Surgical Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Spondylolisthesis and Degenerative Segmental Instability

STUDY DESIGN: This is a retrospective case study. PURPOSE: This study was designed to analyze the surgical outcomes of patients who underwent minimally invasive transforaminal lumbar interbody fusion (TLIF) for the treatment of spondylolisthesis and degenerative segmental instability. OVERVIEW OF LITERATURE: If the surgical outcomes of a procedure are evaluated together with multiple indications, it is not clear how the procedure helped each subgroup of patients. For the reason that some indications achieve better outcomes than the others, we performed a subgroup analysis using validated outcome measures to demonstrate the optimal indications and the treatment results of TLIF. METHODS: We conducted subgroup analyses by comparing the prospectively collecting data from the consecutive patients who underwent single-level minimally invasive TLIF for the treatment of the following 3 subgroups of indications: 23 cases of low-grade spondylolytic spondylolisthesis, 24 cases of degenerative spondylolisthesis, and 19 cases of degenerative segmental instability. RESULTS: The average duration of follow up was 36.1 +/- 9.9 months (range, 24 to 63 months). The preoperative pain and disability scores were significantly improved at final postoperative follow-up in all the subgroups (all measurements: p < 0.0001). The 3 subgroups exhibited an equivalent improvement of the pain and disability scores at the final follow-up. The rates of radiographic solid fusion and complications were also similar among the 3 groups. CONCLUSIONS: Our data suggests that minimally invasive TLIF optimally and equivalently alleviates all of the associated symptoms and disabilities from low-grade spondylolisthesis and degenerative segmental instability. Furthermore, these patients seem to have optimal surgical indications for minimally invasive TLIF, while maintaining favorable surgical outcomes.

Antimicrobial Peptide (LL-37) Expression In Nasal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epithelial cells are the first line of defense in the innate immune system against microorganisms. The antimicrobial peptides are major participants in this system. LL-37, a kind of antimicrobial peptide, is the only cathelicidin protein so far identified in humans. Since the level of the peptide is known to increase in inflamed areas, we tried to find the correlation of the peptide with inflammation in nasal mucosa by examining the expression level of LL-37. Furthermore, we determined the mRNA expression level of IL-1beta and IL-8, both of which are known to be involved in inflammation. MATERIALS AND METHODS: Nasal mucosa specimens were obtained from nasal polyps, chronic infective rhinitis, and normal inferior turbinate mucosa. The LL-37 protein was localized by immunohistochemical staining and mRNA expression of LL-37, IL-1beta, IL-8 were determined by reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: In immunohistochemical study, LL-37 immunoreactive cells were primarily localized in the surface epithelia, the serous and mucous cells of the submucosal glands, and some stromal inflammatory cells. In normal tissue, 2 out of 6 samples (33%) studied exhibited immunoreactivity against LL-37 antibody, but in nasal polyps, 5 out of 8 (63%) and in infective rhinitis, 6 out of 7 (85%) showed positive reaction to the antibody. The number of positive cells were increased in inflammatory specimens, but there was no statistical difference between the normal and inflammatory specimens in epithelial layer, submucosal gland, and stromal inflammatory cells (p<0.05). In RT-PCR, LL-37 mRNA was detected in three of the six normal turbinate samples, but in all fifteen cases of inflammatory nasal tissues. The expression of LL-37 mRNA was correlated with the proinflammatory cytokines, IL-1beta and IL-8 mRNA. CONCLUSIONS: Our results suggest that LL-37 is one of antimicrobial peptides found in the human nasal mucosa, and participates in the innate immune system of the nasal mucosa.