J K Suh

Annulus Fibrosus Cells Interact With Neuron-Like Cells to Modulate Production of Growth Factors and Cytokines in Symptomatic Disc Degeneration

Study Design. We hypothesized that AF/neuron interactions during annular injury were involved in neovascularization and nerve ingrowth, the pathologic hallmarks of symptomatic disc degeneration. Objective. To identify growth factors and inflammatory cytokines related to AF/neuron interactions using in vitro model. Summary of Background Data. Discogenic pain is the chronic intractable pain initiated by tears in the outer annulus fibrosus (AF); this is a unique structure with free nerve endings at outer one-third, located beside dorsal root ganglia. The relationship between AF and neuron cells in annular injury has not been extensively investigated. Methods. Human AF cells were cocultured with a retinoic acid (RA)-treated SH-SY5Y human neuroblastoma cell line (neuron-like cells). Conditioned media from cells cultured alone or in coculture were assayed for growth factors and inflammatory cytokines using enzyme-linked immunosorbent assays. The responses of the neuron-like cells, the AF cells, and the cocultured group to IL-1&bgr;/TNF-&agr; were compared using the same outcome measures. Results. RA-treated SH-SY5Y cells showed significant neurite outgrowth on the 7th day; this is a typical morphologic finding of neuron-like cells. Neuron-like cells produced vascular endothelial growth factor (VEGF) and IGF-1 under basal conditions and dose-dependently secreted small amounts of IL-8 in response to TNF-&agr;. Coculturing enhanced the secretion of VEGF, TGF-&bgr;1, and &bgr;-NGF, and suppressed the production of IGF-1. VEGF in the coculture group and the AF cells was downregulated by IL-1&bgr;/TNF-&agr; stimulation. IL-1&bgr;/TNF-&agr; stimulation enhanced the production of large amounts of IL-6 and IL-8 from AF cells; IL-1&bgr; produced a greater response than TNF-&agr;. The neuron-like cells did not produce detectable amounts of IL-6 or IL-8. Conclusion. These studies suggest that AF cells are involved in an inflammatory reaction and that the interactions between AF and neuron-like cells enhance the production of growth factors responsible for neovascularization and nerve ingrowth. AF injury has the potential to initiate neovascularization/nerve ingrowth and an inflammatory reaction through the interactions of AF and neural tissues.

Morphometric analysis of the working zone for endoscopic lumbar discectomy.

Objective: Our studys purpose was to analyze the working zone for the current practice of endoscopic discectomy at the lateral exit zone of the intervertebral foramen (IVF) and to define a safe point for clinical practice. Methods: One hundred eighty-six nerve roots of the lumbar IVFs of cadaveric spines were studied. Upon lateral inspection, we measured the distance from the nerve root to the most dorsolateral margin of the disc and to the lateral edge of the superior articular process of the vertebra below at the plane of the superior endplate of the vertebra below. The angle between the root and the plane of the disc was also measured. Results: The results showed that the mean distance from the nerve root to the most dorsolateral margin of the disc was 3.4 ± 2.7 mm (range 0.0-10.8 mm), the mean distance from the nerve root to the lateral edge of the superior articular process of the vertebra below was 11.6 ± 4.6 mm (range 4.1-24.3 mm), and the mean angle between the nerve root and the plane of the disc was 79.1° ± 7.6° (range 56.0-90.0°). Conclusions: The values of the base of the working zone have a wide distribution. Blind puncture of annulus by the working cannula or obturator may be dangerous. The safer procedure would be the direct viewing of the annulus by endoscopy before annulotomy; the working cannula should be inserted into the foramen as close as possible to the facet joint.

Remote Cerebral and Cerebellar Hemorrhage after Massive Cerebrospinal Fluid Leakage

Dural tears can occur during spinal surgery and may lead to cerebrospinal fluid (CSF) leakage which is rarely involved in remote cerebellar hemorrhage. Only a few of cases of simultaneous cerebral and cerebellar hemorrhage have been reported in the English literature. We experienced a case of multiple remote cerebral and cerebellar hemorrhages in a 63-year-old man who exhibited no significant neurologic deficits after spinal surgery. Magnetic resonance imaging (MRI) performed 4 days after the surgery showed a large amount of CSF leakage in the lumbosacral space. The patient underwent the second surgery for primary repair of the dural defect, but complained of headache after dural repair surgery. Brain MRI taken 6 days after the dural repair surgery revealed multifocal remote intracerebral and cerebellar hemorrhages in the right temporal lobe and both cerebellar hemispheres. We recommend diagnostic imaging to secure early identification and treatment of this complication in order to prevent serious neurologic deficits.

Increased Vascular Endothelial Growth Factor in the Ventricular Cerebrospinal Fluid as a Predictive Marker for Subsequent Ventriculoperitoneal Shunt Infection : A Comparison Study among Hydrocephalic Patients

Objective The aim of this study is to determine the association between the cerebrospinal fluid (CSF) biomarkers and inflammation, and the predictive value of these CSF biomarkers for subsequent shunt associated infection. Methods We obtained CSF samples from the patients with hydrocephalus during ventriculoperitoneal (VP) shunt operations. Twenty-two patients were enrolled for this study and divided into 3 groups: subarachnoid hemorrhage (SAH)-induced hydrocephalus, idiopathic normal pressure hydrocephalus (INPH) and hydrocephalus with a subsequent shunt infection. We analyzed the transforming growth factor-β1, tumor necrosis factor-α, vascular endothelial growth factor (VEGF) and total tau in the CSF by performing enzyme-linked immunosorbent assay. The subsequent development of shunt infection was confirmed by the clinical presentations, the CSF parameters and CSF culture from the shunt devices. Results The mean VEGF concentration (±standard deviation) in the CSF of the SAH-induced hydrocephalus, INPH and shunt infection groups was 236±138, 237±80 and 627±391 pg/mL, respectively. There was a significant difference among the three groups (p=0.01). Between the SAH-induced hydrocephalus and infection groups and between the INPH and infection groups, there was a significant difference of the VEGF levels (p<0.01). However, the other marker levels did not differ among them. Conclusion The present study showed that only the CSF VEGF levels are associated with the subsequent development of shunt infection. Our results suggest that increased CSF VEGF could provide a good condition for bacteria that are introduced at the time of surgery to grow in the brain, rather than reflecting a sequel of bacterial infection before VP shunt.

Traumatic Cervical Cord Transection without Facet Dislocations- A Proposal of Combined Hyperflexion-Hyperextension Mechanism: A Case Report

A patient is presented with a cervical spinal cord transection which occurred after a motor vehicle accident in which the air bag deployed and the seat belt was not in use. The patient had complete quadriplegia below the C5 level and his imaging study showed cervical cord transection at the level of the C5/6 disc space with C5, C6 vertebral bodies and laminar fractures. He underwent a C5 laminectomy and a C4-7 posterior fusion with lateral mass screw fixation. Previous reports have described central cord syndromes occurring in hyperextension injuries, but in adults, acute spinal cord transections have only developed after fracture-dislocations of the spine. A case involving a post-traumatic spinal cord transection without any evidence of radiologic facet dislocations is reported. Also, we propose a combined hyperflexion-hyperextension mechanism to explain this type of injury.

ASIA SPINE: The Past, Present, and Future

The sharing of international academic accomplishment and friendship is important; furthermore, to better understand and anticipate the future, we should look back and remember where we started. Regarding ASIA SPINE, the authors aimed to record how the pioneers of Asian spinal surgery started this spine meeting series more than 20 years ago and that later developed into the present state of the conference. The authors will also explore the possible future of this conference. In June 1996, when Professor Hiroshi Nakagawa organized the 11th Annual Meeting of the Japanese Society of Spinal Surgery, spinal neurosurgeons from Korea and Japan including Professor Young Soo Kim, Professor Jung Keun Suh, and Professor Nakagawa discussed the establishment of a multinational conference on spinal surgery via a partnership between the 2 countries. Finally, from September 18 to 20, 1997, the First Biennial Meeting of the Japan-Korea Conference on Spinal Surgery was held in Nagoya, Japan, with Professor Hiroshi Nakagawa as the first organizing President. From then, a biennial meeting was held every other year in Korea or Japan until 2009. In September 2010, the next generation of spinal neurosurgeons decided to organize the first meeting of ASIA SPINE in Incheon, Korea, in order to represent all Asian spine specialists. This meeting has been since held annually around the region including in Taiwan. Remembering the pioneers in the field of spinal surgery is invaluable and extremely important. The authors hope that interest in ASIA SPINE will further expand to other nations in Asia who have advanced philosophies and refined technologies. We wish ASIA SPINE continued success and the ability to promote prolonged international friendship among the Asian countries .