Spinal gangliocytoma of lower lumbar nerve root: a report of 3 cases / 中华骨科杂志

Three cases of lower lumbar nerve root gangliomas with spinal instability or lumbar disc herniation are reported. The first patient was treated for lumbosacral pain and discomfort for more than 10 days. Preoperative diagnosis was L 5S 1 intervertebral instability, L 5 bilateral spondylolysis, and L 5S 1 left intervertebral foraminal space occupying lesions to be investigated, the tumor was removed intraoperatively and sent to pathology. Meanwhile, L 5S 1 posterior interbody bone graft fusion and internal fixation were performed. The second patient presented for 1 month due to left lumbar and leg pain and discomfort. Preoperative diagnosis was L 4-5 intervertebral instability and L 4-5 intervertebral disc herniation. Intraoperative exploration revealed a nerve root mass on the left side of L 5, which was surgically removed and sent to pathology. Meanwhile, posterior decompression of L 4 and L 5 intervertebral bone grafting and internal fixation were performed. The third patient presented for 4 days with right lumbar and leg pain and discomfort. Preoperative diagnosis was L 3-4, L 4-5 and L 5S 1 intervertebral disc herniation. Intraoperative exploration found a right nerve root mass of S 1, which showed invasive growth and was closely surrounded by nerve fibers. Partial resection of the mass was sent to pathology, and posterior decompression and internal fixation of L 4-5 and L 5S 1 bone grafting and fusion were performed at the same time. All 3 patients were confirmed to be ganglion neuroma by postoperative pathological examination. Three patients recovered well after surgery. Spinal ganglion cell tumor is mainly originated from primitive neural crest cell migration differentiation of sympathetic ganglion cells, and can also be derived from the sympathetic nerve and peripheral nerves. It is seen more at retroperitoneal and mediastinal, lumbosacral nerve root ganglion cells tumor is rare. Clinically, it is very close to intervertebral disc herniation and difficult to distinguish, often found during operations and less can be clearly diagnosed before operation. Surgical resection is the main treatment for ganglion cell neuroma.

One-stage combined anterior and posterior approach for severe thoracolumbar and lumbar spine fracture / 中国脊柱脊髓杂志

Objective:To investigate the surgical outcome of one-stage combined anterior and posterior ap-proach for severe thoracolumbar and lumbar spine fracture.Method:A total of 62 cases suffered from severe thoracolumbar and lumbar spine fracture undergoing surgery from Jan 2003 to Jan 2008 were reviewed retro-spectively.Of these,there were T11 involved in 2 cases,T12 in 13 cases,L1 in 28 cases,L2 in 10 cases,L3 in 6 cases and L4 in 3 cases.There were 58 fresh fractures and 4 old fractures.Based on Dennis classifica-tion,12 were compression fracture,33 were burst fracture and 17 fracture dislocation.All cases had spine load score≥7 and TLICS score≥5.Of 19 cases with neurological deficit according to Frankel grade,there were 7 A,5 B and 7 C.Combined anterior and posterior approach was performed in all cases,anterior bony graft plus posterior pedicle instrumentation were performed either,of these,52 cases had additional anterior decompres-sion.Result:All operations were performed successfully,with the mean surgical time of 170min (range, 150-210min) ,the average blood loss was 819ml(range,400-2900ml).No iatrogenic neuroinjury,skin infection, dural matter tearing and graft displacement were noted.The preoperative Cobb's angle was 8°-40°(mean, 23.9°), while the postoperative counterpart returning to normal with 5 cases having 2°-10° kyphosis.The preoperative compression rate was 20%-95%(mean,54.5%),while the postoperative counterpart returning to normal in 47 cases,with 15 cases having 2%-30%.The preoperative canal stenosis rate was 5%-90%(mean,51.1%) while the postoperative counterpart was 0-30%(mean,4.7%),which showed significant difference with regarding to these 3 parameters (P<0.05).All cases were followed up for an average of 31 months (range,12-72 months). Bony fusion was evidenced in cases undergoing anterior bony graft.At 10-12 months, the Cobb's angle was 0°-15°(mean,0.62°) ,the vertebral compression rate was 0-30%(mean,4.6%),no significant difference were noted between them and their postoperative counterparts(P>0.05).At final foUow-up,15 of 19 cases with neu-rological deficit had neurofunction improved,while 4 remained unchanged.According to our hospital criteria,of 43 cases with no neurological deficit,there were 30 excellent,9 good,3 fair and 1 bad with the total excel-lent to good rate of 90.6%.Cage subsidence and pedicle screw breaking was noted in 1 case,who developed severe kyphosis presenting with irreducible back pain.Conclusion:One-stage combined anterior and posterior approach for severe thoracolumbar and lumbar spine fracture can ensure three column stability as well as complete decompression,which has good early outcome.

Construction of a Novel Eukaryotic Expression Plasmid pcDNA6/myc-his-EGFP Band Its Applications in Expression of Recombinant Genes / 中国生物工程杂志

Enhanced green fluorescent protein( EGFP), myc epitope and polyhistidine metal-binding tag are often used as a marker for recombinant fusion protein in many gene expression vectors, each marker has its own function, EGFP emits green fluorescence for direct detection, myc epitope facilitates recombinant fusion protein detection using its antibodies, polyhistidine tag allows purification of recombinant fusion protein using resin.Hitherto, no a plasmid vector can integrate all of these functions. In this study we constructed a novel eukaryotic expressive plasmid, designated as pcDNA6/myc-his-EGFP B, which integrated the functions of EGFP, myc epitope and polyhistidine tag. Importantly, a linker octo - peptide in N terminal of EGFP was designed using LINKER program. A DNA fragment encoding a putative protein containing a signal peptide of human interleukin 2(IL-2) in N terminal was cloned into pcDNA6/myc-his-EGFP B in frame with the C-terminal peptide to construct pMHES. 2.2.15 Cells were transfected with pcDNA6/myc-his-EGFP B and pMHES, and Balb/c mice were intravenously injected with pcDNA6/myc-his-EGFP B by tails, results revealed that both of the plasmids worked in 2.2.15 Cells and livers of Balb/c mice. Assuming gene of the IL-2 was inserted into pcDNA6/myc-his -EGFP B in frame with EGFP, myc and 6 × His, three-dimensional structure for this putative expression product was simulated using Modeller8V2, results revealed that IL-2, EGFP, myc and 6 × his did not interfere each other and octo- peptide linker owned certain flexibility. The results suggest that pcDNA6/myc-his-EGFP B may be useful as a genetic tool for mammalian cells and a vector for gene therapy.