<p>It has been claimed that there are considerable differences between pri-vate and non-private patients with regard to the outcome of back surgery.This can be found in the yearly report from the register concerning backsurgery in Sweden. However, the results seem doubtful and the referencescould not be found. Therefore, we analyze the data about nearly 1200patients from the clinic of back surgery in Str¨angn¨as (CSS). It includesthree time periods with somewhat different questionnaires from 1986 to2007 with both private and non-private patients. In the third period,the patients have been evaluated using the SF-36 questionnaire. The re-sults show that most of the differences between private and non-privatepatients are minor and not statistically significant.</p>

Back pain is one of the most common physical conditions in the United States, for which approximately 15% of the population will visit a doctor every year. The most common type of back pain is low back pain (LBP) and millions of dollars are spent every year healthcare are a due to LBP. Although poorly understood, low back pain has been associated to interveterbral disc (IVD) degeneration. The IVD is an important structure that helps maintaining normal skeletal support. It is composed of three different tissues called the annulus fibrosus (AF), and the nucleus pulposus (NP), attached to a cartilage endplate (CEP) at its top and bottom surfaces. The AF tissue is composed of chondrocyte-like cells, while the NP tissue is composed of notochordal cells at a young age, which are replaced by mature NP cells later in life. Common signs of degeneration are the inability to maintain extracellular matrix integrity and calcification of the cartilage endplate. Extracellular matrix synthesis and cartilage endplate calcification are closely related to production of adenosine triphosphate (ATP) or energy metabolism of the cells. AF and NP tissues are known to be structurally and compositionally different; therefore it is believed that their metabolic pathways are also distinct. The objective of this study was to determine the differences between AF and NP cells, specifically in their energy metabolism with and without dynamic loading.

Low back pain is one of the major health concerns in the US. It affects up to 80% of the population at some time during their lives. It not only causes discomfort to patients and affects their physical ability but also has a huge economic impact on society. Although the cause of low back pain is still poorly understood, it is implicated that degeneration of the intervertebral disc is the primary factor. Currently, researchers are trying to use tissue engineering approaches to develop new treatments capable of removing the degenerated disk and replacing it with a biological substitute. However, to create such a biological substitute, we need to first understand the structure-function relationship of the tissue. Only when we understand the function of the tissue, can we begin creating biological substitutes. While culturing a biological substitute, we also need methods to determine how the substitute responds to its environment. At present, there are many different types of bioreactors developed for cartilaginous tissues. However, there is a lack of a system that can detect the chemical, electrical and mechanical response noninvasively with control feedback in real-time. It is hard to provide the optimal culture environment to the substitute without knowing its response in real-time. The objective of this dissertation is to develop new methods to investigate the transport property, oxygen consumption rate and mechano-electrochemical and mechanical properties of the tissue. Because cells are responsible for the tissue health, it is necessary to understand how they can obtain nutrients under different environments, e.g. under different loading condition. In addition, with the use of a bioreactor with the capability of detecting the real-time response combined with a feedback control system, we can provide the most favorable conditions for tissue or biological substitutes to grow. The new measurement methods developed in this dissertation can contribute to further understanding the function of the tissue. The methods outlined in this dissertation can also provide new tools for future tissue engineering applications. Moreover, the findings in this dissertation can provide information for developing a more comprehensive theoretical model to elucidate the etiology of disc degeneration.

It has been claimed that there are considerable differences between pri-vate and non-private patients with regard to the outcome of back surgery.This can be found in the yearly report from the register concerning backsurgery in Sweden. However, the results seem doubtful and the referencescould not be found. Therefore, we analyze the data about nearly 1200patients from the clinic of back surgery in Str¨angn¨as (CSS). It includesthree time periods with somewhat different questionnaires from 1986 to2007 with both private and non-private patients. In the third period,the patients have been evaluated using the SF-36 questionnaire. The re-sults show that most of the differences between private and non-privatepatients are minor and not statistically significant.

Objectives: The purpose of the study was to examine if a pre- and post-operative difference could be seen in self-reported pain disability and self-efficacy among patients undergoing surgery as treatment for spinal disc herniation in order to improve process of rehabilitation. Method: A quantitative and descriptive design was used. 10 patients awaiting surgical treatment for spinal disc herniation were included at Akademiska sjukhuset (The Academic Hospital) in Uppsala. Participation was voluntary and the selection was made by convenience. Data was collected using The Pain Disability Index and Self-Efficacy Scale by which the patient would estimate how hindered they felt because of their pain in everyday activities and their self-efficacy to perform everyday activities. This was done the day before surgery and two weeks after surgery. The data was analyzed with Wilcoxon’s signed rank test and statistical significance was set to p&lt;0,05. Results: The majority of patients reported an improvement after herniated disc surgery regarding PDI and self-efficacy. Statistically significant differences were established regarding both PDI (p=0,012) and Self-Efficacy Scale (p=0,009) in patients (n=10) before and after herniated disc-surgery. Conclusion: The study showed that the majority of the patients reported an improvement in both PDI and Self-Efficacy Scale after surgery. However, no conclusion could be made through this study due to the low number of participants (n=10). / Syfte: Syftet med studien var att undersöka om skillnad förelåg i diskbråcksopererade patienters skattning av hindrande smärta i vardagen och self-efficacy pre- och postoperativt för att bidra till en förbättrad rehabiliteringsprocess. Metod: Metoden som användes hade en kvantitativ och deskriptiv design. 10 patienter med planerad diskbråcksoperation inkluderades på Akademiska sjukhuset i Uppsala. Deltagandet var frivilligt och urvalet skedde genom bekvämlighetsurval. Patienterna skattade hur hindrande smärtan var i vardagliga aktiviteter och hur stor tilltron till egen förmåga var genom instrumenten Pain Disability Index (PDI) och Self-Efficacy Scale dagen innan operation och två veckor postoperativt efter diskbråcksoperation. Data analyserades med Wilcoxons teckenrangtest med signifikansnivå satt till p&lt;0,05. Resultat: Studien visade att majoriteten av patienterna upplevde en förbättring avseende PDI och Self-Efficacy efter diskbråcksoperation. Statistiskt signifikant skillnad förelåg gällande pre- och postoperativ skattning av både PDI (p=0,012) och Self-Efficacy Scale (p=0,009) hos patienterna (n=10). Konklusion: Studien visade att majoriteten av patienterna postoperativt skattade en förbättring både med PDI och Self-Efficacy Scale. Resultaten får betraktas som preliminära på grund av det låga deltagarantalet samt att 2 veckor postoperativt är alltför kort tid efter det kirurgiska ingreppet.

This study investigates the changes due to crosslinking treatment in stiffness, permeability, and glycosaminoglycan (GAG) content of bovine intervertebral discs. The objective of this study was to determine the mechanical and biochemical effects of crosslinking treatment on lumbar bovine tissue. Previous studies have found that crosslinking can increase stiffness and permeability in the intervertebral disc. These changes have not yet been investigated by confined compression, stress-relaxation tests of young bovine tissue. Eleven lumbar motion segments were harvested from calf spines and soaked in a saline solution or one of four crosslinking treatments (genipin, methylglyoxal, proanthrocyanidin, and EDC). Five mm diameter samples were removed from the midannulus region at anterior / anterior-lateral locations, confined in a saline bath, swelled to equilibrium, and tested in confined compression stress-relaxation to 15% strain in 5% increments. Radial samples were also harvested, treated with saline solution and EDC, and tested in the same manner. The aggregate modulus and hydraulic permeability were calculated using the nonlinear biphasic theory. Swelling pressure was calculated as the load at swelling equilibrium. GAG content was measured using the dimethylmethylene blue assay. Differences with P value < 0.05 were considered significant. In the axial orientation, all crosslinking treatments except methyglyoxal at least doubled the aggregate modulus relative to soaked controls (P less than 0.05). Genipin treatment resulted in 78% lower axial permeability, proanthrocyanidin (PA) 50% lower, and EDC treatment 84% lower relative to soaked controls (P &lt; 0.05). GAG content measured in the methyglyoxal treatment group was 25% lower than in soaked control group. Genipin (G), proanthrocyanidin (PA), and EDC treatment increased the swelling pressure by at least 65% (P less than 0.05). In the radial orientation, EDC treatment increased the stiffness by 75%, and did not significantly affect the permeability or swelling pressure. Some crosslinking treatments proved effective in increasing the stiffness and swelling pressure of the disc. The increased swelling pressure in G, PA, and EDC treatment groups relative to soaked controls suggests reduced GAG leaching during soaking treatment, further confirmed by the reduction in permeability in these groups.

This report discusses two examples of the use of Poincare disc models and their different relationships to Euclidean geometry. The topics include light reflection in hyperbolic geometry and the Hyperbolic Pythagorean Theorem; all in relation to the Poincare unit disc and Poincare upper half plane model. / text

Σκοπός: Ο νεοεννευρωμένος μεσοσπονδύλιος δίσκος (ΜΔ), κλινικά θεωρείται μια σημαντική πηγή πόνου στους ασθενείς με οσφυαλγία. Η ταυτοποίηση των νεοσχηματιζόμενων νεύρων, που εκφράζουν τους υποδοχείς των νευροτροφινών, στην εκφύλιση του ΜΔ, σπονδυλικών επιπέδων που αναφέρονται ως πηγή δισκογενή πόνου και η συσχέτισή τους με το ενδοκανναβινοειδές σύστημα αναλγησίας, αποτελεί το αντικείμενο αυτής της μελέτης. Υλικό και μέθοδος: Συλλέχθηκαν 50 ανθρώπινοι ΜΔ ή τμήματα αυτών, μετά από δισκεκτομή σε χειρουργεία κήλης και εκφυλιστικών παθήσεων της Οσφυϊκής Μοίρας της Σπονδυλικής Στήλης (ΟΜΣΣ). Εφαρμόσθηκε ανοσοϊστοχημεία για την ανίχνευση νευρικών ινών, στους ΜΔ, αφού διαπιστώθηκε η εκφύλισή τους. Συσχετίσθηκε η ανάπτυξη νευρικών ινών των εκφυλισμένων ΜΔ με την έκφραση των υψηλής και χαμηλής συγγένειας υποδοχέων των νευροτροφινών, TrkA, TrkB, TrkC και p75, αντίστοιχα. Στα περιστατικά με ανάπτυξη νευρικών ινών ανιχνεύθηκε ανοσοϊστοχημικά η έκφραση του υποδοχέα CB1 των ενδοκανναβινοειδών. Αποτελέσματα: Η εκτεταμένη νεύρωση στον ΜΔ που φέρεται στον έσω ινώδη δακτύλιο (ΙΔ) και μπορεί να φτάνει μέχρι τον πηκτοειδή πυρήνα (ΠΠ), φαίνεται να είναι εξαρτώμενη από τους υποδοχείς των νευροτροφινών TrkA, TrkB, TrkC και p75. Μικρά αιμοφόρα αγγεία συνοδεύουν τις νευρικές ίνες στα σπονδυλικά επίπεδα του ΜΔ που δίνουν δισκογενή πόνο και εκφράζουν επίσης τους υποδοχείς των νευροτροφινών. Ο CB1 υποδοχέας των ενδοκανναβινοειδών ταυτοποιήθηκε σε όλα τα περιστατικά που εμφάνιζαν ανάπτυξη νευρικών ινών. Βρέθηκε να εκφράζεται στα αγγεία που συνοδεύουν τις νευρικές ίνες και σε μερικά νεύρα. Δεν ταυτοποιήθηκε ανάπτυξη νευρικών ινών σε εκφυλισμένους ΜΔ σπονδυλικών επιπέδων που δεν αποτελούσαν αιτία δισκογενούς οσφυαλγίας. Συμπέρασμα: Η αλγοϊδιοδεκτική ανάπτυξη νευρικών ινών στον ΜΔ συνδέεται με την έκφραση των υποδοχέων των νευροτροφινών στις νεοσχηματιζόμενες νευρικές ίνες, δείχνοντας ότι όχι μόνο ο NGF, αλλά και άλλες νευροτροφίνες εμπλέκονται στην ανάπτυξη νευρικών ινών. Η έκφραση του CB1 υποδοχέα των ενδοκανναβινοειδών αποτελεί πεδίο έρευνας για τη θεραπεία του δισκογενή πόνου. / The current study was designed in order to detect immunohistochemically the expression of cannabinoid CB1 receptor and high and low affinity neurotrophin receptors TrkA, TrkB, TrkC and p75 respectively in human painful intervertebral disc (IVD). Previous data have shown an association between nerve ingrowth in human degenerated IVD and patient’s experience of pain. The nociceptive nerve ingrowth into painful IVD is causally linked with Nerve Growth Factor (NGF) production by blood vessels growing into the IVD. NGF causes further innervation and is involved in processes that result in an inflammatory hyperalgesia. There is evidence that cannabinoids show a neuronal CB1 receptor-mediated antihyperalgesic action and a separate inhibition of proinflammatory neuroimmune processes. A total of 50 IVD specimens after lumbar discectomy were included in the present study. The degeneration of IVD was identified and connected with clinical background of patients. An immunoperoxidase method on formalin-fixed, paraffin-embedded tissue sections and specific antibodies against CB1 and neurotrophin receptors (TrkA, TrkB, TrkC and p75) were used. Immunohistochemistry was also performed to detect neural and vascular markers: tubulin (βIII) and CD31. Neurotrophin receptors (TrkA, TrkB, TrkC and p75) expression was detected only in innervated degenerated IVD. Blood microvessels accompanied nerve fibers growing into IVD expressed also neurotrophin receptors. Furthermore, in some nerve fibers CB1 cannabinoid receptor expression was identified. Interestingly, CB1 receptor expression was detected in the majority of vessels accompanying nerve fibers. Nociceptive nerve ingrowth into degenerated IVD was strongly associated with all neurotrophin receptors expression indicating that not only NGF but also and others neurotrophins are involved in nerve ingrowth. Expression of CB1 cannabinoid receptor in innervated IVD suggests a possible therapeutic site of analgesic action. Additional studies would be necessary to clarify the functional role of CB1 cannabinoid receptor in degenerated intervertebral disc.

Thesis (M.A.) - Carleton University, 2006. / Includes bibliographical references (p. 83-88). Also available in electronic format on the Internet.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1972. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 601-626).