PubMed · 14374982
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D COP. 1955. [Vertebral backache].. https://pubmed.ncbi.nlm.nih.gov/14374982/
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PURPOSE: The aim of this study was to test our observation that back pain in thalassemic patients could be caused by premature and extensive lumbar degenerative disc disease, when compared to non-thalassemic patients with back pain. METHODS AND MATERIALS: Sixteen thalassemic patients with their sex- and age-matched controls were recruited into the study, 12 with thalassemia major, and 4 with thalassemia intermedia. Both the thalassemia patients and control subjects suffered from back pain, which was subjective rather than measured/pain scored. All subjects underwent magnetic resonance (MR) imaging of the lumbar spine, and 11 of the cases and 8 controls had lumbar spine radiographs. Each lumbar disc was scored for radiographic appearances and MR features of disc degeneration and disc protrusion. Proportion values for these parameters and median scores were derived at each disc level, and were analyzed and compared. RESULTS: There was a statistically-significant difference between proportion values of cases and controls for the MR features (P value=0.01, n=16) and the radiographic features (P value=0.01, n=11 cases, n=8 controls) of disc degeneration. The median disc level scores for the thalassemic group were uniformly high across all lumbar discs, and at all levels except at L 4/5. The control group conversely demonstrated a predilection for disc degeneration at L4/5 level. CONCLUSION: The distribution of lumbar disc degeneration in thalassemic patients with back pain is more extensive, severe and multi-level in nature compared to matched controls, and disc degeneration should be considered as a significant cause of back pain in this population group.
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STUDY DESIGN: Literature review of current bone graft technology and bone graft substitutes used in spinal fusion applications. OBJECTIVE: We reviewed current bone graft technologies and identified the range of bioactive properties that each possesses, such as osteoconductivity, osteoinductivity, and structural, load-bearing capabilities that can be used to either augment or replace autogenous bone graft in spinal fusions. SUMMARY OF BACKGROUND DATA: Bioactive materials are used in spinal fusion applications to encourage bone formation across an intervertebral motion segment. To be an effective replacement for autogenous bone grafts, a bioactive material must possess the properties of osteoinduction and osteoconduction. METHODS: Literature review. RESULTS: Platelet gel concentrates deliver nonspecific cytokines that influence local cells at the implantation site. Demineralized bone matrix acts as a bone graft enhancer that excludes fibrous tissue of muscle interposition in a fusion mass and is a mildly osteoinductive material. Bone morphogenetic proteins are an integral part of natural bone formation response. They function as differentiation factors that act on mesenchymal stem cells to induce bone formation. CONCLUSIONS: Patient-derived therapies such as platelet gel concentrates contain cytokines that play a role in bone formation; however, none of them is capable of inducing the entire bone formation cascade. Clinical use of these concentrates could possibly interfere with new bone formation. The use of bone marrow aspiration and concentration techniques has not been convincingly studied in spinal fusions in lower order animal or human clinical studies. Demineralized bone matrix contains small and variable amounts of naturally occurring bone morphogenetic proteins. These products can only function as bone graft extenders. Recombinant bone morphogenetic protein products contain much more highly concentrated and focused amounts of bone morphogenetic proteins, and some have been shown to be clinically effective bone graft replacements.