ABSTRACT
BACKGROUND: The management of traumatic upper thoracic spine fractures (T1-T6) is complex due to the unique biomechanical/physiological characteristics of these levels and the nature of the injuries. They are commonly associated with multiple other traumatic injuries and severe spinal cord injuries. We describe the safety and efficacy of surgery for achieving stability and maintaining reduction of upper thoracic T1-T6 spine fractures. METHODS: We retrospectively analyzed a series of traumatic unstable upper thoracic (T1-T6) spine fractures treated at one institution between 1993 and 2016. All patients were assessed neurologically and underwent complete preoperative radiographic analysis of their T1-T6 spine fractures including assessment of instability. Neurological and radiographic outcomes including fusion rates, kyphotic deformity, and successful reduction of the fracture were evaluated along with hospital length of stay (LOS), intensive care unit LOS, and overall complication rates. RESULTS: There were 43 patients (29 males, 14 females) with an average age of 37.7 years. Between 1993 and 1999, 8 patients were treated with hook/rod constructs, whereas between 1995 and 2016, 35 patients received pedicle screw fixation utilizing intraoperative fluoroscopy or computed tomography (CT) navigation. Forty-three patients had a total of 178 levels fused. In this series, there were no intraoperative vascular or neurological complications. Instrumentation was removed in five patients due to pain, wound infection, or hardware failure. The mean hospital LOS was 21.1 days (range 4-59 days), and there was a 95% fusion rate based on follow-up imaging (X-rays or CT scan). CONCLUSIONS: Surgical treatment of upper thoracic spine fractures (T1-T6), although complex, is safe and effective. Reduction and fixation of these fractures decreases the risk of further neurological complications, allows for earlier mobilization, and correlates with shorter hospital LOS and improved outcomes.
ABSTRACT
Tissue engineering strategies for the intervertebral disc (IVD) have traditionally focused either on the annulus fibrosus (AF) or the nucleus pulposus (NP) in isolation, or have simply compared AF cells and NP cells in identical culture conditions. Recently, others in the field have become aware of the advantage of combining the AF and NP into a more comprehensive strategy to address IVD tissue engineering, and have introduced biomimetic approaches to either AF or NP tissue engineering. Here, we introduced a new method for developing a biomimetic, cell-seeded IVD by electrospinning circumferentially-orientated polycaprolactone fibres (AF analogue), seeding them with cells (porcine chondrocytes) and then gelling a cell-agarose solution in the centre (NP analogue). Scanning electron microscopy images demonstrated a high degree of fibre alignment and, along with fluorescent actin staining, confirmed a preferred orientation of cells in the direction of the fibres. Viability assays and histology collectively demonstrated that cells were viable and well-distributed around the interface between the NP and AF regions. In addition, mechanical testing confirmed that the composite IVD scaffolds had higher moduli than the agarose hydrogels alone. As we enter the new decade and the fields of AF and NP tissue engineering begin to merge into a new interfacial and functional IVD tissue-engineering field, approaches such as the method presented here will serve as the foundation for continuously advancing technology that we ultimately endeavour to bring to the clinic for the treatment of patients severely afflicted by degenerative disc disease.
