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.
Low back and radicular pain recently became a major public health problem. Medical expenses in general, and surgical procedures associated with overall care for the lower back pain are high and ...growing. Furthermore, these two chronic pain conditions are also leading causes for missed workdays. Degenerative changes of the intervertebral disc, facet joints, sacroiliac joint or disc herniation as described during imaging diagnostics may or may not be the cause of patients' lower back pain. Diagnostic blocks often precede further interventions in order to confirm or dispute a source of the lower back pain. Chronic lower back pain caused by painful intervertebral disc should be treated using biacuplasty. If the pain of the lumbar spine is caused by facet joints or sacroiliac joint, patient can be offered neuroablative procedures using radiofrequency. In cases where the low back and radicular pain are caused by the central and foraminal spinal stenosis patients are advised epidural steroid injections, unless claudications are present. Patients suffering from the chronic radicular pain may be treated with various nucleoplasty procedures or they may be offered percutaneous radiofrequent neuromodulation. The purpose of above advised procedures is to relieve patients' pain, allow optimal physical therapy, and improved functional capacity, consequently providing better quality of life.
Križobolja i lumboishijalgija su značajni zdravstveni problemi današnjice. Bolesnici s navedenim tegobama često izostaju s posla, a troškovi operacijskog liječenja iznimno su visoki. Adekvatna ...dijagnostika križobolje i lumboishijalgije podrazumijeva detaljno poznavanje anatomije kralježnice i živčanih struktura, kao i rukovanje pomičnim RTG uređajem. Svrha je ovih procedura primjenom kratkodjelujućeg lokalnog anestetika anestezirati pojedine živčane završetke, a u slučaju provokativne diskografije provocirati bol, kako bi se sa sigurnošću potvrdilo koje su anatomske strukture uzrok bolova. To je potrebno stoga što križobolju mogu uzrokovati različite bolesti kralježnice. Najčešće su degenerativne promjene u intervertebralnom disku, promjene malih zglobova, oštećeni sakroilijakalni zglob ili hernijacija diska. Shodno ovome, a ovisno o različitim anatomskim strukturama koje mogu biti izvor bolova, postoji više dijagnostičkih minimalno invazivnih procedura. Svaka dijagnostička procedura, s kojom se egzaktno utvrdi uzrok križobolje ili lumboishijalgije, bolesnika posljedično potvrđuje kao dobrog kandidata za minimalno invazivni terapijski zahvat.
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.
Križobolja i lumboishijalgija značajni su javnozdravstveni problemi modernoga doba. Troškovi operacijskog liječenja često su iznimno visoki, a radno sposobni ljudi s ovim bolestima često izostaju s ...radnoga mjesta. Minimalno invazivno liječenje križobolje i lumboishijalgije podrazumijeva detaljno poznavanje anatomije kralježnice i živčanih struktura, kao i rukovanje pokretnim RTG uređajem. Križobolju i lumboishijalgiju mogu uzrokovati degenerativne promjene u intervertebralnom disku, promjene zigapofizealnih (fasetnih) zglobova, oštećeni sakroilijakalni (SI) zglob ili hernijacija diska, kao najčešći uzrok stenoze spinalnog kanala. Svaka minimalno invazivna dijagnostička procedura, s kojom se egzaktno potvrdi uzrok križobolje ili lumboishijalgije, bolesnika posljedično predodređuje za specifični minimalno invazivni terapijski zahvat. Kod bolova u slabinskoj kralježnici uzrokovanih degenerativnim promjenama u intervertebralnom disku bolesniku se preporučuje jedna od metoda anuloplastike. Ako je križobolja uzrokovana degenerativnim promjenama fasetnih zglobova ili promjenama u SI zglobu, tada se primjenjuju procedure radiofrekventne neuroablacije. U slučajevima kada su križobolja i lumboishijalgija uzrokovane stenozom spinalnog kanala, bolesniku se preporučuju epiduralne steroidne injekcije ili perkutana laserska dekompresija diska. Svrha je ovih procedura, primjenom dugodjelujućih kortikosteroida i kratkodjelujućeg lokalnog anestetika, te primjenom radiofrekventne struje ili primjenom energije lasera, bolesnika na duže vrijeme osloboditi bolova i tako mu poboljšati kvalitetu života, a istovremeno prevenirati ili barem odgoditi velik operacijski zahvat.
Purpose
To validate the AO Spine Subaxial Injury Classification System with participants of various experience levels, subspecialties, and geographic regions.
Methods
A live webinar was organized in ...2020 for validation of the AO Spine Subaxial Injury Classification System. The validation consisted of 41 unique subaxial cervical spine injuries with associated computed tomography scans and key images. Intraobserver reproducibility and interobserver reliability of the AO Spine Subaxial Injury Classification System were calculated for injury morphology, injury subtype, and facet injury. The reliability and reproducibility of the classification system were categorized as slight (
ƙ
= 0–0.20), fair (
ƙ
= 0.21–0.40), moderate (
ƙ
= 0.41–0.60), substantial (
ƙ
= 0.61–0.80), or excellent (
ƙ
= > 0.80) as determined by the Landis and Koch classification.
Results
A total of 203 AO Spine members participated in the AO Spine Subaxial Injury Classification System validation. The percent of participants accurately classifying each injury was over 90% for fracture morphology and fracture subtype on both assessments. The interobserver reliability for fracture morphology was excellent (
ƙ
= 0.87), while fracture subtype (
ƙ
= 0.80) and facet injury were substantial (
ƙ
= 0.74). The intraobserver reproducibility for fracture morphology and subtype were excellent (
ƙ
= 0.85, 0.88, respectively), while reproducibility for facet injuries was substantial (
ƙ
= 0.76).
Conclusion
The AO Spine Subaxial Injury Classification System demonstrated excellent interobserver reliability and intraobserver reproducibility for fracture morphology, substantial reliability and reproducibility for facet injuries, and excellent reproducibility with substantial reliability for injury subtype.
Osteoporoza je sistemska bolest skeleta karakterizirana smanjenjem koštane gustoće i oštećenjem mikroarhitekture. Moguća posljedica je osteporotska vertebralna fraktura (OVF) koja izaziva akutnu ili ...kroničnu bol, smanjenu pokretljivost, smanjenu kvalitetu života i povećan rizik smrti zbog smanjene mobilnosti i kardiopulmonalne disfunkcije. Kada se OVF manifestira klinički, osnovno je optimalno liječenje boli (OLB). Iako prirodni tijek u većine bolesnika dovodi do smanjenja bolova u prvih nekoliko tjedana, dio bolesnika ima perzistentnu bol i/ili kolaps kralješka. U bolesnika s perzistentnom boli može se primijeniti intraartikularna injekcija kortikosteroida i anestetika u zigapofizne zglobove bolnog segmenta (IAI). U bolesnika s kolapsom kralješka ili perzistentnom boli nakon IAI preporučuje se primijeniti perkutanu vertebroplastiku (PVP) ili perkutanu balon kifoplastiku (BKP). PVP je minimalno invazivna operacija u kojoj se uz radiološko navođenje u prelomljeni kralježak utiskuje cement. BKP je varijacija iste tehnike u kojoj se prije aplikacije cementa specijalnim balonom stvara šupljina te se cement utiskuje pod manjim tlakom. U kliničkim studijama dokazan je signifikantan učinak PVP-a i BKP-a u poboljšanju kvalitete života i pokretljivosti, kao i smanjenje bolova u komparaciji s OLB-om, ali u komparaciji s metodom IAI učinak nije signifikantan. U nekim studijama uočeno je smanjenje mortaliteta nakon PVP-a i BKP-a, ali zbog lošeg dizajna studija taj učinak nije siguran. U skupini bolesnika s neurološkim deficitom primjenjuju se otvorene kirurške tehnike za zbrinjavanje različitih oblika prijeloma i deformiteta s dugotrajno dobrim kliničkim i radiološkim rezultatima.
Back pain caused primarily by mechanical disorders is the most common type of back pain and it is usually found in young and middle-aged population, i.e. active population. This is why back pain is ...one of the most important public health problems. Treatment of pain syndrome affecting spine depends on a variety of factors and generally includes conservative and invasive methods. Relative indication for interventional and surgical procedures is long lasting back pain, the symptoms of which, predominantly pain, cause significant problems for the patient on performing everyday activities. Invasive/surgical treatment is applied after minimally 3 months of unsuccessful conservative treatment. Invasive and surgical procedures comprise a wide spectrum of interventions, from interventional and semi-interventional procedures, minimally invasive procedures to extensive, invasive operations that include instrumentation. The choice of intervention is based on clinical findings, duration and severity of pain and other symptoms, as well as on diagnostic reports. Despite recommendations based on the results of clinical studies, individual approach to each patient is the main principle of successful treatment.
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