Cortical bone trajectory screws in the treatment of lumbar degenerative disc disease in patients with osteoporosis

Lumbar degenerative disc disease(DDD)in the elderly population remains a global health problem,especially in patients with osteoporosis.Osteoporosis in the elderly can cause failure of internal fixation.Cortical bone trajectory(CBT)is an effective,safe and minimally invasive technique for the treatment of lumbar DDD in patients with osteoporosis.In this review,we analyzed the anatomy,biomechanics,and advantages of the CBT technique in lumbar DDD and revision surgery.Additionally,the clinical trials and case reports,indications,advancements and limitations of this technique were further discussed and reviewed.Finally,we concluded that the CBT technique can be a practical,effective and safe alternative to traditional pedicle screw fixation,especially in DDD patients with osteoporosis.

Mineralized collagen-modified PMMA cement enhances bone integration and reduces fibrous encapsulation in the treatment of lumbar degenerative disc disease

As a minimally invasive surgery,percutaneous cement discoplasty(PCD)is now contemplated to treat lumbar disc degeneration disease in elder population.Here,we investigated whether the osteogenic mineralized collagen(MC)modified polymethylmethacrylate(PMMA)cement could be a suitable material in PCD surgery.Injectability,hydrophilicity and mechanical properties of the MC-modified PMMA(PMMA-MC)was characterized.The introduction of MC did not change the application and setting time of PMMA and was easy to be handled in minimally invasive operation.Hydrophilicity of PMMA-MC was greatly improved and its elastic modulus was tailored to complement mechanical performance of bone under dynamic stress.Then,PCD surgery in a goat model with induced disc degeneration was performed with implantation of PMMA-MC or PMMA.Three months after implantation,micro-computed tomography analysis revealed a 36.4%higher circumferential contact index between PMMA-MC and bone,as compared to PMMA alone.Histological staining confirmed that the surface of PMMA-MC was in direct contact with new bone,while the PMMA was covered by fibrous tissue.The observed gathering of macrophages around the implant was suspected to be the cause of fibrous encapsulation.Therefore,the interactions of PMMA and PMMA-MC with macrophages were investigated in vitro.We discovered that the addition of MC could hinder the proliferation and fusion of the macrophages.Moreover,expressions of fibroblaststimulating growth factors,insulin-like growth factor,basic fibroblast growth factor and tumor necrosis factor-b were significantly down-regulated in the macrophages cocultured with PMMA-MC.Together,the promoted osteointegration and reduced fibrous tissue formation observed with PMMA-MC material makes it a promising candidate for PCD surgery.

Diagnosis of lumbar degenerative disc disease by using L^(p)-spaces related to generalized interval-valued m-polar neutrosophic choquet integral Operator

Innovative and astonishing developments in the field of spine analysis can commence with this manuscript.The lumbar disks(L1−L2 to L5−S1)are most commonly impaired by degeneration due to their long-standing degeneration and associated strain.We investigate the indications,purposes,risk factors,and therapies of lumbar degenerated disc disease(L-DDD).We assume that the degeneration of five discs creates many effects,making it difficult to differentiate between the different types of degenerated discs and their seriousness.Since the indeterminacy and falsity portions of science or clinical diagnosis are often ignored.Due to this complexity,the reliability of the patient’s progress report cannot be calculated,nor can the period of therapy be measured.The revolutionary concept of interval-valued m-polar neutrosophic Choquet integral aggregation operator(IVmPNCIAO)is proposed to eliminate these problems.We associate generalized interval-valued m-polar neutrosophic Choquet integral aggregation operator(GIVmPNCIAO)with the statistical formulation of L^(p)-spaces and use it to identify the actual kind of degenerative disc in the lumbar spine.For the classification of interval-valued m-polar neutrosophic numbers(IVMPNNs),we set the ranking index and score function.These concepts are appropriate and necessary in order to better diagnose degeneration by associating it with mathematical modeling.We construct a pre-diagnosis map based on the fuzzy interval[0,1]to classify the types of degenerative discs.We develop an algorithm by using GIVmPNCIAO based on interval-valued m-polar neutrosophic sets(IVMPNNs)to identify the degenerative disc appropriately and to choose the most exquisite treatment for the corresponding degeneration of every patient.Furthermore,we discuss the sensitivity analysis with parameter p in GIVmPNCIAO to investigate the patient’s improvement record.