Buck technique supplemented by temporary intersegmental pedicle screw fixation to repair lumbar spondylolysis in youth.

BACKGROUND: Lumbar spondylolysis is a bone defect in the pars interarticularis of the lumbar vertebral, which is a common cause of low back pain in youth. Although non-surgical treatment is a mainstream option, surgery is necessary for patients with persistent symptoms. Buck technique is widely used as a classical direct repair technique, but it cannot achieve reduction of low-grade spondylolisthesis and reconstruction of lumbosacral sagittal balance. We have described a novel surgical procedure based on Buck technique with temporary intersegmental pedicle screw fixation, and report a series of clinical outcomes in 5 patients to provide a reference for the clinical treatment of young lumbar spondylolysis. METHODS: Five young patients with symptomatic lumbar spondylolysis with a mean age of 19.20 ± 5.41 years underwent surgical treatment after an average of 7.60 ± 1.52 months of failure to respond to conservative treatment, using a new surgical procedure based on Buck technique combined with temporary intersegmental pedicle screw fixation. RESULTS: Five patients were successfully operated without serious complications such as nerve and vascular injury. The average operation time was 109.00 ± 7.42 min, the interpretative average blood loss was 148.00 ± 31.14 ml, and the average fusion time was 11.20 ± 1.64 months. All patients were followed up for 2 years after surgery, and the visual analogue score (VAS) of low back pain and Oswestry disability index (ODI) scores were significantly improved compared with those before surgery, and the Henderson's evaluation were rated excellent or good. After the removal of the internal fixation, it was observed that temporary intersegmental fixation could repair the isthmus, reduce lumbar spondylolisthesis, and reconstruct the sagittal balance of the lumbosacral vertebrae while preserving lumbar motion and preventing intervertebral disc degeneration. Postoperative MRI indicated the Pfirrmann classification of the affected discs: 1 case from grade III to grade II, 3 cases from grade II to grade I, and 1 case remained grade II. CONCLUSIONS: Buck technique supplemented by temporary intersegmental pedicle screw fixation is a highly applicable and effective method for the treatment of adolescent lumbar spondylolysis. The isthmic fusion is accurate, and temporary intersegmental fixation can effectively prevent disc degeneration and reconstruct the sagittal balance of lumbosacral vertebra.

Clinical application of free inguinal flaps with retrograde blood supply anastomotic to repair soft tissue defects of extremities.

To observe the clinical efficacy of free inguinal flaps with retrograde blood supply anastomosis to repair skin and soft tissue defects in the limbs. A total of 25 patients with soft tissue defects of the limbs treated from January 2019 to December 2021 were selected and repaired with free inguinal flaps anastomotic with retrograde blood supply. All 25 skin flaps survived; 1 patient had skin flap infection and the wound healed gradually after symptomatic treatment, and 1 patient had venous embolism and the skin flap survived after re-anastomosis. The patients were followed up for 6 to 18 months after the operation. After healing, the patient recovered satisfactorily, and the flap had a good appearance, texture, and flexibility; a reoperation was not required. The patient was satisfied with the effect of the treatment. Retrograde vascular anastomosis with the anterolateral femoral perforator flap is safe and reliable for repairing the soft tissue defects of the limbs. It is convenient for micromanipulation and can achieve satisfactory clinical results, and thus is an ideal repair method.

[Effect of Melittin on collagen type II expression of rat endplate chondrocytes induced by interleukin 1ß].

Objective: To observe the effect of Melittin on collagen type II (Col-II) expression of rat endplate chondrocytes (EPCs) induced by interleukin 1ß (IL-1ß). Methods: Primary EPCs from the lumbar vertebra of 4-week-old Sprague Dawley rats were cultured in vitro and identified by morphological observation, toluidine blue staining and Col-II immunofluorescence staining. Then, MTT assay was used to determine the optimal concentration of IL-1 and Melittin. Next, EPCs at passage 3 were randomly divided into 4 groups: no treatment was done in group A as control group; the optimal concentration of IL-1ß, Melittin, and both IL-1ß and Melittin were used in groups B, C, and D respectively. The expression of Col-II was detected by Western blot after 48 hours intervention. Results: Under inverted microscope, the first generation EPCs were polygonal; cell proliferation decreased after fifth generation, and cell morphology changed into fusiform. The acidic mucosubstance in the cytoplasm (such as Aggrecan) was stained dark blue by toluidine blue. After marking Col-II by immunofluorescence, the positive expression of cytoskeleton (green fluorescence) could be observed. MTT assay showed that IL-1ß and Melittin could inhibit the EPCs in a dose-dependent manner after intervention of 24 and 48 hours, and the optimal concentrations of IL-1ß and Melittin intervention were 10 ng/mL and 1.0 µg/mL respectively. Compared with group A, the expression of Col-II was significantly reduced in group B, and was significantly increased in group C by Western blot assay, but there was no significant difference between group D and group A. The Col-II expression levels of groups A, B, C, and D were 0.991±0.024, 0.474±0.127, 1.913±0.350, and 1.159±0.297 respectively, showing significant difference between the other groups ( P<0.05) except between group A and group D ( P>0.05). Conclusion: Melittin has a protective effect on endplate cartilage, and the research results provide experimental basis for the prevention and treatment of spinal degenerative disease.