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OBJECTIVE@#To evaluate the clinical outcomes of one-stage transpedicular debridement, posterior internal fixation, RBK mixed streptomycin filled bone grafting for the treatment of elderly patients with thoracolumbar tuberculosis.@*METHODS@#The clinical data of 20 elderly patients with thoracolumbar tuberculosis underwent one stage transpedicular debridement, posterior internal fixation, OSTEOSET RBK mixed streptomycin-filled bone grafting from September 2006 to July 2017 were retrospectively analyzed. There were 12 males and 8 females, aged from 62 to 83 years with an average of (72.4±6.9) years old. Visual analogue scale (VAS), Oswestry Disability Index (ODI)were used to evaluate the pain and spinal function. The kyphosis angle (Cobb angle) of the lesion segment and the bone growth of the lesion area were observed by the X-ray films.@*RESULTS@#All the operations were successful, the operation time was (160.9±23.8) min, and the intraoperative blood loss was (317.9± 112.7) ml. The incisions were healed by first intention, and no sinus and incision were delayed. Spinal tuberculosis was completely cured, Frankel grade has one or more improvements. The VAS score decreased from (7.50±1.15) points before surgery to (1.70±1.39) points at 12 months after surgery (<0.05). The ODI score decreased from preoperative (92.50±1.17)% to (12.80±0.89)% at the final follow up (<0.05). The sagittal Cobb angle of the lesion segment decreased from preoperative (24.2±1.6)° to (8.3±0.7)°at 12 months after surgery(<0.05), the kyphosis deformity was significantly corrected. In all cases, bone fusion was achieved in bone graft area, without bone nonunion and device fracture complications.@*CONCLUSION@#One-stage transpedicular debridement, posterior internal fixation, RBK mixed streptomycin filled bone grafting is suitable for thoracolumbar tuberculosis patients with good general condition and less vertebral destruction.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Transplantation , Debridement , Fracture Fixation, Internal , Lumbar Vertebrae , Retrospective Studies , Spinal Fusion , Thoracic Vertebrae , Treatment Outcome , Tuberculosis, SpinalABSTRACT
OBJECTIVE@#To investigate the relationship between spine-pelvic sagittal parameters and clinical efficacy before and after oblique lumbar interbody fusion(OLIF).@*METHODS@#A retrospective analysis of clinical data of 65 patients with lumbar degenerative diseases treated with OLIF were performed from July 2017 to July 2018. There were 26 males and 39 females aged from 33 to 79 years old with an average of (62.72±10.23) years old. Oswestry Disability Index (ODI) and visual analogue scale (VAS) before and at the latest follow up were evaluated. Disc height (DH) and spine- pelvic sagittal parameters of the surgical segment were measured before and at the latest follow- up, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL). According to the difference of PI-LL, it was judged whether PI and LL match and the patients were grouped, PI-LL ranged from -9° to 9° was set as matching group, and PI-LL less than -9° or larger than 9° was set as mismatching group. The spine-pelvic sagittal parameters were analyzed before and at the latest follow-up of OLIF in patients with lumbar degenerative diseases, and the correlation between changes and clinical efficacy was compared.@*RESULTS@#All patients were followed up from 8 to 20 months with an average of (14.20±3.68) months. Operation time was (91.54±25.97) min, intraoperative blood loss was (48.15±10.14) ml, and the hospitalization time ranged from 6 to 19 days with an average of (9.28± 2.50) days. Totally 84 surgical levels, 46 patients were single segment and 19 patients were double segments. VAS and ODI score were improved from (4.88±0.99) point, (67.60±13.73) % preoperatively to (2.85±1.30) points, (30.57±6.48) % at the latest follow-up. There were significant differences in VAS and ODI scores between before and at the latest follow-up. The sagittal parameters of LL, PT, SS, PI, PI -LL and the surgical level DH were (42.80 ±16.35)° , (23.22 ±10.91)° , (26.95 ± 13.30)°, (50.22±14.51)°, (7.53±16.13) °, (0.91±0.29) cm preoperatively and improved to the latest follow-up (49.95± 12.82) °, (17.94±9.24) °, (33.71±12.66) °, (51.65±10.26) °, (1.68±17.00) °, (1.20±0.40) cm;there were statistical differences in LL, PT, SS, PI-LL, DH before operation and at the latest follow up, while no difference in PI. LL of preoperative PI-LL in matched group was (48.76±11.09)° , and (38.00±18.37)° in PI-LL mismatch group, there was difference between two groups. There were no differences in VAS, ODI, PT, SS, PI and DH between two groups. At the latest follow-up, ODI between PI-LL matched group and PI-LL mismatched group were (29.40±5.93)% and (32.86±7.02)% respectively, and had difference in ODI between two groups;while there were no significant differences in VAS, LL, PT, SS, PI, and DH. Pearson correlation analysis showed preoperative PT-LL was positively correlated with VAS;PT was positively correlated with ODI at the latest follow-up.@*CONCLUSION@#OLIF has a good surgical effect on lumbar degenerative diseases, and could change spine-pelvic sagittal parameters of patient to a certain extent, and further restoring the balance of the sagittal plane of lumbar spine.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Lumbar Vertebrae , Lumbosacral Region , Pelvis , Retrospective Studies , Spinal Fusion , Treatment OutcomeABSTRACT
BACKGROUND: ClonePix, a cell cloning and screening system, can quickly and efficiently screen cell clones undergoing suspension culture with low melting point agarose, which can be used to provide a sufficient number of seed cells for biological therapies. OBJECTIVE: To isolate and identify chondrogenic stem cells from the rat lumbar endplate.METHODS: The lumbar endplates of 10 Sprague-Dawley rats with an age of 4 weeks were digested using trypsin and type II collagenase to isolate primary chondrogenic stem cells, followed by suspension culture with low melting point agarose. Then, the cell clones were selected by ClonePix and expanded in vitro for morphological observation.The multidirectional differential potential of cell clones was identified through osteogenesis, adipogenesis and chondrogensis tests, and the monoclonal formation ability was determined. RESULTS AND CONCLUSION: The cell clones could be successfully separated by using the agarose culture system, which were spindle-shaped after in vitro expansion.The osteogenesis,adipogenesis and chondrogensis capacities of the cells were identified using alizarin red, oil red O and safranin staining, respectively. Single cells of the clone group were inoculated into 10 cm culture dishes, and after 12 days of in vitro expansion culture,colonies of cells were observed with the naked eye.With the increase of cell seeding density,the number of cell colonies decreased. When the cells were inoculated into 10 cm culture dishes at a density of 100 cells, the colony forming ability was strongest, and more than 20 cell colonies could be formed. These findings indicate that chondrogenic stem cells that are isolated by the agarose gel culture system have multidirectional differentiation potential and high proliferation ability.
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BACKGROUND: Important extracellular matrixes are reduced with the prolongation of duration of cyclic pressure in the endplate of the intervertebral disc. Meanwhile, the expression of Wnt-5a gene is significantly decreased. There is an important relationship between Wnt-5a gene and intervertebral disc degeneration (IDD). OBJECTIVE: To investigate the expression of Wnt-5a gene under cyclic pressure in a rabbit model of IDD and to explore its role in IDD progress. METHODS: Lumbar intervertebral discs were removed from the 6-month-old New Zealand white rabbits to prepare IDD models and were then randomly divided into experimental (cyclic pressure ) and control (no intervention) groups. The morphological changes of intervertebral discs were observed by hematoxylin-eosin staining and safranin O-fast green staining. The mRNA expression levels of proteoglycan, collagen type Ⅱ, and Wnt-5a were detected by real-time PCR. The protein expression level of Wnt-5a was detected by western blot assay. RESULTS AND CONCLUSION: The morphology of intervertebral discs cultured for 7 days in the experimental and control groups showed a certain change, but was still intact; expression levels of aggrecan, type Ⅱ collagen, Wnt-5a showed differences from the intervertebral discs cultured for 0 day. On day 14, the damage to the histomorphology was severer in the experimental group than the 0-day control group. The mRNA expression levels of proteoglycan, collagen type Ⅱ, and Wnt-5a were decreased in both groups, especially the experimental group, at 7 and14 days. The mRNA and protein expression levels of Wnt-5a revealed the same change trend with time. To conclude, regulation of Wnt-5a expression may alter the process of endplate cartilage degeneration, and thus providing new ideas for the prevention and treatment of IDD.
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<p><b>BACKGROUND</b>C-Jun N-terminal kinase (JNK) signaling pathway and ankylosis gene (ANK) play a critical role in endplate chondrocytes degeneration. The purpose of this study was to investigate whether the expression levels of ANK was associated with the activation of JNK.</p><p><b>METHODS</b>Cartilage endplates of 49 patients were divided into the control group (n = 19) and the experimental group (n = 30). The patients in the control group were graded 0 and those in the experimental group were graded I-III according to Miller's classification. Endplate chondrocytes were isolated by enzyme digestion and cultured in vitro. The inverted phase contrast microscope, teluidine blue staining, HE staining, real time RT-PCR, and MTT were used to observe morphological appearances, biological characteristics, and growth curve of endplate chondrocytes from the cartilage endplate of the two groups. Real time RT-PCR and Western blotting were used to analyze the mRNA and protein expression levels of associated factors in the degeneration process in the cultured endplate chondrocytes with or without subjected SP600125.</p><p><b>RESULTS</b>The expression levels of type II collagen, aggrecan, and ANK in endplate chondrocytes of experimental group were lower than that of control group and phosphorylation level of JNK in the experimental group which was higher than that in the control group. Application of JNK phosphorylation inhibitor to degeneration chondrocytes resulted in a marked decrease in the phosphorylation level of JNK and a significant increase in the expression levels of type II collagen, aggrecan, and ANK.</p><p><b>CONCLUSION</b>The degeneration of the human cervical endplate chondrocytes might be promoted by JNK phosphorylation by down-regulating the expression of ANK.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Anthracenes , Pharmacology , Cells, Cultured , Cervical Vertebrae , Metabolism , Pathology , Chondrocytes , Metabolism , Pathology , Down-Regulation , JNK Mitogen-Activated Protein Kinases , Metabolism , Phosphate Transport Proteins , Genetics , Physiology , PhosphorylationABSTRACT
<p><b>BACKGROUND</b>Ectonucleotide pyrophosphatase/phosphodiesterase (ENPP)-1 is a membrane-bound protein that catalyzes the hydrolysis of extracellular nucleoside triphosphates to monophosphate and extracellular inorganic pyrophosphate (ePPi). Mechanical stimulation regulates ENPP-1 expression. This study sought to investigate the changes in ENPP-1 expression after stimulation using cyclic mechanical tension (CMT).</p><p><b>METHODS</b>Rat end-plate chondrocytes were cultured and subjected to CMT (at 3%, 6%, and 9% elongation) for 20, 40, and 60 minutes to observe changes in the expression of ENPP-1. To investigate the pathway, end-plate chondrocytes were exposed to 10 ng/ml of transforming growth factor beta 1 (TGF-β1), TGF-β1 siRNA, or a specific extracellular signalregulated kinase (ERK)1/2 inhibitor, U0126, in addition to CMT. Changes in ENPP-1 expression were measured by reverse transcription PCR (RT-PCR) and Western blotting.</p><p><b>RESULTS</b>We observed the largest increase in ENPP-1 expression following 3% elongation CMT stimulation. ENPP-1 expression was also increased when end-plate chondrocytes were exposed to 10 ng/ml of TGF-β1, but decreased after TGF-β knockdown with siRNA. ERK1/2 phosphorylation was activated after 3% elongation for 40 minutes, and the stimulatory effect of TGF-β1 on ENPP-1 mRNA and protein expression was inhibited by the suppression of the ERK1/2 pathway using U0126.</p><p><b>CONCLUSION</b>CMT increases the expression of ENPP-1 in end-plate chondrocytes in a manner likely dependent on TGF-β induction by the ERK1/2 signaling pathway.</p>
Subject(s)
Animals , Rats , Blotting, Western , Cells, Cultured , Chondrocytes , Metabolism , Phosphoric Diester Hydrolases , Genetics , Metabolism , Pyrophosphatases , Genetics , Metabolism , RNA, Small Interfering , Rats, Sprague-Dawley , Reverse Transcriptase Polymerase Chain Reaction , Signal Transduction , Stress, Mechanical , Transforming Growth Factor beta1 , Genetics , MetabolismABSTRACT
<p><b>BACKGROUND</b>This study aimed to investigate the effect of pcDNA3.1-vascular endothelial growth factor (VEGF)165 vector on vertebral cartilage endplate vascular buds and intervertebral discs.</p><p><b>METHODS</b>Rabbits were randomly assigned to the control and experimental groups with 10 in each. In the experimental group, we anesthetized the rabbits and exposed the front vertebral body. Using the mark of the longitudinal ossature of the front vertebral body of the lumbar vertebrae, we advanced a needle at the central point of the front fourth and fifth lumbar intervertebral discs and injected 20 µl pcDNA3.1-VEGF165. Similarly, in the control group, we injected 20 µl pcDNA3.1. At 4 and 8 weeks post-injection, we examined the changes of the vertebral cartilage endplate using X-ray radiograph, histology, and scanning electron microscopy.</p><p><b>RESULTS</b>The vertebral cartilage endplate calcification and degeneration in the experimental group were less than those in the control group at 8 weeks post-operation. The average number and diameter of vascular buds obviously increased in the experimental group at 4 and 8 weeks post-operation. The number of vascular buds and the diameter in the region of the inner annulus increased when compared to those in the area near the nucleus pulposus.</p><p><b>CONCLUSIONS</b>The pcDNA3.1-VEGF165 plasmid can increase the average number and diameter of vascular buds and decelerate intervertebral disc degeneration.</p>
Subject(s)
Animals , Female , Male , Rabbits , Intervertebral Disc Degeneration , Genetics , Metabolism , Intervertebral Disc Displacement , Genetics , Metabolism , Microscopy, Electron, Scanning , Plasmids , Genetics , Vascular Endothelial Growth Factor A , Genetics , MetabolismABSTRACT
Spinal instrumentation is a common method for the treatment of spinal disorders, but it can lead to the changes of spine biomechanics. Because of the stress changes, accelerated degeneration of the adjacent segment may occur as time goes by, namely adjacent segment disease. The accelerated degeneration can lead to secondary spinal stenosis, articulated joint degeneration, acquired spondylolisthesis, and spine instability, and some patients may have to receive surgery again. In recent years, the researchers gradually recognized the importance of this disease, and began to investigate its pathogenesis and management.
Subject(s)
Humans , Joint Instability , Postoperative Complications , Diagnosis , Spinal Diseases , General Surgery , Spinal Fusion , Spinal Stenosis , SpondylolisthesisABSTRACT
<p><b>OBJECTIVE</b>To compare and evaluate instrumented posterior fusion with instrumented circumferential lumbar fusion in the treatment of lumbar stenosis with low degree lumbar spondylolisthesis.</p><p><b>METHODS</b>From April 1998 to April 2003, 45 patients who suffered from lumbar stenosis with low degree lumbar spondylolisthesis were divided into 2 groups (A and B) at random. The patients in group A (n = 24, average age 54 years old) were performed decompressive laminectomy, intertransverse process arthrodesis with bone grafting and transpedicle instrumentation of solid connection (SOCON) system. The patients in group B (n = 21, average age 53 years old) were performed the same procedure as group A except adding posterior lumbar interbody fusion (PROSPACE). The main levels of lumbar spondylolisthesis in 2 groups was L(4 - 5) or L(5)-S(1). All cases were classified as degree 1 to degree 2. All patients in the two groups received preoperative myelography or CTM, and were diagnosed lateral recess stenosis and(or) central lumbar canal stenosis.</p><p><b>RESULTS</b>All the patients were followed up from 12 to 72 months. In group A, the results showed that the preoperative clinical symptoms disappeared completely in 12 of 24 patients, pain relief was seen in 91.7% (22/24), anatomical reduction rate was 91.7%. No infection or neurologic complication occurred in this series. In group B, the results showed that the preoperative clinical symptoms disappeared completely in 13 of 21 patients, pain relief was seen in 90.5% (19/21), anatomical reduction rate was 95.2%. Four cases of infection or neurologic complication occurred in this series. Two groups had no significant difference in follow-up clinical outcome and anatomical reduction rate. But group A had better intraoperative circumstances and postoperative outcome than group B, group B had better postoperative parameters in X-ray of angle of slipping and disc index than group A.</p><p><b>CONCLUSIONS</b>The best surgical treatment method of lumbar stenosis with low degree lumbar spondylolisthesis is complete intraoperative decompressive laminectomy, reduction with excellent transpedicle system instrumentation and solid fusion after bone grafting. The use of cage should be conformed to strict indications.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Laminectomy , Lumbar Vertebrae , General Surgery , Retrospective Studies , Spinal Fusion , Methods , Spinal Stenosis , General Surgery , Spondylolysis , General Surgery , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To explore the effect of anterior spinal release on severe scoliosis.</p><p><b>METHODS</b>Twenty-six cases of severe scoliosis were retrospectively reviewed from January 1998 to December 2001. There were 7 males and 19 females with an average age of 15 years (ranging from 10 to 21 years). Twenty-four cases were classified according to King classification for adolescent idiopathic scoliosis, including King type I 4 cases, type II 9 cases, type III 5 cases, King IV 4 cases, King V 2 cases; another two cases were thoracolumbar curve. The major curves were averaged respectively 89.8 degrees, 66.5 degrees, 67.7 degrees, 61.2 degrees on standing, traction, bending and fulcrum film before operation. The distance of apex vertebrae deviated from sacral midline was 39.7 mm before operation.</p><p><b>RESULTS</b>Six cases received anterior spinal release with posterior correction by one stage, 20 cases by two stages. The cases with two stage operation increased the spinal flexibility about 17.8 degrees after anterior release. The major curve was 52.6 degrees on average, and the distance of apex vertebrae deviated from sacral midline was 9.9 mm after operation. The major curve was 54.9 degrees on average, loss the correction 6.4% during follow-up. There was no complication related to the operation in this group.</p><p><b>CONCLUSIONS</b>The anterior spinal release alone has little effect on severe scoliosis with flexibility less than 20% preoperation. The curve can be corrected to a great degree by anterior osteotomy for spine.</p>
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Retrospective Studies , Scoliosis , General Surgery , Spondylolysis , General Surgery , Surgical Procedures, Operative , Methods , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To define the criteria of selective thoracic fusion in adolescent idiopathic scoliosis patients.</p><p><b>METHODS</b>By reviewing the roentgenograms of adolescent idiopathic scoliosis patients undergoing selective thoracic fusion, the curve type, Cobb angle, apical rotation and translation, trunk shift, and thoracolumbar kyphosis were measured and analyzed.</p><p><b>RESULTS</b>There were 12 King type II patients (PUMC type: IIb1 9, IIc3 3). The coronal Cobb angle of thoracic curve before and after surgery were 54.0 degrees and 19.0 degrees respectively, and the average correction rate was 62.7%. The coronal Cobb angle of lumbar curve before and after surgery were 34.6 degrees and 12.5 degrees respectively, and the average spontaneous correction rate was 64.7%. At the final follow-up, the coronal Cobb angle of thoracic and lumbar curve was 18.8 degrees and 15.9 degrees respectively. There was no significant change in the coronal Cobb angle, apical vertebral translation and rotation compared with that after surgery. 1 patient had 12 degrees of thoracolumbar kyphosis after surgery, no progression was noted at the final follow-up. There was no trunk decompensation or deterioration of the lumbar curve. In this group, 3.5 levels were saved compared with fusing both the thoracic and lumbar curves.</p><p><b>CONCLUSION</b>Selective thoracic fusion can be safely and effectively performed in patients with a moderate and flexible lumbar curves, which can save more mobile segments to maintain a good coronal and sagittal balance.</p>
Subject(s)
Adolescent , Female , Humans , Male , Follow-Up Studies , Retrospective Studies , Scoliosis , General Surgery , Spinal Fusion , Methods , Thoracic Vertebrae , Pathology , General Surgery , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To explore the value of surgical treatment on spine metastatic tumor.</p><p><b>METHODS</b>31 cases of spine metastatic tumor with severe pain or/and neurological deficit were selected and treated with various operative methods.</p><p><b>RESULTS</b>Except for 4 cases, all the patients survived from 3 months to 7 years (average 17.6 months). The patients had no complication during treatment. The symptoms and neurological functions recovered with various extent after operation.</p><p><b>CONCLUSIONS</b>Surgical treatment should cautiously be adopted. When the spine metastatic tumor with severe pain and neurological deficit has no response to the conservative methods, the surgical treatment with decompression and internal fixation should be performed to improve the life quality for the patients.</p>