Ankle Bipolar Fresh Osteochondral Allograft Survivorship and Integration: Transplanted Tissue Genetic Typing and Phenotypic Characteristics

Il trapianto fresco bipolare o allograft di caviglia puo rappresentare una valida alternative nel trattamento dell’artrosi post-traumatica nel paziente giovane ed attivo. Nonostante l’utilizzo di tale procedura, poco si conosce sulla ricolonizzazione del trapianto osteocondrale da parte delle cellule del ricevente. Scopo di questo studio era definire il profilo genotipico di prelievi bioptici eseguiti da allograft di caviglia a 21 mesi di follow-up. 22 allograft sono stati inclusi nello studio. Lo score clinico AOFAS e la valutazione radiologica è stata eseguita al follow-up finale di 61±13.6 mesi. 22 prelievi bioptici sono stati prelevati ad una media di 21 mesi di FU. Sono stati analizzati con valutazione istologica ed immunoistochimica. 20 prelievi sono stati confrontati mediante typing genetico con il DNA del donatore e del ricevente. In 6 casi è stata associata una valutazione fenotipica della popolazione cellulare rinvenuta nel prelievo bioptico con valutazione dell’espressione genica. Abbiamo osservato 2 fallimenti. Lo score AOFAS è passato da un valore pre-operatorio di 25,7 ± 8.0 punti a 76.2±14.1 (p<0.05) al follow up finale. L’analisi genotipica ha mostrato una popolazione compatibile con il ricevente in 12 casi, una popolazione mista ricevente donatore in 5 e la presenza esclusiva di cellule del donatore in 3. L’analisi dell’espressione genica ha evidenziato markers specifici della linea cartilaginea. L’analisi genotipica e le valutazioni istologiche ed immunoistochimiche suggeriscono una migrazione di cellule del ricevente nella porzione cartilaginea dell’allograft a partenza dall’osso subcondrale. L’analisi dell’espressione genica sembra suggerire che queste cellule, una volta migrate, possano differenziarsi nella linea cartilaginea.Ankle bipolar fresh osteochondral allograft may represent a valid alternative in the treatment of sever post-traumatic ankle arthritis in young and active patients. Despite the widespread use of this procedure little is known about allograft recolonization by host cells. Aim of this study was to assess the genotypic profile and the phenotypic pattern of retrieved specimens from ankle allografts at 21 months follow-up. 22 ankle allografts were included in the study. AOFAS clinical score and radiographic evaluation was performed up to the final follow-up of 61±13.6 months. 22 bioptic specimens harvested at 21 months follow-up were analyzed by histological and immunohistochemical analysis. 20 specimens were compared with recipient and donor constitutional DNA by genotyping. In 6 cases gene expression was evaluated by means of real-time reverse transcription-polymerase chain reaction. We observed 2 failures. AOFAS score improved from 25,7 ± 8.0 points pre-operatively to 77,5 ±11,2 at 12 months follow-up and 76.2±14.1 (p<0.05) at final follow-up. Genotyping on allograft retrieved specimens showed an exclusive recipient cellular population in 12 cases, a mixed profile in 5 cases and exclusive presence of donor cells in 3 cases. Gene expression analysis showed that grafted cartilage expressed cartilage-specific markers. The genotyping analysis along with histological and immunohistochemical evaluations suggest the ingrowth of host cells into the transplanted cartilage migrating from the subchondral bone and crossing the tidemark. Gene expression analysis seems to suggest that these cells, once migrated, may differentiate toward cartilaginous lineage

Multilevel non-contiguous thoracic pedicle subtraction osteotomy for fixed rounded hyperkyphotic deformity of the thoraco-lumbar junction with anterior bony fusion: technical note

Background: Fixed severe hyperkyphotic deformities spread over more than five vertebral levels represent a therapeutic challenge, especially when the deformity apex is located at the thoraco-lumbar junction, thus requiring a huge amount of correction. The aim of this article is to describe an innovative all-posterior corrective technique based on multilevel non-contiguous thoracic pedicle subtraction ostoeotomy (PSO). Materials and methods: A retrospective review of three patients with fixed severe thoracic hyperkyphosis (a deformity angle of over 70°) with a thoraco-lumbar apex (between T11 and L1) treated by simultaneous two-level thoracic PSO and thoraco-lumbar posterior fusion was performed. Radiographic and clinical records were evaluated pre-operatively, post-operatively and at last follow-up (after a minimum of 2&nbsp;years). Each variable was presented as mean ± SD (standard deviation). Statistical analyses were performed using paired t-tests (P value &lt; 0.05 was considered significant). Results: The mean local deformity angle decreased by 75% (from 81.3° ± 2.1° to 20.7° ± 1.4°, p &lt; 0.001), the post-operative thoracic kyphosis decreased by 46% (from 61.4° ± 2.4° to 33.2° ± 0.9°, p &lt; 0.001) and the sagittal vertical axis decreased by 73% (from 14.7&nbsp;cm ± 0.8 cm to 3.9&nbsp;cm ± 0.3 cm, p &lt; 0.001). No differences were observed in the radiological results between post-operative values and those at the final follow-up. The average Oswestry Disability Index (ODI) score reduced from 65.7 ± 1.8 pre-operatively to 17.3 ± 1.7 at last follow-up (p &lt; 0.001). No neurological, mechanical nor infective complication occurred. Conclusions: The presented technique, although technically demanding, proved to be a safe and effective alternative for the management of fixed severe thoraco-lumbar junction hyperkyphotic deformities. Level of evidence: IV TRIAL REGISTRATION Retrospectively registered

Surgical treatment of severe adolescent idiopathic scoliosis through one-stage posterior-only approach: A systematic review and meta-analysis

: The aim of this meta-analysis was to analyze the results of one-stage all-posterior spinal fusion for severe adolescent idiopathic scoliosis (AIS). A systematic search of articles about one-stage posterior spinal fusion for severe AIS was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data about population, pre-and postoperative radiographical data, surgical procedure details, and complications were extracted. Meta-analyses were performed when possible. Fourteen studies (640 patients) were included. The mean Cobb angle of the major curve varied from 80.0 ± 7.3 to 110.8 ± 12.1. The meta analysis showed a comprehensive coronal correction rate of the major curve of 58.6%, a comprehensive operative time of 274.5 min, and a comprehensive estimated intraoperative blood loss of 866.5 mL (95% confidence interval: 659.3-1073.6, I 2 ≈ 0%). A total of 48 complications (5.4%) were reported. Overall, the meta-analysis showed a major complication rate of 4%. In seven cases, revision surgery was needed. Posterior-only approach is effective enough to correct severe curves and can spare the patient possible adverse events due to anterior approach. However, when choosing this approach for severe AIS, screw density needs to be high and posterior column osteotomies may need to be planned to mobilize the spine and maximize correction

One stage correction via the Hi-PoAD technique for the management of severe, stiff, adolescent idiopathic scoliosis curves > 90°

Study design: Retrospective cohort study. Purpose: to assess the efficacy and safety of Hi-PoAD technique in patients with a major thoracic curve &gt; 90°, &lt; 25% of flexibility and deformity spread over more than five vertebral levels. Methods: retrospective review of AIS patients with a major thoracic curve (Lenke 1-2-3) &gt; 90°, with &lt; 25% of flexibility and deformity spread over more than five vertebral levels. All were treated via the Hi-PoAD technique. Radiographic and clinical score data were collected pre-operatively, operatively, at 1&nbsp;year, 2&nbsp;years and at last follow-up (2&nbsp;years minimum). Results: 19 patients were enrolled. A 65.0% correction rate of the main curve was achieved, from 101.9° to 35.7° (p &lt; 0.001). The AVR reduced from 3.3 to 1.3. The C7PL/CSVL reduced from 1.5 to 0.9&nbsp;cm (p = 0.013). Trunk Height increased from 31.1 to 37.0&nbsp;cm (p &lt; 0.001). At the final follow-up no significant changes, except from an improvement in C7PL/CSVL (from 0.9&nbsp;cm to 0.6&nbsp;cm; p = 0.017). SRS-22 increased in all patients, from 2.1 to 3.9 at 1&nbsp;year of follow-up (p &lt; 0.001). 3 patients had a transient drop of MEP and SEP during maneuver and were managed with temporary rods and a second surgery after 5&nbsp;days. 2 of these 3 cases (66.7%) had a Total-Deformity Angular Ratio (T-DAR) &gt; 25; conversely, among patients who had a one-stage procedure, only 1 (6.2%) had a T-DAR &gt; 25 (p = 0.008). Conclusions: The Hi-PoAD technique proved to be a valid alternative for the treatment of severe, rigid AIS involving more than 5 vertebral bodies. Study design: Retrospective comparative cohort study. Level of evidence: III

Frailty Influence on Postoperative Surgical Site Infections After Surgery for Degenerative Spine Disease and Adult Spine Deformity. Can a Frailty Index be a Valuable Summary Risk Indicator? A Systematic Review and Metanalysis of the Current Literature

Study design: Metanalysis. Objective: Surgical site infections (SSI) is one of the commonest postoperative adverse events after spine surgery. Frailty has been described as a valuable summary risk indicator for SSI in spine surgery. The aim of this metanalysis is to evaluate the influence of frailty on postoperative SSI in this cohort and provide hints on which index can predict the risk of SSI. Methods: Papers describing the postoperative SSI rate in adult degenerative spine disease or adult spine deformity patients with varying degrees of frailty were included in the analysis. The SSI rate in different grades of frailty was considered for outcome measure. Meta-analysis was performed on studies in whom data regarding patients with different levels of frailty and occurrence of postoperative SSI could be pooled. P &lt; .05 was considered significant. Results: 16 studies were included. The frailty prevalence measured using mFI-11 ranged from 3% to 17.9%, these values were inferior to those measured with mFI-5. Significant difference was found between frail and non-frail patients in postoperative SSI rate at metanalysis (z = 5.9547, P &lt; .0001 for mFI-5 and z = 3.8334, P = .0001 for mFI-11). Conclusion: This is the first meta-analysis to specifically investigate the impact of frailty, on occurrence of SSI. We found a relevant statistical difference between frail and non-frail patients in SSI occurrence rate. This is a relevant finding, as the ageing of population increases alongside with spine surgery procedures, a better understanding of risk factors may advance our ability to treat patients while minimizing the occurrence of SSI

Return to sport after posterior spinal fusion for adolescent idiopathic scoliosis: what variables actually have an influence? A retrospective study

Purpose To retrospectively evaluate a cohort of athletically active patients who underwent surgery for adolescent idiopathic scoliosis (AIS), and to determine which clinical, surgical and anthropometric variables influenced their return to sport after surgery. Methods 112 adolescents who underwent high-density posterior fusion for AIS by a single surgeon were analyzed for clinical, surgical and demographic predictors of return to presurgical physical activity levels. Data were retrospectively collected by charts and X-rays analysis and patients interviews. Results Preoperative main curve Cobb was 64.4 +/- 14.12 degrees and obtained correction was 70.0 +/- 12.5%. Included patients played many different sports (Table 4), most of all ballet (44/112, 39.2%), swimming (40/112, 35.7%) and gymnastics (32/112, 28.6%). At an average of 50.3 months follow-up, 76 (67.8%) patients returned to sports (RTS) at an equal or higher level than preoperatively. Younger age, lower Lenke curve type and lower main curve Cobb were significantly associated with RTS. As for RTS timing, patients who returned within the first 6 months were younger, with a higher Lenke and a less severe main curve, a more distal UIV and a more proximal LIV. No complications related to RTS were registered. Conclusion In conclusion, patients with adolescent idiopathic scoliosis safely returned to physical activity after surgery. Younger age, higher Lenke type and lower main curve severity predicted a quicker return to sport. However, prospective studies are needed to confirm these findings

Epigenetic Factors Related to Low Back Pain: A Systematic Review of the Current Literature

: Low back pain (LBP) is one of the most common causes of pain and disability. At present, treatment and interventions for acute and chronic low back pain often fail to provide sufficient levels of pain relief, and full functional restoration can be challenging. Considering the significant socio-economic burden and risk-to-benefit ratio of medical and surgical intervention in low back pain patients, the identification of reliable biomarkers such as epigenetic factors associated with low back pain could be useful in clinical practice. The aim of this study was to review the available literature regarding the epigenetic factors associated with low back pain. This review was carried out in accordance with Preferential Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was carried out in October 2022. Only peer-reviewed articles were considered for inclusion. Fourteen studies were included and showed promising results in terms of reliable markers. Epigenetic markers for LBP have the potential to significantly modify disease management. Most recent evidence suggests that epigenetics is a more promising field for the identification of factors associated with LBP, offering a rationale for further investigation in this field with the long-term goal of finding epigenetic biomarkers that could constitute biological targets for disease management and treatment

Optimizing Patient Care: A Systematic Review of Multidisciplinary Approaches for SLE Management

Systemic lupus erythematosus (SLE) is characterized by multisystemic clinical manifestations ranging from a relatively mild involvement to potentially life-threatening complications. Due to this complexity, a multidisciplinary (MD) approach is the best strategy for optimizing patients' care. The main aim of this systematic literature review (SLR) was to scrutinize the published data regarding the MD approach for the management of SLE patients. The secondary objective was to evaluate the outcomes of the MD approach in SLE patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used. We performed an SLR to retrieve articles available in English or Italian listed in PubMed, Embase, Cinahl, and Cochrane Library concerning the MD approach used in observational studies and clinical trials. Four independent reviewers performed the study selection and data collection. Of 5451 abstracts evaluated, 19 studies were included in the SLR. The MD approach was most frequently described in the context of SLE pregnancy, reported in 10 papers. MD teams were composed of a rheumatologist, except for one cohort study; a gynecologist; a psychologist; a nurse; and other health professionals. MD approaches had a positive impact on pregnancy-related complications and disease flares and improved SLE psychological impact. Although international recommendations advise an MD approach for managing SLE, our review highlighted the paucity of data supporting this strategy, with most of the available evidence on the management of SLE during pregnancy

Sharing Circulating Micro-RNAs between Osteoporosis and Sarcopenia: A Systematic Review

Background: Osteosarcopenia, a combination of osteopenia/osteoporosis and sarcopenia,is a common condition among older adults. While numerous studies and meta-analyses have beenconducted on osteoporosis biomarkers, biomarker utility in osteosarcopenia still lacks evidence. Here,we carried out a systematic review to explore and analyze the potential clinical of circulating microR-NAs (miRs) shared between osteoporosis/osteopenia and sarcopenia. Methods: We performed asystematic review on PubMed, Scopus, and Embase for differentially expressed miRs (p-value &lt; 0.05)in (i) osteoporosis and (ii) sarcopenia. Following screening for title and abstract and deduplication,83 studies on osteoporosis and 11 on sarcopenia were identified for full-text screening. Full-textscreening identified 54 studies on osteoporosis, 4 on sarcopenia, and 1 on both osteoporosis andsarcopenia. Results: A total of 69 miRs were identified for osteoporosis and 14 for sarcopenia. Therewere 9 shared miRs, with evidence of dysregulation (up- or down-regulation), in both osteoporo-sis and sarcopenia: miR-23a-3p, miR-29a, miR-93, miR-133a and b, miR-155, miR-206, miR-208,miR-222, and miR-328, with functions and targets implicated in the pathogenesis of osteosarcopenia.However, there was little agreement in the results across studies and insufficient data for miRsin sarcopenia, and only three miRs, miR-155, miR-206, and miR-328, showed the same directionof dysregulation (down-regulation) in both osteoporosis and sarcopenia. Additionally, for mostidentified miRs there has been no replication by more than one study, and this is particularly true forall miRs analyzed in sarcopenia. The study quality was typically rated intermediate/high risk of bias.The large heterogeneity of the studies made it impossible to perform a meta-analysis. Conclusions:The findings of this review are particularly novel, as miRs have not yet been explored in the context ofosteosarcopenia. The dysregulation of miRs identified in this review may provide important clues tobetter understand the pathogenesis of osteosarcopenia, while also laying the foundations for furtherstudies to lead to effective screening, monitoring, or treatment strategies (PDF) Sharing Circulating Micro-RNAs between Osteoporosis and Sarcopenia: A Systematic Review. Available from: https://www.researchgate.net/publication/368667300_Sharing_Circulating_Micro-RNAs_between_Osteoporosis_and_Sarcopenia_A_Systematic_Review [accessed Feb 26 2023]

Mechanobiology of the Human Intervertebral Disc: Systematic Review of the Literature and Future Perspectives

: Low back pain is an extremely common condition with severe consequences. Among its potential specific causes, degenerative disc disease (DDD) is one of the most frequently observed. Mechanobiology is an emerging science studying the interplay between mechanical stimuli and the biological behavior of cells and tissues. The aim of the presented study is to review, with a systematic approach, the existing literature regarding the mechanobiology of the human intervertebral disc (IVD), define the main pathways involved in DDD and identify novel potential therapeutic targets. The review was carried out in accordance with the Preferential Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if they described biological responses of human IVD cells under mechanical stimulation or alterations of mechanical properties of the IVD determined by different gene expression. Fifteen studies were included and showed promising results confirming the mechanobiology of the human IVD as a key element in DDD. The technical advances of the last decade have allowed us to increase our understanding of this topic, enabling us to identify possible therapeutic targets to treat and to prevent DDD. Further research and technological innovations will shed light on the interactions between the mechanics and biology of the human IVD