Biomedical subjects

S Seitsalo

Publications and source records attributed to S Seitsalo.

At least 37 records · Page 2Linked to original sources

PubMed1996

Immunocytochemical localization of immunoglobulins in disc herniations.

STUDY DESIGN: Disc herniation and control discs were studied for the presence of immunoglobulins immunocytochemically. OBJECTIVES: To study a possible presence of immunoglobulin complexes in herniated disc tissue and to locate them at the tissue level by immunocytochemistry; to compare immunohistologic findings with those obtained in control disc tissue; and to compare the prevalences of immunoglobulin M and immunoglobulin G. SUMMARY OF BACKGROUND DATA: In herniated disc tissue, high activity of inflammatory phospholipase A2 was previously demonstrated, and inflammatory cells were noted immunohistochemically. Immunoglobulins G and M were observed biochemically but have not been located at the tissue level. METHODS: Fifty-two disc herniations and three macroscopically normal fresh cadaver discs were managed by an identical immunocytochemical protocol, using monoclonal antihuman antibodies to immunoglobulins M and G. RESULTS: In 29 of 52 disc herniations (56%), immunoglobulin M deposits were observed, and in 18 of 52 disc herniations (35%) immunoglobulin G could be demonstrated. Almost all the disc herniations where immunoglobulin G was present also contained immunoglobulin M deposits (except for two). In the control discs studied, neither immunoglobulin could be observed immunohistochemically. The immunoglobulin deposits were noted in areas where blood vessels were also present. Morphologically, immunoglobulin immunoreactivity resembling immune complexes was observed. CONCLUSIONS: The results lend support to previous suggestions of inflammation and immune reaction in disc herniations, including previous biochemical studies suggesting immunoglobulin deposition. The exact role of the demonstrated immunoglobulins in disc tissue pathophysiology will have to be clarified further.

Adult↗

PubMed1996

Immunohistochemical demonstration of sensory and autonomic nerve terminals in herniated lumbar disc tissue.

STUDY DESIGN: Thirty-five lumbar disc herniations removed at surgery were studied by indirect immunocytochemistry. OBJECTIVES: To localize immunohistochemically both sensory and autonomic nerve terminals in disc herniations. SUMMARY OF BACKGROUND DATA: Using various more or less specific histologic and histochemical methods, investigators have reported the presence of free nerve terminals in disc tissue. However, very few studies have, to date, convincingly demonstrated nerve terminals in disc tissue that morphologically resemble the tiny nerve terminals of sensory and autonomic nerve fibers. METHODS: Amplification of the peroxidase reaction product in avidin-biotin-peroxidase complex immunostaining by the glucose oxidase-diaminobenzidine-nickel sulfate method was used to visualize small punctate nerve terminals at high magnification. Thin frozen sections from disc herniation tissue prefixed in Zamboni fixative were incubated with antibodies to synaptophysin to visualize nerve terminals in general, and with antibodies to substance P and C-flanking peptide of neuropeptide Y to further characterize nerve terminals as either sensory or sympathetic. RESULTS: Nerve terminals could be demonstrated in 29 (83%) of the 35 disc herniations. They were observed with the synaptophysin antibody in 17 of 35 (49%) disc herniations, with substance P in 16 of 35 (46%) disc herniations, and with C-flanking peptide of neuropeptide Y in 13 of 35 (37%) disc herniations. Morphologically, the nerve terminals were seen as tiny immunoreactive dots. Some of the nerve terminals were observed close to disc cells, possibly suggesting direct interaction. CONCLUSIONS: Small nerve terminals in disc herniations, both sensory substance P endings and sympathetic C-flanking peptide of neuropeptide Y endings, could be involved in mechanisms of discogenic pain, disc tissue neurogenic inflammation, tissue repair processes after injury, and control of local blood circulation in the newly formed blood vessels. Disc cells may be directly affected by the neuropeptides released from nearby nerve terminals.

Adult↗

PubMed1996

Functional and clinical results after anterior interbody lumbar fusion.

The functional and clinical results of anterior interbody lumbar fusion were assessed in 134 patients. Functional tests included spinal mobility and isokinetic trunk muscle strength measurements. The score rating system of the Japanese Orthopaedic association (JOA) and the Oswestry disability index were used for clinical evaluation. Functional results revealed decreased spinal flexibility when compared with normal values. A reduction in physical ability was also seen in the isokinetic trunk muscle measurements. Non-union seemed to have only little effect on the functional results. Patients under 20 years at operation had the best results, but beyond this threshold results did not vary with age. The JOA rating score was 25 or more in 50% of patients. The mean Oswestry disability index was 47.8 (range 1-82) preoperatively and 20 (range 0-68) at follow-up (P < 0.001), indicating a clear decrease in subjective disability. Solid fusion was seen in 107 patients (80%) at follow-up.

Adolescent↗

PubMed1996

Anterior interbody lumbar fusion in severe low back pain.

Clinical, functional, and radiographic results of 83 patients treated by anterior interbody lumbar fusion are presented. Seventy-two percent of patients previously had undergone 1 or more spine operations. In 54% of patients, the main indication for anterior fusion was failed back surgery. There were 52 women and 29 men. The mean age of patients at operation was 43.6 years (range, 21-60 years). The mean followup time was 5 years (range, 2-10 years). Solid fusion was achieved in 104 (81%) of 129 levels on 59 (71%) of 83 patients. The clinical results were estimated 3 ways: the patient's own opinion, the change of Oswestry disability index, and the score rating system of the Japanese Orthopaedic Association. Patient opinions of the benefit of the procedure were the following: 74% very much improved, 12% little improved, 10% no improvement, and 4% worse. The mean Oswestry index before operation was very high at 48.8 points (range, 22-82 points), reflecting the severity of dysfunction in these patients. The mean Oswestry index at the followup study was 30.5 points (range, 0-68 points). In the score rating system of the Japanese Orthopaedic Association, the final rating of 25 points or more (regarded as satisfactory) was achieved in 22 (26.5 %) patients. The decision regarding indications for the operation and the operation itself should be made by experienced surgeons.

Activities of Daily Living↗

PubMed1996

Results of a trial of anterior or circumferential lumbar fusion in the treatment of severe isthmic spondylolisthesis in young patients.

The radiological and clinical results in 27 patients operated on for severe isthmic spondylolisthesis at age < 20 years with uninstrumented anterior interbody fusion alone in 11 or combined anterior and posterolateral (circumferential) fusion in 16 are reported. The mean follow-up time was 5.9 +/- 2.4 years. The two groups were comparable with regard to age at operation, sex, preoperative symptoms, mean preoperative slip and sagittal rotation angle. The follow-up assessment, made by an independent observer, included interview, Oswestry disability index, physical examination, functional tests, and plain radiographs. At follow-up, there were no statistical differences between the groups in subjective, clinical, and functional outcomes. Follow-up radiographs showed no progression of slip in either group. The sagittal rotation angle worsened slightly in the anterior fusion group but improved by 5.8 degrees (p < 0.001) on the average in the combined fusion group. There were no instances of pseudarthrosis. Two patients, one in each group, were reoperated on early for postoperative peroneal weakness; both recovered. The clinical and functional results were satisfactory in most cases. The radiological results concerning the sagittal rotation angle were superior in the combined fusion group, but whether this will affect the long-term clinical result is not known.

Adolescent↗

PubMed1996

The role of external transpedicular fixation in anterior interbody lumbar fusion.

The aim of this study was to see whether results of anterior interbody lumbar fusion could be improved with the help of an external transpedicular device. Anterior interbody lumbar fusion was carried out in 83 patients, using the technique described by Suzuki. Fifty-six (67%) patients were fused with the Magerl-Schläpfer external fixator device as a posterior support. Twenty-seven patients had interbody fusion and a conventional plastic brace for support. The clinical and radiological results of anterior interbody lumbar fusion were compared between these groups. The mean follow-up time was 5 (range, 2-10) years. A total of 128 levels were fused. There were no statistical differences in the clinical and radiological results between patients fused with or without the external fixator. There were many complications associated with the use of an external fixator device. We do not recommend the use of an external fixator in anterior interbody lumbar fusion.

Activities of Daily Living↗

PubMed1995

Basic fibroblast growth factor immunoreactivity in blood vessels and cells of disc herniations.

STUDY DESIGN: Basic fibroblast growth factor immunoreactivity was studied in disc herniation tissue. OBJECTIVES: The first objective was to analyze in which tissue components, if any, fibroblast growth factor is expressed in the disc herniation. The second objective was to compare such expression with that in fresh cadaver disc tissue. SUMMARY OF BACKGROUND DATA: Disc herniation tissue contains vascular ingrowth, which promotes the formation of granulation tissue. Fibroblast growth factor is a potent inducer of angiogenesis and also regulates extracellular proteolysis. METHODS: Twenty-seven disc herniation tissue and five macroscopically normal fresh cadaver discs were treated with an identical immunohistochemical protocol. Serial frozen sections were stained with a polyclonal basic fibroblast growth factor antibody and a polyclonal antibody to von Willebrand factor, which localizes endothelial cells. The immunostaining data were compared with relevant clinical data. RESULTS: Histologically, 74% of the samples contained anulus fibrosus and 59% nucleus pulposus. Basic fibroblast growth factor immunoreactivity was detected in 81% of the samples. There were immunopositive small blood vessels and scattered immunopositive disc cells (67%). Not all observed blood vessels were basic fibroblast growth factor immunopositive. In control discs, no immunoreactivity was observed. CONCLUSIONS: The observed presence of fibroblast growth factor in small blood vessels suggests an active angiogenesis as a result of disc injury. Cellular expression of fibroblast growth factor may be linked to proteolytic activity in disc extracellular matrix.

Adult↗

PubMed1995

Retrograde ejaculation after anterior interbody lumbar fusion.

Retrograde ejaculation as a complication of anterior interbody lumbar fusion was investigated. The diagnosis of retrograde ejaculation was made on the basis of interviews. Patients were informed of the risk of retrograde ejaculation preoperatively. At the follow-up study the patients were asked if they had noticed retrograde ejaculation after their operation. In one case (anejaculation) testis biopsy and vasography was performed. On average, the incidence of retrograde ejaculation as a complication of anterior interbody lumbar fusion has been very low, ranging from only a few cases up to 5.9% of cases involving male patients. We studied 40 male patients with severe low back pain retrospectively after they had undergone anterior interbody lumbar fusion. The mean age at operation was 31.9 years and the mean follow-up time 5.0 years. Retrograde ejaculation occurred after anterior interbody fusion in nine patients. Permanent retrograde ejaculation developed in seven of these patients (17.5%). These patients were all operated on using a transabdominal approach. Major bleeding during the operation (over 2500 ml) was observed in two patients. Seven patients with retrograde ejaculation had undergone a two-level operation (L4-SI), and eight patients had undergone between one and three previous spine operations. Retrograde ejaculation has been underestimated as a complication of anterior interbody fusion in multioperated low back patients. The possibility of this complication should be kept in mind when planning a transabdominal approach for interbody lumbar fusion in male patients. We do not recommend the transabdominal approach in male patients because of the risk of retrograde ejaculation.

Adolescent↗

PubMed1994

A controlled immunohistochemical study of inflammatory cells in disc herniation tissue.

STUDY DESIGN: The presence and abundance of inflammatory cells was studied immunocytochemically in lumbar disc herniations (DH) and macroscopically normal discs for comparison. OBJECTIVES: The objective of the study was to characterize inflammatory cells that appear in herniated disc tissue and to study the relative abundance of various types of inflammatory cells. SUMMARY OF BACKGROUND DATA: Only few macrophages were observed in control discs, whereas abundant macrophages were present in half of the DH. Other types of inflammatory cells were less often abundant in the present material. In about a third of the DH interleukin-1 beta-expressing cells were also observed. METHODS: Twenty-four DH and control tissue from five discs were studied immunocytochemically, using specific monoclonal antibodies to various types of inflammatory cells and interleukin-1 beta. The results were compared with corresponding clinical data. Macrophages were studied with an antibody to CD68 antigen and Ber-MAC3 antibody separately. RESULTS: The obtained results suggest a variable inflammatory cell response in DH, which seems to be often dominated by macrophages at the time of operation. Thus previous suggestions of sometimes very active inflammation in DH tissue are supported. CONCLUSIONS: Inflammation may be important in disc tissue pathophysiology, possibly also in discogenic pain mechanisms.

Adult↗

PubMed1994

Symptomatic lumbar spondylolysis. Neuroimmunologic studies.

OBJECTIVES: This study characterized the defect using neuroimmunologic and inflammatory cell analysis. SUMMARY OF BACKGROUND DATA: Spondylolysis/spondylolisthesis is thought to be caused by a congenital weakness and mechanical stress causing a fracture associated with defective healing. Most of the spondylolysis patients are asymptomatic and the mechanisms of pain in symptomatic patients are unknown. METHODS: Tissue from the spondylolysis defect was collected from seven patients undergoing posterolateral fusion operations. RESULTS: Histologic examination disclosed delayed union/pseudoarthrosis with fibroblasts and macrophages in a pseudosynovial lining membrane and occasional perivascular infiltrates containing mainly CD2 lymphocytes and CD11b monocytes/macrophages. In a vascularized connective tissue stroma PGP 9.5, synaptophysin and neurofilament staining disclosed perivascular nerves, which did not extend to the synovial lining layer and which mainly represented postganglionic sympathetic nerve fibers but also calcitonin gene-related peptide and substance P containing sensory fibers. CONCLUSIONS: Pain in spondylolysis/spondylolisthesis might derive from the spondylolytic defect itself, probably from stretching of the local neural elements rather than from their sensitization/stimulation by local inflammatory mediators. The resemblance of neuroimmunohistochemical changes compared with those reported in the nonunion of long bones and the sparsity of stromal innervation, indicate that the characteristic defective healing is in part due to lack of neurogenic influences.

Adolescent↗

PubMed1994

Straight leg raising test and lumbar cerebrospinal fluid levels of vasoactive intestinal polypeptide and somatostatin in patients with low back pain.

STUDY DESIGN: Straight leg raising was recorded before myelography in 77 patients. At myelography, samples of cerebrospinal fluid were drawn and later analyzed for neuropeptides vasoactive intestinal polypeptide and somatostatin. OBJECTIVES: The study sought to examine correlations, if any, between a positive straight leg raising test and cerebrospinal fluid neuropeptide levels. METHODS: The straight leg raising test was recorded for all patients before a myelography examination was performed because of intractable leg pain symptoms. Forty-seven of the patients were men and 30 were women. Cerebrospinal fluid samples were obtained from all patients upon myelography. Levels of the neuropeptides vasoactive intestinal polypeptide and somatostatin were analyzed in a blind manner by radioimmunoassay, using commercially available radioimmunoassay kits. RESULTS: The results are compatible with previous observations that suggest cerebrospinal neuropeptide levels are altered in conjunction with neural injury or pain syndromes. In the present mixed back pain patient population, which included radicular pain symptoms due to disc herniation and lumbar stenosis, alterations in vasoactive intestinal peptide levels in particular were observed with a positive straight leg raising test. CONCLUSIONS: Nerve root injury, as suggested by a positive straight leg raising test, appears to be neurochemically linked to altered cerebrospinal fluid vasoactive intestinal peptide levels.

Female↗

PubMed1994

Concomitant immunocytochemical study of macrophage cells and blood vessels in disc herniation tissue.

Twenty disc herniations (DH) were studied immunocytochemically for macrophages and blood vessels. Serial thin frozen sections were immunostained with an antibody specific for tissue macrophages (monoclonal antibody to CD68 antigen) and the endothelium of blood vessels (polyclonal antibody to von Willebrand factor). With this method, blood vessels, often abundant, were observed in as many as 16/20 (80%) of the DH studied, 12 disc extrusions and 8 sequestrated discs, whereas abundant macrophages were noted in 11/20 (55%) of the DH. Macrophages were present only in areas with blood vessels and had presumably infiltrated the tissue from them. As has been noted previously, some blood vessels are apparently newly formed as a result of tissue injury, whereas others were present in the disc prior to herniation. This is suggested by the lack of a clear correlation between the presence or absence of blood vessels and the preoperative duration of radicular pain. In areas of the DH where cartilage fragments occurred, both macrophages and blood vessels were particularly abundant.

Adult↗

PubMed1993

Surgical treatment of severe isthmic spondylolisthesis in adolescents. Reduction or fusion in situ.

Twenty-two adolescent patients with severe (more than 50%) slip were surgically treated. Eleven were reduced with Magerl/Dick transpedicular screw devices and fused posteriorly from L4 to S1, and 2 weeks later anteriorly L5-S1; the other 11 were fused in situ L4-S1 (6 patients) or L5-S1 (5 patients) using a circumferential (6 patients), anterior (4 patients) or posterolateral (1 patient) technique without instrumentation. The two groups were comparable as to age at operation, age at follow-up, follow-up time, and preoperative radiologic measurement of the slip, lumbosacral kyphosis, and clinical findings. The mean follow-up times were 56.5 and 59.8 months, respectively. In the reduction group an improvement in the slip of 36.1 percentage points was achieved as compared with 7.7 percentage points in the in situ-fusion group. The sagittal rotation angle improved by 11 in the reduction group and worsened by 2.8 in the in situ-fusion group. There were no differences between the groups in the functional tests or clinical findings concerning pain. Subjective assessment was good in both groups at follow-up; that is, the pain had disappeared. Mean operation time and intraoperative blood loss were significantly higher in the reduction group. Reduction procedures were also associated with a higher number of complications and reoperations. No neurologic complications, however, occurred in the reduction group. Based on this study, in situ fusions are to be preferred in adolescents with severe spondylolisthesis.

Adolescent↗

PubMed1993

Isthmic spondylolisthesis in symptomatic and asymptomatic subjects, epidemiology, and natural history with special reference to disk abnormality and mode of treatment.

Observations during the past 35 years on operative and conservative treatment of adult and young patients with isthmic spondylolisthesis, demonstrate the main indications of fusion are pain and risk of further progression of the slip. At one time, posterior fusion was recommended. Posterolateral fusion in situ was adopted in 1975, and during the past ten years anterior fusion combined with reduction and transpedicular fixation has been performed in severe slips. Surgery was mainly indicated to alleviate pain or to prevent further progression of the slip. It seems possible to alter the natural course of the disease by operation, but it is difficult to prove the connection between the radiographic findings and the pain. The epidemiologic study shows that the prevalence of spondylolisthesis in Finland is 6%, but there are no significant differences between these subjects and controls without spondylolisthesis. Symptomatic patients may have pain, however, even after a long observation time. Prevention of the slip is difficult because, statistically, 90% of the slip has already occurred when the patient is first seen. Posterolateral fusion in situ is the method of choice, especially for most young patients. Anterior fusion is indicated if the slip is greater than 40%-50%. Reduction of the slip is indicated in exceptional cases only.

Adolescent↗

PubMed1991

Intervertebral disc changes in adolescents with isthmic spondylolisthesis.

The lower lumbar discs in adolescent patients with isthmic L5 spondylolisthesis requiring operative treatment were evaluated by means of plain radiography, discography, and magnetic resonance imaging (MRI). There were 14 girls and 13 boys, mean age on admission 14.4 (range, 11-18) years. The mean slip in girls was 45 +/- 23% and in boys 27 +/- 17% (p less than 0.05). Discography was performed in 23 patients (42 discs) and MRI in 16. In 12 patients, both examinations were made. In plain radiographs, normal presacral disc height was seen in 11 patients with mean 14.5% slip, narrowing of the disc height less than 50% in four patients with mean 24% slip, and greater than 50% in 12 patients with mean 52.6% slip. In discograms and MRIs, the presacral disc was pathologic in all patients. Pathologic changes of the fourth lumbar disc were frequent. Concerning disc degeneration, there was poor correlation between findings in plain radiography compared with those seen in MRI or discography. MRI findings correlated with those of discography in most cases. However, MRI was normal in two discs with a pathologic discogram.

Adolescent↗

PubMed1991

Progression of spondylolisthesis in children and adolescents. A long-term follow-up of 272 patients.

The radiologic progression of spondylolisthesis during a long-term follow-up was studied in 272 children and adolescents. There were 134 girls and 138 boys. The mean age at the first visit was 14.3 years (girls, 13.8 years; boys, 14.9 years). The radiologic follow-up time was 14.8 years on average (range, 5-32). The operation was done in 190 patients younger than 20 years of age. Fusion in situ, using a posterior or posterolateral technique, had no statistically significant effect on progression. Surgically treated patients did not differ from conservatively treated patients. Ninety percent of the slip, on average, had already occurred at the first radiologic examination compared with the final amount of slip. More than 10% progression occurred in 62 patients, mainly within the first year postoperatively or after the first examination. Progression of the lumbosacral kyphosis and sinking of the vertebral body was noted in severe slips. Although female gender and dysplasia (spina bifida) at the lumbosacral junction were more frequent in severe slips, they statistically had no value in predicting progression. A wedge form of L5 or sacral rounding also had no prognostic value. These were secondary to the slip and expressed it but did not predict it. The only radiologic variable with predictive value of progression was the percentage amount of the primary slip. In age groups corresponding to the growth spurt in early puberty (girls, 9-12 years; boys, 11-14 years), there was a tendency to progress.

Adolescent↗

PubMed1990

Neuroimmunohistochemical analysis of peridiscal nociceptive neural elements.

Twenty-three perioperative tissue samples from lumbar disc operations on 11 patients were studied immunohistochemically using the sensitive avidin-biotin-peroxidase complex (ABC) method and specific heterologous antisera for the presence of neurofilament-positive neural elements containing nociceptive neuropeptides substance P (SP) and/or calcitonin gene-related peptide (CGRP). Histologically, neural elements were especially abundant in the posterior longitudinal ligament, there being also a few demonstrable nerves in the peripheral anulus fibrosus. These nerves often showed a co-localization of cytoskeletal neurofilaments together with SP and/or CGRP immunoreactivity. It is suggested that pressure and chemical irritation of nociceptive nerves dependent on degenerated discs excite sensory neural elements, especially in the posterior longitudinal ligament and possibly also in the peripheral parts of the anulus fibrosus, while the disc itself, at least if not penetrated by vascular granular tissue, is painless and neuroanatomically lacks a structural basis for pain perception.

Adult↗

PubMed1990

Severe spondylolisthesis in children and adolescents. A long-term review of fusion in situ.

From 1948 to 1980, 93 children and adolescents had fusion in situ for severe spondylolisthesis with a slip of 50% or more, at a mean age of 14.8 years. Of these, 52 girls and 35 boys were reviewed after a mean follow-up of 13.8 years. The mean pre-operative slip was 76% and pain frequency correlated with the severity of the lumbosacral kyphosis but not with that of the slip. Posterior fusion was used in 54, posterolateral in 30 and anterior fusion in three patients. There were no major complications but 16 had re-operations for non-union or root symptoms. At follow-up there were three non-unions. After operation, 19 patients had 10% or more progression of the slip, but 10 showed correction by more than 10% as a result of remodelling. The lumbosacral kyphosis had increased by more than 10 degrees in 45%. Postoperative progression of the slip and of lumbosacral kyphosis was significantly more if the posterior element had been removed. At follow-up 77 patients were subjectively improved, four were unchanged, and one was worse. These results did not correlate with either the degree of the slip, or the angle of lumbosacral kyphosis. Fusion in situ is safe and gives good long-term clinical results. Secondary changes are associated with increased lumbosacral kyphosis, so reduction of this should be considered in severe cases.

Adolescent↗