Study on early efficacy of UBED and PEID in the treatment of L5/S1 intervertebral disc herniation.

INTRODUCTION: This study aimed to compare early efficacy of UBED and PEID in the treatment of L5/S1 IDH. MATERIAL AND METHODS: Forty-two patients who underwent surgical treatment for L5/S1 IDH were divided into two groups: UBED and PEID. Operation time, complications, VAS/ODI score were recorded. MacNab evaluation was completed one and three months postoperatively. RESULTS: All patients were successfully operated without infection, nerve injury, or huge hematoma in the spinal canal. There were no significant differences in operation time and hospitalization days between the two groups (p > 0.05). All patients were followed up after the operation and low back/leg pain was significantly reduced. VAS for low back pain, VAS for leg pain, ODI scores in both groups one and three months after the operation were significantly lower than pre-operation (p < 0.05). There were no significant differences between one and three months after the operation in both groups (p > 0.05). There were no significant differences in VAS for low back pain, leg pain, ODI score, and overall efficacy between the two groups one and three months post-operation (p > 0.05). CONCLUSION: UBED and PEID have very good early efficacy in treating L5/S1 IDH. Because UBED has a wider vision field and more flexible operation, it can be used as a useful complement to PEID.

The impact of dyslipidemia on lumbar intervertebral disc degeneration and vertebral endplate modic changes: a cross-sectional study of 1035 citizens in China.

BACKGROUND: Intervertebral disc degeneration (IDD) and vertebral endplate Modic changes (MCs) are common lumbar degenerative phenotypes related to low back pain (LBP). Dyslipidemia has been linked to LBP but its associations with IDD and MCs have not been fully elucidated. The present study aimed to address the possible link between dyslipidemia, IDD and MCs in the Chinese population. METHODS: 1035 citizens were enrolled in the study. The levels of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were collected. IDD was evaluated based on the Pfirrmann grading system and subjects with an average grade ≥ 3 were defined as having degeneration. MCs were classified into typical types 1, 2 and 3. Covariables, including age, sex, BMI and fasting plasma glucose, were included for the adjustment of the logistic analyses. RESULTS: The degeneration group included 446 subjects while the nondegeneration group included 589 subjects. The degeneration group had significant higher levels of TC and LDL-C (p < 0.001) whereas TG and HDL-C were not significantly different between the two groups. TC and LDL-C concentrations were significantly positively correlated with average IDD grades (p < 0.001). Multivariate logistic regression revealed that high TC (≥ 6.2 mmol/L, adjusted OR = 1.775, 95% CI = 1.209-2.606) and high LDL-C (≥ 4.1 mmol/L, adjusted OR = 1.818, 95% CI = 1.123-2.943) were independent risk factors for IDD. Type 1 MC presented in 84 (8.12%) subjects, type 2 MC presented in 244 (23.57%) subjects, type 3 MC presented in 27 (2.61%) subjects and no MC was observed in the remaining 680 (65.70%) subjects. The type 2 MC group demonstrated a higher level of TC, but the association between serum lipids and MCs could not be confirmed in further multivariate logistic regression. CONCLUSIONS: High TC (≥ 6.2 mmol/L) and LDL-C (≥ 4.1 mmol/L) concentrations were independent risk factors for IDD for citizens in China. However, the association between dyslipidemia and MCs could not be determined. The effect of excess serum cholesterol may be critical for IDD and cholesterol lowering treatment may provide new opportunities in the management of lumbar disc degeneration.

Experimental Investigation of the Secondary Changes in Imaging After Lumbar Disc Nucleoplasty in Rabbits.

AIM: To explore the changes in imaging after lumbar disc nucleoplasty in rabbits. MATERIAL AND METHODS: Twenty-four rabbits were randomly selected for X-ray, computerized tomography (CT), and magnetic resonance imaging (MRI) at 2, 6, and 12 weeks post operation. Moreover, their L3/4, L4/5, and L5/6 intervertebral discs were randomly selected as the untreated, annulus puncture, and nucleoplasty groups, respectively. Changes in disc height index (DHI%) and MRI grade were measured and compared. CT three-dimensional reconstruction was used to evaluate adjacent bone endplate changes. RESULTS: The untreated group's DHI% decreased slightly at different time points (p > 0.05), while that of the nucleoplasty and annulus puncture groups decreased progressively (p < 0.05). At six weeks post operation, the nucleoplasty group's DHI% was significantly lower than that of the annulus puncture group (p < 0.05), with mild osteosclerosis and local rough changes in the endplate. At 12 weeks post operation, a "bone bridge" connection was observed in the nucleoplasty group. There was no significant difference in MRI grade between the untreated and annulus puncture groups at different time points (p > 0.05). MRI grades of the intervertebral disc in the nucleoplasty and annulus puncture groups showed a progressive increase (p < 0.05). Compared with the annulus puncture at the same time point, the nucleoplasty group's MRI grade of the intervertebral disc was significantly higher (p < 0.05). Thus, damage caused by an annulus puncture can lead to progressive degeneration of the lumbar disc. CONCLUSION: Nucleoplasty may have a cumulative effect with the injury of the annulus puncture. Clinicians need to comprehensively consider advantages and disadvantages of nucleoplasty, strictly grasp indications of treatment, and prevent longterm complications.

miR-153 attenuates the inflammatory response and oxidative stress induced by spinal cord injury by targeting of NEUROD2.

OBJECTIVE: Spinal cord injury (SCI) is a common spine surgical injury that leads to loss of activities of daily living. NEUROD2, a member of the neuroD family, is newly known to play a crucial role in SCI progression. We aimed to investigate the underlying mechanism wherein miR-153 and NEUROD2 modulate the process of SCI. METHODS: Expression of miR-153 and NEUROD2 in spinal cord in mice of SCI were analyzed employing western blot and qRT-PCR assays. Microglial cells were transfected with mimic of miR-153 or siRNA targeting NEUROD2 to determine the impact of miR-153 and NEUROD2 on SCI induced inflammatory reaction and oxidative stress. A luciferase reporter assay was conducted to verify the regulation of miR-153 on NERUOD2. RESULTS: MiR-153 expression was decreased in injured spinal cord, while NERUOD2 was increased in a time-dependent manner. Addition of miR-153 mimic or silencing NERUOD2 might significantly inhibit the production of inflammation cytokines and attenuated oxidative stress in microglia cells of SCI. Luciferase reporter assay suggested that NERUOD2 was a direct target of miR-153. CONCLUSION: We proved that miR-153 attenuated inflammatory response and oxidative stress induced by SCI by targeting of NEUROD2, indicating a protective role in SCI progression.

Efficacy of Single Level Versus Double Levels Surgery of Percutaneous Disc Nucleoplasty (PDN) Approach in Treating Lumbar Disc Herniation.

BACKGROUND Although percutaneous disc nucleoplasty (PDN) has been widely applied in treating lumbar disc herniation (LDH) in recent years, the efficacy of surgical levels for PDN on LDH has been reported in limited studies. This study aimed to explore and compare the efficacy of surgical levels (single level vs double level) of PDN in treating LDH. MATERIAL AND METHODS All patients diagnosed with LDH from January 2012 to December 2014 in our hospital who underwent PDN were included in this study. Patients were divided into a single-level group and double-level group based on the number of discs/surgical treatment levels. The improvement of visual analog scale (VAS) score, patient satisfaction, and reoperation occurrence were compared between the 2 groups. RESULTS Of 105 total patients, 75 patients were treated with single-level treatment and 30 patients with double-level treatment. VAS for leg pain and patient satisfaction scores in the double-level group were worse than those in the single-level group at 6 months after surgery (P<0.05). Among all 105 patients, the incidence of reoperation was 11.4%. Also, there was a marked difference in reoperation occurrence at 6 months after surgery between the single-level (6.7%) and double-level (23.3%) groups; however, the difference was not statistically significant (P=0.05). CONCLUSIONS PDN is a safe and minimal-invasive approach, which could effectively treat LDH. The number of surgical levels might be an important factor influencing the efficacy of PND. Caution should be exercised to strictly follow the clinical indications for nucleoplasty.

Serum miR-21 expression correlates with radiographic progression but also low bone mineral density in patients with ankylosing spondylitis: a cross-sectional study.

Increased expressions of miR-21 have been detected in ankylosing spondylitis (AS) patients. The current study was performed to examine the serum miR-21 expression with radiographic severity in AS patients, which was determined based on the modified New York (NY) criteria for sacroiliac joints assessment and modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) system for spine involvement. Bone mineral density at lumbar 1-4 and femoral neck were examined by dual-energy absorptiometry (DXA). Serum miR-21 expressions were determined by quantitative real-time PCR, and receiver operating characteristic curve analysis was performed to identify the diagnostic value of miR-21 expression levels regarding the NY criteria. Elevated levels of serum miR-21 expressions were detected in AS patients compared with healthy controls. AS patients with modified NY grade 4 showed significantly higher miR-21 expression than grade 3 and grade 2. AS patients with spinal syndesmophytes had significantly higher serum miR-21 expressions than non-syndesmophyte patients. Increased miR-21 expressions were significantly related to the disease radiographic severity. In addition, serum miR-21 expressions were negatively associated with lumbar 1-4 and femoral neck bone mineral density. In summary, serum miR-21 expressions were related to structural damage and radiological progression in AS, indicating that miR-21 may act as a switch between inflammation and new bone information and regulate different signal ways between lesioned enthesis and trabecular bone.

Attenuated levels of ghrelin in synovial fluid is related to the disease severity of ankle post-traumatic osteoarthritis.

Post-traumatic osteoarthritis (PTOA) of ankle joints results in pain and reduced joint function. Ghrelin, a 28-amino-acid polypeptide, has been previously identified as the first cognate natural ligand that binds to the growth hormone secretagogue receptor. In the present study, ghrelin has been validated to exert cartilage-protective and anti-inflammatory effects. The current study was aimed at investigating the potential role of the levels of serum and synovial fluid (SF) ghrelin on the severity of disease in patients suffering from ankle PTOA. Ninety-seven patients with ankle osteoarthritis who received an arthroscopical examination and debridement or replacement of the ankle joint were included in the study cohort. Meanwhile, 95 healthy individuals (whose age and sex were matched) who received periodic body checkups were enrolled as healthy controls. Enzyme-linked immunosorbent assay (ELISA) was used to analyze the ghrelin levels in serum and SF. SF was also probed for cartilage degradation enzyme matrix metalloproteinases-3 (MMP-3) and tumor necrosis factor alpha (TNF-α), which is a known pro-inflammatory cytokine. The clinical evaluation was carried out using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot rating scale and visual analogue scale (VAS). The radiographic severity was evaluated using the modified Kellgren-Lawrence (K-L) grading system. We scored for the modified Mankin's score to depict histopathological changes due to cartilage lesions. The diagnostic relevance of the ghrelin concentrations in the prediction of the radiographic grading (in comparison with MMP-3 and TNF-α) was evaluated by calculating the area under the curve of the receiver operating characteristic (ROC) curve. The serum abundance of ghrelin was not significantly altered between ankle PTOA patients and healthy controls. SF ghrelin was negatively correlated with radiographic progression determined by modified ankle K-L grades. In addition SF ghrelin concentrations were negatively related to VAS scores, and positively associated with AOFAS ankle-hindfoot rating. Moreover, SF ghrelin was inversely proportional to the expressions of MMP-3 and TNF-α. ROC analysis curve demonstrated that ghrelin serves as a favorable marker for the diagnosis of radiographic severity by modified ankle K-L grade. The ghrelin concentration in SF is negatively proportional to disease progression in patients suffering from ankle PTOA. Local administration of ghrelin may function as a decent adjuvant therapy to delay the progress of ankle PTOA. © 2019 BioFactors, 45(3):463-470, 2019.

Curative effect and mechanism of radiofrequency ablation nucleoplasty in the treatment of cervical vertigo.

OBJECTIVE: This study aims to investigate the curative effects and mechanism of radiofrequency ablation nucleoplasty in the treatment of cervical vertigo. METHODS: A total of 27 patients diagnosed with cervical vertigo from January 2012 to October 2014 received treatment of radiofrequency ablation nucleoplasty. The narrow-side vertebral artery diameters were examined by using Philips 1.5-T body dual-gradient MRI system. The haemodynamic parameters were detected by using transcranial Doppler sonography. Both of the vertebral artery diameters and haemodynamic parameters were recorded and compared before and after treatment. The curative effects in early post-operative application were evaluated according to the Nagashima standards. RESULTS: Radiofrequency ablation nucleoplasty was performed in a total of 59 cervical discs in 27 patients. The average operation time was 42.7 min, and the symptoms of 92.6% patients were alleviated after radiofrequency ablation nucleoplasty post-operation application. There was no significant difference in the narrow-side vertebral artery diameters before and after treatment in both Group A (p = 0.12) and Group B (p = 0.48); however, the blood flow velocity was significantly higher than that before treatment in both Group A (p = 0.01) and Group B (p = 0.03), respectively. CONCLUSION: Radiofrequency ablation nucleoplasty improves the blood flow in the narrow-side vertebral artery and illustrates the therapeutic effect on cervical vertigo in patients who have no direct compression of the vertebral artery. Advances in knowledge: Radiofrequency intradiscal nucleoplasty can be used as a minimally invasive procedure for treating cervical vertigo.