Degeneration of the human intervertebral disc (IVD) is assumed to underlie severe clinical symptoms, in particular chronic back pain. Since adhesion/growth‐regulatory galectins are linked to arthritis/osteoarthritis pathogenesis by activating a pro‐degradative/‐inflammatory gene expression signature, we hypothesized a similar functional involvement of galectins in IVD degeneration. Immunohistochemical evidence for the presence of galectins‐1 and ‐3 in IVD is provided comparatively for specimens of spondylochondrosis, spondylolisthesis, and spinal deformity. Immunopositivity was detected in sections of fixed IVD specimens in each cellular compartment with age‐, disease‐, and galectin‐type‐related differences. Of note, presence of both galectins correlated with IVD degeneration, whereas correlation with age was seen only for galectin‐3. In addition, staining profiles for these two galectins showed different distribution patterns in serial sections, an indication for non‐redundant functionalities. In vitro, both galectins bound to IVD cells in a glycan‐dependent manner. However, exclusively galectin‐1 binding triggered a significant induction of functional disease markers (i.e., IL6, CXCL8, and MMP1/3/13) with involvement of the nuclear factor‐kB pathway. This study thus gives direction to further network analyses and functional studies on galectins in IVD degeneration. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2204–2216, 2019

Background: The importance of sagittal alignment in healthy individuals and in reconstructive spinal surgery has been studied over the last 15 years. The aim of the present study was to assess the long-term effects of abnormal sagittal alignment on hardware after posterior thoracolumbar spinal fusion. Methods: Patients who had undergone revision surgery (revision cohort, n = 34) due to breakage of their implants were compared retrospectively with patients who had intact implants at the final follow-up investigation after a long posterior thoracolumbar and/or lumbar spinal fusion (control cohort, n = 22). Clinical data and radiological parameters including the sagittal vertical axis (SVA), pelvic incidence (PI), lordosis gap (LG), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and the femoral obliquity angle (FOA) were assessed on fullspine lateral radiographs obtained in regular standing position. Data were analysed using descriptive statistics, parametric and non-parametric inferential statistics. Results: Patients in the breakage group (female n = 21, male n = 9, mean age 60.9 ± 15.6 years) had a higher anterior shift of the C7 plumb line (SVA) (p = 0.02), retroversion of the pelvis (PT) (p < 0.001), PILL mismatch (LG) (p = 0.001), and PI (p = 0.002) than the intact group (female n = 10, male n = 12, mean age 65.7 ± 12.4 years). No significant difference was registered between groups in regard of SS, LL, TK, FOA, and the mean number of comorbidities. Conclusion: Failure of restoration of the SVA and the LG to the acceptable ranges, especially in patients with a high PI, may be regarded as a risk factor for the long-term failure of implants after posterior thoracolumbar spinal fusion.

absenteeism. The large majority of people with LBP are given the label 'non-specific', meaning that a specific patho-anatomical cause for the pain cannot be established. As a phenotype of spinal osteoarthritis, lumbar disc degeneration (LDD) was found to be associated with LBP and can be one of the pain contributing factors. Nevertheless, the predictive value of LDD for long-term LBP outcomes has not been investigated. This study assessed the longitudinal association between LDD and long-term outcomes in older adults presenting with LBP in primary care. Methods: The BACE cohort study was used, including 675 patients aged >55 years visiting a general practitioner with a new episode of nonspecific LBP. Osteophytes and disc space narrowing were considered LDD features, and they were investigated as categorical and dichotomous determinants. The 4-grade Lane Atlas classification was used (i.e. grade 0¼ none, grade 1¼ mild, grade 2¼ moderate, grade 3¼ severe); osteophytes of grade 2 or higher at two or more levels for L1-2 to L5-S1 were defined as LDD presence, likewise disc space narrowing grade 1 or higher at two or more levels from L1-2 to L5-S1. Outcomes at 1-year follow-up were: LBP presence (yes/no), and LBP severity [measured on an 11-point numeric rating scale (NRS)] defined as a NRS score 4/10. The association between LDD at baseline and 1-year follow-up outcomes was assessed with logistic regression models. Models were adjusted for age, gender and BMI. Results: Five-hundred and forty-three patients (85% of the cohort) with baseline and 1-year follow-up data were included in this study. Mean age was 67 years (SD 8), 59% was female and 62% reported severe LBP at baseline. One-hundred eighty-six patients (34%) met the LDD definition for osteophytes and 389 (72%) the LDD definition of disc space narrowing. The LDD definition of osteophytes was significantly associated with LBP presence, but not the 4-grade classification of osteophytes (Table 1). The LDD definition of disc space narrowing was not associated, but patients with grade 1 to 3 narrowing displayed higher odds (compared to grade 0) of having LBP at follow-up (Table 1). LDD definitions for osteophytes (OR¼1.4, 95% CI 0.9-2.1) and narrowing (OR¼1.5, 95% CI 0.9-2.4) were not associated with LBP severity. Patients with grade 3 disc space narrowing exhibited higher odds (compared to grade 0 patients) of having severe LBP (OR¼2.9, 95% CI 1.0-8.3); patients with other LDD grade classification did not show an association with pain severity. Conclusions: This study found an association between some of the features of LDD at baseline and the presence of LBP at 1-year follow-up (Table 1). On the other hand, LDD features were not associated with LBP severity, with the sole exception of grade 3 disc space narrowing (as compared to grade 0). This study warrants further investigation of LDD features as potential prognostic factors in future longitudinal studies.

BackgroundThe aim of the study was to correlate the clinical and radiological outcomes following the conservative treatment of neurologically intact patients with AO A4, A3, and A1 thoracolumbar (TL) fractures.MethodsRetrospective study included 3 cohorts of conservatively treated patients with AO A4, A3, and A1 TL fracture without the use of bracing or casting. At the final follow up segmental kyphotic angle (SKA), regional lordotic angle (RLA), lordosis gap (LG), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), and femoral obliquity angle (FOA), and the Oswestry disability index (ODI) were assessed. Data were analyzed using descriptive statistics, non-parametric inferential statistics, and Spearman correlation analyses.ResultsAge was significantly higher in A4 group than in A1 group (p=0.04). The median 1ry SKA of the A3 group (15 ± 3) was significantly higher than in A1 group (7 ± 7, p=0.04). The median of total ODI in the A4 group (42 ± 53) and A3 group (31.3 ± 27) was clinically higher than in A1 group (11.1 ± 25), however, this difference was not statistically significant. Age as well as SVA correlated significantly with PT, FOA, SKA at the follow up, and the total ODI.ConclusionAge of the patient is a significant confounder that has an important impact on the type of fracture, sagittal malalignment, its compensatory mechanisms, and the resulting clinical outcome following conservative treatment of AO A4 and A3 TL fracture.

BackgroundThe aim of the study was to correlate the clinical and radiological outcomes following the conservative treatment of neurologically intact patients with AO A4, A3, and A1 thoracolumbar (TL) fractures. MethodsRetrospective study included 3 cohorts of conservatively treated patients with AO A4, A3, and A1 TL fracture without the use of bracing or casting. At the nal follow up segmental kyphotic angle (SKA), regional lordotic angle (RLA), lordosis gap (LG), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), and femoral obliquity angle (FOA), and the Oswestry disability index (ODI) were assessed. Data were analyzed using descriptive statistics, non-parametric inferential statistics, and Spearman correlation analyses. ResultsAge was signi cantly higher in A4 group than in A1 group (p=0.04). The median 1ry SKA of the A3 group (15 ± 3) was signi cantly higher than in A1 group (7 ± 7, p=0.04). The median of total ODI in the A4 group (42 ± 53) and A3 group (31.3 ± 27) was clinically higher than in A1 group (11.1 ± 25), however, this difference was not statistically signi cant. Age as well as SVA correlated signi cantly with PT, FOA, SKA at the follow up, and the total ODI. ConclusionAge of the patient is a signi cant confounder that has an important impact on the type of fracture, sagittal malalignment, its compensatory mechanisms, and the resulting clinical outcome following conservative treatment of AO A4 and A3 TL fracture.