SAŽETAK
Adultne deformacije kralježnice značajno pridonose morbiditetu, napose starije popupacije. Iako je spektar uzroka raznolik najčešće se radi o novonastalim deformacijama na temelju ...degenerativnih promjena kralježnice. Osim bolova, osjećaja napetosti i drugih neugodnih simptoma, adultne deformacije rezultiraju biomehaničkim poremećajima, smanjenom pokretljivosti, a ponekad i neurološkim deficitima. Sveukupno, deformacije kralježnice u odraslih osoba uzrokuju značajnu onesposobljenost i lošiju kvalitetu života (fizičku i psihičku), dok su s druge strane u svakodnevnoj kliničkoj praksi relativno zanemarena patologija odrasle dobi. Stoga u ovom radu dajemo natativni pregled najnovijih spoznaja o etiopatogenezi, kliničkoj slici, slikovnoj dijagnostici, liječenju (konzervativnom i kirurškom) i postoperativnoj rehabilitaciji bolesnika s adultnim deformacijama najčešćih uzroka.
Vratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. ...Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralježnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Prvi dio se odnosi na dijagnostiku, a drugi, njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke procedure. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici.
Vratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. ...Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralješnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Ovaj prvi dio odnosi se na dijagnostiku, a drugi njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke postupke. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici.
Spondilodiscitis se u većini slučajeva može liječiti konzervativno, ali kompliciraniji slučajevi koji uključuju prijeteći ili postojeći neurološki ispad, nestabilnost i deformitet kralježnice, jake ...bolove, epiduralni apsces i neuspjeh konzervativnog liječenja zahtijevaju kirurško liječenje. Ciljevi operativnog liječenja spondilodiscitisa su odstranjenje nekrotičnog tkiva i dekompresija neuralnih struktura, uzimanje tkiva za patohistološku dijagnozu i mikrobiološku potvrdu uzročnika, stabilizacija kralježnice, te rana mobilizacija pacijenta. Moderna kirurška tehnika koristi stražnji pristup, prednji pristup i kombinirani pristup u jednom ili dva stupnja, a kirurg je vođen lokalizacijom spondilodiscitisa i individualnim pristupom pacijentu. Stabilnost kralježnice se postiže transpedikularnom fiksacijom titanskim vijcima i stupićima, a prednja kolumna torakolumbalne kralježnice se nakon odstranjenja nekrotičnog tkiva rekonstruira trikortikalnim koštanim presatkom iz zdjelice ili titanskim kavezima ispunjenim spongioznom kosti. U kirurškom liječenju spondilodiscitisa vratne kralježnice stabilnost se postiže prednjim pločama sa zaključanim vijcima i/ili stražnjom stabilizacijom vratne kralježnice. Korist stabilizacije kralježnice titanskim implantatima nadilazi manjkavost implantacije stranog materijala na mjestu upale.
Using a well‐designed rat model, we demonstrated that the stable gastric pentadecapeptide BPC 157 improved the spinal cord injury (FASEB J 2015, 29, 617.5). Previously shown to counteract the ...consequence of peripheral (sciatic) nerve transection/anastomosis, and improve nerve healing (Regul Pept. 2010 Feb 25;160(1–3):33–41.), and brain trauma (Regul Pept. 2010 Feb 25;160(1–3):26–32.), and various encephalopathies (Curr Pharm Des. 2018;24(18):1990–2001), BPC 157, LD1 not achieved, was implemented as an anti‐ulcer peptide in inflammatory bowel disease trials and now in a multiple sclerosis trial(Curr Pharm Des. 2018;24(18):1990–2001). In a study from the day 1 to 1 year, rats underwent laminectomy (level L2–L3), 60 second compression (neurosurgical piston (60–66 g) on exposed dural sac with sacrocaudal spinal cord) received one medication of BPC 157 (200 or 2 μg/kg) or saline (5 ml/kg)) intraperitoneally at 10 min after injury (FASEB J 2015, 29, 617.5). All injured rats underwent BPC 157 exhibit consistent improvement, clinically, constantly better tail motor function, no autotomy; resolved spasticity already by the day 15; microscopically (since day 7), vacuolas and loss of axons in white matter, edema and loss of motoneurons in gray matter, and decrease of the number of large myelinated axons in rat caudal nerve were largely counteracted in BPC 157 rats. EMG recording evidences markedly lower MUP in tail muscle. Concluding, under the conditions of one single application, given soon after spinal cord injury, counteracted were axonal and neuronal necrosis, demyelination, cyst formation. Now, to create, however, a more reliable situation and therapy effect, the therapy with BPC 157 was started after 4 days. The medication was given in drinking water (BPC 157 10 μg/kg, 0.16 μg/mL, 12 ml/rat/day) through next 4 weeks, while controls received drinking water only. Specifically, tail motor function was scored as follows: 1 ‐ complete loss of tail function; 2 ‐ elevation maximum of 1/4 of tail length; 3 ‐ elevation maximum of 1/2 of tail; 4 ‐ elevation maximum of 3/4 of tail length; 5 – normal function. During evaluation, tail motor function score remained debilitated in rats underwent spinal cord injury that received post‐injury. Contrarily, BPC 157 treated rats exhibited huge improvement, which was continued to full recovery.
Conclusion
We documented that even given later after injury, the neuroprotective effect of BPC 157 quickly appears, and, BPC 157 given in drinking water, accordingly recovers the failed motor function in rats with spinal cord injury.
Support or Funding Information
This work was supported by the Ministry of Science, Education and Sports, Republic of Croatia grant number 108‐1083570‐3635 .
This is from the Experimental Biology 2019 Meeting. There is no full text article associated with this published in The FASEB Journal.
To induce spinal instability, we focused on bilateral facetectomy in rats and possible therapeutic benefit with the stable gastric pentadecapeptide BPC 157 given in the drinking water. Recently, ...using a well‐designed rat model (L2‐L3 compression), we demonstrated that the stable gastric pentadecapeptide BPC 157 improved the spinal cord injury (FASEB J 2015, 29, 617.5), concluding that under the conditions of one single application, given soon after spinal cord injury, motor function was markedly recovered, axonal and neuronal necrosis was counteracted, as was demyelination and cyst formation. Previously shown to counteract the consequence of peripheral (sciatic) nerve transection/anastomosis, improve nerve healing (Regul Pept. 2010 Feb 25;160(1–3):33–41.), brain trauma (Regul Pept. 2010;160(1–3):26–32.), and various encephalopathies (Curr Pharm Des. 2018;24(18):1990–2001), BPC 157 (LD1 not achieved) was implemented as an anti‐ulcer peptide in inflammatory bowel disease trials and now in a multiple sclerosis trial(Curr Pharm Des. 2018;24(18):1990–2001). In this study, the bilateral paravertebral muscles attached to the L3–L4 segment were peeled from the lumbar spine to expose the posterior bony elements. The rats then underwent complete resection of bilateral L3–L4 facet joints without neural tissue injuries. The medication was given in drinking water (BPC 157 10 ng/kg, 0.16 ng/mL, 12 ml/rat/day) through next 8 weeks, while controls received drinking water only. Radiological assesment of rat spines acquired at 1 week or 8 weeks was conducted (Figure 1). At 1 week, controls and BPC 157 animals exhibited no gross deformity observed in any plane, disk spaces seem unaffected, neural foramen at operated level is slightly widened, though BPC 157 drinking animals had higher bone density overall. At 8 weeks, both groups exhibited no gross deformity observed in any plane, unaffected disk spaces, widened neural foramen at the operated level is slightly widened, though there was an additional discrepancy in bone density overall between groups (BPC 157 having markedly more sclerotic and better defined bones). Also worth noting is the lack of abundant callus formation in the BPC 157 rats whereas the controls have visible callus formation in seemingly random patterns near the affected level. In addition, a significant motor disability which appears in controls immediately upon injury induction, was completely counteracted in BPC 157 drinking rats.
Support or Funding Information
This work was supported by the Ministry of Science, Education and Sports, Republic of Croatia grant number 108‐1083570‐3635.
This is from the Experimental Biology 2019 Meeting. There is no full text article associated with this published in The FASEB Journal.
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