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Objective To investigate the clinical efficacy of one-stage posterior internal fixation with pedicle screw and anterior debridement of bone grafting through the extraperitoneal approach the medial edge of rectus abdominis in treating severe lumbosa-cral tuberculosis .Methods 17 cases with L4-S1 tuberculosis were treated by internal fixation with pedicle screw ,anterior debride-ment through the extraperitoneal approach the medial edge of rectus abdominis ,and application of allogenic bone from January 2008 to December 2011 .All patients performed X-ray ,CT and MRI examinations before surgery .L5-S1 were involved in 8 cases ,L4-5 were involved in 6 cases ,and L4-S1 were involved in 3 cases;unilateral psoas abscess was found in 6 cases ,while bilateral psoas ab-scess was found in 3 cases ;Among the 17 cases ,8 cases had intraspinal invasion ,and 5 cases were combined with neurological dys-functions ,however ,according to Frankel grade ,4 cases were grade D ,and 1 case was grade C .Regular anti-tuberculosis treatment was given for more than 2 weeks before surgery ,and regular supportive treatment and anti-tuberculosis treatment were given for 9-12 months after surgery .As for regular follow-up(3 ,6 ,9 ,and 12 months after surgery ,and every 6 months later on) ,patients had examinations including ESR and X-ray to evaluate the tuberculosis activity and the condition of bone graft fusion ;while accord-ing to Frankel grade of nerves function ,changes in nerve function before and after surgery were evaluated in patients ,and changes of lumbosacral angle were also comparatively studied before and after surgery .Results There were no great vessel injuries and no nerve injuries except one case who had intraoperative ureteral injury which was repaired in time .The 17 patients were all followed up for 10-36 months(18 months average) ,and all reached clinical healing without complications such as tuberculous peritonitis ,e-rectile dysfunction and retrograde ejaculation .During the follow-up period ,there were no tuberculosis recurrence ,no loosening of in-ternal fixation ,and no break of rod and nail ;the grafted bones were fused in all patients with an average time of 7 .5 months ;accord-ing to Frankel grade of nerves function ,only one patient was grade D ,while the other four cases recovered to grade E .The lumbosa-cral angle of patients was corrected from 23 .8° ± 4 .0°(19 .8°-27 .8°) before surgery to 29 .1° ± 3 .6°(25 .5°-32 .7°) after surgery , and the change was statistical significance(P<0 .05) .Conclusion The one-stage posterior internal fixation with pedicle screw and anterior debridement of bone grafting through the extraperitoneal approach inside of rectus abdominis is a safe and effective meth-od ,which can thoroughly remove the focus ,reconstruct the lumbosacral stability ,and prevent the loosening of bone grafting .
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BACKGROUND:Currently, transplantation of bone marrow mesenchymal stem cel s into the spinal cord is very limited to the recovery of animals fol owing spinal cord injury. Methylcobalamin is a common drug for the treatment of neurological diseases and injuries, but its effects on bone marrow mesenchymal stem cel s are unclear. OBJECTIVE:To study the feasibility of bone marrow mesenchymal stem cel s differentiating into neuron-like cel s induced by methylcobalamin in vitro and to observe the cel viability and proliferation of differentiated cel s. Methods:Rat bone marrow mesenchymal stem cel s were isolated, cultured and purified by density gradient centrifugation and adherent culture. The fourth to fifth generation of bone marrow mesenchymal stem cel s were treated for 24, 48 and 72 hours with different concentrations (25, 50 and 100 mg/L) of methylcobalamin. The morphological changes and cel growth were continuously observed under an inverted phase constract microscope. The viability of induced cel s was detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. The expressions of Nestin and neuron-specific enolase were identified by reverse transcription PCR and western blot. RESULTS AND CONCLUSION:Most of bone marrow mesenchymal stem cel s could differentiate into neuron-like cel s after induction with methylcobalamin. The expressions of Nestin and neuron-specific enolase were up-regulated after 48 hours of methylcobalamin treatment at different concentrations, especial y after treatment with 100 mg/L methylcobalamin. Similarly, the expressions of Nestin and neuron-specific enolase could be increased significantly after 100 mg/L methylcobalamin treatment for 24, 48 and 72 hours, especial y for 72 hours. It is indicated that methylcobalamin can induce bone marrow mesenchymal stem cel s differentiating into neuron-like cel s, and the optimal concentration of methylcobalamin is 100 mg/L.
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BACKGROUND: Posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fractures, which needs surgery treatment. However, the choice of approach method is an argument. OBJECTIVE: To explore the therapeutic effect of transpedicular decompression and pedicle fixation for the treatment of obsolete thoracolumbar vertebral fractures combined with kyphosis deformity.METHODS: A total of 23 cases with obsolete thoracolumbar fractures combined with kyphosis admitted at the Department of Spinal Surgery, First Affiliated Hospital, University of South China were selected, including 14 males and 9 females, aged 18-60 years, mean aged 36 years; The JOA scores of patients were (11.02±1.24) points prior to operation, with (37.43±3.76)° Cobbangel. All patients were treated by transpedicular decompression and pedicle fixation. The functional recovery of lumbar vertebra,bone healing, as well as the complications was compared before and after operation.RESULTS AND CONCLUSION: All patients were followed-up for 6-28 months with an average of 12.5 months. The lumbar vertebra function and kyphosis deformity was notably improved postoperatively. After treatment, the JOA score and Cobb angle was (14.04±2.12) points and (11.02±3.58)°, which was obviously different than that of preoperative (P<0.05). The surfaces of cut bone were healed at 6 months after operation, without complications of pseudoarticulation formation or correction loss. The results suggested that transpedicular decompression and pedicle fixation can achieve a satisfactory result in deformity correction and neurological decompression, which can precipitate the functional recovery.
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BACKGROUND:Techniques of antedor cervical discectomy and interbody fusion have achieved good clinical outcomes since Robinson and Smith first introduced it in 1955.Currently,microendoscopic approaches have resulted in good clinical effectiveness in treating cervical spondylosis.Cage has also been used widely in the clinic.OBJECTIVE:To find a minimally invasive method that uses microendoscopic technique and Cages to treat cervical spondylosis by anterior approach.DESIGN,TIME AND SETTING:A retrospective case analysis was performed at the Department of Spinal Surgery,First Affiliated Hospital of University of South China between January 2003 and July 2008.PARTICIPANTS:A total of 25 patients with cervical spondylosis,15 males and 10 females,averaging 39 years of age (range,33-58 years old),who received treatments at the Department of Spinal Surgery,First Affiliated Hospital of University of South China were included in this study.Each of them had unilateral limb pain,numbness or weakness in varying degrees.MRI image showed one-level cervical disc degeneration in 20 patients and two levels in 5 patients.METHODS:Twenty-five patients underwent anterior cervical microendoscopic discectomy and interbody fusion using carbon fiber reinforced polymer (CFRP) Cage.Surgical techniques,neurological outcomes and complications were retrospectively analyzed.The postoperative treatments were just like the conventional approaches.MAIN OUTCOME MEASURES:Improvements in neurological symptoms were assessed using the Japanese Orthopedic Association (JOA) grading system.Postoperative imaging data including lordosis and fusion condition were examined.RESULTS:All patients received treatments successfully.The mean surgical time was 140 minutes (range,80 to 225 minutes).The hospital stay averaged 7 days (range,6 to 10 days).Patients' neurological statuses improved to varying degrees according to the JOA grading system:7.5 pre-operative (range,4 to 9 points) to 12 post-operative (range,8 to 16 points),with the mean improvement rate of 45.6%.All cases were followed up and the mean follow-up period was 18 months (range,6 to 27 months).Postoperative images showed solid bone fusion without implant migration.No vascular injury and infection occurred.Graft collapse was found in 2 patients,and transient hoarse voice in 1 patient.No other complications were found.CONCLUSION:Anterior microendoscopic cervical discectomy and interbody fusion with CFRP Cage in treatment of cervical spondylosis have the advantages of minimal invasion,sufficient decompression,and satisfactory bone fusion,resulting in a significant relief of patients' preoperative clinical symptoms.
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[Objective]To evaluate the effects of clinical application of B-twin and cage for treatment of lumbar degenetative disease. [Methods]From June 2004 to December 2007,a total of 112 patients with lumbar degenetative disease who underwent posterior lumbar interbody fusion(PLIF) with cage and 79 patients who underwent PLIF with B-twin were enrolled. Sixty patients were selected and randomly divided into two groups(30 in each group). The clinical curative effect, the rate of bone graft fusion, the intervertebral space height and complications in both groups were analyzed and compared.[Results]In the B-twin group, the treatment was a minimally invasive technique, which offered a satisfactory effect with good bone graft fusion, fewer complications and sooner recovery, but the cost was higher than that in cage group. The cage treatment was an open sugery for fenestration operation. It had more complications but more sufficient decompression and lower cost. The rates of bone graft fusion between the 2 groups were not different in statistics.[Conclusion]The B-twin and cage techniques are two treatmens for interbody fusion of lumbar degenetative disease. Both have advantages and clinical application value. It should be choosen according to different specific conditions in the clinical practice.