Study design Review. Objective To formally introduce "degenerative cervical myelopathy" (DCM) as the overarching term to describe the various degenerative conditions of the cervical spine that cause myelopathy. Herein, the epidemiology, pathogenesis, and genetics of conditions falling under this hypernym are carefully described. Summary of background data Nontraumatic, degenerative forms of cervical myelopathy represent the commonest cause of spinal cord impairment in adults and include cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament, ossification of the ligamentum flavum, and degenerative disc disease. Unfortunately, there is neither a specific term nor a specific diagnostic International Classification of Diseases, Tenth Revision code to describe this collection of clinical entities. This has resulted in the inconsistent use of diagnostic terms when referring to patients with myelopathy due to degenerative disease of the cervical spine. Methods Narrative review. Results The incidence and prevalence of myelopathy due to degeneration of the spine are estimated at a minimum of 41 and 605 per million in North America, respectively. Incidence of cervical spondylotic myelopathy-related hospitalizations has been estimated at 4.04/100,000 person-years, and surgical rates seem to be rising. Pathophysiologically, myelopathy results from static compression, spinal malalignment leading to altered cord tension and vascular supply, and dynamic injury mechanisms. Occupational hazards, including transportation of goods by weight bearing on top of the head, and other risk factors may accelerate DCM development. Potential genetic factors include those related to MMP-2 and collagen IX for degenerative disc disease, and collagen VI and XI for ossification of the posterior longitudinal ligament. In addition, congenital anomalies including spinal stenosis, Down syndrome, and Klippel-Feil syndrome may predispose to the development of DCM. Conclusion Although DCMs can present as separate diagnostic entities, they are highly interrelated, frequently manifest concomitantly, present similarly from a clinical standpoint, and seem to be in part a response to compensate and improve stability due to progressive age and wear of the cervical spine. The use of the term "degenerative cervical myelopathy" is advocated. Level of evidence 5.

Degenerative Cervical Myelopathy: Epidemiology, Genetics, and Pathogenesis.

Fusion,四个来自上海的大男孩。2008年第一周,他们发行属于自己的第一张创作专辑《如果未来》。一点一点向梦想靠近的他们坦言:"一开始组乐队只是为了爱好,只是在玩,但是玩着玩着,发现已经不能不玩,可是如果要继续玩,我们需要更大的力气与努力。"这种勇气,我们坚信:音乐、如果,爱,就要,继续!

Fusion 如果,爱

Growth factors (GFs) are soluble proteins secreted by cells that have the ability to regulate a variety of cellular processes and tissue regeneration. However, their translation into clinical applications is limited due to their short effective half-life, low stability, and rapid inactivation by enzymes under physiological conditions. To maximize the effectiveness of GFs and their biologically relevant applicability, a wide variety of sophisticated bio-inspired systems have been developed that augment tissue repair and cellular regeneration by controlling how much, when, and where GFs are released. Recently, protein immobilization techniques combined with nanomaterial carriers have shown promise in mimicking the natural healing cascade during tissue regeneration by augmenting the delivery and effectiveness of GFs. This review evaluates the latest techniques in direct immobilization and relevant biomaterials used for GF loading and release, including synthetic polymers, albumin, polysaccharides, lipids, mesoporous silica-based nanoparticles (NPs), and polymeric capsules. Specifically, we focus on GF-encapsulated NPs in functionalized microporous scaffolds as a promising alternative with the ability to mimic extracellular matrix (ECM) hierarchical architectures and components with high cell affinity and bioactivity. Finally, we discuss how these next-generation, advanced delivery systems have been used to enhance tissue repair and regeneration and consider future implications for their use in the field of regenerative medicine. Nanomaterials can speed up the rate at which wounds heal and tissue regenerates. Songlin Peng from the Jinan University Second College of Medicine, China, and colleagues review the development of artificial materials that achieve this aim by mimicking the hierarchical architecture of the extracellular matrix. Cells can proliferate and migrate by secreting proteins that signal to adjacent cells. These proteins – known as growth factors – bind to specific receptors on the target cell. But it is difficult to harness this simple concept in clinical applications such as wound healing because the instability of growth factors limits their safety and cost effectiveness. Peng and co-workers review recent progress in the use of functionalized microporous scaffolds functionalized with growth factor encapsulated nanoparticles. They also outline its advantages over alternative approaches employing polymers, lipids and mesoporous silica-based nanoparticles. Schematic illustration of Biomaterial Strategies for Controlled Growth Factor (GF) Delivery for Biomedical Applications. (a) The direct approaches for the immobilization/encapsulation of GFs to biomaterials; (b) Nanocarriers for GFs encapsulation and release; (c) GFs encapsulated nanocarriers functionalized biomaterials for tissue regeneration.

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Novel biomaterial strategies for controlled growth factor delivery for biomedical applications

Objectives 1. List the types of spondylolisthesis described by Wiltse, and fully describe the types seen in children and adolescents 2. Describe commonly used radiographic parameters used to quantitate the severity of spondylolisthesis 3. Discuss the etiology of spondylolisthesis 4. Discuss the risk of progression of a child or adolescent with spondylolisthesis, and factors which contribute a higher risk of progression 5. Discuss factors related to symptoms in patients with spondylolisthesis 6. Describe physical findings associated with mild and severe spondylolisthesis 7. Discuss indications for surgery for spondylolisthesis, including specific procedures useful for both mild and severe slippage

Spondylolisthesis 의 手術治驗例

National trends in the surgical treatment for lumbar degenerative disc disease: United States, 2000 to 2009.

Trends in the surgical treatment of lumbar spine disease in the United States.

The purpose of this study was to identify the trends and demographics of patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction in the United States. Patients who underwent arthroscopic ACL reconstruction between 2004 and 2009 were identified by searching Current Procedural Terminology codes in the PearlDiver Patient Record Database (PearlDiver Technologies, Fort Wayne, IN). The year of procedure, age, gender, and region of the United States were recorded for each patient. Associated meniscal procedures and the absence or presence of a femoral nerve block were also recorded. The incidence of ACL reconstruction significantly increased over the study period, from 40.9 cases per 10,000 patients in 2004 to 47.8 in 2009 (p

Trends and Demographics in Anterior Cruciate Ligament Reconstruction in the United States.

Study Design. Retrospective analysis of kinematic magnetic resonance images. Objective. To provide baseline data on the segmental angular and translational motion of the degenerated cervical spine by subtype of kyphotic cervical deformity and to elucidate the relationship between motion and degree of spinal cord compression. Summary of Background Data. Kyphotic deformities of the cervical spine are relatively common and are classified as either global or focal. Nevertheless, the effects of kyphotic subtype on cervical segmental motion and degree of spinal cord compression are unknown. Methods. A total of 1171 symptomatic patients (618 females, 553 males) underwent cervical kinematic magnetic resonance imaging in the neutral, flexion, and extension positions. Cervical spines demonstrating kyphosis were included and classified into 3 groups: (1) “global kyphotic deformity” (C-type) (n = 54); (2) “sigmoid deformity” (S-type) with kyphotic upper and lordotic lower cervical segments (n = 29); and (3) “reverse sigmoid deformity” (R-type) with lordotic upper and kyphotic lower cervical segments (n = 39). Translational motion, angular motion, and degree of spinal cord compression were evaluated for each cervical level along with the changes associated with flexion and extension. Results. In the C- and R-types, angular motion with extension was increased in the upper cervical spine, where there was kyphosis; when compared with the S-type, in which there was lordosis in the upper segments. The results were opposite for flexion angular motion. R-type displayed more translational motion at C3–C4 and C5–C6. Degree of static spinal cord compression of R-type was higher than the others at C3–C4. The dynamic spinal cord compression increased in extension more than flexion in all subtypes. Conclusion. Cervical spine studies that aim to investigate kyphotic deformities should make efforts to discern the different subtypes of kyphotic deformities to more accurately characterize and study the effects that the sagittal alignment has on the kinematics of the spine and the degree of spinal cord compression. Conclusion. Level of Evidence: 3

Effect of cervical kyphotic deformity type on the motion characteristics and dynamic spinal cord compression.

OBJECT Most studies of Modic changes (MCs) have focused on investigating the relationship between MCs and lowback pain, whereas the kinematic characteristics and degenerative disc disease associated with MCs are not well understood. To the authors' knowledge, no previous study has reported on the kinematics of MCs. The purpose of this study was to elucidate the relationship of MCs to segmental motion and degenerative disc disease. METHODS Four hundred fifty symptomatic patients underwent weight-bearing lumbar kinematic MRI in the neutral, flexion, and extension positions. Segmental displacement and intervertebral angles were measured in 3 positions using computer analysis software. Modic changes, disc degeneration, disc bulging, spondylolisthesis, angular motion, and translational motion were recorded, and the relationship of MCs to these factors was analyzed using a logistic regression model. To control the influence of disc degeneration on segmental motion, angular and translational motion were analyzed according to mild and severe disc degeneration stages. The motion characteristics and disc degeneration among types of MCs were also evaluated. RESULTS Multivariate analysis revealed that age, disc degeneration, angular motion, and translational motion were factors significantly related to MCs. In the severe disc degeneration stage, a significant decrease of angular motion and significant increase of translational motion were found in segments with MCs, indicating that a disorder of the endplate had an additional effect on segmental motion. Disc degeneration increased and angular motion decreased significantly and gradually as the type of MC increased. Translational motion was significantly increased with Type 2 MCs. CONCLUSIONS Age, disc degeneration, angular motion, and translational motion were significantly linked to MCs in the lumbar spine. The translational motion of lumbar segments increased with Type 2 MCs, whereas angular motion decreased as the type of MC increased, indicating that Type 2 MCs may have translational instability likely due to degenerative changes. A disorder of the endplates could play an important role in spinal instability.

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Motion characteristics and related factors of Modic changes in the lumbar spine

Study Design. Retrospective analysis of kinematic magnetic resonance (MR) images. Objective. To elucidate the distribution and risk factors associated with missed dynamic stenosis in cervical spine. Summary of Background Data. Motion of the cervical spine is widely accepted to be associated with cervical spondylotic myelopathy; however, the distribution and the risk factors for dynamic spinal stenosis are not well understood. Methods. A total of 435 symptomatic patients (2610 cervical segments) obtained upright kinematic MR images in neutral, flexion, and extension postures. Spinal cord compression (SCC), spondylolisthesis, disc bulging, angular motion, translational motion, disc degeneration grade, Modic changes, segmental alignment, and developmental stenosis were all evaluated. Cervical segments C2–C3 to C7–T1 were divided into 2 groups, determined by the presence of SCC. After excluding segments with SCC in the neutral position, a multivariate logistic regression model was used to evaluate for associated risk factors of SCC in flexion and extension that were not present in the neutral position. Results. SCC in neutral position was observed in 5.3% (139/2610) of segments. After excluding these segments, missed dynamic stenosis was found in 8.3% (204/2471) of segments in extension and 1.6% (40/2471) in flexion. Missed dynamic stenosis in both extension and flexion was most frequent at C5–C6. Multivariate logistic regression analysis for dynamic stenosis in extension revealed that disc bulge greater than 2.4 mm, angular motion greater than 4.8°, moderate and severe disc degeneration, segmental kyphosis, and developmental stenosis were significant risk factors. In flexion, significant risk factors were a disc bulge of 1.9 mm or greater, moderate to severe disc degeneration, and segmental kyphosis. Conclusion. Dynamic cord compression was most common at the C5–C6 segment. Cervical segments with greater disc bulge, more severe disc degeneration, greater angular motion, segmental kyphosis, and developmental stenosis may be at risk for missed dynamic stenosis. Conclusion. Level of Evidence: 2

Trevor P. Scott

Papers

Trends in the surgical treatment of lumbar spine disease in the United States.

Trends and Demographics in Anterior Cruciate Ligament Reconstruction in the United States.

Effect of cervical kyphotic deformity type on the motion characteristics and dynamic spinal cord compression.

Motion characteristics and related factors of Modic changes in the lumbar spine

Risk factors for missed dynamic canal stenosis in the cervical spine.