ABSTRACT
Cervical spondylotic radiculopathy is one of the commonly seen spinal surgery diseases. For well-diagnosed and well-located cervical spondylotic radiculopathy, surgical intervention can effectively alleviate symptoms. With the wide application of minimally invasive surgical techniques, the requirements for precise preoperative orientation of responsible segments have increased, especially in multisegmental cervical spondylotic radiculopathy cases. However, due to the cutaneous pain distribution is often atypical, magnetic resonance imaging and neurological examinations may be not reliable enough for accurate location preoperatively which may fail to get a satisfactory surgical outcome. Selective nerve root block (SNRB) in preoperative localization of responsible nerve roots in cervical spondylotic radiculopathy has gradually increased. Yet this technology has been mostly used by anesthesiologists or radiologists, this field in minimally invasive spinal surgery is relatively blank. As we know, there is no previous review summarized the commonly used approaches of SNRB, the risk factors relating to complications, and the local precise blood vessels anatomy. In summary, we believe that combination these series of points with the necessity of preoperative precise location in cervical spondylotic radiculopathy may increase the safety of cervical SNRB. The keywords about "cervical" and "selective nerve root block" have been used in English and Chinese literature databases. The articles were filtrated by title, abstract and full text. There were 21 articles taken in the review. We summarized the history and distinction of different approaches including anterior lateral approach, lateral approach, posterior lateral approach, dorsal "direct" approach and dorsal 'indirect' approach, and described the indication of each approach. As well as the factors associating with catastrophic complications in cervical SNRB, for instance, the vascular distribution relating to vascular mistaken injection, steroid kind selection because large steroid particle may block some thin but vital arteries. In addition to cervical local blood vessels distribution and variation, the needle trajectory also played a key role in the complications of SNRB. Besides, other controversy points, such as whether use contrast media or not, the importance of the lateral position of the cervical spine, etc., were discussed in this review based on clinical researches. The purpose of the present study is hoping to provide some references for spine surgeons to apply SNRB technology more safely.
ABSTRACT
Cervical spondylotic radiculopathy is one of the commonly seen spinal surgery diseases. For well?diagnosed and well?located cervical spondylotic radiculopathy, surgical intervention can effectively alleviate symptoms. With the wide appli?cation of minimally invasive surgical techniques, the requirements for precise preoperative orientation of responsible segments have increased, especially in multisegmental cervical spondylotic radiculopathy cases. However, due to the cutaneous pain distri?bution is often atypical, magnetic resonance imaging and neurological examinations may be not reliable enough for accurate loca?tion preoperatively which may fail to get a satisfactory surgical outcome. Selective nerve root block (SNRB) in preoperative localiza?tion of responsible nerve roots in cervical spondylotic radiculopathy has gradually increased. Yet this technology has been mostly used by anesthesiologists or radiologists, this field in minimally invasive spinal surgery is relatively blank. As we know, there is no previous review summarized the commonly used approaches of SNRB, the risk factors relating to complications, and the local pre?cise blood vessels anatomy. In summary, we believe that combination these series of points with the necessity of preoperative pre?cise location in cervical spondylotic radiculopathy may increase the safety of cervical SNRB. The keywords about "cervical" and"selective nerve root block" have been used in English and Chinese literature databases. The articles were filtrated by title, ab?stract and full text. There were 21 articles taken in the review. We summarized the history and distinction of different approaches including anterior lateral approach, lateral approach, posterior lateral approach, dorsal "direct" approach and dorsal'indirect'ap?proach, and described the indication of each approach. As well as the factors associating with catastrophic complications in cervi?cal SNRB, for instance, the vascular distribution relating to vascular mistaken injection, steroid kind selection because large ste?roid particle may block some thin but vital arteries. In addition to cervical local blood vessels distribution and variation, the needle trajectory also played a key role in the complications of SNRB. Besides, other controversy points, such as whether use contrast me?dia or not, the importance of the lateral position of the cervical spine, etc., were discussed in this review based on clinical research?es. The purpose of the present study is hoping to provide some references for spine surgeons to apply SNRB technology more safely.
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<p><b>OBJECTIVE</b>To study the expression of Aggrecan and the relationship between the variable number of tandem repeats (VNTR) of Aggrecan and lumbar disc herniation (LDH).</p><p><b>METHODS</b>The disease group comprised of 74 patients already diagnosed with symptomatic LDH. The control group consisted of 15 patients restricted to spinal trauma and 113 healthy blood donors without symptoms of LDH who were not diagnosed with LDH. Disc tissue samples were obtained from surgical operations and blood samples were donated from all participants. The Aggrecan expression in isolated tissues was assessed by western blot using specific antibodies. The Aggrecan gene VNTR region was analyzed by PCR.</p><p><b>RESULTS</b>The Aggrecan expression positive rate of control group was statistically and significantly higher (control group:86.67%, disease group:13.51%;χ(2) = 34.83, P < 0.05) than that of the disease group. Moreover, there was a statistically significant higher frequency of Allele 25 or Allele 21 in disease group compared to controls (A25disease group = 22.97%, A25control group = 12.11%, χ(2)A25 = 8.20, PA25 = 0.004; A21disease group = 6.76%, A21control group = 0.39%, χ(2)A21 = 14.35, PA21 = 0.000). Compared to the participants with 2 Alleles>25 repeats, subjects with 1 or 2 Alleles ≤ 25 repeats statistically and significantly over represented the disease group without the expression of Aggrecan (χ(2) = 5.69, P = 0.017).</p><p><b>CONCLUSIONS</b>The findings suggest a relationship between Aggrecan and symptomatic LDH, where symptomatic LDH has a tendency of allele 21 and allele 25 repeats.In addition, an association between the distribution of Aggrecan gene VNTR polymorphism and the expression of Aggrecan is observed in symptomatic LDH.</p>
Subject(s)
Humans , Aggrecans , Alleles , Intervertebral Disc Displacement , Genetics , Minisatellite Repeats , Polymerase Chain Reaction , Polymorphism, GeneticABSTRACT
BACKGROUND:The self-renew and regeneration capacity of the injured spinal cord is thought to be limited. Accordingly, cel transplantation is one potential strategy for promoting functional recovery after spinal cord injury. OBJECTIVE:To explore the effects ofPTEN silencing on the biological properties of bone marrow mesenchymal stem cels, hoping to offer better seed cels for tissue engineering. METHODS:Bone marrow mesenchymal stem cels were transfected with specific siRNA-silencedPTEN gene using the liposome method, and then RT-PCR was used to detect the mRNA expression ofPTEN. Variation of biological properties ofPTEN-transfected cels were detected by the way of MTT assay, cel cycle analysis, and Transwel assay. RESULTS AND CONCLUSION:PTEN is expressed highly in bone marrow mesenchymal stem cels, which is successfuly interfered by siRNA.PTEN-silenced cels have stronger survival, proliferation and migration abilities, which become a kind of better seed cels for tissue engineering.
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Objective To investigate the methods and effects of posterior fixation and fusion in treatment of complete thoracolumbar fracture and dislocation.Methods The study enrolled 8 cases of complete thoracolumbar fracture and dislocation treated by posterior fixation and fusion with pedicle screwrod system between January 2006 and December 2012.There were 7 males and 1 female,at mean age of 31.9 years (range,19-49 years).Mean time interval between injury and surgery was 8.1 days (range,4-12 days).Fracture-dislocation classification was AO type C,Denis three-column injury,and Meyerding grade V.According to American Spinal Injury Association (ASIA),there 5 cases at grades A,1 at grade B,1 at grade C 1 at grade E.Fracture-dislocation segments included T5-T6 in 1 case,T12-L1 in 3,L1-L2 in 2,L3-L4 in 1 and L4-L5 in 1.Results Mean duration of surgery was 220.6 minutes (range,135-335 minutes) and mean intraoperative blood loss was 1 150 ml (range,500-2 400 ml).Seven cases sustained dural laceration during the operation,which were sutured or covered with autologous fat grafts,but 3 of them were subjected to cerebrospinal fluid leakage and healed after conservative therapy.Anatomic reduction was achieved in 6 cases,partial reduction in 1 and non-reduction in 1.Mean Cobb angle improved from 29.3 ° (range,8 °-51 °) preoperatively to 1.9 ° (range,-5°-10 °) postoperatively.After a mean follow-up of 39.3 months (range,2-76 months),2 cases were recovered from preoperative ASIA grade A and B to C respectively and 6 cases (4 A,1 C,1 E) revealed no significant improvement.There was no implant loosening or breakage.One case was died of lung-related complications at postoperative 4 years.One case sustained lumbar deep infection at postoperative 3 weeks and managed by debridement,irrigation,drainage and implant retention.Conclusion Posterior fixation and fusion is the general treatment principle for complete thoracolumbar fracture and dislocation,but the degree of reduction depends on severity of the injured spinal cord.
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Objective To investigate the treatment and prevention strategies of hematomas in operation area after anterior approach surgery for cervical spondylosis.Methods A retrospective review was conducted on 12 with hematoma compression in operation area out of 785 patients managed by anterior cervical surgery from January 2007 to July 2013,including 10 males and 2 females at age ranging from 40-71 years (mean 56.8 years).Surgery method was anterior cervical corpectomy and interbody fusion using titanium mesh cage plus plate and intraoperative blood loss was 300-1 200 ml.Primary clinical manifestations were neurological dysfunction in 5 patients,dyspnea in 6,and both neurological dysfunction and dyspnea in 1.There were 10 patients with the presence of symptoms at postoperative 0.5-22 hours,1 at postoperative 73 hours,and 1 at postoperative 74 hours.All the 12 patients underwent a second anterior cervical exploration.Results There were 5 patients with epidural hematoma,6 with subcutaneous hematoma,and 1 with both hematomas.After surgical interventions,the patients presented improvement in respiratory and neurological function,with inapparent respiratory abnormality and improved neurological function at discharge.One patient was died of cardiovascular-associated disease after being discharged from hospital.The left 11 patients were followed up for mean 19.8 months (range,6-43 months),with improved Japanese Orthopedic Association (JOA) score at final follow-up.Conclusions Hematoma took place frequently in the early period,especially within 24 hours in operation area after anterior approach to cervical disorders and close attention should be paid to respiratory and limb sensation and motion functions.Early detection and early surgical interventions are the key countermeasures to avoiding the severe results.
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[Objective]To discuss the clinical effect of the anterior approach for the treatment of thoracolumbar burst fractures by decompression and bone graft.[Method]A total of 34 patients underwent anterior approach for the treatment of thoracolumbar burst fractures were retrospectively analyzed from September 2003 to September 2005.According to the Denis classification system,there were 6 type A,16 type B,6 type C,4 type D,and 2 type E.Preoperative and postoperative neurologic changes,spinal canal decompression,segmental angulation,and arthrodesis rate were evaluated.[Result]The average preoperative canal compressopm decreased from 66.5% to 2.0%.Mean preoperative segmental kyphosis improved from 22.10? to 2.30?.There was neurologic deterioration.Twenty-six(86.7%) of 30 patients with neurologic deficits had an improvement by at least one modified Frankel grade.All patients went on to apparently stable arthrodesis.[Conclusion]Types of anterior spinal instrumentation and reconstruction techniques allow direct anterior decompression of neural elements,improvement in segmental angulation,and acceptable rates of arthrodesis without the need for supplemental posterior instrumentation.
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Objective To explore the characteristics of diagnosis and treatment for the pyogenic spinal osteomyelitis. Methods From July 1999 to August 2003, 12 patients with pyogenic spinal osteomyelitis were involved, 7 males and 5 females, aging from 13 to 61 years, with an average of 36.6 years. The pain in the thoracolumbar area was early in the beginning, the temperature was above 39 ℃, and there was no redness and swelling, but the pain on deep pressure and percussion. The spinal movement was limited, but without any symptoms from compression of the spinal cord or cauda equina, and the sphincter function remained normal. The white cell count, ESR, X-ray and MR imaging were analyzed. Among 12 patients, the ESR above 60 mm/1 h in 10,28 mm/1 h and 50 mm/1 h in each 1 respectively. The white cell count of 2 patients increased (1.0?109/L). Transpedicular core biopsy was taken in 4 cases with doubtful diagnosis,the positive rates were 75%. The antibiotics was administrated intravenously for at least 6 weeks in hospital, then succeeded orally for about another 6 weeks. The ESR of 11 of patients decreased more than 50% after 1 month treatment. The conservative treatment was effective in 91.7% cases. Results 9 of 12 patients were available at final follow-up, the mean duration was 2 years and 2 months (ranged from 6 months to 4 years). Among these 9 patients, 7 patients were free of symptoms, 1 patient had slight back pain, 1 patient had chronic severe back pain who was operated because of the relapse after the conservative treatment. Among 7 patients who underwent MR imaging,2 still had destruction in their vertebra and disc. The extent of T1-weighted low signal decreased, while T2-weighted high signal was obvious, but they had no back pain. Conclusion ESR is a more sensitive index than the white cell count for the diagnosis of pyogenic spinal osteomyelitis. MR and pathologic examination are of important significance for the diagnosis of the disease. After the sequential intravenous and oral antibiotic treatment for 1 month, the decrease of ESR is hallmark of the success of conservative treatment, while the failed cases should be treated with surgery.