Endoscopic double line suture repair technique for repairing Iatrogenic dural tear: a technical case report.

PURPOSE: Introducing a suture repair technology, endoscopic double line suture repair technique, for iatrogenic dural injury during Percutaneous Endoscopic Lumbar Discectomy (PELD) surgery. METHODS: A patient with dural injury and cauda equina herniation during PELD surgery was treated with endoscopic double line suture repair technique. RESULTS: A patient with dural injury and cauda equina nerve herniation during PELD surgery was successfully treated using double-line suture technique. After the repair, no obvious cerebrospinal fluid leakage and cauda equina nerve re-herniation was seen. During the postoperative observation period, the wound healed well and there were no complications related to cerebrospinal leakage. During the follow-up period (1 year), the patient reported significant symptom relief and no complications. CONCLUSION: This novel dural repair technology is safe and effective and can be used to treat dural injuries during PELD surgery.

Casticin induces ferroptosis in human osteosarcoma cells through Fe2+ overload and ROS production mediated by HMOX1 and LC3-NCOA4.

Osteosarcoma is a primary solid bone malignancy, and surgery + chemotherapy is the most commonly used treatment. However, chemotherapeutic drugs can cause a range of side effects. Casticin, a polymethoxyflavonoid, has anti-tumor therapeutic effects. This study is aim to investigate the anti-osteosarcoma activity of casticin and explore the mechanism. Crystal violet staining, MTT assay, colony formation assay, wound healing assay, transwell assay, hoechst 33,258 staining, and flow cytometry analysis were used to investigate the effects of casticin on proliferation, migration, invasion, and apoptosis of osteosarcoma cells in vitro. The intracellular Fe2+, ROS, MDA, GSH/GSSG content changes were detected using the corresponding assay kits. The mRNA sequencing + bioinformatics analysis and western blot were used to detect the possible mechanism. We found that casticin caused G2/M phase cell cycle arrest in human osteosarcoma cells, inhibited the migration and invasion, and induced cell apoptosis and ferroptosis. Mechanistic studies showed the ferroptosis pathway was enriched stronger than apoptosis. Casticin up-regulated the expression of HMOX1, LC3 and NCOA4, meanwhile it activated MAPK signaling pathways. Animal experiments proved that casticin also inhibited the growth and metastasis of osteosarcoma cell xenograft tumor in vivo. In conclusion, casticin can induce ferroptosis in osteosarcoma cells through Fe2+ overload and ROS production mediated by HMOX1 and LC3-NCOA4. This provides a new strategy for osteosarcoma treatment.

Evaluation of parallel endplate osteotomy for severe rigid spinal deformities: a retrospective analysis of 36 cases with a minimum 2-year follow-up.

BACKGROUND: To report on the technique and results of parallel endplate osteotomy (PEO) for severe rigid spinal deformity. METHODS: We retrospectively reviewed the clinical data of 36 patients with severe rigid spinal deformities who underwent PEO between July 2016 and December 2018 and who were followed up for at least 24 months. RESULTS: Following PEO, the kyphosis and scoliosis correction rates reached 77.4 ± 14.0% and 72.2 ± 18.2%, respectively. The median intraoperative estimated blood loss was 1500 mL and the median operative time was 6.8 h. The SF-36 scores of physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional and mental health changed from 62 ± 28, 51 ± 26, 49 ± 29, 35 ± 30, 53 ± 28, 45 ± 30, 32 ± 34 and 54 ± 18 at baseline to 81 ± 16, 66 ± 41, 72 ± 40, 64 ± 44, 75 ± 25, 71 ± 46, 66 ± 34 and 76 ± 28 at 12 months postoperatively, 82 ± 32, 67 ± 42, 81 ± 30, 71 ± 41, 80 ± 30, 74 ± 36, 68 ± 35 and 85 ± 33 at 18 months postoperatively, and 86 ± 21, 83 ± 33, 88 ± 26, 79 ± 39, 86 ± 36, 86 ± 48, 80 ± 47 and 91 ± 39 at 24 months postoperatively, respectively. CONCLUSIONS: PEO is an effective technique for successful correction of spinal deformities. At the two-year follow-up visit, all patients achieved better clinical results based on the SF-36 scores.

CRISPR/dCas9-Mediated Parkin Inhibition Impairs Mitophagy and Aggravates Apoptosis of Rat Nucleus Pulposus Cells Under Oxidative Stress.

OBJECTIVE: The aim of this study is to explore the role of Parkin in intervertebral disk degeneration (IDD) and its mitophagy regulation mechanism. STUDY DESIGN AND METHODS: Rat nucleus pulposus (NP) cells were stimulated with hydrogen peroxide (H2O2) to a mimic pathological condition. Apoptosis and mitophagy were assessed by Western blot, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay, and immunofluorescence staining. The CRISPR-dCas9-KRAB system was used to silence the expression of Parkin. RESULT: In this study, we found that Parkin was downregulated in rat NP cells under oxidative stress. In addition, treatment with H2O2 resulted in mitochondrial dysfunction, autophagy inhibition, and a significant increase in the rate of apoptosis of NP cells. Meanwhile, mitophagy inhibition enhanced H2O2-induced apoptosis. Furthermore, repression of Parkin significantly attenuated mitophagy and exacerbated apoptosis. CONCLUSION: These results suggested that Parkin may play a protective role in alleviating the apoptosis of NP cells via mitophagy, and that targeting Parkin may provide a promising therapeutic strategy for the prevention of IDD.

Protection of L1 nerve roots by pre-relieve tension in parallel endplate osteotomy for severe rigid thoracolumbar spine deformity.

BACKGROUND: This is a retrospective study of the use of parallel endplate osteotomy (PEO) for correction of severe rigid thoracolumbar spine deformity. METHODS: From July 2016 to January 2019, 12 patients with severe rigid thoracolumbar spine deformity underwent PEO on T12 or L1 vertebrae were studied. RESULTS: Following PEO at T12 or L1, the mean kyphosis and scoliosis correction rates reached 77.0 ± 8.9% and 75.5 ± 8.0%, respectively and the intraoperative estimated blood loss was 1950 ± 1050 mL, and the mean operative time was 6.98 ± 4.02 h. The SF-36 scores of physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional and mental health changed from 63 ± 28, 50 ± 25, 50 ± 30, 34 ± 19, 53 ± 28, 45 ± 30, 30 ± 36 and 54 ± 18 at baseline to 83 ± 18, 69 ± 19, 72 ± 12, 66 ± 21, 75 ± 15, 72 ± 22, 66 ± 34 and 76 ± 12 at 1 year postoperatively, 83 ± 8, 68 ± 32, 83 ± 17, 73 ± 17, 82 ± 18, 76 ± 26, 70 ± 37 and 88 ± 12 at 18 months postoperatively, 86 ± 6, 83 ± 33, 90 ± 16, 81 ± 16, 89 ± 14, 88 ± 25, 83 ± 17 and 94 ± 10 at 24 months postoperatively, respectively (P < 0.01). Three patients had symptoms of L1 nerve root injury, as reflected by lower limb weakness and inner thigh numbness on knee extension and hip flexion, which was further confirmed by electromyography. CONCLUSIONS: PEO is easier to operate, and the spinal cord and nerve root are under direct vision and can effectively and safely correct severe rigid thoracolumbar spine deformity with satisfactory clinical results. However, it is important to identify, separate and protect L1 nerve roots during surgery in cases where patients have symptoms of back pain, muscle weakness and leg numbness on the convex side after surgery.

Management of Spine Tuberculosis With Chemotherapy and Percutaneous Pedicle Screws in Adjacent Vertebrae: A Retrospective Study of 34 Cases.

STUDY DESIGN: Retrospective study. OBJECTIVE: The objective of this study was to evaluate the efficacy of local chemotherapy combined with percutaneous pedicle screw in adjacent vertebra in the treatment of spine tuberculosis (TB). SUMMARY OF BACKGROUND DATA: Despite the increased treatment concepts and surgical methods, the management of TB, which is increasing in prevalence, remains challenging. Considerable complications existing in the conventional debridement surgery with TB spondylitis requires more attention. METHODS: A retrospective evaluation containing 34 cases of spinal TB (17 males, 17 females; average age 59 years; 14 thoracic TB, 11 thoracolumbar TB, nine lumbar TB) between April 2007 and August 2014 was conducted. All patients were treated with local chemotherapy combined with percutaneous pedicle screw in adjacent vertebrae. The ASIA grade, the Cobb angle, and complications were investigated. RESULTS: All the patients were followed with an average of 18 (range, 12-52) months and were successfully treated without radiculopathy or neurological complications, with 27 excellent and seven fair outcomes at the final follow-up. One case that developed serious abscess in the primary focus underwent anterior focus debridement and bone graft fusion and recovered to the grade of fine at the final following up. As for kyphotic deformity, there was no Cobb angle loss. No other obvious complications were observed in all the patients. CONCLUSION: Local chemotherapy combined with percutaneous pedicle screw in adjacent vertebrae seems an effective method to treat spine TB, with some advantages including smaller trauma, fine neurologic recovery, few complications, and no Cobb angle loss. LEVEL OF EVIDENCE: 3.

[Long-term clinical studies on the treatment of lumbosacral spinal tuberculosis with CT-guided minimally invasive surgery].

OBJECTIVE: To evaluate the clinical effects of CT-guided percutaneous puncture and local chemotherapy for lumbosacral spinal tuberculosis. METHODS: From January 2002 to March 2013, 145 patients (84 males and 61 females) with lumbosacral spinal tuberculosis underwent failed conservative treatment were treated with CT-guided minimally invasive surgery. Their clinical data were retrospectively analyzed. Among them, 143 patients were followed up, aged from 2.5 to 81 years with an average of (42.60 +/- 17.14) years. Fourteen cases (6 cases with internal fixation and 8 cases without internal fixation) recurred and 32 cases complicated with paraspinal abscess after operation. Preoperatively 1 case complicated with lower limb weakness and superficial sensation worse, 1 case with muscle strength decrease, this 2 cases were grade D of Frankle, other cases were grade E. And 1 patient underwent fenestration operation and local chemotherapy, 144 cases with CT-guided percutaneous puncture and local chemotherapy. ESR and lumbar lordosis angle of all patients were observed preoperatively and final follow-up. RESULTS: The mean follow-up time was 67 months (ranged, 21 to 149 months) in 143 cases, and 73 cases more than 5 years. All patients obtained clinical healing. ESR was (44.96 +/- 12.41) mm/h before operation and (7.25 +/- 3.43) mm/h at final follow-up, there was significant difference between preoperative and postoperative (t=35.06, P=0.000). Lumbar lordosis angle was (36.32 +/- 8.55) degrees before operation and (33.35 +/- 8.16) at final follow-up, there was significant difference between preoperative and postoperative (t=13.90, P=0.000). CONCLUSION: When conservative treatment fails for 3 months or more, the patients have good spinal stabilization, nerve function is more than grade D of Frankel, CT-guided percutaneous puncture and local chemotherapy can get satisfactory outcomes for lumbosacral spinal tuberculosis.

Outcomes of percutaneous endoscopic lumbar discectomy via a translaminar approach, especially for soft, highly down-migrated lumbar disc herniation.

PURPOSE: This study reports a new approach for percutaneous endoscopic lumbar iscectomy (PELD), especially for soft, highly down-migrated lumbar disc herniation. METHODS: Seven patients with soft, highly down-migrated lumbar disc herniation who underwent PELD via a translaminar approach under local anaesthesia from January 2013 to June 2015, including five patients who underwent failed PELD in other hospitals, were retrospectively analyzed. Clinical outcomes were evaluated according to pre-operative and post-operative visual analogue scale (VAS) scores, Oswestry disability index (ODI) scores and post-operative magnetic resonance imaging (MRI). RESULTS: The highly down-migrated lumbar disc herniation was completely removed by PELD via a translaminar approach in seven patients, as confirmed by post-operative MRI. Leg pain was eased after removal of the disc migrations. The mean follow-up duration was 9.8 (range, 6-14) months. The mean pre-operative VAS was 7.6 ± 0.8 (range, 6-9), which decreased to 3.1 ± 1.5 (range, 2-5) at one week post-operatively and to 1.3 ± 0.8 (range, 0-3) by the last follow-up visit. The mean pre-operative ODI was 61.6 (range, 46-84), which decreased to 16.3 (range, 10-28) at the one month post-operative follow-up and to 8.4 (range, 0-14) by the last follow-up visit. No recurrence was observed in any of the seven patients during the follow-up period. CONCLUSION: PELD via a translaminar approach could be a good alternative option for the treatment of soft, highly down-migrated lumbar disc herniation.

Limited long-segment fusion for degenerative lower lumbar scoliosis: a special kind of scoliosis.

AIM: The aim of the study was to investigate the feasibility of limited long-segment fusion for a special kind of scoliosis: degenerative lower lumbar scoliosis without severe thoracolumbar kyphosis. METHODS: A total of 43 patients with degenerative lower lumbar scoliosis who underwent spinal surgery at our hospital from June 2003 to September 2012 were included in this retrospective study. The apical vertebrae included L3 and L4, the end vertebra was L2 or L3, and the T10-L2 kyphosis angle was <20°. The limited long-segment fusion group (upper end vertebrae L2) included 19 patients, and the long-segment fusion group (upper end vertebrae T9-11) included 24 patients. The radiographic parameters and Oswestry disability index (ODI) scores were compared between the two groups pre-operatively and at the last follow-up evaluation. RESULTS: The differences in the lumbar Cobb angle, lumbar lordosis angle, pelvic tilt angle, sacral slope angle, T10-L2 kyphosis angle, proximal junctional kyphosis angle, and ODI scores between the two groups pre-operatively and at the last follow-up evaluation were not statistically significant (p > 0.05). The limited long-segment fusion group did not exhibit post-operative proximal junctional kyphosis. CONCLUSIONS: Limited long-segment fusion is effective for patients with degenerative lower lumbar scoliosis without severe thoracolumbar kyphosis.