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Objective:To explore any effect of pulsed electromagnetic field (PEMF) stimulation on intervertebral disc degeneration (IDD).Methods:Forty Sprague-Dawley rats were randomly divided into a control group, an IDD model group, a PEMF group and an observation group. An IDD model was induced in all except those in the control group. Both the PEMF and observation groups were given PEMF stimulation, while the latter was additionally injected with the A2AR agonist CGS-21680. Eight weeks after the modelling any pathological changes in the morphology of the rats′ intervertebral disc tissues were evaluated using saffron solid green staining. The expression of A2AR, cyclic adenosine phosphate (cAMP), protein kinase A (PKA), cysteine aspartate proteolytic enzyme-3 (Caspase-3), type II collagen (COL-II) and matrix metalloproteinase-3 (MMP3) in the intervertebral discs were evaluated.Results:The nucleus pulposus had shrunk, while fibrous tissues and chondrocytes had increased in the IDD model group. In the observation group the nucleus pulposus was intact and of basically normal shape. A2AR mRNA and protein levels were higher in the intervertebral disc tissue of the model group than among the control group, on average, while the levels in the observation group were significantly higher than in the other groups. In the PEMF and observation groups cAMP and PKA mRNA were significantly higher than in the IDD model group. The p38 MAPK and P-P38 MAPK levels of the IDD model group and its average P-P38 MAPK/p38 MAPK ratio were significantly higher than in the control group. In the PEMF and observation groups those indices had decreased to varying degrees, with those of the observation group significantly lower than among the model and PEMF groups on average, except for the p38 MAPK values. Caspase-3 and its mRNA were significantly higher in the model group than in the control group, on average, and those values were significantly lower in the PEMF and observation groups than in the IDD model group. The average MMP3 contents of the IDD model group had increased significantly compared with the control group, while the Col-Ⅱ level had decreased significantly. Compared with the IDD model group, the MMP3 level had decreased but Col-Ⅱ expression had increased in both the PEMF and observation groups, with significant differences between the IDD model and observation groups.Conclusions:The activation of the p38 MAPK signaling pathway by inflammatory factors to induce apoptosis is one of the important reasons for the aggravation of IDD lesions. PEMF combined with A2AR agonists can activate the A2AR/cAMP/PKA signaling pathway, inhibit p38 MAPK phosphorylation, reduce apoptosis of nucleus pulposus cells, and relieve IDD damage.
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Objectives:To explore the clinical efficacy of applying the accurate foraminoplasty technique with visualized chisel under full-visualized spinal endoscopy(FVSE)in the treatment of lumbar disc herniation(LDH).Methods:The clinical data of 143 patients with single-segment LDH undergone operative treatment under FVSE in our hospital between July 2020 and December 2022 were retrospectively analyzed.63 cases were treated with the accurate framinoplasty technique with visualized chisel(Chisel group),consisting of 37 males and 26 females,aged 45.3±15.1 years(range,19-68 years),and body mass index(BMI)was 22.3± 1.8kg/m2(range,19.2-25.6kg/m2);Operative segment:L2/3 in 8 cases,L3/4 in 15 cases,L4/5 in 25 cases,L5/S1 in 15 cases;LDH anatomical classification:20 cases of bulging type,22 cases of protruding type,12 cases of prolapsing type,and 9 cases of free type;LDH location classification:10 cases of central type,21 cases of paracentral type,24 cases of foraminal type,and 8 cases of extreme lateral type.The other 80 cases were treated with trepan technique(Trephine group),consisting of 46 males and 34 females,aged 43.8±14.1 years(range,19-68 years),BMI was 21.5±1.6kg/m2(range,19.2-24.1kg/m2);Operative segment:L2/3 in 9 cases,L3/4 in 17 cases,L4/5 in 30 cases,and L5/S1 in 24 cases;LDH anatomical classification:23 cases of bulging type,31 cases of protruding type,19 cases of prolapsing type,7 cases of free type;LDH location classification:13 cases of central type,27 cases of paracentral type,29 cases of foraminal type,and 11 cases of extreme lateral type.The operative time,total intraoperative bleeding,number of fluoroscopies,and hospitalization time were recorded and compared between the two groups.The intervertebral foraminal area before operation,at 3d after operation and final follow-up,visual analogue scale(VAS)score,Oswestry disability index(ODI),and Japanese Orthopedic Association(JOA)score before operation,at postoperative 3d,1 month,6 months,and final follow-up were recorded and compared between the two groups.The clinical efficacy was assessed by MacNab criteria at the final follow-up.Results:The operative time,total intraoperative bleeding and number of fluoroscopies were 84.6±14.3min,23.1±8.3mL and 2.9±1.6 times in the chisel group and 86.6±15.1min,32.2±6.4mL and 5.6±1.0 times in the trephine group,and the intraoperative bleeding and number of fluoroscopies in the chisel group were less than those in the trephine group(P＜0.05),while no significant difference was there in the operative time between the two groups(P＞0.05).143 patients were followed up for 9-20 months.The VAS scores,JOA scores and ODI at 3d,1 month,6 months and the final follow-up of both groups showed significant improvements compared with the preoperative data,respectively(P＜0.05),and there was no statistical difference between the two groups at the same time points(P＞0.05).The intervertebral foramina area at 3d postoperatively and at the final follow-up in both groups increased than that before surgery(P＜0.05),and the rate of change in the intervertebral foramina area at 3d postoperatively and at the final follow-up in the trephine group was greater than that in the chisel group(P＜0.05).At the final follow-up,according to the MacNab standard,chisel group was excellent in 43 cases,good in 18 cases,moderate in 2 cases,and poor in 0 case,with an excellence and good rate of 96.8％,while the trephine group was excellent in 57 cases,good in 20 cases,moderate in 3 cases,and poor in 0 case,with an excellence and good rate of 96.3％.There was no statistical difference between the two groups in terms of excellent and good rate according to MacNab criteria(P＞0.05).Conclusions:The clinical efficacy of accurate foraminoplasty technique with visualized chisel is similar to foraminalplasty with trephine under FVSE,but foraminoplasty technique with visualized chisel reduces the number of fluoroscopies and bleeding volume.
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BACKGROUND:None of the current treatment strategies has been focused on relieving or reversing the disk degeneration process after degenerative disc diseases. In recent years, more and more scientists try to treat degenerative disc diseases using stem cel therapy. OBJECTIVE:To explore the research status and prospects of stem cel therapy for degenerative disc diseases. METHODS: A computer-based online search of PubMed database between January 2004 and December 2014was performed to search related articles with the key words of “stem cel, intervertebral disk” in English. Literatures related to stem cel therapy for degenerative disc diseases were selected; in the same field, the articles published lately in authoritative journals were preferred. RESULTS AND CONCLUSION: A total of 342 articles were primarily selected, and 43 articles were involved in result analysis according to inclusion criteria. Stem cel therapy is a newly treatment for degenerative disc diseases. Cels appropriate for stem cel therapy include embryonic stem cels, induced pluripotent stem cels, mesenchymal stem cels, human umbilical cord mesenchymal stem cels and chondrocytes or nucleus pulposus cels. Although cel leakage, intervertebral disc infection and tumorigenesis are the main chalenges, stem cel therapy for degenerative disc diseases is promising in the future.
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BACKGROUND:At present, the clinical treatment of lumbar disc degeneration mainly includes conservative treatment, traditional surgery and minimal y invasive surgery. The therapeutic purpose is to relieve symptoms, but the long-term effect is not very satisfactory. Therapeutic methods focusing on biological functional recovery have been concerned gradual y, but the clinical application is far in sight. OBJECTIVE:To review the advances in the treatment of lumbar disc degeneration regarding tissue-engineered repair and biomechanics. METHODS:PubMed database was searched by the first author for relevant articles published before December 2014 using the keywords of“intervertebral disc degeneration, clinical treatment, biological treatment, tissue engineering, biomechanics, repair, progress”in English. A total of 100 articles were searched initial y and final y, 40 articles were included in result analysis. RESULTS AND CONCLUSION:Although the therapeutic schemes are varied, the treatment of intervertebral disc degeneration is a great chal enge for clinicians and basic researchers. Currently there is no perfect clinical treatment, and indications corresponding to various therapies should be paid attention as wel as long-term fol ow-up evaluation. For various reasons, the biological treatment for intervertebral disc degenerative disease is becoming more and more popular, providing a promising prospect for the treatment of intervertebral disc degeneration. So far, large amounts of data have been obtained from animal experiments, but there are stil many problems to be solved. Other chal enges also involve the al aspects of general tissue engineering methods, such as cel s, cytokines and scaffolds. In these studies, the nucleus pulposus tissue engineering based on the combination of heparin-functionalized chitosan hydrogel, cytokines and stem cel s exhibits a promising prospect.