distribution and the strength of different core diameters of cannulated screw are not clear. This study aimed to investigate the mechanical strength of cannulated screws with different inner core diameter under various lumbar spine movements using finite element analysis.ResultsThe results showed that the von-Mises stress of a cannulated screw was larger than that of a solid screw in all loading conditions, especially above 2 mm in cannulated core diameter. In lateral bending, extension, and flexion, the maximum von-Mises stress was found approximate to the proximal thread for all types of screws. In rotation condition, the maximum von-Mises stress was located at the middle of the screw. Additionally, the difference in stiffness of instrumented levels was not significant among four screws under the same loading condition.ConclusionCannulated screws could provide enough stability for the vertebral body fusion comparing to solid screws. The diameter of cannulated core is suggested not to exceed 2.0 mm.

MICROCOMPUTED TOMOGRAPHIC, MORPHOMETRIC, AND HISTOPATHOLOGIC ASSESSMENT OF CONGENITAL BONE MALFORMATIONS IN TWO NEOTROPICAL VIPERIDS.

Congenital malformations have been reported in all classes of vertebrates and may be a determinant of life span and survival. In reptiles, the incidence of congenital malformations can be associated with genetic and environmental causes, including pollution. The characterization of pathological processes involved in the development of congenital malformations of bone in snakes is rare in the literature, but is of great relevance in the field of reptile conservation and environmental health. We describe congenital bone lesions in 50 newborn jararaca (Bothrops jararaca) and 26 South American rattlesnakes (Crotalus durissus terrificus) born from wild-caught pregnant females in Southeastern Brazil. Lesions were evaluated by morphometric quantitative analysis, x-ray microtomography, and histopathologic descriptive analysis. Morphometric analysis showed that jararaca presented more severe axial lesions (kyphosis, scoliosis, and kyphoscoliosis) than rattlesnakes. Female rattlesnakes presented more severe axial lesions than did males. In rattlesnakes, spinal deformities were more frequently diagnosed in the caudal segment of the body. We present x-ray microtomographic assessments and images of malformed snakes (n=9) and characterized novel malformations, such as the agenesis of frontal, parietal, and supraoccipital bones in a jararaca specimen. Histopathologic findings included vertebral body fusion, myositis, coagulation necrosis, and disorganization of periaxial muscle fibers. The new methods and results presented in this study will be useful and informative for future research in pathology, teratology, embryology, and ecotoxicology in snakes.

Back Injury - Mountain Biking

HISTORY: A 31-year-old recreational mountain biker presented with a one-month history of 5/10 low back pain. During a weekend excursion, he rode off of a 15 foot drop and landed flexed forward at the waist on his bike with his tailbone landing directly on the rear tire. He experienced immediate low back pain without radiation, numbness or tingling in the legs, or loss of bowel and bladder control. He was able to complete his ride and walk to his car. He continued to have low back soreness (2-4/10) particularly when sitting upright in a chair that limited his normal 5x/week exercise routine. PHYSICAL EXAMINATION: Examination revealed tenderness to palpation off of the midline bilaterally at L3-L4. He was nontender over the sciatic notches with very mild lumbar paraspinal muscle spasm at L2-L4. Forward flexion was 90% of the floor. He exhibited full extension and lateral bend. L1-S1 sensation was intact. Normal squat, heel and toe walk with 5/5 EHL strength bilaterally. He had negative straight leg raises supine and seated. Achilles and Patellar reflexes were 2 and 2+. DIFFERENTIAL DIAGNOSIS: 1. Lumbar Compression Fracture 2. Lumbar Paraspinal Muscle Sprain 3. Lumbar Disc Injury 4. Lumbar Isthmic Spondylolisthesis TEST AND RESULTS: Lumbar spine AP and lateral radiographs: -No evidence of acute fracture or dislocation. No significant degenerative changes. -Partial fusion of the anterior aspects of the vertebral bodies of T12 and L1, possibly congenital. Lumbar spine MRI without contrast: -Partial fusion of T12 and L1 vertebral body. -Degenerative disc disease at L4-L5 with central annular tear of the disc. FINAL WORKING DIAGNOSIS: Central annular tear of the L4-L5 disc TREATMENT AND OUTCOMES: 1. Rest and activity modification for 7 months. 2. Core strengthening physical therapy program for 8 weeks. 3. Negative radiographs rule out compression fracture with continued symptoms 9 months post injury. 4. Return to 65% capacity mountain biking with new onset low back weakness and radiation of pain into left buttock/testicle. Continued to deny red flag symptoms. 5. MRI revealed an annular tear of the L4-L5 disc. 6. Return to physical therapy for core strengthening program. Pain decreased to only upon awakening after 12 of 16 sessions. Gradual return to activity will be implemented with continued pain free progress with physical therapy.

The treatment of lumbar intervertebral infection via single-stage posterior midline incision and bilateral muscle gap approach

Objective To evaluate the effect of treatment of the intervertebral infection via single-stage posterior midline incision and bilateral muscle gap approach. Methods A retrospective of 39 cases (male 25 cases, female 14 cases) of lumbar intervertebral infected patients from October 2012 to December 2014 who were treated by posterior debridement, interbody fusion using allograft and posterior instrumentation through paraspinal muscle gap approach were analyzed, whose mean age was 48 years (range 11-70 years). According to the confirming diagnosis, patients underwent postoperatively anti-inflammatory or chemotherapy treatment. The disease controlling statues were evaluated based on laboratory results of ESR, CRP; Imaging examinations were taken to evaluate the fusion of vertebral body; Clinical effects were evaluated using the Visual Analog Scale (VAS) and the JOA score of lumbar function. Results In these 39 cases of intervertebral infection patients, 8 cases ware diagnosed as pyogenic infectious, 25 cases were diagnosed as tuberculosis infections, 2 cases were diagnosed as unknown infections, and brucellosis infectious was found in 4 cases. All patients' symptoms were significantly improved. The lower back VAS score: average 8.22±0.93 points before operation, average 2.21±0.88 points one week after operation, and an average score of 0.80±0.58 points by the last follow-up time. The lower extremity VAS score: average 2.32±1.82 points before operation, average 1.89±0.62 points one week after operation, and an average score of 0.61±0.47 points by the last follow-up time. All patients were followed up for 1218 months (average 13 months), One patient with pyogenic infectious occurred wound infection 1 week postoperatively, and healed after a repeatedly surgery. No internal fixation loosening, fracture, or segmental collapse was observed, and good fusion was present in all patients after 12 months. JOA lumbar function score: all patients were effective after operation, the improvement rate was excellent in 76.9%, good in 17.9%, and passable in 5.2%. Comparing with preoperation, the excellent and good rate was 94.8%. Conclusion The treatment of lumbar intervertebral infection via single-stage posterior midline incision and bilateral muscle gap approach was clinically effective, which can completely remove the lesion, and achieve rigid internal fixation. Key words: Lumbar vertebrae; Tuberculosis, spinal; Brucellosis; Infection; Treatment outcome

Cement plug technique for the management of disc-associated cervical spondylopathy in 52 Dobermann Pinscher dogs.

To report the radiographic and clinical outcome of an intervertebral bone cement plug technique for the management of disc-associated cervical spondylopathy in Dobermann Pinscher dogs. Retrospective study of 52 Dobermann Pinscher dogs. A variable degree of cement plug subsidence with loss of vertebral distraction was evident in all dogs (n = 40) that were radiographed >6 weeks postoperatively. In no case was there definitive evidence of vertebral body fusion. Eight dogs had a sudden deterioration in neurological status, cervical hyperaesthesia, or both between three days and 12 weeks following surgery that was considered to be implant-associated; six of these dogs were euthanatized. Following surgery, 43/52 dogs were considered to be neurologically normal or to have improved, however, nine of 43 subsequently deteriorated due to adjacent segment disease. At the long-term follow-up, 34 dogs were considered to be neurologically normal or to have improved. Twenty-nine dogs were dead by the end of the study period. Intervertebral bone cement plug surgery results in an initial improvement in clinical signs in the majority of Dobermann Pinschers with disc-associated cervical spondylopathy. However, it fails to maintain vertebral distraction or achieve vertebral body fusion, and is associated with acute implant complications, additional cervical disc protrusions or mortality in a significant proportion of cases.

Inflammation-driven bone formation in a mouse model of ankylosing spondylitis: sequential not parallel processes.

BackgroundAnkylosing spondylitis (AS) is an immune-mediated arthritis particularly targeting the spine and pelvis and is characterised by inflammation, osteoproliferation and frequently ankylosis. Current treatments that predominately target inflammatory pathways have disappointing efficacy in slowing disease progression. Thus, a better understanding of the causal association and pathological progression from inflammation to bone formation, particularly whether inflammation directly initiates osteoproliferation, is required.MethodsThe proteoglycan-induced spondylitis (PGISp) mouse model of AS was used to histopathologically map the progressive axial disease events, assess molecular changes during disease progression and define disease progression using unbiased clustering of semi-quantitative histology. PGISp mice were followed over a 24-week time course. Spinal disease was assessed using a novel semi-quantitative histological scoring system that independently evaluated the breadth of pathological features associated with PGISp axial disease, including inflammation, joint destruction and excessive tissue formation (osteoproliferation). Matrix components were identified using immunohistochemistry.ResultsDisease initiated with inflammation at the periphery of the intervertebral disc (IVD) adjacent to the longitudinal ligament, reminiscent of enthesitis, and was associated with upregulated tumor necrosis factor and metalloproteinases. After a lag phase, established inflammation was temporospatially associated with destruction of IVDs, cartilage and bone. At later time points, advanced disease was characterised by substantially reduced inflammation, excessive tissue formation and ectopic chondrocyte expansion. These distinct features differentiated affected mice into early, intermediate and advanced disease stages. Excessive tissue formation was observed in vertebral joints only if the IVD was destroyed as a consequence of the early inflammation. Ectopic excessive tissue was predominantly chondroidal with chondrocyte-like cells embedded within collagen type II- and X-rich matrix. This corresponded with upregulation of mRNA for cartilage markers Col2a1, sox9 and Comp. Osteophytes, though infrequent, were more prevalent in later disease.ConclusionsThe inflammation-driven IVD destruction was shown to be a prerequisite for axial disease progression to osteoproliferation in the PGISp mouse. Osteoproliferation led to vertebral body deformity and fusion but was never seen concurrent with persistent inflammation, suggesting a sequential process. The findings support that early intervention with anti-inflammatory therapies will be needed to limit destructive processes and consequently prevent progression of AS.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0805-0) contains supplementary material, which is available to authorized users.

Difficult endotracheal intubation secondary to tracheal deviation and stenosis in a patient with severe kyphoscoliosis: a case report.

We report on a case of difficult endotracheal intubation in a patient with marked tracheal deviation at an angle of 90 degrees combined with stenosis due to kyphoscoliosis with vertebral body fusion. After induction of general anesthesia, a proper laryngeal view was easily obtained using a videolaryngoscope. But a tracheal tube could not be advanced more than 3 cm beyond the vocal cords due to resistance, despite various attempts, including the use of small size tubes, full rotation of the tube tip, and fiberoptic bronchoscopy. Ultimately, the airway was successfully secured by placing a tube tip above the area of resistance and by additionally packing saline-soaked gauzes around the tracheal inlet to minimize gas leakage and to fasten the tube in the trachea.

Observations of sacrocaudal fusion in Greyhounds and other dogs.

To describe the incidence and forms of nonpathological sacrocaudal fusion in racing Greyhounds and compare them with those in a variety of other domestic dog breeds. This retrospective observational study used archived anatomical specimens from 81 racing Greyhounds and 10 Beagles, and archived clinical radiographs from 81 non-Greyhound dogs representing 37 other breeds. Dogs less than two years of age and dogs with evidence of soft tissue or osseous pathology involving the sacrocaudal region were excluded. The incidence of osseous sacrocaudal fusion (any type and complete fusion) was compared between Greyhounds and all of the other dogs combined, using the Fisher's exact test. Sacrocaudal fusion of some type was found in 33 (41%) of 81 Greyhounds but in only 14 (15%) of 91 non-Greyhound dogs (p <0.01). Complete fusion (osseous fusion of vertebral bodies and both transverse and articular processes) between the sacrum and the first caudal vertebra was the most common form in Greyhounds, found in 27 (33%) of 81 Greyhounds, but in only three (3.3%) of 91 non-Greyhound dogs (p <0.01). Sacrocaudal fusion appears to be more prevalent in Greyhounds than in other domestic dog breeds and may be attributable to selection pressure for speed on a region of the spine that is naturally prone to variation. Its significance for performance and soundness requires further study.

PEEK-Halo effect in interbody fusion

Recent developments have seen poly[aryl-ether-ether-ketone] (PEEK) being increasingly used in vertebral body fusion. More novel approaches to improve PEEK have included the introduction of titanium-PEEK (Ti-PEEK) composites and coatings. This paper aims to describe a potential complication of PEEK based implants relating to poorer integration with the surrounding bone, producing a “PEEK-Halo” effect which is not seen in Ti-PEEK composite implants. We present images from two patients undergoing anterior lumbar interbody fusion (ALIF). The first patient underwent an L5/S1 ALIF using a PEEK implant whilst the second patient underwent L4/L5 ALIF using a Ti-PEEK composite implant. Evidence of osseointegration was sought using CT imaging and confirmed using histological preparations of a sheep tibia model. The PEEK-Halo effect is demonstrated by a halo effect between the PEEK implant and the bone graft on CT imaging. This phenomenon is secondary to poor osseointegration of PEEK implants. The PEEK-Halo effect was not demonstrated in the second patient who received a Ti-PEEK composite graft. Histological analysis of graft/bone interface surfaces in PEEK versus Ti-PEEK implants in a sheep model further confirmed poorer osseointegration of the PEEK implant. In conclusion, the PEEK-Halo effect is seen secondary to minimal osseointegration of PEEK at the adjacent vertebral endplate following a PEEK implant insertion. This effect is not seen with Ti-PEEK implants, and may support the role of titanium in improving the bone–implant interface of PEEK substrates.

Multiple extradural and intradural spinal anomalies in a child

A 7-year-old boy presented with history of weakness of the lower limbs and bladder incontinence since early childhood. His magnetic resonance imaging at 4 months of age had demonstrated multiple spinal anomalies (Fig. 1A). He was lost to follow-up after having being advised surgery. Magnetic resonance imaging done 7 years later demonstrated a Chiari type I malformation with a holocord syrinx (Fig. 1B, C), a ventrally located, intradural cystic lesion suggestive of a neurenteric cyst compressing the cord from C3 to C5 levels (Fig. 1B–D), and scoliosis of the lower cervical spine (Fig. 1D). The conus was noted to be low lying and tethered (Fig. 2A), and there was evidence of a split cord malformation (Fig. 2B) with two holocords seen at the L4 level. Computed tomography of the lumbosacral spine (Fig. 2C, D) demonstrated evidence of lumbosacral agenesis, with absence of L5, S1, and S2 vertebral bodies, incompletely formed posterior elements, and total absence of the rest of the sacral vertebrae and coccyx. Some of the other spinal anomalies included partial fusion of multiple vertebral bodies in the dorsal and cervical regions and a few hemivertebrae in the dorsal spine. The boy underwent a foramen magnum decompression, excision of the neurenteric cyst, and detethering of cord. Fig. 2Follow-up MRI of the lumbosacral spine showing (A) the lower extent of the holocord syrinx and a low-lying, tethered conus on sagittal T2 sequence; (B) T2-weighted axial section at L4 demonstrating a split cord malformation with two evident holocords. CT images of the lumbosacral spine showing (C, D) the absence of L5, S1, and S2 and the sacral vertebrae, and incompletely formed posterior elements. View Large Image Figure Viewer Download Hi-res image

Evaluation of 12 Novel Molecular Markers for Degenerated Nucleus Pulposus in a Chinese Population.

A transcriptional expression assessment of human samples. To evaluate 12 new candidate nucleus pulposus (NP) markers in degenerative disc disease in a Chinese population. Disc degeneration is a major contributor of low back pain. However, no specific and reliable markers of degeneration of NP are available. Specimens of NP were collected from 81 patients and grouped into the degenerated disc group (undergoing discectomy and fusion with significant signs of disc degeneration) and the trauma control group (undergoing anterior vertebral body and disc excision and fusion without signs of disc degeneration). Lumbar spine magnetic resonance imaging, hematoxylin-eosin staining, and safranin O staining of sections of NP tissues were conducted to evaluate the severity of the disc degeneration in all samples. Quantitative reverse transcription polymerase chain reaction was performed to investigate the levels of mRNA expression of these genes, as well as those of aggrecan, type II collagen, and SRY-box 9 (SOX-9). Degenerated samples were also divided into groups according to Pfirrmann grading system to elucidate the association of severity of degeneration and gene transcriptional levels. We also tested the relationship between mRNA levels of these genes and clinical characteristics such as hypertension and diabetes mellitus. We demonstrated that 11 of the 12 candidates showed significant differential expression in degenerated discs. Changes in the expression of these 11 genes were determined to be risk factors in degenerative disc diseases. The expression of neurochondrin (NCDN), keratin 8 (KRT8), and matrix Gla protein (MGP) even showed significant changes among subgroups of patients with degenerative disc disease stratified according to the Pfirrmann grading system. The expression of keratin 18 (KRT18), cadherin 2 (CDH2), synaptosomal-associated protein 25 (SNAP25), KRT8, and NCDN was significantly decreased in patients with hypertension. In contrast, the expression of MGP and cartilage oligomeric matrix protein was significantly upregulated in patients with diabetes mellitus. Overall, we demonstrated the clinical utility of 11 novel NP markers for degenerative disc disease. Among them, the expression of NCDN, KRT8, and MGP may indicate the severity of disc degeneration. N/A.

Evidence of spondyloarthropathy in the spine of a phytosaur (Reptilia: Archosauriformes) from the Late Triassic of Halberstadt, Germany.

Pathologies in the skeleton of phytosaurs, extinct archosauriform reptiles restricted to the Late Triassic, have only been rarely described. The only known postcranial pathologies of a phytosaur are two pairs of fused vertebrae of “Angistorhinopsis ruetimeyeri” from Halberstadt, Germany, as initially described by the paleontologist Friedrich von Huene. These pathologic vertebrae are redescribed in more detail in this study in the light of modern paleopathologic methods. Four different pathologic observations can be made in the vertebral column of this individual: 1) fusion of two thoracic vertebral bodies by new bone formation within the synovial membrane and articular capsule of the intervertebral joint; 2) fusion and conspicuous antero-posterior shortening of last presacral and first sacral vertebral bodies; 3) destruction and erosion of the anterior articular surface of the last presacral vertebra; and 4) a smooth depression on the ventral surface of the fused last presacral and first sacral vertebral bodies. Observations 1–3 can most plausibly and parsimoniously be attributed to one disease: spondyloarthropathy, an aseptic inflammatory process in which affected vertebrae show typical types of reactive new bone formation and erosion of subchondral bone. The kind of vertebral shortening present in the fused lumbosacral vertebrae suggests that the phytosaur acquired this disease in its early life. Observation 4, the smooth ventral depression in the fused lumbosacral vertebrae, is most probably not connected to the spondyloarthropathy, and can be regarded as a separate abnormality. It remains of uncertain origin, but may be the result of pressure, perhaps caused by a benign mass such as an aneurysm or cyst of unknown type. Reports of spondyloarthropathy in Paleozoic and Mesozoic reptiles are still exceptional, and our report of spondyloarthropathy in fossil material from Halberstadt is the first unequivocal occurrence of this disease in a Triassic tetrapod and in a phytosaur.

A new type of lordosis and vertebral body compression in Gilthead sea bream, Sparus aurata L.: aetiology, anatomy and consequences for survival

A new type of vertebral malformation is described, consisting of deformed cartilaginous neural and haemal processes and the compression and fusion of vertebral bodies. The malformation is designated as haemal vertebral compression and fusion (haemal VCF). We studied the aetiology of the malformations and described microanatomical histopathological alterations. The malformations were detected during routine quality control in one of six monitored Gilthead sea bream populations. Haemal VCF affected the posterior part of the vertebral column (haemal vertebrae). In 20% of the deformed specimens, haemal VCF was combined with lordosis. At 35 dph (days post-hatching), early anatomical signs of the haemal VCF consisted of abnormal centrum mineralization, malformed cartilaginous neural and haemal processes and developing lordotic alterations. The histological examination of the deformed individuals revealed that haemal VCF is preceded by notochord abnormalities. The frequency of deformed individuals was three times higher at 35 than at 61 dph (50.3% vs. 17.2%, n = 157 and n = 250, respectively). No signs of repair or reversion of malformations have been observed. Thus, the steep decrease in deformities in older animals suggests that haemal VCF is linked to high mortality rates. The results are discussed in respect of the possible causative factors of haemal VCF.

Skeletal deformities in the larvae and juveniles of cultured tongue sole (Cynoglossus semilaevis)

The tongue sole(Cynoglossus semilaevis Gunther) is an increasingly important marine flatfish with sig-nificant potential for aquaculture China.We documented skeletal development and deformities in tank-reared C.semilaevis larvae and juveniles(n=459).The specimens were double stained with alcian blue and alizarin red.We identified 14 types of skeletal malformations,including vertebral body fusion,hyperplasia,local hypertrophy,de-tached haemal and neural spines,bifurcated haemal and neural spines,and a bifurcated caudal fin.These skeletal malformations were most common during the post-metamorphosis stage(day 25,31.8% of specimens) and later during metamorphosis(day 40,25% of specimens).Malformations were most common in the PH(prehaemal re-gion),HE(haemal region),and CA(caudal region) of the vertebral column,but were absent in the CE(cephalic region).Our results provide insight into the developmental process and optimization of rearing conditions for C.semilaevis.

Lumbar hemangioma masking a plasma cell tumor—case report and review of the literature

Background contextVertebral hemangiomata are ubiquitous bone tumors. Often multiple, they are generally benign in nature and slow growing. They typically have a predictable radiographic appearance. Occasionally, hemangiomata may behave in a more aggressive manner, causing pathologic fracture or even symptoms/signs of nerve compression. In such cases, one must be careful not to assume that an atypical hemangioma is responsible. Coexisting, more malignant processes may be present and sometimes may be radiographically undetectable in the setting of acute fracture. This was the case in our patient. Study designCase report/university spine surgery center. MethodsThe patient underwent a corpectomy of her affected vertebra with conversion to a total spondylectomy when intraoperative frozen section was consistent with plasma cell neoplasm. A reconstruction with vertebral body replacement and fusion through anterior and posterior approaches was completed. Subsequently, the literature was reviewed for other cases of atypical hemangiomata to investigate the incidence of coexistent lesions. ResultsThis patient presented with pain secondary to an unstable pathologic vertebral body fracture. Surgery to stabilize her spine was elected. Intraoperative recognition of abnormal-appearing tissue led to the diagnosis of a plasma cell neoplasm that was not seen on imaging. Coexistent in the same vertebra was hemangiomatous tissue that was visible on preoperative imaging. ConclusionsThere are rare reports of aggressively behaving hemangiomata that mainly have occurred in the thoracic spine. There have been no reports of the coexistence of a hemangioma and a plasma cell tumor in the same vertebral level in the setting of acute compression fracture.