Application of oblique lateral interbody fusion in the treatment of lumbar intervertebral disc degeneration in patients with Modic change and endplate sclerosis / 中国骨伤

OBJECTIVE@#To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis.@*METHODS@#A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L2,3 in 2 cases, L3,4 in 5 cases, and L4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed.@*RESULTS@#There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved.@*CONCLUSION@#As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.

Relationship between degenerative lumbar disc disease and peripheral blood lymphocyte subsets / 中国组织工程研究

BACKGROUND: Previous studies have suggested that the main causes of disc degeneration are heredity, aging, malnutrition and load history. The role of immune system in the process of intervertebral disc degeneration is not clear. OBJECTIVE: To observe the changes of peripheral blood lymphocyte subsets in patients with lumbar disc degeneration, and to study the relationship between the severity of lumbar disc degeneration and peripheral blood lymphocyte subsets. METHODS: Blood samples were collected from 76 patients with degenerative lumbar disc disease (experimental group) and 56 healthy volunteers (control group). The percentages of peripheral blood lymphocyte subsets including CD3+ T cells, CD4+ T cells, CD8+ T cells, CD19+ B cells, and CD3-CD16+CD56+ natural killer (NK) cells were measured by flow cytometry. The ratio of CD4+/CD8+ was calculated. The Pfirrmann grading standard was used to evaluate the grade of lumbar disc degeneration in the two groups, and the correlation between peripheral blood lymphocyte subsets and lumbar disc degeneration was further evaluated. The study protocol was approved by the Ethic Committee of the First Affiliated Hospital of Zhengzhou University in China with approval No. 2019-KY-285. Each participant signed informed consent prior to the study. RESULTS AND CONCLUSION: The degenerative grade of the experimental group was significantly higher than that in the control group (P < 0.05). The percentages of CD4+ T cells, NK cells and the ratio of CD4+/CD8+ in the experimental group were significantly higher than those in the control group (P < 0.05). The percentage of CD8+ T cells in the experimental group was significantly lower than that in the control group (P < 0.05). There was no correlation between the grade of lumbar disc degeneration and lymphocyte subsets of the peripheral blood in the control group. In the experimental group, there was a linear positive correlation between the grade of lumbar disc degeneration and the percentage of CD4+ T cells, the ratio of CD4+/CD8+, and the percentage of NK cells (r=0.412, P=0.000; r=0.715, P=0.000; r=0.494, P=0.000), and there was a linear negative correlation between the grade of lumbar disc degeneration and the percentage of CD8+T cells (r=-0.737, P=0.000). Our results suggest that degenerative changes of the lumbar disc may be related to the changes of lymphocyte subsets in peripheral blood, and the increase of CD4+ T cells, NK cells and CD4+/CD8+ ratio may accelerate lumbar disc degeneration. Therefore, changes in the immune system may predict the occurrence of lumbar disc degeneration and may be a target for prevention and treatment of degenerative lumbar disc diseases.

Mid-term effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration / 中国修复重建外科杂志

Objective: To evaluate the effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration. Methods: The clinical data of 39 patients with two-level lumbar disc degeneration who met the selection criteria between June 2010 and December 2011 was retrospectively analyzed. They were divided into group A (20 cases, simple lumbar decompression and fusion) and group B (19 cases, Coflex interspinous dynamic internal fixation combined with spinal fusion) according to different surgical methods. There was no significant difference in age, gender, disease diagnosis, lesion segment, disease duration, Oswestry disability index (ODI), visual analogue scale (VAS) score, and the intervertebral height, foramen intervertebral height (FIH), and range of motion (ROM) of upper operative segment and adjacent segment between the two groups ( P>0.05). ODI and VAS score were used to evaluate the effectiveness before operation and at last follow-up, and the improvement rates were calculated. The intervertebral height [anterior disc height (ADH), middle disc height (MDH), and posterior disc height (PDH)], FIH, and ROM were measured and compared between the two groups. Results: The operation time and intraoperative blood loss in group A were significantly more than those in group B ( P0.05); the improvement rate of VAS score in group B was significantly higher than that in group A ( t=2.245, P=0.031). There was no significant difference in the intervertebral height and FIH of the upper operative segment at last follow-up between the two groups and between preoperation and last follow-up in the two groups ( P>0.05). At last follow-up, the ADH of adjacent segment in group B was significantly higher than that in group A, and MDH, PDH, and FIH were significantly lower than those in group A ( P0.05). The ROM of adjacent segment in group A increased significantly at last follow-up ( t=2.318, P=0.026). There was significant difference in ROM of adjacent segment between the two groups ( P<0.05). Conclusion: The mid-term effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion is similar to that of simple decompression fusion. For those patients whose adjacent segments of the responsible segments have degeneration but have no symptoms or mild symptoms, this treatment can slow down the adjacent segment degeneration.

Relationship between Lumbar Disc Degeneration and Back Muscle Degeneration / 대한척추외과학회지

STUDY DESIGN: Retrospective evaluation. OBJECTIVES: To determine the relationship between lumbar disc degeneration and back muscle degeneration. SUMMARY OF LITERATURE REVIEW: In the degenerative cascade of the spine described by Kirkaldy-Willis, degeneration of the disc and of the facet joint co-occur with aging. However, the muscles of the back are not included in this model. Several studies have reported significant correlations between back muscle degeneration and facet joint arthritis. The purpose of our study was to evaluate relationships between lumbar disc degeneration and fatty degeneration of the back muscles. MATERIALS AND METHODS: In this study, 65 patients over the age of 50 years who had undergone lumbar spine MRI in our orthopaedic clinic were recruited. Fatty degeneration of the back muscles was qualitatively graded from I to III by the degree of the fat signal in the muscle layer, including both the multifidus and erector spinae. Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. Correlations between the back muscle degeneration grade and radiological parameters were analyzed. RESULTS: The degeneration grade of the multifidus correlated positively with age and the grade of disc degeneration. Correlations with other radiologic parameters were not significant. The degeneration grade of the erector spinae correlated positively with age. Other radiologic parameters were not significant. CONCLUSIONS: There was a significant correlation between lumbar disc degeneration and multifidus degeneration. Erector spinae degeneration was correlated with age, but not with lumbar disc degeneration. The degenerative cascade of the spine was accompanied by fatty changes of the multifidus with aging.

Relationship Between Pelvic Tilt and Lumbar Disc Degeneration

STUDY DESIGN: Retrospective analysis. OBJECTIVES: To determine the relationship between pelvic tilt and lumbar disc degeneration. SUMMARY OF LITERATURE REVIEW: The shape and the spatial orientation of the pelvis determine the organization of the lumbothoracic spine. The purpose of our study was to determine the relationship between pelvic tilt and lumbar disc degeneration. MATERIALS AND METHODS: Sixty patients over 50 years of age who had undergone lumbar spine magnetic resonance imaging were recruited. In individuals between 41 and 60 years of age, the normal pelvic tilt is 14°. Patients were divided into a low pelvic tilt (PT) group (<14°) and a high pelvic tilt (PT) group (≥14°). Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. We defined grades IV and V as high-grade degeneration and the others as low-grade degeneration. Radiologic parameters and lumbar disc degeneration were compared between these 2 groups. RESULTS: In the low PT group, the average degeneration grade of each lumbar segment was 2.61 in L1-L2, 2.61 in L2-L3, 3.00 in L3-L4, 3.39 in L4-L5, and 3.84 in L5-S1. The corresponding grades in the high PT group were 2.34 in L1-L2, 2.62 in L2-L3, 3.07 in L3-L4, 3.76 in L4-L5, and 3.55 in L5-S1. The grade of degeneration of the high PT group was significantly higher than that of the low PT group for L4-L5 (p=0.031). High-grade degeneration of the L4-L5 segment was significantly more common in the high PT group (odds ratio=4.65; 95% CI, 1.406-15.381; p=0.012). CONCLUSIONS: Patients with high pelvic tilt had a higher grade of lumbar disc degeneration in the L4-L5 segment regardless of age or gender.

Finite element analysis of lumbar disc degeneration with sacroiliac joint disorder by gait simulation / 医用生物力学

Objective To explore the biomechanical mechanisms of correlation between lumbar disc degeneration and sacroiliac joint disorder though investigating the biomechanical characteristics of lumbar disc degeneration with sacroiliac joint disorders. Methods One normal healthy volunteer and two patients with lumbar disc herniation and sacroiliac joint disorders (one was with sacrum disorders and the other was ilium disorders) were selected. Their CT data were collected to establish three corresponding lumbar-pelvis finite-element models, and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model. The muscle force around the lumbar and pelvis as well as the hip joint force were acquired as loading condition for finite element analysis. The stress changes in L4 and L5 intervertebral discs and sacroiliac joints of the patients and normal volunteer were compared. Results There was no significant difference in the stress of the two sides of L4, L5 disc and two sacroiliac joints in normal model, with a bimodal stress curve. However, in the models of sacrum disorders and ilium disorders, the bimodal stress curve peaks changed, even disappeared. The peak stress differences in left and right side of L4 disc were 0.55 MPa and 0.80 MPa, respectively, the peak stress differences in left and right side of L5 disc were 4.05 MPa and 2.08 MPa, respectively, and the peak stress differences in left and right side of sacroiliac joints were 0.96 MPa and 3.32 MPa, respectively. Conclusions The lumbar disc degeneration with sacroiliac joint disorder leads to the tilt of the body loading line, and sacroiliac joint disorder can aggravate the imbalances of stress on the body sides. The impact of sacroiliac joint dysfunction cannot be ignored in the treatment of lumbar disc herniation.

Finite element analysis of lumbar disc degeneration with sacroiliac joint disorder by gait simulation / 医用生物力学

Objective To explore the biomechanical mechanisms of correlation between lumbar disc degeneration and sacroiliac joint disorder though investigating the biomechanical characteristics of lumbar disc degeneration with sacroiliac joint disorders.Methods One normal healthy volunteer and two patients with lumbar disc herniation and sacroiliac joint disorders (one was with sacrum disorders and the other was with ilium disorders) were selected.Their CT data were collected to establish three corresponding lumbar-pelvis finite-element models,and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model.The muscle force around the lumbar and pelvis as well as the hip joint force were acquired as loading condition for finite element analysis.The stress changes in L4 and L5 intervertebral discs and sacroiliac joints of the patients and normal volunteer were compared.Results There was no significant difference in the stress of the two sides of L4,L5 disc and two sacroiliac joints in normal model,with a bimodal stress curve.However,in the models of sacrum disorders and ilium disorders,the bimodal stress curve peaks changed,even disappeared.The peak stress differences in left and right side of L4 disc were 0.55 MPa and 0.80 MPa,respectively,the peak stress differences in left and right side of L5 disc were 4.05 MPa and 2.08 MPa,respectively,and the peak stress differences in left and right side of sacroiliac joints were 0.96 MPa and 3.32 MPa,respectively.Conclusions The lumbar disc degeneration with sacroiliac joint disorder leads to the tilt of the body loading line,and sacroiliac joint disorder can aggravate the imbalances of stress on the body sides.The impact of sacroiliac joint dysfunction cannot be ignored in the treatment of lumbar disc herniation.

MRS in quantitative assessment of lumbar discs degeneration / 中国医学影像技术

Objective To evaluate the value of MRS in quantitative assessment of degeneration of lumbar discs.Methods Totally 82 patients with lumbago underwent lumbar MR scanning.All the discs were classified with Pfirrmann grades in the sequences of sagittal T2WI.The area under N-acetyl peak,under water peak and the ratio of N-acetyl/Water were measured by MRS.Correlation between MRS values and Pfirrmann grade,age were analyzed.Results In 82 patients,204 lumbar discs were measured by MRS.There were 89,73,39,3 discs in Pfirrmann Ⅱ,Ⅲ,Ⅳ,V respectively.The areas of N-acetyl,water peak and N-acetyl/Water ratio of nucleus region were positively correlated with Pfirrmann grading,respectively (rs =-0.460,-0.204,-0.526,all P＜0.05).There were 62,25,37,51,29 discs in patients aged ＜30,30-39,40-49,50-59,＞59 years respectively.The ares of N-acetyl peak,N-acetyl/Water ratio of nucleus region was negatively correlated with the age (rs=-0.247,-0.385,both P＜0.05).Conclusion MRS can be used for quantitative assessment of lumbar discs degeneration.

The relationship between lumbar disc degeneration of lumbar spinal stenosis and the dural sac cross-sec-tional area by MRI measurement / 实用医学杂志

Objective To explore the relationship between lumbar disc degeneration (LDD) of lumbar spinal stenosis(LSS)and the dural sac cross-sectional area(DSCA)by MRI measurement. Methods 91 patients with central degenerative LSS were randomly selected and 91 age-and sex-matched people without LSS were select-ed as a control group. LDD was classified into five grades by MRI detection according to the method proposed by Pfirrmann and DSCA were measured. Results LDD was not associated with age in LSS. The proportion of severe degenerated disc in lower lumbar levels were higher than that of L2/3 in the two groups;DSCA in severe degenerat-ed disc group was significantly smaller than that in light degenerated group only in L2/3 and L3/4 in LSS. There were no statistical differences in every lumbar level in the control group. Conclusions LDD in L4/5 and L5/S1 of LSS is more severe than that of the normal people. DSCA and LDD are positively correlated in L2/3 and L3/4,but not in L4/5 and L5/S1 for LSS.

Finite element analysis of lumbar disc degeneration with sacroiliac joint disorder by gait simulation / 医用生物力学

Objective To explore the biomechanical mechanisms of correlation between lumbar disc degeneration and sacroiliac joint disorder though investigating the biomechanical characteristics of lumbar disc degeneration with sacroiliac joint disorders.Methods One normal healthy volunteer and two patients with lumbar disc herniation and sacroiliac joint disorders (one was with sacrum disorders and the other was with ilium disorders) were selected.Their CT data were collected to establish three corresponding lumbar-pelvis finite-element models,and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model.The muscle force around the lumbar and pelvis as well as the hip joint force were acquired as loading condition for finite element analysis.The stress changes in L4 and L5 intervertebral discs and sacroiliac joints of the patients and normal volunteer were compared.Results There was no significant difference in the stress of the two sides of L4,L5 disc and two sacroiliac joints in normal model,with a bimodal stress curve.However,in the models of sacrum disorders and ilium disorders,the bimodal stress curve peaks changed,even disappeared.The peak stress differences in left and right side of L4 disc were 0.55 MPa and 0.80 MPa,respectively,the peak stress differences in left and right side of L5 disc were 4.05 MPa and 2.08 MPa,respectively,and the peak stress differences in left and right side of sacroiliac joints were 0.96 MPa and 3.32 MPa,respectively.Conclusions The lumbar disc degeneration with sacroiliac joint disorder leads to the tilt of the body loading line,and sacroiliac joint disorder can aggravate the imbalances of stress on the body sides.The impact of sacroiliac joint dysfunction cannot be ignored in the treatment of lumbar disc herniation.

Finite element analysis of lumbar disc degeneration with sacroiliac joint disorder by gait simulation / 医用生物力学

Objective To explore the biomechanical mechanisms of correlation between lumbar disc degeneration and sacroiliac joint disorder though investigating the biomechanical characteristics of lumbar disc degeneration with sacroiliac joint disorders.Methods One normal healthy volunteer and two patients with lumbar disc herniation and sacroiliac joint disorders (one was with sacrum disorders and the other was with ilium disorders) were selected.Their CT data were collected to establish three corresponding lumbar-pelvis finite-element models,and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model.The muscle force around the lumbar and pelvis as well as the hip joint force were acquired as loading condition for finite element analysis.The stress changes in L4 and L5 intervertebral discs and sacroiliac joints of the patients and normal volunteer were compared.Results There was no significant difference in the stress of the two sides of L4,L5 disc and two sacroiliac joints in normal model,with a bimodal stress curve.However,in the models of sacrum disorders and ilium disorders,the bimodal stress curve peaks changed,even disappeared.The peak stress differences in left and right side of L4 disc were 0.55 MPa and 0.80 MPa,respectively,the peak stress differences in left and right side of L5 disc were 4.05 MPa and 2.08 MPa,respectively,and the peak stress differences in left and right side of sacroiliac joints were 0.96 MPa and 3.32 MPa,respectively.Conclusions The lumbar disc degeneration with sacroiliac joint disorder leads to the tilt of the body loading line,and sacroiliac joint disorder can aggravate the imbalances of stress on the body sides.The impact of sacroiliac joint dysfunction cannot be ignored in the treatment of lumbar disc herniation.

Effects of Electroacupuncture at Weizhong on Expression of Bcl-xL and Bax in Rats with Lumbar Disc Degeneration / 中国康复理论与实践

@#Objective To explore the effect of electroacupuncture at Weizhong (BL40) acupoint on the expression of Bcl-xL and Bax in rats with lumbar disc degeneration. Methods Thirty male adult Sprague-Dawley rats were randomly divided into sham-operated group (n= 10), model group (n=10), and electroacupuncture group (n=10). The lumbar disc degeneration model was established by puncturing the annulus fibrosis in the model group and electroacupuncture group. One month after modeling, the electroacupuncture group was electroacupunctured at Weizhong acupoint for four weeks. HE staining was used to observe the pathological changes. Immunohistochemical staining was used to observe the expression of Bax in the lumbar disc tissue. Western blotting was used to detect the expression of Bcl-xL and Bax protein. Results HE staining showed that the degrees of lumbar disc degeneration from light to severe was ranged as: the sham-operated group, the electroacupuncture group and the model group. The expression of Bcl-xL was lower (P<0.05), and the expression of Bax was higher (P<0.01) in the model group than in the sham-operated group, which was opposite (P<0.01) in the electroacupuncture group than in the model group. Conclusion Electroacuponcture at Weizhong may upregulate the expression of Bcl-xL and downregulate the expression of Bax in rats with lumbar disc degeneration.

The Association of Lumbosacral Sagittal Alignments and the Patterns of Lumbar Disc Degeneration

STUDY DESIGN: Retrospective review and radiological analysis. OBJECTIVES: We investigated whether the lumbosacral sagittal curvature have any relation to the patterns of lumbar disc degeneration. SUMMARY OF THE LITERATURE REVIEW: Recently, there have been many studies on the correlations between the changes of lumbar disc degeneration and associated factors, such as age, gender, weight, occupation, cigarette smoking, and genetics; but, it is hard to find research into lumbosacral sagittal alignments. MATERIALS AND METHODS: This study enrolled 117 young adult patients limited by age (18-35 years), BMD (<30kg/m2), no smoking, occupation except heavy worker, no prior lumbar surgery and no combined spinal deformity. By measuring the pelvic incidence, sacral slope, lumbar tilt angle, lumbar lordosis and lumbar axis indicating the parameters of sagittal alignments, we investigated the correlation between the number and severity of lumbar disc degeneration and the number of herniated intervertebral discs. RESULTS: This study found a moderate correlation between pelvic incidence, sacral slope, lumbar lordosis, and the number of lumbardegenerative disc (r=-0.451, p<0.001; r=-0.433, p<0.001; r=-0.425, p<0.001). We calculated the most proper cut-off value of pelvic incidence associated with more than three segments of multiple lumbar disc degeneration, using a minimum p-value approach. CONCLUSIONS: As pelvic incidence, sacral slope, and lumbar lordosis indicating the parameters of lumbosacral sagittal alignments get smaller, the numbers of lumbar disc degenerations and herniated intervertebral discs increase. When pelvic incidence is below 45.6 degrees, it is more likely for degenerative changes of lumbar disc to affect more than three segments.

Clinical value of discography followed by computed tomography for the treatment of multi-level lumbar disc degeneration / 中国矫形外科杂志

[Objective]To explore the clinical value of discography followed by computed tomography for the treatment of multi-level lumbar disc degeneration. [Methods]Twenty-eight cases were enrolled from January 2005 to January 2008.There were 12 males and 16 females with average age of 38.2 years,ranging from 30 to 56 years.The level of degenerated disc included L3、4 and L4、5(9 cases),L4、5 and L5S1(15 cases),L3、4,L4、5 and L5S1(4 cases).The level of discography included L2、3(10 cases),L3、4(28 cases),L4、5(28 cases),and L5S1(26 cases) with a total of 92 discs.The painful discs(or responsible discs) were screened according to diagnostic criteria of provocative discography and treated with interbody fusion.[Results]Thirty-two responsible discs were screened in total of 92 discs.ODI scores between pre and post operation were significantly different(P

Association of vitamin D receptor gene TruⅠ and FokⅠ polymorphisms with lumbar degenerative disc disease in Han nationality / 中国矫形外科杂志

0.05.[Conclusion]VDR TruⅠ and FokⅠpolymorphisms are not related to LDD in Han nationality.

Treatment of thoracolumbar vertebral fracture by limited decompression of neighbouring segment with internal fixation and intervertebral body fusion / 中国矫形外科杂志

[Objective]To study the feasibility and clinical effect of the treatment of thoracolumbar vertebral fracture with limited decompression of neighbouring segments with internal fixation and intervertebral body fusion.[Method]Forty-three patients with thoracolumbar fractures were treated with this technique.The fusion of bone graft,reduction rate of fracture,nerve functional recovery,the loosening of rectification,subsequent low back pain,and the degeneration of adjacent segments were evaluated.[Result]All cases were followed up for 21.4 months and showed the results of strong spine bony fusion,96.1% satisfactory reduction rate without reduction lost,various differences of nerve functional improvement,a rank-sum test P

Clinical Comparison between Decompression and Posterior Lumbar Interbody Fusion in Chronic Lower Back Pain Involving Degenerative Disc Disease and Spinal Stenosis

Between January 1992 and December 1995, 23 patients with chronic lower back pain involving lumbar disc degeneration and spinal stenosis underwent decompression and posterior lumbar interbody fusion. Two groups of patients were studied, and clinical symptoms, neurological signs and clinical results were compared. With regard to mechanical back pain and clinical results, posterior lumbar interbody fusion was superior to decompression, but as regards leg pain and neurologic signs, the two groups were similar. Posterior lumbar interbody fusion was of considerable benefit to patients with chronic lower back pain.