Successful use of bio plugs for delayed bronchial closure after pneumonectomy in experimental settings

OBJECTIVES: Cell therapies, such as stem cell suspension injection, are used to treat bronchopleural fistula. Although it is safe and effective, injected cells cannot remain within the bronchioles of the fistula due to cell leakage into the thoracic cavity. Here, we inserted a ‘bio plug’ into the fistula, produced using cells and a bio-3D printer, to examine the effectiveness of bio plugs for the closure of bronchopleural fistulas, the optimal cell source and the closure mechanism.METHODS: Bio plugs were made with mesenchymal stem (stromal) cells derived from bone marrow (MSCBM), fibroblasts and rat lung micro-vessel endothelial cells using a bio-3D printer with different cell mixing ratios. Six groups, according to the presence or absence and the type of bio plugs, were compared. The plugs were inserted into the bronchi of F344 rats. The obstruction ratio and histological and immunohistochemical findings were evaluated.RESULTS: MSCBM+ rat lung micro-vessel endothelial cell group exhibited a higher obstruction ratio among all groups excluding the MSCBM group (P = 0.039). This group had fibrosis and CD31-positive cells and fewer CD68-positive cells than MSCBM and MSCBM+ fibroblast groups.CONCLUSIONS: Bio plugs with mixed cells, including stem cells, contribute to bronchial closure in the current experimental setting. Endothelial cells effectively maintain the structure in this model. Although bronchial closure for bronchopleural fistula could not be described as clinical conditions were not reproduced, we collected essential data on bronchial closure; however, further experiments are warranted

Efficacy of Anal Needle Electrodes for Intraoperative Spinal Cord Monitoring with Transcranial Muscle Action Potentials

Study Design Retrospective study. Purpose To examine the relationship between postoperative bowel bladder disorder (BBD) and the efficacy of needle electrodes for the external anal sphincter (EAS) in intraoperative spinal cord monitoring with transcranial muscle action potentials (Tc-MsEP). Overview of Literature Spinal surgery for spina bifida, spinal cord tumor, and spinal tethered cord syndrome has a high rate of postoperative BBD. Monitoring of the EAS with Tc-MsEP is frequently performed during spinal surgery. We initially used plug-surface electrodes for this purpose, but have more recently switched to needle electrodes for the monitoring of the EAS. To date, there has been no comparison between the utility of these electrodes. Methods Waveform derivation, exacerbation of postoperative BBD, and sensitivity and specificity for prediction of BBD by 70% amplitude reduction of EAS activity using needle and plug-surface electrodes were investigated in 239 spine surgeries. The cut-off for the % drop in amplitude for BBD prediction was determined for EAS monitoring using a needle electrode. Results The overall rate of postoperative BBD aggravation was 7.1% (17/239 cases), with the individual rates using needle and plug-surface electrodes being 6.9% (8/116) and 7.3% (9/123), respectively. The waveform derivation rate was significantly higher using needle electrodes (91.3% [106/116] vs. 76.4% [94/123], p <0.01). In patients with baseline waveform detection, the sensitivity and specificity for postoperative BBD were similar in the two groups. With needle electrodes, a cutoff amplitude of Tc-MsEP for the EAS at the end of surgery of 25% of the baseline amplitude had a sensitivity of 89% and specificity of 82% for the prediction of postoperative BBD aggravation. Conclusions The significantly higher waveform derivation rate using needle electrodes suggests that these electrodes are effective for monitoring the EAS in spinal surgery in cases with preoperative BBD

Research History, Pathology and Epidemiology of Ossification of the Posterior Longitudinal Ligament and Ligamentum Flavum

Ossification of the spinal ligaments was first reported by Key in 1838 [...

Choice of Surgical Procedure for Cervical Ossification of the Posterior Longitudinal Ligament

In cervical ossification of the posterior longitudinal ligament (OPLL), spinal cord compression causes neurologic symptoms [...

Range of Motion Determined by Multidetector-Row Computed Tomography in Patients with Cervical Ossification of the Posterior Longitudinal Ligament

The purpose of this study was to measure range of motion (ROM) in patients with cervical ossification of posterior longitudinal ligament (C-OPLL) by multidetector-row computed tomography (MDCT), and to investigate the influence of dynamic factors. The study included 101 patients with C-OPLL and 99 normal control patients. Preoperative MDCT were taken in all subjects in maximum neck flexion and extension. ROM at each disc level between C2/3 and C7/T1 in sagittal view was measured. Ossification morphology at each disc segment was divided into 6 groups: covered disc, covered vertebra, unconnected vertebra, connected vertebra (continuous), connected vertebra (localized), and others. The relationship between ROM and the group of ossification morphology was also investigated. ROM of adjacent intervertebral disc in connected vertebrae (continuous and localized) and those of others were investigated for each group. The average ROM of covered disc group was significantly higher than that of connected vertebra (continuous, localized). The average ROM of connected vertebra (continuous) group was significantly lower than that of covered disc group, others group, and normal control. There was no significant difference between ROM of adjacent intervertebral disc in connected vertebrae and others, but the average ROM of the connected vertebra group was significantly lower than that of the covered disc group and normal control group. Dynamic factor was reduced at continuous segment, but it was not increased in adjacent intervertebral disc

Association between Occupation and Cervical Disc Degeneration in 1211 Asymptomatic Subjects

Magnetic resonance imaging (MRI) system has frequently observed degenerative changes in the cervical discs of healthy subjects. Although there are concerns regarding the link between an individual&rsquo;s occupation and intervertebral disc degeneration (IDD) in the cervical spine, whether the occupation affects IDD is still not clear. This study aimed to evaluate the occupation and IDD interplay using cervical spine MRI among a cohort of healthy individuals, and to evaluate any association between the type of labor and IDD. Using MRI, we prospectively measured at every level, the anteroposterior (AP) intervertebral disc diameter and disc height, in a cohort of 1211 healthy volunteers (606 (50%) male; mean age, 49.5 years). Using a minimum of 100 male and female each from the third to eighth decades of age (20&ndash;79 years), IDD was evaluated based on the modified Pfirrmann classification system to derive a disc degeneration score (DDS). We also measured the AP diameters of disc protrusion and of the dural sac as well as the spinal cord. The overall DDS and number of disc protrusions increased with age. Among 11 occupations, there were no significant differences in AP diameter of the dural sac as well as the spinal cord. For the four labor types (heavy object handling, same position maintenance, cervical extension position, and cervical flexion position), there were no significant differences in overall DDS and number of disc protrusions, with or without work. Also, among the four labor types, there were no significant differences in the AP diameter of the dural sac as well as the spinal cord. In this cross-sectional survey of cervical spine MRI data among healthy adult volunteers, occupation and type of labor might have no effect on IDD in the cervical spine

COMBINED POSTERIOR-ANTERIOR SURGERY FOR OSTEOPOROTIC DELAYED VERTEBRAL FRACTURE WITH NEUROLOGIC DEFICIT

With the aging of society, osteoporotic thoracolumbar compression fracture is a concern. This fracture occurs occasionally; however, some cases progress to neural compromise due to delayed vertebral body collapse requiring surgery. Surgical treatment and postoperative care are difficult because of patients’ serious comorbidities and poor bone quality, and hence, optimum treatment is not clear, even though some surgical approaches have been reported. There were 35 consecutive patients (5 males and 30 females) with osteoporotic delayed vertebral fractures and associated neurological deficit. Mean age at surgery was 70.7 years (range 60–84 years). Average postoperative follow-up was 3.8 years (range 0.6–11.3 years). All patients experienced a single vertebra collapse, except for 1 with a 2-level collapse of lumbar vertebrae. One thoracic (Th7), 19 thoracolumbar (Th12-L1), and 16 lumbar (L2-5) fractures were treated with combined posterior-anterior surgery. The American Spinal Injury Association (ASIA) impairment scale, activities of daily living (ADL) status, and local sagittal angle were evaluated both before and after surgery. Forty-six percent of all patients showed an improvement of more than 1 grade postoperatively on the ASIA impairment scale, and 74% demonstrated an improvement in ADL status. No deterioration was observed in neurological or ADL status after surgery. With regard to sagittal alignment, preoperative kyphosis of 18.4 degrees was corrected to 2.4 degrees of kyphosis postoperatively. However, 11.5 degrees loss of correction was observed at final follow-up observation. Combined posterior-anterior surgery could provide reliable improvement in both neurological and ADL status, although maintenance of postoperative alignment was difficult to achieve in some cases