Comparison Between Percutaneous Transforaminal Endoscopic Discectomy and Fenestration in the Treatment of Degenerative Lumbar Spinal Stenosis.

BACKGROUND This study aimed to investigate the therapeutic and prognostic effects of percutaneous transforaminal endoscopic decompression (PTED) for degenerative lumbar spinal stenosis (DLSS). MATERIAL AND METHODS One hundred eighty-eight patients with DLSS were randomly divided into the fenestration and the PTED group for decompression treatment. Operative time, incision length, amount of blood loss, length of hospitalization, and rates of complications in the 2 groups were compared. All patients underwent computed tomography (CT) scanning and magnetic resonance imaging (MRI) on the first postoperative day. All patients were assessed preoperatively and the treatment effects at 3, 6, and 12 months postoperatively were evaluated using visual analog scale (VAS), Japanese Orthopedic Association Score (JOA) and Oswestry Disability Index (ODI). The modified MacNab criteria were used to assess patient satisfaction 1 year after surgery at the last follow-up. RESULTS Patients who underwent PTED had shorter incisions, less blood loss, and shorter hospital stays than those in the fenestration group, but operative times and complication rates were similar in the 2 groups. Moreover, CT scanning and MRI revealed similar treatment effects in the 2 groups. Compared with preoperative status, improvements in VAS, ODI, and JOA scores occurred at different times after surgery in the 2 groups. In particular, all 3 scores in the PTED group were higher than those in the fenestration group at 3 and 6 months postoperatively. There were no significant differences in MacNab scores between the 2 groups. CONCLUSIONS PTED is safer and more effective than traditional fenestration for management of DLSS.

Triad1 Promotes the Inflammatory Response and Neuronal Apoptosis to Aggravate Acute Spinal Cord Injury in Rats.

Objective: Spinal cord injury (SCI) is one of the most devastating central injuries, resulting in serious locomotor deficits. Triad1 is known to play an important role in SCI, but its effects on the inflammatory response and physiological behavior have not been thoroughly studied. This study is aimed at examining the effects of Triad1 on the inflammatory response and neuronal injury in acute SCI in rats. Methods: Twenty-four male Sprague-Dawley (SD) rats were randomly divided into a control group, SCI group, sh-NC group, and Triad1 knockout group (sh-Triad1). The Basso Beattie Bresnahan locomotor rating scale was utilized for the assessment of the motor ability of rats. Hematoxylin and eosin (H&E), Luxol fast blue (LFB), and TUNEL staining were used to assess the pathological injury, demyelination, and neuronal apoptosis, respectively. ELISA was used to detect the levels of IL-1ß, IL-10, and TNF-α, and qRT-PCR was used to examine the expression level of Triad1. Furthermore, the protein levels of Triad1, Bax, Bcl-2, and cleaved caspase-3 were determined using western blotting. Results: The Triad1 expression level was upregulated in damaged spinal cord tissue. Knockdown of Triad1 improved motor function and reduced SCI as well as apoptosis of spinal cord neurons. In addition, the knockdown of Triad1 inhibited the inflammatory response caused by SCI. Conclusion: Knockdown of Triad1 can reduce SCI in rats with acute SCI by inhibiting the inflammatory response and apoptosis.

Repairing tendon-exposed wounds by combing the Masquelet technique with dermoplasty.

Background: Wound repair is a new field that has emerged in China in the last 5 years. Exposed tendon wounds are one of the most common problems faced in wound treatment today, as the poor blood supply leads to low survival rates of skin grafts. This paper explores the feasibility of applying the Masquelet technique to repair tendon-exposed wounds. Method: We examined 12 patients with tendon-exposed wounds, 5 males and 7 females, from January 2021 to November 2021, including 2 patients with post-traumatic wounds, 8 diabetic patients with dorsal wounds, and 2 patients with various chronic infections. The Masquelet technique was employed to treat these wounds. The wound surface was sealed with antibiotic bone cement to form an induction membrane, the cement was removed after 3-4 weeks, and the wound was repaired with skin grafts to observe survival, appearance, texture, healing, and related functions. Results: All wounds were covered with antibiotic bone cement, and after 3-4 weeks, an induction membrane was applied, and in 10 out of 12 patients, full-thickness skin grafts were applied, and the patients survived. However, in 2 patients, the skin became partially necrotic, but these patients recovered by changing medications. Conclusion: The current study found that direct skin grafting may effectively treat exposed tendon wounds once the Masquelet approach generates the induction membrane. Further, this method is less difficult, less expensive, and easier to care for the procedure that deserves to be used more frequently.

Deep Learning-Based Cervical Spine Posterior Percutaneous Endoscopic Disc Nucleus Resection for the Treatment of Cervical Spondylotic Radiculopathy.

In the past 10 years, the technology of percutaneous spine endoscopy has been continuously developed. The indications have expanded from simple lumbar disc herniation to various degenerative diseases of the cervical, thoracic, and lumbar spine. Traditional surgery for the treatment of cervical radiculopathy includes anterior cervical decompression surgery, anterior cervical decompression plus fusion surgery, and posterior limited fenestration surgery. This article mainly studies the treatment of cervical spondylosis caused by radiculopathy caused by the nucleus resection of the posterior cervical spine percutaneous spinal endoscopy based on deep learning. In the PPECD group, the height of the intervertebral cavity was measured before the operation and during the final follow-up, and the height change of the intervertebral cavity was evaluated. The relative angle and relative displacement of the sagittal plane of the operation segment in the PPECD group were measured, and the stability was evaluated. Using the cervical spine X-ray Kelvin degeneration evaluation criteria, before and during the final follow-up operation, the degeneration of the adjacent segments of the two groups was evaluated. A retrospective analysis of 26 cases of cervical radiculopathy that met the criteria for diagnosis, inclusion, and exclusion was reviewed. Among them, 11 cases were treated with PPECD surgery; 15 cases were treated with ACDF surgery. According to the evaluation method of Odom, the excellent rate and the good rate of the two groups were compared. According to the location of the lesion, the nerve detection or dull tip device is exposed under the armpit or shoulder of the nerve root, and the protruding nucleus pulposus tissue is explored and removed, and annulus fibrosus is performed as needed. After hemostasis was detected, the surgical instruments were removed and the surgical incision was completely sutured. Before the operation and 3 months after the operation, the final follow-up made no significant difference in the overall average height of the intervertebral cavity (F = 2.586, P > 0.05). The results show that posterior foramen expansion is an effective surgical method for the treatment of cervical spondylotic radiculopathy, but surgical adaptation requires strict management. In order to achieve satisfactory results, appropriate cases must be selected.