Objective To evaluate the fixation technique of using the cervical lateral mass plate in the cervical posterior approach operation. Methods Eight patients in this group were admitted from September 2001 to November 2006. Among the 8 patients, there were 6 males and 2 females, with their ages ranging from 28 to 78 years. Cervical vertebral fracture with dislocation was found in 4 patients, C2 spinal cord injury in 1, C1 fracture in 1, cervical spinal stenosis in 1, and C2-5 spinal cord neurofibroma in 1. Muscle strength 3-4. TheFrankel grading system was usedin 6 patients with traumatic injury. Before operation, Grade C was observed in 2patients，Grade D in 3，and Grade E in 1. All the operations were performed according to requirements of the Margel’s method. We positioned 40 screws in all the patients, including 4 screws at C2，6 screws at C3，12 screws at C4，4 screws at C5，4 screws at C6，2 screws at C7，and 6 screws at T1. Results The followingup for an average of 14.1 months (range,645 months) revealed that there was no malposition of the screws in the patients. One of the 8 patients developed spinal instability in the fixed segment at 3 months after operation. The headchestbrace was applied to the patient for 3 months, and the spinal fusion was achieved. The further followingup to 45 months indicated that there was no instability occurring. The remaining patients recovered to their spinal stability by the spinal fusion. The patients also recovered in their neurological function after operation. The Frankel assessment showed that 1 patient had Grade E, 3 from Grade D to Grade E, 1 from Grade C to Grade D, and 1 from Grade C to Grade E. Conclusion The cervical lateral mass plate fixation can provide the immediate and b segmental immobilization for the good cervical spine stability.
Objective To review the current development of the dynamic stabilization devices and their biomechanics as well as clinical application.Methods The related biomedical research papers at home and abroad were consulted and analyzed Results There were obvious advances in the theoretic foundation and the clinical application in treatment of the degenerative lumbar disorders with the dynamic stabilization devices, especially with the nonfusion dynamic stabilization devices. Conclusion The effectiveness of the dynamic stabilization devices have attracted more and more biomedical researchers, especially the posterior dynamic stabilization device, which has provided a new approach to treatment of the degenerative lumbar disorders.
Objective To investigate the effect of local injection of curcumin-loaded mesoporous silica nanoparticles (Cur@MSN) on the repair and treatment of degenerative intervertebral disc tissue in rats, and provide a new strategy for the treatment of intervertebral disc degeneration. Methods Mesoporous silica nanoparticles (MSN) and Cur@MSN were prepared according to the method reported in the literature. Rat nucleus pulposus cells were co-cultured with curcumin and Cur@MSN, respectively, and the growth status and activity of cells in normal environment and inflammatory environment (adding lipopolysaccharide) were observed respectively. Twelve 8-week-old SD rats were randomly divided into 4 groups, including normal group, degeneration group, curcumin group, and Cur@MSN group, with 3 rats in each group. Acupuncture degeneration model was established in coccygeal intervertebral discs (Co7-8, Co8-9) of rats, and corresponding intervention were injected. Imaging, gross pathology, and histological examination were performed after 4 weeks, respectively, to observe the tissue structure and pathological changes of intervertebral discs. Results Under scanning electron microscope, Cur@MSN was spherical in shape, with groove-like pores on its surface. Particle size analysis showed that the particle size of MSN was concentrated in 120-160 nm, and that of Cur@MSN was distributed in 130-170 nm. Zeta potential analysis showed that the average Zeta potential of MSN, curcumin, and Cur@MSN was −12.5, −22.5 and −13.5 mV, respectively. The entrapment efficiency of Cur@MSN was 20.4%, and the drug loading rate was 0.2%. Curcumin released by Cur@MSN in 12 h accounted for about 60% of the total drug dose, and curcumin released in 28 h accounted for about 70%. In cell experiment, there was no significant difference in cell proliferation absorbance among the groups in normal environment (P>0.05), but the cell proliferation absorbance in the Cur@MSN group on the 3rd and 5th day in inflammatory environment was significantly higher than that in the control group and the curcumin group (P<0.01). The percentage of disc height index and the Pfirrmann grade of the Cur@MSN group were better than those of the degeneration group and the curcumin group (P<0.01). The histological score of the Cur@MSN group was lower than that of the degeneration group and the curcumin group (P<0.01). Conclusions Cur@MSN can delay the degeneration process of rat coccygeal intervertebral disc, and has certain repair and treatment effects on its degenerated intervertebral disc. Among them, curcumin can delay the degeneration of intervertebral disc by inhibiting inflammation, and the loading of MSN is helpful for curcumin to exert its biological effects.
Objective To evaluate the effectiveness and safety of preoperative feeding artery occlusion on vertebral resection of invasive vertebral hemangioma. Methods The clinical data of 20 patients with invasive vertebral hemangioma who received posterior lumbar vertebral body resection, bone grafting, fusion and internal fixation between March 2010 and March 2017 were retrospectively analyzed. According to whether feeding artery occlusion was performed before operation, the patients were divided into group A (11 cases, tumor feeding artery occlusion before operation) and group B (9 cases, no tumor feeding artery occlusion before operation). There was no significant difference in gender, age, lesion segment, and disease duration between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, blood transfusion volume, and ambulant time after surgery, hospitalization time, and deep venous thrombosis of lower extremities were recorded and compared between the two groups. Pain improvement was evaluated by visual analogue scale (VAS) score. Results The operation time, intraoperative blood loss, blood transfusion volume, and ambulant time after surgery were significantly less in group A than those in group B (P<0.05). There was no significant difference in postoperative drainage volume and hospitalization time between the two groups (P>0.05). Five patients (3 in group A and 2 in group B) suffered from pleural tear due to intraoperative pleural adhesions. Closed thoracic drainage tubes were placed immediately after suture and extubated on 3-5 days. Both groups were followed up 1-1.5 years, with an average of 1.35 years. In group B, 1 patient died of pulmonary embolism at 7 days after operation; and 2 patients developed deep venous thrombosis of lower extremity after operation, who were treated with inferior vena cava filter and thrombolytic therapy, and recovered well after operation. The local pain of the other patients was significantly relieved after operation, and the pain disappeared at 1 month after operation. The VAS scores of the two groups at 3 days after operation were significantly improved when compared with those before operation (P<0.05). There was no significant difference in VAS scores between the two groups before operation and at 3 days after operation (P>0.05). Three patients (2 in group A and 1 in group B) who had neurological symptoms were significantly relieved after surgery. Bone healing was achieved in both groups at 1 year after operation. No fracture or loosening of internal fixator occurred during follow-up. Conclusion Nutritional artery occlusion before vertebrectomy for invasive vertebral hemangioma can effectively reduce intraoperative blood loss, operation time, perioperative blood transfusion, and other perioperative complications.
Objective To study the development, investigation, and application of the artificial vertebral body so as to provide an essential reference for the future research and clinical application. Methods The recent articles on materials, types, and clinical applications of the artificial vertebral body were reviewed.Results The materials used for the artificial vertebral body were porcelain, alloy, variant bone, and composite. But each of them had its own advantages and disadvantages. The types of the artificial vertebral body were grouped as expandable and non-expandable ones; however, the expandable type was much better. The artificial vertebral body had been applied to the treatments of spinal tumor, tuberculosis, fracture, and infection, with better effects. Conclusion The artificial vertebral body can beextensively applied. However, the materials and types need to be improved.
Objective To evaluate lumbar laminotomy and replantation in prevention of spinal unstability and peridural adhesion after laminectomy.Methods From February 1995 to March 2001,a total of 169 patients(96 males, 73 females,aged 22-63) with lesions in the lumbar vertebral canals underwent surgery, in which the lesions were removed afterlaminectormy and then the excised laminae were replanted. Results The follow-up for 5-9 years showed that all the patients had no complications after the lesions were removed. According to the evaluation criteria formulated by WANG Yongti，81 patients had an excellent result, 67 had a good result, 19 had a fair result, and2 had a poor result. 87.6% of the patients obtained quite satisfactory results.The X-ray films demonstrated that the replanted laminae obtained bony healing and the spine was stable. The CT scanning demonstratedthat the canals were enlarged with a smooth and glossy interior. Conclusion Lumbar laminotomy and replantation is reasonable in design and convenient in performance, which can be promoted as a basic operation in spinal surgery.
Objective To detect the cell density, apoptotic rate, and the expressions of BNIP3 in nucleus pulposus of degenerative intervertebral disc of rabbits, so as to further understand the mechanism of intervertebral disc degeneration. Methods Thirty male New Zealand white rabbits, aging 3 months and weighing (2.3 ± 0.2) kg, were divided into sham operation group (control group, n=10) and intervertebral disc degeneration model group (experimental group, n=20). Interbertebral disc degeneration models were establ ished by puncture of L3,4, L4,5, and L5,6 intervertebral discs in the experimental group; intervertebral discs were exposed only and then sutured in the control group. The degree of intervertebral disc degeneration was evaluated according to Pfirrmann classification by MRI at 4 and 8 weeks after establ ishing models. Apototic cells were determined by TUNEL and histological methods, and the immunohistochemical staining was performed to detect the expressions of BNIP3 in nucleus pulposus of intervertebral disc. Results MRI examination showed that the signal intensity decreased gradually at 4 and 8 weeks in the experimental group. There wassignificant difference in the degree of intervertebral disc degeneration between at 4 weeks and at 8 weeks in the experimental group (P lt; 0.05). The histological observation and TUNEL test showed that high density of nucleus pulposus cells and only a few apoptotic cells were observed in the control group; at 4 and 8 weeks, the density of nucleus pulposus cells decreased gradually with more apoptotic cells in the experimental group. There were significant differences in the nucleus pulposus cell density and positive rate of TUNEL staining between 2 groups, and between at 4 weeks and at 8 weeks in the experimental group (P lt; 0.05). The expression of BNIP3 of nucleus pulposus was negative in the control group; however, in the experimental group, the positive expression rates of BNIP3 of nucleus pulposus (the gray values) were 13.45% ± 1.16% and 32.00% ± 1.82% (194.32 ± 4.65 and 117.54 ± 2.11) at 4 and 8 weeks respectively, showing significant differences (P lt; 0.05). Conclusion The decrease of cell density in nucleus pulposus is involved in the development of intervertebral disc degeneration. Cell apoptosis is one of reasons in the decrease of nucleus pulposus cell; BNIP3 is involved in nucleus pulposus cell apoptosis in the degenerative intervertebral disc.
Objective To research the feasibility and effectiveness of percutaneous kyphoplasty (PKP) by improved injecting tube through unipedicular puncturing. Methods Between January 2012 and Junuary 2016, 60 cases (68 vertebrae) of osteoporotic vertebral compression fractures (OVCF) were treated. PKP was performed through unipedicular puncturing with routine injecting tube in 30 cases (34 vertebrae, routine group), and with improved injecting tube in 30 cases (34 vertebrae, improved group). There was no significant difference in age, gender, disease duration, fracture level, preoperative visual analogue scale (VAS), or vertebral height between 2 groups (P>0.05). The operation time, the volume of bone cement injected, preoperative and postoperative VAS, and preoperative and postoperative vertebral height, and postoperative distribution coefficient of bone cement were recorded and compared between 2 groups. Results Good healing of puncture points was achieved in 2 groups after PKP, and no serious complication occurred. There was no significant difference in operation time and the volum of bone cement injected between 2 groups (t=0.851,P=0.399;t=1.672,P=0.101). Bone cement leakage was observed in 2 cases of 2 groups respectively. The distribution coefficient of bone cement in routine group was significantly less than that in improved group (t=13.049,P=0.000). All patients were followed up 12-36 months (mean, 19 months). The postoperative VAS and vertebral height were significantly improved when compared with preoperative ones in 2 groups (P<0.05), but there was no significant difference in VAS between at 2 days after operation and at last follow-up, in vertebral height between at 2 days after operation and at 1 year after operation, and between 2 groups after operation (P>0.05). X-ray films showed vertebral compression fractures in 6 cases of routine group and in 1 case of improved group during follow-up. Conclusion PKP by improved injecting tube through unipedicular puncturing can improve the distribution of bone cement, restore the height and strength of vertebral body, and reduce the incidence of re-fracture.
Low back pain caused by intervertebral disc degeneration is a common clinical chronic disease. The regenerative ability of intervertebral disc tissue is extremely poor. Meanwhile, current treating methods can not fundamentally solve such problems. With the increasing awareness of the mechanism of disc degeneration and the rapid development of the fields of cellular and molecular biology, gene and materials engineering, using stem cells and tissue engineering technology to slow down or reverse the progress of disc degeneration may become possible. The author reviewed the application of stem cells for treating degenerative discs from present researching status and concepts for the future in the combination of researches reported both at home and abroad.
Objective To explore the feasibilities, methods, outcomes and indications of atlas pedicle screw system fixation and fusion for the treatment of upper cervical diseases. Methods From October 2004 to January 2006, 17 patients with upper cervical diseases were treated with atlas pedicle screw system fixation and fusion. There were 13 males and 4 females, ageing 19 to 52 years. Of 17 cases, there were 14 cases of atlantoaxial dislocation(including 3 cases of congenital odontoid disconnection，4 cases of old odontoid fracture，2 cases of new odontoid fracture(typeⅡC), 3 cases of rupture of the transverse ligament, and 2 cases of atlas fracture； 2 cases of tumor of C2; 1case of giant neurilemoma of C2,3 with instability after the resection oftumors. JOA score before operation was 8.3±3.0. Results The mean operative time and bleeding amount were 2.7 hours (2.1-3.4 hours) and 490 ml (300-750 ml) respectively. No injuries to the vertebral artery and spinal cord were observed. The medial-superior cortex of lateral mass was penetrated by 1 C1 screw approximately 3 mmwithout affecting occipito-atlantal motions. All patients were followed up 3-18 months. The clinical symptoms were improved in some extents and the screws were verified to be in a proper position, no breakage or loosening of screw and rob occurred. All patients achieved a solid bone fusion after 3-6 months. JOA score 3 months after operation was14.6±2.2. JOA improvement rates were 73%-91%(mean 82%). Conclusion The atlas pedicle screw system fixation and fusion is feasible for the treatment of upper cervical diseases and has betteroutcomes, wider indications if conducted properly.