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Objective:To study the repair effects of bone marrow mesenchymal stem cells (BMSCs) injection via the caudal vein on the nerve cells in the spinal cord tissue of rats with acute spinal cord injury.Methods:Sixty Sprague-Dawley male rats were divided into sham operation group, model group and BMSCs group using the random number table method, with 20 rats in each group. The Allen's method was used in the model group and BMSCs group to construct the rat models of a spinal cord injury model. Rats in the sham operation group did not undergo spinal cord injury and only received surgical exposure. 24 hours after the establishment of the model, rats in the BMSCs group were received 0.2 ml BMSCs single cell suspension (2 ×10 6 cells) via tail vein injection. Rats in the sham operation group and model group were received the same volume of 0.2 ml Sodium chloride solution via tail vein injection. The motor function of the rats on the 1st, 4th, 7th, 15th and 30th day after modeling was recorded by Basso-Beattie-Bresnahan (BBB) scoring method. The contents of inflammatory factors tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-β) and Prostaglandin E 2 (PGE 2) in spinal cord tissue of rats were detected by enzyme-linked immunosorbent assay (ELASA) on the 30th day after modeling. Hematoxylin-eosin staining was used to observe the pathological changes of rat spinal cord tissue. Nissl staining was used to analyze the changes of Nissl bodies and neuron cells in rat spinal cord tissue. Result:Compared with the model group, the BBB scores of the BMSC group were significantly increased on the 7 (5.68±0.82 vs 1.82±0.84), 15 ( 10.25±1.55 vs 3.38±0.88) and 30 (13.25±2.36 vs 5.83±1.36) days after modeling, and the differences were statistically significant (all P<0.01). Compared with the model group, the levels of TNF-α, IL-1β and PGE 2 in the spinal cord tissue of the BMSCs group were significantly lower than those in the model group on the 30 days after modeling (all P<0.01). Besides, the spinal cord tissue injury was significantly reduced, and the number of neurons and Nissl bodies in the BMSCs group were also significantly higher than those in the model group (all P<0.01). Conclusions:BMSCs injection via the caudal vein can significantly ameliorate acute spinal cord injury in rats. BMSCs may accelerate the repair of nerve cells in acute spinal cord injury tissue and further promote the recovery of motor function in rats with acute spinal cord injury through the regulation of TNF-α, IL-1β, PGE 2 inflammatory factors.
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Objective To explore the clinical efficacy in bilateral lumbar foraminal stenosis (LFS) after treatment with bilateral facetectomy combined with pedicle screw fixation and interbody fusion.Methods A total of 41 cases of patients with bilateral LFS underwent bilateral facetectomy combined with pedicle screw fixation and interbody fusion from February 2010 to August 2013 in Department of Spine Surgery,the People's Hospital of Tianjin City,were retrospectively analysed.The clinical efficacy was assessed by Oswestry disability index (ODD questionnaire and visual analogue scale (VAS) before and after operation,anterior and posterior disc height and L1-S1 angle were measured as well.Then the ODI and VAS scores,and changes in anterior and posterior disc height and L1-S1 angle were calculated at the time of the last patient follow-up visit.Results All 41 patients were followed up for 12 to 36 months,with an average of (26.2±2.4) months.Compared with preoperation,at the time of the last follow-up visit the back pain VAS score,leg pain VAS score and ODI were decreased,while the anterior and posterior disc height were increased,there were statistically significant differences (P＜0.05).No statistically significant difference was found in L1-S1 angle between preoperation and postoperation (P＞0.05).Conclusion The short-term clinical curative effect of posterior bilateral facetectomy combined with pedicle screw fixation and interbody fusion in the treatment of bilateral LFS is satisfactory.
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<p><b>OBJECTIVE</b>To retrospectively evaluate the clinical evaluation of preoperative lumbar T2 sagittal MRI image in predicting the recurrent lumbar disc herniation (RLDH).</p><p><b>METHODS</b>Between January 2009 and April 2011, 28 patients were diagnosed as recurrent L4-5 disc herniation within 2.5 years after surgery, and 25 of them were included in the study as relapse group. At the same time, selected 25 patients implemented the same surgical methods in the same level as a control group randomly, they were all with good to excellent result and the follow-up time was at least 2.5 years. There was no statistical significance between the two groups in gender, age and body mass index(BMI) (P > 0.05). The lumbar MRI image of two groups of patients before surgery were collected and analyzed, with the disc degeneration grade classified. The χ(2) test was used to analyzed the difference of degeneration between the two groups of patients before surgery. Rank correlation analysis evaluated the correlation between disc degeneration and the period of time from the first operation to the recurrence.</p><p><b>RESULTS</b>In terms of preoperative lumbar disc degeneration, there were 22 cases of low-grade disc degeneration and 3 cases of advanced disc degeneration in the relapse group and 5 cases and 20 cases respectively in the control group. there was significant difference between two groups (χ(2) = 23.27, P < 0.05), low-grade disc degeneration (gradesIand III) was significantly more frequent in the relapse group than in the control group. The patients with low-grade disc degeneration had a higher risk of recurrence, that was the risk of recurrent disc herniation increased by a factor of 4.4 from advanced disc degeneration to low-grade disc degeneration(OR = 4.4, 95%CI:1.983-9.765, P < 0.05). In cases of recurrence, the time interval between primary surgery and the recurrence of the patient with advanced disc degeneration was longer compared with low-grade disc degeneration (r = 0.733, P < 0.05).</p><p><b>CONCLUSIONS</b>Preoperative lumbar MRI image may suggest the possibility of the recurrence lumbar disc herniation.Light disc degeneration is an important risk factor for recurrent disc herniation, and the time interval between primary surgery and the recurrence is positively correlated with severity of disc degeneration.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Diskectomy , Intervertebral Disc Displacement , Diagnosis , General Surgery , Lumbar Vertebrae , General Surgery , Magnetic Resonance Imaging , Recurrence , Retrospective StudiesABSTRACT
Objective To assess the clinical and radiologic outcomes between laminoplasty with forominotomy(LF) and anterior cervical discectomy and fusion(ACDF) in treating cervical radiculomyelopathy(CRM). Methods Datas of 68 patients (ACDF=33, LF=35) from January 2008 to January 2010 was collected retrospectively, the follow-up is at least 2 years. The Japa-nese Orthopedic Association (JOA) score and associated recovery rate were evaluated. For radiographic evaluation, the lordotic an-gle and range of motion (ROM) at C2-C7 were investigated. The Neck Disabilitv Index Scale(NDI) was used to evaluate the degree of patient’pain at the last follow-up. Results Patients’demographics were similar between the two groups. The differences be-tween ACDF and LF in operative time (187min VS 154min),the blood loss (127 ml VS 235 ml) and the sensation of lower extremity (64.0%VS 66.0%) are significant(t=4.170, P=0.000;Z=-6.888, P=0.000;Z=-7.512, P=0.000). 1 case with failed fusion of bone graft 3 months post-operation. 3 cases of adjacent segment degenerative changes occurred at the 2nd year follow-up in ACDF group. But no such complications occurred in the EOLF group. In addition, ACDF group showed lower NDI score than LF group in extracting and amusing (Z=-3.947, P=0.000;t=-7. 523, P=0.000). Cervical lordosis of ACDF increased from 13.7° to 16.2°, while that of LF group decreased from 14.6° to 13.3°(Z=-3.374,P=0.001);Both of the two groups (ACDF/LF) exhibited decreased cervi-cal ROM (14.8° VS 16.5°, t=-2.167, P=0.034). Conclusion The two surgical procedures have similar clinical effects in treating multi-segmental CRM. However, the LF group demonstrated shorter operative time, fewer short-term complications, so it proved to be effective and safe surgical procedure.
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10.3969/j.issn.2095-4344.2013.24.004
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Objective To discuss spinal fusion effect of lumbar intertransverse process in rabbits by using bone marrow stromal stem cells(MSCs)in conjunction with bone morphogenetic protein(BMP)and freeze-dried demineralized bone matrix(FDBM)as scaffold.Methods To separate and cultivate MSCs in vitro,with FDBM as scaffold,osteogenesis was induced by BMP.Sixty Japan white rabbits were randomly divided into three groups.Group A was MSCs+FDBM+BMP,group B was FDBM,group C was autogenous ilium cancellous bone(AIB).Lumbar intertransverse process was fused in lumbar five to six.Rabbits were killed at 8 weeks after operation.The general observation and imageology were used to assess the fusion condition.To estimate the implantation using DR image.Gray scale analysis of DR image caculated the osteogenic density and acreage.The CT scan and three-dimensional reconstruction was used to observe the fusion configuration of lumbar intertransverse process.Results The fusion mass character in group A and C was hard,the morphology was not regulation.The fusion mass was almost absorbed in group B beside little tissue approach transverse process.There were high density image between intertransverse processes,osteogenic density were nonuniform in group A and C.There were nonunion in group B.Consistent callus were existed between intertransverse process in group A and C.There were not consistent callus in group B.Group A was similar to group C in osteogenesis density and acreage.Group B was the worst.There were cartilage and newly born bone trabecular formation in group A and group C.Between transverse process were mainly fiber tissue in group B.Conclusion MSCs in conjunction with BMP and FDBM has the similar osteogenic capability to the AIB and better osteogenic capability than that of FDBM alone when spinal fusion of lumbar intertransverse process is performed in rabbits.