Effects of anti-osteoporosis treatment in elderly patients with osteoporosis and lumbar discectomy and fusion.

BACKGROUND: The effect of anti-osteoporosis treatment in elderly patients with osteoporosis and lumbar discectomy and fusion (LIF) for lumbar degenerative diseases is not well known. OBJECTIVE: This study aimed to evaluate the effect of perioperative anti-osteoporosis treatment in the patients with osteoporosis and LIF. METHODS: From January to December 2022, patients were divided into three groups according to the inclusive criteria: the normal group (Group A), the osteopenia group (Group B) and the osteoporosis group (Group C). Quantitative computed tomography (QCT), height of the intervertebral space (HIS), segmental sagittal angle (SSA), visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were compared between the groups at the follow-up time. The serum Ca2 + , osteocalcin (OC), propeptide of type I procollagen (PINP) C-terminal cross-linking telopeptide of type I collagen (ß-CTX) and 25-OH vitamin D (25-OH VD) levels were compared between the groups at the time of follow-up. Interbody fusion was graded on the X-ray and CT images at the follow-up time. RESULTS: There were 165 patients in this study. There were significant differences in the mean age, mean score, HIS and SSA between the groups at the different follow-up times. There were significant differences in the concentrations of serum Ca2 + , OC, ß-CTX, 25-OH VD and PINP at the sixth month after surgery between the groups. There were significant differences in the concentrations of serum Ca2 + , ß-CTX and 25-OH VD between the pre-surgery and at six months after surgery in Group B and ß-CTX and 25-OH VD in Group C. There was a significant difference in the degree of fusion between Group B and C (χ2= 5.6243, P< 0.05). CONCLUSION: In elderly patients with LIF and osteoporosis, anti-osteoporosis therapy could reduce bone resorption and thus facilitate fusion. Anti-osteoporosis medication tends to enhance radiological, functional, and fusion short-term outcomes.

Clinical efficacy of duloxetine in the treatment of axial symptoms after posterior cervical spine surgery: a retrospective study.

PURPOSE: To evaluate the efficacy of duloxetine in the treatment of patients with axial symptoms after posterior cervical spine surgery. METHODS: Patients with axial symptoms after posterior cervical spine surgery treated by duloxetine or non-drug therapy from 2018 to 2021 were reviewed. Duloxetine was administered gradually, with oral administration of 30 mg in the first week and oral administration of 60 mg from the second week. Visual analogue scale (VAS), 36-Item Short-Form Health Survey questionnaire (SF-36) and EuroQol-5 Dimensions (EQ-5D) questionnaire were used to evaluate the severity of AS at baseline and 1 week, 2 weeks, 1 month, 3 months and 6 months after medication. The occurrence of adverse reactions was recorded. RESULTS: A total of 63 eligible patients who received duloxetine therapy (n = 35) or non-drug therapy (n = 28) were included. All patients were followed up for 6 months. Significant improvements were found in VAS score compared with baseline in both groups (1.87 ± 0.81 vs 6.61 ± 1.16, 3.18 ± 0.67 vs 6.31 ± 1.40; P < 0.05 for all). Meanwhile, the VAS score of the duloxetine group was significantly better than that of the non-drug therapy group at 1 week, 2 weeks, 1 month, 3 months and 6 months (P < 0.05). Besides, according to 36-Item Short-Form Health Survey questionnaire (SF-36), the PCS score and MCS score are significantly higher than before the treatment in duloxetine group (PCS 62.82 ± 6.04 vs 44.36 ± 7.25, MCS 65.50 ± 4.53 vs 55.55 ± 6.06; P < 0.05 for all). And when we compared variables between the two groups, the PCS score of the duloxetine group was significantly better than that of the non-drug therapy group (P < 0.05), but there was no significant difference in MCS score between the two groups (P > 0.05). What's more, EQ-5D score had significant improvements in the duloxetine group compared with the non-drug therapy group at 1 week, 2 weeks, 1 month, 3 months and 6 months (P < 0.05). CONCLUSION: Oral duloxetine has a better short-term outcome than conventional non-drug therapy in patients with axial symptoms following posterior decompression surgery in the cervical spine.

Clinical Effects of Upper Facet Joint En Bloc Resection in the Transforaminal Lumbar Interbody Fusion Surgery-Two Layers and Two Tunnels Strategy.

OBJECTIVE: The upper facet joint en bloc resection is the key step to open the intervertebral foramina for achieving the intervertebral fusion in transforaminal lumbar interbody fusion (TLIF) surgery. Our purpose is to introduce a upper facet joint resection technique which can avoid injuring the nerve root termed "two layers and two tunnels strategy" in TLIF surgery and to evaluate its clinical effects and neurological safety. METHODS: All 108 patients who underwent TLIF surgery using two layers and two tunnels strategy between December 2015 and January 2019 were analyzed for postoperative clinical treatment parameter. The visual analogue scale (VAS) method, Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) scores and the Macnab scoring system were used to evaluate the clinical effects during post-operative check-ups at 7 days, 3 months, 6 months, and the last follow-up visit. Data were represented by mean and standard deviation, and repeated measures analysis of variance was performed to make comparison. RESULTS: The result noted that, the VAS scores for back pain decreased by 30.13% at 7 days post-operation (3.64 ± 0.86), 63.15% at 3 months (1.92 ± 0.55), 72.17% at 6 months (1.45 ± 0.61) and 70.44% at the last follow-up (1.54 ± 0.62) compared with pre-operation (5.21 ± 0.93). The VAS scores for lower limb pain decreased by 44.22% at 7 days (3.86 ± 0.90), 61.42% at 3 months (2.67 ± 0.72), 66.62% at 6 months (2.31 ± 0.79) and 66.47% at the last follow-up (2.32 ± 0.72) compared with pre-operation (6.92 ± 1.04). The ODI scores decreased by 49.08% at 7 days (32.19 ± 5.13), 67.92% at 3 months (20.28 ± 5.50), 74.00% at 6 months (16.44 ± 4.21) and 75.42% at the last follow-up (15.54 ± 3.85) compared with pre-operation (63.22 ± 7.58). The JOA scores increased by 51.41% at 7 days (18.49 ± 1.48), 69.26% at 3 months (22.35 ± 1.44), 73.28% at 6 months (23.22 ± 1.18) and 77.53% at the last follow-up (24.14 ± 0.99) compared with pre-operation (7.37 ± 1.71). Among 108 cases, there is no neurological complications. CONCLUSION: Two layers and two tunnels strategy is an effective and safe procedure that can certainly avoid nerve root injury to reduce neurological complication and increase safety of TLIF surgery.

Magnetic Resonance Imaging Negative Spine Trauma Followed by a Delayed Intravertebral Vacuum Cleft-Kümmell's Disease: A Case Report and Literature Review.

BACKGROUND: Kümmell's disease (KD) is a rare clinical entity characterized by delayed post-traumatic vertebral body collapse, in which an intravertebral vacuum cleft (IVC) is formed. The patient sustained a minor spinal trauma, and their spine X-ray examinations were negative. However, after an asymptomatic period of months, they developed recurrent back pain because of the progressive vertebral collapse of the affected spine. However, no imaging examination could confirm the magnetic resonance imaging (MRI)-negative initial spinal trauma followed by delayed vertebral collapse with IVC. CASE PRESENTATION: We report a case of KD occurring in a 66-year-old postmenopausal patient whose lumbar MRI on sagittal planes were immediately performed following the initial trauma (a ground-level fall) and revealed that the vertebral integrity or connectivity was not interrupted and the marrow signal was even. After an asymptomatic period of 8 months, the back pain reappeared and progressively exacerbated. The wedge-shaped change in the T11 vertebra with an IVC was confirmed by lumbar computed tomography and MRI. Finally, KD was diagnosed following extensive routine hematological and biochemical workups. Percutaneous kyphoplasty was performed to relieve her back pain by restoring her vertebral stability. CONCLUSIONS: We confirmed that the OVF was not the first step in the KD sequence, and the IVC - KD - could from an initial MRI-negative spine trauma.

HOXC13-AS Induced Extracellular Matrix Loss via Targeting miR-497-5p/ADAMTS5 in Intervertebral Disc.

Background/Aims: LncRNAs are a new modulator in the development of intervertebral disc degeneration. However, the functional role and mechanism of HOXC13-AS in intervertebral disc degeneration remain unclear. Methods: qRT-PCR analysis was performed to measure the relative expression levels of HOXC13-AS and miR-497-5p, and the levels of IL-1ß, IL-6, and TNF-α in the medium supernatant were analyzed by ELISA. The related mechanism between HOXC13-AS and miR-497-5p was detected by luciferase assays. Results: The results revealed that TNF-α and IL-1ß induced HOXC13-AS expression in NP cells. HOXC13-AS was overexpressed in IDD specimens compared to control specimens, and higher expression of HOXC13-AS was correlated with high Pfirrmann scores. Ectopic expression of HOXC13-AS promoted MMP-3 and ADAMTS4 and inhibited aggrecan and collagen II expression in NP cells. Furthermore, overexpression of HOXC13-AS increased the expression of inflammatory cytokines, including IL-1ß, IL-6, and TNF-α. Our results demonstrated that TNF-α and IL-1ß induced ADAMTS5 expression and suppressed miR-497-5p expression. miR-497-5p was downregulated in IDD specimens compared to control specimens, and the lower expression of miR-497-5p was correlated with high Pfirrmann scores. The miR-497-5p level was negatively proportional to HOXC13-AS expression in IDD specimens. Luciferase analysis data indicated that ADAMTS5 was a direct target gene of miR-497-5p. HOXC13-AS induced inflammatory cytokine expression and ECM degradation by modulating miR-497-5p/ADAMTS5. Conclusion: HOXC13-AS may be a treatment target for IDD.

Neuroprotective effect of neuregulin-1ß on spinal cord ischemia reperfusion injury.

Objective: This study was designed to see if neuregulin-1ß (NRG-1ß) plays a protective role in spinal cord ischemia and reperfusion injury (SCII).Design: Animal research.Setting: China.Participants: NA.Interventions: Forty-eight SD rats were randomly divided into control group (n = 16), SCII model group (n = 16) and NRG-1ß-treated group (n = 16). In control group, the abdominal aorta was isolated but not clipped. The rats in NRG-1ß-treated group were treated with 10µg/kg NRG-1ß during developing SCII model.Outcome Measures: Neurological scores were evaluated. At 3, 6, 12 and 24 h after the reperfusion, rats were killed. Pathological changes of spinal cord were assessed with HE staining, and immunohistochemical staining of matrix metalloproteinases-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1). MMP-9 and TIMP-1 mRNA levels were assessed using real-time PCR.Results: NRG-1ß reduced the damage of SCII in the rats. The expression of MMP-9 protein and mRNA in NRG-1ß treatment group was significantly lower than the model group (P < 0.05) at 6 h, 12 h and 24 h after the perfusion. The expression of TIMP-1 protein and mRNA in the treatment group was significantly higher than the model group at 12 h and 24 h after the perfusion.Conclusion: NRG-1ß reduced the reperfusion damage in rat model of SCII, in which process MMP-9 and TIMP-1 were probably involved.

MicroRNA-93 regulates collagen loss by targeting MMP3 in human nucleus pulposus cells.

OBJECTIVES: Degenerated disc disease is one of the most common medical conditions in patients suffering from low back pain. Recent studies have shown that microRNAs can regulate cell function in many pathological conditions. The aim of this study was to investigate expression and role of miR-93 in disc degeneration. MATERIALS AND METHODS: Quantitative RT-PCR was employed to investigate level of miR-93 in degenerative nucleus pulposus (NP) tissues. Then, functional analysis of miR-93 in regulating collagen II expression was performed. Subsequently, western blotting and luciferase reporter assay were used to detect the target gene. RESULTS: We showed that miR-93 was significantly down-regulated in degenerative NP tissues and its levels were associated with grade of disc degeneration. Overexpression of miR-93 stimulated type II collagen expression in NP cells. Moreover, MMP3 was identified as a putative target of miR-93. MiR-93 inhibited MMP3 expression by directly targeting its 3'UTR, and this was abolished by miR-93 binding site mutations. Additionally, restoration of MMP3 in miR-93-overexpressed NP cells reversed effects of type II collagen expression. Expression of MMP3 inversely correlated with miR-93 expression in degenerative NP tissues. CONCLUSIONS: Taken together, we demonstrated that miR-93 contributed to abnormal NP cell type II collagen expression by targeting MMP3, involved in intervertebral disc degeneration.

[Experimental study on effect of reduced glutathione on random flap survival in rats].

OBJECTIVE: To investigate the effects of glutathione (GSH) on survival of the random skin flap in rats and the probable mechanism that contribute to this effect. METHODS: Twenty SD rats with 200-250 g in weight, were randomly divided into the experimental group and control group(n = 10). Random flap of 8 cm x 2 cm in size was made on the back of each rat with the pedicel on the angular of the scapular. GSH (250 mg/kg) and NS of the same dose were injected into the abdominal cavity of rats in the experimental group and the control group immediately after the operative, 1st and 2nd days respectively. The rats were killed on the 7th day after the operation. The tissue pathology, the survival rate of the flap, the superoxide dismutase (SOD) activity and malonyldialdehyde (MDA) level were compared between two groups. RESULTS: The mean survival rate of the flap on the 7th day in the experimental group (56.77% +/- 10.67%) was higher than that in the control group (40.16% +/- 7.12%) (P < 0.05). SOD activity in experimental group (306.06 +/- 84.87 U/mgprot) was higher than that in the control group (224.79 +/- 27.12 U/mgprot), while MDA level (3.835 +/- 0.457 nmol/mgprot) was lower than that in the control group (6. 127+0. 837 nmol/mgprot) (P < 0.05). Histological observation showed that the neutrophil infiltration was less in experimental group than that in the control group; that the experimental group was surperior to the control group in angiogenesis, fibroblasts, fair cells and cuaneous gland. CONCLUSION: The intraperitoneal use of GSH may promote the survival rate of the random flaps and the possible mechanism for improvement may lies in that the GSH can reduce the level of oxygen free radical and lipidperoxidation, and lessen neutrophil infiltration.