Posterior fixation and fusion for treatment of Os odontoideum complicated by atlantoaxial dislocation / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize the techniques and evaluate the therapeutic effect of posterior fixation and fusion in the treatment of Os odontoideum complicated by atlantoaxial dislocation.</p><p><b>METHODS</b>From March, 2007 to October, 2010, 10 patients with Os odontoideum (including 6 male and 4 female patients aged from 20 to 65 years, mean 39.8 years) were treated in our hospital. Before and after the operation, the patients underwent X ray, CT and MRI examinations to measure and evaluate the degree of dislocation and neural compression. After preoperative traction for 1-2 weeks, all the 10 patients showed deductible atlantoaxial dislocation. Through a posterior approach, Atlantoaxial pedicle screws fixation were performed in 9 cases, and C2/3 pedicle-Occiput screw fixation was performed in 1 case. All the patients wore cervical collars as external support for 3 months after the operation.</p><p><b>RESULTS</b>The mean operative time was 3 h in these patients with a mean intraoperative blood loss of 420 ml. The symptoms were relieved after the surgery in all the patients, who showed no neck pain or neurological defects. The patients were followed up for 6 to 52 months (mean 22 months), and bony fusion was observed in all the 10 cases within 6 to 8 months without such complications as internal fixation failure or redislocation of the atlas.</p><p><b>CONCLUSION</b>Patients with Os odontoideum complicated by atlantoaxial dislocation should undergo surgical stabilization to avoid severe neurological injury. Pedicle screw instrument in the atlas allows restoration of the spinal stability, short-segment fusion, and maximal preservation of the mobility of the neck.</p>

Effects of rehabilitation training combined with bone marrow mesenchymai stem cell-derived neural stem cells transplantation on the expression of Nogo-A and NgR proteins after spinal cord injury / 中华物理医学与康复杂志

Objective To study the effects of rehabilitation training combined with the transplantation of bone marrow mesenchymal stem cells-derived neural stem cells (BMSC-D-NSCs) on the expression of Nogo-A and NgR protein in rats after spinal cord injury (SCI).Methods The spinal cords of eighty Sprague-Dawley rats were injured using a modified Allen′s impactor (H = 25 mm) at T10. The injured rats were randomly divided into a combination therapy group which was given rehabilitation training and cell transplants, a cell graft group, a rehabilitation training group and a control group. At the 7th day post SCI, BMSC-D-NSCs were transplanted into the injured spinal cords of the rats in the combination therapy and cell graft groups. Hindlimb movement was assessed using the BassoBeattie-Bresnahan (BBB) scale every week, and protein was extracted from the injured spinal cord tissue for Nogo-A and NgR determination by Western blotting at the 1st, 3rd and 7th day after cell transplantation.Results The average BBB score of the rats in the combination therapy group was significantly higher than that of the other groups from 2 weeks post transplantation. The scores in the rehabilitation training group were significantly higher than in the control group from the 5th week post transplantation. Western blotting showed high expression of Nogo-A and NgR protein 24 h post surgery, but these declined with time. For Nogo-A there was a significant difference among the groups at all three time points. In the combination therapy group the expression declined to a minimum by the 7th day. For NgR protein there was no significant difference between the 1st and 3rd day in any group.Conclusions Rehabilitation training combined with BMSC-D-NSC transplantation can have a synergistic effect on functional recovery from SCI. It can down regulate the expression of Nogo-A and NgR protein.