A large percentage of patients report chronic donor site pain after anterior ICBG donation, even when only a single-level ACDF procedure is performed. Moreover, long-term functional impairment can also be significant. Patients should be counseled regarding these potential problems, and alternative sources of graft material should be considered.

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Background: Disc degeneration is characterized by elevated levels of cytokines, TNF-␣ and IL-1␤ and an increase in aggrecan-rich matrix degradation. Results: Cytokine-dependent syndecan-4 expression regulate ADAMTS-5/aggrecanse2 activation in disc cells. Conclusion: Syndecan-4 may play a key role in pathogenesis of degenerative disc disease. Significance: Syndecan-4 may offer a potential therapeutic target for controlling progression of degenerative disc disease.

Although there will always be limitations to any cataloging system, the TLICS reflects accepted features cited in the literature important in predicting spinal stability, future deformity, and progressive neurologic compromise. This classification system is intended to be easy to apply and to facilitate clinical decision-making as a practical alternative to cumbersome classification systems already in use. The TLICS may improve communication between spine trauma physicians and the education of residents and fellows. Further studies are underway to determine the reliability and validity of this tool.