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BACKGROUND:Finite element analysis is a commonly used mathematical modeling method to analyze the biomechanics of the lumbar spine.By constructing finite element models of the complex tissues such as muscles,blood vessels,and nerves in the lumbar region,mechanical analysis is performed to elucidate the pathogenesis of lumbar spine disorders and the mechanical mechanisms of treatment approaches. OBJECTIVE:To review the progress of finite element analysis in understanding the pathogenesis and treatment modalities of lumbar spine disorders,and to propose a new clinical workflow for the implementation of finite element analysis,aiming to provide a reference for future studies and promote the widespread utilization of finite element analysis in clinical diagnosis and treatment. METHODS:The PubMed database was searched using English keywords"finite element analysis,lumbar vertebra",while the WanFang and China National Knowledge Infrastructure(CNKI)databases were searched using Chinese keywords"finite element analysis,lumbar vertebra".A total of 73 articles were included for review. RESULTS AND CONCLUSION:(1)Lumbar spine degeneration in non-slipped patients typically originates from the posterior annulus fibrosus,while in patients with lumbar spine spondylolisthesis,degeneration starts from the lumbar facet joints due to abnormal mechanical mechanisms.(2)Restoring vertebral body height can prevent adjacent-level degeneration,and finite element analysis-measured vertebral compression strength can serve as an effective predictor of fracture risk,replacing bone density measurements.(3)In lumbar spine fusion surgery,selecting fusion devices of appropriate height and placing them transversely can prevent device subsidence.Increased intervertebral strain,circumferential stress,and intervertebral pressure in adjacent segments after fusion surgery may contribute to the occurrence of degenerative changes in neighboring segments.(4)Finite element analysis results suggest that preoperative planning for transforaminal endoscopic surgery should include considerations for osteotomy size to avoid excessive destruction of the articular process,and intraoperatively,preferential selection of a technique that traverses the superior articular process for foraminal dilatation.(5)In percutaneous kyphoplasty,bilateral pedicle screw augmentation should be performed,distributing bone cement on both sides of the pedicle.More advanced non-aluminum glass polyalkenoate cement materials should be selected.(6)Traction therapy should be personalized based on individual patient characteristics,including customized traction angles and forces,to achieve optimal therapeutic effects.(7)Manual therapy can induce relative displacement between the herniated intervertebral disc and the nerve root,thereby reducing compression.(8)The workflow involving CT/MR-AI Plus FEA-AI Plus Surgical robots can enable more precise diagnosis and treatment.
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Objective To verify the mechanism of Buyang Huanwu decoction in the treatment of spinal cord injury based on network pharmacology and molecular docking.Methods The active ingredients and targets of Buyang Huanwu decoction were screened out by TCMSP,SymMap,PubChem and Swiss Target Prediction databases.Spinal cord injury targets were retrieved from OMIM,GeneCards,TTD,and DrugBank databases.Through venny software,the intersection target of Buyang Huanwu decoction and spinal cord injury was obtained.The active ingredient-target network for the treatment of spinal cord injury was constructed with Cytoscape software.Gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis of common targets were carried out by DAVID,and the binding ability of drugs and targets was analyzed by molecular docking technology.Results A total of 106 active ingredients and 225 targets of Buyang Huanwu decoction,1315 targets of spinal cord injury and 112 targets of drug-disease intersection were obtained.The active ingredients of Buyang Huanwu decoction were quercetin,kaempferol,ellagic acid,luteolin and hederagenin in the treatment of spinal cord injury.Conclusion Buyang Huanwu decoction can achieve the purpose of treating spinal cord injury through various signal pathways.
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Objective:To evaluate the reliability and repeatability of thoracolumbar AOSpine injury score (TLAOSIS)and thoracolumbar injury severity score (TLICS) classification scoring system in guiding thoracolumbar fracture surgery, and to explore the main reasons for the consistency of classification scoring systems.Methods:Fifty-five thoracolumbar fracture patients with complete clinical data and radiologic data admitted to Second Affiliated Hospital of Zhejiang Chinese Medical University from January 2018 to December 2018 were enrolled. Based on their preoperative X-ray films, CT and MRI, six physicians were assigned to independently determine the classification using the TLAOSIS and TLICS.For the same patient, the classification was identified as inconsistency among 6 observers if there was an observer in a different type.After a 4-week interval, the 55 patients were presented in a random sequence to the same evaluators for repeated evaluation.All data did not contain any marks related to the type. The Cohen's Kappa coefficient was used to determine the interobserver reliability and intraobserver repeatability concerning fracture morphology, posterior ligament classification (PLC) injury classification and neurological function score. Kappa coefficients were used to observe the consistency of pre- and post-measure measurements within each observer.Results:The two classification scoring systems had good consistency and reproducibility in guiding surgery. For TLAOSIS classification scoring system, the interobserver and intraobserver Kappa values for fracture morphology were 0.806 and 0.667; neurological status were 0.937 and 0.891; PLC injury classification were 0.873 and 0.779; the final recommendation surgery were 0.816 and 0.764. For TLICS classification scoring system, the interobserver and intraobserver Kappa values for fracture morphology were 0.878 and 0.788; neurological status were 0.936 and 0.888; PLC injury classification were 0.809 and 0.691; the final recommendation surgery were 0.811 and 0.705. The two classification scoring systems were statistically significant in fracture morphology and PLC injury classification both in the reliability and repeatability analysis ( P<0.05), but there was no significant difference in the neurological function score ( P>0.05). Conclusions:TLAOSIS and TLICS have good consistency and reproducibility in guiding surgery. The fracture morphology and PLC injury classification are the factors influencing the consistency of surgical guidance for the two classification scoring systems.
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Objective:To compare the differences between thoracolumbar AO spine injury score (TL AOSIS) and thoracolumbar injury classification and severity score system (TLICS) in guiding thoracolumbar fracture surgery.Methods:A retrospective study was conducted of the 55 patients with complete preoperative imaging data who had been treated for thoracolumbar injuries at Department of Spinal Surgery, The Second Affiliated Hospital to Zhejiang Chinese Medical University from January 2015 to December 2016. They were 34 men and 21 women, aged from 21 to 55 years (average, 37.5 years). Of them, 31 were identified as having normal neurological function and 24 as having impaired neurological function. TL AOSIS and TLICS were used to evaluate respectively all the patients, those with normal neurological function and those with impaired neurological function, and consequently made suggestions whether surgery should be performed or not.Results:Among the 55 patients, by the guidance of TL AOSIS and TLICS respectively, conservative treatment was suggested for 19 and 25 cases, either conservative treatment or surgery for 12 and 13 cases, and surgery for 24 and 17 cases. There was fine consistency between the 2 scoring systems in surgery suggestion for thoracolumbar fracture ( P=0.358). Among the 31 patients with normal neurological function, by the guidance of TL AOSIS and TLICS respectively, conservative treatment was suggested for 19 and 25 cases, either conservative treatment or surgery for 6 and 0 cases, and surgery for 6 and 6 cases. TLICS suggested surgery for significantly more patients than TL AOSIS did ( P=0.033). Among the 24 patients with impaired neurological function, by the guidance of TL AOSIS and TLICS respectively, either conservative treatment or surgery was suggested for 6 and 13 cases, and surgery for 18 and 11 cases. TL AOSIS suggested surgery for significantly more patients than TLICS did ( P=0.039). Conclusion:There is fine consistency between TL AOSIS and TLICS in surgery suggestion for thoracolumbar fracture, but TL AOSIS may lead to more surgery suggestions for the patients with complete burst fracture or impaired neurological function than TLICS.
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Spinal cord injury can lead to varied degrees of sensory and motor dysfunction, with high incidence, high disability rate and high cost, causing a huge burden on the patient's family and society. The researches on spinal cord injury have received much attention from all sectors of society. At present, drug therapy is the main treatment for spinal cord injury, and the clinical application of non-pharmacological treatments is still controversial. In recent years, with the deepening of the research on spinal cord injury, the application of electrical stimulation in the treatment of spinal cord injury has made some progress. The author reviews the electrical stimulation, brain stimulation, magnetic stimulation of spinal cord injury, so as to provide reference for the clinical treatment of spinal cord injury.
ABSTRACT
Spinal cord injury can lead to varied degrees of sensory and motor dysfunction,with high incidence,high disability rate and high cost,causing a huge burden on the patient's family and society.The researches on spinal cord injury have received much attention from all sectors of society.At present,drug therapy is the main treatment for spinal cord injury,and the clinical application of nonpharmacological treatments is still controversial.In recent years,with the deepening of the research on spinal cord injury,the application of electrical stimulation in the treatment of spinal cord injury has made some progress.The author reviews the electrical stimulation,brain stimulation,magnetic stimulation of spinal cord injury,so as to provide reference for the clinical treatment of spinal cord injury.