Quantitatively assessing the effect of cervical sagittal alignment on dynamic intervertebral kinematics by video-fluoroscopy technique.

BACKGROUND: Cervical sagittal alignment is crucial for distributing the head load to lower cervical segments and maintaining normal cervical spine function, but its biomechanical effect on the cervical spine was not fully elucidated. OBJECTIVE: To investigate the effect of cervical sagittal alignment on dynamic intervertebral kinematics. DESIGN: Cross-sectional study. METHODS: Healthy participants without neck pain were recruited and divided into lordosis, straight and kyphosis groups according to the C2-C7 Cobb angle at the neutral position. The anti-directional and total joint motions were extracted across 10 epochs of dynamic cervical flexion and extension movements. RESULTS: /findings: The overall anti-directional joint motion during flexion is larger in the kyphosis group when compared with the lordosis group (p = 0.021), while the range of flexion is smaller in the kyphosis group than that in the lordosis group (p = 0.017). The C2/C3 anti-directional joint motion during extension in the straight group is larger than that in the lordosis group (p = 0016). The range of extension in the kyphosis group (p < 0.001) and the straight group (p = 0.002) are larger than that in the lordosis group. The increased range of extension in the kyphosis and straight groups were mainly from the C3/C4, C4/C5, and C5/C6 joints(p < 0.05). CONCLUSION: Changes in cervical sagittal alignment alter both the quality and quantity of the individual joint motions. More adjustments are required by the cervical joints to complete neck movements with the loss of lordosis. The lordotic curvature is a relatively effort-saving mode for the cervical spine from a biomechanical perspective.

Cost and Effectiveness of Percutaneous Endoscopic Interlaminar Discectomy versus Microscope-Assisted Tubular Discectomy for L5-S1 Lumbar Disc Herniation.

OBJECTIVE: To assess the cost and effectiveness of percutaneous endoscopic interlaminar discectomy (PEID) and microscope-assisted tubular discectomy (MATD) for patients with L5/S1 lumbar disc herniation (LDH). METHODS: The medical and financial records of patients diagnosed with L5/S1 LDH and who underwent either PEID or MATD from April 2021 to April 2022 were retrospectively collected. Demographic and baseline information, perioperative observational index, clinical outcomes, and inpatient costs were analyzed. RESULTS: Sixty patients were included, with 30 patients in the PEID group and 30 patients in the MATD group. No significant difference was found in demographic and baseline information between the 2 groups (P > 0.05). The PEID group showed significantly shorter incision length, less intraoperative blood loss, shorter hospital stays, and higher intraoperative fluoroscopy frequency compared with the MATD group (P < 0.05). There were no significant differences in visual analog scale back/leg score, Oswestry Disability Index, and 36-Item Short-Form Survey score between PEID and MATD groups before the surgery and at any follow-up time points (P > 0.05). The total cost, surgery cost, and surgical instruments/materials cost were significantly higher in the PEID group compared with the MATD group (P < 0.05). In contrast, the drug and nursing costs were significantly higher in the MATD group than in the PEID group (P < 0.05). CONCLUSIONS: PEID and MATD provide equivalent clinical efficacy and safety in treating LDH at L5/S1 segment within a 1-year follow-up. However, PEID is less invasive and MATD is less costly. No one surgical technique is superior in all aspects and patients should make decisions according to their top concern.

Diagnostic Values of Peripheral Blood T-Cell Spot Test for Tuberculosis (T-SPOT.TB) for Spinal Tuberculosis.

Background: The T-cell spot test for tuberculosis (T-SPOT.TB) with false positives and false negatives exists in the diagnosis of spinal infection. The objective of this study was to increase the diagnostic value precision and specificity of T-SPOT.TB in the identification of spinal tuberculosis (TB). Patients and Methods: Fifty-two patients suspected of having spinal TB from April 2020 to December 2021 were included, and all patients received T-SPOT.TB tests and surgical treatment. The composite reference standard was used to diagnose spinal TB. The T-SPOT.TB values were compared according to whether spinal TB was diagnosed, and the optimal cutoff values of diagnosis was determined by receiver operating characteristic (ROC) curve analysis. Results: All patients were followed up for at least one year. The sensitivity, specificity, positive predictive value, and negative predictive value of the T-SPOT.TB test in assisting the diagnosis of spinal TB were 91.67%, 71.43%, 73.33%, and 90.9%, respectively. We determined that the values of early secreted antigen target 6 (ESAT-6) antigen and culture filter protein 10 (CFP-10) antigen were determined to be diagnostic for spinal tuberculosis, with areas under the curve equal to 0.776 and 0.852, respectively; the cutoff values for the diagnosis of ESAT-6 antigen and CFP-10 antigen were calculated as 40.5 spot forming cells (SFCs) per 106 peripheral blood mononuclear cells (PBMCs) and 26.5 SFCs/106 PBMCs, respectively. Follow-up for all patients was 12 months, and in this period, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), visual analog scale (VAS) score, and Oswestry Dysfunction Index (ODI%) were different between groups (p < 0.05). Conclusions: The T-SPOT.TB test is considered a milestone discovery in the diagnosis of TB; there are still many false-positive samples, but the diagnostic specificity was improved in the study, allowing spinal infections to be treated accurately and in a timely manner.

Surfactin suppresses osteoclastogenesis via the NF-κB signaling pathway, promotes osteogenic differentiation in vitro, and inhibits oestrogen deficiency-induced bone loss in vivo.

BACKGROUND: Fractures caused by osteoporosis (OP) are one of the main causes of death in the elderly, bringing a heavy burden to the country and society. The imbalance between osteoblast-mediated osteogenesis and osteoclast-mediated bone resorption is an important cause of OP. Therefore, finding drugs that can regulate this dynamic balance can be an important way to treat osteoporosis. Surfactin is a highly effective biosurfactant derived from Bacillus subtilis and it has been proven to have various pharmacological effects in previous studies, but its effect on bone metabolism remains unknown. Here, we performed a study on the role and mechanism of Surfactin in inhibiting osteoclastogenesis and its possible mechanism as well as the role in promoting osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). METHODS: We investigated the effect of Surfactin on osteoclast differentiation and osteogenic differentiation in vitro and in vivo. The effect of Surfactin on the activity of osteoclastogenesis and osteogenesis was verified by CCK-8 assay, quantitative Real-time polymerase chain reaction (qPCR) and Western blotting analysis were used to verify the effect of Surfactin on osteoclast and osteogenic differentiation-specific genes and proteins. The effect of Surfactin on TRAP、ALP activity and mineral deposition was verified by TRAP、ALP and ARS staining. We then used an ovariectomy-induced osteoporosis mice model to observe the effect of Surfactin in vivo. RESULTS: Surfactin is noncytotoxic to BMMs, RAW264.7, and BMSCs. And it can effectively inhibit osteoclastogenesis and promote osteogenic differentiation. Moreover, we found that Surfactin can inhibit the differentiation of osteoclasts through the NF-κB signaling pathway. Surfactin can also alleviate bone loss in ovariectomy-induced osteoporosis mice. CONCLUSIONS: Our results suggest that Surfactin can inhibit osteoclastogenesis through the NF-κB signaling pathway, promote the osteogenic differentiation of BMSCs, and also can effectively alleviate bone loss in ovariectomy-induced osteoporosis mice.

CircRNA expression profile and potential role of hsa_circ_0040039 in intervertebral disc degeneration.

PURPOSE: Circular RNAs (circRNAs) play an critical role in the pathological processes associated with IDD. However, the potential roles of circRNAs in IDD remain largely unclear. Here, we identify the circRNAs expression profiles and elucidate the potential role of candidate circRNAs in the pathogenesis of intervertebral disc degeneration (IDD) through microarray data and bioinformatics analyses. METHODS: We obtained the datasets of microarrays (GSE67566 and GSE116726) from the Gene Expression Omnibus database. The differentially expressed circRNAs and miRNAs were identified using the Limma R package. The target miRNAs and target genes of the candidate circRNAs were predicted using an online tool. Functional enrichment analyses of the target genes were performed using the clusterProfiler R package. A protein-protein interaction (PPI) network was constructed using STRING. RESULTS: A total of 104 differentially expressed circRNAs were identified between the IDD and the control groups, including 41 upregulated circRNAs and 63 downregulated circRNAs (cutoff criteria (|log2 fold change| > 2, P < .05)). Hsa_circ_0040039, which was the most upregulated circRNA (log2 fold change = 2.95), was selected for further analysis. The regulatory circRNA-miRNA-mRNA network comprised hsa_circ_0040039, 2 target miRNAs (hsa-miR-424-5p and hsa-miR-15b-5p), and 77 target genes. Functional enrichment analysis showed that the 77 promising target genes are mainly enriched in the ubiquitin proteasome system and Wnt signaling pathway. Further, the PPI network showed that the top 3 hub genes are BRTC, SIAH1, and UBE2V1. CONCLUSIONS: A total of 104 differentially expressed circRNAs were identified between the IDD and control groups. Hsa_circ_0040039 may serve as a sponge of hsa-miR-424-5p and hsa-miR-15b-5p, to regulate the expression of downstream genes (such as BRTC, SIAH1, and UBE2V1); thus, it may be involved in IDD-associated pathological processes via the Wnt/ß-catenin signaling pathway. Further studies are required to confirm the potential roles of hsa_circ_0040039 in IDD.

Changes of the end plate cartilage are associated with intervertebral disc degeneration: A quantitative magnetic resonance imaging study in rhesus monkeys and humans.

BACKGROUND: The end plate plays an important role in intervertebral disc degeneration progression. The aim of the study was to examine the compositional and structural changes of the end plate with age and to investigate the correlation between end plate and disc degeneration by T1ρ and T2 map magnetic resonance imaging. METHODS: There were 12 young monkeys (6-7 years old), 20 aged monkeys (14-17 years old) and 12 human participants (30-50 years old) in this study. T1ρ or T2 map values of the nucleus pulposus and end plate cartilage were analyzed according to Pfirrmann grades and age. Afterwards, micro computed tomography and histological analysis were used to confirm the end plate changes in monkeys. Pearson's correlation was performed to investigate the relationship between end plate and disc degeneration. RESULTS: In monkeys, T1ρ (r=-0.794, P<0.001) and T2 map values (r=-0.8, P<0.001) of the nucleus pulposus were negatively associated with Pfirrmann grades. Moreover, the T2 map was more suitable than T1ρ for the evaluation of end plate degeneration. Age was an important influence factor of end plate and disc degeneration, which was confirmed by microcomputed tomography, Safranin O/fast green staining, and collagen II staining. The T2 map value of lower end plate degeneration positively correlated with that of the intervertebral discs in monkeys (R2=0.3133, P<0.001) and humans (R2=0.2092, P<0.001). CONCLUSION: This study suggests that the compositional and structural changes of the end plate can be quantitatively evaluated by T2 map. Furthermore, cartilage end plate degeneration is associated with disc degeneration during ageing. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: A better understanding of how the cartilage end plate affects disc degeneration is needed, which may propose a new clinical application using T2 map to evaluate end plate degeneration.

A New Diagnostic Medium for Cervical Spondylotic Myelopathy: Dynamic Somatosensory Evoked Potentials.

OBJECTIVE: To identify and reveal the sensitivity and efficiency of dynamic somatosensory evoked potentials (DSSEPs) in the diagnosis of cervical spondylotic myelopathy (CSM). METHODS: This retrospective study included 31 CSM and 15 control patients. All patients received SSEP examination with stimulation of median and ulnar nerves at neutral, flexed, and extended cervical positions; latency and amplitude were recorded at the C2 and C5 spinous processes and in the scalp over the primary sensory area (C3'/4'). The percentage changes in latency and amplitude with dynamic motion were examined for each lead and compared between groups; the diagnostic cutoff values were determined using receiver operating characteristic curve analysis. RESULTS: All the patients with CSM received surgeries and were followed up for 1 year. Amplitude parameters varied with a dynamic position in both groups; all recorded dynamic SSEP indices except right median stimulus recorded at C5 spinous process, right ulnar stimulus recorded at scalp point C3, and right ulnar stimulus recorded at C2 spinous process were significantly different between groups (P < 0.05), but latency was not (P > 0.05). At the neutral position, the amplitude of left media stimulus recorded at C2 spinous process (LMC2) was associated with CSM, but with low diagnostic accuracy (area under the curve = 0.199). At a dynamic position, the percentage change in amplitude of LMC2 and of left ulnar stimulus recorded at C2 spinous process (LUC2) were determined to be diagnostic of CSM (P < 0.05), with areas under the curve of 0.891 and 0.912, respectively. Both records had high sensitivity and specificity in the diagnosis of CSM; the diagnostic cutoff values of LMC2 and LUC2 were calculated as 10.2% and 19.25%, respectively. CONCLUSIONS: The percentage change in amplitude was obvious during cervical dynamic motion, with records from LMC2 and LUC2 being predictive of CSM diagnosis; dynamic SSEPs provided a simple, accurate, and noninvasive supplementary test for the diagnosis of complicated CSM.

Dnmt3a-Mediated DNA Methylation Changes Regulate Osteogenic Differentiation of hMSCs Cultivated in the 3D Scaffolds under Oxidative Stress.

Oxidative stress (OS) caused by multiple factors occurs after the implantation of bone repair materials. DNA methylation plays an important role in the regulation of osteogenic differentiation. Moreover, recent studies suggest that DNA methyltransferases (Dnmts) are involved in bone formation and resorption. However, the effect and mechanism of DNA methylation changes induced by OS on bone formation after implantation still remain unknown. Three-dimensional (3D) cell culture systems are much closer to the real situation than traditional monolayer cell culture systems in mimicking the in vivo microenvironment. We have developed porous 3D scaffolds composed of mineralized collagen type I, which mimics the composition of the extracellular matrix of human bone. Here, we first established a 3D culture model of human mesenchymal stem cells (hMSCs) seeded in the biomimetic scaffolds using 160 µM H2O2 to simulate the microenvironment of osteogenesis after implantation. Our results showed that decreased methylation levels of ALP and RUNX2 were induced by H2O2 treatment in hMSCs cultivated in the 3D scaffolds. Furthermore, we found that Dnmt3a was significantly downregulated in a porcine anterior lumbar interbody fusion model and was confirmed to be reduced by H2O2 treatment using the 3D in vitro model. The hypomethylation of ALP and RUNX2 induced by H2O2 treatment was abolished by Dnmt3a overexpression. Moreover, our findings demonstrated that the Dnmt inhibitor 5-AZA can enhance osteogenic differentiation of hMSCs under OS, evidenced by the increased expression of ALP and RUNX2 accompanied by the decreased DNA methylation of ALP and RUNX2. Taken together, these results suggest that Dnmt3a-mediated DNA methylation changes regulate osteogenic differentiation and 5-AZA can enhance osteogenic differentiation via the hypomethylation of ALP and RUNX2 under OS. The biomimetic 3D scaffolds combined with 5-AZA and antioxidants may serve as a promising novel strategy to improve osteogenesis after implantation.

Modified Laminoplasty Preserving the Posterior Deep Extensor Insertion into C2 Improves Clinical and Radiologic Results Compared with Conventional Laminoplasty: A Meta-Analysis.

BACKGROUND: Whether modified laminoplasty is better than conventional laminoplasty is unclear. Thus, a meta-analysis comparing the outcomes of preserving or repairing the posterior deep extensor insertion to C2 in laminoplasty was conducted for patients with multilevel cervical spondylotic myelopathy (MCSM). METHODS: Several electronic databases were chosen to search for relevant studies. The primary indices included preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, JOA recovery rate, muscle atrophy rate, preoperative and postoperative range of motion (ROM), ROM decrease rate, and incidence of axial pain. Results are expressed as odds ratios with 95% confidence intervals for the dichotomous outcomes and mean differences for continuous outcomes. RESULTS: Eight studies involving 763 patients were included in this study. The postoperative cervical ROM was significantly higher in the modified group (P = 0.01, MD = 3.0 [0.66, 5.35]), as was the cervical posterior muscle volume (P = 0.02, MD = 28.28 [4.42, 52.3]) and the operation time (MD = -45.04, 95% CI -49.79, -40.29; P < 0.01). The incidence of axial symptoms in the modified group was lower than that in the conventional group (P < 0.01, OR 0.28 [0.17, 0.46]), as was the rate of decrease of cervical ROM (P = 0.004, MD = -6.72 [-11.25, 2.19]). There was no significant difference (P > 0.05) between the groups in blood loss, preoperative and postoperative JOA score, or JOA recovery rate. CONCLUSIONS: Modified laminoplasty had shorter operation times, a lower incidence of axial pain, a higher cervical ROM, and a lower atrophy rate compared with conventional laminoplasty. The clinical and radiologic results of modified laminoplasty have been partly superior to those of conventional laminoplasty to date.

Biomimetic matrix fabricated by LMP-1 gene-transduced MC3T3-E1 cells for bone regeneration.

Bone healing is regulated by multiple microenvironmental signals provided by the extracellular matrix (ECM). This study aimed to mimic the native osteoinductive microenvironment by developing an ECM using gene-transduced cells. The LIM mineralization protein-1 (LMP-1) gene was transferred to murine pre-osteoblast cells (MC3T3-E1) using lentiviral vectors. Western blotting assay indicated that the MC3T3-E1 cells expressed an increased level of bone morphologic protein-2, -4 and -7 (BMP-2, -4 and -7) after LMP-1 gene transduction. The transduced cells were then seeded into calcined bovine bone scaffolds and cultured for 7, 14, and 21 days to construct ECMs on the scaffolds. The ECM-scaffold composites were then decellularized using the freeze-drying method. Scaffolds without ECM deposition were used as controls. The composites and controls were implanted into critical-sized bone defects created in the distal femurs of New Zealand rabbits. Twelve weeks after the surgery, both microcomputed tomography and histologic results indicated that the 7-day-cell-modified ECM-scaffold composites induced bone regeneration with significantly larger volume, trabecular thickness and connectivity than the controls. However, the 14- and 21-day-cell-modified ECM-scaffold composites triggered sustained inflammation response even at 12 weeks after the surgery and showed less bone ingrowth and integration than their 7-day-cell-modified counterparts. In conclusion, these results highlight the viable gene transfer techniques for manipulating cells in a constructed microenvironment of ECM for bone regeneration. However, the unresolved inflammation relating to the duration of ECM modification needs to be considered.

FOXO1-suppressed miR-424 regulates the proliferation and osteogenic differentiation of MSCs by targeting FGF2 under oxidative stress.

Recently, microRNAs (miRNAs) have been identified as key regulators of the proliferation and differentiation of mesenchymal stem cells (MSCs). Our previous in vivo study and other in vitro studies using miRNA microarrays suggest that miR-424 is involved in the regulation of bone formation. However, the role and mechanism of miR-424 in bone formation still remain unknown. Here, we identified that the downregulation of miR-424 mediates bone formation under oxidative stress, and we explored its underlying mechanism. Our results showed that miR-424 was significantly downregulated in an anterior lumbar interbody fusion model of pigs and in a cell model of oxidative stress induced by H2O2. The overexpression of miR-424 inhibited proliferation and osteogenic differentiation shown by a decrease in alkaline phosphatase (ALP) activity, mineralization and osteogenic markers, including RUNX2 and ALP, whereas the knockdown of miR-424 led to the opposite results. Moreover, miR-424 exerts its effects by targeting FGF2. Furthermore, we found that FOXO1 suppressed miR-424 expression and bound to its promoter region. FOXO1 enhanced proliferation and osteogenic differentiation in part through the miR-424/FGF2 pathway. These results indicated that FOXO1-suppressed miR-424 regulates both the proliferation and osteogenic differentiation of MSCs via targeting FGF2, suggesting that miR-424 might be a potential novel therapeutic strategy for promoting bone formation.

[EFFECT OF BODY MASS INDEX ON OUTCOME OF POSTERIOR 360 DEGREES FUSION FOR SINGLE-LEVEL LUMBAR DEGENERATIVE DISEASES].

OBJECTIVE: To investigate the effect of body mass index (BMI) on the outcome of posterior 360 degrees fusion for single-level lumbar degenerative diseases. METHODS: A retrospective study was carried on 302 cases of single- level lumbar degenerative diseases treated with posterior 360 degrees fusion between September 2009 and September 2013. All patients were divided into 3 groups according to BMI: normal weight (BMI<24 kg/M2) in 105 cases (group A), overweight (24 kg/M2 < or = BMI < 28 kg/M2) in 108 cases (group B), and obese (BMI > or = 28 kg/m2) in 89 cases (group C). There was no significant difference in gender, age, disease duration, disease patterns, affected segments, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) among 3 groups (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The lumbar function was assessed by JOA score and ODI at pre- and post-operation (at 3, 6, and 24 months). RESULTS: The operation time, intraoperative blood loss, and postoperative hospital stay of group C were significantly more than those of groups A and B (P<0.05), but no significant difference was found between group A and group B (P>0.05). The patients were followed up 24-45 months. Postoperative JOA score and ODI showed significant improvements in each group when compared with preoperative ones (P<0.05), but there was no significant difference among groups at each time point after operation (P>0.05). There was no significant difference in the incidence of total complications among 3 groups (chi2 = 3.288, P=0.193). The incidence of incision-related complications (infection and poor healing) in group C was significantly higher than that of groups A and B (P<0.05), but no significant difference was shown between group A and group B (P>0.05). However, there was no significant difference in cerebrospinal fluid leak, pseudarthrosis formation, and revision among 3 groups (P>0.05). CONCLUSION: Posterior 360 degrees fusion for single-level lumbar degenerative diseases can obtain good effectiveness in patients with different BMI, but patients whose BMI was > or = 28 kg/in2 have longer operation time, more intraoperative blood loss, longer hospital stay, and higher incidence of postoperative incision-related complications.

Is Mini-Plate Fixation Superior to Suture Suspensory Fixation in Cervical Laminoplasty? A Meta-Analysis.

BACKGROUND: Owing to the small sample sizes in individual studies reported to date, whether or not mini-plate fixation is better than suture suspensory fixation in unilateral open-door laminoplasty is unclear. Thus, we conducted a meta-analysis to evaluate which fixation method is superior in cervical laminoplasty for patients with multilevel cervical spondylotic myelopathy (MCSM). METHODS: Several electronic databases were selected to search the related studies. The main endpoints included operation time, blood loss, preoperative Japanese Orthopedic Association (JOA) score, postoperative JOA score, JOA recovery rate, postoperative anteroposterior diameter, open angle, and the incidence of axial symptoms or C5 palsy after surgery. The results are presented as mean difference (MD) for continuous outcomes and odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes. RESULTS: Six studies, including a total of 436 patients, were included in this review. The postoperative JOA score was higher in patients receiving suture suspensory fixation (group B) than in those receiving mini-plate fixation (group A) (MD, 0.51; 95% CI, 0.07-0.96; P = 0.002), as was the incidence of C5 palsy (OR, 0.37; 95% CI, 0.15-0.92; P = 0.03). In 5 of the 6 studies, including 282 patients, the incidence of axial symptoms was lower in group A (OR, 0.37; 95% CI, 0.21-0.67; P = 0.0009). There were no significant differences (P > 0.05) between groups A and B in terms of operation time, blood loss, JOA recovery rate, postoperative anteroposterior diameter, or open angle after surgery. CONCLUSIONS: Although suture suspensory fixation was associated with better postoperative JOA scores, mini-plate fixation was superior in reducing the incidence of surgical complications. To avoid severe surgical complications, mini-plate fixation is a good choice for laminoplasty for patients with MCSM. Valid evidence depends on more high-quality, randomized controlled trials in the future.

[COMPARISON OF EFFECTIVENESS BETWEEN PARA-MEDIAN INCISION MINIMALLY INVASIVE AND OPEN TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR SINGLE SEGMENTAL LUMBAR DEGENERATIVE DISEASE].

OBJECTIVE: To investigate the advantage and short- and medium-term effectivenesses of paramedian incision minimally invasive transforaminal lumbar interbody fusion (mini-TLIF) by comparing with open TLIF. METHODS: A retrospective analysis was made on the clinical data of 54 patients with single segmental lumbar degenerative disease who accorded with the inclusion criteria between January 2012 and March 2014. Open TLIF was performed in 26 patients (open group), mini-TLIF in 28 cases (minimally invasive group). There was no significant difference in gender, age, disease duration, etiology, and affected segments between 2 groups (P > 0.05). The indexes of surgical trauma, systemic inflammatory response, clinical outcome, and interbody fusion rate were compared between 2 groups. RESULTS: Dural rupture occurred in 1 case of open group, L5 nerve root injury in 1 case of minimally invasive group. All patients obtained primary healing of incision. The operation time, intraoperative blood loss, and postoperative drainage of minimally invasive group were significantly lower than those of open group (P < 0.05). C-reactive protein, leucocyte count, and creatine kinase-MM (CK-MM) of open group were significantly higher than those of minimally invasive group at 24 hours after operation (P < 0.05). At 7 days after operation, the CK-MM of minimally invasive group was significantly lower than that of open group (P < 0.05), but no significant difference was found in C-reactive protein and leucocyte count between 2 groups (P > 0.05). The follow-up time was 1.2-3.1 years in open group and 1.4-2.9 years in minimally invasive group. At 1 year after operation, the Oswestry disability index (ODI) and visual analogue scale (VAS) scores were significantly improved in 2 groups (P < 0.05). Minimally invasive group was better than open group in ODI and VAS score of back pain (P < 0.05), but VAS score of leg pain showed no significant difference (P > 0.05). According to the Suk interbody fusion standard, solid fusion was obtained in 18 cases, probable fusion in 4 cases, and nonunion in 4 cases, and the fusion rate was 84.61% in open group; solid fusion was obtained in 21 cases, probable fusion in 3 cases, and nonunion in 4 cases, and the fusion rate was 85.71% in minimally invasive group; and the interbody fusion rates showed no significant difference between 2 groups (Χ2 = 0.072, P = 0.821). CONCLUSION: Compared with open TLIF, paramedian incision mini-TLIF has advantages of minimal surgical trauma and little blood loss for single-level lumbar degenerative disease. The short- and medium-term effectivenesses are satisfactory.

[Influence and role of expression of extracellular matrix metalloproteinase inducer and matrix metalloproteinase 9 in aseptic loosening of prosthesis].

OBJECTIVE: To observe the expressions of extracellular matrix metalloproteinase inducer (EMMPRIN) and matrix metalloproteinase 9 (MMP-9) around the prosthesis, and to study the relationship between the expressions of EMMPRIN and MMP-9 and osteolysis around prosthesis. METHODS: Interface tissues were obtained at three Delee-Charnley acetabular sections and seven Gruen femur sections from 8 cases (8 hips) undergoing revision after total hip arthroplasty between February 2010 and January 2012, and were divided into osteolysis group and non-osteolysis group based on preoperative X-ray film and intraoperative observation; the tissues from another 8 patients with osteoarthritis undergoing total hip arthroplasty as the control group. The immunohistochemical staining and RT-PCR assays were used to determine the expressions of EMMPRIN and MMP-9. The correlation between the positive cells and the severity of osteolysis were analyzed and compared. RESULTS: Histological examination showed that many macrophages, multinucleated giant cells assembled in the membrane of osteolysis zone, but many fibroblasts and synovial cells in non-osteolysis zones. EMMPRIN and MMP-9 positive cells and gene expressions were observed in every group. The percentage of positive cells and gene expression of EMMPRIN and MMP-9 in osteolysis group were significantly higher than those in non-osteolysis and control groups (P < 0.05), but no significant difference was found between non-osteolysis group and control group (P > 0.05). The percentage of positive cells of EMMPRIN in zone III of acetabular was higher than that in zone I and zone II of revision hip (P < 0.05), but no significant difference between zone I and zone II (P > 0.05). The percentage of positive cells of MMP-9 in zone I and zone III was significantly higher than that in zone II of revision hip (P < 0.05), but no significant difference between zone I and zone III (P > 0.05). The expression of EMMPRIN from high to low in order was zones 1, 7, 4, 2, 3, 5, and 6 at femur; the values of zones 1, 7, and 4 were significantly higher than those of zones 2, 3, 5, and 6 (P < 0.05), but no significant difference among zones 1, 7, and 4, and among zones 2, 3, 5, and 6 (P > 0.05). The expression of MMP-9 from high to low in order was zones 1, 7, 4, 2, 3, 6, and 5 at femur; the values of zones 1 and 7 were significantly higher than those of zones 4, 2, 3, 6, and 5 (P < 0.05), and the values of zones 4 and 2 were significantly higher than those of zones 3, 6, and 5 (P < 0.05), but no significant difference between zone 1 and zone 7, between zone 4 and zone 2, and among zones 3, 5, and 6 (P > 0.05). CONCLUSION: The expressions of EMMPRIN and MMP-9 have certain coherence. The over-expressions of EMMPRIN and MMP-9 may be one of the key points of inhibiting bone reconstruction and bone resorption at bone-implant interface under the stimulation of wear debris.

[Herbal acupoint sticking combined with electroacupuncture therapy in the treatment of Bell's palsy: a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy and safety of electroacupuncture (EA) combined with herbal acupoint sticking in the treatment of Bell's palsy and provide optimizations for the clinic. METHODS: One hundred and two cases of Bell's palsy were randomized into an EA combined with herbal acupoint sticking group (group A, 50 cases) and an EA group (group B, 52 cases), EA at Cuanzhu (BL 2), Yangbai (GB 14), Taiyang (EX-HN 5), Quanliao (SI 18),Xiaguan (ST 7), Yingxiang (LI 20), etc. were applied in both groups and "facial paralys No.I " was applied at Yifeng (TE 17) in group A, once daily and 10 times totally were needed. The score of facial nerve function, clinical efficacy were compared before and after treatment. At 1 and 3 month follow up visit, the quality of life scale( WHOQOL-BREF) and the occurrence of complication were observed. RESULTS: The scores of facial nerve function in group A and group B were all significantly improved compared with those before treatment (48. 2+/- 2. 9 vs 25. 7 +/- 4. 9, 45. 9 +/- 6. 2 vs 25. 8 +/- 5. 5, both P0. 05). The occurrence of complication in group A (1 case) was significantly less than that in group B (8 cases, P 0. 05). CONCLUSION: Compared with EA, the combination of EA and acupoint sticking therapy for Bell's palsy cannot only improve the clinical efficacy and reduce the occurrence of complication but also reliable without any side effect.

[Acupuncture and moxibustion for peripheral facial palsy at different stages: multi-central large-sample randomized controlled trial].

OBJECTIVE: To explore the best intervention time of acupuncture and moxibustion for peripheral facial palsy (Bell's palsy) and the clinical advantage program of selective treatment with acupuncture and moxibustion. METHODS: Multi-central large-sample randomized controlled trial was carried out. Nine hundreds cases of Bell's palsy were randomized into 5 treatment groups, named selective filiform needle group (group A), selective acupuncture + moxibustion group (group B), selective acupuncture + electroacupuncture (group C), selective acupuncture + line-up needling on muscle region of meridian group (group D) and non-selective filiform needle group (group E). Four sessions of treatment were required in each group. Separately, during the enrollment, after 4 sessions of treatment, in 1 month and 3 months of follow-up after treatment, House-Brackmann Scale, Facial Disability Index Scale and Degree of Facial Nerve Paralysis (NFNP) were adopted for efficacy assessment. And the efficacy systematic analysis was provided in view of the intervention time and nerve localization of disease separately. RESULTS: The curative rates of intervention in acute stage and resting stage were 50.1% (223/445) and 52.1% (162/311), which were superior to recovery stage (25.9%, 35/135) separately. There were no statistical significant differences in efficacy in comparison among 5 treatment programs at the same stage (all P > 0.05). The efficacy of intervention of group A and group E in acute stage was superior to that in recovery stage (both P < 0.01). The difference was significant statistically between the efficacy on the localization above chorda tympani nerve and that on the localization below the nerve in group D (P < 0.01). The efficacy on the localization below chorda tympani nerve was superior to the localization above the nerve. CONCLUSION: The best intervention time for the treatment of Bell's palsy is in acute stage and resting stage, meaning 1 to 3 weeks after occurrence. All of the 5 treatment programs are advantageous to Bell's palsy. In the condition of the limited medical sources, the simple filiform needle therapy is recommended in acute stage. For the patients with the disorder above chorda tympani nerve, the line-up needling on muscle region of meridian is not recommended.

[Comparison of therapeutic effects of peripheral facial paralysis in acute stage by different interventions].

OBJECTIVE: To compare the therapeutic effects of peripheral facial paralysis in acute stage by different interventions and explore the better treatments of peripheral facial paralysis. METHODS: One hundred and thirty one cases of Bell's facial paralysis were randomly divided into three groups. In acupuncture group (44 cases), Dicang (ST 4), Jiache (ST 6), Hegu (LI 4), Yangbai (GB 14) and Taiyang (EX-HN 5), etc. were applied; in electroacupuncture group (45 cases), the selection of acupoints and needling method were same as those in acupuncture group, and the electroacupuncture therapy was applied on Dicang (ST 4), Xiaguan (ST 7), Yangbai (GB 14) and Taiyang (EX-HN 5) in acute stage; in medication and acupuncture group (42 cases), Prednisone and Acyclovir were taken by oral administration, Vitamin B1 and Vitamin B12, were applied by intramuscular injection in acute stage, and acupuncture was applied by the way which was same as that in acupuncture group during quiescent and recovery stages. The curative effects were evaluated by House-Brackmann Grading Scale, and the failed rates were observed by follow-up after one and three months. RESULTS: The cured and markedly effective rates were 79.6% (35/44), 93.4% (42/45) and 78.6% (33/42) respectively in acupuncture group, electroacupuncture group and medication and acupuncture group, and the result in electroacupuncture group was superior to those in acupuncture group and medication and acupuncture group (P < 0.05). The cured rates above tympanichord were 54.2% (13/24), 85.2% (23/27) and 48.0% (12/25) in acupuncture group, electroacupuncture group and medication and acupuncture group, and the result in electroacupuncture group was superior to those in acupuncture group and medication and acupuncture group (P < 0.01). There was no significant differences of cured rates below tympanichord among three groups (P > 0.05); and the failed rate in electroacupuncture group was much lower than those in acupuncture group and medication and acupuncture group by follow-up after one and three months (all P < 0.01). CONCLUSION: The peripheral facial paralysis is effectively treated by electroacupuncture in acute stage, and it suggests that electroacupuncture should be applied early during the acupuncture treatment of peripheral facial paralysis.