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Objective To investigate the clinical characteristics of laminar shelling decompression for the treatment of thoracic spinal stenosis.Methods One hundred and twenty-one patients with thoracic spinal stenosis were reviewed.Ages of these 51 male and 70 female patients ranged from 45 to 71 years (mean 54.8 years).There were 72 patients with thoracic ossification of ligamentum flavum(OLF),21 patients with thoracic ossification of posterior longimental ligament(OPLL)and 28 patients with thoracic OLF and OPLL.The lesion segmentum,kyphosis angle of thoracic vertebra and residual area of vertebral canal(RAVC)were measured.All these patients were treated with laminar shelling decompression.Preoperative and postoperative functional statuses were evaluated using a Japanese Orthopaedic Association(JOA)score.Results Thoracic OLF were found between T7 to T12 in 77.0% of the lesions;thoracic OPLL were found between T1 to T6 in 81.1% of the lesions.Of the 121 patients,the mean kyphosis angle was 31.5°±6.8° in upper thoracic spine and,9.4°±3.5° in lower thoracic spine.In patients whose RAVC were more than 80%,the pre- and postoperative mean JOA score was 7.7±1.4 and 9.5±1.6 respectively;RAVC more than 50%,5.2±1.8 and 8.6±2.1 respectively;RAVC less than 5%,4.8±1.4,and 5.6±1.3 respectively.Conclusion Thoracic OLF mostly occurred in lower thoracic spine,while thoracic OPLL mostly occurred in upper thoracic spine.The RAVC is a significant factor to the prognosis of thoracic spinal stenosis.As long as the clinical symptoms correspond with imaging findings,it is better to resect the whole ossification part as much as possible.Thoracic spinal stenosis often recurs after surgery.More attention to decompression ranges and decompression skills shoud be paied during revision surgery.
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BACKGROUND: Previous studies demonstrated that recombinant human bone morphogenetic pretein-7 (hBMP-7) can effectively promote the synthesis of extracellular matrix, repair of damaged disc matrix, restore of degenerative disc height. It is hoped that BMP-7 can be used to control and reverse the intervertebral disc degeneration. However, because of the short half-life of recombinant protein and low biological activity, it is difficult to maintain BMP-7 high concentrations on degenerative disc. Gene therapy can prevent these defects effectively.OBJECTIVE: To study the effect of hBMP-7 gene transfeotion on biological activity of primary cultured rabbit nucleus pulposus cells in vitro, to determine the feasibility of hBMP-7 gene which will on gene therapy research of intervertebral disc degeneration,and to provide basis for further study.DESIGN, TIME AND SETTING: A randomized and controlled observation was performed at the Institute of Cardiothoracic Surgery of Changhai Hospital from December 2005 to September 2006.MATERIALS: Six healthy New Zealand white rabbits of either gender, averaging 4 weeks old and weighing 500 g, were used in this study, and Ad-hBMP7 was constructed by the Cardiothoracic Surgery Institute of Changhai Hospital.METHODS: After rabbits sacrifice under aseptic condition, the nucleus pulposus was got. After digested with Pronase, type Ⅱcollagenase and type Ⅱ DNAase (4 hours, 37 "(2), the cells were seeded in the Petri dishes and were kept in the incubator. After 7 days and then twice a week, the media were refreshed. The nucleus pulposus cells were infected by adenovirus integrated with hBMP7 gene. The cells which were transfected by adenovirus vector for Lac-Z gene and which were not transfected were adopted as control.MAIN OUTCOME MEASURES: The expression of hBMP-7 was determined by RTopCR and Western blot. The effect of hBMP-7 on cell proliferation was surveyed by MTT. Furthermore, the effect of hBMP-7 gene on synthesis of proteoglycan and type Ⅱcollagen was detected by modified dimethylmethylene blue method and ELISA, respectively.RESULTS: Gene sequencing and PCR showed that hBMP-7 gene was inserted correctly and no mutation happened. The pdmary cultured rabbit nucleus pulposus cells were identical with those reported in literature. After Ad-hBMP7 transduct into the nucleus pulposus cells, high level of hBMP-7 expression was observed and lasted over 3 weeks. Also hBMP-7 gene can promote cell proliferation and synthesis of proteoglycan and type II collagen with significant difference compared with control groups (P < 0.05).CONCLUSION: hBMP-7 gene mediated by adenovirus can be the target gene for the further study on gene therapy of intervertebral disc degeneration.
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Objective To retrospectively analyse the anterior and posterior surgical approaches in treatment of unstable burst thoracolumbar fractures and compare radiographic measurement parameters of beth surgical techniques so as to provide references for surgical treatment of such kind of fracture. Methods The study selected 41 patients with unstable thoracolumbar fracture treated with either anterior neurodecomprossion and fixation (n=19) or posterior reposition and internal fixation by pedicle screw (n=22) from January 2003 to December 2005. All patients were followed up for 24-48 months ( mean 38 months) and divided into anterior approach group and posterior approach group. Sagittal alignment was assessed by the Cobb angle depending on lateral radiographs. Results The Cobb angle of the anterior approach group was average 27.3°on admission but 3.1°postoperatively and 4.6° at follow-up; while the Cobb angle of posterior approach was average 26.1° on admission, 3.0°postoperatively and 12.5°at follow-up. There was no statistical difference between Cobb angle on admission and postoperative one (P>0.05) but showed significant differences between them at follow-up ( P<0.01). Conclusion The anterior surgical approach can consistently yield better maintenance of kyphotic correction compared with the posterior surgical approach.
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BACKGROUND: The establishment of animal models is of important significance for understanding the pathogenesis, prevention, and treatment of intervertebral disc degeneration. OBJECTIVE: To develop rabbit models of intervertebral disc degeneration by acupuncture and to analyze the effects of acupuncture on intervertebral disc height and degeneration by X-ray and MRI examinations. DESIGN: A randomized and controlled observation. SETTING: Department of Orthopaedics, Changhai Hospital, Second Military Medical University of Chinese PLA. MATERIALS: This study was performed at the Animal Cener, Changhai Hospital, Second Military Medical University of Chonese PLA between June 2005 and April 2006. Six healthy New Zealand white rabbits of either gender, averaging 6 months old, weighing 2.5 kg on average, were provided by Animal Cener, Changhai Hospital, Second Military Medical University of Chinese PLA [permission No. SCXK (hu) 2002-0006], and recruited for this study. The protocol was performed in accordance with ethical guidelines for the use and care of animals.METHODS: ① Operation was made in experimental rabbits via the anterior retroperitoneal approach. The management for the intervertebral discs was as follows: L3-4 was the control disc without exposure or needle stab; L4-5 was subjected to sham-operation with only exposure; L5-6 was the experimental disc with three times of anterior-lateral needle stab after exposure. Lumbar lateral X-ray film was respectively taken with a CR machine (Simens Company) prior to and 4 weeks after surgery for measuring L3-4, L4-5, and L5-6 intervertebral disc height and calculating the ratio with intervertebral disc height prior to surgery. Each segmental lumbar intervertebral disc T2-weighted signal was measured with a 1.5 T medical superconductive magnetic resonance scanner (Simens Avanto). According to signal intensity, intervertebral disc degeneration was graded: a score of 4 indicated normal intervertebral disc without apparent degeneration but with bright signal, a score of 3 indicated slight degeneration with a little decrease in T2-weighted signal, a score of 2 indicated moderate degeneration with apparent decrease in T2-weighted signal, and a score of 1 indicated severe degeneration with apparent decrease in both T2-weighted signal and intervertebral disc height. MAIN OUTCOME MEASURES: Intervertebral disc height change revealed by lumbar lateral X-ray film; Intervertebral disc degeneration degree analyzed through magnetic resonance imaging (MRI) examination. RESULTS: All 6 experimental rabbits were included in the final analysis. The postsurgery-to-presurgery ratio of intervertebral disc height was 0.982 5±0.017 08 and 0.972 5±0.017 08 for L3-4 and L4-5 respectively, which was higher compared to that for L5-6 (0.550 0±0.02 582). Significant statistical difference existed (P ＜ 0.01). T2-weighted singal score was (4.00±0.0) and (3.75±0.5) for L3-4 and L4-5 intervertebral disc, respectively, which was higher compared to that for L5-6 intervertebral disc. Significant statistical difference existed (P ＜ 0.01). CONCLUSION: After 4 weeks of acupuncture, intervertebral disc height is decreased and interterbral disc degeneration obviously appears.
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AIM:In human being,the exposure of lumbar Intervertebral discs usually requires the anterior transperitoneal or lateral retroperitoneal approaches. To study the feasibility of retropedtoneal approach to the lumbar spine in the New Zealand white rabbits.METHODS: The experiment was carried out between April 2005 and April 2006 in the Animal Center of Changhai Hospital.Second Military Medical University of Chinese PLA.Thirty New Zealand white rabbits,aged 6 months old, of either gender, weighing 2.5 kg,provided by the Animal Center of Changhai Hospital,Second Military Medical University of Chinese PLA [permission No.SCXK (hu) 2002-0006],were used in this study.During the experiment,the management of animals corresponded to Animal Ethical Standard.This study was approved by the Experimental Animal Ethics Committee,Changhai Hospital,Second Military Medical University of Chinese PLA.Transperitoneal approach was used to exposure the lumbar spine of experimental rabbits. The skin was disassociated, and a blunt dissection was made backwardly along the juncture of the maximum back muscle and external oblique muscle of abdomen,and lumbar intervertebral disc was exposed gradually.Observation index:①Operative effect of exposure.②Postoperative general condition (food intake,urination and defecation,activity,incision healing and death or not).RESULTS: Thirty experimental rabbits were involved in the final analysis.①The operative effect of exposure:The dght retroperitoneal approach was chosen,with satisfactory anesthesia and excellent exposure of rabbit lateral lumbar spine. And the exposure was usually accomplished within 15 minutes, with Less bleeding and no retroperitoneal rupture. ②Postoperative general condition: All animals recovered their consciousnesses within about 1 hour. They were intravenously injected continuously for supplementing blood volume,and after that,they were raised in the separate cases and were allowed to move freeLy.On the day of operation.they were fasted and forbidden to access to water.Their appetites began to decrease on the postoperative 1 day.restored from the 3rd day postoperatively and restored to normal on the 40th day postoperatively.All animals survived until after 4 weeks.They could move freely,without paralysis occurred or incontinence. There was one experimental animal whose surgical Incision broke.Debridement and resuture were given, and its wound healed. In all the other animals, the surgical incision healed well.CONCLUSION: Retroperitoneal approach can give an excellent access to the lumbar spine with easy operation and less complications.
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BACKGROUND:Neurotrophin-3 is found in the repair of spinal cord injury in the role of the strongest neurotrophic factor.It can effectively promote axonal regeneration through the glial scar tissue in repairing spinal cord injury.OBJECTIVE:To construct recombinant lentiviral vectors for gene delivery of homo sapiens neurotrophin-3(hNT3),and to investigate the expression of hNT3 gene in Schwann cells after transfection.DESIGN,TIME AND SETTING:Observational experiment was performed from June 2007 to March 2008 at the Central Laboratory of Changhai Hospital.MATERIALS:Bilateral sciatic nerves were harvested from 3-day-old Sprague Dawley rats for culture and identification of Schwann cells.Three-plasmid lentivirus systems:pGC-E1-EGFP,pHelper 1.0 and pHelper 2.0 were gained from Shanghai Chemical Technology Co.,Ltd.METHODS:pGC-E1-hNT3-EGFP plasmid was constructed by double restriction enzyme digestion and ligation,and then the plasmid was transformed into E.coli DH5?.Purified pGC-E1-hNT3-EGFP plasmids from the positive clones was confirmed by PCR and sequencing.293T cells were cotransfected with lentiviral vector pGC-E1-hNT3-EGFP,pHelper 1.0 and pHelper 2.0 by Lipofectamine 2000 to produce lentivirus.2 mL recombinant virus complete culture solution was added according to multiplicity of infection=1,4,8,10,12.The titer of virus was tested according to the expression level of enhanced green fluorescent protein.The control groups were Schwann cells and Schwann cells transfected by no-loaded lentivirus.MAIN OUTCOME MEASURES:The lentiviruses were transduced to Schwann cells,and the transfection efficiency was examined by flow cytometry,the overexpression of hNT3 was determined by Real-time PCR and Western blotting.RESULTS:The exogenous gene sequence of the recombinant hNT3 was completely in accordance with that of its open reading frame in GeneBank.The titer of concentrated virus was 5?107 TU/L.After recombinant LV-hNT3 infection,Schwann cells gave off strikingly bright green fluorescence,and the transfection efficiency amounted to 85%(multiplicity of infection=10).Real-time RCR test showed that the hNT3 mRNA were highly expressed in hNT3-Schwann cells,while did not express in the control group.Western blotting showed the hNT3 expression in Schwann cells.CONCLUSION:Construction of hNT3 gene lentiviral vector can transfect Schwann cells leading to an efficient overexpression of hNT3.
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BACKGROUND:The new technique of spinal nonfusion is used for intervention of early spinal diseases. It can protect the spine motion function and treat the patients either. The interspinous U titanium alloy belongs to the new technique of spinal nonfusion. And this investigation will be a hot spot in the spinal nonfusion technique. OBJECTIVE:To explore the clinical mechanical property of spinal nonfusion interspinous U titanium alloy. DESIGN,TIME AND SETTING:Comparative observation. All patients were selected from the Department of Orthopaedics of Changhai Hospital between June 2006 and December 2007. PARTICIPANTS:A total of 28 patients with degenerative intervertebral disk protrusion and dynamic spinal stenosis,including 23 male and 5 female aged 41 to 58 years old. METHODS:All patients were randomly divided into two groups:intervertebral disectomy alone (n=20):affected segments were removed; implantation group (n=8):affected segments were removed and interspinous U titanium alloy was implanted following interspinous ligament. MAIN OUTCOME MEASURES:The height of the intervertebral space and vertebral canal area of the affected segment as well as JOA scores for lumbar vertebra postoperatively and during follow-up. RESULTS:All 28 patients were included in the final analysis. The height of the intervertebral space and vertebral canal area of the affected segment in implantation group were significantly increased compared with intervertebral disectomy alone group (P
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With deeper understanding for intervertebral disc degeneration,the development and clinical application of protocols in molecular biology,biological intervention in initial stage of intervertebral disc degeneration can retard even reverse the degeneration process. Gene therapy of intervertebral disc degeneration refers to the selection of animal models and gene carriers,application of target genes,etc. It is the key for gene therapy to build human-like animal model,select proper gene carrier and apply ideal target genes. Prior to clinical application,the safety and efficacy of gene therapy should be proved,thus many problems deserve further study.
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[Objective]To investigate the operation indications and techniques of the ISOLA spinal system in reconstruction of the lumber-pelvis continuity after resection of high-level sacral tumors. [Method]A retrospective study was performed in 43 patients with high-level sacral tumor (HLST) between July 2001 to January 2007. Symptoms, signs, histological findings of the tumors and their outcomes were analyzed. All patients underwent resection of HLST and spinopelvic reconstruction with ISOLA spinal system,11 unilateral and 32 bilateral.[Result]Among the 43 patients, 33(77.1%)had chordoma, giant cell tumor of bone and neurogenic tumors. Thirty-four patients alive were followed-up for an average of 35 months(12~62 months), 5 patients had a recurrence of chordoma and 29 patients with HLST were under control. The pain originated from the lumbosacral joint and the spinal nerve root was obviously relieved.The patients could stand and ambulate normally. No loose screw or broken rod were found.X-rays showed no signs of the enlarged screw canal or lowered lumbar spine.The effect was 76.5%(26/34) excellent judged by the ISOLS system.[Conclusion]Spinopelvic reconstruction by ISOLA system after resection of HLST is characterized by easy manipulation, less complications and instant stable fixation. It may be widely used in the clinical practice.
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Objective: To evaluate the efficacy of the third-generation instrumentation including TSRH, CD and ISOLA in the treatment of adult scoliosis. Methods:Thirty-five adult patients with idiopathic or degenerative scoliosis who received treatment with third-generation instrumentation (TSRH,CD and ISOLA) between July 1999 to January 2003 were retrospectively reviewed. The mean preoperative cobb angle of major curves of the frontal plane was 58.1°(42°-95°). The patients received a combined anteroposterior approach or a single posterior procedure. The mean follow-up time was 20 months(10-48 months). Preoperative and postoperative Cobb angles of the frontal plane and sagittal plane and the distance between C7 and CVLS were measured. The subjective assessment was judged by questionnaire. Results: Postoperative clinical appearance of all patients improved significantly. Mean correction of major curves of the coronal plane was 53.2%. Mean loss of correction of the coronal plane in the last follow-up was 4.3°. The distance between the midline of C7 and CVSL was corrected from 2.6 cm to 0.24 cm. The results of follow-up showed that 89.3% patients were satisfied with the outcome. Pneumatothorax and haematothorax occurred in 2 patients. Three patients still complained of low back pain one year after operation because of adjacent degeneration in 2 patients and pseudoarthrosis in the remaining 1 patient. Conclusion: Imageologic findings and subjective assessment of the patients showed that the third-generation instrumentation can achieve good correction and trunk balance in the treatment of adult scoliosis with fewer complications.
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Objective To observe effects of meshed relaxing short incisions (MRSI) on the content of endothelin (ET) in rat tension skin flap,and to investigate the mechanism of meshed relaxing short incisions(MRSI) on wound healing process of tension skin flap.Method We designed an experimental model to investigate the change of ET content caused by MRSI and observe the distribution of ET in rat skin flap tissue each period of wound healing.In the meantime,the immunohistochemistry and auto image analysis were employed.Results Our results showed:(1) ET positive immunologic reaction granules involved in small vascular endothelial cell in rat skin flap tissue increased with prolonging of time within 3 days;(2) the content of ET in MRSI group were significant lower than that of hypertension group (P< 0.05) .Conclusion The decrease of ET contents may be one of the causes that MRSI improves microcirculation of skin flap, and reduces edema and facilitates healing of skin flap.
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The fracture dislocation of axis is a common kind of severe trauma.Because of particular anatomic characteristics of axis, the operation is difficult and highly risky. However, with introduction of new instrumentation and improvement of surgical techniques, innovative methods have been developed in recent years, including posterior C1-2 fusion and internal fixation, decompression by the dissection of C1 posterior arch, occipitocervical fusion and internal fixation, anterior internal fixation for dens fracture dislocation, anterior decompression and internal fixation for vertebral arch fracture dislocation. The available instruments include interlaminar clamp, rod or plate, screw, etc. All these methods and instruments have their respective advantages and disadvantages and indications. In this paper, The indications, effects, and potential complications of them are discussed.
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Objective To study the effects of direct-current field stimulation on spinal cord motor neurons apoptosis after sciatic nerves transection. Methods In experimental group direct-current stimula tors were put into the relevant spinal cord segments and electric stimulation were given instantly after sciatic nervet ransection.In control group, the same st I mulator were put inside without courrent output.The spinal cord specimens were taken 1，4，7，14，28 days after operation. The morphology of the spinal cord motor neurons was observed with the methods of HE staining and light microscope.The spinal cord motor neurons were counted and analyzed with three-dimensional quantit ative method.The TUNEL staining of the specimens was performed simultaneously and the positive-stain spinal cord motor ne u rons were counted. Results 4，7，1 4 and 28 days af ter operation, the number of spinal cord motor neurons and the size of the neurons increased obviously with compare to the control group.The TUNEL staining positive spinalcord motor neurons decreased sign I ficantly according to the control group. Conclusion Direct-current stimu lation may have intervention effects on spinal cord neuron apoptosis after sciatic nerve transection.
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Objective: To study the biocompatibility of CFR/PEEK composite in bone tissue after implanted in lumbar intervertebral space and to evaluate its role in the interbody fusion compared to the allograft bone. Methods: Thirteen beagles were chosen among which 7 were implanted with the disk-like CFR/PEEK composite in the lumbar intervertebral space and the other 6 were implanted with allograft bone. X-ray, QCT and histological examination were employed at 6, 12 and 24 months postoperatively. Results: The X-ray results of fusion segment were in conformity with the QCT's as well as that of histological results. All animals obtained a complete fusion at 24 months. Histological examination revealed that the anterior soft tissue to the implant exhibited a nonspecific foreign body reaction with connective tissue embed the biomaterials. Carbon fragment were seen in the surrounding tissue and some of the debric were phagocytosed by foreign body giant cell. Histological examination of bone and material revealed that new bone grew along the hole of CFR/PEEK implant. Conclusion: CFR/PEEK has an excellent biocompatibility to bone tissue.
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Objective: To find out the pathomechanism of low back and leg pain related to intervertebral disc. Methods: The nucleus pulposus of coccygeal vertebral was transplanted to the cavum epidurale of rats to establish the non-compressive model with transplanted nucleus pulposus. The evoke potentials and morphology of nerve roots were observed. Results: Even without mechanical compression, rats transplanted with nucleus pulposus resulted in significant harm to evoked potential and morphology of cauda equina. Conclusion: The biomechanical and/or immunologic inflammatory effect of nucleus pulposus can result in nerve roots injury and is an important factor in the pathogenesis of low back and leg pain.
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Objective: To study the factors and preventive method of post-operative complications of spinal implant operation. Methods: The post-operative complication of 451 cases who had undergone spinal implant operation were analysed retrospectively. The relative factors of complications were analyzed. Results: Infection, thrombosis of deep vein and failed fusion were the most common complications. Among the factors, the age, operation time and blood lose during operation were closely related with the complication. Using antibiotic was effective to reduce the infection. Conclusion: It is effective to reduce the post-operative complication of spinal implant operation by proper pre-operative evaluation. Using antibiotic to control other diseases is also effective.
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Objective:To investigate the pathogenesis, clinical feature and alternative approach of lumbar disc herniation in teenagers. Methods: The clinical data of 40 inpatients (age ≤21 years, admitted in Changhai Hospital from 1993 to 2001) with lumbar disc herniation were retrospectively reviewed. Of them, 7 patients received conservative treatment and the remaining underwent operation, including interlaminar partial laminotomy on one side (16 patients), hemilaminar laminotomy (14 patients) and interlaminar partial laminotomy on both sides (3 patients). All patients were followed up for 3 to 10 (4.2?0.6) years. Follow-up evalutions were performed via clinical visits. The Japanese Orthopaedic Association's evaluation system for lower back pain syndrome (JOA score) was used to evaluate the outcomes. Results: The lumbar and leg pain was released in all 40 patients after therapy. There was no deterioration of symptoms in the operative groups. During the follow-up, 8 patients had occasional low back pain but it did not affect their lives, 2 patients in the non-operative group had numbness, and no patients had lumbar degeneration in the operative groups. The improvement of JOA score was more significant in operative groups than in the non-operative group. There were significant differences in JOA scores before and after treatment in all groups (P
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To study the mechanism of hyperbaric oxygen (HBO) on spinal cord injury (SCI), we duplicated a SCI model and determined the concentrations of excitatory amino acids [EAA, including aspartic acid (Asp) and glutamic acid (Glu)] in spinal cord tissue after treated with 0 1 MPa HBO, 0 25 MPa HBO, 0 25 MPa N 2 O 2 and hormone, respectively. The results showed that the concentration of EAA (Glu) in the spinal cord significantly increased after injury, whereas after treatment it decreased in all but the N 2 O 2 group. It decreased most significantly in 0 25MPa HBO and 0 25MPa HBO+hormone groups. There were significant differences between 0 25MPa HBO group and 0 1MPa HBO group, 0 25MPa HBO+hormone group and pure hormone group ( P
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To study the effect of hyperbaric oxygen (HBO) on the activity of superoxygen dismutase (SOD) and catalase (CAT) in spinal cord tissue, a rat spinal cord injury (SCI) model was established. The results showed that the activity of SOD and CAT in the spinal cord decreased significantly after injury, bat recovered after the treatment with 0 25MPa HBO and 0 25MPa HBO+hormone. These results suggest that HBO can increase the activity of anti oxidase in spinal cord,and prevent or relieve the injury by free radicals. Thus it can recover the function of spinal cord.
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Objective To evaluate the results of the Secuplate anterior cervical osteosynthesis plate (SACOP) for the treatment of patient with cervical spondylotic myelopathy (CSM). Methods Twenty six patients with CSM underwent anterior decompression fusion and internal fixation with SACOP were reviewed. All patients were followed up for 6 to 12 months (mean, 8 months). Results Neurological deficits improved in 23 of 26 patients after operation. A stable bony fusion according to radiological criteria was achieved in all cases 6 months postoperatively. There was no implants breakage and loosening. Conclusion Intervertebral fusion and internal fixation with SACOP after anterior decompression can offer immediate stability, prevent graft dislodgement, avoid cast immobilization and give a high rate of successful bony fusion for the patient with CSM.