Journal of Spine

Cerebrospinal fluid is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord. It serves multiple critical functions, including cushioning the brain within the skull, serving as a shock absorber for the central nervous system, removing waste products from the brain, and providing a stable chemical environment. Understanding the dynamics of CSF outflow and egress is crucial for diagnosing and treating various neurological conditions. This article delves into the mechanisms and pathways of CSF outflow and egress along the lumbar spine nerve roots.

Lumbar diseases, including herniated discs, degenerative disc disease, and spinal stenosis, are prevalent conditions that cause significant morbidity worldwide. Accurate diagnosis of these conditions is critical for effective treatment planning and patient outcomes. Traditional imaging techniques, such as magnetic resonance imaging and computed tomography, are essential diagnostic tools but rely heavily on the expertise of radiologists. The integration of deep learning into medical imaging has the potential to revolutionize the diagnosis of lumbar diseases, providing enhanced accuracy and efficiency. This article explores the application of deep learning in the multi-angle analysis of intervertebral discs for the intelligent diagnosis of lumbar diseases.

Neuromuscular scoliosis is a severe spinal deformity often seen in patients with underlying neuromuscular disorders such as cerebral palsy, muscular dystrophy, or spinal muscular atrophy. Non-ambulatory patients with NMS are particularly challenging to treat due to their limited mobility, poor muscle control, and overall weakened physical condition. Traditional surgical treatments for scoliosis, such as spinal fusion, are not always suitable for these patients, especially in growing children. This has led to the development of magnetically controlled growing rods which allow for non-invasive adjustments to accommodate spinal growth. However, the method of pelvic fixation in these patients remains a topic of ongoing debate. This article compares two different pelvic fixation methods over a four-year period in non-ambulatory patients with NMS treated with MCGRs.

Introduction: Anterior Cervical Discectomy and Fusion (ACDF) procedures are a staple for addressing persistent pain and radiculopathy associated with of the degeneration, herniation and/or failure of interbody nucleus propulsi. Autograft arguably remains the gold standard after facing stiff competition from recombinant biologic alternatives that provided supra-physiologic quantities of singular growth factor to support bony remodeling. The alternative, novel allograft growth factor used in this series, provides the full complement of growth factors available from the native donor tissue many shown to play integral roles related to specific cascades involved with bony remodeling. Serial radiography is retrospectively assessed for efficacy is supporting fusion.

Methods: An Institutional Review Board was consulted and a waiver granted for retrospective evaluation of the state of fusion captured in radiology accrued during the routine follow-up associated with post-surgical care of patients requiring a surgical intervention where the novel allograft growth factor was utilized. A single, fellowship trained orthopedic surgeon collected data regarding 110 consecutive ACDF procedures that included at least one level where the novel allograft growth factor was included over a period from Nov 2018 thru Nov 2022. Criteria for considering an ACDF intervention included pain, radiculopathy, stenosis, kyphosis, myelopathy, pseudoarthrosis (prior), instability, cord compression, herniated nucleus propulsi (HNP), degenerative disc disease, and/or scoliosis. A collagen matrix scaffold or equivalent carrier was rehydrated using novel allograft growth factor for each of the surgical interventions reviewed. The resulting graft mass was positioned within interbody cages utilized at each level requiring intervention. An independent radiologist assessed serial radiography collected using the Brantigan, Steffee and Fraser criteria to classify state of fusion.

Results: At three months 70 of 162 (43.2%) levels were deemed fused with 85 of 162 (52.5%) deemed partially fused and the remaining 7 of 162 (4.3%) levels reporting with limited evidence of fusion. At six months 90 of 150 (60.0%) levels were deemed fused with 55 of 150 (36.7%) deemed partially fused and 5 of 150 (3.3%) reporting with limited evidence of fusion. At twelve months 114/129 (88.4%) levels were deemed fused 14/129 (10.9%) deemed partially fused and 1/129 (0.8%) demonstrating limited evidence of fusion. At eighteen months 131/133 (98.5%) levels were deemed fused 1/133 (0.8%) deemed partially fused and 1/133 (0.8%) demonstrating limited evidence of fusion. At twenty-four months 132 of 133 (99.2%) levels were deemed fused with the remaining level (0.8%) deemed partially fused.

Conclusion: This novel allograft growth factor demonstrates success with regards to supporting bony fusion desired as a result of an ACDF intervention. This multi-factored approach to supporting fusion includes a number of known growth factors shown to benefit a number of biologic cascades pivotal to bony remodeling including osteoinductive, angiogeneic, proliferative and chemotactic roles. These parallel relationships work collaboratively to contribute to successful bony remodeling and may improve patient outcomes. Further clinical assessment is warranted to better understand the full potential of this novel growth factor allograft.