Clinical Effects of Ultrasound-Guided Acupotomy in Knee Osteoarthritis Treatment.

The protocol presented here demonstrates the operation method of ultrasound-guided acupotomy for knee osteoarthritis (KOA), including patient recruitment, preoperative preparation, manual operation, and postoperative care. The purpose of this protocol is to relieve pain and improve knee function in patients with KOA. A total of 60 patients with KOA admitted between June 2022 and June 2023 were treated with ultrasound-guided acupotomy. Pathological changes and knee function scores were compared before and after the treatment. After 1 week of treatment, the synovial thickness of the suprapatellar bursae was significantly lesser than before treatment (p < 0.05), the Hospital for Special Surgery Knee Score (HSS) was significantly higher than before treatment (p < 0.05), the Visual analogue scale (VAS) was significantly lower than those of the control group (p < 0.05) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were significantly lower than those of the control group (p < 0.05). Therefore, ultrasound-guided acupotomy for the treatment of KOA can reduce synovial thickness, relieve pain, improve knee joint function, and have a remarkable curative effect.

Comparison of Oblique Lateral Interbody Fusion (OLIF) and Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF) for Treatment of Lumbar Degeneration Disease: A Prospective Cohort Study.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To assess the differences in the clinical and radiological outcomes between oblique lateral interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). SUMMARY OF BACKGROUND DATA: Nowadays, there is still a controversy regarding whether OLIF is superior to MI-TLIF in the management of degenerative lumbar disease. METHODS: Between August 3, 2019 and February 3, 2020, 137 patients were assigned to OLIF or MI-TLIF at their request and the surgeon's discretion: 71 in the OLIF group and 66 in the MI-TLIF group. The perioperative data, patient-reported outcomes, radiographic outcomes, and complications were compared between the two groups. RESULTS: The OLIF group showed shorter operation time (110.5 vs.183.8 minutes, P < 0.001), lesser estimated blood loss (123.1 vs. 232.0 mL, P < 0.001), shorter length of hospital stay (5.5 vs. 6.7 days, P < 0.001), and lower serum creatine kinase (CK) (1 day postoperatively) (376.0 vs. 541.8 IU/L, P < 0.01) than that of MI-TLIF group. Both groups showed no significant differences in the visual analog scale (VAS) scores of lower back and leg pain and the Oswestry Disability Index (ODI) scores preoperatively and at 1, 3, and 12 months postoperatively, respectively (P > 0.05). Compared with the MI-TLIF group, the OLIF group showed better restoration of disc height (DH) (4.7/4.6/4.7 vs. 3.7/3.7/3.7 mm, P < 0.01) and lumbar lordosis angle (LLA) (10.5°/10.8°/11.1° vs. 5.8°/5.7°/5.3°, P < 0.001), but not the value of segmental lordosis angle (SLA) (P > 0.05) at 1 day, 1 month, and 1 year postoperatively, respectively. The complication rate of OLIF was higher than that of MI-TLIF (29.4% vs. 9.7%, P < 0.01). CONCLUSION: Compared with MI-TLIF, OLIF showed similar results in terms of patient-reported outcomes, restoration of SLA and fusion rate, and superior results with respect to restoration of DH and LLA, operation time, estimated blood loss, length of hospital stay, and serum CK levels (1 day postoperatively). Even though the complication rate of OLIF is higher than that of MI-TLIF, it does not bring persistent and substantial damage to the patients.Level of Evidence: 3.

Anteroinferior Psoas Technique for Oblique Lateral Lumbar Interbody Fusion.

Oblique lateral lumbar interbody fusion (OLIF) has been extensively used, with satisfactory outcomes for the treatment of degenerative lumbar disease. This article aims to demonstrate a modified lateral approach, also known as the anteroinferior psoas (AIP) technique for OLIF, which is expected to enhance security by operating under direct vision. The core procedures of our technique are as follows. First, a minimal skin incision is recommended 2 cm backward compared with the normal incision of OLIF, facilitating the oblique placement of the working channel and the orthogonal maneuver for the cage placement. Second, two special custom-made retractors, as an alternative to the index finger, are used to pull the psoas muscle to the dorsal side and pull the abdominal organs together with extraperitoneal fate to the ventral side under direct visualization, making the exposure of the working channel convenient and safe and avoiding radiation exposure. Third, the anterior border of the psoas is bluntly dissected and retracted backwards, obviously enlarging the retroperitoneal anatomic corridor and then expanding clinical indications of OLIF. The benefits of this technique include that it has a short learning curve, satisfactory clinical outcomes, and low risk of perioperative complications.

Anteroinferior Psoas Technique for Oblique Lateral Lumbar Interbody Fusion: Technical Note and Case Series.

OBJECTIVE: The aim of the present paper was to evaluate cases of lumbar degenerative diseases treated with oblique lateral interbody fusion (OLIF) using a modified lateral approach (i.e. anteroinferior psoas exposure under direct vision) and to analyze the effect and safety of this approach. METHODS: From June 2016 to April 2019, a total of 226 patients with an average age of 65.5 ± 16.2 years (98 men and 128 women) with degenerative lumbar diseases who underwent the AIP approach of OLIF were followed up and analyzed retrospectively. Data concerning operative and clinical parameters were collected, including operative time, intraoperative estimated blood loss, duration of postoperative hospital stay, and time to ambulation after surgery. For the assessment of clinical outcomes, the visual analogue scale (VAS) score (for back pain) and the Oswestry disability index (ODI) were calculated. Complications were also recorded as surgical exposure approach-related complications. More than 6 months after surgery, 132 patients consented to having MRI examinations to evaluate the psoas muscle atrophy when they were followed up. RESULTS: The mean operative time was 82.5 ± 31.6 min. The mean operative time for each segment of OLIF was 43.3 ± 15.5 min. The mean blood loss was 48.0 ± 11.6 mL. The mean blood loss for each segment of OLIF was 25.3 ± 10.1 mL. No patients needed blood transfusion intraoperatively or postoperatively. The mean hospital stay was 4.1 ± 2.1 days. All patients were followed up for 12-31 months (mean 18.2 months). Clinical assessment showed that the VAS and ODI scores at 6 months after surgery were markedly lower than the preoperative scores (P < 0.001) but did not differ from the scores at the final follow-up (P > 0.05). There was no significant difference in percentage changes of the cross-sectional area of the lean psoas muscle and the T2 signal intensity ratio of gross psoas to quadratus lumborum muscles between the left side (operative side) and the right side (nonoperative side) (P > 0.05). A total of 11 surgical exposure approach-related complications were reported, with an incidence of 4.9%: transient thigh pain/numbness, psoas weakness (2.2%), sympathetic chain injury (1.3%), cage subsidence (0.9%), and segmental artery injury (0.4%). There was no permanent motor neurological deficit, and no injury of vascular, ureter or peritoneal membranes. CONCLUSION: The anteroinferior psoas approach for OLIF is safe and can preserve the psoas and lumbar plexus.

Symptomatic Postoperative Discal Pseudocyst After Percutaneous Endoscopic Interlaminar Discectomy: Case Report and Literature Review.

BACKGROUND: A postoperative discal pseudocyst (PDP) is a cystic lesion that is formed in the operation area of the intervertebral disc, leading to recurrence or even worse symptoms. To our knowledge, to date, there is no research focusing specifically on PDP following percutaneous endoscopic interlaminar discectomy (PEID). CASE PRESENTATION: We present the case of a 27-year-old man with L5 S1 intervertebral disc herniation who was treated with PEID after failed conservative treatment. His leg pain was relieved immediately but reoccurred on the 40th day. MRI showed a PDP. Because loxoprofen and bedrest were ineffective and the patient was anxious, we performed a cystectomy. The patient's symptoms were significantly relieved, and a 6-month follow up showed no recurrence both clinically and on MRI. CONCLUSION: A PDP is more likely to form using the interlaminar approach than the transforaminal approach. For patients with mental stress, severe pain, and neurological symptoms, surgery is suggested to remove the cyst. Discectomy cannot be performed when disc degeneration is mild.

Ascorbic Acid Attenuates Multifidus Muscles Injury and Atrophy After Posterior Lumbar Spine Surgery by Suppressing Inflammation and Oxidative Stress in a Rat Model.

STUDY DESIGN: A rat model of multifidus muscles injury and atrophy after posterior lumbar spine surgery. OBJECTIVE: We determined the effect of ascorbic acid (AA) on the postoperative multifidus muscles in rat model. SUMMARY OF BACKGROUND DATA: Previous studies show oxidative stress and inflammation are two main molecular mechanisms in multifidus muscle injury and atrophy after posterior lumbar surgery. AA may have a protective effect in postoperative multifidus muscles. METHODS: Rats were divided into sham surgery, control surgery, and surgery plus AA groups. Multifidus muscles of the control and AA groups were excised from the osseous structures. The muscles were retracted continuously for 2 hours. In the sham and AA groups, AA was administered via oral gavage daily in the first week. In each group, the oxidative stress was evaluated by measuring malondialdehyde (MDA) and Total superoxide dismutase (T-SOD). The inflammation, fat degeneration, or fibrosis of multifidus muscle were evaluated by quantitative real-time polymerase chain reaction (q-PCR), histology, or immunohistochemical analysis. RESULTS: T-SOD activity was significantly lower in the control group than that in the AA group in the first week. MDA levels were significantly higher in the AA group. Interleukin-6 and tumor necrosis factor-α in multifidus muscles also showed significant differences when treated with AA. The inflammation score on histology was significantly lower in the AA group postoperatively in the first week. In the long run, marker genes for fibrosis and fat degeneration, and fibrosis and fat degeneration scores, were significantly lower in the AA than the control group on days 14 and 28 postoperatively. CONCLUSION: In conclusion, AA attenuated the oxidative stress and inflammation response in the postoperative multifidus muscles, and remarkable differences were observed from the histological assessment and related marker genes expression. Our results provided important insight into the anti-inflammatory and anti-oxidative effects of AA in the postoperative multifidus muscles. LEVEL OF EVIDENCE: N/A.

Multifidus Muscle Atrophy Not Observed Following Two-segment Anterior Interbody Fusion: A Rabbit Model Study With a 12-Month Follow-up.

STUDY DESIGN: Experimental study evaluated magnetic resonance imaging (MRI) and histologic changes in the multifidus muscle after anterior spinal fusion. OBJECTIVE: To determine the effect of spinal fusion on the multifidus muscle in an anterior rabbit model through the use of MRI and histologic evaluation. SUMMARY OF BACKGROUND DATA: Retraction and splitting approach are known to be important factors in postoperative injury and atrophy of the multifidus muscle. The effect and possible mechanism of spinal fusion as an independent factor remains unknown. METHODS: Thirty-six New Zealand white rabbits were divided into two groups. Animals in the fusion group underwent two-level anterior spinal fusion whereas those in the control group underwent similar surgery without spinal fusion. The status of the multifidus muscle was evaluated with MRI and histological analysis at preoperative, 3 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. RESULTS: All rabbits in the fusion group achieved solid fusion. The mean T1-weighted and T2-weighted signal intensity ratios of gross multifidus to psoas muscles were all approximately 1.0 postoperatively, with no remarkable difference between the groups. The mean lesser diameter of myofibrils in either group did not significantly differ between the preoperative and postoperative specimens. There was no significant fibrotic change or fatty degeneration for either group. Decrease in acetylcholine activity or granular degeneration of the neuromuscular junction were not observed, and normal shape and size were found in nearly all samples at all time points in both groups (P > 0.05). CONCLUSION: After two-segment anterior spinal fusion, multifidus atrophy was not observed throughout a 12-month follow up. The rabbit model of anterior fusion is better suited to study the effect of fusion alone on the status of the multifidus muscle. LEVEL OF EVIDENCE: 3.

Effect of pure muscle retraction on multifidus injury and atrophy after posterior lumbar spine surgery with 24 weeks observation in a rabbit model.

PURPOSE: To evaluate the effect of pure muscle retraction on multifidus injury and atrophy. MATERIALS AND METHODS: Sixty-three adult New Zealand white rabbits were divided evenly into three groups: 1-h retraction (group R1), 2-h retraction (R2), and sham surgery (C). The multifidus muscle was evaluated using magnetic resonance imaging (MRI) and histology after 3 and 48 h, and 1, 3, 6, 12, and 24 weeks after surgery. RESULTS: Multifidus muscle injury and atrophy were not observed in group C, but were obvious in groups R1 and R2. Edema, necrosis, and inflammation mainly occurred in the first week postoperatively, and were more severe in R2 than in R1 (P < 0.01). Muscle fiber regeneration began at week 1, fibrotic changes mainly occurred at weeks 3 and 6, and fat degeneration became obvious at weeks 12 and 24 postoperatively. The fibrosis and fat degeneration scores of R2 were higher than those of R1 (P < 0.01). Decreased acetylcholine activity and granular degeneration of the neuromuscular junction were observed in both retraction groups, but was more severe in R2 than in R1 (P < 0.01). CONCLUSION: Muscle retraction was an important factor not only for multifidus injury, but also for long-term multifidus atrophy after posterior lumbar surgery; a longer retraction time caused more severe multifidus injury and atrophy. Muscle fibers can be regenerated postoperatively, and denervation might be the reason for muscle atrophy.

Lycorine suppresses RANKL-induced osteoclastogenesis in vitro and prevents ovariectomy-induced osteoporosis and titanium particle-induced osteolysis in vivo.

Osteoclasts play an important role in diseases involving bone loss. In this study, we assessed the effect of a plant-derived natural alkaloid (lycorine, or LY) on osteoclastogenesis in vitro and in vivo. Our in vitro study showed that receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclastogenesis could be inhibited by LY; this effect was due to inhibition of mitogen-activated protein kinase (MAPK) signalling via MAP kinase kinases (MKKs). The MAPK agonist anisomycin could partially rescue the inhibitory effect of LY. Furthermore, LY also played a protective role in both a murine ovariectomy (OVX)-induced osteoporosis model and a titanium particle-induced osteolysis model. These results confirmed that LY was effective in preventing osteoclast-related diseases in vivo. In conclusion, our results show that LY is effective in suppressing osteoclastogenesis and therefore could be used to treat OVX-induced osteoporosis and wear particle-induced osteolysis.

Upregulation of tumor necrosis factor α and ADAMTS-5, but not ADAMTS-4, in human intervertebral cartilage endplate with modic changes.

STUDY DESIGN: This study investigated the expression of 2 types of ADAMTS in human intervertebral cartilage endplate (CEP) and related mechanisms concerning tumor necrosis factor α (TNF-α)-induced nuclear factor κB signaling pathway. OBJECTIVE: To determine which type of ADAMTS is more strongly expressed and the role of TNF-α in CEP. SUMMARY OF BACKGROUND DATA: ADAMTS-4 and ADAMTS-5 were proven to be essential in the degeneration of articular cartilage and intervertebral disc. CEP is an important structure adjacent to the disc. However, the activities of ADAMTS in CEP are unclear. METHODS: CEPs were obtained from subjects after spinal surgery and categorized as members of either the Modic change group or the control group. Sections of these tissues were stained with hematoxylin-eosin, safranin O, and immunohistochemistry procedures for ADAMTS-4, ADAMTS-5, and TNF-α. Transcriptional levels of aggrecan, type I collagen, type II collagen, type X collagen, ADAMTS-4, ADAMTS-5, and TNF-α were investigated by quantitative real-time polymerase chain reaction. In addition, the effect of TNF-α on ADAMTS-5 and its potential mechanisms are investigated in cultured bovine endplate chondrocytes in vitro. RESULTS: Our data demonstrated that the degenerative changes associated with the expression of extracellular matrix proteins were correlated with increased levels of ADAMTS-5, but not ADAMTS-4, in the CEP of patients with Modic changes. The expression levels of TNF-α in the Modic change group were significantly increased, which was correlated with the enhanced expression of ADAMTS-5. Additional in vitro investigation confirmed that TNF-α could upregulate the expression of ADAMTS-5 by activating nuclear factor κB pathway in cultured bovine endplate chondrocytes. CONCLUSION: We conclude that the upregulation of TNF-α and ADAMTS-5, but not ADAMTS-4, may play an important role in degenerative CEP-induced low back pain. LEVEL OF EVIDENCE: N/A.

Iatrogenic injury to the erector spinae during posterior lumbar spine surgery: underlying anatomical considerations, preventable root causes, and surgical tips and tricks.

The approach-related morbidity resulting from iatrogenic erector spinae injury in posterior lumbar surgery has become an increasing concern for spine surgeons. Many studies have explained the injury mechanisms and reported new surgical approaches to prevent this iatrogenic injury from their own point of views, but there is still no systemic information for a thorough understanding of this iatrogenic erector spinae injury that may give spine surgeons practical advices in their individual operations. We consequently reviewed the literature on the anatomy of erector spinae, causes of injury, and relative minimally invasive approaches. We found that the local anatomic structures make the erector spinae vulnerable to injury during posterior lumbar surgery, especially the medial multifidus which is innervated only by the medial branch of the dorsal ramus, with no intersegmental nerve supply as in the other paraspinal muscles, and the injury factors mainly include dissection, retraction, denervation, and immobility. Studies suggest that the goal of prevention is to preserve the physiological structure of erector spinae and to avoid or limit the injury causes: approaches through spatium intermusculare and approaches with endoscope and tubular retractor system can prevent the erector spinae from injury by less dissection and retraction; non-fusion techniques may prevent the erector spinae from disuse atrophy by preserving the segmental motion and the adjacent erector spinae activity.

Effect and possible mechanism of muscle-splitting approach on multifidus muscle injury and atrophy after posterior lumbar spine surgery.

BACKGROUND: Multifidus muscle injury and atrophy are common after posterior lumbar spine surgery and are associated with low back pain and functional disability. In theory, muscle-splitting and retraction with a self-retaining retractor are considered to be the major surgical factors. The effects and mechanisms of retraction have been well studied, but the exact effect and possible mechanism of injury and atrophy after muscle-splitting still lack experimental evidence. METHODS: New Zealand White rabbits were divided into two groups. In group S, through a skin and lumbodorsal fascial incision, the bilateral multifidus muscles were dissected from the osseous structures in the standard fashion, while in group C, only a skin and lumbodorsal fascial incision was made. In each group, the multifidus muscle was evaluated by magnetic resonance imaging (MRI) and by histological analysis at three and forty-eight hours and at one, three, six, twelve, and twenty-four weeks after surgery. RESULTS: In group C, there was no injury or atrophy of the multifidus muscle after surgery. In group S, the mean T2-weighted signal intensity ratios of gross multifidus to psoas on fat-suppressed T2-weighted cross-sectional MRI scans peaked on week 3 and returned to baseline on week 24. Necrosis and inflammation of the multifidus muscle were evident and became more severe at one week. Fibrotic change was mainly seen at three and six weeks after surgery, and fatty degeneration mainly occurred at twelve and twenty-four weeks. Decreased acetylcholine activity and granular degeneration of the neuromuscular junction were observed at all follow-up times, and the numbers of degenerating neuromuscular junctions increased significantly with time after surgery. CONCLUSIONS: The splitting approach is an important cause of multifidus muscle injury and atrophy in posterior lumbar spine surgery. Denervation and disuse may be important factors in multifidus muscle atrophy in the splitting approach. CLINICAL RELEVANCE: This study provides a basis for the prevention of multifidus muscle injury and atrophy after posterior lumbar surgery.

Interactions between m-phenylenediamine and bovine serum albumin measured by spectroscopy.

This study explored interactions between m-phenylenediamine (MPD) and bovine serum albumin (BSA) by spectrophotometry. The Stern-Volmer equation and UV-vis spectra examination at different temperatures and pH were used to explore different quenching mechanisms. Under simulated physiological conditions, the binding distance between MPD and BSA was 5.18 nm with a ratio of 1:1. The quenching effect of MPD on BSA intrinsic fluorescence depended strongly on pH, and maximum quenching was observed at alkaline pH. Moreover, the thermodynamic parameters of the MPD-BSA system showed that the predominant acting force between MPD and BSA was a hydrophobic force. The impact of MPD on the conformation of BSA and the effects of co-ions on binding interactions were also examined.

[Case-control study on effects of two approaches on multifidus muscle injuries during lumbar interbody fusion of lumbar vertebrae].

OBJECTIVE: To study differences of multifidus muscle injury between Wiltse intermuscular approach and intramuscular stripping approach in one-level small incision transforaminal lumbar interbody fusion (TLIF) surgery. METHODS: A total of 46 patients with unilateral lumbar degenerative disease underwent small incision TLIF from August 2009 to February 2011 by one group of surgeons at a single institution. The decompression side of all patients adopted intra-muscular stripping approach; for the non-decompression side, 22 patients adopted Wiltse intermuscular approach (group A),and 24 patients adopted intra-muscular striping approach (group B). In group A, there were 13 males and 9 females, ranging in age from 36 to 74 years old,averaged 52.7 +/- 9.2; 1 patient had disease in L3, 4 12 in L4,5 and 9 in L5S1. In group B,there were 11 males and 13 females,ranging in age from 32 tio 72 years old, averaged 51.8 +/- 8.7; two patients had disease in L3,4, 14 in L4,5, and 8 in L5S1. The following data were compared between the 2 groups: surgical time from skin incision to completion of pedicle screw placement, suturation time, blood loss. Clinical effects were evaluated by VAS score pre-operatively, as well as 1, 6 and 12 months post-operatively. At the latest follow-up, all the patients were evaluated by MRI. This enabled the cross-sectional area (CSA) of lean multifidus muscle, and the T2 signal intensity ratio of multifidus to psoas muscle, to be compared at the operative level. RESULTS: There was no obvious difference in suturation time, but less surgical time from skin incision to completion of pedicle screw placement, less blood loss, less postoperative back pain in Wiltse intermuscular approach group. For the comparison between the two groups or paired comparison between sides in the Wiltse group, the reduction of lean CSA and increase in the multifidus:psoas T2 signal intensity ratio were all significant lower in Wiltse intermuscular approach group or side. CONCLUSION: The Wiltse intermuscular approach is an easy way for pedicle screw placement, and caused less paraspinal muscle damage than intra-muscular stripping approach, and had positive effects on less back pain.

Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches.

OBJECTIVE: To determine differences in paraspinal muscle injury between a modified minimally invasive approach (MMIA) and a traditional operative approach (TOPA) for one-level instrumented posterior lumbar inter-body fusion (PLIF). METHODS: From March 2006 to May 2008, a consecutive series of 91 patients who underwent a one-level instrumented PLIF procedure using one of two different approaches (MMIA in 41 patients and TOPA in 50), and who were operated on by one group of surgeons at a single institution, was studied. The following data were compared between the two groups: surgical time, blood loss, and changes in postoperative serum concentration of creatinine kinase (CK). More than 1 year post operation, low back pain was evaluated by a visual analog scale (VAS) and the Oswestry disability index (ODI). Some patients were also evaluated by MRI to allow comparison of the preoperative and postoperative cross sectional area (CSA) and fat degeneration grades at the operative level. RESULTS: There was no statistically significant difference in surgical time, but blood loss, serum concentration of CK, and scores of the VAS and ODI were markedly less in the MMIA group compared with the TOPA group. In the TOPA group, the postoperative CSA of the multifidus muscles was significantly smaller than it was pre-operatively. In contrast, there was no significant difference between the pre- and post-operative CSA of the multifidus muscles in the MMIA group. There was more fatty infiltration postoperatively than preoperatively in both the TOPA and MMIA groups, the increase in fatty infiltration being greater in the TOPA than in the MMIA group. CONCLUSION: Compared with TOPA, MMIA can significantly lessen paraspinal muscle injury, and reduce the incidence of low back pain.

Modic changes, possible causes and promotion to lumbar intervertebral disc degeneration.

UNLABELLED: Modic changes are bone marrow and endplate lesions visible in magnetic resonance imaging (MRI). They are regarded as a part of degenerative disc disease and associated with low back pain. And severe disc degeneration was occurred more in the patients with Modic changes. But there is still no study to analyze the relationship between Modic changes and intervertebral disc degeneration. We hypothesize that Modic changes are the possible causes and promotion of lumbar intervertebral disc degeneration. And there are three possible mechanisms for this hypothesis: a structural cause: Modic changes make cartilaginous material easier in extruded disc herniations, to destroy the structure of intervertebral disc and inhibit the absorption of the disc. A biomechanical cause: Modic changes alter the mechanical loading distribution on disc, to initiate a series of disc disruption and inhibit the self-recovery of the disc. A nutritional cause: Modic changes destroy the vascular architecture in vertebral endplate and block the most important metabolism pathway between vertebrae and disc. PERSPECTIVES: (1) Find out procedures to cure Modic changes may be an important breakthrough for disc degenerative disease. (2) Treatment of Modic changes may be a critical step of biotherapy for disc degeneration disease.

Cervical intervertebral disc degeneration induced by unbalanced dynamic and static forces: a novel in vivo rat model.

STUDY DESIGN: Establishment of a novel in vivo animal model of cervical spondylosis. OBJECTIVE: To investigate apoptotic, degenerative, and inflammatory changes occurring in the cervical intervertebral discs of rats. SUMMARY OF BACKGROUND DATA: Cervical degeneration occurs as the result of imbalance of both static and dynamic spinal stabilizers. The disc degeneration that occurs is characterized by increased local inflammation and increased apoptosis of intervertebral disc cells. METHODS: By excising the paraspinal musculature and posterior cervical spinal ligaments of rats, both static and dynamic cervical stabilizers were disrupted. The resultant biomechanical imbalance resulted in biochemical and histologic changes, which were characterized by light microscopy, electron microscopy, immunostaining, enzyme-linked immunosorbent assay, polymerase chain reaction, and in situ hybridization. RESULTS: Histologic analysis showed characteristic degenerative changes of the intervertebral discs and vertebral endplates following surgery. Ultrastructural examination revealed apoptotic changes, which were verified by immunostaining. Instability also resulted in significant up-regulation of inflammatory factors, as shown by enzyme-linked immunosorbent assay, polymerase chain reaction, and in situ hybridization. CONCLUSIONS: By creating static and dynamic posterior instability of the cervical spine, this novel model of cervical spondylosis results in rapid intervertebral disc degeneration characterized by increased apoptosis and local inflammation, such as that seen clinically.

[Effects of yiqi huayu recipe and its decomposed formulas on apoptosis-related factors of anulus fibrosus cells in rats].

OBJECTIVE: To study the effects of Yiqi Huayu Recipe and its decomposed formulas-medicated sera on expressions of bcl-2, Bax and caspase-8 of apoptotic anulus fibrosus cells in rats. METHODS: Immunohistochemical and integral optical density analytic methods were used to observe the effects of Yiqi Huayu Recipe-, Yiqi Recipe-, Huayu Recipe-medicated sera and insulin-like growth factor 1 (IGF-1) on the expressions of bcl-2, Bax and caspase-8 of apoptotic anulus fibrosus cells in rats induced by anti-Fas antibody. RESULTS: As compared with apoptosis group, bcl-2 expression was higher, Bax and caspase-8 expressions were lower in Yiqi Huayu-treated, Yiqi-treated, Huayu-treated and IGF-1 groups (P<0.01). As compared with Yiqi-treated group and Huayu-treated group, Bax expression was lower in Yiqi Huayu-treated group (P<0.05). CONCLUSION: Yiqi Huayu Recipe and its decomposed formulas can delay degeneration of the cervical intervertebral disc, which may be due to its action in regulating the expressions of bcl-2, Bax and caspase-8.