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Biomedical subjects

G Cinotti

Publications and source records attributed to G Cinotti.

At least 19 recordsLinked to original sources
PubMed2004

Experimental posterolateral spinal fusion with porous ceramics and mesenchymal stem cells.

Alternatives to autogenous bone graft for spinal fusion have been investigated for many years. It has been shown that osteoconductive materials alone do not give a rate of fusion which is comparable to that of autogenous bone graft. We analysed the effectiveness of porous ceramic loaded with cultured mesenchymal stem cells as a new graft material for spinal fusion in an animal model. Posterolateral fusion was carried out at the L4/L5 level in 40 White New Zealand rabbits using one of the following graft materials: porous ceramic granules plus cultured mesenchymal stem cells (group I); ceramic granules plus fresh autogenous bone marrow (group II); ceramic granules alone (group II); and autogenous bone graft (group IV). The animals were killed eight weeks after surgery and the spines were evaluated radiographically, by a manual palpation test and by histological analysis. The rate of fusion was significantly higher in group I compared with group III and higher, but not significantly, in group I compared with groups II and IV. In group I histological analysis showed newly formed bone in contact with the implanted granules and highly cellular bone marrow between the newly formed trabecular bone. In group II, thin trabeculae of newly formed bone were present in the peripheral portion of the fusion mass. In group III, there was a reduced amount of newly formed bone and abundant fibrous tissue. In group IV, there were thin trabeculae of newly formed bone close to the decorticated transverse processes and dead trabecular bone in the central portion of the fusion mass. In vitro cultured mesenchymal stem cells may be loaded into porous ceramic to make a graft material for spinal fusion which appears to be more effective than porous ceramic alone. Further studies are needed to investigate the medium- to long-term results of this procedure, its feasibility in the clinical setting and the most appropriate carrier for mesenchymal stem cells.

Animals↗
PubMed2002

Recovery of motor deficits after microdiscectomy for lumbar disc herniation.

We 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) in 12%. The muscle which most frequently had severe or very severe weakness was extensor hallucis longus, followed in order by triceps surae, extensor digitorum communis, tibialis anterior, and others. At the latest follow-up examination, 76% of patients had complete recovery of strength. Persistent weakness was found in 16% of patients who had had a mild preoperative deficit and in 39% of those with severe or very severe weakness. Muscle strength was graded 4 in all patients with persistent weakness, except for four with a very severe preoperative deficit affecting the L5 or S1 nerve root. They showed no significant recovery. Excluding this last group, the degree of recovery of motor function was inversely related to the preoperative severity and duration of muscle weakness. The patients' subjective functional capacity was not directly related to the degree of recovery except in those with persistent severe or very severe deficit.

Adolescent↗
PubMed1999

Contralateral recurrent lumbar disc herniation. Results of discectomy compared with those in primary herniation.

STUDY DESIGN: The surgical outcomes of patients who underwent discectomy for contralateral recurrent herniation and primary herniation were evaluated. OBJECTIVE: To assess whether the clinical results in patients undergoing surgery for contralateral recurrent disc herniation may be as good as those reported after primary discectomy. SUMMARY OF BACKGROUND DATA: No retrospective or prospective investigation has been conducted on the surgical treatment of contralateral recurrent lumbar disc herniation. METHODS: Sixteen patients who underwent surgery for recurrent disc herniation at the same level as primary disc excision, but on the opposite side, were analyzed prospectively from the recurrence of contralateral radicular pain (Group 1). All patients had reported a satisfactory results after primary discectomy. Fifty consecutive patients who underwent disc excision during the study period, who did not report recurrent radicular pain, were analyzed for comparison (Group 2). Overall patient satisfaction, pain severity, functional outcome, and work status were evaluated. RESULTS: At the 2-year follow-up, the clinical outcome was rated as satisfactory in 14 of 16 patients in Group 1 and in 45 of 50 in Group 2 (P > 0.05). Twelve patients in Group 1 and 42 in Group 2 had resumed their work or daily activities at the same level as before the operation (P > 0.05). Radicular pain was significantly improved in both groups at the 6-month and 2-year follow-ups. At the 6-month follow-up, low back pain was significantly improved only in the patients in Group 2; however, at the 2-year follow-up, low back pain was significantly improved in both groups. CONCLUSIONS: Clinical results in patients reoperated on for contralateral recurrent lumbar disc herniation compare favorably with those reported after primary discectomy. The improvement of pain in the low back and lower limbs reported by the majority of patients 2 years after reoperation suggests that fusion is not needed in this patient population.

Adult↗
PubMed1999

Pedicle instrumentation in the thoracic spine. A morphometric and cadaveric study for placement of screws.

STUDY DESIGN: In part 1 of the study, the morphometry of thoracic pedicles and bony landmarks for pedicle screw placement were evaluated. In part 2, pedicle screws were inserted in fresh cadavers, using a different entry point in the left and right pedicles. OBJECTIVES: To identify the safest entry point and screw orientation for pedicle screws in the thoracic spine. SUMMARY OF BACKGROUND DATA: A few morphometric investigations have been performed on thoracic vertebrae, but the safest technique for screw insertion in thoracic pedicles has not been analyzed. METHODS: Mean, range, and standard deviations of pedicle transverse diameter and pedicle orientation were measured in 99 dried thoracic vertebrae. We evaluated the position of the bottom of the superior facet and that of the superior border of the transverse process in relation to the center of the pedicle. The relation between the pedicle axis and the superior facet in the frontal plane was also assessed. In part 2 of the study, pedicle screws were inserted in fresh cadavers at the intersection between the superior border of the transverse process and the middle of the superior facet (entry point A) and between the former and the lateral two thirds of the facet (entry point B). RESULTS: The smallest transverse diameter was found at 16 (mean 4.3 mm) where pedicles measured less than 5 mm in 68% of the specimens. In the frontal plane, the pedicle axis intersected the middle of the superior facet in 15% of specimens, the lateral two-thirds in 62%, and the lateral border of the facet in 23%. Of the 126 screws inserted in fresh human cadavers, 15 (24%) of the screws inserted using entry point A and 10 (16%) of those inserted using entry point B violated the pedicle cortex (P > 0.05). Six (10%) of the screws inserted using entry point A compared with no screw inserted using entry point B penetrated the anterior vertebral cortex (P = 0.03). CONCLUSIONS: Pedicles between T4 and T8 may not be wide enough for screw fixation. An entry point for pedicle screws located at the intersection between the superior border of the transverse process and the lateral two thirds of the superior facet seems more likely to be in line with the pedicle axis than do other entry points. In the lower thoracic vertebrae this entry point, in combination with insertion of the screws more medially oriented than the pedicle axis, significantly reduces the risk of violating the anterior vertebral cortex.

Adult↗
PubMed1999

The morphometry of the coracoid process - its aetiologic role in subcoracoid impingement syndrome.

Anatomical morphometric studies of the coracoid process and coraco-glenoid space were carried out on 204 dry scapulae. No statistically significant correlations were found between length, or thickness of the coracoid process, prominence of the coracoid tip, coracoid slope, coraco-glenoid distance, or position of the coracoid tip with respect to the uppermost point of the glenoid. These anatomical characteristics were independent of the dimensions of the scapulae. Three configurations of the coraco-glenoid space were identified. Type I configuration was found in 45% of scapulae and Type II and Type III, in 34% and 21% of specimens, respectively. The lowest value of the coraco-glenoid distance were seen in Type I scapulae. Morphometric characteristics which might predispose to subcoracoid impingement were found in 4% of Type I scapulae. A total of 27 scapulae, nine with each type of configuration were submitted to CT scanning. Scapulae with a Type I configuration were found to have low values for the coraco-glenoid angle and coracoid overlap, which are known to be associated with a short coraco-humeral distance. Subjects with a Type I configuration, and severe narrowing of the coraco-glenoid space, appear to be predisposed to coraco-humeral impingement. These morphometric characteristics may be easily evaluated on CT scans.

Adult↗
PubMed1998

Microsurgical excision of lateral lumbar disc herniation through an interlaminar approach.

We made a prospective study of 43 consecutive patients treated for intraforaminal (34) or extraforaminal (9) herniations of a lumbar disc by excision through an interlaminar approach, using an operating microscope. The intraforaminal herniations were contained or extruded in 52% and sequestrated in 47%; for extraforaminal herniation the proportions were 66% and 33%, respectively. There was additional posterolateral protrusion or spinal stenosis at the level of the lateral herniation in seven and four cases, respectively. The patients were reviewed at three months and two years after surgery. Radiographs showed three grades of facetectomy: grade I, removal of 50% or less, grade II, excision of 51% to 75%, and grade III, subtotal or total facetectomy. For intraforaminal herniations the results were excellent or good in 88% of patients when reviewed at three months and in 91% at two years. For extraforaminal herniations, there was an excellent or good outcome in 89% of patients in the short term and in all in the long term. The facetectomy had been grade I in 14 and grade II in 25; it had been grade III in four, but only one had had total facetectomy. No patient had developed vertebral hypermobility as a result of the operation. An intralaminar approach using an operating microscope can provide adequate access to a lateral protrusion. It has the advantage of allowing the treatment of posterolateral protrusion or posterior annular bulge and of spinal stenosis at the same level.

Adult↗
PubMed1998

Ipsilateral recurrent lumbar disc herniation. A prospective, controlled study.

We analysed prospectively 26 patients who had revision operations for ipsilateral recurrent radicular pain after a period of pain relief of more than six months following primary discectomy. They were assessed before the initial operation, between the two procedures and at a minimum of two years after reoperation. MRI was performed before primary discectomy and reoperation. Fifty consecutive patients who had a disc excision during the study period but did not have recurrent radicular pain, were analysed as a control group. Of the study group 42% related the onset of recurrent radicular pain to an isolated injury or a precipitating event, but none of the control group did so (p < 0.001). T2-weighted MRI performed before primary discectomy showed that patients in the study group had significantly more severe disc degeneration compared with the control group (p=0.02). Intraoperative findings revealed recurrent disc herniation in 24 patients and bulging of the disc in two, one of whom also had lateral stenosis. Epidural scarring was found to be abundant, intraoperatively and on MRI, in eight and in nine patients, respectively. At the last follow-up, the clinical outcome was satisfactory in 85% of patients in the study group and in 88% of the control group (p > 0.05). Work or daily activities had been resumed at the same level as before the onset of symptoms by 81% of the patients in the study group and 84% of the control group. No correlation was found between the amount of epidural fibrosis, as seen intraoperatively and on MRI, and the result of surgery. The recurrence of radicular pain caused no significant changes in the psychological profile compared with the assessment before the primary discectomy.

Adult↗
PubMed1997

Predisposing factors in degenerative spondylolisthesis. A radiographic and CT study.

We report a prospective study analysing whether possible factors predisposing to degenerative spondylolisthesis (DS) must be present concomitantly in order to cause vertebral slipping. Standard and flexion-extension radiographs were obtained from 27 patients with DS and 27 without spondylolisthesis. The level of the intercrestal line, the lumbosacral angle, the presence of sacralization of L5 and vertebral motion at the L4-L5 level were assessed. Facet joint orientations were measured on CT scans. Only facet joint orientation and vertebral motion at the spondylolisthetic level were significantly different in patients with DS compared with controls. Facet joints were oriented more sagittally both at the spondylolisthetic level and at the levels above and below. An inverse linear correlation was found between the sagittal orientation of facet joints and the mobility of the slipped vertebra. Abnormal sagittal orientation of facet joints and hypermobility of the spondylolisthetic vertebra appear to play major roles among possible factors predisposing to DS. Both factors should be considered in the planning of surgical treatment.

Aged↗
PubMed1996

Results of disc prosthesis after a minimum follow-up period of 2 years.

STUDY DESIGN: This study analyzed retrospectively 46 patients undergoing artificial disc replacement. OBJECTIVE: To assess the clinical and radiographic outcomes of patients who had Charitè SB III disc prosthesis. SUMMARY OF BACKGROUND DATA: Results of disc prosthesis have been reported only at very short-term follow-up periods; preoperative diagnosis and criteria used to evaluate the clinical outcomes were not reported. METHODS: Forty-six patients who had had a disc prosthesis were evaluated clinically and radiographically at least 2 years after surgery. Preoperative diagnosis included disc degeneration in 22 patients and failed disc excision in 24 patients. Disc prosthesis was implanted at a single vertebral level in 36 patients and at two levels in 10 patients. Follow-up evaluation was performed after an average of 3.2 years (range, 2-5 years). RESULTS: Sixty-three percent of patients reported satisfactory results. The success rate was 69% in patients who underwent isolated disc replacement and 77% in those with no previous back surgeries. Seven patients who had unsatisfactory results underwent posterolateral fusion without removing the artificial disc. Two patients underwent removal of the prosthesis. No failure of the implants or loosenings or wear of the polyethylene core were found. Vertebral motion averaged 9 degrees at the operated levels and 16 degrees at the adjacent levels. CONCLUSION: A wrong surgical indication, rather than failure of the prosthesis, appears to be the main cause of unsatisfactory results of disc replacement at medium-term evaluations. Prospective and longer term studies are needed to establish whether disc prosthesis may offer advantages compared with spinal fusion.

Adult↗
PubMed1994

Ligamenta flava in lumbar disc herniation and spinal stenosis. Light and electron microscopic morphology.

METHODS: Ligamenta flava obtained from nine patients with lumbar disc herniation and ten patients with lumbar stenosis were studied at histologic, histochemical, and ultrastructural levels. Lumbar ligamenta flava removed from six patients who underwent surgeries for thoracolumbar fractures were used as controls. RESULTS: Ligamenta flava from control subjects consisted of large elastic fibers, thin bundles of collagen fibers, and few spindle-shaped fibroblasts. In proximity to the laminal insertion, the ligaments had fibrocartilagineous features. In the control subjects who were age 50 or older, the cells decreased in number and areas that had fewer and thinner elastic fibers and a more abundant collagen component were visible occasionally. In patients with disc herniation, the ligaments had similar morphologic features to those of the controls of similar ages. The ligamenta flava from patients with lumbar stenosis showed areas of fibrosis in which the cells were often represented by actively synthesizing fibroblasts and areas of chondroid metaplasia. Degenerating elastic fibers were seen occasionally, while calcified areas were observed often. CONCLUSIONS: Ligamenta flava undergo slight fibrotic and chondrometaplastic changes with aging. No peculiar changes occur in patients with disc herniation. In spinal stenosis, fibrotic changes, chondroid metaplasia, and calcification reduce the elasticity of the ligaments, which may thus bulge into the spinal canal in the standing position even if they are normal in thickness.

Adult↗
PubMed1994

Lumbar spinal stenosis and diabetes. Outcome of surgical decompression.

We reviewed 25 diabetic (mean age 68 years) and 25 non-diabetic patients (mean age 71 years) who had undergone decompression for lumbar spinal stenosis at a mean of 3.4 years after operation to determine whether diabetes affected the outcome of surgery. The preoperative symptoms were similar in the two groups except that an abrupt onset of symptoms, the presence of night pain and the absence of any posture-related pain relief were recorded only by diabetic patients. Nerve-conduction velocity was slowed in 80% of the diabetic and in 25% of the non-diabetic patients. Peripheral vascular deficiency was diagnosed in 20% of patients with diabetes and in 4% of non-diabetics. The outcome of surgery was similarly successful in the two groups. Mistaken preoperative diagnosis was the cause of failure in three diabetic patients, two with diabetic neuropathy and one with diabetic angiopathy.

Adult↗
PubMed1993

The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy.

We assigned 67 patients with central lumbar stenosis alternately to either multiple laminotomy or total laminectomy. The protocol, however, allowed multiple laminotomy to be changed to total laminectomy if it was thought that the former procedure might not give adequate neural decompression. There were therefore three treatment groups: group I consisting of 26 patients submitted to multiple laminotomy; group II, 9 patients scheduled for laminotomy but submitted to laminectomy; and group III, 32 patients scheduled for, and submitted to, laminectomy. The mean follow-up was 3.7 years. Bilateral laminotomy at two or three levels required a longer mean operating time than total laminectomy at an equal number of levels. The mean blood loss at surgery and the clinical results did not differ in the three groups. The mean subjective improvement score for low back pain was higher in group I but there was also a higher incidence of neural complications in this group. No patient in group I had postoperative vertebral instability, whereas this occurred in three patients in groups II and III, who had lumbar scoliosis or degenerative spondylolisthesis preoperatively. Multiple laminotomy is recommended for all patients with developmental stenosis and for those with mild to moderate degenerative stenosis or degenerative spondylolisthesis. Total laminectomy is to be preferred for patients with severe degenerative stenosis or marked degenerative spondylolisthesis.

Adult↗
PubMed1993

Post-operative intervertebral discitis. Evaluation of 12 cases and study of ESR in the normal postoperative period.

Twelve cases of intervertebral discitis following lumbar discectomy were evaluated and ESR was assessed in 70 patients operated on and without evidence of postoperative infection. Six of the intervertebral discitis patients were studied retrospectively and 6 prospectively. In the retrospective group, patients reported that symptoms appeared on average 15 days after the operation. Antibiotic treatment generally began 31 days after the operation and lasted 62 days; symptoms regressed after 3.9 months. All patients showed long-term radiographic vertebral changes and osteolysis in the cases treated later. In the prospective group, the first symptoms appeared on average 5 days after the operation, treatment started after 8 days and lasted 41 days. Symptoms regressed after 1.8 months. There were only 3 cases of vertebral radiographic changes. In both groups, ESR was always more than 70. The most useful diagnostic imaging tests were conventional tomography and MRI. Needle biopsy had no effect on the length of treatment. In 14% of patients without infective complications, ESR increased noticeably a week after the operation but, in contrast to the intervertebral discitis patients, it did not then continue to increase. Close post-operative observation permitted early detection of intervertebral discitis. Early and high-dose antibiotic treatment, even if unspecific, can resolve this infection in a few weeks.

Adult↗
PubMed1992

Bone regrowth after surgical decompression for lumbar spinal stenosis.

We reviewed 40 patients treated surgically for lumbar stenosis at an average time of 8.6 years after operation. In 32, total laminectomy had been performed and in eight bilateral laminotomy, both at one or more levels. Of the 16 patients with degenerative spondylolisthesis, ten had had a concomitant spinal fusion. Patients were assigned to one of four groups according to the amount of bone regrowth: group 0 had no regrowth and groups I, II, and III, had mild, moderate or marked regrowth, respectively. Only 12% of the patients showed no bone regrowth; 48% were assigned to group I, 28% to group II and 12% to group III. Imaging studies showed varying degrees of recurrent stenosis in patients with moderate or marked bone regrowth. All patients with degenerative spondylolisthesis showed bone regrowth, which was more severe in those who had not had a fusion. The clinical results were satisfactory in most of the patients with mild or no bone regrowth and significantly less good in those with moderate or marked regrowth. In the group with degenerative spondylolisthesis, the proportion of satisfactory results was significantly higher in patients who had had spinal fusion. The long-term results of surgery for lumbar stenosis depend both upon the amount of bone regrowth and the degree of postoperative vertebral stability.

Adult↗
PubMed1992

Microdiscectomy in treatment of herniated lumbar disc.

The authors studied 122 patients who had undergone microsurgery for herniated lumbar disc or isolated nerve root canal stenosis. The patients were reviewed one month and three months after surgery and then returned for a final evaluation after an average of 1.4 years. Intraoperative or postoperative complications occurred in 13 cases and consisted of misdiagnosis (discovered intraoperatively) of the level of the herniated disc (7 cases), dural laceration (3 cases), and discitis (3 cases). Limited discectomy was performed in 16 cases and complete discectomy in the others. Two patients who had undergone limited discectomy experienced recurrence; this did not occur when complete discectomy was performed. Discitis occurred in patients who had undergone complete discectomy. Most of the patients who underwent operation for disc herniation at one lumbar level with no complications began walking within 24 hours, and 72% were discharged within 36 hours. Eighty-five percent of the patients had a satisfactory result one month after surgery, and 91% had a satisfactory result at the final follow-up. There was no significant difference between patients with protruded herniation and patients with sequestered herniation. In the patients with nerve root canal stenosis the proportion of satisfactory results was 72% at one month and 88% at the final follow-up. The main advantage of microsurgery is the full illumination of the operative field, and this technique is strongly indicated in cases of single-level herniated disc. Over the short-term, microdiscectomy achieves a higher proportion of satisfactory results, requires a shorter hospitalization period, and allows an earlier return to work than traditional surgery. However, no significant difference was found between microsurgery and traditional surgery over the long-term.

Adolescent↗
PubMed1991

Degenerative lumbar spondylolisthesis. II. Surgical treatment.

The authors analyze the results of operative treatment in 32 cases of degenerative spondylolisthesis with various degrees of compression of the nervous structures. Five types of surgery were performed: unilateral laminotomy; bilateral laminotomy with or without transverse process fusion; bilateral laminectomy with or without spinal fusion; and laminectomy, spinal fusion, and interspinous wiring. Satisfactory results were achieved in 84% of the cases. Seventy-six percent of the patients had further vertebral displacement, and 81% showed varying degrees of articular process regeneration more than two years after surgery; these findings concern both patients who had been treated with spinal fusion and those who had not. Bilateral laminotomy is indicated in patients with isolated nerve root canal stenosis; as the olisthesis is mild and lateral flexion-extension radiographs show no vertebral hypermobility, spinal fusion is not necessary. When central spinal canal stenosis is present, bilateral laminectomy, extensive lateral decompression, and spinal fusion are recommended. Interspinous wiring may be useful for immediate vertebral stabilization.

Aged↗