Optimizing prediction accuracy for early recurrent lumbar disc herniation with a directional mutation-guided SVM model.

Percutaneous endoscopic lumbar discectomy (PELD) is one of the main means of minimally invasive spinal surgery, and is an effective means of treating lumbar disc herniation, but its early recurrence is still difficult to predict. With the development of machine learning technology, the auxiliary model based on the prediction of early recurrent lumbar disc herniation (rLDH) and the identification of causative risk factors have become urgent problems in current research. However, the screening ability of current models for key factors affecting the prediction of rLDH, as well as their predictive ability, needs to be improved. Therefore, this paper presents a classification model that utilizes wrapper feature selection, developed through the integration of an enhanced bat algorithm (BDGBA) and support vector machine (SVM). Among them, BDGBA increases the population diversity and improves the population quality by introducing directional mutation strategy and guidance-based strategy, which in turn allows the model to secure better subsets of features. Furthermore, SVM serves as the classifier for the wrapper feature selection method, with its classification prediction results acting as a fitness function for the feature subset. In the proposed prediction method, BDGBA is used as an optimizer for feature subset filtering and as an objective function for feature subset evaluation based on the classification results of the support vector machine, which improves the interpretability and prediction accuracy of the model. In order to verify the performance of the proposed method, this paper proves the performance of the model through global optimization experiments and prediction experiments on real data sets. The accuracy of the proposed rLDH prediction model is 93.49% and sensitivity is 88.33%. The experimental results show that Level of herniated disk, Modic change, Disk height, Disk length, and Disk width are the key factors for predicting rLDH, and the proposed method is an effective auxiliary diagnosis method.

Development of a Dynamic Nomogram for Predicting the Probability of Satisfactory Recovery after 6 Months for Cervical Traumatic Spinal Cord Injury.

OBJECTIVE: Cervical traumatic spinal cord injury (CTSCI) is a seriously disabling disease that severely affects the physical and mental health of patients and imposes a huge economic burden on patients and their families. Accurate identification of the prognosis of CTSCI patients helps clinicians to design individualized treatment plans for patients. For this purpose, a dynamic nomogram was developed to predict the recovery of CTSCI patients after 6 months. METHODS: We retrospectively included 475 patients with CTSCI in our institution between March 2013 and January 2022. The outcome variable of the current study was a satisfactory recovery of patients with CTSCI at 6 months. Univariate analyses and univariate logistic regression analyses were used to assess the factors affecting the prognosis of patients with CTSCI. Subsequently, variables (P < 0.05) were included in the multivariate logistic regression analysis to evaluate these factors further. Eventually, a nomogram model was constructed according to these independent risk factors. The concordance index (C-index) and the calibration curve were utilized to assess the model's predictive ability. The discriminating capacity of the prediction model was measured by the receiver operating characteristic (ROC) area under the curve (AUC). One hundred nine patients were randomly selected from 475 patients to serve as the center's internal validation test cohort. RESULTS: The multivariate logistic regression model further screened out six independent factors that impact the recovery of patients with CTSCI. Including admission to the American Spinal Injury Association Impairment Scale (AIS) grade, the length of high signal in the spinal cord, maximum spinal cord compression (MSCC), spinal segment fractured, admission time, and hormonal therapy within 8 h after injury. A nomogram prediction model was developed based on the six independent factors above. In the training cohort, the AUC of the nomogram that included these predictors was 0.879, while in the test cohort, it was 0.824. The nomogram C-index incorporating these predictors was 0.872 in the training cohort and 0.813 in the test cohort, while the calibration curves for both cohorts also indicated good consistency. Furthermore, this nomogram was converted into a Web-based calculator, which provided individual probabilities of recovery to be generated for individuals with CTSCI after 6 months and displayed in a graphical format. CONCLUSION: The nomogram, including ASIA grade, the length of high signal in the spinal cord, MSCC, spinal segment fractured, admission time, and hormonal therapy within 8 h after injury, is a promising model to predict the probability of content recovery in patients with CTSCI. This nomogram assists clinicians in stratifying patients with CTSCI, enhancing evidence-based decision-making, and individualizing the most appropriate treatment.

Construction and verification of a nomogram predicting the risk of preoperative deep vein thrombosis progression after elective spine surgery.

OBJECTIVE: This study aimed to construct and verify a useful nomogram that predicts the risk of preoperative deep vein thrombosis (DVT) progression after elective spine surgery. METHODS: Data of patients were collected from 366 patients with preoperative DVT who underwent elective spine surgery at our hospital between July 2017 and May 2022. The least absolute shrinkage and selection operator method combined with multivariable logistic regression analysis were applied to select features for the preoperative DVT progression risk model. The model's capability was evaluated using the concordance index (C-index), calibration curve, and receiver operating characteristic (ROC) curve. The decision curve and bootstrapping were used to analyze the clinical value of the nomogram. RESULT: A total of 366 DVT patients were enrolled in this study. Preoperative DVT progression after elective spine surgery was 24.04% (88 cases). Among these patients, 86 patients had thrombosis extending into a proximal vein or appearing in a different branch of the vein, either ipsilateral or contralateral, and two had a symptomatic pulmonary embolism. D-dimer, lower extremity varicosities, hyperlipidemia, lower limb paralysis, and operation time were among the predictors in the nomogram. Furthermore, the C-index of the prediction nomogram was 0.805 (95％ CI: 0.754-0.856), with an interval bootstrapping validation of 0.786 and an area under the ROC curve value of 0.800. According to the calibration curves and decision curve analysis, the nomogram could accurately predict the probability of preoperative DVT progression after elective spine surgery. CONCLUSION: The advantages of the nomogram included the unique discrimination capability, clinical utility, and predictive accuracy, which was beneficial for clinicians to distinguish high-risk groups of DVT progression after elective spine surgery and formulate relevant prevention measures.

Early Clinical Outcomes of Percutaneous Endoscopic Lumbar Discectomy for L4-5 Highly Down-Migrated Disc Herniation: Interlaminar Approach Versus Transforaminal Approach.

OBJECTIVE: This study is a retrospective evaluation of patients with L4-5 highly down-migrated lumbar disc herniation (LDH) operated with interlaminar endoscopic lumbar discectomy (IELD) versus transforaminal endoscopic lumbar discectomy (TELD). METHODS: From January 2015 to December 2018, 77 patients with L4-5 highly down-migrated LDH were divided into 2 groups according to different surgical approaches. There were 40 patients who underwent IELD, and 37 patients who underwent TELD. The operation time, hospital stay, Oswestry Disability Index, clinical outcome according with modified MacNab criteria, Visual Analog Scale (VAS) scores, and complications were compared between the IELD and TELD groups. RESULTS: Seventy-seven patients were included, 40 and 37 patients underwent IELD and TELD, respectively. The IELD and TELD groups both achieved a significant improvement in Oswestry Disability Index, back and leg VAS scores, and clinical outcome postoperation. Mean operating and x-ray times during operation were significantly shorter in the IELD group than in the TELD group (41.8 vs. 50.3, 1.8 vs. 13.7). There were 3 patients who experienced recurrence in the IELD group and 2 in the TELD group. In the TELD group, there were 3 patients who required revision surgery due to incompletely removed disc fragment. All patients in the IELD group were treated successfully. There was no other complication in these cases. CONCLUSIONS: Both IELD and TELD could be a good alternative option for highly down-migrated LDH in L4-L5. IELD may have advantages in operation time and x-ray times during operation compared with TELD.

A modified cutting line in the single-door cervical laminoplasty via a computed tomography-based morphological study of the subaxial cervical spine.

OBJECTIVE: To modify the conventional methods of grooving and direction during the single-door cervical laminoplasty (SDCL) in the subaxial cervical spine. METHODS: The distance between the left and the right lamina-lateral mass junction at the upper, middle, and lower levels of each segment (DLL-U, DLL-M, DLL-L), angle between the posterior edge of the vertebral body and the lamina (AVL) and thickness of lamina (TL) were measured in the transverse plane. The parameters of preoperative computed tomography scans of 200 patients who had undergone SDCL were measured. The patients were divided into male and female groups and developmental canal stenosis (DCS) and non-DCS (NDCS) groups. RESULTS: DLL-M gradually increased from the cranial to the caudal except for C7, and DLL-L > DLL-M > DLL-U in each vertebra. AVL increased from C3 to C7, TL decreased from C3 to C5 and increased from C5 to C7, with both parameters showing no significant differences between the left and right sides. AVL of the DCS group was less than that of the NDCS group (P < 0.01). CONCLUSIONS: In the SDCL, the ideal surgical trough should be several discontinuous lines sloping from top to bottom, rather than a straight line. The abduction angle during drilling should gradually increase from C3 to C7 in the SDCL averaging 40 degrees. This method mentioned above improves the efficiency of the operation with less blood loss as an extended cut into the lateral mass is avoided.

Nomogram for predicting kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment.

BACKGROUND: Kyphotic deformity occurrence after cervical laminoplasty is not rare. Several studies have emphasized the development of postoperative kyphotic deformity (PKD) will impair the functional outcome of cervical laminoplasty. We established and validated a nomogram prediction model for kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients (CSM) without preoperative kyphotic alignment. METHODS: Preoperative and 1-year postoperative data of 369 patients who underwent single-door cervical laminoplasty (SDCL) at the author's hospital between July 2010 and February 2018 were collected. Using the least absolute shrinkage and selection operator (LASSO) method, significant parameters were selected to develop a nomogram prediction model. The prognostic performance of the model was evaluated using concordance index (C-index) and calibration curve. The discriminatory ability of the prediction model was evaluated by the area under (receiver operating characteristic) curve (AUC). RESULTS: Of the 369 patients, 31 developed PKD in 1 year after the surgery. Using the LASSO regression, six significant variables composed the final model: age, C2-7 sagittal vertical axis, C7 slope, C2-7 angle, flexion range of motion and operation level were selected. The AUC of the nomogram was 0.771. The C-index for the prediction nomogram was 0.771 (95 % CI: 0.672-0.870). The calibration curve also indicated good consistency. CONCLUSION: A nomogram for predicting PKD after SDCL was established and validated. For patients evaluated by this model with predictive high risk of developing postoperative kyphosis, an alternative approach to the subaxial cervical spine such as anterior surgery should be considered.

[Clinical outcomes of spinal endoscopic surgery for tiny lumbar disc herniation with severe radiating pain of lower limb].

OBJECTIVE: To study the clinical characteristics of the patients with tiny lumbar disc herniation and severe symptoms(tLDHSS) and the therapeutic effects of percutaneous endoscopic lumbar discectomy(PELD). METHODS: From January 2014 to February 2019, 34 patients with tLDHSS were reviewed retrospectively, including 20 males and 14 females, aged from 31 to 73 (48.8±10.1) years, with a follow up duration ranged from 8 to 48 (21.8±10.3) months. The clinical manifestations, imaging and surgical data were analyzed. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were analyzed before operation, 1 month after operation and at the latest follow-up. The preoperative and postoperativescores were compared. At the latest follow up, the Macnab system was used to evaluate the effects of the operation. RESULTS: The main symptom of 34 cases was severe radiation pain on one side of lower limbs. The duration of preoperative symptoms ranged from 0.33 to 84 months. The disc herniation was found in 7 cases of L4, 5 and 27 cases of L5S1. According to the MSU division of lumbar disc herniation, 31 cases were located in area B. In all cases, it was confirmed that the protruding nucleus compressed the nerve root, and in 26 cases, the nerve root was obviously inflamed. The operation time ranged from 30 to 80 min, with a mean time of (43.5±9.5) min. The preoperative VAS score was 8.1±1.3 and ODI score was 31.8±6.7. And the VAS score was 1.1± 0.3, 0.7±0.4 on the first month after operation and the latest follow up, respectively. The ODI score was 5.3±2.1 and 0 to 10 (with a median score of 2) on the first month after operation and the latest follow-up respectively. The postoperative VAS and ODI scores were improved compared with preoperative scores.At the latest follow up, 28 cases got an excellent result and 6 cases good according to Macnab evaluation system. During the follow-up period, only one patient had recurrent disc herniation. CONCLUSION: The main symptom of patients with tLDHSS is severe radiation pain on one side of lower limb. It manifests as sudden onset and shorter course of disease. Severe local inflammation was induced by local compression of the protruding nucleus pulposus on the nerve root out of the dura. For this kind of patients, thin layer CT scan has an important diagnostic value. In the treatment of this kind of patients, the symptoms are relieved rapidly, the curative effect is definite and the recurrence rate is low.

Baicalin Induces Apoptotic Death of Human Chondrosarcoma Cells through Mitochondrial Dysfunction and Downregulation of the PI3K/Akt/mTOR Pathway.

The aim of the present study was to investigate the cytotoxic and antitumour effects of baicalin in human chondrosarcoma both in vivo and in vitro. We examined the effects of baicalin on the growth and apoptosis of human chondrosarcoma cells. Baicalin inhibited the growth of SW1353 and CH2879 cells in a dose- and time-dependent manner, but did not inhibit the growth of normal chondrocytes. Baicalin reduced tumour growth and induced apoptotic death in SW1353-transplanted nude mice without reducing their body weight. Further studies showed that baicalin reduced the mitochondrial membrane potential, upregulated the expression of Bax and cytoplasmic cytochrome c, downregulated the expression of Bcl-2 and mitochondrial cytochromes, and activated caspase-3 and caspase-9. Baicalin inhibited the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin pathway by decreasing the expression of phosphorylated phosphoinositide 3-kinase, phosphorylated protein kinase B, and phosphorylated mammalian target of rapamycin both in vivo and in vitro. Moreover, the mice that received SC79 and baicalin exhibited a greater tumour size compared with the mice that received baicalin. The mice that received LY294002 and baicalin showed a smaller tumour size compared with the mice that received baicalin. In the in vitro study, SC79 and LY294002 affected the baicalin-induced cytotoxic effects on chondrosarcoma cells in the same manner. Our data suggest baicalin has therapeutic efficacy in human chondrosarcoma through the induction of apoptosis and inhibition of the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin pathway. Baicalin can be considered a potential therapeutic agent for treating chondrosarcomas.

Cervical spondylotic myelopathy patients with prior cerebral infarction: Clinical characteristics, surgical outcomes and prognostic value of "prior cerebral infarction".

OBJECTIVE: To investigate the clinical characteristics and surgical outcomes of patients with cervical spondylotic myelopathy (CSM) and prior cerebral infarction (CI); to identify whether "prior CI" correlates with poor surgical outcomes. PATIENTS AND METHODS: Twenty-two patients with CSM and prior CI were retrospectively reviewed and included as the CI group while 100 CSM patients without CI were included as the control group (matched for gender, age, symptom duration and surgical approach). Extensive demographic and surgery-related data for patients in both groups were collected and compared. Multivariate logistic regression analysis was performed to assess all potential factors affecting surgical outcomes. RESULTS: Compared to the control group, the CI group had the following: significantly higher percentages of hypertension, "progressive myelopathy", "rapid progressive myelopathy" and "intramedullary T2-weighted hyperintensity on MRI"; lower mean "preoperative mJOA score" and "postoperative mJOA score"; higher percentages of "preoperative mJOA score ≤11″ and "recovery rate of mJOA score <50%". In the CI group, 14 patients had CI within 6 months before CSM, and their percentage of "rapid progressive myelopathy" was higher than that of patients who had CI over 6 months before CSM. Logistic regression analysis showed that smoking, "symptom duration ≥12 months", "T2-weighted hyperintensity" and "prior CI" correlated with poor surgical outcome. CONCLUSION: Rapid progressive myelopathy with advanced neurological impairment and "intramedullary T2-weighted hyperintensity" are common in patients with CSM and prior CI. Surgical outcomes in these patients are poorer than those of ordinary CSM patients. "Prior CI" is a risk factor for predicting poor surgical outcomes.

Is the Cervical Anterior Spinal Artery Compromised in Cervical Spondylotic Myelopathy Patients? Dual-Energy Computed Tomography Analysis of Cervical Anterior Spinal Artery.

OBJECTIVE: Cervical myelopathy is a common, acquired cause of spinal cord dysfunction in older patients. It is postulated that a hypoxic or ischemic environment secondary to chronic spinal cord compression plays an important role in the pathogenesis of myelopathy. This study aims to use dual-energy computed tomography (DECT) to assess the altered blood flow to the spinal cord in patients with cervical spondylotic myelopathy (CSM). To our knowledge, this study is the first to use DECT in identifying comprised anterior spinal artery blood flow in patients with CSM. METHODS: Fifty patients with single disc level CSM and 10 volunteers without CSM underwent DECT of the cervical spine to analyze and compare the ASA. The neurologic status of each patient was evaluated preoperatively and postoperatively at 5 days, 1 month, and 6 months using the Japanese Orthopedic Association (JOA) score. All the patients with CSM underwent single-level anterior cervical discectomy and fusion, and at postoperative day 5, each patient underwent repeated DECT. The anterior spinal artery before and after surgery was compared in patients with CSM. The blood flow in terms of iodine content at a specific region of interest was measured in the axial CT of the volunteers group and in the preoperative and postoperative axial CT of patients with CSM. Correlations between change in blood flow and clinical improvement at each follow-up point were analyzed statistically. RESULTS: Iodine content (100 mg/mL) was 14.2800 ± 1.89527 at the C3/C4 disc level, 14.8280 ± 1.83820 at the C4/C5 disc level, and 15.5000 ± 2.41048 at the C5/C6 level. In patients with CSM, the preoperative iodine content (100 mg/mL) measured was 10.2621 ± 2.37396 in C3/C4 disc-level compression, 12.1438 ± 1.63447 in C4/C5 disc-level compression, and 14.0620 ± 2.44390 in C5/C6 disc-level compression. Postoperative iodine content (100 mg/mL) measurement changed to 13.78 ± 2.77 for the C3/C4 disc level, 14.16 ± 1.90 for the C4/C5 disc level, and 15.14 ± 2.62 for the C5/C6 disc level. The JOA score was 13.650 preoperatively, 14.010 at 5 days postoperatively, 14.630 at 1 month postoperatively, and 15.000 at 6 months postoperatively. The 1- and 6-month correlation ratios between the JOA and change in blood flow were statistically significant, with an r value of 0.746 (P < 0.05) and 0.760 (P < 0.05), respectively. CONCLUSIONS: This study provided evidence for the benefit of DECT as a radiographic tool for identifying the compromised cervical anterior spinal artery in patients with CSM. We believe that DECT is the one of the best radiographic tools available to provide an objective screening tool to detect compromised blood flow in patients with CSM.

Inhibition of Autophagy is Involved in the Protective Effects of Ginsenoside Rb1 on Spinal Cord Injury.

Spinal cord injury (SCI) is a devastating neurological disorder. Autophagy is induced and plays a crucial role in SCI. Ginsenoside Rb1 (Rb1), one of the major active components extracted from Panax Ginseng CA Meyer, has exhibited neuroprotective effects in various neurodegenerative diseases. However, it remains unknown whether autophagy is involved in the neuroprotection of Rb1 on SCI. In this study, we examined the regulation of autophagy following Rb1 treatment and its involvement in the Rb1-induced neuroprotection in SCI and in vitro injury model. Firstly, we found that Rb1 treatment decreased the loss of motor neurons and promoted function recovery in the SCI model. Furthermore, we found that Rb1 treatment inhibited autophagy in neurons, and suppressed neuronal apoptosis and autophagic cell death in the SCI model. Finally, in the in vitro injury model, Rb1 treatment increased the viability of PC12 cells and suppressed apoptosis by inhibiting excessive autophagy, whereas stimulation of autophagy by rapamycin abolished the anti-apoptosis effect of Rb1. Taken together, these findings suggest that the inhibition of autophagy is involved in the neuroprotective effects of Rb1 on SCI.

ß-Escin inhibits the proliferation of osteosarcoma cells via blocking the PI3K/Akt pathway.

ß-Escin exhibits anticancer effects on a panel of established cancer cells. However, the effects of ß-escin on human osteosarcoma (OS) are still unknown. The aim of the present study was to investigate whether ß-escin was effective against OS both in vivo and in vitro. Our results showed that ß-escin induced dose- and time-dependent effects against MG-63, OS732, U-2OS, HOS and SAOS-2 cell proliferation. ß-Escin also exhibited excellent anti-proliferative and pro-apoptotic effects in an established OS xenograft model. ß-Escin and cytotoxic drugs, including cisplatin, methotrexate (MTX), doxorubicin (Dox) and ifosfamide (Ifos), synergistically inhibited proliferation of MG-63 and OS732 cells in vitro. Moreover, ß-escin induced apoptotic death, activated caspase-3, caspase-8 and caspase-9, and regulated expression of Bax and Bcl-2 in MG-63 cells. In addition, our results showed that ß-escin treatment reduced expression of p-PI3K, p-Akt and p-mTOR both in MG-63 cells and in an MG-63 xenograft OS model. Interestingly, SC79, which is an Akt activator, inhibited the anti-proliferative effects of ß-escin on MG-63 cells. Taken together, our data support the conclusion that ß-escin effectively inhibits OS proliferation both in vivo and in vitro. The inhibitory effect of ß-escin, at least in part, is due to the inactivation of the PI3K/Akt signalling pathway.

[Analysis of complications of percutaneous endoscopic lumbar discectomy].

OBJECTIVE: To analyze the complications of lumbar intervertebral disc herniation treated with percutaneous endoscopic lumbar discectomy(PELD), and discuss how to avoid these complications. METHODS: The data of 132 patients with lumbar intervertebral disc herniation underwent PELD from October 2013 and June 2015 were retrospectively analyzed, including 85 males and 47 females with an average age of 42.9 years old. There were 6 cases of L3,4, 68 of L4,5 and 58 of L5S1. The incidences of intraoperative and postoperative complications were analyzed. RESULTS: There was spinal dura mater injury in 1 patient, but no cerebrospinal fluid leakage and nerve function deficit was found, the muscle strength did not decrease postoperatively and the incision healed well. Two patients converted to open surgery ultimately because of stenosis of the intervertebral foramen and adhesion between nucleus pulposus and spinal dura mater; two patients complicated with early recurrence(in 3 months);nucleus pulposus residue developed in 3 patients; all of them were treated by open surgery and got satisfactory results. One patient with heart disease history complicated with supraventricular tachycardia after surgery and 2 patients with the increased cerebrospinal fluid pressure during surgery. CONCLUSIONS: PELD have a steep learning curve, and the technology is a safe and effective method in treating lumbar disc herniation, but the beginners must have enough open surgery experience, and to grasp indications strictly.

Inhibition of Autophagy by Estradiol Promotes Locomotor Recovery after Spinal Cord Injury in Rats.

17ß-estradiol (E2) has been shown to have neuroprotective effects in different central nervous system diseases. The mechanisms underlying estrogen neuroprotection in spinal cord injury (SCI) remain unclear. Previous studies have shown that autophagy plays a crucial role in the course of nerve injury. In this study, we showed that E2 treatment improved the restoration of locomotor function and decreased the loss of motor neurons in SCI rats. Real-time PCR and western blot analysis revealed that the protective function of E2 was related to the suppression of LC3II and beclin-1 expression. Immunohistochemical study further confirmed that the immunoreactivity of LC3 in the motor neurons was down-regulated when treated with E2. In vitro studies demonstrated similar results that E2 pretreatment decreased the autophagic activity induced by rapamycin (autophagy sensitizer) and increased viability in a PC12 cell model. These results indicated that the neuroprotective effects of E2 in SCI are partly related to the suppression of excessive autophagy.

The Effect and Feasibility Study of Transforaminal Percutaneous Endoscopic Lumbar Discectomy Via Superior Border of Inferior Pedicle Approach for Down-Migrated Intracanal Disc Herniations.

Transforaminal percutaneous endoscopic lumbar discectomy (PELD) is gradually regarded as an effective alternative to posterior open surgery. However, migrated herniations bring a great technical challenge even for experienced surgeons due to the absence of the appropriate approaching guideline. We aimed to describe a safe and effective approaching technique for the removal of down-migrations on the basis of the clinical outcomes and complications compared with the conventional approaching method.A total of 45 patients recommended to single-level PELD with foraminoplasty were randomly divided into 2 groups, group A received foraminoplasty via upper border of inferior pedicle, group B was approached through the common transforaminal route. The clinical outcomes were evaluated by Visual Analog Scale (VAS) for leg pain and Oswestry Disability Index (ODI) scores. Then participants were classified into 2 types of migrations (high-grade and low-grade) based on the extent of migration presented on preoperative magnetic resonance imaging (MRI). The various comparisons between the 2 surgical techniques were analyzed.The postoperative VAS and ODI scores significantly decreased in both of the 2 groups after surgery (P < 0.001). The follow-up continued 1 year. With increasing length of follow-up, the disparities in clinical outcomes between the 2 groups were gradually narrowing and there was no significant difference at the end of follow-up (P = 0.32; P = 0.46). There were no differences in the operation time and duration of hospital stay (P = 0.36; P = 0.08). The highly migration group in group B showed a significant longer operation time (P = 0.02), but the extent of migration did not have a significant influence on the operation time in group A with the modified approach (P = 0.19). There were no apparent approach-related complications in group A during the procedure and follow-up period.Foraminoplastic-PELD via upper border of inferior pedicle can serve as a safe and effective minimally invasive technique for removal of down-migrated herniations. Furthermore, it is essential to identify the radiologic characteristics so as to choose the most appropriate approaching technique.

The Contribution of Diffusion Tensor Imaging to Quantitative Assessment on Multilevel Cervical Spondylotic Myelopathy.

BACKGROUND/AIMS: This study aimed at assessing the feasibility of diffusion tensor imaging (DTI) in multilevel cervical spondylotic myelopathy (MCSM) and quantifying the association between DTI parameters and neuronal status as a whole. METHODS: Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were obtained from 32 patients with MCSM and 21 healthy volunteers at each level. The extent of cervical cord compression was evaluated by maximum spinal cord compression (MSCC). The DTI parameters were correlated with myelopathy severity based on modified Japanese Orthopedic Association (mJOA) score in comparison with anatomic morphological and signal changes on MRI. RESULTS: There were significant differences in the DTI values between the patients and those in the control group (p < 0.001). The general mean FA values correlated with mJOA scores strongly (r = 0.507, p = 0.003), even more than MSCC (r = -0.361, p = 0.042); however, such an association was not detected between ADC values and clinical findings (p > 0.05). CONCLUSION: DTI shows a higher potential to quantitatively evaluate the whole neurological deficits of patients with MCSM. It helps us better understand the minor pathological changes within the spinal cord at an earlier stage than abnormal signal changes on MRI.

[Correlation among prevertebral hyperintensity signal, canal sagittal diameter on MRI and neurologic function of patients with cervical vertebral hyperextension injury].

OBJECTIVE: To explore the correlation among prevertebral hyperintensity (PVH), sagittal canal diameter on MRI and neurologic function of patients after cervical vertebral hyperextension injury without fracture and dislocation. METHODS: The clinical data of 100 patients with cervical vertebral hyperextension injury without fracture and dislocation were retrospectively analyzed from September 2010 to December 2013. The patients were divided into PVH group and non-PVH group according to the presence of PVH on T2-weighted magnetic resonance imaging. There were 39 patients in PVH group, including 31 males and 8 females, aged from 21 to 83 years old with an average of (58.10 ± 14.78) years; and the other 69 patients in non-PVH group, including 49 males and 12 females, aged from 32 to 77 years old with an average of (55.05 ± 10.36) years. The sagittal disc level canal diameters of subaxial cervical spine were measured on mid-sagittal magnetic resonance imaging. The age, sex, cause of injury, and the segments of spinal stenosis were recorded. American Spinal Injury Association (ASIA) impairment scale and motor score were used to evaluate the neurological status. RESULTS: The ASIA motor score of the group with PVH was 52.56 ± 31.97 while the ASIA motor score was 67.70 ± 22.83 in non-PVH group (P = 0.013). More patients with intramedullary hyperintensity signal on MRI were observed in the PVH group than in non-PVH group (P = 0.006). There was a significant positive correlation between ASIA motor score and sagittal disc level canal diameter of injury segment (P = 0.003). The neurological status was worse in patients with multi-level sagittal canal diameters below 8 mm. CONCLUSION: The PVH and the disc-level canal sagittal diameter of the injury segment are associated with neurological status. The patients with multi-level sagittal canal stenosis are vulnerable to severe cervical spinal cord injury.

Paeoniflorin inhibits nucleus pulposus cell apoptosis by regulating the expression of Bcl-2 family proteins and caspase-9 in a rabbit model of intervertebral disc degeneration.

Apoptosis plays a key role in the pathogenesis of internal disc disruption (IDD); therefore, the inhibition of apoptosis may offer a novel approach for treating IDD diseases. The aim of the present study was to investigate the effects and the underlying mechanisms of paeoniflorin through the detection of relevant indicators in a rabbit model of IDD. In total, 144 rabbits were used in the study and divided into four groups (n=36 per group). Rabbits successfully modeled with IDD received an intragastric injection of 120 mg/kg·day paeoniflorin (high-dose group), 30 mg/kg·day paeoniflorin (low-dose group) or saline (model saline group), while rabbits without IDD were used as a normal control group. The apoptosis rate of disc nucleus pulposus cells was detected using flow cytometry. In addition, the expression levels of Bcl-2, Bax and caspase-9 in the disc tissues were detected using immunohistochemistry and western blot analysis prior to and following the treatment. The results indicated that the expression levels of Bax in the low- and high-dose paeoniflorin groups were significantly reduced, while the Bcl-2 expression levels were significantly increased when compared with the model saline group (P<0.01). In addition, the expression levels of cleaved caspase-3 and cleaved caspase-9 were reduced in the low- and high-dose paeoniflorin groups, as compared with the model saline group (P<0.05). Furthermore, the average apoptotic index of the high- and low-dose paeoniflorin groups was decreased when compared with the model saline group (P<0.05). In conclusion, paeoniflorin was demonstrated to inhibit the apoptosis of nucleus pulposus cells and the activation of caspase-3 and caspase-9 through the regulation of Bcl-2 family protein expression. These results provide an experimental basis for the future treatment of IDD with paeoniflorin.