Correlation between severity of spinal stenosis and multifidus atrophy in degenerative lumbar spinal stenosis.

BACKGROUND: Degenerative lumbar spinal stenosis (DLSS) is a common degenerative condition in older adults. Muscle atrophy (MA) is a leading cause of muscle weakness and disability commonly reported in individuals with spinal stenosis. The purpose of this study was to investigate if the MA correlates with the grade of spinal stenosis in patients with DLSS. METHODS: A retrospective analysis on 48 male and 184 female DLSS patients aged around 54.04 years (54.04 ± 8.93) were involved and divided into 6 groups according to claudication-distance-based grading of spinal stenosis, which confirmed by two independent orthopedic surgeons using T2- weighted images. Using 1.5T MRI scanner, the severity of MA is assessed based on its negative correlation with the ratio of total fat-free multifidus muscle cross-sectional area (TFCSA) to total multifidus muscle cross-sectional area (TCSA). Adobe Photoshop CS6 was used for qualitative image analysis and calculate the TFCSA/TCSA ratio to assess the severity of MA, compare the grade of MA with the spinal stenosis segment, stenosis grade and symptom side. RESULTS: In DLSS group, The TFCSA/TCSA ratio are 74.33 ± 2.18 in L3/4 stenosis, 75.51 ± 2.79 in L4/5 stenosis, and 75.49 ± 2.69 in L5/S1 stenosis. there were significant decreases in the TFCSA/TCSA ratio of stenotic segments compared with non-stenotic segments of the spinal canal (P < 0.05) while no significant difference between the non-stenotic segments (P > 0.05). TFCSA/TCSA ratios is significant differences in the TFCSA/TCSA ratios of the 6 DLSS groups (F = 67.832; P < 0.05). From Group 1 to Group 6, the TFCSA/TCSA ratio of stenotic segments positively correlated with the absolute claudication distance (ACD). (P < 0.001, r = 0.852). Besides, the TFCSA/TCSA ratios are smaller in the symptomatic sides of the spine than the contralateral sides (t = 4.128, P = 0.001). CONCLUSIONS: The stenotic segments of the spinal canal are more atrophied than the non-stenotic segment in DLSS patients. It is shows that a strong positive correlation between the severity of multifidus atrophy and the severity of spinal stenosis.

Mangiferin protects osteoblast against oxidative damage by modulation of ERK5/Nrf2 signaling.

Oxidative stress has currently been proposed as a risk factor associated with the development and proression of osteoporosis. In this study, we identify the effect of mangiferin (MAN) on apoptosis and differentiation of osteoblast-like MC3T3-E1 cells insulted by H2O2. We firstly found that MAN can promote cell proliferation of MC3T3-E1 cells in a time- and dose-dependent manner and stimulate the phosphorylation of ERK5. Cells were divided as five groups: control, H2O2 (100 µM, control), H2O2 + MAN (5 µM), H2O2 + MAN (10 µM), and H2O2 + MAN (20 µM). MAN can significantly decrease H2O2-induced apoptosis and elevated ROS level of MC3T3-E1 cells. The expressions of caspase-3, caspase-9 and Bax/Bcl-2 were increased with H2O2 treatment, and MAN can reverse these changes. In addition, Nrf2 and its downstream target effectors (HO1, NQO1) were dramatically attenuated in MC3T3-E cells treatment with H2O2, while MAN can significantly increase the expression of Nrf2, HO1 and NQO1. The expression of ERK5 was down regulated by RNA interference in MC3T3-E1 cells, and we found that MAN (20 µM) pretreatment didn't make remarkable decrease in cell apoptosis or expressions of apoptosis-related proteins in H2O2-insulted siRNA-ERK5 cells. This study indicated that MAN can protect osteoblast against oxidative damage by modulation of ERK5/Nrf2 signaling, which can be new agent for osteoporosis.

Treatment of spinal tuberculosis with ultrashort-course chemotherapy in conjunction with partial excision of pathologic vertebrae.

BACKGROUND CONTEXT: The ultrashort-course chemotherapeutical scheme of less than 6 months has been used for part of patients with pulmonary tuberculosis and satisfactory curative effects have already been achieved. However, few systematic and clinical reports so far about medical treatment of spinal tuberculosis by using ultrashort-course chemotherapeutical schemes have been published in the spine-care literature. PURPOSE: To assess the results of ultrashort-course chemotherapy (UCC) in conjunction with partial excision of pathological vertebrae for spinal tuberculosis. STUDY DESIGN/SETTING: This is a retrospective comparative study of case series from a single center. PATIENT SAMPLE: Seventy-six cases of spinal tuberculosis, treated during 1998 and 2003 by senior author, were reviewed. All the cases underwent chemotherapies in conjunction with the uniform partial excision of pathological vertebra and had a minimum follow-up of 2 years. OUTCOME MEASURES: Clinical manifestations, laboratory tests, imaging examination, examination by ultrasonic wave B, drug complications, and clinical effects based on the previously described evaluative measures. METHODS: Of the 76 cases, 28 had UCC with the scheme of 2SHRZ/2.5H(2)R(2)Z(2), 23 had short-course chemotherapy (SCC) with the scheme of 3SHRZ/5H(2)R(2)Z(2), and 25 had standard chemotherapy (SC) with the scheme of 3SHRZ/9H(2)R(2)Z(2). All the patients had anterior partial excisions of pathological vertebrae, large iliac strut graft, and anterior or posterior fixation. The mean time of follow-up surveys for the ultrashort-course, short-course, and standard chemotherapy cases was 42.3 m, 46.5 m, and 55.4 m, respectively. RESULTS: The observance indices included 1) clinical manifestations: disappearance of tuberculosis symptoms, no CC pains, recovery of normal life or work, no percussion pains on pathologic sites, and recovery of neural functions; 2) laboratory tests: normal or close to normal test results of both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) or one of them; 3) imaging examinations: X-ray films, computed tomography scan, and magnetic resonance imaging examinations show disappearance of abscesses, no new destructive foci, bone union on the bone grafting interface, satisfactory correction of deformities, and less than 5 degrees of the angle loss of deformity corrections; 4) examination by ultrasonic wave B: no opaque dark area of fluid sonolucent areas identified in possible sites of paravertebral abscesses or gravitation abscesses; and 5) drug complications: hepatic and renal functions, nervus vestibularis lesion, and gastrointestinal tract reactions. All the cases met the protetrakis indices and obtained complete clinical cure of spinal tuberculosis in the last follow-up. The significant differences of major drug complications were found among the 3 groups, with 5 cases of UCC (18%), 15 cases of SCC (65%), and 19 cases of SC (76%). The lasting chemotherapeutic lesion of liver, kidney, or the permanent nervus vestibularis lesion were found 3 cases in SCC, 5 cases in SC, and no case in UCC group. CONCLUSIONS: No significant differences in clinical cure rate were found among 3 groups. UCC in conjunction with anterior partial excisions of pathological vertebrae, large iliac strut graft, and anterior or posterior internal instrumental fixation achieved excellent clinical results and the lowest complication rate of antituberculosis chemotherapy.

[The clinical causes of the thoracic ossification of ligamentum flavum].

OBJECTIVE: To assess the different causes of thoracic ossification of the ligamentum flavum (TOLF). METHODS: From July 1989 to November 2005, 142 cases were diagnosed the TOLF, in which 121 were operated. The lesions were classified into three types on the basis of the clinical result: (1) In such primary group (Group 1, 90 cases), without incorporation disease and Ca, P and AKP was all normal; (2) In systemic ossified TOLF group (Group 2, 30 cases), 6 cases ankylosing spondylitis, 3 cases DISH, 10 cases fluorosis, 11 cases OPLL; (3) In local spine disease group (Group 3, 22 cases), 5 cases fracture in spine, 4 cases spine TB, 13 cases posterior marginal intraosseous cartilaginous node. Such clinical feature was analysed, moreover surveyed the thoracic kyphosis angle, upper thoracic kyphosis angle, lower thoracic kyphosis angle and the vertebra body wedge change. The effect was assessed using Epstein Scale. RESULTS: (1) In Group 1, the mainly type was connected type (67/90, 74%). The ossified ligamentum flavum was mainly located at the lower thoracic and thoracic-lumber levels. The local type was less. In Group 2, the mainly type was connected type (21/30, 70%). The local type was none. The lesions figure was the most. In Group 3, the local type was the most (18/22, 82%). (2) In Group 1, the ossified ligamentum flavum was mainly located at the upper and lower thoracic levels (225/486, 47%). In Group 2, mainly located at the whole thoracic, some include cervix and lumber. In Group 3, mainly location was related with the location of primary disease. (3) In group 1, the curve was normal in 81% (73/90) of cases. In Group 2, the curve was abnormal in 87% (26/30) of cases. In Group 3, the curve was normal in the 82% (18/22) of cases. CONCLUSIONS: The TOLF relates with systemic ossify disease, the change of load on the spine, aging and so on. It should be classified according to its causes.

[The research of bone morphogenetic protein expression, CT value and mature degree of ossification in the thoracic ossification of ligamentum flavum].

OBJECTIVE: To investigate the correlation of pathology, bone morphogentic protein (BMP) expression, CT value with the ossification of thoracic ligamentum flavum (TOLF) to afford the evidence to choose appropriate treatment methods. METHODS: Twenty-three patients aged 35 - 65 years old had TOLF in my hospital as case. Their courses of disease were 2 months to 9 years. The values of blood calcium, blood phosphorus and AKP in them were normal. The 5 peoples aged 21 - 35 years old who presented fracture of thoracic but not the ligamentum flavum ossification were selected as control. We excluded those who have DISH, ankylosing spondylitis, fluorosis and other disease related with TOLF. The lesion locus were scanned and mensurated by CT. The pathology characteristics were classified into immature ossification and mature ossification by general observation, histology examination. BMP were measured by the immunohistochemical (IHC) staining techniques. RESULTS: The CT value was significantly higher in the case group (547.2 +/- 131.4) than controlled group (137.7 +/- 10.6) (t = 6.922, P = 0.000). Further, the CT value in the mature ossification (702.9 +/- 17.7) was significantly higher than the immature (480.5 +/- 180.2) (t = 5.623, P = 0.000). In addition, BMP both expressed negative in the mature ossification and the controlled group, but positive in the immature ossification. BMP expression was significantly different between the immature ossification and the mature (chi2 = 70.000, P = 0.000). CONCLUSIONS: The CT values, pathological types and BMP expression results are similar to evaluate the ossification degrees of ligamentum flavum, and then could be indirectly judged the maturation degrees of TOLF by CT to confirm the treatment methods before operation.