Factors affecting accuracy and fusion rate in lumbosacral fusion surgery - a preclinical and clinical study

Lumbosacral fusion surgery is indicated in symptomatic degenerative lumbosacral disorder, when the origin of pain is demonstrated to lie within the restricted number of functional spinal units and when the pain is refractory to the conservative treatment, to eliminate painful motion of the spinal units. Inaccurate placement of pedicle screws may cause neurological symptoms, and result in early hardware failure and return of spinal instability symptoms. All spinal instrumentation eventually fails without solid bony fusion, and the presence of symptomatic bony non-union at least a year after fusion surgery is defined as pseudoarthrosis. Bioactive glasses (BAGs) are synthetic, biocompatible, osteoconductive and osteostimulative materials with angiogenic and antibacterial properties, able to bond to bone. In a study of 147 patients and 837 pedicle screws placed due to degenerative lumbosacral spine disorder, 14.3 % breached the pedicle. New neurological symptoms corresponding to the breach were observed in 25.9 % of patients with pedicle breach, and 89.2 % of the symptomatic breaches were either medially or inferiorly. A preclinical controlled study of novel BAG S53P4 putty showed good biocompatibility, slightly higher intramedullary ossification of putty group compared to the control group, and that the binder agent did not disturb formation of new bone in vivo. The interbody fusion rate was 95.8 % with BAG S53P4 putty as bone graft expander with autograft in clinical lumbosacral interbody fusion, indicating at least as good interbody fusion results as the presently used materials. One early operative subsidence remaining unchanged over the study period was observed with putty.Lannerangan luudutusleikkausten tarkkuuteen ja luutumiseen vaikuttavat tekijät Lannerangan luudutusleikkaus voidaan tehdä oireisessa lannerangan rappeumasairaudessa, kun kivun syyn on osoitettu sijaitsevan rajallisessa määrässä selkärangan toiminnallisia yksikköjä ja kun kipu ei vähene leikkauksettomilla hoidoilla. Leikkauksella voidaan poistaa kipua tuottava selkärangan toiminnallisten yksikköjen liike. Epätarkka pedikkeliruuvien asettaminen voi aiheuttaa neurologisia oireita ja johtaa nopeaan kiinnitysosien irtoamiseen ja rangan epätukevuusoireiden palaamiseen. Suuri osa selkärangan kiinnityslaitteista irtoaa lopulta, jollei luutumista kiinnitettyjen kohtien välillä tapahdu. Vuoden kuluttua luudutusleikkauksesta oireista luutumatonta kiinnityskohtaa nimitetään pseudoartroosiksi. Bioaktiiviset lasit ovat synteettisiä, bioyhteensopivia, osteokonduktiivisia ja osteostimulatiivisia materiaaleja, joilla on angiogeenisiä ja antibakteerisia ominaisuuksia, ja ne voivat sitoutua suoraan luuhun. 147 potilaalle lannerangan rappeumasairauden vuoksi asetetut 837 pedikkeliruuvia käsittävän tutkimuksen mukaan 14.3 % ruuveista rikkoi luisen pedikkelin seinämän. 25.9 %:lla potilaista, joilla ruuvi läpäisi pedikkelin seinämän, ilmeni uusia neurologisia oireita, ja 89.2 %:lla oireisista potilaista pedikkeliruuvi läpäisi pedikkelin seinämän mediaalisesti tai inferiorisesti. Prekliinisessä kontrolloidussa tutkimuksessa uudenlainen bioaktiivisesta lasista valmistettu S53P4 luunkorviketahna todettiin bioyhteensopivaksi, ja sen avulla saavutettiin hieman vertailuryhmää parempi luutuminen luuydinontelossa. Tahnan sidosaineen ei eläinkokeessa todettu häiritsevän luun muodostumista. Kliinisessä tutkimuksessa saavutettiin 95.8 %:n luutuminen käytettäessä S53P4 biolasitahnaa yhdessä oman luun kanssa lannerangan nikamasolmujen välisessä luudutuksessa. Siten yhdessä oman luun kanssa käytettäessä S53P4 biolasitahnalla saadaan aikaan vähintään yhtä hyvä nikamasolmujen välinen luutuminen kuin nykyisin käytettävillä synteettisillä luunkorvikkeilla. Tutkimuksessa todettiin yksi leikkauksen yhteydessä tapahtunut nikamasolmujen välisen implantin päätelevyyn painuminen, jonka suuruus ei muuttunut seurantakuvantamisissa

BAG S53P4 putty as bone graft substitute - a rabbit model

Bioactive glass (BAG) S53P4 granules represent a bone augmentation biomaterial for the surgical treatment of bony defects, even in challenging conditions such as osteomyelitis. The aim of this eight-week rabbit implantation study was to evaluate the biocompatibility and bone regeneration performance of a BAG S53P4 putty formulation following its implantation into the proximal tibia bone of twenty-eight New Zealand white rabbits. BAG S53P4 putty was compared to BAG S53P4 granules (0.5-0.8 mm) to evaluate whether the synthetic putty binder influences the bone regeneration of the osteostimulative granules. The putty formulation facilitates clinical use because of its mouldability, injectability and ease of mixing with autograft. Implantation of putty and granules into proximal tibia defects resulted in good osseointegration of the two groups. Both biomaterials were biocompatible, showed high new bone formation, high vascularization and periosteal growth. No signs of disturbed bone formation were observed due to the PEG-glycerol binder in the BAG S53P4 putty. Instead, intramedullary ossification and stromal cell reaction were more advanced in the putty group compared to the control group (p = 0.001 and p </p

Novel Bioactive Glass Putty (S53P4) as Bone Graft Expander in Minimally Invasive Lumbosacral Interbody Fusion

Objective This study aimed to evaluate the clinically achieved interbody fusion rate in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) operations, when using a novel bioactive glass (BAG) S53P4 putty as bone graft expander together with local autologous bone (AB). A second purpose was to assess radiologically the subsidence of intervertebral cage into vertebral endplates. Methods We conducted a retrospective analysis of 20 patients operated on with MI-TLIF for 24 levels by a neurosurgeon in our clinic between 2014 and 2016. In addition to routine follow-up by static plain radiographs, the patients with special complaints were investigated with computed tomography (CT) and/or magnetic resonance imaging (MRI). An independent neuroradiologist analysed the interbody fusion by bridging bone criteria in CT scans and subsidence either in CT scans or in static plain radiographs. The patients were followed up to 12-24 months postoperative. Results The interbody fusion rate of 95.8% could be defined based on CT analysis of the symptomatic patients. Of the eight symptomatic patients, one had interbody cage dislocation of 2-3 mm posteriorly, lucency around a sacral screw and breakage of the other sacral screw. No subsidence of cages was observed. No postoperative infections were detected. Conclusion As bone graft expander, the novel BAG S53P4 putty provides at least as good interbody fusion results as the presently used bone graft expanders and enhancers with no observed subsidence or postoperative infections

Glycans as Potential Diagnostic Markers of Traumatic Brain Injury

The diagnosis of mild traumatic brain injury (TBI) is challenging in the acute setting because the symptoms are nonspecific and often transient, or they develop with a delay. In these cases, the criteria for acute head imaging are frequently not fulfilled. This may lead to missed diagnoses in emergency care. There is a need for developing a rapid diagnostic test to verify the presence of TBI using body fluids. Blood, urine, and saliva samples from 11 adult patients (mean age 64 years, SD 24 years) with acute and clinically diagnosed TBI, and 12 healthy volunteers were collected at Turku University Hospital during a period of 5 months. The injuries necessitated hospitalization for at least one day. The TBIs were classified mild in nine cases and severe in two cases. The mean period between the trauma and the time for obtaining the samples was 27 h, SD 11 h. The samples were analyzed in an ISO-certified laboratory for the number of lectin-bound glycan molecules indicating destruction of nerve tissue. The screening was performed on several possible glycans for binding, and the measurement by degree of fluorescence. In the analysis, the group of patients with TBI was compared with healthy volunteers. The results showed a significant decrease (p < 0.05, Wilcoxon rank–sum two-sided test) in the level of two glycans in plasma, but no significant increase for any glycan; in saliva, one glycan showed a significant increase in the TBI group; in urine, three glycans were significantly different between the groups (one showed an increase, whereas two showed a decrease). The results support the idea of conducting more research on how diagnostic glycans could be detected in body fluids after TBI. As a proof-of-concept, significant changes in the concentration of five glycans were found in plasma, saliva, and urine between TBI patients and healthy controls. This may enable the development of a rapid body fluid-based point-of-care test to identify patients with TBI after a head injury.</p

Intracranial aneurysm is predicted by abdominal aortic calcification index: A retrospective case-control study

Background and aimsPatients with intracranial aneurysms (IA) have excess mortality for cardiovascular diseases, but little is known on whether atherosclerotic manifestations and IA coexist. We investigated abdominal aortic calcification index (ACI) association with unruptured and ruptured IAs.MethodsThis retrospective case-control study reviews all tertiary centers patients (n = 24,660) who had undergone head computed tomography angiography (CTA), magnetic resonance angiography (MRA) or digital subtraction angiography (DSA) for any reason between January 2003 and May 2018. Patients (n = 2020) with unruptured or ruptured IAs were identified, and patients with available abdominal CT were included. IA patients were matched by sex and age to controls (available abdomen CT, no IAs) in ratio of 1:3. ACI was measured from abdomen CT scans and patient records were reviewed.Results1720 patients (216 ruptured IA (rIA), 246 unruptured IA (UIA) and 1258 control) were included. Mean age was 62.9 ± 11.9 years and 58.2% were female. ACI (OR 1.02 per increment, 95%CI 1.01–1.03) and ACI>3 (OR 5.77, 95%CI 3.29–10.11) increased risk for rIA compared to matched controls. UIA patients' ACI was significantly higher but ACI did not increase odds for UIA compared to matched controls. History of coronary artery disease was less frequent in rIA patients. There was no calcification in aorta in 8.8% rIA and 13.6% UIA patients (matched controls 25.7% and 22.6% respectively, p ConclusionsAortic calcification is greater in rIA and UIA patients than matched controls. ACI increases risk for rIAs.</p

BAG S53P4 putty as bone graft substitute - a rabbit model

bone augmentation biomaterial for the surgical treatment of bony defects, even in challenging conditions such as osteomyelitis. The aim of this eight-week rabbit implantation study was to evaluate the biocompatibility and bone regeneration performance of a BAG S53P4 putty formulation following its implantation into the proximal tibia bone of twenty-eight New Zealand white rabbits. BAG S53P4 putty was compared to BAG S53P4 granules (0.5-0.8 mm) to evaluate whether the synthetic putty binder influences the bone regeneration of the osteostimulative granules. The putty formulation facilitates clinical use because of its mouldability, injectability and ease of mixing with autograft. Implantation of putty and granules into proximal tibia defects resulted in good osseointegration of the two groups. Both biomaterials were biocompatible, showed high new bone formation, high vascularization and periosteal growth. No signs of disturbed bone formation were observed due to the PEG-glycerol binder in the BAG S53P4 putty. Instead, intramedullary ossification and stromal cell reaction were more advanced in the putty group compared to the control group (p = 0.001 and p <0.001). In conclusion, the novel mouldable BAG S53P4 putty showed reliable bone regeneration in bony defects without adverse tissue or cell reactions. © 2017 WDG. All rights reserved.Peer reviewe

The age distribution of the new narcoleptic cases among the Pandemrix vaccinated and unvaccinated children and adolescents.

<p>Age presented in years.</p

The prioritization order of the pandemic influenza vaccinations in Finland during the A(H1N1) pandemic recommended by the National Advisory Committee on Vaccinations.

<p>The prioritization order of the pandemic influenza vaccinations in Finland during the A(H1N1) pandemic recommended by the National Advisory Committee on Vaccinations.</p