A clinical and mechanistic study of topical bingpian-induced analgesia / 中国药理学与毒理学杂志

OBJECTIVE Bingpian is an almost pure chemical with a chemical composition of (+)-borneol and has been historically used as a topical analgesic in traditional Chinese medicine for millen-nia. However, the clinical efficacy of topical bingpian lacks stringent evidence-based clinical studies and the underlying molecular mechanisms are unclear.This study verified the analgesic efficacy of topi-cal bingpian in humans, and elucidated the underling mechanisms in animal models of pain. METH-ODS The analgesic efficacy of topical bingpian was examined in a randomized,double-blind,placebo-controlled clinical study at the Shanghai Changzheng Hospital. Capsaicin, formalin, CFA or thermal caused pain/hyperalgesia were established in different mouse models,and bingpian-induced analgesia and the underlying mechanisms were studied in these models.The molecular targets of bingpian were examined by calcium imaging, patch-clamp recording and enzymatic activity assay in mouse sensory neurons or transfected HEK 293 cells. RESULTS (1)Topical application of bingpian leads to significantly greater pain relief than placebo does in a randomized, double-blind, placebo-controlled clinical study involving 122 patients with postoperative pain.(2)TRPM8 channel is the most sensitive molecular target of bingpian and mediates topical bingpian-induced analgesia in mice. (3)A downstream glutamatergic mechanism in the spinal cord contributes to topical bingpian-induced analgesia. (4)Bingpian shows mechanistic differences and advantages as a topical analgesic when compared with menthol.

Surgical intervention and radiotherapy outcome of solitary plasmacytoma of cervical spine / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical features, treatment methods and outcome of solitary plasmacytoma of cervical spine.</p><p><b>METHODS</b>From January 1995 to December 2007, the data of 23 cases with solitary plasmacytoma of cervical spine was analyzed. There were 16 males and 7 females (mean age 56 years, range: 32 - 76 years). Two cases underwent radiotherapy alone and 21 patients received surgery. According to WBB staging system, surgical procedures were defined as total or subtotal resection (6 cases), appendix resection (4 cases), sagittal resection (3 cases) and total spondylectomy (8 cases). All surgical cases were managed using an anterior approach, posterior approach or combined anterior and posterior approach. The cervical spinal reconstruction was achieved through anterior cervical titanium plate and titanium mesh cage filled with auto iliac graft or bone cement, or anterior and posterior combined instrumented fusion. All patients received radiotherapy as adjunctive therapy.</p><p><b>RESULTS</b>Follow-up of the 23 cases lasted 24.0 - 143.0 months (mean: 64.7 months). Neck pains obviously improved, and nerve compression symptoms disappeared or improved after surgery. Neurological function improved by 1 - 2 grades based on Frankel grading system. All the internal fixations were fused well and stability of the cervical spine was fine and no spine instability could be seen in our series. The bone graft fusion rate was 100%. During the follow-up period, 6 surgical cases had local recurrence and finally progressed to multiple myeloma (MM) and 3 died. Two cases without surgical treatment progressed to MM in 1 year and 1.5 years after confirmed diagnosis. They were given systemic chemotherapy. The other 15 patients had disease-free survival and after surgery and adjunctive radiotherapy. Obvious abnormity were not found in such examinations as M protein, bone marrow aspiration and emission computed tomography or PET-CT examinations.</p><p><b>CONCLUSIONS</b>Solitary plasmacytoma of cervical spine is rarely seen clinically. Surgery is recommended as the primary management for patients with overt bone destruction and spinal instability or neurological dysfunction. Tumor excision with adjunctive radiotherapy can obviously reduce local recurrences and lower the possibility of progression to MM. The patients with progression to MM should receive chemotherapy according to chemotherapy protocol while the prognosis is comparatively worse.</p>

Combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation for the treatment of unstable Hangman's fractures: 16 cases review / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the outcome of combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation for the management of unstable Hangman's fractures.</p><p><b>METHODS</b>Sixteen cases of unstable Hangman's fractures were retrospectively reviewed through X-ray, MRI and three dimensional CT scans. Pre- and postoperative radiographs were measured for translation and angulation of C2,3. Skull traction under extension poison was conducted in all the patients right after their admission. Then anterior C2,3 discectomy followed by interbody fusion, either with iliac autograft or with box cage, and locking plate fixation were performed in each case. Because dissatisfied reduction, mainly residual large fracture gap or kyphosis, was found by the C-arm fluoroscopy during operations, posterior compressive C2 pedicle screw fixation was performed in one stage. According to the Levine-Edwards classification, there were 12 cases of type II, 2 of type I a and 2 of type III in this group.</p><p><b>RESULTS</b>Follow-up ranged 6-38 months, averaged 26 months. Fracture union and bone graft fusion were completed in an average of 4 months after operation. Complaints of neck pain and numbness of limbs disappeared in all patients after surgery, but range of neck motion decreased compared with normal people. Translation of C2 decreased from (4.2 +/- 1.4) mm preoperatively to (2.3 +/- 1.1) mm postoperatively, while angulation of C2,3 decreased from 8.6 degrees +/- 2.1 degrees preoperatively to 2.6 degrees +/- 1.0 degrees postoperatively. Both have statistical significance (P < 0.05). No implant failure or infection was observed.</p><p><b>CONCLUSIONS</b>The classification of Hangman's fracture should be modified in combination with MRI and CT scans to determine the stability of the fracture. Combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation is the treatment of choice for patients with unstable Hangman's fractures.</p>

Surgical treatment and prognosis of aneurysmal bone cyst in mobile spine / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of surgical treatment and prognosis of aneurysmal bone cyst (ABC) in mobile spine.</p><p><b>METHODS</b>A total of 12 patients with ABC were operated on from 1996 to 2006, and the clinical data were retrospectively reviewed. The patients included 7 male and 5 female, aged from 16 to 52 years (mean, 29 years). Surgical interventions were selected according to WBB criteria. Seven patients underwent total spondylectomy, four underwent resection of posterior arch, one patient received sagittal resection only. Anti-poster or post-lateral approach reconstruction with bone-graft or bone cement and transpedicular screws fixation were performed in the cases. Eight cases received radiotherapy after the operation.</p><p><b>RESULTS</b>The mean operation blood lose was 3210 ml. The patients were followed-up for 10 to 116 months (mean, 41.8 months). Seven patients got complete recover of spinal cord function, 4 patients experienced local recurrence in 1-2 years post operation. One patient died of multiple metastasis of chondrosarcoma after radiotherapy.</p><p><b>CONCLUSIONS</b>ABC in spine is an aggressive disease with high local recurrence rate. Enbloc if possible provides the best result, with excellent prognosis. Radiotherapy should be selected carefully.</p>

The study of total spondylectomy in the treatment of cervical spinal tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To study the surgical indications, approaches and the clinical results of the total spondylectomy and instrumentation reconstruction in the treatment of cervical spinal tumor.</p><p><b>METHODS</b>From October 1998 to October 2003, 39 patients with lower cervical bone tumors, including 34 cases with primary tumor and 5 cases with metastatic tumor, were admitted and operated on with total spondylectomy. The patients underwent anteroposterior total spondylectomy including anterior cervical plating, titanium mesh reconstruction and posterior instrumentation based on the location of tumor lesions in the lower cervical spine. One vertebral level total spondylectomy was performed in 29 cases, two level in 7 cases and three level in 3 cases.</p><p><b>RESULTS</b>The postoperative follow-up ranged from 6 months to 4 years. A majority of patients achieved good results postoperatively. Nineteen cases had complete relief of neurological status. One patient died of multiple metastases and systemic failure 24 months later. One case with malignant neurilemmoma developed local recurrence one year postoperatively.</p><p><b>CONCLUSION</b>Anteroposterior total spondylectomy and reconstruction can reduce local recurrence, improve neurological function and increase operation therapeutic effect. Meanwhile, the technique of cervical total spondylectomy carries relatively greater risks and should be more attention to the operation indication.</p>

Surgical treatment and its related factors of cervical spondylotic myelopathy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To observe the results and its related factors of surgical treatment of cervical spondylotic myelopathy (CSM).</p><p><b>METHODS</b>Totally 365 CSM patients were reviewed. All patients were treated with anterior cervical decompression and fusion with autogenous iliac bone or titanium mesh cages with local bone graft. Anterior locking plates were used for fixation. Five patients received revision surgery 3 to 6 months after the initial operation.</p><p><b>RESULTS</b>Clinical function was excellent in 175 patients (47.94%), good in 129 patients (35.34%), fair in 44 patients (12.05%), and poor in 17 patients (4.66%).</p><p><b>CONCLUSION</b>Anterior cervical decompresion of CSM has good clinical efficacy. The timing of operation, disease severity, and surgical technique are the important factors affecting the outcome of treatment.</p>

Diagnosis and surgical management of Hangman's fracture combined with intervertebral disc injury / 中华外科杂志

<p><b>OBJECTIVE</b>To study the pathology characteristics and management of Hangman's fracture combined with intervertebral disc injury.</p><p><b>METHODS</b>Twenty-one patients suffered from this special injury were converged in this study. All patients underwent anterior C(2 - 3) discectomy and fusion, 18 cases were fixed by anterior cervical plate. The type of fractures, radiology characteristics, and clinical outcomes were investigated.</p><p><b>RESULTS</b>No graft displacement or absorption, infection and neurologic deterioration occurred. All fresh dislocation of axis and C(2 - 3) angulation were corrected. Fusion of C(2 - 3) intervertebral space and pedicle fracture were acquired in all of the patients. After a mean follow-up of 31 months, ranging from 8 to 48 months, nearly all of the complains disappeared after operation.</p><p><b>CONCLUSIONS</b>Hangman's fracture is not restricted at pedicle of the axis. Fracture combined with intervertebral disc injury is a special type of Hangman's fracture. Anterior discectomy and fusion of C(2 - 3) intervertebral disc is an effective operation method in accord with the pathophysiology of this special injury.</p>

Investigation of resection and reconstruction procedure of high-sacrum tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the way of resection of high-sacrum tumors and the way and duration of the spinal-pelvic TSRH or ISOLA internal fixation.</p><p><b>METHOD</b>From October 1998 through April 2002, 35 patients with sacral tumor were enrolled in our hospital, including 4 cases in L(5)-S(1), 2 in L(5)-S(2), 4 in S(1), 8 in S(1 - 2), 6 in S(1 - 3), 6 in S(1 - 4), 5 in S(1 - 5). 35 patients were followed by lumbo-pelvic TSRH or ISOLA internal fixation and corresponding chemotherapy and radiotherapy.</p><p><b>RESULTS</b>In the follow-up period of 6 - 42 months, the short-term results were satisfactory with the lumbosacral pain reduced and the neurological function improved in different degrees, however dysuria occurred in 1 case and skin necrobiosis at coccygeal incision occurred in 1 case; two cases experienced cerebrospinal fluid leakage and 1 case experienced postoperative infection and delayed healing, 1 case with chordoma and 2 cases with malignant fibrous histiocytoma recurred 1 year after postoperation, one of these 2 cases with malignant fibrous histiocytoma suffered from lung metastasis and died of system failure 19 months after postoperation. No fractured rod occurred.</p><p><b>CONCLUSION</b>Surgical procedure and postoperative comprehensive treatment have important effects on the prognosis. High-sacral tumor resection and reconstruction are effective means of achieving stabilization, providing significant pain relief and preserving ambulatory capacity.</p>