In vitro osteoclast-suppressing effect of sodium ibandronate / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Bisphosphonates (BPs) have been reported to reduce local recurrence in giant cell tumor (GCT) of bone because of their osteoclast-suppressing effect; however, the optimal mode of delivery and the dose and duration of treatment of BPs remain to be established. To address these issues, it is first necessary to clarify the manner of action of BPs on osteoclasts. We herein evaluated the osteoclast-suppressing effect of sodium ibandronate in vitro.</p><p><b>METHODS</b>Mouse osteoclasts (OCLs) were generated in vitro using mouse bone marrow mononuclear cells. First, various concentrations of sodium ibandronate and equal amounts of phosphate-buffered saline were added to cell culture media. The number of multinucleated cells (over three nuclei) was recorded in each group, OCL formation was compared, and the most effective concentration of sodium ibandronate was determined. Then, high concentrations of sodium ibandronate were added to the experimental cell culture media; no ibandronate was given in the control group. Comparisons were made between the two groups in terms of OCL adhesion, migration, and bone resorption.</p><p><b>RESULTS</b>OCL formation was suppressed by sodium ibandronate in vitro; the most pronounced effect was observed at the concentration of 10(-5) mol/L. OCL migration and bone resorption were significantly suppressed at this concentration, though there was no effect on OCL adhesion.</p><p><b>CONCLUSIONS</b>Sodium ibandronate was effective in suppressing OCLs and decreasing resorption in GCT. The strong anti-OCL effectiveness at a high concentration in vitro indicates a topical mode of application.</p>

The study on the relationship between modic change and disc height together with lumbar hyperosteogeny / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the relationship between Modic change and disc height together with lumbar hyperosteogeny and study the role of Modic change in lumbar degeneration.</p><p><b>METHODS</b>The imaging data of 150 elderly patients with chronic low back pain were analysed retrospectively. All patients underwent MRI and lumbar lateral X-ray examination. The lumbar disc from L1-L2 to L5-S1 were selected for this study, including 750 discs, vertebral and endplate close to disc in 150 patients. The incidence rate of lumbar endplate Modic change, disc height and the degree of vertebral bone hyperplasia were recorded. The ratio of disc height/lumbar intervertebral disc height < 50% was defined as disc collapse. The patients were divided into 4 groups in the basis of imaging changes. Group A1:disc collapse without severe lumbar hyperosteogeny; Group A2: disc collapse with severe lumbar hyperosteogeny; Group B1: Neither disc collapse nor severe lumbar hyperosteogeny; Group B2: severe lumbar hyperosteogeny without disc collapse. The incidence rates of Modic change were compared between the 4 groups by χ(2) test. Finally, the influence of disc height and vertebral bone hyperplasia on the incidence rate of Modic change was analysed.</p><p><b>RESULTS</b>Four groups of patients observed a total of 750 discs. The number of intervertebral discs in the group A1 was 208, the incidence rate was 54.3%. The number of intervertebral discs in the group A2 was 135, the incidence rate of group A2 was 34.8%. The number of intervertebral discs in the B1 group was 225, the incidence rate of group B1 was 16.9%. The number of intervertebral discs in the B2 group was 182, the incidence rate of group B2 was 29.7%. There was significant difference of lumbar endplate Modic change incidence rate among the 4 groups(χ(2) = 69.565, P < 0.05). The results of post hoc test showed that the incidence rate of Modic change in group A1 was higher than group A2, B1 and B2 (χ(2) = 12.524, 66.701 and 24.102, P < 0.00714). There was significant difference of Modic change incidence rate between group A2 and B1(χ(2) = 15.032, P < 0.00714), but there was no significant difference of Modic change incidence rate between group A2 and B2 (χ(2) = 0.945, P > 0.00714) . There was significant difference of Modic change incidence rate between group B2 and group B1 (χ(2) = 9.395, P < 0.00714).</p><p><b>CONCLUSIONS</b>The incidence rate of Modic change with disc collapse but without severe lumbar hyperosteogeny is high in elderly patients with chronic low back pain. There is no significant difference of Modic change incidence between patients with both disc collapse and severe lumbar hyperosteogeny and patients with severe lumbar hyperosteogeny but without disc collapse.</p>

Removal versus preservation of the posterior longitudinal ligament in Bryan cervical disc arthroplasty / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Bryan cervical disc arthroplasty can be used to restore and maintain the mobility and function of the involved cervical spinal segments. The efficiency of posterior longitudinal ligament (PLL) resection in anterior cervical decompression and fusion has been demonstrated. However, no clinical reports have compared PLL removal with preservation in Bryan cervical disc arthroplasty. This study aimed to assess the role of removal of PLL in Bryan cervical disc arthroplasty at an 18-month follow-up.</p><p><b>METHODS</b>We performed a prospective investigation of clinical and radiological outcomes in patients after Bryan cervical disc arthroplasty. Sixty patients who underwent Bryan cervical disc arthroplasty were included. The PLL was removed in 35 patients (investigational group) and preserved in 25 patients (control group). All of the patients were followed up for more than 18 months. Clinical (Japanese Orthopedic Association score and Visual Analogue Scale pain score) and radiological (functional spinal unit (FSU) angle, range of movement (ROM), and diameter of the spinal cord) parameters were compared between the two groups before and after surgery (18 months).</p><p><b>RESULTS</b>Clinical outcomes in the investigational group were significantly superior to those in the control group. There were no significant differences in the FSU angle and ROM (P = 0.41 and 0.16, respectively) between the two groups. However, the increase in diameter of the spinal cord in the investigational group was significantly greater than that in the control group (P < 0.01).</p><p><b>CONCLUSIONS</b>Removal of the PLL can improve the clinical outcomes of Bryan cervical disc arthroplasty. This procedure does not have a large effect on imbalance and motion of the cervical spine.</p>

Radiological comparison of bilateral paravertebral muscles in degenerative lumbar scoliosis and its potential importance / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the radiological change of bilateral paravertebral muscles in degenerative lumbar scoliosis (DLS) and analyze its clinical significance.</p><p><b>METHODS</b>As a retrospective study, 66 patients with DLS and 66 patients with lumbar spinal stenosis were retrospectively enrolled from April 2004 to August 2011 as scoliosis group and lumbar spinal stenosis group, meanwhile 66 health persons with no lumbar spinal stenosis were selected as control group. No significant differences were found in the gender, age and body mass index among the three groups. The cross-sectional area (CSA) and percentage of fat infiltration area (FIA) of the bilateral paravertebral muscles at the L(1)-S(1) levels were measured using T2-weighted axial MRI and Image J software. The measured data were analyzed with a paired t-test.</p><p><b>RESULTS</b>In the DLS with bilateral symptom group, the mean percentage of FIA of the multifidus muscle on the convex side were 18% ± 4%, 21% ± 4%, 27% ± 4%, 34% ± 6%, 42% ± 10% and on the concave side were 25% ± 8%, 30% ± 7%, 35% ± 7%, 40% ± 10%, 44% ± 8% at L(1-2), L(2-3), L(3-4), L(4-5) and L(5)-S(1) levels, which showed significant differences between the convex side and the concave side (t = 7.95, 9.30, 5.35, 2.78, 2.38, P < 0.05); the mean percentage of FIA of the longissimus muscle on the convex side were 25% ± 9%, 28% ± 8% and on the concave side were 27% ± 9%, 31% ± 9% at L(3-4), L(4-5) levels, which showed significant differences between the convex side and the concave side (t = 2.52, 3.48, P < 0.05). There were no significant differences in the CSA of both muscles between the concave and convex sides (P > 0.05). In the DLS with unilateral symptom group, the mean percentage of FIA of the multifidus muscle on the convex side were 18% ± 5%, 23% ± 5%, 29% ± 5%, 34% ± 6%, 42% ± 9% and on the concave side were 23% ± 6%, 30% ± 7%, 36% ± 7%, 41% ± 10%, 45% ± 8% at L(1-2), L(2-3), L(3-4), L(4-5) and L(5)-S(1) levels, which showed significant differences between the convex side and the concave side (t = 6.67, 7.96, 6.43, 3.86, 2.15, P < 0.05). There were on significant differences in the CSA of both muscles, and in the percentage of FIA of the longissimus between the concave and convex sides (P > 0.05).</p><p><b>CONCLUSIONS</b>There exist asymmetric degeneration in paravertebral muscle in DLS, which have potential clinical importance on the evaluation of curve progression, and muscle degeneration is more often seen in the concave side. Spinal deformity and radiculopathy may contribute to the paravertebral muscle degeneration.</p>

Analysis of axial symptoms after indirect decompression for ossification of the posterior longitudinal ligament of the cervical spine / 中华外科杂志

<p><b>OBJECTIVE</b>To study the etiology and clinical significance of axial symptoms after posterior operative procedures for ossification of the posterior longitudinal ligament (OPLL).</p><p><b>METHODS</b>From February 2005 to February 2010, 76 patients with OPLL treated were retrospectively experienced. There were 34 male and 42 female with average of 52.1 years (range from 37 to 74 years), the average duration of the disease was 32.1 months (range from 11 to 56 months). Nineteen patients underwent traditional laminectomy in group A, 33 patients received open-door laminoplasty in group B and 24 patients underwent lateral mass screw fixation in group C. All patients underwent X-ray examination pre- and post operative, computed tomography were used for diagnosis of OPLL, the recovery rate was calculated using pre- and postoperative Japanese Orthopedic Association (JOA) scores for each patient. Pre- and postoperative cervical curvature index and axial symptoms were measured and compared. χ(2) test and SNK test were used as statistical methods.</p><p><b>RESULTS</b>All patients were followed up for 14 - 35 months, average (21 ± 5) months. Loss of cervical curvature index was 4.2% ± 1.7% in group A, 2.9% ± 2.2% in group B and 2.3% ± 1.9% in group C. The difference was significant in loss of cervical curvature indice between group A and B (q = 2.94, P < 0.01), group A and C (q = 4.23, P < 0.01). The average JOA recovery rate was 58.3% for group A, 64.3% for group B and 66.7% for group C. There was no significant difference in JOA recovery rate among the three groups (P > 0.05). The rate of early evident axial symptoms was 7/19 in group A, 30.3% in group B and 33.3% in group C and the difference was not statistically significant (P > 0.05). The incidence of late evident axial symptoms was 5/19 in group A, 12.1% in group B and 8.3% in group C, the difference was not significant between group B and C (χ(2) = 13.762, P < 0.01), but of statistical difference between group A and B(χ(2) = 6.368, P < 0.01), group A and C (χ(2) = 11.481, P < 0.01). No kyphotic deformity in the group A, no "Close Door" phenomenon in group B and no internal failure in group C.</p><p><b>CONCLUSION</b>The incidence of early axial symptoms are of no significant difference among the three groups, but late axial symptoms are higher in the laminectomy than other groups, which may be associated with loss of cervical lordosis.</p>

Intervertebral disc degeneration and bone density in degenerative lumbar scoliosis: a comparative study between patients with degenerative lumbar scoliosis and patients with lumbar stenosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Degenerative lumbar scoliosis is common in older patients. Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis. A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed. The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study.</p><p><b>METHODS</b>From January 2001 to August 2010, 96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls. Cobb angle, height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group. The height of L2/L3, L3/L4, L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group. The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups. The bone density of lumbar vertebrae was measured with dual-energy X-ray.</p><p><b>RESULTS</b>In scoliosis group, the intervertebral disc height on the convex side was greater than the height on the concave side (P < 0.001). The vertebral body height on the convex side was greater than the height on the concave side (P = 0.016). There was a significant difference between the scoliosis group and the control group (P = 0.003), and between T-value and the rate of osteoporosis between the two groups (both P < 0.001).</p><p><b>RESULTS</b>were verified using multiple linear regression analysis.</p><p><b>CONCLUSIONS</b>Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces. There is a positive correlation between the angle of scoliosis and the disc index, the degree of degeneration of the intervertebral disc, and a negative correlation between the angle of scoliosis and bone density.</p>