Differences of Sagittal Lumbosacral Parameters between Patients with Lumbar Spondylolysis and Normal Adults / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recent studies have suggested an association between elevated pelvic incidence (PI) and the development of lumbar spondylolysis. However, there is still lack of investigation for Han Chinese people concerning the normal range of spinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population.</p><p><b>METHODS</b>A total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force (Beijing, China) were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A: 36 patients with simple lumbar spondylolysis, and Subgroup B: 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis (slip percentage <30%). Altogether 207 healthy adults were chosen as the control group. All patients and the control group took lumbosacral lateral radiographs. Seven sagittal lumbosacral parameters, including PI, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), L5 incidence, L5 slope, and sacral table angle (STA), were measured in the lateral radiographs. All the parameters aforementioned were compared between the two subgroups and between the spondylolysis group and the control group with independent-sample t- test.</p><p><b>RESULTS</b>There were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher (P < 0.05) in the spondylolysis group than those in the control group, but STA was lower (P < 0.001) in the spondylolysis group.</p><p><b>CONCLUSIONS</b>Current study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population.</p>

Diagnosis and surgical treatment of back pain originating from endplate / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the methods of diagnosis and surgical treatment for patients with back pain originating from endplate.</p><p><b>METHODS</b>All patients received examinations of radiography, CT, and MR imaging. Pain level of disc was decided by discography in each patient. The principal outcome judgment were pain and disability, and the efficacy of surgical treatment was assessed by visual analog scale (VAS) for pain, and the Oswestry disability index (ODI) for functional recovery.</p><p><b>RESULTS</b>All patients with a diagnosis of back pain originating from endplate according to discography were treated with anterior or posterior fusion surgery. The mean follow-up period was three years and five months (from 2 to 6 years). Among of the 21 patients, 20 (95%) reported a disappearance or marked alleviation of low back pain, and experienced a definite improvement in physical function. A statistically significant and clinically meaningful improvement on the ODI and the VAS scores were obtained in the patients with chronic low back pain originating from endplate (P = 0.0001) after treatment.</p><p><b>CONCLUSIONS</b>The study suggests that the discography and fusion surgery may be very effective methods for the diagnosis and treatment of chronic back pain originating from endplate respectively.</p>

The pathogenesis of discogenic low back pain / 中华外科杂志

<p><b>OBJECTIVE</b>To study the pathogenesis of the pain of discography and the discogenic low back pain.</p><p><b>METHODS</b>19 specimens of lumbar intervertebral discs from 17 patients with discogenic low back pain during posterior lumbar interbody fusion, and 12 physiologically aging discs and 10 normal control discs were collected to investigate the morphologic features and innervation containing neuropeptides substance P (SP), neural filament (NF), and vasoactive-intestinal peptide (VIP).</p><p><b>RESULTS</b>The distinct morphologic characteristic of the disc from the patient with discogenic low back pain was the formation of the strip zone of vascularized granulation tissue from the nucleus pulposus to the outer part of the annulus fibrosus in which there was one or several fissures. The structure of annulus fibrosus beyond the strip zone of granulation tissue was basically normal. The structures of the aging discs and the control discs showed the age-related changes. The innervation of SP, NF and VIP immunoreactive nerve fibers in the painful discs was more extensive compared with the aging discs and the control discs. The nerve in growth deep into annulus fibrosus and nucleus pulposus was observed mainly along the strip zone of granulation tissue in the painful discs.</p><p><b>CONCLUSIONS</b>Findings indicate that the strip zone of granulation tissue with extensive innervation in the posterior part of the painful disc is the original site of the pain of discography and the discogenic low back pain. The strip zone of granulation tissue might originate from the injury and subsequent reparation of the margin of annulus fibrosus. The difference of the aging disc and painful disc which can not be differed each other on MRI is the formation of the strip zone of granulation tissue along tear histologically in posterior part of the painful disc.</p>

The diagnosis and treatment of lumbar internal disc disruption / 中华外科杂志

<p><b>OBJECTIVE</b>To study the diagnosis and treatment of lumbar internal disc disruption (IDD).</p><p><b>METHODS</b>Thirty-six patients with chronic disabling low back pain proved by discography as IDD were treated with disc excision and lumbar interbody fusion, and 8 cases were treated with PLIF, 28 with ALIF. The clinical results were evaluated by pre- and post-operative VAS, and the fusion results were evaluated by X-ray studies of the lumbosacral spine.</p><p><b>RESULTS</b>The average period of follow-up was 18 months, ranging from 6 to 26 months. Six patients treated with PLIF basically disappeared low back pain, 2 complained of mild back pain; the VAS after operation was decreased significantly in comparison with that of pre-operation (P < 0.01). Twenty-seven treated with ALIF basically disappeared low back pain; the VAS after operation was decreased significantly in comparison with that of pre-operation (P < 0.01). Fusion rate was 88% in patients who were treated with PLIF, and 97% in patients with ALIF.</p><p><b>CONCLUSION</b>Disc excision and interbody fusion is an effective method for the treatment of IDD, but the operation indications should be known well.</p>