Stem cell therapy in discogenic back pain.

Chronic low back pain has both substantial social and economic impacts on patients and healthcare budgets. Adding to the magnitude of the problem is the difficulty in identifying the exact causes of disc degeneration with modern day diagnostic and imaging techniques. With that said, current non-operative and surgical treatment modalities for discogenic low back pain fails to meet the expectations in many patients and hence the challenge. The objective for newly emerging stem cell regenerative therapy is to treat degenerative disc disease (DDD) by restoring the disc's cellularity and modulating the inflammatory response. Appropriate patient selection is crucial for the success of stem cell therapy. Regenerative modalities for discogenic pain currently focus on the use of either primary cells harvested from the intervertebral discs or stem cells from other sources whether autogenic or allogenic. The microenvironment in which stem cells are being cultured has been recognized to play a crucial role in directing or maintaining the production of the desired phenotypes and may enhance their regenerative potential. This has led to a more specific focus on innovating more effective culturing techniques, delivery vehicles and scaffolds for stem cell application. Although stem cell therapy might offer an attractive alternative treatment option, more clinical studies are still needed to establish on the safety and feasibility of such therapy. In this literature review, we aim to present the most recent in vivo and in vitro studies related to the use of stem cell therapy in the treatment of discogenic low back pain.

Cervical synovial cyst.

Synovial cysts of the cervical spine are extremely rare. They can therefore pose a diagnostic challenge. We present an unusual case of acute symptomatology secondary to spontaneous haemorrhage into a cervical facet joint cyst.

A 5-year retrospective study assessing the association between seasonal and meteorological change and incidence of aneurysmal subarachnoid haemorrhage.

OBJECTIVE: Seasonal variation in incidence of spontaneous subarachnoid haemorrhage (SAH) is well recognised. This retrospective single-centre study aimed to characterise seasonality of SAH in the temperate climate of London, UK and to determine associations of incidence with meteorological variables. We further investigated whether associations vary according to location of aneurysm. METHODS: Admission data on 647 patients admitted with spontaneous SAH from December 2003 to August 2008 was analysed using our neurosurgical referrals database. Average monthly incidence of SAH was correlated with local temperature, atmospheric pressure and humidity data. In a subset of 467 patients, impact of aneurysm location on seasonal variation was evaluated. RESULTS: A non-significant bi-annual peak incidence was observed in Spring and Autumn with a trough in Summer (chi(2) = 1.5, p = 0.47). This trend was particularly marked with middle cerebral and posterior communicating artery aneurysms. However, anterior communicating artery aneurysmal SAH peaked in Summer only. SAH incidence correlated significantly with average humidity (coefficient 0.213, CI (0.02-0.404), p = 0.035) and peak humidity (coefficient 0.128, CI (0.008-0.248), p = 0.041). Temperature and atmospheric pressure did not correlate with incidence. CONCLUSIONS: This study illustrates a pattern of variation in SAH incidence similar to that seen in other populations and climates. However, our data suggests that this pattern differs according to aneurysm location. Unusually, we also find that humidity, and not temperature or atmospheric pressure, correlates with SAH incidence. Seasonal variability in aneurysm rupture is likely to be multifactorial, but meteorological factors may play an important role.