Study on anatomical parameters of adult lumbar intervertebral disc and endplate based on CT / 中国骨伤

OBJECTIVE@#To provide basic data for clinical application and individualized design of lumbar disc prostheses by measuring the anatomical parameters of lumbar intervertebral discs and endplates in healthy adults with CT three-dimensional reconstruction technology.@*METHODS@#A retrospective analysis was performed on 200 males and 200 females with normal lumbar spine who were admitted to the imaging center or outpatient department of the Second Affiliated Hospital of Xinjiang Medical University from September 2019 to December 2020. The age ranged from 20 to 60 years old, with an average of (40.61±11.22) years old. The measurement segment was L1-S1 intervertebral disc, and the measurement indicators included the axial anteroposterior diameter and transverse diameter of the intervertebral disc, sagittal anterior, middle and posterior height, coronal left and right height, intervertebral space angle, and transverse and anteroposterior diameters of the upper and lower endplates of each vertebral body.@*RESULTS@#①In terms of gender, the anatomical parameters of L1-S1 disc axial diameter, transverse diameter, sagittal anterior, middle and posterior height, left and right coronal height and intervertebral space angle were all higher in males than in females(P<0.05), and the anatomical parameters of upper and lower endplates of L1-S1 vertebral body were higher in males than in females(P<0.001). ②In comparison of sagittal height of anterior, middle and posterior intervertebral discs, the sagittal height of L1-L5 intervertebral discs was middle-high > anterior-high > posterior-high(P<0.001), while that of L5S1 intervertebral disc was anterior-high > middle-high > posterior-high (P<0.001). ③In the comparison of left and right coronal height, there was no statistical significance in the left and right coronal height of L1-S1 disc between male and female(P>0.05). ④The L1-S1 intervertebral spaces angle between male and female increased with the increase of vertebral body segments. ⑤The anterior and posterior diameters and transverse diameters of upper and lower of L1-S1 vertebral bodies endplates were height in males than in females(P<0.001).@*CONCLUSION@#The results suggest that gender differences should be considered in the design of adult lumbar disc prostheses. The anatomical parameters of the lumbar intervertebral disc varied with the increase of the vertebral body sequence, suggesting that different anatomical parameters of the intervertebral disc should be considered in the design of the artificial intervertebral disc, and the changes in the height of the sagittal position suggest that the design of the intervertebral disc should be wedge-shaped.

Evaluation of Fenestration and Discectomy for Prolapsed Lumbar Intervertebral Disc by Minimally Invasive Procedure

Background: Prolapsed lumbar intervertebral disc is one of the most common problems encountered in medical practice. In orthopaedic practice patients having lesions of lumbosacral region causing low back pain with sciatica are not uncommon since the begdatainning of recorded history. To evaluate the fenestration and discectomy for prolapsed lumbar intervertebral disc by minimally invasive procedure.Material & Methods:This prospective observational study was conducted at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh during July 2015 to June 2017. A total of 31 patients with prolapsed lumbar intervertebral disc were included for the study. A 3cm incision was made in midline on back centering the desired space of the spine. The analysis was done according to the standard statistical analysis system. Prior to commencement of this study, the research protocol was approved by the Institutional Review Board of ethics of National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR).Results:Mean age was (35.98 ± 8.50) years with the range from 17 to 50 years. Out of 31 patients, 26 (83.87%) patients were male and 05(16.12%) were female. Out of 31 patients 01(03.22 %) had prolapse at the level of L3-L4, 23(74.19%) had at the level of L4-L5 and 07(22.58%) had at the level of L5-S1. In this series the most common causes of muscle weakness in EHL. Out of 31 patients, 22 (70.96 %) patients had weakness in EHL. 08 (25.80%) cases had weakness in FHL and both muscle weakness in 01 (3.22%). Out of 31 patients, 30 (96.78%) patients had preoperative sensory deficit and 03(09.67%) patients had postoperative sensory deficit, which is statistically significant. In preoperative period, moderate pain in 27(83.87%) patients, severe pain in 04(12.90%) patients. In postoperative period had no pain in 22(70.96%) patients, mild pain was noted in 08(25.08%) patients, moderate pain in 01(03.22%) patient. 20(64.51%) patients had para spinal muscle spasm in the preoperative period. Postoperative mean SLR was 81.94 ± 4.774 degree and range was 70?-90?, which was significantly improved. 29 (93.54%) patients had normal spine movement and 02 (06.45%) patients had restricted movement after 3 months of follow up. The minimum period of duration for follow up was 3 months and maximum duration of follow up was 12 months..Conclusions:By considering all aspects fenestration and discectomy is a better technique in the context of our country with the advantage of less tissue injury, good spinal function, smooth patient recovery, improve working status with early rehabilitation and maintain clinical efficacy.

Mechanism of external application of TCM in treating lumbar disc herniation / 国际中医中药杂志

External treatment of Traditional Chinese Medicine (TCM) is a common treatment for lumbar disc herniation, which mainly includes fumigation and washing of TCM, and hot ironing therapy. It can cooperate with oral administration of TCM, Tuina, acupuncture and other therapies to play a synergistic effect and enhance the efficacy. External application of TCM in the treatment of lumbar intervertebral disc herniation is effective with long duration, easy-operated and safe It has showed curative effect in alleviating clinical symptoms and improving lumbar function. Its mechanism mainly includes regulating nerve inflammatory reaction, improving hemorheology and exerting analgesic effect.

Research progress in mechanism of Chinese herbal compounds and monomers in delaying lumbar intervertebral disc degeneration / 中国中药杂志

Traditional Chinese medicine has unique advantages in the treatment of degenerative bone and joint diseases, and its widely used in clinical practice. In recent years, many scholars have conducted a large number of basic studies on the delay of intervertebral disc degeneration by herbal compound and monomeric components from different perspectives. In order to further elucidate its mechanism of action, this paper summarizes the in vivo and in vitro experimental studies conducted at the level of both herbal compound and single components, respectively, in order to provide references for the basic research on the treatment of lumbar intervertebral disc degeneration by Chinese medicine. A summary shows that commonly used herbal compound prescriptions include both classical prescriptions such as Duhuo Jisheng Decoction, as well as clinical experience prescriptions such as Yiqi Huoxue Recipe. Angelicae Sinensis Radix, Chuanxiong Rhizoma, Rehmanniae Radix Praeparata, Achyranthis Bidentatae Radix, and Eucommiae Cortex were used most frequently. Tonic for deficiency and blood stasis activators were used most frequently. The most utilized monomeric components include icariin, ginsenoside Re, salvianolic acid B and aucubin. The main molecular mechanisms by which herbal compound and monomeric components delay of lumbar intervertebral disc degeneration include improving the intervertebral disc microenvironment, promoting the synthesis of aggregated proteoglycans and type Ⅱ collagen in the intervertebral disc, reducing the degradation of the extracellular matrix, and inhibiting apoptosis in the nucleus pulposus cells, etc. The main signaling pathways involved include Wnt/β-catenin signaling pathway, MAPK-related signaling pathway, mTOR signaling pathway, Fas/FasL signaling pathway, PI3 K/Akt signaling pathway, NF-κB signaling pathway, JAK/STAT signaling pathway, and hedgehog signaling pathway, etc.

Research on community promotion and application of single acupoint electroacupuncture therapy for lumbar intervertebral disc herniation / 中国针灸

OBJECTIVE@#To observe the clinical effect of single acupoint [Yaotu (extra)] electroacupuncture (EA) therapy on lumbar intervertebral disc herniation (LIDH) and its promotion and application in community medical institutions.@*METHODS@#This research adopted a three-level promotion model, and used multi-center collaboration topics as a platform. A total of 240 patients with LIDH were divided into a group A (top three hospital, 80 cases, 3 cases dropped off), a group B (secondary hospital, 80 cases, 8 cases dropped off), and a group C (community health center, 80 cases, 7 cases dropped off). All groups were treated with EA at a single acupoint [Yaotu (extra)] under the guidance of a unified experimental protocol. The EA was given 60 min each time and performed 3 times a week for a total of 2 weeks. The changes of visual analogue scale (VAS) scores of three groups before and after each treatment were compared, and the clinical efficacy was evaluated.@*RESULTS@#Compared with before each treatment, the VAS scores of three groups after each treatment decreased (@*CONCLUSION@#The single acupoint EA therapy has a significant effect in the treatment of LIDH, can quickly relieve the pain symptoms, and has the characteristics of simple operation and easy control, suitable for promotion and application in primary hospitals.

Advances in pathogenesis of chronic prostatitis/chronic pelvic pain syndrome / 中华泌尿外科杂志

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disease in men. In recent years, it has become younger, which seriously affects the patients＇quality of life. A deep understanding of the pathogenesis of CP/CPPS will help the choice of treatment. Its pathogenesis is not only related to immune factors, but also related to local microcirculation disorders of the prostate, endocrine hormone imbalance, adjacent gut microbes and compression of lumbar intervertebral disc, but it has not been fully elucidated. Therefore, this article aims to review the pathogenesis of CP/CPPS and provide directions for its diagnosis and treatment.

Effect of yaobishu on protein expression of aquaporin 1 and aquaporin 3 in nucleus pulposus of the degenerated lumbar intervertebral disc in a rabbit / 中国组织工程研究

BACKGROUND: The aging and lesions of the intervertebral disc are closely related to the lack of nutritional blood supply to the disc. Aquaporin plays an important role in the nutritional supply to the intervertebral discs, but the specific mechanism has not been fully defined. OBJECTIVE: To study the mechanism of Yaobishu on degenerated intervertebral disc in rabbits based on the changes of aquaporin (AQP) 1 and AQP3 protein expression. METHODS: Thirty-six New Zealand white rabbits were randomly divided into model group, low-dose Yaobishu group and high-dose Yaobishu group. Animal models of lumbar intervertebral disc prolapse were prepared through an injection of normal saline into L4/5 and L5/6 segments. The model group was intragastrically given normal saline 5 mL/kg per day, the low-dose group was intragastrically given Yaobishu 5 mL/kg per day, and the high-dose group was intragastrically given Yaobishu 10 mL/kg per day, twice a day, for 21 days. After 6 weeks of treatment, the intervertebral discs were taken for anatomical and histological observation using hematoxylin-eosin staining. Expression of AQP1 and AQP3 in the nucleus pulposus at protein and mRNA levels was quantified by RT-PCR and western blot assay. RESULTS AND CONCLUSION: In all the three groups, the annulus fibrosus was destroyed, abnormal cartilage tissue appeared, and the nucleus pulposus was reduced in number. Severest degeneration of the intervertebral disc was found in the model group, followed by the low-dose Yaobishu and high-dose Yaobishu groups in turn. The expression of AQP1 and AQP3 mRNA and protein in the high-dose Yaobishu group and low-dose Yaobishu group increased significantly after 6 weeks of treatment (P 0.05). There were significant differences in the expression of AQP1 and AQP3 mRNA and protein among the three groups (P < 0.05). Therefore, Yaobishu may alleviate the degeneration of the rabbit intervertebral disc by increasing the expression of AQP1 and AQP3.

Intravoxel incoherent motion MR imaging in the quantitative evaluation of lumbar disc degeneration / 西安交通大学学报(医学版)

Objective: To quantitatively evaluate the changes of diffusional and perfusion of degenerative water molecules in lumbar inervertebral disc by multiple b-value voxel incoherent motion imaging. Methods: We selected 60 patients (34 males and 26 females) with low back pain or sciatica from The First Affiliated Hospital of Xi'an Jiaotong University. The subjects underwent lumbar MRI sagittal T2WI and median sagittal multiple b-value weighted imaging. We graded the L1-S1 disc according to the Pfirrmann grading standards, and measured the ADCslow, ADCfast, f values of the nucleus pulla, and the anterior and posterior edges of the annulus fibrosus. We compared the mean values of ADCslow, ADCfast, f at the anterior and posterior edges of nucleus pulposus and annulus fibrosus and analyzed the correlation analysis between them and the grade of degeneration. Single factor analysis of variance combined with SNK test was used in the statistics. Results: A total of 300 discs were measured and the statistical results showed that: ① The mean value of the ADC of the nucleus pulposus of each grade of the lumbar disc decreased with the increase of the grade. Although there was no significant difference between grade and grade Ⅱ, grade and grade , there were statistically significant differences between the other grades (P0.05). Conclusion: The quantitative measurement of nucleus pulposus ADCslow based on IVIM is a potential and more sensitive quantitative magnetic resonance method for evaluating early degeneration of lumbar disc.

Effects of Gravity Loading Countermeasure Garment on Degeneration of Lumbar Intervertebral Disc in Microgravity Environment / 医用生物力学

Objective To analyze the biomechanical effects of gravity loading countermeasure garment on human lumbar intervertebral disc in microgravity environment. Methods Based on CT images of a healthy adult volunteer, the finite element model of L4-5 vertebrae was established. Through the empty load and 400 N axial loading for 4 hours on lumbar finite element model, the biomechanical effect of the non-intervention and gravity loading countermeasure garment were simulated respectively in microgravity environment. Results The central pore pressure, radial displacement and water content of the human lumbar intervertebral disc increased with time in microgravity environment. In the case of wearing gravity loading countermeasure garment, the central pore pressure, axial stress, radial displacement and water content of the lumbar intervertebral disc were reduced after 72 hours of cyclic loading compared with the non-intervention group. Conclusions Wearing gravity loading countermeasure garment can help astronauts to prevent the adverse effects of microgravity on the spine to some extent in microgravity environment.

Clinical Analysis of Primary Thoracic and Lumbar Intraspinal Tumors Misdiagnosed as Lumbar Intervertebral Disc Herniation: Report of 19 Cases

Introduction: Intraspinal tumors were primary and secondarytumors that occurred in the spinal cord, nerve roots, meningesand the tissue of the wall of vertebral canal. Study aimedto analyze the misdiagnosis causes of intraspinal tumorsmisdiagnosed as lumbar intervertebral disc herniation, and toreduce the rate of clinical misdiagnosis.Material and Methods: Clinical data of 19 patients withintraspinal tumors misdiagnosed as lumbar intervertebral discherniation were retrospectively analyzed, and the respectivecharacteristics, essentials for diagnosis and differentialdiagnosis of the two different kinds of diseases weresummarized. The misdiagnosis causes were analyzed, and theprevention measures were put forward.Results: All the misdiagnosed patients’ data on MRI werecollected, and then they received operative treatment.Histological diagnosis results showed that there were 13cases of schwannomas, 3 cases of meningiomas, 2 casesof ependymomas, and 1 case of angiomyolipoma. In 1~36months’ follow-up, pain of all the patients was alleviated.Eighteen patients were healed, and only one patient still feltnumbness at left hip and left leg. No patient reoccurred ordied.Conclusion: Though there were similarities in early clinicalmanifestations between intraspinal tumors and lumbarintervertebral disc herniation, these two different kinds ofdiseases can be identified by collecting the case historydetailedly, performing physical examination carefully, andchoosing the imaging examination appropriately to avoidmisdiagnosis.

Reproducibility of intravoxel incoherent motion in body DWI technique for normal lumbar disc scanning / 实用放射学杂志

Objective To investigate the reproducibility of magnetic resonance intravoxel incoherent motion in body diffusionG weighted imaging (IVIMGDWI)for normal lumbar disc scanning.Methods 50 healthy volunteers were enrolled with informed consent,30 males and 20 females,2 5.20±2.04 years old.Using 3.0T MR on the lumbar spine,the sagittal T1 WI,the sagittal,axial T2 WI and sagittal IVIMGDWI sequences were scanned once,then the second sagittal IVIMGDWI sequence was scanned after 4 hours.The IVIMGDWI sequence used 10 b values (0,10,20,40,60,80,100,200,400,600 s/mm2 ).The discs were graded according to the Pfirrmann grading standard.The ADCfast ,ADCslow ,and f values of each intervertebral disc were measured by two doctors at the postGprocessing workstation.Paired tGtest was used to analyze whether there was a difference between the two scans.The intraGgroup correlation coefficient (ICC)was used to analyze the consistency of the ADCfast ,ADCslow ,and f values of the two acquisitions (P＜0.05)and the consistency of the ADCfast ,ADCslow,and f values between the different doctors (P＜0.05).The IVIMGDWI imaging was evaluated to measure the repeatability of normal lumbar discs. Results Of the 50 healthy volunteers,230 intervertebral discs matched the criteria(Pfirrmann gradeⅠandⅡ).The ADCslowvalue between the two scans was significantly different (t＝2.460,P＜0.05),and the differences in ADCfast and f values were not significant (t＝－0.418,1.273,P＞0.05). The consistency of ADCfast ,ADCslow ,and f values for the two scans were generally (ICC＝0.478,0.306,0.316,P＜0.05 ).Different observers had good consistency in the measurement of interverG tebral disc ADCfast ,ADCslow,and f values (ICC＝0.929,0.909, 0.9 1 1 ,P＜0.05).Conclusion The IVIMGDWI imaging has good consistency in the measurement of normal lumbar disc between different observers.The consistency of IVIMGDWI in two scans of normal lumbar intervertebral discs is general,which may be due to the time interval between the two scans.Because ADCslow represents the diffusion of water molecules in tissues,the microenvironment in the lumbar intervertebral disc has changed,resulting in the difference of ADCslow value.As for the problem that different scanning time may lead to the change of IVIMGDWI data,we will study it further.

Electroacupuncture down-regulates expression of ADAMTS-4 of intervertebral disc in rats with lumbar intervertebral disc degeneration / 针刺研究

OBJECTIVE: To observe the effect of electroacupuncture (EA) stimulation on the levels of a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS-4) protein in the lumbar intervertebral disc tissue and serum in prolapsed lumbar intervertebral disc degeneration (PLIDD) rats, so as to explore its mechanism underlying improvement of intervertebral disc degeneration (IDD). METHODS: A total of 48 Sprague-Dawley rats were divided into sham operation (n＝12), model (n＝18) and EA (n＝18) groups. The PLIDD model was established by puncturing the lumbar discs (L4-L5, L5-L6) with a gauge-22 syringe needle. After modeling, EA stimulation was applied to "Pangguangshu"(BL28), "Zusanli"(ST36) and "Zhijian"for 20 min, 6 times per week for 4 weeks. The lumbar intervertebral disc tissue and blood samples were collected at the 4th, 6th and 8th week after modeling, respectively. The expression of ADAMTS-4 in the lumbar intervertebral disc tissue was detected by immunohistochemistry and Western blot (WB), separately. The content of ADAMTS-4 in the serum was detected by ELISA. RESULTS: Both immunohistochemical stain and WB showed that the expression levels of lumbar ADAMTS-4 at the 4th, 6th and 8th week were significantly up-regulated in the model group relevant to the sham operation group (P<0.01). Following EA treatment, the expression levels of ADAMTS-4 on day 14 and 28 were notably lower in the EA group than in the model group (P<0.05). The serum ADAMTS-4 contents were significantly increased in the model group than in the sham operation group at the 3 time-points (P<0.05, P<0.01), and considerably decreased in the EA group than in the model group on day 28 after EA intervention(P<0.05)．. CONCLUSION: EA can down-regulate the ADAMTS-4 expression of lumbar intervertebral disc tissue in PLIDD rats, which may contribute to its effect in relieving lumbar intervertebral disc degeneration.

Experiments study on mechanical behavior of porcine lumbar intervertebral disc after nucleotomy under compression / 生物医学工程学杂志

In order to study the mechanical behavior of degeneration and nucleotomy of lumbar intervertebral disc, compression experiments with porcine lumbar intervertebral discs were carried out. The lumbar intervertebral discs with trypsin-treated and nucleus nucleotomy served as the experimental group and the normal discs as the control group. Considering the effects of load magnitude and loading rate, the relationship between stress and strain, instantaneous elastic modulus and creep property of intervertebral disc were obtained. The creep constitutive model was established. The results show that the strain and creep strain of the experimental group increase significantly with the increase of compression load and loading rate, whereas the instantaneous elastic modulus decreases obviously, compared with the control group. It indicates that the effect of load magnitude and loading rate on load-bearing capacity of intervertebral disc after nucleotomy is larger obviously than that of normal disc. The creep behavior of the experimental group can be still predicted by the Kelvin three-parameter solid model. The results will provide theoretical foundation for clinical treatment and postoperative rehabilitation of intervertebral disc disease.

A quantitative evaluation of lumbar intervertebral disc degeneration by MR T2 * mapping / 实用放射学杂志

Objective To assess the feasibility and the value of MR T2 * mapping in valuing the early degeneration of lumbar intervertebral disc quantificationally.Methods 67 patients with low back pain and 21 healthy volunteers were chosen for the study.The two groups both underwent 3.0T MR with the axial T2 WI and T2 * mapping images in 440 discs of L1-S1.We graded all intervertebral discs by Pfirrmann score,and measured the T2 * values of annulus fibrosus(AF) and nucleus pulposus(NP).Results The T2 * values of the anterior AF and the NP among different Pfirrmann grades were statistically significant (P =0.001;P =0.000,respectively).There was significant difference in T2 * values of the anterior AF at L3/L4 between patients and volunteers (P=0.043);The T2 * values of the NP at L2/L3,L3/L4,L4/L5,L5/S1 between the two groups were significant difference (P＜0.05).There was also distinct difference in T2 * values of the posterior AF at L1/L2 and L4/L5 between the two groups (P＜0.05).Conclusion The lumbar intervertebral disc degenerates from the NP to posterior AF,and mainly occurs at L4/L5.The T2 * mapping technique can provide a good basis for diagnosing in lumbar intervertebral disc degeneration.

Changes of Serum Cytokines in Patients with Lumbar Intervertebral Disc Herniation and Pain / 现代检验医学杂志

Objective To study the relationship between the pain of the patients with lumbar intervertebral disc herniation (LIDH) and the changes of serum cytokine,and to discuss the clinical significance.Methods From January 2014 to December 2016,74 cases of LIDH diagnosed in the 323rd Hospital of the PLA were selected,including 45 males and 29 females,whose age was 46.2± 16.1 years,and the duration 22.6± 7.8 months.According to the VAS pain score,37 cases were mild,23 cases were moderate and 14 cases were severe.The control was 30 cases of healthy physical examination in the same period,18 males and 12 females,age 45.3 ± 15.8 years.All subjects were collected for venous blood on fasting.MDA,superoxide dismutase (SOD),interleukin-6 (IL-6),tumor necrosis factor (TNF),thromboxane (TX),endothelin (ET),prostaglandin E (PGE) and calcitonin (CA) were all measured by radioimmunoassay.The results were analyzed statistically.Results The compared with normal control group,serum cytokines MDA,SOD,IL-6,TNF,TX,ET,PGE and CA increased in different degrees (P＜0.05～0.01).The VAS assessment of severe pain in LIDH was significantly higher than that of mod erate or mild pain (P＜0.05～0.01).Logistic analysis showed that these serum cytokines were closely related to the pain of LIDH (OR=2.415～4.127,95％CI=1.146～11.735,P＜0.05).Conclusion The serum cytokines in patients with LIDH are closely related to the degree of pain,suggesting that these cytokines in serum may affect biochemical metabolism in the process of pain.

Serum Caspase-3 and Caspase-9 Activity in Patients with Lubar Intervertebral Disc Protrusion / 现代检验医学杂志

Objective To explore the relationship between apoptosis promoting effector molecules caspase-3,caspase-9 and lubar intcrvertebral disc protrusion.Methods 99 of operation patients with lubar intervertebral disc protrusion in their mater nity ward were recruited.Among them,single segment of lubar intervertehral disc protrusion were 70 (Group A),more than one segments of lubar intervertebral disc protrusion were 29(Group B).In addition,40 unrelated healthy people from physi cal examination center were enrolled as controls.Enzyme linked immunosorbent assay (ELISA) was used to examine serum caspase-3 and caspase-9 levels in lubar intervertebral disc protrusion patients.Results The level of caspase-3 in control group,group A and group B,respectively were 11.24±0.41,14.31±0.67 and 17.43±1.86 pmol/L.The caspase-3 activity in each group was statistically significant difference (F=8.47,P＜0.01).The level of caspase-9 in control group,group A and group B respectively were 18.54±2.19,30.57±3.63 and 43.68±5.15 pmol/L.The caspase-9 activity in each group was statistically significant difference (F=7.85,P=0.001).Compared with control group,the caspasc 3 and caspase-9 ac tivity in group A (q=3.08.3.29,all P＜0.05),group B (q=5.78,4.50,all P=0.014) was statistically significant differ ence.The caspase-3 and caspase-9 activity in group A,group B was statistically significant difference (q=3.21,3.22,all P＜0.05).Conclusion The augment of caspase-3 and caspase-9 promoted apoptosis of lubar intervertebral disc protrusion.It was connected with quantity of protrusive segments.The more segments of protrusion,the higher caspase-3 and caspase-9 levels of examination would be.

Observations on the Efficacy of Heat-sensitive Point Medicinal Moxibustion plus Percutaneous Administration of Tetrandrine in Treating Lumbar Intervertebral Disc Herniation / 上海针灸杂志

Objective To investigate the clinical efficacy of heat-sensitive point medicinal moxibustion plus percutaneous administration of tetrandrine in treating lumbar intervertebral disc herniation. Methods One hundred and twenty patients with lumbar intervertebral disc herniation were randomized to treatment and control groups, 60 cases each. The treatment group received heat-sensitive point medicinal moxibustion plus percutaneous administration of tetrandrine and the control group, heat-sensitive point medicinal moxibustion alone. The VAS score and the JOA Score for Back Pain score were recorded in the two groups before and after treatment. The clinical therapeutic effects were compared between the two groups. Results There were statistically significant pre-/post-treatment differences in the JOA Score for Back Pain score and the VAS score in the two groups (P<0.01). There were statistically significant post-treatment differences in the JOA Score for Back Pain score and the VAS score between the treatment and control groups (P<0.01). The excellent and good rate was 80.0％ in the treatment group and 55.0％ in the control group; there was a statistically significant difference between the two groups (P<0.01). Conclusion Heat-sensitive point medicinal moxibustion plus percutaneous administration of tetrandrine is an effective way to treat lumbar intervertebral disc herniation.

Therapeutic Observation of Bai Xiao Moxibustion plus Electroacupuncture for Lumbar Intervertebral Disc Herniation / 上海针灸杂志

Objective To observe the clinical efficacy of Bai Xiao moxibustion plus electroacupuncture in treating lumbar intervertebral disc herniation (LIDH). Method Ninety-six LIDH patients were randomized into a treatment group and a control group, 48 cases each. The treatment group was intervened by Bai Xiao moxibustion plus electroacupuncture, while the control group was intervened by electroacupuncture alone. Before and after the treatment, the lower back pain scores of Japanese Orthopedic Association (JOA) and Visual Analogue Scale (VAS) were evaluated, and the clinical efficacies of the two groups were compared. Result The JOA and VAS lower back pain scores were changed significantly after the treatment in both groups (P<0.05). After the treatment, the JOA and VAS lower back pain scores of the treatment group were significantly different from those of the control group (P<0.05). The pain release time was (2.95±0.59)d after the intervention in the treatment group versus (4.26±0.68)d in the control group, and the between-group difference was statistically significant (P<0.05). The total effective rate was 95.7％ in the treatment group versus 91.7％ in the control group, and the between-group difference was statistically significant (P<0.05). Conclusion Bai Xiao moxibustion plus electroacupuncture is an effective method in treating LIDH and it can reduce the lower back pain.

Application of electromyography in the treatment of multiple segment intervertebral disc herniation with ozone injection / 介入放射学杂志

Objective To investigate the application of lower limb electromyography in guiding preoperative localization for multiple segment intervertebral disc herniation treated with ozone injection and in predicting the curative efficacy.Methods A total of 51 patients with MRI-proved multiple segment lumbar intervertebral disc herniation,who were admitted to authors' hospital during the period from January 2012 to December 2013 and who had complete clinical materials,were included in this study.Guided by DSA,intradiscal injection of ozone together with the injection of ozone plus compound betamethasone and bupivacaine into the space around the spinal nerve was carried out in all patients.The degree of lower lumbago was evaluated with M-JOA score,and Oswestry disability index (ODI) was adopted to assess the curative effect.Results Preoperative electromyography showed that 43 patients had nerve root injury,the positive rate was 84.3％.The positive HIZ sign was detected in 30 patients,with the positive rate being 58.8％.The positive Modic sign was observed in 24 patients,the positive rate was 47.1％.Postoperative MJOA scores indicated that one-,3-and 6-month effective rates were 90.1％,86.2％ and 78.5％ respectively;and postoperative ODI values showed that one-,3-and 6-month effective rates were 87.3％,79.5％ and 74.6％ respectively.Conclusion In treating multiple segment intervertebral disc hemiation with ozone injection,lower limb electromyography is very valuable in accurately making preoperative localization as well as in precisely predicting the curative efficacy,thus this technique is worth popularizing in clinical practice.

Observations on the Application of She Medicine Therapy to Rapid Rehabilitation after Lumbar Spinal Endoscopic Surgery / 上海针灸杂志

Objective To investigate the clinical efficacy of She medicine therapy in rehabilitation after endoscopic surgery for lumbar intervertebral disc herniation.Methods Sixty patients with lumbar intervertebral disc herniation were allocated, using random number table method following registration order, to treatment and control groups, 30 cases each. The treatment group received She medicine therapy and the control group, oral administration of conventional drugs. The excellent and good rate was observed in the two groups after treatment. Post-treatment active straight leg raising times and analgesic dosages were compared between the two groups.Results Active straight leg raising time was significantly advanced (P<0.01) and the number of potent analgesic uses was significantly decreased (P<0.01) in the treatment group after endoscopic surgery for lumbar intervertebral disc herniation. The excellent and good rate was 93.3％ in the treatment group and 80.0％ in the control group; there was a statistically significant difference between the two groups (P<0.05).Conclusion She medicine therapy can help rapid rehabilitation after endoscopic surgery for lumbar intervertebral disc herniation.