Gabriele Martin

Background and Objectives: Low back pain (LBP) is a leading cause of disability worldwide and is frequently associated with intervertebral disc degeneration (IVDD). Current therapeutic strategies are primarily symptomatic and do not restore native disc biology, largely due to the avascular nature of the intervertebral disc and the hostile inflammatory and mechanical microenvironment that characterizes degeneration. The aim of this study is to provide an updated and clinically oriented overview of the pathophysiology of IVDD and to evaluate the current evidence on mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP)-based therapies. Materials and Methods: A focused narrative literature review was performed to evaluate current evidence on MSC- and PRP-based therapies for intervertebral disc degeneration (IVDD). The search was conducted in PubMed. Only studies in English were considered eligible. Results: Mesenchymal stem cells (MSCs) demonstrated regenerative and immunomodulatory effects primarily through paracrine mechanisms, enhancing extracellular matrix synthesis and reducing inflammation and apoptosis. MSC-derived extracellular vesicles emerged as a promising cell-free alternative, potentially overcoming limitations related to cell survival and safety. Platelet-rich plasma (PRP) showed anabolic and anti-inflammatory properties, promoting disc cell proliferation and matrix production, particularly in early-stage degeneration. Clinical studies, including randomized trials, reported significant improvements in pain and function for both MSC and PRP therapies, with favourable safety profiles. However, heterogeneity in treatment protocols and limited long-term data remain significant limitations. Orthobiologic therapies represent a minimally invasive option for patients with discogenic low back pain refractory to conservative treatment. Patient selection is crucial and should consider degeneration stage, disc viability, and clinical presentation. PRP is primarily indicated in early-stage degeneration (Pfirrmann II–III), whereas MSC-based therapies may be considered in selected patients with more advanced but still viable discs. Based on current evidence, a stepwise approach is proposed, progressing from conservative management to PRP, MSCs, and ultimately surgery. Orthobiologics should be integrated within a multimodal strategy including rehabilitation. Conclusions: MSCs and PRP represent a promising and, eventually, complementary orthobiologic therapies for IVDD. PRP is primarily effective in early degenerative stages as a biologic stimulator, whereas MSCs may provide regenerative benefits in more advanced but still viable discs. Further studies are necessary to standardize protocols and confirm long-term efficacy and safety.

Background: Granulicatella adiacens (G. adiacens) is a nutritionally variant Streptococcus generally observed in the human mouth microbiota. Although G . adiacens is involved in bacterial endocarditis and bacteremia, bone and joint infections are extremely rare. In the present study, we reported the first known case of hip osteomyelitis related to G. adiacens . Moreover, a commentary on the available evidence was also performed. Case Presentation: A 59‐year‐old male with a former substance use disorder who initially complained of low back pain with a medical history negative for any other comorbidities, albeit absence seizures. After an accurate evaluation, hip osteomyelitis caused by G. adiacens was diagnosed. In our patient, neither bacteremia nor infectious endocarditis was reported, as well as previous oral surgery. The diagnosis of G. adiacens was performed through 16S rRNA gene sequencing. A three‐stage surgery was performed based on surgical debridement and antibiotic‐cemented spacer implant, antibiotic‐cemented spacer renewal, spacer removal, and prosthesis implantation. Throughout the entire period, the patient received antibiotic therapy with doxycycline and cotrimoxazole. At the final follow‐up, the patient was infection‐free, but a poor hip function was reported. Conclusion: G. adiacens is rarely associated with bone osteomyelitis, probably because of the difficulty in culture isolation that might lead to misdiagnosis, especially in cases of polymicrobial infection. In our experience, debridement, prolonged antibiotics, and two‐stage/three‐ stage prosthesis implantation could be considered as a treatment strategy for hip osteomyelitis involving G. a diacens .

Background: Bone loss management is a tough challenge in orthopedic and trauma surgery that is generally treated using graft or substitute. Bone is the second most common transplanted tissue behind blood. Autologous bone graft represents the gold standard, while allograft is generally used as a secondary option, considering their impressive osteoconductive and osteoinductive properties. However, both allograft and autograft sources are limited. Therefore, synthetic bone substitutes gained popularity due to their low cost and ease of application. β-tri-Calcium phosphate (β-TCP) is a promising material implemented as a bone substitute. One of the limits of bone substitutes is related to their three-dimensional organization, which rarely replicates that of the normal bone. b.Bone™ is a novel bone substitute derived from rattan wood with a unique 3D structure that mimics the architecture of the human bone. This study aims to objectively evaluate the osteointegration of b.Bone™ in complex clinical settings. Methods: We retrospectively evaluated eight patients who underwent surgeries requiring filling bone loss through the use of b.Bone™. Osteointegration of the bone substitute was evaluated radiologically using a modified Van Hemert classification. Results: Eight patients were enrolled into this study: five females and three males with a mean age of 53,75 years old. b.Bone™ was applied in the following shapes: granules in four cases, cylinders in three cases and a prism in one. In four patients, the osteointegration reached a grade Van Hemert 4, three a grade 3, and only one a grade 2. Conclusions: β-TCP-based bone substitutes, such as those derived from rattan, appear to facilitate successful osteointegration in various clinical settings. Future studies with larger cohorts and longer follow-ups are necessary to evaluate the long-term efficacy of this promising substitute.