Novel dual: rod plate system for EOS improves vertebral wedging and permits spinal growth.

BACKGROUND: To determine whether single-stage, growth-friendly instrumentation with a plate-rod spinal system (PRSS) can substantially correct the deformity of EOS at surgery and continue to rectify the deformity throughout the growth period. METHODS: An observational study of 35 children with EOS treated by PRSS between February 2000 and October 2010 during a mean follow-up of 72 months. The mean age at surgery was 7 years. X-rays were taken preoperatively and postoperatively and at each follow-up. The Cobb angle, the apical vertebral wedge angle (AVWA), remaining rod lengths, maximal thoracic kyphosis and total T1-S1 heights were measured and compared. RESULTS: Thirty-one patients, 9 boys and 22 girls, with a mean age of 7 years were completed follow-up. The Cobb angle changed from 64° to 36° after initial surgery and 26° at the last follow-up. The mean AVWA was 15° postoperatively and 5° at the last follow-up. The mean rod tail reserve length decreased from 53 mm immediately after surgery to 12 mm at the last follow-up. The mean preoperative maximum thoracic kyphosis was 41° and changed to 35° and 30° postoperatively and at latest follow-up, respectively. The mean preoperative T1-S1 height for all 32 patients was 52 mm acute lengthening and 122 mm of lengthening by the end of follow-up, respectively. CONCLUSION: The PRSS provided immediate correction of most of the deformity at surgery and continued to rectify remaining scoliosis during the growth period. AVWA may be a useful method for monitoring the function of the PRSS in EOS.

Phosphoglycerate mutase 5 facilitates mitochondrial dysfunction and neuroinflammation in spinal tissues after spinal cord injury.

Spinal cord injury (SCI) is a high incidence worldwide that causes a heavy physical and psychological burden to patients. It is urgent to further reveal the pathological mechanism and effective treatment of SCI. Mitochondrial dysfunction plays an important role in the disease progression of SCI. As a mitochondrial membrane protein, phosphoglycerate mutase 5 (PGAM5) is mainly involved in mitochondrial function and mitosis to modulate cellular physiological functions, but the roles of PGAM5 in spinal tissues remain to be unreported after SCI. The purpose of this study was to evaluate the role of PGAM5 in SCI mice and its relationship with neuroinflammation. The results showed that the mitochondrial membrane protein PGAM5 was involved in microglia activation after SCI, and PGAM5 deletion could improve mitochondrial dysfunction (including abnormal mtDNA, ATP synthases, and ATP levels, Cyt C expression, and ROS and rGSH levels) in spinal cord tissue after SCI, Arg1/iNOS mRNA level, iNOS expression, and pro-inflammatory cytokines TNF-α, IL-1ß, and IL-18 levels. In vitro, H2O2 increased TNF-α, IL-1ß, and IL-18 levels in BV2 cells, and PGAM5-sh and Nrf2 activators significantly reversed H2O2-induced iNOS expression and proinflammatory cytokine production. Furthermore, IP/Western blotting results revealed that PGAM5-sh treatment significantly reduced the interaction of PGAM5 with Nrf2 and enhanced the nuclear translocation of Nrf2 in BV2 cells. The data suggested that PGAM5 was involved in the cascade of oxidative stress and inflammatory response in microglia via facilitating the expression level of Nrf2 in the nucleus after SCI. It provided a reference for clarifying the pathological mechanism and therapeutic target of SCI.

Analysis of injury and pain scores during fusion surgery for multisegmental lumbar spinal stenosis in elderly patients.

INTRODUCTION: Lumbar stenosis has become a common disease. Controversies exist regarding fusion surgery. MATERIAL AND METHODS: The patients were divided into groups per the method of fusion received: the posterolateral fusion group (group P) and the intervertebral fusion group (group I). The patients were further divided into groups based on the number of fusion segments: the 2-segment group (P2 and I2), the 3-segment group (P3 and I3), and the 4-segment group (P4 and I4). The operative time, intraoperative blood loss, blood transfusion volume, and postoperative drainage volume were summarized. In particular, wound healing appearance and management were observed. RESULTS: The operation time and blood transfusion volume of the P2 and P3 groups were significantly less than those of the I2 and I3 groups (p < 0.05). The postoperative drainage volume of group I4 was less than that of group P4 (p < 0.05). Postoperative numeric rating scale (NRS) scores of P2 and P3 groups were lower than those of I2 and I3 groups (p < 0.05), while the NRS scores of P4 group were higher than those of I4 group (p < 0.05). CONCLUSIONS: Posterolateral and intervertebral fusion techniques can be used in the surgical treatment of elderly patients with lumbar spinal stenosis. The posterolateral fusion method should be used when three or fewer segments require surgery. The intervertebral fusion method should be used when four segments require surgery.

Spinal Biomechanical Modelling in the Process of Lumbar Intervertebral Disc Herniation in Middle-Aged and Elderly.

Lumbar disc herniation is one of the common clinical diseases of the lower lumbar spine in orthopedics. The purpose is to remove the herniated disc nucleus pulposus tissue, remove the compressed part of the disease, and relieve symptoms, such as nerve pain. In the past, biomechanics research mostly relied on in vitro measurements, but the complicated internal environment of the human body prevented us from further measurement and research. However, with the development of computer technology, the use of computer CT scanning, software three-dimensional reconstruction, and displacement study three-dimensional spine biomechanics method makes the research of biomechanics into in vitro simulation stage and has gradually become the focus of current research. The postoperative biomechanics was simulated and the comparison model was established at the same time. At the same time, we combined the clinical follow-up data and studied the clinical data for the treatment of postoperative recurrence of lumbar disc herniation. We compared and analyzed the initial operation method and the experimental results and obtained the prevention of recurrence. The results showed that when one inferior articular process was removed, the lumbar spine appeared unstable to rotate to the opposite side; when one inferior articular process was completely removed, the movement of the lumbar spine in all directions was unstable. Better research on the biomechanical properties of the spine will help the diagnosis and treatment of clinical lumbar disc herniation. Therefore, when performing posterior lumbar spine surgery, not only should the exposure of the surgical field and thorough decompression be considered, but also the biomechanical properties of the lumbar spine should be comprehensively evaluated.