The development of artificial cervical disc replacement from the perspective of orthopedic bionic therapy / 中华外科杂志

The modern surgical treatment of cervical degenerative disc disease can be traced back to the advent of anterior cervical decompression and fusion.With the emergence of fusion-related complications,different scholars have promoted the gradual transformation of cervical degenerative disc diseases from "fusion fixation" to "non-fusion reconstruction" through in-depth fusion with materials science,engineering mechanics and other disciplines.The innovation of this treatment concept is consistent with the original intention of "structural remodeling,functional reconstruction,maximum repair and reconstruction of the morphology and function of skeletal muscle system" in orthopedic bionic treatment,which is essentially in line with the "bionic alternative therapy" in orthopedic bionic therapy.This paper focuses on the surgical treatment of cervical degenerative disc diseases,reviews the development history of artificial cervical disc replacement,analyzes the evolution from orthopedic biomimetic therapy,and explores a new direction for the design of artificial cervical disc prostheses and the treatment of cervical degenerative disc diseases in the future.

A single nucleotide polymorphism in the human bone morphogenetic protein-2 gene (109T > G) affects the Smad signaling pathway and the predisposition to ossification of the posterior longitudinal ligament of the spine / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although various systemic and local factors such as abnormal carbohydrate or calcium metabolism, aging, and hormonal disturbances have been suggested as causes of ossification of the posterior longitudinal ligament (OPLL), the etiology of OPLL is not fully understood. The purpose of this study was to investigate whether bone morphogenetic protein (BMP)-2 is a candidate gene to modify the susceptibility of OPLL and the mechanism of signal transduction in ossification.</p><p><b>METHODS</b>A total of 420 OPLL patients and 506 age- and sex-matched controls were studied. The complete coding sequence of the human BMP-2 gene was analyzed using polymerase chain reaction (PCR) and direct sequencing. All single nucleotide polymorphisms (SNPs) were detected and genotyped. BMP-2 expression vectors containing positive polymorphisms were constructed and transfected into the C3H10T1/2 cells. The expression of BMP-2 and the Smad signal pathway in positive cell clones were detected by Western blotting. The alkaline phosphatase (ALP) activity was determined using quantitative detection kits.</p><p><b>RESULTS</b>The frequencies for the 109T > G and 570A > T polymorphisms were different between the case and control groups. The "TG" genotype in 109T > G polymorphism is associated with the occurrence of OPLL, the frequency of the "G" allele is significantly higher in patients with OPLL than in control subjects (P < 0.001). The "AT" genotype in 570A > T polymorphism is associated with the occurrence of OPLL, the frequency of the "T" allele is significantly higher in patients with OPLL than in control subjects (P = 0.005). Western blotting analysis revealed that the expression of P-Smad1/5/8 protein transfected by wild-type or mutant expression vectors were significantly higher than control groups (P < 0.05), but there was no statistical difference in each experimental group (P > 0.05). The expression of Smad4 protein transfected by wild-type or mutant expression vectors was significantly higher than control groups (P < 0.05). The expression of Smad4 protein transfected by pcDNA3.1-BMP2 (109G) and pcDNA3.1-BMP2 (109G, 570T) was significantly higher than the other experimental groups (P < 0.05). The increase in ALP activity has been detected in pcDNA3.1-BMP2 (109G) and pcDNA3.1-BMP2 (109G, 570T) transfected cells up to 4 weeks after stable transfection. Activity of ALP was (30.56 ± 0.46) nmol×min(-1)×mg(-1) protein and (29.62 ± 0.68) nmol×min(-1)×mg(-1) protein, respectively. This was statistically different compared with the other experimental groups (P < 0.05).</p><p><b>CONCLUSIONS</b>BMP-2 is the predisposing gene of OPLL. The "TG" genotype in the 109T > G and the "AT" genotype in the 570A > T polymorphisms are associated with the occurrence of OPLL. The 109T > G polymorphism in exon-2 of the BMP-2 gene is positively associated with the level of Smad4 protein expression and the activity of ALP. The Smad mediated signaling pathway plays an important role during the pathological process of OPLL induced by SNPs of BMP-2 gene.</p>

Compatibility of olfactory ensheathing cells with functionalized self-assembling peptide scaffold in vitro / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Olfactory ensheathing cell (OEC) transplantation is a promising or potential therapy for spinal cord injury (SCI). However, the effects of injecting OECs directly into SCI site have been limited and unsatisfied due to the complexity of SCI. To improve the outcome, proper biomaterials are thought to be helpful since these materials would allow the cells to grow three-dimensionally and guide cell migration.</p><p><b>METHODS</b>In this study, we made a new peptide hydrogel scaffold named GRGDSPmx by mixing the pure RADA16 and designer peptide RADA16-GRGDSP solution, and we examined the molecular integration of the mixed nanofiber scaffolds using atomic force microscopy. In addition, we have studied the behavior of OECs in GRGDSPmx condition as well as on RADA16 scaffold by analyzing their phenotypes including cell proliferation, apoptosis, survival, and morphology.</p><p><b>RESULTS</b>The experimental results showed that GRGDSPmx could be self-assembled to form a hydrogel. Inverted optical microscopic and scanning electron microscopic analyses showed that OECs are viable and they proliferate within the nanostructured environment of the scaffold. Thiazolyl blue (MTT) assay demonstrated that OEC proliferation rate was increased on GRGDSPmx scaffold compared with the pure RADA16 scaffold. In addition, OECs on GRGDSPmx scaffolds also showed less apoptosis and maintained the original spindle-shaped morphology. Calcein-AM/PI fluorescence staining revealed that OECs cultured on GRGDSPmx grew well and the viable cell count was 95%.</p><p><b>CONCLUSION</b>These results suggested that this new hydrogel scaffold provided an ideal substrate for OEC three-dimensional culture and suggested its further application for SCI repair.</p>

Primary spinal melanoma: a case report and literature review / 中华医学杂志(英文版)

This case report describes a 44-year-old woman with primary spinal cord malignant melanoma localized in the lumbar region. This is a very rare lesion. The patient presented with back pain and slight weakness in her lower extremities. Magnetic resonance imaging showed hyperintense signals on T1-weighted images and hypointense signals on T2-weighted images. The entire tumor was removed surgically. The patient's postoperative clinical examination revealed mild neurological improvements. Histopathological investigations confirmed the tumor was a malignant melanoma. When treating common lesions of the lumbar spinal cord with a benign appearance, surgeons should be aware of the potential for malignant tumors.

Characteristic and surgical treatment of cervicothoracic spine fracture / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the clinical characteristic and surgical treatment of cervicothoracic spine fracture complicated with spine cord injury.</p><p><b>METHODS</b>Thirty-eight patients with cervicothoracic fracture and spine cord injury were retrospectively analyzed from January 1998 to January 2007. There were 29 males and 9 females with an average age of 36.4 years ranging from 18 to 58 years. All patient suffered from pain and limitation of motion on cervicothoracic junction. According to American Spinal Injury Association (ASIA) grades, 4 cases were in grade A, 13 cases in grade B, 10 cases in grade C, 7 cases in grade D and 4 cases in grade E. All patients were treated with anterior decompressed, bone graft and Zephir plate fixation in cervicothoracic spine.</p><p><b>RESULTS</b>All patients were followed up for 1 to 10 years, the mean followed up time was 4.5 years. And all patients got complete bone fusion within 4 to 6 months postoperatively. There were no pull-out and breakage of screws or plates. Spinal cord functional recovery improved on average 3.8 degree according AISA standard. Two patients appeared transient hoarse voice after surgery, the symptoms were alleviated from 3 to 6 months after operation. Seven patients were complicated with Horner syndrome preoperatively, and the symptoms were disappeared after operation.</p><p><b>CONCLUSION</b>The clinical situation of cervicothoracic spine fracture with spine cord injury is complicated. And anterior decompressed, bone graft and internal fixation performed on cervicothoracic spine fracture can achieve an efficient and safe clinical outcome.</p>

The application of lumbar discography in the diagnosis and treatment of the discogenic low back pain / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the diagnostic value of lumbar discography in discogenic low back pain and the effects of intervertebral fusion surgery.</p><p><b>METHODS</b>Forty-five cases with 101 discs underwent discography, 360 degree fusion manipulation were performed on 18 discography abnormal cases, 27 cases were treated conservatively. Discography, MRI and provocative pain were observed and all the cases were followed up.</p><p><b>RESULTS</b>Twenty-one cases showed positive provocative pain (21/45, 47%), and 21 discs of 101 were concordant discography (21/101, 21%). All cases were followed up for an average 16 months (15 to 23 months), the satisfactory rate was 83% (15/18) in the surgery group and 41% (11/27) in the conservative group.</p><p><b>CONCLUSIONS</b>It is concluded that the discography is moderately sensitive in the diagnosis of discogenic low back pain. Furthermore, the short term follow-up reveals that operative group has better pain relief than conservative group.</p>