Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Interlaminar Discectomy for Lumbar Disc Herniation.

Background: As the latest endoscopic spine surgery, percutaneous endoscopic interlaminar discectomy (PEID) and unilateral biportal endoscopic (UBE) discectomy have distinct technical characteristics. This study aimed to evaluate the clinical outcomes of PEID and UBE discectomy in the treatment of single-level lumbar disc herniation (LDH). Methods: Between February 2019 and April 2022, 115 patients with single-level LDH at L4-5 or L5-S1 received PEID or UBE discectomy. The patients were separated into two groups based on the surgical method used: Group 1 (the PEID group) (n = 60) and Group 2 (the UBE group) (n = 55). Various parameters, including operative time, hospitalization time, fluoroscopy frequency, total costs, complications, visual analogue scale (VAS), and Oswestry Disability Index (ODI), were evaluated and compared between the two groups. Results: There were no significant differences in the VAS and ODI scores in 12 months after the operation between two groups (P > 0.05). However, the VAS of lower back pain on the first day after the operation in Group 2 (2.53±0.89) was higher than that in Group 1 (2.19±0.74) (P < 0.05). There were no significant differences in the operation time and incidence of complications between two groups (P > 0.05). But total costs in Group 2 (43,121±4280) were significantly higher than those in Group 1 (30,069±3551) (P < 0.05). Conclusion: Both UBE and PEID procedures have similar efficacy in alleviating pain and improving functional ability in patients with LDH. However, UBE surgery results in higher costs than PEID surgery.

Long non-coding RNA DANCR increases spinal cord neuron apoptosis and inflammation of spinal cord injury by mediating the microRNA-146a-5p/MAPK6 axis.

OBJECTIVE: This research was to unravel the impact of the lncRNA differentiation antagonizing non-protein coding RNA (DANCR)/microRNA (miR)-146a-5p/mitogen-activated protein kinase 6 (MAPK6) axis on spinal cord injury (SCI). METHODS: SCI mouse models were established and injected with si-DANCR or miR-146a-5p agomir. The recovery of motor function was assessed by Basso Mouse Scale. SCI was pathologically evaluated, and serum inflammatory factors were measured in SCI mice. Mouse spinal cord neurons were injured by H2O2 and transfected, followed by assessment of proliferation and apoptosis. DANCR, miR-146a-5p, and MAPK6 in tissues and cells were detected, as well as their relationship. RESULTS: DANCR increased and miR-146a-5p decreased in SCI. Silencing DANCR or enhancing miR-146a-5p stimulated the proliferation of mouse spinal cord neurons and reduced apoptosis. DANCR was bound to miR-146a-5p to target MAPK6. DANCR affected the proliferation and apoptosis of spinal cord neurons by mediating the miR-146a-5p/MAPK6 axis. Downregulating DANCR or upregulating miR-146a-5p improved inflammation, the destruction of spinal cord tissue structure, and apoptosis in SCI mice. CONCLUSION: DANCR affects spinal cord neuron apoptosis and inflammation of SCI by mediating the miR-146a-5p/MAPK6 axis.

Administration of necrostatin-1 ameliorates glucocorticoid-induced osteonecrosis of the femoral head in rats.

Glucocorticoid (GC)-induced osteonecrosis of the femoral head (ONFH) is a serious complication of glucocorticoid treatment and is characterized by dysfunctional bone reconstruction at necrotic sites. Our previous study confirmed the protective potential of necrostatin-1, a selective blocker of necroptosis, in glucocorticoid-induced osteoporosis. In this study, rat models of GC-induced ONFH were established to evaluate the effects of necrostatin-1 on osteonecrotic changes and repair processes. Osteonecrosis was verified by histopathological staining. An analysis of trabecular bone architecture was performed to evaluate osteogenesis in the osteonecrotic zone. Then, necroptotic signaling molecules such as RIP1 and RIP3 were examined by immunohistochemistry. Histopathological observations indicated that necrostatin-1 administration reduced the incidence of osteonecrosis and the osteogenic response in subchondral areas. Additionally, bone histomorphometry demonstrated that necrostatin-1 intervention could restore bone reconstruction in the necrotic zone. The protective mechanism of necrostatin-1 was related to the inhibition of RIP1 and RIP3. Necrostatin-1 administration alleviated GC-induced ONFH in rats by attenuating the formation of necrotic lesions, recovering the function of osteogenesis, and suppressing glucocorticoid-induced osteocytic necroptosis by inhibiting the expression of RIP1 and RIP3.

Single Posterior Surgery Versus Combined Posterior-Anterior Surgery for Lumbar Tuberculosis Patients.

OBJECTIVE: Posterior approach of debridement, interbody graft, and instrumentation, and combined posterior-anterior approach of posterior instrumentation and anterior debridement and interbody graft are two essential surgeries for the surgical treatment of spinal tuberculosis (TB), and, until now, which one should be chosen is still controversial. This study aimed to compare the therapeutic efficacy between the single posterior surgery and combined posterior-anterior surgery for lumbar tuberculosis (LTB) patients to elucidate the role of debridement and the effects that result from posterior structure resection. METHODS: One hundred and nineteen LTB patients managed with single posterior debridement, interbody graft, and instrumentation surgery (Group P, 73 cases), or combined posterior-anterior surgery of posterior instrumentation and anterior debridement and interbody graft (Group P-A, 46 cases) from January 2008 to December 2016 were retrospectively analyzed. Different indexes were compared between the two groups to evaluate the curative effect and explore the role of debridement and the effects that result from posterior structure resection: operation time, blood loss, visual analog scale (VAS), Japanese Orthopaedic Association (JOA), Erythrocyte Sedimentation Rate (ESR), C-reactive Protein (CRP), surgical complication type and rate, spinopelvic sagittal parameters (local kyphosis [LK], pelvic incidence [PI] and pelvic tilt [PT], lumbar lordosis [LL], and sacral slope [SS]), drainage retention duration, hospital stay, time of abscess disappearance, time of activity recovery, and time of bone graft fusion by t-test or χ2 test. RESULTS: The follow-up period ranged from 24 to 60 months. No significant variations were detected between the two groups for age, sex ratio, BMI, disease duration, indication, and the preoperative values of VAS, JOA, ESR, CRP, and LK (p > 0.05). The VAS, JOA, ESR, and CRP significantly improved in both groups after the operation (p < 0.05), along with the LK and LL (p < 0.05). Meanwhile, the SS, PI, and PT showed minor improvement after the operation (p > 0.05). Compared to the P-A group, the P group had shorter operation time and less blood loss and hospital stay (p < 0.05). However, both groups presented similar VAS, JOA, ESR, CRP, and LK improvements (p > 0.05). Additionally, the surgical complication type and rate, postoperative spinopelvic sagittal parameters, and bone graft fusion time did not differ between the two groups (p > 0.05). On the other hand, the patients in the P-A group had a shorter time of abscess disappearance and activity recovery (p < 0.05) but a similar time of drainage retention (p > 0.05) compared to the P group. CONCLUSION: Both single posterior and combined posterior-anterior surgeries presented a good therapeutic effect for LTB patients with a low surgical complication rate and good quality of LK correction and LL reconstruction and maintenance. Moreover, single posterior surgery was less traumatic than combined posterior-anterior surgery but with slower TB lesion healing and activity recovery. Compared to debridement, stability seems to be more vital for STB healing, posterior structure resection does not affect the effect of spinopelvic realignment.

MiR-19b-3p Attenuates Chondrocytes Injury by Inhibiting MAPK/NF-Κb Axis via Targeting SOCS1.

In this study, miR-19b-3p was downregulated in osteoarthritic cartilage tissues and IL-1ß-stimulated primary chondrocytes, and miR-19b-3p overexpression reversed the inhibitory effect of IL-1ß on cell viability, the promotion effects of apoptosis, inflammatory factor secretion and extracellular matrix degradation, whereas the opposite effect was observed with miR-19b-3p inhibitor. Moreover, SOCS1 is a target gene of miR-19b-3p. Furthermore, SOCS1 overexpression enhanced cell injury compared with IL-1ß alone treatment, whereas knockdown of SOCS1 restored cell damage caused by IL-1ß. Further studies revealed that miR-19b-3p promoted chondrocyte injury repair by suppressing SOCS1 expression, and we found that was mediated by blocking the MAPK/NF-κB axis. Taken together, our findings may provide a new therapeutic strategy for osteoarthritis.

[Comparative study of two elastic fixation systems in single-segment lumbar disc herniation surgery for nucleus pulposus extraction].

OBJECTIVE: To investigate the clinical application of two elastic pedicle internal fixation systems in single-segment lumbar disc herniation fenestration. METHODS: A retrospective analysis of 64 patients with lumbar intervertebral disc herniation treated by surgery from June 2019 to March 2021. According to the different elastic fixation systems placed during the operation, the patients were divided into ordinary pedicle screw elastic rod link group (elastic rod group) and a special elastic pedicle screw rigid rod fixed connection group (elastic screw group). There were 33 cases in the elastic rod group, including 18 males and 15 females, aged from 30 to 69 years old with an average of(49.18±10.23) years old;and 31 cases in the elastic screw group, including 16 males and 15 females, aged from 32 to 68 with an average of (49.81±9.24) years old. The operation time, intraoperative blood loss, postoperative wound drainage, and postoperative landing time of the two groups were recorded separately. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI) were compared before and 3, 12 months after operation. The height of the adjacent vertebral space on the lateral DR film before and 12 months after the operation was measured. The clinical efficacy was evaluated by Macnab standard. RESULTS: All the patients successfully completed the operation, and were followed up. The operation time, intraoperative blood loss, postoperative wound drainage and postoperative landing time in the elastic rod group were(63.73±12.01) min, (89.55±16.07) ml, (81.67±16.00) ml, (3.45±0.75) d , while in the elastic nail group was (62.96±11.54) min, (88.35±17.14) ml, (82.29±15.40) ml, (3.29±0.78) d, the difference was not statistically significant. The symptoms of low back pain and lower extremity numbness were significantly improved in all patients after operation. There was no significant difference in VAS, JOA score and ODI between the two groups before and after surgery (P>0.05). At 12 months after operation, there was no significant difference in the height of the adjacent vertebral space between the upper adjacent vertebral body and the same segment before operation(P>0.05), and there was no significant difference between the groups before and after the operation. According to Macnab criteria, the elastic rod group was excellent in 30 cases, good in 2 cases, fair in 1 case, while the elastic nail group was excellent in 29 cases, good in 2 cases, fair in 0 cases, and there was no significant difference(Z=-0.42, P=0.68). CONCLUSION: In fenestrated nucleus pulposus extraction for lumbar disc herniation, the two elastic pedicle internal fixation systems are equally effective and can be used. The elastic screw internal fixation system has certain advantages when the distance between the two vertebral bodies is short, and the elastic rod cannot be placed or is difficult to be placed, and it is more widely used.

Comparison of clinical outcomes with proximal femoral nail anti-rotation versus bipolar hemiarthroplasty for the treatment of elderly unstable comminuted intertrochanteric fractures.

BACKGROUND: Although proximal femoral nail anti-rotation (PFNA) and bipolar hemiarthroplasty (BHA) are selected by most of the orthopaedic surgeons for elderly intertrochanteric fractures (ITFs) patients, there is still no consensus on the superiority of PFNA and BPH for the elderly with unstable comminuted ITFs. The study aims to compare the curative effects of PFNA and cementless BHA on unstable comminuted ITFs in the elderly. METHODS: From January 2012 to December 2016, we retrospectively reviewed 62 ITFs patients up to the inclusion and exclusion criteria in the study. Depending on the type of surgery, the patients were divided into two groups: Group BHA (n= 30) and Group PFNA (n = 32). The ITFs were classified according to Evans-Jensen. Hospitalization time, operation time, bleeding loss, weight bearing duration, Harris hip scores, 10-m walking speed, gait and postoperative complications were compared between the two groups. RESULTS: There was no significant difference between the groups in hospital stay (P > 0.05). The BHA group trended to have a shorter operation time and a larger volume of blood loss (P < 0.01).The weight bearing duration was shorter in the BHA group than the PFNA group (P < 0.05).The Harris hip score was higher, the 10-m walking speed was faster and the gait was better in group BHA than group PFNA at three months postoperatively (P < 0.05), but there was no significant difference between the two groups at 6 and 12 months postoperatively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). CONCLUSION: The BHA allows an earlier return to weight-bearing activity, but ultimately has the same effective treatments as the PFNA for the elderly with unstable comminuted ITFs.

The effect of endostatin on angiogenesis and osteogenesis of steroid-induced osteonecrosis of the femoral head in a rabbit model.

OBJECTIVE: This study aimed to investigate whether endostatin, a crucial anti-angiogenic factor, plays a negative role in angiogenesis and osteogenesis and aggravates the progression of osteonecrosis of the femoral head induced by steroid use in a rabbit model. METHODS: 66 New Zealand white rabbits were randomly divided into four groups: glucocorticoid model (GC) group (GC group, n = 18), glucocorticoid model and endostatin group (GC;ES group, n = 18), ES group (ES group, n = 18), and blank control group (CON group, n = 12). In the GC group, 10 µg/ kg lipopolysaccharide (LPS) was intravenously injected into the ear margin, and 24h after LPS injection, 20 mg/kg GC methylprednisolone (MPS) was injected into the gluteus muscle three times, each time at an interval of 24h. The animals of the GC;ES group were given as same treatment as the GC group, except for the addition of ES. MPS was not used in the ES group and CON group. ES group was only given ES, while the CON group was only given the same amount of normal saline. All animals successfully established models of femoral head necrosis, and then the difference among the Immunohistochemistry, Quantitative polymerase chain reaction (qPCR) analysis, Enzyme-linked immunosorbent assay, Biomechanical test, etracyclline-calcein double labeling, and Van Gieson staining indices were compared among the four groups. RESULTS: The combination of MPS and LPS was successful in establishing the femoral head necrosis model in New Zealand white rabbits. The incidence of osteonecrosis after MPS and LPS intervention was 70% (7/10), while that plus ES was 100% (10/10). At the same time, after MPS and LPS intervention, while the empty bone lacuna rate of the femoral head was significantly increased, the number of osteo- blasts was decreased. Also, the expressions of CD31 positive cells, Runx2, Osterix, COL1A1, and VEGF mRNA in the femoral head were decreased, and the levels of osteogenesis-related protein b-ALP, OCN, and angiogenic factor VEGF in the femoral head were decreased. The percentage of the trabecular bone area (%Tb.Ar), trabecular thickness (Tb.Th), trabecular number (Tb.N), labeled perimeter percent (%L.Pm), mineral apposition rate (MAR), and bone formation rate (BFR/BS) in the femoral head after MPs and LPS intervention detected by tetracycline calcein double labeling and Van Gieson staining decreased significantly, except trabecular separation (Tb.Sp) increased significantly. The compressive strength (CS), elastic modulus (EM), and strain energy (SE) of the femoral head examed by biomechanical measurement decreased significantly. All the above changes were more obvious after adding ES intervention. ES mRNA in the femoral head was undifferentiated and increased in the GC, ES, and GC;ES group compared with group CON. CONCLUSION: This study has revealed that ES can inhibit angiogenesis and osteogenesis in the femoral head and aggravate the occurrence and development of femoral head necrosis. Thus, antiangiogenic factors may play an important role in the pathogenesis of ONFH.

Percutaneous endoscopic transforaminal discectomy for the treatment of L5-S1 lumbar disc herniation and the influence of iliac crest height on its clinical effects.

The present study aimed to explore the clinical effects of percutaneous endoscopic transforaminal discectomy using a transforaminal endoscopic spine system (TESSYS) technique for the treatment of L5-S1 lumbar disc herniation and to analyse the influence of iliac crest height on these clinical effects. The clinical data of 76 patients with L5-S1 single-segment disc herniation treated with TESSYS at The Second Affiliated Hospital and Third Affiliated Hospital of Xi'an Jiaotong University between January and December 2016 were retrospectively analysed. Patients were divided into the following three groups according to the positional relation between the highest point of the iliac crest and the L4 and L5 pedicles in the lateral lumbar, as determined by X-ray: Group I, iliac crest height below the upper edge horizontal line of the L5 pedicle (n=42); group II, iliac crest height between the lower edge horizontal line of the L4 pedicle and the upper edge horizontal line of the L5 pedicle (n=29) and group III, iliac crest height above the lower edge horizontal line of the L4 pedicle (n=5). Changes in the postoperative visual analogue scale (VAS) pain score and Oswestry disability index (ODI) of the lower back and lower limbs were observed, and the effects were compared among the three groups. The mean operating time was 86.5±13.5 min. A single patient experienced cerebrospinal fluid leakage due to a mild tear of the dura mater during the operation, which improved after symptomatic treatment. The same operation was repeated in one patient due to the recurrence of disc herniation. In all patients, the VAS pain score and ODI of the lower back and lower limbs at 1 week and 1, 3 and 12 months following the operation were significantly lower than those before the operation (all P<0.05). Furthermore, the postoperative VAS pain score and ODI of the lower back and lower limbs were poorer in group III (L5-S1 lumbar disc herniation complicated with high iliac crest) than in groups I and II (P<0.05). These results suggested that TESSYS was effective in treating lumbar disc herniation. Whether the iliac crest is higher than the lower edge horizontal line of the L4 pedicle is suggested to be one of the factors influencing the outcome of the operation.

ACDF plus Uncovertebrectomy versus ACDF alone for the Treatment of Cervical Spondylotic Radiculopathy: Minimum 5-Year Follow-Up.

OBJECTIVE: The surgical approach for cervical spondylotic radiculopathy (CSR) is controversial. This study aims to investigate the effectiveness of the combined anterior cervical diskectomy and fusion (ACDF) and uncovertebrectomy for treatment of CSR. METHODS: This is a retrospective case control study. One hundred and forty-six patients with CSR who underwent two different procedures (ACDF alone [group A]) and a combination of ACDF and uncovertebrectomy [group B]) from March 2008 to April 2013 were included. The operation time, blood loss, Visual Analog Scale scores of the neck (VAS-neck) and arm (VAS-arm), Neck Disability Index (NDI) score, 36-Item Short Form Health Survey (SF-36) score, fusion segment curvature, global cervical curvature, and the rate of surgical complication were evaluated. RESULTS: There were no significant differences in the basic demographic and clinical characteristics between the two groups (p > 0.05). No significant differences were noticed in the fusion segment curvature and global cervical curvature between the two groups (p > 0.05). Whereas the operation time and blood loss in group B were greater than those in group A (p < 0.05), the VAS-neck, VAS-arm, NDI, and SF-36 scores were better in group B (p < 0.05). The surgical complication rate between the two groups was not significantly different (p > 0.05). CONCLUSIONS: Clinical efficacy of ACDF plus uncovertebrectomy for the treatment of patients with CSR may be better than that of ACDF alone, but at the expense of more operation time and blood loss.

Single posterior debridement, interbody fusion, and fixation on patients with continuous multivertebral lumbar spine tuberculosis (CMLSTB).

BACKGROUND: Patients with continuous multi-vertebral lumbar spine tuberculosis (CMLSTB) were subjected to single posterior debridement, interbody fusion, and fixation to explore their clinical outcomes. METHODS: Sixty-seven CMLSTB patients who underwent single posterior debridement interbody fusion and fixation between January 2008 to December 2017 were studied. The operation time, blood loss, perioperative complication rate, cure rate, Visual Analog Scale (VAS), Oswetry disability index (ODI), Japanese Orthopedic Association (JOA), Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb's angle and time of interbody fusion were analyzed to understand their therapeutic effects on CMLSTB patients. RESULTS: The patients were followed up for 20-48 months, with a mean of 24.3 months. The mean operation time was 215.5 min (range, 120-280 min), whereas 818.0 ml of blood was lost (range, 400-1500 ml) with a perioperative complication rate of 6.0% and a cure rate of 95.5%. During the last phase of follow-up, the mean preoperative VAS score (5.7) and ODI (72.0%) decreased significantly to 1.4 (t = 31.4, P<0.01) and 8.4% (t = 48.4, P<0.01), respectively. Alternatively, the mean preoperative ESR and CRP (74.7 mm /h and 69.3 mg/L, respectively) decreased to average values (tESR = 39.7, PESR<0.001; tCRP = 50.2, PCRP<0.001), while the JOA score (13.9) significantly increased to 23.0 (t = - 11.6, P<0.01). The preoperative kyphotic Cobb's angle (20.5°) decreased to 4.8° after the operation (t = 14.0, P<0.01); however, the kyphotic correction remained intact at the time of follow-up (t = - 0.476, P = 0.635). Furthermore, the mean of interbody fusion time was identified to be 8.8 months (range, 6-16 months). CONCLUSION: Single posterior debridement, interbody fusion, and fixation may be one of the surgical choices for the treatment of CMLSTB patients.

Inhibiting the aberrant activation of Wnt/ß-catenin signaling by selenium supplementation ameliorates deoxynivalenol-induced toxicity and catabolism in chondrocytes.

Kashin-Beck disease (KBD) is an endemic degenerative osteoarticular disorder associated with physical disability and a heavy economic burden. Contamination by mycotoxin deoxynivalenol (DON) and selenium deficiency have been proposed to be key etiological factors for KBD, and can work together to aggravate the progression of KBD. Nevertheless, the mechanism of DON in KBD remains elusive. In the present study, exposure to DON dose-dependently suppressed cell viability and expression of pro-proliferation marker PCNA in human chondrocytes, whereas it enhanced lactate dehydrogenase release, cell apoptosis, and caspase-3/9 activity. In addition, DON incubation shifted metabolism homeostasis towards catabolism by suppressing the transcription of collagen II and aggrecan, and the production of sulphated glycosaminoglycans and TIMP-1, while increasing matrix metalloproteinase levels (MMP-1 and MMP-13). Mechanistically, DON exposure induced the activation of Wnt/ß-catenin signaling. Intriguingly, blocking this pathway reversed the adverse effects of DON on cytotoxic damage and metabolism disruption to catabolism. Notably, supplementation with selenium reduced DON-induced activation of the Wnt/ß-catenin pathway. Moreover, selenium addition abrogated cytotoxic injury and excessive pro-catabolic gene expression in chondrocytes upon DON conditions. These findings confirm that DON may facilitate the development of KBD by inducing cell injury, inhibiting matrix synthesis, and increasing cellular catabolism by activating the Wnt/ß-catenin signaling, which were partially reversed by selenium supplementation. Thus, the current study may presents a new viewpoint for how selenium supplementation ameliorates the development of KBD by inhibiting DON-induced cytotoxic injury and metabolism imbalance in chondrocytes.

MiR-19b-3p attenuates IL-1ß induced extracellular matrix degradation and inflammatory injury in chondrocytes by targeting GRK6.

Osteoarthritis (OA) is characterized by degradation of articular cartilage. MiRNAs are involved in the regulation of chondrogenesis and OA. We aimed to investigate effects and mechanisms of miR-19b-3p in regulating chondrocytes viability, cartilage degradation and inflammatory response. Primary chondrocytes were isolated from cartilages in control subjects and patients with OA. Murine ATDC5 cells were pre-conditioned with IL-1ß in vitro. Expressions and interaction of miR-19b-3p with G protein-coupled receptor kinase 6 (GRK6), and their effects on inflammation, chondrocytes viability and cartilage degradation were determined after miR-19b-3p mimic or GRK6 siRNA transfection. MiR-19b-3p was significantly decreased in OA chondrocytes and IL-1ß-stimulated ATDC5 cells, in paralleled with the elevated type-II-collagen, aggrecan, MMP13 and GRK6 expression. MiR-19b-3p mimic dramatically increased the viability of chondrocytes and suppressed cell apoptosis. It also increased type-II-collagen, aggrecan expression and glycosaminoglycan (sGAG) content, and decreased the expression of MMP-1 and MMP-13 that controlled by IL-1ß. Overexpression of miR-19b-3p inhibited the production of IL-6 and IL-8 in ATDC5 cells. However, the protective effects of miR-19b-3p mimic on IL-1ß induced cell death; IL-8 production and sGAG decrease were greatly discounted by GRK6 lentiviral vectors. Luciferase reporter assay confirmed that GRK6 gene was a direct target ofmiR-19b-3p. GRK6 siRNA transfection antagonized the IL-1ß-induced chondrocytes injury, extracellular matrix degradation and inflammatory response. MiR-19b-3p mimic and GRK6 siRNA showed comparable inhibitory effect on IL-1ß-provoked NF-κB as reflected by the expression of p-p65. NF-κB translocation inhibition with PS1154 reversed the effects of IL-1ß on IL-8 and sGAG. Collectively, miR-19b-3p attenuated OA by targeting GRK6-NF-κB pathway.

[Efficacy evaluation of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in treating lumbar disc herniation with lumbar instability].

OBJECTIVE: To evaluate the clinical effects of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in the treatment of lumbar disc herniation with lumbar instability. METHODS: The clinical data of 146 patients with unilateral lumbar disc herniation with lumbar instability underwent surgical treatment from March 2008 to March 2013 were retrospectively analyzed. Patients were divided into two groups according to osteotomy replantation pattern. There were 77 patients in the traditional group (underwent traditional lamina osteotomy replantation), including 42 males and 35 females with an average age of (49.4±18.5) years;the lesions occurred on L4,5 in 46 cases, on L55S1 in 31 cases. There were 69 patients in modified group (underwent modified lamina osteotomy replantation), including 37 males and 32 females with an average age of (49.8±17.9) years;the lesions occurred on L4,5 in 40 cases, on L5S1 in 29 cases. The operation time, intraoperative blood loss, complication rate during operation, lamina healing rate, recurrence rate of low back and leg pain were compared between two groups. Visual analogue scales (VAS) and Japanese Orthopadic Association (JOA) scores were used to evaluate the clinical effects. RESULTS: The operation time and intraoperative blood loss were similar between two group (P>0.05). There was significantly different in nerve injury rate(5.80% vs 16.9%) and dural injury rate(1.45% vs 9.09%) between modified group and traditional group(P<0.05). The recurrent rate of low back pain of modified group was higher (91.30%, 63/69) than that of traditional group (76.62%, 59/77), and the intervertebral fusion rate of modified group was lower(8.70%, 6/69) than that of traditional group (29.9%, 23/77) at 3 years after operation. Postoperative VAS scores of all patients were significantly decreased at 6 months, 1, 2, 3 years, and JOA scores were obviously increased (P<0.05). At 1, 2, 3 years after operation, VAS scores of modified group were significantly lower than that of traditional group(P<0.05), and JOA scores of modified group were higher than that of traditional group(P<0.05). CONCLUSIONS: Modified lamina osteotomy replantation has better long-term efficacy(in the aspect of recurrent rate of low back pain, intervertebral fusion rate, VAS and JOA score at three years follow-up) in treating lumbar disc herniation with instability.

Comparison of intravenous and topical tranexamic acid in total knee arthroplasty.

BACKGROUND: To investigate the clinical effectiveness of intravenous (IV) and topical tranexamic acid (TXA) in patients undergoing total knee arthroplasty (TKA) by comparing safety, efficacy and patient-reported outcomes. METHODS: In this prospective single-blind clinical trial, 64 patients were randomized into two groups (n = 32 each). The Intravenous Group was administered TXA 10 mg/kg IV (Reyong, Shandong, China) 10 min prior to tourniquet deflation. In the Topical Group, 1.0 g TXA diluted in 50 ml of normal saline was injected into the surgical site, which was bathed in the solution for at least 5 min prior to tourniquet deflation. Outcomes included changes in hemoglobin levels, intra-operative, post-operative, and total blood loss, number of transfusions and number of transfused units, patient-reported postoperative Visual Analog Scale (VAS) score for knee pain, and complications. RESULTS: There were no significant differences in intra-operative blood loss, post-operative blood loss, total blood loss, or post-operative decrease in hemoglobin in the Intravenous Group versus the Topical Group. The number of transfused red blood cell units was significantly greater and-post-operative VAS score was significantly lower in the Intravenous Group. There were no differences in post-operative thromboembolic complications between groups. CONCLUSIONS: Topical TXA is not inferior to IV administration in reducing perioperative blood loss in primary TKA. However, the influence of injection volume of locally applied TXA on post-operative knee pain warrants further investigation. TRIAL REGISTRATION: Clinical ethics committee of Shaanxi People's Hospital (2009), No.125. ( ChiCTR 1,800,015,793 ) registered on 20/04/2018.

[Analysis of clinical effects in the treatment of single-segment lumbar degenerative disease by lamina osteotomy and former vertebral plates regraft].

OBJECTIVE: To compare the clinical effect between the lamina osteotomy and former vertebral plates regraft method and total laminectomy and interbody fusion method in treating single-segment lumbar degenerative disease. METHODS: The clinical data of 167 patients with single-segment lumbar degenerative disease underwent surgical treatment from January 2010 to December 2014 were retrospectively analyzed. There were 92 males and 75 females, aged from 45 to 75 years old with an average of (59.6±12.4) years. The patients were divided into lamina osteotomy and former vertebral plates regraft group(82 cases) and total laminectomy and interbody fusion group(85 cases) according to the different surgical methods used. The general conditions and clinical effects were compared between two groups. General conditions included the operation time, intraoperative blood loss, postoperative drainage, hospitalization time and the clinical effects included the visual analogue scale (VAS), Japanese Orthopaedic Association(JOA), Oswestry Dability Index(ODI), MacNab results, epidural fibrosis (EF), the incidence of adjacent segment degeneration (ASD). RESULTS: All the patients were followed for 18 to 36 months with an average of (24.8±5.7) months, furthermore, there was no significant difference in the follow-up time between two groups. There was no significant difference in general conditions such as operation time, intraoperative blood loss, postoperative drainage, or hospitalization time between two groups. At final follow-up, the VAS, ODI, JOA, of all patients were significantly improved (P<0.05);and the three factors above in the lamina osteotomy and former vertebral plates regraft group respectively were(2.0±1.1) points, (24.0±1.8) %, (19.8±8.2) point, while the results of total laminectomy and interbody fusion group were(2.5±1.6) points, (23.3±2.0)%, and(22.5±8.5) point;there was statistical difference between two groups(P<0.05). According to the standard of MacNab, 59 cases obtained excellent results, 20 good, 3 fair results in the lamina osteotomy and former vertebral plates regraft group;while 47 cases got excellent results, 26 good, and 12 fair results in the total laminectomy and interbody fusion group;there was significant difference between two groups(P<0.05). Sixteen patients(19.51%) with EF and 20 patients(24.39%) with ASD were found in lamina osteotomy and former vertebral plates regraft group;and 30 patients(35.29%) with EF and 37 patients(43.53%) with ASD were found in total laminectomy and interbody fusion group; there was significant difference between two groups(P<0.05). CONCLUSIONS: Both two methods can achieve the ideal effects for the treatment of single-segment lumbar degenerative disease, but the lamina osteotomy and former vertebral plates regraft method can reserve the integrity of posterior ligamentous complex, reducing the incidence of EF and ASD, and is a better surgical method.

Posterior intervertebral space debridement, annular bone grafting and instrumentation for treatment of lumbosacral tuberculosis.

BACKGROUND: The choice of surgical methods for lumbosacral tuberculosis is controversial due to the complex anterior anatomy and peculiar biomechanics of the lumbosacral junction. The objective of this study was to explore the clinical effect of posterior intervertebral space debridement with annular bone graft fusion and fixation for the treatment of lumbosacral tuberculosis. METHODS: We retrospectively analysed data from 23 patients with lumbosacral tuberculosis who had undergone posterior intervertebral space debridement with annular bone fusion and fixation between January 2008 and September 2014. The mean age of the patients was 49.0 years (range, 27-71), and the mean duration of disease until treatment was 10.2 months (range, 6-20). The lumbosacral angle, visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, American Spinal Injury Association (ASIA) grade and Social Functioning-36 (SF-36) score were determined to ascertain the clinical effects of the treatment. RESULTS: All patients underwent follow-up observation. The mean follow-up time was 34.2 months (range, 18-45), the mean operation time was 167.0 min (range, 130-210) and the mean blood loss was 767.4 ml (range, 500-1150). The lumbosacral angle was 21.0° ± 2.1° before operation, rising to 28.8° ± 1.7° after operation (p < 0.05) and being maintained thereafter. The mean VAS score before operation was 8.1 ± 0.6, decreasing to 1.2 ± 0.5 (p < 0.05) at the final follow-up. The mean ESR and CRP values were 49.1 ± 5.6 mm and 64.9 ± 11.9 mg/L, respectively, before operation, decreasing to normal at the final follow-up. The preoperative ASIA grade was C in 6 patients, D in 12 and E in 5. At the final follow-up, all patients had an ASIA grade of E except for one patient with a grade of D. For all patients, the SF-36 score at the final follow-up was higher than the preoperative and postoperative scores. CONCLUSIONS: Posterior intervertebral space debridement with annular bone graft fusion and fixation is an effective treatment for lumbosacral spine tuberculosis.

[Posterior debridement and bone grafting via intervertebral space combined with internal fixation for the treatment of lumbosacral tuberculosis].

OBJECTIVE: To explore the clinical effects of posterior debridement, bone grafting via intervertebral space combined with internal fixation for the treatment of lumbosacral tuberculosis. METHODS: The clinical data of 32 patients with lumbosacral tuberculosis underwent the procedure of one-stage posterior intervertebral debridement, bone grafting and internal fixation from January 2007 to July 2013 were retrospectively analyzed. There were 17 males and 15 females, aged from 27 to 63 years with an average of (49.8±9.2) years. The course of disease was from 5 to 18 months with the mean of (10.7±3.2) months. There was involved the vertebral body of L5 in 1 case, the intervertebral space of L5S1 in 8 cases, and the vertebral body of L5 or S1 combined with intervertebral space of L5S1 in 23 cases. VAS, ESR, CRP, the lumbosacral angle, the height of intervertebral space of L5S1, and ASIA grade were used to evaluate clinical effects. RESULTS: All the patients were followed up from 18 to 39 months with an average of 21.6 months. Operative time was 120 to 260 min with the mean of 175 min, and intraoperative bleeding was 700 to 1 450 ml with the mean of 1 050 ml. VAS before operation was 8.4±1.6, then descended to 3.5±0.8(P<0.05) on the 3rd month after operation and redescended to the level of 1.7±0.6(P<0.05) at the final follow-up. The ESR and CRP before operation were (48.8±10.2) mm and (58.6±5.6) mg/L, respectively, then decreased to (35.6±6.9) mm and (22.5±4.3) mg/L (P<0.05) at the 3rd month after operation and returned to the normal level at the final follow-up. The height of intervertebral space of L5S1 and lumbosacral angle before operation were (7.7±0.4) mm and (19.3±1.2)°, respectively, then improved to (10.3±0.3) mm and (22.4±1.5)° on the 3rd month after operation(P<0.05), and maintained such level, no obvious lost at later. According to ASIA grade, 8 cases were grade C, 19 were grade D, 5 were grade E before operation, and at final follow-up, 1 case still was grade D, others were grade E. CONCLUSIONS: The procedure of posterior debridement, bone grafting via intervertebral space combined with internal fixation is an effective and safe method in treating lumbosacral tuberculosis, it can effectively debride tuberculose focus, maintain the spinal stability, and improve the dysfunction with less complication.

The role of lncRNA MALAT1 in intervertebral degenerative disc disease.

Intervertebral degenerative disc disease (IDDD) is a common disease in clinic that causes pain and heavy financial burden on patients with poor prognosis. However, the pathogenesis of IDDD is not clear. Long non-coding RNA (LncRNA) is involved in regulating various body growth and pathological processes by affecting cell proliferation, differentiation, and apoptosis. However, the role of lncRNAs in IDDD is rarely reported. This study aims to investigate the role and mechanism of lncRNA MALAT1 in the development of IDDD. The nucleus pulposus of the intervertebral disc were collected and the primary nucleus pulposus cells were isolated and cultured. The cells were divided into three groups, including IDDD group, empty plasmid group transfected by pcDNA3.1, or MALAT1 group transfected by pcDNA3.1-MALAT1. MALAT1 expression was detected by real-time PCR. Cell proliferation was assessed by MTT assay. Caspase 3 activity was tested by the activity detection kit. IL-1 and IL-6 levels were analyzed by ELISA. The expression of MALAT1 in IDDD nucleus pulposus cells was significantly lower than that in control group (P < 0.05). The expression of MALAT1 was significantly increased after transfection with pcDNA3.1-MALAT1 plasmid in IDDD nucleus pulposus cells, which obviously inhibited cell proliferation, enhanced Caspase 3 activity, and promoted the secretion of IL-1 and IL-6 compared with IDDD group (P < 0.05). MALAT1 level decreased in IDDD nucleus pulposus cells. Upregulation of MALAT1 expression restrained IDDD through suppressing inflammation; inhibiting nucleus pulposus cell apoptosis, and promoting cell proliferation.

Elevation of IGFBP2 contributes to mycotoxin T-2-induced chondrocyte injury and metabolism.

Kashin-Beck disease (KBD) is an endemic degenerative osteoarthropathy. The mycotoxin of T-2 toxin is extensively accepted as a major etiological contributor to KBD. However, its function and mechanism in KBD remains unclearly elucidated. Here, T-2 toxin treatment induced chondrocyte injury in a time- and dose-dependent manner by repressing cell viability and promoting cell necrosis and apoptosis. Importantly, T-2 suppressed the transcription of type II collagen and aggrecan, as well as the release of sulphated glycosaminoglycan (sGAG). Furthermore, exposure to T-2 enhanced the transcription of matrix metalloproteinases (MMPs), including MMP-1, -2, -3 and -9. In contrast to control groups, higher expression of insulin-like growth factor binding protein 2 (IGFBP2) was observed in chondrocytes from KBD patients. Interestingly, T-2 toxin caused a dramatical elevation of IGFBP2 expression in chondrocytes. Mechanism analysis corroborated that cessation of IGFBP2 expression alleviated T-2-induced damage to chondrocytes. Simultaneously, transfection with IGFBP2 siRNA also attenuated matrix synthesis and catabolism-related gene expressions of MMPs. Together, this study validated that T-2 toxin exposure might promote the progression of KBD by inducing chondrocyte injury, suppressing matrix synthesis and accelerating cellular catabolism through IGFBP2. Therefore, this research will elucidate a new insight about how T-2 toxin participate in the pathogenesis of KBD.