METHODS: Retrospective literature review analysis OBJECTIVE: Analyze the risk factors, characteristics, outcome, and follow up of surgical management of disc herniation in children ≤15 years old (y.o) through a review of the literature.
BACKGROUND: Disc herniation is a rare disease in the pediatric population. While conservative treatment if very often tried, some cases require surgical treatment.
METHODS: A literature search was conducted using PubMed data base using the terms \'pediatric/children/adolescent disc herniation\' and \'surgical management\' as key words. Significant manuscripts i.e: case reports, case series, reviews were identified and analyzed. The exclusion criteria were: series and cases with patients >15 y.o, results non-individualizable and medical management.
RESULTS: 49 studies were identified, 28 were retained. 69 children <15 y.o were identified with a median age of 13 y.o (SD 1-15). The mean FU was 3.3 years. Trauma and repeated micro traumatism were identified as the main causes of disc herniation in this population. It is mostly a lumbar disease, with very anecdotic cases of thoracic or cervical herniation described. In the absence of neurological deficit, conservative treatment should be tried. Different types of surgery exist (open, endoscopic, tubular), with no difference in outcome or complications. The post-operative outcome was very satisfactory, with no neurological sequalae described with excellent recovery.
CONCLUSIONS: Pediatric disc herniation is often caused by precipitating factors such as trauma. In the absence of resolution with conservative treatment, surgical options yield favorable short term clinical outcomes with minimal complications and no neurological sequalae.

Corroborative evidence for discectomy in pediatric or adolescent patients remains scarce, with this single-arm meta-analysis investigating discectomy for lumbar disc herniation (LDH) within this population. PubMed, Embase (Elsevier), CiNAHL, Cochrane Library, Scopus, and Web of Science were searched. Eligible studies reported pediatric patients under 21 years of age with a diagnosis of LDH that was treated surgically with discectomy. This review was registered in PROSPERO (ID: CRD42023463358). Twenty-two studies met the eligibility criteria (n=1182). Visual analog scale (VAS) scores for back pain at baseline were 5.34 (95% CI: 4.48, 6.20, I2=98.9%). Postoperative VAS back pain scores after 12 months were 0.88 (95% CI: 0.57, 1.19, I2=95.6%). VAS scores for leg pain at baseline were 7.03 (95% CI: 6.63, 7.43, I2=93.5%). Postoperative VAS leg pain scores after 12 months were 1.02 (95% CI: 0.68, 1.36, I2=97.0%). Oswestry disability index (ODI) scores at baseline were 55.46 (95% CI: 43.69, 67.24, I2=99.9%). Postoperative ODI scores after 12 months were 7.82 (95% CI: 4.95, 10.69, I2=99.4%). VAS back, VAS leg and ODI scores demonstrated a minimum clinically important difference (MCID) at all postoperative points. Perioperative outcomes demonstrated operative time as 85.71 mins (95% CI: 73.96, 97.46, I2=99.4%) and hospital length of stay as 3.81 days (95% CI: 3.20, 4.41, I2=98.5%). The postoperative reoperation rate at the same level was 0.01 (95% CI: <0.00, 0.02, I2=0%). Discectomy appears safe and effective in pediatric and adolescent patients suffering from LDH. The findings here provide groundwork for future randomized control trials against conservative measures to elaborate on optimal management and elucidate long-term outcomes.

Activation of procaspase-8 in the death effector domain (DED) filaments of the death-inducing signaling complex (DISC) is a key step in apoptosis. In this study, a rationally designed cell-penetrating peptide, DEDid, was engineered to mimic the h2b helical region of procaspase-8-DED2 containing a highly conservative FL motif. Furthermore, mutations were introduced into the DEDid binding site of the procaspase-8 type I interface. Additionally, our data suggest that DEDid targets other type I DED interactions such as those of FADD. Both approaches of blocking type I DED interactions inhibited CD95L-induced DISC assembly, caspase activation and apoptosis. We showed that inhibition of procaspase-8 type I interactions by mutations not only diminished procaspase-8 recruitment to the DISC but also destabilized the FADD core of DED filaments. Taken together, this study offers insights to develop strategies to target DED proteins, which may be considered in diseases associated with cell death and inflammation.

OBJECTIVE: Intervertebral disc degeneration (IVDD) is a common orthopaedic disease and an important cause of lower back pain, which seriously affects the work and life of patients and causes a large economic burden to society. The traditional treatment of IVDD mainly involves early pain relief and late surgical intervention, but it cannot reverse the pathological course of IVDD. Current studies suggest that IVDD is related to the imbalance between the anabolic and catabolic functions of the extracellular matrix (ECM). Anti-inflammatory drugs, bioactive substances, and stem cells have all been shown to improve ECM, but traditional injection methods face short half-life and leakage problems.
RESULTS: The good biocompatibility and slow-release function of polymer hydrogels are being noticed and explored to combine with drugs or bioactive substances to treat IVDD. This paper introduces the pathophysiological mechanism of IVDD, and discusses the advantages, disadvantages and development prospects of hydrogels for the treatment of IVDD, so as to provide guidance for future breakthroughs in the treatment of IVDD.

UNASSIGNED: Thoracic disc calcification is a radiological finding which may be incidental or diagnosed in patients presenting with myelopathy due to spinal cord compression. We performed a study to analyze the imaging patterns of calcified thoracic discs (CTDs).
UNASSIGNED: A retrospective review of the spinal and radiology database of a tertiary referral orthopedic hospital was conducted for the incidence of CTDs between 2007 and 2020. Patients\' demographics and radiological findings were recorded. The relationship between disc size, morphology, spinal cord compression, and management was assessed.
UNASSIGNED: Fifty-one cases of CTDs were identified. The mean size of CTD was 806.2 mm3 (range: 144-2340). The most common level of disc calcification was T9-T10 (24%) in 12 patients. Thoracic disc calcifications in our series commonly involved disc \"protrusion\" in 67% (34 patients), followed by \"mushroom\" type in 31% (16 patients) and \"extrusion\" in 2% (1 patient). 37% (19 patients) had spinal cord compression with 12% (6 patients) undergoing surgical interventions. There was no statistically significant difference in the mean sizes of CTD between the groups with and without spinal cord compression (P = 0.566, independent sample t-test). Patients with \"mushroom\" type calcification were more likely to have surgical intervention (P = 0.01, Fisher\'s exact test).
UNASSIGNED: Thoracic disc calcifications, while common, can still be underdiagnosed till late myelopathic deterioration. Care of the elderly physicians, spinal surgeons, and radiologists need to be aware of them to guide diagnosis and management. Our study demonstrates that disc morphology plays a vital role in myelopathic presentation and therefore determines the need for surgical intervention instead of the absolute size of disc calcification.

BACKGROUND: Incisor malocclusion in rabbits (Oryctolagus cuniculus) is a common clinical problem seen in general practice. Given that the growth rate is about 2 mm per week, a lack of wear quickly leads to feeding difficulties and soft tissue injuries. Therefore, pathologically elongated incisors must be shortened every three to six weeks. The goal of this study was to assess the potential adverse effects on dental and periodontal tissues associated with the three most commonly used trimming methods: nail cutter, diamond-coated cutting disc and diamond burr. The left mandibular incisor of 28 healthy New Zealand rabbits was subjected to four trimmings with one of the three cutting methods. After the fattening period, the mandibles were collected and both mandibular incisors were investigated on dental radiographs, micro-computed tomography scans and histological sections. Dental and periodontal tissue changes were evaluated. This study allowed a more accurate statement of the potential short-term adverse effects of the three trimming methods. At the clinical level, the nail cutter caused the formation of an irregular occlusal surface with sharp edges. Both engine-drive methods allowed the attainment of a smooth surface but the disc was less accurate. Histological evaluation revealed that the primary modifications, including coronal fractures, periodontal ligament widening and inflammation, reparative osteodentine, paracementosis and biofilm accumulation, were found in the nail cutter group.
BACKGROUND: Eine Malokklusion der Schneidezähne bei Kaninchen (Oryctolagus cuniculus) ist ein häufiges klinisches Problem in der Tierarztpraxis. Eine ungenügende Abnutzung führt bei einem durchnittlichen Längenwachstum von 2 mm/Woche schnell zu Ernährungsschwierigkeiten und Schleimhautverletzungen. Deshalb müssen zu lange Schneidezähne alle drei bis sechs Wochen gekürzt werden. Das Ziel dieser Studie bestand darin, die möglichen pathologischen Auswirkungen auf Zahn- und Parodontalgewebe zu bewerten, die mit den drei am häufigsten verwendeten Kürzungsmethoden verbunden sind: Nagelschneider, diamantbeschichtete Trennscheibe und Diamantbohrer. Der linke Unterkieferschneidezahn von 28 gesunden Neuseeländer Kaninchen wurde viermal mit einer der drei Schnittmethoden gekürzt. Nach der Mastperiode wurden die Unterkiefer und beide Unterkieferschneidezähne anhand von Zahnröntgenaufnahmen, Mikrocomputertomographie-Scans und histologischen Schnitten untersucht. Zahn- und parodontale Gewebeveränderungen wurden bewertet. Diese Studie ermöglichte eine genauere Aussage über die möglichen kurzfristigen Nebenwirkungen der drei Methoden zur Kürzung von Incisivi bei Kaninchen. Auf klinischer Ebene verursachte der Nagelschneider die Bildung einer unregelmäßigen Kaufläche mit scharfen Kanten. Beide maschinenbetrieben Methoden ermöglichten die Erzielung einer glatten Oberfläche, wobei die Trennscheibe unpräziser war als der Diamantbohrer. Die histologische Auswertung ergab, dass bei der Kürzung mittels Nagelschneider primäre Veränderungen, darunter koronale Frakturen, Verbreiterung und Entzündung im Bereich der parodontalen Fasern, reparatives Osteodentin, Paracementosis und Biofilmansammlung auftraten.
BACKGROUND: La malocclusion des incisives chez le lapin (Oryctolagus cuniculus) est un problème clinique courant en médecine générale. Étant donné que le taux de croissance est d’environ 2 mm par semaine, un manque d’usure entraîne rapidement des difficultés d’alimentation et des lésions des tissus mous. Par conséquent, les incisives pathologiquement trop longues doivent être raccourcies toutes les trois à six semaines. L’objectif de cette étude était d’évaluer les effets négatifs potentiels sur les tissus dentaires et parodontaux associés aux trois méthodes de taille les plus couramment utilisées: le coupeongles, le disque de coupe diamanté et la fraise diamantée. L’incisive mandibulaire gauche de 28 lapins néo-zélandais en bonne santé a été soumise à quatre tailles avec l’une des trois méthodes de coupe. Après la période d’engraissement, les mandibules ont été prélevées et les deux incisives mandibulaires ont été examinées sur des radiographies dentaires, des examens micro-tomodensitométriques et des coupes histologiques. Les modifications des tissus dentaires et parodontaux ont été évaluées. Cette étude a permis de mieux cerner les effets indésirables potentiels à court terme des trois méthodes de coupe. Au niveau clinique, le coupe-ongles a entraîné la formation d’une surface occlusale irrégulière avec des bords tranchants. Les deux autres méthodes de taille permettent d’obtenir une surface lisse, mais le disque est moins précis. L’évaluation histologique a révélé que les modifications primaires, y compris les fractures coronaires, l’élargissement et l’inflammation du ligament parodontal, l’ostéodentine réparatrice, la paracémentose et l’accumulation de biofilm, ont été trouvées dans le groupe coupe-ongles.
BACKGROUND: La malocclusione degli incisivi nei conigli (Oryctolagus cuniculus) è un problema clinico comune osservato nella pratica generale. Considerando che il tasso di crescita è di circa 2 mm a settimana, una mancanza di usura porta rapidamente a difficoltà alimentari e lesioni dei tessuti molli. Pertanto, gli incisivi patologicamente allungati devono essere accorciati ogni tre o sei settimane. Lo scopo di questo studio è di valutare gli effetti avversi potenziali sui tessuti dentali e parodontali associati ai tre metodi di rifilatura più comunemente utilizzati: tagliaunghie, disco diamantato e fresa diamantata. Il primo incisivo mandibolare sinistro di 28 conigli neozelandesi sani è stato sottoposto a quattro rifilature con uno dei tre metodi di taglio. Dopo il periodo di ingrassamento, le mandibole sono state raccolte e sia gli incisivi mandibolari che le mandibole sono stati indagati su radiografie dentali, scansioni tomografiche micro-computerizzate e sezioni istologiche. Sono stati valutati i cambiamenti nei tessuti dentali e parodontali. Questo studio ha consentito una descrizione più accurata degli effetti collaterali potenziali a breve termine dei tre metodi di rifilatura. A livello clinico, il tagliaunghie ha causato la formazione di una superficie occlusale irregolare con bordi affilati. Entrambi i metodi motorizzati hanno permesso di ottenere una superficie liscia, ma il disco era meno preciso della fresa. La valutazione istologica ha rivelato che durante l’accorciamento con il tagliaunghie sono apparse modifiche principali, tra cui fratture coronali, allargamento del legamento parodontale e infiammazione, osteodentina riparativa, paracementosi e accumulo di biofilm.

Calcified lumbar disc herniations (CLDH) causing calcified ventral stenosis pose a therapeutic challenge to the treating surgeon due to their neural adhesions, location, and hardness.
This retrospective study analyzed all the cases of CLDH/calcified ventral stenosis managed by transforaminal endoscopic lumbar discectomy with a minimum follow-up of 24 months. The preoperative images were analyzed for the level, migration; and grade (Lee\'s migration zones), and location (Michigan State University classification). Detailed surgical technique and intraoperative parameters including the duration of surgery and complications have been recorded. The clinical parameters including visual analog scale (VAS), Oswestry disability index (ODI), length of stay in hospital, days of return to basic work, and patient satisfaction index were analyzed. Postoperatively the images were analyzed for the adequacy of decompression.
The mean VAS for back pain and leg pain was 4.7 ± 2.6 (0-9), and 7.45 ± 2.2 (1-10), respectively. The mean preoperative ODI was 78.2 ± 13.2 (63.2-95.6). Nineteen patients (24%) had neurological deficits preoperatively. The mean duration of surgery was 90.5 ± 15.8 (58-131) minutes. Postoperative magnetic resonance imaging revealed adequate decompression in 97.5% (n = 77). The mean duration of hospital stay was 1.05 ± 0.22 (1-2) days, and the postoperative back and leg pain VAS was 1.14 ± 1.2 (0-3) (P < 0.05) and 1.7 ± 0.5 (0-6) (P < 0.05), respectively. The ODI at final follow-up was 6.5 ± 3.7 (2.2-18) (P < 0.05). Neurological recovery occurred in 17 (89.5%) patients and they returned to basic work/jobs in 19.5 ± 3.3 (14-26) days. The mean patient satisfaction index was 1.18 ± 0.47 (1-2) at a mean follow-up of 5.52 ± 2.91 (2-12.75) years.
Transforaminal endoscopic lumbar discectomy is a complete, safe, and efficacious procedure in patients with CLDH with earlier recovery considering the surgery is performed with the patient being awake.

Specific clinical diagnostic criteria have established a consensus for defining patients with lumbar discogenic pain. However, if conservative medical management fails, these patients have few treatment options short of surgery involving discectomy often coupled with fusion or arthroplasty. There is a rapidly-emerging research effort to fill this treatment gap with intradiscal therapies that can be delivered minimally-invasively via fluoroscopically guided injection without altering the normal anatomy of the affected vertebral motion segment. Viable candidate products to date have included mesenchymal stromal cells, platelet-rich plasma, nucleus pulposus structural allograft, and other cell-based compositions. The objective of these products is to repair, supplement, and restore the damaged intervertebral disc as well as retard further degeneration. In doing so, the intervention is meant to eliminate the source of discogenic pain and avoid surgery. Methodologically rigorous studies are rare, however, and based on the best clinical evidence, the safety as well as the magnitude and duration of clinical efficacy remain difficult to estimate. Further, we summarize the US Food and Drug Administration\'s (FDA) guidance regarding the interpretation of the minimal manipulation and homologous use criteria, which is central to designating these products as a tissue or as a drug/device/biologic. We also provide perspectives on the core evidence and knowledge gaps associated with intradiscal therapies, propose imperatives for evaluating effectiveness of these treatments and highlight several new technologies on the horizon.

UNASSIGNED: HtrA2, a pro-apoptotic protease, plays a crucial role in apoptosis by cleaving inhibitory and anti-apoptotic proteins by translocating from mitochondria to the cytosol. Prior studies in ischemic cells have indicated that cytosolic HtrA2 triggers cFLIP degradation, plausibly through direct interaction. In this study, we have characterized the cFLIP protein, validated its interaction with HtrA2, and demonstrated that cFLIP is also a substrate of HtrA2.
UNASSIGNED: We have identified the probable cleavage sites of cFLIP through gel-based assays and mass spectrometric analysis of the cleaved fragments.
UNASSIGNED: Our findings shed light on a key protein-protein interaction involving pro-apoptotic HtrA2, confirming cFLIP as its interacting partner and substrate.
UNASSIGNED: Understanding the nuances of HtrA2\'s interaction with cFLIP (a decoy protein of the initiator procaspase-8 in the extrinsic apoptotic pathway) and deciphering the cFLIP\'s mode of cleavage, would provide an excellent alternative to modulate the pathway for therapeutic benefits toward diseases like ischemia and cancer.

BACKGROUND: Implant subsidence is recognized as a complication of interbody stabilization, although its relevance remains ambiguous, particularly in terms of relating the effect of the position and depth of subsidence on the clinical outcome of the procedure. This study aimed to evaluate how implant positioning and size influence the incidence and degree of subsidence and to examine their implications for clinical outcomes.
METHODS: An observational study of 94 patients (157 levels) who underwent ACDF was conducted. Radiological parameters (implant position, implant height, vertebral body height, segmental height and intervertebral height) were assessed. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) and Neck Disability Index (NDI). Subsidence was evaluated in groups according to its degree, and statistical analyses were performed.
RESULTS: The findings revealed that implant-to-endplate ratio and implant height were significant risk factors associated with the incidence and degree of subsidence. The incidence of subsidence varied as follows: 34 cases (41.5%) exhibited displacement of the implant into the adjacent endplate by 2-3 mm, 32 cases (39%) by 3-4 mm, 16 cases (19.5%) by ≥4 mm and 75 (47.8%) cases exhibited no subsidence.
CONCLUSIONS: The findings underscore that oversized or undersized implants relative to the disc space or endplate length elevate the risk and severity of subsidence.