Expression of inflammatory factors are increased by sorbitol in lumbar spinal stenosis of diabetic patients / 基础医学与临床

Objective To investigate the related mechanism of ligamentum flavum (LF) hypertrophy in diabetic pa-tients with lumbar spinal canal stenosis ( LSCS ) .Methods Twenty-four diabetes mellitus patients [ DM (+) ] and twenty normoglycemic patients [ DM (-) ] with LSCS were enrolled in this study .Sorbitol in LF was analyzed using D-Sorbitol/Xylitol test kit .The thickness of LF was measured by CT .The structure of LF was observed after HE and Masson's trichrome staining .The cell cycle and proliferation of fibroblastic cell NIH 3T3 line cultured in high glucose were analyzed .Sorbitol of NIH3T3 was detected under different backgrounds in vitro, normal glucose , high glucose and high glucose burdened with aldose reductase inhibitor ( ARI) , Epalrestat .The expression of inflammatory factors was detected by qPCR and Western blot under above different backgrounds .Results LF of diabetic patients exhibi-ted significantly higher level of sorbitol and pro-inflammatory cytokines , TGF-βand of CD68-positive staining than that of the normoglycemic subjects ( P<0.01 ) .The diabetic LF was significantly thicker than that of the controls , and showed evidence of degeneration .The high glucose-cultured fibroblasts exhibited significantly higher levels of sorbitol , pro-inflammatory factors , and TGF-βcompared to the low glucose-cultured cells , and these levels were dose-dependently reduced by treatment with the aldose reductase inhibitor (P<0.05).Conclusions Sorbitol level of the LF is significantly increased in the DM patients with LSCS .Increased sorbitol recruites inflammatory factors and fibrogenic-related factor TGF-βin LF of DM patients with LSCS which may contributes to the LF hypertrophy .

Lumbar Spinal Canal Stenosis Classification Criteria: A New Tool

STUDY DESIGN: Case-control study. PURPOSE: To design a new tool for classifying lumbar spinal canal stenosis (CLSCS). OVERVIEW OF LITERATURE: Grading of patients with lumbar spinal canal stenosis (LSCS) is controversial. METHODS: The Oswestry disability index (ODI) and the neurogenic claudication outcome score (NCOS) were recorded. Four parameters, which indicate the severity of LSCS disease, including Hufschmidt-grade, grading of magnetic resonance imaging, self-paced walking test, and stenosis ratio (SR) were employed. For the SR, quartile analysis was applied for classifying LSCS and the Hufschmidt-grade was modified into a 4-grade score. An initial score was assigned to each metric based on the severity of LSCS. Using the inverse-variance weighting method, the relative weights of these domains and their categories were determined. The score for all of the cases was obtained based on their weight by summing up the points of the four variables. Quartile analysis was used and a CLSCS score was proposed. Finally, intra- and interobserver reliability, and validity were assessed. RESULTS: A total of 357 patients were studied. The final CLSCS score for each case ranged from 4 to 16.5. Based on the quartile analysis, using the new criteria set, the CLSCS score was divided into four categories: CLSCS<7 (grade 0); 7< or =CLSCS<10 (grade 1); 10< or =CLSCS<13 (grade 2); and 13< or =CLSCS< or =16.5 (grade 3). The kappa values of for the CLSCS score indicated a perfect agreement. The CLSCS was correlated with the ODI and NCOS. All patients with grade 3 CLSCS were observed in the surgical group. CONCLUSIONS: The CLSCS score can be helpful for classifying LSCS patients and in the decision-making process.

Correlation between Expression of Inducible Nitric Oxide Synthase and Neural Cell Apoptosis after Chronic Compression of Cauda Equina Nerve in Rats / 中国医科大学学报

Objective To study the relationship between the expression of inducible nitric oxide synthase(iNOS)and neural cell apoptosis after chronic cauda equina compression. Methods Totally 30 male adult SD rats were randomly divided into 2 groups as the control group and the experi?mental group. The control group received sham operation with single laminectomy of L5 lumina. In the experimental group,the silicon sheet was in?serted into the spinal canal of L4 to cause single level compression of cauda equina. The L4 level of spinal cords were harvested at 2 weeks,4 weeks,8 weeks,and 12 weeks after operation in the experimental group,and at 4 weeks in the control group respectively,and then immunohistochemistry and image analysis were performed to observe the expression of iNOS in spinal cord and the TUNEL method was applied to observe cell apoptosis. The morphology of cells was observed by transmission electron microscope. Results There was few amount of iNOS expressed in the control group. The expression of iNOS was slight at 4 weeks in the experimental group and was higher at 8 weeks and 12 weeks compared with the control group. Small amount of neural cell apoptosis was evidenced in the control group,while neuron apoptosis appeared remarkably in the experimental group since 4 weeks and increased with the extension of time. Transmission electron microscopy found apoptosis changes in neurons in the experimental group. Conclusion The expression of iNOS increases in corresponding spinal cords after chronic compression of cuada equine and neural cell apoptosis oc?curs,indicating that iNOS is positively correlated with neural cell apoptosis.

Nocturnal Cramps in Patients with Lumbar Spinal Canal Stenosis Treated Conservatively: A Prospective Study

STUDY DESIGN: Prospective cohort study with questionnaire. PURPOSE: To compare the treatment outcome of nocturnal leg cramps in lumbar spinal canal stenosis (LSCS) patients on conservative treatment with historical surgical cohorts and to determine the sensitivity and specificity as well as positive predictive value and negative predictive value of knee flexion test suggested for LSCS patient. OVERVIEW OF LITERATURE: True prevalence of nocturnal leg cramps in LSCS patients as well as the clinical outcome of its surgical treatment have been reported. METHODS: A questionnaire suggested from previous study with minor modifications was used in this study. Clinical data was collected. Knee flexion test was performed in two groups. RESULTS: The prevalence of nocturnal leg cramp was higher in the LSCS group compared to the control group (second group). In LSCS patients, 38 (88%) had improved leg cramps after the conservative treatment, 3 (6.97%) remained unchanged, and 2 (4.6%) had worsened leg cramps. Of the 43 patients, 21 (48.8%) had no disturbance to their activities of daily living. In the LSCS group, the sensitivity and specificity of the knee flexion test was 53.5% and 33.3%, respectively. The knee flexion test in the LSCS group had a positive predictive value and a negative predictive value of 65.71% and 23.1%, respectively. CONCLUSIONS: Our study demonstrated that nocturnal leg cramps were significantly more frequent in LSCS patients than in the control group.

Comparison of Magnetic Resonance Imaging and Computed Tomography-Myelography for Quantitative Evaluation of Lumbar Intracanalar Cross-Section

PURPOSE: A comparison of MRI and computed tomography-myelography (CTM) for lumbar intracanalar dimensions. To compare the capability and reproducibility of MRI and CTM in measuring the cross-sectional morphology of intracanalar lesions of the lumbar spine. MATERIALS AND METHODS: MRI and CTM of lumbar disc levels from 61 subjects with various lumbar spinal diseases were studied. Dural area, dural anteroposterior (AP) diameter, dural right-left diameter, and thickness of the ligamentum flavum were measured by two orthopedic surgeons. Each section was graded by degree of stenosis. Absolute value and intra- and inter-observer correlation coefficients (ICC) of these measurements and the associations between MRI and CTM values were determined. RESULTS: Except for MRI determination of ligament flavum thickness, CTM and MRI and intra- and ICC suggested sufficient reproducibility. When measurements of dural area, dural AP diameter, and RL diameter were compared, values in CTM were significantly (p = 0.01-0.004) larger than those in MRI (CTM/MRI ratios, 119%, 111%, and 105%, respectively). As spinal stenosis became more severe, discrepancies between CTM and MRI in measurements of the dural sac became larger. CONCLUSION: Both CTM and MRI provided reproducible measurements of lumbar intracanalar dimensions. However, flavum thickness may be more accurately measured by CTM. Because the differences in the measurements between CTM and MRI are very slight and there is very little data to suggest that the precise degree of stenosis is related to symptoms or treatment outcome, the usefulness of the CTM over MRI needs to be confirmed in future studies.

Preliminary study on lumbar facet joint derived inflammatory factors in degenerative lumbar spinal canal stenosis / 中国矫形外科杂志

[Objective]To initially approach the role of lumbar facet joint derived inflammatory factors in degenerative lumbar spinal canal stenosis. [Methods]Totally 75 cases of degenerative lumbar spinal canal stenosis(LSCS)(n=41)and lumbar intervertebral disc herniation(LDH)(n=34) undergoing posterior lumbar spinal surgery in our department were evaluated in terms of the extent of degenerative arthrosis according to the Weishaup grading criteria.The grading of backleg pain,melosalgia and functional impairment were recorded.The excised lumbar facet joints were collected as species.The content of interleukin-1? and tumor necrosis factor-? in the species were determined by ELISA.[Results]There was no TNF-? detected in both of the two groups.More IL-1? was detected in degenerative lumbar spinal canal stenosis group than that in lumbar intervertebral disc herniation group.It was demonstrated that the content of IL-1? in the species increased as the degeneration of lumbar facet joint sharpened.IL-1?-positive cases in degenerative lumbar spinal canal stenosis group showed higher grading of backleg pain,melosalgia and functional impairment.[Conclusion]The cartilage of degenerative lumbar spinal canal produced more IL-1?.Lumbar facet joint derived inflammatory factors might be one of the reasons that cause backleg pain and melosalgia and functional impairment in degenerative lumbar spinal canal stenosis patients.

Preliminary study on lumbar spinal canal stenosis treated by microendoscopic unilateral approach and bilateral decompression / 中国矫形外科杂志

[Objective]To evaluate the clinical outcome of lumbar spinal canal stenosis treated by microendoscopic decompressive laminotomy with facet-preserving technique.[Method]Twenty-nine consecutive patients of posterior lumbar spinal canal stenosis were treated by microendoscopic unilateral approach and bilateral decompression with facet-preserving technique using the METRxTM microendoscopic spinal system.Moreover,operation time,blood loss,use of diclofenac suppositories,intra-and postoperative complications and Imaging evaluation were investigated.Clinical outcomes were evaluated by the Japanese Orthopaedic Association scoring system for lumbar disease.[Result]Twenty-four patients were followed up for 7 to 24 months,mean 15.3 months.Mean preoperative JOA scores were(14.5?3.7),and postoperative JOA scores were(22.4?2.3).The mean recovery rate was 54.7%.Operation time was 94.2 minutes for one level decompression,and mean blood loss was 56.4 ml.The use of diclofenac suppositories was average 0.37 times.Intra and postoperative complications were due to one misjudgment of the vertebral level,one dural tears.Intraoperative endoscopic photograph showed satisfactory decompression of dural sac and contralateral nerve root from ipsilateral laminotomy could be performed completely.Postoperative CT and 3DCT showed bilateral decompression from ipisilateral laminotomy and revealed no damage of the facet joints.[Conclusion]Microendoscopic unilateral approach and bilateral decompression with facet-preserving technique using the METRxTM microendoscopic spinal system minimizes resection of the pathologic compression tissues and is a safe,effective and ideal decompressive method for lumbar spinal canal stenosis.

Two Cases of Acupuncture Treatment for Lumbar Spinal Canal Stenosis Due to Hemodialysis-related Spondyloarthropathy / 日本東洋医学雑誌

One of the complications in patients on long-term hemodialysis is spondyloarthropathy resulting from amyloidosis due to abnormal accumulation of β2-microglobulin. With deposition of β2-microglobulin in soft tissues, such as ligaments and joints, destruction of bones and cartilages begins at the site of ligament attachment and proceeds with the accompanying inflammatory reaction, fibrosis and ligament thickening. The soft tissue proliferative lesion and destruction of bones and cartilages produce spinal canal stenosis and, ultimately, compression of the spinal cord and cauda equina, to give rise to various clinical symptoms.<br>We tried acupuncture treatment on two patients with lumbar spinal canal stenosis due to hemodialysis-related spondyloarthropathy who presented with neurogenic intermittent claudication, and evaluated its effects. Acupuncture treatment involved placement of acupuncture needles chiefly in the stenotic region, once weekly, for about three months. Marked improvement was obtained regarding claudication distance and JOA score in patient number one, who had radicular type intermittent claudication. Slight improvement of claudication distance and improvement of JOA score (particularly relief of pain) were obtained in patient number two, who had mixed type intermittent claudication. These results suggest that acupuncture treatment might be effective for dialysis patients with lumbar spinal canal stenosis associated with hemodialysis-induced spondyloarthropathy.

The Effect of the Electrical Aoupuncture at Pudendal Nerve for Intermittent Claudioation of the Lumbar Spinal Canal Stenosis / 全日本鍼灸学会雑誌

We studied the clincal effect of the electrical acupuncture at pudendal nerve in four cases of lumbar spinal canal stenosis. The experimental effect of the direct electrical stimulation to the pudendal nerve on the blood flow of the sciatic nerve evaluated by Laser-Doppler flowmetry in anesthetized rats. Electrical acupuncture at pudendal nerve resulted in the improvement of the gait distance of all four cases. The specific effect of the electrical acupuncture at pudendal nerve was found in one case who did not show any improvement by the acupuncture at the intervertebral joint points. On one hand, the direct electrical stimulation to rats pudendal nerve resulted in the increase of the sciatic nerve blood flow, which were not evoked by administration of atropine. These results suggest that the electrical acupuncture at the pudensal nerve may be effective for the intermittent claudication of the lumbar spinal canal stenosis. The increased blood flow of the sciatic nerve may play one of the important roles in the effect via autonomic nervous system.

A Clinical Study of Acupuncture Therapy for Lumbar Spinal Canal Stenosis / 日本温泉気候物理医学会雑誌

We executed an acupuncture therapy to 62 lumbar spinal canal stenosis cases who were diagnosed by CT, MRI photo state and clinical symptom and examined the result.<br>The 36 men and 26 women in this study had a mean age of 67.3 years.<br>An acupuncture was executed by aiming to give an effect to the soft tissues and a blood circulation around the area where the stenosis was recognized then pierced facet joint closely and deeply and gave an electric acupuncture stimulus.<br>14 cases were very good and 17 cases had good results according to the JOA score. No cases worsened.<br>We concluded an acupuncture treatment was effective for treating lumbar spinal canal stenosis.