Non-spinal-associated injuries with lumbar transverse process fractures: influence of segments, amount, and concomitant vertebral fractures.

BACKGROUND: Lumbar transverse process fractures (LTPFs) are often with concomitant non-spinal-associated injuries (NSAIs). The purpose of this study was to analyze the correlation between the NSAIs and the LTPFs of different segments, amount, and concomitant thoracolumbar/lumbar vertebral fractures. METHODS: A total of 1,181 patients with LTPFs or thoracolumbar/lumbar vertebral fractures were chosen between September 2006 and June 2010. The patients were divided into three groups: thoracolumbar/lumbar vertebral fractures without LTPFs, with associated LTPFs, and isolated LTPFs (iLTPFs). The correlation of the NSAIs of different sites and the LTPFs of different segments, amount, and concomitant thoracolumbar/lumbar vertebral fractures were analyzed between and within groups by χ test and logistic regression analysis. RESULTS: The incidence of NSAIs with iLTPFs and aLTFP groups were significantly higher than that of vertebral fractures without LTPF group (55.73% and 64.49% vs. 21.32%, respectively, p = 0.000). However, the incidence was not significantly different between the iLTPFs and the aLTFP groups (p = 0.106). The results with NSAIs of different sites were almost the same. L5TPFs were a stronger risk factor to NSAIs (relative risk [RR] = 15.72; 95% confidence interval [CI], 4.47-55.37; p = 0.000) in the iLTPF group (RR = 21.92; 95% CI, 6.68-71.92; p = 0.000) and in the vertebral fractures with associated LTPF group (RR = 9.42; 95% CI, 1.19-74.72; p = 0.034). L5TPFs were also a very important risk factor for pelvic injuries (RR = 46.10; 95% CI, 22.40-94.88; p = 0.000); 65.1% in L5iTPFs were accompanied with Tile-C pelvic injuries, slightly higher than in L5aTPFs (46.7%). L4TPFs were a risk factor to abdominal injuries within iLTPFs (RR = 2.27; 95% CI, 1.23-4.20; p = 0.009). CONCLUSIONS: The incidence of NSAIs is very high in cases with LTPFs, particularly with L5TPFs. A detailed investigation should be performed to search for NSAIs once LTPFs are identified so that appropriate treatment can be initiated. LEVEL OF EVIDENCE: Level III.

Combined single-level subtotal corpectomy and decompression for cervical spondylotic myelopathy treatment.

BACKGROUND: The purpose of this study was to summarize outcomes of patients with refractory multisegmental cervical spondylotic myelopathy (CSM) who were treated by combined single-level subtotal corpectomy and decompression of the intervertebral space using the anterior approach. METHODS: Forty-five consecutive patients with multisegmental CSM were included; their ages ranged from 37 to 72 years. Seventeen (37.8%) patients had noncontiguous or 'jumping' multisegmental CSM and 28 (62.2%) had contiguous multisegmental CSM. The mean preoperative Japanese Orthopedic Association (JOA) score was 8.1 points. All patients underwent combined single-level decompression of the involved intervertebral space and subtotal corpectomy together with subsequent fusion and internal fixation. An anterior approach was used for all patients. A cage filled with bone graft was inserted and internal fixation was performed after single-level intervertebral space decompression. Mesh filled with bone graft was inserted and plate internal fixation was performed after subtotal corpectomy. RESULTS: Follow-up data (average follow-up, 14 months) were available for all 45 patients; the mean postoperative JOA score was 13.2 points, which was significantly different from the preoperative JOA score. Bony fusion was achieved in all patients based on postoperative radiography, and no pseudoarthrosis was observed during follow-up. CONCLUSIONS: An excellent outcome can be achieved with the combination of single-level subtotal corpectomy and decompression of the intervertebral space using the anterior approach to treat multisegmental CSM.

[Effect of siRNA-Cox-2 on the growth inhibition and apoptosis of cartilage endplate chondrocytes].

OBJECTIVE: To investigate the influence of siRNA-COX-2 gene upon the growth inhibition and apoptosis of cartilage endplate chondrocytes and provide new methods and evidence for siRNA in gene therapy of cartilage endplate chondrocytes. METHODS: According to the sequence of COX-2 mRNA, COX-2 siRNA was designed, synthesized, cloned into the GFP reporter pcDNA6.2GW/EmGFPmiR vector and transfected into Hep cell line. The integrity of inset fragment was detected by colony PCR (polymerase chain reaction) and sequencing analysis. The cultured cartilage endplate chondrocytes were divided into 4 groups: control group (untreated), negative siRNA group (treatment with 30 nmol/L negative control siRNA), siRNA1 group (treatment with 15 nmol/L COX-2 siRNA) and siRNA2 group (treatment with 30 nmol/L COX-2 siRNA). The biological activity of recombinants was identified with the interference efficiency of COX-2 siRNA recombinant by real-time PCR and Western blot. And the effects of COX-2 inhibitor on the growth of chondrocytes were detected by WST-8 and the mRNA expressions of survivin, bcl-2 and bax genes measured by real-time PCR. RESULTS: The sequences of inset fragment in 4 siRNA expressing recombinants were correct. After COX-2 transfection, the expression of COX-2 mRNA in chondrocytes was 51.3% ± 7.2% in the siRNA1 group and 35.4% ± 3.6% in the siRNA2 group. Western blot showed that the expression of COX-2 protein decreased, especially in siRNA2 group (P < 0.05). And the cell survival rate was 100.0% ± 8.3% in the control group, 84.9% ± 4.2% in the negative control siRNA group, 52.5% ± 6.7% in the siRNA1 group and 48.9% ± 5.4% in the siRNA2 group (P < 0.05). Meanwhile, the expressions of mRNA of survivin and bcl-2 decreased while the expression of bax mRNA increased in degenerative cartilage endplate chondrocytes transfected with COX-2 siRNA (P < 0.05). CONCLUSION: COX-2-targeting siRNA inhibits the expression of COX-2, suppresses the proliferation of chondrocytes and induces the cell apoptosis. These effects may be attributable to the up-regulation of survivin and bcl-2 and the down-regulation of bax.

[Biological characteristics of human umbilical cord-derived mesenchymal stem cells and their differentiation into chondrogenic and osteogenic cells].

OBJECTIVE: To investigate the isolation and expansion of mesenchymal stem cells (MSCS) from human umbilical cord Wharton's jelly and their biological identities, and explore the possibility of inducing human umbilical cord-derived MSCS to differentiate into chondrogenic and osteogenic cells. METHODS: The hUCMSCs were isolated form human umbilical cord by tissue adherence and digested with collagenase NB4, dispase II and hyaluronidase. The morphology, proliferation and immunophenotype of the 3rd passage cells were analyzed, and then the chondrogenic and osteogenic differentiation was tested and evaluated by specific staining methods.cells were induced to chondrogenic and osteogenic differentiation in vitro. RESULTS: The isolation of hUCMSCs by digestion with collagenase NB4, dispase II and hyaluronidase was efficient. After seeded for 24 hours, the adherent cells showed spindle shape and fibroblast cell-like shape and the size of hUCMSCs was homogeneous. Flow cytometry analysis revealed that the hUCMSCs were positive for CD44, CD105, CD90, CD73, but were negative for CD45, CD34, CD14, CD19 and HLA-DR. These cells could be induced to differentiate into chondrogenic and osteogenic cells under proper inducing conditions. The hUCMSCs retained the appearance and phenotype even after being expanded more than 40 passages in vitro. CONCLUSIONS: The human MSCs could be isolated from human umbilical cord Wharton's jelly, and it was easy to propagate these MSCs. An in vitro method for isolation and purification of hUCMSCs from human umbilical cord has been established. The cultured cells were composed of only undifferentiated cells and their biological properties were stable. The hUCMSCs are expected to be a new type of stem cells of tissue engineering.

[Comprehensive typing and surgical treatment of axial fracture with adjacent section instability: analysis of 17 cases].

OBJECTIVE: To study the clinical and radiographic characteristics of axial fracture with adjacent section instability and the diagnosis and surgical treatment thereof. METHODS: Seventeen patients of axial fracture with adjacent section instability, 11 males and 7 females, aged 34 (23-56) underwent different treatment patterns depending on the fracture type and stability of the atlanto-axial joint and C2-3: resection of C2-3 intervertebral disk and bone grafting, anterior interbody fusion and plate internal fixation, odontoid screw fixation, posterior C2 pedicle screw fixation, odontoid screw fixation combined with bilateral C-2 pedicle screw fixation. Follow-up was conducted for 12 (6-36) months. RESULTS: Postoperatively all patients were immobilized in a hard collar for 3 months. Bony fusion was obtained in all patients in 3 months. There were no operation-related complications, such as spinal cord injury, cerebrospinal fluid leakage, vertebral artery injury, etc. No re-dislocation was found. Neurological recovery was observed in the 3 patients who presented neurological deficits. CONCLUSION: The type of atlas fracture with adjacent section instability and the impact thereof on the stability of the atlanto-axial joint and C2/3 neck joint should be identified early. Surgical treatment results in better outcome.