Pro-inflammatory and neurotrophic factor responses of cells derived from degenerative human intervertebral discs to the opportunistic pathogen Cutibacterium acnes

Previously, we proposed the hypothesis that similarities in the inflammatory response observed in acne vulgaris and degenerative disc disease (DDD), especially the central role of interleukin (IL)-1β, may be further evidence of the role of the anaerobic bacterium Cutibacterium (previously Propionibacterium) acnes in the underlying aetiology of disc degeneration. To investigate this, we examined the upregulation of IL-1β, and other known IL-1β-induced inflammatory markers and neurotrophic factors, from nucleus-pulposus-derived disc cells infected in vitro with C. acnes for up to 48 h. Upon infection, significant upregulation of IL-1β, alongside IL-6, IL-8, chemokine (C-C motif) ligand 3 (CCL3), chemokine (C-C motif) ligand 4 (CCL4), nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), was observed with cells isolated from the degenerative discs of eight patients versus non-infected controls. Expression levels did, however, depend on gene target, multiplicity and period of infection and, notably, donor response. Pre-treatment of cells with clindamycin prior to infection significantly reduced the production of pro-inflammatory mediators. This study confirms that C. acnes can stimulate the expression of IL-1β and other host molecules previously associated with pathological changes in disc tissue, including neo-innervation. While still controversial, the role of C. acnes in DDD remains biologically credible, and its ability to cause disease likely reflects a combination of factors, particularly individualised response to infection

Vertebral Slip Morphology in Dysplastic Spondylolisthesis as a Criterion for the Choice of the L5/S1 Support (ALIF, PLIF, Fibular Graft) in Surgical Treatment

Dysplastic spondylolisthesis is a severe pathological condition, based on dysplastic changes in the lumbosacral part of the spine, that causes the asymmetry of the lumbosacral junction. The appropriate therapeutic algorithm remains controversial. As the gold standard, the surgical reposition of the slipped vertebra and 360° fusion of the affected spinal segment is preferred. Thirty-two patients were operated on between the years 2005 and 2018. Different techniques of 360° fusion, based on the severity of the displacement of the affected vertebral segment, were used. Herein, the advantages and disadvantages of different techniques of interbody fusion are discussed. The slippage and retention after reduction in the vertebrae are evaluated prior to the operation, postoperatively, one year after the surgery, and during follow-up, which was 7 years on average (minimum 2 years for a follow-up). Complications associated with the surgery are evaluated, in addition to the operation time, blood loss, spinopelvic parameters, and patient satisfaction with the surgery. All surgical techniques improved the slippage compared to preoperative conditions. The retention of the reposition was not changed significantly in postoperative controls. The incidence of neurological complications reached 12.5%. Surgical treatment is the only treatment option that successfully addressed the pathological principle of dysplastic spondylolisthesis. All of the surgical methods used led to restoring the symmetry of the lumbar spine, and to the improvement in both radiological parameters and the alleviation of subjective difficulties. The aim of this article is to summarize surgical methods in patients having dysplastic spondylolisthesis with a slip of more than 25%, who were operated on, and to determine the optimal treatment algorithm according to the severity of the slip

Vertebral Slip Morphology in Dysplastic Spondylolisthesis as a Criterion for the Choice of the L5/S1 Support (ALIF, PLIF, Fibular Graft) in Surgical Treatment

Dysplastic spondylolisthesis is a severe pathological condition, based on dysplastic changes in the lumbosacral part of the spine, that causes the asymmetry of the lumbosacral junction. The appropriate therapeutic algorithm remains controversial. As the gold standard, the surgical reposition of the slipped vertebra and 360° fusion of the affected spinal segment is preferred. Thirty-two patients were operated on between the years 2005 and 2018. Different techniques of 360° fusion, based on the severity of the displacement of the affected vertebral segment, were used. Herein, the advantages and disadvantages of different techniques of interbody fusion are discussed. The slippage and retention after reduction in the vertebrae are evaluated prior to the operation, postoperatively, one year after the surgery, and during follow-up, which was 7 years on average (minimum 2 years for a follow-up). Complications associated with the surgery are evaluated, in addition to the operation time, blood loss, spinopelvic parameters, and patient satisfaction with the surgery. All surgical techniques improved the slippage compared to preoperative conditions. The retention of the reposition was not changed significantly in postoperative controls. The incidence of neurological complications reached 12.5%. Surgical treatment is the only treatment option that successfully addressed the pathological principle of dysplastic spondylolisthesis. All of the surgical methods used led to restoring the symmetry of the lumbar spine, and to the improvement in both radiological parameters and the alleviation of subjective difficulties. The aim of this article is to summarize surgical methods in patients having dysplastic spondylolisthesis with a slip of more than 25%, who were operated on, and to determine the optimal treatment algorithm according to the severity of the slip