Rho-Associated Kinase Inhibitor Immortalizes Rat Nucleus Pulposus and Annulus Fibrosus Cells: Establishment of Intervertebral Disc Cell Lines With Novel Approaches

Study Design. Establishment of immortalized cell lines derived from rat intervertebral disc cells by Rho-associated kinase (ROCK) inhibitor, Y-27632. Objective. To determine whether rat nucleus pulposus (NP) and annulus fibrosus (AF) cells could be immortalized, retain their phenotype, and used as cell lines for in vitro cell biology. Summary of Background Data. Intervertebral disc degeneration is a major factor for most low-back pain. However, the mechanism of the disease is not well understood by the limitation to obtain sufficient amounts of primary disc cells. Therefore, the establishment of disc cell lines will help in vitro molecular signaling studies to understand the mechanism of degenerative disc disease. Methods. Cells were isolated from the NP and AF tissues of lumbar discs of adult Sprague Dawley rat. Tissues were digested and cultured with DMEM/Ham's F-12 (1:1) and 20% FBS and antibiotics. From day 3, cells were grown in the presence of 10 μM Y-27632, a well-characterized inhibitor of the ROCK, and subcultured by trypsinization, passaging them 1:3 onto 100 mm culture dishes. Morphologic and genetic analyses were performed on the different passaged cells. Results. ROCK inhibitor successfully immortalized rat NP and AF cells. They passaged for over 50 generations with sustained expression levels of several NP and AF cell markers. In addition, they retained phenotypic features similar to the primary parental NP and AF cells when the cells were challenged with different cytokines and growth factors. Conclusion. We established immortalized rat NP and AF cell lines using a method of treating cells with ROCK inhibitor Y-27632 and demonstrated that these immortalized cells retain the properties of primary cells and could serve as useful tools for in vitro signaling studies or drug screening studies to develop novel therapeutic strategies. Level of Evidence: N/A

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Factors Affecting Postoperative Neurological Deficits After Nerve Root Resection for the Treatment of Spinal Intradural Schwannomas

Study Design. A retrospective clinical data analysis. Objective. To investigate the factors related to postoperative neurological deficits after nerve root resection in the treatment of spinal intradural schwannoma. Summary of Background Data. Neurological deficits could be observed after resection of tumor-involved nerve roots in spinal intradural schwannoma. Thus, it is important to find the factors related to postoperative neurological deficits. Methods. Clinical and pathological data were selected from patients underwent total resection of the solitary spinal intradural schwannoma from T11 to S. Patients were divided into the postoperative neurological deficits positive group (PND group, n = 12) and negative group (non-PND group, n = 52). Clinical features including age, sex, duration of disorders, diabetes, preoperative visual analogue scale (VAS) and SF-36 score, preoperative symptoms, tumor size, tumor location, and immunostaining results were analyzed. Results. Age, sex, duration of disorders, diabetes, preoperative VAS and SF-36 score, tumor length, and tumor-occupied ratio were not significantly different between the two groups (P > 0.05). Lower extremity pain, sensory disturbance, and motor disturbance were found in 25.0%, 50.0%, and 75.0% of patients in the PND group and 76.9%, 17.3%, and 7.7% of patients in the non-PND group, respectively, and the results were significantly different (P < 0.05). The rate of postoperative neurological deficits was higher when the tumor was located in the thoracolumbar junction (T11–L2) than other segments (L2–S; P = 0.009). For immunostaining study, CD34-positive rate was significantly different between the two groups (P = 0.013). Conclusion. The absence of preoperative lower extremity pain, presence of sensory and motor disturbances, and tumor location in the thoracolumbar junction (T11–L2) are the predictors of postoperative neurological deficits. Age, sex, duration of the disorders, diabetes, preoperative VAS score, preoperative SF-36 score, tumor length, and tumor-occupied ratio are not related to postoperative neurological deficits. On immunostaining of tumors, CD34-negative results are related to the development of postoperative neurological deficits. Level of Evidence: 4

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Clinical Relevance of the SRS-Schwab Classification for Degenerative Lumbar Scoliosis

Study Design. Retrospective cohort study. Objective. The aim of this study was to evaluate the clinical relevance of the SRS-Schwab classification for degenerative lumbar scoliosis (DLS). Summary of Background Data. The SRS-Schwab classification has been presented and validated as a useful tool for adult spinal deformity (ASD). This classification includes various types of ASD (degenerative de novo scoliosis or adult form of idiopathic scoliosis). However, DLS has different clinical characteristics and pathophysiology compared with other forms of ASD. Methods. In this retrospective cohort study, 216 (146 conservatively treated and 70 surgically treated) DLS patients were enrolled. The average patient age was 72.1 ± 7.4 years. Clinical parameters for disability were measured using Oswestry disability index (ODI) and back and leg pain numerical rating scale. Radiographic parameters included SRS-Schwab sagittal modifiers (pelvic tilt [PT]; sagittal vertical axis [SVA];pelvic incidence-lumbar lordosis [PI-LL]), T1 pelvic angle, and coronal parameters (Cobb's angle [CA]; coronal imbalance [CI]; coronal deviation distance [CDD]; tilting angle [TA]). Correlations between clinical parameters and radiographic parameters were assessed and surgical rates along the SRS-Schwab sagittal modifiers were evaluated. Results. Only PI-LL as a sagittal radiographic parameter showed a weak correlation with clinical parameters (r = 0.137–0.176) (P < 0.05). Coronal parameters such as CA, CI, CDD, and TA also showed weak correlation with clinical parameters (r = 0.137–0.202) (P < 0.05). Multiple regression analysis identified CA, CI, CDD, and PI-LL to be correlated with clinical parameters. On analysis for clinical outcomes (surgical rates and patient self-reported disability) along the grades of the SRS-Schwab sagittal modifiers, PT and SVA were not related to higher surgical rates or disability. Conclusion. Even though some radiological parameters showed statistically significant results, correlation between radiological and clinical parameters was weak. Not only deformity but also other clinical factors should be considered when evaluating DLS. Level of Evidence: 4

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Reporting of Rehabilitation Intervention for Low Back Pain in Randomized Controlled Trials: Is the Treatment Fully Replicable?

Study Design. Methodological review of randomized controlled trials (RCTs). Objective. To assess the quality of reporting of rehabilitation interventions for mechanical low back pain (LBP) in published RCTs. Summary of Background Data. Reporting of interventions in RCTs often focused on the outcome value and failed to describe interventions adequately. Methods. We systematically searched for all RCTs in Cochrane systematic reviews on LBP published in the Cochrane Database of Systematic Reviews until December 2013. The description of rehabilitation interventions of each RCT was evaluated independently by 2 of the investigators, using an ad hoc checklist of 7 items. The primary outcome was the number of items reported in sufficient details to be replicable in a new RCT or in everyday practice. Results. We found 11 systematic reviews, including 220 eligible RCTs, on LBP. Of those, 185 RCTs were included. The median publication year was 1998 (I-III quartiles, 1990 to 2004). The most reported items were the characteristics of participants (91.3%; 95% confidence interval [CI], 87.3–95.4), the intervention providers (81.1%; 95% CI, 75.4–86.7), and the intervention schedule (69.7%; 95% CI, 63–76). Based on the description of the intervention, less than one fifth would be replicable clinically. The proportion of trials providing all essential information about the participants and interventions increased from 14% (n = 7) in 1971 to 1980 to 20% (n = 75) in 2001 to 2010. Conclusion. Despite the remarkable amount of energy spent producing RCTs in LBP rehabilitation, the majority of RCTs failed to report sufficient information that would allow the intervention to be replicated in clinical practice. Improving the quality of intervention description is urgently needed to better transfer research into rehabilitation practices. Level of Evidence: 1

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Associations between maternal and paternal parenting behavior, anxiety and its precursors in early childhood: A meta-analysis

Erratum to “The puzzle of intrafamilial child sexual abuse: A meta-analysis comparing intrafamilial and extrafamilial offenders with child victims” [Clin. Psychol. Rev. 39 (2015) 42–57]

Back pain after trauma

A 22 year old man presented because of back pain after a car crash. Physical examination identified tenderness over the mid aspect of the back. Non-contrast computed tomography of the dorsal spine...

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