Does local lavage influence functional recovery during lumber discectomy of disc herniation?: One year's systematic follow-up of 410 patients.

Lumbar disc herniation (LDH) is a common disease and lumbar discectomy is the most common surgical procedure carried out for patients with low back pain and leg symptoms. Although most researchers are focusing on the surgical techniques during operation, the aim of this study is to evaluate the effect of local intervertebral lavage during microdiscectomy.In this retrospective study, 410 patients were operated on by microdiscectomy for LDH during 2011 to 2014. Retrospectively, 213 of them (group A) accepted local intervertebral irrigation with saline water before wound closure and 197 patients (group B) only had their operative field irrigated with saline water. Systematic records of visual analog scores (VAS), Oswestry disability Index (ODI) questionnaire scale scores, use of analgesia, and hospital length of stay were done after hospitalization.The majority (80.49%) of the cases were diagnosed with lumber herniation at the levels of L4/5 and L5/S1. Fifty-one patients had herniations at 2 levels. There were significant decreases of VAS scores and ODI in both groups between preoperation and postoperation of different time points. VAS scores decreased more in group A than group B at early stage of postoperation follow-up. However, there were no statistically significant differences between 2 groups in using analgesia, VAS and ODI up to 1 month of follow-up.Microdiscectomy for LDH offers a marked improvement in back and radicular pain. Local irrigation of herniated lumber disc area could relief dick herniation-derived low back pain and leg radicular pain at early stage of post-operation. However, the pain relief of this intervention was not noticeable for a long period.

Celastrol attenuates oxidative stress in the skeletal muscle of diabetic rats by regulating the AMPK-PGC1α-SIRT3 signaling pathway.

Oxidative stress plays a key role in the pathogenesis of diabetic myopathy. Celastrol provides a wide range of health benefits, including antioxidant, anti-inflammatory and antitumor effects. We hypothesized that celastrol may exert an antioxidant effect in the skeletal muscle of diabetic rats. In the present study, MnSOD activity was determined by spectrophotometry. The protein levels were evaluated by western blot analysis and mRNA content was quantified by RT­qPCR. We firstly found that the levels of AMP-activated protein kinase (AMPK), peroxisome proliferator-activated receptor coactivator 1α (PGC1α), silent mating-type information regulation 2 homolog 3 (Sirt3) and manganese superoxide dismutase (MnSOD) were all decreased in the skeletal muscle of diabetic patients. Male rats with diabetes were also treated with the vehicle or with celastrol at 1, 3 and 6 mg/kg/day for 8 weeks. The administration of celastrol at 3 and 6 mg/kg attenuated the deterioration of skeletal muscle, as shown by histological analysis, decreased the malondialdehyde (MDA) level and increased the glutathione (GSH) level assayed by enzyme-linked immunosorbent assay (ELISA) method. It also enhanced the enzyme activity and increased the expression of MnSOD, and increased the AMPK phosphorylation level, as well as PGC1α and Sirt3 expression. The findings of our study suggest that the expression of AMPK, PGC1α, Sirt3 and MnSOD are decreased in the skeletal muscle of diabetic patients. Celastrol exerted antioxidant effects on skeletal muscle partly by regulating the AMPK-PGC1α-Sirt3 signaling pathway.

[Diagnosis and surgery of lumbar disc herniation sequestrating to upper spinal canal: analysis of 17 cases].

OBJECTIVE: To summarize the experience in diagnosis and surgery of lumbar disc herniation sequestrating to upper spinal canal. METHODS: Seventeen patients, 9 males and 8 females, aged 41 (27-54), with the diseased intervertebral discs herniated and upward sequestrated that were confirmed by lumbar MRI, all with definite clinical manifestations of nerve root compression, underwent operation, including 14 cases undergoing semi-laminectomy and discectomy and 3 cases undergoing laminectomy, discectomy, and fusion. Japanese Orthopedic Association (JOA) (29 scores) evaluation standard was used to before the operation and 14 days and 3 months after the operation to evaluate the curative effects. RESULTS: The average operation time was 80 min 50-180 min), and the average blood loss was 170 ml (20-350 ml). Cerebrospinal fluid leakage occurred after operation in 2 cases. The JOA score was 6.7 pre-operationally, and then rose to 24.214 days and 26.53 months post-operationally. The clinical effect was satisfied. CONCLUSION: Lumbar disc herniation sequestrating to upper spinal canal is often misdiagnosed as intraspinal tumor. Confirmed diagnosis depends on the operators' experience and intensive MRI. Operation is necessary for this type of lumbar disc herniation. Lumbar stability must be considered during decompression and discectomy.