To investigate the effect of osteoporosis and intervertebral disc degeneration on the endplate cartilage injury in rats

OBJECTIVES@#To investigate the effect of osteoporosis and intervertebral disc degeneration on the endplate cartilage injury in rats.@*METHODS@#A total of 48 female Sprague Dawley rats (3 months) were randomly divided into Groups A, B, C and D with 12 rats in each group. Osteoporosis and intervertebral disc degeneration composite model, simple degeneration model and simple osteoporosis model were prepared in Groups A, B and C respectively. After modeling, four rats of each group at 12th, 18th and 24th week were sacrificed. Intervertebral height of cervical vertebra C6/C7 was measured. Micro-CT was used to image the endplate of cephalic and caudal cartilage at C6/C7 intervertebral disc. Abraded area rate of C6 caudal and C7 cephalic cartilage endplate was calculated, and then C6/C7 intervertebral disc was routinely embedded and sectioned, stained with safranin O to observe histological changes microscopically.@*RESULTS@#At 12, 18 and 24 weeks, intervertebral disc height of C6/C7 were (0.58±0.09) mm, (0.53±0.04) mm and (0.04±0.06) mm in Group A rats, (0.55±0.05) mm, (0.52±0.07) mm and (0.07±0.05) mm in Group B rats. At 24th week, intervertebral disc height of Group A rats was significantly lower than that of Group B rats (P0.05). At 12 and 18 weeks, the abraded rate of C6 caudal and C7 cephalic cartilage endplate in Group A rats were significantly higher than that in Groups B, C and D rats (P0.05). Microscopic observation of CT showed that ventral defects in C6 caudal or C7 cephalic cartilage endplate in Groups A and B appeared after 12 weeks of modeling; obvious cracks were found in front of the C6 and C7 vertebral body, and cartilage defect shown the trend of "repairing" at 18 and 24 weeks after modeling.@*CONCLUSIONS@#Intervertebral disc degeneration and osteoporosis can cause damage to the cartilage endplate. Co-existence of these two factors can induce more serious damage to the endplate, which has possitive correlation with intervertebral disc degeneration. Osteoporosis plays a certain role in intervertebral disc degeneration process, and accelerates the degeneration of intervertebral disc in a specific time window.

Case-control study on the relationship of chronic low back pain of facet joint origin with the distribution of nerve endings and neuropeptide: a quantitative histological analysis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the density and distribution of nerve endings and neuropeptide Y (NPY) in lumbar facet joints of patients with low back pain.</p><p><b>METHODS</b>Fifteen patients without low back pain were selected as control group (group A). Facet joint samples in group A were obtained during the operation or lumbar spinal canal tumor they suffered from. Those patients with low back pain were divided into three groups according to their different origins of pain, such as not from facet joint (group B, 15 patients) ,from facet joint only (group C, 20 patients), or from facet joint partially (group D, 20 patients). Different origins were determined by VAS after facet joint block. The density and distribution of nerve ending and neuropeptide in the capsular tissues were analyzed by a modified gold chloride staining and immunochemistry respectively.</p><p><b>RESULTS</b>Compared with the ones in group A and B, the fact joints in group C and D were more inclined to be degenerated and got more nerve endings. NPY was expressed mainly in the facet joint of patients with low back pain in group C and D. In addition, there was a significant relationship between the distribution of nerve endings and NPY expression,while none of them were related with MRI Fujiwara grade of facet joint.</p><p><b>CONCLUSION</b>These results suggest that the number of mechanoreceptors, neural sprouting and secreted peptides in the facet joint capsules vary with the change of mechanical or nociceptive stimulation, which may promote the development of low back pain in return.</p>

Kinematic effect of Chinese herbal fomentation on patients with chronic neck pain / 中国结合医学杂志

<p><b>OBJECTIVE</b>To clarify the effectiveness of Chinese herbal fomentation in treating chronic neck pain by means of changes in cervical kinematics.</p><p><b>METHODS</b>Seventy-six patients with chronic neck pain were included in the study and were randomized into two groups based on the random number generator of the SPSS software: fomentation combined with Chinese herbal (Group 1) and fomentation without any medicine (Group 2). In both groups, the fomentation lasted for 60 min and heated to 35 °C, once a day for 28 consecutive days. Standard lateral radiographs of the cervical spine were obtained including the neutral, full flexion, and full extension positions. Before and after intervention, the following parameters were used to evaluate the changes in kinematics: range of motion (ROM), sagittal alignment and instantaneous center of rotation (ICR).</p><p><b>RESULTS</b>After treatment, the ROM was signifcantly higher than that of before treatment in Group 1 (51.5, 95% CI: 49.8-55.9; P<0.05). There was no significant difference between before and after treatment in Group 2 (P>0.05). Although C2-C7 cervical alignment was increased in both groups after treatment, no significant difference was detected between before and after treatment (P>0.05). For Group 1, the significant X coordinate variation was only observed at C5/C6 level (38.1; 95% CI: 34.0, 42.1; P<0.05). There was a significant upward trend in the Y coordinate of the ICR at C5/C6 (-30.5; 95% CI: -34.3, -26.8; P<0.05) and C6/C7 after treatment (-6.1; 95% CI: -6.7, -5.4; P<0.05). For Group 2, the ICR location of each level was not statistically different between the pre- and post-treatment (P>0.05).</p><p><b>CONCLUSIONS</b>Chinese herbal fomentation could improve abnormal mobility in terms of ROM and ICR. Chinese herbal fomentation might be an effective treatment for chronic neck pain.</p>

The application of cervical arthroplasty with Mobi-C for treatment of cervical spondylotic radiculopathy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical effectiveness of cervical arthroplasty with Mobi-C prosthesis for treatment of cervical spondylotic radiculopathy.</p><p><b>METHODS</b>From March 2008 to November 2009, a group of 67 patients with cervical spondylotic radiculopathy were analyzed retrospectively. The short form-36 physical component summary (SF-36) and visual analogue scale (VAS) score were used to compare clinical outcome pre- and postoperatively. The follow-up was performed at 3 d, 3 months, 6 months and 1 year postoperatively. Static and dynamic radiography were taken to evaluate height of disc space, range of motion (ROM) and heterotopic ossification (HO) of index levels.</p><p><b>RESULTS</b>Fifty-one cases were followed up, 16 cases were lost. Average follow-up was for 19.7 months (13 - 31 months). All of patients had improvement for clinical symptoms. There was a significant difference on SF-36 between pre- and postoperatively. The significant difference was found in VAS score in which neck pain was decreased from preoperative 4.6 ± 0.4 to postoperative 2.0 ± 0.5 (P < 0.05), arm pain was decreased from preoperative 6.5 ± 0.4 to postoperative 1.3 ± 0.4 (P < 0.05). There was a significant difference in height of disc space which was increased from preoperative (6.5 ± 1.1) mm to (7.7 ± 0.9) mm (P < 0.05). ROM was increased from preoperative 7.2° ± 3.1° to latest follow-up 8.1° ± 3.2°, however, no significant difference was found concerning ROM pre- and postoperatively (P > 0.05). No other complications were met during follow-up period other than the 17 cases of heterotopic ossification in ClassI, the 7 cases in Class II in 1 year postoperatively, but no any correlation were found between the radiographic finding in HO and clinical symptoms.</p><p><b>CONCLUSIONS</b>Cervical arthroplasty with Mobi-C could improve neurofunctional symptoms, maintain ROM of index level and height of disc space. For accurate patient selection, long term follow-up is still needed in prospective randomized study.</p>