Application of cortical bone trajectory screw in the revision of lumbar disease / 中华骨科杂志

Objective To evaluate and discuss the clinical outcomes and advantages of midline lumbar fusion (MIDLF) with cortical bone trajectory (CBT) screw in the reoperation of lumbar disease. Methods From June 2014 to August 2015, a total of 12 patients, 5 male and 7 female with an average age of 68.5±5.6 years old (ranged from 56-76 years). The indications of reoper-ation including:5 cases of adjacent segment disease, 2 cases of discogenic back pain after lumbar dynamic stabilization, 5 cases of recurrent disc herniation. The interval time from primary surgery to second surgery was 3-9.5 years (average 6.0±2.0 years). Dis-ease level:L2/31 case, L3/42 cases, L4/57 cases, L5/S12 cases. All cases were got the X-ray, CT scan and MRI examination before surgery. The operative duration, blood loss, complications were all evaluated. Back and leg pain were recorded by visual analogue scale (VAS) scores. Functional recovery was evaluated by Oswestry disability index (ODI). Results Operative time was 110-210 min, and mean duration was (158.3±36.4) min. Blood loss was 150-310 ml, and mean loss was (231.7±51.0) ml. There was 1 case of cerebrospinal fluid leakage which treated with pillow supine for 1 week after surgery, and strengthened the prevention of antibi-otics, incision healing, with no headache and other low intracranial pressure of dizziness, the remaining patients had no intraopera-tive and postoperative complications. The time of follow-up was 12-25 months, with an average of (17.9 ± 4.6) months. The back pain of VAS score of preoperative was 3.9±1.4, and the last follow-up was 1.9±0.5, the difference was statistically significant (t=4.506, P=0.001). The VAS score of preoperative leg pain (4.9±1.4) was significant higher than the last follow-up (1.2±0.6, t=9.134, P=0.000). The preoperative ODI was 32.9±3.4, and last follow-up was 13.3±3.2, and the difference was statistically significant (t=15.002, P=0.000). Conclusion MIDLF was applicable with good clinical outcome and technical advantages in current cases, and it might be a choice of reoperation for lumbar disease.

Application of cortical bone trajectory screw in the revision of lumbar disease / 中华骨科杂志

Objective To evaluate and discuss the clinical outcomes and advantages of midline lumbar fusion (MIDLF) with cortical bone trajectory (CBT) screw in the reoperation of lumbar disease. Methods From June 2014 to August 2015, a total of 12 patients, 5 male and 7 female with an average age of 68.5±5.6 years old (ranged from 56-76 years). The indications of reoper-ation including:5 cases of adjacent segment disease, 2 cases of discogenic back pain after lumbar dynamic stabilization, 5 cases of recurrent disc herniation. The interval time from primary surgery to second surgery was 3-9.5 years (average 6.0±2.0 years). Dis-ease level:L2/31 case, L3/42 cases, L4/57 cases, L5/S12 cases. All cases were got the X-ray, CT scan and MRI examination before surgery. The operative duration, blood loss, complications were all evaluated. Back and leg pain were recorded by visual analogue scale (VAS) scores. Functional recovery was evaluated by Oswestry disability index (ODI). Results Operative time was 110-210 min, and mean duration was (158.3±36.4) min. Blood loss was 150-310 ml, and mean loss was (231.7±51.0) ml. There was 1 case of cerebrospinal fluid leakage which treated with pillow supine for 1 week after surgery, and strengthened the prevention of antibi-otics, incision healing, with no headache and other low intracranial pressure of dizziness, the remaining patients had no intraopera-tive and postoperative complications. The time of follow-up was 12-25 months, with an average of (17.9 ± 4.6) months. The back pain of VAS score of preoperative was 3.9±1.4, and the last follow-up was 1.9±0.5, the difference was statistically significant (t=4.506, P=0.001). The VAS score of preoperative leg pain (4.9±1.4) was significant higher than the last follow-up (1.2±0.6, t=9.134, P=0.000). The preoperative ODI was 32.9±3.4, and last follow-up was 13.3±3.2, and the difference was statistically significant (t=15.002, P=0.000). Conclusion MIDLF was applicable with good clinical outcome and technical advantages in current cases, and it might be a choice of reoperation for lumbar disease.

Psychological stress alters the ultrastructure and increases IL-1β and TNF-α in mandibular condylar cartilage

Psychological factors can be correlated with temporomandibular disorders (TMDs), but the mechanisms are unknown. In the present study, we examined the microstructural changes and expression of proinflammatory cytokines in mandibular condylar cartilage of the temporomandibular joint (TMJ) in a psychological stress animal model. Male Sprague-Dawley rats (8 weeks old, 210 ± 10 g) were randomly divided into 3 groups: psychological stress (PS, N = 48), foot shock (FS, N = 24), and control (N = 48). After inducing psychological stress using a communication box with the FS rats for 1, 3, or 5 weeks, PS rats were sacrificed and compared to their matched control littermates, which received no stress and were killed at the same times as the PS rats. Body and adrenal gland weight were measured and corticosterone and adrenocorticotropic hormone levels were determined by radioimmunoassay. After hematoxylin-eosin staining for histological observation, the ultrastructure of the TMJ was examined by scanning electron microscopy. Transcription and protein levels of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) were evaluated by ELISA and semi-quantitative RT-PCR. The PS group showed a significantly higher adrenal gland weight after 3 weeks of stress and higher hormone levels at weeks 1, 3, and 5. Histopathological changes and thinning cartilage were apparent at weeks 3 and 5. In the PS group, TNF-α increased at 1, 3, and 5 weeks and IL-1β increased significantly after 1 and 3 weeks of stress, and then decreased to normal levels by 5 weeks. Psychological stress increased plasma hormone levels and RT-PCR indicated increased IL-1β and TNF-α expression in the TMJ in a time-dependent manner. These results suggest that cytokine up-regulation was accompanied by stress-induced cartilage degeneration in the mandibular condyle. The proinflammatory cytokines play a potential role in initiating the cartilage destruction that eventually leads to the TMDs.

Hormonal treatment for endometriosis associated pelvic pain

Endometriosis is a common gynecological problem associated with chronic pelvic pain. To evaluate the effectiveness of current hormonal treatments of endometriosis associated pain. Randomized Controlled studies identified from databases of Medline and Cochrane Systemic Review groups were pooled.7 RCTs were recruited for evaluation in this review. Data from these studies were pooled and meta-analysis was performed in three comparison groups: 1] Progestogen versus GnRHa; 2] Implanon versus Progestogen [injection]; 3] Combined oral contraceptive pills versus placebo and progestogen. Response to treatment was measured as a reduction in pain score. Pain improvement was defined as improvement >/= 1 at the end of treatment. There was no significant difference between treatment groups of progestogen and GnRHa [RR: 0.036; CI: -0.030-0.102] for relieving endometriosis associated pelvic pain. Long acting progestogen [Implanon] and Mirena are not inferior to GnRHa and depot medroxy progesterone acetate [DMPA] [RR: 0.006; CI: -0.142-0.162]. Combined oral contraceptive pills demonstrated effective treatment of relieving endometriosis associated pelvic pain when compared with placebo groups [RR: 0.321CI-0.066-0.707]. Progestogen was more effective than combined oral contraceptive pills in controlling dysmenorrhea [RR: -0.160; CI: -0.386-0.066], however, progestogen is associated with more side effects like spotting and bloating than the combined contraceptive pills. Combined oral contraceptive pills [COCP], GnRHa and progestogens are equally effective in relieving endometriosis associated pelvic pain. COCP and progestogens are relatively cheap and more suitable for long-term use as compared to GnRHa. Long-term RCT of medicated contraceptive devices like Mirena and Implanon are required to evaluate their long-term effects on relieving the endometriosis associated pelvic pain