Low-frequency electrical stimulation alleviates immobilization-evoked disuse muscle atrophy by repressing autophagy in skeletal muscle of rabbits.

BACKGROUND: The study aimed to investigate the effect of low-frequency electrical stimulation (LFES) on disuse muscle atrophy and its mechanism in a rabbit model of knee extension contracture. METHODS: This study involved two experiments. In the time-point experiment, 24 rabbits were randomly divided into 4 groups: Control 1 (Ctrl1 group), immobilization for 2 weeks (I-2 group), immobilization for 4 weeks (I-4 group), and immobilization for 6 weeks (I-6 group). In the intervention experiment, 24 rabbits were randomly divided into 4 groups: Control 2 (Ctrl2 group), electrical stimulation (ESG group), natural recovery (NRG group), and electrical stimulation treatment (ESTG group). All intervention effects were assessed by evaluating the knee joint range of motion (ROM), cross-sectional area (CSA) of the rectus femoris muscle, and expression of autophagy-related proteins. RESULTS: The time-point experiment showed that immobilization reduced the knee ROM, reduced the rectus femoris muscle CSA, and activated autophagy in skeletal muscle. The levels of five autophagy-related proteins [mammalian target of rapamycin (mTOR), phosphorylated mTOR (p-mTOR), autophagy-related protein 7 (Atg7), p62, and microtubule-associated protein light chain 3B-II (LC3B-II)] were significantly elevated in the skeletal muscle of the I-4 group. The intervention experiment further showed that LFES significantly improved the immobilization-induced reductions in ROM and CSA. Additionally, LFES resulted in a significant decrease in the protein expression of mTOR, p-mTOR, Atg7, p62, and LC3B-II in the rectus femoris muscle. CONCLUSIONS: LFES alleviates immobilization-evoked disuse muscle atrophy possibly by inhibiting autophagy in the skeletal muscle of rabbits.

Comparing the early efficacies of autologous bone grafting and interbody fusion cages for treating degenerative lumbar instability in patients of different ages.

PURPOSE: The aim of this study was to compare the early efficacies of interbody fusion using autologous bone graft or an interbody fusion cage in a modified transforaminal lumbar interbody fusion (TLIF) in patients of different ages with degenerative lumbar instability. METHODS: Data from 33 patients with double-segment degenerative lumbar instability treated with a modified TLIF combined with a posterior fixation system from December 2008 to June 2014 were retrospectively analyzed. The two segments separately received an interbody bone graft fusion and an interbody fusion cage. Patients were divided by age into group A (middle-aged and elderly group, age ≥ 55 years, n = 13) and group B (young adult group, age < 55 years, n = 20). The clinical efficacy of the modified TLIF combined with a posterior fixation system was assessed using the Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS) scores obtained before and after surgery, and at final follow-up. We measured the mean intervertebral space height, intervertebral foramen height, lumbar lordosis angle, and inter-technique differences in the mean intervertebral space height and intervertebral foramen height. Interbody fusion was evaluated using the Suk standard. RESULTS: Patients in group A followed-up for 19.15 ± 8.01 months. Patients in group B followed-up for 14.80 ± 5.47 months. The post-operative JOA, ODI, VAS, and lumbar lordosis angle were improved significantly. Moreover, the early clinical follow-up effect was good. In group A, significant differences in the intervertebral foramen height post-surgery and at final follow-up, and the mean intervertebral space height at final follow-up were noted. The intervertebral foramen and space heights were increased in the interbody cage group. In group B, a significant difference in the intervertebral foramen height at final follow-up was noted. The mean intervertebral space height post-surgery and at final follow-up was significantly increased between the two fusion methods. Bony fusion was achieved in all cases. The fusion time of autologous bone graft and interbody fusion cage was 5.46 ± 1.20 months and 6.77 ± 1.01 months respectively in group A, and 5.50 ± 1.28 months and 6.35 ± 1.76 months respectively in group B, the difference in fusion time between techniques was significant. CONCLUSION: At different ages, the interbody fusion cages can better preserve the intervertebral space and the intervertebral foramen height. However, autologous bone graft can rapidly achieve a bony fusion. Interbody fusion cages are therefore ideal for young adults, while autologous bone grafting is ideal for middle-aged and elderly patients who receive a modified TLIF.

Unilateral biportal endoscopic technique combined with percutaneous transpedicular screw fixation for thoracolumbar burst fractures with neurological symptoms: technical note and preliminary report.

BACKGROUND: Previous studies on thoracolumbar fractures with neurological symptoms have focused on how to achieve satisfactory fracture reduction, adequate nerve decompression, and stable spinal alignment. With the development of the minimally invasive spine surgery technique, achieving satisfactory treatment results and reducing iatrogenic trauma at the same time has become a new goal of spinal surgery. This research used percutaneous transpedicular screw distraction to partially reduce the fractured vertebrae, followed by completing nerve decompression and reducing residual displacement bone fragments with the assistance of the unilateral biportal endoscopic (UBE) technique to achieve full protection of bone-ligament tissue and obtain good clinical efficacy. METHODS: Guide wires were safely inserted into the fractured vertebra and adjacent upper and lower vertebra under the surveillance of anteroposterior and lateral X-ray fluoroscopy. Transpedicular screws were implanted via guide wires on the side with mild neurological deficits or bone fragment compression (the opposite side of the endoscopic operation). A titanium rod was installed and moderately distracted to reduce the fractured vertebra. Then, under the guidance of the endoscopic view, the laminectomy and ligamentum flavum resection were completed according to the position of the protruding bone fragment into the spinal canal, and the compressed dural sac or nerve root was fully exposed and decompressed. An L-shaped replacer was used to reduce residual bone fragments. The ipsilateral transpedicular screws and rod were installed and adjusted to match the contralateral side. The drainage tube was indwelled, and the incision was closed. The preoperative and postoperative images of the patients were evaluated, and the recovery of neurological symptoms was observed. RESULTS: Surgery was successfully completed on all six patients, and no intraoperative conversion to open surgery was performed. Postoperative images showed good reduction of the protruding bone fragment and good placement of all screws. At the last follow-up, the neurological symptoms of all patients returned to normal. CONCLUSION: The UBE technique combined with percutaneous transpedicular screw fixation in the treatment of thoracolumbar fractures with neurological symptoms can effectively achieve the reduction of displaced bone fragments, improve damaged nerve function, stabilize spinal alignment, and protect the integrity of bone-ligament tissue.

Contralateral inclinatory approach for decompression of the lateral recess and same-level foraminal lesions using unilateral biportal endoscopy: A technical report.

Objective: Unilateral biportal endoscopic (UBE)surgery is being increasingly adopted as a minimally invasive technique. The purpose of the current study was to introduce a novel surgical technique for lateral recess and same-level foraminal decompression by the contralateral inclinatory approach with unilateral biportal endoscopy(CIA-UBE) at the lumbar level. Methods: Between January 2020 and February 2022, 10 patients suffering from lateral recess and same-level foraminal stenosis at the lumbar level underwent UBE surgery by contralateral inclinatory approach (CIA-UBE). Magnetic resonance imaging (MRI) scans were examined after surgery to measure the cross-sectional area (CSA) of the spinal canal (CSA-SC), the CSA of the intervertebral foramen (CSA-IVF), and the CSA of the facet joint (CSA-FJ). Postoperative radiologic images using computed tomography (CT) were obtained to investigate the existence of facet joint violation. Clinical outcomes were assessed using Oswestry Disability Index (ODI) scores and visual analogue scale (VAS) scores for buttock and radicular pain. Results: Ten levels were decompressed, and the mean age of the patients was 56.92 ± 13.26 years. The mean follow-up period was 7.60 ± 4.47 months. The average operative time was 85.14 ± 25.65 min. Postoperative CT and MRI revealed ideal neural decompression of the treated segments in all patients. CSA-IVF and CSA-FJ improved significantly, indicating good foraminal and lateral recess decompression with less damage to facet joints. Preoperative VAS and ODI scores improved significantly after surgery. Conclusion: CIA-UBE may be an effective surgical treatment of the lateral recess and same-level foraminal stenosis at the lumbar level, which provides successful surgical decompression for traversing and exiting nerve roots with a better operative view and easier surgical manipulation. This approach may also help to maximize the preservation of the facet joint.

The Learning Curve of Unilateral Biportal Endoscopic (UBE) Spinal Surgery by CUSUM Analysis.

Objective: To assess the learning curve of the unilateral biportal endoscopic (UBE) technique for the treatment of single-level lumbar disc herniation by cumulative summation (CUSUM) method analysis. Methods: A retrospective analysis was conducted to assess 97 patients' general condition, operation time, complications, and curative effect of single segmental UBE surgery performed by a spinal surgeon in his early stage of this technique. The learning curve of operation time was studied using a CUSUM method, and the cut-off point of the learning curve was obtained. Results: The operation time was 30 - 241(97.9 ± 34.7) min. The visual analog scale score of lower limb pain decreased from 5.75 ± 0.81 before the operation to 0.39 ± 0.28 at the last follow-up (P < 0.05). The Oswestry disability index score decreased from 66.48 ± 4.43 before the operation to 14.57 ± 3.99 at the last follow-up (P < 0.05). The CUSUM assessment of operation time revealed the learning curve was the highest in 24 cases. In the learning stage (1-24 cases), the operation time was 120.3 ± 43.8 min. In the skilled stage (25-97 cases), the operation time was 90.5 ± 27.8 min. Conclusions: About 24 cases of single segmental UBE operation are needed to master the UBE technique.